Pregnancy All-in-One For Dummies

Book 5

Chapter 3

Common Concerns and Challenges

IN THIS CHAPTER

Healing engorgement and nipple problems

Determining whether you’re nursing enough

Dealing with mastitis and yeast infections

Soothing colic

Encouraging baby to nurse and checking baby’s weight

Rarely does a woman breastfeed without experiencing some problem along the way. Most problems, like sore nipples, are easily solved. But others can be complicated to manage. This chapter discusses some of the challenges that nursing moms encounter most often and tells you how to deal with them. It also looks at the problem of not producing enough milk — or producing too much! — and the difficulties of handling a baby who doesn’t nurse well, no matter what you do.

Dealing with Engorgement

When first-time moms-to-be ask, “How will I know that I’m really in labor?” women who’ve been there before almost always give the same answer: “Believe me, you’ll know.” The same can be said about breast engorgement.

If you haven’t delivered yet, your breasts probably seem humongous, and you may think they can’t possibly get any bigger. The day or two after delivery, your breasts will feel fuller. As your milk comes in, this fullness can quickly turn into engorgement.

The “before” of engorgement

Almost every new mom experiences some degree of engorgement. Engorgement begins from two to five days after you deliver and lasts 24 to 48 hours if you treat it by nursing your baby frequently. Engorgement signals that colostrum, your baby’s first food, is turning into a more mature milk.

Before your milk comes in, you produce about 1 to 2 ounces of colostrum a day. As your regular breast milk comes in, this increases to about 20 ounces a day. In addition, your breasts have an increased blood flow and enlarged milk ducts.

You may feel like you’re producing milk up to the top of your chest and into your armpits. Your breasts may be hot, hard, and shiny. This is all normal, and feeding your baby frequently resolves it.

The “during” of engorgement

Engorgement occurs whether you breastfeed or not; in fact, engorgement is usually worse in moms who don’t nurse. To help minimize engorgement,

· Begin breastfeeding as soon as you can, preferably in the delivery room.

· Breastfeed 8 to 12 times in a 24-hour period to prevent milk from accumulating in the breasts. Nurse at least 10 to 15 minutes on one breast (and as much as 30 minutes) before switching sides. The baby may need to nurse for longer time periods in the first few days because your milk volume is low.

· Initially, breastfeed from both breasts at each feeding; alternate the side you start with.

· Make sure your baby empties your breasts. If she doesn’t, use a breast pump to complete the job. Contrary to previous beliefs, experts now say that pumping after nursing if you’re engorged does not stimulate more milk production and may help keep your milk production from decreasing due to increased swelling in the ducts.

· Before you leave the hospital, have a lactation consultant or another nursing expert confirm that your baby is latching on correctly.

· Avoid supplemental feedings in the beginning. Your resulting engorgement may not be worth the night’s sleep that you get. If you miss a feeding, pump both breasts so they aren’t twice as full for the next feeding.

Treatments for aching breasts

Although the steps in the preceding section can minimize symptoms of engorgement, they probably won’t eliminate them. Following are suggestions to make you more comfortable when you’re engorged:

· Apply a hot towel to your breasts for five minutes or so, or take a warm shower. This softens the breast tissue and makes latch-on easier. A hot towel also helps get your milk flowing and catches dripping milk; the resulting increase in comfort will help with your let-down reflex.

· Give yourself a gentle breast massage or hand-express some milk in order to improve your milk flow. Try these techniques before you start nursing; sometimes a few drops of milk on your nipple remind the baby what she’s supposed to be doing. Continue the massage while you nurse your baby, massaging the breast the baby is nursing from. Massage the breast during the pause she takes between sucks.

remember Milk production is directly related to milk emptying. If you don’t take it out, Mother Nature won’t put it back.

· Wear a good supportive bra, but make sure it’s not too restrictive. A too-tight bra could decrease your milk flow and cause a blocked milk duct or mastitis (see Book 5, Chapter 1).

· Use deep-breathing techniques to relax and increase let-down. Maybe you thought you were done with breathing techniques after delivery, but they may work better for you here than they did in labor. Sometimes, when the baby first latches on, you’ll feel a pain akin to his twisting your nose off your face. This can last until your milk starts flowing.

· tip Cabbage leaves aren’t just for Mr. McGregor’s garden anymore! Place cold cabbage leaves on your breasts to reduce swelling in the breast tissue. You can put them directly on your breasts for 10 to 15 minutes before you nurse. Leaving them on longer may reduce your milk supply. Don’t use cabbage leaves if you’re allergic to cabbage or sulfa drugs or if you develop a rash.

· Take ibuprofen to relieve discomfort and decrease inflammation in the breast tissue. But don’t take it on an empty stomach.

· To reduce breast swelling, use cold compresses after you nurse. Keep them on for no more than 20 minutes. You can use an ice pack, but something as simple as a bag of frozen peas often works better because it molds to the shape of your breast.

warning Left untreated, engorgement can lead to mastitis, an inflammation or infection of the milk ducts or gland tissue that develops from incomplete emptying of the breast (see the later section “Developing Mastitis”).

Knowing If You’re Nursing Enough

If your baby eats every hour for an hour, you’ll probably suspect that she’s nursing too much. But what if the opposite is true, and you have to wake her up every five hours to eat? You may be tempted to pat yourself on the back for your baby’s wonderful sense of timing, even though you know in your heart she should be eating more. How much is too much — or too little — when it comes to breastfeeding in the first few weeks at home?

remember Unless your baby hasn’t regained her birth weight after two weeks, you don’t need to be preoccupied with how much she’s getting at each feeding. If she’s gaining well, she’s eating enough. If you’re still not sure, read on for suggestions on how to judge how much your baby’s eating.

FEEDING ON DEMAND

Are you always starving when you eat? Do you put food in your mouth only when you absolutely need to eat? If you’re like most of people, the answer is no. Sometimes, you eat because you need something else, like comfort, or you want to fill some need you can’t even explain.

In your first few weeks at home, let your baby set the schedule. If you feel like you’re meeting yourself coming and going at Mom’s Milk Bar, remind yourself that this, too, shall pass.

Imposing a nursing schedule on a newborn may result in some of her needs not being met. For one thing, breast milk is digested quickly — much more quickly than formula. So while it may seem as if your baby can’t possibly be hungry an hour or two after her last feeding, the truth is that she can be. Don’t you sometimes dig through the freezer for ice cream an hour after you finish dinner?

Also, an infant has few comfort resources when something seems not quite right in her world. You are her primary comfort resource! She may not be hungry when she starts rooting, looking for a nipple. She may just need a little comfort.

Another reason to avoid imposing a strict nursing schedule on your baby is that her nutritional needs aren’t always the same. When your baby goes through a growth spurt, she may need to nurse much more often than she normally does. Growth spurts usually occur when your baby is 2 to 3 weeks old, again when she is 6 weeks old, and around the age of 6 months. You may notice your baby wanting to nurse frequently for two or three days. The best way to handle growth spurts is to let the baby nurse as often as she needs; she’ll soon settle back into her established nursing pattern.

Tip: Don’t wait until your baby cries to feed her. Watch for early signs of hunger, such as turning her head as if looking for a nipple, putting her fist in her mouth, or making sucking motions.

Rest assured that as the baby gets older, she won’t always want to nurse when she’s unhappy. Maybe she’ll respond positively to a change of scenery, a little attention, a position change, or a diaper change. Chances are you’ll get her on a nursing schedule in a few months, but in the first few weeks, listen to her needs.

Weighing the baby

If you’re really, really concerned about your milk supply, you can weigh the baby before and after a feeding to see how much she took in. This requires a precise scale (not your bathroom scale, which varies up to 5 pounds, depending on whether you lean forward or backward when you stand on it). You need a scale that weighs in ounces as well as pounds, because your baby’s certainly not drinking a pound of milk at a time. You can buy a baby scale that weighs in ounces if you just have to know, but after a day or two, you’ll probably get bored with weighing.

tip Most pediatricians have a very accurate scale, and if you ask nicely, yours may let you come in to weigh the baby, then nurse the baby, and then weigh the baby again. Keep in mind that you can’t change the baby’s clothes or diaper between weighings; everything has to be exactly the same so that the only variable is the breast milk.

remember Any time you feel that the baby doesn’t seem satisfied or that she shows symptoms of dehydration (see the next section), take her to the pediatrician’s office for a weight check. This doesn’t mean you’re obsessive; it means you’re an observant parent.

Checking for dehydration

warning A dehydrated baby shows some obvious signs. A baby who is severely dehydrated

· Is lethargic: A dehydrated baby lies still and shows little interest in eating or anything else.

· Has skin that “tents” when you pinch it: Instead of springing back, dehydrated skin remains somewhat folded after you pinch it.

· Has a sunken fontanelle and sunken eyes: The fontanelle is the soft spot on the top of the baby’s head.

· Has a slightly dry mouth: The mouth and lips look parched.

· Has fewer wet diapers than normal: Most newborns urinate frequently, up to ten times a day. Today’s disposable diapers are so absorbent that you may not notice a decrease in wetness at first. If you’re concerned that the baby may be dehydrated, use a cloth diaper so you can be sure she’s urinating enough.

Counting dirty diapers

Newborns often pass stool every time they eat. (The good news is that breast-fed babies have slightly more fragrant diapers than bottle-fed babies!) The typical newborn breastfed baby has

· Between 3 and 12 stools a day

· Stools that are soft, seedy, or curdy

· Yellowish to brownish-greenish stools

As breast-fed babies get older, they tend to have less frequent but still soft stools. Stool patterns often change at around 6 weeks of age, when the baby may have one stool each day or may have a stool every three to four days. As babies get older, they become more efficient at using more of your milk, so they create less waste. Constipation is rarely a problem for the breast-fed baby.

Soothing Nipple Issues

Nipple problems can make or break breastfeeding. Many women experience soreness in the beginning; after all, your nipples have probably never gotten this much use! Look at possible causes as soon as any soreness develops so you can try to prevent cracking, bleeding, and scabbing.

Identifying sources of pain

tip If your nipple begins to get sore, especially at the start of a feeding, the most important thing you can do is make sure your baby is properly latched on and that you’re holding him correctly during nursing. If not, the result may be the baby pulling on your nipples and causing damage. Refer to Book 5, Chapter 2 for a detailed discussion of proper latch-on and to review breastfeeding positions.

The fungal infection thrush, discussed in the later section “Sharing Yeast Infections,” can also cause nipple pain. Discomfort from thrush occurs throughout the feeding, not just at the beginning, and is often described as a burning sensation. If you suddenly develop this type of discomfort when you had been nursing without pain, chances are you have a yeast infection.

Coping with soreness

Beyond making sure your baby is latching on correctly, you can try the following tips:

· Massage your breast before having the baby latch on to help soften the areola and encourage your let-down reflex. Pumping or hand-expressing a little milk prior to feeding softens the areola, which can help the baby latch on.

· Don’t just pull your baby off the breast when you’re done nursing. Use your finger to break the suction so he doesn’t cause nipple trauma.

tip If the baby wants to keep sucking after he’s had enough to eat, you can use your finger— rather than your breast — as a pacifier until the soreness decreases. (You’ll know the feeding is finished when you hear long pauses between short bursts of light sucks. If he still wants to suck, offer him your finger.)

· If you notice that your nipples are starting to get sore, try nursing more frequently but for a shorter duration (10 to 15 minutes instead of a half hour, for example).

· Dry your nipples after each feeding. Always pat your nipples to dry them; don’t rub. Air drying works best. If you can expose them to the sun without getting arrested, that’s even better!

· Avoid using soaps that can dry out the nipples and ultimately cause cracking or even eczema.

· After a feeding, rub some of your breast milk on each nipple and let it dry. Then apply a coat of a purified lanolin cream (assuming you don’t have an allergy to wool products).

· Feed your baby on the side that is less sore, at least until your milk lets down.

· If you use breast pads to absorb milk leaks (see Book 5, Chapter 2), make sure they don’t have plastic liners, and change them frequently so bacterial growth doesn’t occur.

If soreness progresses to nipple cracking or bleeding, add these measures to your arsenal:

· Continue to nurse, even if your nipples are bleeding; your baby won’t be harmed. If your nipples start to scab, soften the scabs by hand-expressing some milk, rubbing it on your nipple, and letting it dry before putting your bra or clothing on. Use a purified lanolin cream after nursing.

· Place ice on your nipples right before nursing, but keep it there only for very short periods so your nipples don’t become numb. (Numbness can interfere with let-down.)

· If ice doesn’t help you, try a warm compress (a hot wet washcloth) for a few minutes right before you nurse.

· If you’re in considerable pain, try hand-expressing or pumping for a day, and feed your baby the expressed milk.

· Use a breast shell (see Book 5, Chapter 2) to keep pressure off a sore nipple when you’re wearing clothing, but use it only for short time periods. Make sure that your bra isn’t rubbing against your nipples.

· After you nurse, rinse your nipples with a saline solution. Mix teaspoon table salt in 1 cup warm water. You can also buy packaged saline solutions at pharmacies. Spray the solution on the nipple area with a squirt bottle, and then pat it off.

· Contact a health professional or lactation consultant if you’re not seeing any improvement or if you develop a fever, which could mean a more serious infection. Ask about topical antibiotics, which can be thinly applied. A triple antibiotic like Polysporin (an over-the-counter medication) is better than Neosporin (an antibiotic ointment containing neomycin), which could cause a rash around your baby’s mouth. Some recommended topical antibiotics are available by prescription only. Always discuss antibiotic use with your doctor or lactation consultant first.

Developing Mastitis

You don’t have to be a nursing mom to develop mastitis, a breast inflammation, but nursing mothers are more prone to mastitis, because bacteria that cause the inflammation usually enter the breast through cracks or fissures in your nipples.

Mastitis occurs most often in the first month of breastfeeding, but it can occur at any time. Sometimes the first sign of mastitis is feeling like you’ve got the flu. You may run a fever (over 100.4° F), have chills, or feel achy or ill. Another obvious sign of mastitis is having red, hot, or swollen areas on your breast. Usually only one breast is affected — more often the left than the right.

tip A plugged duct — when milk becomes clogged in a duct — may feel like a tender lump in your breast, but it differs from mastitis because it’s not usually accompanied by a fever or flu-like symptoms. If not treated, a plugged duct can lead to mastitis.

Realizing risk factors

warning If you’re rundown and stressed, or if your immune system isn’t functioning properly, you’re more likely to develop mastitis. Other risk factors for mastitis are

· Incomplete emptying of the breast: Milk ducts can become blocked if the baby doesn’t remove enough milk from the breast, because the milk sitting in the ducts thickens. Blocked ducts increase the risk of mastitis.

· Missed feedings: If you supplement, make sure you pump enough to compensate for the missed feeding.

· Sustained pressure on your breast: This pressure can be from wearing a too-tight bra, carrying a heavy purse or diaper bag, using a baby carrier, sleeping on your stomach, or sleeping with the baby lying on top of you.

· Poor latch-on: If the baby isn’t properly positioned, he won’t empty the milk ducts thoroughly.

· History of breast surgery or trauma: Women with this type of history may be prone to developing blocked ducts and mastitis. Women with fibrocystic breasts (breasts that contain cysts) may also have this problem.

· Sudden weaning: If you stop breastfeeding suddenly, you’re more likely to develop blocked ducts. If you have to wean suddenly, pump your milk until you can gradually decrease the supply of milk you’re making.

· Yeast infections: If your baby has thrush (a yeast infection in the mouth, discussed in the later section “Sharing Yeast Infections”) or if you have a yeast infection, it can lead to mastitis.

Treating the infection

If you experience the common symptoms of mastitis, see your doctor. Most likely, she’ll prescribe antibiotics. You should feel better and see an improvement in the breast within 48 hours after starting the prescription; if you don’t, call your doctor because you may need a different antibiotic. Make sure you finish all the medication, or the infection may return — and it may be worse than it was initially.

tip You can take pain relievers such as ibuprofen or acetaminophen as needed. Alternating hot and cold packs may also help relieve the discomfort. Gently massaging the affected area can increase blood flow and loosen plugs in the ducts.

Following are other helpful steps to take:

· Drink lots of fluid. Staying hydrated helps you feel better and recover faster. This is especially important if you run a high fever.

· Get lots of rest. Remember that you’re sick. You need to lie down as much as possible. Doing so helps your immune system fight off the infection.

· Go braless or wear a loose-fitting bra. Put as little pressure as possible on the breasts.

· Nurse in different positions. Vary the holds you use while nursing so that all the ducts get thoroughly emptied.

Continuing to nurse

If you have mastitis, you should continue to breastfeed. Otherwise, the infection could turn into an abscess, an isolated pocket of pus that would need to be drained surgically.

If possible, start each feeding with the affected breast to make certain the ducts are being drained completely. You may find this too painful; if you do, start with the unaffected side and switch after your milk lets down. Nursing is usually more comfortable after let-down occurs.

remember Some babies may refuse to nurse on the affected side because the milk tastes more salty than normal due to the inflammation. If that’s the case, you’ll have to thoroughly pump the affected side to make sure the infection doesn’t worsen.

Nursing with mastitis is not dangerous for the baby. Either the bacteria that caused the infection came from the baby’s mouth to begin with, or you passed the bacteria on before you realized you had the infection. Continuing to nurse ensures that the baby benefits from the antibodies you’re developing to fight the bacteria.

Having mastitis more than once

Some women are prone to mastitis, developing it several times. Not only is this frustrating and debilitating, but it may also make you question whether breastfeeding is right for you.

If this happens to you, you need to look carefully for the cause. In addition to those listed earlier, causes of mastitis include the following:

· Not finishing the complete course of antibiotics. Many people stop taking antibiotics as soon as they start feeling better, figuring they don’t need them anymore. This allows more resistant and stronger strains of bacteria to infect you again. Make sure you finish all your medication!

· Are you run down? Make sure you’re eating well and resting enough and that you aren’t anemic. Keep taking your prenatal vitamins to help supply nutrients you may be missing. Don’t try to be superwoman, maintaining five carpools and two PTA positions as well as spackling the bathroom and refinishing the deck while nursing with one hand. Sit down and enjoy the experience of nursing!

Sharing Yeast Infections

Perhaps you’ve experienced a vaginal yeast infection — the incredibly itchy, cheesy white growth you can get from taking antibiotics or wearing nylon underwear. When you’re nursing, yeast can grow on your nipples or in your baby’s mouth, causing problems for both of you.

Realizing the origins of Candida

All of us carry some forms of microorganisms on our skin. Candida is a yeast (a fungus) carried by half the population. Normally, microorganisms such as Candida cause no problems at all. However, if the normal balance between good and bad microorganisms in your body is upset, the harmless yeast fungus can overgrow, causing symptoms such as painful red skin, itching, and a white appearance.

Yeast usually flourishes for one of two reasons: Either the good bacteria that keep problem-causing organisms like yeast under control are destroyed (as is the case when you take antibiotics), or an area that is usually fairly dry becomes more moist than normal. Yeast thrives in dark, warm, moist areas — a yeast infection can be in your vagina, under your breasts, in the baby’s diaper area or mouth, or even under your fingernails!

Wearing wet breast pads for extended times can also give Candida a nice, warm growth area, especially because the fungus grows well in the sugar found in breast milk.

remember Both you and your baby need to be treated any time one of you has a yeast infection so you don’t keep passing it back and forth to each other. Yeast is tenacious! Be sure to ask both your obstetrician and the baby’s pediatrician for medication to treat both of you. Your partner can also develop a yeast infection on the head of his penis; he may need to be treated as well.

Thrush little baby, don’t say a word

Thrush generally affects babies in one of two ways: as a mouth infection called oral thrush or as a diaper rash. Both are uncomfortable, and oral thrush can interfere with nursing.

Oral thrush usually shows up as white patches inside the baby’s mouth, including on the tongue. If you wipe the white area off, you can see reddened, irritated skin underneath. The baby may refuse to nurse, or he may nurse only a short time before crying. He may be especially gassy (a side effect of yeast). Before the patches show up, you may notice that the baby’s saliva and the insides of his cheeks have what’s been described as a pearly appearance.

The baby may or may not have yeast in the diaper area at the same time. Diaper rash is especially common if the baby is heavy; yeast grows in the moist crevices. Instead of white spots, you may see a bright red, bumpy rash; the affected skin may be cracked and oozing clear fluid and blood.

If you suspect that your baby has thrush, consult your pediatrician for treatment.

Battling your own yeast infections

You may have a yeast infection and not even know it. With all the discomforts of late pregnancy, a yeast infection may go unnoticed.

remember You probably associate yeast with vaginal infections, but yeast can grow anywhere the conditions are right. Pregnancy can foster yeast growth for several reasons: You may develop extra folds of skin under your enlarged abdomen and breasts; you may experience increased perspiration; and your hormone levels spike. Even your chocolate cravings can contribute to the problem, because yeast thrives in a sugar-laden environment!

If you receive antibiotics after a cesarean delivery, you can easily develop a yeast infection, because killing off the good bacteria along with the bad allows yeast to overgrow. You can infect your nipple with yeast by touching another yeasty area, such as your vagina, and then your nipple, or the baby can infect you with thrush from his mouth.

Yeast on your nipples may not be visible at all; your first symptom may be sharp, stabbing pain in the nipple. Sometimes infected nipples crack, itch, burn, or turn bright red. You may even experience shooting pains in the breast.

tip If your nipples are infected, your first treatment should be to always wash your hands before touching them. Also, rinse your nipples after each feeding, using either plain water or a vinegar solution made with a tablespoon of vinegar per cup of water. This changes the pH of your skin to make it less hospitable for the yeast to grow.

To cure the fungus, first try a local treatment. After each feeding, apply an antifungal cream to your nipples and areola. Gently wipe off any excess if you can still see it before the next feeding.

If topical solutions don’t work, consult your doctor, who can prescribe a medication to take care of the problem. Also, be sure to talk to your lactation consultant. She may have additional information on how to help you treat thrush.

Knowing When Crying Becomes Colic

Do you recognize this baby? She’s sleeping peacefully in her infant seat as you stir the spaghetti sauce for dinner. Suddenly, she wakes up, draws her knees up to her chest, and begins to howl. You try feeding her, rocking her, carrying her in the sling, putting her in the swing, singing to her, and jiggling her up and down, but she just cries. And cries. By the time your partner walks in, two hours later, you and the baby are both sobbing. You shove the baby at him, pour the burned spaghetti sauce down the disposal, and collapse in a heap on the nearest chair.

The first time this happens, you may chalk it up to a bad day. By the fourth or fifth day in a row, your worst suspicions are confirmed: Your baby has colic.

Recognizing the signs

Distinguishing a crying infant from a colicky infant isn’t difficult. Both babies are trying to tell you something, but with the crying baby, you can usually figure out what it is. A colicky baby is just as confused as you are, uncertain about why she’s feeling this way.

The word colic comes from the Greek word kolikos, which translates roughly into “colon.” Colic has long been thought to be a gastrointestinal problem. Unfortunately, no one is really sure what colic is or why it happens. One thing that everyone involved knows is that it can bring parents as well as babies to tears.

Colic attacks start early, at around 2 weeks old. Colic occurs in about 20 percent of babies, occurring equally in boys and girls, whether breast-fed or bottle-fed. It generally reaches a peak at around 6 weeks but may continue until 4 months of age. The worst part of this early infancy condition is that there’s no known cause and no specific treatment. This is what makes a colicky baby so frustrating.

Colic seems to occur most often in first-borns. Perhaps that’s due to first-time parents being nervous about their parenting skills. We can attest that parenting skills become more fine-tuned with each baby, resulting in calmer, more relaxed parents. But beware: Even if your first three babies are angels, the fourth one may have colic.

As quickly as it comes, colic can disappear, or the good days may slowly replace the bad ones. However it ends, by the time it goes away, everyone in your household will be exhausted, frazzled, and praying that your baby will soon go off to college.

remember Colic-type symptoms occasionally indicate a more serious problem. If your baby develops colic, notify your pediatrician to rule out any potential serious conditions that the colic symptoms could camouflage.

Avoiding foods that upset baby

Sometimes what you eat can aggravate colic. If you suspect this may be the case, experiment with eliminating certain foods from your diet to see whether the colic improves.

If your baby’s colic is worsened by what you eat, cow’s milk is the most likely culprit. Gas can form inside her bowel from the protein in the cow’s milk, causing cramping, diarrhea, abdominal pain, or vomiting. Sensitivity to cow’s milk doesn’t happen overnight. It usually takes about two to three weeks before a colicky reaction shows up.

To test for cow’s milk sensitivity, completely eliminate dairy products from your diet for at least two weeks. If dairy products are the culprit, you’ll see a much happier baby within four to five days. If you don’t see an improvement in a week or so, dairy is probably not the culprit.

remember Lactose intolerance and milk protein allergy aren’t the same thing. Lactose intolerance is rare in infants, usually developing after age 2. People of Asian, African, or Hispanic descent have a higher chance of being lactose intolerant. If you’re a member of one of these ethnic groups, you may be surprised to find that you feel better yourself when you lower your dairy intake.

Some foods — such as cabbage, broccoli, and beans — have a reputation for causing intestinal problems or for giving your milk a flavor that the baby may refuse. Spicy foods and foods that give you gas may cause your baby to have an upset stomach. Then again, they may not!

tip Before dismissing things like corned beef and cabbage permanently from your diet, try them one at a time. Doing so can help you figure out whether your baby reacts negatively when you eat them.

Another common culprit is caffeine, which can make you and your baby more restless and irritable. Try to limit yourself to two caffeinated drinks per day.

warning Watch out for foods that you or your partner is allergic to, because allergies sometimes run in families (although more commonly, it’s the tendency toward allergies rather than a specific allergy that’s inherited). In addition to cow’s milk, common allergenic foods include peanuts, eggs, wheat products, soy, citrus foods, corn, and fish. An allergy could cause colic symptoms, or it could take the form of asthma, diarrhea, or eczema. Babies exposed to allergens at an early age are more likely to develop allergic reactions to them later in life.

Nursing through colic

Nursing from both breasts at each feeding may result in the baby getting too much foremilk and not enough hindmilk. The hindmilk — the creamier milk that appears after the baby has been eating for several minutes — has a high fat content that is needed to satisfy her hunger. If the baby doesn’t get the hindmilk, she needs to nurse more often. This means she takes in more foremilk, which contains more sugar. The sugar load, without the fat to balance it, can cause gas and explosive bowel movements.

tip If your baby’s distress seems to be accompanied by loose green bowel movements, she may be getting too much foremilk. Try letting her nurse as long as she wants on one breast so she gets enough hindmilk to keep her satiated longer. When she nurses again, start on the opposite side and repeat the process.

remember Colic-type symptoms are not a reason to give up breastfeeding. Chances are that your baby’s symptoms would worsen if you switched to formula. Colic symptoms should resolve within four to six months.

Getting an Uncooperative Baby to Nurse

Your baby needs to nurse frequently in order for you to develop a good milk supply. In the first couple days of life, most babies are sleepy and nurse only six to eight times a day. By day three, they’re waking up and eating more frequently. Try to nurse every two to three hours after the first few days (count the time from the start of one feeding to the start of the next), or 10 to 12 times in a 24-hour period. This is your full-time job right now, and the job description is simple: Get to know your baby and build up your milk supply.

But what if your baby hasn’t read the job description and is too sleepy, too uninterested, or too frantic at feeding time? Don’t get discouraged. Trust that perseverance will win out.

Looking for hunger signs

Newborns haven’t quite mastered the art of letting you know when it’s time to eat. Your baby’s hunger signs may be subtle, such as

· Sucking his lips, his tongue, his fingers, or his fists

· Starting to fidget (which indicates he’s not in a deep sleep anymore)

· Turning toward your breast (especially if his mouth is open)

remember Crying is a late sign of hunger. Try to read these earlier hints so your baby doesn’t get too hungry. If he starts crying, you may have a harder time calming him down and getting him to nurse.

Feeding the uninterested baby

If they’re not medicated, most babies are interested in breastfeeding shortly after delivery. However, if you need pain medication during labor or require a cesarean delivery, your baby may not be as alert or interested in feeding immediately after delivery. It may take a while before your milk comes in and he’s interested in actively breastfeeding. During this period (which can be as long as 10 days), your baby may seem uninterested and distant. Although this is very frustrating, remember that many babies react this way.

remember Some moms feel rejected by this lack of interest. Keep in mind that your baby isn’t consciously deciding he isn’t interested in breastfeeding, and he isn’t rejecting you or your milk.

Some babies won’t nurse right after delivery if they’ve been suctioned vigorously and have an aversion to anything placed in their mouths. If your baby had some fluid in his nose and mouth that needed to be suctioned out right after delivery, he may not appreciate a nipple in his mouth, but this lack of interest will be short-lived. Keep in mind that pacifiers will draw the same response. If someone jabs a pacifier into the baby’s mouth too hard or too early when he’s not ready to suck, he may feel startled and upset, setting up a negative reaction to mouth stimulation.

Remember also that, like you, the baby’s been put through a complicated physical experience. Maybe his neck was at a funny angle during delivery and the position you’re holding him in is uncomfortable. Try changing positions before you throw in the towel on breastfeeding.

You can also set the mood for nursing. Here are some things you can do to encourage him to relax and breastfeed:

· Talk to him. Make eye contact.

· Unwrap him so he’s not quite as warm and cozy.

· Keep the lights dimmed. He’s very much like the sleepy baby who is retreating from activity.

· Lie on your side to nurse. This encourages you both to relax.

· Take some time to stroke your baby. Gently rub his body. Skin-to-skin contact is a great way to entice and interest your baby.

· Let him suck on your finger initially, stimulating his upper palate. When he seems ready to nurse, try to put him on the breast.

· Tease him with some drops of expressed milk on his lips. Remind him what you’re both doing here.

· Encourage your let-down reflex. Some babies get frustrated quickly — if the milk isn’t pouring into their mouths, they’re going to go somewhere else, like to sleep! Place a warm washcloth on your breasts to get your let-down engine running. Use breast massage while you nurse. Some babies start nursing eagerly but lose interest when the flow decreases; gently massaging the ducts helps keep a steady flow coming.

· Try short, frequent nursing sessions. Nurse whenever you can. If he seems even the slightest bit awake and alert, try to get him on the breast. Remember, this frequent nursing is necessary only until he gets with the program.

If he stays uninterested for more than 24 hours, you’ll have to pump to get your milk to come in, and you may have to feed him the expressed milk through a cup, bottle, or lactation aid. If you persist in trying every few hours or so, he should get with the program.

If none of these suggestions helps, get the assistance of a lactation consultant or La Leche League leader.

Calming the frantic nurser

Some babies seem quite anxious to nurse but can’t seem to grasp the mechanics. They brush past the nipple, mouth open, over and over until they become frustrated and start crying. This turns into a vicious cycle: The baby cries because he can’t grasp the breast, and he can’t grasp the breast because he’s crying. What can you do to stop this merry-go-round without joining him in the frustration?

First, don’t feed the fire. Take a deep breath and try to keep calm. Babies are very sensitive to their surroundings. (This is a good thing to remember throughout motherhood.) If you get upset about his behavior, he’ll become tenser.

tip If he works himself into a real frenzy, help him calm down and start again. Try the following suggestions:

· Walk around the room with him. Babies love movement. He’s used to it — he walked with you for nine months.

· Cuddle him in the cradle position or bundle him snugly with a lightweight blanket so his arms and legs are close to his body. Some babies miss the tightly held feeling they had in the womb, so try to recreate it.

Many times a baby becomes frantic because he missed his early hungry stage while he was sleeping. When he wakes up, he’s overly hungry. To prevent this, feed your baby when you see early hunger signs; don’t wait for him to cry. Nursing him more frequently also helps by preventing your baby from getting to the frantic stage if it’s caused by hunger.

If you’re certain that your baby isn’t overly hungry but he’s still frantic, explore other possibilities. Try changing his position; he may have a sensitive neck or a sore throat after delivery, or he may just prefer another position. Support his neck so his head doesn’t wobble. It sounds simple, but sometimes simple things work.

remember As you attempt to soothe your baby, make sure you’re not stroking both cheeks. Babies have a rooting reflex that causes them to turn their heads toward the source of the stroking. If you’re touching both cheeks, you’ll confuse and frustrate him.

Focusing on Baby’s Weight

Weight loss in a newborn is normal within certain limits. If you breastfeed frequently, and if your baby latches on properly and nurses long enough to get the hindmilk (the creamier milk that comes later in a nursing session), she’ll regain weight very quickly.

Some babies, however, are a little slower to regain weight than others. If your baby is gaining weight slowly, ask a professional to assess her nursing skills. Together you can make sure your baby is

· Nursing often and long enough (at least every 2 hours, lasting at least 15 to 20 minutes on each breast)

· Sucking vigorously enough to cause a let-down reflex in your breasts; you should hear and see swallowing

· Latching on properly to stimulate milk production

· Emptying the breasts with each feeding and appearing satisfied after nursing

· Looking healthy, bright-eyed, active, and alert

A weight gain of 4 to 7 ounces per week or an ounce a day is considered normal for the breast-fed newborn. However, this is an average: Babies don’t gain weight back in a textbook-perfect format.

remember Babies who are larger at birth tend to regain weight at a slower pace. They should, however, regain and surpass their birth weight by 14 days. Baby boys gain weight a little faster than baby girls.



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