Ten Nursing Pitfalls
Diana West and Lisa Marasco
From: New Beginnings, Vol. 29 No. 5-6, 2009, pp. 38-40
As a pregnant or new mother, you might be concerned about making enough milk. The following ten nursing pitfalls are among the most common reasons for milk supply difficulties. Knowing what they are and how to avoid them will help you lay a strong foundation for a successful breastfeeding experience.
Pitfall #1. Latch-On Problems
One of the most common causes of low milk production in the early weeks is poor attachment to the breast. When your baby does not latch on deeply enough, he doesn't have enough breast in his mouth to draw out milk effectively. Less milk is removed and the breast responds by cutting back on production. The good news is that correcting the problem is often relatively easy. Be sure your baby's mouth is open very wide before he latches on to your breast. If you aren't able to fix it on your own, the problem could be related to your baby's ability to suck effectively and may require the help of a lactation consultant.
Pitfall #2. The Sleepy Newborn
Excessive sleepiness has several possible causes. A newborn may be drowsy after delivery because of medications given to you during labor. The effects may be brief, or they can linger for several days. During this time, lots of skin-to-skin contact can help stimulate your baby and trigger his nursing instincts.
Simply not getting enough milk can also cause a baby to sleep too much. He may eventually rouse and show signs of hunger but fall asleep again within minutes at the breast. This in turn leads to needing longer periods of sleep to conserve precious energy. This can happen as a result of low milk supply, a problem with your baby's suck, or baby's medical complications. Supplementation may be needed until milk production can be increased or your baby is able to take more milk. Another cause of infant drowsiness is jaundice, a temporary yellowing of the skin that often looks like a suntan and can make babies lethargic. Wake your baby at least every two to three hours until he begins to rouse more on his own. Gentle methods such as holding him upright, massaging his body, talking to him, undressing him, or changing his diaper are most likely to result in willingness to feed.
Pitfall #3. Unnecessary Supplementation
There are certainly times when a baby isn't getting enough milk and must be supplemented. But there are also times when unnecessary supplements sabotage milk production by reducing milk removal and stretching out feeding intervals. Problems usually start with "just one bottle a day" or "just a few bottles a week," but the more supplements that are given, the more are needed because milk isn't made when it isn't removed. It becomes a slippery slope and bottle feeding eventually seems more convenient or the baby appears to like it better.
Pitfall #4. Pacifiers
Pacifiers can mask the hunger cues of babies who are easily soothed by them. They are often given in the belief that a baby is supposed to be full after so many minutes at the breast. An assertive baby will spit out a pacifier and insist on more milk, but an easy-going baby may not be as persistent. This can disrupt the baby-driven milk-making process by forcing inappropriately long feeding intervals that ultimately reduce milk supply.
Pitfall #5. Clock-Driven Feeding Durations and Feeding Schedules
Mothers are often urged to get their baby on a schedule as quickly as possible to instill early discipline, fit him conveniently into family life, make life more predictable, or for "sleep training." Whatever a parent's fear or motivation, schedules are often regarded as an important parenting goal.
Schedules may seem helpful to parents, but they don't always meet the needs of breastfeeding mothers and babies. Rather than allowing milk production to be driven by your baby as nature designed, schedules artificially determine when feedings will take place. Mothers with an abundant milk supply and vigorously nursing babies may do well, but mothers with marginal milk supplies or babies with sucking difficulties often do not. Even if all looks well in the beginning, a sudden drop-off in production can happen after a few months if an insufficient number of hormone receptors were established in the early weeks because feedings were not frequent enough.
Pitfall #6. "Busyness"
Juggling a baby and the conflicting demands of a busy household is challenging. Feedings can be unconsciously postponed when you're preoccupied by other tasks, trying to get "just one more thing" done. It's especially difficult if you have older children and are always on the run driving them around -- the temptation to put off feedings instead of taking time to nurse right now may be strong. It is crucial to slow down and remember that this baby will only be young once, and his needs are immediate and important. Keeping him close in a soft baby carrier can help you respond to early feeding cues while on the go.
Pitfall #7. Outside Interferences
Some mothers facing a medical procedure, drugs, or hospitalization are told that they can't nurse for a period of time. To make matters worse, little or no guidance is provided on how to maintain milk production and, by the time breastfeeding is "allowed" again, milk supply is damaged. Educating yourself on the facts is your best defense, and regular pumping is your best backup. Dr. Thomas Hale's book, Medications and Mothers' Milk (updated biannually), is an excellent safety reference on the safety of medications while breastfeeding.*
Pitfall #8. Hormonal Birth Control
"Combination" birth control pills containing forms of both estrogen and progesterone can significantly decrease milk production. Newer "minipills" are estrogen-free and a better choice for nursing mothers, but a small number of women still experience a drop in supply. Similar problems have happened with patch and subdermal implant birth control, and a case of low supply related to a hormonal intrauterine device (IUD) has been reported. Depo-Provera, a long-acting injectable hormonal birth control, poses more serious problems because it lasts for three months and cannot be reversed -- the best option is to try a galactogogue to counter the effect. Waiting three months or longer after birth to use hormonal birth control will reduce the risk of problems.
Pitfall #9. Herbs
Just as there are herbs that may help increase milk production, others seem to decrease it. Parsley is a seasoning herb considered to have lactation-suppressing properties in large amounts, such as in a dish like tabouleh. Peppermint and sage are reputed to decrease milk production when consumed in large or concentrated amounts. Frequent brushing with toothpaste containing real peppermint oil or even eating potent peppermint candies has caused trouble for some mothers. Fortunately, most of these herbs don't cause problems unless they are consumed regularly or in large amounts.
Pitfall #10. Alcohol
Alcohol inhibits both the milk ejection reflex and milk production, especially when taken in large amounts. Even a single beer or glass of wine can disrupt the balance of lactation hormones. While the immediate effects of alcohol on milk production and delivery last only as long as the alcohol is in your system, chronic alcohol use has the potential to lower your milk supply overall. See http://www.llli.org/FAQ/alcohol.html.
Bottom line: advice that supersedes your instincts on when to feed your baby can undermine your milk supply.
*Hale, T. W. Medications and Mothers' Milk. Thirteenth edition: Hale Publishing, LP, 2009.