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May 2011

It Takes a Village

Nurturing the Nursing Mom

By Amy Bourne

“I thought breastfeeding was supposed to be natural, so why is it so hard?” This is a comment I hear quite frequently at work. Mothers of newborns are surprised, and naturally disappointed, when their sweet bundle of joy does not nurse like expected. Just like childbirth, the image we have of the experience may be slightly (or not so slightly) different than reality. All the pillows, positions and mastering the “perfect latch” are a lot to figure out—especially on little sleep while you’re adjusting to a new member of your family. Well-intentioned visitors who don’t know the first thing about breastfeeding might offer counterproductive comments like, “Is the baby getting enough to eat?” or, “Just put the baby in the nursery overnight so you can sleep.” Once home from the hospital, many new moms find themselves alone as their partners return to work or are not able (or educated enough) to offer the support moms need. A woman who may never have held a newborn before giving birth is now learning how to care for and feed this little being. It can all be very overwhelming, even though breastfeeding is “natural.”

Natural is an interesting word to use in describing our modern world of breastfeeding. The human race exists because of our ability to breastfeed. Dairy cows have been domesticated only for the last 15,000 years. There were no other choices, so breastfeeding had to work. No exceptions.

Long, Long Ago

Think back on your baby’s birth or the birth stories you have heard from friends, and consider this. You live in a small village in biblical times. You grew up raising your brothers, sisters, cousins and neighbors. You watched your sister breastfeed all six of her kids, and your mother is currently nursing your youngest brother. As soon as you go into labor, women who have done this before and who will support you through your first birth, surround you. Once your baby is born, she is put right to the breast. Everyone around you has breastfed and through observation, you have been well-trained. Your support group of women realizes that successful breastfeeding is paramount to survival, and they treat the breastfeeding relationship with honor and respect. You are made comfortable, most likely lying on your side, and you are brought the most nourishing food available. You are supported. There are no pillows, no nursing books, no breast pumps and no gadgets. It is just you and your baby and the wisdom and knowledge of the women surrounding you.

Even today in many Eastern cultures, the custom of supporting new moms and babies for the first 40 days after birth continues. It is not by accident that these early days are the most crucial in establishing a healthy milk supply and for babies and moms to really get to know each other and develop a feeding rhythm. Yes, we are mammals, and mammals nurse their young, but tuned-in cultures never expect their moms and babies to be masters on Day One (or Day 5 or 10 or 25, for that matter). These smart women realize that even though Mom has had a lifetime of exposure to breastfeeding, this new feeding relationship must still be cultivated and nourished.

A Relationship Between Moms and Babies

And yes, breastfeeding is a relationship, with babies being an equally important part of this equation. Newborns are born with an instinct to latch on and nurse. If you have not seen this yet, go to YouTube and search “breast crawl.” Most people are amazed that a baby less than one hour old can crawl to the breast and nurse, with very little assistance from mom. Did you notice I used the word ”can,” not “will”? It is true that babies are instinctive breastfeeders, but many times what they have been through in the womb and during labor and the delivery lessen this drive, even if just for a few hours. You can imagine that after a long labor and a vacuum delivery, a baby might not be as keen to latch on with gusto as the baby whose mom labored for five hours without an epidural and pushed for 10 minutes. Or you might have a baby who was orally suctioned immediately after the delivery and now does not want anything in her mouth. Sometimes, I’ve even seen babies who have clearly sucked their thumbs in utero, confirmed by a sonogram or two, and after birth have a tight jaw and do not want to open wide. These issues almost always pass. Some linger for a few hours, while others a few days. Mom’s self-confidence may take a mini hit, but with the right support and guidance, this nursing pair can get into the groove.

It was not until recently that we expected ourselves to do such an important job as feeding our young with absolutely no prior training. That would be the equivalent of my reading a book, taking one class in which I never touched clay and then expecting myself to be an expert potter. Breastfeeding was never meant to be something that was written about in a how-to sort of textbook. When anthropologists asked indigenous peoples in Papua New Guinea about breastfeeding and how it was done, they replied simply, “You just do it.” Having grown up surrounded by breastfeeding, they had no idea how to begin to teach someone how to breastfeed, because to them it was as absurd as teaching a toddler how to walk. In the United States, every mother nursing in public seems to be draped in some sort of beautiful nursing cover and learning by book and prenatal class may feel like our only options.

Create Your Own Little Village

However, there are a few things modern mamas can do to bring some of the natural back to breastfeeding. First, try to create your own little village. Find people who will be your breastfeeding champions. Let them make your food, make your bed, run all your errands and hold your baby so you can sleep. If your well-intentioned cheerleaders are helpful but just don’t have the breastfeeding experience you need, then seek out a professional and a support group. A postpartum doula or lactation consultant does the job that your mother or sister or neighbor would have done in the past, offering the hands-on education and support that used to be a normal part of life. Additionally, most areas have new mom and breastfeeding support groups that offer the invaluable opportunity to share experiences and learn from one another. But most importantly, be patient with yourself and your baby! As has been recognized throughout the ages, needing lots of help and support while breastfeeding is perfectly natural.

In March 2005, the American Academy of Pediatrics issued a revised policy statement on “Breastfeeding and the Use of Human Milk.” The document summarizes the benefits of breastfeeding to the infant, the mother and the nation and sets forth principles to guide the pediatrician and other health care providers in the initiation and maintenance of breastfeeding.

The recommendations include:

  • Exclusive breastfeeding for approximately the first six months and support for breastfeeding for the first year and beyond as long as mutually desired by mother and child;
  • Mother and infant should sleep in proximity to each other to facilitate breastfeeding;
  • Self-examination of mother’s breasts for lumps is recommended throughout lactation, not just after weaning;
  • Support efforts of parents and the courts to ensure continuation of breastfeeding in cases of separation, custody and visitation;
  • Pediatricians should counsel adoptive mothers on the benefits of induced lactation through hormonal therapy or mechanical stimulation;
  • Recognize and work with cultural diversity in breastfeeding practices;
  • A pediatrician or other knowledgeable and experienced health care professional should evaluate a newborn breastfed infant at 3 to 5 days of age and again at 2 to 3 weeks of age to be sure the infant is feeding and growing well.

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Amy Bourne is an internationally board certified lactation consultant. She works in an area hospital and runs a private lactation consulting business in Alexandria., 703-401-5056.