Preventing PPD 2: Getting Your Feeding Support in Place

Here's part 2 of my Preventing PPD series. This part will focus on getting your feeding help set up ahead of time. Feeding is the most important part of caring for a newborn, so if things are going poorly it's virtually impossible not to feel bad about yourself and your life. In all likelihood, you'll have at least some minor feeding problems, but if you have the support to get through them they won't drag you down into PPD.

I'm going to be talking about breastfeeding, because most women try to breastfeed. But if you know you can't breastfeed because of medication or physical issues or because you're adopting* or because you're a one- or two-dad family, you'll still be doing yourself a favor by throughly researching your options for formula (regular? organic? DHA-enhanced? soy? etc.) and doing some reading on reflux and GERD so you can recognize the signs right away if your baby isn't tolerating the first formula you try well. There is nothing worse than feeling like you can't even feed your baby, so knowing the issues and being prepared can end up making your first few weeks way less stressful.

I read in a book (I can't remember which one) the following idea, and it hit me as cold truth: Most women wouldn't dream of highlighting or cutting their own hair, but they try to nurse their babies--which is much harder and much more important--without any assistance or support.

"It's natural," they say. Well, of course it's natural. But that doesn't mean it's easy. And most adult women in this country have never seen anyone nursing close-up until they have their own babies. If you haven't seen it day in and day out, and you've never done it, and your baby's never done it, then how, exactly, are you supposed to just know how to do it? And yet women think it's just going to happen.

I hear all kinds of women considering whether or not they should take a breastfeeding class. Are you kidding? Of course you should spend the three hours to learn about what's going to happen and get an intro to the most likely pitfalls. It shouldn't even be a question of whether or not you should do it.

But that doesn't mean that taking a class before you have a hungry baby in your arms is going to give you everything you need to nurse successfully. There are all sorts of completely normal things that make the first few days and weeks of nursing scary and irritating and confidence-shaking. And there are all sorts of completely normal but correctable things that make the first few weeks painful and bizarre and dysfunctional. With no support, you might not be able to keep going. With good support, you can slog through the first 6-8 weeks until it gets easier.

What do I mean by "good support" (aside from a comfortable nursing bra)? I mean having a good lactation consultant that you can call for help, a good support group you can go to for non-pressing questions and moral support, and people in your house you can trust to help you give your best effort to nursing.

A good lactation consultant can save your nursing relationship if things are going badly. It's difficult to try to find one when you're in the throes of post-partum hormones and actual nursing troubles, so it's imperative to have the number of a good LC written on a note on your refrigerator before you have the baby. If you never have to use the number, that's excellent. If you do have to use the number, you'll know where it is to call or to have your partner call because you're crying too hard.

There are a couple of ways to find a great LC. One is to call up your local La Leche League leader (find her number on the LLL website) and ask her who she thinks is the best LC in your area. Another is to ask the leader of your breastfeeding class who she recommends. (If it's a hospital class, the leader may not be an LC or may not be an IBCLC LC.) Another is to check the IBCLC website to find an extensively-trained, certified LC. Do not just assume there will be an LC at your hospital when you give birth. Some hospitals don't have any available (especially if you give birth on a weekend). And you can't be sure of the training you're getting with the "lactation consultants" at some hospitals. Many of them are RNs who have no more specific education on breastfeeding than the three-hour class you just took. Take the time to look for a trained, experienced LC before you need her and things will be much easier for you.

The only way to find a support group is to try them out until you find one you like. My mom forced me to go to the breastfeeding support group near me when I was still pregnant (I think she wanted me out of the house so she didn't have to listen to my complaining for a few hours), and it was eye-opening. I discovered that the leader of the group was a good personality match for me, so I felt comfortable going back once I had my baby. But I also sat through the meeting and heard all the odd little problems women were having that the leader corrected easily and that gave me faith that I could deal with any problems I had because they would probably be totally routine to the LC (they were).

If I hadn't gone to the meeting when I was pregnant, I don't know if it would have been my first instinct to go when I was having minor problems once the baby was out. Most women are emotionally fragile in the months after having a baby, and it's hard to go someplace new. And since we're all convinced we're doing something wrong, we anticipate being judged by other parents and by the leaders of parenting groups. If you know already that a group feels fine to you you'll be able to go without worrying about being judged or feeling stupid about asking your questions. And, as an added bonus, you'll have the schedule of meetings posted on your fridge and you'll already know how to get there.

The first place I'd look for a breastfeeding support group is La Leche League, because they're all over the world and they're free. LLL groups vary radically depending on who the leaders are, so you definitely want to check your local group out. Just because your friend didn't like her local group doesn't mean you won't love yours. And just because I think my group in Manhattan is amazing doesn't mean you'll click with your local group. So find yours on the website and go check it out.

Other ways to find breastfeeding support groups:
*Call and ask the LC you just spent 45 minutes researching. You have her number on your refrigerator.
*Ask your midwife or doctor.
*Call up the local alternative birthing center and ask the receptionist.
*Check out the website of the hospital you'll be delivering at.
*If you see a mom nursing out in public, walk up and ask her if she can recommend a group. She'll be happy to talk to you.

On the home front, the people who are around you for the first few days and weeks postpartum can affect your nursing relationship more than any other factor. As Jamie said in her excellent post "Breastfeeding: What's the normal learning curve?":

If your baby won't latch, do you want your spouse to say, "Let me bring you the formula," or, "Let me bring you the cordless phone and let's talk to the LC together"?

When you are wacked out on hormones and convinced you're screwing everything up and can't feed your child and your body isn't working the way it's supposed to, the opinions and suggestions of the people in the room with you are going to take on a huge amount of importance. So, if nursing is at all important to you, you need to talk to those people and make sure that they're on board with your giving nursing your best-faith effort for a set amount of time. Probably the most common suggestion is 6 weeks. I don't know anyone who enjoyed breastfeeding or felt any super-bonding rush or even could really stand it much before 6 weeks. The people with you don't have to have nursed their own children. They don't have to be female. But they do need to know the basic support plan, which is to:

1. Take care of diaper-changing, meals, cleaning, and laundry, because recovering and nursing should be your only jobs until you've got the nursing down and are recovered from the birth.
2. Bring you a glass of water every time the baby nurses.
3. Not watch the clock at all because newborns nurse at all crazy times and it's normal and good.
4. Encourage you to try nursing first when the baby fusses. If the problem isn't hunger the baby won't latch on and you can move on to checking the next thing.
5. Tell you you're doing a great job!
6. Call the LC for you if they find you sobbing or your nipples are hurting more than just some mild irritation.
7. Not suggest supplementing with formula until after they've called the LC.

Of course it's possible that you're going to have problems that will mean you'll have to supplement or go completely to formula, but won't you feel better about doing that if you know you got all the help possible? And that the people who love you helped you get that help? Then you can walk away feeling proud of yourself for doing everything you could instead of like you "failed" at nursing. (And you won't resent your mother or MIL for undermining your efforts.)

To summarize: I cannot emphasize enough how much improved your post-partum life will be if you have all the breastfeeding support you need lined up before you need it. Lining up the four pieces of support (pre-natal breastfeeding class that you and your partner go to, finding an IBCLC LC, finding a support group, and making sure your support people are committed to helping you make it through the first 6-8 weeks) should be part of the preparation checklist you have, and you should do it before you pack your bag for the hospital. You'll thank yourself for it once your hungry baby is home with you.

* Some adoptive moms can breastfeed. If you're interested, check out afrindiemum's great summary post of a way to get a full supply. If you're not up for the full protocol, you can probably still get a partial supply just by using a SNS or LactAid with formula while you nurse. Any milk you can give your baby is good.

Comments

[Mary Beth]

I'm delurking here to say thanks for this awesome blog and the PPD posts. I just gave birth to my first and am exclusively breastfeeding. I had a great LC that saved our nursing relationship and I was super-lucky to have found her. I would even go one further than your suggestion to have the number of a LC on the refrigerator and suggest actually having a consultation with the LC before the baby is born. My LC actually has a package that includes a pre-birth consult and several postpartum consults. I really wish I had done that. I feel that I would have been more confident the first few days and weeks.

Keep up the good work! This is great!

Mary Beth

[AmyinMotown]

I agree with your suggestion of a class; however, mine made me LESS likely to breastfeed than I was before I walked in! The teacher was bad, and my specific questions -- 1) how soon to attempt some sort of scheduling, because I am pretty ADD and need my days to have some structure, and 2) how I could make sure she would take a bottle because I needed to work -- were completely blown off in a way that made my hormonal self feel very undermined. I got lucky in a couple ways. The hospital where I had my baby has a breastfeeding supprt service with LCs on staff, and I could see someone right in my hospital bed. The woman I saw was so nice and supportive and I really needed that at that time. I had their number memorized those first few weeks and they were wonderful! So I highly second the idea of finding out those resources before you have your baby.

One thing I would ike to get your take on: While I agree with what you support person should be doing for you, I certainly didn't have that kind of support at home for more than the first week and I don't think most people do. Once my husband got back to work, I was on my own (I have close-by family and helpful friends, thank God, but everyone works so I was kind of on my own during the day). What would you suggest for people who are in the role of being mostly their own support person? What's most important that they do or not do? I know I felt so shaky and unconfident those first few weeks alone (which is a place the LCs were soooooo helpful).

[luolin]

Dear Moxie,
Please don't ever take your archives down. This all seems like great advice, and I hope it is still here a year from now when I need it (I hope).
Luolin

[Carla Hinkle]

I cannot recommend having the name of the LC before you give birth enough. I did (luckily a fantastic LC has offices in the same building as my OB), so I went for a little one-on-one consult before the baby was born, bought my Pump In Style from her, and went back to the nursing moms support group on my daughter's one week birthday, where I got great support for my cracked, bleeding nipples and help correcting latch, etc. I went back once or twice a week for 3 months and it made all the difference in the world. Especially since the nurses in the hospital, while well-intentioned, were next to useless.

It also helps to have friends you can call who are moms -- if you have any, even if they aren't in your town or neighborhood, I got some great tips that way too. And it's great for moral support if nothing else.

[Roastedsquid]

I just recently discovered your site and find it to be a wealth of information. I just forwarded this post to my sister who is expecting in June. My LC helped me tremendously and if it weren't for her I would have given up at 6 weeks, sick to death of sore and bleeding nipples. She was able to retrain both myself and my son and we were able to make to 9 months formula free (a long time for a full time working mom!). Anyway, I just wanted to add, that if your insurance does not cover lactation consultants, you can use money from your Flexible Spending Account for medical purposes toward this expense. I did not find out until afterwards, so I a hard time digging up the receipt. I just want to get the word out there for those who are doing some financial planning for the impending birth.

[Amy]

I'd like to second Luolin's request that you keep the archives available as long as you can do so. They've been invaluable to me since I found them. I only wish I had found them when I was still pregnant.

The advice that people have given about having an LC before you give birth is priceless, but there are a couple pieces missing. First, don't wait until your last month to find an LC. My baby came 5 weeks early and even though I had planned to breastfeed, really I had only planned to plan to BF. I didn't have my support in place in time, and I think that is much of the cause of my terrible, no good BF experience. (Too much NICU time + NICU staff that discouraged BFing = baby who never made transition to breast. I pumped for 13 months.)

Second, just because someone has the title LC doesn't mean they are the right fit for you and your needs. I was directed to the "LC" at my pediatrician's office when my baby wouldn't stay latched beyond the third draw at my breast. The LC said she had never seen anything like that before and encouraged me to just keep pumping and bottlefeeding. It seemed odd to me, but I trusted her because my pediatrician employed her. Although she was a nurse, she didn't know what she was talking about, but by the time I realized this, the uphill battle to BF was too steep and I quit trying and became quite depressed.

I'm sorry to go on like that, Moxie. You can delete or edit this comment down if you want. But, in short, my experience has shown me that I shouldn't have assumed I'd have that last month of pregnancy to get ready, and that when my gut told me that the answer I got was not helpful to me, I should have kept looking. Not all LCs are created equally.