Learning to read baby's body language and hear vocal cues is an acquired art, one that takes time to acclimate to. It's easy to miss hunger signals or mistake them for other needs. For now, familiarize yourself with the warning signs of insufficient feeding. If your baby is having fewer than six wet and three dirty diapers a day, is excessively fussy at the breast, has a sunken fontanel (soft spot), acts lethargic, and is not at or above birth weight by two weeks postpartum (or steadily gaining thereafter), he is probably not getting enough milk and needs to see his pediatrician immediately. Fortunately, with some work and a little guidance, you should both be able to get back on track.
Why Your Body Isn't Cooperating
There are dozens of reasons why milk supply or nursing itself may not be making the cut, but most of them can be overcome with patience, special equipment, and/or professional training and guidance.
Medication: Antihistamines, decongestants, contraceptives, and some other medications can have a detrimental affect on milk supply. Talk to your doctor before taking any medication while nursing.
Inverted nipples: If you have inverted nipples, a good latch may be elusive. Breast shields designed to pull the nipple out can help.
Prior breast surgery: Many women nurse successfully after breast surgery, but certain types of breast augmentation (enlargement) or breast reduction surgery do have the potential to hinder your milk supply, depending on how they are performed. Talk to your doctor if you've had breast surgery and are having lactation problems.
Hypotrophic breast disease: Some women have structural problems with the breast tissue that decreases the number of milk-producing ducts. You may still be able to nurse, but baby might require supplemental feedings. Again, speak with your provider about your options.
Retained placental fragment: Lactation problems can be a sign that a piece of your placenta was retained in delivery. Since this can also cause severe hemorrhage and infection, a suspected retained placenta should be assessed by your provider immediately.
Stress: New motherhood and all its related stressors can inhibit milk supply, and tension can make letdown (milk ejection) difficult. If you're uptight about nursing problems, the cycle perpetuates itself. Try to look forward to nursing as a relaxing,
Poor technique: Letting baby empty one breast before moving on to the next will stimulate milk supply and allow her to reach the fatty and filling hindmilk at the end of her drink.
Poor nutrition and hydration: Good eating habits and plenty of water are essential to your milk production efforts.
Nipple confusion: The mechanics of drinking from a bottle are very different from those of feeding from the breast. If a bottle is introduced before breastfeeding is well established, it's possible for your baby to develop a preference for it.
Babies born prematurely, those with a poor sucking reflex, or those with a cleft lip or other health problem can have problems nursing initially. If your baby needs supplemental feeding in the hospital for any reason, you can request that it be administered with an eyedropper, syringe, feeding cup, or supplemental feeding system to avoid nipple confusion. You should also talk with your pediatrician and a lactation consultant about adaptive techniques and other options.
A lactation consultant is a health care provider who specializes in breastfeeding support and training. If you're having difficulties with nursing, a consultant can be a huge help in helping you overcome breastfeeding difficulties. Your ob-gyn or your child's pediatrician can provide a referral if needed. Some large pediatric practices retain lactation consultants on staff.
Breastfeeding problems with your first baby may have made you gun-shy. The stress of having a firstborn baby coupled with the exhaustion of new motherhood could in the past have sent your body into a tailspin; there's a good chance this time will be different. You have the added benefit of experience on your side, so don't be afraid to try again.
A board-certified lacation consultant will have the designation “I.B.C.L.C.”(International Board-Certified Lactation Consultant) or “I.B.C.L.C., R.L.C.”(Registered Lactation Consultant). These means she meets specific eligibility and experience requirements and has passed a board examination administered by the International Board of Lactation Consultant Examiners (IBLCE). Sometimes consultants are nurses who have earned board-certification.
Many certified lactation consultants are also La Leche League leaders. Don't overlook the value of La Leche League support if you have no lactation consultant in your area. The organization can be a tremendous source of emotional support as well as practical advice and expertise.
A breast pump can be useful in ramping up your milk production if you're having supply issues. It's also a great tool for moms heading back to work who want to keep nursing, as well as for mothers of babies who are temporarily unable to nurse for various health reasons.
A pump may be manual (hand-powered), battery-powered, or an electrical unit. The hand-powered pumps have the advantage of being inexpensive and portable but can take some getting used to and take longer to empty a breast. They use a piston-like action or a squeeze bulb to create the suction that removes the milk from your breast.
Hospital-grade electric units are probably the most efficient and allow you to pump both breasts at the same time, though they are bulky to transport and costly to purchase. Weekly or monthly rental units are frequently available through lactation consultants, hospital programs, or private businesses. For safety reasons, you will have to purchase a personal kit for use with the rental unit that contains all the elements that come in contact with your breast milk, including tubing and bottles. The kit can be used for as long as you plan to pump and usually runs around $20 to $30 for the basics.
Supplemental and Finger-Feeding
If you're having breastfeeding problems, a supplemental nursing system (SNS) can help you provide baby with added nutrients of pumped breast milk or formula while still giving the benefits of suckling. A bottle or bag milk reservoir hangs around your neck, and two narrow silicone tubes channel milk flow from the reservoir to your nipple, where the open end of the tube is taped. As baby feeds on both the supplemental milk and breast milk you're providing, her suckling action further stimulates your milk production.
Beyond the immediate physical benefits of helping to speed your postpartum body back in shape, breastfeeding can have long-term benefits for maternal health. Studies have suggested that women who breastfeed have a lower risk of developing premenopausal breast cancer and ovarian cancer and postmenopausal osteoporosis and hip fractures.
Finger-feeding is similar in principle to an SNS and is sometimes used as an alternative. It uses a narrow feeding tube attached to a syringe or reservoir in which breast milk or formula is placed. The other end of the tube is taped to your index or middle finger, and the baby gets her nourishment by sucking on your finger. If baby is not latching onto the breast for whatever reason (for example, nipple confusion, separation from mom, weak sucking reflex), finger-feeding can provide nutrition without introducing a rubber nipple to the feeding process.
Women who are having problems producing enough milk for whatever reason may be able to supplement from a local breast milk bank if one is nearby. Milk donors are screened for health problems in a process similar to blood-donation screening. Again, a lactation consultant or pediatrician should have further information on what's available in your area.
Mastitis is an infection of the breast that can be caused by a plugged milk duct. If you develop mastitis, you can and should keep nursing. Your baby cannot get ill, and the breastfeeding process will actually help the mastitis resolve itself faster by easing the pain and draining the milk ducts.
Signs of mastitis include:
Breast is warm to the touch
Red, tender streaks on the breast
Pain and swelling
If you develop mastitis, stay on your nursing schedule and try to get sufficient rest to help your body heal. A warm water bottle, warm wet compress, or soak in a hot shower can help to ease the discomfort. If the mastitis doesn't start to clear up in a day or so or begins to worsen, you might need an antibiotic. Your health care provider can advise you as to what medications will be safe for breastfeeding.