What to Expect the First Year (20 page)

“I just gave birth a few hours ago—and I'm beat and my daughter's really sleepy. Can we rest up before we try nursing? I don't even have any milk yet.”

The sooner you nurse, the sooner you'll have milk to nurse with, since milk supply depends on milk demand. But nursing early and often does more than ensure that you'll be producing milk in the coming days—it also ensures that your newborn will receive her full quota of colostrum, the ideal food for the first few days of life. This thick yellow (or sometimes clear) substance, dubbed “liquid gold” for its potent formula, is rich with antibodies and white blood cells that can defend against harmful bacteria and viruses and even, according to experts, stimulate the production of antibodies in the newborn's own immune system. Colostrum also coats the inside of baby's intestines, effectively preventing harmful bacteria from invading her immature digestive system, and protecting against allergies and digestive upset. And if that's not enough, colostrum stimulates the passing of your baby's first bowel movement (meconium;
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) and helps to eliminate bilirubin, reducing any potential jaundice in your newborn (
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).

A little colostrum goes a long way—your baby will extract only teaspoons of it. Amazingly, that's all she needs. Since colostrum is easy to digest—it's high in protein, vitamins, and minerals, and low in fat and sugar—tiny amounts will satisfy your sweetie's tender appetite while serving up the perfect appetizer for milk meals to come. Suckling on colostrum for a few days will get your baby off to the healthiest start in life while stimulating the production of the next course: transitional milk (see
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for a menu of milk stages).

So grab a short nap if you both need to—and then grab your breastfeeding buddy and get busy. There's milk to be made!

“Since my milk came in today, my breasts are swollen to three times their normal size, hard, and so painful I can barely stand it. How am I supposed to nurse this way?”

They grew and grew through 9 months of pregnancy—and just when you thought they couldn't get any bigger (at least, not without the help of a plastic surgeon), that's exactly what happens in the first postpartum week. And they hurt—a lot, so much that putting on a bra is agony, never mind latching on a hungry baby. What's worse, they're so hard and so swollen that the nipples may be flat and difficult for your baby to get a grasp on, making breastfeeding not only a major pain, but a serious challenge.

The engorgement that arrives with the first milk delivery comes on suddenly and dramatically, in a matter of a few hours. It most often occurs on the third or fourth day postpartum, though occasionally as early as the second day or as late as the seventh. Though engorgement is a sign that your breasts are beginning to fill up with milk, the pain and swelling are also a result of blood rushing to the site, ensuring that the milk factory is in full swing.

Engorgement is more uncomfortable when nursing gets off to a slow start, is typically more pronounced with first babies, and also occurs later with first
babies than with subsequent ones. Some lucky moms (usually ones who nursed before) get their milk without paying the price of engorgement, especially if they're nursing regularly from the start.

Fortunately, even the worst engorgement is temporary. It usually lasts no longer than 24 to 48 hours (occasionally it can linger up to a week), gradually diminishing as a well-coordinated milk supply-and-demand system is established.

Until then, there are some steps you can take to ease those aching breasts so your baby can get a grip on them:

• Use heat briefly to help soften the areola and encourage let-down at the beginning of a nursing session. To do this, place a washcloth dipped in warm, not hot, water on just the areola, or lean into a bowl of warm water (yeah, you'd probably want to try this only at home). Or use microwaveable warm packs designed to be slipped into your bra (these can also be chilled after feeds to relieve soreness). You can also encourage milk flow by gently massaging the breast your baby is suckling.

• Use cool after nursing—you can chill the warm/cool packs and place them in your bra for relief, or use ice packs. And though it may sound a little strange and look even stranger, chilled cabbage leaves may also prove surprisingly soothing. (Use large outer leaves, rinse and pat dry, chill, then make an opening in the center of each for your nipple, and position a leaf over each breast.)

• Wear a well-fitting nursing bra (with wide straps and no plastic lining) round the clock. Pressure against your sore and engorged breasts can be painful, however, so make sure the bra isn't too tight. And wear loose clothing that doesn't rub against your super-sensitive breasts.

• Remember the rules of engorgement: The more frequently you feed, the less engorgement you'll encounter and the faster you'll be able to nurse pain-free. The less frequently you feed, the more engorgement you'll encounter and the longer nursing will be a pain. So don't be tempted (understandable as it is) to skip or skimp on feedings because they hurt. If your baby doesn't nurse vigorously enough to relieve the engorgement in both breasts at each feeding, use a breast pump to do this yourself. But don't pump too much, just enough to relieve the engorgement. Otherwise, your breasts will produce more milk than the baby is taking, leading to an off-balance supply-and-demand system and further engorgement.

• Gently hand-express a bit of milk from each breast before each feed to ease the engorgement. This will get your milk flowing and soften the nipple so that your baby can get a better hold on it. It'll also mean less pain for you during the feed.

• Alter the position of your baby from one feeding to the next (try the football hold at one feeding, the cradle hold at the next;
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). This will ensure that all the milk ducts are being emptied and may help lessen the pain of engorgement.

• For severe pain, consider taking acetaminophen (Tylenol), ibuprofen (Advil or Motrin), or another mild pain reliever prescribed by your practitioner (ask if it should be taken just after a feeding).

“I just had my second baby. My breasts are much less engorged than with my first. Does this mean I'm going to have less milk?”

Actually, less engorgement doesn't mean less milk—it means less pain and less difficulty with breastfeeding, and that's definitely a case of less is more. And it's a case that holds true for most second-time breastfeeding moms. Maybe it's because your breasts are more experienced—having been there and done that before, they're better prepared for the incoming milk. Maybe it's because you're more experienced—you know a good latch when you see it, you're a positioning pro, and you were finessing those first feeds in no time, with less fumbling and less stress.

Even first-timers can get off easy in the engorgement department—often because they've gotten off to a good and early start on breastfeeding (not because they're short on milk supply). Very rarely, a lack of engorgement—combined with a lack of let-down—is related to inadequate milk production, but only in first-time moms. But there's no reason to worry that a milk supply might not be up to par unless a baby isn't thriving (
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).

“Every time I start to feed my baby, I feel a strange pins-and-needles sensation in my breasts as my milk starts to come out. It's almost painful—is it normal?”

The feeling you're describing is what's known in the breastfeeding business as “let-down.” Not only is it normal, it's also a necessary part of the nursing process—a signal that milk is being released from the ducts that produce it. Let-down can be experienced as a tingling sensation, as pins and needles (sometimes uncomfortably sharp ones), and often as a full or warm feeling. It's usually more intense in the early months of breastfeeding (and at the beginning of a feeding, though several let-downs may occur each time you nurse) and may be somewhat less noticeable as your baby gets older. Let-down can also occur in one breast when your baby is suckling on the other, in anticipation of feeding, and at times when feeding's not even on the schedule (
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).

Let-down may take as long as a few minutes (from first suckle to first drip) in the early weeks of breastfeeding, but only a few seconds once breast and baby have worked out their kinks. Later, as milk production decreases (when you introduce solids or if you supplement with formula, for instance), let-down may once again take longer.

Stress, anxiety, fatigue, illness, or distraction can inhibit the let-down reflex, as can large amounts of alcohol. So if you're finding your let-down reflex isn't optimal or is taking a long time to get going, try doing some relaxation techniques before putting baby to breast, choosing a quiet locale for feeding sessions, and limiting yourself to only a single occasional alcoholic drink. Gently stroking your breast before nursing may also stimulate the flow. But don't worry about your let-down. True let-down problems are extremely rare.

A deep, shooting pain in your breasts right after a nursing session is a sign that they're starting to fill up with milk once again—generally those post-feeding pains don't continue past the first few weeks.

“Even though I'm not engorged anymore, I have so much milk that my baby chokes every time she nurses. Could I have too much?”

Sure, it may seem like you have enough milk right now to feed the entire neighborhood—or at least a small daycare center—but soon, you'll have just the right amount to feed one hungry baby: yours.

Like you, many moms find there's too much of a good thing in the first few weeks of nursing. Often so much that their babies have a hard time keeping up with the overflow—gasping, sputtering, and choking as they attempt to swallow all that's gushing out. That overflow can also cause leaking and spraying, which can be uncomfortable and embarrassing (especially when the floodgates happen to open up in public).

It may be that you're producing more milk than the baby needs right now, or it may be that you're just letting it down faster than your still fledgling feeder can drink it. Either way, your supply and delivery system are likely to work out the kinks gradually over the next month or so, becoming more in sync with your baby's demand—at which point overflowing will taper off. Until then, keep a towel handy for drying the spilled milk off of you and baby during feedings, and try these techniques for slowing the flow:

• If your baby gulps frantically and gasps just after you have let-down, try taking her off the breast for a moment as the milk rushes out. Once the flood slows to a steady stream she can handle, put baby back to the breast.

• Nurse from only one breast at a feeding. This way, your breast will be drained more completely and your baby will be inundated with the heavy downpour of milk only once in a feeding, instead of twice.

• Gently apply pressure to the areola while nursing to help stem the flow of milk during let-down.

• Reposition your baby slightly so that she sits up more. She may let the overflow trickle out of her mouth as she feeds (messy, yes, but what isn't these days?).

• Try nursing against gravity by sitting back slightly or even nursing while lying on your back with your baby on top of your chest.

• Pump before each feeding just until the initial heavy flow has slowed.
Then you can put your baby to breast knowing she won't be flooded.

• Don't be tempted to decrease your fluid intake. Drinking less won't decrease your milk supply (any more than increasing fluid intake will increase production).