I took a breastfeeding class last week.  Yes, I actually took a class. And I’ll be attending it again this coming week as well.  This from a midwife, someone who has taught countless other women about breastfeeding, and who has helped countless women get a good latch with their brand new baby.  But there’s a big difference between helping a newborn (as in, minutes-old) baby latch for the very first time versus addressing the myriad difficulties and complications which come up over the course of time: the engorgement, the first growth spurt, and then what happens after the first growth spurt.  There’s much to be said for getting a baby onto the breast in the first hour of life, but as a midwife you’re not doing much lactation support at 3 weeks of life.  Maybe a bit more at the 6 week postpartum check-up, but in between birth and 6 weeks, a lot of breastfeeding happens, and a lot of challenges arise.

Case in point: for me, my challenge is oversupply.  I have a huge oversupply problem!  Who would have guessed that I would be such a milk goddess??  Whenever I thought about potential breastfeeding snafus, I always thought about undersupply.  It didn’t even really occur to me that oversupply could be a problem.  But it can indeed  be a problem.  A very challenging problem, in fact.  So, I will speak to this for a bit, since I now have first-hand experience with it (and maybe someone else wants to write a guest article about first-hand experience with an undersupply problem?).

This is what oversupply looks like: ever since my son’s growth spurt, my breasts have been painfully full.  When he tries to latch, he has a hard time getting his little mouth to even indent the breast, and then when he does, the milk flows down so quickly it completely overwhelms him, and he ends up pulling back and choking.  This has made his latch very painful for the past few weeks.  In an attempt to stem the overwhelming tide of milk, he’s been pursing his lips and using a much smaller latch than he was the first two weeks, which has led to him sucking little grooves into my nipple and turning the nipples black and blue.  I keep trying to get him to use a wider latch, but inevitably he closes his mouth to a smaller diameter again, and I can’t really blame him.  I would do the same, too, if the milk was flowing so quickly into my poor mouth.  During let-down, my let-down has been so forceful that I have actually sprayed him in the face with milk, like a shooting milk geyser!  Poor guy, how is he supposed to drink from a breast that is out to get him like this?  Every feeding has become a wet and sticky mess.  By the end of it, I’m covered in milk, he’s covered in milk (bring on the baby acne!) and my clothes are covered in milk.  Forget trying to nurse in public at this point, there is no way we can be discreet at this point.  Every feeding feels like a pitched battle against the exploding milk fountain of doom!

Then, there are the digestion issues.  Because the milk is flowing so fast, he ends up gulping a lot of air.  Despite frequent burp sessions, his little belly is full of air by the end of the feeding.  He’s also become a really fast drinker to try to cope with the let-down.  He may finish the breast in about 10 minutes, but it hasn’t satisfied his urge to suck yet, so he continues to try to suckle at the breast for another 20 minutes or so.  And because he’s drinking so quickly, and filling up so quickly, he’s not always getting to the hind-milk at the back of the breast, which comes at the very end of the feeding.  I just found out that hind-milk is crucial to improving his digestion.  If he’s getting enough hind-milk, he digests everything more slowly, and the poop is mustard yellow and much easier on his G.I. tract (less gas, less explosive poops, less fussing).  If he’s not getting enough hind-milk, everything digests much too quickly, with a lot more gas and fussing involved, and comes out green instead of yellow.

I went to a breastfeeding class last week, and this is the advice I was given: first, try more upright feeding positions, where he’s sitting up or across my chest but I am leaning back so that his head is over the breast, rather than under it.  This will make the milk have to work against gravity, which might help slow the flow down.  I was pumping a little bit before feeding him to try to soften the breast somewhat and make it easier for him to latch.  The lactation consultant advised to stop pumping immediately, because this was just encouraging more milk production!  Instead, I can manually express just a bit, if I have to, but if at all possible I should just let him eat directly from the breast, and supposedly that will help regulate our supply/ demand more quickly.  She advised I continue with the frequent burpings, and that if he finishes the breast quickly but still wants to suck, I can offer him a pacifier or clean finger to suck on instead, since continued sucking helps with his peristalsis and may also help him digest the milk more easily and spit-up less.  She suggested that I could also try block feedings if I wanted to in an effort to make sure he gets enough hind-milk (this is where I offer him the same breast for 2—or more—feedings in a row, so that I know for sure that the breast is completely drained and that he got the hind-milk before moving on to the other breast).  However, other advice is suggesting that maybe block feedings are not the best idea, since this increases the risk of mastitis and may eventually lead to undersupply (see the link below from Nurtured Child).

I’ve been looking up some other resources about oversupply on the web.  This is what I’ve found so far, which has been very helpful:

Kellymom.com – great resource for all things Breastfeeding.  I just added it as a permanent link under the Breastfeeding section.

Nurtured Child: Managing Oversupply (written by a LLL leader), which discusses frequent switching of sides rather than block-feeding as a way of dealing with it.

At the moment, we’re skipping the block feedings, I’m doing manual expression when needed, and just letting the little guy eat directly from the breast when he’s hungry.  And hoping that the supply/ demand issues will sort themselves out soon.  But no, it’s not easy.  Even with too much milk, there are still challenges.  I will keep you all posted!

Dear Parents, I am your brand new, wonderful baby. I have very simple needs, but I cannot communicate them to you, therefore, I am a mystery.  I also am changing very rapidly, and every day will be different.  I promise you–DIFFERENT.  Make no assumptions, there are no patterns, just when you think you know who I am and what I like, I will CHANGE.  Oh, and let me tell you about my first growth spurt. It will happen sometime when I am 2-3 weeks old, and it will come out of nowhere, like a bolt of lightning.  Up until my growth spurt, I may have been a good nurser.  You may have been banking on me sleeping at least 2 hour stretches at a time. You may have thought you had figured out what kind of bouncing or rocking or swaying or singing I enjoyed.  You may have been gaining some confidence with your new parenting skills. HAH! I am here to tell you that my growth spurt will throw all of this out the window. It won’t just throw it out the window, it will toss it up, spit on it, tear it to shreds, set fire to the shreds, and then throw the ashes out the window all done while laughing maniacally.  During my growth spurt, I will DEMAND food every hour, on the hour, and when you offer me your breasts, I will flail at them and spit them out because they will be EMPTY and so inadequate for my growing needs.  I will not just be fussier than usual, I will be INCONSOLABLE.  I will introduce you to several of my more distressing cries which I have been saving for just this occasion: the high-pitched wail, the piercing shriek, the crying-so-hard-I-choke-and-stop-breathing-for-awhile, the so-red-in-the-face-you’ll-think-you-need-to-call-911—these and other specialty cries I prepared for you.  I will not let you sleep. AT ALL. EVER.  You might have thought other parents were just joking when they said they literally got NO sleep, but really, TRULY, you WILL NOT SLEEP.  You will spend 24 hours trying to comfort me.  You will pull your hair out. You will wonder where you can return me to.  You will question the decision you made to have a baby.  You will question whey you ever wanted to have sex, ever, in your life, instead of joining a convent at the tender age of 13.  You will be forced to watch an all-night Hugh Grant movie marathon in bleary sleep-deprivation while I gnaw and masticate your nipples to a pulp in my unending demand for milk, of which you are so unable to provide for me.  And then, finally, when I pass out from exhaustion after wailing for 8 hours, I will only sleep for 2 hours before beginning the cycle all over again.  THIS IS MY GROWTH SPURT!  BE AFRAID! BE VERY AFRAID!

In other words, the next time I tell other women about the growth spurt, I will try a little bit harder to prepare them for it. Not that anything can really prepare a new parent for it, but I will, indeed, make a bigger deal about it.  And, for the record, we did survive.  It wasn’t quite 24 hours, more like 36, but now, on the other side of it, I can vouch for the fact that your milk supply does catch up, remarkably quickly, and normal nursing does resume again, about a day later.  But honestly, new parents, be on the lookout for the growth spurt—it is truly no joke!!!

Via Gothamist, New York City mayor Mike Bloomber has recently pledged $2 million dollars to city-run hospitals for the promotion of breastfeeding, with the goal of getting more women to breastfeed for six months or longer.

“We don’t yet have any hospitals in New York City that meet national ‘baby-friendly’ standards,” Bloomberg’s health commissioner, Dr. Thomas Frieden, said at a parenting conference last week.”That means getting formula out of the nursery. It means putting the baby on the breast immediately after birth. It means that every person who interacts with that mother and child is supportive and encouraging of breast-feeding.”

Well, three cheers for that! I can tell you, a boost like this is sorely needed, particularly in public hospitals, since research has shown that the rate of breastfeeding increases with income, education and age, and public hospitals most often take care of the women who have the least. I hope a fair portion of this money is spent not only advertising and promotion among the general public, but on education for hospital staff. Women need so much help and support in order to be able to breastfeed, especially during those early crucial days in the hospital, when both mother and baby are still learning how; the attitude and encouragement of the hospital staff, from the doctors and pediatricians on down to the PCAs and nurses’ assistants, is absolutely crucial.

For a long time, breastfeeding education and attention has been given short shrift, but thank goodness things are starting to change—from much-publicized public nurse-ins in places like Toys R’ Us to the Massachusets ban of hospital distribution of diaper bags loaded with formula coupons and advertising. The hospital where I am currently doing my clinicals (a public new york city hospital) has recently created a new policy where formula is never placed in a baby’s bassinet when the baby is brought out to the mother, even if the mother is breast and bottle feeding. If the mother wants formula, she has to specifically ask for it. Small steps like that, but the hopefully the overall impact is much greater.

Mothering magazine recently ran a competition to create an internationally recognizable symbol for breastfeeding. The winning symbol, created by graphic designer Matt Daigle, can be seen at the top of this post. This symbol has been made part of the public domain, so it can be downloaded and displayed anywhere, by anyone. The intention is not to segregate breastfeeding mothers, or to designate specific places for breastfeeding, but to simply indicate that breastfeeding is welcome and acceptable on the premises. Hopefully we’ll start to see this symbol cropping up all over the place, in restuarants and malls and airports and libraries, movie theaters and convention centers, maybe even on subways and buses….starting with our public hospitals (I’m going to print out a couple of these and bring them to clinicals tomorrow).

One of the women in this room had had absolutely no problem breastfeeding her baby during my first night of work: both of them were learning so well, the baby was latching beautifully, and I got to spend a lot of time with them, teaching the mother how to latch and unlatch her baby, teaching her that yes, her baby really can breathe okay, even when her face is pressed all the way against the breast, teaching her how to prevent sore nipples, and how to recognize that her baby is getting enough, and how and when to start switching breasts, and what to expect once her milk comes in, and the safety-pin trick, and all of the gazillion things I love to teach and explain about breastfeeding. And they were doing great! The mother was loving it, and the baby was looking incredibly content, and I thought all was well.

Then, when I returned the following night to take care of them again, I learned that the baby had slept all day long, and hadn’t eaten at all for the past 15 hours (even though she had had several wet diapers, which is always a good sign). I reassured the mother that the first few days of life are sort of erratic in terms of sleeping and eating, and that eventually she and her daughter would fall into a routine, but as the night dragged on, the baby became fussier and fussier, and we were unable to get her to latch despite our best efforts, and despite the baby’s apparent hunger. Every time we put the baby to the breast, she would become absolutely hysterical, and then it would take several rounds of rocking and patting and sometimes walking with her to calm her down enough to try again. I couldn’t figure out what had happened! The night before, they could have been the poster couple for La Leche League, and then, one night later, it was a completely different story. The baby was hungry, and latching well enough, but every time she latched, she would just hang on the breast, refusing to suck, or else suck once or twice, and then grow hysterical again. I kept reassuring the mother, who was rapidly losing her confidence and her sanity, and we kept trying. I would leave the room to take care of my other patients, and come back to find the mother still awake and the baby still screaming.

Finally, finally, around 5:00 am, at our wits end, I suggested we try the side lying position, since we’d tried everything else and none of it had worked, and boom! I don’t know what it was about that position, especially when the other positions had been working just fine the night before, but all of a sudden, everything clicked again. The baby latched right away, calmed down immediately, nursed for at least 35 minutes, and then fell straight asleep. The mother got crampy from the nursing (which is also always a good sign that the latch is good, and that the baby is sucking well), I gave her some Motrin, and then she fell asleep too. They were absolutely adoreable sleeping together in the same bed after being up all night together. I pulled the curtains around them and shut the door and made sure that no one disturbed them.

And I know she’s not my baby, and this woman, prior to working with her for the past two nights, is a complete and total stranger to me, so you might say why do I even care so much? But I can’t even begin to tell you how happy and relieved I was that everything is going so well for this pair, and that the baby finally had such a good feeding, and that the mother didn’t end up losing her faith in herself, and in her body’s ability to feed her baby. The immense sense of satisfaction I felt as I left work this morning was indescribeable. It’s so nice to have such lovely patients, and to do work that you believe in so passionately (such as helping women breastfeed). I’m so lucky to love my job (well, love certain aspects of it, anyway), and to be able to feel like I’m making such a difference in people’s lives. Yes, I am on a breastfeeding high. Today, life is good.

And speaking of postpartum, guess where I ended up working again last night? Still haven’t seen a birth for weeks (boo, hiss), but I did get to do some great breastfeeding education with four women in particular. There is so much to teach when it comes to breastfeeding, though, that sometimes it’s incredibly frustrating, because you never feel like you have enough time to cram it all in—adequate hydration, and how to know that the baby is getting enough, and how to latch and unlatch, and reassure the mother that the baby is breathing just fine, and how to care for sore nipples, and how often to feed, and for how long, and when to switch breasts, and how to position the baby. You would want to spend at least an hour just talking about breastfeeding alone, but you have eight patients at a time, and inevitably three of them need pain medication and a third is asking for another ice pack and the fifth wants to get out of bed for the first time since her cesarean, and the sixth needs another IV bag hung, and breastfeeding always seems to get short shrift. However, I do try to spend as much time as possible on it, even at the expense of my break, or my charting, because I really believe that if a woman and her baby can have positive breastfeeding experiences while they’re in the hospital, they’ll be able to go home with so much more confidence, and not abandon breastfeeding for “something easier”. And it’s true, breastfeeding does require a lot more work than bottle feeding, especially in the beginning when both the mom and baby are still learning how, but the benefits are so obvious (granted, I am quite biased, but even so…do formula-fed babies ever look even 1/4th as blissed-out and contented as the breast-fed babies?? I think not!). By the end of the night, three of the babies were latching beautifully, with exactly that look on their faces. And I must be doing something right, becuase one of the couples even asked if I was willing to moonlight on the side and give them some lactation support at home in the coming weeks, which is an offer that is actually tempting (although the next question is…how much do you charge for something like that?).

However, the fourth woman I worked with had an adoreable little guy who kept insisting on sucking on his lips and tongue, no matter what we did. In fact, his tongue actually curled up towards the roof of his mouth, so that when you opened his mouth, you couldn’t see the roof of it because his tongue was always in the way. We tried so hard to get him to open his mouth by stroking his nose and lips in a downward motion, and then trying to get the breast in his mouth, but he never opened his mouth wide enough for that because he was always busy sucking on himself instead. The few times we were able to get his mouth open, his tongue was always in the way. At best, we were able to get his outer lips around the areola, but that was it. I feel certain that if we could have just gotten him a little taste of the breast, he would have been hooked. He was obviously hungry, but was self-conforting by sucking on his lips and tongue. I spent over an hour with her trying to get him to latch. Does anyone have any suggestions for how to get a baby like that to actually open his mouth? I think I’ll post this on a breastfeeding message board as well and see if anyone else has any tips either. I’m usually pretty good at helping women get their babies to latch, but he really stumped me. Gotta learn more. First, though, gotta sleep. Good night!