by Tom Johnston
Welcome back. This is the second part of a two part series on the role of the father in breastfeeding.
In the first article we explored each team member's role in the breastfeeding relationship. We talked about Mom's job, which is to put the baby to the breast, to offer the breast, and love the baby. We talked about the Baby's job, which is to put the breast in his mouth, suck and swallow until satisfied, and love mommy and daddy. We talked about Dad's job which is to take over the job of the lactation consultant when the family goes home.
The father is the one who will be available to answer questions at 3 AM. The father is the one that mom trusts, she listens to her partner much better than she listens to her lactation consultant. Many mothers struggle with confidence when breastfeeding, they doubt the baby's desire to breastfeed, they doubt their families support for breastfeeding, and most of all they doubt themselves and their abilities breastfeed.
A new mother struggles with confidence almost every day and her shaky confidence is easily destroyed by a doubting father. When you say something foolish, like "I don't know honey, maybe we need to give him a bottle," you have just damaged your family's chances at breastfeeding success.
So, if you've come this far, your still with me and it's time to learn how to breastfeed. I break it down into three simple steps.
- When does the baby need to eat?
- How does the baby eat?
- When is the baby done eating?
It really is that simple, so let's dive in.
When does the Baby need to eat?
The first thing you have to understand is that in all my years working with families, I've never met a baby that read the rule book before birth. Contrary to what most baby books will tell you, a baby does not eat for 10 minutes on each breast every 2-3 hours. What nonsense! Babies are not born with watches, and even if you give him one, he can't read it anyway.
When a baby has stress (hunger, cold, wet or dirty diapers, pain, or loneliness) he will show you some very predictable signs. He'll curl up his hands and feet and bring them to the center. He'll bend at the knees and cross his feet or put his heels together (that's called centering behavior). He'll start to turn his head and may suck on his hands. Eventually he'll start to fuss and finally cry.
All of these are stress signs. Sometimes he'll be hungry, sometimes lonely; but when he does those things he is asking for you to pick him up and tend to his needs. Since you won't know what he wants by looking at him, I always recommend you start in the kitchen (AKA -- the breast). If he's hungry, he'll take the breast when you offer it.
But never insist that a baby "has to be hungry" just because it's been a while since he's had the breast, and the opposite is true as well. Likewise, don't automatically assume he can't be hungry just because he only ate an hour ago.
Babies are unpredictable, but when you offer the breast, he'll eat if he's hungry. As a general rule, newborns eat 8-12 times a day, usually in clustered groups of 3-4 times in a four hour period, they then take a 3-4 hour nap and start over again. Don't count on it, but know that while no two babies eat on the same schedule. One thing is for certain, in all my years I've never seen a baby actually eat for 10 minutes on each breast every 2-3 hours.
How does the baby eat?
This is a tough one; every baby is different, just like every person is different. But there are a few simple principles that you can follow. When baby is ready to eat and he's in the kitchen, he will stretch out his hands, move the breast to where he wants it, open his mouth VERY wide, and take the breast deep into his mouth.
He'll latch on well, he'll suckle in bursts of rapid sucks followed by a short pause, you may hear a soft quiet swallowing sound, and then he'll do it again. Sometimes he'll appear to be sleeping, as he lies peacefully on the breast while holding the breast in his mouth.
Don't be fooled, babies don't really sleep on the breast; they rest and wait for their drinks to settle in their stomach. I am fond of saying, "Only college students and Army Privates like to chug." Everyone else takes a few sips then puts their drink down, then start again. Don't expect him to chug his milk and get it over with quickly, he wouldn't expect the same from you.
When your baby is on the breast you need to make sure he is latched on well and that he is transferring milk well from mom to baby. Every time your baby latches on, you will need to look for signs of a good latch, and here they are:
Nose and Chin touching the breast: He should bury his face deep in the breast. You do not need to pull the breast away from his face. If you do you will pull the nipple away from his mouth, or change the shape of the breast in his mouth. There is no need to fear that he will suffocate on the breast.
First, remember, he isn't stupid, he won't suffocate for one more drink of breast milk, if he can't breathe, he'll just turn his head or pull away.
Second, have you ever noticed the creases on the side of your nose and how they tend to run up to your eyes? Have you ever noticed that there is a dimple on the side of your head where your eye sockets are? That is a continuous channel from the nose to the side of the head that I call "The Baby Snorkel System." Air moves from his nose, to his eyes, under his eyes and out the side of his head. If you don't believe me put your face underwater, cover your face with your hands and blow air out of your nose; you'll see the air move out of the side of your head.
Full Round Cheeks without dimples: If his mouth is full of breast, his cheeks are full of breast. If you see dimples on his cheeks or creases around his mouth, he does not have the breast deep in his mouth. When his mouth is only half full he is creating a vacuum of empty space, and he is hurting your lovely bride.
Wide Open Jaw: The infant has a small mouth and he has to open that mouth VERY wide to get all that breast tissue deep into his mouth. Get ready, here's where you get to measure something. If you measure the angle from his nose, to his ear, to his chin that angle should be greater than 60 degrees, 90 degrees is even better. I recommend using your fingers, put one finger on the nose, your palm on his ear, and another finger on his chin, and measure that angle. 45 degrees is a closed and empty mouth, and that hurts!
No Pain. NO PAIN! NO PAIN! NO PAIN! Did I mention it shouldn't hurt to breastfeed? Traditionally, nipple pain in early breastfeeding was considered normal and unavoidable. That is a myth whose time is long past. New understanding of the anatomy of breast milk structures in the nipple and areola shows that there is no fat or cushion in the nipple and that all cushion is held back on the areola.
When the infant pinches the nipple with his mouth or tongue your wife will get pain, which is exactly the same thing that will happen if you pinch the nipple with your thumb and forefinger. Pinching the nipple is always a bad thing. Your wife wouldn't let you do it either! If you can't get away with it, neither should baby.
Not only will the baby hurt his mother, but he will also not be able to effectively bring milk out. When you pinch the nipple, you bend the tubes that bring down breast milk. Just like any other straw, if you bend it you can't drink from it. Don't let the baby bend those tubes or pinch the nipple. If your wife has nipple pain, you need to fix the latch immediately, and if you can't, you need to get in to see a lactation consultant as soon as possible.
Flared Lips, Up and Down: In order for a baby to take the breast deep in his mouth he will have to flare his lips as he opens his mouth widely. His tongue will extend and push out his lower lip, and he will wrap his lips around the areola. If there is a latching problem it is often failure to flare the bottom lip. All that being said, when he is properly buried into the breast you can't see his lips. Know that if everything else is okay, the lips are probably okay. But if there is nipple pain, dimples in the cheeks, or a narrow jaw, you will need to help your baby open his mouth and push his bottom lip and tongue out.
But how do I do that? One may ask. Don't worry I'll show you. Now, I'm a soldier, I've been a soldier my entire life, and as a soldier I use soldier analogies when I teach. If any of you have ever served in the Armed Forces, you will get this next bit well. If not, I'm sorry in advance. When a baby has a bad latch, it is almost always a double feed. You have two rounds in the chamber at the same time (in this case, breast and lower lip). And just like any other double feed, you'll have to pull SPORTS (slap, pull, observe, release, tap, and shoot). If you've never been in the military, don't worry, just remember SPORTS, guys like sports so we can use that to help you remember the steps to fixing a bad latch.
S -- Slap: Put your hand on the baby's back and push him toward the breast.
P -- Pull: Reach in between the chin and the breast and pull down on the baby's chin to elicit a rooting reflex.
O -- Observe: Does it work? Does the jaw open, do the cheeks fill and round out, do the lips flare, and does the pain go away?
R -- Release: Let go of the chin and let the baby suckle and test the new latch.
T – Tap/Try again: Repeat the first four steps two or three times to see if you can correct the bad latch.
S – Shoot – Darn it!: We have a hopeless double feed. We'll have to take him off the breast and try again.
If you can't fix the latch with the basics of SPORTS you are going to need remedial action. You're going to have to drop the magazine (take the baby off the breast), clear the chamber (calm the child then elicit a rooting reflex off the breast to encourage a VERY wide open mouth), and reload (put him back to the breast).
Eventually these steps will almost always help solve a bad latch. Very rarely you may find that even though you do everything right your baby will not latch correctly. He may have chosen to sleep rather than eat, he may be over stimulated, or he may just need an experienced hand to help him out. Give him a break, let him rest for an hour or so, and try again. If he ever goes 24 hours without eating, get in to see a lactation consultant right away.
When is my baby finished eating?
When baby is finished eating he will relax his hands, release the breast, pull away from the breast, and fall into a deep sleep that I call "The Milk Coma." Remember, your baby can't tell time. Some babies will finish the breast in 10-15 minutes; some will finish the breast in 45-60 minutes.
Both babies will have taken the same amount of milk, and that amount is "ENOUGH." There is no easy way for you to measure how much a baby eats when he is on the breast, but know that the actual amount of ounces he drinks is immaterial. What is important is that he goes to breast interested in feeding, and that he pulls away content, relaxed, and sleeping.
A baby that is satisfied after feeding, growing steadily, looking healthy and is generally a happy baby, is almost certainly getting "enough" to eat. The number one concern of new mothers is that they do not make enough milk. Try not to worry about it, keep offering the breast to the baby, and he will always get "enough" to eat.
Sex while breastfeeding
Now that we've covered feeding, let's talk about sex while breastfeeding. You may be afraid to ask, so I'll tell you. Breastfeeding (and for that matter, parenting) will impact your sex lives. Both of you need to know that some mothers have an increased libido (thanks to repetitive oxytocin surges), while others have a decreased libido (thanks to prolactin and a decrease in estrogen). Fathers may face problems with the "Madonna Complex" (She’s a mother now).
All of this will impact your sex life. It is important for both parents to understand that all aspects of parenting, are demanding, physical work with only short bursts of sleep interrupted by a newborn that demands attention at inconvenient times. Mom will need constant support and help from her lover. The more help she can get from her husband, the more energy she will have for other activities. In other words, "You've got to give a little, to get a little."
So there you have it; breastfeeding from a man's perspective. Fathers are powerful allies contributing to breastfeeding success. Do not allow yourself to be excluded from this time in your child's life. Study and learn, roll up your sleeves and get in the game. Your family stands a much better chance of success if you actively support breastfeeding and actually help your wife breastfeed.
Tom Johnston is a midwife and lactation consultant. Tom obtained his Bachelor's degree in Nursing at Austin Peay State University in Clarksville, Tennessee and his Master's Degree in Midwifery at the University of Rhode Island in Kingston.
Tom is uniquely placed as a man in both Midwifery and Human Lactation and the father of seven breastfed children. He has spent his career advocating for the rights of fathers in the perinatal arena and has spoken on a variety of topics at conferences around the world, most recently for the Association of Woman's Health and Neonatal Nurses (AWHONN) and the International Lactation Consultant's Association (ILCA). In his written work he has advocated for better science in the field of bedsharing and has authored a chapter on the role of the father in breastfeeding for Breastfeeding in Combat Boots: A survival guide to breastfeeding in the military.
Copyright © Tom Johnston. Permission to republish granted to Pregnancy.org, LLC.