Common Concerns During the Early Weeks of Breastfeeding
During your hospital stay, the nurses probably assisted you in latching your baby on to your breast. Without such expert guidance, you may be having difficulty getting your baby to attach correctly now that you are home. Even infants who once nursed well may have difficulty latching on if the mother's breasts become swollen and firm when her milk comes in abundantly. In addition to the extreme frustration a latch-on problem causes, both your baby's well-being and your milk supply can be placed in jeopardy if your infant is unable to nurse correctly.
Try the strategies outlined in this article. If you are not having success getting your baby to nurse well within a few hours, you need to call your baby's doctor and make a plan for assuring your infant receives adequate milk. I strongly advise you to seek assistance promptly from a lactation consultant or to call the nursery at the hospital where you delivered. Ask a neonatal nurse if you can return right away for assistance in getting your baby to breastfeed. The hospital probably has an efficient electric breast pump that you can use while you are there. If your breasts are engorged, expressing some milk will soften your nipple and areola and make it easier for your baby to grasp your breast. Any milk you express can be fed to your baby. Even if you have to pump and feed your expressed milk for a day or so, with patience and practice, your baby can learn to latch on and nurse correctly.
Some babies have overcome latch-on problems with the use of a silicone nipple shield placed over the mother's nipple. The shield is stiffer and more protuberant than the mother's own nipple, and most babies accept it readily. Your nipple is drawn into the shield as your baby breastfeeds. After nursing with the nipple shield for a while, you should try to remove it and attach your baby to your breast. A nipple shield should be used only with the direct supervision of a lactation consultant or other breastfeeding specialist who can assure that your infant obtains adequate milk nursing with the shield and closely monitor your baby's weight gain. I also recommend pumping your residual milk after you breastfeed using a nipple shield, since nursing with the shield is not as effective as direct breastfeeding. Your baby's doctor needs to know that your infant is having difficulty breastfeeding.
How Do I Arouse My Sleepy Baby?
While some newborns awaken on schedule and act hungry, others fail to demand feedings as expected and must be coaxed to nurse. The parents of such infants often mistakenly conclude that they have "such a good baby." At a time when new parents are exhausted and overwhelmed, an apparently contented, nondemanding infant can seem like a blessing. Uninformed health professionals often reinforce this misperception by telling new parents how fortunate they are to have a newborn who sleeps through the night.
But a nondemanding infant is not a blessing. Such a baby can create a false sense of success at first because the infant seems so satisfied. Before long, however, ineffective and infrequent nursing can result in an underweight infant and an inadequate milk supply. If your newborn is not demanding at least every three and a half hours, you need to try to awaken the infant to nurse. Try the following measures to arouse your baby from light sleep (look for rapid eye movements, arm and leg movements, facial twitches, or mouthing motions) and entice her to nurse:
- Dim the lights. Babies are more likely to open their eyes in subdued room lighting and will close their eyes in the presence of bright lights.
- Unswaddle the baby. Babies get drowsy when they are overly warm and swaddled. You may need to undress your baby down to her diaper to make her less cozy and stimulate her interest in feeding.
- Position your infant upright, either sitting on your lap with your hand under her chin or placing her over your shoulder as if you were going to burp her. When positioned upright, most babies will reflexively open their eyes.
- Perform "passive" sit-ups with your baby. While supporting your baby on your lap in the sitting position with one hand behind her head, gently lean her backward until she is fully supine (lying on her back). Slowly rock her back and forth at the hips, going from sitting to reclining, about four to six times. This usually will cause her eyes to open.
- Talk to or sing to your baby. Use a high-pitched voice and exaggerate your intonation and accentuate each syllable. "You're a h-u-u-u-n-g-r-y b-a-a-a-a-b-y."
- Massage your infant. Gently rub her arms and legs, stroke her head, wipe her face with a warm wet cloth, or massage the soles of her feet. Gently run your finger along her upper lip. Start in the midline and move toward the outer edge, one side at a time.
- Change her diaper or perform cord care. The stimulation involved in changing your baby's diaper and washing her bottom may suffice to arouse her. If that doesn't work, applying alcohol to the base of the umbilical cord is a pretty surefire way to awaken a sleepy baby. The cold alcohol against the baby's abdomen almost always gets a response.
- Offer a little expressed milk to your baby by spoon, cup, or dropper. Hand express or pump as much colostrum or early milk as you can. You can dribble a little milk onto your nipple to entice your baby to nurse. Some drowsy babies who appear disinterested in feeding actually have borderline low blood sugar. Giving them a little nourishment can perk the baby up and bring her to an alert state in which she can nurse effectively.
- Stimulate sucking activity using your clean little finger. After washing your hands, place the nail side of your little finger against the baby's tongue and stimulate her palate with the fleshy part of your finger. After your baby starts sucking, remove your finger and offer your breast.
From Dr. Mom's Guide to Breastfeeding by Marianne R. Neifert. Copyright © 1998 by Marianne R. Neifert. Used by arrangement with Plume, a member of Penguin Group (USA) Inc.
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