The First Six Weeks of Breastfeeding (& Special Birth Situations)

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Christina Valdez with her two month old, Oliver. Photo Credit: Ana & Ivan Photography

THE FIRST SIX WEEKS

OTHER CONSIDERATIONS

The First Six weeks

Is My Baby Gaining Enough Weight?

Look at the baby, not the scale.” It’s practically the newborn-nursing moms’ favorite motto.

You’ll probably worry about the baby’s weight at least once (um, per day?). But also consider: Is your baby content? Does she have periods of alertness appropriate for her age? Are you following a growth chart that reflects the typical pattern of a breastfed baby, not the outdated ones that many pediatricians still use even though they’re based on formula-fed babies as the standard? Is she reaching early milestones?

Remember that weight is but one single determinant of a baby’s overall health. It’s usually obsessed over and grossly emphasized by medical caregivers because, let’s not forget, medicine is essentially a measurement of input vs. output. It is simply the only ‘evidence’ toward a calculable conclusion at a medical appointment; alas, early weight unpredictability can be unreliable as an accurate predictor of a health problem on its own.

As a wide weight range exists among physically mature human beings, the same goes for the younger, more immature versions of these human beings. We both start out and end up unique — big, small, tall, chunky, lean, solid; comparing for sake of comparing does no one any good.

Your doctor will know when it’s time to be concerned about baby’s chub or lack thereof, so until then you might want to quiet the alarm bells.

Links:

Should My Baby Be Sleeping Through the Night?

Ah no… no, baby should not necessarily. All babies have slightly different circadian rhythms and circumstances that interrupt them throughout the night, and babies (like many adults) will continue to have nighttime needs that vary somewhat from their peers.

Sleep-training is in effect actually sleep-forcing if we can understand that sleeping ‘through the night’ is a developmental milestone. Manipulating such a sensitive thing before the child is ready can result in other challenges later.

One of the reasons breastfed babies in particular seem to wake frequently overnight is the fact that they drink human milk. They break their food down quickly because human milk is designed to allow for trouble-free digestion. It’s like the baby’s stomach absorbs it and empties at the drop of a hat (or the turn of your pillow yet again).

In matters of sleep, bottles do make a difference and so do solids (we’ve all heard the old “just top ’em off with some rice cereal” bit, right?). Natural sleep patterns are demonstrated by healthy, exclusively breastfed babies. Formula and solids WON’T help! (Find out why not in the Baby-Led Solids section).

Nevertheless, no matter how a baby is fed, you should know that parenthood will in part be defined by sleepless nights and nap-free days. The good news is your baby will sleep eventually; the bad news is YOU probably won’t

You can catch a break though! Read Co-Sleeping With a Breastfed Babe wherein you’ll learn how breastfed babies tend to sleep lighter, but their mothers actually get more sleep than the bottle-feeding set.

Also check out Dr. Sears’ book Nighttime Parenting: How to Get Your Baby and Child to Sleep and the new book by Diane Wiessinger, Diana West, Linda J. Smith, Teresa Pitman called Sweet Sleep: Nighttime and Naptime Strategies for the Breastfeeding Family.

Via LLLI store

“Sweet Sleep: Nighttime and Naptime Strategies for the Breastfeeding Family” by Diane Wiessinger, Diana West, Linda J. Smith, Teresa Pitman.

Links:

This SUCKS–not just literally. Will it be like this forever?!

What? No! I’ll let you in on a little secret. Find out in this post: It’s Great That Baby Likes to Suck, but Wow, Breastfeeding Straight-Up SUCKS!

Also read these other pieces: Help! I don’t want to breastfeed! and Prepare: The Learning Curve of Breastfeeding. by Best for Babes.

Danielle Rigg, JD, CLCBest for Babes.

Other Considerations

Cesarean Section

Many studies have noticed the comparative difficulties in breastfeeding between those who experienced surgical and natural births.

One study found that “women who had a cesarean section experienced a significant delay in initiating breastfeeding compared with women giving birth vaginally, with or without instrumental assistance.”

Another paper concluded that “the inability of women who have undergone a cesarean section to breastfeed comfortably in the delivery room and in the immediate postpartum period seems to be the most likely explanation” for decreased rates of exclusive breastfeeding among surgical births.

The key to a sustained future with breastfeeding might be getting through the recovery period, which is usually more grueling and physically limiting for mothers who have undergone major surgery.

That said, women shouldn’t allow an emergency or elective surgical delivery interfere with plans to breastfeed as many babies emerge in the operating room as nursing pros!

In fact, Dr. Sears thinks that a cesarean section should not dramatically impact breastfeeding, and c-section mothers can be as successful as vaginally-birthing mothers “as long as their commitment to breastfeeding remains high” (here are some other Dr. Sears tips). It appears that mothers just need to be thoroughly informed about what they can expect.

So what can be done to ensure a good nursing kick-off? The mother should strive to accomplish skin-to-skin breastfeeding as soon as possible after a c-section and she should make arrangements for this as a ‘just in case’ directive even if she is expecting a vaginal birth. Many c-section mothers even prearrange with their doctors to initiate the first breastfeed while being sewn up, which is entirely possible if given an epidural rather than general anesthesia. Expect to be lying flat on your back and to not have full range of arm motion available  (a nurse or partner should be appointed to help hold the baby’s head upright).

Research Gentle C-Section to see if this more family-friendly type of surgical birth is right for you. With a ‘Gentle C,’ a clear partition can replace a solid one just before delivery so a mother can see her child being born, if she prefers. EKG wires can attach to her back, freeing up her chest for skin-to-skin bonding. Find out more in this informational video.

TIPS

  • Have whoever will be assisting you at home (husband, mother, etc) watch how the professionals (nurses, doctors) help you.
  • They should also learn to do the ‘lower-lip flip’ technique at a moment’s notice and continually assess latch for you, as your view may be obstructed in certain nursing positions.
  • Side-lying and clutch/football hold positions may be the most comfortable (though for a while, you may feel that no positions are what you’d call ‘comfortable.’ Hang in there — you just had major surgery!).
  • After a cesarean section, expect to stay at the hospital for two to four days. Your initial recovery period will continue for weeks, however, so you’ll need to rally all the help you can get to take care of day-to-day things.
  • Try to use post-operative pain medication only when necessary as it can make mother and baby too sleepy to establish breastfeeding well. BabyCenter advises about what to expect in regard to postpartum pain relief:

If you get an epidural or spinal for your c-section, your anesthesiologist may add morphine, which can provide excellent postpartum pain relief for up to 24 hours without the grogginess that comes from systemic narcotics. Some anesthesiologists leave the epidural in for 12 to 24 hours after surgery so you can get more medication through it if needed.

After that, you’ll be given systemic pain medication, usually pills containing a narcotic and possibly acetaminophen. It may help to take ibuprofen, too. You’ll also be given a stool softener to counteract the constipating effect of the narcotic.

If you have general anesthesia for your surgery or you don’t get a dose of morphine through your spinal or epidural afterward, you’ll be given systemic narcotics for immediate postpartum pain relief. You’ll either get a shot of pain medication every three to four hours or you’ll use a system called “patient-controlled analgesia”: You push a button when you’re feeling discomfort and medication is delivered through your IV. A machine controls the doses so you don’t get more than the safe amount.”

DID YOU KNOW?

  • Another challenge is lower oxytocin patterns in a newly-postpartum c-section mother as compared to a mother who birthed vaginally. A mother can prepare for this by finding natural ways to boost her oxytocin after birth if necessary.
  • Greater populations of harmful bacteria such as E coli and C difficile are present in a child born via cesarean section, which means that breastfeeding (without supplementation) can be especially beneficial. Have you considered a vaginal swab? If it’s safe in your condition, you can mimic the bacterial environment of a vaginal birth by swabbing your vagina (or rectum) and wiping on your baby’s skin. This will introduce the right healthy flora into your baby’s system. Don’t be afraid to discuss it with your doctor!
  • Milk may take a few days longer to come in due to anesthesia and medications, the stress of surgery, and especially if the baby and mother have been separated. Try to have patience and keep your focus on frequent feedings or expression. Alternative feeding methods such as cup, syringe, and finger-feeding are better options than supplementing with a bottle, if breastfeeding isn’t possible.

Links:

Premature Birth & NICU

See the Premature Babies section.

Sleepiness After Birth

Many babies are especially sleepy after birth. If any labor drugs (including anesthesia, epidural, labor augmenters such as Pitocin/Syntocin, pain blockers, etc.) were given to the mother, the baby is in a better position for decreased alertness and unshakeable sleepiness in the first day postpartum. Think about it: any drugs that passed through the mother’s system in the process of labor also coursed through her baby’s to some degree.

Despite what doctors assure us, no medications have truly been proven safe for an unborn baby. The bad news is that labor drugs do affect babies and breastfeeding. But the good news is that whatever happens in your birth will not certainly define your future with motherhood. The best way for a mother and her baby to get to a place of emotional healing and physical recovery after a medicated or traumatic birth? Start breastfeeding!

Sometimes the use of labor medications can’t be avoided, and that’s okay, but you should at least know how to best prepare for the potential aftermath. For a breastfed baby, excessive post-birth sheep-counting can be a ‘make or break’ obstacle for many mothers who really need to hasten the supply-demand process in such a time-sensitive window. (Uh…no pressure, right??)

You’ll spend much of the first year (or few) trying to get your child to sleep. Though you’ll be inclined to sit back and enjoy your baby’s long vacations to dreamland, in the very beginning sometimes you’ll need to crash the slumber party with a feeding. Newborns need to breastfeed at LEAST every 2-3 hours. Less frequent feedings is a clue to your supply that there is less demand, and then it’ll be more work to convince your body that the baby is just very sleepy, not any less hungry.

Any amount of time that a baby is at the breast is never wasted; the more he’s on the breast doing anything at all (drinking, nibbling, licking, breathing, just hanging out), the more that your milk-making signals stay in gear.

TIPS FOR NURSING A SLEEPY BUB:

  • Wake baby during REM (rather than deep) sleep.
  • Undress yourself from the waist up, and make sure baby is nude (or with a diaper at most). If the environment isn’t warm enough, cover baby’s back with a light blanket but make sure as much of his skin touches his your skin as possible.
  • Shoot for less ‘relaxing’ positions to keep him alert. Stretch his limbs out and keep his body straight.
  • Try switch nursing. Alternate breasts back and forth for about five minutes on each side. Not only does this stimulate milk production, it can keep a lazy or sleepy baby engaged in the main event. This method should only be used short-term, such as during the first few days of breastfeeding, during a growth spurt, or if a baby is circumstantially distracted away from the breast.
  • Encourage wakefulness: talk to him, tickle his feet or chin, stroke his back.
  • Hand-express some milk to moisten your nipple to make it more appealing, or put a droplet or two on his lips to get him to open up.

Universal Vitamin Supplementation

You can ask your pediatrician to test your baby’s vitamin and mineral levels before giving any supplements, which is an especially good idea if you suspect they’re only being pushed routinely. Your baby isn’t some run-of-the-mill, factory-produced, cookie-cutter baby! She’s biologically and physiologically unique and she deserves all the special treatment she can get. 🙂 And you can be there to make sure it happens, whether that means boosting her baseline health with vitamins or eschewing those extras altogether.

While vitamins are necessary to support basic health, some vitamins can become toxic at too-high levels. Also keep in mind: test values may also not be the best determinant of a breast-fed baby’s health as many of the standards were recorded based on biologically abnormal (though not necessarily unhealthy) levels in formula-fed babies. Be sure to research which tests you prefer for your baby and specify accordingly.

Nursing mothers are advised to continue regularly taking their prenatal vitamins. Insurance may even cover a prescription prenatal for the entire duration of breastfeeding.

VITAMIN F.A.Q.

Do I really need to have my baby injected with vitamin K at birth?

No! if you don’t wish to give this shot, you can refuse it (click here for exemption help if you live in New York state). It’s been given purely as routine since 1944 as just one of many prickly gifts babies receive on their first birth day. The Merck pharmaceutical package insert for vitamin K shots reads:

“WARNING – INTRAVENOUS USE Severe reactions, including fatalities, have occurred during and immediately after the parenteral administration of AquaMEPHYTON® (Phytonadione).”

Yikes! Okay, let’s look into this a little more because “fatalities” doesn’t sound too good! Not a risk of fatalities, mind you, but fatalities that have occurred. This informative article (and interview with vitamin K expert Dr. Cees Vermeer, PhD) educates with a few facts:

  • Vitamin K is necessary for proper blood clotting and most babies are born with insufficient amounts of it. A rare number (between 0.25 – 1.7 percent) of babies suffer from Hemorrhagic Disease of the Newborn (HDN), characterized by life-threatening internal bleeding after birth. The article lists the factors for increased risk of HDN.
  • The injection is given universally to all babies (unless refused by the parents) as a standard preventative for HDN.
  • It also became a standard as circumcision rates increased in the period right after birth before vitamin K levels could stabilize on their own (blood loss from the surgical procedure is deleterious to this natural process). Interesting to note:

“[A] newborn’s natural prothrombin levels reach normal levels between days 5 and 7, peaking around the eighth day of life, related to the buildup of bacteria in baby’s digestive tract to produce the vitamin K that is necessary to form this clotting factor. Day 8 is said to be the only time in a baby’s life when his prothrombin level will naturally exceed 100 percent of normal.

As it turns out, Genesis 17:12 of the Bible mandates the circumcision of infant boys on the eighth day after birth—a recommendation pronounced long before we had the science to back it up.”

  • The risks: Immediate pain after birth can cause psycho-emotional distress due to the fact that infants do feel pain; the injection can contain toxic preservatives, not to mention the dose is 20,000 times what is necessary for newborns (the vitamin itself is non-toxic, but remember that’s not the only ingredient); the injection site is ripe for infection.
  • According to Dr. Mercola, it’s a myth that vitamin K injections are associated with cancer/leukemia.

Alternatives to the vitamin K shot (discuss the best route with your pediatrician):

  • Breastfeeding mothers can increase their own vitamin K levels via supplement to benefit her baby. Usually, this is all that’s necessary.
  • Several low oral doses of liquid vitamin K1 has no side effects, contrary to the shot.
  • If you intend to give the vitamin K shot only to help with circumcision healing, you can always just…not circumcise.

Does my breastfed baby need extra vitamin D? 

First things first: vitamin D is not actually a vitamin, it’s a hormone manufactured in reaction to ultraviolet B-ray sun exposure. Next, you should know there are three ways in which a breastfed baby can get vitamin D: breast milk, exposure to sunlight, and vitamin supplements (read this FAQ on vitamin D and breastfeeding). Most importantly, it’s extremely rare for an exclusively breastfed baby to suffer from vitamin D deficiency.

However, an increasing number of Western women are found to have low levels of vitamin D, usually attributed to inordinate amounts of time indoors. Let’s look at that.

  • A nursing mother’s vitamin D level will affect its level in her breast milk. Her vitamin D status during pregnancy will directly affect the stores that can (and perhaps will) sustain her baby for the next three months or so. If the baby and mother receive enough sunlight after this period, there is no need to supplement.
  • If a mother is concerned about her vitamin level, she should confirm it through a simple blood test. If it is found to be low, she can increase her own dietary vitamin D or take a vitamin supplement in order to elevate levels in her breast milk before manipulating the direct intake of her child. If the baby is still not meeting his vitamin D needs through breast milk (again, confirmed with a blood test), he should receive greater amounts of sunlight to help him produce enough himself.
  • What should be done if the mother has had her vitamin D levels confirmed as satisfactory via testing, but her baby appears unable to produce his own vitamin D even when regularly exposed to sunlight? If her baby has started solids, a dietary increase in vitamin D may be warranted. Vitamin supplementation follows as an option for certain babies.

Keep in mind that this vitamin is ideally absorbed primarily through the skin rather than in the digestive system. The skin is an organ specifically designed to handle large amounts of vitamin D, while the gastrointestinal system is not developed for such heavy vitamin D processing — in fact, it “may permit toxic amounts to be absorbed.” Yes, vitamin D levels in breast milk are not comparatively ‘high,’ but that’s due to the fact that nature and biology assume normal intake through sun-to-skin exposure rather than the rough detour of oral consumption.

You ask: Okay, but if vitamin D deficiency is so rare, why do the AAP (and many pediatricians) recommend that all babies take a vitamin D supplement?

Well, like all vitamins, this one is vital for development and maintenance of basic vitality. Severe deficiency can lead to infant and childhood rickets (which was a major health problem prior to the 1920s in the U.S.), bone disease and osteomalacia in adults, and more. When a child has started consuming solids and other liquids, it’s important to include beverages fortified with vitamin D and remain vigilant about ratio of calories to protein to avoid nutritional deficiency diseases such as rickets.

The organizations and medical field professionals who push universal supplementation are — how else can I put it? — simply lazy if not bothering to test for risk factors. For a righteous cause, yes, but at the expense of the vast majority of infants who do not need (and could be harmed by) supplementation.

So, how much sun exposure is actually necessary? This is a multi-factorial issue involving race, age, location, amount of outdoor time, and even fashion choice. There are many variables to account for as individual factors in determining an appropriate amount of sunlight needed to manufacture vitamin D. For example, for a Caucasian infant under six months old who lives in Cincinnati, a minimum amount is two hours per week if only her face sees the sun, or half an hour if her extremities also receive sunlight (through a window doesn’t count).

Also, a person can ‘stock up’ reserves on vitamin D during good weather months for the following sunless seasons. According to a Mothering Editoral by Cynthia Good Mojab, MS, IBCLC, RLC:

“Studies have shown that children can store enough vitamin D to avoid deficiency for several months when they are exposed to only a few hours of summer sunlight.”

Does my breastfed baby need extra iron?

Did you know that iron-deficiency anemia is rare in exclusively breast-fed babies? I know, it’s hard to believe because many people are instructed by especially educated individuals to supplement their breast-fed babies with iron before they can even sit up on their own. But Lil’ Junior don’t need all that (most likely). Here’s why…

Formula iron vs. breast milk iron

Less than 1% to a maximum of 12% formula-contained iron is actually absorbed and digestible by babies (hence the exorbitant serving size), as opposed to the 50-70% of iron that’s actually retained and usable in breast milk. It’s a case (again) of posing formula-fed babies as the inappopriate standard for infant health. According to a 1991 study by Dechant KL and Clissold SP Drugs:

“Infants who were not exclusively breastfed for at least seven months did develop anemia by 12 months of age without the addition of iron-rich foods or supplemental vitamins.
It was also concluded that infants who were breastfed exclusively for seven or more months had good iron status when checked at 12 and 24 months of age.”

Are you aware that iron supplements can actually cause vitamin deficiency in a breastfed baby?

  • Iron-fortified cereals (or any solid food) will interfere with iron absorption in a breastfed baby. The iron in breast milk is especially bio-available, and other forms of introduced iron end up competing with that more usable form, thus forcing the child’s body into a sort of iron-source warfare that ends up making way for the weaker links–which are the extraneous, competing, less bio-available iron sources from vitamin supplements, formula or milk alternatives, or early solids. In this way, giving supplemental iron to an exclusively breastfed baby actually decreases overall iron absorption and puts her at greater risk for anemia (which will probably be mistakenly blamed on breastfeeding!).
  • Who would need an iron supplement? If your baby exhibits signs of anemia and has tested positively for it, you can incorporate age-appropriate natural sources of dietary iron if she has started solids.

Christina Valdez with two month old Oliver. Photo Credit: Ana & Ivan Photography.

Don’t miss the continuation of this series. Previous topics:

PREPARING BEFORE BIRTH (Read Part 1 here)

  • Be Able to Recognize “The Booby Traps”
  • Choosing a Pediatrician
  • Know the Ten Steps to Successful Breastfeeding
  • Breastfeeding After an Epidural
  • What’s Colostrum?

GETTING STARTED AFTER BIRTH (Read Part 2 here)

  • Breast Crawl
  • Delay the Baby’s First Bath
  • Getting a Good Latch
  • Newborn Procedures
  • Positions for Breastfeeding

THE FIRST SIX WEEKS

  • Is My Baby Gaining Enough Weight?
  • Should My Baby Be Sleeping Through the Night?
  • This SUCKS–not just literally. Will it be like this forever?!

OTHER CONSIDERATIONS

  • Cesarean Section
  • Premature Birth & NICU
  • Sleepiness After Birth
  • Universal Vitamin Supplementation

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