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When breastfeeding doesn’t just come naturally

Nursing is not an all-or-nothing method. Every mom’s journey looks different.

(Bea Müller for The Washington Post)

New mothers often hear “breastfeeding is natural,” but for many it sure doesn’t always seem that way.

I’m a mom, baby nurse, a certified lactation counselor, and a mom of four young children. I consider myself very well versed in the ins and outs of breastfeeding. Yet when I gave birth to my fourth child about seven months ago, all did not go smoothly. Leaving the hospital, we struggled with a painful latching because of my baby’s lip and tongue tie — a band of tissues that tethers the tip of the tongue to the floor of the mouth — along with bleeding nipples and newborn jaundice. It was a tough transition home, but we worked through it as a team.

Breastfeeding is not an all-or-nothing method of feeding your baby — every mom’s journey looks different, with some people nursing exclusively, some pumping, some supplementing with formula — and it has both triumphs and struggles which can ebb and flow throughout the breastfeeding journey.

I have found that this point really resonates with a lot of new mothers out there. In 2020, I created a website offering online guides and courses to help new moms with breastfeeding and infant care, and started an Instagram feed for parents. In both cases, breastfeeding questions and worries are always front and center.

Yes, breastfeeding can feel extremely blissful and make a mom proud, but it can also feel very lonely and isolating when there are struggles to get it working. There is so much to navigate not only in the early days but even the later months. Parents need help learning how to deal with different situations, but they also need the support of a community.

Feeding my daughter taught me about what it means for the body to need help

Here are some of the most common questions I get asked about breastfeeding.

After the baby is born, what do I feed them until my milk ‘comes in’? I’m worried the baby will be hungry.

Your body actually begins producing a substance called “colostrum” or “first milk” in the second trimester of pregnancy. Colostrum is a thick, nutrient-dense substance that can nourish your baby until mature milk is produced. If you have decided to breastfeed your new baby, it’s important to nurse or pump frequently those first few days while your body transitions from producing colostrum to mature milk. This generally happens around days three to seven postpartum, with the huge shift in hormones after birth. Whether it’s a suckling baby or breast pump those first few days, milk will likely not be coming out in copious amounts. But those frequent nursing sessions actually give your body signals that there is a “demand” for mature milk. During this time, it’s important to work with your health-care team to ensure your baby is latching on to the breast well — it can take some practice by both the mom and the baby to get a good latch — and to check that your pump is fitted/working effectively if you’re pumping. It’s also important to follow up with your baby’s pediatrician for weight checks to make sure that your baby is getting enough milk through breastfeeding and thriving.

Why do we understand so little about breastfeeding?

I heard breastfeeding is painful at first, is this true?

Though breastfeeding your baby in those early days can cause nipple sensitivity, it should not be painful. If there is pain, it’s a sign that something needs to be adjusted. This could be related to positioning while you’re nursing, to the baby not latching on to the breast deeply enough, or oral ties in the baby’s mouth — that impede the movement of the tongue. You can call upon a lactation consultant if you’re unsure what to look for. It’s important during this time to work toward finding and correcting the cause of the pain. It’s also important to care for yourself and your body — there are nipple balms, creams and gel pads that provide soothing relief while you and the baby are getting used to breastfeeding.

My baby started sleeping longer stretches at night. Do I need to wake up to pump in the middle of the night so I’ll keep producing enough milks?

Typically, your body will adjust to meet an increased demand from your baby during the daytime hours, which allows for those longer nighttime stretches without the mother having to wake up to empty the breast through nursing or pumping. With this change, you may notice your breasts feeling hard and engorged at night as your body adjusts. It’s important, during this time especially, to take care of yourself physically and keep yourself comfortable. If you wake up engorged and uncomfortable in the middle of the night, it’s okay to use a pump or hand express to take off enough milk to feel relief, but not enough to empty the breast, which would signal to the body to keep producing that much milk at night. Some people, however, do find that the lack of nursing during the night because of a baby’s sleep change affects their milk supply — lowering it — during the day. In that case, you may have to add back a middle of the night pumping session or a “dream feeding” — where you offer your baby a nursing session while they’re asleep — back into your routine. Every woman is different, and how their body adjusts to different situations can vary.

The breastfeeding story is more complicated than you think

Should I start saving up milk for when I go back to work?

First things first: you don’t need a freezer full of milk to return to work. You only need enough milk saved up to get you through the next day away from your baby. If you’re working out of your home, you should find a quiet and private place to pump to replenish the breast milk the baby uses each day. However, some women like to try to pump a little bit “extra” every few days or so to leave in the freezer just in case. If this feels like something you’d like to try, look for opportunities to collect milk, especially in the early weeks during maternity leave.

When nursing your baby, milk typically leaks out of both breasts, though you can only have your baby on one breast at a time. Many women like to use breast “shells,” which cover the breast and collect any leaks, or a manual silicone pump, like the Haakaa pump, that attaches to the non-nursing breast, while the baby nurses on the other side. A few weeks postpartum, some women also begin introducing one session per day with their electric breast pump per day to collect “extra” milk to store for later. This also gives you a chance to get familiar with your pump before returning to work. Remember, even a little bit per day adds up over time.

Are more moms waiting to wean, thanks to covid?

How long should I breastfeed?

Many women choose to continue breastfeeding after they return to work, and some choose not to. It’s important to find what works best for you and your family and work/life balance, as well as your mental health. Some mothers choose to keep breastfeeding as much as they can in their new schedule, some just after the workday is over, some just at bedtime (or wake-up time) and some not at all. Studies have shown that the health benefits of breastfeeding can last far beyond the one-year mark both for the baby as milk changes and for a breastfeeding mother. There is not a “switch” that flips at six or 12 months where breastmilk is no longer beneficial. It’s important that parents feel educated and supported in their decisions — whether that’s ceasing breastfeeding or continuing past a certain point.

Karrie Locher is a mom/baby registered nurse and the mother of four children 5 years old and under. She runs karingforpostpartum.com which provides online courses for new parents and an online Instagram community for parents at www.instagram.com/karrie_locher/

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