1. Be prepared
Plan ahead while you are pregnant to free up some time once your baby is born. If your baby nurses 10 times a day, and each feeding takes roughly half-an-hour, that’s five hours a day – and you haven’t even changed diapers, gotten up any burps, or had a shower. It will get easier and less time-consuming, but first you have to get through these early days. If you can stock your freezer with easy meals, or arrange to have dinner delivered, or bring someone in to do housework (even if it’s your Mom), you’ll be able to focus on getting breastfeeding well established.
2. Consider possible challenges
Find out about any issues you may have. For example, have you had breast surgery of any kind? That doesn’t mean breastfeeding is out of the question, but it may be helpful for you to talk to a lactation consultant or other experts to be prepared for any difficulties. Do you have inverted nipples (ones that sink down into the breast rather than poking up)? Again, breastfeeding usually works just fine with this less-common type of nipple, but consulting in advance can be helpful. If you take any medications, find out now if they are compatible with breastfeeding (most are) and discuss alternatives with your doctor.
3. Get advice
If there’s a La Leche League Group (LLL) in your community, go to a meeting – or a full series of four, if possible – while you’re still pregnant. Learning from other mothers who have “been there” is a great way to get practical advice that works in the real world. As new mom Christina McCarthy says, “My midwife told me to go to an LLL meeting before I had my baby. This way, if I did run into any issues, I would feel more comfortable asking for help from people I’d already met. I was glad I went – it was the first time I had ever seen anyone nurse a baby up close. Being there showed me that nursing didn’t have to be a big production. I watched in amazement as women casually breastfed their babies. It was very reassuring because I’d heard horror stories about how hard nursing was.”
4. If possible, let baby pick his birth day
Breastfeeding is a fairly complex skill for a newborn, and the baby who arrives a little early – even a week or two – may have difficulty figuring out how to coordinate latching on, sucking and breathing. Most of them get it eventually, but being induced before baby is ready can make getting started harder.
5. Be aware of the impact of interventions
Pain-relieving medications, such as epidurals, and other interventions in labour and birth can all make breastfeeding a little more challenging. A 2009 study in Sweden found that significantly fewer babies of mothers who had epidurals during labour were able to breastfeed during the first four hours after birth, and significantly fewer were fully breastfed at discharge from the hospital. And as for IVs, those extra fluids added to your system have to go somewhere, and once your baby is born some will end up in your breasts. It’s tough for a little baby to latch on to breasts that are painfully swollen with these fluids, as well as milk.
There are times, of course, when inductions, IVs and anaesthetics in labour or even a Caesarean section are essential, and many mothers do breastfeed successfully after these interventions. Don’t hesitate to ask for extra help. You may need to hand-express milk for the first few days (until your milk comes in and any engorgement has gone away – at that point, a pump may work) until your baby is able to latch and nurse effectively. If you’ve had a C-section, ask for help to find a comfortable position for feeding the baby, perhaps using a pillow to protect your incision. Be patient with your baby and with yourself!
6. Ask for anti-fungal
If you need antibiotics during labour (or afterward), ask about taking an anti-fungal medication as well. Antibiotics increase your risk of developing thrush, an overgrowth of a yeast organism that is normally on your body that can cause sore nipples for you and a sore mouth for your baby.
7. Allow baby to self-latch
Allow your baby to self-attach at the breast. Babies, as it turns out, know a lot more about breastfeeding that we used to think. Given the opportunity, your newborn can move to your breast and latch on effectively. These instincts are strong right from birth and seem to last for at least four to six weeks. Here’s how to do it: Lie on your back, or get comfortable in a semi-reclining position or sit upright, supporting the baby’s shoulders and bottom as he lies vertically (head toward your head) on your chest or abdomen. Then just follow his lead as he moves toward one breast or the other.
8. Stay close
Keep your baby close to you so you can feed as often as the baby wants to. A 2006 UK study divided newborns randomly into three groups. Babies in the first group were kept in bed with their mothers, those in the second group were in a co-sleeper attached to each mother’s hospital bed, and the babies in the third group stayed in little bassinets next to the mothers’ beds. The babies who were in bed with the mother breastfed more than twice as often when compared to the babies who had been in the bassinet instead. (Those in the co-sleeper arrangement were in between, but similar to the bedsharing babies.) Four months later, those babies who had been in bed with their mothers were about twice as likely to still be breastfed as those who had been kept in the bassinet.
If you opt to keep your baby in a bassinet or crib, watch closely for feeding cues. Babies generally breastfeed frequently in the early days and this is important to establish a good milk supply. Swaddling or wrapping your baby, or giving him a pacifier, can make it harder for him to let you know “hey, mom, I need to nurse again.”
As much as you can, keep your baby in skin-to-skin contact with you. This will both signal your breasts to make more milk, and encourage your baby to feed frequently and calmly. The easiest way to do this is to wear an oversized, button-front shirt with nothing underneath. If you’re sitting down or reclining, your baby can just lie tummy-down on your chest. If you need to be up and walking around, a wrap-type baby carrier can help keep the baby in place.
10. Don’t watch the clock
Watch your baby instead. Rules like “feed the baby for 20 minutes on each side” or “wait four hours between feedings” don’t mesh with what researchers tell us about how breastfeeding works. The only way your baby can increase your milk production, if he needs to, is by feeding more frequently, and in the early days those frequent feedings are essential to establish the “milk factories” you need. And only your baby really knows how much milk he’s getting and how long he needs to stay at the breast – guidelines like “20 minutes” are based on averages, and neither you nor your baby are average!