I wrote this essay over 4 years ago chronicling my difficulty breastfeeding Big A — and what I learned in the process. During this time there just happened to be government-sponsored TV ads geared toward getting more women to breastfeed. While Fearless Feeding will not cover breastfeeding, it helps prepare parents for all the potential pitfalls that can happen during the 18 years of feeding. While we hope parents won’t experience too many feeding challenges, we know preparation is power!

“My boobs would have to fall off for me not to breastfeed,” I wrote to a friend, thanking her for buying me a nursing pillow. During my first pregnancy I watched, with a touch of arrogance, the government-sponsored TV ads promoting breastfeeding.

These ads showed a pregnant woman riding a mechanical bull with the voice over: “You wouldn’t take this kind of risk with your baby so then why would you take the risk of not breastfeeding.” I thought to myself, I certainly won’t.

Yet after my beautiful baby girl was born, breastfeeding proved to be the most challenging aspect of motherhood. That’s because every three hours I had a hungry baby who couldn’t always latch on my breasts, caused me intense pain and managed to make my nipples unrecognizable. Each nurse had a different opinion on how to remedy my situation. One urged me to use a nipple shield. The lactation consultant at the hospital, who visited me daily, said nipple shields slow down milk production. Another nurse already had me pumping milk and feeding my daughter through a bottle.

Looking back now the hospital seemed like a joy ride compared to my experiences at home. After my baby had trouble latching on my breasts her first night home from the hospital, I arranged to meet with a lactation consultant. This was just the beginning of what seemed to be a never-ending battle. Just when one problem was solved another reared its ugly head. I discovered that my daughter was inefficient at removing milk which is why even after hour-long nursing sessions she still wasn’t gaining enough weight.

One of the pediatricians in my daughter’s medical group recommended I supplement with formula. I had already started pumping milk and told her I preferred to supplement my baby with expressed-breast milk. I was surprised when she tried to talk me out of pumping. She said it would tire me out and feeding formula would allow me to sleep longer at night. But I did my homework. I knew that adequate removal of milk is what stimulates more milk production and my baby wasn’t removing enough. So, in my eyes, I had to be vigilant about pumping breast milk.

The lactation consultant supported my decision to pump and put me on a pretty strict schedule. First, I would breastfeed my baby. Second, I’d supplement her with a bottle of expressed-breast milk. And third, I’d hook myself up to a breast pump for 10-15-minutes. There was a direct link between my mood and how well each nursing session went. And just when I thought we were over the hump, at seven weeks, my daughter totally refused to breastfeed. Disappointment doesn’t even come close to describe my emotional state.

My mind wondered back to those government ads and anger soon replaced my previous arrogance. According to Centers for Disease Control and Prevention, 74 percent of women attempt breastfeeding in the hospital but by six months only 41 percent are still breastfeeding. I began to sympathize with all those women who couldn’t make it to six months.

Then I thought about my own situation. After all, I felt as prepared as anyone to breastfeed. I read books, took classes and had the fancy nursing pillow. But did I have a realistic picture of what it would be like? I only learned what could go right and not what could go wrong. Every brochure and book tells you, “breastfeeding shouldn’t hurt if you’re doing it right.” “It’s rare that a woman can’t breastfeed.” This advice, which comforted me when I was pregnant, became utterly useless to me after I had a baby.

What I needed to know was what circumstances could come between me and my desire to breastfeed. I needed to know how inefficient newborns can be at breastfeeding. I needed to know what to do if my baby did not gain enough weight. I needed to know that my baby could prefer the bottle weeks after breastfeeding. I needed to know that even doctors and nurses can sabotage my efforts. I needed to know how important establishing a plentiful milk supply is those first few weeks. And, yes, I needed to know that it hurts.

But instead, new moms like me get guilt-ridden messages and the “breast is best” tag line. Wouldn’t our tax dollars be better spent finding ways to break down the barriers that keep women from continuing to breastfeed?

My baby is over a year old now and I’m proud to say she received breast milk for 11 months. After getting the biggest rejection of my life, I relied on the breast pump to keep my milk supply up and nourish my baby. I kept trying to nurse my daughter and it wasn’t until she was between four and five months old that she really started catching on.

Throughout this process I’ve learned more than I ever thought I would about breastfeeding, milk supply and pumping milk. And despite my difficulties I’m still pro breastfeeding. In fact, I can’t wait to make it work the second time. But the next time I will handle things differently. Most importantly, I will be prepared for all that can happen between deciding to breastfeed and my boobs falling off.

This is a guest post from Bridget Swinney MS, RD, award-winning author and well-regarded nutrition expert in the field of prenatal nutrition, child nutrition and family eating matters. Bridget has worked as a clinical dietitian, public health nutritionist, WIC Program Director, diabetes educator and weight loss group facilitator. Her book, Eating Expectantly, won the Child Magazine’s Top Ten Parenting Books of the Year, and Baby Bites was awarded a 2008 iparenting.com Media Award. The 4th edition of Eating Expectantly will arrive in May 2012. Bridget is also a spokesperson for Similac.

Pregnant women and new moms often ask me which nutrients will give their children the healthiest start possible. The good news is that adding just a few nutrient-rich foods can provide benefits for both mom and baby.

Below are seven nutrients that are important during and after pregnancy — for both mom and baby. Some of the nutrients, such as calcium, may seem commonplace, but others, like lutein, are rather new on the “nutrient radar screen.” All of these nutrients present multiple benefits to infants and young children, from strengthening their eyes to assisting in brain development.

Read on to learn more about the nutrients and easy ways to incorporate them into your diet!

1. Folic Acid: Benefits: Folic acid helps with the production of red blood cells and assists in cell division. It’s a critical nutrient during early pregnancy when errors in cell division can lead to birth defects.

Food Sources: The CDC and March of Dimes recommend that all women of childbearing age consume a multivitamin containing folic acid. Food sources include fortified grain products such as bread and cereal, as well as blackeyed peas, dried beans and peas, spinach, asparagus, broccoli, avocado and orange juice.

Meal idea: Black bean wrap with avocado and a glass of orange juice.

2. Lutein: Benefits: Lutein protects a baby’s eyes by absorbing potentially damaging light and helps defend against oxidative damage. In addition, a recent study found lutein in the infant brain in key regions for memory and learning. Lutein is important because much of what babies learn is based on what they see, so the more we can do for their eyes — and brain — the better.

Food Sources: Moms should seek leafy greens, eggs, and certain vegetables and fruits, such as kiwi and zucchini. Infants rely on breastmilk (note that lutein levels are dependent on maternal intake) and infant formula that contains lutein (such as Similac).

Meal idea: Creamy spinach soup.

3. Fat, Specifically DHA: Benefits: DHA is found in the cell membranes of the brain and eye and is important for brain function. Babies need a high percentage of fat in their diets to assist brain growth during the first year. The right balance of essential fatty acids is critical to infant development.

Food Sources: Moms should consume cold water fish (no more than 12 ounces per week, according to the Food and Drug Administration), fortified eggs, flaxseed, walnuts and walnut oil. They should also seek a prenatal vitamin with DHA. Breastmilk (depending on maternal intake of DHA during and after pregnancy) and infant formula with added DHA are ways in which infants get this key nutrient.

Meal idea: Salad with grilled salmon and toasted walnuts.

4. Choline: Benefits: Choline is an important nutrient that helps brain cells develop properly and supports baby’s memory and learning.

Food Sources: Most pregnant and breastfeeding women do not have enough choline in their diets. Not all prenatal vitamins contain choline, so dietary intake is important. Women can get choline primarily from eggs, beef, salmon and chicken. Infants rely on breastmilk (depending on maternal diet) and infant formula with added choline.

Meal idea: Microwave Scrambled Eggs

5. Iron: Benefits: Iron is part of the protein hemoglobin, which carries oxygen to different parts of the body including the brain. It’s especially important during times of growth. Iron deficiency anemia is common during pregnancy and during the first two years and can have devastating effects on pregnancy outcome and infant development.

Food Sources: Moms should incorporate lean beef, lamb, dark poultry meat, beans and iron-fortified cereals into their diets. Until baby starts eating solids, breastmilk and iron-fortified infant formula are the best ways to ensure baby gets iron.

Meal idea: Crock pot roast with zucchini and red peppers.

6. Calcium: Benefits: Calcium is the main structural component of bones and teeth. It’s also needed to support vascular, muscular and nerve function, and hormonal secretion.

Food Sources: Moms should consume dairy foods, salmon, spinach, turnip greens, kale or fortified juices. Dark, leafy greens can also be easily incorporated into baby food.

Snack idea: Greek yogurt-pumpkin parfait.

7. Vitamin D: Benefits: Vitamin D aids in calcium absorption, which helps build baby’s bones and teeth. Emerging research also shows a possible connection between vitamin D deficiency and diabetes as well as autism.

Food Sources: The best source of vitamin D is sunshine. However, sun exposure for infants should be limited. Unlike many of the nutrients mentioned in this post, breast milk is not an adequate source of vitamin D so the AAP recommends that all breastfed infants receive a daily supplement containing 400 IU (often provided via vitamin D drops). Fortified infant formula contains adequate vitamin D. Food sources of vitamin D include salmon, tuna, mackerel, milk, some mushrooms, and fortified foods and juices.

Meal idea: Salmon chowder with a glass of milk.

These nutrients are important for more than just pregnant and breastfeeding women. If there is even a possibility that you might become pregnant, incorporate these nutrient-rich foods into your diet. And remember to keep feeding these healthy foods to your child as they grow. Explore this blog and my books for fun, creative ways to serve up delicious and nutritious family meals.

This is a featured guest post by Elizabeth Ward, MS., RD, author of Expect the Best: Your Guide to Healthy Eating Before, During, and After Pregnancy.Elizabeth regularly writes for publications such as Men’s Fitness and WebMD, and blogs about about family nutrition and weight control issues for USAToday.com. Check out her pregnancy blog, Expect the Best Pregnancy, where you will get the latest and most credible nutrition advice during pregnancy.

Is a baby in your plans for the near future? Perhaps you’d like another child, but you’re just not ready yet.  No matter. When you’re in the childbearing years, it pays for you (and your male partner!), to prime your body for pregnancy, especially when you consider the possibility that conception can occur when you least expect it.

Preparing for pregnancy doesn’t differ much from living a healthy lifestyle.  Here are three steps, culled from my book, Expect the Best: Your Guide to Healthy Eating Before, During, and After Pregnancy, to help you have the healthiest child possible.

1. Practice Girth Control.  Being underweight or overweight may thwart a woman’s chances to conceive; when a future dad is overweight, his excess body fat may make matters worse.  

In addition to affecting fertility, being overweight when you conceive increases the risk of certain birth defects, including heart defects, and neural tube defects (NTD) like spina bifida.  Overweight women are also more prone to type 2 diabetes which may prove problematic for mom and baby.  And, women who enter pregnancy overweight tend to stay that way until delivery, and well beyond.

Starting a pregnancy at a healthy weight gives your child a better chance of developing properly, and reduces health risks for mom during pregnancy, including high blood pressure.

Determine your body mass index (BMI) to know whether your weight falls into a healthy range.  For help achieving a healthy weight at any stage of life, consult a registered dietitian (RD) by using the American Dietetic Association’s free referral service.
 
2. Fill in Nutrient Gaps.  Eating a balanced diet based on MyPyramid will help you and your partner get the nutrients that contribute to your good health, and that of your child’s, but that often go missing from the typical American diet, including calcium, fiber, magnesium, vitamins C and E, potassium, and carotenoids (used by the body to make vitamin A). 

Women in their childbearing years should pay particular attention to their intake of folic acid and iron. You need 400 micrograms (ug) of folic acid every day if you are capable of conceiving a child. That’s because folic acid helps to prevent NTDs, during the first 30 days of pregnancy – often when a woman does not know she’s pregnant. 

Women who are not pregnant require 18 milligrams of iron daily, but many are not meeting that quota.  Iron-deficiency anemia affects an estimated 8 million American women. It’s harder to correct an iron deficiency during pregnancy, when iron requirements soar, so make sure you get enough iron each day before conception occurs. 

While dietary supplements are not suitable substitutes for a balanced diet, a daily multivitamin fills in small gaps in nutrients that can sap fertility, particularly in men who don’t get enough vitamin C, folic acid, and zinc. 

Women who may become pregnant should take a daily multivitamin with 100% of the Daily Value for iron and folic acid. Men don’t need the extra iron and should take a multivitamin with no iron, or very low iron. 

3. Re-Think Your Drinks.  If you’re trying to conceive, it may be time to evaluate your caffeine and alcohol consumption. 

Some studies suggest excessive amounts of caffeine may result in miscarriage and stillbirth, while others question caffeine’s effects.  While the jury is still out regarding the safety of caffeine during pregnancy, it’s probably wise to limit your intake. The March of Dimes recommends 200 milligrams or less of daily caffeine- about the amount found in 10 ounces of Starbucks coffee – after conception occurs. It’s not a bad idea to start cutting back beforehand, however. There is some evidence that caffeine may hamper fertility.

There’s no safe amount of alcoholic beverages to drink during pregnancy, but how about when you’re trying to conceive?  It makes sense to enjoy a cocktail or glass of wine when you’re sure that you’re not pregnant. However, health professionals recommend erring on the side of caution when trying to conceive.

The Centers for Disease Control and Prevention (CDC) and the March of Dimes contend that drinking and trying for a baby do not mix.  Even moderate drinking (one or fewer drinks daily for a woman; two or less for a man) may make it more difficult to conceive for some couples. In addition, it is possible, no matter how careful you are, to be pregnant and not know it, and alcohol is particularly detrimental to a developing baby during the first trimester. 

In men, heavy drinking produces sperm with defects that may hinder their ability to fertilize an egg. Although the link between moderate drinking and fertility is murky, it’s wise for men to play it safe by limiting alcoholic beverages to two or less a day.

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The process of raising healthy eaters actually starts before conception. The health of women entering –and during – pregnancy has a profound impact on the health of both mom and baby.

Part of my job is to inform you (my readers) of important changes in public health recommendations. The Institute of Medicine last tackled pregnancy and weight in 1990 – almost 20 years ago. Health experts have been talking about the need to re-examine these guidelines for the last several years. Yet the newly released guidelines from the Institute of Medicine don’t look much different from the 1990 ones. That said, a lot was learned in the process. Let’s take a look…

A Different Population of Women
Pregnant women today look drastically different than moms-to-be did just 20 years ago. First off, more women start pregnancy either overweight or obese and they gain more weight during pregnancy. Women are also having children later in life with a substantial increase in multiple births. All of these factors increase the likelihood of chronic disease and complications during and after the prenatal period.

Key Takeaways
The Institute of Medicine extensively reviewed studies to determine the optimal range of weight gain for pregnant women. Here are some highlights from the report:
–Weight at the start of pregnancy may be the most important factor for a healthy pregnancy. The science clearly shows that pre-pregnancy weight alone can predict undesirable prenatal health outcomes.
–Women who gain more than the recommended amount of weight during pregnancy are more likely to have c-sections, preeclampsia, gestational diabetes and they are likely to remain overweight long after birth.
–Women who start off pregnancy underweight and gain less than the recommended amount of weight tend to have small (for gestational age) babies. Women who gain more than the recommended amount of weight tend to have large (for gestational age) babies.
–Gaining too little or too much weight has also been associated with preterm birth.

The Guidelines
Below are the 2009 guidelines from the Institute of Medicine. The guidelines assume that women gain 1.1-4.4 pounds in the first trimester. The biggest change from 1990 is the smaller range of weight gain for obese women:

Underweight <18.5 (28-40 pounds)
Normal Weight 18.5-24.9 (25-35 pounds)
Overweight 25.0-29.9 (15-25 pounds)
Obese > 30 (11-20 pounds)

Provisional guidelines for twins: normal weight (37-54 pounds), overweight (31-50 pounds), obese (25-42 pounds).

Want to know your BMI. Check it out here.

To Sum Up
Beginning pregnancy at a healthy weight and gaining a sensible amount during the pregnancy provides a healthier start for both you and your baby. This is an incredible opportunity because it allows you to develop a healthier relationship with food before your child is even born.

For more information on nutrition and pregnancy see our pregnancy nutrition section.

Subscribe to Raise Healthy Eaters to learn more about nutrition during pregnancy.

References
Weight Gain During Pregnancy: Reexamining the Guidelines

It’s been 22 days since my second child was born. My nipples throb and I’m loopy from little sleep and bad TV – what better time to have a frank discussion about breastfeeding?

I wish someone would have told me what nursing was really like before I had my first child. Yes, I took the breastfeeding class but it did little to prepare me. My child had a weak suck, didn’t gain enough weight and ended up receiving most of my breast milk through a bottle. I was the poster child for an anxious new mother (my in-laws have told me multiple times how much better I am doing the second time around!).

Equipped with realistic information, I believe the act of getting breast milk to babies can be more successful – and rewarding – for many women. Here’s what I think moms-to-be need to know…

1. The first 6 weeks are grueling: When I was having difficulties breastfeeding my daughter, a friend told me that even when everything goes right, nursing is still hard. Now that I have a successful feeder the second time around I know what she means.

The tough first 6 weeks are the result of recovery from birth mixed with severe lack of sleep and hormonal changes. In order to establish a successful breastfeeding relationship, it’s up to mom to feed baby around the clock (every 1-3 hours). And the first couple nights home from the hospital babies tend to be awake most of the night and asleep all day. Being solely responsible for feeding a baby can weigh on a new, exhausted mother.

Instead of being taking off guard with this reality, a mom-to-be can prepare by letting her loved ones know that breastfeeding will be her main concern the first few weeks. Family and friends can help by bringing meals, watching the baby while she sleeps or babysitting older children. She can work to get everything done before birth so she can put all her energy into feeding, knowing that at about 6 weeks baby will sleep longer and feedings will become more predictable.

2. It hurts! Every nursing book says that breastfeeding shouldn’t hurt if you are doing it right. But most of the moms I know including me, say that sore nipples are a pain those first few weeks. This adds to the challenge of initiating a breastfeeding relationship because newborns like to nurse constantly.

Being proactive about nipple pain management can help a new, nursing mom. Make sure you have some nipple cream like Medela’s lanolin that you can put on your nipples after feeding. Let your nipples air dry when you can. The pain is often due to a bad latch so make sure you see a lactation consultant in the hospital, have one visit you at home or go to support groups for additional help.

3. Pick out a lactation consultant ahead of time: The night I brought my first child home from the hospital my breasts were engorged and she couldn’t latch on. I was up at 3am searching frantically for a lactation consultant hoping to find one available 24 hours a day.

When things go wrong at home you don’t have the luxury of time – you need someone to come right away. Before the baby comes get a list of lactation consultants from friends and pick one just in case you need her. You can even call her ahead of time to check availability. Hopefully you won’t need one but it’s good to have a name and number in your back pocket.

4. Have a pump just in case: Some moms-to-be figure they don’t need a pump right away because they won’t use it until later. Every new mom needs a pump! If your baby has difficulty breastfeeding or won’t latch you’ll need to pump to keep your milk supply up. And if the doctor recommends you supplement with formula you might as well supplement with your own breast milk.

Remember, milk production works on supply and demand and if you give formula your supply decreases. If this happens in the first few weeks, you may not be able to get your supply back up later. Additionally, pumping allows your husband or partner to take over one late night feeding to give you a much-needed break.

5. You’ll be convinced you don’t have enough milk: Newborns nurse frequently. I used to take this as a sign that I didn’t have enough milk. The books I read said newborns feed every 3 hours. Apparently my second child didn’t read these books because he likes to feed constantly – and I’m trusting he knows what he’s doing. Babies also go through growth spurts at 3 weeks and 6 weeks when all they want to do is nurse. Knowing this is normal can ease your mind and build confidence that you do indeed have enough milk.

As long as your baby is gaining weight and having enough pee and poo diapers, they are fine. Save the routine-building for after 6 weeks and just feed your baby when they seem hungry.

6. The payoff is huge: Okay, enough of the downsides to breastfeeding. Once you get past 6 weeks you begin to see the benefits. Pain subsides and feedings become predictable. You start to enjoy the time alone with your baby. When baby wakes in the middle of the night there’s no need to warm up milk you just feed them and put them back to sleep. Babies become more efficient and breastfeed quicker. Knowing how hard it once was makes your success even sweeter. When it’s time to wean it’s usually hardest on mom.

7. There’s a third feeding option: When my first child refused to breastfeed at 7 weeks I was devastated. But I remembered that my sister-in-law pumped milk for her daughter for 6 months. So I decided to pump as long as I could. Not only did I make enough milk for my daughter but I produced about 5 extra ounces a day that I stashed in the freezer. Yes, pumping was a pain but I was still able to get breast milk to my daughter and it got easier as time went by. I kept offering her the breast and at 4 months she started to breastfeed. We made it 11 months with a combination of breastfeeding and pumping. I was very grateful for that pump!

Don’t get me wrong. I have nothing against formula. I know that breastfeeding does not always work for every mom. But exclusive pumping is another option for moms to consider. Most healthcare providers don’t know about full-time pumping and may discourage you from it. Just know that many moms make it work – for more information see this book/website on exclusive pumping, check out www.gotbreastpump.com and visit the online support forum (pumping moms) at Baby Center.

My hope is that breastfeeding goes smoothly for new moms everywhere. But by being prepared for the potential pitfalls, moms are more likely to be successful in this venture.

For more on infant nutrition see our Infant Feeding Guide

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