A wife of noble character who can find?...She speaks with wisdom and faithful instruction is on her tongue...Her children arise and call her blessed; her husband also, and he praises her. Proverbs 31:10, 26 & 28

Wednesday, November 9, 2011

Breastfeeding: The Nitty Gritty (or: why I think I have never had mastitis)

I've decided to keep the breastfeeding theme going. If you're a guy reading this I'll probably get a little personal so you might want to stop reading this post now.

Either I've got really good genes or was given some great advice when I was new to breastfeeding. I think it was more the advice so I thought I'd share that advice here.

Firstly I'd like to say that I am NOT a lactation consultant and if you really need advice and are having problems you NEED to talk to one. In Australia we have the Australian Breastfeeding Association that you can ring. I'm only passing on the information that I've learned on my breastfeeding journey.

Of course it hasn't always been a smooth road but really the only times I've had trouble while breastfeeding is when I've been too tired to pay too much attention to how well the baby has latched on. The first thing that you need to learn is how to latch the baby on to your breast properly. Don't be afraid to ask the nurses in hospital to help you until you feel you've got it down to a fine art. You're only in there with their experience for a short amount of time. With my second child I would call someone in every time I felt he needed a feed and get the nurse to help me get him to latch on. With my newborn I make sure I'm sitting up nice and straight and comfortable, the baby is normally resting on a pillow on my lap. This allows me to use both my hands to position the baby's head and my breast. I'll normally hold the baby's head in one hand and my breast in the other, then I tickle their mouth with the nipple and when their mouth is wide open pretty much shove them on (very descriptive, I know). Make sure their bottom lip is near the edge of your areola, this should mean that your nipple is in far enough.

More often than not even if you don't get cracked nipples, or mastitis, you may still get grazes or just be sore. I don't really recommend using anything except breast milk on your nipples as the idea is to keep them as dry as possible in between feeds and most products out there have harmful ingredients in them. When I first started having children the big thing was putting lanolin on your nipples to moisturise them and yes it might have been 'natural' but the sheep the lanolin came from were dipped in chemicals so there was every chance that these chemicals were in the lanolin. Anyway I think if you keep them dry enough in between feeds, changing your nursing pads when they get wet from leakage, you can do without these moisturisers. Plus do you really want your baby swallowing these with their feed? There's even no need to wash your nipples with anything special, just water will do. This will keep them as natural as possible for your baby.

So you think you've gotten the whole breastfeeding thing down pat and then your milk 'comes in'. What joy! (only kidding). It can be quite a shock when you're new to this, and these days they send you home from hospital before your milk comes in and if you do not have a good support system with good advice in place you may be at a loss. This is where most new mums get into trouble, they're milk supply is in excess of their baby's needs and the breasts aren't getting drained enough. There are a few things that you can do to help with this until things settle down, that won't affect your milk supply.

I've mentioned in a previous post that I have never used a breast pump. I'm not against them, I just never needed to, but I have hand expressed. When you're full to bursting and you're baby is already satisfied and it's no good trying to make them drink more hand expressing will give you some relief. Position your thumb above your nipple, on you areola and two fingers under and gently press. You won't get anything squeezing your nipple, it needs to be the areola. You can express into a sterilized container and keep it for baby or into a cloth nappy or rag, I've even heard of someone expressing straight into the bath to be washed away.

Change baby's position when you feed him or her. Where the baby's chin is is where your breast gets drained the most so it's useful getting comfortable with other feeding positions such as the football hold and laying down. Just make sure that the baby's chin is towards the sore part of your breast. Also as you feed gently rub your breast towards the nipple. This will help dislodge any blockages that might be building up and help with the release of milk from that part of your breast.

I don't hear this technique very often and it can be misused and start to dry up your milk but it can be useful for really engorged breasts if you use it the right way. That is cabbage leaves. You only need to use a part of a clean leaf tucked into your bra against the sore part of your breast. Don't leave it there for long and don't use this too often as you don't want it to affect your milk supply. This is more for if the other techniques just aren't doing their job and I would suggest that you get more professional advice than mine before trying this technique. I don't know the science behind this, though I am sure that you could find out if you googled it, but it does work.

When your milk first comes in it may feel like it will stay that way forever but it will soon sort itself out as your body comes to learn how much milk your baby needs.

Make sure that each breast is drained before moving onto the next one. I remember being told to feed 10 mins on one side and then 10 mins on the other. This is BAD advice! I only feed on one side per feed and if the baby falls asleep before I think he or she has finished and wants more a 1/2 hour later I'll offer the same breast back. This will make sure that the baby has had the more filling hind milk and not just the fore milk and will make sure that your breast is drained, leaving less of an opportunity for blocked ducts. If you have a problem remembering which breast you fed the baby on last, which is a reality for a sleep deprived new mum, I keep a clean tissue in the bra cup that I did not feed the baby on. This tissue is not replacing the nursing pad but just tucked in as a reminder that I did not feed the baby on that side. On the other hand if you think that baby has drained that particular breast but is still looking for more then do change sides (this especially happens when baby is having a growth spurt or you haven't rested enough or drunk enough water), don't forget to offer the second breast first for the next feed.

I've probably left a lot of other information out but the Australian Breastfeeding Association has a great informative website and if that doesn't have the information you're after I highly recommend that you ring one of their Lactation Consultants.

Sunday, November 6, 2011

Tips for Successful Breastfeeding

My last post ended up being so long that I decided to split it in two.

My tips on successfully breastfeeding:
  • don't worry about doing everything. You need to rest to build up a healthy milk supply and the housework will always be there but time with your newborn or young baby slips away so fast and before you know it they're a toddler and don't have as much time for you.
  • drink plenty of water. Lay off the tea and coffee for a while, or at least cut it down. Water is the best thing for a breastfeeding mum and baby.
  • listen to your baby. I know this can sound a bit trite but you and your baby need to get to know each other and your baby will let you know how they're going. Whether it's throwing up from too much feeding or needing extra feeds because they're going through a growth spurt there'll be some indication of what needs to be done.
  • don't be afraid to ask for help. Once more I'll post the link to the Australian BreastfeedingAssociation for those who live in Australia. Christian was my 5th child and I still needed their experience to help me through a rough patch.
  • Find positive, supportive people who will encourage you to continue when you're feeling like giving up. This doesn't mean people who'll just tell you to 'suck it up, Princess' but people with helpful advice.
  • This may fly in the face of some public opinion but I don't recommend supplementary feeding. Your body is able to cope with your baby's demands. If you think they are extra hungry feed them more and soon enough you'll be supplying more milk. I personally think that supplementary feeding interferes with a mum's milk supply too much but also feeds the doubts that are there in the back of your mind. That's not to say that the occasional bottle doesn't come in handy. I have to confess that even after having seven cherubs I've never expressed milk using a machine, only hand expressed for some relief, and so when I've had to leave my baby with someone I've left a bottle, but I prefer to leave them only between feeds anyway so the bottle is just a back up.
  • get a sling or a wrap to wear your baby at times when they're needing comfort, not a feed. I can't believe that I waited until my 6th child to get a sling but it is the best investment ever! I don't mean the usual clip on pouches that are found in most baby shops, that hurt your back, neck and shoulders, but something like a ring sling or a Moby Wrap. I bought my ring sling off Ebay, you can just search 'ring sling' and I made my own wrap, it's so simple and no sewing. There are plenty of instructions on baby wearing on the internet to find out how to use the sling and wrap. I was able to go to the beach with 4 children on my own. I had the baby in the sling and was holding the toddlers hand at the edge of the water while the other two paddled in front of me. It was so liberating. I've also been able to feed while walking around the shops, with no-one the wiser, something I never thought I would do.
  • Research, research, research! If you want to be successful at something put the effort into the research. You won't regret it.
I'm sure there are plenty more tips I can tell you but I believe these are the best ones.

Don't Give Up On Breastfeeding

It's less than two weeks now until bub is due and I've been doing a little extra reading just to get my head in the right place. A great blog I've found is The Mule. She has some great informative and inspirational blogs about birth and breastfeeding which has inspired me to blog about my breastfeeding experiences. I say experiences because every child is different and your body is also different after every baby so just because you think you failed the first time doesn't mean it'll happen again, but also just because you've succeeded before doesn't mean that for a subsequent child you won't be incredibly challenged and feel like giving up.

When I was younger I worked in Child Care. I had an Associate Diploma in Child Services and thought I knew everything. I'd also grown up with two younger sisters, I was 13 and 15 when they were born and loved looking after them. Then I go and have my own baby and everything that I knew went out the window. My little sisters were bottle-fed so breastfeeding was new ground for me, I was also the first of my friends to have a baby so I didn't have their experiences to go on. I started off feeding well. Josiah latched on well, the nurses in the hospital were very helpful so I didn't end up with mastitis or cracked nipples, it was a great start to breastfeeding. But around the 6 week mark Josiah started crying all the time and wanting to suck. He had a dummy but as an inexperienced parent I thought he was hungry so I kept feeding him and he kept throwing it up. I didn't understand what was going on. How could we have it all sorted out so easily and then this? It wasn't until it was too late that I realised that he had severe reflux and that was his problem, I thought it was me and my milk. I was feeding him every hour and he was throwing most of the feed up and still crying and still wanting to nurse. I don't remember anyone encouraging me to continue breastfeeding but that doesn't mean it never happened, I never have a good memory after a baby is born (or before). I went to a Maternal Health Drop In Centre but still felt discouraged and incompetent and decided that the best thing for both of us was to put him on the bottle. Because I had grown up with bottle-fed babies it was very easy for me to listen to my inner doubts and wean him onto the bottle, I thought that at least that way I knew how much he was getting and in that respect I was right. He still threw up a lot, though. We nick-named him Cyclone Chuck because he'd get into a room and destroy it whilst throwing up everywhere.

After realising that it was reflux and not me that was the problem I regretted putting him on the bottle so hastily and was determined with child number 2 that I would breastfeed as long as possible. So Elijah came along and while I was in hospital I would call the nurse in every time I needed to feed him so that he latched on properly. I think they got sick of me needing so much attention but I figured that's what they were there for. Once more at around the 6-7 week mark I had a crying baby who couldn't seem to get enough from me. Only this one didn't throw up as much. Just in case I decided to space his feeds a little further apart than I thought he wanted. He was a big boy, 9lb7oz when born, so wasn't about to waste away. This worked for me and within a week or two we were back to a normal routine. I put his fussiness down to a growth spurt and all my children have gone through this period of fussiness between 6 and 8 weeks of age.

Kahlia was very different. We didn't have any latching problems but she cried and cried and wouldn't be put down. She needed more feeding than the boys, it could be because I had 3 little ones so was a lot busier and not resting enough or drinking enough water for good healthy milk production, but making her wait for too long between feeds was not the way to go with her. I fed her more often and when this was still going on at 3 months started feeding her solids early. This helped settle her greatly and didn't interfere with my breastfeeding her. I managed to feed her until she was 13 months old.

I fed Daniel until he was 7 months old and regretted putting him on the bottle, even though I was classed as successfully breastfeeding him we had so many problems once he started being bottle-fed. Once he was on the bottle we noticed he had an allergy to lactose and to gluten, we hadn't noticed it before then. So we had to find formula's without either, which in 2000 and 2001 was very hard, they'd just started bringing in food that was without one or the other but not both. Thankfully he grew out of it between 2 and 3 years of age and he probably would've had these problems eventually if I had fed him for longer but I think that breastfeeding negated the effects of his allergies and we wouldn't have had to face them so early. If you're wondering why I stopped breastfeeding him so early it was because I had 4 little ones with only 18 mths between Elijah and Kahlia and 22 mths between Kahlia and Daniel. I was overwhelmed with life and didn't think I could cope with anymore children and was so stressed with the thought of getting pregnant again I just wanted to go on the pill. Look at me now, having baby no. 8.

So far I'd been very blessed and hadn't had to experienced cracked nipples or mastitis, but with Christian I made the mistake of buying cheap nursing pads with plastic on them and accidentally put one in my bra with the plastic side on my skin. This kept my nipple from drying out between feeds and sure enough next feed cracked nipple. It was extremely painful and after a couple of days I noticed puss coming out, ewwww! I hadn't experienced that before and wasn't sure if I should still be feeding on that side so I rang the Australian Breastfeeding Association for some information and was told that it was still fine to feed him on that side especially as I didn't want my milk supply to slow down. I decided though that that side needed a bit of a rest so I'd feed twice on the good side and once on the sore side and then when it was healed went back to feeding normally. I fed Christian until he was 14 months old.

With Rose I had a completely different experience. I didn't feel my milk come in like usual and I rarely felt the 'let down' that I usually felt when I fed my babies, yet we had no feeding issues with her and I fed her until she was 18 months old. I loved the experience of feeding her at that age but once again I was pregnant and she weaned herself off me.

And Emily, child no.7, she was even worse than Kahlia. Because I had issues with her quick birth and it took the nurses so long to figure out that I was in a lot of pain and I had a separation of the stomach muscles I was put on strong painkillers. That was okay while I was on them, Emily slept a lot and seemed like the perfect baby. But once I came off them, which I did as soon as possible, she was another child altogether. It seemed like she was always attached to me, and when she wasn't she was crying and crying. She wasn't too chucky so I think it was coming off the painkillers that affected her so badly and thankfully I had a sling and a wrap so I could carry her with me and also older children who could hold my fussy little girl.

So seven children and 7 completely different experiences. I've been so blessed to not have had any attachment issues, or mastitis. My advice is to read as much possible on the positive experiences of breastfeeding and get good counselling from people who are going to encourage you. It is easy, when you're new at this, to just go and get some formula but I know that if you get the right advice and persevere you can get past that stage.

I guess people might be wondering why I stopped feeding my children when I did and the most common reason was that I was pregnant again. I know about tandem feeding but I get so sick and tired and my body doesn't do well being pregnant and breastfeeding at the same time so for the sake of the new little one I normally stop when I'm a couple of months pregnant.