In my 3rd year in medical school we had a few lectures on breastfeeding. Firstly a lecturer from the Physiology department taught us exactly how the hormones oestrogen and progesterone assists in the development of glandular tissues in the breast, and the changes that take place in the areola and nipple as you go through puberty. We were taught how the pituitary gland secretes the hormones oxytocin and prolactin that assists with the let-down reflex and milk production. We had a session on the 10 steps to successful breastfeeding (from a hospital-management point of view) that would save the whole community. And then we had a lecture with Sister Vanessa Booysen. She is a registered Nurse that has worked in the NICU for many years, and that has an absolute passion for breastfeeding and the nurturing of babies.
She lovingly taught us about the benefits of breastmilk (especially in the premature babies she has worked with for so long), the immune benefits, the bonding, positive emotional outcomes for mom and baby, the ultimate love story that is breastfeeding. It was inspirational! When we walked out of that class we all (the male students included) just wanted to go and breastfeed something! 😉
In the 8 years of working that followed I always very passionately explained to the mommies in the obstetric unit and sitting beside the beds of their babies in Neonatal ICU how very important breastfeeding is. It broke my heart when a mother chose to bottle feed before even trying to breastfeed or when we had to start a premature baby on formula milk because the mother was not interested in expressing. I believed everyone could breastfeed if they tried hard enough! I probably was a little bit of a “breastfeeding-cheerleader/tirant”!
Fast forward another year and now I have my own little milk monster that have been on this breastfeeding journey with me for almost 7 months! I have learned so much and have definitely gained a lot of respect and empathy for breastfeeding mothers. My cheerleading-approach will be more thoughtful and caring in the future.
(Warning– I am sharing my journey openly and honestly! If you are not comfortable with your boobs yet, this might get a bit squeamish!)
Despite all my physiological knowledge about the breast and breastmilk, I did not know much about breastfeeding and the trouble-shooting of the niggly-midnight-issues. I read a lot of blogs and attended the ante-natal classes to make sure I was as prepared as I could be. We attended the class on breastfeeding when I was around 28weeks pregnant. We were shown the technique for hand-expressing, and that night I tried it out… great was my surprise when a drop of milk appeared!!! How amazing are our pregnant bodies that our breasts are ready to produce milk the moment that it is needed!
Seeing as I did not have a normal vaginal delivery, I was adamant that I would at least get this breastfeeding thing right! When our midwife placed the crinkly, pink, warm body of our son on my chest in the theatre and he looked me in the eyes, the oxytocin surge was immediate! Our midwife assisted me right there to help him to latch on my breast (quite an awkward feat while still lying on the theatre table with all the drapes and cables in the way). In the recovery room our little boy finally got the hang of it and tried the sucking thing for a few minutes. I was overjoyed!
The next three days in hospital were mostly a bootcamp of breastfeeding! I made sure I had an easy-access top on, and baby stayed in or next to my bed so that I could feed him on demand. I was very worried when he did not pee for a whole day (yes, I kept checking for the blue line on the nappy!) and woke my husband in the middle of the night with a photo of the blue line when it eventually appeared! J Luckily the nursing staff was very supportive, and the baby-sister gave a pearl of wisdom : if baby has passed both stool and urine once after birth, we know he can do it. Then you do not worry too much for the next 3 days as output can vary. They take in very little fluids (colostrum is very concentrated) so they do not produce a lot of waste initially. Once your “milk has come in”, then they should have 4-6 wet nappies a day if baby is drinking enough.
As with any bootcamp you are tired, sore but satisfied by the end of it! Baby fed almost hourly the first two nights (clusterfeeding), this was necessary to stimulate my breasts enough for them to realise they need to up the production as they have to provide milk for a hungry little human for the next few months. My nipples where very tender, but fortunately did not bleed. I had the nipple-cream in my hospital bag, but in the end it was much easier and much more effective to apply colostrum to my nipples after each feed and let it air-dry.
By the time we went home, we were both a little bit more comfortable with the whole process. By then my milk had come in (this basically means that the milk has transitioned from colostrum (very rich, concentrated milk, 1ml colostrum = 25ml formula milk, looks golden in colour) to normal breastmilk (whiter in colour and baby needs more of it to keep him happy) and your breasts are now ready to produce larger volumes.) In the beginning your breasts overshoot in supply and baby still has a relatively small demand, and thus your breasts end up looking and feeling huge, heavy and warm (engorged). I was privileged that my milk-factories was moderate in their supply, so I never had hard, lumpy breasts. Another pearl of wisdom from my lactation consultant, Sr Vanessa Booysen, was that told me that I can feed from one breast per feed (this was at about day 6) so that baby can empty the breast completely – good for me and baby (he gets both the fore-milk and fattier hind-milk to keep him full for longer). At times baby struggled to latch as my breast was too full and I had to hand-express a little bit to make the areola-area soft enough for baby to manipulate.
After one week we went to a clinic to have baby weighed. I initially thought weekly weigh-ins are unnecessary, but in the end it was so comforting to know that baby was growing well, and the sister gave me a wonderful pep-talk each week. Baby always became hungry in the middle of the consultation, so his latch and positioning and my posture could also be evaluated, and the sister gave valuable tips each time. I also joined La Leche league on Facebook, and a local breastfeeding whatsapp group. I learned so much from the other moms, and it was wonderful to know I was not alone.
At 2.5 weeks I noticed that there was a little blister on our son’s upper lip that sometimes formed after a feed, then would fall off and then form again. I asked around and heard that it was mostly associated with a lip-tie. After some more investigations, I realised that he had a small lip tie of his upper lip, but because he was latching and feeding and growing so well, we decided to just watch it. Lip ties usually resolve later (while for example brushing your teeth), and mostly does not need any interventions. Speak to your breastfeeding consultant, paediatrician or ear-nose and throat specialist if you are worried.
By week 3 my parents came to visit and baby and I started practising to feed with a feeding-cover. It was good to become comfortable with this in my own home, as it has saved me during many coffee-shop or mall visits. I only started expressing after 6 weeks as I did not want to mess with the demand/supply process (your milk production is relatively stable after 6 weeks) and we only tried to give baby a bottle after 10weeks (mostly because I was too lazy to express). Many moms express/bottle feed much earlier with big success. In my experience very few babies really get “nipple confusion”, they may start to prefer the bottle because it is so much easier to get the milk out. Breastfeeding is hard work! It is thus important to do paced feeding if you do give some bottles in between.
After 6weeks my nipples and breasts were not sore anymore, baby latched like a pro and suddenly only drank for 5-10minutes per feed (he used to take at least 20min per feed initially). Suddenly all the initial worries, pain, frequent feeds was worth it and I started to really enjoy these special times with my little boy.
“And my God will meet all your needs according to the riches of his glory in Christ Jesus.” Phil 4:19
We fell into a synchrony of request and production and all was well until he was almost 5months old and hit yet another growth spurt. I received very sad news from a friend and suddenly my milk production dropped! Baby boy wanted to drink every hour (grazing is also not good for milk production, as he only drinks a few sips and then stops, so the breast only replaces those few sips). I drank litres of water, jungle juice and tea, and spoke to my lactation consultant again. She advised that I use a few Rescue tablets and just relax, Oxytocin will do the rest. I also visited my clinic again, and seeing that our little boy actually gained some weight helped a lot to calm me down! After praying and declaring that God is my provider, and believing that He will also provide milk for our baby, I could finally feel my breasts filling and having a proper let-down again. I am so thankful that we can continue our breastfeeding journey for now.
So in a nutshell… make up your mind, have a good support system (especially a passionate lactation consultant) and believe that God will do the rest! What did you learn during your breastfeeding journey?