Breastfeeding Support

Despite Celebri-hype, Breastfeeding is Hardly an Easy Weight Loss Plan

"Wow, that breastfeeding really keeps you thin!"

I've heard this a few times and I'm always tempted to reply,

"Yeah - I actually had kids because I got so sick of spending a whole hour of my time at the gym everyday.  What a timesaver that was!"

The calorie-burning aspects of breastfeeding have been given a lot of attention in recent years.  Although the calorie burn is real, the net effect on body weight can vary a lot from woman to woman.  Regardless, it had been highlighted on websites that support and promote breastfeeding.  But the place you really hear about the breastfeeding weight loss bonanza from is Hollywood. 

Celebrities and public figures who breastfeed their babies do so much good for breastfeeding rates and general public health.  It's truly wonderful when they are willing to go the extra mile and speak openly about their breastfeeding experiences (right Michelle Obama?). The site Best for Babes has an excellent forum for the famous to engage in productive, informative discussions about breastfeeding that can inspire moms and educate the public.

So I'm really happy about Gwyneth Paltrow, Angelina Jolie, Jennifer Garner, Rachel Wiesz, and, of course, Kourtney Kardashian, showing their fans how it's done. I do have a problem, however, with tabloidish "celeb breastfeeding" clips that invariably hone in on weight loss as THE reason to breastfeed.  It's really an absurd idea. 

Breastfeeding a baby is a huge commitment and one that requires much more from a mother than any diet or workout routine.  Maybe weight-loss is what the editors focus on because they think it's what the readers want to hear about.  Maybe celebrity-moms tend to focus on it because they feel it's a way to speak about breastfeeding in terms that Hollywood can appreciate. 

Maybe the weight loss angle is how some celebrity moms deal with managers, publicists, directors and others who might not be so understanding about the intense commitment to mothering a breastfeeding mom takes on.  The subtle threat of "support this or I put on 30 lbs" is probably a smart power play for a star mom who wants time out of the spotlight to spend with her baby.  

Whatever the reasons for this "breastfeed your way to a hot bod" idea, it has one good (to encourage breastfeeding) but two annoying outcomes.  One, is that if you are thin (usually because you have little time to eat when you breastfeed, attachment parent, cloth diaper and add any of the following: run the household, work outside the home, blog, cook, work at home, workout, coach, serve on the school board, etc...) people rudely and absurdly imply that dress size is your true motivation for breastfeeding. 

The second flipside annoyance comes when this same busy schedule leads to weight gain because there is less time to eat right and excercise.  If you haven't transformed into a swimsuit model by the time your baby hits 12 weeks, you start to get the not-so-subtle questions like, "So, do you think the breastfeeding will start to take off some of that baby weight eventually? Are you going to keep at it?"

Newsflash TMZ, assorted frenemies, and Aunt Judy: stars and moms commit themselves to breastfeeing out of concern for their children - not their waistlines.  I enjoyed seeing a recent story about Heidi Klum's breastfeeding in which she said breastfeeding weight loss is blown out of proportion and, BTW, she does it because "Breastfeeding helps (her) child." 

Don't get me wrong - I support anything that increases breastfeeding rates, including making moms aware of the high caloric burn of breastfeeding. But those looking in from the outside shouldn't use this information to make belittling (and ridiculous) assumptions that moms breastfeed (or continue breastfeeding) because it's a convenient "cheat" for keeping slim.

*Update:

Just found this great post on this topic from Sustainable Mothering:

Not Another Blog Post About Breastfeeding and Weight Loss

An Unscientific Reason to Attachment Parent

Attachment Parenting
If you attachment parent (AP), then you believe in the principals laid out by Attachment Parenting International.  This type of parenting has been popularized, in large part, by Dr. William Sears, who has his own list of "Baby B's." AP emphasizes on bonding with your newborn, breastfeeding, co-sleeping, and responding to your baby's cries.  In essence, it means following your natural instincts as a parent - to snuggle and love and soothe your baby. 

Baby Training
Baby training (BT) methods, which often go hand-in-hand with letting babies "cry it out" (CIO), follow a very different style of of parenting.  Made popular in books like Babywise, these methods encourage parents to resist the "temptation" to "give in" to the desire to feed, hold, or soothe their crying babies.  Attention is dispensed according to a disciplined schedule designed to teach babies when it's okay to need food, diapering, or human contact. 

You Can't Actually Train a Newborn
BT promotes the idea that a baby's needs can be managed and controlled.  This can be a welcome idea for overwhelmed, tired new parents.  Unfortunately, it's not true. The needs of a baby, especially a new baby, are very high and cannot be "managed" away.  New babies are also biologically incapable of being trained to sleep or eat on a schedule, so training a baby is simply not a realistic goal.

You Can Train A Parent
Parents, unlike new babies, can be trained. If a new mom is instructed not to "give in" to her baby's cries, and this type of "disciplined" parenting is encouraged by everyone around her, she can be conditioned to repress her natural urge to hold and soothe her baby.  Her baby won't actually learn to need less human contact - he will still cry.  He'll just be ignored.  A continually ignored baby may finally become detached after enough isolation - giving up on the parents who won't "give in" to him, but many babies will just keep crying - hoping for those moments when the BT schedule decides their cries will be answered. 

Will Your Early Parenting Style Decide Your Child's Fate?
Does BT, CIO style parenting turn children into cold, psychotic delinquents? No. Does AP guarantee happy, successful, loving children? No. So many parents who argue the relative merits of these parenting styles (and the continuum between them) focus on whether or not a kid can "turn out just fine" one way or the other.* 

Your choice of early parenting style will certainly affect how your baby relates to you and likely reflects how you feel about your child or having children in general.  Your choice of parenting style will have some impact on your child's personality, too, but it will get mixed in with hundreds of other factors in determining how he "turns out," including general health, genetics, education, peer group, siblings, environment, cultural influences, talents, preferences, and many other things.

Why Bother Attachment Parenting, or Even Breastfeeding?
So why bother attachment parenting?  Why even bother breastfeeding for that matter? Breastfeeding, of course, has a more direct, objective impact on health and intelligence (some studies debate aspects of the IQ claim, but most research supports it).  There are, however, plenty of formula-fed children who "turn out just fine" by adulthood.  For the sake of argument, let's even pretend that baby-trained, formula-fed kids "turn out" no different that breastfed, attachment-parented ones.

More Effort, More Commitment, and More Awesome
Guess what? Attachment parenting is still a much nicer way to live. Yes, it's more work. It takes more time, and more commitment to being a mom or dad. Breastfeeding alone is a huge undertaking, especially if you have to go back to work while your kids are still little.  The thing is, you had a baby.  Don't fight the situation - enjoy it!  Snuggle him, comfort him, hold him, love him, play with him.  Forget your hairdo and miss the call.  Let him take up your time and invade your life, you'll be glad you did.

I'm not talking to the parents who are just trying to survive and cannot AP or breastfeed for reasons beyond their control (working two jobs to pay rent, medical problems, etc...).  They probably don't have time to read parenting and breastfeeding blogs.  I'm talking to people who spend so much time and energy trying to manage their children and protect some highly marketed idea of "my precious child-free time" that parenting becomes a miserable chore. 

Babies Are Not Evil
We all have times we just want to take a long, quiet bath or finish writing a blog post or have a uninterrupted conversation with our spouse.  We all want to put on nice clothes and go out for a glass of wine with friends on occasion. What I don't understand is the fearful, defiant reaction some people have to attachment parenting and the sadly common attitude that babies are selfish manipulators trying to horn in on the lives of their parents. 

You're expected to hope and pray for a beautiful baby, but the second that baby comes out you'd better "watch out" for that kid.** It's like your baby is some menacing stalker.  With a deadly serious look, someone will warn you,  "Too much coddling and before you know it, they'll want to be held all the time!" Quick - file a restraining order! Or just leave them alone in a crib sobbing their little heart out, that'll teach 'em.  I don't get it.

Throw All the Science Out the Window and AP and BF Still Win
Yes, there are lots of scientific (psychological and medical) reasons to attachment parent and breastfeed.  But the argument for attachment parenting practices - like breastfeeding, cosleeping, and lavishing your child with love - doesn't hinge on those studies.  That's why articles like Hanna Rosin's "The Case Against Breastfeeding" and "gotcha" press releases like this one (describing one study that indicates increased intelligence in breastfed babies may be due to genetics) have little impact on my views of parenting.  Attachment parenting and breastfeeding aren't about winning a medal or creating a perfect child,  they're about giving yourself permission to love your children and enjoy the awesome experience of being a parent. 

 

*I have noticed that "turn out just fine" is a phrase used a lot by people defending a parenting practice they don't feel good about.

** common parental advice, but do we really need to "watch out" and protect ourselves from helpless infants?

Clogged Ducts are The Enemy...

… here's how I knock out my nemesis,
GI Jane style.

By Jen Humberson, MD

I am writing this as a mother of two boys whom I nursed for one year each. I’m also a pediatrician, but I’m writing this as a mom. Some of my thoughts below might not be ones I’d share gracefully in the office.

So in two years of nursing I probably had clogged ducts 15 times. I have no idea if this is average, but I certainly know friends who’ve had 5 or so. I got to where I could tell when one was starting and begin my routine ASAP to keep it from getting worse. One thing I DID know from my medical experience: clogged ducts can lead to mastitis, and I do not ever want to have mastitis. I’ve seen lots of people in lots of pain, but none of it compares to the women I’ve seen with untreated mastitis.

How do you know if you have a clogged duct? Well read good sources of information. My signs? A vague feeling like one section (think pie slice) of one breast wasn’t emptied at the end of a feeding, and the same area feeling more so a feeding or two or three later. Or feeling a lumpy firm area (again, sometimes like a pie slice, sometimes like a rock) in my breast that became increasingly tender. Sometimes the area was starting to pink up, and sometimes the veins in that area would become a little bluer, a little more noticeable. Only once did I have the “little white spot on the end of the nipple” that some resources describe.

What to do? Simple. Get the area unclogged. How to do that? Not always easy. I would do a few things, alternating between them, until I got it completely unclogged (when the whole breast is soft, there’s little to no more milk coming, and the pain is pretty much gone about 12 hours later, save for some bruising if you had to cause some… read on.)

1.  Nurse, nurse, nurse. Let your baby drink as much as s/he wants as often as s/he wants while you’re trying to get unclogged. While nursing, as much as possible, massage (with your hand) the firm and tender part of your breast. How hard? Not as hard as you can take it- Harder than that. This is the not-fun part, but it is ABSOLUTELY worth it when you get it unclogged and you avoid further problems. Frankly, nursing alone only solved my clogged ducts once or twice

2.  Take two to four ibuprofen, ie Motrin or Advil (400mg to 800mg) with your doctor’s okay. It will make the next part more bearable.

3.  Pump, pump, pump. Find a good t.v. show, brew some tea, and pump the affected breast (you can pump both if you want to) and, with your hand, massage the tender firm area like it’s a bear about to mawl your baby. You can start gentle, but you will likely have to use a good bit of pressure (read: a heck of a lot) to get the milk to get through. Also increase the strength of the pump to the highest you can stand without harming your nipples. You will know when it really starts releasing as there is a flood of more milk (sometimes yellowish or reddish- don’t be alarmed) and the area slowly turns softer. KEEP GOING until the whole breast feels soft and there’s pretty much no more milk coming. This method worked for about 75% of my clogged ducts. The worst ones took 2 or 3 pumping sessions, usually about 30 minutes long each (one time was 45 minutes but finally worked).

4.  Shower Power. Basically, you use your hands to massage and somewhat manually pump the affected breast. I used this method more after I realized how well it worked with my second child. After trying the first two, if the area is still partially or completely clogged, turn on a steamy shower, as warm as you can take it, and step in and massage the firm tender area more firmly than you can take and use the fingers of your other hand to express some milk.

In my experience, it often took 5 to 15 minutes, and occasionally two showers, but then the area unclogged and I was able to manually express the milk until the whole breast was soft.

Re-clogging: The same area will be sore and slightly swollen for a day or two, and is also at risk of re-clogging. So try to make sure your breasts get completely emptied with every feeding or pumping over the next few days.

Be Proactive: The sooner you start trying to clear a clogged duct, the easier it will be. The longer you wait, the harder it will be (and the more you’ll regret waiting- you might get to the point where you can’t tolerate even the slightest touch to the area).

If your pain is severe, you get a fever, or your baby isn’t eating well or seems ill, call your doctor. I was able to treat all mine at home, but I was aggressive and I knew the signs of when I should call my doctor.

This post might highlight some of the rougher parts of breastfeeding, but the VAST majority of my nursing times were some of the most intimate, cozy, beautiful times I’ve had with my children.

I hope this helps if you ever have clogged ducts. Please write any other things that worked for your clogged ducts in the comments!

Getting Through Severely Cracked Nipples (not for the fainthearted)

"Cracked Nipples" sounds pretty bad, but considering it describes nipples that look and feel like they've been pressed against a belt sander, the term is actually a euphemism. I feel a strong sisterhood with anyone cursed to pass through this dark, dark place on the path to established breastfeeding and a strong jealousy toward the lucky majority who never had to deal with this. This is not a post about pain, which is common; it's about raw, abraded, and even broken skin.  I've been through it twice, and still can't decide which time I was less prepared for.

With my first, I knew I might have sore nipples, but had no clue what horrors were in store.  After a natural birth, I thought I'd conquered a pretty tough experience, but that was nothing compared to the first weeks of breastfeeding. I tried everything - changing my latch, using lanolin, applying breastmilk, leaving my boobs clean and dry - all of it.  Nothing worked, and soon my beautiful baby began to resemble a savage pirana and my supply began to fade.

Now I have read (and you may have, too, if what brought you to this post is your own pain) that cracked nipples are only caused by caused by poor technique and latching problems. To be sure, a number of things I learned from working with a certified lactation consultant, including better technique, helped me get back on track with my first son.  Then, 3 1/2 years later and with almost 3 years of breasfeeding experience under my belt, I was again looking down at my beautiful newborn baby past two horribly cracked, insanely painful nipples. 

Though I fully agree that poor latch can be the culprit, I have also observed that some women just have really delicate skin or an extra rough-nursing baby (or both).  Expert latching or no, these women will have an extra hurdle getting started breastfeeding (and not just with kid #1).  If you're the girl on the ski trip whose cheeks and lips get chapped the first day, this is a bad omen.

Unfortunately, study after study shows that ointments, creams, gels, breastmilk, and warm compresses don't help much with cracked nipples (breatmilk can help reduce pain). What does work? Preparing beforehand and doing what you can for the pain and damage to get through it and keep on nursing.
 
First consider the basics of lactation. Note that Lactation II, the milk production phase that begins at birth and ends 3-5 days later, does not depend on suckling the way later milk production does.  This means your milk will not come in faster if you nurse constantly in the first 48 hours (plus, the colostrum you produce at this time is perfect nutrition for your baby - no need to rush it!). 

You won't feel sore until the second or third day, and it's better if this doesn't hit you like a ton of bricks.  Certainly, feeding on demand is best, but don't initiate extra frequent or long sessions in a race to bring your milk in.  It won't help, anyway, and instead of a first place trophy you may end up with sore, damaged nipples.

Once you're home, keep your boobs in a breathable accessible place, like the open air.  An open nursing bra will let you add nursing pad quickly as needed.  This "boobs out" state is a great reason that anyone not in your innermost circle will be more comfortable waiting a few weeks for when all this "early breastfeeding stuff" is done before they intrude, I mean visit.  Although it truly saddens me that so many people are scandalized and offended by breastfeeding, use it to your advantage when you can.  You'll catch the downside of it enough once you're ready to take your baby out in public

Besides seeing a lactation consultant, pacing yourself, and keeping your boobs out/dry/clean, you can try to deal with the pain.  Remember this is not advice for everyone who has a twinge of pain or general soreness, it's advice for people whose skin is worn off and scabbing over. 

Here are some options:

1. Nipple Shields:  These can be hard to use properly so get help choosing and fitting one at a breastfeeding class or with a consultant.  They can also complicate and already tough process for both you and your newborn.  That said, a good nipple shield can really save your skin.  You may hear that nipple shields can cause the dreaded "nipple confusion" (more thoughts on this later). Unfortunately, when your nipples started bleeding, you officially left the realm of "ideal scenario" and entered the realm of "make it work" (this applies to #5, A Pump, too). 

2. Ice Water: Sound awful? It is for a minute, but when your nipples are wrecked, numbing them can get you through the first extra painful moments after latch-on.  

3. Drugs: Motrin (ibuprofen) and Tylenol (acetaminophen) are cleared for breastfeeding mothers (look them up here, but still talk to your pediatrician about her recommendation).  Like many biochemists (the very people who make them), I am sketched out by almost all drugs, especially while pregnant or nursing a newborn.  I don't take cold medicines, skip the lidocaine at the dentist, and did two natural births.  That said, I took Motrin and was happy to have it when my nipples were a warzone.

4. Lamaze Breathing: Another technique that keeps your focus off the pain and on the goal (one feeeding at a time until you start to heal).  The bonus is, you probably have this technique fresh in your mind.

5. A Pump: This is never a first resort for an early breastfeeding problem, but it's often the last. If you have major damage, alternating between your baby and a pump (which will still hurt) can spare some areas that have gotten especially worn down.  Also, pumping can help you get out of a vicious cycle of pain/damage -> incomplete emptying of the breast through nursing -> reduced supply -> increased, frustrated suckling -> pain/damage, etc..

6. A Stout Heart: I think I've been pretty candid about how bad this can be, but there is one more thing that no one likes to mention. If your nipples are cracked, they will bleed.  Your baby will injest some blood.  Sounds like something out of a nightmare, but it does happen. It's not going to hurt your baby.  It may cause your baby to have reddsih brownish spit-up.  Don't lose it, and don't quit brestfeeding over it.  Being a mom is tough stuff.  Being a breastfeeding mom is even tougher.  Talk to your IBCLC and your pediatrician about what you are going through and get through it - you will! 

The biggest thing that will get you through this phase is knowing that it will end.  It can take up to a month or more for your boobs to improve.  Once they get adjusted to nursing and your newborn becomes less of a savage, the damage will completely heal, the pain will fade, and you will still be nursing your lovely bundle of snugglefection. You'll be on your way to sucessful mothering and able to use the most reliable rule of parenting - "When the baby cries, stick a boob in her mouth." It really is a magical balm - for you and your baby.  Until you get there, do what you can to make it though - and remember you are not alone. 
 

Note: This post does not address two other problems that cause nipple pain, mastitis and thrush.

Also see:

A great and thorough discussion of nursing pain from from PhD in parenting

More information about cracked nipples from kellymom

Please post any other references you know in the comments!

Good Girls versus Bad Girls?

The question, "Brestfeeding moms, why can't you cover up?" (ed. note: post has been removed - see update). brought up lots of comments, tweets, and blogposts this week.  For this, I should thank the original authors even though the interesting ideas really came from the comments rather then the post, which is basically the title question followed by some light scolding. It brought up relevant issues, however, like personal modesty, public propriety, legal rights, and even whether it's okay for women to get angry at one another. 

I think it's pretty clear from the rest of my site what side I'm on in this issue and how I feel about frenemy-moms (I call them frenemoms) who soothingly, condescendingly dose out platitudes about judgement-free parenting and then turn around and oh-so-gently remind those who "want to breastfeed" to both respect and help perpetuate the uneducated view (or should I say food-industry educated view) that nursing a baby is a rather offensive thing to do.   

But the photo comparison really got me thinking about the whole issue in a new way.  The frenemoms ask "Why do this?" next to this picture of a mother and her baby.  To me, this scene looks a lot more like a classic madonna and child painting (any of the madonna lactans) than the "fashion don't" they're being portrayed as.  The mom here also seems appealingly worldly, strong and a tad rebellious, like a nursing Che Guevara:

breastfeeding mother

The "fashion do"-type photo (below) finishes the question with "When you could do this." 

This woman looks scary to me.  She's half-buried under a giant pastel swath of fabric, despite the fact that she seems to be sitting in her own home.  What's under there, anyway? Is she the Modern Ghost of Christmas Present, hiding Ignorance and Want under her giant cloak? Don't get me wrong, I've nursed in a sling or with a scarf or blanket, but I don't get the big tents. 

Even the very shy and modest breastfeeding moms among us would surely still prefer the Madonna mom to the draped menace, right?  What could the menace have over the Madonna? 

Then I realized - the drape looks safe. It's not only a breast cover, but a complete nursing cover.  The entire process is hidden including the baby.  Some moms probably feel a wave of relief as they look from the dangerous "exposed" mom to the safe "good girl" mom protected from scorn and controversy by her generous drapery.

I used to assume all women who "want to breastfeed" feel 100% right about their decision, but this article and the surrounding brouhaha have demonstrated that some moms who love nursing their babies and understand the health benefits are still bothered by the feeling they are doing something questionable or edgy.  

Or maybe lots of us feel like we're doing something edgy, and some are just more comfortable with that.  Can only the liberals, hippies, scientists, and lactivists (the ones who are fine with, even happy about, being viewed as "bad girls") pull it off?  Will the "good girls" always feel the need to hide in the breastfeeding closet, keeping "that" topic and activity under wraps? I hope not.

I hope we can work back toward a society in which breastfeeding is seen as an purely wholesome act, free from controversy.  I want a place where no stern aunts or opinionated neighbors feel the need and right to ask if you're STILL breastfeeding to poke at some inner guilt they know/hope is there - a place where a woman doesn't have to feel lucky that her frenemom "didn't make fun of her or tell her to quit" nursing her child.

Why can't we recognize the sight of a mother nursing her child as wholesome and reassuring anymore? I suspect it has a lot to do with formula marketing and the commodification of women's breasts, but that's fodder for another post. For now, I place my hope in the "bad-girls" - the liberals, hippies, scientists, and lactivists - to lead the way with Breastfeeding Pride and the fight for proper legislation.

Perhaps in time the "good girls," who don't want a battle and steer clear of controversy, will emerge from their tents as the stigma dies out. Then you won't have to be a public nursing ninja to get through the day taking care of your kids, you'll just have to be a mom.

 

Other interesting posts on this subject:

From PhD in Parenting

From Happy Mom Amy

If you of know more - please add them in the comments.

 *Update:

It seems the link to the original blog post "Breastfeeding Moms, Whay Can't You Cover Up?" is broken - because the post has been taken down. Too bad - I feel the post brought up a lot of relevant issues, and the comments section was full of different perspectives on nursing in public. 

How much milk should I be making?

This short post comes from my response to a question in the comments of the Pumping Sucks post (thanks Kelly).  

The amount of milk you make and how much fat and calories it contains will vary a lot from person to person (and from day-to-day and hour-to-hour in the same person).  This article from the journal Pediatrics provides an interesting overview of what 71 "normal" moms produced:

Volume and Frequency of Breastfeedings and Fat Content of Breast Milk Throughout the Day

The paper is thorough - it even describes the output of "the more productive breast" versus "the less productive breast."  Ah, the poor, "less productive breast" all it ever hears is "Marcia, Marcia, Marcia."

They observed a per day milk output of 440-1220g, which translates roughly to 15-41 oz. (only two women fell outside this range, both on the high side). The mothers have infants from 1-6 months old.  This data is consistent with the kellymom discussion of this topic, which gives 25 oz. as the average milk consumed per day by a breastfed baby 6 months and older.  If you are on the low end - you may just make more caloric milk.  As long as your baby is gaining weight, don't worry! 

After around  6-7 months, breastmilk consumption and production plateau as you start adding to the menu mashed-up, breastmilk-added versions of all the super healthy foods they'll snub in pre-school. Milk production may even decrease a little after that, but that doesn't always mean less nursing since the boob is an all around comfort station for breastfed babies and toddlers.  

Breastfeeding continues to provide key nutrition and immune support as you add new foods, which is why it's encouraged for at least a year or two by most medical and health organizations and as much longer than that as possible by most toddlers.  

Pumping Sucks (Except When It Doesn't)

Pumping sucks. The machine itself appears in direct violation of the Geneva Convention. Once you actually shove your boobs into the crazy holders and it starts yanking away on your nipples, you will have the urge to flee and/or weep.  Why are you even in the situation of strapping yourself into this thing?  Usually something stressful, like being separated from your baby or having major supply issue related to one or more breastfeeding problems. This can make the pump look and sound even more like Darth Vader.  

A good breastpump is, however, the only effective way to release and capture breastmilk without a baby. The function of the pump is actually not as much to suck as to mimic suckling. This stimulates signaling hormones (released by your brain in response to your breasts) that tell your breasts to release/ eject milk (more info).

Ideally, you would never need to pump. There are two reasons you might: 1. your baby is sick or having a hard time effectively nursing (and therefore losing or not gaining weight) or  2. you have to go somewhere like back to work or just out for the day and you cannot bring your baby with you.

One of these things is probably going to come up at some point (hopefully only the latter and not for awhile) - be prepared! Buy a high quality pump before you give birth and have a lactation consultant or a pumping expert you know (whose cool with seeing your boobs) demonstrate (on you) exactly what to put where and how to get it whirring away.  

Suction, fit, posture, and practice all come into play. Only a little milk will dribble out based on the machine's pull. Remember, the machine does not really pull the milk out, it stimulates your brain to tell your breasts to spray the milk out. Only then, 3-5 minutes after you started (8-10 min. sometimes) will you feel the tingle/burn of let down and the majority of the milk you'll pump in that session all come flowing out in 1-2 minutes. Don't expect more than 2-3 oz total every 3-4 hrs.  

I should also mention you are likely to find yourself with at least one broken or missing part, rendering the breastpump useless, when you need it most - say, 10 minutes before you give talk for 50+ people about chromatin remodeling proteins. Did I mention pumping sucks? Except when it's the difference between being able to breastfeed or not.  Then, it just kind of suckles.

How To Become A Public Nursing Ninja

Breastmilk consumed in a crowded mall won't improve your baby's health or IQ any more than usual.  There will come a time, however, that you will actually leave your house again.  When you do, however modest you may be, you won't want to trudge to your car in the cold or to some foodcourt bathroom to nurse.

Don't schlep or hide for fear of harassment or exposure!  Embrace your inner ninja.  Remember your rights, and remember that people who see you nursing your baby will be encouraged to do the same (or support it) when the time comes.  If you're nervous, start small - use a subtle cover and bring a friend (who is ballsy and supportive or large and male, or both).  

A nursing tent is not a subtle cover, and makes you look like you're hiding in a clothy tank preparing to attack (in a very un-ninjalike fashion).  A small blanket bunched artfully between your baby's head an the public can work - although I've found a scarf draped from your shoulder can be the most versatile way to make it difficult for anyone who doesn't desperately want to be to be offended to see much actual boob - or even to notice you are nursing.  You can also easily nurse in most slings with minimal exposure.  

Once you've gotten some practice, you can move on to a great nursing shirt alone - the best are fitted and open in a folded flap across the chest.  I love the Boob Design shirts I used to buy at the Upper Breast Side in Manhattan (basic black long sleeve).  They clearly show that you are nursing, and yet show little breast or nipple.

One thing other thing - when in hostile territory, don't forget your game face! This is the look that says :

"I am really busy and doing something important.  Spare yourself the withering iciness of my annoyed glare and the very sarcastic way I will say 'really' if you dare confront me about this - not to mention the frosty but longwinded lecture you (and your manger, if applicable) will get from me if you dare press it further than that." 

Once you get your confidence up, it's time to post pics on facebook, attend a nurse-in, or get brave like these ladies from the Park Slope neighborhood in Brooklyn, described hilariously in New York Times blogger Samantha Story's piece excerpted below.

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"While I struggled to manipulate my son’s head to cover as much of my breast as possible, these women took their comfort with nakedness to a whole new height.

One woman had her shirt completely unbuttoned, her pretty pink, lacey maternity bra on display. Another had one breast lopped over the top of her tank top. The third had twins. She wasn’t wearing a shirt — or a bra for that matter — just a hoodie sweatshirt unzipped with a baby at each breast. She walked around the restaurant with them in her arms, her body swaying in a comforting dance.

If only I was a 14-year-old boy! I admired their lack of self-consciousness but had to admit I was uncomfortable — it was as if I had landed in a private living room, and it felt as if I were privy to their intimacy unbeknownst to them.

But open and comfortable breast-feeding is quintessential daytime Park Slope. Moms are just as relaxed nursing at the local pizza parlor as they are in each other’s homes. "

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Awesome.  But if that's not your style, just find the level that suits you're inner public nursing ninja - and don't forget your game face. 

Expect a Tough Time in the First Month

True, the first time you hold and nurse your brand new baby is total bliss.  Then a few days pass, and you can begin to feel extremely tired from having a baby and then waking every 2-3 hours to nurse.  Next, your nipples become sore and you will probably get anxious about your milk coming in (which takes a few days) and the baby’s cries all begin to sound hungry.  Your baby may not regain his birth weight on time, your nipples may become damaged from the high-powered sucking of a newborn who could suck the paint off a car.  They may even bleed and hurt far more than childbirth did, and a breast infection may rear it’s ugly head.  Whatever hurdles you encounter, you can begin to feel very, very alone and start to believe that you are uniquely unsuited to breastfeeding or cursed with an inadequate supply.  Not true! 

Most women have at least a few of these problems, and being ready for them and prepared to respond quickly and with a clear head is how you can make it to the elusive second month - when your boobs actually heal, stop feeling sore, and begin to work properly.  At this point, your baby has learned how to effectively suck milk out of whatever is presented.   Then it’s on to other interesting problems like how to use that bizarre-looking pump (if you've been lucky enough not to need it to help establish your supply) and how to nurse in public on those days you just aren’t feeling fierce. 

Update: 

This useful infant feeding chart from Tiny Playground helps you keep track of what is going on so that you can address a supply or latch issue before your baby has weight gain problems or dehydration.  I wish I'd had this not only for me but also for discussions with my lactation consultant and pediatrician.  Thanks Adrienne!

 

Find a Certified Lactation Consultant

There may have been a nurse who helped you with breastfeeding in the hospital, or your midwife or doula may have helped you get started, but you should still schedule a visit with a certified lactation consultant for 3-5 after your deliver, when your milk supply is beginning to depend on proper nursing.  With everything that is going on it's hard to make this a priority, but even if you and your baby have the milk flowing perfectly, this person will still able to provide valuable information.  She can observe your technique, find out how much milk you baby is getting, check your breasts, check your baby, show you how to use your pump, and provide other valuable advice. 

No matter how intelligent, well-read, and surrounded by supportive friends and relatives with breastfeeding experience you may be, you will still benefit greatly from seeing a certified lactation consultant, who is a medical professional.  An in-home visit will run around $75-150 and may be covered by your insurance or the benefits office at your workplace - check both!  Even if you have to pay this out of pocket, do it.  This person may be as important as your pediatrician in assessing how you and your baby are doing early on and getting you both off on the right foot.  Of course, just like pediatricians, some are a lot more helpful and competent than others.  To find one, do some research online and get recommendations.  Make sure this person is certified as an IBCLC (International Board Certified Lactation Consultant)!  Here is a helpful site that allows you to find certified lactation consultants in your area.  Your consultant may also have or be able to recommend a group class.  Group classes are a great follow up to an in-home visit, are not expensive, and are a nice way to meet other moms in your exact situation.

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