Breastfeeding Basics with Christina Smillie

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Christina Smillie observes a mother breastfeeding

Dr. Christina Smillie

Many years ago I was asked to visit a new mother having trouble breastfeeding her baby. Not having much experience, I called a colleague for advice. The instructions she gave me for the mother went something like this: Sit in a straight-backed chair, with a pillow behind your back. Rest your feet on a thick book on the floor, so your knees rise above the level of your hips. Place a pillow on your lap to raise the baby to the height of the nipple.

And that was only the beginning.

In earlier generations, no one had to explain to mothers how to feed their babies. Women grew up seeing their mothers, aunts, cousins and sisters breastfeeding. But once formula feeding became prevalent, nursing mothers lost their role models, along with their confidence. Instead of being natural and pleasurable, breastfeeding seemed difficult and technical.

Dr. Christina Smillie, a pediatrician and International Board Certified Lactation Consultant, recently visited Israel to give a series of lectures. On the first day, she shared her early experiences helping mothers whose babies weren’t breastfeeding. She noticed that most babies, when placed near their mother’s breast in a supported position, started to nurse on their own. As she worked with more mothers she realized that “left-brain” instructions—logical and structured–didn’t help. The instructions interfered with an instinctive “right-brain” process.

When she meets mothers Smillie suggests that the mother lie in a half-reclining position, with the baby placed on her stomach or chest. The baby can lie at any angle. She showed several videos of babies who suddenly began breastfeeding, surprising the mother who hadn’t known that the baby could do it. She has also produced a video for new mothers.

Smillie lists four points to keep in mind when putting a baby to breast for the first time:

How Babies Learn to Feed:

  1. First, a calm baby
    We don’t make a baby learn to feed
    We allow the baby to follow his own instincts to learn
  2. Baby, not mother, initiates feeding
    Mother follows baby’s lead
  3. Seeking comfort guides the mother
    NO PAIN
  4. Instincts start the process of learning
    It is the successful transfer of milk that teaches the infant.
    Move from an instinctive process to a learned process.

[© 2011 Christina M. Smillie, MD. Reprinted with permission.]

Smillie emphasized again and again how the mother and baby instinctively know what to do. Without being prompted, the mother often begins to stroke or talk to the baby. The mother adjusts herself, the baby, or her breast. The baby is not helpless, either: They are born with the “stepping” reflex, which helps them crawl to the mother’s nipple and take the breast, and have more control of their head than we generally give them credit for.  There’s no “right” position for breastfeeding as long as everyone is comfortable.

Breast Refusal: A Learned Behavior

But what about a baby who cries when placed on the mother’s chest? Smillie explained that this is usually because the baby has developed a negative association with the breast. A mother generally tries to calm a crying baby. When the baby cries on the right shoulder, she transfers the baby to the left shoulder. If that doesn’t work, she gets up and walks around. But when the baby cries at the breast, the mother often keeps trying—in other words, she doesn’t respond to the baby’s distress. The baby quickly learns that this is a place where mommy doesn’t give comfort. After a few minutes of trying to breastfeed, the mother offers the bottle and everyone relaxes. So the baby associates the bottle with a relief of tension.

The next time the baby cries when put to the breast, the mother interprets the baby’s behavior as a preference for the bottle.  But the problem is simply that the breast has been a place where the baby’s need for comfort was not met. Many babies have been “shoved” on to the breast at some point, which can cause or exacerbate the problem.

If the baby has developed an aversion to the breast, Smillie usually recommends that the mother express milk for a few feedings or days, while gradually making the breast a comfortable place again. Babies have short memories.  She finds that babies whose mothers have never offered the breast take it more easily at older ages, because they have no negative association.

If you are a mother, what helped you learn to breastfeed? What didn’t help?

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Comments

  1. I probably knew about placing the baby near the breast soon after birth with my second and third child, but with my first, I was clueless. I eventually had a friend show me some positioning, which helped a lot, but being the bookworm that I am, I read a number of books and really got good at positioning (as I had sore nipples, so positioning was important). I also used a boppy pillow, and I learned to squirt milk into my son’s mouth. Unlike your breast upset babies in your post, my son learned to want to come to me and no one else, much to my husband’s chagrin. My now almost 17 year old does enjoy my husband’s company, so that attachment doesn’t last forever.

    La Leche was good at helping me meet other breastfeeding moms, but by the time I went to a meeting, I already had the basics down.
    Leora recently posted..Curried ChickpeasMy Profile

    • Hi Leora!
      Most of my babies were happy to go to my husband, and as you say even if not the attachment doesn’t hold through to adulthood. Thanks for sharing how you learned.

  2. well, almost two weeks after birth, I have to say nursing on the delivery table is enormously helpful. in getting things started on the right foot. And my daughter really wanted it. She was on one breast for a few minutes and then the midwife put her in the warming tray while she left the room for a few minutes. I had to ring for her to come and give her back to me and she took the other side.

    Nursing lying down is also good for us. She’s gotten very good at finding the nipple in the dark.

    Also, I’ve just come to know and accept that my nipples will be sore for the first week while they toughen up again. Last baby I was told if I aim the nipple for the roof of the mouth, it will hurt less. I haven’t managed to get that angle right, but so far, the nursing is going fine, it just hurt a bunch for about a week. With that pain, I understand why so many women give up so early.

  3. alpidarkomama says:

    There are also women for whom all the help in the world doesn’t work, like me! I had terrible problems with milk supply from the very beginning. After trying everything else, domperidone (a drug) helped, but the second I was off of it my supply nearly disappeared again. I tried for 12 weeks before I had to give up or go crazy. :) I have three other friends who had similar problems. So often it’s not lack of knowledge, but real physical difficulties.

    • alpidarkomama,
      You are right that some women do have challenges with making enough milk. In a different lecture, Smillie shared techniques that she felt were the most useful (massage and hand expression, less so galactogogues like Domperidone and fenugreek).

    • My SIL had the exact same issues. She also tried everything including drugs. She has three beautiful healthy daughters raised on formula. With each birth she drove herself mad trying to get nursing going. Though I encouraged her as much as I could, I also comforted her by reminding her that her previous daughters did just fine on formula and there’s nothing wrong with it.

      • Abbi, it seems that the mother is better than any warming tray. They did an experiment with twins–one was a little cold and one was a little warm. Each of the mother’s breasts warmed or cooled according to what the baby on that side needed. Glad you have found your groove! Sometimes, letting the baby lead in positioning helps with that initial pain.

    • The book Making More Milk is an excellent book for any mother who is having trouble or has had trouble with milk production. Even if you were not able to produce enough milk the first (or second or third)time you very well may be able to produce enough the next time. It is a good idea to get this book before your next baby.

      Dr Jane Morton of Stanford University has a great video that explains how to hand express from the beginning to increase your supply:

      http://newborns.stanford.edu/Breastfeeding/HandExpression.html

      and another one called Maximizing Milk Production: http://newborns.stanford.edu/Breastfeeding/MaxProduction.html
      Beth recently posted..Breastfeeding Is Protective Against SIDS And This Effect Is Stronger When Breastfeeding Is ExclusiveMy Profile

  4. I find it very helpful to nurse lying down. It is also very helpful to me that after every birth there is a lactation consultant at the beit hachlama. If I add it up, I’ve been nursing for about a decade by now. But I still always have a hard time getting started.

  5. Safranit says:

    I still find the “no pain” to be theoretical in my case. I had three kids all nursed until over 2 years of age, but the first month is very painful. I’m too big and their mouths are too small….It doesn’t last forever, but that first month kills me…and I don’t really believe it could be any other way for me. (Sought out Lactation consultants each time….)

  6. BookishIma says:

    In my experience (in which I had a wonderful lactation consultant – but not until after things were already going wrong), there are two things I wish I’d known. So much of the breastfeeding literature makes it sounds like getting the baby to latch on properly is extremely difficult. In fact, I don’t think it is is, IF everything is fine with the baby. (It’s very helpful to have another woman show you how to hold the baby and position yourself so it’s easy for the newborn to latch on, certainly.) I was panicked about latch and thought I was doing it all wrong. Well, and this it the second thing I wish I’d known, breastfeeding is certainly somewhat painful at the beginning, but it should not be excruciating. I thought the pain and bleeding was all because of my bad latch, but it was because my baby was tongue-tied. I like the recommendations here that emphasize that although breastfeeding is a learning process for mother and baby, it is not extremely difficult, usually. If it is, you should seek help right away – there may be another problem. I ended up nursing until toddlerhood after that difficult start!

  7. Thank G-d, I was able to nurse both my boys immediately after they were born. I found that nursing my second was much easier and painless (with my first I experienced cracking and bleeding. Not fun).

    The challenge I’ve found is pumping and also with keeping up with nursing after the babies start solid foods. With my first, we didn’t introduce formula until he was 10 months old. I stopped nursing around that time as well. With my second, we introduced the bottle at a month, but with pumped breast milk, but as I only had a hand pump and a toddler, I soon started using formula instead.

    I feel okay about it (as in, I’m not wracked with guilt), but I would love to hear some tips on ways to be better at pumping and ways to keep nursing until a year. I do still nurse my baby, but maybe only once or twice a day, generally in the morning or the evening, but not in between.

  8. One way to make sure that your baby nurses for a year is not to spoon feed them 3 meals a day and give them snacks. One way to do this is with baby led feeding. Baby led feeding is when a baby feeds herself after they have nursed. For example you would put little cubes of cooked sweet potato for the baby to pick up or you can just let them eat what your eating (crumbled up hamburger, small pieces of cooked broccoli, or some brown rice).
    Beth recently posted..Breastfeeding Is Protective Against SIDS And This Effect Is Stronger When Breastfeeding Is ExclusiveMy Profile

  9. When my second son, now a year old, was born at Hadassah Ein Karem and had trouble latching, a few different nurses there were able to get him to latch using the method described here – basically putting him in the middle of my bare chest and letting him move himself on. So this method has already been popular in at least one Israeli hospital!

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