Breastfeeding Basics: What you need to know

Breastfeeding is nature’s most perfect system specifically designed to enable mothers to nourish and nurture their babies.  However, it isn’t always as easy as you think it should be, in fact sometimes it can be downright challenging. It is a learned activity for both mom and baby where information and encouragement can often be helpful as you adjust to the rhythm and routine of feeding your baby in the early days after birth. 

Step One: The Latch

Finding a comfortable position:

Being comfortable when breastfeeding is almost as important as latching the baby to the breast.  Breastfeeding takes time – an uncomfortable position with little support can cause tension and pain in the back and neck.  A chair with arms and good back support is best.  Using a footstool so the legs can bend at the knees can increase comfort.  Pillows or a rolled up receiving blanket can be used to support a mother’s arms, wrist and raise the baby as needed. Once you are comfortable sitting up feeding, moving to a lying down position is essential for getting the rest you need!

When latching to baby to the breast:

· Bring your baby’s body close against yours with ‘tummy to mummy’, slightly tilted up towards the breast and with his bottom tucked and legs wrapped around your side. 

· Support your baby’s head with the opposite arm to the side your baby is feeding on lining up his “nose to nipple”.

· Cradle his head in your hand with your forearm running along his back.

· Tilt his head back slightly.

· Support your breast by placing your hand flat against your rib cage, under the breast with your thumb pointing up.  Raise the breast slightly.  This allows you to bring him towards your breast with the nipple pointing to the roof of his mouth. Rolling up a receiving blanket and putting it under the breast can help support the breast and allow the nipple to stay in the correct position without pulling in your baby’s mouth when you let go of the breast.

· Caress your baby’s lips with your nipple encouraging him to open his mouth wide.

· Once the mouth is open wide, move your baby quickly towards the breast by exerting gentle but firm pressure between his shoulder blades with the base of your hand so his chin and lower jaw make first contact with the areola.

· When your baby has latched, his top lip will be close to the nipple, with the areola showing just above his top lip. His chin should be tucked close against your breast and his body uncurled. Your nipple will be drawn back deep into the mouth, cushioned between the soft palate and the tongue.

· The football hold is great to especially for moms who have larger breast where the nipple naturally points out in a side direction.  Use the same principle, but with your baby tucked into you side with their feet up and around your back.

WATCH THE LOWER LIP, aim it as far from the base of the nipple as possible, so your baby’s tongue draws as much of the breast as possible into his mouth. The tongue has to be on the underside of the nipple when latched, pulling the nipple deep into the back where the soft palate is.  The soft palate acts as a cushion for the nipple, protecting it from being rubbed between the hard palate and the tongue when it isn’t back far enough in the mouth.  That is where the painful blisters and cracks come from!! :(((

WIDE MOUTH / GAPE

Your baby needs a wide mouth before being moved onto your breast. Teach your baby to open wide by:

• move baby toward breast, touch top lip against nipple
• move mouth away SLIGHTLY
• touch top lip against nipple again, move away again
• repeat until baby opens wide and has tongue forward

• You can also try running your nipple along the baby’s upper lip, from one corner to the other, lightly, until baby opens wide.

What to do if your baby is not sucking? 

Some babies do not initially know how to suck.  They clamp or bite down rather than suck.  My second child was like that and if I hadn’t had a first child who had a natural suck, I would have had a bigger challenge.  That is the benefit of a second baby…there is only one first time learner!  Training your baby to suck by putting a clean finger in their mouth and pressing gently on the tongue can help stimulate and improve the such reflex in the first day or two. Once they start sucking, remove the finger and quickly introduce the breast.  It is a trick that has solved much early confusion.

What to avoid when breastfeeding:

·      positioning your breast across your body 

·      chasing the baby with your breast

·      flapping the breast up and down

·      holding your breast in a scissor grip

·      not supporting the breast

·      twisting your body towards the baby instead of slightly away

·      aiming nipple to centre of baby’s mouth

·      pulling baby’s chin down to open mouth

·      flexing baby’s head when bringing to breast

·      moving breast into baby’s mouth instead of bringing baby to breast

·      Pushing face into breast when encouraging gape

·      moving baby onto breast without a proper gape

·      not moving baby onto breast quickly enough at height of gape

·      having baby’s nose touch breast first and not the chin

·      holding breast away from baby’s nose (not necessary if the baby is well latched on, as the nose will be away from the breast anyway)

The first breastfeed:

Ideally, you want to nurse your baby as soon after birth as possible with most babies being eager and interested in feeding within the first 2 hours of being born. Colostrum, baby’s first milk, is present from the moment of birth, offering excellent protection from infection and many diseases. The first 24 hours after birth is often called the “Day of Grace” and once your baby has had a feed, she will likely sleep as you recover from the birth. She may not want to feed again for some time as many babies have tummies that are full of amniotic fluid.  They tend to be mucousy and may spit up a lot as they work the fluid through their system. By day 2, most babies have moved to a regular feeding schedule, wanting milk every couple of hours.

It takes about three days for your milk to come in. In the first 24 hours, you can expect your baby to pee and pass meconium (baby’s first bowel movement) at least once.  As your milk supply increases and your baby feeds more, you can expect her bladder and bowel function to increase as well.

Normal Elimination Patterns

The usual pattern of elimination is as follows

·      Day 1 = 1 void and probable passing of meconium (tar-like colour)

·      Day 2 = 2 voids and meconium

·      Day 3 = 3 voids and meconium (you may see changes in stool colour)

·      Day 4 = 4 voids and transitional stool (brown or green)

·      Day 5 = 8+ voids and breast milk stool (grainy mustard colour)

By day 2, as mentioned, your baby will probably want to feed every two to three hours. This is about 8 feeds in a 24-hour period. Babies will nurse on average 15-30 minutes at a time, sucking and swallowing with little breaks in between. Because the first three days your baby is getting colostrum, and may be demanding as much as it can suck, switch breasts regularly for equal stimulation. This helps bring the milk in as well as protecting your nipples from becoming sore.

As the milk transitions from colostrum, you may feel as though your baby begins non-stop feeding for anywhere from 12 to 24 hours—and it’s totally normal!  This is DEMAND and then supply: your baby establishes how much milk she needs you to produce in order to grow, as well as helping to prevent engorgement.  Once the milk is in, your baby will most likely go back to a feeding pattern of every 2 to 3 hours—which feels much more do-able!!

Challenges with Feeding

Sore Nipples:

Sore nipples are very common in the first few days of breastfeeding.  Getting the latch right is really important but even if you have a good latch, it can be normal to feel some discomfort in the first week. Some tenderness with the initial latch can be experienced but pain should not last longer than about 30 seconds.  If you experience a sharp shooting pain or pinching that lasts longer than 30 seconds, you will need to re-latch.  Break the baby’s suction by pressing in to your nipple with your finger and gently scooping the nipple out of the baby’s mouth.  Pulling the nipple out of the mouth without releasing the suction may damage the nipple more. Using a good nipple cream that is safe for baby is good to use after each feeding.  The ointment keeps the nipple moist allowing the blisters or cracks to heal. Expressing breast milk and gently rubbing into end of nipple can help with healing as well.

Engorgement:

Engorgement is a common experience for many women. It is a sign that your milk is in. Your breasts can feel very full and tight and often look swollen, with the veins being very prominent. You may be surprised by their increased size.  However, they will soften and adapt to your baby’s needs within the first 2 weeks of life.  Engorgement usually occurs by the end of day 3.  Sometimes your baby will have difficulty latching when you are engorged. A warm cloth, bath, shower, or using a breast pump for a few minutes to soften the breast and allow some milk out can help her to latch on a little more easily.  Placing cold green cabbage leaves on your breasts between feeds can also be helpful as well as taking 400 mg of Ibuprofen to assist with any pain and inflammation you might experience. 

Blocked Ducts:

Blocked or clogged ducts occur from inadequate emptying of your breast while feeding. A good latch and a lengthy nurse are the best ways to avoid this problem. Blocked ducts feel like lumps in the breast that disappear when the breast is emptied. Sometimes it is helpful to massage the lump while the baby is feeding. You should massage down the breast towards the nipple. This can be painful; however, it is necessary in order to prevent infection.  

Mastitis:

Mastitis is a breast infection that is caused by a blocked duct.  Preventative measures include: frequent, well positioned, on demand breast-feeding, rest, fluid, nutrition, clean sheets and proper hand washing. You can expect a small increase in your temperature when your milk comes in which should be short lived and should not progress into flu-like symptoms.  Remember to alternate breasts with each feed to ensure emptying as well as stimulating your supply. A good feed lasts at least 15-20 minutes on one breast ensuring your baby gets both front and hind milk.

What to do if an infection occurs:

·      Page your midwife or doctor.

·      Get into bed and rest for at least 24 hours. 

·      Nurse your baby as often as possible especially on the side that is infected.

·      Massage the infected breast.

·      Take 1000mg vitamin C 2-3 times a day.

·      Increase fluids to 8-10 glasses.

·      Hot compresses soaked in comfrey root, lavender and ginger root.

·      Grated potato in the form of a poultice can draw out the heat and resolve clogged ducts.

·      Poke root tincture 4-6 drops every 2 hours for 6 hours (4 times in total), then 4 drops every 6 hours for the next 24-36 hours. Or poke root capsules 3 times daily for 3 days.

·      Take homeopathic Phytolacca 5-8 times a day.

·      Consider antibiotics if you are not getting better with using natural remedies.

The journey of breastfeeding is profound as it is the beginning of your relationship with your baby. Unlike labour, which has a beginning and an end, it goes on and on for many months, and sometimes even years. Getting the support you need, can change your breastfeeding experience from something that many women find initially challenging into the most amazing experience of all.  Remember, the questions you want to ask yourself is my breastfeeding comfortable?  Is it effective?  If the answer is yes to both of these...than you are doing great!  If not, you may want to consider getting more support so that your breastfeeding experience is everything you and your baby want and need it to be.