Breastfeeding

When and how long to feed

Newborn babies should be encouraged to go to the breast within half an hour of birth, usually while still in the delivery room. In the first few minutes after birth, if your newborn baby is placed in skin-to-skin contact on your chest, and his arms and legs are free to move, he will maneuver towards your nipple, just like all newborn mammals in their quest to survive. Your newborn baby may decide to suck right away or, more likely, he may be interested in gazing into your eyes first. Depending on the size of your breast or the length of your delivery, your newborn baby might need a bit of assistance to reach your nipple. After going through a few different stages of alertness ranging from quiet awake to alert to drowsy, your newborn baby may fall into a deep sleep. After a few hours, he will awaken for his next feeding.

Your newborn baby may feed frequently, every one-and-a-half to three hours for the first few days to stimulate your breasts to produce more milk volume. Whenever your baby shows signs of waking or hunger, like mouthing movements or placing his hands to his mouth, he should be put to the breast. This is called feeding on demand or feeding on cue. Try to put your baby to the breast before he starts to cry vigorously, because he will not be able to concentrate on breastfeeding while upset. Allow your baby to suck on your well-washed finger until he settles, then try to latch to the breast once again. Alternate which breast you start with at each feed, and allow your baby to nurse as long as he wants on the first breast, so he can receive more of the calorie-rich hind milk.

You can tell your newborn baby has finished the first breast when his suckling slows and your breast becomes soft. Although breastfed babies often don’t need to burp, give your baby a short break, then offer the second breast. Allowing your baby to suckle on both breasts at each feeding will help to establish your milk supply. Some mothers who need to return to work early will only feed their baby on one breast in the early weeks and pump the other breast to deep-freeze their breast milk, in order to provide a continual supply for bottle feeding by an alternate caregiver when they return to work. This makes your body think that you are feeding twins.

The ability to produce a good milk supply depends on a few factors, the most important being the frequent and routine removal of the milk from the breast. You may notice that your breasts tingle or leak milk when you think about your baby or hear him cry. This is called the letdown reflex. You can enhance your letdown reflex by getting adequate fluids and sleep, reducing your stress level and trying to maintain a relaxed environment until you and your baby have breastfeeding well established. In the first few weeks, while you develop a feeding relationship with your newborn baby, ask your partner and friends to help with other household duties like cooking, cleaning, laundry, and errands. If you experience difficulties, call your birth hospital for a recommendation of a lactation consultant or other breastfeeding specialist, a breastfeeding clinic, and/or a mothers’ support group.

It will take three to four weeks to become well established with feeding patterns and to feel that you have some sense of schedule with your baby. That schedule might be feeding every two to four hours; all babies are different. Within a single feeding, your baby might be very hungry and gulp milk steadily for 10 minutes to complete a feed. At other feedings, your baby might feel the need for a slower feeding with more cuddling and want to nurse for 30 to 40 minutes. It is this baby-driven control with breastfeeding that prevents the overfeeding observed with measured bottles of milk, which is a contributor to excessive weight gain.

It is generally accepted that a baby needs about eight feedings per day to gain weight properly. If feedings are delayed or the breast isn’t emptied at a regular feeding time, the breast will become full and uncomfortable. This pressure in the breast will send a message that you don’t want this milk and will reduce the milk production hormones, therefore decreasing milk production.

Latching on

A comfortable latch for both mother and baby is very important for successful breastfeeding, and ensures that your baby gets as much milk as possible and that your nipples don’t get sore.

Hold your baby in a comfortable position across your chest, or upright sitting on your hip, so that his face is directed toward your breast. Support your breast with your free hand when getting him to latch on. Bring your baby close to your breast and touch his cheek, the corner of his mouth, or his lips with your breast or nipple. Your baby will turn his head and open his mouth. This is called the rooting reflex. It may be helpful to express or massage some breast milk down to the nipple for your baby to taste or lick before you get a wide open mouth to latch.

When your baby’s mouth opens wide, move quickly to bring his mouth over the brown area of the breast, called the areola, to get as much breast tissue into his mouth as possible. Your baby should not just suckle on the nipple alone because this will cause discomfort and poor milk transfer.

Once your baby begins to nurse, you can feel your breast moving in and out. Your baby will relax his head back so that his nose is just touching your breast; with his lips turned outwards, he will breathe easily.

If your baby has not latched on properly and is causing discomfort, insert your finger into the corner of his mouth to break the suction and remove him from your breast. Reposition and re-latch until you feel comfortable. It may take a few moments of initial rapid suckling until you hear your baby start to swallow your milk and then the sucking slows down as he continues to drink your milk.

Nursing twins

The easiest way to nurse twins at the same time is to use the football hold for both babies. Prop some pillows to support each baby, which will give you a free hand to latch one at a time. Alternate breasts to maintain a good milk supply in both breasts if one baby tends to suck more vigorously than the other until the babies decide which breast they prefer.

Knowing when your baby is getting enough milk

Many breastfeeding mothers wonder if their baby is getting enough milk, especially in the first week or so, when their newborn baby is expected to lose some of his birth weight. Babies may feed more at some feeds than others. You will know that your baby is getting enough milk in the first two weeks if he passes three to four substantial, yellowish bowel movements and soaks six or more diapers per day after your milk has come in.

He will also seem satisfied after each feeding if allowed the opportunity to burp and to return to the breast for ”dessert” after a brief nap. Many babies wake up 15 to 30 minutes after they have been put down because they fell asleep at the breast. Just like adults, once they have a few minutes to let dinner settle, they often want to finish their feeding with a little dessert before really settling in for a good sleep. This is often the time when well-meaning friends and relatives suggest a soother or that mother doesn’t have enough milk. Just offer the breast again!

By the end of the first two weeks, your newborn baby should be back to his birth weight and his bowel movements may become less frequent. If your baby is gaining weight and content, you are on your way to an established breastfeeding relationship.

Taking medications while breastfeeding

Most drugs can be transferred to a baby through breast milk. However, many medications that reach the breast milk do so in very small quantities. This means that a baby will receive only tiny amounts of the drug. If you need to take a medication while breastfeeding, check with your doctor to make sure that the medication is compatible with breastfeeding.

Breast pumping

You may need to express your breast milk for many reasons: to make latching easier by softening the breast, to relieve breast engorgement, to stimulate more milk production, to freeze extra milk for returning to work or a night out, or to feed a premature or sick baby. Milk can be expressed by hand by gently and rhythmically squeezing the milk out of the breast, but most mothers prefer to use a manual or electric breast pump. For occasional use or if not near electricity, a manual pump is usually sufficient but must be practiced a few times to be used effectively.

If you have a premature or sick baby who needs to spend an extended amount of time in hospital, or if you are planning to pump a lot of extra milk to return to work, you will need a hospital-recommended double electric breast pump. These pumps are very effective in establishing and maintaining a good milk supply for several months. The cost of a good breast pump to supply the best nutrition for your baby is a small portion of what it would cost to bottle feed him formula during the first year of life.

Milk can be stored for up to 48 hours in the refrigerator, up to three months in a freezer that has a separate door from the refrigerator, and for six months or longer in a deep freezer. Frozen milk can be thawed in the refrigerator or under warm running water. Thawed milk should not be refrozen. Never thaw or warm breast milk in a microwave as this will destroy some of the special protective ingredients.

Who should not breastfeed?

Women who are HIV-positive or have AIDS in developed countries risk transmitting the virus to their baby through direct breastfeeding. If the expressed breast milk is pasteurized, it can be fed to babies to protect them from infections but eliminate the possibility of disease transmission.

Women with active, untreated tuberculosis must be separated from their baby for the first two weeks of treatment, during which time they may express their breast milk for their baby.

Women who develop chickenpox shortly before or after childbirth should be separated from their baby until the baby has been immunized, but expressed breast milk can be given to the baby.

Women with active herpes lesions on their breasts may transmit the herpes virus to their baby.

Women undergoing cancer treatment should not breastfeed. Drugs that fight cancer are harmful to babies. If a mother is being given cancer drugs, her baby should not receive breast milk.

Women who need to take certain other drugs such as amiodarone, chloramphenicol, lithium, radioactive agents, or tetracycline should not breastfeed.

Babies with galactosemia need to be on a lactose-free diet, and therefore, cannot receive breast milk.

For further information about medications in breastfeeding, ask your breastfeeding specialist or doctor.

A few words for fathers

Breastfeeding is nature’s way to provide the best possible start for your baby. Breastfeeding also provides protection for your partner’s long-term health as well. Breastfeeding is not always easy without support and understanding as this is a learning experience between a mother and her newborn baby. For the first few weeks of your baby’s life, the best help you can provide is to nourish and care for your partner while she nourishes your baby. Fathers can change diapers, bathe their baby, and cuddle and rock their baby while mother has a nap or takes a shower. Please don’t forget those other household jobs like laundry, cleaning, and the grocery shopping. The more time your partner has to spend with your newborn baby, the easier her transition into motherhood will be; breastfeeding will be established faster and her confidence to care for your baby will increase.

Printed with permission from www.aboutkidshealth.ca. Please visit AboutKidsHealth for more great articles relating to child health and family quality of life.