The challenges of breast feeding

When the reality of breastfeeding does not compare to your image and plan.

If breastfeeding is natural, why is it so hard?

Just as a woman develops a birth plan, whether written or in her head, many women also have an image or plan for how they will feed their newborn and what it will look like. However, most women in the United States have never seen a baby feed at the breast. When searching for images of a baby or newborn feeding, most of the images are of a baby being bottle fed. If you think about decorations for a baby shower a bottle is one of the first images that are associated with a baby. Not that I think decorating for a baby shower should be a bunch of leaky boobs (although that would certainly be a shower to remember), the image that comes to mind for most is a baby with a bottle in their mouth.

When you find images of an infant nursing at the breast, its always soft lighting of the baby (never a newborn) looking up at their mother as they happily nurse at the breast or the romanticized image of a mother swinging on a porch swing with a flowing white dress, flowers in her hair as her infant gently suckles from her mostly covered breast. The real image... a mom that has not showered in a few days, the messy bun on the top of her head, nightgown or loose fitting tee with spit up stains in places she is too tired to notice still wearing a pad and granny panties to maximize what little comfort she can find after pushing a human being from down under or avoiding her c-section scar. Did I mention cracked nipples and breasts she barely recognizes that are warm, firm and tender to the touch. Well those images definitely won't sell baby products, so we will just keep that between us... There in lies the problem, the real image does not sell and mothers are rarely prepared for what happens after birth and the harsh reality of learning to feed her baby in a constant state of sleep deprivation.

While prenatal care is more standardized, preparing mom and her partner for the postpartum period is not. The topic of breastfeeding is often for mom to seek out on her own, online or at a private class outside of her normal OB visits. I have worked with so many fantastic Obstetricians and Pediatricians - most will admit that they have received little if no formalized lactation training. Give them a lump or a bump in a boob and they know what to do or where to send you, however the functioning lactating breast is more unknown. Many base their knowledge of breastfeeding on their own or their partners experiences and the little dribs and drabs they got in residency. Certainly with years of practice they do build on their lactation knowledge but unless they have sought out additional training, very few healthcare providers in the US have standardized training in lactation.

So how is a woman expected to prepare for breastfeeding her infant? What does those close to her think about breastfeeding? Did her mom breastfeed? Does her partner support her breastfeeding even when it gets hard? When she goes back to work, will she get support and a safe clean place to pump without fear of being judged for expressing her milk? Is breastfeeding all or nothing? What pump should she order through her insurance? Are her breasts too big...too small...or are her nipples too flat...too big or too small? Can she breastfeed after augmentation or reduction? Can she exclusively pump? Can her partner still bottle feed without causing latch issues? What is nipple confusion? Are pacifiers bad? If she wants to have a glass of wine, does she have to pump and dump? If she needs to take medication, is it safe for baby?

Long gone are the days of living in the same village as your extended family where breastfeeding is supported and taught to you by your family members as you have witnessed nursing infants as a norm. Many women have rarely if ever watched a mother breastfeed their infant, the art of breastfeeding is no longer being handed down generation to generation. An expectant mother can take a general breastfeeding class which is certainly helpful but limiting. She can ask her friends with children what worked for them, but that can be wrought with all the reasons breastfeeding did not work for them. She can attend a breastfeeding support group while pregnant, but most will find that difficult and in the times of COVID, virtual support groups are more the norm. One of the best ways to set herself up for success is to develop her own postpartum feeding plan that covers all those bases - with the understanding the best laid plans often go awry - so plan for the awry if that occurs. Take a antepartum breastfeeding class, research what support groups are available in your area, start vetting a breastfeeding professional that either does home visits or will do in office lactation consults. The alphabet soup of lactation credentials (IBCLC, CLC, CBC, CLS, CLE, Peer Counselor, Postpartum Doula) is definitely overwhelming, while I feel any breastfeeding support is better than no breastfeeding support, an International Board Certified Lactation Consultant has the highest level of lactation training outside of a Physician who is a Breastfeeding Medicine Specialist. An IBCLC is often the best situated for when breastfeeding is not going well and has the education and experience to offer their full support. Researching and finding an IBCLC while you are still pregnant will greatly increase establishing a successful breastfeeding relationship with your baby. Have an honest discussion of what breastfeeding means and looks for your partner. When asking for advice from friends and family, make sure it is a variety of experiences good and bad, what do they wish they did differently? Find a pediatrician that is supportive of breastfeeding. The first few weeks home with your baby will be full of doubt and lack of self confidence, moms are great at judging themselves, find providers and lactation professionals that do not judge but aim to support whatever feeding decisions you make. Let people help you... often from a far like dropping off a warm meal, ordering takeout for you, or by doing a load or 3 of laundry.

Finally, set yourself up for success in the hospital. Advocate for yourself and your baby. Room-in with your newborn, they actually sleep a lot those first few days and keeping them close will help you learn their ques. Delay the bath at least 8 hours if not 24 hours, do skin-to-skin as much as you can in those first few days to help baby transition from that cozy 98.6 degree hot tub to the cold outside world. Invite your partner to do skin-to-skin when you are tired, baby gets all the same benefits and your partner will bond with the baby. Remember, skin-to-skin stabilizes the infants body temperature, blood sugar, heart rate and respiratory rate... aka everything! Avoid medically unnecessary formula supplementation - all babies lose weight and take 2 weeks to get back to birth weight!!! Moms who have had a c-section or a prolonged induction get much more intravenous fluids which often causes additional water weight for the infant - basing weight loss on the 24 hour weight is a better indicator of true weight loss. Ask for help, you may find one nurse or lactation consultant is more helpful, don't waste the opportunity to learn from them. Don't shy away from asking for help once you are home. While most lactation consultants do not take insurance, their fee will often be regained through the savings from not relying on formula or they may be able to supply you with a superbill to get insurance reimbursement. Finally, find your momma tribe - fellow moms who get what you are going through when you are all going through it - the good, the bad and the ugly - your partners may find support from their partners as well. You will often find them in some of those prenatal classes and after you give birth, support groups - you will all be your greatest cheerleaders.

It takes a village to raise a child, don't be afraid to build your own village : )

You got this momma!