Saturday, June 5, 2010

Anxiety That Works: Breast Feeding 101

Some parents are not interested in breast feeding, and that is fine. Many, however, want to but "can't." This is for them.

There are many reasons why a mother may be unsuccessful at breast feeding. I want to discuss the most common ones. First, it is important to understand that formula is an invention of the 20th century. Before this breast milk was essential for survival. No other species uses infant formula. So, believe it or not, women were designed to be able to breast feed. Without this capacity the human race would have ended long ago. So why are so many well intentioned women unsuccessful?

The most common reason that I see is improper expectations. No one told the mom how hard breastfeeding is. The first week of breastfeeding is hell. Expect that and you will be ready to go. It gets much easier, but during the first week, you will have major doubts about how well you are doing, your nipples will be sore, your baby will not be satisfied, and dads will be stressed as well.

There is a natural cycle that takes place. The baby is hungry and cries. The mother reads this as a sign of hunger and puts the baby to the breast. Not much milk is produced, so the baby is not satisfied. The unsatisfied baby either remains on the nipple or falls asleep for a short period and then wants to eat again. Mom puts baby on the breast again. In order for the mother to start producing milk she must receive this sucking, and a hungry baby is going to want to suck more than a full baby. This sucking causes mom to produce a hormone, called oxytocin, which is responsible for making milk. So, yes, you are "starving" your baby, but that is what nature intended. A hungry baby yields more sucking and more sucking produces more milk. A mom who is concerned that she is not giving her baby enough nutrition is going to be inclined to keep putting the baby on the breast, which leads to more sucking. You see how that works? Nature is pretty smart.

Problems arise when that anxiety hits, and, instead of putting the infant on the breast, many families jump to formula. The baby is satisfied and everyone is happy, but breastfeeding is essentially over. It is important to embrace the anxiety (this is one of the very few times I will suggest this) of breastfeeding. This is what nature intended. Anxiety is part of the cycle.

Giving formula in addition to breastfeeding almost never leads to long term breastfeeding. The infant gets full and mom therefore misses out on important sucking. When well intentioned families are already doing "both" during the first week of life, the chance of long term breastfeeding drops dramatically.

Likewise, the long term success for mothers who are trying to pump and then bottle feed the breast milk is pretty poor. Moms often resort to this because they are anxious that the baby is not getting enough milk. Pumping allows them to see how much the baby is taking. This may help the family's anxiety level, but it typically does not lead to long term breast feeding.

Tips for success:

  1. Relax! Trust the system that nature has designed. Understand that your anxiety and frustration is a crucial component to the system. Your baby being unsatisfied is also part of the system.
  2. Be a breastfeeding gladiator. The first week is a battle. Let nothing get in your way from being successful. Sleep, pain, and anxiety are for the weak, not the breastfeeding gladiator. Understanding the challenges that lie ahead is half the battle. Prepare yourself mentally!
  3. When in doubt, put the baby on the breast. The more sucking you get, the sooner and more milk you will produce. If the baby is on the breast for 24 hours straight, that is great! You may not like it, but you have just dramatically increased you chance of successful breast feeding.
  4. Fight through the soreness. There is no way around this, your nipples will get sore. Sometimes they will crack and bleed. Continue putting the baby on the breast. The soreness will improve.
  5. Ask for a Lactation Consult prior to leaving the hospital. Most hospitals will have a Lactation Consultant on staff to help breastfeeding mothers. If one is not available have a nurse watch how the baby latches on and feeds. They can be very helpful. (However, there are nurses that will see the breastfeeding frustration and recommend that you give the baby a bottle. Politely refuse, she does not know the harm she is doing.)
  6. Trust the baby's weight. This will show how well you are doing. All babies lose weight in the first 3-4 days of life, but they should be getting back to their birth weight around 7-10 days old. Ask you doctor to recheck the infant's weight if you are concerned about how you are doing.
  7. Let your pediatrician tell you when things are not going well. As I mentioned, you are going to be convinced that the breastfeeding is not working. Ignore that voice in your head, listen to an outside source that knows the process. There may be times that supplementing or pumping is recommended, but parents, who are overwhelmed with breastfeeding anxiety, are often not good at making that decision.

Finally, around day 3-5 of life, moms will start producing milk. This is typically an overwhelming sensation. When a mom says that her milk "might" be in, she is not yet producing milk. If the answer is, "oh, yeah," then her milk is in. Once a mom has made it to this point, the chance of long term breastfeeding is excellent.

1 comment:

  1. Funny how you don't have as many comments on this as your "controversial" sleep training article. I think you are right on here. I have breast fed for 6 months thus far and I was so completely unprepared. I pumped and gave the milk to my baby but I see how this is more harmful in the long run as I am now not pumping as much and have had to supplement with formula for when I have to leave the baby because I don't pump a lot anymore. :(