Are You Really Ready, informed, and Confident about Breatfeeding?

Why should you learn as much as you can about breastfeeding? 
Especially before the baby is born?

This blog will identify difficulties that mothers might not anticipate.....

Below I've listed some common misconceptions

new mommas often make:

• "Breastfeeding will just come naturally," There's no need for a breastfeeding class.

• "The Nurses and Lactation Consultants will teach me everything I need to know while in the hospital."

• "I know taking a class is important, but I ran out of time."

• "I have a specific Birth Plan written. My baby will be latching on within one hour after birth.

• "My pregnancy has been problem free, so I'm sure the delivery will be healthy and normal as well!"

• "Yes, we conceived through IVF due to 5 years of infertility. I have gestational diabetes, low thyroid hormones. The baby is measuring small and the perinatologist (OB doctors bosses) diagnosed my baby with IUGR (Intrauterine Growth Restriction) and my water just broke at 36 weeks gestation, even though I was scheduled to have my labor induced next week d/t these complications....but I'm sure they'll fix any breastfeeding problems while we're in the hospital." 

• "I'm sure the "Personal Use" Breast pump that My insurance is covering will work just fine if I have any breastfeeding issues."

• "My Baby cries every time I place her in the bassinet. She is so fussy and irritable, she must be starving. I must not have enough milk/colostrum?"

• "When I pump, I don't get much milk out. my supply must be really low."

• "When I offer the baby a bottle of pumped mother's milk or formula, she drinks it down so vigorously...I must be starving my baby."

• "My breasts felt so full initially (during the first 2 weeks) But now my breasts feel much softer. It feels like my milk has just 'disappeared over night!'"

• "When My baby latches I feel significant pain throughout the feeding. I notice blisters, and dark red bruising in the form of a crease across the nipple. I feel like crying whenever the baby starts to act hungry. Is this normal? Will this ever get better? I'm not enjoying breastfeeding at all. I had no idea how difficult this would be, and how much breastfeeding would take over my life. I honestly am starting to think about giving up."

Women who can't find time due to busy work or school schedules, or they just neglect becoming educated about breastfeeding typically lack self confidence in breastfeeding. Without this important information, it is easy to fall into the trap of doubting your body's ability to nourish and nurture her baby...which leads to supplementing with formula for a non-medical reason. Having said this, I trust and support mothers who honestly feel the baby needs to be fed more. I will always support the breastfeeding mom and baby no matter what!!

Lets go over the misconceptions listed above to help you know what you can and cannot expect...especially without breastfeeding education! 

• It is true that many healthy full term Newborns who have not had major interventions during labor and delivery are born, lay on his/her mother's chest and latch right on! Just like this baby pictured above. This is why we call the first hour after delivery the "Golden Hour." And it can happen naturally, or it may require a few slight adjustments with mom or baby. 

• Nurses and Lactation Specialists or Board Certified Lactation Consultants are generally available to see and help mothers with latching, pumping, and understanding if baby is really feeding or just sucking (there is a difference between a lactation specialist and an IBCLC...AND there is also a difference between feeding and just sucking! These are important things to know, and they're taught in a breastfeeding class!) What is important to note here is that nurses and lactation consultants are spread VERY thin in a hospital setting. They do not have the time to give you all of the information you will want and need to breastfeed successfully. We are able to do our best, and usually are able to give good pieces of help and advice, but a smart mother will have taken a class before delivery...or shortly after if she delivered sooner than expected. If a mother can afford to, she should strongly consider hiring, or asking her mother or mother-in-law to give the gift of hiring a personal lactation consultant (IBCLC) to help you in those first difficult weeks of breastfeeding. This is a tremendously invaluable gift to yourself or from someone who wants to help you but is unsure how to go about it!

• It is common understanding among Labor and Delivery nurses that if a patient comes into the hospital with a written birth plan that she expects to be followed implicitly, everything that can go wrong, will go wrong!!...much to our own dismay! Some medical interventions are unavoidable, and essential for the safety of the mother and fetus. While other medical interventions are performed routinely, needed or not needed. Whether medical interventions are routine or life saving, research indicates that in many cases they may affect breastfeeding. Interventions like forceps or vacuum assisted deliveries, IV pitocin, epidural anesthesia, Cesarean Sections, IV narcotic pain medication, IV Magnesium Sulfate for maternal high blood pressure, excessive IV fluids which contributes to the swelling in your breasts just as much as your feet, ankles and legs! All of these interventions may affect breastfeeding in a direct or indirect way. Of course all mothers plan to have an uncomplicated delivery that goes smoothly. As your care givers, we really want the same, but the reality is that despite our best intentions as medical professionals, we may need to intervene to ensure a healthy mom and baby. All the better reason to know what your breastfeeding options and have lactation resources available when things don't happen as planned.

• Whenever you give birth to a baby less than 38 0/7 weeks gestation, the infant is more likely than not to have initial breastfeeding difficulty. Although your OB considers your pregnancy "full term" if the delivery is 37 0/7 weeks to 41 weeks. And this is true in the OB world, but in the breastfeeding world, we anticipate a baby born in the 37th week to need extra breastfeeding support. These babies need time to get further brain development, as well as strength and stamina. Remember, babies born at 37 weeks miss out on 3 weeks of "free food" without having to work for it inside of their mother. When does breastfeeding become easier for these babies? I usually ask the mother when her due date was...and then explain that that date is when we can expect the baby to be an efficient, effective breastfeeder. Unfortunately we won't be able to fix late preterm infant's breastfeeding problems during their hospital stay. These mother's need to know how to support the baby eating enough, while also protecting her milk supply, until baby gets bigger and stronger. Please read this excellent article if your baby is born before 38-40 weeks: Excellent article written by Katie Madden IBCLC about breastfeeding late preterm infants

• Healthy, strong, full term infants with good latch/sucking skills will always remove more milk from the breast than a breastpump ever will. However, a pump will remove more milk than a poorly breastfeeding baby. But always keep in mind that it is a mistake to assume that the amount of breastmilk you are able to pump is exactly what your body is making. don't fall into this trap and think your milk supply is low. Please seek professional help if you really feel your milk supply is lower than what your baby needs to gain weight and be healthy.

• Bottle feeding is "passive" easy feeding. In fact, babies will usually suck and swallow rapidly with a bottle...giving parents the impression that he/she has been starving. That may or may not be the case. Rapid swallowing with a bottle is not necessarily due to the infant being hungry. In most cases, once the infant starts the suck:swallow action, they create negative pressure in their mouths which fills it full of more milk, requiring baby to swallow again to protect their airway...except it happens over and over so they guzzle to keep up with it. Breastfeeding is very different from this. It is an "active" feeding process, and baby has to initiate milk to start flowing, and has to keep sucking to keep the milk flowing. Giving a bottle is not necessarily wrong, but the person feeding the bottle needs to be taught how to do it in a manner that protects breastfeeding if possible. Watch this Youtube video demonstrating how to "pace" the flow of the bottle so that it is more like the breast.

• I make it a point to educate all of the first time parents in my classes or during consultations that they should expect the first 2 weeks of breastfeeding to be....well...rough! Lets just say, "There will be tears!" Latching can be uncomfortable during the initial 30 seconds of feeding during that first couple of weeks. Moms usually feel very overwhelmed, like breastfeeding has taken over their life....this is because....breastfeeding has taken over their life...but not forever! Breastfeeding challenges usually start getting better after that initial 2 weeks that can make some mothers question whether or not she can actually do this. I guarantee that some moms may actually consider quitting, or at least have a better understanding of why some mothers do quit earlier than expected. In my life, I can handle almost anything...just as long as I know what it is I need to go through. If I am unprepared to deal with a difficult situation, I don't deal very well. I find that this is true for most parents. If they expect breastfeeding to be challenging, tiring, and overwhelming, then they are more likely to hang on and keep trying, "because Jill says it almost always gets better after the first 2 weeks."

• Babies are "held" for 9 months inside their mothers. Once they are born, bathed, diapered, dressed, swaddle wrapped and placed in a bassinet across the room from his/her mother the baby realizes they are no longer in their "comfort zone" or what I call "Home Base" or "Baby's Habitat" and they start to cry.. In my professional opinion, a newborn will not be spoiled by being held...in fact, the baby should be held (diaper on only) skin to skin with mom in an upright position between her breasts with a blanket covering both to keep baby warm.  Babies that are smart, want to be held. Parents who are smart figure out ways to keep their baby close. 
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• Baby slings, "baby wearing," co-sleeping in a safe sleep environment, with safety precautions taken, are all ways to keep baby close. I even support fathers who will place baby skin to skin! Holding baby's on mother's chest skin to skin most often results in a baby who latches on better, breastfeeds better, and mother's milk usually comes in sooner. I say do it!!! Mom and baby both win!!

• There is a difference between the "personal use" breast pump your insurance will provide for you and a "hospital grade" pump. A personal use breast pump is meant for use when mother's milk supply is fully in, abundant, and sufficient for baby's needs. Baby is latching on well, breastfeeding is comfortable for the most part, and baby is gaining weight as expected at the pediatricians office. Personal use pumps are meant to pumping here and there just as needed. They usually cost around $200-250. Please remember to speak with your insurance provider to know how, where, and when you can get your personal use double electric breast pump.

• A hospital grade breast pump costs $2000. 

• They are typically rented at a weekly rate for various reasons: *Mother is not producing enough milk yet, *Baby is not latching well, or not latching at all, *Mother is experiencing severe pain with latching and needs to give her traumatized nipples time to heal. 

• Essentially, a hospital pump is highly recommended when breastfeeding is NOT GOING WELL! If a lactation specialist or IBCLC does not make this very clear to you, she is leading you down a path probable breastfeeding failure. Yes, I have seen mothers who used a personal use pump (and one I don't really even think is a good one) and she was able to maintain a sufficient milk supply. So if you are experiencing breastfeeding difficulties, it would be very helpful to rent a hospital grade breast pump to use until you see a Board Certified Lactation Consultant and work through the glitches you may have run into! If your baby is admitted to the NICU and stays longer than mom after she is discharged, most insurance companies will cover the cost of a hospital grade breast pump for use until baby is able to take most feedings at the breast and is discharged. Then the pump will need to be returned to avoid paying rental fees...unless, of course you feel that you are not ready to move to your personal use pump yet. Communicate with the medical supply store you rented from and ask if you can extend use of the pump by renting it. It's worth asking, but there are other places that mothers can rent a hospital grade breast pump.

• If you continue to experience severe nipple trauma/damage, and the pain persists during the entire feeding...something is wrong here. Have an IBCLC look at how baby is latching and suggest changes that may relief the pain. This may require Newman's Ointment to start healing your nipples, or hydrogel pads. When I speak with a mother who is ready to quit breastfeeding due to the severe pain, I know that there is likely a problem with a pathological latch and suckling. These mothers should feel comfortable speaking to their infant's primary care provider, or if she is not able to find the help she needs, seek the help of an LIP who specializes in diagnosing and treating ankyloglossia. I often note what appears to be "tethered oral tissues" that restrict infant's tongue from elevating to the palate, or moving bilaterally, many times the infant can extend his/her tongue out past the lower gum line, but has difficulty sustaining the extension. All of these may be seen in a child with ankyloglossia, but appearance should never be the only factor in diagnosis. The PCP or specialist should look at the "entire breastfeeding story" Not just what it looks like!

Dr Lawrence Kotlow DDS is a national expert in Pennsylvania diagnosing and treating tongue and lip ties

You can find the names of the only preferred providers in the state of Utah by going to the private Facebook page  "Utah Tongue and Lip Tie Support Group" They are always willing to admit moms who want support from other mothers experiencing the same issues they are. There are 3, maybe 4 providers who have been trained properly and perform full lip and tongue releases in a consistent manner. For expert information go to /Dr.Ghaheri website and blog and read his blog. Dr. Ghaheri lives in Portland area, and has taught many, including some of providers who are recommend here in Utah. You will learn so much about ankyloglossia and how it affects your baby. Many times the baby also needs further "body work" done, such as cranial sacral therapy. Starting out doing tummy time on day one! This is an exercise I like to give dad for when he returns home from work or school. The dad pictured below is doing both skin to skin and tummy time, which is great! Tummy Time can also be accomplished with dad and baby clothed. In 15 min dad would gently turn baby's head to the other side. Baby is to lay quite flat while the parent monitors and loves their newborn. Babies rarely get to lay on their bellies because we teach "Back to Sleep" Many parents are not giving their babies time on their tummies. This simple exercise with baby has so many benefits, including helping a baby breastfeed better!

How to do the "Tummy Time Method" and the many benefits,

•  Okay!... I think you get the picture I'm trying to paint here (so-to-speak). This post is long, and I could go on and on and on! Get educated as much as possible before you deliver. A great option is to take a class at your local hospital, or better yet take an online class at your own pace. this type of class is still available to you after you deliver, and heaven knows everything you learned in that hospital class two months ago has long been forgotten! A great online option is Lactation link! They even offer a FREE 6 day email course to begin to turn your breastfeeding worries into confidence!

• Consider having a lactation consultant do an breast exam at your local OB/GYN's office before you deliver. If your OB doesn't have a lactation consultant on staff, ask for a referral to an IBCLC. This will help address any possible situations that could be an issue: flat, or inverted nipples, widely spaced breasts that didn't grow during pregnancy, Infertility, Hypothyroidism, Gestational Diabetes or Insulin dependent diabetes, and morbid obesity. all of these hurdles can be identified before delivery, and mom can show up to the hospital knowing what to expect. She will understand when we need to use a breast pump, to hand express her own colostrum, different breastfeeding positions to try, finger or spoon feeding colostrum, and the possible need to supplement with Pasteurized Human Milk (PHM) which is currently available in many hospitals. If PHM is not available, or if mom doesn't like the idea of using donated milk from other screened mothers, we may need to use formula for medical reasons. Legitimate medical reasons include hypoglycemia (low blood sugar, which happens to be more damaging to a newborn's brain than low oxygen). Or Infant weight loss that is greater than 8-10% of birthweight.

Whew!!! Let's wrap this up with the bottom line. 
While struggling through any breastfeeding issue:

1. Feed the Baby!!! Breast, nipple shield on breast, tube at breast, finger or spoon feed hand expressed colostrum, pumped colostrum or mother's milk, PHM in a tube, or bottle, maybe even using formula as a last choice. However you do it, Feed him/her!!

A baby who is well fed, will eventually become a better breastfeeder.

2. Protect Your Milk Supply!!!

This means pump using a hospital grade pump every single time the baby is fed by a source other than from at your breast. Even if the baby seems to be sucking on the breast, they may not be removing what they need for various reasons. If nobody tells your body to make milk by demanding it (pumping or suckling) then the body doesn't make enough milk, and mom suffers with continuous low milk supply. Remember this: Supply=Demand... I'm sorry to say that there are no magic pills or teas or cookies that will increase your milk supply alone. If you are not pumping in conjunction trying teas and cookies, mom will likely be weaning before she had anticipated.

3. Keep Trying!! (and try your best to be very patient 😁) If you are dedicated to #1 and # 2, you will have time and options to get the baby breastfeeding! If you do not feed the baby well, or offer lots of bottles without pumping, you lose your options...

Many Private practice IBCLC's can be found here HERE