After discussing various significant issues about breastfeeding, o which you can have a look by visiting this page, there remain a few others that we think you must be aware of in order to deal with any sudden situation correctly.
BREASTFEEDING FOLLOWING A CESAREAN DELIVERY
The special closeness that breastfeeding provides will be particularly important if you deliver by cesarean section. Since you will not have experienced the physical sensations of birth, nursing will afford you the intimate contact and comfort that are essential to both mother and baby. Your breasts will fill up with milk just as if you had delivered vaginally. Because you will need extra rest, you will appreciate being able to just take your baby to bed with you and leisurely feed him, instead of having to get up to wash bottles or prepare formula.
You should plan to nurse as soon after delivery as possible, just as you would after a vaginal delivery. If you have epidural anesthesia, you can hold and nurse your baby right in the recovery room. If you have general anesthesia, however, you will have to wait until you are alert before getting started.
Your abdominal incision will necessitate finding alternate nursing positions. Experiment until you find one that is easy and comfortable. Many cesarean mothers prefer the side-lying position. To assume this position, use pillows to support your back, your abdomen, and possibly your upper leg. Place your baby on his side, facing you, and cradle him in your arm. Pull him in close to you until your nipple touches his lip. Wait for him to open his mouth, then make sure that his jaws are well past the nipple. To burp him, roll onto your back and roll the baby onto your chest, face down. Then roll onto your other side to nurse him from the other breast.
Some women prefer to nurse in a sitting position. If you do, bend your knees somewhat and support your feet to lessen the strain on your abdomen. Place your baby on a pillow in your lap and cradle him in your arm. The clutch position or football hold is another position that relieves pressure on the abdomen. While sitting, hold your baby on a pillow at your side as if he were a football. Use your hand to support his head at your breast.
Continue taking your pain medication as needed. Most analgesics do not affect the baby. However, check with your doctor to be sure.
Do not become discouraged if you and your baby seem to get off to a slow start. Remember that this will be the beginning of many months of a happy, rewarding nursing relationship.
BREASTFEEDING BY WORKING MOTHERS
If you plan to return to work after your baby is born, you can still enjoy a happy and successful nursing experience. Your baby will benefit from whatever time you spend breastfeeding, as he continues to receive your breastmilk and its protective properties. Your baby will be healthier, resulting in fewer sick days.
If possible, arrange to visit and nurse your baby on your lunch hour, or have your baby brought to you. If this is not possible, leave either breastmilk or formula with his sitter to be given to him while you are at work. Many women prefer their infants to continue having only breastmilk and arrange to pump their breasts once or twice each day while they are at work. Many excellent breast pumps are available from your breastfeeding counselor or certified lactation consultant. Continue nursing your baby on request while you are at home. If you do not pump while you are at work, your milk supply will even out to meet the reduced demand.
If at all possible, delay returning to work outside the home until your baby is a year old. The first year is very important in a child’s development and a very precious time for mothers. Unless you have severe financial problems, the time you spend with your baby will be more beneficial to your family than the income you will receive from working, especially after you deduct taxes, baby-sitting fees, the cost of formula and extra clothes, and the other expenses related to work. You may find that the money left over is not as significant as you thought it would be.
If you must work, choose your baby sitter carefully. A trusted relative or friend is your best choice. Otherwise, you will need to thoroughly check references before leaving your child with a stranger. Ideally, you will find someone who will care for your baby as you would. A person who keeps only one or two children can provide a more homelike atmosphere and plenty of cuddling. In addition, exposure to fewer children will reduce your baby’s chances of catching colds or other illnesses, which would further increase your doctor bills, as well as create concern and cause you to miss work. (For a further discussion of childcare, see “The Childcare Decision”.)
- Wear clothing that makes it easy to pump.
- Find a quiet, private area with a comfortable chair.
- Listen to soft, relaxing music.
- Look at a picture of your baby.
- Place a baby blanket, with the scent of baby powder or lotion, over your shoulders or on your lap.
- Place a warm cloth on your breasts.
- Massage your breasts.
- Relax your shoulders and visualize your baby or the milk flowing.
- Drink a beverage while you are expressing.
BREASTFEEDING IN SPECIAL OR UNUSUAL SITUATIONS
Many mothers have successfully breastfed in special or unusual situations. If you have twins, triplets, or a preterm baby, you can receive valuable support from a certified lactation consultant or La Leche League International. You can also get information on continuing to nurse if you need to be hospitalized for an illness such as tuberculosis, hepatitis, epilepsy, or cancer. Help is also available if your baby has Down syndrome, a cleft palate, or a mental or physical handicap, or if he must be hospitalized. For information or support, contact a certified lactation consultant or La Leche League International. You will receive specific guidelines, as well as help in contacting other mothers who have nursed in circumstances similar to yours.
CONTRAINDICATIONS TO BREASTFEEDING
A few situations exist in which breastfeeding is contraindicated. If you have had a double mastectomy or breast reduction surgery in which your nipples were surgically removed and reattached, you will not be able to breastfeed. Additionally, if you were ever exposed to the AIDS virus, you should not breastfeed. Rare cases have been reported of infants acquiring the virus through their mothers’ breastmilk. A woman with untreated active tuberculosis should also refrain from breastfeeding.
A mother who uses cocaine or any other illegal recreational drugs should not breastfeed because these substances pass readily through the milk and can cause serious or fatal reactions in the baby. Several other substances may require temporary cessation of nursing. These include radioactive isotopes, antimetabolites, cancer chemotherapy drugs, and a small number of other medications.
If your baby is diagnosed with galactosemia, he is missing a liver enzyme and is unable to metabolize lactose. Since breastmilk is high in lactose, breastfeeding is contraindicated in this case. Continuation would cause mental retardation. The baby must be placed on a special formula such as Nutramigen. Some states check for this disease as part of the infant screening test.
LA LECHE LEAGUE
La Leche League is an organization of women who have successfully breastfed their children and who enjoy helping others do the same. The organization had its beginnings at a family picnic in Franklin Park, Illinois, in 1956. Two nursing mothers attending the picnic recognized the need of new mothers to receive factual advice on breastfeeding. Previous generations had had mothers and grandmothers within their households who could supply this assistance. Our changing family structure, however, had left mothers without good role models, resulting in a lack of information.
Local groups meet monthly to discuss a series of topics ranging from breastfeeding and nutrition to other areas of concern to new mothers. If you are considering breastfeeding, it is helpful to attend a series of meetings before your due date. To find a La Leche League chapter nearest you, check your local telephone directory or contact La Leche League International.
You may want to keep the telephone number of your local La Leche League leader handy. La Leche League leaders can provide information, support, and personal knowledge to mothers who have breastfeeding questions. Leaders have experienced breastfeeding with their own babies and understand the concerns and difficulties new mothers may have. These women volunteer their time to assist mothers through phone calls and sometimes even in-home visits; their services are free of charge.
CERTIFIED LACTATION CONSULTANTS
Certified lactation consultants are paid professionals who have completed a prescribed course of study and passed an examination. They are qualified to do breastfeeding assessments on mothers and babies, and to assist with all types of breastfeeding problems. Their services include providing at-home or office consultations, conducting prenatal and working mothers’ classes, and offering breastfeeding supplies. The first lactation consultants were La Leche League volunteers who felt that the field of breastfeeding counseling would be legitimized by certifying competence in minimal standards of knowledge and skills. The first test was administered in 1985, and since that time, this specialty has gained wide acceptance in the medical community.
Many hospitals employ certified lactation consultants to assist new mothers with breastfeeding. The consultations are often covered by health insurance if they are ordered by a pediatrician. Ask your pediatrician, local hospital, or childbirth instructor to recommend a certified lactation consultant or contact the International Lactation Consultant Association (ILCA) Headquarters.