Not-So-Secret Secret #52: Breastfeeding is Hard Work.

I’m just coming off a weekend working in the newborn nursery, and these days there’s a lot of talk about breastfeeding. My hospital is in the process of becoming “Baby Friendly”, which means that the medical center is taking big steps to encourage the best way to feed that little one– with breast milk.

And it make good sense– the “delivery system” is built into us mamas; the nutrition is optimal (human milk for human babes, right?); and through antibodies in breast milk, babies get protection from certain diseases that they can’t build on their own just yet.

Now, don’t get me wrong– breastfeeding is awesome and I’ll be the first one to jump in and say that. But in all of our talk about the virtues of nursing, we often neglect to mention just how HARD it really is. It takes practice. And commitment. And it’s painful. Learning to breastfeed was harder than taking my medical boards. Really.

When I was pregnant with my little guy, I thought that breastfeeding would be a snap– moms have been doing this for centuries, right? Babies have built in reflexes to make them eat– what could possibly be hard about it? It would be like in the movies (if there were movies about nursing)– I would deliver my newborn (sans pain medication of course); within minutes he would immediately latch on; I would magically have gallons of colostrum. And all of this would happen with a warm glow of sunlight shining behind both of us– a halo, if you will. And my hair would not be messed up.

But what really went down was this: I was in active labor for 3 days (no kidding); I pushed for 5 hours (no kidding). I had to have a C-section and went on to have a postpartum hemorrhage with a uterine clot that had to be manually extracted (again, no kidding). So needless to say, there was no immediate latch, there was no magical let down, and there was no shining sunlight– I was in an operating room in Portland in the fall, for Pete’s sake. And most certainly, my hair was seriously messed up.

What I did have was an amazing nursery nurse who made it her priority to get that kid on the boob, in the recovery room no less, and even when I felt too tired and worn out to do anything. (I had the chance to watch her in action with a mom and baby this weekend, and she has mad skills!). My great husband kept us on track with the nursing schedule and kept ME on track with my own eating schedule. My lactation consultant’s constant support helped me realize we were doing a good job even when I felt like we weren’t. To me, this is what “Baby Friendly” means– in whatever way possible, supporting moms and babes through the feeding tough patches in order to ensure long term success.

A few tips to get things off to a good start:

— Breastfeed early and often. Having the baby latch on in the first hour after delivery, while he or she is still awake and active, is the first step to establishing nursing. Feeding often, up to 8-12 times a day, not only helps establish milk supply, but also helps mamas read hunger cues better.

— Lactation consultants are your best friends. They are there to help you make good decisions about feeding, and are often a part of a nursery care team. Definitely take advantage of their amazing knowledge and skills.

— Ask for help, and take it whenever and however you can get it. If having your father-in-law do a Target run buys you some time to rest between feedings, so be it. More support for the cause!

— Resist the urge to offer the bottle early on. Breast feeding is all about supply and demand– once the demand (the baby) is gone, the supply dwindles as well. Protect that supply!

— Pumping can help build and maintain supply. After the first couple of weeks, starting a pumping schedule can help establish a stash of milk and also increase demand by a little bit. Remember, when you first start out pumping, you may not get very much out– this doesn’t mean that your not making milk. Rather, your body has to make more supply to keep up with the new demand (pumping). So, more milk down the line.

— Be good to yourself. Eat well, laugh a lot, snuggle with that baby. And remember, no matter what happens, if you are trying to breast feed, you are doing a good job already.

— Lena

Not So Secret Secrets

Welcome to our “Not so Secret Secrets of Doctors!”

Lena and I are creating this blog to share some of the lessons we have learned in our combined 20 years of “doctoring.” We are passionate providers of pediatric care and want to share some of the latest research and hot topics in child health and well being with you.

Lena and I met a decade ago, while we were both working on the Navajo Reservation in northeastern Arizona. I had gone to rural America convinced that I would spend my career there. My journey through my five years on the reservation is a long story that will no doubt be an entry here at some point, but the short version is that I saw a child die almost every month in my five years on the reservation. Infectious disease, poverty, drug use, suicide and accidents occur in as high a rate there as in many underdeveloped countries. It was a very hard job.

When I made the move to Oregon in 2009, the United States was in the recession, and though I thought that I would change from being a federal employee to joining a private practice, I found that decisions necessary for the local pediatric groups to financially survive were just too hard. The private practice in town that had served much of the Medicaid community for the prior 30 years had to stop taking new Medicaid patients at a time when many families were losing their income and needing state supplied insurance. Refusing to see patients who needed care because of finances felt wrong to me, so I took a job as an employee with our local community health center. It has been an interesting transition. Small town politics, changing patient demographics, and lack of mental health resources have had a profound effect on practicing medicine in this town. National debates touch us too. Whooping cough outbreaks, meningococcal outbreaks, and teen suicide are issues in our community. Measles has come to Oregon via Disneyland, though not to either of our pediatric practices yet. We are well aware that Oregon has the highest childhood vaccination exemption rate in the country.

I hope you enjoy our perspectives and use our blog as a resource and sounding board.