Guest Post: The 5 P's of Successful Breastfeeding - Part 2

We are excited to share part two of Breanne Clinger's hit post, "The 5 P's of Successful Breastfeeding", and her "6th P" written especially for Help Me Grow! Breanne is a Labor and Delivery Registered Nurse, Prenatal Educator, and author of the blog Mommy To Be Prep.

4. Patience with your Baby and Yourself While Learning and Mastering Breastfeeding
When working with mothers on breastfeeding, I have noticed the babies sense and mimic their mother’s emotions! If the mom starts becoming frazzled or stressed that the baby is not latching
appropriately, the baby will become frazzled too. When the mother is able to stay relaxed and calm, it helps to sooth the baby, and the two can work better as a team. Remember, you are both learning together.

5. Persistence in the Continuation of Breastfeeding
Breastfeeding gets easier and easier with practice and the work does pay off, just stay with it! 
How often and long should you breastfeed? Each baby and mom are different. Womenshealth.gov recommends newborn babies breastfeed at least 8 to 12 times every 24 hours (every 2-3 hours) to help bring in your milk supply. Follow your baby’s schedule and adapt to them. Each feeding may be 15-20 minutes but there is no set time! Your baby will let you know when they are finished.

How do you know if your baby is getting enough?

When you first begin to breastfeed, your baby’s stomach is very tiny! It starts off the size of a cherry and by three weeks it develops into the size of an egg.  Although the baby’s stomach is small, it is a common fear for the mother that she is not producing enough milk for her baby.  You can be reassured you are producing enough milk for your baby by self expressing from the other nipple your baby is not breastfeeding from. This way, you can see approximately how much milk you are giving to your baby. You can also know your baby is getting enough milk when he or she shows signs of being more content and satisfied after feedings. The amount of wet diapers the baby has within a 24 hours lets us know if the they are hydrated. Your baby should have at least one wet diaper the first day, two wet diapers the second, three wet diapers the third and four wet diapers the fourth day (easy rule right?) Thank goodness the rule doesn’t continue much past that! By day five and after, your baby should have at least six wet diapers a day. Your baby’s weight will also be tracked daily while at the hospital. It is normal for newborns to lose up to seven percent of their birth weight within the first three days of delivery. Your pediatrician will inform you if your infant’s weight ever becomes concerning.  To see a visual chart of this information click here.

When should you stop breastfeeding?

Any amount of breastfeeding is better than none, but The American Academy of Pediatrics recommends babies be exclusively breastfed for “about the first six months of life. This means your baby needs no additional foods (except Vitamin D) or fluids unless medically indicated. Babies should continue to breastfeed for a year and for as long as is mutually desired by the mother and baby.” The World Health Organization (WHO) recommends babies to be breastfed even longer, “Exclusive breastfeeding is recommended up to six months of age, with continued breastfeeding along with appropriate complementary foods up to two years of age or beyond.”

Where can you find extra support and guidance for breastfeeding?

•  You may call the National Breastfeeding help line at 800-994-9662 available Monday-Friday  9am-6pm EST. You will be connected to to a breastfeeding peer counselor that can help  answer common breastfeeding questions and help you decide if you need more assistance from  a doctor or lactation consultant.
•  You may visit www.ilca.org to find an International Board Certified Lactation  Consultant in your area.
•  Find a local breastfeeding support group online through Facebook.
•  Utilize The Women Infant and Children program (WIC) provided to low income families. For local WIC information visit www.fns.usda.gov/wic/breastfeeding/breastfeedingmainpage.htm or you may call the national office at 703-305-2746.
• The woman body is “UDDERLY” amazing to support and give life to another growing human! You can do this. Just remember…

6. Prevention of Mastitis 

Remember when Mrs. Doubtfire is making dinner for his family and it all turns into a disaster? Especially when his phony breasts catch on fire, “This hollandaise smells like burnt rubber!” Although experiencing mastitis lacks the humor of Mrs. Doubtfire’s white blouse in flames, this breast infection may feel painfully similar. Other symptoms of mastitis include flu like symptoms, tenderness, warmth and redness. Mastitis is usually just in one breast (Tilson, 2007).Call your Obstetrician as soon as possible if you develop a fever for longer than 24 hours, if you find pus or blood in your breast milk, if both breasts feel infected, if you have red streaks near the area, or if the symptoms come suddenly and are severe (Office On Women’s Health, 2014). To best prevent mastitis you must know some common causes which can be grouped into four categories; unresolved engorgement, plugged ducts, cracked nipples, or a mother with a low resistance to infection.

Unresolved Engorgement

You can expect your breasts to become more full during the third to fifth day after the birthday of your little one due to your mature breast milk coming in (Office On Women’s Health, 2014). The increase in volume of milk, as well as the additional blood and fluid traveling to your breasts may give you a Dolly Parton sensation. Some women hardly notice, while others feel uncomfortably bursting! It is important to relieve the engorgement because restricted milk flow leads to mastitis. Usually this discomfort will dissipate in 12-48 hours when utilizing these tools, if not, contact your healthcare provider (Mohrbacher, 2003, p. 492).

• Breastfeed frequently and on cue. Breastfeed in a variety of positions, as this will encourage milk flow.
• Do not switch your baby to your other breast until the baby shows signs of being completed (falling a sleep, or takes themselves off the breast independently).
• If your baby is not able to nurse at the breast, but you are planning on breastfeeding, pump or self-express during the times your baby would normally be feeding.
• Apply warm compresses to assist in milk let down.
• Cold compresses can also be used between feedings to decrease the pain and swelling. 
• Gently massage the affected area using your fingers in a circular motion moving towards the nipple (this works great in a warm shower).
• Use cabbage leaves to ease engorgement pains. After washing, use the inner leaves and break a part the hard vein. Place inside your bra at room temperature or cold from the refrigerator. Change the leaves every couple of hours or if wilted, and of course do not continue if an allergy manifests. There are speculations, but it is not proven if it is the coolness of the cabbage leaves, or an innate property of cabbage itself that creates relief for the mother.
• Utilize a lactation consultant early on. If you find you are engorged and your nipples have become flat due to the pressure in your breasts, latching may be even more difficult.  Picture yourself trying to latch hold of these water balloons with your own mouth, without the use of your own hands! You can now imagine the frustration your poor baby may experience when dealing with engorged breasts! Expressing breast milk prior to nursing may soften the breasts for an easier latch. If you are still unable to get your baby latched with this trick, or your baby is not having enough wet or dirty diapers, contact your doctor (Mohrbacher, 2003, p. 108).

Plugged Ducts

Missed feedings, abrupt weaning, an incorrect latch, excessive use of artificial nipples, and consistent pressure on your breasts will plug your baby milk sprinklers right up and may lead to mastitis! Sorry belly sleepers you thought delivery of your baby meant return to the normal sleeping position… not the best notion placing all of that pressure on your chest. Also wear a comfortable supportive bra, one that is not too tight. Utilize the techniques mentioned above such as warm compresses, massage, and frequent breastfeeding!

Cracked Nipples

As a labor and delivery nurse, I get the opportunity to come in contact with many... feet. It seems as though for many expecting women to feel ready to have their baby, they must have their toenails freshly polished. It could be the 12-hour shifts getting to me, but I have come to the conclusion that nipples are like feet. Besides the fact that they like to be covered in the day and free at night in the bed, they both serve fundamental purposes– walking and feeding. Feet can get sore, cracked, and blistered from an improper shoe and excessive walking. Nipples can get sore, cracked, and blistered from an improper latch and excessive suckling. Both the feet and nipples need to be cared for. I would even argue that having two breast friendly tools in your hospital bag is more important than your freshly polished piglets (and I say that out of love for my pedicures)! The first tool is a nipple cream such as lanolin. Lanolin is a great basic cream to start with and is hypoallergenic.  You usually will be able to get a free sample of lanolin at your Dr.’s office or at your hospital (I carry a sample in my pocket to put on my chapped lips!) Some of my patients have also used coconut oil and say that has worked well for them. Triple Nipple cream or APNO (All Purpose Nipple Ointment) is a heavy duty prescribed nipple cream that works as an anti-fungal, a steroid to decrease inflammation, and an antibiotic. A big no-no that you may have heard from Aunt Betty is to use moist tea bags on your nipples, research shows that this may actual promote drying and cracking (La Leche legue International, 2011). The second nipple friendly tool is breastfeeding knowledge. You cannot exactly pack that in your hospital bag, but having some breastfeeding knowledge on what a correct latch looks like will be tremendously helpful in preventing your nipples from being damaged.


A Mother with a Low Resistance to Infection

Mastitis is often the first sign that a mamma is over working herself. The key here is to try your best to take care of yourself because stress, not eating well, and a lack of sleep can all contribute to a less efficient immune system. A couple of tips:

• Make sure you are getting an adequate amount of iron through your diet or by supplement. Excessive blood loss from delivery can cause you to be anemic which increases your risk for infection and makes you even more exhausted. 
• Make a list of five friends or family members who you know you can count on when you are in need of relief. When you are feeling unable to cope from stress or exhaustion call one of these friends to your aid.
• Drink plenty of water and continue to take your prenatal vitamin while breastfeeding.
• If smoking, stop smoking. Cigarette smoking is a double whammy because it puts a mother more at risk for plugged ducts and infection. See mommytobeprep.com “4 Steps To Quit Smoking While Pregnant” for help.
• Stay away from people with a cold or flu and wash your hands frequently.

Now that you are informed with how to resolve engorgement, prevent and treat plugged ducts, avoid your nipples from turning into The Sahara Desert, and prepared to keep yourself holistically balanced, you are on the road FAR south of mastitis! Best of luck and congratulations! And please remember, always keep your Doctor informed and ask any questions, they know what is best for you and your babe.

Resources:

La Leche legue International. (2011, June 21). How Do I Heal Sore Nipples? Retrieved from www.lalecheleague.org/faq/heal.html

Mohrbacher, N., & Stock, J. (2003). The breastfeeding answer book. Schaumburg, IL: La Leche League International.

Office On Women’s Health. (2014, July 21). Breastfeeding: Common Challenges. Retrieved from www.womenshealth.gov/breastfeeding/common-breastfeeding-challenges.html#f

Tilson, B. (2007, October 14). Mastitis-Plugged Ducts and Breast Infections. Retrieved from www.llli.org/llleaderweb/lv/lvmarapr93p19.html