Early as a La Leche League Leader, I learned from Linda J. Smith the lactating body works like an ice machine: When you remove ice from your ice maker, there is a sensor in your freezer that tells the freezer to make more ice. Its goal is to replace the ice. When you remove milk from your breasts, there is a trigger in your your body that tells the body to make more milk. Its goal is to replace the milk.
If you do not use the ice, the freezer does not continue to make more. If you do not remove the milk, the body does not continue to make more.
The baby and body expect milk to be removed 12-24 times in the first 24 hours of life. This ensures the baby gets enough. This ensures the body gets the message to start making milk.
Once you get past the first 24 hours, it is normal for babies to eat 8-12 times in 24 hours, and more than that can be normal, too. Milk effectively removed at this frequency is often enough to build a robust milk supply.
Keys for the first few days include:
Because the body makes milk by wanting to replace the milk that was used, we know cookies, special drinks, supplements, etc., don't improve supply alone. You can't eat lactation cookies and drink Starbucks' Pink Drink and expect more milk if you aren't feeding your baby (or pulling milk out via a pump) 8-12 (or more!) times in 24 hours.
We are a culture steeped in instant gratification. We can get things next-day from Amazon. We can get fast food 24 hours a day. We don't have to wait long in many cases to get what we want. Milk supply doesn't work like this. There is an element of work that comes with having an adequate supply, and that is feeding or pumping 8-12 times in 24 hours.
To get the most optimal start, it isn't that difficult:
Some people respond more to negative messages, so for fun, let me share ways to make breastfeeding hard:
The biggest success factor for breastfeeding is time for you and your baby to be together. Your baby is programmed to be with you, to want to be close, to want to feed freely. Babies don't come out and say, "Hey, we've been a little too close for a little too long -- please put me in my own room, in my own crib." In actuality, babies do not know where they end and their parent begins. They have been rocked, held snugly, been kept warm, heard all the sounds of your body and your voice, and they have not been hungry -- think about that! They were fed through their blood. So suddenly, it's bright, they're cold, they have no control over their arms or legs, and where's that person!? My person? It is a lot to adjust to. And can you guess what answers all those questions of discomfort? Being at the breast.
There is an amazing author out that by the name of Kimberly Seals Aller. I heard her say this at a conference once: The first time you had consensual sex, it probably wasn't the greatest. You may have wondered, How do people do this? Why do people make it seem so easy? I'm pretty sure I did that all wrong. Did you walk away and say, "Well, that didn't work, so I'm never going to do that again." Generally not. We stick with it. We figure things out. It takes time and practice.
While breastfeeding is not sexual, the idea that, if it doesn't work the first few times it isn't going to, often causes many of us to quit before we have even had a chance to practice and figure things out better. Repeat this to yourself: Just because it isn't working right now doesn't mean it won't work. Seek help, because it is out there. We should not be expected to figure things out on our own. Heck, if you can't find help, reach out to me! I may be far away from your location, and I can try to help you find support appropriate for your situation.
Let me close with Linda Smith's "Coach's Rules":
1. Feed the baby
2. The parent is right
3. It's the parent's baby
4. Nobody knows everything
5. There's another way
You can do this! And with support, you don't have to do it alone!
Places to reach out to before baby, for support, or if struggling:
Find an IBCLC
La Leche League
Tori is the mother of three boys, a La Leche League Leader, and a birth doula. Her baby, Otto, was born in September, 2015 -- he had ties, but no one really knew until his weight dropped in response to his decreased desire to eat. In Tori's words, she documents their journey, and how hard it was to find help while her baby was struggling to eat and grow.
"Here's a timeline of our journey to the breast.
Born Sept 21 2015, weighing 9lb 3oz, noisy latch, unsettled baby, needy baby.
Jan 2016- weight arrested at 13lb 4oz (in hindsight, because milk supply tanked and no longer fueled by postpartum hormones, looking for adequate sucking to maintain it, baby not sucking adequately or very long per feeding). He would pull off at letdown, refused to latch deeply and the bottom lip never flanged like it's supposed to.
Feb 2016- weight unchanged for 1 month, I started pumping, building back my supply and trying every way under the sun to supplement. SNS, Haberman feeder, syringe, 8 different types and flows of bottles, all with little success. Syringe was best because required no sucking and because of severe posterior tongue tie he was unable to suck properly.
In Feb I saw our Ped, LC, and Speech Pathologist. All 3 professionals examined his mouth and stated that tongue tie was not present, because he could thrust his tongue out of his mouth. I mentioned posterior tongue tie with all 3 professionals and was told in so many words, 'it's not real.'
I had 2 meetings with speech pathologist who encouraged me to spoon feed him and use Haberman feeder to help avoid mouth aversion. She refereed us to Children's Hospital to have a barium swallow study done to watch on X Ray my baby swallowing, mainly to check for silent aspiration which can over time cause pneumonia. The soonest they could get my baby in was April 7th, 2016, 2 months from the time the study was requested.
Over this month my frustration and desperation grew to a crippling degree. I didn't sleep, I was spoon, syringe, bottle, breast feeding around the clock. My baby was fussy but never showed signs of dehydration that I was told to look for (soft spot sunken, dry lips, listlessness, dark urine, few diapers). He had normal large stools and urinated clearish non-smelly urine 12 times per day. At urging of Speech Path, I started keeping a detailed log of every single bit he would eat. I did this for 5 days, it varied from 14 oz to 20 oz, guessing with how much transferred during breastfeeding.
March 4th 2016- I took him for another weight check with Ped. Still no weight gain. 2nd month. I lost it in the office. She offered to draw labs on him and I said yes. Labs showed a drop in blood sodium levels.
March 6th- we repeat labs at emergency room and sent to Childrens because of sodium. By this time I had connected finally with dentist who does posterior tongue tie revision. It's $500, and our insurance was not accepted, so I had been trying for several weeks to get an appointment and gather the money to pay for it. I wanted to revise him before our hospital stay, but both Drs agreed he was too sick. So we put it off until after the stay.
March 7th- after 6 hours of stress for my exhausted baby, with multiple more lab and urine draws, Children's finally placed a feeding tube in my baby. We fed him through a tube down his nose, 2 oz every 2 hours for 3 days. His weight gain was on average 15 grams per day. They were also supplementing his sodium and watching it closely to make sure it was rising, and it was.
March 8th- Barium swallow study performed and severe tongue restriction and silent aspiration of syringe feeding observed.
March 9th- I was persistent enough to get an ENT doctor in my hospital room to revise his tongue. This doctor used a long metal tool to lift my baby's tongue deeply and revealed a frenulum far back under his tongue that no one had ever laid eyes on before. The ENT doc cut this about 1/2 inch long piece of skin and handed my baby to me. My baby IMMEDIATELY latched differently than he ever had, drained my entire breast, which he never had done, and we only did one feeding through the tube that day as he learned to use his newly released tongue. ENT doctor exclaimed 'Oh, that released a lot,' when he did it, in surprise.
March 10th- morning weight gain was 130 grams after breastfeeding all night.
March 11th- consulted with speech path, ped doc and ENT about stretching his tongue to keep revision from re-adhering and all told me not to, but because of my own research I did it anyways.
March 13th- constant weight gain of on average 120 grams per day and maintained sodium levels, so we went home.
I'm attaching two pictures, that were taken 9 days apart. The first one is the day of the lab draw and the 2nd one is the day of hospital release.
I believe sodium levels were low because my baby was starving, not unlike someone with anorexia. I received consults from endocrinologists, geneticists, nephrologists (kidney doctor), lactation consultants, urologists and speech pathologists during our hospital stay. The doctors didn't think sodium was low because of his lack of feeding but were searching for other causes. They did an ultrasound on his kidneys and discovered they were enlarged, but recommended just watching them every few months to ensure they don't get worse. It's my opinion that the kidney issue is unrelated to the sodium levels, but there are still some tests out on his hormones that will answer that for sure (adrenal hormones).
I urge you to educate yourself, if you work with moms and babies, and stop telling mothers that posterior tongue tie isn't real, and to start learning how to clinically recognize it. My case was typical yet on the extreme side, and my baby and I were made to suffer because it went untreated.
I'm personally feeling a huge amount of guilt, and the months leading up to our hospital stay were traumatic for us both. I share this with you in love and kindness and hope you will learn and grow as I have."
I am grateful to Tori and her willingness to share her story. Tori and Otto were let down by many health professionals -- any one's education or awareness could have quickly changed the course of events before hospitalization was needed. Tori has chosen to contact these health professionals, not to stir angry feelings or place blame, but to simply ask them to learn more, so they can help the next family and prevent complicated issues like she and Otto faced.
You may not even know it, but you and your baby have been working hard, preparing for the next step in your relationship after pregnancy and birth -- breastfeeding. Just as you provided everything your baby needed to grow on the inside, you are sequenced to continue this job once baby is on the outside. Currently I am working toward increasing my formal lactation knowledge to better serve the Bakersfield and Visalia areas. To add to my current 6500 direct breastfeeding counseling hours, I am completing 90 hours of specific lactation education (required to become eligible to sit for the exam to become an IBCLC). I came across these quotes while studying, and I was struck by the timing of these events!
While we are designed to nurse our babies, that doesn't mean it will happen easily. If you are experiencing breastfeeding issues, reach out for some help! There are many places to look, starting with the hospital where your baby may have been born, WIC offices, local public health options, private practice IBCLCs, and group support gatherings, such as La Leche League and Breastfeeding USA. Often you can call any of these resources for some phone help or questions answered. If you need more support, hopefully the person on the other end of the phone can further direct you to the best resources for your situation.
Just because we are mammals and breastfeeding seems like it should be "natural," that doesn't mean we won't need some good information and ideas from others who are in positions to help. Don't be afraid to get some guidance -- you are your baby are in this together!
For more resources, view this past post.
My older sister likes to remind me that once upon a time, while pregnant with my first, I responded to her question of, "Are you going to breastfeed?" with an unsure, "...if I can." To this day I still deny it. I honestly have no recollection whatsoever of that conversation -- I know she wouldn't make it up, though.
Over 16 years later, life has put me in a different place. I have successfully breastfeed my four children. Soon after my second baby's birth I went on to become a breastfeeding counselor, leading meetings for local mothers and mothers online, taking phone calls from frantic mothers all hours of the day and night, making home visits and hospital visits, and participating on our county's local breastfeeding coalition. I have written articles for journals, magazines, and blogs, spoken at breastfeeding conferences, and I am currently working toward becoming eligible to sit the exam to be an IBCLC. I cannot imagine who that person was who meekly replied, "...if I can," all those years ago.
Yet with all the future-breastfeeding moms out there, this is a common feeling. I think it stems from allowing a bit of room for failure -- not setting the bar too high in case of disappointment. Simply put, lowering expectations.
You only have to go as far as your nearest mother to find why this answer has held its place as, I would guess, the number one response: We love to share our horror stories. Any pregnant woman can attest to this when it comes to birth stories -- suddenly women are crawling out of the wood-work to tell you their impossible experiences -- the pain, the suffering, the horridness of it all, oh, and good luck! This carries over to breastfeeding experiences as well.
One day in the grocery store, a young clerk asked, while checking my items, if this was to be my first baby? I was prepared for her to launch into her personal drama, so with my fists clenched, and most likely talking through gritted teeth, I replied, "Yes." She looked at me so sweetly and honestly. "You are going to do just fine." I was stunned! She must have sensed this -- she went on to say, "Having my son was the best experience of my life. I wouldn't trade his birth for anything." I left for my car feeling like she had just revealed a secret to me -- I felt this young lady, about my age, had seen something in me I did not know I possessed. I felt powerful.
Birth and breastfeeding are related in the way we think about them both: We hope for the best, but in the end, we do not have ultimate control over how things will turn out. This tends to be more true for birth than for breastfeeding. Some of the most committed breastfeeding mothers I have met have been mothers who had to have cesarean births after planning completely natural births. I think many of them found exerting energy into the breastfeeding relationship healed the loss the cesarean birth left with them.
As women, we need to focus on sharing our positive feelings about birth and breastfeeding. We need to assure other mothers although there can be problems and set-backs, there is always a way to accommodate, adjust or overcome with the right network of support.
Let me share the biggest secret to a successful breastfeeding relationship: Know where to get help. You can always call me with your breastfeeding concerns. My doula role ends after your baby's birth, but my role as your breastfeeding counselor continues until you no longer need me.
♥ four young boys and a boy dog (offspring)