Getting started breastfeeding

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Mothers have been nursing their babies since time began.  It should come naturally, right?  But that’s not always the case.  Why not?  Taking a look back in time, we’ll see that the difference is in our experience.  We need only go back a few generations, or indeed look to some more traditional cultures of today, to see that when a girl grows up watching her mothers, aunts, sisters and neighbors nursing, when those same women surround her after she gives birth, she has the experience and support necessary to have a successful breastfeeding experience.

Fortunately, even in the absence of this communal support, it is possible for women today to nurse their babies successfully.  The increased knowledge and support of doctors, combined with readily available lactation consultants, breastfeeding support groups, midwives and postpartum doulas, makes a tremendous difference for the modern nursing mom.

Benefits of Breastfeeding
There are many benefits to breastfeeding for both baby and mom. 
•          Breast milk is the perfect food for a baby.  It contains the nutrients, fats, sugars, proteins and calories that a baby needs, and it changes to meet the needs of the baby as she grows. 
•          Breast milk provides antibodies that help keep a baby healthy and protect her from illnesses.
•          Breast milk is easier to digest.
•          Breastfed babies tend to be leaner and less susceptible to obesity and related illnesses, later in life.
•          Nursing ensures that a new mom is doing what she needs to do (i.e. sit and relax) in order to recover from childbirth.  Think of it as nature’s “time out” for new moms.
•          Nursing helps a woman’s uterus shrink back to its pre-pregnancy size, and may lessen post-partum bleeding.
•          Making milk expends calories.  As a result, nursing helps burn more calories, and may help a new mom lose her baby weight faster.
•          Exclusive breastfeeding may delay the return of a new mom’s menstrual cycle, although it should not be relied on as a method of birth control.
•          Breastfeeding can lower a woman’s risk for breast and ovarian cancer.
•          Breast milk is less expensive than formula.
•          Breast milk is always ready; there are no bottles to prepare, and no need to keep a hungry baby waiting.
•          Breastfeeding can foster bonding between a mother and her newborn.

Getting Started
In reality, all a woman needs to breastfeed is her breast and her child.  However, there are many items that may help a new mom during this process.  My recommendation is that you don’t spend a ton of money on items you may not need.  If you decide that a certain item would be helpful, you can always purchase it at a later time.

Recommended items to have on hand:
•          Nursing pads – there are many varieties of nursing pads out there to choose from.
o          Simple disposable pads are the least expensive.*
o          Some disposable nursing pads are contoured and/or have adhesive backs to keep them from slipping.
o          Washable cotton and wool nursing pads are reusable.
•          Pure lanolin, such as Lansinoh® is wonderful for healing sore and cracked nipples – a little goes a long way.*
•          Cloth diapers or burp cloths have many uses, particularly when it comes to feeding and burping.
•          1 or 2 nursing bras are all you should buy at the very beginning.  Wait until nursing has been established and you know what size you’ll need, before buying more.  A sleep bra can be helpful, particularly when your milk is first coming in.  You’ll need someplace to tuck those nursing pads!  Some women prefer wearing regular bras that can be pulled up or down for nursing.
•          Find the name and phone number of at least one lactation consultant whom you can call if you need assistance.

*note: many hospitals will have these available – don’t be afraid to ask!

Items you may want to consider at some point include:
•          Breast pump.
•          A nursing pillow or Boppy® can be helpful for positioning baby comfortably while nursing.
•          An angled nursing stool can also help with positioning, particularly if you’re sitting in a rocking chair or glider.
•          Nursing tops can be useful for nursing in public.  Some women find layering works just as well for them.  Button down shirts are also useful – unbutton from the bottom rather than the top, for discreet nursing!

Other things to note:
•          A support person, whether a partner, parent, friend, or postpartum doula can be a tremendous help.
•          Always have a bottle of water on hand to ensure you’re getting proper hydration.


Positioning

For sitting positions, begin by using pillows or rolled blankets to make sure that your arms are well supported.  You do not want them to tire, while baby is nursing. 

Cradle hold
This is perhaps the most common nursing position. 

•          Lay baby across your lap, facing you, so that you are tummy to tummy.  Baby’s face should be level with your breast.  You may need to use a pillow or nursing pillow to support her.  Lay her head in the crook of your elbow, with your arm behind her, supporting her body.  Her body should be in a straight line, from head to foot.  Tuck her lower arm around your waist, to keep it out of the way.

Football hold
This position is good for small babies.  It can also be helpful if you’re having a difficult time getting your baby to latch on properly, since it provides a clear view of both breast and baby’s face.  This position is good for women with large breasts or flat nipples.  Women who have had a c-section may find this position more comfortable, since the baby is not lying across the lap.
•          Lie baby next to you, on her back, facing your breast, with her body tucked under your arm, and her feet behind you.  Use pillows to bring her up to level of your breast.  Cradle her head in your hand, using your upper arm to tuck her body close to you.

Cross-cradle hold
This position is very similar to the cradle hold, but it allows mom more control over positioning.  It is a good position to try if you’re having a difficult time latching properly, or if you’re nursing a small baby. 
•          As with the cradle hold, baby should be laying across your lap, facing your breast. 
•          Use the arm opposite the breast baby is nursing from to cradle baby against your body.  Her head should be cradled in your hand. 
•          Use the hand holding baby’s head to guide her into position, while holding your breast with your other hand.

Lying down
This position is wonderful for middle-of-the-night feedings, as well as for recuperating moms.  I nursed my son in the delivery room, using this position.
•          Lying on one side, make sure that your body is propped and well supported with pillows. 
•          Baby should be facing you, so that you are tummy to tummy.  Her face should be lined up with your lower breast.  You may want to place a pillow or rolled blanket behind her, to keep her from rolling.  You can also put your lower arm behind her, to keep her in place, but you may find your arm tiring or falling asleep after a while.
•          Use your upper hand to hold your breast, if necessary. 
•          To switch sides, you may either cradle baby against your body while rolling over (with baby on top during the roll) or simply lean forward further, so that she can nurse from the upper breast. 

Latching
It is essential that you have a good latch each time baby nurses.  This will prevent most soreness, and make for a more successful nursing relationship.

In my opinion, one of the most important elements to beginning a successful nursing relationship is timing.  It is much easier to latch a baby who is not hysterical.  When your baby begins to make fussy sounds, turns her head, or tries to stuff her fist into her mouth, offer the breast as soon as possible.  Granted, it is not always possible to get both mom and baby ready to go before the crying begins, but the more often you’re able to do this, the less frustrated you will both be.  Keep in mind that this is the very first skill you are teaching your baby.  She will learn it more easily when she’s not upset.  In the first few weeks, when a new mom’s job is to recuperate and nurture her baby, rely as much as possible on the help you’re offered.  This will allow you to focus on your baby, as soon as she needs you.  After a few months she’ll be a pro, and if you need to keep her waiting a few minutes to finish a load of laundry, she’ll know just what to do when the breast is offered.  In these first weeks, while she’s learning, you both deserve a relaxed and nurturing experience.

•          Hold the breast, using a C-position.  Four fingers should be together on one side of the breast, with the thumb opposite.  Make sure you’re holding the breast back behind the areola.
•          Tickle baby’s cheek to get her to turn towards the nipple.  You can also express a tiny drop of milk to tempt her.  Rub this on her lips.
•          Wait for a wide open mouth.  Do not attempt to latch on when baby’s mouth is only slightly open.
•          When baby’s mouth is open wide, pull her towards the breast, so that the nipple and a good part of the areola are in her mouth, and the nipple is pointing slightly towards the roof of her mouth.
•          If baby does not have the full nipple and a good portion of the areola in her mouth, latch her off and try again.
•          To latch off, stick your pinkie into the corner of her mouth, to break the suction.  Then pull her away from the breast.
•          If the latch is good, you should only see a small portion of the areola.  This will depend on how large your areola is. 
•          If the latch is good, baby’s lips will be flared, like a fish’s lips.  If baby’s lip is not flared, use a finger to gently pull it out.



Discomfort
If the latch is good, you may feel some discomfort due to the fact that your nipples are not yet used to the vigorous nursing of a baby’s mouth.  You should not, however, be in immense pain.  The vast majority of pain from nursing is due to a poor latch.  The best solution is to latch off and try again.

If you feel burning or itching pain during or after nursing, check baby’s mouth for a white substance that looks somewhat like curdled milk.  This could be thrush, and should be treated by your doctor.

Burping
Burping is the act of expelling air bubbles from the digestive tract.  In babies, these air bubbles can lead to discomfort and spitting up.  As adults, we do this spontaneously as needed.  Newborns often need some help to expel this air from their tummies.

Your baby may or may not need to burp while feeding.  Breastfed babies tend to take in less air while eating than their bottle-fed counterparts.  It may take some trial and error on your part, to determine whether your baby needs to burp, and what position works best for her.

Many women find burping their babies before switching to the other breast works well for more than one reason.  Expelling any trapped air will make baby more comfortable, and also make room for more milk.  In addition, because many newborns will doze while nursing, the act of repositioning and burping your baby may wake her up so that she will continue to eat.

There are several burping positions, all of which place some pressure on baby’s belly, while allowing you to assist her in expelling air bubbles.  Don’t forget to protect the area with a burp cloth, since many babies will burp up a small amount of liquid.
•          Place baby against your shoulder, with her abdomen pressed against your chest.  My babies always enjoyed this position. 
•          Sit baby up in your lap, leaning forward slightly, with your arm or hand pressed against her abdomen.  Don’t forget to support her head, as well.
•          Lie baby face down on your lap. 

Once baby is in position, pat or gently rub her back.  If baby does not burp after several minutes, she probably does not need to.


Problems

Poor latch
The main reason women experience discomfort during breastfeeding is poor latch.  It is essential to have a good latch every time.  This will prevent discomfort and damage to your nipples.  It can be very tempting to settle for an “ok” latch, especially if baby is hungry and you are frustrated.  But if you can teach baby how to latch properly from the very beginning, it will lead to a much more pleasant, satisfying, and successful breastfeeding experience.

If your baby’s latch is poor, use the method described above to unlatch her from the breast.  You can try repositioning to see whether baby is better able to latch from a different position.

Sometimes babies will benefit from sucking on a clean adult pinky.  If baby is fussing and cannot latch on properly, try this trick: present a clean pinky with a trimmed nail, nail side down against baby’s tongue.  This may not only soothe baby, but the shape and size of the pinky may help her to better latch on the next time the breast is presented.
Pain
There are many different causes of breast pain.  The key to solving the problem is recognizing the cause.

•          Poor latch – nipple pain and tenderness, as well as soreness and cracked nipples, can be the result of a poor latch.  As mentioned above, the best solution for this is to make sure you have a good latch each time.
•          Thrush – thrush is a fungal infection, and needs to be treated by a doctor.  If your baby seems to have white in her mouth that looks like curdled milk but does not wipe off, this is thrush.  Your doctor may treat this with medication, or may suggest an herbal remedy.  It’s essential to treat both mother and child, so the infection can clear up.
•          Plugged milk duct – a small area of tenderness accompanied by a lump may be a plugged milk duct.  Continue to breastfeed, allowing baby to empty the breast as completely as possible, to try and unclog the duct.  Massage of the area can help, as can warm compresses or warm shower.  Plugged milk ducts can lead to mastitis.
•          Mastitis – mastitis is a breast infection, and also needs to be treated by a doctor.  Symptoms of mastitis include tenderness, soreness of the breast, a hard red lump, fever, and/or flu-like symptoms.  It is important that you continue to breastfeed while undergoing treatment for mastitis, since milk ducts that are not emptied are often associated with the development of mastitis.  As with plugged ducts, warm compresses and showers can help ease the symptoms, but medical treatment is essential.
•          Cracked nipples – nipple cracking is most often caused by poor latch.  You can and should continue to nurse if your nipples are cracked.  Air drying your nipples after nursing can be helpful.  Also, you can use a small amount of Lansinoh® ointment on each nipple after nursing.  Lansinoh® is safe for baby, and does not need to be wiped off before nursing.  Be sure to change your nursing pads frequently, as the dampness can further irritate cracked nipples.

Sleepy baby
The old adage “never wake a sleeping baby” doesn’t always follow when you’re trying to make sure your newborn is getting enough to eat.  While many babies will be very vocal in their need for sustenance RIGHT NOW, some babies have a difficult time staying awake long enough to take in enough milk at each feeding.  Newborn jaundice can cause a baby to be very sleepy, and in that case regular feeding is essential to flush the bilirubin from baby’s system.
•          Undressing your baby may be enough to rouse her from her slumber and get her interested in nursing.  If your baby is swaddled, begin by unswaddling her.  Remove her socks and try tickling her feet.
•          If baby falls asleep at the breast, try switching positions between sides. 
•          If baby falls asleep each time she is put to the breast, try superswitching.  This involves changing sides every few minutes, to keep baby stimulated and awake.

How to know if baby is getting enough

One of the best ways to determine whether your baby is getting enough milk is to monitor her output.  In the first few days of life, baby will produce between 1 and 3 wet diapers, as well as 1 to 3 sticky black stools.  After the first 5-6 days wet diapers should increase and stools should turn soft, mustardy, and seedy. 

Another sign to look for is whether your baby seems satisfied and content after feeding, and does not wake looking for more food soon after finishing a meal. 

Breast milk changes in constitution during each feeding.  The first milk will be thin and translucent, like skim milk.  This is the thirst-quenching foremilk.  As the feeding progresses, the consistency of the milk gets thicker, richer, and creamier.  It’s important for your baby to fully empty one breast before switching sides.  This will ensure that baby is receiving the filling and satisfying hind milk that she needs to grow.

Signs of dehydration
•          Not wetting, dirtying diapers
•          Lethargic
•          Sunken fontanel

Artificial nipples

During the first weeks, while mother and baby are both learning, it’s best to avoid artificial nipples.  This will help baby avoid nipple confusion, which can make latching on more difficult. 

Many moms want or need to provide supplemental bottles of either expressed milk of formula at some point.  Once breastfeeding is well established, typically around 6 weeks of age, is a good time to introduce an occasional bottle of expressed milk or formula.  This will provide mom with a little bit of freedom, and for many moms returning to work, bottles are a necessity. 

With regard to other types of artificial nipples, many women find that they are relieved to provide a pacifier when their baby seems to want to nurse constantly.  While this can be a big help at times, it’s also important to keep in mind that a baby who wants to nurse all the time is probably doing so for a reason.  This is how babies increase mom’s milk supply during a growth spurt. 


Breastfeeding is a wonderful way to connect with your newborn, as well as the perfect nutrition.  If you find that you are struggling, know that you’re not alone.  Most women need support to have successful breastfeeding experiences.  Reach out for this help, and enjoy every moment.