Breastfeeding & Breastfeeding with Raynauds

 

Breastfeeding

I decided to write this in case anyone asks me for breastfeeding info and/or in case my daughters ever want to know what it was like for me. It's crazy how you can breastfeed five kids but still have to remember things again every time that you'd forgot. So I'm sure that by the time my daughter's may want info on breastfeeding, I will have forgotten a lot so I figured I'd write it down. 

To start off, just a heads up--in my opinion, breastfeeding for the first few weeks is as natural as cutting off your own arm. If you don't have pain, you are so freaking lucky! I breastfed five kids and never did not have pain or scabs at the beginning. But they all were growing correctly so it's not that I did not have correct latch like everything and every lactation consultant will tell you. I am very small chested though and maybe that is the reason I had problems. Long story short-- breastfeeding is painful at the beginning but then it gets better and is rarely painful!

I'll start with how to breastfeed--The only position that worked for me with a newborn was the cross cradle. Hold the baby with the opposite hand of the side you want to feed on and then use the hand that's on the same side you want to feed on to squeeze your breast with a c shape in your hand to make the nipple more accessible. Have your nipple about at their nose. At first, you need to pull down their bottom lip to be able to help the baby get the deep latch. You wait for them to open their mouth and then pretty much pull their lip down and then shove as much breast in their mouth as possible-aiming the nipple towards the roof of their mouth. Hopefully they begin to suck.  It usually takes a few times for that first bit while they learn what the heck they are doing.  After a while, they naturally open up big on their own and you rarely have to pull their lip down anymore.  A good latch is seen when their mouth is wide open with their lips flanged out like a fish with a lot of areola in their mouth and the bottom lip (really their tongue) is moving up and down sucking.  They typically suck vigorously for a bit and then start to get slower and fall asleep and unlatch themselves.

(Continuing about how to hold them)  After a couple weeks then you can switch to the cradle position after you begin the feeding in the cross cradle (i could never use the cradle position when they were tiny.) Laying down and nursing never worked for me until the baby is way (like months) more established. Otherwise it's just a mess all over.  I've heard that the football hold is best for large chested women. 

(Back to the first feeding.)  From the very first feeding, put nipple cream (Lansinoh is my fave brand. Medela is yellow and smells funny and the Parents Choice brand is too thick) on your nipple afterwards. Put a nursing bra on pretty quickly and use breast pads to keep the fabric from rubbing against your nipple. The cream should help give relief while your nipples get used to the sucking. I have gotten scabs each time and they usually take a week or two to fall off. Depending on what feels best to you, letting your nipple get lots of air and not keeping them covered all the time, may help the scabs heal sooner.  I always tried to do some of each.  If they hurt really bad, I would put the cream on to try to soothe them.  And if they were ok, I'd let them air out for a bit.  You only have to do this for the first week or two and then they'll heal and you'll feel ok.   With a couple of my babies, I have gotten lacerations and they took a little less than a month to heal and then I was good. 

Within a day after birth, I have always had latch pain.  Latch pain is a REALLY painful feeling when the baby first latches on and for the first bit of the feeding.  Mine was so painful that my body would cringe or spasm as it happened so I had to try really hard to control it to not scare the baby.  Thankfully it lasts about 10 to 30 seconds and then goes away. That latch pain goes away after about 2 weeks. SO grateful for that! I've wondered if latch pain is the breasts way of you learning that the baby is latching correctly.

If it's your first baby (and even on later babies, but DEFINITELY on the first), call the lactation in or your nurse every single time you try to feed.  They are a great help!  But make the lactation person just watches and talks to you, not do things for you because I found that they like to get in a way. (On the first couple feedings it is ok for them to touch, but after that, you need to be pulling their mouth down and such... They're not always going to be by you to do it for you, so just tell them to watch you.)  I'm telling you to have them come but I'm also going to tell you that they're not perfect.  I found that they often contradict each other and themselves, but they're just trying everything, so I think all the varying opinions is helpful.  But if you're ever feeling like they're not helping, it's because they can't guarantee anything.  I felt like they always would say "it looks like a good latch" but could never tell me that "yes it is". How you can tell us if your baby has latched well and got a good feeding is if the baby is content after a feeding and they stay content for a bit. It's always hard with newborns because they are tired and sleep so much, but the baby will be fussy and make little whining sounds a lot if they're hungry.  But with newborns, watch their diapers a lot for proof.

Other lactation plug-- with my first, she had no idea how to suck and could never latch on.  After a different consultant trying with each feeding, she was  a day old and had never been able to get anything and this one tried her last resort--a nipple shield.  I used it and covered it with milk so the baby could taste something and she finally sucked.  The problem with the shield is that it doesn't give the same latch as without it, so they were worried she wouldn't get enough food and I wouldn't get enough stimulation to make milk. We had to use a syringe with a tiny tube filled with formula for her to suck on while she sucked on my breast so that she would actually get something and then I had to pump after.  Once my milk came in, we quit using the formula in the syringe, but that baby was never happy with breastfeeding and could never do it without the shield which gets annoying to keep clean.  With my fifth, I was given a shield because I was already scabbing on the first day, but that baby absolutely hated it and it didn't work at all even with multiple attempts at the suggestion of the consultant who was trying to prevent my nipple from further damage.  So long story short there-- what works for one doesn't work for all which is why you might get different info with every feeding.

Final lactation consultant info-- Lactation consultants will tell you to pump to increase your milk supply and/or to express extra milk or colostrum. Don't do it. You don't want to make more-- you want to make what your baby needs and the baby will tell that by how much they suck. If you make more that what they're telling you they want to eat, then you're going to be full all the time and so uncomfortable because the baby is not eating it and engorgement will be so much worse. I also think it increases your chance of clogged ducts. 

So, speaking of engorgement. It comes like day 4-5 usually. Before that, the baby gets a thick liquid called colostrum and then engorgement is when it turns to milk.  Engorgement is pretty awful. You'll feel like you have softballs  or rocks just stuffed in there. The most important thing to do is to make sure to empty them. So after the baby finishes one side, express all the extra that is in there  (you can feel around your breast and feel hard spots of milk to massage out) to make sure that it says soft. Depending on how much the baby ate, there might not be much or there might be a ton. I had to do this for the two days of engorgement but bottom line is you just want to make sure that they stay as soft as possible for those couple of days. And then things improve from there.

What I'm writing is jumping around like crazy, but oh well! 

This chart was given to me with my fifth and this was the first time I felt like the information was correct. Previously I'd been scolded for having such a sleepy baby, but finally they accepted that that is how it is! It is great information for how the first few days will go.

Now a word on pacifiers--In the first few days when they cluster feed, it hurts so bad and you think that maybe you should get a pacifier, but likely you shouldn't and the cluster feeding will chill out after a few days. I wouldn't offer a pacifier for over a week at least and just so that you can really get to know your baby. Offer the breast anytime they're crying so that you can find out what they need. Even if they nurse to go to sleep that's fine. If they do end up just sucking and sucking and sucking and sucking and sucking and are not eating (like you cannot hear them swallowing and every time they are acting this way for 20+ mins) then then you can introduce them to a binkie because you don't want to have them  use you as a binkie.  But in my experience, babies only use you as a binkie occasionally, it's not every time. I could tell they were using me as a binkie when it would start hurting a long time after it had stopped hurting (during initial latch on pain during the first couple weeks) during the feeding. If I waited and let them fall off on their own (after a long time), my nipple would be pointed like a tube of lipstick and sometimes have a straight white line down it. Once I saw that that had happened, the next time that happened I knew I needed to stick my finger in their mouth and unlatch them to prevent them from making it a learned habit but also to prevent myself from pain. After a week or so, I found the binkie helpful to get the baby back to sleep in the middle of the night and sometimes during the day. I still tried to not offer it every time they fussed because I didn't want it to be what they expected. I had done this with my first and she used the binkie all the time--it's nice to keep them quiet but it's so hard to wean them off of it if they get used to having it in their mouth all the time and they always want it and can't self soothe. With my others who took binkies, I introduced them after a week and would use them to help them soothe themselves back to sleep until they started sleeping better and then they just quit using it which is nice--use it when needed and then just have them wean themselves off it.

Bottles are a tough one, just like binkies. Bottles can be your best friend or your worst. My first baby was given a bottle within days of birth and it ended up being that she eventually was only bottle fed through pumping. I believe it was because I offered it too early and too often. I also was mistaken that I was empty in the evenings. I felt like she was so hungry in the evenings and that I was making nothing but I learned later that's not true and they can always get something and that evenings are just rough with babies and they want to eat much more frequently in the evenings. I would wait at least a week to introduce a bottle so that the baby has no nipple confusion. A bottle is so much more simple to use because it comes immediately and at the same rate always. I would try to offer a bottle once a day to try to get them able to take breast and bottle.  Try to have someone else give te bottle for the first while so they know they have to suck from you.  If possible, try to get them to take formula so that they will be ok to take it if you leave and don't have pumped milk available.  It tastes vastly different so in my experience they won't take later on.  My second was a great eater and would eat from me all day and then would take a bottle before bed at night.  It was so nice to be able to have some evening time to myself!  Then before I went to bed I would pump since she hadn't eaten and that was what she'd eat the next night. (This all comes in time--like months into life.)

Speaking of pumping.  I did it within days of my first couple of kids.  But with the last three i didn't.  i just wanted the right amount instead of always having to pump every day-- i was just too tired to pump along with everything else. i would occasionally pump if i felt overly full or the baby was refusing to eat but i didn't consistently pump until they started going to bed much earlier or sleeping much later than usual in the morning because I'd be too full and they'd just choke like crazy. But with them I was also never able to get them to take a bottle so i don't know if it's the best or not.  You just have to do what is best for you.  I had energy to pump with the first couple but not the last couple.

The routine I found best to feed the baby for the first while is:

First feed on one side. Burp them or attempt to (some babies are impossible to burp and just are going to spit up no matter what you do), then immediately change their diaper (which wakes them up) and then offer the other side. The baby falls asleep at pretty much every feeding, so instead of letting them sleep after each side, it is better to wake them up and offer them to other side to make sure they get a full feeding instead of just relaxed and tired from sucking. After a month or two, you get to know your baby and will know if you need to keep doing that or not. I've had babies that have ate both sides every time, babies that have ate one side and half of the other and babies that only eat one side and are full. Every baby is different in their sucking and eating habits. You can make more or less milk per breast just depending on each baby and their sucking preference.

For the first months, but especially during the first few weeks, you want to feed (or try to feed-- sometimes you'll have crappy feedings) at least every 3 hours during the day. If you do this, then you can allow them to sleep as long as they will once during the night. Hopefully you'll at least get four hours a night. Most of my babies gave me this but I had one that wouldn't and I would have to put her back to sleep with a binkie because she wasn't hungry which made for really annoying attempts at feeding. Depending on how feeding is going during the day and once you get to know your baby's habits, you hopefully will have more than one chunk at night where they go longer than 3 hrs without eating. But during the day, wake them up to eat

I read a book called "7 laws that rule breastfeeding" with my first and it is a really good resource to start with and I would definitely suggest reading it with your first. The thing that I felt that was most important from that book was to always offer the breast. Other sources say you should get the baby in a habit of eat, play, sleep, eat, but I say eat, play, eat, sleep, eat. I always get better results when I feed my baby before they go to sleep than when I try to just rock them. There is so much less fighting and I always feel better knowing they're getting food, emptying me so I'm comfortable, and stimulating my production so that I won't lose my supply.

About spitting up. It's normal and fine typically. And fussy babies are normal in general (a lot get more enjoyable after three months--it's just the way it is). Don't change your diet just because they spit up. Only change your diet if they are screaming uncontrollably in pain. You'll be able to tell the difference. They can be all sorts of gurgly in their belly and that doesn't mean things aren't right. If they seem to be handling it ok and don't seem too put out by it-all is fine. If the baby does have occasional screaming fits and diaper rash and it can be attributed to chocolate, then stop chocolate and see if it improves. But I would really suggest not going off dairy unless you absolutely have to. There are VERY few babies actually sensitive to it or lactose. If they scream every feeding out of pain and aren't gaining weight then that is your sign that things are truly wrong. Breastfeeding is hard enough, but restricting your diet makes it worse. Chocolate is the only thing I was willing to give up (1 out of 5 of my kids would scream and get awful rash when I had it) and thankfully my kids all did fine. They all spit up quite a bit and would occasionally spit up more for certain foods, but I think it's super important to try to not restrict your diet-- for your enjoyment and so the baby gets different "tastes".

The very most important thing I can tell you about breastfeeding breastfeeding is this: breastfeeding is convenient and cheap and incredibly healthy for your baby but 'fed is best' not 'breast is best'.

If your mental health is suffering, you need to do what's best for you. I pumped for my first child for a year because she was the hugest fighter and it was so stressful to try and get her to eat.

My second was the dream child who took both breast and bottle. But then totally quit on her own after getting a cold. She had formula for a few months.

My third only took the breast and I never was able to get away from him for a year (I have always quit at a year max) which was really hard.

My fourth was a huge fighter like my first but this time I was going to fight it and see if I won. I did end up winning but at an expense. I got clogged milk ducts a couple times. We tried to give her a bottle nightly for a month and it never worked so it was the same situation of not getting away from her for a year.

I'm writing this as my fifth is almost 5 months old and I haven't even tried the bottle because life has been too hectic.  It's really frustrating to be the only one to be able to take care of the baby sometimes, but pumping is more of a stress to me than just dealing with it and seeing if maybe I can get her to take a sippy cup or something soon.

I'm so lucky that I was able to feed them. It was not easy, but it was doable. BUT FORMULA IS A GIFT FROM GOD. it is incredible that scientists have been able to formulate something that can help infants grow almost as perfectly as breastmilk. Never feel guilty or let anyone tell you it isn't good enough for your baby. I would have given money to have had my 3rd and 4th babies take some formula so that I could have a few hours off.

Please more than anything, know that FED IS BEST!!!!!!! I WROTE THIS STRICTLY AS INFO. I WHOLE-HEARTEDLY SUPPORT FORMULA IF THAT IS WHAT YOU CHOOSE!!!! NEVER, EVER SHAME A MAMA FOR USING FORMULA.

--I mentioned clogged milk ducts so I wanted to talk about that for a second. A clogged milk duct is when a milk duct gets clogged obviously. It's usually a red mark on the outside of your breast and it's incredibly painful and there is a hard lump inside your breast. You have to get rid of it so that hopefully it does not get infected and turn into mastitis. (If you start feeling like the flu (achy) and have a fever and can barely move because of the aches, call your doc and get a prescription - I thankfully never had it but this is what I've heard.) When I had mine they lasted for about 24 hours and I had a fever but was still able to do things. I would put heat on them constantly with "hot hands" and do my best to massage it and have the baby eat first on that side every time. I did all sorts of reading online about having their chin towards the clog and stuff and feeding them on all fours hanging above them to have gravity help too. They are very painful and scary and so I was willing to do anything.

Random: I have Raynaud's when I breastfeed. That means my nipples lose circulation and turn white. I have never been officially diagnosed by someone, but I have all the symptoms and my sister and brother have been officially diagnosed so I'm pretty sure it's in my genes too!

With my first, I read about it in the book I mentioned (I read it after I started breastfeeding-I would suggest reading it before and then maybe again during the first few days) and thought "that's exactly what happens to me". Deep chest pains, shooting pains, nipple pain and burning nipples, and red, white, and blue nipples. Also , the nipples are very sensitive to cold and hurt badly in the cold. What happens is that blood flow is constricted. Before I read that book I thought I must have thrush because of the shooting pains and was doing treatment for it. But I found out from the pediatrician that the baby didn't have thrush and therefore I didn't. And then later read about raynaud's and knew that was it. I've done A LOT of internet reading on raynaud's. Nearly all the people who had it were also treated for thrush with no results. So when I read about it with my first, I immediately went on nifedipine and was on it a full year. I asked for it with child 2 and 3 and took it for a full year too and it was good. With my 4th, after a month or two I wasn't sure if it was working. I thought it was that only one brand was working and I had a different brand, because I was still feeling the shooting pains. I read so much stuff (everything I could find at the time) and what I found out that many women were only given a two week dose or two doses and that was it. Not only was I feeling the pains still, but also was feeling dizzy (the med lowers your blood pressure) so I weaned myself off of it around three months. When the pains came, I would massage my breasts where it hurt strongly to get rid of the pain. It worked and I was fine the rest of the year.

With my fifth, I asked every doctor and lactation consultant I could if they knew anything. There is very little known about it so I got very little info. The only thing anyone could suggest was thick breast pads to keep the nipples warm. It had been about 4 years so I reread everything I could possibly find on the internet again.  I just decided to try no medicine because I really didn't want my blood pressure lower because I hate feeling so faint and light headed. The pain for the first few weeks was quite excruciating. Cold would make me ache. I put hot hands and warm breast pads on my nipples and breasts a lot to calm the pain. (I did not buy the expensive wool breast pads that I was told about and I'm glad I didn't--they wouldn't have been worth it for me--i would warm my regular ones on a heating pad if I really wanted them warm, but I didn't need it after the first month or so.  But what I read it that some women have the pain come back every time they are cold-like even in the frozen food section, so maybe they are good for some) The first month hurt a lot but by six weeks I was good. I occasionally have to rub out the pain, but I am thrilled to have survived without medicine so that I know. My nipples still turn white sometimes, but the pain isn't even close to as excruciating as the beginning.  I wonder if I had done a couple weeks of the med if I would have been better and been in much less pain and then been able to move forward without any med. My guess is that I could have.

This condition is insanely rare, so don't think it will happen to you. But I want to put it here for that woman who is searching every end of the internet trying to learn about it like I did!

One other thing.  The MER.  Milk Ejection Reflex.  It's when you have letdown.  Mine is always painful and multiple times through the feeding and so forceful that all my kids have choked zillions of times.  But oh well, they'll eventually deal with it!  (It can help (especially in the early weeks) to stimulate your letdown and then have the baby eat to not have them choke immediately, but that's not what I'm writing about.)  Some people can't feel it, but I always could as very pins and needle-ly.  But oh well, you deal with it for the few seconds it is there.  But why I'm talking about it-- I never had a problem with it until my 5th.  Randomly one night, my letdown wouldn't come for minutes.  It was very frustrating to the baby and incredibly worrisome for me.  For the next couple of days it was delayed, but it came back to normal.  I had it happen again weeks later and it was the same with getting it back.  What I read was that frustration and exhaustion and anxiety and such can really affect your MER.  Both times I had lost it, I was having those feelings.  So if this is happening to you, really try to relax and be calm amidst all the exhaustion that comes and when you go to feed the baby, smell your baby before feeding them and try to think about relaxing.   Hopefully yours will come back to normal too, but if it doesn't, call your doctor and try some oxytocin spray.  I never tried it but had a friend who had severe postpartum anxiety and the oxytocin spray was the way she was able to feed her baby.