Breastfeeding and Lactation Support Guide to Breastfeeding

Breastfeeding Holds & Latches
There are several ways to hold a baby when breastfeeding. There is no “right" hold when breastfeeding. Find a hold that feels good to the mother and baby. Just like any new skill, breastfeeding takes practice and patience.

Find a hold that lets mother relax her shoulders and arms. If mother chooses to sit up, find a seat with good back support. Try using a footstool to take pressure off her back and pillows to make her comfortable. Many women choose to use a special nursing pillow made to give support to her arms and baby while breastfeeding. Boppy pillows are hard to use in a hospital bed. Some mothers like to breastfeed while lying on their sides. This works well after a Cesarean birth or for women with large breasts.

No matter what hold is used, check the following important points:

• Wash your hands before beginning.
• Helping the baby latch on is difficult if the baby is crying or upset. Calm the baby by snuggling or putting the baby skin to skin before attempting to nurse. Placing the baby skin-to-skin in the beginning helps the baby to seek the breast.
• The baby should be pressed against mothers body with feet, bottom, and shoulders pulled in close (no gaps). Hold the baby by placing the palm of mother’s hand on the upper back. Wrap the thumb and middle finger around the base of the baby’s skull placing the finger tips below the baby’s ears to prevent the baby from turning sideways. DO NOT push on the back of the baby’s head. The baby should be positioned so the head, shoulders, knees, and chest face the breast.
• Hold the breast with a "C” hold. "C" hold means four fingers underneath the breast and the thumb on top of the breast. Position your fingers and thumb to run in the same direction as the baby’s lips. Make sure the fingers are well away from the areola. Gently lift and support the breast so the nipple is pointing upward. This makes it easier for the baby to get more of the areola in his or her mouth. Also, having a roll under a large breast for support can be helpful.
• Position the baby’s nose so you can lightly tickle his or her upper lip up with the nipple. It may take several attempts before the baby opens wide, like a yawn. The baby’s ears, shoulders and hips should be in a straight line, no twisting or turning.
• The baby’s head should be free to tilt back a bit. The chin should touch the breast first. Use the tips of the fingers at each ear at the base of the head or jaw line to keep the baby facing the breast. Pushing on the back of the baby’s head makes it difficult to get an effective and deep latch.
• Be patient until the baby opens the mouth wide. Do not allow the baby to latch onto the nipple only! This can be painful. Also, this can cause the skin on the nipple to break down and become sore.
• When the baby opens wide, quickly and gently push from behind the baby’s back and shoulder blades toward the breast. The lower lip should be further away from the nipple than the upper lip. This is called an “asymmetrical latch." Breastfeeding comfort depends on where the nipple lands in the baby’s mouth. Toward the back of the baby’s mouth is a soft “comfort zone” the nipple needs to reach.
• A clicking sound means the baby is not on the breast deep enough. If you need to remove the baby from the breast and try again, break the suction between the baby and breast by placing a clean finger near the corner of the baby’s mouth. This helps prevent sore nipples.
• A correct latch-on is a learned response. Be patient!

Signs of a Good Latch-on

• Baby’s mouth is wide open.
• The baby’s chin is firmly touching the breast and the head is tilted back.
• You may hear the baby swallow ( a soft sound like “ca – ca”).
• Both lips are rolled outward.
• Mother feels a tugging at the breast but no pain.
• There are several periods of active sucking, swallowing and stopping to breathe and rest ring a feeding.
• IMPORTANT: If breastfeeding hurts, seek help right away from a certified lactation consultants (IBCLC).

Feeding Frequency & Newborn Cues
Once mother is comfortable and the baby has a good latch, let the baby nurse as long as he is sucking and swallowing or until he lets go. Some newborns get all the milk they need in 20 minutes, but others may take 35 to 45 minutes.

• Do not let the baby nurse on one breast for more than 30 minutes.
• Take the baby off the breast and try to burp the baby.
• Breastfed babies don’t always need to burp.
• Offer both breasts throughout the day.
• Start the next feeding on the breast the baby nursed on less at the previous feeding. This supports good milk production and prevents the breasts from over filling.

Remember; feed the baby every time the baby is hungry. Yes, even if mother just nursed an hour ago. Watch for hunger cues! Most newborns nurse only about 4 times in the first 24 hours, but by day four are nursing 8 to 12 times in 24 hours. In the early sleepy days, babies may not show signs of hunger as often. Wake the baby at least every 3 hours and try to get the baby to nurse. Massaging the breast while the baby is nursing can increase milk flow and keep the baby nursing.

Hunger Cues
Hunger cues are special movements and sounds the baby makes when he or she is hungry. The baby may:

• Flex and wiggle arms or legs,
• Hold his or her fist tight, bring hands up to the mouth and suck on the hands,
• Be in a light sleep with eyes moving under his lids or looking with bright alert eyes,
• Turn the head toward a touch on the cheek (this is also called “rooting”),
• Make suckling motions of the mouth,
• Bob the head when held skin-to-skin, or
• Make squeaky noises.

Crying is a late sign of hunger. HOwever, crying doesn't always mean the baby is hungry.

Signs a Baby Is Not Hungry

• Letting go of the breast or falling asleep after a long feeding
• Turning away from the breast
• Resisting going to the breast
• Arms resting calmly along the side of the body

Waking Baby
A sleepy baby for the first 36 hours after birth is normal. Baby’s first two hours of alertness are followed by 36 hours when your baby may be very sleepy. Don’t worry; this sleepiness is followed by increased wakefulness and interest in breastfeeding. Do not give baby formula because he or she is too sleepy to breastfeed.

• To wake a sleepy baby to eat:
• Take some clothing off and undress him to the diaper. Putting the baby next to mother’s skin will keep the baby warm.
• Change the diaper or burp the baby.
• Give the baby a massage – gently rubbing the inside and outside of the palm of the hand can stimulate the baby to suck.
• Express some milk onto the baby’s lips. Drops of milk on the nipple can stimulate a latch.
• Switch breast or try a different position.

Notes
Avoid supplements with formula and avoid use of bottles and pacifiers. Newborns should not receive supplements with formula unless medically indicated. Offering supplements with a bottle disrupts the baby’s natural sucking instinct, changes the pH of the gut allowing changes in gut flora, and causes over filling of the baby’s stomach with casein protein that is difficult for the newborn to digest. Overfilling the stomach can cause spitting up or uncomfortable abdominal cramping and a fussy baby.

Babies should always be offered the breast first. The next best option is expressed breast milk. If mother is unable to put the baby to breast, a breast pump should be set up within six hours and mother instructed on pumping. The baby’s stomach capacity is only 5-10 cc in the first 24 hours and does not reach the size of a ping pong ball (1ounce) for 2 weeks. Mothers should be counseled to limit supplemental feeding and to give a maximum of 15 cc for the first 2-3 days only if advised to supplement breastfeeding by their baby’s doctor.