Wednesday, June 22, 2011

Breastfeeding Basics - Part I: What You Should Know Before You Give Birth

By the time you're about ready to give birth, you have had to make lots of decisions. You've decided where to give birth and how, you've picked out or purchased all kinds of baby gear, and you've agreed on a name or two you like. And, hopefully, you've made a decision about how you intend to feed her. You've no doubt read about all the pros and cons of breastfeeding and formula feeding. You've been "informed" by friends, family, coworkers, and the barista at Starbucks about what the best choice is. And, if you're reading this, you've probably decided that you'd like to give breastfeeding a shot. It seems like the healthiest thing for baby, and probably for mom. It's definitely got all sorts of benefits you'd like to take advantage of. And you're a bit staggered by the cost of formula.

But all those books have so much information in them! Which one do you read? What do you really need to know right now?

Before you go into labor, or lie down on the gurney to go to the OR, or arrive at the hospital for your induction, before your water breaks and you start making frantic phone calls to your family letting them know the baby's coming, you should have a few vital bits of information stored away so that you can initiate breastfeeding as soon as possible and have some idea of what to expect. When I had my first baby, despite assuming I was going to breastfeed, I found out very quickly that there was a lot I didn't know about this process that was supposed to be "natural" and "normal" and "instinctive." Sure, it's instinctive for baby, but mom actually has to learn a few things. (And, to be honest, the baby has to practice a bit, too!) I was bombarded with advice from people all around me, and, in the end, my son ended up formula-fed. I was shocked at how much I didn't know going in. I want to help you avoid that shock. Thus, this first segment in a series of posts.

Defining Terms

First, there are terms and phrases you'll hear in relation to breastfeeding. Here are a few you should know right away.

Latch: The baby's "latch" is the arrangement of the baby's lips, tongue, and gums on your nipple and areola. The quality of his latch affects how efficiently he can remove milk from your breasts and swallow it, as well as how comfortable (or uncomfortable) breastfeeding is for you. If the baby is latched well, he should be taking your nipple far back into his mouth, and his lips should be flared around your areola. He should not be chewing or sucking on the nipple directly, and his tongue should be over his bottom gums. The latch usually should be "asymmetrical," meaning the bottom jaw is farther up on the breast than the upper jaw.

Exclusive Breastfeeding: Exclusive breastfeeding means that nothing is ingested by your baby other than breastmilk - no water, no formula, no juice, no cereals, no foods of any kind. The American Academy of Pediatrics and the World Health Organization recommend exclusive breastfeeding for the first six months of a baby's life, at which point solids may be introduced. (This definition allows for the administration of Vitamin D drops, if recommended by your doctor. Some babies may need a Vitamin D supplement, but your pediatrician will discuss this with you.)

Colostrum: Colostrum is a special substance produced by your breasts in late pregnancy and in the first few days after birth. It is a thick, golden substance full of antibodies, concentrated nutrients and proteins, and other substances vital to a newborn’s health. Colostrum is sometimes called “liquid gold” because of the unique beneficial properties it contains and the short period of time in which it is produced. Colostrum is the only food your baby needs in the first few days of life.

Nursing on demand: When you hear the expression “nurse on demand,” this means that you should put your baby to your breast whenever she seems hungry and allow her to nurse for as long as she wants. You will learn your baby’s hunger cues through observation and trial and error. This is the healthiest way to feed a young baby, as it will ensure that the baby is getting enough to eat and will aid in establishing a healthy milk supply so that you can continue producing enough milk for your baby.

Skin-to-skin: Putting a baby “skin-to-skin” refers to the baby being held against the chest of a caregiver (usually the mother), with the adult shirtless and the baby naked or only in a diaper. The direct contact of the baby’s skin with the skin of a caregiver helps the baby to regulate his own body temperature, lets him hear the calming sound of a heartbeat, and helps him regulate his own breathing and heart rate. Putting the baby skin-to-skin with the mother directly after birth promotes the release of beneficial hormones in baby and mother, stimulates milk production in the mother, and calms the baby. You can request that your baby be put skin-to-skin with you immediately (or within one hour) after birth, as the baby will instinctively seek out your nipple and begin to nurse.

Lactation consultant (IBCLC): A lactation consultant is a medical professional who is specially trained to help new mothers (and babies) learn to breastfeed, keep up on the latest research regarding breastfeeding, feeding techniques, and information, do breastfeeding research, provide advice and education to nursing mothers, and diagnose and treat breastfeeding difficulties and issues. International Board Certified Lactation Consultants (IBCLCs) receive thousands of hours of hands-on and classroom training in order to become breastfeeding experts. A good IBCLC is your best resource for any breastfeeding questions you may have and to help solve any breastfeeding problems you may encounter. Many hospitals now employ IBCLCs who can come to your room in the postpartum ward to help you learn to breastfeed your baby.

How Does Milk Production Work?

This is definitely something you need to understand before you actually have a baby to nurse. This is the one bit of information that I wish I'd known before my first son was born. 

In the first few days and weeks after giving birth, milk production is driven largely (although not entirely) by hormones. Toward the end of pregnancy, you start producing large amounts of prolactin and other hormones, which stimulates the breasts to start making colostrum, the thick, golden substance defined above. After giving birth, usually within two to six days, the colostrum you are already producing will be replaced by mature milk, which looks like, well, milk. This switch-over to mature milk should happen regardless of whether you've started breastfeeding, since it is hormonally driven, but if you don't stimulate continued milk production by nursing a baby or pumping your breasts, milk production will gradually taper off and eventually stop. What this boils down to is, in order to make milk and continue making milk, you need to nurse a baby and continue nursing a baby.

Breastmilk production and supply are driven by demand. As your baby nurses, he drains the milk from your breasts. This milk removal sends a hormonal signal to your brain, which sends more hormones back to your breasts to signal them to make more milk. If there is no demand placed on the breasts for more milk (i.e., no baby is nursing, or you are not removing the milk by pumping it), then the breasts will stop producing milk. The less often you remove milk from your breasts, the less milk you will produce. The best way to ensure a good milk supply is to nurse your baby whenever he is hungry and allow him to nurse until he is full. This will signal your brain and breasts to keep producing milk.

Weight Loss

It is normal for a baby to lose 5 to 7% of his birth weight in the first few days of life. Babies are born "full," meaning that they have been receiving nutrition nonstop through the umbilical cord right up until they are born. A newborn baby's stomach is about the size of a golf ball and is not elastic. This means it can only hold a very small amount of food at a time, which is all he really needs anyway. The colostrum provided by your breasts, as long as you are feeding the baby whenever he is hungry, is sufficient to provide his nutritional needs in the first few days of life. Once your mature milk comes in, the baby should start putting on weight again. The goal for most babies is to regain that birth weight by about two weeks of age.

A small weight loss (less than half a pound for most full-term, healthy, normal-weight babies) is not cause for concern, and does not mean you need to offer any supplemental feedings of formula. If you have any concerns about your baby's weight loss and gain patterns, you should talk to your pediatrician.

As an example of a normal weight loss and gain pattern, my second son was born 7lbs., 6oz. When we were discharged from the hospital less than 48 hours later, he weighed only 6lbs., 14oz., a loss of 8 ounces. However, by his two-week follow-up visit with the pediatrician, he weighed 8lbs., 1oz., which means he gained back those eight ounces, plus another 11 ounces, in two weeks.

This only applies in the first few days of life until your milk comes in. If your baby is losing weight after having started to gain, you should have the baby evaluated immediately by a pediatrician, and you should be seen by a lactation consultant to determine if you have a sufficient milk supply and if the baby is getting enough to eat.

Pacifiers and Bottles

I promised this would be short, so there's just one more topic to discuss. The introduction of a pacifier or bottle too soon in the breastfeeding relationship may cause problems with the baby's latch and desire and ability to feed from the breast. This is not true of all babies, but it can and does happen, and is called nipple confusion or nipple preference. In order to avoid  problems in the early days, lactation experts generally recommend that you wait until about four weeks of age before introducing any kind of artificial nipple. What this means is, in the hospital, you should inform the nurses immediately that you do not want your baby to be given a pacifier or offered a bottle - even a bottle of breastmilk.


Well, the reasons are different for pacifiers and bottles. With pacifiers, they can often become a crutch to allow you to delay or avoid feeding the baby. If the baby learns to comfort-suck from the pacifier, he may not give you the proper hunger cues and may even skip a feeding. In the early days and weeks of life, it is important that the baby feed as often and for however long he wants to, in order to put on weight and achieve the rapid growth that is normal and necessary for a young baby. When your baby is a bit older (three to five weeks), has established a good breastfeeding relationship, has demonstrated good growth, and knows how to latch properly and eat his fill, then introducing a pacifier is less of a problem and may even be beneficial. 

The problem with bottles is different. A bottle is generally easier to drink from than the breast. Bottles tend to drip regardless of whether the baby sucks. When the baby swallows, more milk comes from the bottle nipple, forcing the baby to swallow again, which causes more milk to flow. Because this takes so little effort, some babies will "forget" how to latch and suck properly at the breast, especially those who are already having trouble staying latched and maintaining the stamina to feed effectively. There is also evidence that even one bottle of formula can interfere with the proper population of beneficial bacteria in the gut and expose and sensitize a baby to proteins not found in human milk.

That's it! I hope this summary helped condense things for you into a manageable bite, so that when you do go into labor or give birth, you'll feel like you have the knowledge you need to get started.

The next segment in this series will address topics important relevant to the first few days of your baby's life.

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