How to avoid the pitfalls of breastfeeding as a new mother- the early days

Let's be totally honest here for a minute.  
Being a first time mom is scary.  
There are so many new things that you have to learn so quickly when you have a baby.  How to feed your child is one of those things you have to learn, whether you choose to use a bottle or a breast.  If you do decide to breastfeed your child, the path can seem a bit more nerve-wracking.  
I remember that when my son was just a tiny newborn I was so afraid that my milk wasn't going to be enough for him.  I remember watching the numbers on the scale so nervously hoping they would rise when we visited the pediatrician.  I remember wondering and obsessing over just how many ounces he was really getting when he nursed.
From many other women with whom I've spoken, these fears seem to be common, almost normal thoughts for a first time breastfeeding mother.  As a mother who was able to successfully breastfeed my child, and continues to do so at 18 months old while pregnant with my second baby, I want to share some of the pitfalls I've found to be common in the early nursing days.  Questions I had, fears I've heard from many other mothers, and logistics of nursing that have been common issues and reasons why women stop breastfeeding. Maybe if I share a few of these here, it may help a few more first time mamas not to share some of the same struggles we did in the beginning.  
Let's start out with the early days.  
When you first have your child, it is recommended by many breastfeeding advocates that you opt for skin to skin contact and try to breastfeed within one hour of birth.  Now, that isn't to say if you don't have a vaginal delivery or non-complicated birth in which you are unable to do either of these things, that you can't breastfeed your child.  I've known MANY women who didn't get to see their children until sometimes hours  (or even days) after birth and were still able to breastfeed.  I had a vaginal delivery with no complications which allowed me to do skin-to-skin and to breastfeed after birth, I believe it was a half hour or 45 minutes after.  However, I still found it to be confusing as a first time mom.  I'm pretty sure I asked one of the nurses, "Am I supposed to feed him now?"  To which my young nurse casually replied, "Well, if you want to, I guess you can go ahead."  
Not a ton of support there, obviously, to a first time mom who initially found the whole bit of breastfeeding to be a bit odd and a little awkward.  I think it would have been really helpful to have someone tell me, that yes, I should try to feed him at that point.  
(The most recent research I've read suggests trying to breastfeed within an hour of birth as baby has a period of increased awareness after birth in which the drive to nurse and the sucking reflex is at a high point.)
So, what about the actual breastfeeding?
Well, right away, for me, it didn't hurt.  
And then it did.
A day or two after my son was born, it really started to hurt initially when he latched on.  We had a lactation consultant come in several times to check on us, and we had a few latch problems mainly on my end with my anatomy, his part was just fine.  She recommended a nipple shield, told me that it shouldn't hurt, and that we'd probably have to use the shield for all the time I breastfed because of my anatomy.  Yikes.  On day 2-3 she was able to give this prediction?  Okay, well, I didn't know any better, so we began to use the shield and moved on.  
It took me a period of about two-three weeks of pain during the initial latch when nursing my son (in the beginning, and then again a few months down the line when I wised up and finally ditched the nipple shield, which we've done just fine without) before it didn't hurt to nurse him.  I've heard over and over from healthcare professionals that "If it hurts, something is wrong."  However, from MANY mamas with whom I've spoken, my experience has been similar to theirs, in that there is an adjustment period for a few weeks until your body gets used to breastfeeding, and that can be normal for some women.  Most of what I have heard, like what I experienced, is that the pain should stop a minute or so after the initial latch.  My lactation consultant friend Kelly also mentioned to me that she wants mamas to watch for pain lasting longer than a few minutes, misshapen nipples, bruised, cracked, or blistered nipples, if baby is falling off the breast frequently, or if you hear a clicking sound while baby is nursing, and if so, contact a lactation consultant!
Then comes the scary part- is the baby getting enough?
You may have already seen charts like this around, but here is the approximate size of baby's stomach in the early days.

It is really, really small.  
The first few days of baby's life are filled with weight loss, and then typically- hopefully- weight gain.  You are nursing so frequently in the beginning (at LEAST 10-12 times per day in the beginning) because baby's stomach is so small, and they are taking, just as they should, really small amounts at the start.  We nursed a TON in the beginning, sometimes 14 times per day and up, and I was still really nervous about my son actually gaining weight at his first pediatrician appointment after we left the hospital.  I'm pretty sure we were seen just shy of one week old, and they wanted him back at his birth weight again.  I believe we made it, or were really close, at that time.  However, I have heard more recently that it can take almost two weeks for some babies to gain back their birth weight, and that isn't a completely abnormal thing.  
The main thing at that point is to keep going in for checks of birth weight and really watch the amount of wet and dirty diapers you are getting.  My hospital gave me a paper chart to take home to track everything down.  This is also where I break my never-wake-a-sleeping-baby rule, if they aren't gaining weight like my medical staff would like them to, I wake the baby to feed them.  
If your babe does have trouble gaining weight in the beginning, and you are committed to breastfeeding, I would try a weighted feeding prior to supplementing with formula.  A weighed feeding is where you change baby's diaper, weigh them before a feeding, nurse them, and then weigh them immediately after feeding them.  The purpose of this is to see exactly how much they are taking at each feeding.  This is something you can do with a lactation consultant in their office or your home, by yourself, or with any other support persons you have for birthing/post partum care.  (My doula offered this service to us.)  A word of caution though if you are doing a weighed feeding on your own- use a scale that is really exact.  We are talking about ounces here, so unless your scale is VERY precise, you may want to pick up a baby scale to have at home.  We have one we purchased specifically for babies that proved to be very helpful in our breastfeeding journey.
Also, a word to the wise about weighed feedings- most times, I've found that my mama friends were doing these at night, or later in the day.  After being up all night, no one wants to schedule early morning appointments, and sometimes your lactation consultant or doula coming to your home happens to be later at night.  We did weighed feedings some nights when my husband came home from work.  The problem with this is, for many women, your body produces the most milk in the morning and the least milk at night.  If you do a weighed evening feeding, you are probably going to see a really small number of ounces that they are taking in, and that is normal.  Try to do a morning weighed feeding for your first nurse of the day if it is possible, as again, this is the time your body is producing the most milk.  
So, how about when your milk comes in?
I'm one of those women who didn't know when their milk came in.  Most of the women I know were acutely aware of when this happened to them, but for me, there were never any signs or anything to show me that it did.  I never felt let-down, I never felt that crazy engorgement when my milk came in.  It just did, silently in the background as I was feeding my son.  I actually had my doula come over to our house and look at bottles of milk I had pumped because I couldn't tell the difference between colostrum and milk.  This was where a support person- lactation consultant or doula, etc.- was really important.  Again, this was one of those times in the early breastfeeding days that I really just needed someone to tell me, "Yes, your milk has come in, and yes, it is all your baby needs right now."  Thankfully, my doula did just that.  She was able to look at it and immediately tell me it was breastmilk and not colostrum, and she pointed out the separating of the foremilk and fatty hindmilk in the bottle.  
For those women who do feel/know when your milk comes in, some advice from a lactation consultant friend of mine is to not be scared.  Things change rapidly in the look and feel of your breasts, you may leak, feel pain, feel tightness, and baby may have a harder time latching initially when your milk comes in.  She mentioned that it is okay to pump sometimes in the beginning of the feed just for a bit to soften the breast and allow for an easier latch.
If your milk doesn't come in right away, again, refer to the chart above.  In those first few days, your baby needs SO little at a time as their stomachs are so small.  We can gulp down in one swallow an incredibly larger amount than your baby takes during an entire feeding during their first few days.  If it goes past the first few days and your milk still has not come in, I HIGHLY recommend seeing your lactation consultant as often as you need to help you get through that period of time, just like breast milk, a good lactation consultant is worth their weight in gold.  
These are just a few tips for the very early days of breastfeeding from my trip along the way.  I'll be posting a few more topics about breastfeeding for the first few months, breastfeeding in toddlerhood, and breastfeeding through the more troublesome moments (clogged ducts, mastitis, teething, etc.).  Check back this week to read more!
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