The Realities of Breastfeeding in the First Weeks of Mothering

Last year, a study published in the journal Maternal and Child Nutrition by Grant and colleagues at Cardiff a University highlighted the disparities in peer support for breastfeeding. Peer supporters are women like me who have themselves breastfed and who volunteer their time to support women on their breastfeeding journeys and signpost them in direction of more qualified help if there are significant problems. The article also identified changing societal pressures regarding breastfeeding as an obstacle to breastfeeding initiation, from fears of breastfeeding in public to misunderstandings about how breastfeeding works. It made headlines, so I'm not writing to share the findings (you can read them for yourself here) but I wanted to share some stories of breastfeeding initiation from my own experience as a doula and a mother that I believe will help new mothers in the first weeks of breastfeeding their baby. 

Why do so many women "give up" in the first six weeks? 

In 2012, around 81% of mothers living in the UK intended to breastfeed their babies. By the time these babies were six weeks old, only 24% of those mothers where still breastfeeding (Unicef). The rates were similar last year. That means that approximately 81 women in 100 could not meet their own goals as a mother and that their children will not receive essential benefits which only mothers' milk ptovides. I don't think this a failure on the part of these women because we all want to do our best for our children. Many mothers who do not achieve their goal to breastfeed suffer longlasting feelings of guilt and failure. A small number may even struggle to bond with their child.  So what is going on here and how can we help? 

A recent client of mine, let's call her Sarah,  provided a truly interesting insight. Sarah, had a normal vaginal birth and immediate bonding with her baby. She was healthy, she had a supportive partner,  she had NHS care in the form of prenatal breastfeeding classes, and she had adequate maternity leave to be with her baby. And still she came to me when her baby was a few days old in pain and concerned she would not be able to successfully nurse her child. 

After watching Sarah nurse her baby I could tell there were no significant problems. Her nipples were a little flat but nothing that couldn't be solved by working on the basics of a good latch. By the end of our session, she felt more confident. In the next few days and weeks feeding her baby became completely natural to her. 

In our last conversation, Sarah remarked that she believed her lack of confidence came from lack of realistic information about what breastfeeding in the first weeks actually feels like. Although she had taken the prenatal breastfeeding classes, she still had several misconceptions about breastfeeding that were only cleared up once she had shared experiences with me as a fellow mother. 

So what is breastfeeding really like in the first weeks? 

Although breastfeeding is the biologically normal way for humans and other mammals to sustain their offspring, it is far from a natural process and there seems to be anthropological evidence that breastfeeding is a skill that must be taught. Among the Himba tribe, grandmother's move in with new mothers in order to teach them how to breastfeed their babies. You can read more about these remarkable people here . 

We have little exposure to breastfeeding before having children because we don't don't openly breastfeed in public within our culture, so it's difficult to know what to expect. 

When I was pregnant with my first child, I was fortunate to have had some exposure. My mother and my aunties had breastfed their babies so I had grown up knowing about it. I had friends who breastfed their babies and I admired the gentle bond they had. I had spent some time in health circles and I had some knowledge about breastfeeding and the infant gut microbiome. I felt quite passionately that I wanted my baby to have these benefits and that I wanted to feel this bond with my baby. 

When my daughter was born my midwife proclaimed about my breasts when I attempted our first feed, "you've got the goods. That's what we like to see!" Indeed, everything went swimmingly and in the first days I was walking about the house with baby nursing in sling. 

From day three until the end of the second week after my daughter's birth things were very different. 

As my milk came in my breasts became engorged and my tiny AA bust swelled to DD overnight! I was seriously uncomfortable with such a drastic change in my body. They felt hard, heavy, and tender. 

My nipples were red raw no matter how carefully I latched my baby on. There wasn't any particular problem, but I felt uncomfortable for the first five seconds of a feed. The skin changes around my nipples also meant they were more sensitive to touch and any friction from clothing. 

I was constantly leaking milk all over my clothes. When I nursed my baby, the opposite breast would leak and I would be left smelling of stale milk. When I heard my baby's noises I would leak. I would leak when my husband gave me a cuddle. Sometimes I would leak for no reason at all. 

I was hungry, thirsty, uncomfortable, stinky and tired! 

Thankfully, I had the support of my partner and a few mummy friends so I persevered. Here are some tips that really helped me:

Set aside two weeks at least after your baby's birth to stay at home and get to grips with it. Don't expect to learn how to feed your baby and do everything else as normal. It's an immense skill to learn and it takes practice. Staying at home ensures you can learn it at your own pace without worrying about what you look like to others. Breastfeeding also takes a lot of energy from your body, so staying home ensures you can take care of yourself whenever you get the opportunity by sleeping when your baby sleeps, eating while you nurse, etc. 

Don't have high expectations for other things, in fact don't expect to do anything except nurse, rest, and feed yourself. Newborns nurse for a cumulative average 8 hours a day.  That's a full day all by itself, so don't over tax yourself by trying to fit too much in. 

Some physical discomfort is normal, but if your instinct tells you something is amiss don't hesitate to ask for help. There are lots of changes to your body after you birth and your breasts begin to produce milk.

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Hormone changes may make your nipples more sensitive to pain, so wear comfortable clothes. Avoid shirts with seams near the breasts. Do not wear underwire bras or if you feel comfortable, don't wear a bra at all. 

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When your milk comes in your breasts may become engorged. You can relieve engorgement by hand expressing a few drops of milk before a feed.

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Skin changes to your breasts and nipples along with your baby's suckling may cause chaffing. Massage a few drops of milk into your nipples after each feed to moisturise your nipples and prevent cracking skin.

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You may feel some cramping when you nurse. Breastfeeding causes the release of hormones that tell your uterus to contract. It helps your uterus to shrink back to its pre-pregnancy size but it can be a little uncomfortable. 

If any of these symptoms persist beyond two weeks or if the discomfort increases it may be a sign of problems brewing. Additionally, if you have fever, red spots or hot spots on your breasts, or persistent pain throughout a full feed you may want to seek help from a peer supporter, lactation counsellor, or your midwife.  

Find some friends to support you. It really helps to speak to other breastfeeding mothers about your successes and struggles especially if your partner is unsupportive or often away at work. If your friends can help out by bringing you meals and cleaning up the house this means you will have more time to rest and bond with your baby. If you are away from friends and family consider hiring a postnatal doula.  

Stay hydrated and nourished. Making milk takes a lot of energy. Milk is mostly water and glucose among other nutrients, so you need to get plenty of these nutrients back in your body. You need to consume a minimum of 500 extra calories while breastfeeding. Most women also feel thirsty while feeding, so it's a good idea to sit down to nurse with a snack and a glass of water.  

What to do if you are still having problems

If you are still having difficulty breastfeeding beyond 10 days to two weeks, you have other concerns, or your baby is not gaining weight there may be more significant problems. You should see a qualified breastfeeding counsellor or a GP to be assessed and referred to appropriate services. 

I have been a breastfeeding mother for two and a half years and a breastfeeding peer supporter with the Association of Breastfeeding Mothers. I hold regular breastfeeding support meet ups in Durham UK that you can find on my Facebook page. I provide breastfeeding support as part of my birth and postnatal packages, but if you would like additional one-to-one support, please contact me by email or telephone.