FAQ 7. Fussy baby

Q. But what if I keep trying and things still don’t seem to be going well?

A. The mom at the left is having a good breastfeeding experience. But maybe you’re not quite there yet. It’s kind of like learning any new skill. At first you might feel a bit unsure, but with practice things get better. But maybe not as fast as you would like. And maybe you are thinking you might need some help. That’s totally normal!

Then this is when it’s good to get information from another experienced mother who had a good breastfeeding experience. You can go to a La Leche League meeting. Or talk to a friend who had a good breastfeeding experience.

But if you keep having difficulty after several days, and baby fusses and cries at the breast a lot and doesn’t seem to be catching on or if your baby is feeding often but is not content, and s/he’s having trouble latching, or if you have sore or cracked nipples, and so on, then it’s probably a good idea to see a lactation consultant.

An International Board Certified Lactation Consultant (or IBCLC) has training to know how to help troubleshoot and resolve breastfeeding challenges. An IBCLC might have more training than a consultant who is non-board-certified.

It’s better to check it out if you have any doubts about the latch and whether your baby is getting enough milk, than to assume that things are good enough, only to discover your baby is not growing well. A consultation might be available through your local hospital but you still might want follow-up, especially if you have reason to think that things still aren’t going smoothly after a few days postpartum. Or perhaps a health worker might recommend you get specialized help with a more in-depth consultation than they are able to offer.

Some IBCLCs do home visits for a fee. But that fee probably costs a lot less than six months’ worth of formula!

If you feel quite sure that things aren’t going smoothly and don’t seem to be getting better, then getting help sooner than later will make things easier for both you and your baby, because the sooner you start learning better habits, the easier it will be to work on the solution, and also the less likely that you might need to supplement your own milk.

An International Board Certified Lactation Consultant is trained to be able to teach moms how to get the baby latched on effectively in different positions, and how to tell if the baby is getting enough milk AND can help determine if the situation is serious and the baby should see a doctor right away.

In cases like this, once the medical problem is resolved, then the lactation consultation can be an excellent complement to the medical care. For example, if the baby is not getting adequate milk due to ineffective latching and is seriously underweight, then s/he might need a supplement while you learn better breastfeeding techniques from the lactation consultant.

Fortunately nowadays, many health workers are adopting a collaborative approach to health care, with doctors, midwives, nurses, and lactation consultants all offering their care and expertise in different capacities to help families get off to the best start possible.

A lactation consultation often results in better latching, better milk production, and improved health in the baby fast — often after just a few hours or a day or two.

But if you are doing everything right after seeing a lactation consultant and if it does not result in improved health status in the baby quickly, THEN YOU SHOULD TAKE THE BABY TO THE DOCTOR RIGHT AWAY. Better to be safe than sorry.

In some cases, you really might have to give the baby a supplement until the breastfeeding is going well — but hopefully this will only happen once a doctor determines this is necessary, if a consultation with a lactation consultant has not resulted in improved milk production and flow — and, of course accompanied by better weight gain and growth in your baby. You might also need to pump to build up your milk. (Like breastfeeding itself, that also should not hurt!)

Your doctor can also prescribe medication that can increase your milk production. There is also some evidence that certain herbs can increase milk production, but they should probably not be used if you are taking prescribed medicine to increase your milk as they could affect the medicine’s absorption.

What if you are already giving formula? An IBCLC can help in this situation too. She can show you how you can increase your milk production, and therefore increase how much of your own milk you can provide to your baby while decreasing the formula. Pretty soon, with commitment, you can probably be fully breastfeeding unless there are special medical needs in your individual situation.

Also, I think it is best not to use a soother at all, especially if you have any issues regarding latching or milk production. I think it is best to let your baby soothe at the breast whenever possible. Most babies who never have soothers pace themselves and get a good amount of milk.

A lactation consultant can help you to make sure the baby gets a good balance of foremilk to hindmilk. Too much foremilk can mean too much milk sugar and not enough calories, which can cause fussiness and digestive problems. But this is another situation that can be fixed!

It helps to dress so that you can allow the baby to get to the breast easily. (You can buy nursing dresses now. Or else wear a sweater or shirt with pants or skirt, so it is easy to pull the top up for baby to breastfeed from underneath.) Skipping opportunities to breastfeed when your breast feels full can result in lowered milk production.

Maybe you can see by now that breastfeeding is not a “hit or miss” thing, and not hereditary, but something that is learned.

And when breastfeeding is going smoothly, most women have enough milk (or can make enough milk) to feed twins or triplets. Then they still usually have plenty of milk to continue to nourish the baby a lot while very gradually adding solids over the next couple or years or beyond, ideally until the child no longer feels the need to breastfeed.

So the question is not “Do I have enough milk?” but “How can I make sure that baby will get all the milk I do have or could be producing?” This means getting the baby latched on effectively, allowing the baby to nurse freely, without timing feedings, and not restricting feeding frequency. In fact, really frequent feeding in the early days and weeks after birth helps to ensure the breast will make plenty of milk.

Some babies only get a little bit of milk at a time, and might need to feed again in a couple of hours or even less, especially in the really early days when their tummies are tiny.

Remember that with breastfeeding there is a big range of variation in normal. Some babies nurse 6 times a day. Others nurse 8, 16, 20. It depends on the baby. Assuming that the baby is happy and peaceful after feedings and visits to your health department show s/he’s gaining well, then those variations in frequency are normal and healthy.

And let the baby finish the first breast before going to the other one. Some babies only nurse from one breast each time, but that is probably only needed if you have an overproduction situation or very fast milk flow.

Otherwise, offering both breasts ensures that your baby gets more milk. If you have had a breast injury to one breast or one breast removed, you can probably breastfeed using just the other breast, and you will still make enough milk in most cases.

If allowed to wean at their own pace, most babies will tend to nurse until toddlerhood. Breastfeeding older babies continues to give them lots of nutrition and antibodies to illness for the next couple of years or even longer. And they breastfeed for the emotional comfort and closeness with mom that they feel — which helps them to feelĀ  calm and grounded and secure, and sets the stage for them to be confident and secure as they grow older.

But even if women believe in breastfeeding in principle, some of us do have various challenges. I think that mostly the reasons that women have challenges with breastfeeding are because, like me, we live in a modern culture with a lot of misconceptions that have been passed down from mother to daughter and neighbour for the last few generations.

These misconceptions were perpetrated by well-meaning but misinformed women who lost a lot of the previously understood breastfeeding ideas that we had before formula was introduced as an infant feeding method, and then marketed as “almost the same as breastfeeding”.

Artificial feeding really took hold around the middle of the twentieth century, and some of the companies deliberately discouraged breastfeeding by writing parent-targeted literature that is filled with incorrect ideas, or ideas that made formula-feeding seem preferable to breastfeeding.

Some of those myths were often inadvertently created and incorporated into mothers’ experiences when bottle-feeding practices were introduced into breastfeeding experiences. Then those things were passed along, (such as timing feedings) and, without knowing why, women lost a lot of knowledge of the basics that make breastfeeding go smoothly.

An example is timed feedings. Measuring and timing ARTIFICIAL feedings might be necessary to avoid overfeeding or underfeeding. But timing feedings does not work for breastfeeding, because the breast does not have a set amount of milk in it. The amount varies throughout the day and the rate of delivery of milk varies during the day too — and from mother to mother — so when baby is allowed to breastfeed freely they will self-regulate.

Maybe in a non-formula-feeding culture, breastfeeding would be more “instinctive” but in cultures like that, little girls grow up seeing how to hold and breastfeed a baby, so they learn how to do it by watching. Is that instinctive? Probably the urge to nurture is instinctive. How to actually breastfeed seems to be learned.

In any case, many young women learn more about how to artificially feed than how to breastfeed, even if on principle they believe that breastfeeding is good. But the bottle-feeding practices are very entrenched and get applied to breastfeeding unless we get proper information.

For example, one of the reasons I had trouble getting my baby latched on was because I was holding him on his back and trying to get him to turn his head toward me. (I held him on his back because that was the position I was taught as a young girl to use to bottle-feed a baby.) But that back lying position doesn’t work for breastfeeding! Try turning your head and try to press your lips together and swallow. Not too comfortable is it? Well, that’s what we’re asking baby to do when we do that.

So, the trick is to have your baby FACING you, tummy to tummy, or facing your breast directly in the football hold. Baby can much more easily open their mouth, like a big yawn, when their whole body is facing the breast. When baby opens extra wide like a baby bird, bring her in close, and give baby the chance to get and compress a lot of breast tissue, especially the underside of the nipple and areola (the darker area around the nipple).

Also, in that position, support the baby’s head, but allow it to tip back a tiny bit, which allows the baby to breathe. You should NOT press your finger onto your breast to help baby breathe, and you should not need to help baby breathe if baby is latched on right.

Also, make sure you are not covering the underside of your areola if you are holding the breast underneath, which can keep baby from getting a good latch.

No fingers or clothes or bra fabric either, where you want baby’s mouth to go! No matter whether you are holding baby in your arms or lying down, make sure there is nothing in the way of baby getting to the breast, especially the underside of the areola.

Try using only one or two fingers to hold your breast from underneath, or try letting go of the breast completely. Some moms find that holding the breast helps as baby latches, and once baby is nursing happily, they can stop holding the breast itself, but just support the baby’s head and body. Or they just support the breast with one finger underneath the breast and back to their own body, near their ribs.

Fortunately, women and health workers alike have been actively reclaiming much of that almost-lost knowledge, and are teaching each other, so that we are now re-learning a lot of it and now we are able to help mothers AVOID problems in the first place, or at least help them to nip problems in the bud with workable solutions. So getting educated is a good start.

Knowing that there are resources to help deal with challenges if they do arise is also a good way to arm yourself with confidence that you will be able to breastfeed and will be able to overcome any challenges that you are facing. I will list some other breastfeeding myths vs facts, and breastfeeding pointers, in other questions.

Oh, and the help I got made all the difference, and even though I had been advised to supplement with formula, instead I got help at La Leche League, as I said, and things went very well after that. My only regret is that I had not known about League meetings before my baby was born, so that I would have known more about what to do to keep that problem from happening in the first place. And I also would have learned a lot more ahead of time about breastfeeding myths vs truths. That’s another question. See more topics and discussions in the menu at the top.