What to Expect the First Year (18 page)

Knowledge is always power—but it's particularly powerful when it comes to building a successful breastfeeding relationship with your baby. The more you know—about process (how milk is made and how it's dispensed), about technique (how to position your baby properly), about mechanics (how to tell whether your baby's getting milk to swallow, or so much milk that he or she is gulping), and about logistics (knowing when a meal is over or when it's time
for another)—the more confident (and empowered) you'll feel as a breastfeeding mom. To raise your breastfeeding IQ before you put your baby to breast, take this mini-course in breastfeeding basics first.

Just when you thought your body couldn't do anything more mind-blowing than making a baby, it follows up that amazing act with lactation, which is considered the natural completion of the reproductive cycle—and it's a pretty phenomenal finale. Here's how it works:

• How milk is made. The process of milk production is automatically initiated the instant you push out the placenta (or it's delivered during a C-section). That's your body's signal—after spending 9 months feeding your baby inside you—to gear up for the shifts in hormones that will allow you to feed baby from the outside. The levels of the hormones estrogen and progesterone decline dramatically in the moments after delivery, and the level of the hormone prolactin (one of the hormones responsible for lactation) rises dramatically, activating the milk-producing cells of your breasts. But while hormones trigger the start of lactation, they can't keep milk production going without some help, and the help comes in the form of a tiny mouth—namely your baby's. As that tiny mouth suckles at your breast, your prolactin level increases, stepping up milk production. Just as important, a cycle begins—one that ensures that a steady production of milk will continue: Your baby removes milk from your breasts (creating demand), and your breasts produce milk (creating supply). The greater the demand, the greater the supply. Anything that keeps your baby from removing milk from your breasts will inhibit the supply. Infrequent feeding, feedings that are too brief, or ineffective suckling can all result in diminished milk production. Think of it this way: The more milk your baby takes, the more milk your breasts will make. Even before that first sip, baby's first demands for the premilk colostrum power that production line.

• How it flows. The single most important function that affects the success of breastfeeding is the letdown reflex, which allows the milk to flow. Let-down occurs when your baby suckles, prompting the release of the hormone oxytocin, which in turn stimulates that milk flow. Later on, when your breasts get the hang of let-down, it may occur whenever suckling seems (at least, to your body) imminent—as when your baby's due for a feeding, or even when you're just thinking about your baby.

• How it changes. The milk your baby gets isn't uniform in the way that formula is. Ingeniously, the composition of your milk is, well, fluid—it changes from feeding to feeding and even within the same nursing session. The first milk to flow when your baby starts suckling is the foremilk. This milk has been dubbed the “thirst quencher” because it's diluted and low in fat—it quenches your baby's thirst without satisfying his or her appetite. As the nursing session progresses, your breast produces and dispenses hindmilk—milk that is high in protein, fat, and calories—and that's the filling stuff. Cut a nursing session short—or switch breasts too soon—and your baby will miss out on hindmilk, causing hunger to strike sooner, and even preventing
weight gain (a foremilk-only diet is too low-fat and too low in nutrients). To make sure your little one gets his or her fill of nourishment, wait until one breast is well drained (it's never completely empty) before starting the other. How to tell? A breast that is well drained will feel much softer at the end of the feeding than it did at the start—and you'll also notice that the milk flow has decreased to a trickle and that your baby is swallowing less often.

As half of the breastfeeding team, your needs matter during feeds, too. Here's how to get yourself situated for a successful breastfeeding session:

• Seek some peace and quiet. Until breastfeeding becomes second nature to you and baby (and it will!), you'll need to focus as you feed. To do this, get settled in an area that has few distractions and a low noise level. As you become more comfortable with breastfeeding, you can keep a book or magazine, phone or tablet handy to occupy you during long feeding sessions. But don't forget to put it down periodically so you can interact with your little nurser—that's not just part of the fun for you, it's part of the benefit for baby. Talking on the phone can be too distracting in the early weeks, so let any incoming calls go to voice mail. You may also want to avoid watching TV during feedings until you get the hang of breastfeeding.

• Get comfy. Settle into a position that's comfortable for you and your baby. Try sitting on the couch, in an armchair or glider, or propped up in bed. You can even nurse lying down in bed (now, doesn't that sound pretty good right now?). If you're sitting up, a pillow across your lap (or a specially designed breastfeeding pillow) will help raise your baby to a comfortable height. Plus, if you've had a cesarean, the pillow prevents baby from putting pressure on the incision site. Make sure, too, that your arms are propped up on a pillow or chair arms—trying to hold baby without support can lead to arm cramps and aches. Elevate your legs, too, if you can. Experiment to find the position that works best for you—preferably one you can hold for a long time without feeling strained or stiff.

• Quench your own thirst. Have a drink—of milk, juice, or water—by your side to replenish fluids as you feed. Avoid hot drinks, in case of spilling. And if it's been a while since your last meal, add a healthy snack to keep you energized.

There are plenty of positions you and your baby can eventually explore while breastfeeding—you may even end up inventing a few of your own. But the most important one to know is the “basic” position, the one from which most other positions take form. Here's how it goes: Position your baby on his or her side, facing your nipple. Make sure that baby's whole tiny body is facing your breasts—with his or her ear, shoulder, and hip in a straight line (your baby's face will be parallel with the breast he or she will be feeding on, and those little boy or girl parts will be parallel with the other breast). You don't want your baby's head turned to the side—instead it should be straight in line with his or her body. After all, imagine how tricky it would be for you to drink and swallow while turning your head to the side—it's the same for baby.

Lactation specialists recommend two nursing positions during the first few weeks: the crossover hold and the football (or clutch) hold. Once you're more comfortable with breastfeeding, you can add the cradle hold and the side-lying position. So get into your starting (basic) position, and try these:

• Crossover hold. Hold your baby's head with the hand opposite to the breast you'll be nursing from (if you're nursing on the right breast, hold your baby's head with your left hand). Your wrist should rest between your baby's shoulder blades, your thumb behind one ear, your other fingers behind the other ear. Using your right hand, cup your right breast, placing your thumb above your nipple and areola at the spot where your baby's nose will touch your breast. Your index finger should be at the spot where your baby's chin will touch the breast. Lightly compress your breast. This will give your breast a shape that more closely matches the shape of your baby's mouth. You are now ready to have baby latch on.

Crossover hold

• Football or clutch hold. This position is especially useful if you've had a cesarean delivery (and you want to avoid putting baby's weight on your incision site), if your breasts are large, if your baby is small or premature, or if you're nursing twins. No previous experience on the gridiron is required. Just tuck your baby under your arm like you would a football: Position your baby at your side in a semi-sitting position facing you, with baby's legs under your arm (your right arm if you are feeding on the right breast). Use pillows to bring the baby up to the level of your nipple. Support your baby's head with your right hand and cup your breast with your left hand as you would for the crossover hold.

Football or clutch hold

• Cradle hold. In this classic breastfeeding position, your baby's head rests in the bend of your elbow and your hand holds your baby's thigh or bottom. Baby's lower arm (if you're nursing from your right breast, it's baby's left arm) is tucked away, under your arm and around your waist. Cup your breast with your left hand (if nursing from the right breast) as in the crossover hold.

Cradle hold

• Side-lying position. This position is a good choice when you're nursing in the middle of the night or when you need some rest (that is, when you're able to have some—you'll always need some). Lie on your side with a pillow supporting your head. Position your baby on his or her side facing you, tummy to tummy. Make sure his or her mouth is in line with your nipple. Support your breast with your hand as in the other nursing positions. You may want to put a small pillow behind your baby's back to hold him or her close.

Side-lying position

Whichever position you choose, be sure you bring baby to the breast—not breast to the baby. Many latching-on problems occur because mom is hunched over baby, trying to shove her breast in her little one's mouth. Instead, keep your back straight and bring your baby to the breast.

A good position is a great place to start. But for breastfeeding to succeed, a proper latch—making sure that baby and breast hook up just right—is a skill you'll have to master. For some moms and newborns, it's effortless—for others, it takes practice.

• Know what a good latch looks like. A proper latch encompasses both the nipple and the areola (the dark area surrounding the nipple)—not just the nipple alone. Baby's gums need to compress the areola and the milk ducts located underneath it in order to start the flow. Sucking on just the nipple will not only leave your infant hungry (because the glands that secrete the milk won't be compressed) but will also make your nipples sore and even cracked. Be sure, too, that your baby hasn't completely missed the mark and started eagerly sucking on another part of the breast entirely (newborns, born suckers that they are, often will keep sucking even when they're not getting milk). This can cause a painful bruise on tender breast tissue—and of course, won't get baby fed or supply stimulated.