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Breastfeeding Basics

Breastfeeding is a natural act that your body prepares itself to perform. However, breastfeeding does not always “come naturally” to both mother and baby. Often it is a learned activity that may take some time and effort to perfect. Once you have learned the various techniques and are comfortable nursing your baby, breastfeeding is extremely easy and convenient. The following information will help you understand how and when to feed your baby.

Your Breast Milk
A mother’s breast milk is tailored to suit her baby’s needs. It varies in composition between feedings and throughout the course of lactation.

• The first breast milk you give to your baby is called colostrum (yellow and clear in color).
  • Colostrum is easily digested and acts as a laxative to clear your baby’s intestinal tract.
  • Colostrum contains antibodies and passive immunities for health protection.
• Your mature milk will come in anywhere from two to five days postpartum.
  • At the beginning of a feeding, the mature milk is bluish and contains lactose and proteins, but little fat; it is called foremilk.
  • The end of a feeding produces hindmillk. The hindmilk contains more fat, which is the main source of energy for your baby.

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When to Feed Your Newborn

• Wake your baby for a feeding at least every three hours or a minimum of eight times in 24 hours. This is important because some newborns would rather sleep than eat and they might not cry for feedings.
• Feed your baby when he or she demands. If your newborn is hungry before a three-hour time frame has passed, then go ahead and feed him/her. Hunger/feeding cues from your baby include rooting, fists at the mouth, and searching movements of head and mouth.
• The baby will give you feeding cues when he/she is full (i.e. pulls away, pauses more than he is suckling, no longer roots for the breast or stops suddenly.
• Newborn babies need to be fed eight to 12 times within 24 hours. The average length of a feeding session is 30 minutes.
• Offer your baby both breasts (alternating each breast) for as long as he/she will stay active and rhythmical with your encouragement.
• Milk production is regulated by how often your baby nurses and by how much milk is taken out of the breasts during each feeding. The more often you feed, the more milk you will have.

As your baby grows and becomes skilled at breastfeeding, the frequency and duration will start to decrease. Try not to get discouraged with your newborn baby’s nursing frequency, you will eventually be able to do more than sleep and nurse!

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Waking Your Baby
Often newborn babies would rather sleep than eat. It is up to you to ensure your baby is getting enough nutrients. Remember, newborns should be feeding eight to 12 times within 24 hours. To wake your baby, try the following:

• Undress your baby down to the diaper.
• Use a cool washcloth on baby’s face.
• Change diaper.
• Massage and talk to your baby.
• Hand express drops of milk and put to baby's lips.

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Signs Your Baby is Eating Enough
In general, most babies lose some weight in the first days of life due to the extra fluids they have upon birth. A newborn should regain its birth weight by two weeks of age, and continues to gain four to seven ounces per week for the first two to three months of life. The following guidelines will help you determine if your baby is getting an appropriate amount of breast milk:

• Baby is feeding well eight to 12 times every 24 hours.
• Sufficient urinary function and bowel movements are:
  Day 1: at least one wet diaper and one stool
  Day 2: at least two wet diapers and two stools
  Day 3: at least three wet diapers and two to three stools

When mom’s mature milk comes in and breasts feel full (between two to five days after birth) expect at least six pale, odorless, wet diapers and three to four yellow stools.

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Breastfeeding Positions
Finding a comfortable breastfeeding position for you and your baby is key to breastfeeding success. Alternating positions throughout the day will prevent pressure points or blisters on your nipples and will help in emptying your breast. A certified lactation consultant can help you select comfortable breastfeeding positions and techniques that work for you.

Common positions to consider are:

Cradle Hold
The cradle hold is the most commonly used nursing position. Sit in a comfortable chair, with arm rests if possible. Place your baby on your abdomen, tummy-to-tummy. The baby's head is in the crook of your arm and the face to your breast. The baby's knees are underneath your other breast. The baby’s head, back and legs should all be in a straight line. If you feel your nipple starting to hurt during the feeding, check baby’s position.

Cross Cuddle Hold
Place a pillow on your lap and put the baby on top of the pillow. You will use the hand on the same side as the breast to support the breast. Instead of holding the baby’s head in the bend of your elbow as in the cradle hold, hold him with the opposite arm, so that your hand rests between the shoulder blades and supports the back of his neck and head. The baby lies chest to chest with the mother.

Football Hold
A good position for mothers who have had cesareans, or who have small babies or large breasts or forceful letdown. This hold allows babies to take milk more easily. Cradle the back of your baby's neck in your hand, with the body under your breast and toward the elbow. Place a pillow under your elbow to support your baby's bottom. Your other hand supports your breast. This position gives you control of the baby's head and eases latch on positioning.

Side-lying or Lying Cradle Hold
This is a good position for mothers who have just had a cesarean section because the baby does not put pressure on the mother's stomach. Lie on your side with one arm supporting your head. Your baby lies beside you with the head facing your breast. Pull the baby in snugly and place a pillow behind to support the baby.

Latch and positioning techniques
Comfortable nursing requires the correct positioning of the baby at the breast. Here are some guidelines to help you become skilled in the art of breastfeeding:

• Brush your nipple against baby's bottom lip, causing him/her to open wide as if yawning. Hold your breast with the thumb on the top and fingers at the bottom, supporting the breast.
• Your nipple should be centered in baby’s wide-open mouth.
• Try to get as much of the breast's areola (the pigmented area of the breast) as possible in baby's mouth, without forcing it, of course.
• Check that baby’s nose and chin touch the breast. Baby's lips should be flanged (turned out).
• Slowly pull the baby’s head slightly away from the breast to see if baby has a good hold.
• Support the underside of your breast with your hand throughout the feeding session. Your fingers should be away from areola.
• You should feel a ‘pulling’ or ‘tugging’ sensation, after the initial latch-on discomfort. You should then sit back, relax and enjoy the closeness of breastfeeding your baby. If the latch is still painful after one minute, take baby off by breaking the suction with your finger. To break the suction, place your finger between baby’s mouth and your breast. Pulling the baby off without first breaking suction may cause your nipple to become sore.
• Try to reattach the baby to your breast. In a correct position, you will be comfortable and the baby will be able to get a lot of milk. You will know that the baby is properly attached when you see jaw and temple movement with baby’s rhythmical suck. You will hear your baby swallowing (gulping at times).

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Sore Nipples and Blocked Ducts
Sometimes when a mom is learning to breastfeed, nipples can become sore, irritated, or chaffed. The best preventative measures for sore nipples are to learn the proper latch and position.

Other sore nipple prevention measures include:

• Begin feeding on the breast that is the least sore or sensitive.
• Alternate feeding positions. If one breast is favored, the other will become engorged and painful.
• Use a breastfeeding cream or your own breast milk on nipples after every feed; then air dry.
• Avoid using or getting soap on your breasts while showering.

A blocked duct can feel like a pea-size lump within your breast (under your skin) and is sore or painful to the touch. Mastitis occurs when a blocked duct becomes inflamed or turns into a breast infection. If this occurs, contact your physician to discuss treatment.

Blocked ducts can be caused by:

• Nursing baby in the same position during every feeding session.
• Over-abundant milk supply or nursing from one breast.
• An unsupported, heavy breast or a bra that is too tight (underwire bras are not recommended).
• A change in baby’s feeding schedule or frequency.

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Engorgement
Engorgement is a swelling of the breasts caused by expanding veins and the pressure of new milk (usually two to five days after delivery). It also occurs when several nursing sessions are missed and not enough milk is expressed from the breasts.

To treat engorgement or a blocked duct try the following:

• Alternate feeding positions throughout the day.
• Feed baby frequently to keep milk supply moderate.
• Take a warm shower or apply a warm compress to affected area.
• Massage affected breast in the direction of the nipple area while you nurse.
• Encourage the baby to actively feed and empty the affected breast.
• Ice the area after each feeding to decrease inflammation

Contact your physician if inflammation and/or pain persist.

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Pumping Breast Milk
At times, women who breastfeed need to use a pump to express their breast milk. Reasons for expressing breast milk vary. Some women pump milk to; relieve breast engorgement, to permit another person (spouse, family member, caregiver) to feed the baby, or because they are returning to work.

Expressing milk can be done with a commercial pump, or it can be done with your hands. Breast milk volume is regulated by supply and demand. Pumping is a way to keep your breasts regularly stimulated while you are at work, on errands, or if your baby is sick and has temporarily stopped feeding. It is normal not to get milk the first few times you pump, keep trying.

Guidelines for expressing breast milk:

• If pumping milk for a newborn, pump eight to 10 times within a 24-hour period (to match the feeding frequency of a newborn).
• Wash your hands with soap and water before pumping.
• Apply a breastfeeding cream to nipple to increase comfort if there is nipple tenderness.
• Briefly massage your breasts to encourage milk flow.
• Center the flange over the nipple.
• Begin pumping with the suction set on minimum. After 30 seconds, increase pressure to comfort level.
• During the baby’s first few days: Single pump 15 minutes on each breast or double pump 15 minutes simultaneously on both breasts.
• Once your milk comes in, discontinue pumping by the clock, and pump according to the flow of breast milk.
• Gentle breast compression during pumping may increase supply and fat content of milk.
• Frequent, short pumping sessions are more productive than fewer, longer pumping sessions.
• The amount of pumped milk is not an indicator of how much the baby is getting when breastfeeding.

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Breast Milk Storage Guidelines
Human milk is not homogenized; therefore there are certain steps that you must take to ensure that it is safely stored.

• Store breast milk in glass or plastic sterile containers or bags.
• Make certain they are clean.
• The quantity of stored milk per bag or container should be equal to the approximate amount your baby takes at each feeding.
• Leave room at the top of the container for milk expansion if freezing.
• Label container with baby’s name, date, time of collection and medications that you are taking.

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