A roadmap to breastfeeding

It’s seldom easy, sometimes challenging and almost always worth it in the end. If you’re trying to breastfeed your babe and struggling to find your footing on this new path, know you’re not alone. We’ve all been there, and we’ve all wondered: How can something so natural be so difficult?

Consider this your compass for navigating the nursing world. With plenty of practice (and perhaps some direction from a lactation consultant or breastfeeding support group), you’ll soon be able to cruise through feedings with confidence.

We’ve gathered research, talked to top experts and found tips on how to make nursing work for you. Although breastfeeding offers a number of benefits for both mom and baby, don’t get discouraged if formula feeding (supplemental or exclusive) is ultimately the route you take. Bonding with your little one and providing nourishment and love is the final destination we’re all aiming for, regardless of whether it comes from a breast or a bottle.

Sense of direction
Every baby is unique and has her own set of needs, but most experts recommend feeding your bambino every two or three hours, which adds up to about 8 to 12 nursing sessions a day. “This helps to establish the mother’s milk supply and ensures that the baby is eating enough,” says Emily Cope, RDN, a nutritionist in Rochester, New York, who works with new moms. Some newborns may feed even more frequently, she notes.

If your babe is nursing fewer than eight times per day, it’s a good idea to loop in your health care professional to make sure nothing is amiss. Although everything is likely fine, your doctor can weigh and measure your little one to make sure she’s growing on track.

“One thing to consider is a mother’s storage capacity. A mother who stores more milk often needs to feed less. A mother who stores less milk feeds more often,” says Jennifer Pitkin, IBCLC, in the Iowa City area, adding that breast size does not factor in to this equation.

Most lactation consultants suggest feeding on demand, which is precisely what it sounds like: feeding your babe as often as she wants and needs. To start, feedings can last from 10 to 20 minutes per breast—or longer.

“As babies grow, the length of time between feeding will stretch out,” notes Cindy Leclerc, RN, IBCLC, of Saskatoon, Saskatchewan, Canada. If you’re feeding every two hours, you’ll be scheduling your life around nursing sessions at first, but you won’t be stuck in that pattern for the next 12 months. It’s only short-term. As your babe gets older, her stomach capacity will grow, and she’ll feed less often.

Bumps along the way
If a new mom is in pain, concerned about her milk supply or doesn’t know when (or if) she should introduce a bottle, she can feel overwhelmed and stressed out. The solution? Get help.

“Breastfeeding can be painful at times, but it should not be a continually painful experience,” says Cope. “One of the best solutions to common breastfeeding problems is for a new mother to work with a lactation consultant.”

A lactation consultant can determine if the pain is from an improper latch (most common) or a possible infection (like thrush or mastitis). Not only is she familiar with the roadblocks that you’ve never heard of—let alone had to deal with—but she can also give you advice specific to your situation.

Cope assures that lactation consultants have experience addressing every imaginable issue and are there to give novice nursing moms advice and encouragement—not to judge. Don’t be ashamed to ask for guidance; you’re new at this, so it’s unfair to expect your body or your brain to automatically know exactly what to do.

Lactation consultants are often available at hospitals and birth centers. Ask if this is the case at your place of delivery, and be sure to get your lactation consultant’s contact information in case you need additional help after you’ve headed home.

Alternate routes
It’s not unusual to encounter a few unpleasant detours on your nursing journey. Read up on them ahead of time, so they don’t throw you too far off course should you encounter them along the way.

Milk supply
Many moms stop breastfeeding or supplement with formula because they’re worried they don’t have enough milk—but in fact they do. “It may sound counterintuitive, but one of the best things you can do if you feel like you’re not producing enough milk is constantly nurse your baby [to] stimulate greater milk production,” explains Cope. “Breast milk is a supply-and-demand item. If the demand increases, so will the supply.”

Try these additional tips to promote adequate milk supply:

• Drink plenty of liquids, especially water.
• Eat a diet rich in fruits, vegetables and whole grains to ensure mom’s body has adequate calories and nutrients to produce enough milk, says Cope.
• Pump milk with a quality breast pump, which can help increase milk supply in most cases, says Leigh Anne O’Connor, IBCLC, of New York, who has been working with new moms for 17 years.
• Reintroduce a night feeding, especially if your baby sleeps long stretches. The witching hours are an ideal time to stimulate milk supply as prolactin levels (a hormone that helps make milk) are higher then, says Leclerc.
• Nurse on both breasts at every feeding.
• Get rid of the pacifier—meet all of baby’s sucking needs at the breast instead. n Avoid the bottle until breastfeeding and milk supply have been well-established.
• Ensure a proper latch.

Concern about low milk supply is so prevalent that La Leche League International names “How can I tell if my baby is getting enough milk?” as one of the most asked question its leaders hear from mamas. Thankfully, there are signs that can tell you if you’re on the right track.

The usual method involves keeping a tally of baby’s wet diapers and bowel movements. During the first few days, when your little one is sucking down colostrum, she’ll likely wet only one or two diapers a day. After your milk comes in (usually around day four), she’ll up the number to about six or seven. Bowel movements typically happen two to five times per day for the first several months of your infant’s life.

Another outward indicator that your hungry diner is getting plenty to eat is her weight. Infants should gain approximately 4 to 7 ounces per week after the fourth day of life.

Nipple trauma
In most cases, pain is the result of an improper latch. If you’re nursing and the hurt doesn’t ease up after the first few sucks, try to re-latch, advises Leclerc.

“If there is dimpling in the baby’s cheeks or a smacking noise during the feed, re-latch baby, as these can be signs of a shallow latch,” she says. “Also, mom’s nipple should look elongated and round after a feed. If the nipple is slanted like a tube of new lipstick or has a white line across it, it can indicate too much pressure on the nipple.”

Cope suggests preventing cracked nipples by applying a baby-safe lanolin or nipple balm before breastfeeding.

If the damage has already been done, she counsels that one of the best remedies is to apply the mother’s own breast milk to the problem area: “Breast milk contains antimicrobial, antifungal, antiviral and healing properties that help to heal the nipple and surrounding area if it becomes swollen or cracked.”

Nipple confusion
“If mom is planning on pumping or formula-feeding, she should ensure that breastfeeding is well-established before introducing a bottle,” advises Cope. Why? Because breastfeeding has a learning curve for both baby and mom, whereas a bottle is often easier for baby to get the hang of.

“I recommend waiting until baby is 6 weeks old before introducing a bottle. This gives time for mom’s milk supply to become established and gives baby time to practice at the breast before being introduced to something new,” says Leclerc.

Breaking out a bottle too soon might make it difficult to then teach baby how to nurse. “Once mom is confident that breastfeeding is well-established she can introduce a bottle at feeding times,” says Cope, who suggests choosing a bottle with a natural shape and the appropriate nipple flow for baby’s age.

For newborns, look for slow-flow nipples. If the flow is too fast (i.e., the nipple hole is too big), then your wee one won’t have to rely on her sucking reflex as much. Later on, she might not want to feed directly from mama’s breast because it’s more work than the bottle. Plus, infants may overfeed when their meals are served with a nipple that has the incorrect flow.

Of course, there’s always a chance that your babe will be one who prefers the breast over the bottle, which can make it challenging if you’re heading back to work or need someone else to pitch in with your munchkin’s frequent feeding schedule (especially at the crack of dawn when dad is looking particularly handsome with a bottle in hand). Leclerc suggests the following tips for getting your baby to take a bottle:

• Put breast milk in the bottle and warm it to body temperature.
• Choose the slowest flow nipple in the brand you select.
• Hand the bottle off to someone other than mom (because baby’s come to expect the breast from her).
• Try when your baby is sleepy or just waking from a nap.

The final destination
Breastfeeding isn’t guaranteed to be easy—or even to be the best option for your family and lifestyle. But if you can make it through the hard parts, both you and baby will reap the rewards.

For baby, breast milk is the ideal food because it contains the perfect nutrient profile to sustain her growth. “As the baby continues to grow and [her] needs continue to change so, too, does the composition of mother’s milk in order to accommodate those needs,” says Cope. “Baby also benefits from the immunity passed through mother’s milk, which may protect [her] from a variety of illnesses.”

For moms, breastfeeding promotes postpartum weight loss, as well as hormonal balance. And let’s not forget the convenience it offers. There are no bottles to wash, sterilize or pack. You have everything you need for baby’s meal—anytime, anywhere.

Still, it’s good to go into the process knowing that it often takes dedication and commitment in order to make it work. “As a breastfeeding mother myself, I admit that it’s very hard to breastfeed,” says Cope. “There are many times I’ve wanted to give up, feeling frustrated and defeated. But each day seems to get easier, the pain subsides, and the joy that comes from the special bond of knowing that you are providing your baby with the best nutrition possible is irreplaceable.”