various things I learned about breastfeeding
the alchemic secrets of turning blood into milk
I didn’t think much about breastfeeding before I started breastfeeding. All I knew was that my breasts were supposed to make milk that my baby would drink. It seemed like a factual, practical, thing. Now, after almost a year, I know a bit more about how difficult and wonderful it is. I see it more as an active relationship between me and my child and less like a thing to do. Like any relationship, the experience is unique to those in it, but these are a few things I learned along the way.
The breast crawl
As soon as she was placed chest to chest with me, she started searching. Tiny little mouth open like a bird. Tiny little body somehow able to squirm around and lift her head. She wriggled her way to my nipple and latched on. I’d never seen anything so incredible. I couldn’t believe she knew how to do that. She found her way to me! The doula said it was called the breast crawl. Mammals are literally born with an instinct to crawl to the breast, using some combination of scent and sight. Apparently newborns can smell the nipple, and the areola darkens and becomes larger during pregnancy to be more easily visible for a newborn.
Breastfeeding is not always a choice
I thought breastfeeding was going to be just putting the baby on the boob since she already knew how to find it, but it turns out that’s just one part of it. A baby needs to latch deeply enough with their mouth wide open to be able to effectively draw out the milk, and a mother needs to produce enough milk and be available at least every three hours. It sounds straightforward, but each of those requisites are often out of our control. Like many other aspects of modern life, it seems like choosing to breastfeed has become a matter of privilege and luck.
It takes 2-5 days for breast milk to even come in after birth. The baby still nurses in those initial days and might be able to get a drop here and there of a nutrient dense colostrum, but their weight starts to drop until they’re able to really start drinking. Once they’ve lost 10% of their birth weight, doctors usually start recommending formula supplementation.
My milk came in on the third day, just when she was getting close to 10% weight loss. The milk was there, but we had to get her to latch.
Even though babies can make their own way to the breast, they aren’t always effective at getting the milk out. Before being discharged from the hospital, we were visited by two lactation consultants who showed us what we were supposed to do. Grab the base of baby’s head firmly in one hand. Use the other hand to grab a handful of the breast to firm it up. Tickle baby’s upper lip or nose with the nipple to get them to open wide enough to quickly shove their open mouth onto the nipple. Always move baby to boob, never boob to baby. Make sure their bottom jaw is really open. They need to be taking deep sucks, not shallow ones. Make sure you see them swallowing. It should be suck, suck, swallow. If it’s suck, suck, suck, suck, suck, they’re not drinking. Two days later, the midwife recommended a new protocol. Do skin to skin all day. Sit in bed leaning back. Squeeze the base of her head to tilt her head back. Squeeze the breast while she sucks. Switch her between each breast back and forth if she slows down at all. It’s not that easy to maneuver a baby who has no head control while in postpartum recovery with no core strength.
She latched and started gaining weight. We made it through the first few days.
In Canada, 91% of parents start out breastfeeding and less than 50% of babies are exclusively breastfed by the time they’re 5 months old. Just over 70% of the time, it was due to not having enough milk or having difficulty with breastfeeding. In the US, that number starts at 84% and less than 50% of babies are exclusively breastfed by the time they’re 3 months old. It is difficult!
There’s no easy way to feed a baby
There’s no easy way to feed a newborn, whether by breast or bottle. It is a relentless three hour cycle, around the clock. From the start of one feeding to the next is three hours. That’s three hours to feed, change, tummy time, swaddle, before it starts again. For pumping moms, they also have to pump during those 3 hours, and clean the pump parts. For formula feeding, it means sterilizing bottles and preparing formula. Day after day and night after night. For breastfeeding moms, there’s no sterilizing but there are also no shifts.
After a few weeks, I wanted to try giving her a bottle of pumped milk so I could sleep longer than two hours at a time. I watched her gulp down the bottle even though we tried to slow it down. After a bottle, she was fussier with me. We had to do lots of skin to skin to build our connection to encourage her to latch again. Online, I found stories of other moms whose babies immediately developed a preference for the bottle - for a non-temperamental, constant flow nipple - and they weren’t able to breastfeed again. Most babies are able to combo feed just fine, but mine would get so mad at me, for my milk either coming too fast or not fast enough.
There’s no easy way to feed a baby, but the most difficult seems to be by exclusively pumping. The moms who pump around the clock to provide milk for their baby to drink by bottle really have to deal with it all. I don’t know if I could’ve done that. I was scared that she might just refuse to breastfeed if the bottle were an option, and decided it wasn’t worth the risk.
Supply and demand
In the first few weeks, milk production is mostly driven by hormones; afterwards, it becomes driven by demand. It can take 6-8 weeks for the supply to regulate to the demand. When there’s more milk than is being drank, the breasts become full and hard, but pumping or hand expressing will signal the body to make even more. It’s a delicate balance.
The milk would just drip drip drip. My husband would follow with a mop. Somehow the dried milk rings on the hardwood floor keep re-appearing. They disappear under the wet mop and reappear when dry. We still find little spots around the house.
Having breasts that are too full for too long can lead to clogged milk ducts, which can in turn lead to mastitis, which comes with flu-like symptoms. It was only in 2022 (!) that doctors figured out that “clogged milk ducts” were the result of inflammation and that treatment should actually be typical inflammation treatment - ice, gentle lymph drainage, feeding on demand. The prior understanding of needing to “clear” the clog using heat and trying to suck it out was actually the exact wrong thing to do, only triggering more inflammation and making it easier to get an infection if tissue was damaged in the process of trying to clear the clog.
The let down
Breastmilk is stored in the milk ducts, but doesn’t flow down to the nipple until the “let down” reflex is triggered. The baby’s sucking causes the pituitary gland to release a flood of oxytocin which signals tiny muscles in the breast to squeeze out the milk. It can take a minute or two before the let down happens. When it happens, to me it feels like a tightening or tingling right behind both nipples. Both breasts start spraying. There’s only so much that 5-ply organic cotton nursing pads can absorb, so trying to breastfeed in public was never that easy for me.
There’s an immediate thirst that kicks in right after the let down. I imagine it’s my body performing the alchemy of turning blood into milk.
A short shelf life
At first, I collected the let down from the side she wasn’t on and started building a freezer stash of extra milk, just in case. When we tried to use it, we found that my frozen breastmilk tasted disgusting. Breastmilk has lipase, which helps to break down fats for the baby to digest, but it also gives the milk a gross metallic flavour as the fats continue to break down while frozen. Depending on the person, the milk can have higher levels of lipase. I had to dump it all out.
The best thing ever
It took about three months, but eventually, breastfeeding started feeling more routine and familiar. My supply regulated and my breasts weren’t constantly full of milk. She figured out how to latch and stay awake while eating. Nursing sessions went from an hour to 45 minutes, to 20 minutes, to 10 minutes. We could just enjoy the connection without worrying about whether we were doing it right or whether it was all going to start going wrong.
Maybe it’s just what happens when dosed with oxytocin every 3 hours, but breastfeeding started to feel like the best thing ever. I used to feel that mothers got the short end of the stick when it came to pregnancy, birth, breastfeeding - we have to give over our bodies and endure so much. Now, I feel lucky that I get to do it. That I get to hold her and nurse her to sleep. That I get to be her comfort and home. Sometimes she crawls over for a bit of rest and latches herself. She wants to be scooped up and held, eyes open, just taking a cosy break before scampering off again.
I don’t know when or how we’ll wean yet. Eight feeds turned to seven, to six, five, four… soon she’ll be 1 and we’ll have made it to a year.