Monday, June 10, 2013

All the milk and none of the cookies

Moving forward with L&D 1102, we've got another loaded topic to discuss. The questions I received were "When does the milk come in?" and "What about formula supplementation? Will it screw up breastfeeding?" So I'll get to those questions and maybe a few others also, because at work, I often hear the same questions over and over again.

What this post isn't: a litany of awesome reasons to breastfeed (I mean, we already know this, right?)

What this post is: the ins & outs, and what/where/when/why/how's of breastfeeding. I left off the who, because surely that's an obvious answer.
And no good L&D post comes without a disclaimer. It's the one you've all grown familiar with: I'm not an expert. I'm not a lactation consultant - just speaking from experience. What I talk about here can't ever replace your doctor's advice.

So lets get started. You want to breastfeed, and you've just been handed a squishy newborn. What now? First things first, just dig your heels in, get stubborn, and prepare yourself to work hard. Breastfeeding your first baby isn't exactly rainbows and cupcakes. It takes a lot of energy when you're the most exhausted. It's easy to throw in the towel, but it takes some determination to see things out to completion. Anyone can do the bottle shake, but there's only one person who can nurse your child (even at 3am-- and then again at 4:15). That's you and it's an important job.

After you've decided that you're in this for the long haul, it's time to latch that baby on. There are lots of nursing positions: Cradle, Cross-Cradle, Side-Lying, Football (which is my personal favorite for the floppy newborn phase), so pick one, and grab a couple of pillows. Positioning is really important in those first few weeks. I can't tell you how many times I ended up with a sore neck or shoulders from hunching one way or the other just to make nursing as easy as possible for my little man. Pay attention to this: A newborn doesn't have the neck control or the strength to hold himself on the breast all by himself. One hand has to support your breast, while the other holds the baby to the breast. This won't go on forever, but in the early days, it's really key to good nursing sessions. Once you're all set up in a good position (tummy to tummy, nipple to nose!), it's time to get the nipple to the mouth. When he's all wide-mouthed and "baby birding" it, that's the perfect time to latch on. A word about latching on: It's more than just having a nipple in a mouth. We're talking Dyson Root Cyclone Technology pulling the entire nipple (including almost all of the areola as well) into his mouth. When it happens, you'll know. Honestly, I didn't get the full latch-on until my second or third nursing session, but from that point on, I knew exactly what I was going for when it was time to nurse.

As a warning, it can be painful. Let me reword that: It's probably going to be painful. Now there are definitely instances where pain is the result of poor latch or other issue. But, I also think it's a widely held misconception that nursing shouldn't be uncomfortable, because even with a great latch and intact nipples, the first minute or two of each nursing session would make my toes curl. Remember that stubborn-ness? This is where you dig your heels in, grit your teeth and get over yourself.

So, When does the milk come in? In short, it can take days for your milk to come in. This means that at first it will appear as if you aren't making anything at all. The #1 most asked question/most heard excuse is "but I'm not making any milk." When your baby is only hours old, there is very little milk being made (like, as in drops of milk), and not only is that first milk super concentrated and extra fortified, but also your 2 hour old newborn has a stomach the size of a marble. It doesn't take much to fill up that tiny tummy. You'll go through three stages on the way to mature milk: Colostrum is first and it's that super concentrated, extra fortified milk I just mentioned. It's thick and sticky and a golden yellow color. Transitional milk is what comes around between colostrum and mature milk. It's less thick, higher in volume and still a yellowy color. Lastly, mature milk comes in. It's the highest in volume, the most thin and almost a bluish white in color. Typically it takes 48-72 hours for your milk to come in, but it can be transitioning as early as 24 hours or as late as 5 days (for me, it was 4 days).

Aside from being stubborn as a mule, breastfeeding success comes with repetition. Demand leads to supply, so stimulation is needed for milk production. This means that in those early days, baby goes to the breast frequently. Your goal is a well-nourished baby and a stable milk supply, which unfortunately comes with little sleep and majorly sore nipples. Whether you're reading hunger cues or trying to maintain some semblance of a nursing schedule, you should shoot for 8-12 nursing sessions in a 24 hour period. For the first 4 weeks, I nursed at least every 3 hours while awake. He always went to the breast for feedings, and if my boy only nursed on one side, I'd pump the other. I also got into the habit of pumping after the first feeding of the day and prior to going to bed. As my milk supply leveled out, I dropped to either morning pumping session or evening pumping session. Nowadays, I only pump at work or if I've missed a feeding and am feeling engorged. Being really diligent in a nursing schedule means routine stimulation which in turn equals milk production.

I'd say this is a good stopping point for today. I originally had written a few more paragraphs, but things started to get overwhelming. As with the epidural question, this whole breastfeeding thing could take up about five separate posts. In the next post, we'll tackle formula & supplementation and how that can affect breastfeeding. Later, we'll look at tips, tricks, and must-haves for nursing success.

To Be Continued.......

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