What to do when breastfeeding isn't working out
You made the decision to breastfeed your baby. You told all your friends and family, read all of the websites and books, and maybe even took a breastfeeding class (or three!). None of that matters now, because you’re exhausted, sore from birth, overwhelmed, the baby in your arms is crying – and maybe you are, too – and you’re not sure if you made the right decision. Breastfeeding is supposed to be the most natural act in the world, so why isn’t it coming naturally?
Take deep breath, take a step back, and follow the Three Rules of Breastfeeding, while you work through the causes for your current problems. No “window of opportunity” is closing; in fact, often this step back saves the breastfeeding relationship. Follow these three rules and you will have all the time you need to learn how to breastfeed your baby.
The Three Rules of Breastfeeding
Rule #1: FEED THE BABY! If baby is not latching on well, or not at all, he may need some milk away from the breast, to protect his weight gain and attitude while you two work this out. If baby is low on calories, he’s going to be a terrible breastfeeder (think about how little energy you have if you miss a meal).
How do I tell if my baby is getting enough milk? In the early weeks when you’re getting the hang of breastfeeding, it’s important to keep track of baby’s output, particularly soiled diapers, to make sure that baby is getting enough milk. Some babies show all signs that they’re swallowing milk and it turns out they’re fooling us, so watch those diapers: Calories in means poo out! If baby isn’t getting enough milk, their stools will decrease well before their wets, so don’t assume everything is fine if your baby is still making wet diapers but has not stooled in a while. In the first month, exclusively breastfeeding babies will typically have three to five stools in 24 hours, and they must be larger than the size of a quarter to count. If a baby gets any formula, switch to counting wet diapers as an indicator, in case the formula constipates baby. You should see four to six really wet diapers in 24 hours, and they will be lighter than a yellow Post-It Note, with no strong odor. If you don’t see this output, it’s a big sign baby isn’t getting enough calories.
What if my baby is not getting enough milk at the breast? If your baby is breastfeeding and output is low, you might choose to offer expressed breast milk or donor milk after he has breastfed, very slowly (taking five minutes to offer ½ ounce or 15ml), to make sure he has had a full feeding. By feeding him slowly, you don’t have to worry about him overeating or eating too fast. If your baby was born a few weeks early and seems to “act lazy” or fall asleep within just a few minutes after latching, you might have better success to offer expressed milk as the appetizer before putting him to breast, to give him the energy and patience to work harder.
How much milk should my baby be eating? Newborns will only take about a teaspoon of milk – usually colostrum – at each feeding for the first 24 hours, because their tiny tummies are still very small. That’s one reason why they need to be fed so frequently, because they can’t hold very much and human milk digests quickly, unlike milk for baby bunnies or baby cows. Gradually baby will work up to more milk on Day Two, Day Three, and so on, until he will take about two ounces per feeding on Day Seven (this is for an average-sized, full-term baby). By Day Fourteen, most babies are taking about 2.5 ounces per feeding, eight feedings per day. Small babies might take less; larger babies might take more.
I’m scared of…NIPPLE CONFUSION! Considering how this term is used as a threat so often in breastfeeding circles, it’s no wonder! Nipple confusion is the term used when a baby who had formerly been latching on suddenly no longer latches. Actually, baby isn’t confused at all: He just wants to be fed! If a baby is struggling at the breast, feeding after feeding, crying in protest and being pushed into mom’s breast anyway, and getting hungrier by the hour, that baby is at risk of deciding that breastfeeding is not for him. In protest, he will refuse to latch, even if he’s never seen a bottle in his young life. Other babies who are also struggling to get fed at the breast might be given a bottle after the doctor notices he’s not gaining weight fast enough. If a baby gets a bottle in the traditional manner, lying flat on his back with a bottle pouring into his mouth, he may easily decide, “Hey, this is awesome – all I have to do is lie back and keep from drowning! I’m never going back to the breast again!” He now prefers the bottle. On the other hand, if baby is fed in a way that preserves breastfeeding, this will not happen.
So should I feed my baby with a cup or syringe? These are good short-term solutions to feeding baby while avoiding bottles, for a few feedings. If, however, it turns out baby needs to be supplemented for longer than just a few days, or if it’s 4 a.m. and more milk is ending up on baby’s onesie than in baby’s tummy, consider feeding the baby using upright, paced bottle feeding.
How do I give my breastfeeding baby a bottle? Most bottles flow way too quickly compared with breastfeeding; remember, feeding a newborn at the breast usually takes 20-30 minutes, start to finish. Compare that with the five minutes it takes to watch Junior suck down two ounces from that freebie bottle nipple provided by the formula company. Sit baby upright, like he’s sitting on Santa’s lap, allowing his chin to tilt back off his chest, about the same angle as our chin as we drink from a glass of water. When baby takes the nipple in his mouth, only tilt the bottle sideways until the level of the milk is just barely covering the hole in the nipple (there will be a little air bubble near the collar of the bottle). Holding the bottle sideways keeps the milk from dribbling into his mouth when he’s not sucking, allowing baby to breathe and take his time. Offer ½ ounce, then put the bottle down and burp him, to help slow down the feeding. Repeat this, ½ ounce at a time, until he seems content, then set the bottle aside. This method should ensure it takes him at least 5-10 minutes to drink an ounce, to avoid over-feeding or feeding too fast. Here's a video of the technique to show anyone else who is feeding baby.
Rule #2: Protect and improve Mom’s milk supply. If breastfeeding isn’t going well, we often focus so much on Rule #1 (feed the baby!), we forget about doing anything about Mom’s milk supply. During the first three weeks after your baby is born, your body is calibrating how much milk you’ll need for the entire time you’re breastfeeding. It’s critical that you stimulate your supply frequently and either breastfeed efficiently or pump the milk out thoroughly, so your body will establish a fine milk supply for the rest of the time you're breastfeeding this baby. If baby isn’t latching on at all, or is leaving a lot of milk behind after feedings, it’s important that Mom pumps her milk to provide supplemental milk for baby away from the breast, and to keep her milk supply going in the right direction. Mom’s breasts need to be emptied at least eight times in 24 hours to maintain current supply, 10-12 times in 24 for several days to increase supply. Details pumping how-to’s are covered in my other blog.
Rule #3: Keep happy things happening at the breast. This rule seems logical, but it’s often overlooked. If baby struggles to latch repeatedly, feels like he’s being shoved around too much at the breast (beware of well-meaning but aggressive hospital nurses), or if he isn’t getting enough milk, feeding after feeding, he’s going to decide the breast is not a fun place to be. Then he’ll fight and kick and scream and arch as soon as you try to put him in the nursing position, which will break your heart. If this happens, it’s not a death sentence for breastfeeding, it just means you’ll have to launch a P.R. campaign to get him back to the breast again. This rule also means that breastfeeding shouldn’t hurt. If Mom dreads every feeding because her nipples are so raw and painful, that’s not happy things and she is going to consider quitting. Keep it happy, get help, and things will improve quickly.
This list should include Rule #4: Get help sooner rather than later. You deserve a positive breastfeeding experience, and that might mean getting help. Also, if baby is struggling to feed and you don’t get help for a few weeks, your milk supply may suffer. Sure, breastfeeding is natural, but so is childbirth, and you certainly didn’t do that alone.
Call the lactation consultants in the hospital, call a private practice International Board Certified Lactation Consultant (IBCLC) for an appointment, visit your WIC breastfeeding peer counselor, call local La Leche League and Breastfeeding USA volunteers, and go to any and all breastfeeding support groups near you. Middle of the night and you're out of ideas? Get answers to your breastfeeding questions 24 hours a day by calling the Arizona Department of Health Services' 24-Hour Breastfeeding Hotline at 1-800-833-4642. Keep asking for help until you and your baby are breastfeeding happily.
Breastfeeding will continue to benefit you and your baby throughout your lives, long after the breastfeeding relationship is a distant memory. Hang in there – it gets better!
