The early weeks of pregnancy are fragile—and confusing. Here, the answers to your questions.
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Q My milk has come in, and I’m engorged and uncomfortable. How long will this last?
A According to Jan Riordan, Ed.D., R.N., I.B.C.L.C., associate professor of nursing at Wichita State University in Kansas, and author of Breastfeeding and Human Lactation (Jones & Bartlett, 1999), engorgement is a normal part of breastfeeding and is necessary for milk production, but it will diminish in a few days. The more your baby nurses, the more your body will get used to the supply and demand of breastfeeding. You can expect more regularity by the second week.
Q I’d like to lose my pregnancy weight, but I’m nursing and have heard that losing weight too quickly can cause my milk to dry up. What’s a realistic and safe goal?
A After the first postpartum week, a lactating woman should plan on losing no more than 2 pounds a month, says Ruth Lawrence, M.D., a neonatologist and professor of pediatrics, gynecology and obstetrics at the University of Rochester School of Medicine in New York, and author of Breastfeeding: A Guide for the Medical Profession (C.V. Mosby, 1999). According to Lawrence, studies show that a breastfeeding woman needs a well-balanced diet with a minimum of 1,800 calories a day and plenty of fluid.
Mothers who consume less than this deplete their own nutritional stores and risk becoming ill or affecting their milk production.
Exercise is fine, Lawrence says, but don’t expect to lose the extra 5–8 pounds of fat that every woman carries for the entire lactating process. But do be aware that milk produced after strenuous exercise contains more lactic acid, which some babies dislike. If you tend to work up a sweat when exercising, make sure you nurse before your workout; afterward, you might want to postpone nursing for 30 minutes or discard the first teaspoon of milk from each breast.
Q How can I tell if my baby is getting enough milk?
A “There are several indicators of adequate intake,” says Audrey Naylor, M.D., associate clinical professor of pediatrics at the University of California, San Diego, and co-founder of Wellstart International, an organization dedicated to educating health professionals about the science and management of lactation. In a newborn, look for four to six very wet diapers and several bowel movements a day. When the baby is at the breast, look and listen for the rhythm and sounds of swallowing. Also note how your breasts feel before and after nursing; most women find that their breasts feel full before feedings and more comfortable afterward. Your baby’s weight gain is another indicator, as are signs that he seems to be thriving and is satisfied after nursing. If you still have doubts, consult with your pediatrician or a lactation expert.
Q Can I use breastfeeding as a birth-control method?
A Not with any certainty. According to Naylor, studies show that breastfeeding exclusively is 98 percent effective as birth control if some very specific guidelines are followed. For instance, your baby must be less than 6 months old and must be nursing at least every four hours around the clock. In addition, you cannot have started your period.
Because of these parameters and the risk of birth-control failure if they are not met, a better option might be to use a different type of contraception, such as condoms or a diaphragm. After six weeks, you can take birth-control pills that contain only progesterone, but avoid combination pills containing estrogen.
Q I’m pregnant but want to continue nursing my 1-year-old. Can I breastfeed both children once the baby is born?
A Most pregnant women can continue nursing with no problem, but it depends on your obstetrical history, according to Naylor. Oxytocin, the hormone responsible for milk letdown, can also trigger labor. Women prone to miscarriages or preterm labor should therefore ask their doctor if they can continue nursing. Do keep in mind that some babies dislike the altered taste and texture of breast milk during pregnancy and stop nursing altogether.
Once the baby is born, you will likely be able to nurse both children. But it’s important to remember that while your older child is eating supplemental foods, breast milk is your newborn’s only nutrition. Breastfeeding the newborn should therefore take priority.
Q What if breastfeeding doesn’t work for me? How long should I try before giving up?
A According to Riordan, studies show that successful breastfeeding depends largely on the mother’s commitment and motivation. That said, it can sometimes take several weeks to get into a comfortable routine. Don’t give up before talking to a lactation consultant, experienced breastfeeding mother or La Leche League member; most problems with nursing can usually be corrected.
Kathleen O. Ryan is a Houston-based writer specializing in health, fitness and family issues.