Breast-feeding your baby

It has been said that breast-feeding is "natural." While this is true, it may take some time for you to become comfortable with this new skill.

Find a comfortable position
First, find a comfortable position. You may try sitting up and using a cradle hold or you may be more comfortable lying down on your side with the head of the bed elevated a few inches and a pillow under your head. A side-lying position may tend to flatten your nipples, so it may not be good if you have flat or inverted nipples. If you have had a cesarean section or tubal ligation, or have large breasts, the football hold may be most comfortable. Try changing your position with each feeding.

Correctly positioning your baby
Next, turn the baby to his side so that the baby is hugging you - one arm up and one arm around beneath the breast. The baby's mouth should be at the level of your nipple. Grasp the breast with a "C" hold, with the fingers below and the thumb above and behind the dark areola area. Help the baby find the breast by pulling the baby toward you until her cheek is touching your breast with the nipple next to her mouth. When the baby turns toward the nipple and opens his mouth wide, place the nipple and areola in his mouth on top of his tongue as far as 1 or 1 1/2 inches back. You may need to stimulate the baby to open her mouth, especially if baby is sleepy.

Keep using the "C" hold while nursing until proper grasp is obtained. Sore nipples are most often caused by the baby sucking only on the end of the nipple. Proper position is very important. The muscles in front of the ears should move and the earlobes wiggle. The baby's lips should be flanged out around the areola. You should be able to see the baby's tongue wrapped around the nipple and areola and extending to the gums if you gently pull his bottom lip down a little.

Hand expressing a few drops of colostrum first may encourage baby to suck. If baby is crying or fussy, sometimes it helps to burp her before you start to nurse.

How long to nurse
Always try to burp the baby after each breast. Babies need to nurse about 10-15 minutes on each side each feeding. While many newborns will not nurse this long at first, that will be your goal. The hind or back milk has more butterfat and calories and is more satisfying for the baby than the first or front milk. Your baby will gain weight better if she empties your breasts with each feeding. (Your breasts are never totally empty since your body is constantly producing more milk.)

Most breast-fed babies will want to nurse about every 3 hours. About 3-5 days after delivery, your milk supply will increase. While colostrum is bright yellow and thick, breast milk is thin and bluish white, looking more like skim milk.

Removing the baby from the breast
When removing the baby from the breast, insert a clean finger into the corner of baby's mouth to break the suction.

After nursing the baby, wipe the nipples dry and let them air dry as much as possible. Your bra flap may be left down, even under your clothes. If you are in a hurry, a hair dryer may be used to blow your nipples dry. Avoid plastic lined nursing pads.

Relieving engorgement and sore nipples

If your breasts get very full and engorged, you may want to try several things to relieve the discomfort.

1. Always wash your hands carefully before you touch your breasts. Breast infections are frequently caused by bacteria from your hands getting into the breast milk and growing there.
2. Apply warm compresses or get in the shower about 3 minutes before each nursing. Ice packs may be used on the breasts between feedings, but hot compresses will then be needed to stimulate the milk let down when you are ready to nurse. This heat/cold treatment is only necessary during the engorgement period.
3. Begin doing breast massage and nipple stretching as soon as possible. Breast massage helps to improve circulation and help decrease clogged milk ducts from the extra fluid that accompanies milk "coming in." Do the breast massage from the underarm and upper breast toward the nipple all the way around the breast. Massage each time before nursing. Nipple stretching helps open the ducts and makes the nipples more elastic.
4. Start nursing on the least sore side first if you are having problems with any soreness. If the breast is full, use your hand or a pump to express enough of the milk so the areola is soft and can be positioned properly. If the nipple is flattened due to full breasts, it is very difficult for the baby to latch on properly. This will increase soreness.
5. While sore nipples are often caused by the baby sucking only on the nipple, some women develop sore nipples despite their efforts to prevent them. According to Karen Pryor in Nursing Your Baby, "usually this soreness consists of a pain that makes you wince (or even brings tears to the eyes) as the baby first grasps the nipple, and which fades away as the milk lets down. Soreness generally starts around the 20th feeding, gets worse for about 24-48 hours, then rapidly disappears. Limiting sucking or skipping feedings only postpones the peak of soreness." When treated properly, sore nipples usually disappear in a few days. Warm, moist compresses applied to the nipples after a feeding may help tenderness. Lansinoh, which may also be helpful for tender nipples, is available over the counter.
6. If soreness occurs before 48 hours, check the baby's sucking pattern. Sometimes babies pull their tongues to the back and top of their mouths, pushing your breast to the front so that what looks like a good position may not feel like one. If you are unable to tell or see the position, place a clean index finger in the baby's mouth, soft side up against the baby's palate (roof of the mouth). Notice the sucking motions the baby uses. If the baby pushes your finger out, you know she is also pushing your nipple to the front of her mouth. Practice rubbing the baby's soft palate with the pad of your finger to start the baby's suck reflex. Gently push the tongue down and to the front, using a circular motion with your finger. As the baby starts to suck, the finger should be sucked back into the mouth. If the baby is sucking properly, this will not cause gagging or choking. If choking or gagging occur, remove your finger and start again, but this time, bring your finger forward a little and try again to flatten the tongue toward the front. When the baby is sucking correctly, try to nurse again. You may need to do this before each feeding for several days, until your baby learns to suck properly. It is better not to give artificial nipples during this process.
7. If no soreness is occurring, offer the last nursed breast first. A diaper pin clipped to your bra might help you remember which side to nurse first.
8. Wear a well-fitted bra when you are up and about between feedings. It may be more comfortable for you to remove your bra during feedings.
9. Do not skip feedings and do nurse frequently. Allowing the breasts to overfill will make it more difficult for your baby to nurse. Also, the baby will be so hungry that he will nurse even more vigorously. Both of these will increase the problem.

Frequency of nursing
Breast-feeding is supply and demand. When your baby hits a growth spurt and is growing rapidly, she will want to nurse more frequently. Growth spurts are known to occur between 10 and 14 days, between 5 and 6 weeks, between 3 and 4 months, and so on. You will recognize growth spurts by the fact that your baby will suddenly start wanting to nurse very frequently, sometimes about every hour and a half to 2 hours. They will nurse very frequently for about 24-48 hours, then revert to regular feeding schedule because they now have your milk supply built up to what they need. It should be said here that your milk has not "dried up," is "rich" enough and that this is a perfectly normal thing for breast-fed babies to do. Your breast milk is perfect for your baby.

Breast pumps
You may want to consider purchasing a breast pump, especially if you plan on nursing for several months or going back to work. There are several types from which to choose:

Electric

• More expensive
• Faster
• Can do a double pump which stimulates prolactin levels to increase milk production
• May rent on daily or three or five month basis. Cheaper ones do not work quite as efficiently as larger ones, but may do what you need. Examples: Gerber, Lactina, Medela, Ameda-Egnell

Battery operated

• Moderate priced
• Some are AC/DC (1. Mag 2. Evenflow)
• Examples: Battery only - Gentle Expressions Sears

Hand or manual

• Usually less expensive
• Takes a little longer to become efficient with use. Examples: Medela, Ross, Mary Jane, Marshall
• Check various features with friends

Avoid bicycle pump types. They are inefficient, cause trauma to the tissue and increase chances of infection. There are many breast pumps available. Those listed as examples are only a few of the ones on the market.

You may try to use your breast pump any time the baby does not nurse well or you are feeling very full and uncomfortable. Moist heat to your breasts may help trigger your "let down" reflex. You may not get more than 1/2 oz. at first, but you will do better the more you try. Put the expressed milk in your bottle, take a piece of tape and mark the date and time on the tape and put that on the bottle so you will know how old the milk is. Put that bottle in the freezer. The next time you pump, you put the milk in another bottle so that you can cool it first in refrigerator for a few hours. When it is cold, you can add to the first bottle. For newborns, about 4 oz. to a bottle is sufficient. Add more as your baby gets older.

Storing breast milk
Breast milk may be stored in the refrigerator for up to 48 hours and in the back of a freezer for up to two months. Breast milk will expand when frozen, so leave some space at top of bottle or freezer bag. If using freezer bags, it is best to double bag the milk. Defrost by placing bottle in cold water and gradually increase temperature of water. Do not microwave. Once defrosted, milk needs to be used within twenty four hours.

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