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The recommendation from the American Academy of Pediatrics and other medical groups is clear—babies should be breastfed until at least their first birthday. But few mothers and babies make it that far. Although more than 70 percent of new mothers in the USA breastfeed just after birth, just 16 percent are still breastfeeding at one year (Ruowei et al. 2005). The reasons that so few make it to that goal are complex— a society that doesn't always support breastfeeding; alternatives that can seem easier during difficult times; a lack of education or understanding about the significant differences between the health of breastfed babies and bottle-fed babies. But most mothers who really want to can make it to a year, and beyond. This article provides some tips to help you get there.
1. Find Support
Although many mothers initiate breastfeeding after birth, it's still unusual for a new mother to have a lot of experience with seeing breastfeeding in action. The changes a new mother experiences after the birth of a baby are hard to anticipate and oftentimes surprising. The theoretical notion of planning to breastfeed can be radically different from caring for a real, live baby at the breast. For that reason, it's comforting to be around people who know about breastfeeding.
One of the easiest ways to find supportive people is to attend La Leche League meetings during your pregnancy. Experienced Leaders often note that mothers who are involved with LLL before the birthtend to have an easier time because they are more educated about the normal course of breastfeeding. Plus, if there are unexpected issues, mothers who have already attended meetings are often more comfortable calling a Leader they already know.
It can also be helpful to educate family and friends about your goal. When Unity Dienes, a Leader in New Hampshire, was expecting twins, she made sure that her husband, Klee, understood her goals by writing up a list of reasons why it was so important for their boys to get her milk. Unity's advance work meant that when they encountered challenges in those early weeks, she had his full support. "He was amazed at how many different reasons there were," she says.
2. Learn to Breastfeed in Public
Learning how to breastfeed in public can be a big challenge—especially in communities where breastfeeding isn't as common. Women who can't get comfortable breastfeeding in public generally find it harder to make it to a year or beyond. If she doesn't want to nurse in public, a mother would either need to limit her excursions or pump her milk for bottles. Either of those can be frustrating and can limit the breastfeeding relationship.
Some mothers find nursing clothing to be helpful when they need to nurse in public, while others find it just as easy to breastfeed discreetly by lifting their shirt from the bottom and making sure their baby covers all of the exposed skin. Many mothers gain confidence by practicing in comfortable environments —such as a La Leche League meeting—or by watching themselves in a mirror so they know what they look like to those who may be watching. Sometimes enlisting a friend to come along for early outings can make a mother more comfortable. "Even if someone can tell you are breastfeeding, it's not a big deal," says Unity. "Try to develop that mind set. You are feeding your baby. You are comforting your baby. That's what your breasts are for."
Often a mother will actually be encouraged in her breastfeeding relationship by strangers who see her breastfeeding. "I was very nervous about breastfeeding in public with my first baby," says Dawn Burke, a Leader in Georgia. Once, when her daughter was about eight months old and the pair was out at a farmers' market, her baby became desperate to breastfeed. Dawn found a secluded spot on a milk crate at the edge of the public/employee area and sat down to breastfeed. An older male employee approached and loudly praised her for breastfeeding. "It is good to see you nursing your baby!" Dawn remembers him saying. "I am from India," he continued, "and breastfeeding is very important there. You keep nursing your baby. It's very good!" Now, Dawn says, "I tell mothers at meetings to take support wherever they find it!"
3. Limit the Use of Bottles and Pacifiers
Some babies clearly do use bottles and pacifiers and manage to continue breastfeeding for at least a year. But, as stated in THE BREASTFEEDING ANSWER BOOK, getting sucking needs met somewhere other than the breast is a risk factor for early weaning. Using artificial nipples during the early weeks can interfere with a baby's ability to breastfeed effectively.
La Leche League suggests limiting pacifier use in the early weeks, which can seem confusing to some mothers in light of the recent recommendation of the American Academy of Pediatrics that babies should sleep with pacifiers to reduce the risk of Sudden Infant Death Syndrome. LLL believes that the recommendation did not take basic breastfeeding management into account and could threaten the development of longer-term breastfeeding relationships. According to a statement issued by LLL:
Pacifiers are artificial substitutes for what the breast does naturally. Breastfed babies often nurse to sleep for naps and bedtime. The recommended pacifier usage could cause a reduction in milk supply due to reduced stimulation of the breasts and may affect breastfeeding duration.
In other words, if pacifiers are good for babies, why not use the best—the breast?
4. Find Ways to Involve Dad
One of the most common reasons new mothers give for pumping milk is that they want their baby's father to be able to give the baby a bottle. Frequent bottles, however, can lead to early weaning, so finding another way for daddy to connect with his baby can be crucial. In many families, bath time or an infant massage is a special daddy-baby bonding opportunity that offers skin-to-skin contact and comfort.
Cindy Howard, a Leader in California, recalls that her husband disliked giving their daughters bottles because his daughters seemed to behave as if they were getting second-best. When their youngest daughter, Gwen, was a baby, John connected with her by rubbing her feet to comfort her when his wife attended an early morning exercise class.
Jennifer Moquin, a Leader in Pennsylvania, let her husband, Anthony, take the late shift with their night owl baby. She would breastfeed the baby and then lie down to sleep a bit while daddy walked the baby around, played special songs to her, and showed her pictures on the wall. "She was mellow, but wide awake," Jennifer recalls. "It was always a really nice time for them."
5. Create a Daily Rhythm
Strict schedules can make it hard for a mother to respond to her own baby's cues. They can also lead to decreased milk supply, because milk is removed from a mother's breasts less often. It can be confusing for mothers to hear that babies are "supposed to" breastfeed eight to 12 times in a 24 hour period or that babies "should" breastfeed for 10 or 15 minutes on each breast when their baby is doing something different. According to THE BREASTFEEDING ANSWER BOOK, "Length of feedings varies with the baby's personality and age. A baby's breastfeeding style also may change as he grows." Many mothers find it helpful to spend less time looking at the clock and counting the number of times their babies go to the breast. As long as your baby is gaining enough weight, simply watching his or her cues is enough.
For some mothers and babies, though, having some sort of predictability to the day is important. A mother can gradually provide some structure by giving her baby predictable cues. Having a specific order to the day—a time for baths, walks, or books, for example—can help the baby and the mother find a rhythm that works for them. Some babies will fall into a more regular breastfeeding pattern as they grow older. Others will continue to want to breastfeed frequently throughout the day.
6. Breastfeed for Comfort
Some mothers worry that offering the breast for comfort when baby is upset will create an inappropriate emotional connection with food. They worry that their child will turn to food for comfort, rather than eating to satisfy physical hunger. They might believe that it's better to try to separate food from emotions. If we are honest with ourselves, though, we will realize that all of us associate certain emotions with certain foods. Cindy Howard, who is also an International Board Certified Lactation Consultant, gives the example of the traditional birthday cake. There is rarely much nutritional value in the cake. It's the emotional component of celebrating with others that matters.
When you offer the breast for comfort, you are encouraging your baby to turn to you for comfort instead of a non-human object. The human contact matters more than the milk. Plus, breastfeeding for comfort keeps your supply plentiful and reminds the baby that by breastfeeding he can help himself to feel good again.
7. Recognize the Signs of a Nursing Strike
Babies often have periods during which they seem more or less interested in breastfeeding, but it is very unusual for a baby to actually choose to wean before one year. It is not uncommon, however, for a mother to say her young baby is "weaning" when the baby is actually in the midst of a nursing strike or making a developmental leap that is distracting him from breastfeeding. According to THE BREASTFEEDING ANSWER BOOK, the most typical age for a nursing strike is between three and eight months.
The key to avoiding weaning inadvertently is to recognize and deal appropriately with a nursing strike. Molly Remer, a Leader in Missouri, remembers that when her son, Lann, was five months old, he stopped breastfeeding during waking hours for a week due to having a cold. Apparently frustrated because he was congested and having trouble breathing while breastfeeding, Lann simply refused. Molly breastfed him while he slept and tried various tricks to get him back to the breast during the day. Breastfeeding while in motion worked best, so she walked and breastfed. Lann is now two years old and still breastfeeding regularly.
Another very typical time for something that can look like weaning, but isn't, is the second half of the first year as babies start to move and be more aware of their environment. Some are so distracted that they never stop to breastfeed. Some mothers find that offering to breastfeed more often, bringing a baby into a dark room to breastfeed, or taking advantage of nighttime nursing opportunities can get them through this stage. Frequently, when babies refuse to breastfeed, though, there is something else going on that has upset the babies' lives, such as an illness or teething or a big change in the family, such as a move. And, sometimes, rarely, babies will wean naturally before a year. The benefits of breastfeeding to a baby's health are so strong, however, that it is worth efforts to make sure that a baby is not simply going through a short-lived stage before stopping breastfeeding.
8. Handle One Day at a Time
Some mothers are planners: they want to decide how long they will breastfeed before their baby is even born. They think, "I don't really want to nurse a three-year-old, so I will wean now." Others may plan to breastfeed until a year or beyond, but may feel overwhelmed during the early days and fear that they can't possibly make it to their goal.
Instead of making a firm decision in advance, try taking it one day at a time. When your baby is a newborn the idea of breastfeeding an enormous 12-month-old can seem daunting. When you are helping her blow out her candles on her first birthday, your baby won't seem nearly so huge.
Ariel Valencia, a mother in California, has used the "one day at a time" approach to help her continue to give her son, Evren, only her milk. Ariel works outside the home and finds it difficult to pump enough milk for him while she is away. She sets two-week goals and has already made it to five months.
9. Don't View Breastfeeding as an "All-or-Nothing" Proposition
Occasionally mothers introduce formula—perhaps to cope with a supply deficit while they are working or because they choose not to pump milk when they are separated from their baby.
Julie Nelson, a mother in New York, introduced formula to her son, Nicholas, at nine months when she stopped being able to pump enough for him while she was at work. She continued to breastfeed during the evenings and on weekends and Nicholas continued to breastfeed through his first birthday.
10. Enjoy the Moment
Remember, it's okay to fall in love with breastfeeding. "It's going to be your heart, not your mind that makes you continue," says Unity Dienes. So prime your heart to love breastfeeding. Unity suggests that mothers:
•Make sure breastfeeding doesn't hurt—you can't fall in love with something that hurts.
•Avoid having anything in between you and your baby, including a nipple shield or a bottle with pumped milk. Whenever something is between you, it makes things more difficult.
•Snuggle with your baby. Savor his sweet smell and his fuzzy head. Watch to see the milk your body made dripping out the corner of his mouth. Falling in love involves all the senses.
When a mother embraces breastfeeding, it becomes that much easier to breastfeed for a full year and beyond. That's the true "secret" to breastfeeding. If a mother enjoys breastfeeding or commits herself to it, it's likely that it will be easier for her to allow comfort nursing, figure out how to nurse in the presence of others, and get the support she needs.
This period in your baby's life is fleeting. As you adjust to this new experience, remember to take things as they come and try to enjoy the moment.
References
Mohrbacher, N. and Stock, J. THE BREASTFEEDING ANSWER BOOK. Schaumburg, Illinois: La Leche League International, 2003.
Ruowei, L. et al. Breastfeeding rates in the United States by characteristics of the child, mother, or family: The 2002 national immunization survey. Pediatrics 2005; 115(1):e31-e37.
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