Breastfeeding can be a very rewarding part of being a mother. It can also be very stressful. Being prepared and getting off to a good start can make all the difference. Educating yourself on the basics of breastfeeding can help you be more successful.
Preparing for breastfeeding can begin while you are still pregnant.
- Attend a breastfeeding class. Many hospitals offer breastfeeding classes.
- Develop relationships with friends who are breastfeeding or who have breastfed their children.
- Locate your local LLL (La Leche League ) for mother to mother breastfeeding support (3).
- Read breastfeeding books (see references at the end of this blog).
- If you have concerns about your nipples or breasts such as inverted nipples, prior breast surgery, or if you have implants- you may want to visit with a lactation consultant who can offer special support to help with your specific issues.
Once your baby is born, it is recommended that you initiate breastfeeding within the first hour if possible while your baby is alert and the rooting reflex is strong (1). Usually within about 2 hours after birth, the baby may become fatigued and will fall asleep and will be hard to arouse for many hours.
Colostrum is the first milk a baby receives from the breast. It is produced in the last months of pregnancy and is a very concentrated protein with very little fat or sugar. It has protective white blood cells and is easily digested (1). As the colostrum is removed from the breast, more mature milk will be be produced in the breast. This process takes about 2-3 days to occur.
Many women will notice that their breasts become larger, heavier, and appear swollen as the milk glands start to produce this mature milk. Frequent feedings help to lessen the chance of engorgement which happens when the breasts produce more milk than the baby is taking. Massaging the breast prior to nursing can help relieve engorgement and you may even need to hand express (squeeze out) some milk to slow the nipple to soften enough for the baby to latch onto correctly.
You may also develop a low grade fever while milk is coming in, and breasts may feel tender and lumpy. This normally lasts about 24-48 hours. You should wear a supportive nursing bra that is appropriately sized, massage breast prior to feeding and apply ice packs after feeding to help with pain.
Some nipple tenderness and breast soreness is normal especially for first time mothers. However, pain throughout the feeding, an unsatisfied infant or bleeding/blistered nipples requires extra care. A baby must have an adequately opened mouth to nurse and the correct latch where both lips are turned outward- called flanging. The whole nipple and most of the areola (the brown area around the nipple) should be in the baby's mouth. The baby will usually suck two to three times then swallow with a "kah" sound. If you have concerns that your baby is not latched on correctly, use your finger to gently break suction between the nipple and the baby's mouth, remove the breast, reposition the baby and try again. It is a learning process for birth mom and infant.
A visit with a lactation consultant can help pinpoint a poor latch or incorrect hold that may affect the baby's ability to nurse properly. The football hold is one of the best holding positions to give the mother control of her infant's head and visualize her breast and her infant's mouth.
Caring for the nipples can help prevent cracks, dryness, chafing and blisters. When you are bathing, do not apply soap to the nipples as it is very drying for the skin. A rinse with warm water is best. Allow your nipples to air dry after after each feeding, moist nipples placed into a nursing bra may encourage chafing and the growth of candida (yeast).
Cotton bras allow for good air circulation. Change nursing pads when they become wet as they can encourage yeast growth. When nipples are completely dry, you may apply some pure lanolin moisturizer to help protect the nipple tissue.
Leave any blisters or scabs alone- as opening the skin can cause bacterial infections. Cracks, blisters and abrasions are often the result of a poor latch or tongue tie. If this occurs, you will want to make sure your hold is correct and that your baby has a good latch with mouth wide open, whole nipple in mouth and is making appropriate nursing
If you cannot get a good latch, do not delay- have your baby evaluated by a pediatrician or lactation consultant. The longer a problem continues, the more difficult it may become to correct the problem.
The first few days of nursing may help to insure your milk supply. Babies typically nurse about 8-10 times every 24 hours (2). This averages out to a feeding about every 2-3 hours. Most babies will start out feeding even more frequently than this- some will nurse every hour until the more satisfying mature milk comes in. Many babies "cluster feed": which means they will nurse very frequently for 2-5 hours then take a longer 3-6 hour break. Other infants will want to nurse every 2 hours around the clock.
If your baby has been nursing for 15-20 minutes, you may want to burp him or her and then offer the other breast. Some babies may not burp, either way, offer the second breast to see if they are still interested. If your baby does not nurse from the second breast, start the next feeding with that breast to insure supply.
Getting breastfeeding off to a good start can be helped by keeping track of feedings during the day and the night. Recording feedings help a new mom have confidence her infant is adequately fed. Averages for wet diapers would be about 5-8 wet diapers in a 24 hour period (2). Some breastfed babies have a bowel movement every feeding and some may have only one a day or even skip a day or two.
Mothers should try to eat a healthy diet and get enough water to support herself and the making of breast milk and continue her prenatal vitamins. Rest whenever possible and utilize your support system to help with household chores and with any other children so you may focus on your newborn.
There are many rewards with breastfeeding. With support from the hospital staff, family and friends, other breastfeeding mothers and professionals such as lactation consultants, and the La Leche League, breastfeeding can be one of the most fulfilling activities of motherhood. Not to mention saving your family a bundle of money on feeding costs.
Getting the basics down can result in a successful start to a wonderful part of motherhood. Educate and prepare yourself. Don't be afraid to ask for help. As you learn to breastfeed your infant, your infant is also learning how to nurse- the rooting and sucking reflex are inherent but nursing takes time and practice to perfect. Knowing this before you begin your breastfeeding journey can make all the difference in your confidence.
- The Nursing Mother's Companion 4th ed. by Kathleen Huggins, R.N., M.S. 1999
- The Breastfeeding Book by Martha Sears, R.N. and William Sears, M.D. 2008
- La Leche League International at www.llli.org