Friday, February 11, 2011

On Call with Dr. Dora Suldan, MD

Breastfeeding, the most natural way to nurture your baby, can pose challenges for first timers!

Dr. Dora Suldan, Pedimedica’s “parent resource” for breast feeding families and mother of three, can coach you through the ins and outs and get you over any bumps along the way.

As a resident in pediatric training, before having kids of my own, I had an idea that I would breastfeed my kids, because it would be the healthier choice for them. I didn't realize, until my first child was born, however, that breastfeeding her would become so important to me on a personal level. Intellectually, I can talk about the fact that breastfed babies are better protected from infection, may have better fat metabolism, and therefore, healthier cholesterol levels in later life, have decreased risk of chronic conditions such as diabetes, celiac disease, allergies and some cancers, or even do better in school. There have been studies showing that breastfeeding for at least two years over a woman's lifetime, can lower her own breast cancer risk as well. There are no guarantees, however. My own twins, never tasted formula and were home with a nanny, but still got their first ear infections at 5 months. Nevertheless, the benefits of breastfeeding are well known and documented in numerous studies, and since we want what's best for our kids, we choose to breastfeed.

One problem, I find, is that people have expectations for their breastfeeding experience that may be unrealistic. It's natural, right? So it must be easy! Nothing could be further from the truth. It hurts the first two weeks, even if the baby latches on properly. The first month or so, you are exhausted from a baby that wakes frequently (breastfed or not) and there doesn't usually seem to be enough of a schedule to let you catch up. Oh, and the advice to sleep when your newborn does, isn't particularly helpful, if you are home alone with a toddler too. When is mom supposed to eat, get dressed, take a shower, feel like her own person again? Just wait. If you get to the two month mark, and latch, supply, and growth issues have been resolved, when you catch that adorable milky smile as the baby finishes a feed, you'll never want to stop. OK so I exaggerate the part about never stopping, but I think you know what I mean.

Lets address some troubleshooting issues with the nursing experience. It starts before the baby is born. Reading about breastfeeding helps. I would recommend reading several books. If you do that, you will realize that each may have a slightly different point of view. That knowledge alone, is helpful when the baby is born, and you start to hear different advice from various sources: doctors, nurses, relatives, and friends. Not everything is dogma, and if you hear different bits of advice, you won't panic that you are not doing things exactly so.

My experience as a pediatrician is that most babies that receive formula in the hospital tend to wean earlier than their parents may have intended. Often it is an issue of supply. Normal nursing involves feeding TEN times a day. Too often, I see a mom that nurses 3 or 4 times, then gives formula, because, “There isn't enough milk.” The way your body knows to produce the milk, is through release of oxytocin in the brain, alerting the breast milk glands to produce more milk and to later release it through the milk ducts. The breast has receptors that are stimulated when the baby feeds. Thus, when the baby nurses more often, more milk will be produced. If the baby is offered formula, he or she doesn't feed as often on the breast, and you miss the opportunity to stimulate the supply. Unless you are going to pump at the same time that you give a bottle, your body won't know that there is a baby that needs more milk. Why sit hooked up to a pump, when you can have your adorable infant in your arms instead?

Some moms have been advised to pump to see how much milk they have. I don't recommend this in most cases. Pumping and only seeing a few drops of colostrum would tend to discourage most people. Also, a baby that latches well can more efficiently get milk out of mom than even the best of pumps. The colostrum that arrives initially is lower in volume than the milk that arrives later, but it is packed with all the nutrients the baby needs. As long as the baby has at least 1 wet (urine) diaper the first day, increasing by one a day, and at least one bowel movement daily, your newborn will get enough milk. Babies are born with excess water weight. They can lose up to ten percent of their birth weight in the first few days, but generally gain it back by two weeks of age. Rest assured, that your doctor will monitor the weight gain and feel free to discuss your concern at those frequent newborn visits.

Finally, remember that you will produce enough as long as you feed frequently. Thus, a mother of twins can produce enough to exclusively nurse the twins, because the body gets double the stimulation when she nurses twins. It is helpful to switch sides. With a single baby, nurse longer on one side, then “top off” on the other. Next feeding will start on that second side. With twins, you might want to feed each twin per side then switch for next feeding. Don't be scared to ask for help. A lactation consultant can help by working with you if there is a supply or latch problem. Sometimes a little intervention early on can make a huge difference in the overall experience and ability to nurse for a longer time period.

So what's Dad's role in all of this? Remember, Mom just gave birth and her body needs to recover from not just the childbirth itself (abdominal surgery in case of a cesarean delivery), but the 9 month gestation as well. Now she is also producing milk for your baby. Fathers are instrumental in the breastfeeding process. Avoid company that will not actually help you. If someone will come over to cook a meal, fold laundry, and you are not uncomfortable nursing in their presence, welcome them with open arms. If, however, Mom will feel pressured to entertain the guests while they hold the baby, and she thereby misses opportunities to feed, that will be counterproductive. Dads can run interference with the friends and relatives. Fathers can also pick up the slack on things Moms may otherwise feel obligated to do. If pumping is necessary, Dad can give the bottle, and/or change diapers while Mom pumps. That way there is some chance to “rest” during this hectic time. Mom nurtures the baby with her milk; dad nurtures the whole family with his help in the process.

As for the older siblings, breastfeeding the newborn provides important learning opportunities. We want our older kids to eat healthy, and we model this by showing that Mom and Dad are doing everything possible to make sure the new baby gets the healthiest nutrition as well. Even toddlers can be enlisted to help “their” baby by bringing a burp cloth, sitting with Mom or otherwise “helping,” by alerting you if the baby spits up. Having sibling involvement can improve their relationship with the baby. Just as, “It takes a village to raise a child,” it takes a family to nurture a newborn.

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