Tips for Successful Breastfeeding

  • Put the baby to the breast and try to nurse as soon after birth as possible.
  • A baby needs to nurse 10-12 times in a 24-hour cycle. The more you nurse the more your milk supply will increase. Frequent breastfeeding stimulates milk production and reduces engorgement.
  • To latch on: Sit back in a comfortable, well supported position, do not lean over the baby. Support your breast with one hand. Place the baby’s head in the crook of your elbow. Pull the baby’s feet in close to your other side. Hold baby at the level of your breast. The baby’s face and body should be turned in to face your body. Tickle the baby’s lower lip with your breast and wait for her to open wide, and then pull the baby in close to you when ready to latch on. The baby should be holding as much of the areola in her mouth as possible.
  • Baby’s need night feedings: Human milk is easily digested and passes quickly through the digestive system, therefore a baby needs to eat every 2-3 hours throughout the night. A newborn may be sleepy and may need to be awakened to feed.
  • Watch your baby, not the clock: Learn the signs of hunger such as turning toward the breast, opening the mouth/rooting reflex, and bringing her hands to her mouth. If the baby is crying she has been hungry for too long. Learn these signs and anticipate hunger according to her schedule and cues. Some baby’s may need to be awakened to be fed.
  • Enough Milk? : After your milk comes in, around day 3-4 postpartum, a baby should have 6-8 wet diapers in a 24 hour period and 3-5 bowel movements per day. This confirms that the baby is well fed and well hydrated.
  • Remember: Correct positioning and latch on techniques are the solution to most breastfeeding problems.
  • Keep your nipples clean and dry: Do not scrub the nipples or use soaps to wash them. Use pure lanolin on nipples to treat or prevent dry, cracking, chapped, or raw nipples.
  • To remove the baby from your breast: Break the suction first by inserting a clean, small finger into the baby’s mouth, or gently pull down on her chin. Tugging on the nipples can cause irritation.
  • Foremilk and Hindmilk: The milk expressed during the beginning of the feeding is more liquid and satisfies the baby’s thirst. The milk expressed later is creamier and has more fat content, which satisfies hunger and adds to weight gain. Both are very important. To encourage the expression of hindmilk make sure you are nursing for at least 20 minutes.
  • Discourage the use of pacifiers and bottles before breastfeeding has been well established. Pacifiers and bottles are “band-aid” solutions to most breastfeeding problems. With help, see if you can get to the root of the problem.
  • Questions? : Call your midwife or lactation consultant.

 

THE ADVANTAGES OF BREASTFEEDING FOR MOTHER AND INFANT

  • Breastfeeding protects babies from disease: The frequency and severity of many childhood illnesses such as ear infections, colds, and even chronic conditions such as asthma are greatly reduced because of breastfeeding. They have a lower incidence of diarrhea, sepsis, gastroenteritis, and some forms of childhood cancer, among other illnesses.
  • Breastmilk increases IQ: Fatty acids and other nutrients found in breastmilk assist in the healthy development of the brain and lead to higher IQ levels that last into adulthood.
  • Exclusive Breastfeeding: The longer and more frequently a baby is breastfed only breastmilk the more the immune response increases. They are then protected from childhood leukemia and lymphoma, obesity, and respiratory infections and other illnesses even more.
  • Breastfeeding develops the immune system: Human milk contains immunoglobulins, leukocytes ,and anti-inflammatory factors that help a baby’s immune system to develop after birth.
  • Human milk contains properties that destroy the cells of many types of cancer, HIV, and chlamydia. Research on breastmilk has led scientists to make new developments in the search for the cure for these diseases.
  • Breastfeeding is affordable: It does not require expensive equipment or accessories.
  • Postpartum stress is reduced among mothers who breastfeed.
  • Breastfeeding reduces a woman’s risk of developing breast cancer.
  • Babies who receive human breastmilk have a reduced chance of developing type 2 diabetes and becoming obese.
  • Breastfeeding facilitates bonding between you and your baby. It is a special time of sensory input for the baby as she smells you, hears you, makes eye contact with you, and feels     the comfort of your body close by.

 

Tips for Successful Breastfeeding

Milk Intake Guide for the Newborn

Write a practice guideline that gives the expected breastmilk intake for the healthy newborn for each of the first five days, per feeding and per day, as well as the equation to determine adequate milk intake for the following ten weeks of the newborn, based on infant weight. Keep it in your postpartum records.

 

Day 1 – The newborn will get a few drops to 5 cc’s of colostrum per feeding.  For the entire day, the newborn will get a few drops to 1 oz of colostrum.

 

Day 2 – The newborn will get 5-15 cc’s, .5 oz or 1T of colostrum per feeding.  For the entire day, the newborn will get 1-3 oz or ¼ to ½ c per day.

 

Day 3 – The newborn will get 15-30 cc’s, .5-1.5 oz or 1-2 T per feeding.  For the entire day, the newborn will get 4-8 oz or ½ to 1 c per day.

 

Day 4 – The newborn will get 30-45 cc’s per feeding.  For the entire day, the newborn will get 8-12 oz or 1 ½ c per day.

 

Day 5 – The newborn will get 45-60 cc’s, 2 oz or 3-4 T per feeding.  For the entire day, the newborn will get 12- 18 oz or 1 ½ to 2 cups per day.

 

To figure out adequate milk intake for 5 days to 10 weeks: 2.5 X baby’s weight in lbs = ounces of milk needed.

 

Milk Intake Guide for the Newborn

Is My Baby Getting Enough Milk?

Is My Baby Getting Enough Milk?

  • Your new baby may have only one to two wet diapers during the first two days after the birth. At about the third or fourth day the baby should have at least six to eight wet cloth diapers or five to six wet disposable diapers.
  • In the first day or two after the baby has been born, the baby will pass meconium which is the greenish – black tarry stool. After the third day the baby should start having two to five bowel movements.
  • The baby can lose up to ten percent of her birth weight in the first three to four days after the birth. Once the milk has “come in” on day three to four, the baby should start gaining four to seven ounces per week or a pound a month.  This gain should be counted from the lowest weight (on day three or four) and not the birth weight.
  • The baby should nurse often, every one and a half to three hours averaging about eight to twelve times per day.
  • The baby should look healthy with good color and firm skin.
  • The baby will usually suck quickly to stimulate the milk let down. You should then hear the baby swallow after every one to two sucks.  If you can’t hear the baby swallow you can listen for a slight pause in the baby’s breath.
  • Your nipples should not be sore. If you have pain there may be a sucking problem.  Contact your doctor or midwife.

 

If the baby is not gaining weight or is loosing weight get help.  Keep in touch with the baby’s Doctor or Midwife.  There could be an underlying health problem.

Offer the breast for as long as the baby will nurse.  If the baby is sleepy, you may need to wake her up and encourage her to nurse.

Offer both breasts each time you nurse.  This way you can make sure that the baby can have all the milk available to her and well as stimulating the breasts to make more milk.

Make sure that the baby is latching on well.  Remember that the baby’s lips should be on the areola, and well behind the nipple.  Contact your Doctor or Midwife if you feel the baby is not latching on well.

Don’t start supplementing your baby with anything other than your breastmilk without talking to your Doctor or midwife first.

Make sure that you are well rested, eating nutritious food and drinking plenty of water.

Some things that can affect your milk production are: not breastfeeding early and frequently.  The milk or colostrum must be removed from the breast frequently to stimulate breast milk production.  Breast surgery, postpartum hemorrhage, thyroid disease, insufficient glandular tissue, prolonged sever engorgement and retained placenta.

 

Is my baby getting enough milk

Engorgement, Milk Stasis and Mastitis

Engorgement, Milk Stasis and Mastitis

 

Engorgement: It is normal for the mother’s breasts to get larger, heavier and tender when the mother’s milk “comes in”.  This is caused by extra blood and lymph fluids moving to the breasts to help get them ready to produce milk as well to the increasing volume of the milk itself.

The baby that is allowed to breastfeed whenever it wants in the early days after the birth may breastfeed for short periods of time, as often as a few minutes every hour, or for long stretches until the milk “comes in”.  If a mother’s baby breastfeeds often and well it has a less likely chance of experiencing painful engorgement.

If you experience engorgement and the baby is having a difficult time latching on you can:

  • Express milk by hand or with a pump until the breast is soft enough for the baby to latch on.
  • Use brief heat and massage right before breastfeeding which will relax and stimulate the milk flow.
  • Breastfeed frequently and have the baby finish the first breast before offering the other.
  • Fully drain the breast once or twice with an effective breast pump.
  • Use cold compresses between the feedings to reduce swelling and relieve pain.
  • Use cabbage leaves to sooth the pain of engorgement.

 

Milk Stasis: Milk stasis is when the milk is not removed from the breast quickly enough and it “backs up”.  It can be prevented by frequent nursing or pumping until the breast becomes soft enough to nurse on.  If not taken care of it can lead to a breast abscess which may require surgery.

 

Mastitis: Is a term used to describe any inflammation of the breast.

Symptoms of mastitis are:

  • It comes on suddenly.
  • The pain is localized.
  • The breast is red, hot, and swollen.
  • The mother has flu like symptoms.
  • The mother has a temperature of 101 degrees or higher.

What to do?

  • Apply wet or dry heat to the affected area and massage gently while it is still warm.
  • Continue to breastfeed the baby or hand express some of the milk right after treating the area with warmth and massage.
  • Breastfeed frequently on the affected side.
  • Wear loose clothing; take some time off from the bra.
  • Try different nursing positions.
  • Rest

If symptoms do not get better within 24 hours the mother will need to see her Dr. for possible antibiotic treatment.

 

Engorgement, Milk Stasis and Mastitis

Caring for the baby that refuses to latch on

Caring for the baby that refuses to latch on

 

Possible issues for a baby refusing the breast from the first nursing

  • Pain- A baby may be in pain due to a birth injury. If the pain is aggravated by being held, the baby may cry at the first attempt at nursing. Examples of birth injuries are: a broken clavicle, bruising, misaligned neck vertebrae, or a pinched nerve.
  • Breathing issues- A baby having trouble coordinating suck, swallow, and breathe reflexes may well have a problem with breastfeeding.
  • Oral aversion- Some babies resist having anything in their mouth, often due to a trauma such as being deeply suctioned.

 

There are some mechanical issues that can cause a baby to have an ineffective suck. These issues include:

  • Cleft palate- It is possible for a baby with a cleft lip to nurse effectively, with the mother using her finger to close off the cleft, but if she has a cleft palate, she will need extra help to keep breastfeeding.
  • Tongue tie- Tongue tie is when the frenulum beneath the tongue is too short or tight to allow for full range of tongue movement. If the baby doesn’t get full movement of her tongue, she may have a difficulty in getting the milk she needs. One sign of tongue tie is when the tongue does not extend over the gum line. If the baby can suck, this will cause sore nipples.
  • Clamp-down reflex- A baby with tongue tie may use the clamp-down technique, using his gums for the job of holding the breast that his tongue can’t do. Other babies with a range of issues also use this technique. Clamp-down reflex may be evident when it is very difficult to unlatch a baby from the breast. Mom may have a nipple that is misshapen and she may feel bruised.

 

What to do?

If the mother wants to breastfeed there are several different ways for her to provide her baby with breastmilk if the baby cannot latch on.  They are as follows:

  • Syringe Feeding – This device can be used directly at the breast or for finger feeding. Feeding the baby at the breasts should be the first choice. When a baby is not able to latch on in the early days, this can be a great way to supplement. When the baby gets fed from a syringe held at the breast, she can feel successful feeding at the breast while the underlying breastfeeding difficulties are identified.
  • Supplementation at the breast – Supplemental Nutrition System (SNS) and Lact-aid are commercially available feeding aids that bring milk to the breast by means of thin tubing.
  • Cup feeding – Cup feeding can work for getting food into a baby without introducing nipples. Breastmilk is put in a smooth rimmed, shallow cup. The cup is place at baby’s lips and baby can sip the milk. There are specially designed cups for cup feeding an infant.
  • Finger feeding – The finger feeding method involves a tube or syringe that delivers milk to the baby. It can be the tube of a supplemental feeding device or a special fingerfeeder. In the case of tube, a small flexible tube is connected to a container of milk.  It is taped to the caregiver’s finger and as the baby sucks on the finger she receives milk.
  • Haberman Feeder – If the baby is refusing to breastfeed and is having difficulties with other feeding methods a specialty feeding nipple such as the Haberman Feeder by Medela can help.  A Haberman Feeder is a specialized nipple designed for babies with facial or oral problems that interfere with their ability to breastfeed effectively.

 

Caring for the baby that refuses to latch on

 

Breast Changes to Expect During Pregnancy and Lactation

Breast Changes to Expect During Pregnancy and Lactation

 

  • You may feel burning or tingling and note enlargement as early as four weeks of pregnancy.
  • Enlargement happens from the outer border of the breast to the inner breast and continues throughout pregnancy. The growth is not always even.
  • The breasts may develop stretch marks, no matter what moisturizer you use, depending on your genetic disposition to them. New stretch marks look bluish, purple and older ones take on a silvery appearance.
  • Your nipples may darken and become very sensitive. Your partner may need to know this.
  • If you are nursing while pregnant your milk production may decrease due to the demands of pregnancy. To keep up, make sure you are getting an additional 500-600 calories per day of nutrient rich food, in addition to your pregnancy diet.
  • If one or both breasts develop an infection you could notice red streaking on the breast, a hot sensation, puss coming from the nipple, or severe engorgement. Keep breastfeeding and call your midwife.
  • If you develop a clogged milk duct a tender lump may appear on your breast, again, call your midwife.
  • Your baby may not be latching on correctly if you are developing cracked, bleeding, or raw nipples. Seek advice from the La Leche League or your midwife.
  • The size of your breasts has nothing to do with how much milk you can produce or how well you will breastfeed. Babies don’t care about size…why should you?

 

Care of the Breasts During Pregnancy and Lactation

 

  • Spend an equal amount of time with a bra on as without. Bras interfere with normal superior lymph gland drainage and encourage build-up of toxins in milk. Gently massage the breasts after removing your bra. Try bras that are not constricting of the rib cage and do not have an underwire. You may need to buy several different bras during pregnancy to accommodate your growth. Bras are important for support and comfort, so make sure you buy the best for you.
  • The best thing for sore nipples is correct positioning of the baby on the breast. In the mean time use only 100% lanolin as a soothing salve for irritated nipples.
  • Cold cabbage leaves or compresses help ease the heat and swelling of engorgement. So does feeding often.
  • Try warm compresses or showers before feeding to ease the intensity of engorgement.

 

Breast Changes to Expect During Pregnancy and Lactation

Assessing and Treating Nipple and Deep Breast Pain

Assessing and Treating Nipple and Deep Breast Pain

Are your nipples red and chapped?

This is a temporary condition and will improve.

 

Are your breasts sore when the baby latches on, but okay when the milk ejection reflex occurs?

Make sure the baby is latched on properly and that the natural skin oils are left on the skin.  Do not wash the breasts with soap or antiseptics.  Lanolin may be used to promote moist healing.

 

Is it incredibly painful when the baby draws the nipple into the mouth?

The mother can massage the breast to stimulate the milk ejection reflex and then put the baby onto the breast.

 

Do you have crescent-shaped abrasions either above or below your nipple?

The position of the baby when nursing may need to be changed.  Latch on should be explained again making sure that the baby is opening it’s mouth wide and that it is held high on the mothers chest, stomach to stomach.

 

Does the baby’s tongue retract behind the lower gum?

Have the mother draw the baby in close so that the breast is deep into the baby’s mouth then try to bring the baby’s tongue forward.  If the lip is drawn inward pull it back out.  Try different positions for nursing.

 

Is there pain throughout the feeding with bright pinkish redness extending beyond the nipple and areola?

Have the mother treat her nipples, the baby and the rest of the family for Candida.

 

Are their lesions on the breast?

Refer to Dr. for possible bacterial or herpes infection.

 

Does the deep breast pain come during feeding?

This could be due to forceful let down or mastitis.  Have the mother check for a hard sore area in her breast that hurts when pressed or if it radiates through the breast and is not located in one area.  If in one area treat the mother for mastitis.

 

Does the breast pain come between feedings or right after a feeding?

This can be caused by a sudden refilling of the milk ducts.

 

Did you have a rough labor in which you could have strained a muscle?

Support the baby’s weight with pillows and see if this can help.

 

Assessing and Treating Nipple and Deep Breast Pain