Breastfeeding

Dear parent, breastfeeding or pregnant mom, friend of breastfeeding and interested individual. Jeanelde asked me to write about Breastfeeding and supplied me with the following topics, and a few questions listed under each topic, to look at over the next few weeks: “Getting Started with Breastfeeding and mastering a good latch” (part 1). “Supply and Demand” (part 2), “Pain and Discomfort” (part 3) and “Diet requirements when Breastfeeding” (part 4).

Let us kick off with part 1!

Getting Started with Breastfeeding and mastering a good latch ~ (part 1)

A quick note before answering the questions below: La Leche League (http://www.llli.org/) says breastfeeding is an art and a science. It requires some patience, some know-how and eventually it is going to be easy and natural.

It used to be easy and natural from the start but nowadays we need to learn about breastfeeding. I believe for two reasons:
Because breastfeeding is invisible. We do not know what it looks like anymore – we don’t know what is normal and
because we interfere with nature, for example: ◉the birth process, (with inductions, augmentation of labour, vacuum & forceps deliveries, Caesarean births, pain relief medications), ◉mom & baby separation after birth and after that ◉not rooming-in, ◉baby oral insult (which is vicious suctioning of airways, dummies, supplements, the list goes on) and then we end up with possible consequences like a delayed onset of breastfeeding (which means it takes longer for breastfeeding to establish), baby developing a disorganized suck or having a diminished early suckling response (and THIS could have an influence on the exclusivity and duration of breastfeeding) and as a result, a delayed Lactogenesis2, which means it takes longer for the milk to “come in”).

SO we need to know what is normal and when to seek help if it is not.

How can I get breastfeeding off to a good start?

After reading my “note” above I am sure you know the answer already ;-). Getting breastfeeding off to the best possible start means choosing normal birth and selecting caregivers and places of birth that promote, protect, and support normal birth (like a Baby Friendly Hospital). Though you might have had many interventions during labour and yet baby managed to breastfeed just fine, normal, natural birth “sets the stage” for problem-free breastfeeding (what nature intended), while a complicated, intervention-intensive labour and birth “set the stage” for problems. This is why we have IBCLCs (International Board Certified Lactation Consultants), to help babies overcome the possible results of our interference with nature. Good news is nature wants us to succeed. Lactation is not as fragile as many people think – otherwise the human race would never have survived!

Here is a Summary of the “steps to successful breastfeeding”:
Start breastfeeding baby within 30 minutes after birth (keep mom & baby in Skin-to-Skin contact)
NO artificial teats or dummies
NO supplements
~ Add these and you will have a 13x better success rate for breastfeeding:
Room in 24/7
Feed on cue*
When going home from the hospital, be given contact detail of a breastfeeding knowledgeable person
~ These steps would be nice too
Hospital has a written breastfeeding policy
All staff trained in breastfeeding
Pregnant women informed about breastfeeding
Moms shown how to maintain lactation even if separated from baby
* feeding cues: WAKING UP, rooting, putting hands in mouth, smacking lips, etc.

Someone once said “the single most important factor in establishing successful breastfeeding is the volume of milk produced in the first one to two weeks postpartum”. So doing everything one can to make breastfeeding works well in the early weeks is important to breastfeeding success. “Successful” breastfeeding consists of a few elements: Lots of milk + confident mother + good latch from baby + all in a basket of support. Parents need to make a commitment to breastfeed. Once they have made a commitment they will find a way to do it.

Mothers need to make sure they have a support network ready to support them in breastfeeding, especially if they are not having their baby in a Baby Friendly accredited hospital. SUPPORT SUPPORT SUPPORT! If breastfeeding is difficult, especially during the 1st week, prompt and reliable assessment by an IBCLC is vital!

In their book “Breastfeeding Made Simple: Seven Natural Laws for Nursing Mothers”, Nancy Mohrbacher and Kathleen Kendall-Tackett say breastfeeding is a relationship. Instead of thinking about breastfeeding as a skill to master, (or a measure of your worth as a mother), instead think of breastfeeding as primarily a relationship. As mothers hold their babies (and a lot of holding is encouraged as skin-to-skin contact is our first step towards successful breastfeeding2), baby will be more comfortable in seeking the breast and breastfeeding will flow naturally out of this affectionate relationship. All relationships require work. Breastfeeding during the early weeks is HARD work, but after the “adjustment” period (about 40 days – remember in the Bible, it rained for 40 days and then the sun came out?), breastfeeding becomes a minor activity. We enter the “reward” period. Milk supply has established, breastfeeding is established and breastfeeding becomes easy and natural, like it is supposed to be.

When will my milk come in?

LactogenesisLG2) starts bout 30-72 hours after birth since the placenta’s high progesterone levels blocked the receptor sites in the breasts during pregnancy, preventing it from making large volumes of milk. Now that the placenta is gone, the progesterone levels drop and prolactin (milk making hormone) can come into the breasts to make the milk. Milk making is complex process involving thyroid hormone, insulin, prolactin, etc.

We will take a quick look at possible engorgement when milk “comes in”, in part 3.

Lactogenesis1 (LG1) is when the breasts start to produce milk products (colostrum) around week 16 of your pregnancy. Colostrum, is a thick golden (color due to high Beta-Carotene) creamy substance, you will see it up to day 3 when milk supply increases (or “milk comes in”).

Colostrum helps with the breakdown of stomach fluids, thus helping to clear out mucus secretions, swallowed at birth/in the womb. Colostrum has a laxative effect, so it promotes passing of meconium (baby’s first stool – a thick greenish-black tarry substance which collected in baby’s intestines during pregnancy) – so less chance for physiological jaundice. Research shows baby breastfeeding at least 9-11 times in 24 hours from birth, prevents exaggerated bilirubin levels.

Colostrum comes in small amounts, which are perfect to fill a newborns tummy, since after birth baby’s newborn tummy is the size of a marble, only able to hold 5-10 ml per feed. It will stretch gradually and by the time the milk supply increases (LG2), around day 3-4, baby’s tummy expands to hold more milk (30 ml) per feed. By 2 weeks baby’s tummy can hold 60-75ml per feed and at a month about 90-120ml per feed.

Lactogenesis3 (LG3) happens anything between 6 weeks and 3 months – this is when milk production stabilizes and becomes supply=demand.

See http://kellymom.com/hot-topics/milkproduction/ for more information on how milk production works.

What can I do to help my baby latch on correctly?

Some mothers have seen little breastfeeding among their family and friends. Knowing some main points about positioning and attachment/latching can help breastfeeding to go well.

SO…..
GET READY: wash your hands; you don’t need to wash your nipples, a shower or bath once a day is enough. Have a drink of water or juice.
GET COMFORTABLE: you can breastfeed in any position but you need to be comfortable (since you are going to feed for many hours, many days, many weeks, many months and maybe many years ;-). MAKE SURE BABY IS COMFORTABLE: baby needs to be comfortable (because this will make baby feel secure and help baby’s innate reflexes come out)….. AND THEN THE LATCH NEEDS TO BE COMFORTABLE. When breastfeeding, the correct positioning of baby at the breast is crucial. Improper positioning leads to improper latching which is a major cause of sore nipples and insufficient milk transfer.

Watch for early feeding cues like rooting, putting hands in mouth, smacking lips, etc. NB: crying is a LATE sign of hunger.

Let’s try the cross-cradle latch: Baby depends on smell and Skin-to-Skin contact (sensory input) to allow him/her to orientate and focus on food AND baby needs to feel safe enough to think about food (positional stability helps with this).

Positional stability is supporting baby across the back, between the shoulders, supporting the head, just below the ears with your thumb on one side and middle finger on the other side. ◉When helping baby to latch on e.g. the left breast, you will be holding baby with your right hand & arm. ◉Do NOT hold baby’s head, hold behind the neck, with one of baby’s arms on either side of your breast (muscles on either side of baby’s spine needs to experience equal movement for optimal function of the head, neck and oral area). ◉Hold baby so close that there are NO gaps between mom and baby. ◉Guide baby towards breast. ◉If you need to / want to, support your left breast with your left hand, 3 fingers at the 9 o’clock position and, thumb at the 3 o’clock position (well back from the areola) in a U-grasp – this shape will look the same as baby’s mouth opening. Mothers who form a C-shape are shaping the breast in a horizontal line and baby’s mouth is up-down – in a vertical line, it’s like trying to eat your sandwich turned vertical, does it make sense now to shape the breast according to baby’s mouth?

When both sensory input & positional stability are achieved, baby will automatically move into the “Instinctive position” which is:
~ head tilting back
~ leading with jaw & mouth to breast
~ mouth opened wide
~ tongue down & over bottom gum line
~ ready to take breast into mouth

Brush baby’s lips with your nipple – baby will begin to open his/her mouth (you are stimulating the rooting reflex) – you aim your nipple at the palate. Bring baby in with an “umff” onto the breast. Your nipple hits baby’s palate, stimulating baby to start suckling, milk hits baby’s throat, stimulating baby to start swallowing and that nice suck-swallow-breath cycle starts….

Check:
– Ear-should-hip in straight line
– No gaps between mom and baby
– When baby is feeding nicely with that long-drop-in-the-jaw movements, baby’s nose is free from the breast, telling us that moms nipple is along baby’s palate – in the comfort zone where there will be no abrasions or frictions or risk of nipple damage.
Keep feeding until baby “falls off” the breast by him or herself – during the early weeks this can be anything from 20 to 40 minutes of “nice” feeding. See video’s on latching from the “The Newman Breastfeeding Clinic” here: http://www.nbci.ca/index.php?option=com_content&view=category&layout=blog&id=6&Itemid=13.

How do I know if baby is not latching on correctly?

Or what is a poor latch?
Baby’s mouth is not wide open
Nose obstructed by breast tissue
Cheeks sucked in / dimpled when suckling
Mother experiences pain throughout the feed (keep in mind most mothers experience a 10-20 second nipple stretching pain which will / should disappear within 2-3 weeks)
Baby comes off the breast easily / frequently
Nipple is compressed / misshapen after baby detaches
Result:
Pain – sometimes
Nipple damage – sometimes
Inefficient milk transfer –USUALLY, leading to a decrease in milk production, baby developing poor suck habits and this leads to early weaning.

Let us recap:
Some main points to look for regarding the position of a baby at the breast are:
– baby’s body needs to be in line, with ear, shoulder and hip in a straight line, so that the neck is neither twisted nor bent forward or far back;
– baby’s body needs to be close to the mother’s body so the baby is brought to the breast rather than the breast taken to the baby;
– baby’s whole body needs to be supported;
– baby’s body needs to be facing the breast with the baby’s nose to the nipple as s/he comes to the breast.

Some main points to look for regarding the attachment of the baby to the breast are:
– baby’s chin touching the breast;
– baby’s mouth wide open;
– baby’s bottom lip turned outwards;
– more areola visible above than below baby’s mouth.

Some main signs of effective suckling are:
– baby takes slow, deep sucks and mom hears swallowing sounds;
– baby’s cheeks are full and not drawn in;
– baby feeds calmly;
– baby finishes feed by him/herself and seems satisfied;
– mother feels no pain.

Can you suggest a few breastfeeding positions?

Babies may feed in ANY position so long as baby gets milk and mom is comfortable in the process ;-). But here are a few “traditional” suggestions anyway:

Cross cradle hold: Mom can sit comfortably in armchair or in bed, pillow across lap to support arms. Bring baby up to level of breast. Holding baby in the “cross-cradle” hold for the first few weeks (e.g. when helping baby to latch on the left breast, you will be holding baby with your right hand & arm) gives baby more control. Baby’s head should be in line with his/her body (ear, shoulder and hip should be in line). As you hold baby, keep baby’s chest against yours and baby’s bottom tucked in to form a C-shape, comma-like position, baby’s bum/hips really close to your body.

Football hold / clutch position: good position for first few days, especially if you have had a caesarean birth, also recommended if baby has a blocked-up nose due to a cold. Mom sits on a chair or if still in hospital, ask for the head of the bed to be raised. Support lower back and arms with pillows. If baby is really big you can rest baby’s bottom on pillow near your elbow. Baby tucked under mum’s arm, baby’s legs behind you, and baby’s head at your breast. Use arm and pillow to support baby. Cradle baby’s neck in your hand and support baby’s upper back with your arm. Baby should face your nipple and areola. Do not lean forward, bring baby to the breast!

Lying position: pillow behind your back and one under your head, one between your knees. Baby lies on his/her side, tummy to your tummy. You could place a rolled cloth nappy behind baby to support baby’s back or support baby behind the neck with your upper arm. Feed from lower breast. Baby still needs to look up at the breast – tuck in baby’s bottom really close to your body.

I trust (and always hope!) that you have found this information valuable. I truly believe that knowledge guides our practice, strengthens our values and supports our role in transforming health. Next time we will look at “Supply and Demand”, if you have any concerns or questions please feel free to email me at leana.habeck@gmail.com or like our page on fb:
https://www.facebook.com/pages/Breastfeeding-Clinic/130925103612950?fref=ts&ref=br_tf, or for tit-bits of info: https://www.facebook.com/pages/Antenatal-Postnatal-Tit-Bits/618430578228800.

A parting thought: “The path to health is created—or diminished—over an individual’s lifetime. It blends the things we are exposed to, our experiences, and our interactions with others. What happens today influences tomorrow’s health. A new baby who is breastfed is well on his or her way to enjoying a life with good health!”

Meet Our Lactaion Expert – Leana

Leana, a mother of 3 beautiful breastfed children, has a degree in Nursing (from University of Stellenbosch) and she is a qualified Perinatal Educator (University of Johannesburg). She has been helping many parents prepare for birth and early parenthood through antenatal classes in Stellenbosch and Somerset West. Leana is also a La Leche League Leader and IBCLC (International Board Certified Lactation Consultant). Over many years, together with two colleagues at “The Breastfeeding Clinic” in Somerset West and Stellenbosch, she has helped many families nourish their babies with breastmilk.