After the birth of your child, there is so much running through your head. Is my baby eating enough? Is my baby peeing and pooping enough? Does my baby weight enough? What is going on with my body? Luckily, you are not alone. Many women ask these same questions.
The Size of Your Baby's Stomach in the First Few Weeks (And Other Things to Keep in Mind)
What is Colostrum? Before a mother’s milk comes in, she will produce colostrum. As early as the fourth or fifth month of pregnancy, some mothers notice colostrum leaking from their breasts. Colostrum is a fluid that is yellow in color and contains millions of protective cells (John Hopkins Medicine, n.d.). The colostrum produced helps to provide the baby with multiple nutrients that cannot be given any other way. Due to the antibodies found it, colostrum is often called baby’s first immunization or “liquid gold.” Colostrum helps babies pass their first bowel movement, which in turn helps to reduce the chances of the baby having jaundice (Breastfeeding...For My Baby. For Me, n.d.). Around day three through five, a steadier milk production will take place to meet the rest of baby’s nutritional needs.
What May Delay My Milk from Coming In? Sometimes, there may be a delay in milk production. Some conditions that may cause a delay in milk coming in include: severe stress, cesarean (surgical) delivery, bleeding after birth, obesity, infection or illness with fever, diabetes, thyroid conditions, and strict or prolonged bed rest during pregnancy ( Johns Hopkins Medicine, n.d.). Milk is also dependent on supply and demand. If you do not directly feed/pump, your body will not produce more milk. If you are having trouble with delayed milk production or a decrease in the amount of milk, review the number of feedings you give and the length of time it takes from start to finish (Johns Hopkins Medicine, n.d.). Your body will know how much milk is needed, so it is important to start breastfeeding right away, and keep to a schedule so that you can establish a supply.
Possible Troubles Faced with Breastfeeding After Birth Tongue Ties What is a tongue tie? At birth, some infants are not able to move their tongues properly due to a tightness in tissue in that area. This can in turn affect their ability to breastfeed. This is called a tongue tie. Similarly, a baby's lips can be attached to his gums, making it difficult to get a good grasp on a nipple. Babies with lip ties almost always also have tongue ties (Ritter, n.d.). Tongues and lips are only considered tied if the movement is restricted, and in turn impairs mobility (Ritter, n.d.). It is important to have your child assessed right away by a health care professional is suspected, as to avoid any further complications.
How and why do tongue ties affect breastfeeding? Problems with securing a latch to the breast are often common among babies who are tongue-tied. Overcompensation by increased suction can cause nipple damage and pain. Not only will this cause pain, but it may also affect the baby’s ability to sufficiently drain the breast, leading to problems with supply. In severe cases, baby is not able to attach at all (Ritter, n.d.). Therefore, it is important that this problem is recognized early on, and fixed.
Treating tongue and lip ties The first step in treating a tongue or lip tie is to have it evaluated. A lactation consultant or other health care provider should be able to recommend a practitioner (usually a pediatric dentist or Ear, Nose and Throat Specialist (ENT) who can diagnose and release the tie (Ritter, n.d.). Usually a tongue or lip tie can be fixed right away. Using a scalpel, scissors, or laser, the tongue and lip tie can be released. Lasers require no anesthesia however, and can minimize the bleeding experienced from the procedure (Ritter, n.d.). It is important that you discuss your options with your health care provider, as to ensure the best method for your child.
Cleft Palates What is a Cleft Lip/Palate? A cleft palate is a split or opening in the roof of the mouth. A cleft palate can be submucosal (not seen by the eye and often missed during postnatal checks), or involve the soft palate, or both hard and soft palates (Farrow, n.d.). In conjunction with a cleft palate, there may also be the presence of a cleft lip. A cleft lip and palate include lip, gum (alveolar ridge), and the hard and soft palates. The size of the cleft varies from a few millimeters to a centimeter or more (Farrow, n.d.). Luckily, cleft palates are treatable with the health of health care professional.
How Often Do Cleft Lips/Palates Occur? Cleft palates are more common than one might think. In the US, approximately 1 in 600 live births are found to have a cleft lip/palate (Farrow, n.d.). However, this frequency does vary from country to country.
Cleft Lips/Palates and Breastfeeding There are some hardships to be faced when attempting to breastfeed with a cleft lip/palate. To breastfeed, both proper compression and suction is needed. Depending on the size and type of cleft, as well as the maturity of the baby will determine if a proper latch is successful. Babies with a cleft lip only are more likely to breastfeed than those with a cleft palate or a cleft lip and palate (Farrow, n.d.). It is important to receive as much breastfeeding support as possible following the birth of a child with a cleft lip/palate.
Useful Techniques When Dealing with a Cleft Lip/Palate While breastfeeding with a cleft lip/palate may be difficult, it is not impossible. Some techniques that have proven to be effective include: closing the child’s lip with your fingers to help make a seal, experimenting with different positions to allow baby to uphold suck and swallow, such as using the breast tissue to close the cleft, maintaining an rich milk supply, and assisting with the milk letdown through hand expression, breast compressions, and visualization of the milk flowing (Farrow, n.d.).
Repairing a Cleft Lip/Palate Luckily, there are ways to fix a cleft lip/palate. The cleft can be repaired in one surgery or multiple stages - the palate and lip together or separately (Farrow, n.d.). However, it is important that the option of surgery is discussed early on as time is a factor. The lip can be repaired as early as two months or as late as a year and a half after the birth of the child. The cleft palate however, can be fixed in the early weeks, at around six months, or after the child’s first birthday (Farrow, n.d.). Breastfeeding is possible after surgery, however, while some surgical teams will allow breastfeeding/bottle feeding following surgery, others will require temporary weaning from breast/bottle for some weeks (Farrow, n.d.). Recovery is an important time to maintain one’s milk supply. Often, breastfed babies will find comfort in breastfeeding after surgery, but sometimes it may take them a few hours or days. In the meantime, the baby may be more willing to feed with a cup or spoon because lip suction is not needed (Farrow, n.d.).
Sore Nipples An unpleasant experience after postpartum and while breastfeeding is sore nipples. Sore nipples are usually caused by poor positioning or latch during feedings. Some remedies for sore nipples include: making sure the baby has both the nipple and a large part of the areola (the dark part around the nipple) in their mouth, holding the baby close, receiving help to check that the child is in the correct position, nursing the baby before they are very hungry by watching for early hunger cues, massaging the breasts before feeding to help the let-down reflex, and changing feeding positions ("Breastfeeding...For My Baby. For Me.", n.d.). If you find yourself with sore nipples, there are ways to treat it. To speed healing, rub some expressed breast milk on the sore area after feedings and let nipple air dry. Breast milk helps fight infection of the affected area. However, do not use soap or creams on your nipples, and make sure to wear cotton bras and clothing ("Breastfeeding...For My Baby. For Me.", n.d.). It important to let your breasts “breathe” and not feel restricted as this will also have a negative effect on your milk supply.
Thrush Thrush is a common occurrence in both mother and child (even if one is not breastfeeding). Thrush is a yeast infection that can form on the nipple, on the breast and in the baby’s mouth from contact with the nipple ("Breastfeeding...For My Baby. For Me.", n.d.). Luckily, it is easily treatable. If your baby has a diaper rash with red sores, they may have thrush. Another noticeable sign of thrush is if the baby’s tongue is white. If it cannot wipe off, it may be thrush. However, if it does wipe off, it may be leftover milk from an earlier feeding. Thrush symptoms include: itchy and slightly pink nipples and areola, red and very painful nipples and areola both during and after feeding, and pain moving through the breast, especially after feeding. Both mother and baby will need treatment and should see their health care provider so that they may obtain anti-fungal medication ("Breastfeeding...For My Baby. For Me.", n.d.). Thrush is very contagious, and should be treated right away.
Plugged Milk Ducts Plugged milk ducts are another issue that can be easily treated. Usually a plugged milk duct is caused by an area of the breast that is not being completely emptied ("Breastfeeding...For My Baby. For Me.", n.d.). A plugged milk duct can be noted if the area is still sore and firm after a feeding. Common reasons why a mother may experience a plugged milk duct include: tight bras, bras with underwires, or tight clothing. In order to help relieve the pain of a plugged milk duct one should nurse the baby on the sore side first, gently massage the sore area from the armpit down toward the nipple (do this while baby is suckling or while in a warm shower), remove any dried milk on the nipple with warm water, and change positions at each feeding ("Breastfeeding...For My Baby. For Me.", n.d.). If the plugged duct is not treated in time, this can lead to further complications. Mastitis is an infection in the breast that causes fever and flu-like aches, pains or a red-hot area on the breast ("Breastfeeding...For My Baby. For Me.", n.d.). It is important to address this issue early on by calling your doctor. If possible, try to nurse from the affected side to relieve some pain in the meantime.
Breastfeeding is NOT wise if one or more of the following conditions is true:
An infant diagnosed with galactosemia, a rare genetic metabolic disorder
The infant’s mother:
Has been infected with the human immunodeficiency virus (HIV)
Is taking antiretroviral medications
Has untreated, active tuberculosis
Is infected with human T-cell lymphotropic virus type I or type II
Is using or is dependent upon an illicit drug
Is taking prescribed cancer chemotherapy agents, such as antimetabolites that interfere with DNA replication and cell division
Is undergoing radiation therapies; however, such nuclear medicine therapies require only a temporary interruption in breastfeeding ("Diseases and Conditions Breastfeeding CDC", 2016).