30 Breast Feeding Lessons from a First Time Mom

Ok, when I was pregnant and preparing for life with baby, I really (quite naively) thought there wasn't much to breast feeding. This was reinforced by the fact that my mom kept telling me it would be fine and easy (since that was her memory of how it was when she had me). I got the same vague feedback from my mother-in-law. Compounding this was the unfortunate circumstance that my husband and I missed our very last birthing class, the one in which the group learned for three hours about newborn care and bringing baby home. So I was wholly unprepared for how challenging I would find the breastfeeding experience to be.

In addition, I'll add that my situation was fairly un-problematic compared to some-- I had enough milk, my baby was interested in nursing, I didn't have other underlying medical conditions that posed barriers. Also, my baby was full-term, healthy, and so was I at the time of her birth. I also had a vaginal birth, so I wasn't dealing with recovery from major surgery or a cesarean wound that would limit breast feeding positions for laying the baby across my abdomen. However, even with all this good fortune, I still really struggled! There were days I felt so alone and enveloped in despair and failure. This hopefully just underscores the idea that even if you're seemingly set up for success, breast feeding does require some knowledge and work--- a fact that I was completely unaware of prior to going through the experience.

With that said, here are the major lessons I learned as a first-time breast feeding mom (my baby is currently 4 months and we are still going strong-- a feat I could not imagine was possible in week 1!!)

The Latch

1. The latch is integral and needs to be learned (in my case) by both the mom and the baby. A good latch looks like this:

Image taken from https://www.ameda.com/milk-101-article/reducing-breastfeeding-pain-starts-with-deep-latch/

Here's another good diagram showing the mechanics of a good latch: 

Image taken from https://www.pinterest.com/mcclinton92/breastfeeding/

One tecnique I discovered during my breastfeeding journey for getting the latch right is called the "flipple". See it posted to one of my favorite accounts  called Legendairy Milk on facebook here.

2. I was fully unprepared for three dynamics of the latch:
a) How can you tell if the latch is correct?
b) How much of your nipple and tissue really needs to get into your baby's mouth to ensure it is correct?
c) What the hell are you supposed to do if the baby just continues to not get it right?

3. Answer to 2a) above- A good latch really should not hurt at all. I was confused about this because I thought it was supposed to hurt for the first 1-2 weeks. I had read both perspectives on mommy blogs online- that it shouldn't hurt AND that you should expect it to hurt at first. In my case, the latter was false/ a misunderstanding. That is, in my experience, I came to understand that some slight "discomfort" when getting started was acceptable (and over time I came to not have any discomfort at all), but any immediate, sharp, pinching pain was a sure sign that the latch was wrong. 

4. Answer to 2b) above- a lot of breast tissue needs to be in the baby's mouth, in addition to the complete nipple. See diagram above. Any position in which your baby just has their lips on your nipple will cause pain and indicate an incorrect latch. I've heard this called "straw sipping".

5. Answer to 2c)-  If you have pain, then you need to break suction in the baby's mouth (use your finger like a fish hook in the corner of their mouth and pull gently to remove their suction from the nipple) and try again. This is the only way for both you and the baby to learn the proper latch. You may need to relatch 50 times in one nursing session but it's imperative that you don't let baby continue sucking with a poor/shallow latch because you will cause yourself more pain if you do, and the baby won't learn good habits. 

Image taken from https://www.pinterest.com/mcclinton92/breastfeeding/

6. What are actual mechanics and methods for getting the baby to get a good latch? This was my million dollar question. It seemed I read over and over that you need to relatch if it's wrong, but I then would just have the same problem over and over without know how to do it better. So here are a few methods I learned:
a) The baby can't really latch well or transfer milk well (re: suck down a good quantity) if their chin is tucked in close to their chest. You want them to have their head tilted upward so they are reaching forward for the nipple. One method to get them positioned in this way is to use the cross cradle, and start with the baby at your middle (their head right in between your right and left boob). Then gradually slide the baby closer to the nipple you want them on but allow them to "reach" for it with their neck, rather than starting them out parallel or too close to the nipple.
b) When getting started, move the baby close to the nipple, then tickle their top lip or even below their nose with the nipple, then wait for them to open their mouth really wide (they call this a gape), then while the mouth is super wide, press the supported baby head/neck toward the nipple. If you don't bring the baby to the nipple at the right timing, say when their mouth is not fully open, then they will tend to get a shallow latch that will hurt and you'll have to try it again.
c) If you're really struggling to get the latch right, start over from the beginning and try the newborn "breast crawl". This means you lay back, put the baby on your belly, support them slightly on their sides so they don't slip off of you, then let them crawl to your boob. They'll instinctively plop their face onto your nipple and usually get a good, deep latch naturally. If nothing else is working, then practice this so that both of you can get used to what it's supposed to look and feel like. 

7. What will happen if you try to nurse with a poor/shallow latch? Your nipple will be hitting the hard pallet of the baby's mouth (feel the roof of your mouth with your tongue-- first you'll feel the hard pallet and if you go further back toward your throat, it will soften up to your soft pallet). If your nipple doesn't get sucked far enough back to the soft pallet, it will hurt. If this continues frequently enough, you will not only have pain, but your nipples will get misshapen (get the shape like a fresh lipstick) and eventually scabbed. Here's a diagram showing the pallet differences:

Image taken from https://www.pinterest.com/pin/543809723747333541/

8. One way to check that the latch is good (aside from the absence of pain) is to check that the baby's lips are flanged out- the top lip should be flipped up and the bottom lip should be flipped down, like this:

Image copied from https://www.pinterest.at/pin/571042427722288865/

Pumping

9. If you are committed to having a successful breastfeeding experience, you typically should be emptying your breasts 8-12 times per days (and your baby may not be able to complete this for you depending on your supply). This is because you want to avoid getting a clogged duct which can lead to mastitis and you want to keep your milk supply up. This means you may need to pump the extra milk out, even if you're exclusively breastfeeding. This was a complete surprise to me, that I had not read about anywhere and no one had mentioned to me. You'll be able to tell whether you need to pump or remove extra milk that the baby isn't getting out if your boobs remain hard/engorged even after baby has nursed, or if you try hand expressing or pumping and there is still a lot of milk flowing. In my experience, pumping was more commonly needed in the beginning (between weeks 1- 8) before my body knew how much milk to produce to keep the baby fed. Emptying your breasts regularly will also increase your milk supply because empty breasts will refill. 

10. The ideal duration to pump with an electric breast pump is between 10- 15 minutes, or until the milk stops flowing. A lactation consultant I worked with told me to pump for 12 minutes, which is what I did in the beginning when I was getting used to the process and didn't yet know my body or what I was doing. That amount of time was usually sufficient for my milk to stop flowing (i.e. the pump keeps going but you don't see any drops or sprays of milk coming out through the flange). You typically don't need to continue pumping if no milk is coming out-- though there are some practices that encourage long duration pumping in order to increase supply. 

11. The best methods for pumping are: electric, hospital grade pump (I got mine through my health insurance for free), a manual pump for which you squeeze a handle to remove milk, or a silicone pump called a Haakka (or similar off-brand version). Any of these will allow you to remove milk well to empty your breasts. Some women do hands-on removal by which they squeeze their breasts to remove milk, but I never got very good at that and prefer to use a device to help me pump.

Storing Milk

12. Our midwife and pediatricians told us that you can add fresh milk to any bottle or storage device that also has liquid milk in it. Liquid milk can be stored in the refrigerator up to a week. In other words, don't add fresh milk to frozen milk. Here is a guide from Medela on milk storage best practices:

13. For storage, I ended up using Lansinoh bags in 6 oz quantities, but later read about a storage method that is zero waste. In this method you put milk into ice cub trays then store the cubes in jars or other containers. Then grab however many cubes you think baby will eat in one sitting and melt them. This allows you to avoid one-use plastic for storage and to better calculate and melt only the amount you will need per feeding.

Uses for breast milk (other than feeding)

14. Occasionally you will come across milk that is not appropriate for feeding, such as if it's left out on the counter un-refrigerated for too long or not frozen in time to still be good or if you have some alcohol and don't want to feed it to your baby (I've read that as long as you are sober enough to operate a vehicle, your milk is fine to feed to baby). In these cases, don't throw your milk away! It can be used for other purposes. For example, breast milk is extremely good at healing skin issues if you apply it topically, for both you and baby, so keep it and use it for:

• baby acne
• baby eczema
• stretch marks
• cradle cap
• diaper rash

I discovered that if I bought a small spray bottle or roller bottle and put just a tiny quantity in each and then refrigerated them, I could apply it topically as needed and it really helped the above issues. Alternatively, I've read that you can dump in just enough to make bath water cloudy, and then either bathe baby or yourself and this can help heal skin issues. Last, I've read that you can mix it with coconut oil to make a lotion. So don't pump and dump! Keep it and apply topically!

Clogged Ducts

15. If you do get a clogged duct, here are the symptoms:

• pain at a particular point in the breast tissue
• redness near the clog (if it get's infected and progresses to mastitis, it will start to burn and be hot to the touch)
• decreased milk output from that breast
• a hardened mass in the tissue where the pain is

16. And here's the common protocol for remedying a clog:

• massage the clog (I was told to do this aggressively). But counter-intuitively, I later read the you should massage the part of your tissue closest to the nipple first, and work your way back. This works such that you are removing blocks in the front so that milk behind the clog can come out; the metaphor I heard was that this works like a traffic jam- you need to remove the piled up "cars" in the front that are causing the back up before the line of cars in the back can get through, rather than trying the force the cars in the back to build pressure on the jam (which won't ultimately work).
• take the hottest shower possible and continue massaging the breast tissue near the clog
• take sunflower lecithin to thin out your milk
• drink a gallon of water per day (this will also thin your milk and keep you hydrated to prevent an infection, aka mastitis)
• fill a Haakka silicone breast pump or even a bowl of water with warm water and epsom salt, and dangle/bathe the breast in this concoction for 10- 15 minute intervals ever hour. (Make sure to wipe off your breast before baby feeds again because you will be salty).
• keep breastfeeding! This is a tough one because it will likely be very uncomfortable to nurse when you have a clog, but every resource I found agreed that having the baby suck out the clog is the most effective way to clear it. If you need to take pain meds to manage this, then do so. I took acetaminophen in 600 mg quantities to manage the pain and continue nursing the baby when I had a clog.

17. How to prevent a clog? Drink enough water, feed the baby frequently on both breasts, pump regularly when baby is not emptying breasts, don't allow yourself to get too engorged and stay that way, take sunflower lecithin. *Note that if you have a strong letdown or overproduction of milk, sunflower lecithin (re: thinning out your milk) will exacerbate the problem, so you may need to pump or hand express milk in the begining of each session to keep from overwhelming the baby.

Mastitis

18. Mastitis is an infection you can get if you get a clogged milk duct and fail to clear it in sufficient time. To prevent this, the best thing to do is to do the steps above to clear the clog before it progresses to an infection. That said, I did almost everything mentioned above and was not successful at clearing my clog, and it progressed to mastitis within 24 hours (it can happen faster too!) Symptoms of mastitis include:

• redness of the skin over the part of your tissue that is clogged
• burning sensation and heat radiating from the reddened clog
• increasing temperature and fever
• headache, shakiness, general malaise, and feeling pretty "sick"

19. To treat mastitis, you should immediately call your medical provider. For me, they prescribed a 10 day course of antibiotics, and I understand mastitis is considered pretty serious so they wanted me to take immediate and swift action. You will likely feel pretty sick, in addition to the pain and discomfort in your breast tissue. The biggest treatments you need to do at this point include:

• get antibiotics if prescribed
• rest (alert your support system that you have mastitis and need extra help with the baby because you won't heal if you can't rest)
• drink a gallon of water per day (120 oz)
• avoid sugars to the extent possible (this is especially important if you are prescribed antibiotics because you will be at risk for developing an overgrowth of yeast)

Once you employ these protocols, keep nursing and eventually the clog will clear. I was very confused about this in my case, where I wondered if I needed to keep trying to clear the clog myself even though I already had mastitis. My providers said to relax on the effort to clear the clog once I was on antibiotics, and instead to just focus on resting and healing like I would if I had a bad flu or cold. The clog will clear itself with time- mine cleared within 2 days of getting antibiotics. Do not continue aggressively massaging, but do continue nursing.

20. My mastitis yielded a severe yeast infection due to the strong antibiotics, so watch out for that! If you do get prescribed antibiotics and get any symptoms of yeast, do the following:

• immediately adjust your diet to avoid sugar, carbs, caffeine, dairy
• eat lots of veggies and good fats, including avocados, coconut, salmon, almonds
• take a good probiotic (avoid the "smoothie-like" probiotic shakes that often contain a lot of sugar)
• eat coconut oil, add it to drinks, salad dressing, replace butter and other oils with it and apply it topically as needed
• drink and apply grapefruit seed extract oil as an anti-fungal as needed

21. If you do get a yeast infection due to mastitis and antibiotics, work really hard to prevent the yeast from traveling into your milk ducts and accordingly, to thrush in the baby's mouth. Do this by religiously doing the protocols above in #20, and adding in gentian violet if needed (be careful, it will stain all with which it comes in contact). In my case, I got yeast rashes all over my breasts, and treated it with the very strict diet above (also called the anti-candida diet), took an oral probiotic, applied coconut oil, grapefruit seed extract and hydrocortisone cream 1%. I was advised not to take any antihistimines because they would decrease my milk output. After religiously practicing all of this for about three weeks, I was grateful that it worked well to provide me relief and keep the yeast from infecting my milk ducts. 

Pillows

22. Pillows will really help with breastfeeding when you're getting started and the baby can't hold their head up and you're not yet that comfortable supporting their little bodies completely. I ended up really liking the Boppy pillow with a waterproof cover (your baby will inevitably end up spitting up on it). But I have a friend who swore by the Brestfriend (I don't know, she lent it to me but I could never really quite get it to be comfortable for me-- after having baby, my boobs were huge so maybe that's part of it?). Also, when the lactation consultant came to our house, she recommended simply piling up multiple bed pillows on both sides of me and this worked really well too. 

Positions

23. The cross-cradle worked best for me in the newborn phase because it requires you to support the neck. Dangle feeding is good if you have a clog (you literally lean over the baby on hands and knees to get the boob in their mouth). The breast crawl is good if you have a forceful letdown because gravity literally limits the spray. Side lying, though it was challenging for me at first, became my best friend for nighttimes and for the forceful letdown.

Forceful Letdowns

24. A forceful letdown is when the power of your letdown is too much for the baby to handle well, and they end of gasping and choking because there is just too much milk for them to swallow at once. You can manage this situation by:

• using the side-lying position- it allows extra milk to dribble out the side of the baby's mouth so they don't get overwhelmed
• pump or use the Haakka before feeding to lessen the flow
• pinch the nipple or aereola to slow the flow down
• avoid taking sunflower lecithin
• make sure to exclusively breastfeed for the first 8 weeks so your body learns how much milk you actually need for baby
• if you're not totally engorged and/or don't think/feel you are at risk for getting a clogged duct, avoid pumping as much as possible. This is because the more frequently you empty your breasts, the more frequently they will refill themselves. So if you're pumping all the time, your body will produce more milk. This is a difficult feedback loop to avoid, wherein you have milk, so you pump it to avoid a clog, but then you produce more milk than the baby needs, so you have to pump it, etc, etc. I ended up just creating a huge freezer stash early due to this situation-- but I preferred to pump the extra milk thereby taking preventative measures to avoid the clog rather than prevent the oversupply. 

Tongue Tie

25. Our baby had what they call a tongue tie, which basically means the tongue can't stretch out long enough to remove milk and latch well. Our doctor recommended that we clip the tongue tie on day 3 after birth because we had the following three symptoms: baby was losing weight, I had misshappen nipples, and I had extreme pain and scabs on my nipples. We were told that there was a chance the tongue tie would stretch out naturally over time, but it might not. Also, surprisingly, the doctor looked at my tongue and said I had one too although my mom said she didn't remember ever having pain or trouble breastfeeding me. They said the only risk was that it might not work (i.e. might not relieve breastfeeding difficulties). They also said it should not hurt the baby, would be quick, and was not putting baby at risk of other problems. We opted to do it, which seemed to help things briefly, but then we needed additional help to completely remedy breastfeeding challenges. When the doctor completed the clip, it was extremely fast (a matter of seconds), baby didn't even cry, and there was no blood or noticeable scars whatsoever. 

Water

26. Keep in mind throughout your breastfeeding journey that water is milk- the more water you drink, the more milk you can produce and the less risk you are at for clogs. I could never figure out how much I should be drinking until I got mastitis and then was told I should aim for a full gallon per day (or 120 oz's). I had previously been drinking barely 60 oz's per day, so I was well below the optimal amount. 

Fore milk versus Hind milk

27. Your milk is comprised of two basic components: fore milk and hind milk. I understand fore milk is the watery, sugary component that usually comes out in the beginning of a feed, and is then followed by hind milk, which is the thick, fatty part that contains hormones that put the baby to sleep. In order for your baby to gain weight well and to sleep well, you want the baby to get enough hind milk. That said, we did some experimenting based on advice from one of our midwives, to keep the baby on one boob for a two hour block, before switching to the other in order to get her more hind milk (this is called block feeding). In retrospect, we believe this led to the clogged duct situation because I wasn't emptying both breasts frequently enough. So another midwife told us to ignore this advice and try to feed the baby from both breasts at every feed. In order to ensure that baby is getting enough hind milk generally, practice allowing baby to feed for as long as they want-- in other words, don't pull them off before they're through. Once they seem to "finish", i.e. pull themselves off, then burp them, and try topping them off on the other boob. This worked well for me.

Colostrum

28. Colostrum is the "liquid gold" that is in your boobs immediately following delivery before the more "white" and "watery" milk fully comes in. It's in very small quantities (just a few tablespoons). But this milk is super special, in that it has substantial healing properties. So keep any colostrum you're able to either pump or hand express and feed it to baby if they get any colds or sickness. 

Milk Killers

29. Beware that the following will kill your milk supply:

• peppermint
• antihistimines
• dehydration
• lack of pumping or feeding
• stress
• improper latch or not fully emptying breasts

Resources

30. Seek out help and resources via the following:

• Legendairy Milk
• Local Lactation consultants
• La Leche League
• Kellymom
• Takingcarababies

Hopefully this helps all the new breastfeeding mommas out there!