The 3 Rules of Breastfeeding

Things can get complicated, especially in the first few days. Unexpected situations can arise that completely derail breastfeeding. You may feel so off track that you're anxious and stressed to the max, wondering if you can still do this, and not knowing what to prioritize. Don't worry, all is not lost! Keep in mind the 3 rules of breastfeeding, and in no time, you'll be making progress toward your goal.

Jaundice makes babies very sleepy, and their breastfeeding effort is then compromised.

Many unforeseen factors can interfere with the establishment of breastfeeding in the early days and weeks. Most of these factors are completely beyond parents' control. You may have taken a breastfeeding class and felt prepared, and extremely committed to this method of feeding. Now that baby is here and you're dealing with special circumstances that you didn't expect, you watch helplessly as breastfeeding falls by the wayside, because more pressing issues are being addressed. Maybe your baby made a trip to the NICU, or had low blood sugar, or jaundice. Maybe you had a traumatic delivery or medical complications that left you exhausted, ill, or otherwise unable to put baby to breast early and often. Whatever the case, when a mom who planned to breastfeed, finds herself lagging in milk production, and faced with formula feeding her infant, it doesn't feel good. You might feel sad and defeated. You might fear that the breastfeeding relationship you envisioned, has slipped out of your grasp for good.

As a hospital lactation consultant, I come across this scene on a weekly basis. And I can offer not only hope, but a solid plan to recapture that breastfeeding goal. The first step is to shed the guilt! New moms might feel like they have failed in some way, and this can be compounded by the "Baby Blues." The Baby Blues are normal, transient feelings of sorrow that are the result of big hormonal changes in the first couple of days and weeks. Give yourself space to feel down, and know those feelings are part of your body's normal postpartum adjustment. Do communicate with your support team, and try to look forward, not back. Don't dwell on what went wrong, or how it could have been different. Chances are, it was out of your control. Let's preserve the option to breastfeed by taking command of the present situation, whatever that may be. There are 3 rules to follow, that should be prioritized in numerical order.

#1. Feed the baby! This is the most important thing. Of course, your baby has to eat. The faster baby gains weight, the easier it will be to breastfeed him. And if your supply is not up to speed yet, then bring on the reinforcements. Donor breastmilk is a great resource and is available in many special circumstances, but sometimes parents have to ask for it because it is not automatically offered. If it isn't an option, then formula is OK. Formula is nutrition, and it provides essential volume to baby when breastmilk volumes are low. It may be a shock to see the baby you planned to breastfeed, sucking down a bottle of formula, but IT WILL BE OK. Babies who linger under birthweight don't breastfeed vigorously. If his breastfeeding efforts are weak, uncoordinated, or if he can't even go to breast yet, then let's get that food into him in the easiest way possible, to strengthen him. When a baby is healthy, above birthweight, gaining weight well, and past his due date, his efforts at the breast will improve. If he needs bottles of formula to accomplish all those items, that's OK! Feel positive about this when you see him drinking and being satisfied.

#2. Protect your supply. This means empty both breasts at least every three hours, around the clock. Typical guidance is pump both breasts for 15-20 minutes, every 3 hours. Do the math and this is 8 times in 24 hrs. Make sure your pump flanges fit correctly. You'll want a hospital grade, double electric pump if your baby cannot provide any stimulation himself. A Spectra, Medela, or hospital grade Ameda are good choices. Those wearable pumps will not get the job done unfortunately, as convenient as they are. If possible, pumping both your breasts at the same time is ideal, not only because it saves time, but also because the simultaneous nipple stimulation elicits higher peaks of lactation hormones. If you want to increase your milk supply, the best thing to do is empty your breasts more frequently, NOT pump for longer at each session. The more demand, the more you will make. Anytime your breasts sit full for longer than 3 hours, you are sending a signal to decrease milk production.

If your mature milk has come in and you want more of it, try one power pumping session every day. A power pumping session simulates a vigorous, demanding baby who is cluster feeding. After pumping for 15", rest for 15" and then pump again, for 10". Rest for 10", and then pump once more for 10". In one hour, you will have pumped three times. You can adjust the pumping and rest times, but the goal is to mimic that baby who is breastfeeding on and off for the better part of an hour.

There is a window of opportunity in the early days postpartum, to signal your body to make this milk. Sometimes circumstances delay mom from emptying her breasts until several days have passed. Even if you're late to the game, it's worth a try. If you never reach full production of 24-32 ounces per day, (for a singleton) your baby will appreciate ANY amount. Breastfeeding doesn't have to be all or nothing. Plenty of moms make it work by combination feeding.

#3. Practice at the breast. If this isn't possible yet, then just focus on Steps #1 and #2, and feel confident knowing that you are doing all you can do, for now. The last step is implemented once things have settled down, everyone is calm and healthy, or at least stable/recovering. At that point, you may start offering the breast first at each feeding. It might take days or weeks until both you and your baby are ready for this. I once worked with a mom who convinced her baby to breastfeed after three months of bottle feeding! It's rarely too late, although it is best to start as soon as possible. Baby may take inadequate amounts at first, but that's expected, and he can be topped off with a supplement of donor milk, mom's expressed milk, or formula.

Depending on the circumstances, baby may need lots of practice before we can trust that he can transfer a "weight-gaining amount" from the breast. This is a great time to work with a lactation consultant on his latch. He may need a lot of encouragement to suck actively if he is accustomed to a bottle. A nipple shield might help if he won't latch at all, or doesn't stay latched, or won't suck actively. A feeding clinic or lactation consultant should perform a weighted feed to quantify exactly what baby transfers from the breast, and track his progress over days and weeks. He'll make vast improvements if you hang in there! Definitely check out my Triple Feeding blog article if you are working on step #3. The process is very detailed, and I offer 10 hacks to make it easier.

I need a little more time until I can breastfeed well!

The main thing, when breastfeeding is interrupted, or fails to launch smoothly, is to take a deep breath and avoid stressing about factors that you can't control. If you can find a breastfeeding support group, you will realize how many other moms struggle and face similar challenges. You are not the only one, and you CAN overcome these obstacles. Remember the three rules, and do the best you can! Your baby is lucky to have you.