Breastfeeding – what to expect?

Breastfeeding should be a pleasant and rewarding experience for all mothers and babies. To this end we have tried to include the most important factors about breastfeeding on the Milk Matters website to help you and your baby.

When left together skin to skin for a few hours after birth, most mothers and babies manage to breastfeed quite happily, without much assistance. However breastfeeding is not something that you have to do on your own. Most mothers appreciate some guidance and reassurance.

Breastfeeding is a new skill for you and your baby and both of you will find it easier with practice. As with any other new skill, getting advice and assistance from an expert in the field can be hugely beneficial and the best thing you can do for yourself and your baby is to seek help sooner rather than later.

Learning how to position and latch your baby, as well as about your baby’s feeding cues, will go a long way to helping breastfeeding to be an enjoyable experience for you and your baby.

Latching & Positioning

A good latch and position will ensure that:

• your nipples do not become sore or cracked
• your baby gets is as much breastmilk as he wants at each feed
• your breastmilk supply builds up and is maintained

Do not be concerned if you find latching and positioning difficult to master initially. Both you and your baby are learning a new skill.

You need to seek expert help (e.g. from a lactation consultant) without delay if:

• it is painful to breastfeed
• you  have sore or cracked nipples
• your baby is not gaining weight well
• your baby is not thriving
• breastfeeding is still not going well after your have tried the tips below about positioning and latching
• your experience is making you consider supplementing breastfeeding or giving up breastfeeding

The sooner you seek help, the better for you, for your baby and for breastfeeding.

Positioning:

The best position for breastfeeding depends on the individual mother and baby and their particular circumstances.

Whether lying down or sitting, get comfortable with your back well supported.

Comfortable positioning is important for both mother and baby.
Pillows are useful to help support mom’s lower back and arms.

• All positions require you to support your baby’s neck and shoulders, rather than his head.
• Keep his body close to yours
• Keep his knees, hips, tummy and nose facing you.
• Position him so that his upper lip or nose is in line with your nipple.
• You baby’s chin rather than his nose should be tucked into the breast.
• Most, if not all, of the areola should be in his mouth.
• B. The baby goes to the breast not the breast to the baby
• It is far easier to achieve when your baby is not wrapped in a blanket or even better, is held skin to skin.

The position a mother uses in the first few days may also differ from the position she uses in the longer term.

When in a sitting position:

• Have your back well supported and your knees slightly higher than your hips.
• Before putting the baby to the breast, ensure that his mouth is level with your nipple without having to lean forward or lift your breast. A cushion or two may help to position him in this way.

Good breastfeeding positions are:

• Underarm or rugby-ball position
  • To feed on the right breast, mom holds her baby under her right arm supporting her baby’s body, shoulders  and neck with her right arm and hand, baby’s feet are towards mom’s back.
  • Useful after caesarean birth, for little babies, twins and larger breasts.
• Crossover position
  • To feed on the left breast mom could simply bring baby across to the front of her body, in other words, from her right towards her left breast, still holding her baby in her right arm and hugging him towards her body.
  • An excellent position for the first few days or weeks.
• Side lying
  • Mom lies on her side and her baby alongside on the bed facing her, tucked close to her body and supported by her upper arm.
  • This position is also useful after caesarean birth or when mom would like to nap while breastfeeding.
• Madonna position
  • When using a Madonna alternative position, support your baby’s head by holding or rather supporting her neck and shoulders with your thumb and forefinger stretched out towards her ears.
  • Once breastfeeding comfortably most moms revert to the well-known Madonna position where baby lies in the crook of mom’s arm or preferably mom’s forearm but still tucked in close to her body.

Below, the correct and incorrect way to position your baby.

Here are some breastfeeding positions that may assist you.

A Good Latch

Mature healthy babies know instinctively how to find the breast and to breastfeed when left skin to skin with their mothers after birth. Too often we tend to hurry the process along.

• You and your baby need to be warm and comfortable.
• Some babies may need a little coaxing; Hold your baby on his side facing your breast while you support his neck and shoulders.
• Remember to relax, especially your neck and shoulders, while feeding and have a drink available.

To achieve a good latch, it is imperative that your baby is well positioned as described below:

• Support your breast with your free hand with the so-called c-hold or ballerina hold. Double check that the supporting fingers, below the breast, are not too close to the areola (brown area).
• There must be plenty of exposed areola (dark area around the nipple) for your baby to latch onto.
• Once positioned, if necessary, stroke your baby’s cheek to encourage her to turn her head towards your breast.
• To encourage her to open her mouth, stroke her upper lip against the nipple.
• Many babies will automatically “root”, open their mouths, once positioned.
• When she opens her mouth wide brings her towards the nipple and breast. N.B. Baby to the breast, not breast to baby.
• For correct latching, the nipple, together with a good part of the areola, should be drawn into your baby’s mouth.
• After the initial chewing movements, your baby should be suckling and swallowing with a rhythmic, slow deep motion.
• NB the suckling should not cause nipple pain. Pain is an indication of an incorrect latch.

Check the latch:

• There should be no pain.
• Your baby’s cheeks should not show any dimpling.
• No sucking or clicking noises should be audible.
• Your baby’s mouth is wide open.
• Your baby’s chin is tucked into the breast.
• Your baby’s lips are curled outwards.
• Less, if any, areola is showing below your baby’s mouth than above.
• a strong jaw action and movement of the muscles above your baby’s ear would indicate that your baby is latched and suckling well.

Ending the feed:

• When baby has had enough, he will fall asleep or release the nipple.
• However, if you need to stop the feed sooner it is very important that the suction should be broken first. Insert a clean finger into the corner of his mouth between the gums and hold it there while releasing the nipple.

Videos

Excellent videos about latching and positioning can be found on the International Breastfeeding Centre’s website.

Your Newborn Baby’s Feeding Cues

Learning to understand your newborn baby’s cues allows you to respond to her needs, to feed her at an optimal time and not wait until she is crying before feeding her. A baby will show long before she starts crying that she is ready to feed, giving you the opportunity to feed your baby while she is calm. Missing the cues and waiting until the baby is crying heartily may mean your baby your baby is not able to latch and feed successfully despite being hungry.

An example of how a newborn baby may behave on wakening:

• She tends to stretch then wriggle and squirm.
• If left alone she will become more restless then turn her head from side to side and put her fingers or fists into her mouth.
• If left alone for longer she begins to make little noises
• if ignored, the noises become louder and louder and eventually develop into a full bellowed cry.

The best time to feed your baby:

• Is when she indicates to you that she is hungry by turning her head from side to side and putting her fingers or fists into her mouth.
• Leaving her to cry loudly may be too late, as she would need to be settled before you could feed her.

The quiet alert time:

• The so called quiet alert time, when your baby has just woken or, after her feed when she is still awake but very calm, is a good time to massage, bath or just enjoy spending time communicating with your baby.

Colostrum

Colostrum,  produced in the first few days after birth, is the perfect food for any newborn baby, premature or full term.

Even when moms are not planning on breastfeeding, it is highly recommended that they offer their babies colostrum in the first few days.

Colostrum contains:

• all the nutrients in perfect proportions for your baby
• many protective immune factors otherwise lacking in newborn babies
• such concentrated nutrients that your baby only needs around 5ml every 2 hours in the first 24 hours.

Frequent Feeding, Demand Feeding or Baby Led Feeding

What is Frequent, Demand or Baby-Led Feeding?

This means you follow your baby’s cues and feed your baby as often and for as long as your baby wants to feed, rather than according to a schedule.

Frequent, Demand or Baby Led Feeding will ensure:

• A good milk supply that satisfies your baby’s needs
• A more contented baby
• Less stress for you and the family as your baby will cry less
• That your baby gains weight well

How often is frequent?

1. Your baby’s breastfeeding pattern or lack thereof, in the first few days, is noindication of his long term pattern or lack thereof.
2. It is normal for babies to feed around 10 to 12 times, in 24 hours during the first few days.
3. After the first few days, should you baby still be feeding often and not settling between feeds have a lactation consultant or breastfeeding expert check your baby’s latch.
4. Should your baby be feeding more often during the night than during the day, you could wake him up for an extra 1 or 2 feeds during the day time, to encourage longer stretches at night.

How long is long enough?

1. As a rough guideline, if your baby initially breastfeeds for less than 5 min or for longer than an hour, the latch needs to be checked.
2. In general the length of feeds may vary from feed to feed; allow your baby to drink for as long as he wants to at one breast before offering the other.
3. Should your baby’s feeds consistently last for an extended time and he not settle well afterwards, have a lactation consultant or breastfeeding expert check your baby’s latch.

N.B. It is not possible for your milk to be too thin or too weak. Even woman who are undernourished produce nutritious milk for their babies. 

Good reasons for Frequent, Demand Feeding or Baby Led Feeding:

Note: A good latch with the nipple and areola in your baby’s mouth is always important.

• Frequent feeding encourages a better milk production and ensures a more contented baby.
• The subsequent stimulation of the breast results in the release of hormones into the blood stream.  One of the hormones, oxytocin, causes the muscle cells around the milk producing glands to contract, squeezing milk into the milk ducts.  It may be felt as a tingling sensation and is known as the let-down reflex.
• Breastmilk is easily digested and moves rapidly from the stomach into the intestinal tract, necessitating frequent feeds.
• Initially your baby’s stomach capacity is small – 5 to 10 ml, gradually increasing to 20 ml by the third day.
• Frequent feeding will also prevent your breasts becoming engorged or hard and uncomfortable.
• Allow your baby to finish feeding at the first breast before offering the second side.  At times he may not want more from the second breast; offer that side first at the next feed.
• PROVIDED YOUR BABY IS POSITIONED AND SUCKLING WELL, he may feed for as long and as often as he needs.  During the first few days babies may need around 10 or more feeds in 24 hours.
• To encourage your baby to sleep for longer stretches at night feed him more frequently during the day.
• Given time, you and your baby will adjust to your own pattern. Most babies will demand less frequent feeds as the weeks go by.

Establishing a good Milk Supply

• A good latch is always vitally important.
• It is perfectly normal to have a only little milk or colostrum, as it is called, in the first few days.
• Your baby’s tummy is only as big as a marble – it can only hold 5 to 10 ml. For this reason your baby needs frequent feeds, around 10 or more, in the first day or two.
• This frequent stimulation results in an increased milk supply.
• By day 3 or 4 your breasts are likely to feel full and heavy.
• This settles down within a day or two and by 6 weeks the breasts feel quite soft again – this is no reflection of how much milk you can produce.
• You will always have enough breastmilk if you allow your baby to feed as often as he wants and for as long as he wants and his latch is good.
• After the first few days, should you baby still be feeding often and not settling between feeds have a lactation consultant or breastfeeding expert check your baby’s latch.
• Breastfeeding should not be painful! Cracked or sore nipples are caused by a poor latch, which a lactation consultant can help you to correct. Do not wait – get help to lessen your pain and to ensure your baby gets sufficient milk.

Winding or Burping your Baby

Burping or the lack thereof is of great concern to parents.

The truth is that not all babies need to burp all the time and wind does not always cause them discomfort.

Usually it is not necessary to spend any more than 5 minutes burping your baby. If nothing happens, continue the feed or continue as though he has burped. Your baby will pass the wind – either up or down – some other time.

Persistent attempts to make your baby burp can disturb the baby more than the wind itself!

Including Dads

• Dads are not be able to breastfeed but they can play an enormous role in supporting breastfeeding moms.
• Besides Kangarooing (skin to skin care), dads are particularly good at winding/burping babies, getting them to sleep and playing – Dads are fun!
• A dad often does things differently to the mom – this does not make it wrong, just different! Respect this difference and let your baby enjoy both “Mom’s Way” and “Dad’s Way”.
• When your baby is around 6 weeks or more Dad could offer him a feed of expressed breastmilk once in a while so that you can get some extra sleep or have a little time to yourself. Not too often or it can affect your milk supply.
• Mothers are able to form close bonds with their babies and fathers often feel left out. Work hard at including him when it comes to caring for your baby -it is his baby too remember.
• Criticism and corrections are discouraging and hurtful for anyone, including new dads (and moms for that matter). We are all much more willing to help the next time if our efforts are encouraged, supported and appreciated.