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Breastfeeding Beyond the Basics

Jean Godwin, a lawyer in Washington, DC, returned to work when her baby was 10 weeks old. Now, two months later, she's trying to find the time to pump breast milk at the office¿ -- and wondering how much longer she can keep nursing. Elizabeth Fish, of Menlo Park, CA, stays home with her 3-month-old son. Between taking care of him and her two other children, and trying to renovate their house, she's so tired she doubts she can continue to breastfeed.

The pressures felt by Godwin and Fish show why nursing women often end up weaning their infants earlier than they'd expected. In fact, two-thirds of American women who breastfeed (and only 59 percent attempt it) quit before their babies are 6 months old. This despite the recommendation from the American Academy of Pediatrics (AAP) that infants be exclusively nursed for the first six months, then continue to receive breast milk along with other iron-enriched solid foods, at least until their first birthday.

If you choose to breastfeed, how can you do it successfully for that ideal first year or for as many months as you'd like? Getting past the initial challenges of learning to nurse is the most important step. But new obstacles may crop up as your baby grows. Some strategies for dealing with the biggest hurdles:

Dia L. Michels is the coauthor of Milk, Money, and Madness: The Culture and Politics of Breastfeeding.

Maintaining Your Milk Supply

Establishing an adequate milk supply is one of the earliest breastfeeding accomplishments, but maintaining it requires a new level of understanding. That's because the amount of milk your baby consumes will vary. "The number one reason most women quit is because they believe they aren't producing enough milk," says Lawrence Gartner, M.D., chair of the AAP work group on breastfeeding. "A mother never sees how much her baby is consuming. If breasts were transparent, women would be able to see the milk pouring out, and understand that breasts usually provide ample nourishment."

Generally, in the first six months your baby will drink slightly more milk each day, and your supply will probably increase to keep up. In the second half of the year, as you introduce solids, your supply will naturally taper off. If you don't think you're producing enough milk, look for these clues: Your baby doesn't seem content and relaxed after a feeding; there's a drop in the number of wet diapers; he continues to mouth or suck after nursing, as if he's searching for food; or he's not gaining weight. If you see any of these signs, call your doctor and then try these techniques to keep your milk flowing:

  • Pump up the volume. Nurse or pump more frequently until your flow resumes. Try to empty each breast at least twice as often as you normally would each day. If you work, breastfeed as much as you can when you're home, take as many mini-breaks as you can throughout the day to pump, and use your lunch hour to completely empty your breasts.

  • Nuzzle while you nurse. Skin-to-skin contact can trigger hormones that stimulate milk production.

  • Get comfortable. If you've shed your nursing bra in favor of something more flattering, make sure it supports the whole breast and doesn't feel too tight; constriction can put pressure on the milk ducts and contribute to your low supply.

  • Boost naturally. There are some health-care providers who say that fenugreek, a seed that is available in capsule form at most health-food stores, can increase milk supply. The standard dose: two to three capsules, three times a day. "We've been recommending fenugreek to mothers with low milk supply for years, with tremendous results," says Kathleen Huggins, a perinatal specialist and author of The Nursing Mother's Companion. "We find that most mothers notice a real improvement within 48 hours."

  • Start solids slowly. For the first year, breast milk is a baby's major source of iron, calories, and nutrition. So nurse before offering her cereal or other foods, at least until she's eating regular meals made up mostly of table foods (around 8 to 12 months). Also, try giving her the main solid meal in the late afternoon or early evening, when your milk supply is usually lowest.

    The Myth of All-or-Nothing Nursing

    Many women think they must wean completely if they can't nurse at every feeding or if they don't produce enough breast milk to fill a bottle. In fact, you should try to continue breastfeeding and supplement with formula, since even a small amount of breast milk can be beneficial to a baby's health.

    Some ways you can introduce formula and still breastfeed successfully:

  • Nurse as often as you can. By four to six weeks, the milk supply is usually well established, and many mothers, when they return to work, settle into a pattern of pumping by day, while nursing morning and night. Try to breastfeed twice in the morning: right after you get up, and before you leave. At night, nurse as often as possible. Some babies who are breastfed continue to wake up at least once during the night, up to 12 months and beyond.

  • Regulate the flow. Sucking milk from a bottle is different from breastfeeding, and because each action requires the use of different muscles, a baby may become less willing to suckle a breast once he's become used to a bottle. Using a low-flow nipple (available in most supermarkets and drug stores) and switching your infant from a bottle to a cup as soon as possible (at about 6 months of age) may help keep him interested in nursing.

  • Coordinate with your caregiver. Experts say one of the most common problems is a well-meaning caregiver who feeds a baby shortly before Mom comes home. Talk to your provider about how to time feedings so that you can nurse soon after you walk through the door.

  • Mix it up. If you don't have enough expressed breast milk to make up a complete bottle, you can combine it with formula for each feeding. This minimizes the change in flavor (which bothers some infants) and helps provide the enzymes that will help your baby digest the formula better.

    Getting the Most Out of Pumping

    Going back to work will present many challenges. But breastfeeding and working -- even full-time -- can be done. To pump most efficiently:

  • Choose your pump wisely. If you have your own office or a private room, you can pump with a high-quality automatic-cycling double pump that you can rent or buy (call the Breastfeeding National Network for an equipment dealer near you). If not, a better choice might be a good portable, manual pump that you can take into a bathroom stall.

  • Vary your schedule. Pump at least twice a day at different times. Your body has a natural rhythm, and experimenting can help you find the best time to extract your milk.

  • Relax. Look at your baby's picture, and have a beverage or a snack. If you experience let-down difficulty, take deep breaths, listen to soothing music, or imagine her nursing.

    The Soreness Factor

    As a rule, breastfeeding shouldn't be uncomfortable after the first week or two. But there are some conditions that can occur later, causing discomfort or pain:

  • Thrush is an overgrowth of yeast organisms that live in warm, moist environments, such as on your breasts or in your baby's mouth. Signs of an infection include burning nipples and shooting breast pain. To complicate matters, thrush can be passed back and forth between your baby's mouth and your breast. Cracks in your nipples or a vaginal yeast infection are predisposing factors for thrush while breastfeeding, as is taking antibiotics. If you're in pain, see a doctor; he may prescribe an antifungal medicine.

  • Plugged milk ducts announce themselves with tender spots or a sore lump in your breast. They can be caused by missed feedings, not eating or drinking enough, or tight-fitting bras that reduce both milk and blood flow. Exhaustion may also play a role, though doctors aren't sure why.

    To relieve a plugged duct, nurse frequently -- especially on the affected breast -- even though it may be painful. Apply a warm compress to the sore area and gently massage it while you breastfeed. Additional pumping can also help to unplug the ducts. Some preventive strategies: Drink lots of fluids, snack regularly -- especially on high-protein foods (which promote tissue and cell rejuvenation), take lecithin supplements (a natural emulsifier that can help keep milk ducts from becoming plugged up), and try to get enough rest.

  • Mastitis results from an inflammation of the breast; symptoms include redness, soreness in a single area, body aches, and fever. Any time you have a sore breast and a fever, call your doctor. Continued breastfeeding, additional pumping, and heat help alleviate mastitis, though antibiotics are usually required, too.

  • Teething can make a baby's gums swollen and sore, so he may chew on your nipple to ease his discomfort. To help relieve his gums, offer him a frozen teething ring before you nurse. "Once your baby is actively nursing, he can't bite you because his tongue is covering the bottom gums," says Terriann Shell, a lactation consultant, in Big Lake, AK.

    Since babies tend to bite at the end of a feeding, quickly remove yours from the breast as soon as you think he's stopped nursing, says Shell. To gently break the suction, put your pinkie into his mouth.

    No matter how long you decide to breastfeed, the choice should be yours -- not dictated by the obstacles. And remember: Success isn't measured by the amount of milk you produce or how long you breastfeed -- it's by doing the best you can, in every way, for your baby.

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