Parenting: Breastfeed

"I think I'll instinctively know how to breastfeed," says mom-to-be Michelle Beerman of Allentown, Penn. "After all, it's what I was biologically programmed to do."

She's not alone in her thoughts. As more and more information comes out about the importance of breast milk, more and more women are throwing out the bottle.

Although breastfeeding is natural, it's not as "instinctive" as some might think – especially not in societies where bottle-feeding seems to dominate the maternity landscape. Fortunately, breastfeeding success is the overwhelming norm for women who have the right information and expectations. iParenting expert advisors can help provide you with both.

Expectations
"One of the problems I've found working with pregnant moms is that they are so focused on 'the birth' that they only half listen to anything post birth!" says Karen Zeretzke, IBCLC, a certified lactation consultant in Baton Rouge, La.

Remember, in the grand scheme of things, birth is "lightening fast." After that, you have 18 years – or more – of caring for your child. It makes sense to put some emphasis on the choices that will impact you for years to come.

According to Ann Calandro, RNC, IBCLC, a certified lactation consultant in Waxhaw, N.C., a positive attitude about breastfeeding is key to your success. "It is this attitude that will carry [moms] over bumps in the road and even mountains should they appear in the horizon," she says.

Calandro believes that early exposure to successful breastfeeding creates this positive attitude. "[La Leche League] meetings, classes, being around other mothers and seeing the loving relationships is what makes mothers realize that this is what they want for themselves and their own babies," she says. "Once the attitude is there, nothing is going to impede their success. There is such a unique difference in the way that breastfeeding mothers and babies interact. The air is charged with this love, and it is contagious!"

Following Calandro's advice to create a positive attitude about breastfeeding before Baby arrives will leave you with much more than information – you will develop realistic expectations, and you will build a support group in the process.

"Establishing a support network ahead of time is important, but not because breastfeeding is so difficult that moms need all the help they can get," says Melissa Clark Vickers, MEd, IBCLC, a certified lactation consultant in Huntingdon, Tenn. "Women naturally seek other women for help, advice and a pat on the back that comes best from one who's 'been there, done that.' Breastfeeding is just another opportunity for sharing and bonding with other women. Not only do they learn tips and techniques from the 'pros,' but they also build a network for help IF there are problems."

You should also locate an international board certified lactation consultant in your area. They are the "true" lactation experts. (Some lucky babies are able to claim an IBCLC for their pediatrician or family doctor, too.) Getting in touch with an IBCLC before birth will save you from scrambling after birth, if you should need to have questions answered.

Information
Once you have a support network – and a positive breastfeeding attitude – in place, it's time to tackle the technicalities. Clark Vickers has answered a few of the most common – and critical – questions about breastfeeding. Knowing and understanding these answers puts you one step closer to success:

Do I need to do anything to prepare my nipples for breastfeeding so they won't get sore?
Not too many years ago, the answer to that question would include a variety of suggestions, all designed to decrease the risk of sore nipples. Pregnant women were told to "toughen" their nipples with towel rubbing and nipple pulling. Some women were actually told to use a toothbrush to scrub their nipples! OUCH!

Thankfully, we know more about preventing sore nipples, and that the very things that were being suggested to toughen the nipples only made them MORE likely to get sore. The major cause for sore nipples is poor positioning of your baby at your breast. When the positioning is corrected, the pain goes away. Breastfeeding should not hurt!

Thanks to special oil secreted by the Montgomery glands, those "bumps" around the areola, your nipples stay clean. There's no need to use soap to wash them, and in fact, soap can dry the skin. Clear water is enough. If you find your nipples seem to be dry, it is OK to use a mild skin cream during pregnancy.

After your baby is born, you'll want to only use something that won't have to be washed off before the baby nurses, such as ultra pure lanolin like Lansinoh for Breastfeeding Mothers.

Many women experience sore nipples, but most do so unnecessarily. Pain is a sign that something is NOT right: either positioning, poor latch-on, or rarely, more complicated problems. If your nipples hurt, seek help immediately from your network of breastfeeding experts.

How do I achieve proper positioning?
The key to successful breastfeeding is how you position the baby. It is normal to feel awkward at first, but soon you'll both be pros. First of all, you need to be comfortable, so use pillows behind you and under your arms to support yourself and your baby.

Next, think about how you will place your baby at the breast. Your breast is his dinner plate. It needs to be right in front of him, with his nose at your nipple level. He shouldn't have to turn his head side to side or front to back to reach the nipple. You may need to place a pillow under him to raise him up a bit. Turn him on his side, facing you. This is especially important and is one big difference between breastfeeding and bottle-feeding. His tummy should be next to you, and with a tiny newborn, it may actually lie across your other breast. His hip, shoulder and ear should be in a straight line, and one hand should be on either side of your breast.

Cradle your baby in your arm with his head near the bend of your elbow and his bottom in that hand. Use your other hand to support your breast. Place your thumb on top and cup your fingers underneath, holding the breast well away from the nipple and areola (the dark area around the breast). Tickle your baby's lips with your nipple and wait for him to open WIDE, like he's yawning. Be patient! Anything less than a wide opening can result in him latching onto your nipple rather than the breast – and that hurts!

When he does open wide and his tongue is down, hug him quickly to your breast, chin first. This will result in him getting a good mouthful of breast. Aiming the nipple toward Baby's nose and pulling him in chin first will cause him to latch somewhat off-center and will put more of the breast where those tongue muscles can do their job.

Tiny as they are, newborns are ready, willing and able to nurse. You'll feel some suction, but it shouldn't hurt! If it doesn't feel right, then use your little finger to slide in the corner of his mouth. This will break the suction, and you can gently take him off and try again. Remember, first nursings are practice sessions.

How can I tell if my baby is latched on well?
There are a number of good signs:

• It doesn't hurt! This is so important. If it hurts, then something is not quite right. A minor change in positioning can make all the difference in the world in comfort at the breast.
• He is breast-feeding, not nipple-feeding. He should have about an inch of the areola in his mouth so that his jaw and tongue action are milking the sinuses, or storage areas, not just clamping down on the nipple.
• Contrary to advice in the past, he'll be latched off-center, with more of the breast in his mouth where his tongue is. You can change positions to get at other areas of the breast.
• His lips look like fish lips, both curled outward.
• His tongue is cupped under your breast. You may be able to gently pull back on the corner of his mouth to see the tongue.
• His jaw movements are rhythmical. His cheek muscles will be working (but not sinking in) and he may even wiggle his ears! Listen for a soft "kaw-kaw" sound that means he's swallowing.

How do I know my baby is done nursing?
How do you know when you have had enough to eat? You may push the plate back from the table, get up and walk away. Or you may hang around and enjoy the company, but not eat anything else or perhaps just nibble every now and then.

Obviously your baby can't get up at the end of the meal, but he can let you know his tummy is full. Here are some signs to look for:

1. He comes off the breast with that marvelous "drunken sailor" look. Milk may run out of his mouth, and he generally looks pleased with himself.
2. His body is relaxed. Typically, at the beginning of the feeding, his hands may be clenched in tight fists, and he is totally absorbed in the business at hand. As his tummy fills, he relaxes his fists and the rest of his body.

He may still want to hang out at the breast and occasionally suck some more. "Hanging out" at the breast serves a useful purpose, too!

You can also tell he's getting plenty by looking at what comes out the other end. He should be soaking six to eight diapers every 24 hours and having two to five bowel movements or more a day. The wet diapers are an indication he's getting enough fluid, and the bowel movements indicate he's getting enough calories. He should also be growing in all directions: weight, length and head circumference.

He should be relatively content between feedings. Oddly enough, this one comes fairly low on the list – not because it isn't important, but because the baby who is not getting enough to eat may be so lethargic that he is mistaken for a content, "easy" baby who sleeps a lot.

In time, all this will be second nature to you. Just as learning any new skill requires practice, the more often you put your baby to your breast, the quicker both of you will learn. And remember, if you need help, just ask.