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Breastfeeding by Design
Part 2
by Heidi Bingham
All rights reserved. This information is protected under copyright laws.
1998 Heidi A. Bingham

For permission to reprint this article, please contact Heidi A. Bingham,

Now that you understand the "why's" of breastfeeding, let's touch on the "how-to's." These suggestions are consistent with the AAP statement on breastfeeding and are a good start to parenting styles commonly known as Attachment Parenting and Ecclectic Parenting. I will not go into detail on techniques or nursing positions. You can get this information from many good books or experienced moms. Also, these suggestions are for a healthy, full-term baby. If your baby is ill, premature, or hospitalized for any reason, you will need specialized information. I suggest contacting La Leache League International. Also, for the full-term baby in the hospital, read Breastfeeding the Hospitalized Baby by Cyndi Egbert.

You will want to start preparing to breastfeed while you are still pregnant. This entails several things:

  • First, find and befriend other women who can support you in breastfeeding. Look for women who have successfully breastfed their own children. Some will tell you they breastfed, but they only continued for a matter of weeks to a few months. These women really won't be the encouragement you're looking for in the long run. Also, avoid moms and others who insist on scheduled feeding of newborns. Newborn feeding schedules can spell disaster for long-term, exclusive breastfeeding and as a new mom you don't need this type of advice undermining your parenting. You may already know some women in your neighborhood or in your church who will be a great help to you. If not (or even if you do), you may want to consider looking up your local chapter of La Leche League. LLL is the foremost authority on breastfeeding and offers support for breastfeeding mothers world-wide.

  • Second, if you're planning on a hospital birth, check with your OB-GYN or midwife and the hospital where you'll be giving birth to check on their policies and support for breastfeeding. They should encourage exclusive breastfeeding on demand beginning immediately after your baby's birth. They should also encourage natural, unmedicated childbirth as medications can affect both you and your baby, and get you off to a shaky start with nursing. If they are not supportive, keep looking. If you are having a homebirth (I highly recommend it) these things will not be as much of a consideration. Homebirthing midwives are generally knowledgeable in breastfeeding and if you're birthing unassisted, you don't have to worry about anyone interfering.

  • Third, when looking for a pediatrician to care for your new baby (and this should be done before the baby is born), be sure to ask about breastfeeding. You will want to find a pediatrician who is knowledgable about breastfeeding as well as the growth patterns of breastfed babies. The growth charts used by most doctors to track your baby's growth were developed by watching babies fed artificial baby milk (commonly known as formula). Breastfed babies exhibit different growth patterns than ABM babies and your doctor should understand that. Also, you will want to be sure your doctor will not encourage you to switch to ABM at the first sign of difficulty. It takes time to learn to breastfeed correctly, and you will not want to give up too soon. In their recent policy statement, Breastfeeding and the Use of Human Milk, The American Acacemy of Pediatrics recommends that doctors "Promote and support breastfeeding enthusiastically." Continue interviewing doctors until you find one who does.

  • Fourth, you will want to take time to be sure your nipples are prepared. Most women have nipples that protrude. Some have nipples that are inverted or flat, or protruding nipples that retract when the areola (the dark area surrounding the nipples) is gently squeezed. Your baby will need a protruding nipple to grasp when feeding, but if your nipples are inverted, flat, or retracting don't despair. These conditions can be treated by wearing breast shields inside your bra to draw the nipple out. Check with your La Leche League group or specialty catalogs for these.

Once baby arrives, you'll find breastfeeding is a learned art. It begins immediately after the baby is born, continues through a learning period of 2 to 3 months, becomes more comfortable from 3 months on, and at some point tapers off in the weaning process. Each phase will bring its own challenges and rewards to you and your baby.

The First Few Days
Your baby will be surprisingly alert after birth and for up to 2 hours. When baby is placed on your stomach, you will probably notice him nuzzling his face around on you. This is the rooting reflex as he looks for your breast. Help him to latch on (your nurse, midwife or doulah may assist you) and allow him to nurse for as long as he wants. He may fall asleep in the comfort of your arms or he may nurse a while. Either is OK.

After the first feeding, nurse the baby frequently, without concern for the duration of the feedings. Look for signals that your baby wants to nurse: nuzzling, squirming, a little fussing. Do not wait for your baby to cry. According the the AAP, "Crying is a late indicator of hunger." Also, crying returns the newborn's blood circulation to fetal patterns. Allowing your baby to cry before you feed him is not healthy. (See my article on parenting styles for more information.) This is known as feeding on demand, or cue feeding.

You may not think the baby is getting much at first and that's OK. Baby comes with some fat reserves that give him time to learn to nurse and time for the milk to come in. Breast milk is produced on a supply and demand basis. The more baby nurses (demand), the more milk your breasts will be produced (supply). On the other hand, if you limit baby's time on the breast, you are limiting the demand and the supply will decrease accordingly. Failing to establish a good milk supply from the beginning could jeapordize your breastfeeding relationship later.

If you are in a hospital, be sure the nursery staff is aware that you are breastfeeding and instruct them not to give the baby bottles. One bottle can mix up a newborn. It takes a different set of muscles to nurse than to suck from a bottle, and the actions of bottle feeding and breastfeeding are almost exactly the opposite. This can cause nipple confusion in a baby and get you off to a difficult start. Besides, there are very few reasons to give a newborn ABM. My first was given ABM because she had some low blood sugar (a common occurance in infants under 7 pounds). When I had my second baby, I learned this was totally unnecessary unless the baby was showing signs of lethargy. Breastfeeding is also the best way to prevent and correct jaundice in most newborns, so do not discontinue breastfeeding if your baby develops a bit of jaundice.

Once you get home, continue to feed on cue, day and night. Most babies don't distinguish between day and night. It makes little difference to them. This is where your first training opportunity comes as parents. No, I'm not encouraging any discipline or allowing the baby to cry it out, just gentle guidance. When baby wakes at night, keep it dark and quiet. Try laying down to nurse baby. Stay calm. During the day, be sure the baby gets plenty of stimulation. You can play with baby, carry him in a sling, let him lay on the floor and look at some hanging toys. After a few days, when the baby gets over what I call his "sleepy period," he'll get the difference between day and night. Meanwhile, it's important not to stress your little one. Don't jostle or shake him. Don't force him to stay awake and scream when he's all but dropping into an exhausted sleep. Be gentle and compassionate at all times.

Tips for Bottlefeedng
As I noted in Breastfeeding By Desing, part 1 occassionally a mom is unable to breastfeed for various reasons. If you are one of these moms and you are bottle feeding, you'll undoubtedly be tired getting up at night to warm bottles. I noticed in some of my baby catalogs a neat device that you plug in and put on your bedside table to keep a bottle cool so it won't spoil. Then, it heats the bottle when you need it. I'm not usually one for the newfangled gadgets of modern baby care, but if you can afford it, I'd recommend this one. If you chose to give your baby a bottle lying down at night, be sure he's propped up so his head is higher than his bottom. This helps the fluids to flow down his throat and prevents ear infections. Also, don't allow your baby to fall asleep with the bottle. When formula or other liquids pool in babies mouth and remain while he's sleeping it puts him at risk for baby bottle rot, a condition where his teeth are severely decayed. Even though your baby doesn't have any teeth yet, this is important.

The first 3 months
For the first few months, you will want to continue cue feeding your baby. Pay attention to your baby, learning his signals. You will soon begin to know when baby is wet or dirty (change him), tired, hungry or just needs comfort (nurse him). Newborns commonly nurse 8 to 12 times per day or every 2 to 2-1/2 hours, day and night, timing from the beginning of one feeding to the beginning of the next. If your baby wants to nurse more frequently, that's not unusual. If you have a frequent nurser, see Elizabeth Baldwin's Article, So I Nursed Him Every 45 Minutes. On the other hand, you don't want to let your baby go much longer than 3 hours during the day or 4-5 at night. Breastmilk is easily digested by baby, so he will need the frequent feedings whether he wakes or not. Also, delayed feedings may put your milk supply at risk. Wake your baby if he does not wake up on his own. Unwrap and undress your baby. Change his diaper. Tickle his toes. Play with him a few minutes before offering the breast.

Some babies are easy to nurse, others are not. Some references insist baby must take both breasts at each feeding, alternating the starting breast. Others say it's OK for the baby to feed from just one breast at a feeding, alternating which breast the baby gets at each feeding. I always offer both breasts to my babies at each feeding. My first 3 babies took both breasts. My fourth usually only takes one breast at each feeding. That's OK because the milk production keeps up with her that way, also.

When baby signals to be nursed, get comfortable (you may be there a while). You may want to get a glass of water to keep by your side. I highly recommend this as I tend to get very thirsty as my milk lets down. Play some quiet music or watch some TV, if you want. Try to relax. After you get the hang of nursing, you may want to read a magazine. Get the baby latched on in whatever postion works for you both and let the baby nurse as long as he seems to want to on that side. From the Womanly Art of Breastfeeding:

The length of a breastfeeding session should be determined by the baby's interest and response. He will usually suck eagerly, swallowing often, for the first ten minutes or so. Then the flow of milk may decrease and he begins to doze or lose interest. That's the time to switch him to the other breast. You may want to stop at this point to burp him or change his diaper, and then get him started on the other side. As long as he is sucking correctly, you can let him nurse as long as he wants on the second side.
At the beginning of each feeding, the baby receives a watery foremilk. When the milk lets down, he will be receiving hindmilk, which is rich in calories, proteins, vitamin, minerals, and all the other good stuff your baby needs. If the baby has nursed well on the first side, getting plenty of hindmilk it isn't so important that he nurses well on the second. Keep in mind that babies nurse when they are thirsty or need comfort also, so he may be sucking to fill a need other than hunger. That's OK, too. If you've heard "don't let baby use you as a pacifier," ignore it. Mom was the original pacifier! You can tell them, "I don't let my baby use a pacifier as mommy!" On the other hand, some babies seem to need to suck constantly. If this is the case you may want to offer a pacifier after 6 weeks to 2 months when the risk of nipple confusion is lessened. Be wary that you don't allow the pacifier to become a mother substitute.

Tips for Bottlefeeding
Pay attention to your baby's cues. Because of the nature of formula, bottlefed babies are easier to put on a schedule than breastfed babies, but don't be too quick to impose one. It will happen naturally over time. In the early months (and always) be sure to feed him when he's hungry. Always hold the baby, do not prop the bottle. This is important bonding time for you and your baby. Babies thrive on lots of touch, particulary skin-to-skin contact. When you're at home you can unbutton your blouse and take baby's shirt off to increase skin contact. This may seem strange at first, but you'll soon grow to enjoy it and look forward to these intimate moments with your little one.

A nursing mom will also offer the breast to comfort her baby. You will not want to give your baby a bottle to comfort him, but there are other options. Offer a pacifier, your finger, or a teething-toy. Take time to hold, rock or walk your baby. You may be tempted to use other-mother comforting measures since you don't need to nurse, but don't. Your baby needs you, not a motorized bouncy chair. This isn't to say never put your baby in a swing or other automatic soother, but you want that to be the exception, not the norm.

Three months to six months
By now your milk supply is well established, you are comfortable with breastfeeding and your baby is quite adept at it. Continue to breastfeed your baby on cue, remembering that baby could signal to nurse when he's hungry, thirsty or needs comfort. Unrestricted, unlimited breastfeeding continues to be the best for baby during this time period. Your baby does not need solids yet, and if he shows signs of hunger, more breastmilk is by far, the best way to go.

Six months onward
Sometime after six months you may notice that your baby is naturally beginning to work into a routine, preferring to nurse at certain times during the day or night. Some babies are ready for routine earlier than others. During this time with your guidance, baby is learning to distinguish between what he wants and what he needs and he is also developing a limited capacity to wait. Follow your baby's cues. When you see the beginnings of a routine developing, you can gently guide your baby, helping him to adapt. This is a process that may take as many as several months. Don't push too much or too fast and if you detect too much stress in your baby or you, back off for a while and work at it again when you're both ready. Above all, always be sure to meet your baby's needs. Remember that breastmilk continues to be a vital part of your baby's nutrition througout his entire first year, that baby still gets wonderful immunilogical benefits from breastmilk, and that baby will still nurse when thirsty or needing comfort. If your baby signals to nurse at a time you're not expecting and you believe he has a need, then by all means, nurse him! His cues are your guide, not the clock.

I see teaching a baby a routine much like helping a baby learn to walk. You don't take a newborn, stand him on his feet and expect him to go. You do watch for signs that baby is ready to walk. You take baby by the hands and encourage the first shaky steps. You let go only when he's steady and you stay close by to catch him. It's a matter of noticing when the baby is ready to walk and helping him through the process. You establish a routine the same way. You notice the baby is ready to develop a routine and you guide gently. As a matter of fact, much of parenting in the early years follows this model. I discuss it in my article on Parenting Styles. Notice, I'm using the term "routine" and not "schedule." A schedule implies more rigidity than I intend. It implies clock watching and forcing the baby to delay feeding until 3 or 4 hours have passed. A routine, as I use it1, is much more loose. An example of what has worked well in my family is: baby nurses when he wakes up, again late morning, early afternoon, when getting up from his nap, after your dinner, at bed time, and once or twice during the night. This is not something I have chosen for my babies, but something they have naturally developed as they've adapted to the rythms within our family. Don't get stuck on your routine. As the baby matures, the routine will change. It is constantly evolving and you must be ready to change right along with it.

Once your baby is about 3 months old, you'll probably start hearing the question, "Is he sleeping through the night yet?" Getting your baby to sleep through the night has somehow become a mark of "good parenting." Dont be dismayed. This question comes from a time when bottle feeding and clockwatching was the norm. Mothers were told to let the baby cry it out. Now we know better. Sleeping through the night will come in good time. So, when you hear the inevitable question, just smile and say, "He's a good sleeper." It is my recommendation that you keep the baby in bed with you. Nursing this way, you can latch the baby on and you can drift back off to sleep while baby nurses to sleep. If you can't sleep this way, at least keep the baby next to your bed to minimize baby's separation anxiety and your inconvenience. Read more on sleep options in my article about Shared Sleep.

Tips for Bottlefeeding
As I mentioned, bottlefed babies are often easier to schedule than breastfed babies. You may notice the beginnings of a routine before the 6 month period. Again, don't be strict about it. You'll want to follow the suggestions on gently guiding the routine as I outlined in the breastfeeding paragraphs. As always, be sure to feed the baby when he's hungry and comfort him when he needs comfort. Your baby may also be sleeping longer periods of time at night, but don't be tempted to teach him to sleep throught the night by allowing extended periods of crying (that is, crying for more than 5 minutes). This does nothing to make a baby comfortable sleeping on his own and you may be conditioning yourself to sleep through his cries or him to give up in his efforts to try to communicate with you.

Introducing Solids, Extended Nursing and Weaning
For the exclusively breastfed baby, The American Academy of Pediatrics recommends holding off on solids until the baby is at least 6 months old (see the AAP policy statement, Breastfeeding and the Use of Human Milk). Remember, breastmilk is the perfect food designed by God specifically for your baby. So, unless your baby shows excessive interest in the foods you're eating, don't introduce solids earlier. Even if baby insists on eating before then, there's no reason to make solids a regular part of your baby's diet until he is 6 months or older. A baby that shows excessive signs of hunger before 6 months needs more breastmilk, not solids. Delayed introduction of solids has many benefits: it dereases the risk of your baby developing allergies to various foods; it cuts down on the need for those little jars of commercial baby foods as the older baby can move right to softer table foods; it increases the amount of time baby is exclusively getting the perfect food; the extended nursing time reinforces the bond that you are creating with baby.

Once you do introduce solids, take it slowly. Introduce one food at a time over a period of 3 to 5 days and watch for any signs of allergy including, but not limited to, increased fussiness, diaper or other rashes, or a runny nose. Continue to nurse frequently throughout the day and night. Baby will be getting much of his nutrition and calories from breastmilk for a while yet. The transition from exclusive breastfeeding to exclusive table food and drink takes time. Expect the process to take at least several months, and in some cases several years. Pay attention to your baby's signals and needs. Even when baby is getting most of his nutrition from table foods, he may still nurse for the comfort and bonding it provides.

As your baby grows accustomed to the food and begins enjoying it, you can schedule his solid meals to coincide with the family's mealtimes. This may occur quickly with some babies, but don't be surprised if baby isn't interested in 3 meals a day until he's around a year old. Be sure to continue nursing as often as necessary in between solids. A breastfed baby does not need extra fluids until he is capable of drinking from a cup. If he's thirsty, nurse him. Do not introduce a bottle at this time. When he's ready for a cup you can offer him a few sips of pure water or diluted fruit juice. You do not need to buy the special baby juices. Look in the regular juice section for unsweetened juice. Begin with the clear juices, like apple and white grape. Stick with single juices, not combinations yet, and avoid citrus juices until the baby is about 1 year old as they can be too acidic for baby's system.

Tips for Bottlefeeding
The AAP still recommends solids be introduced to a formula fed baby between the ages of 4 and 6 months. Formula, unlike breastmilk, does not change to meet the needs of an older baby, therefore it is necessary to introduce solids earlier. Look for signals that your baby is ready and begin slowly. It's not likely that your baby will be ready for table foods yet, so you'll be buying little jars from the grocery store or preparing your own baby food. Purchase (or make) single foods, not combinations, and introduce them to baby one at a time over a period of 3-5 days. Watch for signs of allergy. Check with your pediatrician or a good baby book for recommendations on which foods to introduce first. As your baby grows accustomed to the food and begins enjoying it, you can schedule his solid meals to coincide with the family's mealtimes. Bottle fed babies can also be offered purified water or diluted fruit juice in a bottle to quench thirst. The suggestions above also apply to the bottlefed baby. The baby should receive some formula throughout his first year. Do not introduce cow's milk until baby is one year old. You will find that the process from formula to table foods goes more quicly than weaning a breastfed baby. This is becuase breastfeeding meets needs other than hunger/nutrition. Pay attention to your baby's needs for comfort and bonding and continue rocking, cuddling, and holding him frequently.
Don't rush the weaning process! Even though your baby's nutritional needs are being increasingly met by table foods, nursing remains an important part of your relationship. The Hebrew root word for wean is gamal. Along with wean, it is translated as reward, dealt bountifully, ripen. It carries connotations of something complete, fullfilled. Rushing a child through the weaning process will not allow this relationship to "ripen." I love Psalm 131:2.
Surely I have calmed and quited my soul,
Like a weaned child with his mother;
Like a weaned child is my soul within me
Here, the completiong of the weaning process produces such great peace within the child that David uses it as a word picture to convey the incredible peace we should be at in the presense of God. As a breastfeeding mother, my goal is to bring my nursing relationship with my children to the point of ripening, so that the child is completely fullfilled in it and ready to move on to other things.

1A popular parenting program, Preparation for Parenting, also uses the term "routine" to describe it's feeding schedule. Their use of routine differs from mine. They limit the number and length of nursings an infant may get, impose the routine on the child according to the wishes of the parent, and are completely against cue or demand feeding. I do not recommend this type of routine at all. For more information, read A Review and Commentary of Preparation for Parenting.

Links to Breastfeeding Information and Resources.
Breastfeeding the Hospitalized Baby by Cyndi Egbert

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