Breastfeeding blues

Julie Kristof just assumed she’d breastfeed her second child. After all, she’d nursed her first baby, Alex, from the moment he was born until he was 14 months old. But when Miriam was born, she made some attempts to latch on, but didn’t suck.

“This absolutely broke my heart,” says the Montreal mom. Once released from the hospital, Kristof and her husband, Murray, spent the next 24 hours trying to persuade Miriam to nurse, but “it was a nightmare of screaming and frustration.” Breastfeeding wasn’t working out.

Kristof is like a lot of Canadian mothers: 85 percent of moms start out breastfeeding. But that number quickly starts to dwindle — by six months, only 17 percent of moms are breastfeeding exclusively.

What goes wrong? Any number of things. Perhaps the baby can’t or won’t latch on well, or mom’s milk production isn’t keeping up with her baby’s needs, or other responsibilities make it challenging for the mother to be “on call” for her hungry baby. Whatever the cause, the Canadian Paediatric Society’s stated goal of “exclusive breastfeeding to six months, and continued breastfeeding with added solids for two years and beyond” seems increasingly elusive.

So let’s say you’ve read the books, talked to the lactation consultant at the hospital, received some help from the public health nurse — and breastfeeding is still a problem and you’re feeling frustrated and upset about the whole thing. Hang on — it’s not over yet. There are still possible solutions.

The baby who can't nurse

Some babies will simply refuse to latch on at all. Some will latch, but can’t suck effectively (perhaps because of a cleft palate or a tongue-tie). In Kristof’s case, Miriam was not only unable to breastfeed, she couldn’t suck effectively on a bottle either, and a feeding tube needed to be inserted through her nose to her stomach (no cause for this has yet been found). Or the baby may latch, but it’s so painful for the mother that she can’t continue. Breastfeeding seems impossible.

Strategy 1: Express yourself! If your baby can’t take your milk directly, consider expressing your milk for him. Kristof began pumping soon after her daughter was born, and Miriam was fed her mother’s milk for the first five months of her life. Pumping your milk is time-consuming, and because a pump is less efficient than a baby who’s nursing well, mothers sometimes find their milk supply gradually decreases. More frequent pumping or taking herbal supplements, such as fenugreek and blessed thistle, or the prescription medication domperidone, may help boost milk production.

Strategy 2: Latching later Often the baby who won’t latch at first will catch on later — sometimes much later. Lactation consultant Linda Romphf of Winnipeg says: “Skin-to-skin contact can work miracles in these situations. I tell mothers not to worry about the baby latching or not. Just enjoy your baby and aim to have skin-to-skin cuddle times five or six times a day. If you keep your milk supply up, the baby will eventually catch on.” Or try to have a nightly bath with your baby if time is tight. Six to eight weeks is a common time for the non-latching baby to begin feeding at the breast, but some babies may take longer.

How much longer? Wendy Burpee adopted her son, Oliver, from Korea when he was seven months old. “He’d been bottle-fed since birth,” she says. “I had started building a milk supply when we first decided to adopt, but because of delays, I let it decrease. When we finally got Oliver home, I began holding him skin to skin, then trying to latch him on using a nipple shield and feeding tube.” At first, it was awkward, and she soon discarded the nipple shield. With help from a lactation consultant, and lots of persistence on Burpee’s part, Oliver eventually began breastfeeding — and is still nursing now at 15 months.

“I think it is reassuring to mothers who are having trouble getting their babies to nurse to hear that story,” Burpee adds. “If Oliver can learn to breastfeed after having only bottles for seven months, then the chances are good their baby can learn too.”

Not enough milk

Sometimes mothers feel that if they aren’t producing enough milk to breastfeed exclusively, then they might as well wean. “Concern about milk supply is one of the most common problems mothers seek help with,” says Romphf.

Strategy: Supplemented breastfeeding Romphf reminds mothers that the benefits are dose related: “The more human milk the baby gets, the healthier he or she will be. Even if you need to partially formula-feed, it’s worth it to keep breastfeeding as well.”

The tricky part can be persuading the baby to continue breastfeeding since this takes more work than getting milk from a fast-flowing bottle. Diana West, a lactation consultant in New Jersey and co-author of The Breastfeeding Mother’s Guide to Making More Milk, suggests giving your baby a little formula first, then the breast. Why? A baby who is less hungry may be more willing to work at breastfeeding. Romphf adds that with this approach, because the baby is more relaxed, “you get all the lovely parts of breastfeeding — the baby touching the mother’s hair and falling asleep at the breast.”

Robyn Berman, a Halifax doula who runs a breastfeeding support group, says she sees many mothers who struggle with supplementing. “One mother told me that every time she looked at the bottle of formula, she just felt horrified. But if you need to supplement, then it’s not a bad thing.”

Unhappy at the breast

Your baby latches on for a moment, then cries and pulls away as milk sprays her face. She squirms and fusses through every feeding. Or perhaps — even though your baby is gaining weight — he nurses for a few minutes, falls asleep, then wakes up 20 minutes later screaming with hunger again. Maybe he’s gassy and obviously uncomfortable — and when you give him a bottle of formula, he finally sleeps for hours.

Strategy 1: Detective work “While most babies are fine no matter what Mom eats, some are sensitive to foods or drinks in the mother’s diet,” says Peterborough, Ont., lactation consultant Melisande Neal. “Dairy is a frequent offender, but it can take two to three weeks of no dairy at all to really be able to see the difference.” Other common sensitivities: wheat, caffeine, soy and citrus fruits.

Strategy 2: Block feeding See milk spraying out, a fussy, gulping baby and gassiness? Think oversupply. The treatment? Feed your baby, then pump or hand-express until your breasts seem “empty” (they’re never really empty). Then start “block feedings.” For example, each time the baby wants to nurse over the next four hours, offer just the left side. Then, for the four hours after that, offer just the right side. This strategy will often “reset” the milk supply to a more manageable level.

Bottle-feeding like a breastfeeding mom

If you do wean to a bottle, approach it like breastfeeding. Lactation consultants Linda Romphf and Diana West suggest:

• Hold your baby for every feeding, positioned so he can see your face.

• Whenever possible, have skin-to-skin contact with your baby at feeding times.

• Change sides partway through the feeding, to help your baby’s visual development — you want him to look up at you from both perspectives.

• Hold your baby in a semi-sitting position and keep the bottle horizontal so your baby has to actively suck the milk out. If he pauses or seems to be trying to turn away, remove the nipple from his mouth and then offer it by touching his bottom lip. If he doesn’t open his mouth and try to take the nipple, stop feeding him — perhaps try a burp or diaper change — and then offer it again.

• Don’t encourage your baby to take the last half-ounce or so from the bottle. Let him stop when he’s ready.

Bidding breastfeeding goodbye

Perhaps despite all your hard work, breastfeeding just hasn’t worked. For some mothers, that doesn’t feel like a big deal. They buy some bottles and formula, and move on. For others, the emotions are intense. “I remember one mother who felt the loss of the breastfeeding relationship was like a death,” says Halifax doula Robyn Berman.

Guilt can be an issue too, adds Berman. “Sometimes mothers feel guilty about not trying to keep going longer; sometimes they feel guilty that they didn’t start supplementing earlier and their baby was hungry.”

Julie Kristof, whose second baby, Miriam, couldn’t breastfeed, comments that she didn’t feel guilty because she knew she had tried everything. All the same, the emotional impact was huge. “It was a lot like mourning. I was very sad and angry, and sometimes I was incredibly resentful of Miriam, which was totally unfair — she simply is not able to do it.”

Some of those feelings are eased for Kristof by the loving relationship she has forged with her daughter. “Now that she is 14 months old, everyone will tell you that she is a mama’s girl. No one else can soothe her the way I can, and no one else’s voice calms her the way mine does. Just the normal bathing, singing, cuddling and spending lots of time together has built a very strong bond.”

And in the end, that’s what it’s all about. As lactation consultant Diana West says: “Think about how much your baby is growing to love you and how much you are growing to love him. Many kinds of milk can nurture the body, but only your love can nurture his soul.”