In the age of Super Mom, breast-feeding has become standard practice. Mothers who stay home nurse their babies as a matter of course. Others juggle work with feedings, often stopping on the fly to nurse at noon.
It may sometimes be hectic, but doctors now say breast-feeding is terrific for most babies and good for most mothers.
It offers infants ideal nutrition and enhances their resistance to infection and allergies. In the mother, it promotes uterine healing and may reduce the risk of breast cancer. Most important, the nursing relationship fosters bonding between mother and child.
On the other hand, breast-feeding isn't always easy, and it certainly isn't problem-free.
The new mother quickly realizes, with some shock, that her demanding, unpredictable infant is quite unlike the peaceful cherub she had anticipated.
"No one really told me what to expect," recalls Phyllis McIntosh, a 40-year-old first-time mother from Silver Spring. "So much of what you read is all sweetness and light, how peaceful it is, no problems, it's the most wonderful thing going. I think it's a very cruel thing . . . to lead women to believe that it's all going to be hunky-dory. Because a lot of women do have problems. Breast-feeding is not necessarily an easy job."
McIntosh, whose daughter Heather is now 11 months old, had a caesarean section, a procedure that can delay milk production and cause other problems. McIntosh was advised to concentrate on her own recovery, even though this meant spending less time nursing.
*Once back home, Heather slept most of the day and didn't nurse very often. "Somehow," McIntosh says, "the importance of nursing frequently to build up my milk supply wasn't stressed or didn't get through to me."
By the time Heather was 3 weeks old, she was crying a great deal, and the pediatrician found that she wasn't gaining enough weight. McIntosh was told to nurse her every two hours except at night, a regimen that soon took its toll. "My nipples were sore to the point where I would sit there and sob," she remembers, "and I was just a basket case because I felt I was doing nothing but nursing."
Despite her efforts, Heather, who still cried quite often, lost an ounce when she was weighed 12 days after McIntosh began nursing more often.
The pediatrician ordered supplementary formula, and Heather became much more content.
McIntosh, however, was devastated. She felt like a failure, yet she wanted to continue nursing, at least part time. But her pediatrician warned her that her breasts would stop producing milk if she gave the baby more than one bottle a day. By nursing less, the child would stop stimulating the production of breast milk.
Feeling backed into a corner, McIntosh sought more information from several sources. She received conflicting advice and tried to increase her milk supply by using a breast pump. Nothing worked.
Finally, McIntosh found a new doctor, and that made a difference. He told her that mothers work out all kinds of nursing arrangements and said there was no reason she couldn't combine breast and bottle feedings in any way she wished. "This took the pressure off," McIntosh says, "and I relaxed. Soon I found that I had more milk than I'd ever had before."
With her new doctor's help, she alternated breast and bottle feedings. She continued nursing Heather on a diminishing basis until the baby was 8 months old. She also joined a mothers' support group and found that several of the women had had significant problems with breast-feeding.
Joining the group earlier, she believes, would have helped her combat her feelings of isolation. "You are made to feel that you are the only one who's having problems," she says, "but that isn't the case. Mothers need to know that they are not alone."
Susan Elliott, formerly an instructor for Family Life and Maternity Education (FLAME), agrees, adding: "New mothers who are learning to breast-feed need one-to-one support from a breast-feeding mother, a breast-feeding adviser or a doctor who is willing to put in the time to be right with them when they have difficulties and see them through the rugged places at the beginning.
"Too often, women are unprepared when they have problems," Elliott says. "Then, if they lack good support, they are likely to stop breast-feeding and may feel quite disappointed."
It's vital, however, to choose a supportive person carefully. McIntosh discovered that some nursing "experts" are dogmatic and overbearing. And even an otherwise assertive woman may have trouble dealing with a dogmatic adviser when she is feeling inadequate and vulnerable in her new role as a mother, Elliott says.
Women who plan to combine work and breast-feeding need even more support. Elliott suggests that the new mother take some time off at first. "It's nice if you can be free for at least three months, but you really need to be home for six weeks. It takes that long for the milk supply and the baby's routine to be established and for you to recover fully from the pregnancy and delivery," she says.
Even this advice must be kept in perspective, Elliott says. "Everything I've ever heard of has worked for some people and not worked for others. When it comes to nursing, there are no ironclad rules." Getting Help
Some hints on getting ready to nurse:
* Read at least one good book on nursing. Suggestions: "Nursing Your Baby" by Karen Pryor (Harper & Row, $3.50 paperback) or "The Womanly Act of Breastfeeding" by the La Leche League International ($7.95 paperback). Both are available at local La Leche League chapters (see phone numbers below).
* Select a physician who understands the difficulties of nursing and who will be supportive.
* Line up a support group. Area groups include:
La Leche League: Maryland and D.C., 856-3160, and Northern Virginia, 534-8548.
Parents After Childbirth Eduction (PACE), 279-8727.
The Parent Connection, 320-2321.
Parent and Child, 652-5383.
American Society for Psychoprophylaxis in Obstetrics (ASPO), the original Lamaze training group. 549-2226.
Family Life and Maternity Education (FLAME), 276-9248.
* Get information and help from the Jewish Social Services Agency's "Warm-line," 881-3700, TTY 984-5662.
* Line up a specific support person -- friend, relative or professional -- who is experienced at breast-feeding.
After the baby arrives:
* Nurse as frequently as possible during the first few weeks -- generally about every two to three hours, except for one longer stretch at night.
* Make sure the infant is facing the breast and does not have to turn his head to nurse. This saves wear and tear on the nipples and is more comfortable for the baby as well.
* Avoid "nipple confusion." Many babies, after sucking on rubber nipples, pacifiers, or even fingers of siblings or adults, become "spoiled" and unwilling to put forth the necessary effort to grasp their mother's nipple.
* Learn to hand-express breast milk. This skill will enable the mother to prepare occasional relief bottles of breast milk; relieve engorgement, especially when a feeding is missed; and assure an adequate milk supply.