Friday, May 28, 2010

Nursing basics

This post is intended for General Audiences -- even guys! I know you won't be nursing your babies, but a knowledgeable, supportive husband is the #1 thing that will help a mom succeed at nursing her kids. I think a lot of men are embarrassed hearing about nursing, but really, there shouldn't be anything embarrassing about it. As for my women readers, I know few if any of you are currently expecting, but many of you will end up having kids, and this will be good to know.

Also, I'm kind of hoping that this can be of help to the nervous first-time mom who googles "nursing basics" and finds herself faced with half a hundred baby websites which all seem to have the same two paragraphs of advice. This is what happened to me, so I assumed I knew everything there was to know about nursing -- which was NOT TRUE. However, on getting home from the hospital, I discovered that now that I knew what to look for, I could find out way more than the lactation consultants had told me.

I'm writing this because I strongly believe nursing is important, and that every mother should try it. However, I think what we need isn't a lot more pressure to do it. After all, every doctor, midwife, nurse, parenting magazine, and even formula commercial tells us it's best for baby. We all know that, and yet by six months, most moms have given up on it. They are trying and giving up. Why? Not because they're not convinced it would be good to do it -- because they have tried and failed.

I see tons of moms, in person and online, saying, "Oh, I tried, it didn't work." "I didn't have enough milk." Yet I have also read that 95% of moms can nurse successfully! Most problems can be resolved -- they just aren't. When I read people's stories, I can often pinpoint the exact place where they went wrong. Often, by the time they realize what they should have done differently, it's too late. So I'm writing a list of important things to know BEFORE you have a baby and start trying to nurse. Hopefully, this way you'll be ready by the time you (or your wife) have a baby and need answers right away -- not on the next business day.

1. You have to try to nurse the moment the baby is born, if you can. This will help so much -- though c-section mothers and others who can't nurse right away usually can still succeed. In my case, the hospital urged me to try to nurse at birth, and told me it was their policy to hand the baby to the mom right away. However, there was meconium in the water when they broke it, which meant they were going to have to suction his lungs in case he had inhaled some. Well, he came out screaming, so there really wasn't any danger, but they suctioned his lungs anyway. This makes nursing a little harder, apparently -- it hurts their throat so they don't want to nurse. I didn't know that, and besides, I wanted to follow medical advice. If the doctor recommends suctioning the baby's lungs, don't worry too much -- it may be necessary to suction them, so don't feel bad about that.

However, after they'd done that, they seemed to find it necessary to bathe and swaddle the baby too. This is a big no-no. You should get the baby skin-to-skin with you as soon as possible. An unmedicated baby placed skin-to-skin with his mother at the moment of birth is often able to find his way and latch himself on unassisted. I wish we could have had that. I didn't even know to unwrap the swaddle when they finally gave him to me after 20 minutes, so my efforts at nursing the baby in that first hour were a failure, and later efforts were quite a struggle.

Husbands, consider this your job: if you see someone wandering off with the baby the instant he's born, chase them down and get that baby back to mom! If he's healthy and there are no complications, there is no procedure that must be done and can't be done either while mom is holding the baby, or later.

2. A newborn is usually awake and alert for the first 1-2 hours after birth, but after that, he falls asleep for around 12 hours. So, that alert window is a great time to start nursing. If you miss it, don't worry. The baby is born well-nourished and won't starve. However, as soon as he wakes up, or about 12 hours after he is born, you should start trying to nurse right away. If you're lucky, there will be a lactation consultant in the hospital to help you. If you're even luckier, they won't be pushy and obnoxious like mine were. Getting the baby to latch on properly is the most challenging part of nursing, and it's one that meets you right away. Read up on what a good latch looks like, and how to correct a bad latch. A bad latch means pain for you and not enough milk for baby. This is a good source.

3. During the first 2-4 days after the birth, you don't actually have real milk. You have colostrum, which is a nutrient- and antibody-rich fluid and is all your baby needs during those first few days. There isn't a lot of it -- he'll be taking a few teaspoons at a feed, and that's all. However, that's okay. The baby may lose a small amount of weight during the hospital stay, and that's okay too. Mark lost about seven ounces, but had gained it back by his pediatrician appointment five days later. Be very reluctant to give any supplement at this time. Some doctors and nurses are more used to formula-fed babies, so they may be concerned at this small weight loss. Unless the baby is losing a lot of weight or is jaundiced, try to avoid supplements. If you do need to supplement, ask that it not be given in a bottle, but with an eyedropper or a supplemental nursing system. If a newborn is given a bottle even once, he may learn to prefer it and won't nurse as well. The same goes for pacifiers. Instruct the hospital nursery not to give any form of bottle or pacifier, but to bring the baby to you if he is hungry.

4. About 2-4 days after the birth, the real milk comes in. The body doesn't know that you didn't have triplets or something, so it provides a lot, just in case. At this time it is crucial that you let the baby nurse all he wants. If, after a few days, there isn't much nursing going on, milk supply decreases drastically. From this point on, milk supply goes by demand. If the baby's nursing a lot, supply increases; if he's not, supply decreases. So if the baby seems extra hungry, and you give him a bottle, your supply will never catch up to your baby's needs. Instead, try to nurse very frequently, use a pump if recommended, and supplement only if absolutely necessary, and then preferably with a supplemental nursing system.

5. Nurse very frequently, especially for the first few weeks. Like I said, supply follows demand. If you think the baby might be hungry, nurse him. If he's fussy at all, nurse him. If it's been three hours since you last fed him, nurse him. Yes, even if he's asleep. A baby shouldn't be sleeping through the night at that age anyway -- waking him to eat now isn't going to stop him from sleeping well when he's older. (I only had to wake the baby to eat once, ever.) Ask your doctor or nurse when it will be okay to let him sleep longer. But your rule of thumb in the first two or three weeks should be at least every three hours. Don't be hampered by any kind of schedule in this beginning period either. These can be established later. First, you have to establish a milk supply that keeps up with your baby's needs.

This is where I think a lot of moms go wrong: they expect nursing to work like formula, where you can feed every 3-4 hours and be sure of success. This just isn't so. Some moms and babies are going to need hourly nursing at first to keep up supply and keep baby's tummy full. During Mark's waking hours, we nurse about every hour. He takes three-hour naps which he nurses before and after. At night, he's down to waking once or twice a night, but in his first weeks he was waking every 2-3 hours. This is normal, and it's when you start following all the advice you got to "sleep when the baby sleeps." Co-sleeping is great for mom to get rest while baby gets frequent nursing. It didn't work at all for me -- I couldn't sleep -- but it might for you. Read up on safe co-sleeping, if you want to try it.

6. Don't nurse less because you are afraid of what people will think, or because you want to go out in public and not have to nurse then, or because your relatives judge you. That happens a lot, but you kind of have to conquer your self-consciousness and fear of judgment and put your baby's needs first. If you're not ready to nurse in public, make plans for what you'll do if the baby is hungry. My first trips out of the house with baby were to church and choir practice. I discovered I could nurse in the stairwell of the choir loft at church, and go upstairs (it was a private home) at choir practice. Now, though, I'm pretty savvy with a cover and can manage anywhere -- though I'd still be uncomfortable if people were staring at me. Your personal comfort level may vary. But know that you are protected by law if you nurse in a public place. Whatever you do, don't just let a 2-week-old infant cry from hunger just because you're in public. Find a solution -- even if that solution is to go straight home.

7. Get plenty of rest, food, and water. Don't skimp on the fat -- babies need fat. Husbands: nursing a baby, in the early weeks, is a fulltime job. Do everything else, if you can. That includes bringing her everything that's out of reach while she parks on the couch for an hour at a time. It is no fun nursing a baby who is falling asleep while you're dying of thirst and there is a glass of water just--out--of--reach.

8. After 3-4 weeks, you can introduce pacifiers and bottles of expressed milk, if you want. Don't overuse these, though. You spent all this work teaching the baby to nurse, and you don't want him to forget how it's done.

9. Watch the numbers of wet and dirty diapers a day, especially for the first week or so. The nurses will probably tell you how many to look for. Since the baby can't tell you how many ounces he's getting, this is how you will be able to tell he's getting enough.

10. Nursing sometimes hurts at first. Many advice articles say that if it hurts, you're doing something wrong. This isn't necessarily the case. Be prepared with lanolin ointment and the knowledge that pain doesn't usually last past two weeks.

Those are all the tips I can think of for now. For anyone who's wondering, nursing Mark is going just fine. Though we had some rockiness at the start, trying to get him to latch on, he's certainly getting plenty to eat. One of my nicknames for him is Milkboy, which I call him after a meal when he gives me that pie-eyed, milk-drunk look and drools milk down his chin. (Yes, I find even this absolutely adorable.)


Fidelio said...

Oh, yes, it can hurt a LOT at the beginning. 8-P But it doesn't last, thank goodness.

Nice post! Also, I posted a "gift" of sorts for you on my blog. :)

some guy on the street said...

From your contingent of unwed gentleman readers, thanks for the heads-up. And very sensitively written, too!

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