Breastfeeding. The word brings up a lot. Some women are adamant that breastfeeding is the only way they will feed their baby; others feel neither here nor there about it; still others are confident they will go straight to formula feeding.
Regardless of what you decide works best for you in the tumultuous days and weeks following birth, it’s helpful to do your homework about options before your little one arrives.
I often liken birth to a wedding. We spend days and weeks planning for the floral arrangements, the appetizer menu, the wedding playlist—or in this case, the birth plan. Should I give birth in a hospital or a birthing center? OB or midwife? Epidural or au naturel? What if I need a C-section? Bradley method or hypnobirthing? And boom, the baby comes however they come (which they all do, one way or another) and you come home parent to a tiny human for which you may quickly realize you feel entirely unqualified to care for. Not unlike how after the much-planned reception is over, you wake up a wife and realize there’s a whole marriage after the wedding.
Postpartum planning isn’t as popular as birth planning, but it should be. A lot of moms feel blindsided. “Why didn’t anyone tell me it was this hard?” I often hear. “I thought breastfeeding would be natural.” I often say that breastfeeding just might be the hardest “natural” thing you do. Childbirth is also “natural” but I don’t know any moms who would say it is easy.
I could give you a bullet list of 25 things to know about breastfeeding but for the purposes of this primer, let’s start with two.
Attend a local breastfeeding group. While you’re pregnant.
Unless you grew up with a lot of siblings or around nieces and nephews, it’s likely you didn’t see breastfeeding much. And it’s even more unlikely that you saw a newborn nursing. Maybe you’ve seen an eight-month-old child nursing at a restaurant. But an 8-month-old nursing compared to an eight-day-old nursing may as well be comparing the local toddler ballet performance to the New York City Ballet.
The newborn weeks are some of the toughest in parenthood but oh so fleeting. Even if you are a veteran mom, you only had a two-week-old for a brief time. Not to mention that the memories of hardship with a newborn tend to fade away after about a year or so. By attending a breastfeeding group, you will see babies of all ages and stages, up close and personal.
Many childbirth ed classes incorporate lactation education (which I highly recommend) but nothing beats watching these little babes in action, in person, in the flesh. La Leche League groups are free to attend and will put you in contact with other local moms in a similar season. You can also find breastfeeding support groups through your hospital or local baby stores and clinics.
Find a lactation consultant. While you’re pregnant.
I’ll never forget my husband googling “lactation consultant in Queens, NY, NEED HELP NOW” frantically at 3 am with my first child, who was three days old and screaming incessantly. It’s a lot easier to find help before you have a three day old.
Ask around. Doulas are amazing resources and are highly connected in your local birth community. So are your care providers. They will be able to give you a few names of lactation consultants who can help. Put their numbers on your fridge. Get more than one name, because of the nature of lactation care, people want help right away and it’s easy for them to get booked up quickly.
As of right now, the International Board of Lactation Consultant Examiners (IBCLC) is the highest credential in lactation care and will have the best luck with insurance reimbursement. If you do not need such expert care, there are other certifications, as well as volunteers through La Leche League who can give fundamental advice and simple emotional support. Even when things go well with breastfeeding, many moms still often have a million questions, and every new mom needs a cheerleader.
Even if you saw a lactation consultant in the hospital, it doesn’t mean that things can’t go sideways once you are home. A lot happens in the first week or two with a new baby. They grow more in the first year of their life than they ever will again. Their oral motor skills are rapidly developing, and whatever you dealt with at 24 hours post birth could be an entirely different narrative by even day three or four.
The above suggestions are what I consider the two most important pieces of advice I can give pregnant women to set themselves up for breastfeeding success.
Once your baby has arrived, there are a few important things to look out for.
How to know your baby is getting enough milk
As a lactation consultant, a common question I hear is, “how do I know he’s getting enough milk?”
It’s a totally normal query. The most important numbers with a breastfeeding baby is their diaper output and weight gain, not ounces of milk or lengths or number of feeds. (Although those can provide helpful additional data.)
For the first four days of life, you want to look out for the number of diapers for how many days old they are. So for the first 24 hours, or at one day old, expect to see 1 wet diaper. At two days, 2 wet diapers. At three days, 3 wet diapers. After day four and onward, you want to see 4-6 heavy (or 6-8 less heavy) wet diapers and 1-2 dirty diapers.
The first 4 days can be like looking for a light switch in the dark. Before milk has transitioned into mature milk, it’s hard to gauge what they are getting and newborns are often so sleepy they fall asleep before they finish a feed. If you think your baby isn’t getting enough, make a call! A La Leche League leader, an IBCLC, or another breastfeeding expert is only a phone call away.
Assume you will have enough milk
True “low milk supply” is not as common as women think, and there will usually be other pre-existing conditions that increase the risk of low supply.
Milk supply in a healthy mom and baby is the perfect example of a demand/supply economy. Formula supplementation without any pumping can actually cause a low supply. You can drink the teas, make the lactation cookies, and eat oatmeal all you want, but the most effective way to make milk is to remove milk. If your baby is having a hard time removing milk (due to a baby’s oral restrictions, newborn sleepiness, weak suck, and so on) then using a breast pump is the next best thing.
I always say we just have to get the milk in the baby, and that part is easy if you’re pumping. Start off assuming that you will have enough. If you end up struggling with true low supply, an IBCLC is skilled in helping you meet your breastfeeding goals, even if that means moving the target a bit. A mom with a low supply can still nurse. It just will look different than a mom who is exclusively nursing at the breast.
Try your best to get over the hump
“I can’t do this.” “There’s no way I’ll be able to do this for x months.” “I’ll never make it to 6 weeks!”
The first months can be hard. Like super hard. I often tell moms to not even think about the x amount of weeks or months they’ll keep breastfeeding. Take it one feed at a time. Eventually, it really does get easier.
The hard work put in upfront pays off. Babies eventually latch like a pro (keep in mind they nurse about 10 times a day, every day; if you did something 10 times a day for three months, you’d be pretty pro at it, too). The learning curve is steep, but slowly, over time, feeds become much less of a production. That nursing pillow you had to use and just that way with this nursing cream and that burp rag just balanced there slowly fades into obsoletion. Next thing you know, you’re at a BBQ and covertly and adeptly latching your baby like no big thing.
When things don’t go as planned
Also like a wedding (and marriage), you can just about guarantee some things will not go as planned. For many different reasons, moms either choose not to breastfeed or determine it is not best for their family situation. A baby is still a baby and they need to be fed and nourished. Regardless of how a baby is fed, they still have developmental needs.
One of the greatest lies the breast vs. formula controversy has stirred is that one negates the other. Breastfeeding is the biological norm. Therefore any infant care should stem from a place that acknowledges this. Just because a mom doesn’t breastfeed doesn’t mean they still can’t meet their baby’s biological needs stemming from breastfeeding instincts. Some of the most nurturing visits I have are the ones where I help a bottle-feeding mom.
Here are a few practices that bottle-feeding moms can do to meet these needs:
Switch sides. A breastfeeding baby switches sides which is helpful for their eyeline development. If a baby is held in the same one position, it can create asymmetries. A bottle-feeding mom can still address this need by switching sides when bottle feeding.
Let baby lead feedings. Don’t make them finish a bottle if they don’t want to and don’t rely too heavily on schedules. Paced bottle feeding allows a baby to send signals that yes, they want more, or no thanks, that’s enough. Feeding is a baby’s first form of communication, long before they can talk. So let them communicate!
A baby has some days when they eat more and some days when they eat less (kind of like you!). Some babies want to eat in smaller quantities more frequently while others are happy to stretch feeds longer and eat more in one sitting. So watch the baby, not the clock. Feeding in any form is a wonderful path to bonding, there’s no reason a bottle-feeding baby should lose out on this crucial relationship-building opportunity.
Bottle feed while doing skin to skin. A breastfeeding dyad has skin-to-skin built-in, but there’s no reason a bottle-feeding mom shouldn’t get that extra dose of oxytocin that comes with good old-fashioned skin-to-skin and cuddles.
Wear your baby. No matter how you feed, your body is your baby’s home. It’s the only thing they’ve known for nine long months. By wearing your baby throughout the day in a wrap, it reinforces this and decreases the stress hormone cortisol for both baby and mom.
Whether it is a choice a mom makes or a choice she feels was thrust upon her, a lot of moms feel guilt and shame if they end up not breastfeeding. Every mom wants to give their child the best. At the end of the day, it’s nobody’s business but yours how you feed your baby. What matters the most is that moms feel they are given support and knowledge to make informed choices. This is why I am such an advocate for postpartum planning . . . before you are postpartum. If breastfeeding is something you really want to prioritize, put support people in place before you need them. And if you’re not so sure that breastfeeding is for you, know that you can still nourish your baby’s development no matter how you feed them!
The first 1,000 days from conception to age two have been proven to be profoundly impactful on a human life. No other period is as influential in determining health outcomes and long-term well-being. That’s because the brain is developing at a rapid pace. Experiences forge neuron pathways in the brain that are lifelong. Breastfeeding by design helps wire these connections, but they can (and should) still be fostered without it. The real scandal is that by shaming moms for how they feed and creating divisions between “breast is best” and “fed is best,” babies can get lost in the debate. Prioritizing the quality of environment and relationships a baby is surrounded by makes for stronger moms and families.
That’s it, folks. The two most important things you can do to set yourself up for success with breastfeeding is to watch real live babies nurse and find and ask for help. Everything else flows from these starting points. While preparing can help moms and babies have the smoothest transition, at the end of the day, it’s helpful to remember instinct is on our side: moms know how to take care of their babies.