Breastfeeding Questions and Answers

Breastfeeding BabyOver the last 20 years, I have observed doctors, nurses and lactation consultants provide numerous approaches and invite numerous controversies to breastfeeding.  I have found that the common key to successful breastfeeding is to establish a successful latch as soon as possible and don’t do anything subsequently to screw that up.

The latch is simply the baby opening his/her mouth wide and being pulled against the colored portion of the breast (the areola) so that the baby gets as much of the areola in his/her mouth as possible. The baby is then able to use his/her tongue to push milk out of the breast. The lips create a seal around the areola then with a sucking motion the baby brings milk is into the mouth.

Mothers and babies that have successfully mastered  the latch and subsequent sucking and swallowing  prior to leaving the hospital are very effective at breastfeeding. Those who do not accomplish this prior to leaving the hospital  are often unsuccessful at breast feeding.

The following 8 most asked questions help delineate many of my recommendations for breastfeeding. The answers are based on the premise that the latch is the key to breast feeding.

  1. Should you breastfeed in the delivery room?
    Absolutely, if possible, frequent repetition is very important to getting the baby to latch and feed successfully. If for no other reason, breastfeeding in the delivery room provides another opportunity to establish the latch.
  2. Should you room in with the baby instead of sending the baby back to the nursery at night?
    Yes, this allows you more chances to breastfeed the baby and establish a good latch. This also allows you to put the baby to breast as the baby is starting to wake up and move about. Instead of the baby being brought to you when he/she is screaming and crying from the Nursery. Getting the baby to latch when he/she is calm and hungary is much easier than when he/she is yelling and hungry.
  3. Should you restrict visitor to the hospital during your stay?
    Yes and No.  Visitors should be restricted to short visits unless the
    mother is completely comfortable breastfeeding with the visitor. Otherwise, the opportunity to establish a good latch and breastfeed will be compromised.  This is where fathers are helpful. Fathers can very politely thank visitors for coming and allow them to go on their way. Visitors get to see the baby, fathers get to help and mother and baby get to breastfeed. Everyone wins.
  4. Should you bottle feed and breastfeed in the first few weeks after birth?
    Unless there is some significant reason, for example, the baby is significantly premature, sick, or mother is ill the answer is usually NO.  The question falls under the category of “don’t screw up the latch”.  When babies drink milk from a bottle they use their tongue to stop milk flow not to start it as they do in breastfeeding. This difference in feeding styles is called “nipple confusion”. Plus, it is easier for infants to stop the milk flow with the tongue than to push the milk out with the tongue as in breastfeeding. Some caregivers believe that nipple confusion is insignificant. At least in the first few weeks, my experience is that both breast and bottle feeding severely inhibit the baby from latching and often leads to breastfeeding failing or being stopped prematurely.
  5. So can you ever supplement with a bottle?
    Yes, in fact I encourage it, but not until about one month of age. Just after birth women have colostrum, a thin brownish substance, instead of breast milk coming from the breast. The colostrum is very rich in calories and is replaced by breast milk when the baby is about 3 days of age. Initially the colstrum is small in quantity but sufficient for the needs of the baby. As the baby needs increase, the baby sucks at the breast more aggressively and more efficiently. This process causes the breast to make more and more colostrum and subsequently breast milk which allows the baby an easier time feeding. By a few weeks of age, the baby is very efficient at breastfeeding. The breastfeeding mom is making lots of milk and the ease of breastfeeding makes for a very satisfied mother and baby. In fact, if you wait past 7-8 weeks to introduce a bottle, babies will often have trouble taking the bottle because they are so good at breastfeeding, thats all they want to do. For many mothers who want to have some alone time a way from the baby, this creates a problem and mother decide to stop breastfeeding out of frustration.  This clearly screws up the latch.Offering a bottle, once every day or two at about 1 month of age doesn’t inhibit the latch or breastfeeding. The baby will still readily accept the bottle. This allows the father to finally feed the baby and mother some free time for herself. A win win situation for all concerned. The only problem that I have found with this approach is that if the baby feeds from a bottle multiple times a day (especially if the bottle is formula and not pumped breast milk); mother’s milk supply will start to decrease. The baby then will not to get enough milk sucking at the breast. Then, the baby will start to find bottle feeding much easier again. This may cause the baby to refuse to latch and subsquently stop breastfeeding.
  6. But what happens if a baby is losing a lot of weight in the hospital or is getting increasingly jaundice(yellow) or not latching well? Now what?
    As long as the baby is not ill or there is another medical contraindication, the answer is to cup feed.  This is again one of those controversial topics. This technique involves the nurses giving the baby pumped colostrum/breast milk or formula (if no colostrum/breast milk is available or there is not enough) by using a tiny cup. The baby is fed this breastmilk/formula after the baby breastfeeds at the breast first. The cup technique does not involve sucking by the baby. So, it does not screw up the latch. Cup feeding can cause the baby to choke if not done properly. I use cup feeding in the hospital only with an experienced nurse for periods of up to 24-36 hours until the latch and efficient breast feeding has started. Since I do not want parents to use a cup at home and sometime babies still need supplimentation for a few days after leaving the hospital, I will often use a finger feeder or SNS. These are simple apparatus that are essentially an open syringe cylinder with a tube attached. The tube is attached to the breast with tape with the opening at the areola where the baby are latching.  Formula is then place in the open syringe and the baby sucks on the breast and gets extra fluid. Or another way to use the “finger feeder” is one can tape the tube to one’s finger in front of where the baby will suck. The baby then sucks on one’s finger, after feeding at the breast first. Again the baby gets extra fluid without screwing up the Latch. This is usually only needed for a few days until mother’s milk supply increases. This technique often allows mother and baby to be successful at breastfeeding when they otherwise might have given up.
  7. Can a pacifier be used in a breastfeeding infant?
    No and yes.  No, in the first few weeks, because of the nipple  confusion issue. Babies that suck on pacifiers take short rapid sucking motion instead of the longer and more forceful motions of breastfeeding. This confusion could screw up the latch. But, again after a few weeks, a pacifier could be introduced once breastfeeding is established.
  8. How do I know my baby is getting enough milk?
    If the baby is urinating at least once per day of life (one wet diaper in the first day, 2 in the second, 3 in the third and so on) until 6 days of life and older, the baby should have at least 6 wet diapers per day; the baby is getting enough milk. The only addition to this is that the urine should not have red crystal or orange tinge after 72 hours. After 72 hours of life the urine should be yellow.  If the urine has red crystals or is orange tinged at 72 hours, the baby is not taking enough breast milk and one should talk with your infant’s pediatrician.

As always if there are more questions, please call the office.