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Wednesday, 15 January 2014

Breastfeeding: The truth, the whole truth and nothing but the truth...

I've been breastfeeding my boy for over three months now. I never believed (when I started writing this pot when he was just 3 weeks old), that we would get to this point and still be going strong.

When I fell pregnant again earlier this year, one of the things I really wanted to do was breastfeed. I'd planned to do the same when I had Brooke, but it went horribly wrong after a nasty case of mastitis landed me back in the hospital when Brooke was just twelve days old. It was a really stressful time. Being a first time Mum is so overwhelming all by itself, and the struggle I had trying to establish breastfeeding really upset me and left me totally deflated.

I had wanted to nurse Brooke so so much, and of course the Midwives and Health Visitors are full of encouragement and advice that it is the best way to feed your baby. But what they don't tell you, is exactly what breastfeeding entails in those early days. The early days that are so important for establishing successful breastfeeding. There are NHS leaflets that specifically explain how to make up a formula feed, but there is nothing of the same ilk, that explains cluster feeding, cracked nipples or engorgement. In my experience, there is zero real information to really let Mums know exactly what to expect when breastfeeding.

After I stopped breastfeeding Brooke and switched to formula, (which I have to add was the best thing for her, and me at the time - this is not a post to slur on formula-feeding), I read a lot about breastfeeding, and subsequently learned so much more about the science, if you will, behind it. The more I found out, the more I realised that I was probably on the right track with Brooke, I just hadn't known what to expect in those crucial early days. I didn't know it would be normal for her to want to nurse frequently, or for her to switch between breasts several times within the hour and for all of this to actually be really normal. All I had heard about from the health professionals, as well as from friends and family, was "three-hour feeding routines" and the benefits of me being able to see how many ounces Brooke was taking if I switched to a bottle. At no time did anyone explain to me that if I took a "babymoon" for the first two weeks, let Brooke nurse on demand, keep her skin to skin, and follow her cues, that she would have probably breastfed from me beautifully.

So when I knew I was going to be a Mummy again, I knew I would make breastfeeding work. I read more and more and spoke to my other Mum friends who had successfully breastfed, and I asked a tonne of questions. I wanted to educate myself as much as possible about getting baby to latch, skin to skin contact, the duration and frequency of feeds - I wanted to be ready for everything. I also downloaded a fantastic book to my Kindle, which I read through the night in those really early days of feeding (when it feels like there is a baby permanently attached to your boobie!) This book, Baby Led Breastfeeding, really helped me understand what to expect in the beginning, so it comes highly recommended.

And whilst this book is truly awesome, what I think would have really helped me when I needed a quick answer or a quick point of reference, was a breakdown of all the things to expect, in a nutshell, over those first few days and weeks. And when unfortunately I didn't find anything like this, I started making my own notes and scribbles (left in various places all around the house), of what I was experiencing, with the idea in my frazzled, sleep-deprived brain, that I'd sit down and write a Breastfeeding 101 when I eventually found 2 mins! It's taken me 3 months...

Now I am really no expert, in fact I am very new to this game and just taking it as it comes with Jesse. But these are few things I picked up and want to pass on, which hopefully will be a benefit to other Mums who want to breastfeed. This isn't intended to be a "This is how your Breastfeed", it's just a "This is how Jen feeds Jesse" which, will hopefully be of benefit for Mums like me who really want breastfeeding to be successful.


Days 1-5

For me, I found that once I had got past those first five days, I felt like I was getting somewhere. I'd read a lot about the first 6 weeks being the toughest, but I felt after just five days (and nights!), that we were on our way to established feeding. It sounds like a very short period of time, just five days, but those five days are often very very long, with little sleep or rest. What helped make those days more manageable and allowed me to literally sit with my boob out for the duration, was my husband. He would take over with Brooke and allow me to focus everything on Jesse. This time I felt, was absolutely essential, as I needed to be available to Jesse to give him skin-to-skin and to offer him feeds regularly. If it's your first baby then you don't really have any extra demands so you can sit until your hearts content with your nipple under your baby's nose, but if it's a second, third, fourth baby, then you need a support system around you to allow you that one-on-one time. 

Skin-to-Skin

The best way to get feeding started, is to latch baby on in that first alert period they have shortly after they're born. Babies will naturally root and look for the breast given the opportunity, which is why skin to skin (which also has huge benefits aside from feeding: calms baby, regulates heartbeat and temperature), is really crucial. When a baby is placed on his mothers chest, the relevant feeding hormones are stimulated and the baby will instinctively look for the breast during his or her first period of alertness. Your midwife will ask you if you want skin-to-skin during your labour, and she will be on hand to help you take your nightie or top off when your baby is born, and place him or her onto your chest. 

What I have found with both of my kids, is that after about 30-40 minutes they started to root, and at this point, my midwife always helped me get them latched on. Take advantage of having the midwife there if you're unsure about the baby's latch and they'll help you relatch baby if necessary.

Sleepy Day

After Jesse initially fed in the hospital, he slept. He slept a lot. He was born on Wednesday night, and after two small feeds between 9.30pm and 12.30am, he slept all night long and didn't feed again until 8.30am the next day. After he fed that morning, he slept a lot more, and only fed once again that afternoon. Naturally I felt he wasn't feeding enough, when really he'd had plenty and was simply catching newborn zzzz's.

Is my baby getting enough?

With formula feeding, it's so easy to look at a bottle and say, "Right, at 2.00pm my baby ate 3oz", but obviously with breastfeeding you can't do this. This really shouldn't put anybody off at all. With breastfeeding, babies are totally in control of how much they take . They latch on and latch off when they've had enough, so it's impossible to overfeed a breastfed baby. I found with formula, it was easy to get stressed over an unfinished bottle, whereas with breastfeeding, I trust that Jesse has exactly the amount he wants (and I don't stress that he hasn't consumed the amount that's recommended on the formula tin). Baby's have such teeny tiny tummy's as well, and need very little in terms of quantity in those early days. This diagram really made it clear to me that Jesse was getting plenty from the small little and often feeds he was having.



Nappies

When you can't see the ounces measured on a bottle, you can see and feel the weight of a nappy. This is how I knew that Jesse was getting enough. The nappies went hand in hand with the feeds, so on the days he fed little (probably up to about day 3), the nappies would be wet but not overly so. Again, this was totally normal. By days 4 and 5 when my milk came in, the nappies became rapidly fuller. This also gave me the confidence to keep going, as it was becoming evident that things were definitely moving in the right direction.

Cluster Feeding

From Day 3 Jesse began to feed little and often, also known as Cluster Feeding. It's at this time that so many women think (because I know I did!), "I'm not satisfying my baby, he's feeding ALL the time." This again, is totally and completely 100% normal.  Breastfeeding works on a supply and demand basis, so those days of cluster feeding are essential so that your baby can put his or her order in for the amount of milk he or she needs. If you reach for the formula at this point to "top up" (as I did), your body isn't going to make enough milk for that feed when it comes around again. This can lead you into a pattern of topping up other feeds and your milk supply will dwindle. Have trust in yourself that your body will make the exact amount of milk your baby needs, and have trust in your baby that he will take as much milk as he needs at each feed (even if he did only feed 20 minutes ago...!)

Engorgement

By Day 5 my milk was in and I was resembling Dolly Parton. Engorgement can be very painful and your breast may feel hot and sore. Again - totes normal, but if you feel uncomfortable (Jesse at this point was still sleeping A LOT), use a warm flannel to soothe your breasts and gently hand express a little bit of milk off so that you're comfortable. Don't pump or hand express too much because your body at this point, is still in the "supply and demand" stage, so the more you express, the more your body will think you need. As much as you can offer your baby the breast, and even the smallest feed will help if you're feeling uncomfortable.

Frequency of Feeds

With Brooke, I believed I wasn't satisfying her appetite because she wanted to feed a lot. In my mind, and because I was hearing it so much from other Mums, I was under the impression that she should be going this magical "three hours" between feeds. I know now that this is unrealistic. And pretty much an impossibility for a breastfed baby. Midwives now advise that all babies should be fed on demand, and I would say this is definitely essential for a breastfed baby. Breast milk is much lower in fat than formula, so it digests a lot quicker, meaning your baby may be hungrier a lot sooner than three hours after his last feed. My advice would be to not have any expectations in those first few weeks and certainly don't be disheartened if it feels like your baby is feeding rather frequently. It's all really normal and doesn't mean you don't have enough milk, or that your baby is not full.

Duration of Feed

Even at the stage Jesse's at now, my Mum comments on how he doesn't feed for long - I imagine in her mind, like mine, she had visions of a baby being permanently attached to my nipple. The duration of feeds vary. Some times a quick top up before we head out will last no longer than a couple of minutes, but if he's settling down to go to sleep, he might latch on, feed and stay latched on having a little bit of a comfort suck for around 20 minutes. In those very early days (the first 2 weeks), I pretty much allowed myself to sit with him latched on for 24/7 if he wanted to, but I think as soon as he knew it was readily available on demand, he naturally spaced his feeds to suit his individual appetite.


Comfort Sucking

When Jesse first started cluster feeding, I found myself asking "is he feeding or comfort sucking?" Feeding seemed to be rather constant with not much let up. A few months in, I now know it was all cluster feeding, as comfort sucking can be a little painful, as the latch isn't as strong (because he's not actually feeding) and it feels like the skin is being chaffed - ouch! I tend to just pop my finger into the side of his mouth and unlatch him off if he's only sucking for comfort, he's normally sparko by this point and sleeping contently.



Let Down

Let down is the tingly, almost pins and needle type sensation you feel, when your milk starts to flow. When your baby latches on, he or she will suck quite rapidly, this stimulates oxytocin and this encourages the muscles in your breast to contract and "let down" the flow of milk. You will notice that those quick and rapid sucks, slow right down once your milk has let down, as your baby takes big gulps of milk, with small pauses to swallow. I have a seriously strong let down and in the early days it would make my eyes water. Even now it's still pretty strong, but to be honest I take that as a good sign that I have a good supply of milk.

Latching

There's a lot of information around latching. When I was reading about how to latch my baby on, I did find it really confusing. Consistently I read that babies should, "open their mouths wide" to latch on, but Jesse has never really done this. I also think that establishing a good latch takes time as I don't think it's something you're going to achieve perfectly, the first time. It took me a good two weeks for the latch to not be sore or tender. Like anything, practice makes perfect and Jesse found a way to latch that works for him. He barely opens his mouth to latch and just sucks the nipple straight to the back of his mouth as soon as he sees it.

There are a few things to look out for though that will give you a good indication that baby is latched and getting his grub. I could see little bits of milk at the corner of Jesse's mouth when he fed, I could see the pink on the inside of his mouth and his lips curled to achieve the best latch, and I could hear as he took those slight pauses to swallow.

Jesse also had a real preference for the left boob, and as it's I'm right handed, it felt easier to feed him on the left side and have my right hand free. Despite this, I alternated breasts at every feed (and still do), so that I could achieve a good latch on both sides. At three months old he still prefers the left side and will often prefer to snuggle into this nook for a sleepy feed, but he equally takes a full feed from the right side when he's drained me from the left!

Cracked Nipples and Nipple Pain

Unfortunately, the "if your baby is latched they'll be no pain", is a little bit misleading. I can say now that at 3 months, it doesn't hurt in the slightest to feed (it didn't even really hurt much after the first week or so), and my nipples are still in really good condition (ahem...!), but realistically you will have some discomfort in the early days. It won't last, it really won't. As you and baby keep working together, he or she will find what works for them and the latch will improve, but don't be disheartened by a bit of tenderness, or a slight graze - keep feeding. Use a good nipple cream to protect them, Lansinoh is unquestionably the best, and as another Mum advised me when I had a really painful graze, breastmilk will keep it clean and help it to heal. Don't avoid feeding from a grazed nipple as this will dry it out and make it harder to heal. 

Milk Blisters
I had never heard of milk blisters and got quite panicky when a little blister type bubble appeared on Jesse's upper lip. A quick search on Google reassured me that they're also really normal and heal very quickly.

I really hope that this blog can offer a bit of help to Mums like me, who so desperately wanted to breastfeed my baby, but felt a bit overwhelmed and confused by the information that's out there. If anyone wants to ask any questions, please do. I am by no means any expert but I can share my experience and lend a listening ear.

Just as a side note, if any kid can sell breastfeeding, it's my kid! He's nearly 14 weeks old, exclusive fed and he is the biggest baby EVER. He's filling 3-6 months clothes and totally dispels the myth that breastfed babies don't sleep well; he sleeps for hours, 2-3 hour daytime naps and 5-6 hour spells in the night. He really is a fantastic feeder AND sleeper.


I wish you all the love and support on your feeding journey xxx



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