Breastfeeding - getting it right
The key to breastfeeding success is to know why you are doing it. If you understand in your heart and mind why breastfeeding is best for your body and breast milk is best for your baby, then you will be motivated to persevere through challenges.
Breast milk is a living fluid containing organisms and proteins that offer protection against bacteria and viruses: breastfeeding reduces the risks of your baby suffering from acute diarrhoea; respiratory, urinary tract and ear infections; asthma and allergies; coeliac disease, ulcerative colitis, insulin dependent diabetes and childhood lymphomas. Breastfeeding also aids your baby's speech, eyesight and intelligence and promotes a special bond between you and your baby.
As your baby grows, the composition of your breast milk changes, to meet her changing needs. Some immune compounds in breast milk have been shown to increase at around six months (just when babies become mobile and are exposed to a greater range of germs) and, in many instances, the long-term protective effects of breastfeeding are related to its duration.
Apart from a healthy baby, the benefits for mothers who breastfeed include less postpartum bleeding, delayed return of menstruation after childbirth, a reduced incidence of obesity later in life, and protection against osteoporosis, ovarian cancer and pre-menopausal breast cancer.
Watch your baby, not the clock!
One of the biggest concerns mothers have is whether their babies are getting enough milk but if you watch for signs that your baby is hungry ( rooting movements and sucking on fingers – crying is a LATE sign of hunger!) and allow her access to the breast, you can be reassured that she will take exactly the amount she needs.
Supply and demand
Your baby's sucking at your breast stimulates milk production: the more your baby sucks, the more milk your breasts will make and according to research by Dr Peter Hartmann and associates at the University of Western Australia, an empty breast will make milk more quickly while a full breast will make milk more slowly. This means that milk production will speed up or slow down according to how hungry your baby is.
This is particularly important to remember when your baby has a growth spurt and wants to feed more often for a few days to keep up with his needs. Although it is fairly common for babies to have growth spurts at 6 weeks and 3 months, these can happen at any time.
At first your baby's tummy is only the size of his tiny fist and breast-milk is very quickly digested so your baby will need frequent feeds, at least in the early weeks. It is perfectly normal for a breastfed baby to need feeding every two hours at first – and that means two hours from the beginning of one feed to the beginning of the next, not two hours between feeds.
Babies also regulate the type of milk they need by the way they suck. The first (fore) milk will quench their thirst, which is why they often have very short frequent feeds on hot days, just as we sip from our water bottles. Hunger will be satisfied by longer sucking periods when baby gets the fatty hind milk which is squeezed down into your ducts by the reflex known as 'letdown'. Allowing your baby to finish the first breast before offering the second side will let him get exactly the milk he needs.
This is why it is better to watch your baby, not the clock, because if your baby is hungry but is not allowed to breastfeed because a rigid feeding schedule says it's not the right time, your breasts will remain full and your milk production will slow down. Also, if you offer a bottle as a 'top-up', your baby won't be sucking the whole amount of milk from your breasts so they won't get the message to produce the amount of milk your baby needs. As you offer another bottle, and so on, the decreased sucking will cause your milk supply to dwindle.
Beginning to breastfeed
After a drug-free birth, newborns who are kept warm and allowed uninterrupted skin-to-skin contact with their mother, will often seek and latch onto the breast without very much help at all ( see http://breastcrawl.org/ ). Dads, it is best to have a threesome cuddle at first so baby gets to know the smell of his food (Mum's breasts) without confusion - cuddle mum and baby as baby lies on mum's body. If you are patient and allow your baby to take his time, this first breastfeed is usually quite a long suckle lasting anywhere from about half an hour to a couple of hours
Although at this stage, your baby will only be getting small amounts of colostrum, the early, yellowish fluid which is high in antibodies, this first feed is especially important to help your baby imprint a breastfeeding sucking technique which is different from that required to milk a bottle teat. If you have a shower after this first feed, it is best to not wash your breasts just yet. The reason for this is that when baby next feeds, he will be guided by the smell of the amniotic fluid he left on your breasts at the very first attempt to feed (of course it's fine to wash your breasts after this but please don't use any perfumed soaps).
If you have had medication or complications during the birth or if you and your baby are separated initially, please be reassured, nature allows ongoing opportunities to bond with your baby and establish feeding, but it may mean you will need extra help.
Baby to breast
If you don't yet have a baby, it can be a good idea to practise these breastfeeding holds (as best you can!) with a doll.
Cradle hold – Nestle baby in your arm so her neck rests in the bend of your elbow or on your forearm, her back along your forearm and her bottom in your hand (as she gets older and longer, your hand will support her back and shoulders). Turn her whole body so she is facing you tummy to tummy (remember the rhyme 'Chest to chest, chin to breast'), and support the weight of your breast in a 'C' shape with your other hand (with your fingers underneath and your thumb on top) so it will fit into baby's mouth. Baby shouldn't have to turn her head or strain her neck to reach your nipple (try drinking a glass of water while looking over your shoulder!).
Football hold – For babies who squirm, arch their backs and slip off the breast easily, or for small or premature babies who need more guidance and support, a football hold, with your baby tucked under your arm and her feet behind you, may work better than a basic cradle hold. This position can also be used to relieve pressure on a sore nipple or a caesarean scar and is usually the easiest way to breastfeed twins at the same time.
Lying down to feed – Lying down to breastfeed is a great way to get extra rest and can be an easy way to position the baby for feeding, especially if you are feeling sore after birth.
Lie on your side with one or two pillows to support your head, hold baby close, facing you, with his nose pointing towards your breast and guide him on with your top hand.
Position, position.
Latching your baby onto the breast in a good feeding position can prevent early breastfeeding problems such as sore nipples or insufficient milk. Some nipple tenderness is normal in the early days (a little like breaking in a new pair of shoes), but it isn't supposed to really hurt. If your nipples really hurt or look squashed when they come out of baby's mouth, get an expert to watch you feed: the problem may be due to incorrect positioning.
Once you have baby in a comfortable hold:
With your free hand, express a few drops of milk to moisten your nipple. Gently tickle baby's lips with your moistened nipple. As soon as she opens wide, direct your nipple into her mouth (above the tongue) and quickly pull her close to you. Get a large part of the areola into baby's mouth. Flange her lips outward by lining her nose up with the nipple and touching her top lip to your nipple: she should gape automatically. Put her onto the breast quickly and firmly, chin-first, brushing her bottom lip into a flange as you do so.If you have flat or inverted nipples or if your baby has a weak suck, as soon as she starts to suck, compress your breast with your thumb and finger – this holds the milk ducts forward so baby won't lose her grip so easily.If baby seems to be latched on incorrectly, gently break the suction before removing her from the breast: to do this, insert your finger in the corner of her mouth and gently lift her lips and gums off the nipple. Then try again.If you have very large breasts, use a rolled handtowel under your breast to support its weight so it isn't heavy on the baby's lower jaw, tiring her out.
Breasting out all over
Most women experience a few days of 'engorgement' – hot, tight and tender breasts – as their milk 'comes in'. This is caused by increased blood circulation in the breast area, and happens especially with first babies. Because your breasts swell up, they can be difficult for the baby to latch onto.
Engorgement can be minimised by feeding frequently from birth so that your milk comes in more gradually. If your breasts do become engorged (or any time you have lumpy breasts when breastfeeding), it helps to have warm showers and to gently massage your breasts towards the nipple, expressing a little milk before you feed, so baby can latch on more easily. After a feed, you may find relief by tucking cold cabbage leaves inside your bra, but as an enzyme in the cabbage is the effective ingredient, don't overdo this treatment or it may diminish your milk supply: let comfort be your guide.
Getting help
Although breast-feeding is a natural process, it doesn't always come easily so it is wise to find out as much as you can about breastfeeding before you have your baby:
Attend some meetings at your local Australian Breastfeeding Association (www.breastfeeding.asn.au) or La Leche League (http://www.laleche.org/public, where you will get to know the people who can help you if you have difficulties -it is always easier to call somebody you know and trust, than a complete stranger. You will also see babies being fed and pick up some tips to boost your confidence about mothering in general as well as breastfeeding.Read a good breastfeeding book and take it with you to hospital so you can dispel conflicting information. My book "Parenting By Heart" has a comprehensive section on breastfeeding, or you can grab a copy of my ebook and recording series, Breastfeeding Simply - you can download this right away and listen on an MP3 player as you exercise, drive or feed your baby (you won't need a spare hand to hold a book!).
If you need specific help with breastfeeding I recommend contacting a certified lactation consultant. Lactation consultants are allied health professionals experienced and trained to solve breastfeeding difficulties - please check that anyone claiming to be a lactation consultant is a member of a professional body such as ALCA (Australian Lactation Consultants Association) or ILCA ( International Lactation Consultants Association) and Board certified (IBCLC). Many Lactation consultants will do home visits if you need extra help, but are finding it difficult to get out and about to a clinic.
Remember, it is better to call as soon as you are concerned about breastfeeding issues rather than leave it until things become really difficult and you lose confidence altogether.
