Tuesday, January 31, 2017

25 things every Nursing mom should know:


Nursing, for those who are willing to try, has been worth the pain, stress, sleeplessness and sacrifices. No judgement to those who decide otherwise, because it has definitely not been easy trying to ensure that my children are exclusively breast fed for as long as possible before I go insane. I made it to 5 months with each child before introducing semi-solids, and to a year with my son before I introduced another cow's milk (yes, I am the first cow in this scenario).

It is a thing of mathematical insanity though at this point to ensure that I pump more than I feed her when she gets bottles and there are days she gets many as I am up and about with my son at school, in classes and at birthdays, either dragging her along just so I can nurse her both ways in the car, or leaving her at home with bottles. Whichever way you cut it, nursing is a commitment of time, of your body, and most of all - of patience.

There are numerous things you can do to ensure that you are keeping your "supply" up and trying to give your child the most (and best) than you can. Below are some tips to take some of the guess work out of your nursing relationship.

For tips and tricks on labor and delivery, or on newborns click here. 

25 things every mom should know about nursing:

Early Milk: 


1. Supply and demand: Your body will make what your child needs, it has a way to anticipate the demand and supplies what they need. It also adjusts based on what your child requires at the time.

2. Colostrum
: is the early milk (more like yellow clear liquid and more commonly called "liquid gold") that your child gets before your milk actually "comes in". It is full of antibodies and is extremely healthy for your baby. It may not seem like a lot but it is heavy and can keep them feeling full at birth (keep in mind that their tummies at birth are the size of a marble, and will grow with each day, as will your supply). It is generally on day 4 after baby is born (after the 72 hour mark) that your milk kicks in, but it can be a little sooner or later as well. Sooner, is more likely the second or third time around (third time is not an experience I will ever have, but it's the word on the street in third time mom circles).

3. Latch, latch and latch again: 
The way to let your body know what your child needs is to keep latching your baby. It is important to wake them atleast once in 3 hours and put them on in the early days, even though it's not easy to get it in to their tiny mouths and even tinier tummies, your supply will be established based on how often (not how long) your child latches. So put them on and at this point it is important to make sure they get at least a few minutes on each side before they doze off again. If they are doing short feeds (15-20 minutes or less), then start them off on one side and then switch sides, leaving them to stay on the second side for as long as possible. Then at the next feed, let them stimulate the side they last fed on for a few minutes, and then switch (leaving them to drain the side they did not feed on last for longer). This is a little unorthodox but it will ensure that both sides are stimulated with each feed. If you have shorter gaps between feeds (they feed on the hour for example), then you can just alternate sides and not worry about it. You will have to judge your baby as each baby is unique however, as a rule of thumb, they tend to sleep a lot in the first 24-48 hours as they are also exhausted from labor and delivery and from all the sights and sounds in their new world.

4. Fore milk and hind milk: Yes, there are two types of milk your body makes (three, if you count colostrum). The fore milk is thin and watery (you will notice this once you are pumping), and the hind milk is thicker and richer and will keep baby fuller. It takes about 15-20 minutes for a baby to start getting hind milk when they are feeding. So, while it may be comfortable for you at that point to switch sides when you are doing a 40 minute feed, your baby is better off being left on one side as your body will learn to adjust to the long feed and give your baby the fattier hind milk that will keep them fuller longer (you can always pump the other side once you know what kind of gaps you have, or wait and drain the other side completely in their next feed).

5. Go braless: Not permanently (don't you wish.....)! But just until your supply kicks in properly (day 3 approximately). You can stick nursing pads in your shirt - they make for great cover up, or use a gown. And yes, you will need the support soon, but for the first three days till your supply comes in, try not to sleep on your belly or do anything to constrict your milk ducts.

 About you: 


6. Nursing hunger: is real! Do not let anyone tell you otherwise. Moms will often tell you how they put on weight during breast feeding when you are actually supposed to lose weight since you are burning approximately 500 calories a day when nursing exclusively. Well, you don't have to eat like a cow too, but you may be hungry enough to want to - try and stick to healthier options and you should be able to strike a balance.


7. Nursing may get you into shape: Well, it will make your uterus contract back to shape (which  can be extremely painful at first, like contractions all over again - but ask your MD if you are extremely uncomfortable and they can give you something to help - I had to). However, while you are burning extra calories, you are also that much hungrier so do not expect to magically drop all your weight just by nursing (particularly if you have put on more than just on your belly). You can always work on this once your baby is eating more and feeding less, just focus on the miracle you have created and your body will eventually be yours again to do with as you please... just not yet.

8. Gym time: You may think that you can finally work out like you need to (minus the constricting sports bra), or like you used to.. but hold up. Getting over tired or dehydrated in anyway will affect your supply. Lots of women choose not to work out at all in the early days because of this. If you do choose to start, start slowly and do it at a time that feels natural to you (don't wake up super early and enthusiastically as that is likely to catch up to you).  From personal experience - I didn't work out till 8 months the last time, I was alone with my son and just couldn't. I have a better support system this time around and tried going to the gym at the 2 month mark, it was in the mornings before the day catches up to me and my supply dropped drastically within the week, to the point where my daughter - who enjoys long leisurely cluster feeds in the evening - was sobbing and I had to supplement with my pumped supply. I stopped immediately and have started again now at 5 months, and have started slowly, I don't go if I haven't slept well and I try to go later in the day so that it's not cutting into my sleep, and it's definitely going better.

9. Lanolin it up: Even if you don't feel sore, you will eventually, specially in the beginning with the little one latching and unlatching (and when you just start to pump). It is also normal for there to be some discomfort when you just latch in the initial stages, (it should not last through the feed but if it's just for the first few minutes, that's normal). So apply some lanolin it will help you even preventive and is totally safe for the baby.

10. Drink up: Since breast milk is 88% water, the baby is going to be draining you of fluids. It's normal to feel thirstier while nursing, I would feel parched in the initial days as soon as my letdown started. So drink up and stay hydrated, even if you don't usually feel the need to drink a lot of water. 

11. Not necessary to eat the fat to make the fat: I've met a lot of mothers who have put on more weight during breast feeding than pregnancy. Nursing hunger is real, and it often makes you irrational - I do eat a lot more than I did even while I was pregnant, but it's important to continue to watch what you eat and not load up on the kind of calories that will make people ask you when you are due (after you have delivered!). In some cultures including the Indian culture, it's common for the families to try and feed you foods that are heavy in fats and high in sugar - eat what you desire (you are burning 500 calories a day after all), but don't force yourself to give in because you think that is what your baby needs. Fenugreek and oatmeal are some of the healthier options when looking for galactogues (yes, that's a fancy word for foods that will help you lactate). 

12. Your health benefits: We all know that nursing benefits babies, but it benefits you too and reduces the risk of heart diseases, diabetes and high blood pressure (in moms who nurse for 12 months.) However. regardless of how long you feed, your immunity while nursing is also stronger than it was before. So if you find you have been sick less often, that's attributable to your baby too. If you do get sick however, don't worry too much about making your little one sick because by the time you are even showing symptoms and realize you have a bug- they have received antibodies from you to help them fight it off, and they will continue to receive these until you have recovered.

About your baby:


13. Cluster feeding: ( I find this fascinating so humor me and read on even though it looks like a long paragraph) My daughter cluster feeds, she will suckle for hours on one side (literally has gone up to 90 minutes on a side - and I have cat napped or been so drained on the other side that I have not been able to swap). She has done this since her first week and continues to act famished in the evenings even now that she is on solids. It would lead me to wonder how she is possibly getting any milk beyond 45 minutes, and is she even getting anything or is it just for the comfort. If she is not getting anything, why is she not screaming? 
It turns out, (after a lot of research) that we have a limited storage capacity (that differs from person to person and even one side to another - which is why there is always a stud and a dud - yes, I'm talking about a stud boob and a dud boob). However, when the baby suckles, we are also making milk on the spot, and that milk tends to be much fattier and much more filling. So babies who cluster feed (which is more common in babies born before 40 weeks), and filling up on that heavier fatty milk and may even be the ones who are more in need of that heavier milk. So follow your child's cues and if they need to be on for long or are still hungry after you think they should be done - as exhausting as it is, stick with it. Your body knows what they need better than your mind does, and if they were hungry or not getting enough - they would scream, shout, refuse to sleep and make sure you know it. 

14. Growth spurts: Babies go through multiple growth spurts of phases where they will suddenly be much hungrier than usual, feed more at night and will also be crankier - which is their way of dealing with the sleep debt and hunger. It can last from 24 hours up to a 3 days. Try to stay calm and remember that it will be over soon, they will never need you the way they do now, and as bone-crushingly exhausted as you may feel, you are doing the best you can for your little one. (Sorry about the cliche's, but positivity just may get you through your crankiness).

15. Nipple confusion: If you are planning to use a pacifier (no judgement, seriously) and don't want to be a human pacifier, wait until your baby has crossed the one month mark. Same with introducing a bottle or pumped milk if you are planning to nurse exclusively. They do get confused, and can have trouble latching after. My son would switch from bottle to breast smoothly but my daughter would cry and fuss when I switched her back (though the second time around I do end up pumping and feeding more than I did the last time). If you do need to get out and give pumped milk before the one month mark, doctors recommend using a bowl and spoon - probably because it is so frustrating that you will just suck it up and take your child wherever you need to do. I found that the ideal time to introduce a pump bottle was at a month - try not to wait too long as some kids can reject the bottle entirely (few of them do though as they get more milk at a faster speed, though I have heard of kids who just would not take the bottle). 

16. Take their cues: My little one was a really small baby, she was born before the 37 week mark and we would marvel at how thin and delicate she was (quite the opposite of the little munchkin she looks like now). Plus, she would feed for 7-9 hours a day and I would wonder if she is possibly getting anything from me since she is so hungry and just did not want to be pulled off. I would try and weigh her while holding her to see if she was putting on anything and worry that I just wasn't making enough milk this time around. Even wondered if I needed to supplement though my doctor has told me not to. 
In all this confusion though I forgot the most important thing: my baby and her cues. They will let you know if they are getting enough and they will scream and refuse to sleep if they are not. Apparently, babies born earlier need to stock up a little more, and then they settle, and it took about 4 months for her feedings to become a little more normal, but then she was sleeping well by the end of 6 weeks as she was full and satisfied. So follow their cues, and if you are worried, talk to your doctor or put them on a baby scale, putting your mind and ease will help you get the rest you need to make that milk.

About your milk:


17. Protein and calcium: "mature" human milk has 3-5% fat, less than 1% protein, and close to 7 percent carbohydrates. It has close to 80% water and amino acids enzymes, hormones and most importantly -anti-bodies. All of this is being taken from your body, so make sure to eat protein, calcium and take a good multi-vitamin (continuing your prenatal is best). 

18. Liquid gold: Pictures speak a 1000 words, so I'm going to type less and just show you this one.
Two bags of milk from the same mother: the right one pumped when baby has a cold.
Yes, the milk is a different color when baby has a cold because baby's secretions go into mom's skin, and mom actually produces the anti-bodies to help the little one fight off whatever is plaguing her. So if your nursing baby is unwell, try and give them less pumped milk and more milk directly. Also, you will notice when you pump that your milk is more yellow - how amazing is that (or rather, how amazing are you!) 



Nursing issues: 


19. Lecithin supplements: I came across this less heard of supplement in my research on blocked ducts, and the relief I got changed my entire nursing relationship when I was about to give up at a month the first time around. I have cried with painful let downs and blocked ducts until I discovered this wonder pill (I don't mean to market for it but it really did help). It is actually a fat (an "essential" fat) that is taken out of soy beans, and no it does not make you put on weight. Quite the opposite as it is medically used to reduce fat and cholesterol in the body (and actually is also used to treat dementia which some of us may have post a crazy pregnancy). When you are nursing however, it increases the fat (specifically polyunsaturated fatty acids) content in your milk, and makes your milk less sticky. This in turn prevents blocked ducts. It is also a natural supplement that is healthy and has no known side effects so feel free to add it to your prenatal. The recommended dose for nursing moms is 2000-4000 mg a day (capsules usually come in 1000-1200 mg dosages). 


20. Plugged ducts:  It pains me to have to relive this agony while talking about it so I'm going to skip to cures, specially since we have discussed a method of prevention above. If you do have blocked ducts - don't ignore it, as it will take a few days to go and make nursing uncomfortable (to put it mildly). You don't have to rush to a doctor or a lactation consultant either but here is what you can do at home (and what works). The pain is most during let down so just before you start feeding put hot water in a shot glass (you can add in some salt or even epsom salt as that will help your body give out fluids/ milk and help the duct open up), and put this shot glass on your chest. It will help open the duct but it will soften the skin and also start let down. You can then dab off the salt if any and then nurse. You can also use a soft silicon nipple shield if it is very painful (avoid the plastic type as your child is likely to gag on those, and you will have to hold it in place). I had to exclusively pump the blocked side and feed from the other side for about 24 hours when it last happened to me. Remember to use lanolin after your feeds, and also do hot compresses. Put rice in a sock, heat it in the microwave for about a minute, and hold that against your chest, when you are not feeding. The heat will also help the duct open up. If the duct looks like it's ready to open (skin is soft and bulging, you can peel the skin back with your nail - but personally, that's exposing yourself to infection, so it's better if you wait.) Post shot-glass soak, you should keep pumping, and even post feed you should pump. If you empty each side, it is less likely to get blocked. 

21. Empty each side:  Emptying each side is a way to prevent blocked ducts and also a way to make sure that your baby gets the fattier milk, and that your supply is shored up. However, if your child goes long gaps without feeding then you can either pump the other side while you feed, or drain one side completely and then just give them a couple minutes on the other side at the end (so that your supply doesn't drop, and you do not get too engorged). I usually feed atleast 45 minutes each side and then if they unlatch and want to feed again, then I swap. My kids have both done long feeds though. For shorter feeds, you can alternate each side, and pump at the end to get out some of the fat and give it later in the bottle. 

22. Red Raspberry leaf extract and satavari:  Once you start pumping you will get a good picture of how blessed you really are in the milk department. However, if you do feel you need a little push - red raspberry tea extract and shatavari powder are two natural supplements that give you a little boost. There are many different tablets that have indredients from these. Red raspberry is also known to make your letdown start faster (and less painfully for those who have that issue), and shatavari tablets are known to boost supply (there are multiple forms including powder, however, when I tried the powder during my last pregnancy I found that I was also getting uterine contractions with them and was quite uncomfortable). However. I took the tablets initially in this pregnancy to help with those 9 hours of feeding and I did not have any trouble with them (it's all available on Amazon).


Pump and save: 


23. Pump and pump: Speaking of pumping, while it's definitely not my idea of fun, I've gotten used to doing this a few times a day now that I get out of the house for work, and activities with my son (and my baby is given a bottle when I am out). It is important to try and main that your total pumped in a day or two at most, is more than your total given by the bottle. However, even if I am home all day and all her feeds are from me, I make sure to pump atleast once so that my supply is shored up by that amount, and I know that all that frozen milk will come in handy later. Once you start solids too (and when they start sleeping better), you can pump out that feeds that they are now skipping, and it will shore up your freezer supply a great deal.
quick way to keep track of the frozen..

24. Pump and store: Start pumping in the early days, even before you are giving a bottle, this supply plus the additional you pump (over what you need to give by bottle), can be frozen for up to 4 months in a freezer and up to 12 months in a deep freeze (though I am more comfortable with 6). It will help you out when you are weaning later (I nursed for 11 months last time, gave pumped/ frozen milk for one month and then introduced cow's milk at the one year mark - no formula). I currently have 500 ounces frozen, in the last 5 months - I'm not trying to brag, and frankly those 15 litres will only last less than 20 days if I had to give her exclusively pumped milk for any reason, but I mention this to give you hope that it is possible to put away milk in excessive quantities (and if you can make the freezer space). I personally like the Lansinoh bags as they can be stored flat and stacked up, even though the Medela pump and save bags are easier to pump into. 

25. Label away: Make sure you write the date and amount of milk on the bag - the amount will look less after freezing as the fat clusters together, so go with the original amount when estimating the feed size, people also write AM/PM - as the cortisol and melatonin levels differ in your milk - that is. the stress hormone and the sleep hormone, however I find that those are variables I just cannot add into this hectic equation. 

This post has been purposefully comprehensive, so that it encompasses all you need to know and many of the things that keep you up at night while you are nursing. For quick tips and tricks on nursing feel free to go to my first tips and tricks posts. 

I have also intentionally left out weaning, as I have covered it before (for tips on how to wean click here) but more so because when to wean is a personal choice. They say that one year is when the baby gets the most out of mom's milk and doesn't need it anymore - but sometimes babies need the comfort for a little longer, and some times moms need to put their needs, ability and sanity on the table too. I have close friends who only chose to feed for a few weeks or months and it did not alter my opinion of love for them a bit, and I have friends (fewer in number) who crossed the one year mark like I did which is no easy feat but is also not one that should be met with judgement either but rather with an acknowledgement of the fact that nursing takes time, patience, commitment, unselfishness and dedication. While the anonymity we are afforded on the internet gives us a platform to pass judgement, I find it helps to offer understanding instead and sometimes even a deaf ear. Even more so when all you need is love and support and faith - in yourself, your body and your own decisions.
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More to come!
TKV

P.S. The many who reach out to me know that I am always available to help with questions and quick tips when possible. Those who do not - feel free to know that there's someone in the internet space happy to give you support if and when you need it, or if you have questions you need answered.



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