Commitment: What changes in one's breast can a new mother expect as she breastfeeds her baby?
Kathleen Huggins, R.N.: During pregnancy many changes occur in your breasts in preparation for nourishing your baby. Initially, you probably noticed they were more full and tender than usual. Their increasing size during the first few months of pregnancy is caused by the development of the milk-making structures within them.
Many women prefer to wear a supportive bra during pregnancy, although some may be just as comfortable without one. You may also notice that your bra band feels tighter which may lead you to purchase new bras or bra extenders.
With this growth the blood flow to the breasts increases, and veins in the breasts may become clearly visible. Some women develop stretch marks on their breasts like the ones that can occur on the abdomen during pregnancy.
The nipple and the area around the nipple, the areola, may double in size and deepen in color; this darkening may serve as a visual cue to the newborn.
Also during this time, small glands located in the areola, known as Montgomery’s tubercles, become pronounced. Their function is to secrete an antibacterial lubricant that keeps the nipple moist and protected during pregnancy and breastfeeding. This is why soaps and special creams are unnecessary in caring for your breasts, and may even be harmful: soaps remove the breast’s natural lubricant, and creams may interfere with its antibacterial action.
The nipples often become more sensitive during pregnancy in preparation for nursing. Some women find that their nipples are overly sensitive and even hurt when touched. This sensitivity diminishes as pregnancy advances; it should not make breastfeeding uncomfortable. Other women enjoy the sensitivity and feel great pleasure when their breasts are fondled during lovemaking.
By the fifth or sixth month of pregnancy, the breasts are fully capable of producing milk. Some women begin to notice drops of fluid on the nipple at this time. This fluid, known as colostrum, comes from the many tiny openings in the nipple and is the food your baby will receive during the first few days after birth. Some women do not leak colostrum, but it is there in the breasts just the same.
As women, we all receive messages about our bodies and what they “ought” to look like. These messages affect our self-image, including our feelings about our breasts and how they look. You can probably remember how you felt about your breasts as they developed in early adolescence. You may have felt proud as they grew larger and you began wearing a bra. Perhaps you were embarrassed if they developed earlier or grew larger than the other girls’. You may have felt anxious if they took a long time to grow, or self-conscious if they were small.
Even now you may wish that your breasts were smaller or larger, fuller or less droopy. You may not resemble the women with “perfect” breasts portrayed in photographs of nursing mothers. Women with large breasts, especially, often feel insecure about nursing, fearing that their breasts will grow much larger still or leak milk excessively. Actually, large breasts seldom grow bigger after delivery, and they tend to leak less than small breasts.
Each woman’s breasts are very different from all others, but the breast, regardless of size, is perfectly designed for its ultimate purpose—to nourish and nurture our children. The breasts not only provide an infant with superb nutrients for growth and development, but also offer the warmth, the comfort, and the security that every growing baby needs. In this respect, they are most beautiful. Some women fear that breastfeeding will ruin the appearance of their breasts.
Pregnancy typically causes the breasts to enlarge, and sometimes to develop stretch marks. During the first few months of nursing, women whose breasts are normally small or medium-sized generally find them to be bigger.
Women whose breasts are normally large can usually expect them to stay about the same size while nursing, as they were late in pregnancy. As the baby gets older and begins nursing less often, most women notice their breasts reduce in size. At weaning, the breasts typically appear smaller still and somewhat droopy, but within six months they often resume their usual size and shape.
A recent study done in the U.S. found that women who nursed had no more sagging than women who bottle-fed. Researchers found that several factors including increased maternal age, the number of pregnancies, higher body mass index, larger pre-pregnancy bra size and smoking were identified as significant independent risk factors for the adverse effect upon breast appearance.
Commitment: What is the best way to prepare one's nipples for breastfeeding?
Kathleen: Nipples rarely need attention in preparation for nursing. Many years ago mothers were instructed to “toughen” their nipples to by rubbing them with a dry wash cloth but now we know that nipples do not benefit by any prenatal maneuvers.
The best way to avoid soreness during the early days of nursing is to learn how to latch the baby so that he/she gets a large mouth full of the breast.
The mother should assist the baby by getting a latch that is off-centered or asymmetric with the baby’s upper lip just over the nipple and the lower lip as far away from the nipple as possible. This can be accomplished by having the baby’s nose (rather than the mouth) lined up in front of the nipple. There are some great illustrations of this at http://www.mommyguide.com/modules.phpop=modload&name=News&file=article&sid=93&mode=thread&order=0&thold=0
You may find that using a thin coating of medical grade lanolin after nursing of you experience tenderness with nursing. Should you and your baby struggle with latching, consider a visit with an experienced lactation consultant.
Commitment: What is the best way to promote breastfeeding once the baby is born? Are there things a mother should do within the first few hours of birth that will help this process along?
Kathleen: One of the best ways to promote breastfeeding is to let your caregivers know that you would like the baby to be quickly dried and placed skin-to-skin on your chest. After the birth of a baby, the most important place for him to be is skin-to-skin with his mother. This special time eases the transition from the uterus to the outside world. After a quick drying, being placed on his mother’s bare chest satisfies his need for comfort and energy conservation.
Studies show that when babies are allowed to rest skin-to-skin with their mothers compared with babies that are swaddled and placed in a crib, the skin-to-skin babies have more respiratory stability, higher blood sugar rates, and cry much less. When mothers delivered by cesarean birth and were separated from their term newborns, another study demonstrated that fathers who spent the first hour skin-to-skin with their newborns were just as effective in protecting their infants temperatures persisting as long as twenty-four hours later.
When newly born babies are dried and immediately placed on their mother’s bare chest, wonderful moments of joy follow for mother, father and baby. Babies are born in a special quiet state of alertness, ideal to meet his parents. The baby’s eyes are wide open and he is especially interested in his mother and father’s face as well as the sound of their voices.
This position offers warmth, love, security and food. Most all unmedicated babies when placed on the mother’s chest have the amazing ability to crawl to the breast and decide when to begin breastfeeding. The majority of babies will complete the breast crawl in 30-60 minutes.
This skin-to-skin contact should continue until the baby completes his first nursing. All baby care like weighing, bathing and eye care can be postponed until your baby completes his first nursing. Mothers who nurse during the first two hours are much more likely to be successfully nursing weeks and months later.
Commitment: What advice do you have for mothers whose baby's won't latch on or refuse to breastfeed?
Kathleen: Have patience! Some babies for any number of reasons may struggle with latching on. If this is the case from the start, you will want to begin pumping colostrum and then mature milk every 2-3 hours until your baby is able to latch. In this case, you will certainly want to visit with an experienced lactation professional. Most all babies will eventually learn to latch and when that time comes, you will appreciate that you have an abundant milk supply for him.
Some babies will begin nursing well and then have trouble once the milk comes in. In this case, using a pump to drain both sides may help with the initial engorgement and in many cases, once the period of engorgement is over, the baby will usually return to the breast especially if the mother is skilled at offering the breast in a helpful manner.
Whatever the reason, do not think that your baby does not like you or breastfeeding. Keep in mind that he just needs a bit more time and assistance.
Commitment: What can a mother do to ensure an ample milk supply?
Kathleen: Most mothers will have plenty of milk so long as they are draining both breasts well every 2-3 hours either with a vigorous nursing baby or a full automatic electric breast pump. You will know that your milk supply is fine, so long as the newborn has not lost more than ten per cent of his birth weight and begins gaining an ounce a day from the fifth day of life. It is expected that newborns return to their birth weight by 10-14 days of age.
The newborn that is stooling daily and has yellow stools by the fifth day of life is most likely getting plenty of milk.
The baby will have this rate of weight gain until about 3-4 months of age and then slows to about 3-4 ounces a week until close to six months of age.
Commitment: What are some reasons a mother may not produce enough milk?
Kathleen: Mothers whose baby is not nursing often or is not swallowing frequently may fail to stimulate an adequate milk supply. Mothers who do not experience breast fullness by 72 hours post partum may not be producing sufficient milk. One of the reasons for the delayed onset of milk production is long labor with an abundance of IV fluids. This can be seen when mothers whose labors are induced, are given Pitocin to stimulate or strengthen contractions, are anesthetized with an epidural and those laboring mothers who go on to have a cesarean birth.
Babies who are born at 37 weeks gestation or earlier may fail to nurse vigorously and drain the breast well. In these situations, intervening early with the use of a hospital grade fully automatic and visits with an experienced lactation consultant will usually turn late onset or low milk supplies into abundant milk.
Commitment: How can a mother know if their breastfeeding baby is getting enough milk?
Kathleen: As mentioned above, monitoring the baby’s early stooling pattern (daily and mustard colored by day five), gaining an ounce a day by the fifth day of life, and thereafter.
Commitment: What are some ways to treat engorged breasts?
Kathleen: Engorgement is a combination of the beginning of milk production as well as an increase in the flow of blood to the breast. Heat most typically increases engorgement.
The best treatment is frequent feedings, ensuring that at least one breast is softened at each feeding (this may mean feeding fro just one breast per feed), avoiding heat to the breast with warm cloths or direct shower spray, and the use of cool packs to the breasts after feedings. For most women, engorgement lasts a couple days.
Commitment: What is mastitis? What is the best treatment for mastitis?
Kathleen: Mastitis is the term used for a breast infection. Mothers who experience traumatized nipples in the early days of nursing are at greater risk for mastitis in the following weeks so avoiding nipple damage by latching the baby well is very important. Mothers who are delaying or skipping feedings especially during the winter months are also at risk for developing mastitis.
If a mother experiences headache, flu-like symptoms (including fever) a tender, reddened breast should treat the affected side with moist heat packs prior to nursing, starting each feed on the affected side, using Tylenol or Ibuprofen every 4-6 hours. If these symptoms persist beyond 12-24 hours, speaking with your OB or midwife about being treated with antibiotics is urged.
Commitment: How can a mother who is breastfeeding minimize her baby's exposure to toxic chemicals?
Kathleen: More and more questions have arisen about the environmental pollutants we are exposed to, such as insecticides and other toxic chemicals. Many of these substances are stored in fatty tissues of the body, and, as a result, small amounts may be detected in breast milk.
Experts on the subject, however, have been unable to identify any risks to the baby from such amounts, and most believe that the nutritional and immunological benefits of breast milk far outweigh the possible risks of environmental pollutants.
Sadly, our children receive even greater exposure to some of these chemicals in the womb than they do at the breast.
If you want to minimize your baby’s exposure to toxic chemicals, follow these guidelines during pregnancy and as long as you are breastfeeding:
• Stop using pesticides in the home, in the garden, and on pets.
• Avoid exposure to organic solvents, which are in paints, furniture strippers, gasoline fumes, non-water-based glues, nail polish, and dry-cleaning fumes. Air dry-cleaned clothes outdoors before wearing them, and avoid permanently moth-proofed garments.
• Adopt a diet low in animal fat, by choosing lean meats and low-fat dairy.
• Avoid smoking
• Avoid eating fish species that have been found to have high levels of mercury and PCB, including shark, swordfish, and king mackerel, and fish caught in contaminated waters, especially the Great Lakes.
The U.S. Food and Drug Administration says that pregnant women can safely eat 12 ounces per week of all other types of cooked fish, but recommends limiting consumption of grouper, martin, and orange roughy. The Environmental Working Group is even more conservative; this nonprofit organization suggests also completely avoiding fresh tuna, sea bass, Gulf Coast oysters, marlin, halibut, pike, walleye, white croaker, and largemouth bass, and eating no more than one serving a month of canned tuna, mahi mahi, blue mussels, Eastern oysters, cod, pollock, Great Lakes salmon, Gulf Coast blue crab, wild channel catfish, and lake whitefish.
Safe fish and shellfish, with mercury levels lower than .2 parts per million, include farmed trout, farmed catfish, fish sticks, shrimp, pollock, wild Pacific salmon, haddock, summer-caught flounder, croaker, clams, flatfish, mid-Atlantic blue crab, freshwater sport fish, and scallops. Check with your state or local health department about the safety of local species.
• Carefully wash or peel fresh fruit and vegetables.
• Avoid crash diets, which can increase the excretion of toxic substances into breast milk.
• If you work with chemicals, ask your doctor to refer you to specialist who can advise you about their safety.
Formula feeding may also expose a baby to toxic metals and harmful bacteria. High levels of aluminum have been identified in most formulas.
In 2008, thousands of infants in China became sickened with kidney damage after formula makers intentionally added the chemical melamine to infant formula to increase its protein levels. The U.S. Food and Drug Administration detected trace amounts of melamine and the presence of cyanuric acid in some of the most popular brands of formula sold in the U.S. Initially the FDA stated they were unable to establish any safe level of melamine and its related compounds in formula but when so many national brands were found to contain the chemical, they later changed their view saying that the trace amounts found in U.S. formulas were acceptable.
Melamine is used in some U.S. plastic food packaging and can rub off onto what we eat; it's also contained in a cleaning solution used on some food processing equipment and can leach into the products being prepared.
Many parents are unaware that powdered infant formulas are not sterile and are often contaminated with harmful bacteria, which can make infants sick. Most “gift bags” given out at hospital discharge contain powdered infant formula. The World Health Organization (WHO) and the UN Food and Agriculture Organization state that infants less than two months, low birth weight and preterm infants are at greatest risk for infections associated with powdered infant formula and suggest that infants under this age not receive powdered formula.
Recently, formula companies have added probiotics, live intestinal bacteria, to their powdered infant formulas to help prevent diarrheal infections. This poses a dilemma as the instructions on reconstituting the powdered formula are to use low water temperatures so that the added bacteria is not destroyed. This is against the WHO guidelines on the safe use of powdered formulas to use higher water temperatures to kill the dangerous bacteria that may be present.
From time to time, manufacturing errors in the production of infant formulas have had serious consequences. Frequently, contamination occurs because the person preparing the baby’s bottle takes too little care in handling and storing the formula and feeding equipment, or in mixing the formula with water. Babies have suffered lead poisoning when their formulas have been mixed with tap water high in lead content. Water pollution is a potential problem even if the water is purchased in a sealed bottle.
Many mothers use bottles to feed breast milk or formula. Recently, it has come to the attention of parents that clear plastic baby bottles that are made of polycarbonate contain the chemical Bisphenol A (BPA). Over time the BPA is believed to leach out into the liquids fed to infants. Although most data comes from animal studies, many scientists are concerned about BPA causing behavioral and developmental problems in children. A panel of governmental scientists now recommends that parents avoid using polycarbonate bottles and sippy cups and replace these with BPA-free bottles.
Commitment: What is your best advice for new mothers who are exhausted from breastfeeding?
Kathleen: Well, new mothers are often exhausted regardless of their feeding method.
Bottle feeding mothers certainly spend a lot of time awake in the night both preparing and feeding formula. Caring for a newborn is certainly tiring especially when mothers take on more than caring for the baby or do not nap when the baby is quiet. Accepting or asking for help with cooking household chores also is important when recovering from birth, which can take many weeks before regaining their strength and energy.
Many mothers also find that they get much more rest if they sleep with or next to their newborns. Mothers since the beginning of time and around the world have slept along side of their babies and most find the experience restful and rewarding. Of course, mothers who co-sleep must do so safely. To learn more about safe co-sleeping refer to the Nursing Mother's Companion or Sleeping With Your Baby by sleep expert Dr. James McKenna.
To purchase The Nursing Mother's Companion click here.
Kathleen Huggins is the author of the bestselling The Nursing Mother's Companion and , The Expectant Parents Companion and co-author of “The Nursing Mother¹s Guide to Weaning” and “Nursing Mother, “Working Mother”, as well as the newly released “25 Things Every Nursing Mother Should Know.” A registered nurse, board-certified lactation consultant, and owner of the maternity shop Simply Mama, she lives in San Luis Obispo, California.