10 things I wish I had known about breastfeeding before starting (and a few things I’m glad I already knew)

After 20 months of feeling like a cow, including pumping away and storing seemingly infinite quantities of milk for my little one, and now still nursing my toddler, my brain is teeming with advice regarding breast feeding. Thankfully, I think I have some willing readers. Many of us new moms are breast feeding, and some of us are doing so with moms who never breastfed us. How smart and healthy could I have been, mom, had I been breast fed?  We will never know!

Just kidding, we all turned out all right. But nursing and pumping and going through the daily strategies of the routine is a challenge, and it helps to have a village to discuss it all.

I must apologize to readers for not having produced this blog post sooner. The recesses of my brain prove less reliable than I imagined in reminding me what I have already shared on the blog. After discussing my pumping experience with many people I had thought I had been posting regularly about nursing and pumping, but as I go through archives . . well . . .aside from discussions of my personal experience, I have precious little reference to the resources which helped me early on while nursing. As I go through these nuts and bolts, while I am stressing some of the more challenging aspects of breastfeeding, please know that despite all the challenges and difficulties, nursing my child has been totally and completely worth it. I feel very fortunate that I have been able to breast feed successfully.

So without further ado – here are . . .

10 things I wish I had known about breastfeeding and pumping

  1. Even under perfectly normal and healthy circumstances, breastfeeding can be painful.
    From the moment my son latched on – with a particularly strong latch – I seemed to be the only one concerned with “latch problems.” My doula, midwife, and lactation consultant were all satisfied with my son’s latch, but I could not get over the discomfort, which took awhile to get used to and finally relieve. This is not to say that breastfeeding *should* be painful – ideally, it should be quite comfortable, but there will be many times when it isn’t. As the breast gets used to frequent latching, especially during those early months when a baby may be feeding every hour, feeding can be quite uncomfortable. In this case, it required me to get help when I needed it: so don’t forget to contact a lactation consultant, a friend, seek medical interventions, whatever works for you. But if breast feeding isn’t working for you, seeking help is the important thing. And remember that the discomfort doesn’t necessarily end after the early months. When your child is developing teeth and starts biting, it takes endurance and strength to teach them not to bite, and it takes courage to get through the more dramatic bites without crying out to the point of frightening your child. Be prepared for challenges like these along the way.
  2. Breastfeeding can be the most aggravating experience of your new life with your child.
    Before I started nursing, I viewed breastfeeding as an unbeatable way to share a bond with a child – a close experience, profound in one’s ability to nourish a tiny, living being. And that it is. At the same time, however, it has succeeded in also being the most aggravating thing about raising my son.  Sleepless, delirious nights plagued my early weeks of nursing, when it seemed that for hours at a time my son wanted to nurse. I couldn’t get any sleep – no sooner would he finish a feed when I would burp him, and after what seemed like 30 seconds to a minute he already wanted to feed again. While those days passed (fortunately), never in these nearly two years have I felt completely free – my son still nurses and wants to nurse at night, and I haven’t had a full night’s sleep from day two of having a baby until today. It’s a tough thing to be so needed so constantly. Yet – when I c ome home and my son reaches out to me, and demands time to cuddle with only me at certain times in the evening – the value of the bond is steady before my eyes.
  3. Entertainment during nursing is essential to a mom’s sanity.
    Even though your child’s mind may be very much occupied and awake with the idea of feeding during those all too frequent middle of the night feeds, momma’s mind on the other hand is likely about to fizzle out. It was all I could do to stay awake during late night feedings during those early days. My personal solution? Get on my iPod touch and read cloth diapering blogs . . and more blogs and more blogs and more blogs.  Not a terrible way to pass the time, but I wish I had been reading more books (hello, Kindle) or listening to audiobooks, which are a favorite pastime of mine anyway. Or maybe reading medical literature. Basically, try to find a way to be awake in the dark without disturbing the whole household — and without falling asleep while feeding your baby. If you can figure out a way to read something useful while nursing, do it. (I couldn’t – my mind would just go blank whenever I had time to think to myself . . still does).
  4. A pump is a pump is a pump.I admit that this is not always true – for moms of NICU babies a hospital grade pump is essential.  But I admittedly agonized way too much over which breast pump to get – do I get the Pump in Style? The Ameda Purely Yours Ultra? Simplisse?  (I chose the Ameda) . . but does it really matter? If you have a reputable brand just be happy with it and don’t worry too much. I spent a long time choosing a pump and now, after having used one for a year I know I loved my pump – but I probably would have loved any pump.  The same goes for bottles – we had several brands including Breast Flow and Dr. Brown’s, and both worked well. More important than the pump is having a quiet place to pump, getting into a good routine, staying organized, and having the right resources available at the right time.  E.g. Always keep spare pump parts with you – see this blog post. ‘Nuff said.
  5. Frozen Milk is mainly for emergencies.
    When I started the pumping process, I found woefully little in my nursing guidebooks on pumping and how to really go about it. It took a lot of blogging and emailing women and talking with women for me to figure out a truly good pump routine. One golden rule: Remember that refrigerated freshly pumped milk can last a week, but frozen milk should be used within 24 hours of thawing. So at work I pumped into my ameda bottles (and into evenflo glass and medela bottles actually) and instead of moving them to plastic to freeze immediately, I would use the previous day’s pumped milk for the day’s feed. I would label the milk according to the age of the bottle and try to use the oldest bottles first.  By the end of the week, I would take whatever extra bottles I had accumulated and store the milk in Lansinoh milk bags for freezer storage, and I would make sure to either pump once over the weekend or to keep a days’ worth of milk for the next week. Now how much milk is needed per day? The rule of thumb is that a breast fed baby needs one ounce of milk for every hour mother will be away from them.  So in actuality it was much less milk than I thought. (see below). Storing milk in small quantities is also essential to avoiding wastage – at most daycares they are requried to discard milk if it hasn’t been completed within an hour of removal from the refrigerator. When I sent L to daycare I started sending milk in 2 ounce quantities, and gradually progressed to 4-ounce bottles, most of which he would drink. And when getting milk ready to feed, don’t worry if a little fat accumulates on the side of the bottle – just swirl it out (do not shake). Frozen milk is best there for emergency purposes – my son hated drinking it, and it made his stools runny, but it was a good backup if we ran out of fresh milk or for days when I hadn’t been able to pump as much – or on the few Mondays when I didn’t have a full day’s supply of fresh milk stored and ready to go. It is good to have the frozen milk in quantities equivalent to a bottle you would use for you infant, because you can thaw the whole bag immediately in water and use it immediately, rather than thawing it overnight. Here is a helpful handout I found on DrMilk.org that you can use or provide to adults taking care of your breastfed infant.
  6. Breast fed babies do not necessarily bottle-feed as high a volume as formula fed babies drink. 
    From residency I always thought that infants should increase their volume intake as they get bigger. First you want them to drink 1-2 ounces and later 4 ounces, then 6, then 8 ounces a feed. This seems to work for bottle fed infants, who have a much higher flow of milk from the bottle for the effort they put in, and the same caloric intake to each sip of milk they take. But the same does not go for breast fed infants – first of all, hind milk (high fat content) has very different nutritional value than foremilk, and depending on the woman, the caloric value of breast milk can vary a lot. Even as a baby grows, the fat content changes – for older children, breast milk volumes taken may be smaller but the milk has a high nutritional value.
  7. Don’t overpump
    Initially I thought I’d have trouble pumping and got discouraged because I was only pumping 1-2 ounces a session. This amount at first is TOTALLY NORMAL. Don’t worry and keep at it. Once I started pumping regularly at work I did fine, but was so worried I wouldn’t pump enough that I tried to pump 4 times a day – once before attending work, once in the morning, once at lunchtime, and once in the afternoon before leaving work. This was way too much pumping and I could have gotten by with 2 sessions a day (and in fact I did get by with this), so use your judgment. There is nothing wrong with starting with extra pumping sessions, but remember that once you start pumping and if you continue, your body will make that much more milk and you may have engorgement and pain when trying to wean the sessions, so use your judgment. If you accumulate as much as I did (to the point where I had to donate to two different women) you will run out of freezer space quickly. Initially, try to have at least several days worth of milk available when you are starting daycare/nanny so that you have enough to meet your child’s patterns. For freezer reserves (it is best to keep a few day’s worth of milk in freezer storage – about 60 ounces is plenty.). I used Lansinoh storage bags because they seem most economical and store flat and never leaked. Remember to put the plastic bags inside another plastic bag or a box when storing in the very back of your freezer – if you do have a leak from a bag then your milk is wasted. and you want to limit temperature changes and air exposure of your bags of milk to keep it best. But unless you are relying exclusively on pumped breast milk or have to get milk from milk banks/other suppliers (and thus have increased needs for stored milk), save yourself the time and don’t overpump an army’s worth of milk. At one point half my freezer was dedicated to milk storage and I had no room to put food into it!
  8. All MD breastfeeding Moms should learn about Dr. Milk.org (Mothers Interested in Lactation Knowledge)
    This website and the associated facebook group (membership is for physicians and by invitation only) is a great resource created by Dr. Laurie Jones, a physician and international board certified lactation consultant (IBCLC) in Arizona who advocates for physician mothers who breast feed. Had I known about Dr. Milk early on I think I would have had an easier time by fielding my questions with other physician moms. It doesn’t substitue having a lactation consult with a certified IBCLC but for moms inside the medical community it’s a great way to discuss issues we are experiencing. In addition to providing resources, it has also been a great way for me to share what I can with new mothers. Highly recommended website.
  9. Don’t rely on the regular CDC growth charts in assessing the weight of an exclusively breastfed child.
    The standards on the CDC growth curves show data for an American population that included many formula fed (though it also reflects breastfed) infants. Breastfed infants grow according to different patterns than their formula fed counterparts, and while the curves balance each other out by the time a child is 2, under the age of two it is best to look at the WHO growth charts when evaluating an exclusively breastfed baby – the WHO growth charts have data from children in six countries with a sample that is thought to request growth under ideal conditions. It reflects a bigger range of acceptable weights of infants and also have data from a higher proportion of breastfed infants. The difference you see can be dramatic. My own son’s weight tracks between the 10th and 25th percentile on the CDC growth chart, but near the 50th percentile on the WHO chart.
  10. Don’t feel guilty if something doesn’t work the way you planned.
    Breastfeeding is tough and does not work for everyone. It is tough enough being a mom without feeling guilty for any problems that happen or prevent you from breastfeeding, so just forget about guilt and do your best. Just by trying to breastfeed you are making an effort for your baby and it doesn’t work for everyone. A corollary to this advice is not to let the La Leche League book The Womanly Art of Breastfeeding make you feel guilty. Now I have this book on my shelf as it is highly regarded, and I did use it for a reference early on, but it is often heavy handed. It remains so active in its support of breastfeeding that it makes you feel like your infant should be at the breast constantly without a break and that you should co-sleep with your newborn baby (a distinct no-no in the pediatric world) and should thank your lucky stars to be breastfeeding constantly.  In the book, anything short of their recommendations is failure. Let me assure you that many people do not follow all their recommendations and their children turn out find. The book does offer some good advice, but if you do read it, remember not to fall into the trap of guilt if you want to do something differently from what is advised in the book. It is only one opinion among many.

And here are some things I am very glad I knew before I started breastfeeding . . .

  1. Kellymom.com
    This is by far my favorite resource when looking for advice for myself or for my patient’s mothers who breastfeed. It contains a serious wealth of evidence-based information that is frequently updated on most any subject related to breastfeeding – search for a question and you will likely find the answer somewhere, if after a little digging. It has information on virtually any subject related to breastfeeding. So search away!
  2. Always have water at the bedside, and eat enough food!
    Mama’s energy is paramount to being able to have energy for the baby and a sufficient milk supply, and breastfeeding means that you should be eating an additional 500 calories a day. This is no easy feat given fatigue and limitations on time in a busy mom’s life. I got used to carrying small snacks with me and eating them as much as possible (yogurt, carrots and hummus, cheese sticks, a bag of nuts before leaving work). Eggs became my best friend and to this day (almost 2 years into breastfeeding) I boil a bunch of eggs at the beginning of the week and eat 1-2 hardboiled egg a day, depending on how long I expect to be at work and what else I have eaten. I also keep water at the bedside because I inevitably get crazy thirsty in the middle of the night, and I keep a big bottle of water at me at work. If I don’t drink enough water or eat enough, the headache I get is enough to remind me to do better the next day!
  3. Having the right pumping bras is key
    Sorry for the TMI to those who know me, but it is good to start out with a good fitting night nursing bra and some nursing tanks for early breastfeeding. After you’ve been feeding for several weeks and have an established supply, go out to a bra store and *get fitted* properly and buy a few nursing bras for work and, if you want, a nursing sports bra (I just got regular sports bra – great for inspiring your exercise routine after pregnancy). It’s important not to get the work-related bras too early because you want to make sure to know the proper sizing, which will definitely change over the initial months. Working mamas: make sure to get a good fitting pumping bra as well. I recommend the Simple Wishes bra, because it has velcro that makes it is adjustable to several sizes and thus is more versatile, and the fit more dependable than the Medela.
  4. Trying different feeding positions can ease comfort
    Having the La Leche League book was actually helpful with this one because it gave good advice on initiating different feeding positions. It was helpful to learn that as a baby grows you can find different comfortable feeding positions, so experiment with which feeding styles work for you! There are also many ways to feed – including feeding an infant while you are walking with them in your arms or in a carrier, so try different ways to increase your options!

 Your Feedback and Tips?

Hmm . . I’m sure that there is more advice and things that worked well for me, but it’s taken me so long to write this piece that I have to give up for now and get some sleep. It’s getting late and I’m sure that my little guy will wake up for a night feed soon enough. What advice and help worked for you and helped you breastfeed? Any burning questions regarding nursing that you need help with? I’d love to hear it!

About

A pediatrician. Now turned first-time mom. Venting and giving you all the wisdom I acquire over the days . . .

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