Tuesday, July 19, 2011


I am sure there are a million sites online about breastfeeding.  When I had my first child, I think I read almost every one of those sites.  I really had a very hard time nursing.  As a physician, I was taught to give breastfeeding advice, but when I became mom, I was in serious shock!  I knew it was difficult and was taught to cheer the moms on and tell them to hang in there... but really... I had no idea just what that meant.

So issues encountered included...
1)  Positioning
Initially, it was very tricky to figure out...  football hold, cradle hold, using a boppy vs not...  I say experiment and go with what is most comfortable for you and your baby.  Poor kid.. sometimes he ends up in the most awkward positions as we're trying to figure this out.  Plus, being so close after delivery is an added challenge depending on type of delivery and rate of recovery.  Moving around is painful and hard enough, let alone having to do so while trying to hold a tiny newborn.
2)  Latching
Again, it takes some practice holding this tiny little body and his or her loosey goosey head rolling all over the place while trying to position their little mouths to open just right and clamp down without tearing off the nipple... But then BRACE yourself because it hurts like the dickens every time they do latch on and begin sucking.  With my first child I had to pre-medicate myself with ibuprofen about 30 min before I nursed to take the edge off.  I've since found that with subsequent pregnancies... the intensity and duration of pain is less and less.  With my first, I had a very difficult 3 months... then 3 weeks with my second, and about 3 days with this one!
3)  Engorgement
So at about day 3 when the milk actually comes in one may experience a whole new level of pain.  This time not just isolated to the nipple but the entire breast.  Engorgement occurs because the body is adjusting to know exactly how much milk to produce.  When there is an overproduction, the breasts feel full (and engorged) which may become very painful.  At this point, many are tempted to pump, however, I learned the hard way that that is not the answer.  Ironically, very little milk will actually get pumped out because the ducts swell shut when the breast gets so engorged.  At the same time, the pumping will stimulate your body to think that it needs to produce even more milk which will compound the issue.  Instead, one should use heat before feeds and try to massage towards the milk flow.  Then use ice to help with the discomfort after feeds.  After a couple days, the body really should adjust.  However, the transition is a challenging period because baby will sometimes have a hard time latching on and may get frustrated when not much milk is being produced.  Therefore, there can be a lot of crying.  Crying will then cause stress which then further decreases milk production.  Crying also can cause lack of sleep which also decreases the milk supply.  To get through this tough time, persevere and keep in touch with your lactation consultant who can often offer good tips and encouragement.  At the end of the day, do what you can... most lactation consultants will tell you that everyone can breastfeed if you try try and try... That may be true, however, I know that the amount of discomfort, pain, and even milk supply can vary to such a degree from person to person.  Whether the reason is medical, emotional, or both, do not feel like a horrible mother if you have to supplement with formula for a little while or even for the remainder of baby's infancy.
4)  Blocked Ducts
So this is what happens when the engorgement issue does not get resolved and supply is surpassing demand.  One or several areas of the breast can become rock hard and extremely painful.  A lot of heat, hard massage, and vigorous sucking will eventually relieve this.  Baby's suck is stronger than a pump but if baby is too upset to latch on (since latching is generally more difficult when the ducts are this blocked and there is this much swelling) then gotta pump.
5)  Mastitis
You know you have mastitis when in addition to painful hard swollen breasts you now also have a fever and feel unwell.  Your skin may also become red, warm, and tender.  Call your physician if you suspect this because you will likely need antibiotics.
Sounds fun, eh?  Well...  here is what I've learned to do after putting medical knowledge and experience together...
  • Introduce the breast early after delivery to get the baby to latch on properly before engorgement 
  • Medicate with motrin or tylenol if necessary to take the edge off the pain associated with latching/sucking (and use lanolin on nipples if sore/cracked)
  • Right before nursing either run hot water in the shower or use baby diaper filled with hot water to soften and increase milk flow
  • During nursing massage as baby sucks to ensure all milk is getting emptied
  • Do not limit baby to 5-10 min per breasts.  Instead, nurse as long as baby wants on one side to avoid incomplete voiding and avoid imbalance of foremilk vs hindmilk (which is another topic but can cause gas and green stools!)
  • Ice if necessary at the end of the feeds for comfort (frozen vegetable bags work well here)
  • Wear loose fitting bra
  • Pump if necessary from other side that did not get nursed
  • Try to nap before, during, and/or after nursing because sleep helps decrease engorgement and increase milk supply
  • Finally, drink plenty of fluids... try to finish a glass of water before, during, and after each feed
The whole experience was definitely the hardest when I was a first time mom... boy was there a lot of crying from baby and me both!  With each subsequent pregnancy, nursing became easier and I had fewer issues with engorgement/blocked ducts.  But even with the first pregnancy, once I got past the initial hump (maybe 3 weeks to 3 months)... nursing became such a wonderful and intimate experience that I had a hard time weaning.

So if you are a first time nursing mom... frustrated and discouraged and surfing the web for answers...  hang in there!  Most of the sites give similar information... at the end of the day, turn off the computer and get some rest... then try and do what you can.  Time is the real answer and if you persevere long enough it will all click... but if it doesn't don't lose heart, it'll still be all good.