Parenting Advice
Breast Feeding ? How to do
By Martha Sears, R.N., and William Sears, M.D., Babytalk
Breastfeeding works! If it didn't, the human race would not have survived.
For thousands of years women have breastfed their infants, despite famine,
war, and personal crises. I (Martha) have logged eighteen years of
breastfeeding our own eight children through a variety of challenging
circumstances. I juggled breastfeeding and working with our first three
infants. Stephen, our seventh child, was born with Down syndrome, yet with a
high dose of commitment and some tears, for three and a half years I was
able to give him the developmental benefits that came with my breast milk.
For an encore, our eighth child, Lauren, came into our family by adoption
when she was a newborn, and with a lot of support, I was also able to
breastfeed her.
Breastfeeding even under the best of circumstances can present challenges,
as both mother and baby are learning what to do. Yet, breastfeeding is well
worth the effort it takes to overcome hurdles you encounter. Your baby
receives important nutritional, immunological, and developmental benefits,
and both of you get to enjoy the special closeness of a nursing mother and
baby. Here are some common problems breastfeeding mothers experience, and
the solutions our personal and professional experience has taught us.
How can I get my baby to latch on properly?
In our experience, the most common breastfeeding obstacle is improper
latch-on. A baby who does not take the breast correctly will not get as much
milk and will probably give his mother sore nipples. Here's what we tell
mothers:
First, position yourself correctly. Milk flows better from a relaxed mother,
and it's easier to breastfeed your baby if your arms, back, and shoulders
are well-supported. Prepare a nursing station in your favorite room with a
comfortable chair, plenty of pillows for support, and peace and quiet or
soothing music. After you've prepared your body to breastfeed, prepare your
mind. Take a few relaxing breaths and imagine your nourishing milk flowing
from your breasts into your baby. Help your infant to relax, too. If she's
crying, rock and sing to her until she quiets down. If she's sleepy, gently
bring her body into a sitting position while saying her name. Babies latch
on best when they are in a quiet, yet alert, state.
Next, position your baby correctly. Whether you use the cradle hold (baby cradled in your arms lying on a pillow on your lap), the clutch or football hold (baby's body tucked to the side, under your arm, near your breast, neck supported by your cupped hand), or the side-lying position (nursing in bed), be sure that Baby's head and body are turned to face your breast with her mouth at the level of your nipple. Pull her in close -- she should not have to turn her head or strain her neck to reach your nipple.
Cup your breast in your hand, with your fingers and palm underneath and
thumb on top, well behind the areola. Avoid the "cigarette hold" (when the
nipple is between your two fingers) because your fingers would be right
where baby needs to latch on. Express a few drops of milk. Using your
milk-moistened nipple, gently massage your baby's lips, encouraging her to
open her mouth wide, like yawning. As she opens wide, direct your nipple
slightly upward and toward the center of her mouth, and with a rapid arm
movement, pull her close to you, so that her mouth will close down over your
areola. We call this technique "RAM," an abbreviation of "rapid arm
movement." It may sound startling at first to say "RAM Baby on," but it
really helps mothers remember two important components of latching on: that
they need to move their arm to draw their infant in closer (rather than
leaning forward, which can make their backs sore), and that they must move
quickly before the baby's mouth closes again.
Make sure your baby feeds from the areola, not just the nipple. To prevent painful breastfeeding, her gums should take in a one-inch radius around the nipple as she latches on. Compressing this area allows your baby to get more milk, since the milk sinuses are located under the areola.
Pinching, Cracked Nipples, and How Much Is Enough?
What if I feel a pinching sensation?
While a bit of initial discomfort is to be expected in the first two to four
days of breastfeeding, persistent pain usually means your baby is not
latching on properly. To improve Baby's latch-on, be sure his mouth is wide
open as he takes the breast; both of his lips should be turned out
(everted). When your baby takes the breast with mouth open wide, he'll have
a "fish mouth" look as he nurses, and you should not be able to see your
nipple. Be sure your baby's tongue is between his lower gum and your breast.
(If you pull down gently on Baby's lower lip, you should be able to see his
tongue.) If his bottom lip is pulled inward instead of outward, use the
index finger of the hand that is supporting your breast to pull out that
lower lip. (You may need a helper to take a peek under the breast and do
this for you while Baby is latched on.) This "lower lip flip," as we call
it, may be all that's needed to keep your infant from tight-mouthing your
nipple.
If your baby doesn't get onto the breast well at the first try, take him off
(break the suction with your little finger inserted into his mouth) and try
again, waiting for that wide-open mouth. Don't settle for a less-than-great
latch-on: Be patient, keep trying, and soon your baby will learn exactly
what to do.
How can I tell if my baby is getting enough milk?
In the first few weeks, many mothers worry about whether their babies are
getting enough breast milk. There's no handy way to measure the ounces going
in, and the amount of milk you can pump bears little relation to how much
milk your baby is getting from the breast. It's better to watch the baby for
signs that he is getting enough to eat. Do you notice a few drops of milk
leaking from the sides of your baby's mouth and hear him swallow after every
one or two sucks? Does he seem content after a feeding? By the fourth day
after birth, your baby should wet about six diapers a day. Pale, almost
water-colored urine suggests baby is getting enough milk to stay adequately
hydrated; darker, apple-juice-colored urine suggests that he is not. Baby's
stool output is another helpful indicator. Within a day or two of your milk
coming in, your baby's bowel movements change from sticky black meconium to"milk stools." These are yellow, seedy, mustard-colored and the consistency
of cottage cheese. Babies between 1 and 4 weeks who are getting enough milk
will produce at least two to three of these stools a day, often more. If a
lot of urine and stools come out in the diaper, rest assured that enough
milk is going in. (During the second or third month, some breastfed babies
may have only one bowel movement a day while still getting enough milk.)
You'll also observe that your breasts feel softer after a feeding in which
baby takes plenty of milk.
The bottom line is baby's weight gain. After the normal initial loss of five
to seven percent of their birth weight (five to seven ounces for an average
6-pound baby), babies should regain their birth weight by two weeks of age.
As a general guide, a baby getting sufficient milk should gain four to seven
ounces a week, or a minimum of a pound a month. If you think your baby is
not getting enough milk, take immediate steps to improve nursing (a
lactation consultant or your doctor can help) and take your child to the
pediatrician every few days.
What if I have cracked nipples?
Cracked nipples are usually caused by improper latch-on. When your baby
doesn't get enough breast tissue into his mouth, all the sucking pressure is
concentrated on the nipple.
Try feeding Baby first on the side that is the least sore. Usually the most
uncomfortable part of a feeding is the minute or two of sucking it takes to
trigger your milk-ejection reflex. Once the milk is flowing freely, nursing
will probably be more comfortable. Mothers with sore nipples are often
tempted to nurse less frequently, but this aggravates the problem, since
your breast can become engorged, making it more difficult for Baby to latch
on. Try to feed more frequently while being vigilant about proper latch-on.
After nursing, you can massage medical-grade ultrapure lanolin ointment onto
the cracked area. If the crack does not improve within a day or two, call a
lactation consultant. If it becomes infected (if your baby has thrush, for
example, the yeast can infect your breasts), your doctor can prescribe
medication.
Clogged Ducts and Feeding After C-Section
How do I handle a clogged milk duct?
If you notice a tender lump somewhere in your breast, it may mean that a
duct leading from the milk-producing glands to the nipple is blocked with
milk. Untreated, the area can become inflamed and even infected (a condition
called mastitis). To treat a clogged duct, apply warm moist compresses to
the area for a few minutes before feeding. Breastfeeding on the sore side
first often helps, as your baby is more likely to dislodge the plug at the
beginning of a feeding when her sucking is strongest. As Baby nurses, gently
massage the area down toward the areola to encourage the plug to clear. If
you start to develop flu-like symptoms (fever, chills, body aches, and
fatigue), you may have mastitis. Your doctor can prescribe antibiotics.
Plugged ducts are most likely to occur when your infant is nursing less
often -- if you're away from home, or when she suddenly begins to sleep for
longer stretches at night. To prevent them from recurring, breastfeed
frequently, especially if your breasts feel full. (If your baby isn't
hungry, pump and store the milk.) Feeding your baby in different positions
also helps. Avoid tight bras and sleeping on your stomach, as both can put
unnecessary pressure on your breasts. Most important, get adequate rest:
Recurrent mastitis can be a sign of a run-down immune system.
I'm scheduled for a c-section. How will I breastfeed during my recovery?
After a cesarean birth, your body must be allowed to heal while you learn to
care for your baby and breastfeed. You need extra help: Ask the nurses or
your lactation consultant for help with early feedings, and have them show
your partner how to help you get positioned for nursing. Breastfeed in the
side-lying and clutch-hold positions to keep Baby's weight off your
incision. Use lots of pillows: If you nurse lying down on your side, you'll
need two pillows behind your back, a pillow between your knees, one under
your head, and one to support baby on his side. Wedging a "tummy pillow"
between the bed and your abdomen can help keep the pressure off your
incision. You can also nurse while sitting up in bed; a day or two after
surgery, you may be more comfortable nursing while sitting up in a chair,
with your infant on pillows in your lap. Some mothers mistakenly assume that
they should refuse pain medication, but there are medications that are safe
for breastfeeding moms to take. Pain will only suppress your milk production
and keep you from enjoying your first few days with your new baby. The
anesthesiologist can give you a long-acting anesthetic immediately after the
birth to ease postoperative pain when you are first holding and nursing your
baby. It may take a bit longer for your milk to come in following a cesarean
birth, and longer for the baby to learn to latch on, but mothers who have
surgical births can be just as successful at breastfeeding as mothers who
deliver vaginally.
Supplements and Biting
What if I need to supplement with formula?
"Combo feeding" (breastfeeding and supplemental formula) can work, but it's
important to get breastfeeding off to a good start for a few weeks before
introducing commercial nipples. Otherwise, babies can become "nipple
confused," which means they try to suck at the breast the way they get milk
out of a bottle. This is not very effective, and it can be painful! If
formula supplementation is medically necessary within the first month, a
lactation consultant can help you try supplementing with a syringe or a
nursing supplementer, a handy device that delivers breast milk or formula
through a flexible tube attached to your nipple, while baby breastfeeds.
Supplementers help babies learn to suck from a mother's nipple. As an added
perk, mother gets the milk-making hormonal stimulation as Baby sucks at her
breast.
Breastfed babies sometimes refuse to take bottles offered by Mom because it
just doesn't feel right. Dad or a substitute caregiver may be more
successful at persuading a baby that food can come from other sources.
Choose a nipple with a wide base so that baby has to open his mouth wide as
he does at the breast. This will minimize problems with lazy latch-on when
baby is fed at the breast.
Don't take it personally if your baby appears to prefer pumped breast milk or formula from a bottle. It usually doesn't take as much effort to get milk from a commercial nipple. (This is a good reason to avoid them in the early weeks.) If you are planning to combine breastfeeding with formula supplements, or if you find yourself doing this, try to give breastfeeding priority. The more you substitute formula feedings for feedings at the breast, the less milk your breasts will make, and it's possible that your baby's interest in breastfeeding will also wane. Combo feeding works for many mothers, but use some caution or your baby may stop breastfeeding before you had planned on weaning.
Help! My baby bites during feedings!
Babies eventually sprout teeth, with the first ones arriving around six
months of age, and when they get them, they experiment with them, which can
lead to a startled "ouch" from Mom when she gets nipped during nursing. Even
though babies do bite the breast that feeds them, you don't need to be a
human pacifier. And, this doesn't mean it's time to wean (even toddlers with
lots of teeth can breastfeed without causing pain). It is time to teach your
baby some nursing manners. It's okay to holler "ouch!" when Baby clamps
down. To pry your nipple out of your child's mouth without any further
damage, wedge a finger in between his gums and hook it around your nipple.
If he bites down again before the nipple is out of his mouth, your finger
will protect your tender nipple. That startled "ouch" may frighten some
babies and intrigue others. If your baby cries at your reaction, calm him
and immediately resume nursing. If he bites again -- with a curious gleam in
his eye -- it's time to end the feeding and do something else together.
Eventually, your infant will associate biting with an end to the feeding,
and will stop biting. Another trick used by mothers of biters, me included,
is to draw the baby in closer to the breast as soon as you feel that first
nip, or even when Baby looks like he's about to bite. He'll automatically
let go in order to breathe.
Breastfeeding requires large doses of commitment, a helping of patience, and
a sense of humor. While you may experience some problems, rest assured that
with help, you will likely be able to work through these challenges and
enjoy this special bond with your baby.
Contributing editors Martha Sears, R.N., and William Sears, M.D., are coauthors of The Breastfeeding Book.
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