Wednesday, February 29, 2012

Is This Normal Or Is Something Wrong?

There is a lot I wish I had known when I began breastfeeding. Some things are specific to my experience (c-sections effect on birth weight, etc) and some things I think are things all moms need to know. I write about this kind of thing a lot- but there is a reason for that- those first 6 weeks, almost every mom doubts her breastfeeding ability, her supply, her child's latch, or some other aspect of breastfeeding.

To know what is natural or "normal" I really suggest this site .

However, it is one thing to read the information, and another to be the mom doubting if what you are experiencing is normal. For that reason, it is always good to hear from other moms what was going on during the first few weeks and months. I decided to take a very un-scientific poll on this blog's facebook page. It was a very small sampling as I only had it up for a few days- but the percentages reflect what I have noticed on breastfeeding boards, forums, and other sites.

I asked moms who breastfed for at least 6-10 weeks what behaviors, etc that they experienced. I am going to start with a few "common myths"

I never became engorged so my milk didn't come in properly.
30% of moms who answered the poll never experienced engorgement. Several of these moms had an  oversupply or breastfed exclusively. It is just as common to not feel engorged as it is to feel engorged. For me, my milk came in gradually. THIS IS COMPLETELY NORMAL! I wouldn't have even known that my milk was coming in had it not been for the LC who pointed out that the milk was getting white. Please, do not feel that just because you never felt "full" or engorged that you have a low supply.

My baby spits up, is fussy, colicky so he must be allergic to my milk.
Baby's digestive system is very immature. It is just starting to handle food, and it takes time. This is why we don't just jump right into solids. It is common for baby to spit up, or be colicky. Fussiness is also common. 50% of moms who answered the poll had babies who spit up or had reflux issues. If you are concerned, talk with your pediatrician about ways to handle this. If your pediatrician suggests formula- switch doctors. Formula often makes this worth. Same with colic. 33% of moms said their child had colic. Many parents also confuse normal gas pains and fussiness with colic. Colic is inconsolable crying for 3-5 hours a day most days of the week. Not many babies actually have true colic (although I know a few of the moms who answered the poll definitely dealt with this). Most of the time it is normal fussiness and gas. The immature digestive system and the change from having constant nourishment through the umbilical cord, to having to nurse and then digest the food and then nurse again, is a big change for a baby. 40% of moms who answered the poll, experienced a fussy baby.

My baby is low on the charts and/or gaining weight slowly so I must have supply issues.
First, it is important to understand two things- 1) Every baby is different. We have to have babies at the low end of the charts, and some at the high end of the charts. With Lil Man I had to learn this as I watched him not even make the charts because he was so small. Hearing other moms say "Mama's milk is great because my baby is in the 90th percentile" really hurt. THOSE CHARTS ARE NOT TEST SCORES- BEING IN THE 10th PERCENTILE DOESN'T MEAN YOUR CHILD IS FAILING. I can not even count how many times I have shared that last sentence on boards and threads where I see moms worrying about percentages. When do percentages matter? When your child is not proportionate and is in the 90th percentile for height, but 5th percentile for weight. Or when at 3 months your child is in the 90% and at 6 months is suddenly down to 20%. This is when you should be concerned. Not when you have a child who is in the 15% bracket for height and 10% bracket for weight. When something doesn't add up. 2) Some doctors still use the CDC chart- this chart is based on FORMULA FED BABIES. Formula fed babies tend to be heavier during certain ages and then lighter during others. Double check with your pediatrician what chart they are using. The CDC has directed doctors that they should be using the WHO growth charts until age 2 and then the CDC growth charts after that. The WHO growth charts are based on breastfeeding being the normal source of nutrition, and it also compares weight to height- which lets you know if there really is a problem.
Once you get past the charts- it is important to understand that breastmilk is more easily digested and broken down by baby. It converts into energy better, and the remainder- passes through the body and out into their diaper easier. Sure, some breastfed babies are nice and plump, but many are not. 50% of the moms who answered the poll said their babies had slow weight gain. But that doesn't mean their babies were not healthy.

My baby eats all the time. Either I am not making enough, or something else is wrong. 
We have all heard that "breastfed babies need to eat every 2-3 hours during the day and every 3-4 hours at night." In fact, that was almost taught as the golden rule in the breastfeeding class I took. Problem with that- It isn't true in the beginning. In the beginning those number reflect a bottle fed baby (more on that in a moment). A breastfed baby often needs to eat more often then that during the first month or two of life. Around 8 weeks, the feedings spread out a little more, but until then, it is not uncommon for mama to be feeding baby every hour on the hour, both day and night. (It isn't as bad as it seems, I promise, and the time is really short when you look back on it.) Some moms get concerned when they pump, and then baby takes 3-4 ounces and doesn't need to eat for another few hours. Well, bottle fed (both EBM and formula) babies will often finish a bottle- even if they are not hungry. Think about when you go out to dinner, and you order your meal, and they bring out a serving 2-3 times what you eat at home. Even though you may be content 1/3 of the way through- think about how often you continue eating, sometimes even ordering dessert. Especially if you see everyone else still eating- basically encouraging you to eat. That is what the bottle is like. Baby might be full at 1-2 ounces, but because there is still some there, and someone is encouraging them to continue drinking it, they eat more than they need, and there for are OVERLY FULL. Also, they may continue to eat because the sucking that is done is not just about nutrition but comfort (hence comfort nursing).  This may be why they continue to drink from the bottle, even after they are full. Finally, babies at a young age are only meant to take in 1-2 ounces every 2 hours. If you are truly concerned- seek the help of a IBCLC (certified lactation consultant).
97% of moms who answered the poll experienced frequent nursing. Frequent nursing is probably the most common newborn breastfeeding behavior, and is also probably the thing that makes moms question their supply and their breastfeeding relationship more than anything else.

Other common things that moms who answered this poll encountered-
36% of moms experienced a baby who frequently broke latch. This is often caused by over active letdown or an over supply. You can read more about how to handle that HERE.
88% of moms experienced a sleepy nurser. A lot of babies fall asleep at the breast. To help with this- try to keep from swaddling baby for the first 10 days after birth, never swaddle while breastfeeding. Strip baby down to the diaper, tickle baby's feet, and other things of this nature to help keep baby awake. What helped Lil Man was changing his diaper BEFORE feeding him.
Approximately 45% of moms experience frequesnt waking. So many moms are ready for their little ones to sleep through the night (the medical definition of sleeping through the night is NOT a 8-12 hour stretch but a 5 hour stretch- parents often want their definition of 8-12 hours). First, remember that this time is short. Second, most children need to wake and eat at least 1-2 times a night, even until close to 18 months of age, some longer. Also, it is important to realize that breastmilk is again, easily digested and baby needs to eat more. This is actually HEALTHIER for baby then having formula stick in their digestive system making them feel full and giving them less nutrients. Lastly, there are so many benefits to baby waking to eat at night. They are less likely to experience SIDS if they are still waking at night. (I am still trying to find the link for this. I had it the other day but this post got deleted and I have to find it again.) When a baby sleeps through the night, they fall into a deeper sleep and are less likely to wake if their breathing is obstructed. Frequent waking, as well as being breastfed instead of formula fed, has been shown to lower the risk of SIDS.

So often, we think that those who succeed at breastfeeding must have had a easy journey. This very unscientific poll shows that is more common for moms to have obstacles than not.

So, now that we understand these "issues" are common or normal, how do we overcome them. Patience as far as night nursing, frequent nursing, and so forth. Having a great support system- a partner that supports breastfeeding, LLL or Nursing Moms group that you can attend to 1) get out and 2) ask advice, a IBCLC lined up to help determine if there are true supply or latch issues, and family and friends that are willing to help take care of other responsibilities or children during the first few months when you spend most your time nursing.

I feel so bad when I hear a mom has given up breastfeeding because she thought something was wrong because she encountered one of these behaviors. I hope every mom will realize they are not alone, seek out support, and do their best to get through this obstacle. I think the best advice I was ever given was "Don't quit on your worst day."

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