by
Cynthia B. Flynn, CNM, PhD
Having taught hundreds of women to breastfeed, I have learned
that good prenatal education can really help to promote and
sustain breastfeeding. Here is what I tell moms before their baby
is born:
1. Babies like to eat when they're born, but many are too small
to make their own sandwiches. You or dad may need to do it for
them! The way you do it is to get your baby in a comfortable
position, tummy to tummy with the baby's back and neck straight
(I show them cross-cradle with a doll), and then put your thumb
on the baby's nose and your little finger on the chin when you
hold your breast. If you put a little pressure on your breast,
you will make a "sandwich" which is easy for the baby to eat (I
show the mom by lining up my flattened palm horizontally with
their mouth). If, however, you put your thumb and pinkie on the
baby's cheeks, it is almost impossible to eat the sandwich (I
show the mom by holding my flattened palm vertically next to
their noses). Dad can help make sandwiches if mom is tired.
2. It takes about 3-4 days for your milk to come in. Before that,
you make colostrum which is VERY concentrated, so it only takes
drops, not ounces, to fill baby up. Besides, babies come with a
three-day supply of food on their shoulders called "brown fat."
If you can see even a drop of colostrum, that's plenty; the baby
knows how to get more where that came from.
3. Every woman has a "sweet spot." If you start squieezing next
to your nipple and work your way out towards the edge of the
areola (brown area), eventually you will find the place that
makes the colostrum/milk come out the easiest. This is the "sweet
spot." When you press on it, the milk comes out even without
sucking--which is a lot easier for baby and prevents sore nipples
in mom. So it is important to find the sweet spot. Once you do,
go just a fingerbreadth farther out in each direction to find
where to put your thumb and pinkie to make the sandwich. Then, if
the baby's lips are touching your thumb and pinkie, the baby will
be on the sweet spot and not have to suck!
4. When your milk comes in, it may be hard for the baby to latch
on. Try to nurse a little extra so your breasts don't overfill.
If you pump a lot, your body will think you have a huge baby and
just make more!!! But if you have to pump or hand-express a
little so the baby can latch, try to finger-feed or cup-feed the
milk you pumped to the baby after you have breastfed. That way,
your breast will make the right amount.
5. After your body figures out how big a baby you have, it will
seem like your breasts get less full (they do!). The way you know
your baby is getting enough to eat is to count the number of wet
diapers--there should be one for each 24 hours of life, so one
the first day, two the second day, and so forth until the baby
makes 6-8 each day. Plus babies should look full and sleep well.
6. The cure for a "snacker baby" who wants to eat for five
minutes every 45 minutes is to put them on the following
schedule: from noon to 3:00pm they can have as much as they want
whenever they want it from the right breast; from 3:00pm to
6:00pm they can have as much as they want whenever they want it
from the left breast, and so forth for the whole 24 hours. This
allows the resting breast to fill (and heal if necessary!) so it
is easy to nurse well from and it increases the probability that
the "active" breast will be fully emptied--including the valuable
hind milk which is especially filling for baby. In fact, this
schedule is not a bad idea to try for all beginners so mom
doesn't get exhausted from the snacking.
7. Once everything settles down into a nice rhythm, there often
comes a day when the baby is about three weeks old when the mom
will not have enough milk. This is normal. The baby has
just had a growth spurt, and is no longer 7 pounds, it's suddenly
7 1/2. What you need to do is keep putting the baby to the
breast. It won't be happy, because it is not getting as much as
it wants, but it will get some, and more importantly, it will
tell the mom's brain to get with the program and make more! If
the mom gives the baby water or formula, the brain will never get
the message that the breasts need to make more milk. In fact, if
the baby gets formula, the brain will think it needs to make
less, and will do so. Eventually, the milk supply will disappear
and the mom will think "she didn't have enough milk." If you have
enough milk at 2 weeks to keep your baby healthy, then you will
have enough at three weeks if you are willing to put up with a
cranky baby for a few hours. It's hard to have an unhappy baby,
especially for a new mom. But it's worth it, though, because then
your baby gets to continue breastfeeding, which is the best thing
for the baby's health. So be tough!
Cynthia B. Flynn, CNM, PhD
Associate Professor of Nursing, Seattle University
Nurse-Midwife, Valley Medical Center
President, American Association of Birth Centers
Expert Midwife, pregnancy.org
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