Lauren Moses-Brettler had a really rough start nursing her first baby, Holden, who wouldn’t latch for almost a week after he was born. “It was the most stressful experience of my entire life,” she recalls. “I wasn’t sleeping, which was the biggest shock to the system ever, and I was losing my mind trying to pump every few hours.” Meanwhile, her partner, Damian, was finger-feeding Holden with a tube taped to his finger.
It turned out that he had a significant tongue tie, which was missed both in the maternity ward and at the breastfeeding clinic. It was caught by a private lactation consultant who came to her home. “She was like our angel; our lifesaver,” she says.
They got the tie released, but by that point, her supply had been affected because Holden hadn’t been effectively nursing in those crucial early days after birth, so her body had gotten the message that it didn’t need to make much milk. The answer for her was the drug domperidone, which brought her supply up so she was able to nurse him, which she did for close to three years.
But she never forgot the stress of worrying about her supply. So, when she was pregnant with her second child, Dorian, she and her midwife came up with a plan to encourage and protect her ability to make milk: Keep him on the breast as much as possible in those early days. To her relief, Dorian latched on right after he was born. “He was that textbook baby that basically sort of crawled himself up my chest, and latched immediately after birth,” she says. But even still she heeded her midwife’s advice. “I was super-cautious about always putting him on the boob, but also about not giving him a pacifier for a while, and definitely no bottles. And the first eight weeks he was always on my boob. I didn’t have any supply issues.”
This good news story is what every second-time parent wants—especially if breastfeeding was challenging the first time around. But each parent and child has a unique experience when it comes to nursing, so there are no guarantees. It’s something you have to learn to do—together.
You can prepare all you want—have read all the books—but whether a newborn is able to nurse successfully can be affected by a number of different factors on the baby side, says international board–certified lactation consultant Dallas Parsons. “They’re born with instincts that drive them to breastfeed, but sometimes those instincts can be a bit suppressed from delivery, from what’s happened after the birth, like if they’ve been separated, or, if they’ve got some muscle tensions or a tongue tie or something that could be getting in the way,” she explains.
For instance, a long labour, or even a really quick one, can sometimes tire a baby out so that they’re too sleepy to latch well at first. Opiates like morphine and Demerol, which may be given to the parent during labour, can affect the baby this way, too. And if there have been interventions, like forceps or vacuum delivery, the baby may have bruising or muscle soreness that impacts her ability to nurse because certain positions are painful. Signs of this can include the fact that she may be fine latching on one side, but pulls away or arches and resists on the other, says Parsons. Or, she may have a very shallow latch because she has a tight jaw that isn’t opening wide enough. (A lactation consultant is trained to identify these issues, and can offer solutions for managing them.)
A couple of other physical factors that can affect nursing can include torticollis, which is when a baby’s neck has shortened muscles on one side, and cleft palate.
And what a nursing relationship is like can also be driven by the baby in non-medical ways, says Trevor MacDonald a La Leche League leader based near Winnipeg. “Sometimes they’ll have positions that they’ll prefer over others,” he explains. Some may just have a different preference for routines. “Dorian was way more attached to nursing than Holden ever was … there could be a million reasons why,” says Moses-Brettler. “Holden was my first, and also because I was on the domperidone, he would nurse and get a lot and come off full, and go two to three hours between. He put himself on a schedule. Whereas Dorian, because I always put him on, he was always nursing.”
On the parent side, there are a number of issues that could affect milk supply, such as previous breast or chest surgery, an endocrine or untreated thyroid condition, or more rarely, insufficient glandular tissue, which means you don’t have enough glandular tissue in your breasts to make enough milk to exclusively breastfeed. But the most common cause of low milk supply is a baby that isn’t nursing effectively (therefore not removing enough milk from the breasts) or frequently enough in those early days to establish a solid supply.
The heartening news is that if you’ve nursed before, even for a short time, your body is likely set up to give you a head start. “Whatever breastfeeding you’ve done, even if it wasn’t exclusively, or if it was for a very short time, that ductal work, that glandular tissue, has started that development process, so it’s easier to get it going again,” says Parsons. “I've met lots of moms who had challenges breastfeeding the first time, didn’t have enough milk, and then second baby comes along and they’ve got tons of milk, way more than they ever experienced with their first.”
You also have the benefit of a bit more knowledge, she notes, which will give you a more informed perspective on what’s happening in terms of nursing. But that doesn’t mean there won’t be a learning curve in terms of what it’s like to nurse a newborn (how quickly we forget!), even if you got the hang of nursing with your first.
If you had a tough time nursing your first, Parsons says her No. 1 recommendation is to meet with a compassionate lactation consultant toward the end of your pregnancy to talk about what happened before, what you would have liked to have seen go differently, and come up with a plan to follow if things start to slide this time, too. “What a good lactation consultant will do is get a history and find out if there maybe something physically, that affected nursing,” says Parsons. Connecting with a lactation consultant before the baby arrives will also give you one less thing to worry about if nursing issues pop up this time, too. Parsons says she gets her clients to have their partner text her when they go into labour so she knows that she may be needed soon.
It can be especially important to connect with support ahead of time if you belong to a marginalized community, notes MacDonald, a transgender man who nursed both of his kids. “It can be quite challenging sometimes for LGBTI-identified parents to find a local group that is welcoming or a lactation consultant that is welcoming and knowledgeable in that area, so it’s even more important to do some of that research ahead of time.” MacDonald, who founded a Facebook group called Birthing and Breast or Chestfeeding Trans People and Allies that offers conception, birth and chestfeeding support for transgender and genderfluid/gender neutral people, says that one area folks can find this kind of information and support is online.
Parsons’ second piece of advice is to make sure you have people around to help take care of your other child, or children, after the baby arrives, whether that means your partner takes extended time off of work, you hire a postpartum doula, or a family member stays with you, so that you can focus on getting nursing going well.
Anyone who has had breastfeeding challenges knows how hard it can be on the parent. You may feel guilty, sad or angry about what happened before, and anxious about trying to nurse again. If that’s the case for you, it’s especially important to choose an experienced lactation consultant who can validate your concerns and give you recommendations, says Parsons.
MacDonald says it can be helpful to frame successful breastfeeding in a way that won’t leave you deflated if it doesn’t work out. “I think about Diana West’s book, and particularly the title of it, which I love so much, Defining Your Own Success: Breastfeeding after Breast Reduction Surgery,” he says. “The general message is that any amount of human milk that your baby gets is significant and beneficial, and to be proud of that. It doesn’t have to be an all-or-nothing type of feeling.”
There is one thing that Parsons says you can do right after your baby is born that will go a long way toward getting nursing off to a great start. “The crucial piece of breastfeeding that all lactation consultants would agree on is continuous uninterrupted skin-to-skin contact as often as possible after birth,” she says. “Allowing mom and baby to be together, so baby can be in that natural habitat on mom’s chest near her breasts where the baby is going hear mom’s heartbeat, smell her, and be more likely to attach and have a good latch and get breastfeeding going well.”
One other way to avoid trouble is to keep a close eye on signs nursing is going well, which can be so hard to miss when your attention is divided between the newest member of your family and your other kids. “Having those ticky boxes of ‘OK, the weight gain’s good, the poops and pees, we’re getting those, and the baby seems satisfied but not lethargic,’ those are signs that things are on track,” says Parsons. Though even experienced nursing parents can miss more subtle clues that all is not well, especially if their baby continues to gain weight. I breastfed my eldest for close to four years, but didn’t notice that my youngest had a tongue tie and was not nursing well (thank goodness my doula pointed it out when she visited us at six weeks postpartum; she likely saved our nursing relationship).
It’s also important to listen to your gut and your body, no matter what the experts say, so you can get the help you need. “If a parent successfully nursed a first baby, and things just don’t feel right with the second baby, or if they’re in pain while nursing, even if a lactation consultant or lactation helper of some kind says the latch looks great, if they’re in pain and it’s not getting any better, the latch isn't great. Something is wrong,” says MacDonald.
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