Tuesday, July 5, 2011

Breastfeeding Basics - Part III: The First Six Weeks

I hope that by now you've read the first three installments of this series, the Introduction, Part I, and Part II. This post will address the first six weeks postpartum.

Your milk should have come in full force before the end of the first week of your baby's life. You'll be practicing attaining a good latch, experimenting with the most comfortable and convenient ways to hold your baby, and getting used to responding to your baby's cues and needs. You're starting to recover from the birth but still basking in the glow of having a newborn baby.

You may also be feeling quite overwhelmed. You're having to wake often at night to feed your baby. You feel like you're constantly feeding, changing diapers. You feel like you have no time that is your own. And you're still not quite used to this "parenthood" business.

Hang in there! It does get easier.

There are two bits of advice I would offer all new mothers in regard to breastfeeding.

The first is, "Keep nursing!" You have probably gathered by now that the more you nurse, the more milk you make, and the more practice you and your baby get at breastfeeding. Nursing on demand is the main key to a successful breastfeeding relationship.

The second piece of advice is "Give it six weeks." The first six weeks are hard. I won't sugarcoat it. Your hormones are crazy, you're sleep-deprived, you're still recovering from the strain of the birth (and possibly still healing from tears, episiotomy, or c-section), you're nursing constantly, and you feel like you don't even have a moment to pee or eat without the baby needing you. I know. It's hard. It's okay to admit that it's hard. It's okay to be frustrated if the baby starts fussing just as you sit down to eat your dinner. But, there's something about that six-week mark that makes the future seem brighter. Once you've gotten through six weeks, you're feeling better, you and the baby are better at this breastfeeding thing, you've been through two growth spurts, so the baby may be spreading out his feedings a bit, and you're starting to get into your role as a mommy.

Hang in there.

It does get easier.

A few practical points to help you keep going.

Nursing in Public

By the time your baby is a few weeks old, you've undoubtedly needed to be out and about with him, even if it's just to doctor's appointments or the grocery store. And if you were out for more than an hour or two, you probably needed to nurse him while you were out. Some women don't mind nursing in public, while others hate it. It can be uncomfortable, especially if you're still new to nursing and are not keen on the idea of exposing your breasts for any passer-by to notice. Also, you may have gotten used to nursing at home, in a comfortable chair, using pillows to help support the baby.

Here are a few tips to make nursing in public easier on you.

  1. Wear nursing-friendly clothing - The most comfortable ensemble I've found for nursing in public is a standard nursing bra under any tank top or camisole (or a nursing tank!), with a loose-fitting t-shirt or blouse over that.  You unhook the bra, lift the top shirt, and pull down the neckline of the undershirt so that only a few inches of boob are exposed, just long enough for the baby to latch. You can let the top shirt fall over the baby's head or drape over the breast that is in use so that no skin is showing. The undershirt covers your stomach, sides, and back, and the baby's head covers the rest.
  2. Purchase or make a nursing cover - There are many brands of nursing cover out there, from a hat for the baby to an apron-like contraption for mom. If the first tip doesn't offer you the coverage you want, or you are not able to wear such an ensemble for some reason, a nursing cover can be helpful. In a pinch, you can also drape a blanket or towel across your shoulder to cover the baby.
  3. Practice at home - If you know you're going to be in nursing-in-public situations often, get some practice at home, first. Try nursing cross-legged on the floor, or sitting in a dining-room chair, or even in your car in the driveway or garage. If you get some practice holding the baby without your comfy chair or pillow fort, nursing in public will come more easily as well. Also, practice in front of a mirror so you can see how little skin is actually exposed while you nurse.
  4. Find nursing-friendly locations at places you frequent - Many malls now have family-care areas that include comfortable and private nursing stalls. See if yours offers such an amenity, as it can be very helpful. Baby stores such as Babies R Us often have Mother Rooms, with a comfortable chair and a door that closes so you can nurse privately. Most department stores have no problem with your using a fitting room stall to nurse, or they may have a lounge area in or near the restroom that would be more comfortable. You can also ask at many stores if there is a private location you could use, other than a restroom. I have also found it quite comfortable to nurse in my car in a pinch.

Many, many babies, regardless of how they are fed, go through a fussy period in the evening from about two weeks of age until about three months of age. This fussy period can last anywhere from an hour to three or four hours, and usually consists of the baby crying or fussing for no apparent reason, nursing often, and being very difficult to soothe. This is usually called "colic," although most medical professionals don't actually know what causes it. This time every day or evening can be very stressful, as hearing your baby cry and not being able to comfort him is upsetting. There are plenty of books and websites out there offering miracle cures for "colic," but, as with hiccups, some techniques work better for some people than others. In the end, you just have to find the best way to get through it. If there are other caregivers around, don't be afraid to take turns holding the baby, rocking him, dancing around, singing to him, etc. Sometimes white noise such as static from the radio or running the vacuum cleaner can be soothing. If he wants to nurse, nurse him. This frequent nursing is called "cluster feeding," and nursing is often the best comfort you can offer. Many babies also calm down during a ride in the car, if you can manage it. The good news is that for most babies, this fussy period peaks at around six weeks of age and gradually gets better and better (lasting for less time or not happening every day) over the next six weeks after that.

Food Sensitivities

Very few babies actually react to something their mother is eating. Yes, proteins and some other substances from what you ingest do get into the breastmilk in small quantities, and some babies may be sensitive to these substances. If your baby shows increased fussiness, gassiness, spitting up, or a rash after you eat a specific type of food, try eliminating that food from your diet for a few days or weeks and see if the symptoms improve. If the symptoms are more constant, it may be something you eat all the time. The most common culprits are dairy products and eggs. Some babies are also sensitive to nuts, soy, and caffeine. If you believe your baby is reacting to something in your diet, you'll need to completely eliminate that food from your diet for at least two weeks to really get a sense of whether it's making a difference. Keep in mind that common foods like dairy products and eggs make their way into many foods you eat, even if they aren't specifically milk or egg products, so check package labels carefully.

Remember, though, that unless you have a reason to think your baby is reacting to something you're eating, you should feel free to eat whatever you want (within reason!). You don't have to restrict your diet unless your baby is sensitive to something you're eating.

Growth Spurts

One last topic to cover. After the first week of rapid growth, your baby will probably fall into a fairly predictable pattern of nursing. And then, suddenly, you'll find that he won't stop nursing, possibly for hours at a time. After two to three days of this strange and frustrating nursing behavior, he will suddenly spend a day sleeping almost the entire day, waking less often than usual to eat and possibly making you fear something is terribly wrong. If your baby follows this pattern at around three weeks of age and again around six weeks of age, he probably just experienced a growth spurt. The best possible thing you can do during a growth spurt is nurse on demand. As annoying or frustrating as it can be to have the baby attached to you for what may actually be hours at a time, it's important to remember that this is very short-term, and that it means your baby is headed for a period of rapid growth. Providing him with the milk he needs is vital. Plus, the frequent nursing will help increase your milk supply to meet the demands of your bigger baby! 

If this increased, frequent nursing lasts for more than three days, you should see a lactation consultant to make sure you're producing enough milk or that your baby is getting enough. If the excessive sleep lasts for more than a day or so, you should see your pediatrician to make sure nothing else is going on. Also, watch your baby for signs of lethargy (acting tired, not wanting to nurse, seeming sleepy or "limp") and dehydration (dry mouth and skin, sunken fontanel, dry eyes, dark urine). If you see anything unusual or concerning, absolutely call your pediatrician immediately!

I think that's all you need for now. Remember, give it six weeks! Keep at it! It does get easier. The next post will cover six weeks to three months, the second half of the "newborn" or "fourth trimester" period.

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