What to Expect the First Year (42 page)

Solution:
Make sure your baby finishes one breast (10 to 15 minutes minimum should do the trick sufficiently) before you offer the second. That way she'll be able to quench her thirst with foremilk but still cash in on the calories in the hindmilk. Let her nurse for as long (or as little) as she likes on the second breast, and remember to alternate the starting breast at each feeding.

Possible problem:
Your baby is considered a sluggish or ineffective suckler (called a “lazy” suckler by the experts). This may be because she was preterm, is ill, or has abnormal mouth development (such as a
cleft palate
or
tongue or lip tie
). The less effective the suckling, the less milk is produced, setting baby up for failure to thrive.

Solution:
Until she's a strong suckler, she will need help stimulating your breasts to provide adequate milk. This can be done with a breast pump, which you can use to empty the breasts after each feeding (save any milk you collect for future use in bottles). Until milk production is up to snuff, your doctor will very likely recommend supplemental bottle-feedings of formula (given after breastfeeding sessions) or the use of a supplemental system, or SNS (see
box
). The SNS has the advantage of simultaneously stimulating your production while supplementing your baby's supply.

If your baby tires easily while feeding, you may be advised to nurse for only a short time at each breast (be sure to pump the rest later to empty the breast of the hindmilk and to keep up your milk supply), then follow with a supplement of expressed milk (which will contain the all-important and calorie-rich hindmilk) or formula given by bottle or the supplemental nutrition system, both of which require less effort by the baby.

Possible problem:
Your baby hasn't yet learned how to coordinate her jaw muscles for suckling.

Solution:
A baby who hasn't quite yet mastered the art of the suckle will also need help from a breast pump to stimulate her mama's breasts to begin producing larger quantities of milk. In addition, she will need lessons in improving her suckling technique—the doctor may recommend you get hands-on help from an LC and possibly even a pediatric occupational or speech therapist. While your baby is boning up on her technique, she may need supplemental feedings (
click here
). For further suggestions on improving suckling technique, contact your local La Leche League.

Possible problem:
Your nipples are sore or you have a breast infection. Not only can the pain interfere with your desire to nurse, reducing nursing frequency and milk production, but it can actually inhibit milk let-down—especially if you're tensing up.

Solution:
Take steps to heal
sore nipples
or cure
mastitis
.

Possible problem:
Your nipples are flat or inverted. It's sometimes difficult for a baby to get a firm hold on such nipples. This situation sets up the negative cycle of not enough suckling, leading to not enough milk, to even less suckling, and less milk.

Solution:
Help baby get a better grip during nursing by taking the outer part
of the areola between your thumb and forefinger and compressing the entire area for him to suckle on. Use breast shells between feedings to make your nipples easier to draw out.

Possible problem:
Some other factor is interfering with milk let-down. Letdown is a physical function that can be inhibited as well as stimulated by your state of mind. If you're stressed out about breastfeeding (or in general), not only can let-down be stifled, but the volume and calorie count of your milk can be diminished.

Solution:
Try to de-stress before and during feeds by playing soft music, dimming the lights, using relaxation techniques, or meditating. Massaging your breasts or applying warm soaks also encourages let-down, as does opening your shirt and cuddling baby skin-to-skin during feeds.

Possible problem:
Baby's become frustrated at the breast—due to problems on her side or yours. The frustration leads to fussing, which leads to tension for you, which leads to more frustration and fussing for baby, and a cycle begins, sometimes sabotaging breastfeeding.

Solution:
Seek the hands-on help of a lactation consultant, if possible, to get any latching, positioning, or other problems resolved so both you and baby can stay calm and on task. Try to relax yourself and your baby as much as possible before feeds (see previous
tip
)—and always begin feeds before your baby starts showing hunger cues (and is more likely to become frantic at the breast).

Possible problem:
Your baby is getting her sucking satisfaction from a pacifier. Babies are born to suck, but too much sucking on a nonnutritive pacifier can sabotage your baby's interest in breastfeeding.

Solution:
Save the pacifier for only when baby sleeps (or put it aside for now)—instead, breastfeed baby when she seems to want to suck.

Possible problem:
Your baby's appetite is dampened by supplementary water.

Solution:
Giving your breastfed baby a supplementary bottle of water is a no-no before 6 months, since it not only supplies nonnutritive sucking but can also decrease her appetite and, in excess, dangerously dilute blood sodium levels.
Click here
for more on supplementary water.

Possible problem:
You're not burping baby between breasts. A baby who's swallowed air can stop eating before she's had enough because she feels uncomfortably full.

Solution:
Bringing up the air will give her room for more milk. Be sure to burp baby between breasts (or even mid-breast if she's a slow feeder) whether she seems to need it or not—more often if she fusses a lot while nursing.

Possible problem:
Your baby is sleeping through the night. An uninterrupted night's sleep is great for you, but not necessarily for your milk supply. If baby is going 7 or 8 hours a night without nursing, your milk may be diminishing, and supplementation may eventually be needed.

Solution:
To make sure this doesn't happen, you will have to wake your little sleepyhead (and yourself) at least once in the middle of the night. She shouldn't be going longer than 4 hours at night without a feeding during the first month.

Possible problem:
You're stomach sleeping. Yes, you earned it after so many months of side sleeping. But when you sleep on your tummy, you also sleep on your breasts—and all that pressure on your breasts can cut down on milk production.

Solution:
Turn over, at least partway, to take the pressure off those mammary glands.

Possible problem:
You've returned to work. Returning to work—and going 8 to 10 hours without breastfeeding or pumping during the day—will definitely decrease milk supply.

Solution:
One way to prevent this is to express milk at work at least once every 4 hours you're away from baby (even if you're not using the milk for feeding).

Possible problem:
You're doing too much too soon. Producing breast milk requires a lot of energy. If you're expending yours in too many other ways and not getting enough rest, your breast milk supply may diminish.

Solution:
Try a day of almost complete bed rest, followed by 3 or 4 days of taking it easy, and see if your baby isn't more satisfied (hey, you'll feel better, too).

Possible problem:
There are bits of placenta left in your uterus. Your body won't accept the fact that you've actually delivered until all the products of pregnancy have left the building—and that includes the entire placenta. If fragments remain, your body may not produce adequate levels of prolactin, the hormone that stimulates milk production.

Solution:
If you have any abnormal bleeding or other signs of retained placental fragments, contact your practitioner at once. A dilatation and curettage (D&C) could put you and your baby on the right track to successful breastfeeding while avoiding the danger a retained placenta can pose to your own health.

Possible problem:
Your hormones are out of whack. In some women, prolactin levels are too low to produce adequate amounts of milk. Other women have thyroid hormone levels that are off, causing a low milk output. And in still others, insulin deregulation can be the cause of a low milk supply.

Solution:
Speak to your doctor or endocrinologist. Tests can determine the problem, and medications and other treatments can get you back up and regulated, hopefully getting your milk production back up and running, though the process will likely take time, and supplementation with formula may be necessary at least in the short term.

Once in a while, even with the best efforts, under the best conditions, and with the best support and professional advice, it turns out a mom can't provide all the milk her baby needs. A small percentage of women are simply unable to breastfeed exclusively, and a small few can't breastfeed at all. The reason may be physical, such as a prolactin deficiency, insufficient mammary glandular tissue, markedly asymmetrical breasts, or damage to the nerves going to the nipple caused by breast surgery (more likely to be the case if you've had a reduction than an augmentation). Or it could be due to excessive stress, which can inhibit let-down. Or, occasionally, it may not be pinpointed at all.

If your baby isn't thriving, and unless the problem appears to be one that can be cleared up in just a few days, her doctor is almost certain to prescribe supplemental formula feedings (
click here
)—possibly with a formula designed for supplementation. Not to stress. What's most important is adequately nourishing your baby, not whether you give breast or bottle. In most cases when supplementing, you can have the benefits of the direct parent-baby contact that nursing affords by letting baby suckle at your breast for pleasure (hers and yours) after she's finished her bottle, or by using a supplemental nursing system. Often, a baby can return to exclusive breastfeeding (or the combo;
click here
) after a period of supplementation—a goal that's definitely worth trying for.

Once a baby who is not doing well on the breast is put on formula temporarily, she almost invariably thrives. In the rare instance that she doesn't, a return trip to the doctor is necessary to see what is interfering with adequate weight gain.