Wednesday, July 18, 2012

Prepare for Breastfeeding

1- You can’t really do anything to prepare your breasts for breastfeeding. Sorry. Unless you have inverted nipples, in which case you can start wearing “breast shells” which draw out your nipples.

2- Large areolas are a blessing, not a curse. If your areolas are too SMALL, then baby nurses outside of the areola and it feels like your breast is being ripped into pieces. One of my areolas is slightly unevenly sized and I have to latch my son onto that side in a way that avoids him over-latching. Large areolas are GOOD. I don’t know why a LC would tell you that. Ugh. An areola is basically the skin that baby is supposed to latch onto. They don’t have to take the entire thing into their mouth. It’s this great flexible area of stretchy/soft smooth skin. Baby only has to take about 1″ of the areola into their mouth. Your areola can take up your entire breast and it’s still not a problem. Large nipples can pose a bit of a challenge with a newborn, particularly a preemie. But large areolas? Not even a little bit of an issue.


3- Breast shields while feeding can cause more problems. They basically cause “Nipple confusion”. They should only be used as a last resort.

4- Was the blood coming from inside of your breast, or from the nipple? There are different solutions to the two different issues. Blood also does not necessarily pose a problem.

5- It sounds like you were using bottles. This causes ALL SORTS OF PROBLEMS including nipple confusion which results in tattered bloody nipples. Avoid bottles at all costs. Avoid pumps. Pumps can make your breasts bleed if you use them wrong, or too early.

6- You were not “making one ounce”. You were able to pump one ounce. Which is different. I could pump 1/4th of an ounce and then nurse my son. Weighing before and after nursing him, he’d have gained 8 ounces! Pumps are ineffective. They usually only pump out a woman’s “over supply”, not even touching the capacity that the breast has to produce. Baby is MUCH more effective at getting mom’s milk out. Nurse. Ignore the pump, don’t use bottles. AT ALL.

7- You can’t do anything to ensure healthy milk flow until your baby is born. Once your baby is born this is what you can do:

a- Put your baby to the breast right away. Within the hour. It’s best to just place baby near the breast and only try to latch him on if he starts to root around. Pushing the issue and trying to force baby to latch on is the start of a LOT of problems.

b- Make sure that you have a lactation consultant meet you at the hospital within the first 24 hours after you give birth. Meet with the LC BEFORE you give birth, have your breasts examined. Ask her to explain any problems that she sees, and ask for more information. Areolas cannot be “too big”. Anyone that tells you this, or that recommends jumping right to nipple shields is a fraud and deserves to be slapped.

c- Room in. Don’t send baby to the nursery for the night. Make sure your hospital allows and encourages rooming in. If they don’t, change hospitals immediately.

d- Put a big “NO PACIFIERS, NO FORMULA, NO SUGAR WATER, NO FOOD BUT BREASTMILK” sign on your baby’s bassinet.

e- Understand the various reasons why baby might “need” supplementation after birth. There are FEW. If baby is born prematurely, if baby is born at a very low birth weight (under 6lbs), if baby has low blood sugar (Request a BLOOD TEST if the finger/heel prick test shows low blood sugar. The prick-test is horribly inaccurate in a newborn and often results in babies being given bottles when it is unecessary)

IF baby needs supplementation, request that it be given via eyedropper, and request that the amount of supplementation be under an ounce so that baby will still be motivated to nurse.

d- Understand that there are a lot of reasons that are given to use formula/bottles at the hospital, and they are all pretty much bogus.

- Baby is going to lose weight, this is normal. It’s not fat, it’s fluids. Baby retains a LOT of fluid, particularly if mom was on IV fluids. Baby pees and poops after birth and loses weight. Normal. Baby is NOT starving to death. If mom has not had IV fluids, baby can lose 10% of their weight and be fine. If mom had IV fluids during labor, baby might lose more than 10% depending on how long mom was on the IV and how much fluid was pushed into mom. In some cases this is as high as 20% if baby has retained a large amount of fluid. If baby loses more than 7% of his weight in the first 72 hours after birth, breastfeeding should be OBSERVED but supplementation is not necessary.

- Baby does not need to go back up to birth weight until baby is 2-3 weeks old. Many doctors push to have baby back at birth weight by their one week checkup. Baby should not be losing weight at this point, but baby does not have to be back up to birth weight.

- Baby does NOT need to make 6-8 wet diapers per day from day one of birth. This is the diaper count for when mom’s milk comes in. Mom’s milk can take 3-5 days (or even longer) to come in. This is fine. Baby’s tummy is TINY at this point and colostrum is more than enough to fill it. Count wet diapers by “one per day of life” so for day one, baby should make one wet diaper. Day two it should be two wet diapers, day three three wet diapers and so on. Once mom’s milk comes in or once baby passes day 6, the count is 6-8 wet diapers. Once mom’s milk comes in the definition of “wet” changes a bit. In the early days it’s generally “soaked” diapers, but once mom’s milk comes in it’s “damp” diapers. So one damp diaper = one diaper, one soaked diaper = 2 diapers. So if you have two soaked diapers and three damp diapers on one day, that’s 7 “wets”.

- Once baby passes his meconium (the green-black tar of first poop) baby does not need to poop as frequently. It’s normal for a breastfed baby to go a week or two without pooping… UNLESS baby’s poop is hard, or baby’s belly is hard and he’s distressed. Formula will only make digestive issues worse, so “baby is not pooping” is not a valid reason to give formula.

- Jaundice. Formula will make it worse. Jaundice is normal. Bili lights are the preferable treatment for newborn jaundice, although for mild jaundice you can take baby for a walk in the sun instead. Jaundice only becomes a problem if a blood test shows that the numbers are too high. Many nurses push formula when baby’s levels are slightly high, and threaten mom with “Oh baby will have to stay in the hosptial if you don’t give formula”. BULL. There’s even something called “breastmilk jaundice”, this is fine and normal and nothing to be concerned about. Many nurses push formula for jaundice. Request a blood test. You can also request something called a “billi blanket” which allows you to bring baby home and do bili treatments using the portable blanket.

There are a lot of other reasons why someone might be pushing formula. Most of them are bullshit.

My son latched on for a couple of minutes here and there for the first 72 hours of life. The longest I could get him to latch on was about 5-10 minutes, and that was ONE TIME on ONE SIDE. My milk came in on day three and he latched on fine.

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