Ina May's Guide to Breastfeeding

9
The First Three Months

Growth Spurt

During the first three months of your baby’s life, it is quite normal for her to go through periods when she suddenly wants to nurse more often. At these times your breasts may feel emptier than usual after a feeding, and your baby may seem less satisfied after she finishes a nursing session. When she nurses at this increased rate for a period of three days or so, your milk supply will increase to match her need. It’s not unusual for this to happen when she is at the following ages: two or three weeks, six to eight weeks, and three months. She is going through a growth spurt, and her behavior is her way of putting in the order for stepped-up milk production.

Slow Weight Gain

Make sure that you weigh your baby the same way every time—either naked or with a single dry diaper. Be aware that all scales are not calibrated to one another, so slight discrepancies are to be expected. If her weight gain is less than about six ounces per week during the first three or four months of life, or you aren’t getting enough wet and poopy diapers per day, it’s important to increase the amount of nourishment she is getting.

Why Isn’t Your Baby Gaining Enough?

If your baby isn’t gaining enough weight, and there isn’t a problem with your milk supply or her latch, then her slow weight gain might have something to do with how you feel about nursing and whether or not you are comfortable with it. I have known women whose letdown reflex during the first several weeks functioned only when they were in a room alone with their babies, because they needed that degree of privacy. And I have known others who weren’t able to let down their milk because they were confusing the pleasant feelings associated with nursing with sexual feelings. I first learned of this problem from a friend, whose first baby was gaining quite slowly, despite the supplemental feedings she was giving him in addition to nursing. As we discussed her feelings, she told me that nursing actually felt very good but that it seemed a little weird for her to be feeling that good with her infant son. My response was that nursing is supposed to feel good and that the pleasant feelings are what trigger the letdown reflex (and thus the release of the fat-rich hindmilk). Once she realized that what she was experiencing was normal, she relaxed and allowed the good feelings to flow. Her son began to get her hindmilk, and he started gaining well without further supplementation.

A similar case involved another friend who had nursed her first child, a daughter, for more than a year without a problem. Her next baby, a son, was born plump and healthy. When I noticed that his weight gain during the first month of life was poor, my friend asked me if I could pinpoint the cause. Her pediatrician had seen him and ordered lab tests, which came back normal. The doctor’s recommendation was to begin supplementing with formula. As she sat with her baby on her lap with her shirt open, I saw right away that her milk supply wasn’t the problem—milk was dripping from both breasts as we spoke. She told me that he sometimes seemed like he wanted to sleep more than he wanted to eat. Watching them together, I noticed that she treated him differently from the way she treated her daughter. With a concerned expression on her face, she held him a foot or so away from her body, looked at him intently, and asked him why he didn’t want to nurse. Mind you, he was less than a month old. At that point, I suggested that she try smooching and cuddling him so I could see how he would react to some tender attention from her. When she kissed him on the cheek a couple of times, I saw an instant change in this skinny baby. He began to bloom, his eyes opened wider, and he began to relax his lower lip (which had been drawn in so far that it was barely visible). He responded so obviously to her treating him like her adorable baby boy that she couldn’t miss her powerful effect on him. He rewarded her by gaining ten ounces that first week, and from that point on, he thrived.

Pacifiers can also be the culprit for a slow weight gain. Do you ever give your baby a pacifier? If so, put it away. Any sucking that she does should be on your breast. If not, the pacifier is getting the stimulation that should be telling your breasts to make more milk. Don’t forget that night feedings are important for delivering the most milk during a nursing session to your baby.

Some babies with slow weight gain have trouble relaxing enough to take in the amount of milk that satiates them. They take a couple of swallows, then jerk away, sputter, get angry, and start to cry. If this happens with your baby, you may find it hard to get her to settle down long enough to get both the lower-fat and the high-fat milk from the breast. In these cases, after your initial letdown has taken place and your baby’s nursing has slowed down, it sometimes helps to compress your breast to increase the flow again. Do this as long as it stimulates your baby to drink a little more from that breast. This may increase her intake on that feeding enough to get her really satisfied before she lets go and dives into deep sleep. Do finish off one breast before you move to the other.

Health Conditions or Illnesses That May Affect Milk Supply

Of course, it is also possible that your baby is not gaining properly because your milk supply is low, which may be caused by an illness or a physical condition. Is it possible that you are anemic? Anemia has been reported to contribute to low milk supply. If you lost a lot of blood during birth or if your hematocrit or hemoglobin was low before you gave birth, it may help you to eat more iron-rich foods, such as dark-green leafy vegetables, blackstrap molasses, unsulfured dried fruits, sunflower and pumpkin seeds, beets, red beans, and eggs. Seaweeds, especially kelp (also known as kombu) and dulse, are rich in iron and can be sprinkled in soups or on other foods. One to two tablespoons of seaweed flakes or powder can be taken per day. Egg yolks are also rich in iron.

Two diseases that can affect your ability to produce milk if they go untreated are underactive thyroid condition (hypothyroidism) and diabetes. Both diseases are diagnosed by blood test and are treatable. There are also several diseases or conditions that may be treated with medications that can decrease milk supply. These include depression, allergies, hypertension, migraine headaches, insomnia, and asthma. See Appendix A for information on the safety of various medications while breastfeeding.

If you have had postpartum bleeding that has persisted past six weeks, it is possible that a bit of placenta remains inside your uterus. This condition can decrease your milk supply in the early weeks. Check with your family physician or obstetrician if you think that you may have this condition.

Raynaud’s Phenomenon and Nipple Pain

One rather obscure cause of nipple pain that might make nursing difficult during the first months of a baby’s life is Raynaud’s phenomenon. Though it is well known among physicians as a symptom of rheumatic diseases such as lupus, scleroderma, and rheumatoid arthritis (particularly when it affects the fingers), Raynaud’s can occur in people who have no illness. It is generally triggered when there is a sudden drop in temperature or an emotional upset. The major symptom is that a couple of fingers turn white or blue and they hurt. When put into warm water, the usual skin color returns and the pain subsides.

Not many physicians are aware that Raynaud’s phenomenon sometimes happens in the nipples of breastfeeding women. It doesn’t usually occur while the baby is nursing but rather just after the baby lets go, when the nipple is exposed to the air temperature (which is cooler than the baby’s mouth). A spasm in the blood vessels causes burning pain, and the nipple will become white or sometimes blue. When the spasm is past, the nipple will return to its normal color, and the pain may lessen or turn to throbbing rather than burning.

Raynaud’s phenomenon is often associated with other causes of nipple pain, such as trauma from a poor latch or a thrush infection. When this happens, the treatment for the primary cause of the nipple pain will often solve the Raynaud’s problem within a couple of weeks as well. Sometimes the application of heat alone will solve the problem, but other times it becomes necessary to try medication.

One medication you may want to try to eliminate pain from persistent Raynaud’s phenomenon is nifedipine, a prescription drug that was formulated to dilate blood vessels in people with hypertension. The dosage in the case of Raynaud’s phenomenon is one thirty-milligram tablet of the long-acting version of the drug. Take it for two weeks and then try to do without it. Very rarely, there is a case of Raynaud’s that requires three or four two-week courses of nifedipine to achieve pain-free nursing.

Mona’s story shows what a dramatic difference nifedipine can make to the lives of mothers with severe Raynaud’s phenomenon that won’t respond to home remedies.

 Mona: Breastfeeding Ethan began to be challenging once we came home from the hospital. I had pain during feeding, but a few minutes after I was done feeding him, I would have this deep pain that, quite frankly, was awful. When I looked at my breasts at this point, the tips of the nipples were completely blanched. They were pale, almost white. This situation persisted for about a month, during which I obtained two different lactation consultations. Both checked his latch and our technique and confirmed that that was NOT the problem. They independently suggested that I may have Raynaud’s phenomenon of the nipple. I could also elicit the pain if I went outside in the cool weather. I basically couldn’t leave the house if there was the slightest breeze.

I found brief periods of relief by taking hot showers and also by making socks filled with rice and heating them in the microwave. I would then put these in my nursing bra after nursing or to go outside.

A major breakthrough came when I heard about nifedipine, a vasodilator. I then made an appointment with my obstetrician and basically begged him to prescribe this for me. He was skeptical, but after researching the safety of the drug, he agreed that it would be safe to take it while I continued breastfeeding. He gave me enough for six weeks. I took one thirty-milligram tab each day for two weeks. My copy of Kathleen Huggins’s The Nursing Mother’s Companion said only for the worst cases do you need to repeat this dose. After four to five days, I began to get relief. I was a completely different person and began to enjoy life again. Breastfeeding became a pleasure, instead of a painful experience. In my case, I stopped taking the medications after two weeks and the symptoms started to return. I immediately returned to the meds and took them for the full six weeks. I have had absolutely no pain since. Interestingly, when I went back to see my obstetrician for an annual exam, he told me that he has since had a few patients with my symptoms and has prescribed the nifedipine with success. He calls me his test case. My realization was that there is a disconnect between the lactation consultants who see nursing moms and the physicians. The lactation consultants had seen Raynaud’s phenomenon many times in their careers, but the physicians had not. I am assuming this is because by the time the women who had experienced it made it to their six-week checkup with their obstetrician, they had given up breastfeeding because it was so uncomfortable.

Before I was pregnant I used to jog a lot, and I would have some discomfort with my nipples if I stayed in a wet sports bra and it was cooler outside. I don’t know if this is related.

Herbal Supplements to Increase Milk Supply

Several herbs are considered to be beneficial to supporting a good milk supply. These include alfalfa, raspberry leaf, borage, fennel, fenugreek, and blessed thistle. You may already have fenugreek on your spice shelf if you like to make Indian curries, as it is one of the principal ingredients used in this kind of cooking. You can take any of the herbs listed above in capsule form. I’ve heard the most positive feedback about the effects of fenugreek and blessed thistle used at the following dosage: three capsules of each herb taken three times a day. Another favorite of mine is six to eight alfalfa tablets per day.

One cautionary note about fenugreek is that this herb is a blood thinner. If your postbirth bleeding continues beyond five weeks and you are using fenugreek to increase your milk supply, it would be wise to stop using it until you stop bleeding.

Drugs That May Increase Milk Supply

Though there are quite a few prescription drugs that can be used to increase milk supply, several of them have serious side effects. Review the list below with caution.

·   Several drugs that were originally intended for the treatment of schizophrenia can increase the release of prolactin by lowering dopamine levels in lactating women, thus increasing milk supply. The problem with these drugs, though, is that most—if not all of those available in the United States—have nasty side effects, such as tremors, uncontrollable twitching, and fatigue.

·   Dr. Jack Newman recommends domperidone (Motilium) for increasing milk supply. Originally developed to treat gastrointestinal disorders, it is dispensed only with a physician’s prescription. The Food and Drug Administration (FDA) warns against its use because of possible cardiac side effects (seen in sick mothers who were receiving the drug via intravenous lines). Be aware that this drug has not been tested in babies.

·   Another medication used to increase milk production is Reglan (metoclopramide). It’s said to be quite effective if used for a week or two, three times a day, in ten-milligram doses and then tapered off one dose per week. However, women with a history of depression shouldn’t take it, as side effects such as weakness, fatigue, or depression can occur.

Using a Supplemental Nursing System (SNS)

Sometimes babies do need supplemental feedings. One way to deliver these without using a bottle (which can cause nipple confusion and interfere with your baby’s sucking technique) is by using a supplemental nursing system (SNS) sometimes called a lactation aid. This is a small container—either a bottle or a plastic bag—that has a thin plastic tube leading from it to your breast. The tube should extend about a quarter inch past your nipple. The container is filled with expressed milk (or formula) so that when your baby suckles at your breast, she draws the milk through the tube at the same time that she stimulates your nipple, thereby encouraging more milk production. Some commercial models feature a container that can hang around your neck by a cord. Others have a clip that allows you to fasten the device to your clothing.

You can also fashion your own SNS by inserting thin tubing into a bottle, which you can set down next to you. You may have to experiment a little to find the right gauge of tubing to deliver a flow of milk that is neither too fast nor too slow for your baby. The tube must reach the bottom of the bottle without being bent.

Babies’ Sometimes Inconvenient Preferences

Babies are like anyone else: If the milk flows more easily from one breast than the other, they may develop a preference for that breast. I have known a few babies who just refused to feed from one of their mothers’ breasts. You will be comforted to know, though, that their mothers were able to nourish them quite well from the preferred breast. While you may feel somewhat lopsided, there is no real harm associated with one-breast feeding. Some women whose babies show this tendency learn to offer the least favorite breast first and then finish off with the “favorite” breast.

Some babies so prefer the breast to a bottle that they will refuse to take a bottle, even when it contains mother’s milk. This can be a problem for you if you are a working mother. There’s a nice little flexible plastic cup that works well for babies like these. It’s called a Foley cup, named after its inventor (see Resources). Even very young babies can drink from this small, flexible cup, which can conform to the shape of your baby’s lower lip. When introducing your baby to the cup, hold her propped in your lap at about a forty-five-degree angle. When she’s calm and ready for a drink, give her a small amount of expressed milk and then wait for her to swallow before giving more.

Too Much Milk

If you are producing too much milk, and none of the tactics discussed on page 113 helped adjust your milk production, you might try to manually express some milk shortly before you anticipate your baby waking up. The removal of some of this foremilk can make it less likely that your baby has to cope with what must seem like trying to drink from Niagara Falls. It will also make it easier for her to get your hindmilk. Could you consider catching some of your overflow and making it available to a local milk bank? You will make someone else very happy by doing this.

“Colic,” or Incessant Crying

All babies cry, but some cry a lot more than others. Babies who cry a lot during the early months of their lives are often called “colicky” or “high-needs” babies. They may spend many of their waking hours crying inconsolably, amazing you at their endurance and how directly their misery can impact your own inner peace. Young babies, especially those under the age of three months, cry for lots of reasons that may at first seem mysterious to you. They may cry from hunger, thirst, fright, because they want to be held, because they need to burp or fart, because they are uncomfortable, or because they don’t like being wet or poopy. Sometimes they cry because they haven’t figured out how to stop.

It’s good to remember that “colic” is neither a disease nor a medical term. It’s a grab-bag term that people apply to a baby who cries a lot. There are many things you can try to help your baby through a crying jag. As you go along, you’ll get more proficient at understanding what’s bothering her and what you can do about it.

Whatever action you take to calm your baby, you first need to calm yourself. If your baby’s cries make you tense and nervous, you can relieve your own tension by slowing down your movements and deepening your breathing. Babies imitate their parents over the long haul, so be the kind of model you want your baby to copy. If you were a cat or dog, you would probably be licking her. I’m not saying that you have to do this yourself (although you may), but that’s the kind of mood you should be in to calm your baby. Once you are calm, you will be ready to settle her down in whatever way feels most natural to you. For example, you might want to shush her, rock her, or gently pat her.

Crying sessions are often most intense between about four in the afternoon and seven or eight o’clock in the evening. If this is the time of day when you yourself feel the most tension, you can probably understand why your baby does too.

Don’t be surprised if you get a lot of contradictory advice about how to calm your crying baby. Please don’t listen to anyone who attempts to put you or your baby on a schedule. Clocks have nothing to do with this bond between breasts and babies. Time-honored ways of calming fussy babies include feeding, holding, rocking, swaddling, walking (outside when possible), singing, or making other soothing sounds. Do what you can to replicate the atmosphere of your womb—the rhythmic movement, the swooshing sounds, and the feeling of being held tightly.

Sometimes frequent crying in the first weeks of life is a matter of your baby’s temperament. Extra-sensitive babies are more apt to show this behavior than babies of a more placid temperament. If you are the parent of a young baby who cries a lot, it’s important for you to know that lots of very well-cared-for babies do this, especially during their first three months of life, and still turn out to be emotionally secure, good-natured people. If you are a first-time parent dealing with this, these months may seem like an eternity, but trust me, it will pass. By the time your baby approaches the age of three months, she will generally have gotten much better at calming herself. If not, you might want to have a look at Elizabeth Pantley’s The No-Cry Sleep Solution: Gentle Ways to Help Your Baby Sleep Through the Night.

It could be that your young baby is crying so much because she is not getting enough loving touch from you. Like all newborn mammals, whatever their species, human babies tend to cry out when they are not in physical contact with their mothers or when they can’t hear her voice or feel her presence nearby.

Sometimes the crying is closely related to feeding. If your baby is excited, almost frantic before a feeding, she may be breathing too fast to swallow without gulping down a lot of air with the milk when she is held to your breast. This will make her double up as if with stomach cramps and begin to scream. Sometimes it is possible to improve this pattern if you begin the feeding before she is completely awake and excited. Once she is already worked up, an upright position will help her burp, and some rocking and gentle swinging may calm her. Some babies nurse more efficiently in an upright position; in general, they swallow less air this way than when they drink while lying in your arms.

Wearing Your Baby

One of the first and most important technological innovations humans made tens of thousands of years ago were the cloth or leather baby slings that enabled mothers to have both of their hands free as they foraged for food. These slings are just as relevant today, as you’ll likely find out if your little one requires your physical presence to stay calm while awake. Wearing your baby in a sling or baby carrier as you go about your day may greatly reduce the amount of time that your baby cries.

There are all kinds of slings available these days, and most allow several different ways for babies to be carried in them. Your baby may face you or face away from you in the sling. She may be snuggled into an upright position or a more horizontal position.

There are some safety tips related to baby-wearing that you should be aware of.

·   Avoid standing at the stove or drinking hot drinks while you are wearing your baby. Eating, however, is all right.

·   It’s not a good idea to wear the baby sling in a car, as it is not meant to be a substitute for an approved car seat.

·   If you drop something while wearing your baby, squat to pick it up instead of bending at your waist. Retrieve the dropped item with one hand as you steady your baby with your other. Bending at the waist is likely to cause strained back muscles, which can be painful for a long time.

You, During the First Three Months
Lack of Sleep

Waking up every two hours during the night can have a powerful effect on your consciousness. The struggle to wake up several times in one night when you have already been sleep-deprived for weeks can show you sides of your personality that you may not recognize. It may even cause you to do things during the night that you don’t remember having done.

Here’s a story about the mind-numbing fatigue of early parenthood, as told to me by my friend and fellow midwife Carol Leonard. As the single mother of a newborn son, Carol found herself more tired than she had ever remembered being. As her son’s piercing cry rang out for the fifth time one night, her head throbbed with pain. Even though it was still pitch-black, she felt it would hurt her head less to feed her son with the lights off in her room. Opening her pajama shirt, she lifted her squalling son into her arms and held him to her breast. Instead of latching and settling down to eat, he writhed and thrashed in her arms and screamed even louder. Overwhelmed now, she burst into tears of frustration and self-pity as he wailed at maximum volume. Still unable to figure out what was wrong, she fumbled around in the dark and switched on the lamp on the bedside table. Now her problem was fully evident: She had taken hold of him upside down and was now trying to nurse his bottom! The absurdity of this situation, as well as the obvious solution, reactivated her sense of humor.

It’s one thing to read a story such as this and another thing to experience the exhaustion that often goes with being a new parent. It’s especially hard when you are the grown-up-in-charge more than ninety percent of the time. When you reach this level of sleep loss and fatigue, don’t discount how helpful even a ten-minute nap can be. The same goes for how much of a boost you can feel when someone else holds your baby for ten or fifteen minutes. Avoid caffeine (which may make you more alert only in the short term), because your caffeinated milk may compound the lack-of-sleep problem by interfering with your baby’s sleep patterns.

However tired you may feel from lack of sleep, you can always improve your physical and mental condition by relaxing. Take several deep breaths, making sure to exhale very slowly. Lower your shoulders and straighten your spine if you are in a twisted or slumped position.

When your baby has woken you up, avoid giving in to the impulse to hurry through a feeding so you can get back to sleep. If you move more slowly and deliberately, rather than rushing your baby, you will be less likely to make a mistake that will cost you your next nap.

Smile sometimes, even if you don’t feel like it. It’s times like these when you most need to smile. Maybe you will notice, as I have, that smiling when you feel rotten can lift your spirits. A smile has the power to instantly change your hormone balance within, which makes it worth doing. Hint: Even a sardonic smile can help. It’s a step toward reactivating your precious sense of humor. Try to find a way to laugh at least once a day too—the more the better.

You may like singing to your baby. Music has the power to lift the spirits—both yours and hers. And it may also work for lulling you both to sleep. You should kiss her often and tell her how glad you are that she was born. She will get the message from your loving voice, and that should make both of you feel better.

Postpartum Depression

In her insightful Of Woman Born (1976), Adrienne Rich said it very eloquently: “My children cause me the most exquisite suffering of which I have any experience. It is the suffering of ambivalence: the murderous alternation between bitter resentment and raw-edged nerves, and blissful gratification and tenderness.”

When a woman has postpartum depression, her experience dips more and more into the area of “bitter resentment and raw-edged nerves,” and the moments of bliss and tenderness come fewer and farther between. Part of our problem is that doctors in the United States are taught not only that postpartum depression is prevalent—that between one and three million U.S. women will experience it every year—but that there is no way to prevent it. My own experience makes me disagree with this, because during my early years as a midwife, my partners and I used to comment on how rarely we saw postpartum depression among the first several hundred births in our community. When we did encounter a case, we could easily understand why the woman had postpartum depression, as she was invariably under some kind of extraordinary stress.

Here is a list of the many risk factors that are associated with postpartum depression:

·   Sleep deprivation

·   Poor nutrition

·   Traumatic birth experience

·   Fatigue

·   Domestic problems

·   Pain

·   Prior history of depression

·   Short (unpaid) maternity leave

·   Stress over insufficient income

·   High-needs baby, including preemies

·   Sick baby

·   Previously stressful life experiences

·   Personality type that seeks to control

·   Sore nipples and other breastfeeding problems

·   Social isolation

·   Unwanted pregnancy

The comparatively low incidence of postpartum depression in my community can be explained, I believe, by the good nutrition that all of the new women received, the rarity of traumatic birth experiences, the active intervention in cases of domestic problems, our system of flexible maternity leave, our tolerance for babies in many workplaces, and the absence of social isolation.

On the individual level, good planning during pregnancy can reduce your chances of falling into postpartum depression. If you and your partner are having domestic problems, for instance, it is important for you to seek help from a family therapist before the baby is born. You don’t want the added stress of fighting with your partner when you are caring for a new baby at home, so it’s better to get your problems resolved (one way or another) before your baby comes.

Social isolation is a major factor in many cases of postpartum depression. If you have no family members or friends living nearby, it’s important to try to make some contacts while you are still pregnant. One way might be to attend a La Leche League meeting in your area. Befriending women from this or another breastfeeding group is a good idea, as they will be going through similar experiences and will be able to commiserate with you and help you with any problems you may have.

The nature of postpartum depression makes you retreat into yourself, feel that you are alone, and that there probably is no help for you. One of the most important things you can do if you think that you are sliding into depression is to ask for help. Here is a list of typical symptoms:

·   Sad or anxious feelings

·   Insomnia

·   Headaches day after day

·   Mood swings

·   Poor appetite

·   Ankle swelling

·   Panic attacks

It is important to take active steps to address postpartum depression when you have these symptoms. Sleep and nutritious food are both restorative and can occasionally alleviate symptoms enough that no treatment is necessary. The help of a postpartum doula or a trusted family member or friend can also prevent the normal fatigue of new parenthood from progressing to postpartum depression.

You might also want to try making the following tea, which herbalist Susun Weed recommends in her Wise Woman Herbal for the Child-bearing Year:

½ oz. chopped licorice root, 1 oz. raspberry leaf, 1 oz. chopped rosemary leaves, 1 oz. skullcap. Use 1 teaspoon of the chopped mixture to 1 cup of boiling water and drink 2 to 3 cups per day.

Make a cup for yourself, or get someone to make one for you. Used in tandem with the other restorative measures discussed above, this tea will help soothe your frayed nerves.

Postpartum Psychosis

It is important to know that postpartum depression, if unaddressed, can worsen. Severe symptoms include:

·   Violent fantasies

·   Fear of hurting the baby

·   Thoughts of suicide

·   Hallucinations

Postpartum psychosis is much less common than postpartum depression, affecting about one to two women in every thousand. Like postpartum depression, it can occur as early as two or three weeks after birth, but I have seen it happen as late as seven or eight months following birth.

Fathers’ Feelings

Fathers’ feelings about breastfeeding matter a great deal. When a couple lives together, the woman will usually care very deeply about having the approval of her baby’s father regarding breastfeeding. In fact, statistics have shown that if most men in a given sector of society decide that their wives shouldn’t breastfeed, there won’t be very much breastfeeding among the women of that social group. The opposite is also true—a father who is positive about breastfeeding can help his partner make breastfeeding work out well. For example, if a woman is extremely frustrated and is about to give up on breastfeeding because of some challenge—that may at the moment seem unsolvable to her but that could in fact quickly change—she may find that the true scope of the problem is put into perspective by an understanding spouse who values breastfeeding enough to help make it work. And if a woman doesn’t have enough female relatives to give her the kind of support, ancestral wisdom, and practical knowledge that was traditionally shared among women when breastfeeding was the rule rather than the exception, a supportive partner can help compensate for that lack.

Helpful dads look for chances to change the baby’s diapers and clothes, bathe or burp her, take her for a walk, sing to her, or comfort her. One of the major ways dads can help their partners with breastfeeding is by educating critical friends or relatives about the nutritional virtues of breastfeeding. Another important—and too often overlooked—way that a man can show support for his partner is to frequently let her know that her attractiveness is enhanced, not spoiled, by breastfeeding. Many women in our culture are uncertain about whether their changing bodies will continue to be attractive to their partners, so this type of reassurance will help give her the patience and persistence to get through the months ahead. I have met many wonderful men who are quite empathetic with their nursing wives or partners, and these guys are very creative in the ways they find to help their partners.

Both you and your partner will have to make many adjustments in the ways you relate to each other as you become used to being parents. Since your baby is the most helpless person in your family, she will become priority number one for you. And, since you will be having no lack of physical contact with her, you may find your libido dormant for the first few weeks of motherhood, as do many women whose libido was active throughout pregnancy. Your partner may not have anticipated feeling left out or rejected because of these changes. One of the most important things you and your partner can do during this stressful period is to make time together whenever you can, even though sexual contact is probably going to happen less frequently than before your baby came. Appreciate what he does to help you, and tell him how much it means to you that he doesn’t complain when your share of the housework is left undone.

Your Sex Life

Several factors are likely to affect your sex life during the first few months following birth. These include the personality and needs of your baby, your birth experience, your own physical and emotional condition, your partner’s work schedule, the number of older children you have, whether you have to return to a job, and your partner’s needs. Add to these the sheer amount of attention that a new baby requires and the missed sleep and exhaustion that generally stem from this.

I recommend waiting until you have no more bleeding or discharge before you resume lovemaking that involves penetration. In most women, this process takes about three weeks. Waiting three or four weeks until the uterus is well closed protects you from infection during the postpartum period. Childbirth tradition from many cultures worldwide is that couples wait forty-two days before the resumption of lovemaking. Since we no longer have culturally agreed-upon norms, I think you are the one who should signal when you are ready to resume lovemaking—and you shouldn’t feel pressured into it. If penetration hurts, you should wait, or choose some other form of loving your partner.

When you feel that you are ready, your lower postpartum estrogen levels may mean that you have a vaginal dryness you haven’t experienced before. Natural lubricants such as coconut oil or cocoa butter may be helpful in this case. Another physical difference you might encounter while lactating is that if you have an orgasm while making love, you may spray milk. Keep an extra towel handy.

Breastfeeding as Birth Control

If you offer your breast whenever your baby is interested, day and night, your prolactin levels should be so high that you will be infertile for about six months following birth. Do you want numbers? You’llhave less than a two percent chance of becoming pregnant as long as each of the following conditions is met:

·   Your period has not returned.

·   Your baby is drinking only your milk (with any supplemental feedings or drinks being given rarely if at all).

·   Your baby is less than six months old.

·   You feed your baby at least every four hours during the day and at least every six hours during the night.

As you can see, one of the advantages of night feedings is that they help suppress your return to fertility. Let’s say that you have an outside job that involves regular separation from your baby. In this case, you’ll need to express your milk at least as often as your baby would have nursed, with no more than a four-hour interval between pumping sessions.