Breastfeeding Your Baby

We at the Womens Health Group support all women in their choices to feed their baby. We promote breastfeeding as an ideal choice for nurturing and promoting health for mum and baby. We offer support though our breastfeeding workshop and mobile phone out of hours.

Breastfeeding Your Baby

Breastfeeding is a normal biological feeding process for a newborn and all other methods of feeding should be regarded as an alternative means to breastfeeding.

Positioning and latch-on to breastfeeding

The way you hold your baby and how he latches-on to the breast, are the keys to comfortable feeding for you and your baby. Correct positioning and latch-on can prevent many of the common problems mother’s encounter when starting to breastfeed. Although breastfeeding is natural, it is a learning process for both you and your baby. Allow yourself several weeks to perfect these techniques. At any time that you are unsure that you are feeding correctly, seek the help of a lactation consultant or other knowledgeable health care provider. Once breastfeeding is fully established, it can be one of the most rewarding experiences of new motherhood.

Getting Comfortable

Choose a comfortable chair or sofa with good support for your back. Use a footstool to bring your knees up so your lap is slightly inclined and the pressure is off the small of your back. Position pillows where ever needed to support your arms and relax your shoulders.

Positioning your baby

With any position you choose to hold your baby, turn your baby completely onto his side, “tummy to tummy”, so his mouth is directly in front of the breast and he does not need to turn his head at all to get to the nipple.

Position your baby with his nose to your nipple so he has to “reach up” slightly to grasp the nipple. His chin should touch the breast first, then grasp the nipple.

Place your baby’s lower arm around your waist. This will draw him close to you. Look for a straight line from your baby’s ears, to shoulders, to hips. His legs should curl around your waist.

Basic positioning for breastfeeding

The cross-cradle hold is one of the preferred positions for the early days of breastfeeding. You will have good control of the position of your baby’s head when you place your hand behind your baby’s ears. Roll the baby to face you “belly to belly”.

The football hold (clutch hold) is good for mothers who have had a caesarean delivery because the weight of the baby is not on the abdomen. Tuck the baby under your arm with pillow support to place the baby at breast height. Tuck a pillow or rolled receiving blanket under your wrist for support. Place your baby’s head in the bend of your arm or on your forearm and support his body with your arm in the cradle hold. Roll the baby towards you “belly to belly”.

Side lying is great for getting a bit of rest while your baby nurses or if you want to avoid sitting because of soreness. Notice the pillow support and your back and the baby’s back, and between your legs. Roll the baby towards you “belly to belly”.

Is your positioning correct?

1. Support baby on pillows at breast height

2. Roll the baby toward you, “belly to belly”

3. Line the baby up “nose to nipple”

Latch-on

Compress your areola slightly to make a “nipple sandwich” for the baby. This will allow the baby to get a deeper latch-on. Make sure your fingers are well behind the edges of the areola (1 to 1 ½ ‘’ from the base of the nipple).

U hold

Support the breast with your hand in a “U” position, then squeeze gently to form a “sandwich” for the baby. Use a “U” hold for positions where your baby is across your lap (cross-cradle or cradle hold).

C hold

The “C” hold is used when the baby is in the football hold. An easy way to remember how to hold your hand is to keep your thumb by your baby’s nose and your fingers by the baby’s chin. That way you will automatically rotate your hand to match the baby’s positioning. Stroke your baby’s lips up and down with your nipple and pull him quickly to the breast when he opens his mouth wide. Be sure to wait for his mouth to open WIDE (like a yawn) and his tongue to come forward. He should get the nipple and a “big mouthful” of the areola (the dark brown part of the breast) in his mouth. Bring the baby to the breast, not the breast to the baby!

Listen for swallowing every 3 to 5 sucks (May not be apparent until your milk comes in). Once your milk has come in and you have a let-down reflex, you will notice swallowing with every suck.

Are you offering the breast correctly?

1. Sandwich hold

2. Wait for a wide open mouth

3. Bring baby to breast, not breast to baby

Check your latch-on the chin should touch the breast, the nose should be free. Worried that your baby can’t breathe while at the breast? Don’t! If the baby truly can’t breathe, he will let go. Usually, babies can breathe easily even when pressed close to the breast because they can breathe around the “corners” of their noses.

Do not press on the breast to make a breathing passage for the baby. This can distort the shape of the nipple in the baby’s mouth and contribute to soreness as well as limit the drainage from the area of the breast above your fingers. If necessary, pull the baby’s hips in closer to you. This should free up the nose. Some mothers describe pain as their baby latches-on that eases as the milk begins to flow. This will subside over time, as your body adapts to breastfeeding. If it persists, remove your baby from the breast and re-attach him.

Look for these signs:

  • The angle of your baby’s lips at the breast is greater than 140 degrees or greater.
  • Most of the areola is in your baby’s mouth (1” from the base of your nipple, slightly more towards the baby’s lower lip than towards the upper lip).
  • Both upper and lower lips are flanged (rolled out). You feel deep pulling sensation as the baby nurses. It should not be sharp pain or last more than a moment during the latch-on.
  • If you need to remove your baby from the breast, slip your finger between his lips and gums to break the suction. • Wait for the suction to release, and remove him.

Is your latch-on correct?

1. The angle of the lips is greater than 140o

2. Lips flanged (rolled out, both top and bottom)

3. Nose and chin touching breast

Tips for large breasted mothers

Place a rolled towel or small blanket under your breast for support. Focus on holding the area just beyond the areola and use the sandwich techniques described earlier. Try gently pinching up a big to skin on the edge of the areola to make a flat area across the tip of the nipple, hold your fingers like holding a fancy tea cup. Some mothers feel more comfortable with a

very supportive bra that provides support to the breast while the cup is opened for feedings. Others prefer to go without

a bra.

Signs of a good latch-on

  • The baby has a deep latch with an angle where the lips meet the breast of at least 140 degrees.
  • Both upper and lower lips are flanged (rolled out).
  • All or most of the mother’s areola is in the baby’s mouth.
  • More from the bottom of the areola than the top (asymmetrical latch-on).
  • Mother is comfortable through the feeding.
  • There may be some latch-on pain that subsides quickly.
  • Baby latches-on easily with minimal attempts and stays latched-on.
  • There is movement in the baby’s temples with sucking and the jaw moves up and down an inch or more.
  • There is slight movement of the mother’s skin near the baby’s lips.

Signs of a good feeding

  • Hearing swallowing at least every third suck once the milk comes-in.
  • Consistent sucking with only brief pauses.
  • The breasts are softer after feedings.
  • Appropriate output for age. (1 wet diaper on day 1, 2 wet diapers on day 2, 3 wet diapers on day 3, 6 wet diapers on day 4 and on, several stools each day).
  • Feeling strong, deep, “pulling”, sucking, no sharp pain.
  • Seeing milk in the baby’s mouth.
  • Leaking from the other breast or feeling of a “let-down” reflex or noticing a change in the baby’s sucking rhythm from faster to slower.
  • Baby nurses 8 -12 times per day (24 hour day). Less than 8 or more than 12 is a concern.
  • Minimal weight loss during the first few days (<10% of birth weight) and return to birth weight by 2 weeks.

Waking a Sleepy Breastfeeding Baby

Babies are often sleepy during the first week or so. Babies can sleep from 2-20 hours post delivery. They may not awaken often enough to feed: remember newborns need to eat 8-12 times per 24 hours. Or once the feeding has begun, they may fall asleep again. Here are a few suggestions for waking your baby. Some work better on certain babies than others. When one quits working try another.

  • Hold baby skin-to-skin.
  • Undress the baby to his nappy to cool him off and make him more alert.
  • Rub and massage the baby in various places Top of the head Bottom of the feet, cross the belly Up and down the arm. Change the position of the baby, from cradle hold to football hold and back again.
  • Change the baby’s nappy.
  • Start to pull the nipple from the baby’s mouth (Make sure that this does not result in the baby sucking on just the tip of the nipple. If it does break the suction and re-attach the baby to the breast).
  • Talk to the baby. Babies respond to mom’s voice.
  • Try adjusting room lights up for stimulation or down so the baby can comfortably open his eyes.
  • If your baby is unarousable after a reasonable amount of time and the use of several techniques, contact your general practitioner.

Is My Breastfeeding Baby Getting Enough Milk?

One of the biggest concerns as new parent’s is how much or how often the baby breastfeeds. Here are some guidelines to reassure you that your baby is getting enough.

Your newborn baby should nurse 8 - 12 times in 24 hours during the first 2 - 3 weeks. As your baby gets older he will become more efficient and feedings may be less frequent.

Some feedings may be close together, even an hour or so apart. Other feedings will be less frequent. Feedings do not need to be evenly spaced and are often irregular in the newborn baby.

Count the number of wet diapers your baby has.

Typical patterns for wet diapers is:

1 wet diaper on day one

2 wet diapers on day two

3 wet diapers on day three

4 wet diapers on day four

5 wet diapers on day five

6 wet diapers on day six and from then on.

Your baby should also have several stools per day. Stools change from meconium (tarry, sticky, black) to brownish to yellow over the first few days of life. After 6 weeks babies may void and stool less. However, the urine should always be a light yellow colour and the stool should be soft.

Babies generally lose a little weight in the first few days after birth and then begin to gain. This is a normal pattern. Have your baby’s weight checked a couple of times during the first 2 weeks, especially if you are concerned that your baby is not eating enough. A check of his weight is the only sure way to determine adequate intake. Once your baby has regained his birth weight you can relax and let your baby set the pace for the feedings.

Signs of hunger

  • Rooting
  • Mouthing movements
  • Tense appearance
  • Grunting, other sounds
  • Hand-to-mouth activity
  • Kicking, waving arms
  • Crying

Signs of a good latch-on

  • Relatively comfortable, latch-on pain subsides quickly
  • Lips at the breast at least 140o angle or greater
  • All or most of the areola in the baby’s mouth with more areola covered from the area near his chin
  • Lips flanged (rolled out)

Signs the Baby is Full

  • Drowsiness, sleepiness
  • Baby comes off the breast spontaneously
  • Relaxed appearance
  • Hands and shoulders are relaxed
  • Sleeps for a period of time before arousing to feed again

Signs of a good feeding

  • Easy latch-on, stays latched-on
  • Hearing swallowing
  • Noticing that the breasts are softer after feedings
  • Feeling strong, deep, “pulling”, sucking
  • Seeing milk in your baby’s mouth
  • Leaking from the other breast or feeling of a “let-down” reflex
  • 15 - 20 minutes vigorous sucking on each breast or 20 - 30 minutes on one side
  • Wide jaw movements and consistent sucking

Sometimes, babies seem to take a good feeding at the breast but wake within a few minutes wanting more. Offer the breast again. It will likely be a short feed “top off” feeding and your baby will drop off to sleep.

Seek alternative help from your Lactation Consultant, Public Health Nurse or GP if the following has resulted or you have concerns.

  • Your baby has not begun to gain weight by his fifth day after birth or has not regained his birth weight by 2 weeks.
  • Your baby is not voiding at least 6 - 8 times per day
  • Your baby is not having several stools per day These signs can indicate inadequate feedings and can become a serious concern if not corrected quickly. You may wish to keep a written record of when your baby voids, stools and feeds for a few days so you can accurately report this.

Breast Engorgement

Breastmilk usually “comes in” sometime during the first week after delivery. This means your milk changes from colostrum, or early milk, to mature milk. Your body may make more than your baby needs during this period and it is easy to become overly full.

To prevent engorgement

Nurse frequently, about 8-12 times per day.

Make sure your baby latches-on well so he will empty your breasts effectively.

Do not skip feedings or give formula feedings during the first several weeks.

For moderate engorgement: (Your breasts are as firm as the tip of your nose):

Apply heat before feedings to soften the breast and encourage the let-down reflex. Stand in the shower and let warm water run over your breasts. This will feel good and encourage leaking.

Do some gentle breast massage. Make circular motions in small areas with your finger tips and move your hand all around the breast. Then stroke from the outer breast toward the nipple.

  • Place your hand in a “C” position at the breast, fingers under and thumb on top.
  • Place your fingers behind the edge of the areola, about 1 to 1 ½’ from the base of the nipple.
  • Press your fingers back toward your chest.
  • Squeeze your fingers together.
  • Rotate your hand to empty all sections of your breast.
  • Empty one breast, then repeat the process on the other breast. Go back and repeat the process on each breast again to remove additional milk.
  • There is a video on hand expression at http://newborns.stanford.edu/Breastfeeding/HandExpression.html.
  • Apply cold after feedings to reduce the swelling and provide comfort. You can use ice packs or bags of frozen peas wrapped in a light towel. Apply for 10 - 20 minutes.

For extreme engorgement: (Your breasts feel as hard as your forehead) Apply cold to the breasts, no heat. This will reduce swelling, slow the re-filling of the breasts and provide some comfort. Lying on your back helps the excessive fluid in your breasts be reabsorbed by your body)

  • Ice in a re-sealable bag or bags of frozen vegetables over the breasts will feel good and reduce swelling. Use a towel or cloth between you and the ice.
  • Cabbage leaves may be applied to the breasts before feedings to reduce swelling. Although this may sound like an unusual treatment, many women have found it effective in relieving the pain and fullness of engorgement. Scrape (or pound) the cabbage to release the juices. Apply cabbage that has been in the coldest part of the fridge and apply to your breasts. Wear the cabbage inside your bra for 15-30 minutes at a time, 2-3 times per day, not more. More can reduce your milk supply. Do not use cabbage applications if you are allergic to cabbage or you develop a skin rash.
  • You may need to use a breast pump for a few minutes to remove some milk from your breasts before feedings. This will help soften and shape the nipple to make it easier for the baby to latch-on. If your baby doesn’t empty your breasts sufficiently during feedings or only feeds on one breast, you may need to use a breast pump after feedings for a day or two. It is important to treat engorgement before your breasts become very full and painful. This back pressure on the milk producing cells in your breast can damage them and reduce your over-all milk supply. If, despite using these methods, you cannot obtain relief, seek help from a lactation consultant or other knowledgeable health care provider.

Storage and Handling of Breastmilk

Working mothers or others who are pumping breastmilk for their infants should store the milk in the cleanest and safest way. It can be stored in any clean container: plastic, glass or nurser bags.

Recommendations for storage temperatures and times vary greatly from one authority to another. We are recommending guidelines based on research and common sense.

Room Temperature

Freshly pumped breastmilk can be kept at room temperature for 8 hours after pumping. If it will need to be kept longer, please refrigerate. Milk that has been previously chilled should be kept at room temperature for no longer than an hour or so.

Refrigerated

Breastmilk may be stored in a refrigerator up to 8 day if collected in a clean and sterile way but If you think that you may not use it within that time period, freeze it. You may add “new” breastmilk to breastmilk that has been refrigerated. Chill the “new” milk before adding to already chilled milk. The milk must be discarded if it is older than the expiration date of the original milk. If you find you have milk that has almost reached its expiration date in the refrigerator, you may freeze it for later use.

Frozen

Breastmilk may be stored in a freezer for up to 6 months and in a deep freeze for up to 12 months. The freezer is cold enough if it keeps your ice cream solid. That will be about 0o F or -20o C. It should be placed in a part of the freezer that will not be subject to changes in temperature as the door is opened and closed.

If plastic nurser bags are used, they should be doubled or protected from being bumped and torn in the freezer.

You may add “new” milk to previously frozen milk. Chill the “new” milk prior to adding it to a frozen container of milk. The expiration date of that container of milk will be from the date of the original milk.

It is best to freeze milk in feeding sized quantities. If you are just starting to pump, you may not yet have an idea of what will be the right size for your baby. Freeze in 2-3 oz quantities to start. You don’t want to thaw out more milk than your baby will take in 24 hours. You can always get more if necessary, but you will be dismayed if you have to discard pumped breastmilk. After you have some experience with how much your baby takes from a bottle, you can freeze milk in that quantity.

Thawed

Breastmilk can be thawed in a bowl of lukewarm water in just a few minutes or held under lukewarm running water. Then it can be warmed to serving temperature in the same manner. Never make it warmer than body temperature. Never use a microwave to thaw or warm breastmilk. Any milk left in a bottle after a feeding must be discarded. Thawed breastmilk must be discarded after 24 hours. Do not re-freeze it.

Transporting

If you are pumping breastmilk at work, you should chill it either in a refrigerator or a portable cooler bag. A cooler bag can be used to transport it home. Studies have shown that freshly pumped breastmilk keeps well at room temperature for several hours (some studies say up to 8 hours) so if chilling your breastmilk is difficult, it can be stored at room temperature for several hours, and then refrigerated as soon as possible.

BPA (Bisphenol A)

In light of the recent controversy about BPA contamination of breastmilk leaching from certain kinds of plastic, breastmilk should be stored in glass, polyethelyne (cloudy type of rigid plastic) or polypropolene (specially designed mother’s milk storage bags) containers rather than polycarbonate containers.

When Your Baby Refuses Your Breast

If your newborn has had some bottle feedings or uses a pacifier a lot, he may seem confused at the breast, or even refuse to go to the breast. Sometimes babies have difficulty latching-on if your nipples are soft and flat. Some babies learn to prefer the relatively fast flow from a bottle nipple and become frustrated at the relatively slow flow from the breast. Sometimes lying down with your baby and cuddling skin to skin helps. Allow your baby to awaken being held skin-to-skin.

Feeling you and smelling you just might do the trick for the baby to WANT to take the breast. Encourage the baby to locate the breast when he feels ready and seems hungry. As they awaken, babies tend to move their head and hands around in search of the breast. Allow him time to find the nipple on his own. When the baby feels the breast on his cheeks and chin, he will open his mouth and latch-on. Try this several times each day for an hour or two. Not only is skin-to-skin contact great for promoting breastfeeding, it helps enhance your baby’s nervous system and is fun to do.

If your baby needs more assistance, make sure he is positioned correctly at the breast. Roll the baby on his side and position him so his mouth is directly in front of your breast. He shouldn’t have to turn his head to get to the breast.

If your nipple is difficult to grasp, roll it gently between your fingers to make it stand out. Make your breast into a “nipple sandwich” by gently compressing behind the edge of the areola. This “U” hold or “C” hold will allow the baby to attach more deeply to the areola. Use a “C” hold when the baby is in a cradle or cross-cradle hold. Use a “U” hold when the baby is being held in a football hold. Be sure to line up the “sandwich” with the baby’s mouth. If you keep your thumb in line with your baby’s nose and your fingers on the opposite side of the breast, you have the right hand position .Express a few drops on milk on your nipple or drip some milk over your nipple for your baby to taste. Stroke your baby’s lips with your nipple (from nose towards chin) until his mouth opens wide and pull him quickly onto the breast.

Encourage your baby softly and calmly. If, after 5-10 minutes, your baby does not latch-on to the breast, offer pumped breastmilk or formula in a way that will not compromise breastfeeding. It is best not to persist beyond 10 minutes if your baby is resisting the breast. You want the breast to be a pleasant place for your baby to be, not a battle ground. Persistence and patience will remedy this situation.

Don’t confuse your baby with bottle nipples or pacifiers at this time. After breastfeeding is going well, they can be used.

Remember, your newborn needs to nurse 8 - 12 times per day. You should expect to see 6 - 8 wet diapers and several stools each day. If using these hints doesn’t help resolve these problems, seek assistance from your Lactation Consultant public health nurse or knowledgeable practitioner.

A lactation consultant may use a nipple shield, a supplemental nurser or other types of equipment to match the flow of milk from the bottle, while the baby is learning to experience the breast. While you are working on transitioning the baby to the breast, be sure to use a hospital grade breast pump at least 8 times per day to maintain your milk supply. Returning the baby to the breast is always easier if there is an abundant flow of milk available

Plugged Ducts and Mastitis

It is always a good idea to assess your breast at frequent intervals so you can assess as early as possible any signs of plugged duct or mastitis.

Plugged Ducts

If you notice a small lump the size of a pea in your breasts, it may be a plugged duct. This occurs when a portion of the breast does not get emptied completely during feedings.

  • Apply a warm compress to the area before a feeding and massage the lump towards the nipple. You can also massage towards the nipple during a feeding. It may take 2 or 3 feedings for it to completely empty.
  • You may also position your baby’s chin towards the area of the lump. This is where the greatest emptying will occur.

Mastitis

Mastitis occurs most frequently in mothers who have had a cracked or blistered nipple or who are undergoing a period of stress such as returning to work, participating in holiday activities or experiencing a change in normal daily routine.

  • Apply warm compresses before feedings and do some gentle breast massage.
  • Keep your breast empty by frequent nursing.
  • It is important to continue to breastfeed, even on the affected side.
  • If your baby does not empty that side well, use a good quality breast pump after feedings.
  • During this time, rest in bed as much as you can and drink plenty of fluids.
  • If unresolved after 24 hours of doing the above consult your obstetrician or GP, who may prescribe an antibiotic.

You must take a full 7 -10 day course of medication. Do not stop taking it until the prescription is gone even though you start to feel better. Inadequately treated mastitis is more likely to return.

Symptoms may include: High fever, starting suddenly , reddened area, red streaks, pain and a lump in the breast, Flu like symptoms, chills, and extreme tiredness.

If you find a persistent lump that does not respond to these measures, please see your obstetrician or GP. It could be a different problem.