I was stumbling through the internet today and came upon a mother in waiting with breastfeeding questions.  She asked five questions, but all of them were the same.  “CAN I BREASTFEED IF…?”  I tried to answer, but my response was too long, so I put it here instead.  Enjoy. 

My first word of advice is to find a good lactation consultant.  It helps to have someone who you can talk to, who listens to you when ask questions and can help you find real world solutions to your real world issues.  That said, I love to answer questions about breastfeeding and will gladly try my hand at yours. 

“Can I breastfeed if…?” This is perhaps the most common question I get from pregnant women.  The answer is simple, YES.  You can breastfeed even if you are infertile and have never been pregnant.  You can start breastfeeding one month after the baby is born because you change your mind.  You can breastfeed adopted children and other people’s children.   You are a mammal and the only biological reason for having breasts is to nurse your offspring.  That said, there are things that are known to throw up barriers to breastfeeding, actions that work against your efforts and make all but the stout hearted mother throw in the towel.  A new mother is sore, frightened, filled with doubt, tired, and just plain vulnerable.  Often left alone to her worst fears she reaches for the only “safety net” she can think of, the bottle.  And that is where the trouble starts.  Almost every obstacle can be overcome but the recommendations made by lactation consultants are an attempt to prevent these obstacles and make things as easy as possible for every new mother.      

1.  Can I successfully breastfeed with medical interventions during delivery?  Yes, but for every intervention there is a price to be paid.  While many interventions (fetal monitoring, artificial rupture of membranes, intrauterine pressure catheters, etc…) have no effect on breastfeeding, others affect breastfeeding in hidden insidious ways.  Some are obvious; Narcotics in the blood stream pass to baby and make it very difficult for your baby to breastfeed for the first 1-2 days because he is literally high as a kite.  Epidurals seem to have a similar affect although not nearly as powerfully and the literature is conflicting (principally because the studies are measuring several different things in different ways and attempting to answer the same question, don’t get me started), just take it from a midwife and lactation consultant who has helped thousands of new mothers breastfeed, there is no comparing the baby born of natural childbirth to those born from medicated births.  Some are more insidious; mothers who take more than 3 liters of IV fluid have babies who are more likely to lose more than 10% of their birth weight which leads pediatricians (and mothers) to worry that the otherwise healthy infant isn’t eating, even if it is obvious that he is.  Simply put, every intervention is a potential barrier to breastfeeding, the fewer you allow to be placed in your way, the easier breastfeeding will be.    

 2.  Can I bf even if I don't co-sleep?  Yes, not everyone co-sleeps.  Although technically I think the term you are looking for is “bed-share”.  The difference is small but important.  Co-sleeping means the baby is nearby (perhaps a cradle next to the bed or a side-car sleeper connected to your bed).  Bed-sharing is sleeping in the same bed, most women bed-share with their husbands and many choose to co-sleep with their infants.  That said, studies show that women who sleep with their infants in the same bed breastfeed easier, sleep deeper and are more rested upon waking, and interestingly enough are more alert while sleeping.  It is a paradox that the mother (I frequently refer to mothers as super-human) can sleep both deeply and alertly and wake feeling refreshed.  Can you breastfeed when your baby is in another room, certainly but you have to wake more fully to go get him and sleep less soundly which makes you more fatigued during the day and that makes everything more difficult.  So yes, you can, but it just makes your life harder.    

 

3.  Can I bf, while still offering bottles of expressed milk?

 Again, of course you can, but bottles of expressed breastmilk are detrimental to breastfeeding success for most women and until you become a cow they are just plain hard to come by.  It is important to understand that the bottle is not the breast.  Bottle fed infants often take in much more than they need or want (did you know a newborn’s stomach is so small that it only holds one teaspoon?).  That is because gravity feeds the bottle fed infant, not the infant.  The infant must swallow or drown, and that is why they vomit so often.  While certainly, spit happens, it happens far more often on a bottle fed infant and primarily due to over feeding, not the liquid that is fed.  That over feeding wastes precious milk and leads mothers to think that the baby wants more than the mother can produce.  This is coupled with the fact, as I alluded to before, you are not a cow.  A woman’s breast is complex and I can’t just hook you up to a milk machine and make milk come out (believe it or not).  Pumping is no substitute for breastfeeding and many (dare I say most), will find they get out less than half of what is actually in the breast.  Some women are pump depended, and some can pump very well, but many find that pumping is difficult and depressing.  So yes, you can offer expressed breastmilk but it is difficult and puts a barrier in the way to successful feeding. 

4.  What should I expect in those first few weeks?  I forget what it was was like or more likely, I blocked it out.

Many women will tell you that the first few weeks are difficult.  I am frankly baffled at that idea.  The baby sleeps up to 20 hours a day, how can we possibly not get enough sleep?  Now, before you get offended, “You’re just a man, how can you possibly know?”  I am the father of 8 children, I am a midwife (not a mid-husband), and I am an IBCLC (lactation consultant), mothers and babies are my life.  What I find is that being a mother is not difficult, you are super-human, you have super powers that make mothering rather easy in the first few days HOWEVER, most new mothers do not allow themselves to only be a mother.  The first few days are an endless stream of visitors and well wishers, doctors, nurses, audiologists, pediatricians, in-laws, out-laws, cousins, neighbors, Facebook posts, tweets, phone calls, and every other person under the sun.  It is that never ending stream of visitors that makes life hard on the new mom and dad, not the one little baby.  I recommend that new parents forgo the world, close the door with a “NO VISITORS” sign and tell everyone to leave them alone.  Tell them that if they really care about you and your baby they will leave you alone and bring you a hot dish next week.  Your baby needs to spend as much time on your chest as humanly possible, preferably naked and skin to skin.  He will attempt to suckle up to 10 times an hour.  It is very much like a child learning to play the piano by practicing scales.  They don’t make music, they learn the basics first and the music comes later.  But when baby sleeps, mommy and daddy sleeps.  Sleep in shifts, it takes two people to make a baby because it takes two people to take care of a baby.  If you already have children, you are a more prepared set of parents and it will come even easier to you, you can tag-team the newborn and the other children.  Believe me, I know, from which I speak.   

5.  Do I have to be completely attached to baby 24/7?  A shower alone or a walk with Isabella sound pretty important to me?

Again, no, but it sure makes life easier if you are.  Let’s take a look at the animal kingdom for a second.  What happens if you take a gorilla’s baby away?  They lose their mind.  This instinctual need to be near your newborn makes mothering very easy.  You don’t have to be joined at the hip, of course you need time to pee, and a shower sure feels wonderful after a hard night.  But keeping separation to a minimum in the first few weeks of life makes everything easier. 

My biggest problem in the hospital is that mothers do not hold their babies unless I give them permission to do it.   It seems odd and even counter-intuitive, but it is true.  I am frequently called to help a new family with breastfeeding and almost every time I walk in the room someone else is holding the baby.  Baby is wrapped tightly and in Grandma’s arms, auntie’s arms, daddy’s arms, all those “well wishers” who do nothing but make your life miserable are holding YOUR baby.  

Often the baby is wrapped up like a burrito and stuffed in the Tupperware drawer (the bassinette), and no one is holding the poor thing.   When I ask mom why she isn’t holding her baby she often (no kidding) will say “I didn’t know I could.”  That is your baby!!  He isn’t the responsibility of the nurses or the doctors, he is yours, you had him, you will raise him, do with him as you please.  We are visitors in your world, not the other way around. 

All questions about “ownership” and parental rights aside, let’s get down to brass tacks.  How can your baby learn to breastfeed if you never let him practice?  It is like hanging him from the ceiling and wondering why he doesn’t learn to walk.  So yes, babies need to be held, they are miserable when they are not in their mother’s arms.  Yes, you can leave him with daddy or grandma for short periods of time, but ultimately you are the only one in the world who can give him what he needs.  You are the only one in the world who can offer him that life giving nourishment.  Just like only mommy can push him out, only mommy can bring him up.  Love him, hold him, and everything else just naturally falls into place.