How can I successfully breastfeed?  One of my most answered questions.  Families in our culture have heard so many horror stories about breastfeeding they expect for it to be excruciating and incredibly hard.  They expect failure because most of their friends and family didn't nurse past a few weeks due to pain or had so many "weight gain" issues they "had" to supplement.

The problem is not the mother - it's the culture and care providers and their lack of knowledge and experience.  It takes the RIGHT information and it takes the RIGHT questions and it takes a LOT of support.  I don't always have all the answers, but I do have a lot of resources and I have the perspective that moms and dads need to proactively seek MULTIPLE answers UNTIL breastfeeding works.

Before we get into this... let me just say that if you're not a link-clicker - start now.  There are some goodies embedded in this post!

So, how can you make breastfeeding work?

1. Learn about breastfeeding.  If you are not aware of the biological needs of a baby AND you're not completely confident with your abilities and your gumption to seek help as much as possible until it works, then you need to read and watch a lot.  Dad needs to learn, also!  Dad will be a significant factor in the breastfeeding relationship because he will motivate mom (or not).  He will get support or he'll grab formula when things get tough... We want him to reach for the support, right?!  If you are not aware of how your birth choices (from home/hospital, to care providers, positions, and medications) influence breastfeeding then you need to keep learning.  Don't make your culturally-influenced lack of information the reason to choose formula.  Some recommended resources are: www.kellymom.com, http://breastfeedinginc.ca/, Breastfeeding Made Simple, and Ina May's Guide to Childbirth.  There are a ton of places you can search for information and many great books - but most I gear more towards counselors than families because I want families to find what they need and enjoy the information in a quick format.
2. Know who and what is available close to you.  You can contact Dr. Jack Newman through his website.  You can e-mail me.  You can join a breastfeeding community through Kelly Mom on Facebook.  However, you need to have PHONE NUMBERS and E-MAIL of people IN YOUR AREA.  Multiple numbers.  If mom doesn't want to call, but she has questions, it is DAD'S JOB TO CALL!!!  If there are questions, get help!  You need numbers for people available after 5:00pm and in the middle of the night.  You need numbers for people who are available when someone doesn't pick up their phone or isn't available.  You need numbers for people to get a second opinion because sometimes its just a matter of semantics to make it work.  You also need to know the DATE and TIME that your local breastfeeding support group meets.  Whether that is the MOV Esali Birth Breastfeeding Social, a La Leche League group, or whatever mom group KNOWN for their QUALITY breastfeeding help THAT RESULTED IN BREASTFEEDING WORKING - you need to know when and where they meet in person and nurse their babies and help with breastfeeding specifically.  This has nothing to do with certifications, businesses...etc. - it is whomever provides you with support and QUALITY information and multiple available until it works.
   
3. Use laid back breastfeeding with baby belly to belly.  Cradle positions are great for older babies - and sometimes new babies - but they tend to put baby's head towards the side of mom's body which causes baby's chin to tuck... and just like its hard for you to drink with your chin at your chest - babies are just tiny humans... its hard for them, too.  Pull baby closer to your middle.  Stop propping yourself up with pillows and breastfeeding wrap pillows...etc.  If breastfeeding is legitimately working for you and easy (especially if you're nursing well in public without all those pillows), great... but sitting up and leaning forward tends to cause baby to roll away and not get a deep latch.  Baby should be belly to belly (skin to skin helps) and often laid on top of you or at least with you leaning back instead of sitting up straight or forward so they do a lot of the work and latch deep.  Use whatever position works for you and baby - but, make sure baby's head is back when he's latching AND to stay latched and belly to belly to help avoid pain.
4. Mouth open, lips flared.  Baby will typically come onto the breast asymmetrically - but it is a pretty quick movement of pulling the baby close to you.  The key is waiting until their mouth is open wide and sometimes it helps to hold your breast until you both really get the hang of it or baby gets older.  Just be sure you're bringing baby TO YOU not moving your body to the baby (this is where laying back really helps or baby will pull off, cause nipple pain, and/or your back will start to hurt).    What is most important - even if the initial latch on wasn't smooth - is to make sure baby's tongue can reach the sinuses to compress the milk into their mouth.  If their lips aren't flared, the latch will be shallow and nipple pain is sure to follow.  Remember, babies BREAST feed they don't nipple feed.  It doesn't matter what your nipples are shaped like, if baby is latched well the nipple gets worked around... though inverted or flat nipples may have adhesion that release in the first weeks of breastfeeding.
5. Watch for baby getting milk.  It isn't the ears or even a sound.  It isn't weight or a time.  Breastfeeding works when baby gets milk and mom is comfortable.  Baby will nurse on your breast and their mouth will look similar to the way yours does when you fill up your mouth with a straw.  Nuuuuuuurse, quick pause-swallow..... nuuuuuuuuurse, quick pause-swallow.  Get a glass of water with a straw.  Wrap your tongue around it, close your lips with your tongue slightly sticking out - now draw the water up the straw.  Notice what your chin and mouth do... that's what little humans do when they drink, too, facilitated by suction.  Now, tuck your chin to your chest and try to repeat drinking.  Maybe you drank, maybe you didn't.  If you swallowed - I bet you received a lot of air.  You might be getting something to drink, but your belly is going to hurt soon - a little "colicky" - and you might even feel like something is going to come back up if you drink too much.  Little flutter sucks might bring the milk down at the very beginning and also allow baby comfort after they've filled their belly, but if you did this with your straw - you wouldn't get much to drink, would you?  Baby should quickly move to this rhythmic pattern once initially latched on to the breast.  If you're engorged or baby isn't latched deep - baby might not be able to bring the milk down (see step 6).  You need to KNOW what to look for so that when you're home you KNOW when baby is getting milk.  THIS is how mothers get confident.  You can fumble through the mechanics - but when you SEE your baby getting milk, your confidence simply builds and then you don't feel helpless.  You know to remedy the situation until it works.
6. Use breast compression.  If baby doesn't have this nurse-pause-swallow pattern and/or baby quickly falls asleep at the breast - take your thumb on top and your fingers on the bottom of your breast and squeeze until baby gets into this pattern.  When baby starts the pattern, stop.  When baby stops the pattern or falls asleep, repeat compression.
7. Don't use pacifiers or your finger.  Babies need to nurse.  Babies and mommies learn to breastfeed by breastfeeding.  Your artificial nipples are only reducing your milk supply and making both of you learn a fill in and a non-nutritional approach that doesn't include any antibodies and will eventually lead to not nursing, milk supply issues, pain and pretty much every issue anyone has with breastfeeding.  Most nipple shields do the same as well.  NEVER use a nipple shield without continuous support until breastfeeding works.  I've never met a mom that has used a nipple shield and didn't experience milk supply problems or early weaning or breast refusal (if not all three).  If breastfeeding isn't enjoyable in some capacity - get help until it works.  Pacifiers are not the answer.  Babies nurse a lot - and a baby with unlimited access to the breast WILL get milk and WILL learn to nurse. If baby is _______________ (nursing often, too much, pacifying, falling asleep, hurting you, "colicky"...etc.) then you need help.  Long ago - before societies saw a lot of breastfeeding problems... before people started living isolated lives... when they were simply gathering food and nurturing their families... mothers sat together and saw babies nursing from when they were children.  They saw toddlers and children nursing.  That's what they did every day.  They grew up KNOWING and they became a mother with CONTINUOUS KNOWLEDGE AND SUPPORT.  YOU have to create that because our culture is not setup that way.  Asking for help doesn't make you less of a mother - it makes you a wise mother  that knows what to do to make breastfeeding work.
   
8. Check for Oral Restrictions.  This is also one of those areas that you need a qualified person to check for oral restrictions & tongue/lip ties.  This is also NOT the first step in breastfeeding success.  Having another person just tell you to get your baby revised without physically supporting you is not the best way to counsel a mother.  Ties are just one kind of oral restriction.  Many babies growing in our sedentary modern culture and birthing with women that are not physiologically supported have tight muscles and ligaments as well as cranial pressure that contributes to decrease in cranial and oral nerve function as well as shape of the mouth.  Unless there are clearly visible tongue or lip ties, bodywork is the best place to start.  You also need good breastfeeding support AFTER a tie (lip or tongue) is revised and continue bodywork.  Tongue ties cause a LOT of problems; however, baby will need therapy from a speech therapist, craniosacral therapy, massage, or a chiro adjustment...etc. to loosen tight muscles around the neck, jaw, shoulders...etc. to release from being cramped in the womb, being in a less than optimal position in the womb, or from being pushed on during birth or often pulled on during birth....  the release allows their tongue to move and untuck and allow a sufficient latch.  If baby needs a tie revision, they ALSO need body work because a tie will cause tight muscles in and of itself.  Sometimes a tie revision alone will not fix anything because of these tight muscles.  Sometimes a tie won't fix anything because what really needed to happen was positioning and breast compression.  Tie revisions help a lot of moms, but you need to get one on one breastfeeding support FIRST and possibly from multiple people depending on the experience of the person helping you.
9. Use a supplemental nursing system or spoon or a cup.  Don't use bottles.  Don't supplement unless you've exhausted steps 1-8.  Supplementing while at the hospital and/or during those first few days before your milk even matures is ludicrous.  Your baby's stomach is small and can't handle a lot of food.  If jaundice is a concern GET BREASTFEEDING SUPPORT ASAP!  Taking baby away from mom to limit nursing or supplement will only increase jaundice risks and increase breastfeeding failure incidences.  Babies can be spoon or cup fed AFTER this initial period ONLY IF they NEED it because steps 1-8 have been exhausted.  A supplemental nursing system is a No. 5 French Feeding Tube that you lay beside your breast and into a bottle/container of milk so the baby HAS TO LATCH to supplement the breast.

OK, so there you have it.  Set yourself up for success.  Know who to contact and DO IT.  Learn when baby is getting milk.  Repeat over and over and over again UNTIL IT WORKS!