Mom to Mom: The Practical Side of Breastfeeding

By Kimberly Kennedy

I remember when I first started breastfeeding: It was intimate, rewarding—and complicated! The “how to’s” were readily available. But like many women, I still had pragmatic questions. So let me share some answers, mom to mom, about the practical side of breastfeeding.

MEETING YOUR NEEDS

How hard can it be? Stick your breast in baby’s mouth, and let him do the work. Right? Well, not exactly. Breastfeeding doesn’t always come naturally to baby or mother, and there may be days when you feel like giving up. So build a support network of friends, family, a lactation consultant, La Leche League, and an online support group to get questions answered daily.

The Christ Hospital has opened an outpatient lactation clinic called Expressions and More at The Christ Hospital. “We did a study last year which showed that women have more issues after discharge than before,” says Charla Payne, RNC, a board-certified lactation consultant for The Christ Hospital. Women can schedule consultations as well as rent or purchase supplies. Payne also reports that many breastfeeding services and supplies are now covered by insurance. Expressions and More accepts Medicaid and has a fund set up for those who can’t pay.

Does nursing hurt? It shouldn’t! You may feel an uncomfortable, prickly sensation the first couple minutes as the milk flows down to the nipple (i.e., the “let down”). But if pain persists, talk to a consultant.

Will my breasts leak? Probably, during a feeding, after a shower, or if you are late for a feeding. Apply gentle pressure to the front of the nipple. During early months, you’ll need thick, absorbent nursing pads, and possibly two at night. As you drop feedings and your breasts are less full, use thinner pads. You’ll find disposable pads at pharmacies and washable pads where you purchase nursing bras. When nursing, unhook the bra cup and roll it inward with the pad inside.

How do I remember which breast to offer? During a feeding, the second breast you offer may not be emptied. So to prevent plugged ducts, offer it first at the next feeding. To remember, place a ring or watch on the hand corresponding to the side the baby is nursing on; switch every time the baby switches breasts. At the next feeding, offer the breast on the side where the object is. You can also buy a nursing watch which tells you the time and side of your last feeding! (Available at Boutique 280.)

When do I nurse if I have an appointment? If it will likely coincide with a feeding, offer one breast before the appointment and the other after.

When do I get things done? Accept the fact that, during your baby’s first year, you’ll have to let some stuff go. Enlist the support of family members. Plus, once you get comfortable with breastfeeding, you’ll find that you can eat, write notes, use the phone, answer e-mail, or read a book—while nursing!

What about me? Breastfeeding demands a lot, physically and emotionally. and it goes more smoothly if you’re relaxed. So get plenty of rest, drink fluids, and eat right. Reduce stress and limit visitors the first few weeks.

Do I have to limit my diet? Payne says that you don’t have to limit certain foods, like spicy, caffeinated, or gaseous foods. However, it’s a good idea to limit large fish, like tuna, because of the risk of excessive mercury.

What about nighttime feedings? To prevent engorgement (that full, painful feeling), you’ll want baby to take both breasts at each feeding. But it can be a challenge to keep her awake! Turn on a light, unwrap her swaddling blanket, and slowly but firmly rub your thumb over the bottom of her foot. If this doesn’t work, be practical: Wake baby up in a couple of hours and offer the other breast.

If sleep deprivation is wearing you down, let your husband give a bottle of pumped breastmilk for one of the feedings. Place it in a cooler at your bedside; hubby can warm it in an electric bottle warmer.

MEETING BABY’S NEEDS

How do I know he’s getting enough? Visit your pediatrician one week after birth; she can tell if the baby is getting enough milk by weight gain and the number of dirty diapers. (Note: Breast reduction surgery can affect your milk supply.)

How often will baby eat? So that you know what to expect, Payne says that feeding 8 to 12 times a day is normal. But every baby is different, and feeding patterns change. Your baby may settle into a pattern of every 2 ½ to 3 hours, then go through a growth spurt and eat more frequently; your body then responds by making more milk.

How long will baby eat? Payne says that 8–15 minutes per side is an average range. But there will be times when it’s shorter or longer on one breast. As baby and breast become more efficient, 8–10 minutes per side is common.

How long should I burp him? Two or three minutes is usually sufficient. If your newborn spits up most of his meal, burp him in the middle of a feeding.

ON BEYOND BREASTS

What do I need? Set up a nursing area: Choose a comfortable chair, pillows for arm and back support, a small footstool, and a nursing pillow. Fill a basket with burp cloths, nursing pads, lanolin (for sore nipples), water bottle, baby nail clippers, pen and paper, telephone, tissues, remote control, and a good book.

To avoid nipple confusion, when do I introduce breastmilk in a bottle? Payne suggests between week three and four, once breastfeeding is going well. Continue several times a week.

Do I need a pump? Absolutely! To prevent plugged ducts if you miss a feeding or to stockpile breastmilk for Dad, Grandma, or a babysitter to give.

A single manual pump is quick and inexpensive. Double pumps are fast, convenient, and vary in price. A new innovation is the hands-free design; place it inside your bra and go about your business! Not all pumps work for all women.

When pump shopping, Payne suggests looking for the flexibility to use batteries or a car adapter; ability to change flange size; ease of finding replacement parts; appropriate suction.

Where do I nurse in public? Find a quiet place, free of distractions. The back seat of your car can be ideal! Baby-product stores often have nursing areas, and major department stores have a lounge with a chair or couch.

What do I do about everyone offering suggestions? Good and bad advice will come—whether you want it or not! Say, “Thanks for sharing!” and then trust your instincts; if it doesn’t seem right, don’t do it.

PROBLEMS

What if my baby bites? “When baby is teething, be mindful,” says Payne. Don’t let baby hang out at the breast. “Once baby is done feeding, take him or her off the breast so they’re not tempted.” When baby bites, say Ow! or don’t bite with a stern (not scary) voice and unlatch baby. Wait 20 seconds before latching on. If you’re consistent, it should stop within a few days.

How do I know if I have a plugged duct? You will notice a painful, firm area on the breast that does not soften after a feeding. Massaging and applying heat between and before feedings can often unplug the area. Try a hot bath or shower, or microwave a wet cloth inside a baggy and place it inside your bra. Always offer the plugged breast first, and gently but firmly massage the area during the feeding. If possible, place the baby so her chin faces the direction of the plug. If the plug is on top, lie on the bed, facing baby, with baby upside down. A plugged duct often resolves itself in 48 hours. If it doesn’t, seek medical attention.

How do I know if I have Mastitis? Mastitis is an infection which rapidly spreads through the body and sometimes starts with a plugged duct. If you notice a hot, painful, red area on the breast (hard or soft), monitor it closely. If it spreads, it is not alleviated by breastfeeding, and you develop flu-like symptoms (aches or fever), call your gynecologist immediately for an antibiotic. Don’t wait 24 hours—you could quickly find yourself incredibly ill! Continue to nurse from the affected side, offering it first.

My vagina doesn’t feel normal; is this connected to my breastfeeding? Some women experience vaginal dryness, burning, and redness due to the decrease in estrogen. If this is a problem, consult your physician who can prescribe vaginal estrogen.

HOW TO SHOP FOR A NURSING BRA

Your breasts will grow and your rib cage will expand during pregnancy. Purchase one or two inexpensive bras with a larger cup and band size to get you through the last months.

Immediately postpartum, you will need a well-fitting, comfortable nursing bra, as you will likely wear it 24 hours a day! Buy two or three so you have a backup for the inevitable leak. The most important function to look for is flaps that can be opened and closed with one hand and without looking.

Consider a professional fitting. The back of the bra should not ride up, and shoulder straps should not dig in. Breast tissue should not spill out. Avoid underwire bras, as pressure from a wire can cause a plug.

It is hard to imagine how large your breasts will grow when they are full of milk! Nursing bras are designed for this expansion, so your nursing bra cup size may be the same as before pregnancy. It’s recommended that you wait until later in your pregnancy to shop for a nursing bra. When trying one on, place two nursing pads inside each cup to simulate full breasts. If it’s early in your pregnancy, be sure there is room at the catch for rib-cage expansion. If later in your pregnancy, be certain the band can be tightened after delivery when your rib cage reduces in size.

If you are unsure of the size, purchase two, saving receipts for returns after the baby is born. You may need a larger size for the first six months and a smaller one once baby starts solids and demand goes down.

BREASTMILK STORAGE GUIDELINES

Store milk in small quantities, 2 to 4 ounces, so you can thaw as little or as much as you need. Use plastic storage bags, such as “disposable bottles.” Squeeze the air out, twist the top of the bag, and tie. Label with date and quantity. Place inside a freezer bag. Here’s how long it will last:

Thawing: Place bag under warm running water or into a pan of warm water.