By Barb Carder, RN, International Board Certified Lactation Consultant – Cornerstone Lactation Services

Many new mothers have a strong desire to breastfeed their babies. Desire does not always translate into success and moms need help particularly after they leave the hospital and are on their own. As a lactation consultant, I have talked to countless mothers who have been told that babies do this naturally and that it’s an “instinctive” process. Babies have reflexes which help them at birth but have certainly never actually nursed before. Some babies come out of womb and nurse right after birth, for many others it’s a learned process. As they are learning, it can be an anxious time for a new mother who wonders if they are getting enough to eat and whether their baby will ever figure it out. Lactation consultants play a critical role after mom and baby go home – helping to continue the learning process, making sure baby is doing his job and that new moms are educated and reassured.

I wanted to share a story of actual lactation issues and how they were resolved. In the interest of confidentiality, no real names are used.

New mother Susan and baby Ava came to me on Day 4 of baby’s life. This is Susan’s first baby so she has lots of questions and concerns. Susan’s mature milk is coming in strongly and her breasts are very full. She does not understand how Ava did fairly well in the hospital and now struggles to latch and often cries. Susan cries as she tells me this and feels that as a mother, she must be doing something wrong. How many times I have heard this story! We cannot blame our sweet innocent little baby, so we blame ourselves. Well-meaning friends and family sometimes add to our woes by suggesting that mom just give baby a bottle and forget about the whole breastfeeding “thing”. This is not helpful when Susan has been planning and looking forward to nursing since she found out she was pregnant. What has happened here is simple to explain. During pregnancy as many changes took place, Susan’s nipples changed. As the breasts grew larger and became full of colostrum, her nipples flattened out. Nurses in the hospital put breast shells on Susan (to evert (push out) the nipples) and this helped Ava to latch. However, when Susan went home, even though her husband tried to help, our new mother and new baby were experiencing lots of changes. When Susan called for my help, I immediately asked her to pump her breasts to soften them and then try to latch Ava.

When I saw them in my office the next day, Susan had been pumping and bottle feeding her milk to baby Ava because she could not get her to latch on. Everyone was frustrated. Susan still felt that it was all her fault, Ava was crying and Dad just wanted his “girls” to be ok. We pumped to soften Susan’s breasts and used some fresh pumped milk to entice Ava back to the breast. While this is happening, I am explaining the process of mature milk coming in strongly between day 3 and day 5 of baby’s life. Also, as Ava tries to latch, Susan’s milk starts to “let down” and Ava is having trouble with the volume that is suddenly rushing into her mouth. After we soften breasts with the pump and evert the nipples, Ava is able to latch with help. Showing Dad how to help Susan gave him a job and made everybody happy. As baby Ava stayed at the breast and gulped, Susan and Dad exchanged relieved smiles. On the second breast, things did not go as smoothly. Ava struggled again, and we had to give her a little pumped milk so that she would calm down and not cry. One of the hardest things as a new parent to deal with is learning that babies cry. Feelings of inadequacy and helplessness need to be handled at this point with compassion, education and lots of support.

Susan, Dad and baby Ava went home feeling a lot better and when I called the next day, they were still doing well, but still struggling a little with one breast. It took Ava a little longer but eventually she learned to like them both. We scheduled a weight check for the next week and Ava was back to her birth weight. It was a happy beginning.

It’s not always a quick fix. The most important thing I can say to new mothers to be is know your resources. Find a lactation consultant in your community who is independent or works for her delivering hospital and arrange a visit when baby comes home. The next most important thing is for mom and dad to take a breastfeeding class before delivery so that they have a pretty good idea, at least in theory, what it’s all about.

*Sponsored by Cornerstone Lactation Services