By Jarold Johnston, CNM, IBCLC

Dad’s job is to take over the job of the lactation consultant when the family goes home from the hospital. The father is who will be available to answer questions at 3 a.m.

Many mothers struggle with confidence when breastfeeding: They doubt the baby’s desire to breastfeed, they doubt their family’s support for breastfeeding, and most of all, they doubt themselves and their ability to breastfeed. A new mother struggles with confidence almost every day, and her shaky confidence is easily destroyed by a doubting father. When you say something foolish like, “I don’t know, Honey, maybe we need to give him a bottle,” you have just damaged your family’s chances at breastfeeding success.

So, if you’ve come this far, you’re still with me and it’s time to learn how to breastfeed.

When Does Baby Need to Eat?

The first thing you have to understand is that in all my years working with families, I’ve never met a baby that read the rulebook before birth. Contrary to what most baby books will tell you, a baby does not eat for ten minutes on each breast every two to three hours. What nonsense — Babies are not born with watches!

When a baby has stress — hunger, cold, wet or dirty diapers, pain, or loneliness — he will show you some very predictable signs. He’ll curl up his hands and feet and bring them to the center. He’ll bend at the knees and cross his feet or put his heels together — that’s called centering behavior. He’ll start to turn his head and may suck on his hands. Eventually, he’ll start to fuss and finally cry. All of these are stress signs. Sometimes, he’ll be hungry; sometimes lonely. But when he does those things, he is asking for you to pick him up and tend to his needs.

Since you won’t know what he wants by looking at him, I always recommend you start in the kitchen — aka, the breast. If he’s hungry, he’ll take the breast when you offer it. But never insist that a baby “has to be hungry” just because it’s been a while since he’s had the breast. Likewise, don’t automatically assume he can’t be hungry just because he only ate an hour ago. Babies are unpredictable, but when you offer the breast, he’ll eat if he’s hungry.

As a rule, newborns eat eight to 12 times a day, usually in clustered groups of three to four times in a four-hour period. They then take a three- to four-hour nap and start over again. Don’t count on it, but know that while no two babies eat on the same schedule, one thing is for certain: In all my years, I’ve never seen a baby actually eat for ten minutes on each breast every two to three hours.

How Does Baby Eat?

This is a tough one: Every baby is different, just like every adult is different. But there are a few simple principles that you can follow: When Baby is ready to eat and he’s in the kitchen, he will stretch out his hands, move the breast to where he wants it, open his mouth very wide, and take the breast deep into his mouth. He’ll latch on well, he’ll suckle in bursts of rapid sucks followed by a short pause — you may hear a soft swallowing sound — and then he’ll do it again.

Sometimes, he’ll appear to be sleeping, as he lies peacefully on the breast while holding the breast in his mouth. Don’t be fooled: Babies don’t really sleep on the breast — they rest and wait for their drinks to settle in their stomach. I am fond of saying, “Only college students and Army privates like to chug.” Everyone else takes a few sips, puts their drink down, and then start again. Don’t expect your baby to chug his milk and get it over with quickly.

When your baby is on the breast, you need to make sure he is latched on well and that he is transferring milk well from Mom. Every time your baby latches on, you will need to look for signs of a good latch:

1. Nose and chin touching the breast — He should bury his face deep in the breast. You do not need to pull the breast away from his face. If you do, you will pull the nipple away from his mouth or change the shape of the breast in his mouth. There is no need to fear that he will suffocate on the breast. First, remember, he isn’t stupid — if he can’t breathe, he’ll just turn his head or pull away. Second, have you ever noticed the creases on the side of your nose and how they tend to run up to your eyes? Have you ever noticed that there is a dimple on the side of your head where your eye sockets are? That is a continuous channel from the nose to the side of the head that I call the “baby snorkel system.” Air moves from his nose to his eyes, under his eyes and out the side of his head. If you don’t believe me, put your face underwater, cover your face with your hands, and blow air out of your nose — you’ll see the air move out of the side of your head.
2. Full, round cheeks without dimples — If his mouth is full of breast, his cheeks are full of breast. If you see dimples on his cheeks or creases around his mouth, he does not have the breast deep in his mouth. When his mouth is only half-full, he is creating a vacuum of empty space and he is hurting his mother.
3. Wide open jaw — An infant has a small mouth, and he has to open that mouth VERY wide to get all that breast tissue deep into his mouth. Get ready: Here’s where you get to measure something. If you measure the angle from his nose to his ear to his chin, that angle should be 60-90 degrees. I recommend using your fingers, put one finger on the nose, your palm on his ear, and another finger on his chin, and measure that angle.  Forty-five degrees is a closed and empty mouth, and that hurts!
4. No pain — NO PAIN! NO PAIN! NO PAIN! Did I mention it shouldn’t hurt to breastfeed? Traditionally, nipple pain in early breastfeeding was considered normal and unavoidable. That is a myth whose time is long past. New understanding of the anatomy of breastmilk structures in the nipple and areola shows that there is no fat or cushion in the nipple and that all cushion is held back on the areola. When the infant pinches the nipple with his mouth or tongue, Mom will feel pain, which is exactly the same thing that will happen if you pinch the nipple with your thumb and forefinger. Pinching the nipple is always a bad thing. Not only will the baby hurt his mother, but he will also not be able to effectively bring milk out. When you pinch the nipple, you bend the tubes that bring down breastmilk. Just like any other straw, if you bend it, you can’t drink from it. Don’t let the baby bend those tubes or pinch the nipple. If Mom has nipple pain, you need to fix the latch immediately, and if you can’t, you need to get in to see a lactation consultant as soon as possible.
5. Flared lips, up and down — In order for a baby to take the breast deep in his mouth, he will have to flare his lips as he opens his mouth widely. His tongue will extend and push out his lower lip, and he will wrap his lips around the areola. If there is a latching problem, it is often failure to flare the bottom lip. That being said, when he is properly buried into the breast, you can’t see his lips. Know that if everything else is OK, the lips are probably OK. But if there is nipple pain, dimples in the cheeks, or a narrow jaw, you will need to help your baby open his mouth and push his bottom lip and tongue out.

But how do you do help the baby get a good latch? Here the steps to fixing a bad latch:

• Put your hand on the baby’s back and gently push him toward the breast.
• Reach in between the chin and the breast and gently pull down on the baby’s chin to elicit a rooting reflex.
• Observe: Does it work? Does the jaw open, do the cheeks fill and round out, do the lips flare, and does the pain go away?
• Let go of the chin and let the baby suckle and test the new latch.
• Try again: Repeat the first four steps two or three times to see if you can correct the bad latch.
• Darn it! We’ll have to take him off the breast and try again. If you can’t fix the latch, you are going to need remedial action. You’re going to have to take the baby off the breast and calm the child, then elicit a rooting reflex off the breast to encourage a VERY wide open mouth and put him back to the breast.

Eventually these steps will almost always help solve a bad latch. Very rarely, you may find that even though you do everything right, your baby will not latch correctly. He may have chosen to sleep rather than eat, he may be overstimulated, or he may just need an experienced hand to help him out. Give him a break, let him rest for an hour or so, and try again. If he ever goes 24 hours without eating, get in to see a lactation consultant right away.

When is Baby Finished Eating?

When Baby is finished eating, he will relax his hands, release the breast, pull away from the breast, and fall into a deep sleep that I call the “milk coma.” Remember, your baby can’t tell time. Some babies will finish the breast in ten to 15 minutes; some will finish the breast in 45 to 60 minutes. There is no easy way for you to measure how much a baby eats when he is on the breast, but know that the actual amount he drinks is immaterial. What is important is that he goes to breast interested in feeding, and that he pulls away content, relaxed, and sleeping. A baby that is satisfied after feeding, growing steadily, looking healthy, and is generally a happy baby is almost certainly getting enough to eat. The number-one concern of new mothers is that they do not make enough milk. Try not to worry about it, keep offering the breast to the baby, and he will always get enough to eat.

So, There You Have It: Breastfeeding from a Man’s Perspective

Fathers are powerful allies contributing to breastfeeding success. Do not allow yourself to be excluded from this time in your child’s life. Study and learn, roll up your sleeves, and get in the game. Your family stands a much better chance of success if you actively support breastfeeding and actually help Mom breastfeed.

Sex and Breastfeeding

Now that we’ve covered feeding, let’s talk about sex while breastfeeding. You may be afraid to ask, so I’ll tell you. Breastfeeding — and for that matter, parenting — will impact your sex lives. Both of you need to know that some mothers have an increased libido, thanks to repetitive oxytocin surges, while others have a decreased libido, thanks to prolactin and a decrease in estrogen. Fathers may face problems with the “Madonna Complex”: She’s a mother now. All of this will affect your sex life.

It is important for both parents to understand that all aspects of parenting are demanding, physical work with only short bursts of sleep interrupted by a newborn that demands attention at inconvenient times. Mom will need constant support and help from her lover. The more help she can get from her husband, the more energy she will have for other activities. In other words, “You’ve got to give a little to get a little.”