What I needed at 3 a.m. wasn’t equipment. It was a person and a plan.
Feeding was hard from the first weeks through my child’s first year. What I needed was a person who could watch a feed and tell me what to do that day, and this is how to line that up before the birth.
Feeding, month by month
The early months. Breastfeeding my first child was hard from the start. My baby’s latch wasn’t improving, even when I followed every tip. Some feeds, my baby took about an ounce. My milk came fast, and the flow was a struggle. At my six-week visit, I asked for a referral to lactation support.
In the early months, I got a stomach bug and my supply dropped suddenly, to about 10 ounces a day. Some nights my baby fell asleep after a hard feed, and I didn’t know whether that was enough or what I was supposed to do about it that minute.
Later in the first year, after my supply dropped again, I was pumping six times a day to get back to exclusive breastfeeding, and asking how to cut that down without losing what I had. Around the same time, I noticed milk coming out of my baby’s nose, and feeds bunching up at the end of the day. (The reflux, and what it meant for sleep, is in “Safe Sleep Rules for Every Caregiver.”)
The first year. Toward the end of the first year, my child was refusing almost everything except morning oatmeal, accepting food and spitting it out. I wrote a feeding summary for a specialist: “[My child’s] weight increased by a few ounces but [has] continued to drop on [the] growth curve.” I told the specialist I found it hard to keep set mealtimes “because we are constantly trying to feed [my child],” and that I had started relactating (rebuilding my milk supply after it had dropped off), because my child always seemed to want milk.
Eczema. When my child’s skin flared while I was still breastfeeding, I questioned everything I ate and took: vitamin D, cod liver oil, my prenatal, low-histamine fruit, even popcorn. Much later, the eczema improved around the time of weaning. I noticed the timing, but I don’t know what accounted for the improvement.
When someone else did the feeding. A caregiver didn’t follow the feeding plan I had demonstrated. During the weeks she was with us, my child lost weight. After that, I wrote detailed instructions, asked for a feeding log and did trials before relying on anyone.
How I hand off feeding now
- I demonstrate the feeding plan to every caregiver and watch them do it.
- I ask for a log of feeds, diapers and sleep.
- I write symptom summaries to bring to specialists.
Key points
- Under the Affordable Care Act, most plans must cover breastfeeding support, counseling and a breast pump for as long as you breastfeed. Before the birth, ask your plan how to book a lactation consultant (an International Board Certified Lactation Consultant, or IBCLC) and save the number.
- The CDC says breastfeeding mothers generally don’t need to avoid particular foods. If you think something you eat is affecting your baby, ask the pediatrician before cutting out whole food groups.
- WIC, the federal nutrition program for women, infants and children, offers breastfeeding peer counselors along with food benefits, and if you have Medicaid, you may already be income-eligible. Apply during pregnancy, not after.
I had the pump, the bottles, the nursing pillow and the cream. None of it answered the question I actually had at 3 a.m.: is my baby getting enough, and what do I do right now?
Feeding help that’s covered
- Check your coverage. Under the Affordable Care Act, most plans must cover breastfeeding support, counseling and a breast pump, for as long as you breastfeed; grandfathered plans (older plans that existed before the law) are the exception. Ask what your plan requires, such as pre-authorization or a specific supplier, and whether it covers renting a hospital-grade pump if you need one.
- Use the free help, too. WIC offers breastfeeding peer counselors along with food benefits; if you have Medicaid, you may already be income-eligible. La Leche League has volunteer-led groups you can find by location. Ask your hospital whether it runs a lactation warmline (a phone line for feeding questions) or support group after discharge. More options are in “Help That Costs Less, or Nothing.”
- Ask the pediatrician how feeding will be checked: weight checks, diaper counts and when to call.
- Most breastfeeding mothers don’t need to cut out foods. The CDC says breastfeeding mothers generally don’t need to avoid particular foods. If you think something you eat is affecting your baby, talk to the pediatrician before cutting out whole food groups.
- Assign the practical work in advance: who brings the baby to you, who washes the parts and who keeps the log.
Take this back
To discuss with your care team and pediatrician:
- Who can assess a feed in person in the first week?
- How will we know my baby is getting enough?
- What should I do today if feeding is painful or not working?
- How can I pump less without losing supply?
- Which specialist should assess reflux or breathing symptoms after feeds?
To discuss with the people in your life: Which feeding jobs will you take?
What I needed
What I needed wasn’t equipment. It was a person who could watch a feed, assess the latch and the baby, and tell me what to do that day. When I didn’t have that person, the assessing fell to me, often at night, without knowing what I was looking for.
Don’t wait if
Get emergency care immediately if your baby is struggling to breathe, turns blue or gray, or is difficult to wake. Call 911 if you cannot wake your baby or think the situation is life-threatening. For poor feeding, fewer wet diapers than expected or concerns about weight gain, contact your pediatrician promptly for advice and assessment. Don’t wait for a routine appointment.
Next in the series: “Safe Sleep Rules for Every Caregiver”
