Boobies 101 - for mommas who intend to nurse

Okay - so this thread will be for info & questions for mommas getting ready to birth & breastfeed. YAY!

First things first...
PLEASE know that whatever happens - there is no such thing as succeeding & failing. The ONLY failing is failing to try. What you try to focus on is setting goals for yourself with nursing & then meeting those goals. Sometimes we easily meet or exceed goals in life & sometimes we end up realizing that goal may not have been realistic in a given situation.

So arm yoruself with knowledge & preparation & you are MUCH more likely to meet whatever personal goals you have set.
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FIRST THIS FIRST!!!!
Pre-Baby breast & nipple check!
What? Never heard of it? me nether - but it SHOULD be part of your regular pregnancy care....and I'll tell you why.
DO NOT try to "toughen up your nipples" . If you've never heard of that, good. If you have, ignore it. It does nto help & is actually shown to cause more problems that if you leave well enough alone.


Onto checking. Have your breasts grown in pregnancy or stayed close to the same? Do you have cleavage where your breasts start off touching each other in the middle or is there a gap? Could your breast shape in ANY way be described as "tubular"? Now is a good time to evaluate this. This *could* indicate hyoplastic breast tissue & is associated with a higher risk of low supply. This does NOT mean you will have low supply, nor does it mean there is nothing you can do. There are some EXCELLENT herbal helps for this - the best one I know if is goats rue. You can get a great galactogogue (a substance that helps promote lactation) from motherlove with goats rue in it called More Milk Plus Special Blend. I will warn you though, it is known to permanently make breasts larger, as it promotes the growth of breast/ductal tissue - which is good if you need that - but can be undesirable for larger chested mommas.
http://www.motherlove.com/product/580-More-Milk-Special-Blend.html

Onto nipples...now we need to check for nipple inversion as it is MUCH better addressed BEFORE babies arrives. So if you already known your nipples are inverted, great. If you aren't sure, stimulate your nips - do they stick out, pull in, or do nothing? Then squeeze your nip about 1 ince behind the nipple - in the areola section & check again. If they do not stick out with BOTH tests - you ahve some level of flat or inverted nipples. This is NOT anything that will keep you from nursing, but it does make latching harder & often painful & *can* be addressed BEFORE baby comes to make early latching easier.
What can you do? Get something like these: http://www.amazon.com/Supple-Inverted-Nipples-Breast-Feeding/dp/B001ARH6H2/ref=pd_sbs_ba_6/190-4754544-5456821 and start using it ASAP. You mght find it helpful, if you don't plan to buy apump to also use something like this to help draw the nipple out first: http://www.amazon.com/Lansinoh-LANSINOH294983-Latchassist-Nipple-Everter/dp/B00112EIWW/ref=pd_sim_ba_1

Other than that - those are the only tow possible true physical "prepartions" to make - everything form here on out will be MENTAL preparation.  

When you say cleavage touching, does this mean with or without a bra?

I'm so glad I didn't bother trying to "toughen up" my nipples like my mother swore by this time lol it didn't do much last time :/

Quoting NevviesMom:" When you say cleavage touching, does this mean with or without a bra? I'm so glad I didn't bother trying ... [snip!] ... so glad I didn't bother trying to "toughen up" my nipples like my mother swore by this time lol it didn't do much last time :/"

I mean braless - as in can you feel bone between the breasts? (and BTW you CAN on me - I have a huge gap & I was able to nurse, bu tI di ddo a LOT of galactogogues with #1)

The "best start"...

When it is possible, let your care providers know of your preference to breastfeed immediately after delivery. Also tell them you want no formula, sugar water or binkies offered. Babies have an amazing inborn desire to latch when they are just born & alert & wide eyed. A great example of this is the video the breast crawl. If you've never watched it, you should. It is beautiful & eye opening if you've never seen a baby, just born, crawl across momma's belly to her breast & latch itself. It also gives an intimate look at normal early latching behavior. I absolutely think this is WHY my 1st had a good latch - he was awake, alert, just born & latched himself on. I had zero pain with him despie having a severe tongue tie even (whcih I had nothing done for since it never interfered).

If for some reason that is not possible, do not fret. It is easiest to do it that way, but that doesn't always work out.

Quoting justanothamotha:" Okay - so this thread will be for info & questions for mommas getting ready to birth & breastfeed. ... [snip!] ... are the only tow possible true physical "prepartions" to make - everything form here on out will be MENTAL preparation.   "

can you buy the supplement at a drug store?

Quoting *~* Superwoman *~*:" can you buy the supplement at a drug store?"

That one you can IF you have one in your area that stocks it. You can all the company 970.493.2892 and they can tell you if there is a retailer in your area that stocks it. When I have dealt with them I have just had it shipped as the closest store to me is an hour away. :/ If you live in or near a big city you may be able to pick it up locally. They are most often stocked by health food stores, but there are pharmacies as well that stock their products - it is more likely to be a local independent pharmacy though rather than something like Rite Aid.

Understanding the science behind milk production & how decisions in the early days & weeks directly impact overall milk production.

Breastfeeding is all about biology. So there are "biological rules". If you want good production, there are the crucial rules to live by in the first 8-12 weeks (and the earlier you are, the more critical they are in avoiding additional problems).

1 - Nurse early & often.
2 - Skip the use of bottles & binkies whenever possible until 4-6 weeks.
3 - Do not watch the clock, watch your baby
4 - If it hurts, it's a PROBLEM not a test of endurance (either latch, nipple damage from prior bad latch, tongue tie, or infection) GET HELP ASAP


1 - nurse early & often - Nurse as soon as you can after delivery & at ANY hunger signs. Crying is a late hunger cue. It is easier to latch if you attempt to feed baby before baby is so hungry he/she is crying. Hunger cues can be stretching, fist sucking & mouthing/tongue thrusting. In the first 28 days go no longer than 3-4hrs max between ANY two feeds & get in at LEAST 8 feeds/24hrs - perferably 12 or more. This helps mature milk come in faster & once it does, it helps to build supply.

2 - skip bottles & binks until 4-6 weeks - If you must, you must, but if you can possibly avoid it, do. Nipple confusion & bottle preference is a very real thing. Even if it didn't happen to you before or your friend had 3 kids & none of them had it - it does happen. Some babies will do just fine but getting stuck with a baby that is refusing to nurse is NO fun for anyone & greatly reduces the chance you will be able to nurse. And you can't predict which baby will do it until you are already in trouble. So if you can just avoid it in those early weeks, you can most often avoid the complications it *can* bring. If baby needs to be fed away from breast, a
or
is a better option at avoiding latch issues. Also if baby is not being breastfed due to latch issues, the bottle is the LAST way you want to feed them as that will only exacerbate any current latch issue.

3 - Do not watch the clock, watch your baby - This means it does not matter if it is only 20 mins since last feed - if baby is cuing for hunger, feed baby. Newborns often have very erratic feeding patterns early on. Offer both breasts at every feed in the first 4weeks, but just let baby decide when to come off the breast. Once baby does, burp & then offer side #2 if baby wants it. How long baby stays on either side does NOT matter. So again, watching the clock doesn't matter, your baby will tell you EVERYTHING they need to tell you in behavior and in their diaper. Ewwwww. True though. You pee & poop out what goes in...so baby should have ONE wet diaper per day for every day they are old until about day 5 & from there on out you are looking for 4-6 per day. So 1 on day 1, 2 on day 2 & so on. They MUST poop daily in these early weeks & if they do not, see a lactation consultant ASAP. By day 3 the poop should start to lighten up & become a characteristic mustardy color with a few curds in it. If your baby has dark tarry stools after 4 or 5 days, you NEED a lactation consultant ASAP. By the end of week 1 you should expect 2-3 good poops daily & 4-6 wets. (However - after about 4 weeks - the bowels usually makes a big change & babies will go many days without pooping - 7-10 days. This is NORMAL. Afterward your babe may return to pooping often or stick with pooping once a week, every 4th day, every day or whatever pattern suits baby. It is ALL normal). The point is - if you feel anxious about what baby is taking in - count diapers. It helps you avoid clock watching.

4 - If it hurts, it's a PROBLEM not a test of endurance (either latch, nipple damage from prior bad latch, tongue tie, or infection) GET HELP ASAP
Pain is NOT a "normal" part of nursing. Read that right though. It is NOT that I think mommas are faking it or that pain doesn't happen - I am saying it is not "normal biologically"...it is caused by lack of education, support & correction of latch issue early & swiftly. I have had pain too - it was a problem, not something to simply put up with. So not endure until you "toughen up", pursue an answer to it & a correction for it. The earlier the better. You can find an IBCLC here: http://www.ilca.org/i4a/pages/index.cfm?pageid=3432 ANYWHERE in the world just about. You can contact your local La Leche League here http://www.llli.org/webus.html (AGAIN anywhere in the world) or call them 24/7 for free help over the phone at a toll free call 1-877-4-la-leche.

Dad's support impacts outcome....

How can dad help? http://www.lansinohprofessional.com/patients/tips-for-dads

And getting dad on board is really important. So if you haven't had a talk with your Dh/So about how important nursing is to baby's health & yours - now is a great time to do so!!!

I love this, wish it had been made when I was pregnant.
You should add expected hurdles that you will come across, such as cluster feeding, feeling like you don't have a supply, nipple confusion and problems leading from supplementing, tongue tie in infants etc etc.
Oh and I wish I'd read this when I was pregnant too:
http://theleakyboob.com/2011/08/baby-explains-normal-newborn-behavior/

This so AWESOME. These are fabulous tips for breast feeding moms. I wish I could hand a print out of this at our clinic.

Quoting nursemaya -mommy to 2:" This so AWESOME. These are fabulous tips for breast feeding moms. I wish I could hand a print out of this at our clinic."

Can you not because it's BG? If it's just about me - feel free to take the info. I just typed it out - it isnt' taken (no copy & paste) from any other sources...so there is no copyright issue there.

Also mention how important it is not not supplement in the first few weeks and nurse, nurse, nurse!!
In the first few weeks after birth your breasts grow special nerves called receptors, they sense prolactin release (the thing that's really important for milk production.) The more you feed in those first few weeks the more of these receptors are made, the more prolactin is detected and the easier and better your breasts are at sensing how much milk you need, regulating and upping your milk supply.
A lot of pregnant women get it in their head that they will not produce enough (I know a lot of friends and I were having a talk about it when our LO's were first born) as they have heard various stories from people, then that worry is worsened when their babies go through growth spurts and feed non stop, they feel they are not producing enough, it's important to make a point that only something tiny like 5% of new moms won't produce enough and that every baby feeds tons to build supply, it doesn't mean there isn't any milk!

Love this! Thanks for all the helpful information!!

HOW MILK SUPPLY WORKS

When a baby nurses they have a specific jaw movement they do that is kind of like a sock puppet talking. lol They open & shut (not shut - but semi-close) their jaw in a rhythmic way along with the suckling. This is one of the reasons that pumping is often hard to maintain even when done regularly as compared to nursing. This compression of the areola compresses ducts found behind the areola that send signals to the pituitary gland. The pituitary gland is what controls your prolactin levels. Prolactin levels (as it s sounds pro - lact - in) promote lactation. Milk removal also helps to trigger this (thus why pumping does work (and it works better for some than others).

The more often milk is removed, the higher the levels go. You have more surges in prolactin from frequent nursing & pumping than from longer nursing sessions (or pumping). This is why scheduling feeds is not recommended AND why babies in growth spurts will drive you bonkers nursing every single hour or more as they try to up your supply.

One thing that is NOT often explained it was brings prolactin levels down....breastmilk contains special amino acids that are called supressor peptides. The SP's do very little if baby is fed frequently & milk keeps flowing. However, if you skip a feed or delay it & stay engorged, the milk is setting in the ducts. The longer it sets, the more of these SP's are getting reabsorbed by your system. These SP's then send a chemical message to your pituitary that you are making "too much " milk (since it is just setting around) and it lowers your prolactin level, this down regulating milk supply. This is a GOOD thing. When you are done nursing, this is what will dry you up. When you are actively nursing, this protects agains tissues like plugged ducts (although it isnt' fool proof obviously, since those still happen sometimes).

The point in telling you all this is so you understand how what YOU do effects what your boobs do. So if you delay feeds (maybe by supplementing or using previously pumped milk) and you don't pump - you risk not only getting a plugged duct, you risk down regulating your supply because your body doesn't know *why* you didn't remove milk, it just knows that it made "too much" so it *tries* to "fix it" by making less. And in those early weeks, this can happen VERY fast for some mommas. The good news is, you can get back to where you were, teh bad news is that it's not fun to do it - which usually involves a fussy baby due to slow milk flow & maybe some extra pumping between feeds when you are already tired. It makes that 4-5 hr nap a LOT less rewarding when you spend 2 days struggling after to get back on track. :/ It will not always be so touchy as it is early on, but those first few weeks are tough.

STUFF YOU MIGHT WANT TO HAVE

Nursing bras - I hate them. Many moms loves them & you may. I don't love bras in general though, so that is an issue for me. LOL I bought some, used them early on & then quit. If you are pregnant - buy 1 number up (so if you are 34, buy 36 & go up 1 cup size from where you are at pre-baby. Do not stock up. Your breasts will peak in size in the first two weeks & then start to settle. You don't want 6 bras that fit awesome for 2 weeks & then are useless. Once baby is here you can buy or order more.

Nursing Tanks - Very similar to nursing bras, but less restrictive around the center IMO. I just don't like to fuss with the clasps - but larger breastfed women often NEED a bra or tank bra of this type for proper support & comfort.

Instead of those I found that *personally* (I am smaller chested) I preferred a tank from regular clothing that had a slight padding (helps cover leaks and disguise the outline of a breastpad and that has a built in shelf portion. They most often come with underwires & I just cut that out. When my babies were bigger & leaking was infrequent & light, I could skip wearing a breastpad & the foam in there was enough to prevent me from leaking through *if* a small oops happened. I just found I could buy those by the dozen for about what a good nursing tank seemed to cost. They also cover your belly if you are lifting a shirt to nurse & if you own them in a ton of colors, no one can even see that it's a tank. I have them literally in the rainbow...so if I want to wear a teal shirt, I have a teal tank that goes under it.

Nipple cream (most common seems to be medical grade lanolin) - everyone knows the name Lansinoh - but you can get others. You can also use olive oil, coconut oil, Mother love herbal makes a vegan one (no animal products) tha tis all organic. I end up plugging them a lot - but it's only because they carry stuff & make stuff that I don't know where else you can get it. If anyone does - feel free to share! I am not affiliated with them in any way - wish I were, I end up advertising for them I guess.  

Nursing pads (disposable or washable) - not much to say here. Washable is great because they save money & I thought they felt better. You can make your own super easy if you sew. I didn't even bother to make mine cone shaped after a while....that IS nice on new nips though. For disposables my personal favorite is Johnson & Johnson. Whatever you do - change often. Keep your nips dry. It helps them heal if there is any irritation AND it helps prevent yeast growth. If you can leave the girls hanging out to air dry as much as possible DO. It's the best thing for early nips. I just tell people to think of my house like Africa. Well not everyone just the females. I don't actually leave the girls flopping for my dad or FIL or anything.

Pumps (manual, electric, dual or single) -First of all you don't NEED a pump, especially if you will be home. If you do NEED one, you will likely need it for work or school, in which case you want the best you can get, seriously. If you are signed up for WIC in the US you can get a FREE loaner that is a GREAT pump, so ask. If not, you can have your Dr write a prescription & some insurances will cover them (you have to go through a durable medical equipment place to get it)...most women say it is the Medela brand to go with. Many swear by the PIS (pump in style ) or swing. I have a dirty little secret that i start there & think the playtex double embrace is better. :/ I know it isn't as durable, but I got about 1/3 more milk output with it....so to me I don't care. It has inner soft flanges that do compressions while pumping that medela doesn't offer & that was much more comfy & much better output & this was after a year of doing Medela. The moral? There is no one size fits all. The ONLY thing I know for SURE - YOU DO NOT WANT TO TRY TO PUMP MANUALLY on a regular basis. It is MUCH harder than it seems like it would be. So if you know you will need to pump regularly - get an electric...do it. Seriously. You WILL thank me. (there will be a much bigger/thorough post on pumping later)

Milk storage systems (bags or bottles) - I used bottles when I was working because I only pumped today what would be used tomorrow & I pumped right into the bottles themselves. For freezers no one will argue bags are the best. Research a bit - some leak more than others. Most are fine.

Bottles & nipples - This requires a different post. I will just say there is NO nipple that helps ensure your baby won't get nipple confusion. The ones shaped more like a breast help a breastfed baby be willing to take the bottle, NOT the other way around. So if you are worried about nipple confusion, don't spend uber bucks trying to avoid it. The bottle nipple WON'T matter - DO NOT get fast flow nipples though. Stick with a low flow nipple ALWAYS if you intend to keep nursing. Faster flow nips ARE known to cause nipple confusion/bottle preference/nursing strikes.

Nursing Covers - Wear one if you want, don't if you don't. They ARE often handy for the early weeks when you are trying to get latch down with baby. They are pretty much a must if you end up using something like a nipple shield. If you want to skip it, then do. If you feel nervous - practice nursing setting in front of a mirror. You will soon see you can nurse your baby with no issue and never show a thing. I *would* recommend the kind with a metal wire in the front so it will stand out away & you have a clear view of baby. Those are much handier than trying to use a blanket & keep it in place & latch a fussy newborn.

Nipple Shields - used sometimes when needed, often because the hospital staff doesn't know what else to do to help mom get baby latched. We'll cover hits in another topic.

Breast Shells - Can be used to help draw out flat or inverted nips - also useful in keeping really sore nips from rubbing against anything, including clothing.

Gel Soothers - kind of pricey, but well worth it. Available at most pharmacies now. They are hydrogel wound care bandages in the shape of breastpads & are AWESOME if you have nipple damage. One set lasts 72 hrs.

Breastfeeding Pillows - Boppy, breastfriend, etc. They are really handy & helpful, not a must. In fact I thought my Boppy was good - then I used it to set on for postpartum healing while tearing through my rectum. BEST.BUTT.PILLOW ever!!!! SO I bought two. I swear to you - best thing EVER to set on for hemorrhoids, so if you got the 'rhoids now, buy yours TODAY - don't wait for baby.

AND THE MOST underutilized tool - BOOKS (I personally swear by The Womanly Art of Breastfeeding)
Seriously - your BEST tool is what you know. The more you are ready for what it will be like - the better you will avoid unnecessary issues, pain & problems. You will still probably struggle a bit - the difference is, knowledge helps ensure you get through it easier & faster & make it to the other side.