Breastfeeding your baby is a great bonding experience – and has many health benefits for both mom and baby. However, it is not always an easy road. Some mothers have concerns and questions about the experience along the way.
Amy Saglibene-Parmelee, RN, BSN, IBCLC, is the lactation program coordinator at Rochester Regional Health and understands some of the common breastfeeding issues new moms go through.
Lactation education and support
When it comes to breastfeeding, the goal of lactation consultants is to increase a mother’s knowledge and self-confidence, so that she is able to achieve her goals. Receiving targeted breastfeeding education and support prenatally and throughout the breastfeeding journey can have positive impacts on breastfeeding initiation and duration.
Saglibene-Parmelee has been working in inpatient and outpatient settings to provide lactation education and support for families whose babies are enrolled at Rochester General Pediatric Associates.
“There is often a lack of knowledge and education about breastfeeding, especially during COVID-19, for women,” Saglibene-Parmelee said. Many women felt like they didn’t get enough education and in-person assistance regarding the mechanics of breastfeeding while they were in the hospital. This was mostly due to their stay being shortened.”
Choosing a visit with a lactation consultant can be very helpful. Sessions are in a one-on-one environment and tend to last at least an hour. The consultation is comprehensive and focuses on both mom and baby. Consultants will often try to observe a feeding during the visit to give specific suggestions on what may improve.
For the mother, this can involve assessing her breasts and nipples to ensure everything is optimal for the baby to start feeding and have it be successful.
For the baby, consultants will look at their mouth shape, palate, and tongue to ensure adequate function and range of motion. This can help to determine if a baby has good muscle tone in their jaw, which assists with them latching and sucking effectively.
A lactation consultant can also bring an attending pediatrician into the visit for further evaluation, if needed. This can give added perspective for all involved and allow the mother an opportunity to ask any related or unrelated questions about the health of the baby.
What are some common issues?
One of the many challenges of being a new mom can include not knowing what a “typical” feeding may look or feel like. Mothers who choose to breastfeed are often learning on the fly, not just about their own bodies, but about the bodies and behaviorsof their newborn.
Each mom and baby is unique, but there are some issues that come up more often during the breastfeeding process.
Sore or cracked nipples
Many moms say their nipples feel tender or painful during the first few days or weeks of feeding with their baby. Women who experience ongoing nipple pain or nipple trauma should seek further evaluation from a lactation consultant as soon as possible.
Nipple pain may be due to a poor or shallow latch at the breast. This can occur when the baby is not positioned properly to achieve an asymmetric latch. The baby needs to flange both lips out to get the suction they need, usually taking in more of the areolar tissue. This asymmetric latch is usually comfortable for the mom and does not result in damaging her nipple tissue.
Babies who arrive earlier may need more time to develop their suck-swallow-breathe rhythm. These early babies often need additional lactation support in the first few weeks following birth to ensure they are effectively transferring milk from the breast and obtaining the calories needed to grow appropriately.
Engorgement
Engorgement happens when a higher volume of a mother’s milk comes in, which brings more blood and lymph into the breast tissue. This situation can be painful for mothers to experience, but generally lasts for about 24-48 hours. During this time, it’s important to empty the breast frequently, either by direct breastfeeding or using a breast pump, no fewer than 8-10 times each day.
When there is a significant amount of milk in the breast, the nipple can flatten out – which can make it hard for the baby to latch.
Lactation consultants can demonstrate how to massage the breasts to reduce the mom’s pain and ease some of the milk building up.
Low milk supply
This discussion often happens with first-time moms. Saglibene-Parmelee suggests this stems from a need for better understanding about milk production and the volume of milk that a mom needs to sustain her baby on breast milk alone.
This is described as perceived vs. actual low milk supply. In the first few days of an infant’s life, a mom will make colostrum – a thick form of milk that contains important nutrients, such as antibodies, for the baby. Colostrum is thicker and more nutrient dense than the mature breast milk that comes in later. Since a newborn’s stomach is small in the first couple days after birth, they do not require large volumes of colostrum – only about one teaspoon per feeding. For this reasons the body produces less colostrum as compared to the volume of breast milk in the weeks to come. Producing small amounts of colostrum is not necessarily a sign of low milk supply. It is normal and similar to the idea of training wheels needed to help a newborn learn to breastfeed in their first few days of life.
All newborns lose weight initially, but most are expected to regain their birth weight by 10-14 days, gaining approximately an ounce a day. Early and frequent weight checks at the pediatrician’s office are recommended to help monitor a newborn’s weight. Pediatric providers can make referrals to outpatient lactation support services when additional help is needed.
Babies cry a lot in the first few months. Every cry is not a hunger cry. As time goes on, new mothers learn how to recognize different types of infant cries and how to calm their baby. It’s essential for breastfeeding educators to include information that helps new mothers understand newborn normal behavior, normal sleep patterns, how identify early feeding cues, and how to soothe a fussy baby.
“Many women worry they are not going to be able to make enough milk for their babies,” Saglibene-Parmelee said. “Having early conversations about normal milk volume and appropriate weight gain for a baby are incredibly important. Helping moms and their families understand normal newborn behavior, frequent feeding patterns, and what constitutes a good milk supply, can help alleviate undue worry and concern for many of these moms.”
Pumping
Mothers who choose to pump breast milk can often get an electric breast pump through their medical insurance. Most insurance companies have benefits to cover pumps so a woman will not need to buy a brand new one on her own.
Using a pump will allow a mom to pump into bottles or bags and store the breast milk for a later time. This provides an alternative to women who are separated from their baby or are returning to work and still want to provide breastmilk for their baby.
“There are very few insurances now that are not covering breast pumps,” Saglibene-Parmelee said. “The process for getting pumps may vary from plan to plan. Women should contact their insurance carrier during their pregnancy to inquire about coverage.”
If a mother is unable to obtain a breast pump during pregnancy, Rochester Regional Health will provide her with a list of Durable Medical Supply (DME) stores during her hospital stay where she can obtain a pump.
After selecting a DME, a prescription for a pump in the mother’s name will be sent to the DME by a Rochester Regional Health staff member. The DME will then contact the mother to verify her insurance and contact information, letting her know which pumps her insurance covers. At the end of the conversation, the DME will either mail the pump to her home or have it available for pickup.
Lactation consultants will work with mothers at the hospital to ensure they know how to work their pump. They will also have conversations with women who are going back to work about their rights to pump at their workplace.
New York State law requires a woman’s employer to provide her with break time to pump breast milk at work. The employer also needs to provide a private room with a chair and table. Restrooms do not qualify as a private room.
Where can I go for help?
There are several resources available, both in-person and online, for new mothers who want to seek out help from providers and other parents.
These sources of support include:
- Breastfeeding support groups, such as the ROC City Baby Café, are for both expecting moms and new moms. These groups provide evidence-based information and support from lactation professionals within a comfortable, open-forum setting. For pregnant women, knowing ahead of time what to expect after delivery and how to start breastfeeding is very helpful.
Many attendees find the advice and support from other breastfeeding moms participating in the group are also very valuable.
This service is provided free of charge. Due to COVID-19, these sessions are being conducted via Zoom. Dates and times are posted on the Baby Café website.
“We are able to provide education, dispel some myths, and make sure patients have evidence-based information so they can make an informed decision about how to feed their baby,” Saglibene-Parmelee said.
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