Expert: ruth kraft - 1/16/2009

Question
aloha im 22 weeks pregnant with my third child and i want to try breastfeeding again. with my first i was so excited to breastfeed and was adimant about going all the way with it. the first couple of days went by and i was doing everything that the nurses told me ( i called frequently just to be sure) it was painful, my son wasnt gaining the appropriate weight and when i tried to pump hardly anything would come out. maybe a ounce or two but thats about it. i was so sad thinking something was wrong and i panicked and stopped breastfeeding/moved to the bottle. two years later, i had my second child and was determined to try again. i breastfed from birth to about two weeks after ad the same thing pretty much happened again. i was feeding around the clock for long periods of time around 45 minutes or so on each side and baby would ALWAYS want to nurse. pretty much around every two hours sometimes shorter. she had one bowel movement in the first week and with talking to doctor/nurses/support lines they just said wait it out a little bit and thats normal. still at the 2 week check up she lost some weight and still hardly any bowel movements and the same thing, when i tried to pump nothing was coming. i felt discouraged when the doctor finally said supplement. friends told me how they'd done both but i began to get frustrated because how much formula/breastmilk, to feed before or after bottle that sort of thing and i just moved to bottle completely. now my oldest will be 4 on the 16 and my daughter will be 2 on the 14, and my due date coming up in may im trying to get all the advice again as possible and hopefully this time it will work out. i have small breasts, but ive been told that's no worry, and im a young mother( tomorrow i make 20) and ive been told thats fine too. i just dont know what happened before or what i did wrong but im not going to give up. any advice will be GREATLY appriciated. thanks so much.

Answer
I commend you for trying so hard in your first births. It sounds to be though your issues that you were doing the right thing the best you knew how. Sadly, your problem is fairly common as nurses and friends, although wanting to be helpful, are often not as versed in breastfeeding as they seem to think they are. there are many idiosyncrasies that can change how one person nurses their baby and what works best for them.

my guess would be, being that I wasn't there, that your latch and/or position was off. Pain and the indication of the baby not having many bowel movements. when babies are getting plenty of milk, they poop all the time... a couple times a day at least. that  can take a week to get to that point depending on how the birth goes etc. if you have a c-section, it can take longer and sections effect nursing.

There could have been a couple other things going on, but I will assume that there was likely a latch/position issue.

So, my suggestion to you, find a lactation consultant, or a breastfeeding councilor. or even a post partum doula who specializes in breastfeeding and hire them to come to the hospital after the baby is born for a couple hours, then also after you have been home for a few days, and another check at about 2 weeks. ( more or less if needed ) evaluate the latch,birth process and subsequent latches, evaluating pain or lack there of along the way... Because you seem to have had what is perceived as poor milk production  ( that was likely due to the baby not being latched well ) If you want a safety net, after baby is born, start pumping on the second day, every two hours until you see flow and nurse simultaneously.  pump or nurse first doesn't really matter ) this will help build the milk supply... its alot of work at first, but it will be short term.
if you find milk comes in on your third day as it should (4th is cesection ) you can reduce  your pumping frequency. pump for approx 10 min each side.

you can also take fenugreek, ( natural herb that comes in capsules) mothers milk tea, or blessed thistle ( another herb ) to help build supply if needed.

You have been told correctly that being young and also having small breasts has no bearing on milk production.

Also know, that babies will nurse all the time. for the first 6 weeks they instinctual nurse. they do it to build their immune system, get nourishment, connect with you and feel safe, which promotes brain growth, ( the more they are side by side with you the faster their brain grows ) and also they are teaching your breasts how fast they want flow etc... that takes 6 weeks. so expect for those 6 weeks to be every 2 hours for the first few and then moving to maybe 3 and a rare baby 4.

that being said, on their first day of life they should have a wet diaper , second 2 wet diapers, third 3 wet diapers and one dirty diaper, and it should get more frequent form there. how to know if your baby is getting enough? the diapers are the first thing, and alertness is another. if baby isn't getting enough they often become lethargic and sleep ALOT...

important things to remember: breastfeeding should not be painful. sometimes at first it can be uncomfortable while you have hormonal changes but it should not be painful. if baby is latching and it hurts, something is wrong. get it fixed as soon as it starts to hurt. call whoever you have hired ..if there is some uncomfortableness it should go away more each day. if pain is getting worse , its not hormonal. its latch.

baby mouth should be open wide, nipple point to the roof of the mouth and baby should latch with tongue down, and over the entire nipple. not the areola... just the nipple. they should look like a fish while latched.  puckered lips...  baby should be belly to belly... meaning babies should be laying on his side, facing your belly. they should be touching. the shoulder, hip and ear should be in a straight line for the baby to nurse perfectly and well for those first few weeks. as the baby matures and masters nursing this isn't as important. but if you can place a ruler on baby and get a straight line , shoulder, hip and ear, then he will get milk at a much better rate than any other position.

those are the most important points to remember. if you have a hard time finding someone or cannot afford their prices, you can also call LLL and find someone who does free breastfeeding concealing too. investing money into a doula or breastfeeding councilor at first will save you hundreds in formula down the road. and you and baby will be healthier and happier :)

I wish you luck .

Ruth Kraft
www.honoringwomen.com