What to expect when you're expecting (132 page)

Breast augmentation is far less likely to interfere with breastfeeding than a breast reduction, but it depends on the technique, the incision, and the reason why it was done. While many women with implants are able to nurse exclusively, a significant minority may not produce enough milk. To make sure your supply meets your baby’s demand, you’ll need to keep close tabs on his or her growth and the number of dirty and wet diapers accumulated daily.

Got Pierced?

You’re all set to nurse your baby-to-be, but there’s one wrinkle—or rather, one ring, or one stud—that you’re not sure what to do with. If you have a nipple piercing, good news: No evidence shows that nipple piercing has any effect on a woman’s ability to breastfeed. But experts (in both the lactation and the piercing businesses) agree that you should remove any nipple jewelry before you nurse your baby. This is not only due to the potential for infection for you; it’s also because the jewelry could pose a choking hazard for your baby or injure his or her tender gums, tongue, or palate during feedings.

But do be sure to give breastfeeding a fair trial. The first few weeks can be challenging, even for the most enthusiastic breastfeeders, and are always a learning process (though getting help from a lactation consultant or a sister or friend who has breastfed could make things easier if you’re having a hard time). A full month, or even six weeks, of nursing is generally needed to establish a successful feeding relationship and give a mom the chance to figure out whether breast is best for her.

Some women who choose to breastfeed find—for one reason or another—that they can’t or don’t want to do it exclusively. Maybe exclusive breastfeeding doesn’t turn out to be practical in the context of their lifestyle (too many business trips away from home or a job that otherwise makes pumping a logistical nightmare). Maybe it proves to be too physically challenging. Fortunately, neither breastfeeding nor bottle-feeding is an all-or-nothing proposition—and for some women, combining the two is a compromise that works. If you choose to do the combo, keep in mind that you’ll need to wait until breastfeeding is well established (at least two to three weeks) before introducing formula. For more information on combining breast and bottle, see
What to Expect the First Year.

Unfortunately, the option of breastfeeding isn’t open to every new mother. Some women can’t or shouldn’t nurse their newborns. The reasons may be emotional or physical, due to the mother’s health or the baby’s, temporary (in which case breastfeeding can sometimes begin later on) or long term. The most common maternal factors that may prevent or interfere with breastfeeding include:

Serious debilitating illness (such as cardiac or kidney impairment, or severe anemia) or extreme underweight, though some women manage to overcome the obstacles and breastfeed their babies.

Serious infection, such as active untreated tuberculosis; during treatment, breasts can be pumped so a supply will be established once breastfeeding resumes.

Chronic conditions that require medications that pass into the breast milk and might be harmful to the baby, such as antithyroid, anticancer, or antihypertensive drugs or mood-altering drugs, such as lithium, tranquilizers, or sedatives. If you take any kind of
medication, check with your physician if you’re considering breastfeeding. In some cases, a change of medication or spacing of doses may make breastfeeding possible. A temporary need for medication, such as penicillin, even at the time you begin nursing, doesn’t usually have to interfere with breastfeeding. Women who need antibiotics during labor or due to a breast infection (mastitis) can continue to breastfeed while on the medication.

Exposure to certain toxic chemicals in the workplace; check with OSHA (see
page 194
).

Alcohol abuse. An occasional drink is okay, but too much alcohol can cause problems for a nursing baby.

Drug abuse, including the use of tranquilizers, cocaine, heroin, methadone, or marijuana.

AIDS, or HIV infection, which can be transmitted via body fluids, including breast milk.

Some conditions in the newborn may make breastfeeding difficult, but not (with the right lactation support) impossible. They include:

A premature or very small baby, who may have difficulty sucking or latching on properly. A preemie who is sick and has to spend time in the NICU (neonatal intensive care unit) also may not be able to nurse, though you can pump to establish a good milk supply and feed the breast milk to the baby with the help of the hospital staff.

Disorders such as lactose intolerance or PKU in which neither human nor cow’s milk can be digested. In the case of PKU, babies can be breastfed if they also receive supplemental phenylalanine free formula; with lactose intolerance (which is extremely rare at birth), mother’s milk can be treated with lactase to make it digestible.

When Father Knows Breast

It only takes two to breastfeed, but it often takes three to make it happen. Researchers have found that when fathers are supportive of breastfeeding, moms are likely to give it a try 96 percent of the time; when dads are ambivalent, only about 26 percent give it a try. What’s more, say researchers, keeping dad in the breastfeeding loop (by providing him with lots of nursing know-how so he can better support you) can help extend the length of time you end up breastfeeding—plus it could make nursing easier overall. Dads: Take note, and join the breastfeeding team!