Carry on nursing: breastfeeding longer

Strategies to help you breastfeed for a full six months and beyond

Arie Brentnall-Compton‘s eight-month-old son, Rhett, has beaten the odds. He was exclusively breastfed for more than six months, and so was his big brother, Luke. And Brentnall-Compton didn’t add solid foods to their diet until they were past the six-month mark.

What kept her going? “I’d done a lot of research on my own, and that convinced me that six months was the earliest that babies might need solids,” she explains. “Also, Luke was a huge baby — he weighed 23 pounds eight ounces at his six-month weigh-in. I figured if he’d done that well on just my milk, there was no rush to start on solids. Just looking at him gave me confidence!”

Canadian Paediatric Society (CPS) guidelines for infant feeding issued in early 2005 say that Rhett’s getting the best possible nutrition. These current guidelines recommend exclusive breastfeeding for six months, then adding solid foods and continuing to breastfeed for two years or beyond.

Rhett, however, is in the minority. Statistics Canada numbers show that, even though about 86 percent of mothers start out breastfeeding, the majority of babies are weaned by four months.

Any breastfeeding is good, acknowledges lactation consultant and author Linda J. Smith, but research shows when babies are fed according to the CPS guidelines they are healthier in the short and long term — with fewer infections, lower rates of allergies and less obesity, for example. So how can new mothers beat the odds and achieve these breastfeeding goals? Here are some tips from Smith.
Flexible feedings
Sometimes new mothers who were comfortable with baby-led feedings in the beginning feel that by two or three months the baby should be on a schedule. But scheduling feedings or trying to stretch out the time between feedings can lead to milk supply issues with older babies — who are still growing rapidly. Of course, older babies don’t need to nurse as often as newborns, and many are becoming fairly predictable about when they want to eat. It may not be as simple as “every three hours” though; some babies nurse less often during the morning and afternoon, but more often in the evening, or have another individual pattern.

Smith adds that parents should also be prepared for when the baby who is usually quite regular in his feedings has some “frequency days,” wanting to nurse more often. “Research has shown that the way the baby increases the milk supply, and adjusts the amount of fat in the milk to meet his needs, is by adjusting the frequency of feedings.”

Lactation consultant Maureen Fjeld, of Calgary, Alta., says, “It’s often easier if you think about nurturing or mothering the baby at the breast, rather than about feeding. You don’t have to interrupt what you’re doing or go sit in a special chair to nurse the baby — you just quickly put the baby to the breast and continue on, and don’t worry about how long it will be until he nurses again.”

Night nursing
In addition, new studies have shown that women have varying milk storage capacities in their breasts (and breast size doesn’t necessarily correlate with storage), so some mothers need to feed their babies more often than others.

That may include feeding during the night, Smith adds. “Prolactin levels tend to be higher during night feedings too, and prolactin is a hormone which encourages milk production, so trying to eliminate those night feedings too soon can lead to early weaning.”

The myth that adding solids will help baby sleep longer and more soundly at night has also been convincingly proven not to be true.

So how can you survive six (or more) months of interrupted sleep? Smith recommends bringing the baby into bed with you or keeping her right beside your bed, so that you can nurse lying down and without completely waking up. As babies get older, they are often more agreeable about being entertained by dad for a couple of hours in the morning or on weekends so mom can get more sleep. If you can manage an afternoon nap with the baby too, that may make it easier to cope with the nighttime nursing.

Diminishing distractions
In the early weeks, babies tend to be totally focused on breastfeeding. By around four or five months, though, your baby is often easily distracted by anything else that’s going on — and this can make breastfeeding difficult as the baby lets go every time she hears a noise or notices someone walking by.

“You may need to mute the TV while your baby nurses,” says Smith. “Some babies will nurse a bit longer if they are in a sling or covered with a blanket, to screen out some of the distractions. It can take some experimenting to figure out what will help your baby.”
Troublesome teeth
As babies approach the six-month mark, many are getting their first teeth, and that can lead to new breastfeeding challenges. The teething baby may fuss at the breast because his gums are sore, or may bite down towards the end of a feeding to relieve the pain.

Giving your baby a chilled teething ring to chomp down on may help with the discomfort; you can also ask your doctor about pain-relieving medications. If the baby does bite you while breastfeeding, pull him in close or (gently) cover his nostrils with your finger so that he has to open his mouth and release the breast to breathe. (This works better than pulling back, which often causes the baby to clamp down harder.)

Milk supply concerns
“Mothers often worry that they don’t have enough milk as their babies grow bigger,” says Fjeld. “They notice that their breasts are softer than in the early weeks and that they don’t get that ‘full’ feeling that they used to. But that’s normal.”

As you continue breastfeeding, your breasts get more efficient. The milk doesn’t let down until the baby begins nursing, and you are less likely to experience leaking. Sometimes, this leads to a baby who acts frustrated at the breast. He may pull on and off a few times as he waits for the milk to “let down,” and you may think that this signifies he’s not getting enough milk, when all it really means is that he’s a bit impatient.

While babies usually gain six or more ounces a week in the early months, by three or four months the rate of weight gain slows down. This is normal.
Working without weaning
Not everyone is lucky enough to have a paid parental leave. A big barrier to continued exclusive breastfeeding for many women is either needing to return to work or school, or simply wanting to spend some time away from the baby.

Smith encourages mothers to look for ways to get out, visit with friends, even do some work while bringing baby along. While that’s often possible, it isn’t always.

For a short outing without baby, you may be able to plan for a time when your baby is typically content without nursing for a couple of hours. For longer or more frequent separations, it’s worth investing in a good pump or learning the technique of hand expression so you can provide your baby with breastmilk even when you’re apart. Karen Campbell, a nurse in Guelph, Ont., who returned to work when her son Harry was four months old, began building up a supply of frozen milk in the weeks before she needed to go back.

“But I kept that mostly for back-up,” Campbell explains, “because freezing kills some of the important protective antibodies in the milk. I pumped every day in the morning, on my lunch break and at the end of my shift, so he usually had enough fresh milk in the fridge to get him through the next day.”

Continued breastfeeding means a healthier baby and, therefore, less missed work for parents. Fjeld points out that the baby’s digestive system is his first line of defence against infection, and that breastmilk coats the lining of the gut to prevent bacteria and viruses from invading the baby’s body. Your milk also contains antibodies to any illnesses you have been exposed to.
Family feuds
“I think that most people have gotten the message that breastfeeding is good for babies,” says Fjeld. “But many don’t know how valuable and important it is to continue breastfeeding for six months and beyond. So mothers get comments from the grandparents and others like ‘Are you still nursing that baby?’ or ‘He’ll starve if you don’t give him some cereal.’”

She points out that a generation ago, parents were advised to start solids by six weeks, not six months, and many were told that formula and breastfeeding were equivalent. “They are, understandably, not familiar with the new research and are just going by what they were told 30 or 40 years ago,” she says. “Often if you can share with them our new understanding of the importance of continued breastfeeding, they realize that you are just trying to do the best for your baby’s health.”

Fjeld adds that this is one reason she encourages mothers to attend breastfeeding support groups like La Leche League. “If you hang out with other breastfeeding moms, you get the encouragement you need to keep going and the tips and ideas to get past some of the challenges,” she says.

A mother’s gift
Six months of “nothing but the breast,” says Smith, “is a precious opportunity to give your baby an amazing gift — to create a foundation of health for his entire life.”

“You can have a life and still exclusively breastfeed your baby,” says Fjeld. “I think it helps to talk to other mothers and find out how they did it, how they incorporate breastfeeding into their busy lives. Often, it’s easier than you think.”