Chapter One Preparing Hello, nice to meet you, welcome to our meeting! Refreshments are on the table. You're welcome to sit anywhere you'd like. Oh, you're expecting a baby? That's wonderful! You probably have lots of questions--and we're happy to help. Whether you're pregnant, adopting, or working with a surrogate, congratulations! Maybe you can't wait to have your baby in your arms--but you still have lots of questions. Maybe you are feeling a mix of emotions: along with excitement, you're wondering how a baby will affect your relationships or you're concerned about how your career path will change. Maybe an earlier pregnancy ended in a miscarriage or stillbirth, so you find it hard to even look ahead to holding a baby in your arms. Some of us have been there, too. We hope you have supportive friends, family, or counselors to help. Perhaps you've breastfed before and nursing didn't go well. That's what happened to Kirsten: I have breastfed twice, and each time was completely different. The first time, breastfeeding was tough, painful, and frustrating because I didn't have enough milk. This time I prepared myself much better by reading a few books about breastfeeding and talking to other mothers who have successfully breastfed. This made a huge difference. This time I could really enjoy breastfeeding. --Kirsten, from the Netherlands, living in Austria As you research baby names, parental leave, and other issues, you're probably also thinking about how to feed your baby. Today, most expectant parents choose breastfeeding--for very good reasons. You might be wondering what you need to do to prepare. We have some ideas for that! Preparing to Breastfeed Here's the good news: Your body has already done a lot of preparation. In fact, it started even before you were born. As your body developed inside your mother's womb, tiny ducts for carrying milk formed in your chest, under your nipples. During puberty, as your breasts grew, these ducts developed branches. Once you started menstruating, more branches grew during each cycle. Milk-making tissue started to grow as well, and you may have noticed some breast sensitivity before each period. During the first three months of pregnancy, the ducts and milk-making cells grow more quickly. You may have noticed breast tenderness, a change in your bra size, and maybe blue veins or stretch marks on your breasts. Your areolae, the darker brown or pink circles around your nipples, may get darker and larger. Small bumps, Montgomery glands, may form on your areolae. They secrete tiny amounts of oil and milk to keep your nipples clean and moisturized. These are all good signs that your body is getting ready to nourish your baby! The insides of your breasts are like maps of small towns connected by roads and highways. Your breasts grow tiny clusters of milk-making cells called alveoli. These alveoli are hollow, surrounded by thin muscle bands. Milk collects in the hollow centers, is squeezed out by those muscles, and follows the ducts to your nipple. Other ducts join along the way, so that milk flows out at the nipple through four to eighteen nipple holes (pores). During the middle three months of pregnancy, breast growth continues. Between the twelfth and sixteenth weeks, your breasts start to produce colostrum, your baby's first milk. During the last three months of pregnancy, you might leak drops of colostrum. If you don't leak at this point, no worries--your breasts are still getting ready to feed your baby. If you've always felt that your breasts look different, or if you haven't experienced any tenderness or changes at all, talk with your healthcare provider, and for tips to get breastfeeding off to the best possible start, see chapter 17. Extra Breastfeeding Challenges At the start, you might need extra help with breastfeeding if you have or have had * diabetes of any kind * scant breast tissue that hasn't grown during pregnancy * bariatric surgery * a thyroid disorder * polycystic ovary syndrome (PCOS) * breast surgery of any kind * infertility issues * other pregnancy or postpartum complications If you are expecting multiples or if you know your baby is likely to need special care because he'll be born early or with health issues, you also might need extra help with breastfeeding at the start. Check out chapters 17 and 18 and consider contacting a La Leche League (LLL) Leader, an International Board Certified Lactation Consultant, or a healthcare provider with breastfeeding expertise. Expressing Colostrum The last few weeks of pregnancy may be a good time to learn how to express milk using your hands. Don't expect more than drops at first, but it will add up! Trevor collected an impressive amount of colostrum, a little at a time: I began painstakingly collecting my precious liquid. By the end of the pregnancy, I had forty or fifty syringes . . . a total of 20 or 25 ml. --Trevor, Manitoba, Canada You can freeze any colostrum you get. This first milk is packed with immune factors to protect your newborn--if your baby needs any extra milk after birth, it's the best possible choice. Don't worry, for each drop you express, you'll make more to replace it. So if you feel like expressing your colostrum and your healthcare provider agrees, go ahead! For how to do this, see chapter 15. A Different Way Are you adopting, or is your baby being carried by a surrogate? Is breastfeeding a possibility? How do you prepare? Yes, breastfeeding may well be possible! Some mothers who are adopting take hormones to encourage breast growth. Some others simply put the baby to the breast often and use a breast pump as well. Aren't breasts amazing? Results vary--you might make a small amount of milk--or a lot! For more on this alternate route for breastfeeding, see chapter 17. The Baby Is Born and Breastfeeding Begins! After birth, the hormonal "wall" that held back milk production comes down when your placenta is delivered. The alveoli secrete colostrum (the first milk) for the first few days. Then, the volume increases and you begin producing mature milk. For what to expect in the early days after birth, see chapters 4 and 5. You probably have lots of questions. Here are common ones expectant parents ask at LLL meetings. What About Emotional Preparation? Just as pregnancy causes changes in your breasts and uterus, it changes your brain. Although science says that any parent caring for a child experiences changes, pregnancy and breastfeeding give you a head start. Milk-making hormones help you be more responsive and nurturing when your baby is born. You might forget things--mostly those that have nothing to do with taking care of your baby. The old connections in your brain make room for new ones that help you tune in to your baby. How Important Is Breastfeeding, Really? Extremely! There is almost nothing you can do for your child in her whole life that will affect her both emotionally and physically as profoundly as breastfeeding. You've probably heard that breastfeeding is good for your baby's health. But the impact of how babies are fed goes far beyond their health, as Ivannia learned: I am the mother of two teenagers and a preteen. I breastfed all three because I always knew it was the best way to protect them. I was, however, unaware that I was also protecting myself from postpartum stress and expensive medical bills. --Ivannia, Costa Rica This would be a much longer book if we described all the ways that breastfeeding is valuable for you, your baby, your family, the healthcare system, and our planet. And research keeps finding more. Here are a few highlights. The Impact on Your Baby Your milk provides the appropriate nutrition for your baby's healthy growth and development. Human milk is packed with vitamins, minerals, healthy sugars and fats, proteins, and living cells, all working together to help your baby grow and develop, especially her brain. Your milk protects her from infections, both bacterial and viral--everything from ear infections to diarrhea, pneumonia, and much more. At the same time, your milk helps your baby's immune system develop and become strong. And that's just the milk. The act of nursing at the breast helps your baby develop strong jaw muscles and a wide palate, leading to straighter teeth and less risk of later problems such as sleep apnea and snoring. The impact continues long after your baby stops breastfeeding. Even as an adult, someone who was not breastfed is at higher risk for many diseases: type 1 and type 2 diabetes, heart disease, obesity, Crohn's disease, ulcerative colitis, certain cancers, and depression, among others. Excerpted from The Art of Breastfeeding: Completely Revised and Updated 9th Edition by La Leche League International, Bibiana Moreno Carranza, Jayne Joyce, Anna Swisher, Teresa Pitman All rights reserved by the original copyright owners. Excerpts are provided for display purposes only and may not be reproduced, reprinted or distributed without the written permission of the publisher.
