A lot of families contact me with the goal of transitioning from bottle-feeding to breastfeeding or chestfeeding. In the vast majority of cases, the families originally intended to exclusively breastfeed, and their plan was derailed by early feeding challenges. Baby may be breastfeeding some of the time but need extra milk if the family is still working on increasing milk supply, or if baby has trouble breastfeeding effectively.
Guilt, shame, and disappointment are common emotions that come up for new parents who haven't yet reached their feeding goals. One of my most important roles as a lactation consultant is to validate parents' feelings. In our competitive and impatient culture, it's easy to feel less-than when our efforts don't immediately lead to the results we seek. I invite parents to step back and recognize it will likely take some time to figure everything out. In the meantime, focusing on The Three Keeps from The Womanly Art of Breastfeeding (La Leche League International, 2010) is very helpful.
1. Keep your baby fed.
I call this Rule #1. Parents who are using bottles, formula, or donor milk often feel bad about it, and I always praise them for keeping their babies well-fed. Babies who are getting enough food are typically more alert and thus easier to feed by any method, especially breastfeeding. Families who are supplementing their babies' feedings with extra milk should be working closely with their health care providers (lactation consultant, pediatrician) and getting regular weight checks to ensure that they are feeding appropriate amounts.
2. Keep your baby close.
Babies who spend a lot of time in close physical contact with their lactating parents typically return to the breast sooner. Skin-to-skin contact is important for helping babies to orient to the breast, so I encourage families to do as much of this as they can. Babies need to return to the breast on their own terms. If the breast has become a battleground, with baby actively resisting breastfeeding, then it's time to work on creating positive associations. A great starting point is lots of snuggling without any attempts at breastfeeding. Parent and baby may enjoy a warm bath together (with parent getting into the tub first and having partner hand over baby). Sleeping together also helps, as long as the family is following safe bedsharing guidelines.
3. Keep your milk flowing.
Some babies are part-time breastfeeders as parents work on building a full milk supply with pumping and hand expression for added breast stimulation. In other cases, the lactating parent is only pumping and hand expressing, and all feeds are given by bottle. In either case, consistent and effective milk remove is critical! I see the best results when there are at least 8 breast drainings per day. I also talk to parents about the importance of avoiding long stretches in which milk just sits in the breasts; 4 hours is about the maximum amount of time anyone should go without removing milk as they're trying to boost supply.
Babies who have difficulty latching will likely need some extra support, and this is something that I do all the time. Often a few adjustments to positioning make a big difference. There may be a physical issue that we need to address, such as a tongue tie. Some babies do well with the assistance of a nipple shield for a brief time, and this is definitely a tool that should be introduced with help from a lactation consultant.
A parting thought: babies are born to breastfeed, and this instinct stays with them for many months. I have heard of cases in which an older baby of 8 or 9 months was adopted and breastfed for the very first time! It often takes patience, persistence, and good support to get a baby back to breast, but it can absolutely be done.
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One lactation consultant's musings about milk.