Some more thoughts on Breastfeeding.

Just a few more thoughts on breastfeeding. I have my sincere doubts that anybody will use my hours-old blog as an authority on breastfeeding, but I feel an obligation to ensure that anyone who DOES come across it while searching for honest information gets as much as possible. What I'm about to say will not come as a shock to anyone who has breastfed successfully. If you have been unsuccessful in the past, and learn why through this post, please know that I don't intend for it to be hurtful, derogatory, insulting, or judgmental in any way. Much of what I'm about to post here is the result of overwhelming amounts of misinformation and lack of education. If you were the victim of this, it's not your fault.

Dos and Don'ts of Breastfeeding

1) DON'T pump and then bottle feed, at least not for about 4 weeks. There are many reasons mums choose to do this earlier, and some are valid. Some are not. We will examine a few right now.

"But how do I know how many ounces he's getting?"
Answer: You don't. It's not important. What's important is: he's gaining weight (at least 6 oz/week after re-attaining birth weight); he's wetting at least 4-6 times per day (easier to tell with cloth diapers, but some of the newborn size 'sposies have a wetness indicator strip on them), he's pooping at least once per day (usually 2-3 times, but some babies will just have one super-poop); his poop is mustard coloured and full of little curds or seeds. I reiterate: there is no need whatsoever to quantify how much breastmilk your child gets in ounces. It's not even meaningful, since there's no way to know how many calories your baby is getting per ounce. Breastmilk changes from mum to mum. It changes from morning to night. It even changes from the beginning of a feeding to the end of a feeding. The number of ounces your baby is getting is NOT. IMPORTANT. Whether he's gaining weight, making urine, and passing feces is the only meaningful measurement of how much he's eating and drinking.

"But my husband/partner/mum wants to feed him."
This IS valid. Feeding can be an important bonding experience, and the non-nursing parent often feels left out of this bond. I recommend waiting for your supply to establish itself; this takes about 3 weeks. I don't suggest waiting longer than 6 weeks, if you ever plan on bottle-feeding, because transitioning from breast to bottle, even with expressed breastmilk, can be difficult after that time. Once your supply is established, spend 2-3 days feeling out your baby's routine (if you nurse on a schedule, you can skip this step.) Find a time of day when baby is going at least 2.5 hours between feedings. Pump 1/2 to 3/4 oz (about 15-25 ml) from each breast after it's been 2 hours. Since baby is not going to nurse for another 30 minutes, your body will replenish most of that amount by baby's next feeding. Morning tends to be the best time for this, as the hormones that are responsible for stimulating milk production peak overnight. Personally, I pumped 3/4 oz from each side before each feeding at 6 AM, 9 AM, and Noon. That meant that I had a 4 1/2 oz bottle ready for Tristin's 9 PM feeding. I (or his dad, or his granny) gave him the bottle, and then at about 10:30 I pumped again - this time getting 4-6 oz in one sitting, since it had been four and a half hours since I'd nursed. I popped that bottle in the fridge, and used it for his bedtime feed the following evening. In this manner, I was able to build up to where I always had 2 bottles worth in the fridge, AND I was freezing 10-12 oz per day. (See end of post for storage tips.)

Ok, that got a little off topic, but that's how you go about making sure that somebody else gets the chance to have feeding-bonding time with baby, without damaging your supply.

See, what your doctors, nurses, mothers, and possibly even lactation consultants don't tell you is that your pump does not stimulate a letdown reflex nearly as well as your baby does. Since you get no letdown, you don't express as much milk using a pump as you do while actually nursing. This leads to the mistaken belief that you don't produce enough milk ("But I'm only making 1 oz every 3 hours!"), and, much more serious, it doesn't actually drain your breasts. And the only way to make your body make more milk is to completely drain your breasts at regular intervals. Now, your baby is able to accomplish that for you; your pump is not. Don't believe me? Try this:

After baby has nursed to his satisfaction, hand him off to your partner, or put him in his crib, playpen, bassinet, or what have you. Beginning at your collarbone, massage in slow, firm-but-gentle circles downwards towards your nipple. Once you get ther, support your breast with one hand and roll the areola between the thumb and forefinger of the other hand. You might see a drop or to of milk expressed.

Now, do the same thing after you pump next time. Did you spray 4 feet across the room? See, TOLD you you're not empty. Your breast is just (very wisely) trying to hold onto that milk until baby comes to take it out. Moral of the story: if you pump instead of nursing, you may actually be causing the supply issue.

So, that about sums up DON'T pump and then bottle feed.

2) DON'T stress about eating/drinking right!

Basically, you can eat/drink whatever you did before becoming pregnant while breastfeeding. One of the biggest reasons women cite for giving up on breastfeeding is that it's too hard to follow the "rules". So throw them away! (Yes, yes, hypocrisy, irony, how well I know thee.) There is a caveat to this: don't use breastfeeding the way some women use pregnancy, i.e. as an excuse to eat whatever they're "craving" because that "must be what baby needs". However, there is no one perfect diet. It is possible that some of what you eat will need to change; baby may be sensitive to some foods (tomatoes and citrus are quite common), or have no tolerance for caffeine (bye-bye, coffee and chocolate!), but only you and your baby can decide that - and not all babies have the same intolerances.

Can you drink coffee while nursing? Absolutely. I wouldn't suggest drinking it after about 3 PM; your baby WILL get the caffeine from your system, and if you're trying to teach him to sleep at night, that won't be helpful. The reason many medical professionals say Absolutely No Coffee is because it's a diuretic and may reduce your supply, if you allow yourself to become dehydrated. Many new mums hear No Coffee and think it's for the same reason that you shouldn't have coffee during pregnancy: that is, that it can actually harm the baby. This is not the case; the risk of coffee during pregnancy is more related to a reduction in placental blood volume, resulting in low birth weight and a host of other problems.

Can you drink beer/wine/liquor while nursing?

This is a somwhat delicate issue, so I will hedge my reply a bit. There is absolute truth in the old wives' tale that a glass of stout (think Guinness) will help your milk production. I don't know if the same is true of paler ales. As for the question of drinking and nursing in general, I go by the rule that if you can't drive, you can't nurse. However, I don't see a particular problem in having the occasional drink with dinner. I don't pump and dump after doing so. My argument stems from several theories. First, let's look at some math:

Beer has 5% alcohol. If I drink 2 beers (24 oz) that works out to about 1.1 oz, or 22 ml, of pure alcohol.

After 2 beers, my blood alcohol level is probably about 0.05%. I estimate this based on the fact that the legal limit is 0.08, and while I wouldn't drive after 2 beers unless it was an emergency, I feel comfortable that I would still pass at a checkstop.

My son takes about 8-10 oz per feeding. Assuming my breastmilk has the same amount of alcohol as my blood (reasonable assumption), 0.05% of 10 oz is 0.005 oz, or 0.15 ml of alcohol.

Second, let's look at the ingredients on gripe water.

Get the picture?

3) DO sleep when baby sleeps!

This is a good tip for any new mum, but especially important if you're nursing. Oxytocin and prolactin, the hormones responsible for milk production, drop drastically the longer you're awake. They tend to peak after about 4 hours of uninterrupted sleep; thus the good ol' 2AM feeding. However, until your baby is sleeping more at night than during the day, you should just sleep every time he does, for as long as you can. Dad can do the dishes and the laundry for once. Oh, and if you don't like having a 9 PM bedtime, well, tough. Until your supply is well established, you can't risk staying up past baby's bedtime - especially if he's not sleeping reliably at night yet.

4) DO invest in a good nursing bra! (Or several! In different sizes!)

Your breasts may or may not change sizes, become rigid (engorged), or leak during your breastfeeding journey. Regardless, it is very important to wear a good bra. Breastfeeding has been made complicated enough without the added complications of back/neck/shoulder strain or skin damage/stretch marks from the sudden increase in the weight of your breasts.

5) DO what feels right!

In an earlier post, I mentioned that I nursed on a schedule. I knew I wouldn't be able to handle nursing on demand with my baby, and to be honest I didn't think being "on demand" was helping my supply any; Tristin wanted to nurse 100% of the time he was awake, so I never had any time to build up any significant amount of milk in my breasts, which meant that he never got full, which meant that he never slept for more than 45 minutes at a stretch, which meant that he was awake and wanting to nurse. Bad circle to be in. So, it was a very, very difficult 3 days, but by the end of 3 days he was getting a full tummy every three hours, and by the end of the week he was sleeping 5-7 hours in a row, AT NIGHT. (Please note: if he was asleep at the time of a scheduled feeding, I woke him up. He usually went right back to sleep after, but that way we never got off schedule.)

The schedule was right for us. It might not be right for you. All babies are different. So, if it feels right to you to eat an extra meal, to cut out chocolate, to drink exactly 8 litres of water a day - do whatever feels right to you. If you're finding yourself stressed out about breastfeeding, chances are you're trying to do it someone else's way, not yours.

Good luck!


(N.B. A little about milk storage: There are mixed opinions on the length of time you can store milk. The times listed are on the outside of what I felt comfortable with.

Fridge: store at the back, away from the door, in a container that has been carefully cleaned and has an airtight seal. Can be used up to 6 days after pumping. Milk may separate; shake gently, but only immediately before warming to serve or you'll make butter.

Freezer compartment of fridge: store at back, away from door, in sterile container - either the disposable bags or storage bottles that have been boiled. Can be used up to 2 months after freezing.

Deep freeze: store in bottom, away from door, in sterile container. Can be used up to 6 months after freezing.

Thawed milk from freezer: If thawing in fridge, allow 12 hours. Can be used up to 24 hours after thawing, or 36 hours after removal from freezer. If thawing at room temperature, allow 3 hours. Can be used up to 8 hours after thawing, provided that it has been placed in fridge after thawing. Otherwise, must be used immediately.)