I just want to say upfront that I don't want this to turn into a pro-breastfeeding, anti-formula feeding post. I'm not going to sit and spout on and on about the benefits of breastfeeding or the "horrors" of formula. I trust that many of you know yours stuff and know the arguments on both sides of the fence. So, I'm just not going to go there.
Also, I should mention that I have had a number of friends who truly could not breast feed. One friend of mine lost so much blood during delivery that from the beginning, no matter what she did, she was unable to establish a good supply. Another struggled with hormone imbalances of the thyroid that they were never able to get under control. Yet another had to go on a strong drug for disease treatment that would have caused her child harm. And countless more who have lost their supply because of stress, fatigue, or what have you, and were unable to produce enough milk. I don't want this to at all be construed as a critique of these women or even of women who choose to formula-feed right off the bat.
My main desire for this post is to instill some confidence in pregnant and postpartum mothers who desire to breastfeed. In those months leading up to the birth of my son, I was terrified of breastfeeding. I worried that it wouldn't work out. I worried that I wouldn't be able to figure out how to do it. I worried about sore nipples, incorrect latches, positioning, and most of all, milk production. I've had so many friends who lost their milk supply and I didn't want that to be me.
I was panicked, mostly because my perception of the difficulties behind breastfeeding were blown way out of proportion. Hardly anyone comes up to you and tells you their success stories. It's just one failure story after another and that gets a soon-to-be mommy worried. So, here are some things you should know.
1) For the vast majority of women, breastfeeding is possible. If you ask any woman in Bangladesh how many women she knows who are unable to breastfeed, she'll likely tell you that she doesn't know any healthy woman unable to do so. Now, we're not in Bangladesh and frankly, our support network for breastfeeding mothers in the West is significantly lacking. Largely, breastfeeding mothers in the West are sequestered alone at home, have little night help, and are juggling a number of responsibilities outside of the home (i.e school, work). Also, our Western culture is not as tolerant of breastfeeding as are the Bangladeshi. So, I'm not suggesting it's equal territory. However, as far as milk production itself is concerned, when underfed women in third-world countries are able to have such success, perhaps there needs to be some re-evaluation of cultural implications around breastfeeding rather than an assumption that breastfeeding is too hard or impossible for most women.
2) Demand feeding is the key. If there was anything, anything, that will affect your supply the most, it's how frequently and how long your baby feeds. There are a number of infant care books on the market suggesting that babies should eat less frequently and longer so they get full feedings and get more of the hindmilk. Unfortunately, these books are greatly lacking in knowledge surrounding lactation and sadly, are incorrect in their approach to establishing a lasting milk supply. I'm not going to suggest they won't help them sleep longer or whatever they're selling as the main point of their book. They have their place and their purpose, but milk supply isn't one of them.
While a mother may be able to maintain her supply in the first few months while feeding on a schedule, most find a dramatic decrease in their milk supply around 3-4 months of age. This is because in the early weeks and months, milk production is controlled by the hormones progesterone and prolactin while over time it moves to a supply-demand system. I have seen countless women who have suffered supply loss around the 3-4 month mark. Know that this type of supply loss is preventable as well as reversible.
Just as a side note, remember that breastfeeding accomplishes more than nutrition. On a strictly biological need level, it also quenches thirst. Babies should not be forced to be "hungry" for a feed because some feeds are to provide "food" and some are to provide "water." Do not force your baby into an eating schedule in the first 3-4 months of life. At that age they cannot manipulate so take them at their word when they tell you they want to eat. A baby who does not want to breastfeed will make it known (any mom who has been there knows what I mean. You cannot force a baby to breastfeed!).
If you're interested in the nuts and bolts of milk supply, here is a wonder article written by a reputable lactation consultant on the subject.
3) If you do experience low supply, there are ways to help. Most doctors will suggest pumping as a way to check or increase supply. However, there is something to note about pumping--pumping only tells you how much you can pump. Unless you are using a hospital grade pump, you will not be able to extract the same amount of milk as you would from your baby sucking straight from the breast. If you are returning to work or school full-time, check with your local hospital to see if you can rent or borrow one of these pumps.
Another device that many lactation consultants will suggest is a supplemental nutrition system. This is a tube-like structure that can be placed at the breast that delivers formula or pumped milk to your baby while they are suckling at the breast. The act of having the baby suckle at the breast will, in itself, increase your supply (provided any health issues surround the low supply have been addressed) while still providing nourishment for your baby so she is able to grow and thrive in the interim. This is a wonderful option for adoptive mothers or mothers who are hoping to relactate after losing their supply.
4) Talk to the expert. Your pediatrician likely isn't it. If you were having heart problems, your family physician could only do so much for you before they would turn you over to a cardiologist. The same is true of pediatricians and breastfeeding. Pediatricians have little, and often no, training in lactation science. They are taught the benefits thereof but many, if not most, cannot offer reliable help when it comes to breastfeeding mechanics or how to increase milk supply. If you find yourself struggling, seek out a lactation consultant or a La Leche League leader. They have been trained especially in helping breastfeeding moms. Your likelihood of success when seeking out their help is significantly higher than when referring to your pediatrician or left to your own devices and the internet. Again, imagine yourself trying to self-treat your heart problem using internet articles. If money is an issue, consider the cost of formula feeding vs. a consultation with a lactation consultant (ranging from $30-100). You will find yourself saving that much money in the first month of transferring to formula. A La Leche League leader usually will offer her services for free.
5) Keep baby close. Whether you choose to co-sleep or sleep separately, baby should remain in the same room as the mother for the first 11-12 weeks of life. This is because the close proximity of mother and baby helps to establish supply (it will also reduce your baby's risk for SIDS). While your head may know that you have a baby, your body also needs to know. Keeping your baby in close proximity, especially at night when prolactin levels are highest, will help to encourage a good supply. Wearing your baby in a sling or wrap, preferably skin to skin, will also help to increase and maintain milk supply.
6) Remember that you can't have your cake and eat it too--most of the time. Breastfeeding has its challenges. One of them is that you're the one on call, no matter what time of day, or night. I completely understand why some families choose to use formula in the nighttime so Dad can take a night feed. And I don't blame a parent for wanting their child to sleep through the night at an early age.
But, like all things in life, sometimes goals aren't compatible. Having a baby sleep through the night at 7, 8, 9 weeks old will often spell disaster for a mother's milk supply. I say often because it's not always true, especially if the baby started sleeping through without too much outside encouragement. In the first 12 weeks of life, a baby calling for night feedings should be seen as a necessity rather than an inability to put himself back to sleep. Whether breastfeeding or sleeping through the night is your goal, you'll need to evaluate which is your main goal and which is secondary. Only a family can make that decision for themselves. Or you can cross your fingers for a natural sleeper. Yeah, I did that...not so lucky. Maybe next time.
7) Accept help and take time for you. Most of us are offered plenty of help with the birth of a new baby, but we don't take it because of pride or what have you. But, if someone offers to hold the baby while you take a nap, take them up on it! (Really, who doesn't love to snuggle a newborn? Let them have the chance!) If you really need some time for yourself, take the babysitting offer from Grandma so you can go shopping or whatever it is that brings you happiness. More than anything, you need to take care of yourself. It may feel selfish, but remember that you taking care of you allows you to take care of baby.