Information on Baby Nursing

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Baby Nursing

Each baby has a unique style of nursing, andyours may mesh easily with your milk supply andlifestyle or may require that you make some ad-justments. Some infants get right down to busi-ness, sucking vigorously and efficiently withoutmuch hesitation. These "barracudas" contrastsharply with the "gourmet" nursers, who taketheir sweet time, playing with the nipple at first,sampling their meal, and then eventually getting started. Some babies vary the gourmet approach by resting every few minutes, asif savoring their feeding, or even falling asleep one or more times during the nurs-ing session. The "suck and snooze" types may exasperate a mother who feels thatshe doesn't have all day to nurse. While it's all right to provide a little mild stim-ulation (such as undressing him) to get Sleepy back on task and complete hisfeeding, some downsizing of your expectations for the day's activities may benecessary to prevent ongoing frustration.

Newborns also vary in the frequency with which they need to nurse. A typi-cal span between feedings will be two to three hours or eight to twelve times perday, but during the first days after birth, the interval may be longer, with only sixto eight feedings in a twenty-four-hour period. The baby will feed more oftenthan usual during growth spurts. The time involved in a feeding will also vary,but a typical feeding will take ten to fifteen minutes per breast.

As with nearly every aspect of life, what is said to be "typical" may not matchwith what happens in reality—especially with newborns. For example, your firstnursing experiences in a hospital setting may be somewhat confusing, especially ifyou are not rooming in. Many hospital nurseries still adhere to the tradition ofbringing out all the babies to their mothers for feeding on a fixed schedule. Butmost babies don't automatically synchronize to Nursery Standard Time and maybe sound asleep for these nursing "appointments." The result is repeated frustra-tion for mothers whose zonked-out newborns seem to have little interest in latch-ing on, let alone sucking, during the first few days after birth. In a worst-casescenario, a baby who hasn't been ready to nurse with Mom might wake up and sound off whenhe's parked in the nursery, only to have his cryingignored or answered with a bottle. Many hospitalnurseries now bring newborns to their motherswhen they're hungry rather than in fixed shifts.Overall, however, rooming in gives everyone a bet-ter chance to get acquainted and, more important,nurse when the baby is awake and hungry.

Don't worry if your baby doesn't seem terri-bly interested in frequent nursing during the firstfew days. That will change, often just after youbring him home. The early phase of sleepinessthat occurs as he adjusts to the outside world willusually give way to more active crying and nurs-ing—sometimes every few hours—after the first
week. Some parents are aghast when this happens. The mellow baby they enjoyedin the hospital suddenly seems wired and insatiable just a few days later. Don'tpanic. Instead, look at this as a time to hone your nursing skills with a very will-ing partner.

The newborn baby normally will announce his desire for milk very clearly,with some insistent crying every two to four hours. When this occurs, it is ap-propriate to tend to him promptly, change him if necessary, and then settle in fora feeding. Some infants make sucking movements or fuss for a while beforeovertly sounding off. There's no point in waiting for full-blown crying before of-fering the breast. For five to ten minutes you will notice him swallowing after ev-ery few sucks. and then he will shift gears to a more relaxed mode or even seemto lose interest.
At that point he can be burped, either by lifting him and placing his headover your shoulder, or by sitting him up with your hand under his jaw and gently patting him on the back. You can also place him face down across your lap, withhead supported and chest a little higher than abdomen, and gently pat his back.
Once he burps, he may show interest in the other breast. (If he doesn't burpand yet he appears comfortable, you can still proceed with the feeding.) Since thefirst side may be more completely emptied during the feeding, it is wise to alternatethe breast from which he starts. (A small pin or clip that you move from one sideof your nursing bra to the other can help remind you where to begin next time.)
Relatively frequent nursing is typical after the first days of life, and it willhelp stimulate your milk production and let-down reflex. A newborn who seemsto be very content with infrequent feedings (more than four hours apart) shouldprobably be checked by your physician to confirm that his activity level is satis-factory. He may in fact need to be awakened to feed every three hours to ensureadequate weight gain during the first two or three weeks.

Problems and Concerns with Nursing

'How do t know if she's getting enough?" During the first few days after birth,this concern often prods new mothers toward bottle feeding, where they havethe security of seeing exactly how much the baby is consuming. Remember thatthe quantity of milk you produce during a feeding will start with as little as halfan ounce (15 ml) of colostrum during the first day or two and increase to anounce (30 ml) as the milk supply arrives by the fourth or fifth day. After the firstweek, your milk output will range from two to six ounces per feeding.Obviously, there is no direct way for you to measure how much your baby is sucking from your breast, but other signs will indicate how the two of you aredoing:

• When the room is quiet, you will hear your baby swallowing.

• Once your milk has arrived, you may notice that your breasts softenduring a feeding as they are emptied of milk.

• After the first four or five days, you should he changing six to eight wetdiapers each day. In addition, you will notice one or several small, darkgreen stools—sometimes one after every feeding—that become lighterafter the first (meconium) stools are passed. As your milk supplybecomes well established, your baby's stools will take on a yellowishcolor and a soft or runny consistency. Later on, stools typically becomeless frequent.

• Tracking your baby's weight will give you specific and important infor-mation. It is normal for a baby to drop nearly 10 percent of her birthweight (about eleven or twelve ounces, for example, for a seven-poundbaby) during the first week. Usually she will have returned to her birthweight by two weeks of age, and thereafter she should gain about two-thirds to one ounce per day. Obviously you can't track these smallchanges at home on the bathroom scale. Instead, it is common to have acheckup during the first week or two after birth, during which your babywill be weighed on a scale that can detect smaller changes. If there is anyquestion about appropriate weight gain, your doctor will ask you toreturn every week (or more often, if needed) to follow her progress.

One of the most important—and hardest—things to remember if you areconcerned about the adequacy of your nursing is to relax. If you approach everyfeeding with fear and trembling, you may have difficulty with your let-down re-flex. Furthermore, newborns seem to have an uncanny sense of Mom's anxiety,and their jittery response may interfere with smooth latching on and sucking.Remember that for many women, breast feeding requires time, effort, and learn-ing. Even if your first few feedings seem awkward or your baby doesn't seem tobe getting the hang of it immediately, you should be able to make this processwork. Take a deep breath, take your time, and don't be afraid to ask for help ifyou are truly having trouble getting started.

"It hurts when I nurse!" No one wants to spend a good portion of the day in mis-ery, and a strong dose of pain with every feeding can demoralize even the mostdedicated breast-feeding mother. Some tenderness during the baby's first few sucks of each feeding is not unusual for a few days after birth while a callus is be-ing formed.

Many mothers also feel aching during the let-down reflex, and some mayeven notice a brief shooting pain deeper in the breast after nursing as the milksupply is refilling. For some women the engorgement of the breasts prior to eachnursing session can be very painful. It is possible, in fact, to have intense painwith engorgement even when your nursing technique is correct and nothing spe-cific is wrong with your breasts. Some mothers who are unprepared for such se-vere discomfort may give up on nursing too soon. But becoming comfortablewith nursing may, in fact, take a few days or even a few weeks as your baby learnsand your body adjusts to this new function.

In most cases, pain serves as a warning that should not be ignored. If youhave significant, ongoing pain with nursing, you should review this with yourdoctor and attempt to identify one of the causes that can and should be treated.
Intense discomfort can arise from traumatized, cracked, or inflamed nipples,which, of course, are sensitive areas to begin with. If the nipple is irritated at thetip, it is probably entering your baby's mouth at an upward angle and rubbing onher palate. During the latching-on process, try holding your breast so the nipplepoints downward. This is often easier if you are sitting, using the cuddle or foot-ball hold.

If the nipple is more tender at the base, it is more likely being chewed dur-ing feedings. Remember that your baby needs to take the entire areola into hermouth when she latches on, so your nipple lies against her tongue. If she won'topen her mouth fully or slides off the areola after latching on, your nipple will begummed continually while you nurse. To add insult to injury, your baby may notget enough milk when this occurs. The combination of miserable mom and cry-Mg newborn is often enough to send Dad out into the night in search of formula.

To help your baby latch on to the whole areola (and not just your nipple),wait for her to open her mouth wide enough and then gently pull her to thebreast. If you are engorged and she is having difficulty forming a seal around theareola, you can express or pump some milk so that area will be softer. You mayhave to utilize the football hold to give your hand better controlof her head and thus keep her from sliding off the areola. If she seems to lose herposition during the feeding, don't be afraid to pull her gently from the breast andthen reattach. If she has a strong hold, you should first loosen it by pulling down-ward gently on her chin or inserting a finger into the corner of her mouth to re-lease the vacuum seal formed by her gums.

Other causes of painful irritation of one or both nipples, or even full-blowninflammation known as dermatitis, include:

• Overzealous use of soap and water that can remove the skin's own mois-turizers. Rinse your breasts during your normal shower or bath but keepsoap away from your stipples.

• Continuous moisture on the skin surface. This can occur when thebreast is not allowed to dry off after a feeding or when the pads of anursing bra are moist. Air drying for a few minutes after nursing is thesimplest solution, while making certain that your nursing bra is dry aswell.

• An allergic reaction to breast creams or oils. Paradoxically, traditionalremedies for breast soreness such as vitamin E preparations or impurelanolin may make the problem worse if they provoke an allergic dermati-tis. If your nipple develops redness, swelling, and a burning sensation,stop using any nipple cream. If the problem persists or worsens, see yourdoctor. You may have to use a mild anti-inflammatory prescription creamfor a few days to calm this problem down more quickly.

• An infection with the yeast organism known as Candida albicans, whichwill also be present in the baby's mouth. In this case the irritation maynot only burn but also itch. Candida may appear sometime after youhave been nursing without any problems. A tip-off is the presence ofsmall, white patches inside your baby's cheeks. Candida infection in thebaby's mouth (also known as thrush) is not a dangerous condition, butit can be a persistent annoyance.
Candida infections usually respond to treatment with an antifungalcream (check with your doctor). At the same time, your baby should begiven antifungal drops by mouth. If both of you are not treated concur-rently for several days, the infection may bounce back and forth betweenyou. Furthermore, in order to prevent reinfection, you will need tochange nursing pads after every feeding. If your baby is receiving anyfeedings from a bottle or is using a pacifier, you will need to boil therubber nipples and pacifiers every day until the infection clears.

• Rarely an ongoing eczema problem that has appeared on other parts ofyour body will erupt on the breast during nursing. You will want toconsult with your doctor about appropriate treatment, which mayinvolve the short-term use of a mild anti-inflammatory cream.

• A potentially more serious cause of pain is mastitis, an infection causedby bacteria that gain entry into breast tissue, usually through a crackednipple. Symptoms include pain, swelling, heat, redness, and tendernessin a localized area of one breast, accompanied by generalized aching and fever. If there is no fever, it probably is a plugged duct and does notrequire antibiotics. Should this problem develop, it is important tocontact your physician. Antibiotics that are safe for both mother andbaby will normally be prescribed, and acetaminophen may be used toreduce both pain and temperature. The use of warm, moist compressescan assist in the treatment. In addition, it is important to continue nurs-ing, although you may be more comfortable with more frequent, shortersessions. Your baby will not become ill by nursing from an infectedbreast, and emptying the breast of milk helps clear the infection. Icecubes can be applied directly to the breast (at first in quick, shortstrokes) above and below the infected area. This can help reduce painand swelling.

Aside from some of these specific treatments for breast and nipple pain, howelse do you spell relief until the cracking or irritation heals?

• Don't attempt to toughest your nipples, either before or after the birth,by rubbing, stretching, or pinching them.

• Acetaminophen (or ibuprofen) may be taken thirty to sixty minutesbefore you nurse. Of course, it is wise to take medications only whennecessary while nursing, but a short-term pain reliever that helps youcontinue nursing will be a worthwhile exception.

• Take some measures to "move things along" during your feedings.Express a little milk before your baby latches on and then gently massageyour breasts while nursing to help them empty more quickly. Think interms of shorter but more frequent feeding times.

• Air dry your stipples for several minutes after you nurse. Some mothersfind that ice applied to the nipple just before nursing may reduce painwhen the baby latches on. Many traditional remedies such as breastcreams, oils, vitamin E capsules, or even tea bags have fallen out of favor,especially since some may actually increase the irritation. However, apure lanolin preparation applied after nursing may help restore normalskin moisture and decrease pain.
•If your baby forms a strong suction with her gums, be sure to release hergrip before you pull her from your breast.
•If all else fails, consider pumping your breasts and allowing your baby toaccept your milk from a bottle while your nipples are healing, especiallyif they have been bleeding. This is less desirable during the first several days while she is still learning the ropes, but it's better than giving up onnursing altogether.

Remember that a temporary time-out from breast feeding to allow for heal-ing or for any other reason (for example, an illness affecting either mother orbaby) does not mean that you cannot resume nursing when things calm down.Pumping your breasts at feeding time will help you maintain your supply.Furthermore, even if your baby has spent a fair amount of time with a bottle, shecan learn (or relearn) to obtain nourishment successfully from your breast.

"My baby wants to nurse all the time. I'm getting sick of being a human pacifier." All babies derive comfort and satisfaction from sucking, but some are true enthusiasts who would be more than happy to turn every nursing session into a ninety-minute marathon. You may be happy with this arrangement, but more likely it canead to sore nipples and a gnawing concernt. Fortunately, you are not without options.

A healthy newborn, properly attached to the breast and sucking continu-ously, will empty about 90 percent of the milk available on each side within tenminutes. You can usually hear and feel the transition from intense sucking andwallowing to a more relaxed, pacifying sucking after five to ten minutes on each,ide, at which point you can decide how long you want to continue. If you're bothfeeling snugly and comfortable, relax and enjoy it. But if it's the middle of the night and you need sleep, or other children need your attention, or you're gettingsore, you won't destroy your baby's personality by gently detaching her.

A problem can arise, however, if your baby sounds terribly unhappy and in-dignant when you decide enough's enough. How do you respond? The answerdepends on how far along and how well established you are in your nursing re-lationship. In the earliest days when milk is just arriving or you're not surewhether she is truly swallowing an adequate volume, it is probably better to giveher the benefit of the doubt and continue for a while longer. This is especiallytrue if you are blessed with a casual "gourmet" or "suck and snooze" baby whomay not empty your breast very quickly.
But watch the various indicators of your progress: good swallowing sounds,frequent wet diapers, weight gain, and softening of your breast after feeding. If these are going well and you feel you have developed a smooth nursing routineafter two or three weeks, you can consider other calming maneuvers, includingthe use of a pacifier. If your soothing maneuvers aren't working, how-ever, or your baby doesn't seem to be gaining weight, contact your baby's doctor forfurther evaluation and recommendations Some mothers make the mistake of assuming that every sound from a babyshould be answered with nursing, when something else (or nothing in particu-lar) may be bothering her. If for example, she has just finished a good feedingthirty minutes ago and begins to fuss after being put down for a nap, it is rea-sonable to wait and listen for a while, since she may settle down on her own,rather than trying to nurse her again. Otherwise you may find yourself spendingnearly every minute of the day and night with your baby attached to your breast.As the days pass, you will become more discerning about the meaning of yourbaby's various crying messages.

If you are having a significant problem with breast feeding—whether it be latching on, anatomy problems, sore nipples, sluggish nursers, slowweight gain, or anything else—seek out a lactation consultant for some addi-tional help. This is a health-care professional whose wealth of knowledge andpractical suggestions can help both mother and baby succeed at breast feeding,even when the going gets very tough. Your baby's doctor or a local hospitalshould be able to give you a referral.

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