Thanks for joining us on this breastfeeding journey with Marian*. This is #3 of 4 posts in this mini-series. As you may remember from the first post, Introducing Marian and Kirat, we interviewed a second time mom and chronicled her breastfeeding journey. Continue reading to learn about Marian’s experiences with Birthing Levi*.
In Birthing Diana, we looked at Marian’s breastfeeding and birth expectations as they compared to the reality of her experience with her first child, Diana*. In the summer of 2016, Marian gave birth to her second child, Levi.
When she gave birth to her first child, Marian had an assisted birthing experience – with induced labor and an epidural. She partially attributed these interventions to the difficulties she had breastfeeding Diana. However, when she gave birth to Levi, she did so without any interventions (no epidural, C-section, or Pitocin). A vaginal birth uncomplicated by medications like Pitocin, allows for the normal, physiologic release of oxytocin, which may contribute to the alertness of both baby and mom after delivery.1 An alert newborn is more likely to locate the nipple and suckle immediately after birth.1
So how did a natural birth effect Marian’s breastfeeding experience with Levi compared to Diana?
“It was like night and day.”
The biggest difference during the first week was that Marian felt her milk “come in.” During Lactogenesis Stage I (lacto = milk, genesis = creation), the milk is composed of colostrum — an early golden, viscous milk high in fat and immunoprotective components — in amounts less than 100 mL/day. During Lactogenesis Stage II, the “milk comes in” and yields on average 500 mL/day for the infant to consume. The milk in Lactogenesis II is more like mature breast milk with higher ratios of carbohydrates and protein to fat.2 In short, roughly 36-96 hours after delivery, there is an anatomical change in the breast that happens at the level of the cell in the mammary gland.2 This change is prompted by the decrease in levels of progesterone after the placenta is removed from the body (pro = promoting, gest = gestation, or pro-pregnancy), and the subsequent increase in levels of prolactin (pro lactation hormone).2
Even though mothers are starting to produce milk in higher volumes, the fullness they experience in their breast is not simply having too much breast milk. Engorgement is also due to the simultaneous dilation of blood vessels in the breast with a delay in the ability of lymphatic vessels in recycling excess fluid. This lag time in fluid recycling can lead to engorgement, or fullness, that mothers experience 3-5 days after delivery during lactogenesis stage 2.3,4 In addition, the engorgement that many experience may be one of the reasons that the first two weeks of breastfeeding are so difficult for mothers. The fullness of the breast and areola-the dark part of the breast-makes it difficult for babies to properly latch, as correct latching requires the baby to open the mouth widely, so that a large portion of the areola (or breast tissue) is captured in the mouth. If the breast (and areola) are engorged, it is harder for the newborn to take in enough breast, thus, the baby ends up slipping off and gumming the nipple.4 Gumming or sucking on the nipple is both incredibly painful for the mother and ineffective for the baby.
Because Levi did not lose as much weight as Diana, Marian did not have to finger feed for an extended amount of time, pump, or struggle with the latch immediately following birth. In fact, Levi fed for about one hour on both breasts immediately after delivery.
During the first two days back at home, Levi was doing really well and Marian was enjoying the complication-free breastfeeding: Levi was swallowing, latching and waking up on time for feedings every 2-3 hours. However, at her two week appointment with her general practitioner, Marian’s nipples were feeling really sore. Her doctor did not mention any problems with baby Levi’s growth. Marian felt that she did not receive appropriate advice on breastfeeding. She thought that this was because she was there for a general wellness check-up and that the focus was not on her problems or the problems that may lie ahead with breastfeeding.
It was only when Marian met with a lactation consultant two weeks after leaving the hospital that Levi’s weight gain became a real problem. At this point, he was below his birthweight and the lactation consultant suggested that Marian pump as much as she could. The consultant also suggested Marian drink nursing tinctures (Mother’s Love) and teas (Herblore) to promote milk production and referred Levi to an Ear Nose and Throat (ENT) doctor for a frenotomy.
Even after the frenotomy, however, Levi’s weight gain was not adequate. Although Diana felt more prepared for the birth of Levi and experienced initial success when breastfeeding, a few weeks after birth she again struggled, just as she did after Diana’s birth.
Experience and knowledge are not the only tools needed to successfully breastfeed. Even with copious amounts of information parents can have trouble. Support systems are also important. Let’s talk about that in the next blog Support Systems.
Hope this helps,
Written by Kirat Sandhu
Edited by Ileisha Sanders, mother of 2
*Names changed to protect privacy
1 Lothian, J. A. (2005). The birth of a breastfeeding baby and mother. The Journal of perinatal education, 14(1), 42-45.
2 Neville, M. C., Morton, J., & Umemura, S. (2001). Lactogenesis: the transition from pregnancy to lactation. Pediatric Clinics of North America, 48(1), 35-52.
3 Academy of Breastfeeding Medicine Protocol Committee. (2009). ABM clinical protocol# 20: Engorgement.
4 World Health Organization. (2009). Infant and young child feeding: model chapter for textbooks for medical students and allied health professionals.
5 Dollberg, S., Botzer, E., Grunis, E., & Mimouni, F. B. (2006). Immediate nipple pain relief after frenotomy in breast-fed infants with ankyloglossia: a randomized, prospective study. Journal of pediatric surgery, 41(9), 1598-1600.