... and you thought the worst was over.



263x252-breastfeedingThis applies to parenting as well.

Each baby is different, each feed is different and things will change from day to day and from feed to feed. All that you need to do is to get an idea of what works for you and your baby and go with that. One of the biggest problems I find when it comes to breast feeding is that everyone from your nurse at the hospital to some stranger you meet at the checkout counter is quick to give advice. Although they are well meaning all this advice can often be conflicting and confusing. I always think of the analogy – Everyone is quick to blow up the balloons but no one bothers staying for the party.

Being a new mother is a huge undertaking. Think of yourself as the life support system for another human being. If you didn’t make it into the office for a day or so things still would carry on without you and the work will get done. However, if you don’t show up to care for your baby nobody can do the same job you are doing …just think of motherhood like that. You are not” just a mom”. You have the most important job there is.

Firstly you have to understand that every baby and every mom is different. Now is not the time to be competitive. Leave that for the kindergarten years. There will be plenty of time to compare your kid’s milestones, toilet training, language skills and just about everything else to their piers. Some babies are easier. They feed better and sleep longer. Other babies may not be as easy and almost everything that you will do will seem difficult and challenging. But with time and patience (lots of it) you will become more experienced and confident at breastfeeding and caring for your baby. Things, which seemed so difficult and frustrating at the beginning, like changing your baby’s diaper at 2am while they are wriggling and screaming, will all of a sudden become second nature. Most moms will tell you that once you get the hang of it you can feed and change your baby in the middle of the night without waking up!

Here are some very basic rules that may help to overcome the speed bumps during the first few weeks of motherhood:

Get To Know Your Baby’s Schedule.

Having your first baby is one of the most demanding and challenging things
263x252-breastfeeding-03 that will ever happen to you. The baby becomes the focal point of your life. Almost everything that you do is related to your baby. This often applies to your relationship as well. Gone are the days of sitting and having a meal with your partner or even having time to sit on the couch to talk or watch T.V.
The first 3 months after having a baby can seem like an endless stream of feeding, changing diapers, and trying to get your baby to sleep. The few moments that you have to yourself are usually taken up by trying to take a shower, get some rest and mundane things like returning e-mails and bill paying. Women often complain to me that before having a baby they were able to accomplish so much in their day. After having a baby getting washed and dressed seems like a major accomplishment.

Partners are often sleeping is a different room as they have to go to work. All of this may lead to a breakdown in communication between the two of you. Couples often complain that the only time they see each other is to hand the baby over so one can get a break. This may cause a few “speed bumps” in what was once a wonderful loving relationship. If this is happening to you do not worry. It is very common and usually resolves at about 3 months (100 days). By that time your baby is usually sleeping most of the night, eating at predictable intervals and you both feel more comfortable and confident at being parents. Try to make time even if is very short that the two of you can sit and talk or have a meal together. This may not always be possible but at least try to get some together time. Also tell your partner what you are feeling and things that they can do to help you.

Daytime Feeds

During the daytime, I recommend waking your baby up every three to four 263x252hours. To do this, unwrap your baby and maybe even take its clothes off. Make sure that the room is nice and warm before you undress your baby. Tickling the baby’s feet or face will also help wake it up. Blowing very gently onto their faces also works very well.

Try to put baby on your breasts for about 20 minutes a side. They will not feed for the full 20 minutes. What you can expect to happen is that the baby will latch, have a few sucks on the nipple and then fall back to sleep. Keep stimulating the baby so that they keep sucking as much as possible. After 20 minutes or so of feeding on one breast change the baby to the other breast. You will find that the baby may prefer one breast to the other. There is no easy way to overcome this preference. Try changing your hold on the baby to see if it makes the baby favor the other breast. Try the football hold rather than the across body hold or even try feeding the baby while lying on your side. You may also consider changing the baby from one breast to another more frequently to see if this helps the latching and sucking. You can move the baby from one breast to another every few minutes to see if this helps the latching and feeding.

Putting your nipple against the baby’s cheek may stimulate the baby to find your breast and open its mouth wider in order to latch better. This is called the rooting reflex.
After the baby has been on both breasts for approximately 40 minutes or so, take the baby off your breast. Try to burp the baby. Some babies burp easier than others. Try holding the baby up against your chest with its head on your shoulder. Gently pat the babies back. This may help promote a burp. You may need to change the baby’s diaper as well. This whole process has taken you about an hour. Now its time for you to have a break. Put the baby down and get some rest for the next 2 to 3 hours before its time to feed again.

Night Feeds

This is where most new parents come unstuck.263x252-breastfeeding-04

Most babies will wake to feed at around 10pm and will want to feed until 2am or even later. The typical feeding pattern at this time is that they wake up and cry then latch and suck for a few minutes and then go back to sleep Then just as you think they are all tucked in and cozy they wake up and start the crying and latching thing all over again. This is called cluster feeding and it will drive you crazy. Remember what I said about sleep depravation .By the second night of doing this most parents are at their wits end with frustration and exhaustion. The whole situation is made even more unpleasant by the fact that you are in pain from the delivery and your hormones are taking a nosedive making you an emotional train wreck. Here are some solutions.

Try to divide the care at night. You do the feeding till lets say 2am while your partner or helper gets some sleep. When you start to feel desperate for a break, which usually happens around 2am, give the baby over to your designated helper. They take the baby out of the room so you get rest and sleep.

The nurses on the ward will usually tell you that your breast milk comes in on the second day. For most moms this is incorrect. The milk usually comes in on the 5th to 7th day and trust me you will know when your milk comes in. Till then your baby gets the colustrum, which is very rich in fats and calories but not very filling.

By the third if not the second day after the birth your baby is losing weight and getting very hungry. It is normal for all babies to lose weight for the first few days if not the first week of life. Your baby will usually only start to gain weight after the first week.

A hungry baby is an unhappy baby and you will usually be able to tell this from your baby’s cry. A hungry baby’s cry is typically a high-pitched yell versus the shorter, softer and less intense cries of a baby that just wants a feed.

Its 2am,you are exhausted, your nipples are cracked, raw and bleeding and all you want to do is be some place else .I now think that it is time to consider giving your baby some formula or donor milk.

Your baby is hungry and wants something to eat. Until your milk comes in you will most likely need to supplement your baby with some formula or donor milk. I suggest giving your baby the formula or donor milk via a bottle. There are bottles on the ward but you may want to bring a small feeding bottle to the hospital with you. Your baby will not get nipple confusion. Remember that your baby is only getting the bottle after being on the breast for a few hours.

What typically happens is that your baby will latch onto the bottle and suck back about half to one ounce of formula or donor milk. It will take as much as it needs to feel full and satisfied and then the baby usually goes to sleep for a good 4 to 5 hours. This is usually enough time for you to get some rest and feel rejuvenated, refreshed and ready to continue caring for your baby.

Some babies will not latch onto the nipple. If this is the case then feed the baby through a small syringe, which is also available on the ward. Ask the nurse for it if necessary. I do not recommend using the syringe before trying the bottle. Feeding through a syringe can be very inefficient and wastes a lot of time. If your baby will not take a bottle you have no choice. When using a syringe to feed your baby, put your pinky finger into the baby’s mouth so it can suck on your finger. Then you slide the syringe along the side of your finger into the baby’s mouth and inject the fluid into the baby’s mouth while it sucks on your finger. Expect that a lot of the formula to spill out of your baby’s mouth and onto your lap.

Some nurses on the ward may be resistant to you giving your baby some formula or even donor milk. For this reason I tell you to bring a few bottles of premixed formula to the hospital to use just in case you need to and the nurses are not willing to give you any.


Should I use formula?

Breast is best but sometimes a little formula is needed.

Formula has gotten a bad rap over the years. Let me make one thing very clear, giving your baby an ounce or two of formula does not mean that you are formula feeding. It will also not result in any compromise to your babys immune system or any other unwanted side effects. All you are doing is giving your baby much needed calories and hydration until you produce enough milk to keep your baby well hydrated and satisfied. How would you feel if we stopped feeding you for a few days?

Any newborn formula is fine to use. I recommend the Nestle good start formula but you can use any brand you wish. There is no need to use soy formula unless medically indicated.

What is donor milk?

This is milk that has been donated form breast-feeding mothers who have more milk production than they need to feed their babies. They donate this extra milk to the hospital. These moms’ are screened for infections that can be transmitted in the milk such as hepatitis or HIV.

The availability of the donor milk varies from time to time. It is usually available on the postpartum wards. After you leave the hospital it may be more difficult to get the donor milk. If you chose to give your baby donor milk when you get home, it may be possible to buy some of the milk from the milk bank in the hospital to take home with you.

How much volume do I need to give?

Your baby will take as much as it needs. It’s stomach is very small , about the size of a large grape, so half an ounce should be more than enough.
When you are breast-feeding it is difficult to know just how much milk your baby is getting, especially before your milk comes in. While in hospital your baby will be weighed daily and this will give an indication how much milk your baby is getting. It is normal for your baby to lose some weight in the first few days after birth. If the baby loses more than 10% of its body weight it is then important to give the baby some formula or donor milk in order to rehydrate it. Checking for wet diapers is another way to check that your baby remains well hydrated. If your baby does not have a wet diaper in the space of about 4 to 6 hours it may be coming dehydrated.

How do I know if I will be able to produce enough breast milk?

The answer is you cannot tell before you start to feed .The size of your breast has very little to do with the amount of milk you can produce. Some women with small breasts can produce gobs of milk while other more buxom women hardly produce any milk. It is very common to leak some breast milk before the baby is born. This does not necessarily mean that you will have a good milk supply soon after the birth. For the first day or so it is common to produce only a few drops of early milk called colustrum. This milk is usually a darker yellow color compared to real milk. It is also richer in fat and calories than regular breast milk. With each feed you will usually produce more breast milk but the real” mother load” will only come in after 5 to 7 days and trust me on this, you will know when it arrives.

If you have had a breast reduction you will probably be able to produce some breast milk but this will probably not be enough to keep your baby well fed as it grows. Most women who have had breast reduction surgeries will need to supplement the feeds with formula or donor milk. Even if you will need to supplement, it is still very important that you breast feed as well.

How will I know how much milk I am producing?

For the first few feeds, you will only produce a few drops of milk. The amount of milk will usually increase with each feed. The baby will lose weight for the first few days and then as you start to produce more milk, the baby will stop losing weight and eventually gain weight. Don’t expect the baby to gain weight for the first week of its life. A way to find out how much milk you are producing is to use a breast pump or to weigh your baby after a feed. In most cases your baby will tell you if it is hungry.

Breast Engorgement

When your milk comes in your breasts can become very full and engorged.
This can be very painful. Some women say that the pain of breast engorgement is as uncomfortable as labour. You can also get a fever along with the engorgement. This usually happens about the 4th to 6th day after birth. Your breasts become very hard and can feel like wood.

Some things that help alleviate these symptoms include taking a small green cabbage and put it in the freezer. Peel off the frozen leaves and put them in your bra. Change the leaves every 30 minutes or so. Do this between feeds. This looks funny, smells awful but works great. One of my patients, who found this advice useful, recommended that I tell my patients to use red cabbage. “It will make them feel sexier “she advised. Putting ice packs on your breasts also helps.

Before you feed the baby, apply a warm compress to your breasts as this will help open up the milk ducts and make breastfeeding a little easier. Another good trick is to take some clean baby diapers, wet them, and put them in the microwave for about 30 seconds to warm them up. Now place the warm diapers in your bra. You can reheat the same diaper a number of times. Having a warm shower before you feed your baby may also help ease painful swollen breasts

Things To Help Milk Production

Firstly keep well hydrated and rest. If that is not working then I can prescribe a
medication called domperidone (not the champagne) to help improve your milk supply. Feeding your baby more frequently may also help improve milk production.

When do I need to pump?

In the first few weeks there are only a few reasons for you to use a breast pump.

If your nipples are inverted, pumping for a few minutes on each breast before you let the baby latch may help to pull the nipples out thus making it easier for the baby to get a better latch on the nipples.

If your baby is too tired to feed and falls asleep on the breast you may need to pump in order to stimulate the breasts and to get some of the colustrum to feed to your baby. Babies can be very sleepy during the first week of life especially if they are jaundiced.
Lastly, if your nipples are too painful to feed, pumping helps rest the nipples.

Once your milk has come in it is fine to use a breast pump in order to store extra milk to use if you are unable to feed.

What is the best breast pump to get?

Before your milk comes in you will need to use an electric pump, as you will need a lot of suction applied to the breast in order to get the milk out. You can buy one new or get a gently used one on Craig’s list.

The hospital gift shop also sells electric pumps. Once your milk has come in you can use an electric pump if you have one or you can use a hand pump, which you can buy from most pharmacies and is not very expensive.

You can also rent a pump from the hospital or you can rent one from one of the larger pharmacies. London Drugs and Shoppers on Broadway rent pumps.

What To Do For Very Painful Engorged Breasts

A very useful trick is to take a cabbage and put it in the freezer. A green cabbage will do but a patient of mine suggested that a red cabbage might make you feel a little more attractive. Take off the frozen cabbage leaves and put them in your bra. Change leaves every hour. This looks funny, smells awful and works great. This advice has saved a lot of moms who are having difficulty with breast engorgement. Not every mom will have this difficulty but those that do, the cabbage trick works great.


To get your baby to latch, your baby’s mouth needs to be as wide open as
263x252-breastfeeding-02possible. To help do this put your nipple on the baby’s cheek. Stroking the babies’ cheek with your finger also does the job. Blowing gently on its forehead might help open up its mouth. Once your baby’s mouth is open, take its head in one hand and your breast in the other and bring the two together. Try to get your babies mouth as far over your nipple as possible. It will feel as if you are almost suffocating your baby. Don’t worry you wont. You want the baby to bite as far back on the nipple as possible. If the baby nibbles on the tip of your nipple, it will cause a lot more discomfort. Ideally you want the baby to suck on the skin surrounding the nipple call the areola. This skin is less sensitive than the nipple and little more robust too. If you feel that the baby is latching and sucking over the end of the nipple or if the latch is not felling quite right remove the baby from your breast. To break the latch put your baby finger into the side of the baby’s mouth. This should break the seal and gently pull the baby off your breast.

How To Hold The Baby:

263x252There are two basic holds; one is holding the baby across your chest or tummy. The baby is lying on your forearm. The back of your baby’s head is resting on your hand. You usually have to be sitting up in bed or on a chair to feed in this position. The other position commonly used is the football hold. Here you hold the baby on your forearm against the side of your chest just as a quarterback running with a football. In both of these positions you are supporting the baby’s head in your hand and you can adjust the latch by moving the baby’s head from side to side or onto or away from your breast. These are the easiest and most comfortable positions to use when learning to breastfeed.

Once you become more comfortable at feeding and your milk has come in some women like to breastfeed their babies lying down. This works well especially well at night. You lie on your side and the baby lies on the bed and facing you. The baby can only reach the lower breast in this position and so to feed to baby on the other breast you will have to turn over onto your other side and move the baby with you as you turn. Don’t use this position if you are very tired or on medication which can make you drowsy. There is a small risk that you can fall asleep and roll over on top of the baby. As you become more experienced and proficient you will find positions that will allow you to breast-feed more efficiently. Most babies prefer one breast to the other. It is important to get your baby to feed on both breasts. Try the breast that the baby prefers first and then switch over to the other side.

What To Do For Sore Cracked Nipples

Your nipples will crack, they will bleed, they will blister and they will be sore 263x252and there is not much you can do about this. Firstly, make sure that the baby is latching correctly which most babies do. Using some lanolin cream or some moisturizing cream will help prevent some of the cracking. The pain in your nipples is something you are just going to have to bear with and get through. However, if your nipples are exquisitely tender and it is too painful to breastfeed, then there are two tricks you can use. One is to apply a nipple shield. This can be bought from the breastfeeding aisle at any pharmacy. You put the nipple shield over your nipple and the baby sucks on the nipple shield thus preventing direct trauma to your breasts. The problem is that most babies do not like latching onto the nipple shield. If this does not work and you are still very uncomfortable, you might have to give breastfeeding a break for one to two days and breast pump during this time.