Even new mothers who seem to sail through the first days of breastfeeding have questions: How do I know if my milk supply is enough for my baby? How long should the baby nurse? What can I do about sore nipples?
WebMD talked to Laurel Schultz, MD, a San Francisco-area pediatrician and mother of two boys, about some of the most common breastfeeding questions and concerns new parents have and how to deal with them.
What are some of the common breastfeeding problems you see among the new mothers in your practice?
I visit mothers in the hospital right after their babies are born, and I see them regularly after that, so I see a variety of problems: nipple soreness, improper latch (that is, the baby latches onto the breast in a way that causes trauma to the nipple), engorgement, breast infection, babies who won't wake up to nurse, and women with insufficient milk supply. I'd say that sore nipples are the most common breastfeeding problem I see.
The first time you see a new mother, what do you tell her about how long and how often to breastfeed?
I advise new moms to pace themselves in the beginning and not to nurse for long stretches, so their nipples can build up to it. I tell them, "These are your first steps in a marathon: You don't want to get exhausted at the beginning of the race." I cringe when a new mom tells me that she just nursed for 45 minutes because I know she is going to feel it the next day.
In terms of how often and how long to nurse, I advise new moms to do 10- to 15-minute sessions on each breast. At the same time, I encourage them to nurse frequently -- every three to four hours or so -- to build up milk supply. Also, colostrum, the early milk, is very nourishing, so I like to see the baby get plenty of that.
Some doctors recommend a schedule, but I think it's going to depend on the baby: Some will nurse every two hours; others will nurse every four.
Sometimes people become concerned if they're told their baby has lost weight in the first few days, so I remind them that it's normal for newborns to lose 10% of their body weight in the first few days of life.
What do you tell new parents about the first few weeks after they bring their newborn home?
New parents tend to overdo it. I advise people to keep the number of visitors down. If your husband's brother comes to visit and you're chitchatting with him, it may be hard to ask him to leave the room so you can nurse. When you're not nursing your baby, you should be resting.
I urge people to keep their expectations down in terms of what they need to do in those early weeks. I hear people bragging about walking to Starbucks two days after their baby is born. But I advise new moms to rest at home with their baby -- not just for infection control, but for their own well-being.
I tell women, "This is your chance to be a princess. Let people fill your water glass, let people bring you meals." We aren't used to letting people take care of us, but that's what you need to do in the beginning.
What do you suggest if your newborn is really sleepy? Should mothers wake babies up to breastfeed them?
It depends on how old the baby is. I tell new parents that every day is different, and my advice changes every day.
On the first day of life, I tell parents not to worry if their baby sleeps. The usual pattern with a newborn is to nurse a little right after birth and then go to sleep -- sometimes for 24 hours.
After that, my advice depends on how much weight your baby has lost. If the baby has lost a lot of weight, I encourage parents to be more aggressive. If the baby is still really sleepy by the second or third day of life, when the mother's milk in, I advise the mom to get the baby undressed and feed her or him tummy against tummy. You have to get the baby out of the swaddle.
After those first few days, if a baby is really sleepy and has lost more than 10% of its body weight, we advise supplementation: baby formula or pumped breast milk. New parents often resist giving their baby formula, but at that point I really start to push because it's a medical issue. Usually, after a couple of days, the baby's weight is back up, and we can stop supplementing.
How can you tell if your baby is getting enough milk?
I judge that by keeping an eye on the baby's weight.
When do you recommend that parents introduce bottle-feeding? And is nipple confusion a real problem?
I recommend that parents start a bottle between 21 and 28 days. It's a mistake to wait too long after that, or you may have trouble getting your baby to accept a bottle at all.
I encourage new parents to introduce a bottle. I think it's great for dads to have an opportunity to feed the baby and for moms to get a break, and for parents to be able to have a date night, so they can nourish their relationship. When I advise parents to introduce a bottle, I often turn to the dad and say, "Wouldn't you like to have a chance to feed you baby?" They always say, "Yes."
Nipple confusion is actually pretty uncommon. Only a small percentage of babies have it. Having said that, you don't want to introduce a bottle too soon in case your baby is part of that small percentage that do have nipple confusion.
In my experience, it's usually the parents who give up nursing, not the child, because the bottle can be such a convenience. Once they see how convenient it is, it can be a slippery slope if parents aren't really clear about what they want. Parents have to be committed to breastfeeding to keep it up.
Do you recommend that new mothers avoid certain foods while breastfeeding?
I tell women to eat a healthy diet and observe what happens. Let your baby declare himself if he has an allergy -- if he does, it will show up by four to six weeks.
If a baby is colicky, it could be caused by diet sensitivity, but this is the case for only a small minority of kids. On the other hand, if you see a connection between your baby's distress and certain foods, by all means cut those foods out of your diet.
I tell mothers to eat gas-producing vegetables -- such as cauliflower, broccoli, and brussels sprouts -- in moderation. Extremely spicy food should also be avoided. I also advise mothers to avoid foods their child's father is allergic to because there's increased risk that the baby will be allergic to those foods as well.
As far as wine and caffeine, a glass of wine or a cup of coffee with a meal is OK, but don't overdo it. In general, I think people are too sensitive about diet issues and nursing, and many of the behaviors they blame on diet have nothing to do with that.
What kind of support do you recommend to a mother who is having breastfeeding problems?
I routinely refer patients to lactation consultants. I'd say that over half of my patients see a lactation consultant after their babies are born, even if they don't have a significant problem, just to get some guidance and advice.
I also refer people to La Leche League on occasion, depending what the problem is. It turns out that LLL has excellent advice for weaning an older child, which is kind of surprising.
Are there mothers who simply can't nurse for physical reasons or because they don't produce enough milk?
Yes, and I've actually seen a fair number recently. Some women can't nurse because they've had breast surgery. Others can't nurse because they're on certain medications that could harm their baby. In many cases, they stop taking the medication during their pregnancy, but their physician wants them to go back on once the baby is born.
Very few women can't breastfeed because they produce insufficient breast milk. This is rare, but it does happen, and I want to support these women and make it clear that it's not just a failure of will. Despite their best efforts, some women simply can't produce a sufficient supply of milk.
What do you tell parents who don't want to breastfeed?
This is really rare -- I'd say one in 30 of the people I see don't want to breastfeed.
When a woman says she doesn't want to breastfeed, I find out why by asking just one or two questions to determine if the decision is based on a misconception. If it is, I try to clear that up.
If a woman has thought through her decision and has no misconceptions, and it seems like a mature decision, I don't try to persuade her -- that would be disrespectful, I think. But I also tell her that it's very hard to bottle-feed in this society and that she may get some bad reactions.
There is a very strong bias in favor of breastfeeding out there, which is probably a good thing, but it can be hard if you don't do it. I also tell these parents that my formula-fed babies turned out just fine -- they're healthy and smarter than I am!
And for women who have to give their babies a supplemental bottle of formula, I reassure them that this doesn't negate the benefits of breastfeeding. It's the same as having complications when you're giving birth; it doesn't negate the experience.
Breastfeeding is like parenting in general. You can read about parenting and learn a lot, but it's like reading about swimming: ultimately, you can only learn by doing. You have to just dive in.
