Breastfeeding

Breastfeeding: back to basics
by Debbi Donovan, IBCLC

The single most important thing that you can do to assure your success in breastfeeding is to begin preparing during your pregnancy. Though breastfeeding is natural, it is not instinctive. By attending breastfeeding classes you can begin to learn more about the loving act of feeding your baby at your breast. Mother-to-mother support, as provided by La Leche League can also prove to be invaluable. At these meetings you will share experiences with other nursing mothers and can begin to learn more about the art of breastfeeding.

Early Initiation

Breastfeeding should be initiated as soon as possible following your baby's birth. Research has shown that in the two hours following the birth, infants are in a state of alertness, which is accompanied by a strong sucking reflex. It is at this time that your baby, eager for the comfort of your arms, will lick or nuzzle your nipple and may even decide to latch on and take her first taste of your milk (colostrum). These early feeds have an imprinting effect and help to get breastfeeding off to a good start. Although breastfeeding without delay is optimal, if circumstances don't allow it, or if you can't persuade your baby to take your breast, don't become discouraged. Many moms whose babies have gotten a delayed start at nursing have gone on to establish a wonderful nursing relationship. Continue to give your baby many opportunities to learn this new skill.

With abbreviated hospital stays being the norm these days, keeping your baby in your room allows you to squeeze in a lot of practice breastfeeding in a short amount of time. Rooming-in has been shown to contribute to breastfeeding success. If you are having difficulties, ask to see the hospital's Lactation Consultant (LC) or ask your OB or Pediatrician to recommend an LC in private practice. While in the hospital, remind the nursing staff that you want your baby to be given no supplementary feeds (formula or water) and no pacifiers. Water and formula are unnecessary and may confuse your baby as she is learning to breastfeed.

Nurse Baby Early and Often

Your baby should be fed on cue at least every two to three hours. Nursing your baby early and often helps to keep your breasts soft and graspable, and helps to lessen or even prevent engorgement. Watch your little one for signs of hunger, such as sucking sounds and/or lip movements, rapid eye movement during the light sleep cycle and changes in facial expression. Try to anticipate your baby's hunger by watching for these signs. A hungry baby may be difficult to help settle in at the breast. Nursing on cue stimulates your breasts to produce plenty of milk. The more your baby nurses, the more milk you will make.

Nursing Positions

Once you are home and beginning to settle in, find a comfortable spot to feed your baby. It is difficult for some moms to get comfortable nursing their newborn in bed. If this is the case, find a comfortable chair to sit in. Have lots of pillows handy. Support your arm and back with pillows. Lean back slightly and have feet resting on a low footstool (a thick phone book will work too), knees slightly raised. Your baby should be level with your breast. (Again, pillows help to raise your baby without putting excess strain on your arms and back.) Nursing should be comfortable for you and your baby. Unwrap her and place her against your bare skin. If it is chilly in the room, cover yourselves with a light blanket. Skin to skin contact stimulates your baby, helping her to remain alert during these early feeds.

Although the clutch ( football) hold often works best with a newborn, use the position which is most comfortable for you. Babies nurse best when they feel secure and well supported.

	In the clutch hold, have your baby lying alongside you at breast level and use your hand to support your baby at her shoulders, rather than her head. Check to see that her body is in proper alignment.
	For the cradle hold, your baby should be on her side, body in a straight line from ear to hip. You should both be tummy to tummy. Again, have your baby at breast level, supported by pillows if necessary. Using the C-hold with thumb above breast and rest of hand cupped below, tickle your baby's lips with your nipple and allow her to open her mouth widely, as in a yawn. Bring her quickly to your breast. If she isn't able to get a good mouthful of breast, with close to one inch of the areola, or if you are uncomfortable, gently break the suction by inserting your finger into her mouth. If necessary, calm your baby, and try again.
	When properly positioned her nose should be resting against your breast. You do not need to press your finger down on your breast to create an airway. If you tuck your baby's body in more closely to yours, it will widen the gap a little between your breast and her nose. When positioning is correct, your nipple will be guarded from trauma and your baby will be able to best access your milk.
	Sometimes "right" and "wrong" positioning does not look dramatically different, but it does feel different. Remember, breastfeeding should be comfortable, even during these early weeks. Pain is an indication that something is wrong.

Timing

Allow your baby to finish one breast first, untimed, before offering the other breast. This will allow her to access your rich hindmilk that is so important for growth. Allow the feeding to end when she comes off your breast relaxed and satisfied. Be sure to feed your baby at least eight to twelve times in 24 hours. Breastmilk is easily digested and it is not unusual for your new baby to be hungry again an hour and a half following the last feed.

How Much is Enough?

Many moms worry whether or not their baby is getting enough milk. In the early weeks, as breastfeeding is getting established, it's a good idea to monitor your baby's output. Your baby should be having at least six to eight wet cloth diapers (five to six disposables) and two bowel movements a day, beginning around day three -- about the time your milk supply increases. This should continue until your baby is about six-weeks-old, when her wetting and stooling pattern may begin to change. Your baby should have regained her birth weight by the second or third week of life. Average weight gain during the first six months is four to eight ounces per week.

The Nursing Relationship and Postpartum Adjustments

The early postpartum period is a time of great change. It may take several weeks until you feel comfortable taking care of your baby and nursing her. Keeping outside activities to a minimum during this time will help you to settle in and allow you to get the rest you need during this challenging time. You and your baby will be on your way to establishing a satisfying nursing relationship. With good preparation, information and support, most breastfeeding families navigate the postpartum period with few difficulties. If you are nursing and are experiencing difficulties, contact a Board Certified Lactation Consultant or La Leche League leader for further help.

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