Breastfeeding highs and lows

by Meagan Ellis, Canadian Family

Within seconds of initiating her first breastfeeding session with her newborn daughter, Louise Dame was in excruciating pain. “It hurts! It hurts!” the Calgary mother kept telling the attending nurse. “Just leave it for a minute,” was the nurse’s continual reply. By the end of that session, Louise’s breast was sorely bruised and her daughter, Sophie, was still hungry.

Over the next few days, a succession of unit nurses attempted to help Louise with the womanly art of breastfeeding, each with a different method, none of them successful. Louise’s pain increased to the point where one nurse had to force her to feed, so unwilling was she to put herself through the torturous process again. “I knew I was doing it wrong but I didn't know how to fix it,” Dame recalls. “Sophie was crying all night long because and she was so hungry and the room was cold. So I walked the halls comforting her, working up the courage to try again.”

The problem, as she now realizes, was that her daughter was just not latching on to the breast properly. A few days later, a distraught Dame met with a special lactation consultant who taught her the proper method for holding and feeding her baby. But it would take another three weeks of sore breasts and an additional three weeks of fears about having a poor milk supply before Dame would finally be able to relax and enjoy the nursing process. “Breastfeeding is one of the hardest, but most worthwhile, things I will have ever done,” she now says.

One of the biggest misconceptions about breastfeeding for first-time mothers - even highly motivated ones - is that it will be easy. “I thought it would be like those baby monkeys you see on TV who go to the breast and start feeding right away,” says Andra Christie, a Nanton, Alta., resident and mother of three. “But there is a certain method to it. You have to work at it.”

And working at it is well advised because the benefits of breastfeeding are well established. Breast milk contains all the right protein, fat, vitamins and minerals that a baby needs to grow. As well, breastfeeding helps protect the baby from infection, allergies and even obesity (the effort required discourages overfeeding). Mother’s milk is cheaper than formulas and bottles, and is always sterile and conveniently available. Nursing helps a mother lose weight by using up the fat she gained during her pregnancy and helps the uterus return more quickly to its pre-pregnancy state.

Best of all, nursing sessions create an intimate time for the mother and her baby to make eye contact and bond more closely.

Twenty-five years ago, only one Canadian woman in four chose to breastfeed. Today, thanks to positive publicity, almost four in five mothers choose to do it. Unfortunately, says Dr. Beverley Chalmers, a Kingston, Ontario based international health consultant on babies, 30%-40% of these mothers have stopped by three months-despite the fact that doctors recommend exclusive breastfeeding until the baby is at least six months old. “The drop- off in breastfeeding from initiation to just a month after birth is huge,” says Chalmers.

One major problem, she suggests, is that too many women go into breastfeeding without a proper understanding of how it works. “They think there’s some kind of mystique about it, that why some babies will feed and others won't is a mystery. You may be lucky, or you may not have enough milk, or your breasts are the wrong shape or size or whatever. There’s all this misinformation and myth surrounding breastfeeding,” Chalmers says.

Knowledge is the key to breaking down these myths and in most parts of Canada that knowledge is readily available. Many hospitals offer prenatal classes for couples and operate breastfeeding clinics with lactation consultants to work with new mothers who need to learn not only proper nursing techniques but also the signs of a hungry or replete baby. Chalmers recommends that new moms check out the principles of the Baby-Friendly Hospital Initiative, a joint venture of the World Health Organization (WHO) and UNICEF, which was created to promote breastfeeding around the globe. Its website offers information on breastfeeding, as well as basic principles for mothers and health care professionals to follow. “If a mom knows how it’s supposed to work, then she’s able to do the things that might help much more easily,” says Chalmers.

For Dr. Cindy-Lee Dennis, assistant professor in the University of Toronto’s nursing faculty, the biggest challenge breastfeeding mothers face is keeping their confidence up. “The number one reason women discontinue breastfeeding is because they say they have insufficient milk,” says Dennis, “but less than 1% of mothers actually produce an insufficient amount.” Too many lose confidence when the baby doesn't latch on right away, or is not feeding properly. This is where a good support system comes in - to help a mother overcome any problems that come her way. Does her hospital have a breastfeeding clinic? Does her family doctor know a lot about about breastfeeding? Is there a local group she could attend? Did her sister or friends breastfed? “Look at the whole support network, both professional and private,” Dennis says.

Studies conducted by Dennis found that women who receive regular support from other mothers who have breastfed are more likely to continue breastfeeding. Role models do much to enhance a woman’s confidence. “If you can see an ordinary person doing it, it makes it seem like you, too, can do it,” says Dennis.

Providing mothers with a good support system includes having a medical system that follows UNICEF’s and the WHO’s Baby Friendly Initiative guidelines, says Chalmers. This means allowing the baby and mother to room-in together at the hospital, and having the baby breastfeed within an hour of the birth. “At the time of birth, the baby should be given directly to the mother. The infant should be delivered straight onto the mother’s abdomen, and not be should not be separated from her ever,” Chalmers says. “Any examinations or cleanings should be done while the baby is in skin-to-skin contact with the mother.” If mother and neonate are separated or the baby is fed water or formula, which often happens in hospitals, breastfeeding becomes more difficult to initiate.

With the right knowledge and loving support, most women should be able to avoid the pains and frustrations that often come with breastfeeding, and focus on the joys of connecting with and nourishing their child. To ensure the most productive and pain-free breastfeeding experience, Canadian Family offers the following tips:

  1. Make yourself comfortable before nursing

    Any kind of tension in the mother could inhibit milk flow. “Whatever relaxes you, do it,” says Chalmers. This may mean having a warm shower, or drinking some tea or even a beer before feeding. Listen to soothing music, or surround yourself with friends or family members who will encourage your breastfeeding. And if you want to eat onions or garlic, then go right ahead. “There’s a myth that babies can't handle certain foods,” says Chalmers. “In most cases, if the mom is comfortable eating it, then so will the baby be.”
  2. Properly position the baby

    Hold the child with his stomach and face toward you so that his neck and spine are aligned in a straight line. His nose should be lined up with the breast’s nipple. Hold the breast with four fingers underneath, away from the areola (pigmented area) and with the thumb on top. Bring the baby to your breast, rather than vice-versa. You can adopt any position you like: sitting up, lying on your side, or even laying the baby down and leaning over him. The important things are that the baby is facing you and you are comfortable.
  3. Get a good latch

    Stimulate the baby’s mouth with your finger or the tip of the breast until she opens her mouth as wide as a yawn. Don't attempt to feed her until her mouth is wide enough to hold most of the areola, not just the tip. “You’d be amazed. Those babies open their mouths so wide, they look as though they have flip-topped heads,” says Lisa Strauss, a Nanton, Alta., mother of three. When Baby’smouth is open wide enough, quickly pull her toward the breast. As her tongue meets the nipple, her mouth will close over the areola and seal it, and her lips will roll out. The tip will now be deep in the baby’s mouth, allowing her to suck on the full areola. You should see the sucking motion along the jaw line, and may be able to hear the swallowing noises. Strauss was told to listen for the 'k' sound, a “kah, kah, kah” noise that lets you know the baby is sucking and swallowing properly.
  4. Feel free to try different approaches

    Move the baby around, experimenting with various placements to see what works best for both Baby and Mom. Dennis notes that while a good latch is essential, mother and baby are free to decide the best way to establish this. An individual baby, however, will often prefer a certain position, and a mother should stick with that as long as Baby is properly emptying the breast. “If something’s working, then why not continue with what works?” Dennis says.
  5. To stop the feeding, never pull the nursing child off directly.

    You must break the suction (it’s amazingly strong!) by placing a finger in the corner of the baby’s mouth and then pull him gently away.
  6. Feed on demand

    Babies nurse more easily when fed on demand rather than on schedule. In fact, they can become cranky and difficult to feed if forced to follow a routine. Demand feeding will keep Baby happy and your milk supply high. Mothers should look for signs of hunger, such as salivation, sucking on thumbs or fists, or turning head to the side as if searching for the breast. The baby will nurse every two to three hours. The duration of feedings will vary-some babies, with experience, will be able to feed in less than 20 minutes- but if Baby is feeding for an hour or more, that is too long says Dennis.
  7. One at a time

    There are two types of breast milk, foremilk and hindmilk. a complete meal should include both, and that is best achieved by doing a complete feed on one breast, then starting the next feed on the other. This allows the baby to reap the nutritional benefits of a balanced meal, and helps maintain milk supply equally in both breasts. Eat well so that you can keep up your energy and milk supply. Drink plenty of fluids during each session, as breastfeeding can be dehydrating.
  8. Take good care of yourself

    You can't breastfeed well if you're not up to it, so rest often during the day. Keep your breasts exposed for a few minutes after nursing and allow a little milk to dry on them to toughen them and keep them from getting cracked or infected. Don't put soap on cracked nipples, as this will promote drying.
  9. Buy a good breast pump

    “Forget the emollient creams and nursing pillows-a good breast pump is the most important thing a breastfeeding mother can buy,” says Dennis. Pumping out the milk will relieve engorged and uncomfortable breasts, and create a freezable supply of milk for times when Mom is unable to breastfeed. Dennis recommends the Medela hand pump as one that is easy and comfortable to use.

    Ideally, breastfeeding should continue well into the second year of your child’s life, says Chalmers. But after the recommended initial six months of exclusive nursing, Baby’s iron stores (built up in utero) begin to run out, so iron-fortified infant cereals should be introduced to the baby’s diet around the half-year mark. Giving Baby formula or water earlier than that will create less of a demand for breast milk and a drop in the mom’s supply. “It’s a vicious cycle,” says Chalmers. “If you think your baby is not getting enough and you give a bit of formula to top her up, she'll drink less and you'll produce less, so you'll give more formula. In a few days your milk supply diminishes altogether.”

  10. Wait till 4 weeks to introduce the bottle

    From time to time, Baby may need to be bottle-fed, but Dennis suggests waiting until she is 4 weeks old to try this. The earlier the baby is given a bottle, the less inclined she will be to continue breastfeeding, as this takes a lot more work. But after a month, Dennis says an infant can be given a bottle periodically so that she can become adjusted to it. “Because you can't at six months suddenly introduce a bottle and expect her to take it,” she says. Feeding from the breast is much different from feeding from bottle and requires a stronger sucking action. “The baby needs to learn to cope with the flow from a bottle in the event that someone other than Mom has to feed her.”

The ideal person to introduce Baby to the bottle is Dad. With many babies unwilling to accept bottles from their mothers because they're so accustomed to being nursed by her, this will create a special routine that belongs to Dad alone. Men who may have felt left out of the feeding process will now feel included, and women will feel less guilty about being the only ones experiencing that special bonding time with the baby.

It’s also recommended that you give your baby vitamin D supplements from birth. This is one essential vitamin that breast milk does not supply enough of. D helps reduce their risk of later developing type 1 diabetes, multiple sclerosis, rheumatoid arthritis and many common cancers. Babies under a year should be given 200 IU of vitamin D supplements a day, rising to 1,000 IU of vitamin D after they turn 1 year.

At the end of the day, the most effective way to ensure a smooth breastfeeding experience is to go into your pregnancy with the desire to breastfeed. “The best advice I got from anybody when I was expecting my first,” says Strauss, “was that nursing is something you have to really want to do, because in the beginning, it is no picnic. And that was absolutely true for me.”

Breastfeeding is not for everyone, says Chalmers. For some mothers, the discomfort is too much to deal with, while for others, it is simply an inconvenience. Many women complain that there is too much pressure placed on them by healthcare professionals and breast feeding proponents to nurse for as long as possible, and they feel guilty when they cannot do it for very long. Both Chalmers and Dennis agree that the mother should never feel pressured into breastfeeding for a certain length of time. “Being a good mom is not made up of six to eight breastfeeding sessions a day,” assures Chalmers. “It’s everything else you give to your baby, and it’s a lifetime of parenting that makes you a good mom.”