oops a daisy, have finally checked the info, and here is the missing bit (well done Katy44 for spotting and guessing what the rest of the sentence was.
NEVER use an underwire nursing bra as the wires can press up against sensitive breast tissue and cause plugged ducts and mastitis problems. This is especially important for large-breasted women. Cut-out nursing bras (where a flap remains at the bottom of the bra to 'support' the breast even when nursing) are also not recommended by many experts. Athletic/tight bras can reduce milk supply greatly, and loose, unsupportive bras that simply pull up or down can cause uneven drainage problems, soreness, and plugged ducts as well. (This is a particular problem for large-breasted women, so avoid these looser bras like the plague!) If you are having trouble with your bra irritating your pregnancy belly in late pregnancy, try tucking a cloth diaper underneath your breasts, or order a Pambras Bra liner from Amplestuff (see Clothing FAQ for ordering information). Be very strict about hygiene as well (see hygiene section below), since yeast infections can add to the irritation.
Normal breast care in pregnancy is to wash them every day with water. Don't use soap, body gel, or shampoo on them because these are often too drying and irritating. Dry thoroughly with a towel, especially under the breasts. Then turn your portable hair blow-dryer (on cool) onto the areas underneath to be SURE all excess moisture is gone. (
If you DO develop a yeast infection under the breasts, be especially vigilant in your hygiene. Drying with a blow-dryer and changing your bra often is critical. Another treatment is to apply plain yogurt (the kind with live bacterial cultures) on the affected skin areas---only a small amount is needed!
. Neither are special creams necessary before delivery. The only cream that is recommended by most experts is "Lansinoh" which is so pure, hypoallergenic and non-toxic that it does not even need to be wiped off before nursing. Another possible cause of soreness and cracking is thrush, a yeast infection that affects both mother and baby. Both people must be treated carefully in order to cure thrush (for more information, see section on Investigating Soreness Problems below).
10. Experiment with Nursing in Public.
However, some women swear by nursing tops, so you could try purchasing one or two and see if you find them more convenient or not.
For those whose best position is the football hold, get a large diaper bag (well-filled) and use it to help support the baby while nursing. Sit down cross-legged on the floor or normal-style on a couch, then place the diaper bag just behind one leg. Lay baby down with his head in your lap and his body across your leg and the diaper bag, then lift your shirt slightly and proceed as normal. A small blanket can assist here as well if needed for modesty. Practice this first at home to get used to it, but with a bit of practice, this is really quite handy and quite discreet.
To most people's surprise, nursing in public is actually easier than trying to use a bottle of either formula or pre-expressed milk in most cases. Once you get used to it, it is far more convenient, so pursue getting comfortable nursing in public. Surprisingly, it's also easier when traveling, so it's well worth the hassle of learning! Don't risk your hard-won breastfeeding relationship by bringing along a bottle because you are too embarrassed to learn how to breastfeed in public.
Nursing in public can be particularly challenging emotionally to women with large breasts. Used to years of harassment and shame from rude comments and stares, it can be difficult to overcome the long-term programming we have bought into. Even when we have broken free of many of the other hassles and stereotypes, breastfeeding publicly can remain an intimidating obstacle. However, make it a goal not to be a prisoner of your past and other people's ignorance. Don't let them win!
Declare your independence and take steps to conquer this goal. You may need to do it in small increments, which is fine. Start by rehearsing at home and finding out which clothes and positions are most discreet so you won't feel too exposed at first. Practice with a blanket if that makes you feel better. Then practice in front of your husband or partner, and ask his support in giving you advice. Some women say that trying in front of a mirror was helpful; others did not feel it was helpful. Do what works for you. Progress to nursing in front a trusted friend or relative or at a La Leche meeting (it may bother you less to nurse where others are also nursing). Again, it may be strange to them if you don't use the cradle position they are all probably using, but don't worry about it---do what works for you. Next, progress to nursing in a quiet, nearly private corner at a busy place like a mall or the airport, then slowly move closer to the busier parts each time you are out and need to breastfeed. Keep challenging your limits, but do it in small increments that you are ready to handle. Don't put yourself in a position that you know will be awkward or humiliating, and do surround yourself with supportive people. Finally, work up to breastfeeding wherever you need to, whenever you need to.
Most well-endowed women, with time and patience, are able to learn to breastfeed comfortably in public. However, if you never do get completely comfortable with breastfeeding in the open, go with the level you can live with. Push your envelope, but don't make yourself neurotic. If you need to always use a blanket-fine. If you prefer to seek out a quiet bedroom at a friend's house, do it. If you prefer to find a dressing room (no bathrooms!) in a store, or a quiet, semi-secluded area in a furniture store, go for it. The important thing is to challenge your limits at times, but still stay in a comfortable enough place that will allow you to do what's really important-nourish your baby in the best, most healthy way. Don't compromise baby's health by resorting to formula just because nursing in public is hard for you (take steps to find a middle-of-the-road way instead), but don't berate yourself if you never feel enough at ease to just attach your baby while speaking to a board meeting. Give yourself time---you'll find a compromise that works for you.
11. Educate Yourself Thoroughly Ahead of Time.
Womanly Art of Breastfeeding.. Don't expect your obstetrician to help you much with breastfeeding; most OB's do not deal with this much, and many are poorly educated about lactation. Neither will your pediatrician be much help, in all likelihood, and may actually be a hindrance. In breastfeeding, it is up to YOU to be proactive and take charge.
A good source for experienced experts that is free is the La Leche League or the Nursing Mother's Council. Some people hesitate about these organizations, but they are really very helpful, so find a group that suits your attitudes and situation. Take the advice you need for yourself and leave the rest behind---
It is especially important to seek out the company of other nursing mothers shortly after birth or in the first week or two post-partum. This is when most breastfeeding problems occur and when most new moms get poor advice from doctors or relatives that interferes with breastfeeding. It is no surprise that breastfeeding 'failure' occurs most often in this period or shortly after, and getting help during this time is absolutely critical to resolving things. If breastfeeding does 'fail', frankly, it is not usually failure on the part of the mom, but on the part of her health care team to support her adequately. But there are many precautions that the new mom can take to sidestep this possibility as much as possible.
Definitely watch the Medela video listed below (it's available for check-out from many LLL groups too, or you can purchase it) and watch it multiple times both pre- and post-partum. This is an amazing new skill that you and baby will be learning, and book learning only goes so far! Watch the video for hands-on demonstrations and try to get exposure to other nursing moms for live demos! Direct observation is extremely important in breastfeeding, just as it is in any other skill. Be patient with yourself; you are learning complex new behaviors, and so is baby. Allow yourself time to learn, just as you would if you were learning to play an instrument, and consult the experts.
12. Nurse FREQUENTLY and avoid bottles and pacifiers religiously.
NEVER restrict the time or amount of nursing baby does in the early weeks, and don't use ANY supplemental bottles or pacifiers in the first 6 weeks. Insist on this at the hospital as well (you may have to be quite assertive). Try placing a sign with baby that states that NO supplemental bottles are to be given, and definitely have your baby room in with you. Sometimes hospital staff can actively sabotage breastfeeding, even with the best of intentions, so you must be vigilant that no supplemental bottles are given.
It is not uncommon for large babies (8-9 lbs. and over) to be given supplemental bottles routinely. Many health providers just assume that such a baby is in danger of hypoglycemia (low blood sugar) and will need glucose water or formula to stabilize. Tell the staff that if they are in doubt, they can test the baby's blood to be sure, but unless it is DOCUMENTED that baby has low blood sugar, your big baby is NOT to be given any supplemental bottles. For babies of diabetic mothers (of whatever type, including gestational diabetes), hypoglycemia is indeed a danger for baby. It is definitely appropriate for these babies to be tested soon after birth to determine whether their blood sugar is low. It is NOT appropriate to automatically assume that their blood sugar WILL be low and to routinely give these babies a bottle. Most health providers will agree that if the blood sugar level is marginal, nursing and then retesting blood sugar is enough, repeating the process as necessary. Colostrum is an IDEAL food for a hypoglycemic baby, and it is highly concentrated so not a lot is needed. However, if the blood sugar has dipped too low or is not rising fast enough in response to nursing, the baby WILL need supplemental formula or glucose water (opinions vary, but formula is probably better since it has protein that will even out a baby's blood sugar rise). This does NOT have to be given via bottle, however---insist that the staff use cups, spoons, eyedroppers or syringes instead. If you have any type of diabetes, it is wise to learn this technique ahead of time so you can be ready with it if needed, and it is also wise to teach it to your spouse or a doula/labor assistant so that they can use it for you if you are unavailable due to a C-section (you can find out about this technique from a LL. leader or an IBCLC). Other cases where a baby might routinely be given a supplement because of concern about hypoglycemia include very low birth-weight babies and babies whose birth involved a great deal of trauma or difficulty. Again, ask the staff to document the problem before proceeding, and to use non-bottle methods if supplementation becomes necessary.
Definitely leave behind any free samples of formula you may be given upon discharge. In the emotional and often exhausting days just after birth, these can prove to be too much of a temptation, especially to friends or relatives who just want to 'give mom a break.' Your milk supply is based on supply and demand and any interference in the first weeks can be devastating. If baby does not nurse at least every 1-3 hours, your breasts will 'think' they do not need to produce as much milk and you may have supply problems. If you don't nurse often enough in the first few days (very common with sleepy babies and moms after a medicated or difficult birth), your mature milk may take longer to come in. Nervous moms, relatives, and health providers may then use a bottle for supplemental formula, thus lengthening even more the time between nursings (AND causing possible nipple confusion in the baby), providing even less stimulation for the breasts, resulting in less milk and the need for more supplements, and thus a truly vicious cycle is born.
Adding to this confusion is the common advice (even from some health providers) telling mom to nurse the baby only 5-10 minutes per side to lessen possible soreness and get the nipples 'used' to nursing. A newborn should not be restricted like this, and correct positioning is the key to avoiding soreness in most cases. Many newborns need 20-40 minutes for a feeding, and some (especially the sleepy ones) take 45-60 minutes for a feeding. If your baby is sleepy and has trouble staying awake for a whole feeding or does not want to wake at least every 3 hours for a feeding, try undressing him to his diaper and rubbing his back or tickling his feet, talking to him all the while. If he is near your uncovered breasts and smells the milk, he will likely soon awaken for more, but he may need more active encouraging---do whatever it takes. (You can add a blanket after he starts nursing to keep him warm, if needed.)
After the first few days, baby will most likely awaken more regularly and space his feedings more evenly, but frequent nursing in the first few days is so important to establishing supply and bringing in the mature milk quickly that it is vital NOT to "let sleeping babies lie" more than a couple of hours (this will also help prevent severe engorgement--see below). A general guide is to nurse at least 8 times in 24 hours, or at least every 2-3 hours; more often if your baby is a preemie or if you are worried about your breast being overly large for him to latch onto. And remember that colostrum (the first 'milk' after birth) does not usually come in great quantities because it is highly concentrated. It may seem like you are not making enough milk in spite of numerous feedings, but unless baby shows signs of listlessness or dehydration, all is probably well. The more you nurse, the sooner the mature milk comes in, but it can be delayed by a traumatic birth or lots of drugs, so be patient and don't panic prematurely. If in doubt, consult a lactation professional.
14. Learn More About Pumping, If Needed.
If you need to use bottles eventually, wait until at least 4-6 weeks have passed to minimize nipple confusion and prevent supply problems. This is EXTREMELY important! Many working moms who are expert pumpers recommend investing in/renting an excellent pump; the cheap ones can make the situation worse and can even damage your nipples. Use a hospital-grade pump, and consider one that pumps both sides simultaneously. Though this is expensive, it will be cheaper than paying for formula. Don't be surprised if you have very little output at first from pumping; new moms often find this, and it does NOT indicate that you are not making enough milk when nursing (nursing ALWAYS produces much more). Pumping efficiency doesn't seem to occur for some women until at least 6-8 weeks post-partumsome even laterwhen supply becomes better-regulated, so don't panic. It may be helpful to try massaging your breasts periodically during pumping to encourage multiple let-downs. Also, women with very large breasts (and especially large areolas) may find that they need a pump with a bigger 'flange'. Medela and Ameda/Egnell both carry larger flanges just for this purpose. Other women prefer a flexible plastic flange so they can massage the areola themselves while still pumping. Reportedly, some women who are well-endowed find that some pumps work better for them than others, though of course not everyone agrees. The Medela "Pump In Style" (PIS) is a new, very popular, and affordable entry in the breastpump market, but some women contend that it is not a good choice for very large-breasted women. Again, YMMV.
Another common tip from working moms is that "AVENT" bottles and nipples are the least confusing to babies that must learn to go between breast and bottle, so you may want to invest in them vs. other types like Nuk or Playtex, though some people swear by Nuks instead. YMMV. (Avent has a web page at www.avent.co.uk/avent.html.) If you plan to work outside the home, be sure to consult a support group like misc.kids.breastfeeding for hints, or read The Working Woman's Guide to Breastfeeding, by Nancy Dana and Anne Price, available from the La Leche League catalogue. Another source of information is the Pumping FAQ available at www.greatstar.com/lois/pump.html. Pumping, working, and breastfeeding CAN be done successfully, but lots of guidance helps. You will definitely want to consult with the many other women who are also combining nursing, pumping, and working.
15. Massage Breasts Periodically While Nursing and Investigate Soreness Problems.
Massaging the breasts gently while nursing helps to ensure that all ducts are being emptied, which is especially important if you have any lumps or sore spots. Don't forget the areas underneath your breasts and the areas up by your arms. This is especially important to do if you are well-endowed and have a tendency towards lumpy or fibrocystic breasts, but be careful to use a light touch. If you are using the "C" hold to support your breast, be sure your touch is gentle and not causing duct problems. Watch carefully for any signs of a plugged duct and be sure your bra is not the problem by being either not supportive enough, or conversely, being too tight or rubbing in certain areas. Bras are often the source of recurring duct problems, so you may want to purchase a different type if you are having ongoing problems.
Soreness is often one symptom of a plugged duct, so increase your nursing time as much as possible, use hot compresses and massage, and seek help from a good nursing manual, or, if it does not clear up quickly, a lactation consultant. Another common source of plugged ducts in larger-breasted women is sleeping on too-full breasts. Try wearing your nursing bra to bed, at least for the first few months, and see if you can find a way to sleep that does not put so much pressure on the breasts. An untreated plugged duct can turn into mastitis, which can be very serious. Watch for hardened red spots or lumps, a white 'plug' on the nipple, fever, chills, achiness or nausea. This will need treatment from a health professional, but in the meantime, increase your nursing times as much as possible and try to aim baby's chin in the direction of the problem. A full discussion of plugged ducts and mastitis is far too complex for this FAQ, so be sure to seek extra help. Finally, antibiotics are often needed to help get rid of mastitis, but be sure to watch afterwards for signs of thrush.
Thrush, a yeast infection of the nipples and/or of baby, is another common cause of soreness in many women. Some women are very prone to it, while others get it after a course of antibiotics. Thrush pain is often described as itching, burning, or shooting, and baby often concurrently has curdy white patches in its mouth or a yeasty diaper rash. If you have ongoing, unexplained soreness even after having checked your latching position and baby's suck, recurrent thrush is often the culprit and you may need to be very aggressive in its treatment. Both you and baby must be treated, and often your bras as well. Rarely, the yeast will go deeper and get into the milk ducts, causing 'ductal yeast' which is even harder to treat. However, with stronger measures and drugs, even difficult cases of thrush can be handled.
Continue nursing frequently in all of these cases (since less-frequent nursing will make things worse) and see a lactation consultant as soon as possible. The La Leche League homepage has more information on treating these common maladies as well, and puts out several informational pamphlets about them.
16. Dealing with Leakage Problems and Overactive Let-Downs.
Many people assume that large breasts will produce more milk than small ones, and that leakage will be a huge problem for well-endowed women. This is not true. Some small-breasted women leak copiously, and some very large-breasted women never leak at all. However, if you do leak, be sure to use nursing pads in your bras (ones without plastic liners) and to change and wash them frequently. You will also want to wear a bra to bed and to sleep on a towel as well. Pre- expressing milk may be especially important for you so that your baby is not overwhelmed by a gush of milk. If your baby seems to gasp and choke at first, or seems to pull off the breast quickly or frequently, this may be the problem (overactive let-down). Pumping or pre-expressing a little ahead of time may be your best bet. Another technique that can help is to nurse flat on your back in the Aussie Hold (see section on Nursing and Sleeping) so that the milk has to flow against gravity.
One possible consequence of overactive letdowns is a foremilk/hindmilk imbalance. In this, the baby receives too much of the lactose-rich foremilk, and not enough of the fat-rich hindmilk. The abundance of lactose in baby's intestines causes too much gas, and baby is often fussy or colicky for no apparent reason, even after food allergies are ruled out. Baby's stools are often green, frothy, and explosive, and baby is very gassy. Another side effect (which does not always occur) is an inadequate weight gain, since baby is not getting enough of the very important fatty hindmilk. Even women without an obvious overactive letdown can experience this imbalance, especially if baby does not nurse long enough on one side before switching to the other side. For example, the advice for sleepy babies is to stimulate them in order to nurse frequently, switching sides often. However, if baby does not nurse either side long enough to receive more of the rich hindmilk, he can get too much foremilk and present these same symptoms. The 'cure' is to be sure baby gets enough time at the breasts in one session that he will get the hindmilk, or to reattach frequently to the same breast over and over in one nursing session, then use the same technique on the other breast at the next nursing session. Either way, it is important to establish first that the problem is not an allergy to a food mom is eating, which can complicate matters still further. (See following section.)
If your baby is excessively colicky, fussy, or gassy, you may want to try eliminating certain foods from your diet in order to see if this is what is bothering the baby. The most common culprits are dairy foods (very common), citrus foods, peanuts, chocolate, caffeine drinks (including many sodas), eggs, tomatoes, corn, or wheat (gluten).
19. Always Pre-Express a Few Drops of Milk.
Pre-expressing a few drops of milk before starting a nursing session if you have flat or inverted nipples can be very helpful . If your nipples are very sensitive or if you are sore, this is a good preventative strategy as well. Another strategy is to rub an ice-cube over your nipples before nursing. The cold may help numb them if they are sore, and the cold will also help many flat nipples become more erect. However, ice is not always convenient, so it's a good idea to learn to hand-express some milk anyway.
20. Nursing a Small or Premature Baby When You Have Large Breasts.
Another concern for large-breasted women is when you have a tiny baby (such as a preemie) and a large breast for that small little mouth to latch on to. The football hold is the best hold for small or premature babies, since it allows the most control over baby's head. For an extremely small baby or preemie, you may have to pump for a while before baby is mature enough to get a good latch-on; in the meantime you can feed the baby through alternative means like a cup, spoon, syringe, or eyedropper (do NOT use a bottle if possible----see section on Supply Problems above), or your breastmilk may be able to be fed to your baby through a tube. In some cases, a special bottle such as a Haberman Feeder may be an appropriate compromise (these are available from places like Mommy's Little Helpers, see reference information in resource section at bottom).
Your breasts automatically produce colostrum and milk that has already adapted for a preemie's special needs, so it is vital that you pump and feed him as much of it as possible. Use a hospital-grade electric double pump, which many hospital Neonatal Intensive Care Units may already have. If not, it is well-worth the rental price to get one (formula is more expensive in the long run). Your mission while you wait for your baby to mature enough to nurse is to do as much hands-on care of your baby as possible (stroking, rocking, kangaroo care, etc.), to see that baby receives your milk as much as possible through whatever method is most appropriate, to keep up your supply by pumping very frequently (you may need to investigate herbs or drugs that can help stimulate your supply), and to keep trying to encourage baby to develop a wider mouth position when rooting (an IBCLC can help you with techniques for this). Once baby is ready to try nursing, pre-express some milk so that your nipple and areola are less overwhelming in size for a tiny mouth, and then try using the nipple to stimulate a wide-open rooting response. At first baby may not be able to get adequate coverage, but keep trying. Your only measure of success is that you are learning to position the baby well for nursing and that you are encouraging him to open his mouth wider. It doesn't matter at first whether he actually latches on successfully or not; in fact, most preemies probably won't at first. Keep your expectations realistic--- this process will take quite some time. In the meantime, be sure to keep pumping AFTER each latching/nursing session, so that your supply stays up. Be patient; it is likely that you will need to pump quite a while, but it can make such a difference in a preemie's health that it is well worth the effort. Even when baby begins to get some milk, you will need to continue pumping until the baby is actively nursing and swallowing for at least 15 minute sessions at a time. The NICU nurses or an IBCLC familiar with preemies can help you decide when you no longer have to keep pumping.
Even if your baby is only small and not a preemie, nursing with large breasts may be a challenge, especially around engorgement time. Nurse as frequently as possible in the first few days in order to minimize the degree of engorgement and then be sure to use a pump or hand-express a fair amount of milk before beginning a feed during engorgement. This should reduce the overwhelming size differential. Wearing your baby in a sling or close to your skin as much as possible in the first days tends to minimize engorgement, and using warm washcloths or taking a warm shower before pre-expressing can help as well. Keep encouraging a very wide mouth by re-trying latching often, using the nipple to stimulate the baby's rooting response. Another trick is to have baby suckle on your (clean) upside-down pinkie beforehand, then substitute larger fingers until baby is better at opening its mouth wider, then quickly substitute the breast. Again, patience in trying and re-trying the latch multiple times until baby learns to open wide enough is very important. If you are having consistent difficulties getting baby to open up, this is another situation where the specialized techniques of a lactation consultant can help.
21. Breastfeeding Successfully After a C-Section.
Breastfeeding after a C-section can be more challenging, but it certainly can be done. If you know you are going to have a C-section, write it into your birth plan that baby not be given any supplements during your surgery unless it is documented that his blood sugar levels are low. Oftentimes, a supplement will be given automatically to keep the baby happy and quiet while your surgery is being finished (the part involving the baby is very brief), or it will be assumed that baby must be hypoglycemic from a difficult birth and needs help. Also include a stipulation that if a supplement IS needed, it be given by syringe, eyedropper, spoon, or cup instead of a bottle, and be sure that your spouse or your doula/labor assistant knows how to do this ahead of time. If your C-section is a surprise, you can also request this, but there may not be any personnel present who know how to do it and so it may not be honored (but you can ask!). If the baby is not hypoglycemic, request that baby not be given ANY supplements until you are awake and ready to try nursing. (See further stipulations about big babies, babies of diabetics, and babies from traumatic births in section about Avoiding Bottles above.)
Once surgery is over and you are ready to nurse, be sure to try the football hold first. Have your hospital bed cranked up to a comfortable angle---higher is better than lower. Use LOTS of pillows wedged between you and the bed railing to bring baby up to your breast level; never lean in to baby. Also cover your incision with a pillow for good measure. The advantage of the football hold is that it keeps baby off of this incision and allows you greater positioning control. Since the cradle hold is difficult under the best of circumstances for well-endowed women, the football hold is even more important after a C-section.
If you must remain prone due to discomfort or spinal anesthesia, try nursing in a side-lying position, though this is often quite difficult for well-endowed women. If you find this positioning impossible, many women have luck with the Aussie hold described above under the Nursing and Sleep section, but be sure baby is able to breathe around your breast tissue. If necessary, gently depress the breast around his nose slightly to ensure that baby has ventilation. Babies' noses are flared and made just for this situation so he won't need much help, but with very large breasts this is occasionally needed. Be sure you use a very gentle touch since too much pressure on delicate milk ducts can cause problems with plugged ducts and mastitis. Request an IBCLC as soon as possible. Although hospital lactation consultants and nurses may be able to help, they often give poor advice or are not prepared for the situation of a very well-endowed woman.
Another problem encountered by many C-section moms is a sleepy baby (and a sleepy mommy) from medications given during labor and surgery. This may slow down baby's nursing time, giving mom less stimulation and baby less effective sucking, and delaying the arrival of mom's mature milk. In normal unmedicated births, the mature milk usually comes in within 2-4 days. In medicated births, this can be longer. In medicated, traumatic births like many C-sections (and especially those with general anesthesia), mature milk is often delayed until 4-6 days. Again, a baby is usually fine on just colostrum during this time, but if the time begins to stretch out too much or baby shows signs of dehydration or other problems (see an IBCLC to be sure), then some supplementation may be necessary. ALWAYS NURSE BEFORE ANY SUPPLEMENTATION, and try to be sure all supplements are given by alternative methods instead of bottles. Use a hospital-grade pump to help stimulate milk production, and promptly investigate using herbs to increase your supply if things are not progressing. Nurse as frequently as possible (at least every 2 hours), waking baby up and stimulating him in order to get efficient sucking and longer nursing times. Don't limit baby's time at the breast, and be patient if he tends to fall asleep during nursing sessions. Just keep waking him up and giving him lots of time on each side to complete the feeding (you want to be sure he is getting lots of rich hindmilk as well as the initial foremilk). Rooming in will help this process, though you may want to have your spouse there to help you in the first day or two. Don't worry about your pain medication being unsafe for baby; you will only be given kinds that are safe. You will probably be given antibiotics, so you may need to watch for signs of thrush afterwards (see section on Soreness). You will also want to get up and walk as soon as you can after the anesthesia wears off, since this speeds healing and will eventually make breastfeeding easier. If you have a lot of edema (fluid) after the surgery, the walking also helps it go away faster, though it will still take some time. Your doctor should be aware that you are breastfeeding so he will NOT prescribe diuretics for the edema. Walking and time are the best cures for this side-effect (though ice-packs for the feet and ankles are mighty soothing!).
Another common side-effect of C-sections and other traumatic births is jaundice. This is also more common after diabetic pregnancies, when labor has been induced by pitocin, when certain drugs are used, and with epidurals. There are many types of jaundice and it is too complicated an issue to discuss in detail here, but in the most common kind (physiological jaundice--which appears a few days after birth), it is NOT necessary to stop breastfeeding, and it is usually NOT necessary to offer supplementary formula or water. Many pediatricians still believe that the old practice of "washing away" the jaundice with glucose water or formula is effective, but it is now believed that this may actually slow down the process of getting rid of the excess bilirubin causing the jaundice. In most cases, nursing a nearly naked baby VERY frequently (especially by a sunny window) is enough to get him over the jaundice, since colostrum speeds the passage of meconium (baby's first stool). Delayed passage of meconium has been observed to be associated with higher levels of bilirubin, so the best therapy is to nurse the baby frequently and without supplementation from birth. Your doctor will probably ask for heel sticks to test that baby's bilirubin levels do not rise too high, and if they do, special phototherapy may be needed. See a nursing manual for advice in these situations, but temporary weaning is not usually necessary. In fact, extremely frequent nursing will probably aid the process.
When you get home, take it very easy. Arrange for lots of help around the house. Your ONLY job should be to rest and to nurse baby. Take baby to bed WITH you, or use a plush recliner to relax in if that is more comfortable for you. Nurse the baby as OFTEN as possible and be sure to stay well-nourished and well-hydrated. (Reading the section on Supply Issues may also be helpful.) Other than that, your only job is to recover. This is major abdominal surgery and it is often traumatic to the emotions as well as to the body. Writing down as much as you can remember can help relive and heal the experience, and when you are ready physically, seek out more information about C-sections and recovering emotionally from them. For some women they are no big deal, but for others they are very traumatic indeed. A good resource is ICAN network, which has chapters all over the United States as well as a mailing list on the Internet. However you recover, keeping breastfeeding going through C-section difficulties can be emotionally healing in a way that nothing else can. If breastfeeding is unable to withstand the MANY pressures on it after a C-section, healing can be doubly traumatic, so be sure to seek out help if you need it, but don't feel bad if the deck was just too stacked. This is not an easy situation to handle.
22. Experiment Ahead of Time with Positioning.
Before your baby is born, use a doll or stuffed animal of an approximate size to help you practice the different positions, get more comfortable with the idea of nursing (especially the idea of nursing in front of others), and know how many pillows you may need to help support the baby. Although nursing a live baby is definitely harder, this can give you a bit of a head start. Find some private time and space and give it a try a few times, and use the time to practice deep breathing and visualizing a successful breastfeeding relationship, whether public or strictly private. Determination to succeed is a large part of success, as is adequate information and timely, expert help. You can do it! See yourself doing it internally, and then follow through!
Helpful General Breastfeeding Resources
Here are some further resources for Breastfeeding Help. Good luck in your breastfeeding relationship! It is one of the most healing and self-affirming things in this world. Many women who are ambivalent about being extremely well-endowed find the experience of breastfeeding tremendously healing. It certainly is a beautiful gift to both you and your baby!
Breastfeeding Your Baby-A Mother's Guide: Positioning #610V010 (English); Video from Medela, (800)435-8316. Further contact information below. Includes section on the football hold--one of the few videos to adequately cover this. Excellent hands-on demonstration of all 3 classic breastfeeding positions; good commentary and advice. May also be available for check-out from La Leche groups.
The Nursing Mother's Companion by Kathleen Huggins. Boston: Harvard Common Press, 1990. THE BEST AND MOST PRACTICAL NURSING GUIDE AROUND! Especially good for quick trouble-shooting when problems occur. Rated as a "best possible choice" among breastfeeding guides in the Journal of Human Lactation. Take this book to the hospital with you--really!
Breastfeeding Your Baby by Sheila Kitzinger. New York: Alfred A. Knopf, 1995. Excellent photos of traditional cradle holds. Good discussion of that position. Beautiful nursing photos and general advice.
CARE NW (Care and Advice on Reproductive Exposures) 1-900-225-CARE ($3 for first minute, $2 for each additional) [email protected] Provides information on the effects of drugs and other exposures on the developing fetus and during lactation. If you are not sure about the safety of a certain drug or chemical exposure during pregnancy or during breastfeeding, call and they will research it for you. They often have more accurate and up-to-date research than many doctors, so use this service when in doubt.
The Breastfeeding Advocacy Web Page www.clark.net/pub/activist/bfpage/bfpage.html or www.clark.net/pub/activist/bfpage/medref.html General information about breastfeeding and its medical benefits-many links to other sites. Excellent resource.
La Leche League International 1-800-LA-LECHE; (847) 519-7730 P.O. Box 1209 9616 Minneapolis Avenue Franklin Park, Illinois 60131-8209 www.prairienet.org/llli/homepage/html Information and community support for breastfeeding mothers; great source for medical research on lactation. Its catalogue contains many breastfeeding-friendly parenting and birthing books and many of these are available for check-out from local LL chapters. A great way to save money and still research parenting!
International Lactation Consultants Association P.O. Box 4031 University of Virginia Station Charlottesville, Virginia 22903 (312) 541-1710 Professional Breastfeeding Help. Call to find a local professional breastfeeding consultants.
Extra Emphasis P.O. Box 1725 Tahoe City, CA 96145 (916) 581-0848 (info) (800) 539-0030 (orders only) (916) 581-5719 (fax) Mail-order catalogue of hard-to-find bra sizes, both in large bands/ large cups AND small bands/large cups. Also carries many non-nursing bras. Brands include Goddess, Leading Lady, TrSportT, Fancee Free, and Olga. A truly outstanding resource!
Cameo Coutures, Inc. Dallas, TX 75247 (214) 631 - 4860 Where to get custom-made nursing bras. Expensive but worth it!
Motherwear P.O. Box 114 Northhampton, Massachusetts 01061-0114 (413) 586-7532 (800) 950-2500 Comfy nursing bras to 48H; nursing wear up to 3X. Many other baby/nursing products as well; high-quality products. Great resource.
Mommy's Little Helpers 9250 Watson Rd. St. Louis, MO 63126 (800) 859-3559 (314) 849-2128 Anything you could need to help support breastfeeding, including special equipment such as the Haberman Feeder for babies having breastfeeding troubles. Also has Avent bottles and nipples and many other nursing aids. However, their nursing bras are generally not well-reviewed by larger women, though they do carry nursing bras up to 50LL.
Medela, Inc. P.O. Box 386 6711 Sands Rd. Crystal Lake, Illinois 60014 (800) 435-8316 A great deal of pumping information and resources, including an extra-large pump flange for large breasts. Also has the terrific video on positioning listed above, as well as a longer version of the video, aimed at more general breastfeeding information.
Ameda/Egnell,Inc. 765 Industrial Drive Cary, Illinois 60013 (800) 323-8750 A great deal of pumping information and resources, including an extra-large pump flange for large breasts.
Avent Bottles www.avent.co.uk/avent.html. The bottles and nipples often recommended as being best at minimizing nipple confusion for babies who must switch between breast and bottle. Expensive, but apparently worth it.
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