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24 March 2013

What I Wish I'd Known About Nursing & Pumping

I'm not sure if it's just spring or that I'm at that optimal age for our generation between having completed grad school a few years back and so actually earning more than $50K per year, and still having the physiological capability to bear children, but whatever the cause - I know a LOT of pregnant women right now, and they all plan to work after giving birth. And as we say en espanol - ?como no?! The way the world is now the vast majority of families are going to have to engage both parents in out-of-home work. So, I interrupt our discussion about paid care leave to share with you what I've learned about nursing.

A lot of the soon-to-be-new-moms are, however, giving birth for the first time, and  a few have asked me about breastfeeding. Most people cannot believe I nursed full-time for a year and that my son didn't quit nursing until he was 17 months old while I also worked full-time and hour from home. (Yes, pat on the back.) Now, I'm not crazy, I'm just irrationally tenacious when I'm committed to something. I guess some people would say that's the same thing, but the silver lining is this - you only have to be crazy to figure this stuff out... a perfectly normal person can use all my tips and remain certifiably sane.

So, here's how you do it (partners, dads, and caretakers, it's good for you to know this stuff, too)... and I'm going to state both the obvious and not so obvious:
  1. If for any reason you have a hunch that your child's latch is not right - call the lactation specialist sooner rather than later, i.e. before two weeks after birth. (Bleeding, discomfort and an insatiable baby are tick-offs.)
  2. If that still doesn't work, your baby's tongue may have a connective flap underneath that is too long. See a pediatrician ASAP, and get it snipped. This hurts about as much as having your ears pierced and used to be routine in hospital births through the 60s; it's not very painful nor is it uncommon.
  3. Cabbage leaves - before or after nursing just place a fresh leaf on each side in your bra - this eases the pain and prevents congestion - especially if you are sore or engorged. 
  4. Stay hydrated: that doesn't mean tossing back a 10 oz glass of water every 2 hours. It means a lot of sipping. If you have to make herbal tea to keep yourself sipping - do it. If you do consume large amounts of water quickly, you'll actually dehydrate when your body works overtime to achieve a correct water-electrolyte balance. Pickles also help - the B vitamins help you stay hydrated.
  5. Which leads me to coconut water. Coconut water is an insanely good natural source of electrolytes. Without them, your body will not hold onto the water you need. Bananas are also great. (Don't use Gatorade, you can't digest it and neither can your baby.) Coconut water also has some kind of magical immune boosting power, so it's good for mama and baby. In South America mothers used coconut water to wean their children.
  6. Eat well. LOTS of protein and yes, carbs! Oatmeal is great for making milk in part because it has the perfect (and I don't like that word) balance of protein and carbs for the human being. I ate it every day with nuts for extra omegas - also good for baby. And you can use instant, which is great for new mommas.
  7. Get sleep. I didn't get enough and I regret it considerably: Dad can do one feeding a night!!! Yes, he can! And you won't lose your milk! But, if you're worried, pump into a bottle right before going to bed, and let papa heat it for baby for that 3 am wake-up.
  8. Once you've kinda got the whole infant thing down (I dunno... between 6 and 8 weeks old...) start pumping a bottle a day - that's 4 oz. You can freeze it or papa can give it to start bottle feeding, say once a week. We did both. Also, it's good to have a store for "what-ifs". For me it was a clogged duct that resulted in an infection. I was on strong antibiotics for 10 days that of course killed the probiotics in my son's stomach making him very uncomfortable. We had milk frozen. I kept pumping while on the antibiotics, and was able to give him the pumped milk - spread out once a day when he was in day care months later.
  9. Pumping tips: 
  • If you're going back to work get a GOOD pump! Medela is the best in my opinion and it needs to be both sides at once, a double pump. Obama passed a law that all pumps and pumping accessories and add-ons like bags are now covered by medical flexible spending, so keep your receipts for your FSA.
  • You'll probably need to pump about every 3 hours. I fed my son at 6 am, pumped at 10am, pumped at 2pm, and then fed him at 5:30pm for bedtime (and pumped later, but I'll get to that).
  • Always pump until the milk stops - that might be 12 minutes, it might be 23. Then KEEP pumping for at least 3 minutes. I would always got a second let down. I quickly went from pumping 3 oz per pump (about 20 mins) to 6 oz (about 25 mins) after I added the extra time- capturing the second let down. This happens because the sensation of "sucking" tells your body to make milk, so while you're pumping what was already sitting there - more is being made. You want to capture that let down, too so that your body is encouraged to keep making lots of milk.
  • When you're done, make yourself that herbal Fenugreek (Yogi is good) tea and sip away, then chow a couple tablespoons of peanuts. Making milk burns 500 - 800 calories a day, so don't diet.
  • If you wanna work out - that's fine. I did starting at 8 weeks, lost all my baby weight before returning to work at 20 weeks, and never dieted. I was eating constantly - but lots of protein.
  • Like most mothers - either when mama goes back to work, or baby starts sleeping through the night, you may see a drop in your milk. This is really frustrating, but don't worry, you can get it back. Here's how:
  1. Fenugreek herbal drops. If you get them really fresh they're very good. Drops are better than the pills also, and the taste is a bit fizzy. I put half a dropper's worth right on the tongue followed with OJ, 3 times a day. And Brewers yeast - for me it was 2 pills three times a day with the Fenugreek and I saw immediate results with both. (I never found published reasons not to use either of these; they were recommended to me by moms and midwives; and have been used for centuries.)
  2. Sipping - I would sip the "Nursing Support" Yogi tea (or Celestial Seasonings Bedtime) about an hour before bed, and a couple times during the day if I was up to it.
  3. Extra pumping really helps. Add on 2 more minutes after your second let down at work. this might put you at 35 minutes of pumping time twice a day at work, but remember - it's not forever; your work life will last loooong after your infant becomes a toddler.
  4. My son went to bed at 6 or 6:30pm for the first year, so I would nurse him at bedtime, then pump immediately after putting him down to get that second let-down, and again before bed, while sipping tea. That 9pm pump got me beyond what I needed per day for him, which helped a lot when those growth spurts came along.

My son, 2 weeks old

Dads, partners and babysitters, here's what you can do:
  • When warming milk, do it slowly. First defrost in the bag or bottle in the fridge. When ready to feed baby, run the bag/bottle under warm water from the faucet to loosen all the fats and proteins stuck to the bag (you can massage it), then heat water in a pan, take the pan off the stove, and drop the bottle into the pot gently circling the bottle - loosen all the good fat from the bag or bottle with massage and warm water.
  • DO NOT HEAT MILK in a PAN OR MICROWAVE! High heat kills all the good stuff.
  • DO NOT SHAKE THE BOTTLE! That also kills all the good stuff.
  • When you bottle feed baby, hold him or her like mom would while nursing. Go ahead and put a pillow on your lap so you can make yourself and baby comfortable.
  • Please hold your lil one both on the right and the left so he/she does not come to prefer one side, which can make it harder for mama to nurse on both sides (which she needs to do).
  • Babies consume a bottle much faster than nursing; after the feeding burp your baby over your shoulder or resting over your horizontal arm or lap. Try a few methods, and either rub or pat. I found firm, massage like rubbing in a circle over the back most effective but I'm sure every child is different.
  • Remember, baby is getting comfort from nursing, so try putting the baby's main blanket or mom's shirt over your shoulder while you feed. Later, mom and dad's scents will comfort baby and this really helps at bedtime, or when baby has to be with a different caretaker. (In earlier posts I talk about how the parents' scents comfort the baby, because she or he is made of you - you smell familiar because you are family - so that blanket needs mom and dad's scent - not another loved one, to do the job of giving comfort.)
  • Dads and partners, doing that one night feeding a day will make a BIIIG difference! You'll bond with baby; s/he will go back to sleep FASTER and sleep deeper - as will you and mom; your sweet love will be better rested the next day; and you'll know you made breastfeeding more sustainable - win-win!
My son, 17 months old

For all the new moms - LOVE you lots!! Congratulations on giving birth to your very own! If you have questions, leave a comment. If I cannot answer it - I'll find one for you before you go nuts between feedings!
And, if you have tips to add, please do so in the comments. Thank you and good luck to everyone!!

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