Latching Well: Breastfeeding with an Integrative Approach

By Caroline Conneen, FNP R.D. IBCLC

Breastfeeding is a great choice for you and your baby. Learn effective and reliable ways to latch and feed well. Integrated techniques come from select areas within lactation, nutrition, and advanced practice nursing. Each chapter reveals key skills that work for both mom and baby. Delve into this book to learn the secrets of making your experience a success. Loaded with practical advice, full of real-life examples, and important questions that mothers ask, this book is for you! How to latch your baby comfortably and all about baby's suck spotTrue-to-life vignettes, stories from moms who have been thereSafe sleeping guidelines and the truth about skin to skinThe intuitive play-feed-sleep cycle and what it teaches your babyYour baby's age and stage affect feeding and sleep patternsFirst year feeding of solids with sound nutrition guidelinesQ&A section featuring answers to questions from real moms"Lactation and breastfeeding are among the most sophisticated biological processes occurring in life.  In many cases, they are misunderstood by both the participants in breastfeeding and the healthcare community. Caroline Conneen has created a down to earth and easily understandable book that seems to cover every conceivable issue related to breastfeeding.  As a pharmacist who has worked with the breastfeeding community for over 40 years, I am greatly impressed with the simplicity of, and yet the depth of, the information presented." Frank J. Nice, RPh, DPA, CPHP Pharmacist, Author, Speaker, and 40 years as a Lactation Expert

• Language: English
• Publisher: Christian Faith Publishing, Inc.
• Release date: Mar 16, 2021
• ISBN: 9781098013462

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Latching Well

Breastfeeding with an Integrative Approach

Caroline Conneen, FNP, R.D., IBCLC

Copyright © 2021 by Caroline Conneen

All rights reserved. No part of this publication may be reproduced, distributed, or transmitted in any form or by any means, including photocopying, recording, or other electronic or mechanical methods without the prior written permission of the publisher. For permission requests, solicit the publisher via the address below.

Christian Faith Publishing

832 Park Avenue

Meadville, PA 16335

www.christianfaithpublishing.com

Photos with credit of MWHC are property of Mary Washington Healthcare, Fredericksburg, VA 22406, used with permission. Front cover photo by Jessica Williams. All other photos are property of Mother’s Best, LLC.

Unless otherwise noted, Scripture quotations are taken from the Holy Bible, New King James Version®. Copyright © 1982 by Thomas Nelson. Used by permission. All rights reserved.

Scripture marked (GW) is taken from GOD’S WORD®, © 1995 God’s Word to the Nations. Used by permission of God’s Word Mission Society

Disclaimer: Suggestions and ideas included in this book are from both evidence-based principles and the practical application of the art and science of breastfeeding. Information is intended to supplement advice from health care providers and does not replace individualized patient care. Consult with a medical care provider in respect to any symptoms or health concerns that require diagnosis, treatment, or ongoing management. The publisher and author disclaim any liability to any party, express or implied, of information presented, for any reason.

Printed in the United States of America

Table of Contents

The Choice to Breastfeed

Taking Care of You

Better Bonding

Achieving the Best Latch

The First Twenty-One Days

Soothing Your Baby

Having Enough Milk

Born with an Extra Need

Supplementing the Breastfed Baby

Overcoming Breastfeeding Challenges

Ages and Stages

Introducing Solids

Working and Weaning

Dedication

To my three children, who continue to bless me with firsthand experience at motherhood.

Acknowledgment

My gratitude extends to all the families with whom I’ve had the privilege of helping. You’ve taught me more than you know.

To Judi Hall, having worked with you just shy of two decades, you are a constant source of encouragement. Always appreciating and acknowledging my simultaneous passions for infant and toddler nutrition, breastfeeding, and advanced practice nursing, you encourage me as I strive to bring them all together.

To Dr. Frank J. Nice, for your ongoing contributions to the breastfeeding world. Thank you for your positive words and comments about this book, particularly for your suggestions regarding the medications. You are a true example of a man living life well.

To my dear friend Amanda McGrady, I don’t know if it is your library science skills, but you have an incredible ability to edit. Thank you to Robin Haile, whom I precepted. You gave me the better gift throughout the finishing touches of this book by your beautiful positive presence.

Thank you to Dr. Susan Ludington, whose books, research, and presentations have revolutionized neonatal care. Planting a seed of inspiration, your work has impacted how I have taught thousands of breastfeeding women. Thank you to Cathy Thompson, one of my first nurse mentors and our mutual friend, who introduced me to you years ago. Cathy, you will always be remembered as a courageous, strong, and charming character.

A special thanks to my husband, Patrick, who stepped up in caring for our children while I was in graduate school studying to become a family nurse practitioner. I could not have done it without you.

And last but not least, thank you to my amazing father, loving mother, and our awesome God, who created each one of us for such a time as this.

Foreword

Breastfeeding is both an art and a science. While babies are born with an instinct to feed, the process of breastfeeding is not instinctual. When mothers and babies receive guidance and support, the experience is successful.

As an author, physician, and mother, I have seen how breastfeeding enhances bonding and parenting in life-giving ways. Latching Well: Breastfeeding with an Integrative Approach uniquely emphasizes breastfeeding along with skin-to-skin care and opportunities for age-appropriate infant stimulation over time. A baby’s curiosity, attention span, and developmental milestones are enhanced. Yet, too often, mothers and babies do not practice skin to skin after birth when it is often medically possible.

Recognizing the benefits of skin-to-skin care and infant stimulation, the author incorporates these techniques into teaching mothers how to breastfeed. Skin-to-skin care and breastfeeding go hand and hand, have similar benefits, and are useful in parenting all babies. The synergy of these concepts working together increases breastfeeding success.

Relevant principles from the fields of infant development, attachment parenting, and nutrition are wrapped around the heart of breastfeeding. Teaching much more than a creative, yet straightforward technique of how to latch your baby, this is a parenting book that guides with love and good sense. Written thoroughly and with sensitivity, learn how to feed and nurture your baby well in the first year of life.

Ruth A. Lawrence, M.D.

Distinguished Alumna Professor of Pediatrics and Obstetrics/Gynecology

Northumberland Trust Chair in Pediatrics

University of Rochester School of Medicine and Dentistry

Rochester, New York

Author of Breastfeeding: A Guide for the Medical Profession, 8th Edition

Preface

What an exciting time for new families! One full of anticipation, expectations, hopes, and dreams. For many, breastfeeding is an integral part of early parenting. In this book, I share with you from my heart a passion that has fueled my career for over twenty-five years.

As a young mother, I remember the advice I received from my obstetrician. When he saw me on his rounds just before I was released from the hospital, he stated, Don’t let this baby run your life. Just feed her every four hours for ten minutes. I know he meant well, but what he said turned out to be bad advice.

In my ignorance, I followed his directions. After twenty-four hours of being home, I noticed that my newborn had not had a single wet diaper. I called the only pediatrician in our rural town and was informed they could not help me since I was not an established patient. (Important lesson: Select a pediatrician before your baby is born.) In desperation, I turned to my precious baby girl wondering what to do.

Fortunately, my maternal instincts took over. I decided to ignore my doctor’s advice and feed her whenever she wanted for as long as she wanted. It worked. By the time she was four months old, she tipped the scales at a generous sixteen pounds and was thriving on pure breastmilk.

Despite the rocky start, this experience would bloom into a desire to help mothers receive sound guidance. When new parents get the right information and support, most breastfeed successfully. Parents learn to be flexible and to love in a way they’ve never known before.

Enjoy this book as you begin your special adventure. I wish you, your baby, and your growing family well.

All the best,

The author welcomes your comments and may be reached at [e-mail]

Author’s Comment

Numerous descriptions of infant behaviors at certain ages are found throughout the book. Norms are used to illustrate a point and as a way of teaching, not as a means of assessing development. Offered as examples to help associate a specific behavior with a baby’s age, it is sometimes written as though your little one is actively participating.

Behavior changes rapidly during the first year of life and especially during the first six months. If born early, be sure to adjust your baby’s age to the description. For example, a three-month-old begins drooling more and can hold onto a rattle. If born a month early, adjust this expectation to four months of age, or three months after your due date.

The book is written to be read through with one exception. In Part 3, suggestions are offered for feeding babies who need to be supplemented and for those born sooner than expected. In addition, suggestions for medical, anatomical, and hormonal conditions that impact breastfeeding, are included. While most mothers will not encounter these situations, it is a helpful resource if you experience any breastfeeding challenges.

Within the chapters, mother is referred to as her or she and baby as he. To even out the male and female gender references, baby is she in the question and answer section, in the vignettes, and in other areas, such as tables and charts. Partner or dad is used interchangeably to refer to the mom’s support person or to the father of the baby.

No information in this book is meant to substitute for medical advice or care. If you’re struggling with breastfeeding, seek the help of a lactation consultant. Please see your baby’s health care provider or your own for medical concerns, depending upon with whom the issue lies. Children need regular checkups that often include immunizations and extra health care visits when not feeling well.

Part 1

Off to a Great Start

Chapter 1

The Choice to Breastfeed

You are giving your baby a gift only you can provide. When considering the benefits of breastfeeding, it becomes an outstanding choice. The myriad nutritional advantages and immune-boosting powers are unsurpassed. Bonding and closeness along with the idyllic image of nurturing your baby are not only natural but also beautiful.

Yet questions laced with uncertainty and fear easily arise. What if it hurts? How will you juggle work outside the home? What if you’re not able to make enough milk? On top of that, what if your partner feels left out while you’re breastfeeding? Let’s take a look at some facts to reaffirm your choice.

Best for Baby

The American Academy of Pediatrics (AAP) recommends, "Exclusive breastfeeding for about the first six months of a baby’s life, followed by breastfeeding in combination with the introduction of complementary foods until at least twelve months of age, and continuation of breastfeeding for as long as mutually desired by mother and baby."

While any amount of breastmilk is beneficial, the healthiest babies are breastfed exclusively for six months. The benefits of breastfeeding are cumulative and long-lasting. The longer a baby receives breastmilk, the healthier the baby. Amazingly, the benefits hold true not only while the baby is getting breastmilk but also continue throughout his lifetime.

Healthier Baby

Excluding well-child visits, a breastfed baby sees a provider one time for every six when compared with a formula-fed baby. As a child, the infant who was breastfed is less likely to have asthma, allergies, childhood cancer, and juvenile-onset diabetes. As an adult, the infant who was breastfed is less likely to have heart disease, gastrointestinal conditions, and weight issues. Breastfeeding benefits last a lifetime.

Only you can make milk for your baby.

Study after study confirms that benefits increase the longer you breastfeed. Even partial breastfeeding offers benefits. When a baby receives breastmilk for three weeks, he’s healthier than if he has it for three days. Three months of breastmilk and he’s healthier than if he takes it for three weeks. A year is better than six months and so on. Any amount of breastmilk is great!

It may seem silly to imagine that only three days of breastmilk makes a difference, but it does. Milk produced in the first few days is called colostrum. It is the gentlest first food and serves as his first immunization. Initial feedings, having mere drops to teaspoons, protect the inside of a newborn’s intestines in a special way. The first colostrum feedings lower future risk for irritable bowel syndrome, obesity, and many other diseases.

Nutrients

Breastmilk contains an ideal balance of carbohydrates, protein, and fats. Your body makes it specifically for your baby. Milk composition changes throughout each feeding and continues to change over time to meet his needs. If you deliver sooner than expected, your body knows and produces more colostrum for longer. It is high in protein and works to mimic his growth rates at the end of the pregnancy. Isn’t it neat that your body knows how to make the perfect milk for your baby?

Babies absorb more nutrients from breastmilk than formula, which is why breastfed babies tend to take less volume than formula-fed babies, yet still gain well. Formula companies spend large sums analyzing the special components in breastmilk, trying to make formula as close to it as possible. Your breastmilk is something that only you can give your baby.

Immunity

Live protective antibodies are active in colostrum. His intestines completely absorb them intact without breaking them down as a foreign protein. They offer a passive protection against illnesses and diseases for which you have immunity. He’s less likely to get sick when exposed. The effect is maximized when breastmilk is his only nourishment.

Passive immunity benefits continue as long as your baby receives breastmilk. It is not unusual for an entire family to get the flu or a disturbing gastrointestinal illness, and to see the breastfed baby remain well. He is less likely to experience colds, ear infections, diaper rashes, and hospitalizations for any illness.

Infants begin to make their own antibodies as they receive immunizations and booster vaccines. Developing his own antibodies to ward off infection, he creates an active immunity. When exposed to a disease against which he’s been vaccinated, he’s well equipped to fight it off. Because the immune systems are stronger, a breastfed baby makes more antibodies in response to vaccines.

Obesity Prevention

Breastfed babies are 30 percent less likely to be obese as children. Breastmilk flows rhythmically in response to your baby’s suckle bursts. He will stop suckling when full and keep suckling when hungry. Infants who are able to learn this concept are in tune with their appetite and are less likely to overeat.

Leptin, a hormone naturally found in breastmilk, helps regulate appetite. Lactose is the main carbohydrate source found in breastmilk. It requires more energy to break down and results in a smoother rise in blood sugar. Instead of lactose, some infant formulas contain corn syrup solids as the main carbohydrate. Used in many processed foods and broken down easily, corn syrup quickly raises blood sugar and is believed to contribute to weight issues.

Good Exercise

Breastfeeding is simply the best exercise for a newborn who isn’t yet moving or crawling around. Contrary to popular myth, crying is not healthy exercise but his way of communicating. Breastfeeding strengthens the jaw, neck, and respiratory muscles as he develops his suck, swallow, and breathe pattern while feeding. Increased strength acquired from breastfeeding lowers the risk of sudden infant death syndrome (SIDS), helps with proper speech development, effective swallowing, and with permanent teeth coming in straighter.

Character Development

Breastfeeding builds character. That’s right, you teach your baby patience by way of delayed gratification. When feeding by bottle, milk comes out quickly and he passively clamps the upper and lower gums to slow down the generous flow. Alternatively, when breastfeeding, his tongue extends, making a gentle sweeping motion for several minutes before milk begins to flow. Despite being hungry when first latching onto the breast, he works for his food, teaching him patience. Delayed gratification is considered one of the most important indicators for future academic success and it’s first practiced at the breast.

Best for Mom

Breastfeeding is your gift to your baby, but what’s in it for you? Quite a bit. Benefits include faster weight loss after delivery, bonding well, convenience in not having to prepare bottles, less risk of female cancers, and substantial cost savings. Breastfeeding moms experience less stress and a reduced chance of feeling down. When breastfeeding goes well, it’s an empowering parenting tool. For many moms, the advantages are a pleasant surprise.

Happier Mom

Having a new baby is a joyous occasion, but it can also be exhausting and stressful. There is a lack of sleep and plenty of unsolicited advice to contend with, not to mention the host of things in your life before your little one arrived. The hormones oxytocin and prolactin released while feeding help you bond with your baby and relax. Your mental health is enhanced through this neuroendocrine response. It is thought to be part of the reason breastfeeding reduces the incidence and severity of postpartum blues and depression.

Healthier Mom

Many other maternal health benefits exist. The risk of osteoporosis, heart disease, and some female cancers in the ovaries and breast, are reduced. During pregnancy and lactation, women absorb more calcium from foods. For the duration of breastfeeding, a mother’s bone density goes down, but then rebounds and surpasses its baseline after weaning. Bones strengthen as they improve in their mineralization and reduce a mother’s chance of getting osteoporosis by about half.

The longer a woman breastfeeds over her lifetime, the more she reduces her risk of premenopausal breast cancer. In addition, it provides added protection against ovarian cancer. Breastfeeding for a total of more than thirteen months lowers the risk of rheumatoid arthritis and metabolic syndrome. The syndrome includes having elevated blood pressure, lipid levels, blood sugar, and extra abdominal weight. Reducing the risk of metabolic syndrome lowers the risk of heart disease, stroke, and diabetes.

Weight Loss

One of the top reasons mothers initially choose to breastfeed is for a natural and easy way to lose the weight gained during pregnancy. While this may sound selfish, it’s not the reason moms are likely to continue breastfeeding. Burning an average of five hundred calories each day, it’s the equivalent of energy used when running five miles. Extra fat stores laid down during pregnancy provide some of the needed energy for producing breastmilk.

You’ll find your appetite to be similar to when you were pregnant, and you will be thirsty. While consuming a generous and well-balanced diet, most lose an average of twenty to twenty-five pounds by six weeks. After this, weight loss slows to a couple of pounds each month. Gradual weight loss does not interfere with milk supply, although drastically restricting food intake can.

Hormones produced while breastfeeding help flatten the abdomen as the uterus shrinks back to pre-pregnancy size. While breastfeeding is a completely natural way to lose extra pregnancy weight, it pales in comparison to the bonding, health benefits, and empowerment it offers. After getting through the initial learning phase, chances are that you’ll be pleasantly surprised by how much you enjoy breastfeeding.

Convenience

Once established, breastfeeding is convenient. Assuming your newborn is sleeping nearby, it’s easier at 2:00 a.m. to reach over and offer a breast than it is to get out of bed to prepare and feed a bottle. Breastmilk digests more quickly than formula and he feeds more often. Even though you are likely to breastfeed more frequently than if you were giving a bottle, you will feel more rested, making it easier for both of you to fall back asleep.

For those who enjoy frequent traveling, shopping excursions, or other outings, breastfeeding is especially convenient. You’re able to nourish your baby without carrying along or searching for clean water, bottles, and warming devices. When shopping, it’s easy to find an empty dressing room with a bench for feeding. Short trips and running errands around town involve less planning and preparation.

Cost Savings

The cost of formula can put a drain on the wallet during the first year of life. At the time of this writing, a 32 oz can of powdered infant formula is $35.58. It makes fifty-six 4 oz bottles and lasts eight days for a baby drinking 28 oz a day. The direct cost of the formula is $135 per month or $1,625 per year.

Even greater savings lie in reduced health care costs. Breastfed babies get sick less often resulting in fewer doctor visits, copays, prescription fees, over-the-counter medication, and time lost from employment. The true cost savings of breastfeeding is difficult to capture since the money saved on an illness or a disease never acquired is unknown. Regardless, the gift of good health is priceless.

Breastfeeding Supplies

Besides having a desire to succeed at breastfeeding, you may want to have a few things. They include nursing bras, breast pads, and a breast pump.

Nursing Bras

At about thirty-six to thirty-seven weeks of pregnancy, consider getting fitted for a comfortable nursing bra and feel free to start wearing it. Comfort is important because you’ll want to sleep in your nursing bras for the first several months. Have at least two bras, one to wash and one to wear.

Cup size will be about the same throughout the first six months of breastfeeding. From about four days after birth through the first two weeks, your breasts may feel full and heavy. A good nursing bra that fits well will work through this time. The band should be adjustable so you can make it smaller within a few weeks to months after giving birth.

Breast Pads

Some women leak very little, or not at all, and don’t need breast pads. When feeding on one breast, the other can leak and a pad absorbs the milk. If you need them, wearing them at night with a bra prevents the sheets from getting soaked. Breast pads can be disposable or reusable. Have some of each. Disposable ones are great for travel and when you’re behind on laundry. Reusable breast pads, such as those made with cotton, are economical and comfortable.

Change disposable pads each time they become wet with milk. Otherwise, when it dries on the pad, it becomes uncomfortable to remove. If you leak a lot, it may be necessary to change disposable ones several times a day or as often as each feeding.