Mother's Milk - Breastfeeding 101 - part I

BREAST FEEDING 101

Positions

I remember seeing this poster and thinking, "oh thats easy, great, BFing sorted!" I kid you not, I honestly thought that was all there was to it. And it turns out this is just the tip of the iceberg. Never mind everything else you need to know, these positions are just the basics, I've even had to feed my baby upside down ... here's why you need to have options.

The important thing to remember when choosing a position is that you and baby need to be comfortable. Before you settle into it, decide whether you can comfortably carry that position for an hour and don't be afraid to break latch and start again. If at first you don't have enough pillows, the right chair, the right stool etc for a position, you'll have to settle for one of the other positions, till you buy the right 'equipment'. The diagrams always make it look so simple, like all you need is a pillow. Hahahaha. Well, it does happen eventually, but in those first few weeks I bought a new device almost everyday, and at least 6 more pillows.

Remember if you're comfortable, you'll be relaxed (very important for baby's energy and your milk supply), you'll be less likely to shift position and change your latch, and you shouldn't have any muscle ache later.

I always imagined feeding time to be a great time to catch up on reading... surprise surprise, you need both your hands and your eyes to BF! Have a look at the positions above, it is imperative in the first few weeks that you have one hand on baby and one holding your breast correctly in her mouth.

Also remember that different positions drain different areas of your breast, so if you want to prevent engorgement (without the cabbage) you will need to swap occasionally. And, if your ducts are blocked in a specific area, there will be occasionally be a position you need to stick to till its drained.



Getting ready

What you need:

Adequate lighting. Breast feeding demands precision and attention at first. You need to see obvious things like baby's latch and subtle things like the movement of her ears while she drinks. Make sure you have a nightlight this is bright enough to see this but also dim enough so baby can go back to sleep easily.

A stable chair with the correct seat height and correct arm height. You want to get as close to the position you need to have baby's mouth be at the level of your nipple while sitting back comfortably. Rocking chairs are not great at first because you want the back to support your weight and hold your position

A footstool. For this you can use anything till you find the correct height for you. My lactation consultant suggested phone books, I eventually used a few novels and now I use one of those plastic stools for potty training.

"Brestfriend" have a great (very costly) stool that adjusts to different levels

[Incidentally, the lactation consultant also gave me a great tip for passing stools. Use the stool while you're seated on the toilet, with your bum as far back as possible and leaning forward. And drink a cup of warm water before you go. Trust me this will come in handy for that inevitable BFing constipation or postnatal anal fissures or painful piles.]

Pillows. At first I was using a wooden rocking chair and needed pillows to cushion my back and under my arms. I was then advised to buy a plastic garden chair, which also needed the same cushioning. Both required a cushion or 2 to hold baby up to the right height. I used a scatter cushion on my lap then placed my long preggy over that.
Understandably this all took some preparation before I could settle down to feed, and sometimes I even needed someone to hand me the baby after I set up. You can appreciate how this won't work when you're doing it 8 times a day and in the middle of the night.

I finally discovered the greatest invention for BFing since boobs!

THE BRESTFRIEND!

I found the brestfriend completely by accident at Baby City, and it changed my life completely. It cleverly attaches around your waist at any level you choose and offers both back support and support for baby. There's a gimicky side pocket for your nipple cream and water I guess, but nothing dramatically useful. So now I need no-one to help me and my bed is covered with useless pillows! 

So if we put it all together we should have something that looks like this:

much better than:














In second image you can see the mommy is hunched so she can reach baby, her legs are crossed to get baby up to her nipple level, she has little back support leaving her neck over-flexed. The chair has arm support but its useless at that height, if she rests her arms there her shoulders will bunch up and won't be very comfortable.

You will also need small towel or towelling nappy to place under your breasts. Breastfeeding can be a messy business!

Latching

Great, now that we're sitting comfortably, we need to latch baby to breast. You probably all know by now that baby has to have most of the areola in her mouth. The anatomy works so that the nipple is actually down baby's throat and she can stimulate the milk ducts with her tongue. If the nipple is not far down enough, her tongue is going to create a type of chafe on your nipple, also known as cracked nipples! :( If she isn't draining your breasts correctly, you are also at risk of developing blocked ducts and mastitis (breast fever) :(


This method worked best for me after trying a few, and is still the method I use when I've been a bit lazy and my nipples have taken strain....

When holding your baby in a cross-cradle hold, feeding on your right breast and holding baby with your left hand

step 1: Hold baby with your thumb just behind her right ear and 2 or 3 fingers around the left ear. You need to be able to 'steer' baby onto your breast, so be firm, but not so firm that you won't feel her pulling back if she needs to. Cradle the rest of her body on the crook of your arm so that the front of her body is facing your waist.

step 2: Locate 8 o'clock position on your right areola if top of your areola is 12 o'clock. At about 1cm from your nipple, place your thumb in that position and hold your breast. You will notice that if you push firmly enough, the nipple will point outwards, great, thats what you want!

step 3: 'Steer' baby, chin first toward your nipple and 'place' the bottom lip of her open mouth about 1cm from your nipple

step 4: This is tricky, but after a little practice gets very easy: Sweep the nipple into baby's mouth with your right hand while simultaneously tilting baby's mouth over and onto your nipple. 

To do this your right thumb sweeps from 8 o'clock, in a straight line, to 4 o'clock, and your left hand takes baby over and onto your nipple.

step 5: This is important! Check that baby is puckering her lips over your areola. Check that most of your areola is in her mouth. Allow 10 seconds of pain or discomfort, but the latch should be painless after that. If any of these are incorrect take baby off your breast! Do not pull her off, your nipple will follow.. painfully! Instead place a finger in the corner of her mouth and apply gentle pressure to open the mouth, then remove the baby from your breast.

Don't be afraid or hesitant to de-latch your baby! You will both suffer in the long run if you don't. Just keep trying to get it right. 

step 6: Once your baby is latched painlessly, continue to support her head gently with your left hand, and with the right hand, grib the breast just before the areola begins and squeeze it gently into a burger type shape, holding your hand in a C. This puts less pressure on your nipple, and you should feel a little relief as you do it. Remember that you may compress the ducts under your fingers, so don't hold it too firmly.

step 7: Watch that your baby is actually drinking and not just comfort sucking by trying to listen for a (very subtle) gulping/swallowing sound and watching to see if her ears are moving with each swallow.

also see video http://www.drmomma.org/2010/08/breastfeeding-latch-trick.html

Correct Latch

What next?

Knowing when your baby has finished a round of feeding is easy. In the first few weeks, newborns simply fall asleep and stop drinking (later they more obviously, pull away). They may continue to suck, but you will no longer hear any swallowing noises. Before you delatch, try to wake baby first by stimulating her with touch or sound. Speak to her, tickle her toes, rub her head, whatever works for you, and allow her to continue drinking again. If she cannot wake up, don't worry, delatch, then burp her in whichever way you prefer. (more about burping later) You can then return her to the same breast or swap to the other side depending on what is needed. A good way is to feed baby in one position, then swap to a different position on the same breast in round 2, allowing most of the breast to be emptied. An empty breast feels like it felt pre-pregnancy, supple and soft. This may be obvious to you but I didn't have empty breasts till a physiotherapist had to drain them, simply because I thought they were supposed to feel like rugby balls when you were breastfeeding!

Remember that babies feed in courses, sometimes they have a 5 course meal, sometimes they want a quick snack, sometimes they want a few seconds of dessert. You can't predict what they will want but you can make sure that they haven't fallen asleep at the dinner table without finishing their meal.


Please feel free to share your breastfeeding make or break moments in the comment box...