Breastfeeding Should Not Hurt
Of all the things I cover in my breastfeeding class, the thing I most want to impress upon expecting mamas and their partners is that breastfeeding should not hurt. Pain is not acceptable, period. Discomfort, yes. But pain? No, no, no. If you're cringing or wincing or crying out "ow, ow, ow, OW!" (even if you don't say it out loud) while breastfeeding, something is not right.
Can we repeat that once more for good measure? Breastfeeding should not hurt.
For some women -- a small minority of women -- breastfeeding is easy and painless. Baby comes to the breast on his own, the milk flows, baby sucks beautifully, mama feels euphoric, and the angels sing. But for most women -- yes, MOST WOMEN -- breastfeeding takes practice. After all, if this is your first baby, neither of you has ever done this before. And if it's your second or third, 50% of the partnership is brand new at this and needs practice. Have patience -- with yourself most of all -- and it'll work out in time.
What to do if breastfeeding is painful? The most common reason for pain -- both while breastfeeding, and the nipple irritation, cracking, and bleeding that can come later -- is an inadequate latch. In order for your baby to properly extract the milk from your breast, her mouth must be open wide (really wide) and take in much more than just the nipple. (The picture on the Palo Alto Medical Association website shows it well. Take a look.) If your baby only has your nipple in his mouth, nursing will be painful; if he has a wide open mouth that takes in some or all of the areola (depending on the size of your areola) deep into his mouth, nursing will not be painful. Uncomfortable (weird, tingly, awkward, etc., etc.) at first -- for a minute or so -- but not painful.
There are books written about breastfeeding and how to get a great latch, but my guess is that since you're reading this now either the books didn't help you or it's 3am and you're desperate, so I'll try to keep things brief. Keep referring to that picture as you read this (it should have opened in a separate window).
- Get comfortable. Sit or lie where you can relax and hold the baby securely (and don't worry if that's not in the fancy nursing chair you bought... you'll use it eventually. Your old, stained couch may just fit the bill perfectly).
- Position your baby well. In the cross-cradle hold (see modifications below if you prefer the football hold), you should be belly-to-belly with your baby, with her full body leaning into yours. If you're nursing on your right breast, hold her head with your left hand so that your left arm is supporting her body and your left hand is securely holding her head. Hold your right breast with your right hand.
- For the football hold: While nursing from the right breast, baby should be positioned in a V side-to-side on your right, with her bum against the couch or chair and her legs toward the ceiling. Prop up her body with some pillows so that her mouth is about level with your nipple, and support her back with your right arm and hold her head in your right hand. Hold your right breast with your left hand.
- Wait for baby to open his mouth widely. Some babies instinctively open wide and tilt their head back, others need a little encouragement. If yours is in the second category, you can encourage him to open his mouth by dragging your nipple from his nose down to his chin (firmly enough so that his lower lip folds down), squeezing your nipple to hand-express a few drops of milk and then dragging from nose to chin, or manually tilting his head back with your hand (just his head, still keeping his body smooshed against you) -- this will instinctively cause him to open his mouth, just as you do when you tilt your head back. (An important note: This assumes that your baby is not in a deep sleep. Your baby doesn't need to be super awake to eat, but in the early days when you're both getting the hang of nursing, he should be pretty alert. I'll cover ways to wake a sleepy baby separately.)
- Bring your baby to the breast, aligning baby's nose to your nipple. Again, baby to the breast -- not breast to baby. When she opens her mouth widely, bring her whole body to your breast and firmly press her body into yours. (The firmness is so that a seal forms between your breast and her mouth -- placing her on your breast rather than pressing her to it won't form a tight seal.) Aim for your nipple to hit the roof of her mouth -- that's what stimulates her to suck.
- Focus on yourself for a minute. Once he's latched on, evaluate how you feel. Is it painful? Are you holding back tears or literally crying out in pain? No problem. Just take him off your breast (use your finger to break the seal on his mouth if necessary), take a few deep breaths and try again. (And again and again. Remember what I said about patience and practicing?) If you're feeling OK, a little uncomfortable but basically fine (maybe a 5 on a pain scale of 10?) reevaluate in another minute or so. The discomfort should gradually subside, both over the course of each individual feeding and over days and weeks.
And what if you're still having trouble? Please seek professional help. I say this as both a mom (I had major, major, major difficulties nursing my oldest daughter, and one visit with a lactation professional really turned things around) and as a lactation counselor. Very often just a minor tweak to what you're already doing will make a world of difference -- changing positioning, working on timing, learning about hunger cues. And now that the Affordable Care Act is in effect, lactation consultations are often reimbursed (partially or in full) by insurance companies (you should check with your individual carrier first, though). I can be reached at email@example.com or 917.209.1573 if you're local, but if you're not, find someone nearby to help you.
Feeding Cues 101
One of the most common questions I'm asked when I work with new moms is, "How do I know when my baby's hungry?" The most obvious (crying) is actually a late feeding cue, and waiting until your baby is really hungry to try to nurse can have downsides. It probably won't make a difference if breastfeeding is well established, but in the early days a crying baby is likely to get frustrated easily; may not have the focus to latch on well; may suck so vigorously that it's painful for mom; or may be tired from crying and not have the energy to nurse long enough to really fill her belly. And a downside for mom: You're likely to get flustered much more easily if your baby is crying (you are innately sensitive to your child's cry), and you may not have the patience to try again (and again) if the latch is less than ideal.
Feeding cues to look for:
- Increased alertness after sleeping (fluttering eyelids, increased body movements... basically not in a deep sleep)
- Flexing of the arms and legs (which can be hard to see if a baby is snuggly swaddled -- which I happen to be a huge fan of -- but it's something to note)
- Clenched fists
- Rooting (baby turns his head toward your chest... or anybody else's!)
- Attempting to bring hand to mouth
- Sucking fist or finger
- Mouthing motions of the lips and tongue
- And again, crying is a late feeding cue
Any sign of the movements above mean it's time to nurse.
And just to keep you on your toes, some babies go from zero to 60: deeply, soundly asleep and then crying up a storm. He may exhibit one of the signs above for a brief second, but if you aren't staring at your baby -- and you really can't stare at your baby every second of every day -- you'll miss it. That's OK. Really, truly OK. Just nurse him as soon as you can, and know that newborns typically nurse every two to three hours (that's start to start), so keep a passive eye on the clock and you'll be better prepared for when he wakes up.
Increasing Milk Supply
One of the more agonizing aspects of new motherhood with my oldest daughter was her slow -- very, very slow -- weight gain as a newborn. All babies lose weight after birth, and up to 10% is considered "normal," so be prepared for that if you haven't given birth yet and don't fret too much if your baby is inching toward that 10% marker. The reasons for the weight loss are myriad; I'll focus here on the most common reason given for slow weight gain: low (or insufficient) milk supply.
Milk production is a supply and demand relationship. "Demand" more of your body via more frequent nursing, and your body will produce more. As I said in the prior post, newborns typically nurse every two to three hours, start to start. The part that often gets lost in that sentence is the "start to start" -- meaning (for every three hours) 8am, 11am, 2pm, 5pm, 8pm, 11pm, 2am, 5am, which equals eight feedings per day. (If breastfeeding is painful, please see Breastfeeding Should Not Hurt above, and call a lactation professional if you're still in pain. Maternal pain is an indication of an inadequate latch and likely inadequate milk transfer from breast to baby. The fee pales in comparison to what you will pay for formula if you're unable or unwilling to continue breastfeeding.)
If your baby is gaining weight slowly, increase the frequency by 30 minutes: 8am, 10:30am, 1pm, 3:30pm, 6pm, 8:30pm, 11pm, 1:30am, 4am, 7am, which equals 10 feedings per day. I should say here that I generally promote passive time monitoring (just like you, your baby has times when he'll be more hungry and less hungry), but if he's not gaining weight and you're becoming daily visitors to the pediatrician, watching the clock for a few days will make a big difference. Not enough of a difference? Increase the start-to-starts to every two hours. If feeding every two hours around the clock leaves you a crumpled mess (never a good thing!), try to nurse every two hours during the day and go slightly longer between feeds at night so you can rest.
In addition to signaling your body to produce more milk, you'll be kick-starting your baby's metabolism. A newborn's stomach is about as big as her tiny fist, which is why newborns need to nurse so frequently. The increased milk will stimulate her body to process the milk, her stomach will expand to hold the milk, and eventually she will take in more milk with each feeding, which in turn increases the time between nursings.
Your new friend, the breastpump. Pumping is not fun in any way, shape, or form, period. Breastpumps are an amazing invention, though, and can be enormously helpful in increasing supply (not to mention allowing women to go back to work, and even just out to lunch for an ever-so-brief respite from mothering). Pumping is in addition to the increased frequency described above -- the extra stimulation ("demand") helps increase your supply. Start with 5 minutes of pumping after baby's done nursing (ideally with an electric double pump; a hand pump works well, too, it's just more work). You may produce only a drop or two, or nothing at all -- that's okay, stick with it. It takes time for your body to adjust to the increased demand, but it will adjust. Give your baby whatever you produce (via bottle, spoon, or medicine dropper) -- immediately after pumping if he's awake, or save it to give after the next feeding.
What about teas, herbs, and foods? I'm frequently asked about the necessity of drinking nursing teas, and my short answer is that it is not "necessary." If you like the taste and it helps you feel well and hydrated, drink it; but if not, don't force yourself. I happened to like the taste, but I really loved the ritual of having a cup of hot tea, so it was certainly beneficial. I also tended to like the recipe for lactation cookies (lots of good stuff in there, especially since I always add extra chocolate chips), but again -- I think the benefit for me was in the joy of eating a cookie and in not feeling hungry. Remember, though, that without increased stimulation -- via direct nursing or pumping -- your body will not significantly increase milk production.
What if the pediatrician recommends supplementing with formula? Without question, follow your pediatrician's recommendations and work to increase your supply. If you pump and produce a measurable amount (say, half an ounce) of breastmilk, ask your pediatrician if you can reduce the recommended amount of formula by the same amount (half an ounce in this example).
Myths and Misconceptions
Following are a few of the more common myths and misconceptions that I hear from pregnant women and new moms (and their mothers!), and some simple reasons why they aren't true.
- Bigger breasts, more milk. Breast size does not matter when it comes to milk production. An A-cup breast can produce just as much milk as a DD-cup breast.
- After baby nurses, breasts are "empty." Milk production is essentially continual -- replenishment begins as soon as a baby initially latches on at each feed.
- Supplementing is necessary until milk "comes in." Colostrum -- the thick, honey-colored liquid that breasts first produce after childbirth -- is frequently called "liquid gold" because of its incredibly valuable nutrients and high fat content. Science has yet to duplicate it.
- It takes 10 minutes of nursing to get to the "best" milk. Research has shown that the fat composition between the foremilk (at the beginning of a feed) and hindmilk (at the end of a feed) is highly individual and depends on a variety of factors. Learn more here.
- Eating more food and drinking more water is important for milk production. The specifics of what you eat and drink typically do not impact milk production. Eat when you're hungry, drink when you're thirsty; make smart choices so that you feel good.
- Lack of rest diminishes milk supply. The amount of sleep you get each night will not affect your milk production; however, a tired or stressed mama may become frustrated easily or lose patience quickly (with herself most of all!).