Breastfeeding Master Class Episode 2: Birthday!!!

In our last episode we discussed the importance of skin to skin right after birth. Today we're going to focus on what happens next.  Baby needs to stay skin to skin until after the first breastfeeding.  In the first hour or two your baby is more awake than he or she will be for the next 24 hours.  Get some good feeding in during this time.  If baby feeds well right after birth it's an excellent predictor of future breastfeeding success.  Those first little neuron connections formed in your new baby's brain will be all about feeding.  That's a good thing.  They'll remember what to do once they're ready again.

Gratuitous show-offage of my youngest's first feeding.  Ignore

the wrapped up baby and poor breast holding technique.  I wasn't 

a Lactation Consultant yet.   Much since then have I learned.  And 

yes, I know they're huge.  My boob was bigger than her head til 

she was two.

Now it is important to note that there are things you can do to help make learning to breastfeed easier in the first days.  First, plan for a natural delivery.  Epidurals and narcotic pain medicines can increase baby's sleepiness.  Pitocin and IV fluids can make your areolas swell up and swallow your nipples whole.  Bathing of baby before 6-8 hours of life is also a bad idea.  It makes them cry, cold, and exhausted.  They need to stabilize on mom's chest for a good long time before that kind of trauma.  I know that sounds overly dramatic but remember that nice idyllic life baby is used to.  That's not to say that if you have to have a medical delivery or baby gets a bath quickly that breastfeeding can't go perfectly well but these are a few things you can do to improve your chances of a successful breastfeeding experience.

So while baby is sleeping off his or her dramatic entry, keep them close.  Preferably skin to skin but at least in your room and within eye sight.  That will help so that when baby gives you those little cues that she might be ready to try to feed, you'll see them right away.      
        

Too Late!!!

Feed Me!!!

What to look for:

                                 *1st-moving around in his/her sleep

                                 *2nd-lip licking/opening and closing the mouth

                                 *3rd-rooting/sucking on hand

                                 *4th-crying

Now if you have a baby that has no interest in feeding the first day and won't wake up at all, it's OK.  We have a plan for that scenario.  We call it manual breast expression which is just a fancy way of saying you squeeze the milk out of your boob.  You can

Your milk "coming in" literally only means
there is an increase in the amount of milk.
It doesn't mean you didn't have any before.

collect it in a cup or spoon to feed to baby but I prefer just putting the drops right in the baby's mouth. It's a good idea to do this every 2-3 hours.  The reason for this is two-fold.   First it sends the message to your brain that it is milky time and in 48-72 hours your milk will "come in".  Second it will get some nutrition to baby.  Plenty of it.  In the first day babies will only get 3-5 ml each feeding.  That's a teaspoon or less and is all those little tummies can handle at first.  So all you ladies who are worried that you don't have enough milk at first, don't be! You have plenty.  And you'll continue to have plenty with lots of stimulation in the first few days.  For more information on manual expression watch this video from Dr. Jane Morton at Stanford School of Medicine.

Once you start closing in on the 24 hour mark you'll notice that baby is starting to show more interest in feeding.  It will probably start out with a few sucks then maybe 5 minutes and pretty soon it will be 20-40 minute nursing sessions.  Next time we'll talk about latching and how to know baby is getting enough!

Anti-Body Guard

There seems to be a misconception out there in the wide world regarding antibodies in breast milk.  I cannot tell you the number of times I have heard people say something to the effect of, "I couldn't breastfeed the baby but I was able to a little in the hospital so at least he got all of the antibodies!"  True that colostrum has a higher concentration of antibodies.  That's because its concentrated.  A wise LC friend likes to explain to new parents that colostrum is like orange juice concentrate.  It has all the same components of breast milk just without the added water.  Milk
                                                                                       "coming in" just adds that water.


So I'm just wanted to throw this out there kind of explaining how this all actually works.  Human children are born incredibly immature compared to other mammals.  That's because we have to manage to fit a big brained head through a narrow upright-walking pelvis.  I guess sometimes evolution doesn't fully think these things through.  But I digress.  Just as those little brains and bodies are immature, so are babies' immune systems.  It takes approximately 12-14 years to reach full physical maturity, way longer than that for mental and emotional maturity, so the relatively short span of 5ish years to reach immunological maturity is pretty fast!

Well, in this case...

Baby is getting antibodies from mom through the placenta prior to birth.  Those will stay with baby for several months.  Breastfeeding infants continue to get antibodies from their mother's breast milk, not just for the first few days but for as long as the baby is nursing.  So any germies mom comes in contact with, she's going to make an antibody for it and pass it on to baby.   Even more amazing if baby contacts the pathogen first there are special receptors in mom's breast that start synthesizing antibodies for it right away.  By the next feeding, boom antibodies!




It's no mystery why most kids will wean somewhere between 2 and 5 years when left to their own devices.  They aren't just using mom for comfort.  Moms don't just not want babies to grow up.  Breastfeeding is comforting but also continuing to give kids significant health benefits.  Your breasts don't have a magic expiration date when they stop manufacturing antibodies until they just stop manufacturing milk.  Older children start getting their nutrition elsewhere but they still need the boobie tap for the immunity.  When I was nursing my youngest at nearly 5 I would joke that there was nothing left in there but dust and antibodies because my production had dropped down to not much above colostrum levels.


So there's my novel about the misconception that only colostrum contains antibodies.  Not true at all.  And it pains me to hear even other health care professionals perpetuate this myth.


Here is a great link with more in depth info from breastfeeding guru Dr. Jack Newman.

 

Breastfeeding MasterClass Episode #1: The Nicest People in New York City

Breastfeeding MasterClass Episode #1:  The Nicest People in New York City

This is just a little anecdote I use to show the importance of skin to skin contact (AKA cuddle care) with mom directly after delivery.

So imagine you've lived your entire life in a beautiful tranquil place, a secluded farm house or deserted island, comfortable and secure.  One day a helicopter comes in and picks you up and drops you into Times Square in New York.  It's loud, busy, terrifying!  That's what it's like for a baby being born.  From a happy tranquil place to a loud room full of strangers and lights as they lay crying on a warmer bed being measured and assessed.  But imagine if instead of Times Square, you are brought to a nice, cush Park Avenue apartment with the two nicest people in New York.  It would still be a difficult transition but those people are there to help you through.  That's what it's like when baby goes directly onto mom's chest after birth.  Baby is able to deal with the transition much easier because he is surrounded by the hands, love, and voices he recognizes.  That's not even taking into account how much warmer babies stay and how much less they cry when they have cuddle care with their parents.

But lets not even think about baby right now.  What about those sweet New Yorkers waiting for their new arrival?  If they can't see him, he's lost in the crowd, imagine their worry!  When you see your baby across the room with nurses and doctor's surrounding him, of course you will be distraught!  Also, we are undermining your parenting abilities from the very start by basically telling you we can take better care of your baby than you can.  When baby is placed on your chest everything else in the room goes away.  The focus is like a laser on your baby and your partner.  Most women barely notice delivering the placenta and any post delivery maintenance that needs to be done.  And baby is right there ready for his first meal!  Most babies will breastfeed sometime in the first hour after delivery and if given that opportunity, do a better job with breastfeeding in the long run.  And moms, if you are not feeling well enough to have the baby on your chest after delivery, dad is the best substitute!  Babies can do this skin to skin care on dad's, grandma's, or any other support person's chest.  Anyone can keep baby warm and comfortable, the only thing that will have to wait is feeding.  But be careful daddies.  Babies don't care that your nipples are just decorative.  They may still try to latch!

I hope you enjoyed our first MasterClass episode!  Any questions or comments welcome below.

Boobie MasterClass

The whole reason I started this blog originally was because I had had a few patients recommend that I put some of my wise teachings in YouTube form.  Since I have a face for radio, I'm not super comfortable with that.  So I will occasionally be using this platform to post some of he tidbits I use in my education of patients. These will have the MasterClass designation in the title, so look for it if you want some excellent educational morsels pushed directly into your face holes.  First one coming later today!

Just because this is awesome.