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10 things expectant parents
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1. Breastfeeding is an important health issue. Hundreds of medical studies have been done on the differing health
consequences of breastfeeding and formula-feeding. I want to be absolutely clear that I am NOT saying that all, or even most, formula-fed babies are sick. Nor am I saying that all breastfed babies are healthy. The studies I am pointing to are epidemiological in nature. When researchers look at different feeding methods among populations and compare disease rates among them, they have consistently found higher disease rates among the population that was fed substitutes for human milk. It is therefore worth investing some of your time and energy in breastfeeding. Take some steps before your child is born to increase your chances of success. Be prepared to take steps to solve problems that arise. Make a committment to do whatever you can manage to do to make breastfeeding work for you and your baby. If, despite your best efforts, breastfeeding does not work out, you will at least have the consolation of knowing that you did your best, and that your baby probably got some of the benefits of the earliest feedings. 2. Breastfeeding is a learned art. If you have grown up around breastfeeding women, you probably know enough to breastfeed without expert help. Indeed, those other breastfeeding women in your life are likely to be the best experts you can turn to for help. However, if you have been raised in a bottle-feeding culture (the U.S. and the U.K. being the most pervasive in their bottle-feeding bias), you may never have even glimpsed another woman breastfeeding. If you mistakenly think that breastfeeding is simply instinctive, you may not think it necessary to educate yourself about the process and it will be harder for you to accept the help you may need to get started. If, instead, you go into breastfeeding with the knowledge that it must be learned and that you are not trained, you will be able to arm yourself in advance with the knowledge you need to succeed, and you will know when to accept expert help. Because breastfeeding is a learned art that has been lost to the majority of mothers in a bottle-feeding culture, all mothers should be prepared to deal with some breastfeeding problems. This does not mean obsessing over every horror story that you hear, but it does mean being aware that problems can arise, and learning how to find help if they do. 3. The best sources of information on breastfeeding. La Leche League International, the Nursing Mothers Council, the National Childbirth Trust (U.K) and the Nursing Mothers Association of Australia are the best sources of accurate and helpful information about breastfeeding. If you can afford it, buy a book, such as La Leche League's "Breastfeeding: Pure and Simple" that covers all of the basics. You may also be able to find helpful books in your local library or borrow them from a local La Leche League group. 4. Many breastfeeding problems are caused by medical mismanagement. Ideally, you should be able to choose health care providers that are educated about and supportive of breastfeeding. But that is not always possible. It is an unfortunate fact that, in addition to educating yourself about breastfeeding, you may have to educate your obstetrician, pediatrician, family practice doctor, midwife, maternity floor nurses, etc., about breastfeeding. You must also be prepared to fend off bad advice and unnecessary procedures that may interfere with breastfeeding. To avoid misunderstandings, it is advisable to set aside some time in your preparation for childbirth to discuss breastfeeding with your health care providers. Make it plain that you are committed to breastfeeding your baby and that you want to remove all unnecessary barriers to breastfeeding. One of the most important issues to discuss is the avoidance of all artificial nipples in the first days of life. Nipple preference (where a breastfeeding baby learns to prefer an artificial nipple to his mother's) is a leading cause of breastfeeding failure, yet routine bottles and pacifiers are still common in some hospital nurseries. It can't hurt to ask your doctors and hospital to sign a document promising not to use artificial nipples, and make sure that document makes its way into your baby's chart. Then, if supplementary feeds are necessary, they can be administered by cup, spoon, dropper, syringe, or tube. Some other important issues you might want to discuss with your doctors are: what effects any labor medications may have on the initiation of breastfeeding, whether cleaning and examination of the baby can be postponed until after the baby has had her first feed, whether rooming in with your baby can be arranged and, if not, will the nursery staff bring your baby to you frequently enough to get breastfeeding started, whether circumcision (if such is your choice) can be postponed until after breastfeeding has been well-established, whether there are trained lactation consultants on staff at the hospital or pediatrician's office, and whether a family history of allergies makes breastfeeding especially important for your baby. You might also ask the doctor how she deals with a mother who is concerned about the adequacy of her supply because her baby is nursing every hour. If she responds that formula supplementation is the first line of treatment for this concern, you will know for sure that you are dealing with an ignorant doctor, and should not rely upon her advice regarding breastfeeding. Frequent nursing may have nothing to do with inadequate milk supply, and unnecessary supplementation is the fastest road to the end of breastfeeding. 5. If it hurts, it is likely that something is wrong. Breastfeeding is not supposed to hurt. While some women experience discomfort in the first days of nursing, real pain is almost always a sign that something is wrong. Some possible problems that can cause pain and nipple damage: incorrect latch, incorrect positioning, incorrect sucking, and yeast infection (thrush). These problems can usually be solved, but only if you seek the right kind of help soon enough. If you wait too long, the baby may be hard to re-train, your nipples may be seriously injured, and the joy of breastfeeding may be replaced with dread and misery. And if you seek help from someone who doesn't really know much about breastfeeding, or who doesn't take the time to watch you and your baby nursing, you may be worse off than with no help at all. The best kind of help is a personal visit with an International Board Certified Lactation Consultant (IBCLC). The IBCLC is the only internationally-recognized credential showing thorough training and expertise in the diagnosis and treatment of nursing problems. In a personal visit, a lactation consultant can examine your baby and your breasts, observe you and your baby nursing to evaluate latch and positioning, let the baby suck on her finger to evaluate the baby's sucking behavior, listen for the sound of the baby swallowing, talk to you and get a total picture of your nursing relationship. She can then work with you to put together a treatment plan to solve your breastfeeding problems. Of course, like any health care professional, a lactation consultant will expect to be paid. If that bothers you, try to remember that the formula to feed a baby for the first year of its life will cost about 15 times more than a visit with a lactation consultant. Not to mention the risk you run of additional medical expenses that may arise because of the greater risk of illness in formula-fed babies. 6. Know the signs of dehydration. The scariest risk of the early post-partum period with a breastfeeding baby is the risk that the baby's fluid intake will be so low as to cause dehydration. Here are the signs: (a) fewer than six very wet diapers per day, (b) significant color or odor to the urine (it should be clear and nearly odorless), (c) dry skin that doesn't spring back immediately after being pinched, (d) sunken fontanel (that's the soft spot at the top of the baby's head). If your baby exhibits any of these symptoms, get immediate medical attention. If you do have to supplement your baby's fluid intake, remember that cup, spoon, syringe, dropper and tube feeding are all preferrable to a bottle, and expressed breastmilk is preferable to any artificial baby milk. If the baby is not exhibiting the symptoms of dehydration, has good color and can be heard swallowing after every couple of sucks, it is unlikely that you are having problems with your supply of milk, regardless of how frequently the baby is nursing. Supplementing with formula because of unreasonable fears at this stage can cause breastfeeding failure. The baby's reduced demand will lead to reduced supply and further supplementation, in a downward spiral toward the complete cessation of breastfeeding. 7. You will need support to breastfeed. Support can come in many forms. The most important support for many mothers comes from the baby's father: if he is fully supportive of breastfeeding, it is much easier for the mother to find the strength to breastfeed in a bottle-feeding culture. For some mothers, support can be a relative, friend or neighbor who has breastfed, and who acts as a positive model. For some, it is an organized support group, such as La Leche League. For some, it is a lactation consultant or other medical professional who provides expert help when difficulties arise. Without support, many mothers will quickly abandon any efforts to breastfeed because it makes them feel even more isolated at a time in their lives when the stresses of a new baby have already isolated them. 8. Your breasts are functional and their function is feeding babies. While many of us have grown up believing that our breasts were primarily sexual, the reality is that their sexual function is a cultural construct. The biological reality is that our breasts are for feeding babies. It helps to keep this in mind as you prepare yourself for dealing with people who think there is something indecent about feeding a baby with your breasts. There is absolutely no reason why you should not feed your baby wherever and whenever any bottle-feeding mother would feel comfortable feeding her baby. If the bottle-feeders aren't forced to feed their babies in the bathroom, neither should you. To avoid unwanted attention, it is wise to learn how to nurse discreetly and to wear clothing that permits easy access to your breasts without disrobing. But try not to let the fact that you take those precautions make you ashamed if someone detects what you are up to. Feeding your baby is not an indecent act no matter where it occurs. 9. Human milk can be provided in mother's absence. When mother and baby must be separated, expressing and storing human milk is not only possible but relatively easy. With good hand expression technique or a good quality pump, about fifteen minutes of break time twice a day, and a place to express milk in privacy, most mothers can provide all of their babies' need for milk even if they are working full time. If this is your plan, you will need some additional education and preparation regarding expressing and storing your milk. Take a look at Breastfeeding and Returning to Work for a start. 10. It is normal to breastfeed for two years or more. Exclusive breastfeeding, in which the baby receives no nourishment other than his or her mother's milk, usually lasts around six months. Somewhere around the second half of the first year, most babies are ready to start eating some other foods. But the transition to a diet that is similar to that of an adult is meant to be gradual, and human milk is a healthy part of a child's diet for some time after the first solids are introduced. Studies by anthropologists and comparative biologists have revealed that the probable natural weaning age (that is, the age at which no more nursing occurs) of the human species is over 2 1/2 years. There is no harm in permitting a child who wants to continue nursing for two years or more to do so. In fact, it is quite common everywhere in the world that bottle-feeding is not the cultural norm. The fact that it is not unusual in our culture for a child of 3 to be drinking milk from a bottle or using a pacifier is a clue that the need to suck is a fundamental human need that does not disappear at six months or one year of age. Formerly part of need to know about breastfeeding
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