“Are you going to breastfeed?” This was consistently the second or third question friends, family and strangers would ask in our conversations about my impending bundle of joy. My response was equally common: “I’m going to try! We’ll see how it works out.” Like most expectant women, I was under the impression that whether my child would receive breast milk was left up to the gods and goddesses of lactation luck. The idea that my body would produce milk was so foreign. The notion that my baby would even know how to nurse seemed iffy. My plan was to keep my fingers crossed and mind open.
As it turned out, the fate of my baby’s nourishment wasn’t contained in my breasts themselves—or even in my baby—but rather in the set of circumstances that would unfold, the access to help I would have and the hearty dose of perseverance I possessed. After five years of breastfeeding between my two children, along with numerous interviews with lactation experts, I now know that “how it works out” depends largely on what you do, what you avoid and what you learn (the earlier the better). Stack the odds in your favor by reading up on the factors that really determine your baby’s breast or bottle destiny.
My lack of knowledge about breastfeeding when my son was born did prove problematic, but I had a potent force working in my favor: sheer determination. As my due date neared, I was driven like a husky in a dog-sledding race to make breastfeeding work. I would not be deterred, despite the hurdles my lack of nursing savvy afforded me.
Had I known then that breastfed babies have a 60 percent increase in protection against sudden infant death syndrome (SIDS)—the number rises to over 70 percent protection for exclusively breastfed infants—or that nursing reduces the mother’s risk of postpartum depression, anxiety and even breast cancer later in life, the ante would have been upped even further. Still, by the time my son was delivered, I knew that breast milk is packed with germ-fighting antibodies and that was motivation enough for this protective postpartum parent who couldn’t bear the thought of her delicate newborn getting an ear infection or stomach flu.
My desire to nurse my baby was not unusual. In fact, approximately 80 percent of new moms intend to breastfeed, and 77 percent initiate breastfeeding. But at the one-week mark, half have already given their babies formula, and only 31 percent are breastfeeding to any extent at nine months. This is despite the American Academy of Pediatrics (AAP) recommendation for exclusive breastfeeding for the first six months and continued breastfeeding—along with the introduction of iron-rich foods—for at least the first year of an infant’s life. The World Health Organization (WHO) makes an even heartier recommendation: Breastfeed for two years and beyond for maximum benefits to your baby. But 32 percent of moms exclusively breastfeed for just half the recommended six months, even though 85 percent of moms set their own goal of three months.
The numbers show, it seems, that motivation is not enough. So what roadblocks get in the way? And is there anything you can do to get past them? Spoiler alert: Yes!
Trust your body
The first glaring mistake I made is a common one. At first, I worried that my baby wasn’t getting enough milk, so I began to pump furiously—a full bottle after each feeding my baby took during the day. If something happened to my supply (or to me for that matter), my freezer would be at the ready, I resolved. The results were not pretty. Plugged ducts and painful engorgement lead to breast infections (termed mastitis), which cause a lot of unnecessary suffering.
But it’s the opposite mistake stemming from the same unfounded fears that threatens breastfeeding success for most: early formula supplementation. “Supplementing formula when it’s not medically indicated is a slippery slope,” says Julie Duncan, RN, CCE, CLC, a perinatal parent educator and lactation consultant in Atlanta. Doing so means that baby will take that much less from the breast, which interferes with the establishment of a full milk supply. “More time at the breast brings in more milk faster,” emphasizes Duncan.
Concerns about supply are the primary reason would-be breastfeeding moms switch to formula in the first three months, but when you take early supplementation out of the equation, low milk supply is rare. “There are a few medications, like allergy medicine and some birth control pills, that can create supply issues. But generally, if you have a vigorously sucking baby and you’re exclusively breastfeeding from the start, you will make plenty of milk,” Duncan assures.
Your milk will not fully come in for three to five days after your baby is born. During this time, you’ll produce a premilk substance called colostrum, and your baby will lose between 5-7 percent of his birth weight. This is normal and is not a cause for panic.
“The truth is, new babies don’t need or want a lot of milk. What they want is to suckle at the breast,” says Brandi Jordan, MSW, IBCLC, a newborn care specialist and certified lactation consultant in Pasadena, California.
Your full-term baby’s weight loss is not only normal but also necessary, says Duncan. Babies have to lose this weight; it’s a result of fluid loss, including meconium (baby’s first bowl movement). Jordan concurs: “Babies are already quite full (of meconium) when they’re born, so they don’t have space for large volumes of milk. However, the insatiable need to suck causes them to pass the meconium.” By the time newborns have cleared some space, most mamas have begun to increase their volume of milk. It’s a perfectly orchestrated system.
If during those first five days your baby loses 10 percent or more of his birth weight, or if he’s still losing weight after day five, don’t assume you’re banished to the bottle. Have a breastfeeding session evaluated by a certified lactation consultant. She’ll be able to catch any problems, such as an improper latch or a too-sleepy baby, early enough to protect your breastfeeding goals.
Choose a baby-friendly hospital
The most perilous roadblocks to your breastfeeding success will likely occur at the hospital after baby is born and include too much time away from your baby, supplementation with formula or water and limited lactation support. When choosing where to deliver, look for a hospital that follows the United Nations Children’s Fund (UNICEF) and WHO’s “Baby-Friendly Hospital Initiative” (babyfriendlyusa.org). Many hospitals nationwide are working toward this designation (though only about 4 percent have fully attained it). It consists of 10 steps proven to increase both exclusivity and duration of breastfeeding. (Click here to learn more.)
If there isn’t a qualifying hospital near you (or if it doesn’t jive with your insurance plan), you can still request that these concepts be put into play. “If a woman is unable to give birth at a baby-friendly hospital, she should become her own advocate for the practices the initiative includes,” says Wendy Haldeman, MN, RN, IBCLC, co-founder of the Pump Station and Nurtury in Santa Monica, California. Include the 10 steps in your birth plan, and stash copies in your hospital bag. You can give the list to your doctor or midwife, labor and delivery nurses, doula and anyone else who plays a part in baby’s grand entrance.
“The research is clear on the importance of exclusive breastfeeding,” says Haldeman, “and the baby-friendly protocol alone doubles the chances of achieving it at three months.” Unless there’s a medical reason you or your baby need separate care, try to nurse within an hour after birth and stay together (skin-to-skin) as much as possible. This will dramatically improve your chances of getting breastfeeding off to a good start.
Create the demand
Based on the principle of supply and demand, breast milk quantity is produced in direct response to stimulation from the baby nursing. If you’re separated from your baby too much in those first few days and nights or if you try to limit feedings to fit a schedule, inadequate stimulation can reduce the demand and jeopardize your supply.
The AAP confirms what lactation experts work diligently to emphasize in the field: A newborn baby needs 8 to 12 feedings per 24 hours and needs to be fed on demand. This is especially critical before your milk comes in because your supply is being established (which is also why supplementation creates a risk).
Your newborn will likely nurse every 20 to 90 minutes in the early days (yes, that’s almost continuously at times) and fall asleep after just a few minutes at the breast. “Babies are born with stomachs the size of a marble, so they simply can’t hold much milk,” Duncan explains. “The colostrum mothers produce before their milk comes in is the perfect amount to fill that tiny tummy.” In fact, notes Haldeman, studies show newborns fed with bottles are overfed by about 25 percent.
The size of a newborn’s stomach explains the necessity of frequent nursing that babies seem to demand. Frequent ingestion of colostrum in those early days also provides two incredible benefits to your vulnerable newborn: immunity from disease and infection and protection from hypoglycemia (thanks to its high protein content). On-demand feeding gives your baby what he needs to thrive and gives your breasts the stimulation they need to work their production magic.
You are not alone in this important endeavor nor should you feel that way. Support from your partner, extended family, community and workplace is something you and your baby deserve and should actively expect. The WHO’s Infant Breastfeeding Bulletin states, “In societies where breastfeeding is highly valued and therefore strongly encouraged and supported … lactation failure is virtually unknown.”
As further proof of the importance of an informed and heartening support system, a recent study published in the American Journal of Public Health found that mothers with support from an international board certified lactation consultant (IBCLC) were three times more likely to be exclusively breastfeeding at three months and less likely to wean in the first six months. “The most important thing you can do is have access to someone who really understands breastfeeding and can give you accurate information,” says Jordan.
Take advantage of every in-hospital lactation assessment you’re offered, and line up support before you leave. Most hospitals have IBCLC support lines you can call as much and as often as needed after you bring your baby home. The Affordable Care Act requires insurance companies to pay for in-person lactation consultations, so you can get the care you need in those critical first weeks and beyond. Duncan estimates about 80 percent of problems can be corrected over the phone, but the remain- ing 20 percent require hands- on help.
“Mothers are often surprised at how difficult it can be at first,” reports Jordan. “Knowing upfront that there is a breastfeeding learning curve, lining up support and anticipating the considerable time commitment it takes can help.”
Whether the issue is supply or pain, get help as soon as you know something is wrong. “If you suffer and try to push through, you’re likely to end up with real trauma to the nipples and more likely to give up entirely on breastfeeding,” Jordan cautions. Pain is usually caused by an improper latch, positioning or yeast infections from the baby’s mouth—and there are solutions to each of these problems.
Maintain the demand
During the day, offer your newborn baby a feeding every one and a half to three hours or whenever he’s nuzzling, rooting or indicating he’s hungry with agitated movements. You’ll learn your individual baby’s signs over the first few weeks. “Close proximity also helps moms better read their babies’ cues,” advises Duncan. She recommends a bedside bassinet or sidecar-type co-sleeping device at night.
Be careful with any sleep training in the first six months. According to Duncan, many cases of mastitis result from the sudden change in the number of feedings that comes with attempts at early night weaning. Jordan agrees, “Going long stretches at night too early on will actually increase the likelihood that mom will get plugged ducts, which can lead to mastitis.”
“There’s a lot of confusion about normal night sleep for a baby,” says Duncan, but we’re learning that breastfed newborns especially do need to wake about every three hours at night, sometimes more.” (In the first three months, the frequent waking is believed by some researchers to be part of the reason breastfeeding is so protective against SIDS.)
A lactation consultant can help you get the most out of each feeding with massage and gentle compression techniques that will help your baby get full feeds and sleep longer. When your baby reaches about 12 pounds, he will likely start dropping one feed or lengthening sleep duration between all feeds at night. “The key is to increase the length between feeds over time, so that your breast and production levels have a chance to acclimate to a new feeding frequency,” explains Jordan. “Don’t try to go from feeding every three hours to going a seven-hour stretch.”
Return to work
Going back to a 9-to-5 job can be a hurdle when it comes to breastfeeding, but it doesn’t have to mean switching to formula. Invest in a high-quality electric breast pump, and you can continue giving your baby premium nourishment while making the in-office presentation or board meeting circuit. (Under the Affordable Care Act, your insurance company is required to cover a breast pump.) The more flexibility you can build into your day job the better, especially if you’re returning to work before the three-month mark. Many expectant moms bank vacation and sick days during pregnancy, so they can extend their maternity leave as long as possible to keep breastfeeding going strong.
Ask for flex-time, unpaid leave or telecommuting whenever possible during this precious first year with your baby. According to Jordan, an empowered mind-set is key when returning to work. “Stop worrying about how you’ll be perceived, and take your nursing breaks. It doesn’t make you less of an employee if you’re taking care of your baby,” she insists. Companies are realizing they spend less on health care and have more loyal and productive workers when they provide a supportive environment for breastfeeding for one year.
While leaving breastfeeding up to fate is not advisable, getting by on sheer motivation also leaves much to be desired. In fact, my motivation in some ways might have been a classic case of too much of a good thing—I came close to hitting that proverbial wall more than once. Jordan wisely notes that moms do better when they take the pressure off and take breastfeeding day by day. “Every day you breastfeed is better than the last,” says Jordan. “With every drop of breast milk you give your baby, you are doing a wonderful thing.” P&N