My top 10 tips
- Make sure you are comfortable. Whether you choose to feed lying down or sitting up make sure you are comfortable and will be able to remain comfortable if you have to stay there for an extended period of time. Some mothers choose to sit in a rocking chair or up in bed with pillows behind the back. It can also be helpful to sit with a pillow on the lap to help support the baby a little. You will find a comfortable position after a bit of experimenting. Experimentation will be especially important if you have had a caesarean or an episiotomy as you may find it harder to get comfortable. You might find it helpful to talk to a midwife for some suggestions if you are having trouble.
- Make sure you are have some breastfeeding clothes that open at the front well enough to allow you to hold your baby close to your breast. Better still, go top less while you are learning to breastfeed. This has many advantages. It provides close skin to skin contact with your baby which boosts those warm fuzzy feeling hormones which will make lots of milk. Going topless will also expose your nipples to air allowing them to remain dry, helping to avoid bacterial infections and thrush.
- Hold your baby close and remove any wraps or excess clothing.
- Make sure you baby’s entire body is turned towards you so that the hips, tummy and chest are against you. Many mothers find that they get the best attachment when the baby is at the same level as the breast, with the mouth at the same level as the nipple.
- Gently touch the baby’s mouth with the nipple. Your baby will open its mouth instinctively when you bring the nipple to it. This is the rooting reflex.
- Some mothers find it helpful to support the breast with the opposite hand as the baby attaches. If you do this make sure that your hand is well away from the areola so as not to get in the way of the baby’s mouth.
- Encourage your baby to open the mouth nice and wide.
- As you brush your nipple against the mouth, your baby will open wide for the breast. Avoid moving the breast or chasing the open mouth. Hold the breast still and the natural rooting reflex will help your baby to find the nipple. Just wait for the open mouth and bring your baby nice and close. The tongue will come forward and you baby will latch on. Most of the time this ensures a good, natural attachment. If you have trouble or feel unsure, ask for help.
- Bring the baby to the breast rather than the breast to the baby.
- You might find it helpful to support your baby behind the shoulders as you bring it to the breast in quick, gentle motion.
- Don’t push your baby’s head onto the breast. This may mean the nose coming in contact with the breast and baby will have to pull off to breath.
How do I know my baby is well-attached to the breast?
The number one golden rule of proper attachment is: If it feels right, it is right. If it hurts or is causing damage to the nipple then you need to consider attachment in more detail.
The tips below are a guideline only. If you and your baby are both comfortable and there is no pain associated with feeding beyond the initial stretching of the nipple then you and your baby are doing it right.
Tips for good attachment (or latch)
- Your baby’s mouth will completely cover the nipple and be well over the areola- Often referred to as a good mouthful of breast.
- The tongue will be underneath the nipple
- The top and bottom lip will open out over the breast
- The chin touching the breast and the nose clear
This is a great video about getting a good latch from Ameda.
Getting off to a good start
Breastfeed your baby as soon as possible after the birth
Most newborns can be put to breast within minutes of birth. Surprising research has shown that given the chance, babies only minutes old will crawl up to the breast from the mother’s abdomen, and start breastfeeding all by themselves. This process may take up to an hour or longer, but the mother and baby should be given this time together to start learning about each other. Babies who “self-attach” run into far fewer breastfeeding problems. This process does not take any effort on the mother’s part, and allows for the mother to birth the placenta naturally and rest after the birth.
Keep your baby close
There is absolutely no medical reason for healthy mothers and babies to be separated from each other, even for short periods. There are still some hospitals in Australia which have routine separations of mothers and babies after birth and are years behind the times. Most of the time the reason is so that Mum can get some rest.
There is no evidence that mothers who are separated from their babies are better rested. On the contrary, they tend to be more rested and less stressed when they are with their babies. Mothers and babies learn how to sleep in the same rhythm. This means that when the baby starts waking for a feed, the mother is also starting to wake up naturally. This is not as tiring for the mother as being awakened from a deep sleep by a well meaning nurse telling her that it is time to feed her baby.
The baby shows signs that its time for a feed long before crying. The baby’s breathing may change or it may start to stretch. The mother, being in light sleep, will wake up, her milk will usually have a let down and the calm baby will be happy to breastfeed. If the baby is spending the night in the nursery, it may have been crying for some time before being brought to it’s mother for feeding and may refuse to take the breast even if he is really hungry simply because it is too upset. Keeping your baby as close as possible while in hospital is a great way for you to rest while your baby feeds contentedly and builds up a good supply.
Breastfeed according to need
Unrestricted breastfeeding is the key to establishing milk supply and preventing many difficulties. This means offering the breast whenever baby show signs of hunger during the day and throughout the night It also means letting your baby finish the feed in their own time and coming off the breast when ever they are ready rather than after a certain amount of time.
Babies have different feeding needs. They may need to feed as many as 10-15 times in 24 hours or a few as 6-8 times. Some feed fast, some feed slowly. Some stop and start frequently. If you let your baby tell you when it’s ready for food, you will always know you meeting its needs.
You can’t over feed a baby on breastmilk. Their appetite for breastmilk will match their need and the better you are at letting go and allowing your baby to control that need, the more successful you will be at breastfeeding.
Another thing to keep in mind is that feeding patterns change often. A baby that was content with 6 feeds a day may well start wanting to feed 12 times. This often occurs in times of appetite increase and serves the purpose of increasing you milk supply. The feeding pattern generally settles down again after a few days.
Avoid the use of bottles
There are three major reasons for this.
The first is that it is a different mouth action required to drink from a bottle than from the breast. It will be harder for the baby to learn good attachment at the breast if it has to adapt to both breast and bottle. Poor attachment can lead to painful breastfeeding, cracked nipples and incomplete emptying. These things can lead to low supply problems and more often than not, early weaning.
Secondly, some babies will take whatever method gives them a quick feed and may refuse the breast because it is a slower flow of milk. In the first few days, when the mother is producing only a little bit of milk, and the baby gets a bottle that gives him a fast flow, it may prefer the fastest flow method. Also be aware that even if a baby will take both the bottle and the breast the bottle will still be affecting the delicate balance of successful breastfeeding, even if it is expressed breast milk. There are alternatives available if the baby has a need for supplementation with formula. If you are in hospital have been told that your baby needs a bottle, I encourage you to ask to see a lactation consultant who will be able to help you through any attachment problems and may give you a supplemental feeding system if required. This is a system which allows supplemental formula feeds to be taken from the breast via a thin tube. This means that you are still getting the hormonal stimulation of the baby at the breast and it is as close as possible to a normal breastfeeding situation for your baby.
Thirdly, giving a bottle interferes with the golden rule of breastfeeding. Supply=Demand. If the baby is taking the milk from a bottle, it’s not taking milk from the breast. This means you make less milk. Some people believe you can get around this by expressing your breastmilk. The problem with this is that no matter how good a quality it is, whether you are pumping by hand or using a $1000 machine, no pump is going to be as good at getting the milk out of the breast as the baby is. You may not be completely emptying the breast with the pump which can again lead to low supply. Also, you don’t get as much hormonal stimulation from a pump. You get some stimulation of the nerves in the nipple, but it’s harder to get the loving, bonding warm and fuzzy feelings of holding your baby close from a pump. Those feelings make milk.
So what do I say to a Dad that wants to feed his baby a bottle, so that he can bond with and nurture his baby too? What about the tired Mum who just needs a 4 hour stretch of sleep and has someone there ready and willing to feed her baby for her?
To this I say: Dad can do everything but feed the baby. There are plenty of other things that he can do. He can change nappies, have a bath with his baby, hold his baby between breastfeeds or carry baby around in a sling. And don’t forget about the general house hold chores that need doing. Washing clothes, dishes and preparing meals are great ways to nurture your new baby by taking the load off and nurturing its new Mum. Let Mum concentrate on making milk. That’s the only thing that Dads can’t do.
Ensure you have good attachment at the breast.
If you are in hospital, ask a midwife or better still a lactation consultant to watch you feed. If at home, consider getting a privet lactation consultant to visit you or perhaps have an experienced breastfeeder watch you. Often this will give a nervous new Mum the confidence to know that she is doing it properly and that the baby is latching on correctly. If your baby is attaching well you are more likely to establish a good supply and breastfeeding will be a comfortable experience.
If you are being told your two day old babies attachment is good despite your having very sore nipples, be sceptical, and ask for help from someone who knows.
Don’t stock up on formula while you are pregnant just in case.
If you need to use formula, go and get it when you really know you need it. If you have it on hand just in case, you are very likely to reach for it the very first time you find yourself with a screaming baby even after you’ve tried every single thing you can think of that might help.
If you find yourself in a situation where your baby can’t feed, you need to get medical attention. If you think your baby is not getting enough milk, you need help with breastfeeding. Call the ABA helpline on 1800mum2mum and talk to someone and get some initial advice. Get a lactation consultant in to help and feed, feed, feed! If your baby is on the breast, they are getting some milk. There is never no milk coming out, even when it feels like it. “But I need formula because the baby is not getting enough!” This may be the case, but, more likely, you haven’t been given good help and the baby is simply not getting your milk effectively. This problem can be overcome with good help as soon as the problem develops.
Remember that babies cry for other reasons other than hunger. Go through the How do I know my baby is getting enough milk check list below to help you know if your baby is getting enough. If your baby is under 7 days old and you’re worried that baby is not getting enough, go to hospital and get help straight away.
How do I know my Baby is getting enough milk?
This is such a common concern for mothers. I have spoken to many mothers who say they would feel more comfortable giving their baby a bottle because that way they can measure how much is going in. A bottle is not a good solution here since this can create supply problems, blocked ducts and general interference in what is a delicate balance of supply and demand.
Here is a check list to help you to know that your baby is getting plenty of milk
- Are you feeding your baby according to its need rather than a schedule?
Yes- Super! This the best way to ensure you will maintain a good supply that meets your baby’s needs exactly.
No- Start doing so ASAP, your breasts will quickly adjust to your babies needs and you will be meeting your baby’s appetite in no time.
- Does your baby have at least 6 pale wet cloth or 4-5 heavy wet disposable nappies in a 24 hour period?
Yes- Super, this is the best sign that you are meeting your baby’s needs!
No- Check that you have a good attachment and start following the guidelines for increasing your supply. You might find it helpful to see a lactation consultant or to speak with a breastfeeding counsellor.
- Is your baby generally content even though there may be times of fussiness, wakefulness and unsettled behaviour?
Yes- Well done!
No- Check that you have a good attachment and start following the guidelines for increasing your supply. You might find it helpful to find a lactation consultant or to speak with a breastfeeding counsellor.
- Are your baby’s eyes bright and does baby have good skin tone? If you gently pinch the skin does it spring back into place?
Yes - Great!
No - This is a sign of dehydration. I suggest you take your baby to a hospital and not only get help for your baby but demand help with breastfeeding. Ask to see a lactation consultant to check your baby is attaching properly and to help you get started with a supplemental nursing system while you work at increasing your supply. In this instance a bottle of formula may be necessary to help rehydrate your baby while you get the help you need to get started with a supplemental nursing system.
- Has you baby been gaining any weight and grown in length?
Yes - Keep up the good work!
No - This is the least reliable indicator that your baby is getting enough milk. Different scales measure differently and a baby can weigh much less or much more depending on when they last emptied their bowels, weather they had a heavy wet nappy on last time and what clothes they wear during each weighing. Also keep in mind that a baby will lose a little weight after the birth and it can take a bit of time to regain this, especially if your baby got off to a rocky start with medical problems following the birth. If all the other indicators are there but your baby doesn’t appear to have put on any weight or to have grown in length, just make sure you have a good attachment, you are feeding when your baby wants to be fed and continue to check for the other indicators. If you are concerned speak to a breastfeeding counsellor or a lactation consultant.
If it doesn’t work out
Sometimes in spite of a mothers best efforts and all the encouragement and support in the world, breastfeeding challenges can not be conquered.
While it is uncommon for a woman to not physically be able to produce enough milk, breastfeeding can be overwhelming for other reasons, such as a baby that does not suck well or extreme tiredness and depression. Many mothers have managed to overcome these types of problems with lots of patience and support; others have had to make the decision to wean. If you feel that weaning is the best option for your family, give your self a pat on the back for persevering for as long as you have and remember that even a little breast milk is going to give your baby many of the benefits of breastfeeding. This is especially the case if you baby has received your colostrum which is rich is immune factors and will help build a strong immune system.