LEARNING HOW TO BREASTFEED

When we finally came home from the hospital our baby was 6 weeks old and she was exclusively bottle fed. My first goal was to switch over to breast feeding because I couldn’t imagine living in the sort of a future where every 3 hours I would be spending 15 minutes pumping, then washing the pump parts, laying them out to dry, warming the milk, bottle feeding the baby for half an hour, cleaning the bottle and only getting an opportunity to sleep in the tiny gaps between all that! If that was my future I couldn’t imagine ever even being able to leave the house! I didn’t want to be dependent on the ball & chain of bottle & pump, so I made a commitment to spend every waking moment of that first week focused completely on learning to breastfeed. It was August so the hot, humid, lazy weather contributed to a conducive atmosphere of sticky, nearly naked repose.

I was constantly researching on my phone during that long week, looking up better ways to get the baby to latch on, different positions and ways of holding the baby, tips and tricks that lactation consultants and other moms had discovered. Here’s the combination of things that eventually worked for me and my baby:

Skin to skin:

Beginning on Monday morning I took off all our clothes except my underwear and her diaper and I laid her across my bare skin as often as I could even when we weren’t nursing. This has been shown to help babies become more interested in nursing in part because the smell of milk is all around them, wafting out of your skin and surrounding them in a warm scent-cocoon of sensory awakening. For the first 6 weeks of her life so far my baby had experienced minimal holding, mechanized tube feeding and countless painful and uncomfortable physical sensations. Her environment had been full of the sounds of beeping machines and the smells of sterilized hospital equipment. My baby had never been truly held skin to skin in a soothing and relaxing environment. I needed to give her reassuring and positive experiences of being safe inside her own body and teach her about the pleasures of being held and fed by her own mother.

The “Laid back” breastfeeding position:

This was extremely helpful because I had been trying to use all the commonly recommended positions and baby holds (cradle hold, cross hold, football hold etc.) with little success. I already had learned the week before that my baby was best able to bottle feed in a side lying position where I wasn’t restraining or holding her in any particular position and she was able to control the flow of milk from the bottle by changing her own position. Based on that knowledge I figured my girl might like a less hands on position for breast feeding too but it took me a while to figure out the best method. In the laid back position you recline comfortably with your baby on top of you and let them come to the nipple in their own time. I Had some difficulty managing this at first because little babies don’t have very good neck strength so she had a hard time lifting her head to get onto the nipple. I found that if I propped myself up in a semi-reclining position I could support her more easily and still get the benefits of the laid back nursing approach. Here are a couple video links to help you understand more about this.

https://www.youtube.com/watch?v=d8SI4XKkOl8

https://www.youtube.com/watch?v=KWj_fXUe2sg

https://www.naturalbreastfeeding.com/

Deep Latch Technique:

This was another helpful technique and after watching a bunch of videos I began to be able to observe my baby more closely and see when she was just rooting for the nipple vs. when she was actually ready to open her mouth and jaw wide enough to create a good latch. The basic idea here is that you guide the babies head (from a hold on the back of the neck behind the ears) and as they open their mouth you tip their head forward to kind of scoop your breast into their mouth. The latch begins from their chin/lower lip as their mouth goes up and over your nipple to cover the entire areola. The goal is to get a good deep latch that puts a full mouthful of your breast into their mouth, not just the tip of the nipple. This technique was helpful but it seemed to be designed for a cradle or football hold where the mother has control of the babies positioning and it didn’t work as well in the semi-reclined pose where the baby is more in control of positioning. I tinkered with the balance between the two techniques until I found a middle ground where I could effectively guide her onto the breast but still be in a semi reclined position because each time I tried the cradle hold I wound up hunched over and dipping my nipple in her mouth like a tea bag.

Here’s a link to the deep latch technique:

https://www.pumpstation.com/blogs/articles/video-how-to-breastfeed-deep-latch-technique

Nipple Shields:

By Wednesday morning I knew that we needed another strategy. This process of researching and experimenting through trial and error really had helped her to want to nurse but after two days she was still having a difficult time latching on and her suck seemingly wasn’t strong enough to empty the breast which left me worried that she wasn’t getting enough to eat. A big part of the cause of this latch issue was that up until then she had been exclusively bottle feeding. Bottle nipples are not like real nipples, it doesn’t take much sucking to get milk out of a bottle and unlike a real breast, the baby can just suck on the tip of the bottle nipple with their lips and still get milk out. A real nipple takes more work and uses a completely different set of movements using the tongue to create suction and extract the milk. In order to go from Bottle to Breast the baby has to go through a process of re-learning how to suck. (Another thing that was making it more difficult for my baby was that she had a tongue and lip tie but I’ll discuss that in a later post!)

One tool for transitioning from bottle to breast is something called a Nipple Shield. In the hospital I had been given a nipple shield and shown how to use it but I was very hesitant to try it again at home because I had read so many stories on the internet of women whose babies would ONLY nurse if they used a nipple shield. However, the purpose of a nipple shield in this context is to make latching easier and to get more milk into the baby so in the interest of ditching the bottle I decided to give it another try. The options were either Pump & bottle feed forever or Breastfeed but have to always use a nipple shield. The choice was clear.

After a few false starts I realized that it helped her if I squeezed a bit of milk into the tip of the silicon nipple before offering her the breast so that she understood that there was milk to be had if she just sucked a little. After a nerve wracking morning of trial and error she got the hang of it and began to empty my breast over the course of half an hour! At first it was hard for me to manage all the moving parts: getting the baby latched on while keeping the flexible silicon shield stuck in place over my nipple. It kept falling off as she rooted around and tried to start sucking. I discovered that if I licked the inside of the rim like a postage stamp before putting it over my nipple it really helped to create suction and keep the sides from flaring up and covering her nose.

By the end of the day on Wednesday she had become a breastfeeding champion using the nipple shield. The next day was our pediatrician appointment so we had to leave the house for the first time. I took an emergency bottle of milk and tucked the nipple shield into my bra and we got in the car. After the appointment I decided to try nursing her while sitting in the shade in my car and she did great! I can’t even describe what an amazing feeling of liberation it was to be sitting in a parking lot nursing my baby and not worrying about needing to pump as soon as I got home! I felt like we were free to live our lives!

Ditching the Shield:

By the time we got home from our pediatrician appointment on Thursday afternoon I was determined that we could learn to breastfeed without needing the nipple shield. I didn’t want to become one of those sad stories of women who nursed their babies for 2 years but had to use a nipple shield each time. I wanted to just pick my baby up and pop her on the boob without depending on any props or tools which might get lost, forgotten or dirty while on the go and make it hard to live life spontaneously. After doing a lot of research that afternoon here’s what I did:

I would start her off with the shield and once she was sucking strongly I would gently put my finger in the corner of her mouth, break the suction and slip the shield off quickly hoping that she didn’t notice. The first 20 or so times that I tried this tactic she wasn’t having anything to do with my trickery and she would refuse to go back to nursing. So I’d put the nipple shield back on and we’d start again. I tried doing this trick in a few different positions and I eventually settled on a cross hold while slightly reclining. I often tried starting a nursing session by giving her my breast without the shield just to see if she really needed the shield and we’d go back and forth throughout the nursing session. By the end of the day she was beginning to accept my breast without the shield and as we continued to work on it through the night she slowly got used to it and got better at latching on again after I slipped the shield off.

I did notice on Friday that my nipples were beginning to feel sore and abused and I realized that her latch had gotten progressively worse as I was focused on slipping the nipple shield away from her. The nipple shield itself encourages a poor latch because the baby can cheat and suck on it like a bottle nipple. She didn't have to get as much of the nipple in her mouth in order to get milk so she got lazy about it. On Friday I focused again on the deep latch technique that I had learned before, to help her get more of my breast in her mouth and not just sip on the tip. Once again I tried out some new positions and found a few that helped with this issue too:

Side Lying Nursing:

Once I had taught myself and my baby how to nurse and then eliminated the nipple shield this position really was helpful because it took the strain off my arms, neck and back and allowed both me and baby to relax. It was also a relief to have her sucking on my nipple at a different angle. My nipples were starting to get sore in specific places and changing her body’s position in turn changed her mouth position on the nipple which changed the pressure points and relieved the repetitive soreness. Later on I also had some issues with blocked milk ducts and I found that the side lying position helped for that too.

A Note About Nipple Care

When I was using a breast pump every 3 hours for six weeks I relied on the little tubes of Medela Lanolin that the hospital provided. Without the lanolin coating the inside of the pump cups I would soon have chaffed my nipples raw. However, when I switched to breastfeeding I didn’t end up using any of the nipple creams, butters or salves that I owned. They just didn’t seem to make a difference to the overall feeling while breastfeeding and I didn’t like the fact that I was inadvertently feeding salve and cream to my baby and also they just made my nipples extra sticky at a time when I was already leaking into all my bras and sticky with my own milk. Instead what I did was apply coconut oil occasionally and try to keep my nipples dry between nursing times by changing the breast pads in my bra and leaving my boobs out to dry whenever I was at home. I never used soaps of any kind on my nipples since those can have a drying effect. Soreness and chaffing are almost always a result of poor latch/positioning so I tried to alleviate the pain by experimenting with different ways to hold my baby and different angles for latching her on as well as focusing on getting a deeper latch where more of my breast was in the baby’s mouth and not just the nipple.

Breastfeeding in the Ergo Carrier:

This changed my life and made everything so much easier. After some experimentation I found that I could nurse my baby upright while she was in the Ergo Carrier. Nobody could really tell that I was nursing and She could fall asleep or be awake, nurse if she was hungry or observe the world as she pleased. This enabled me to nurse while going for walks, nurse while I worked in the garden, nurse while visiting friends and family, nurse in the grocery store, nurse on public transportation, nurse while in a parade the list goes on an on! Nursing my baby in the Ergo gave me my freedom and got me out of the house and out enjoying summer after 6 weeks trapped in a hospital room with my baby.