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Breastfeeding Tips and Tools

October 20, 2014

Breastfeeding has well-established benefits for both mom and baby; it fosters the development of the infant’s immune system, strengthens the maternal-infant bond, has economic advantages over formula feeding, helps mothers return to their pre-pregnancy weight and might even act as a buffer against type 2 diabetes and obesity for the infant.

Furthermore, breast milk provides the perfect balance of carbohydrates, fats, and protein while providing necessary vitamins and minerals that no formula can match. As for the mother, convincing evidence exists to suggest that breastfeeding can also help reduce risk of ovarian cancer and osteoporosis.

The American Academy of Pediatrics recommends exclusive breastfeeding for the first 6 months of life, and continuous breastfeeding throughout the introduction of complementary foods for 1 year, or as long as mothers choose. While the benefits of breastfeeding are well established, some mothers run into some barriers to breastfeeding and don’t always have access to a lactation consultant. Here are a few tips for moms who are or plan to breastfeed:

Choosing a Baby Friendly Hospital - If you’re a mother who plans on breastfeeding, one of the best things that you can do is to plan to have your baby at a "Baby Friendly Hospital". The World Health Organization (WHO) and the United Nations Children’s Fund (UNICEF) started the Baby Friendly Hospital Initiative to encourage breastfeeding by all mothers. Hospitals that are certified as baby friendly have staff that are trained to ensure mother’s can successfully and confidently breastfeed before going home. An up-to-date list of Baby Friendly Hospitals can be found here. For those who cannot find a Baby Friendly Hospital near them, they can seek out a Certified Nurse-Midwife here and Certified Lactation Consultants here.

Successful Latching - Getting an infant properly latched onto a breast can prove challenging for some moms, and improper latching may lead to pain or concern about adequate milk production. Comfortably support yourself, especially your back, shoulders, neck and legs. Position your baby close to you, belly to belly, so he/she does not have to turn his/her head to reach your breasts. The baby’s nose and mouth should be facing your nipple. Try some different holding positions to see which is most comfortable for you and the baby. Some common positions are laid back, cradle, cross-cradle, clutch/football, and side lying. Support your breast so it is not pressing on your baby’s chin. Your baby’s chin should drive into your breast.

Latch baby onto your breast when your baby’s mouth is open wide and pull your baby close by supporting his/her back. Make sure your baby is not only sucking on your nipple, but also the areola (the black area around the nipple). When squeezing the breast to shape it for an easy latch on, mothers should keep their index finger and thumb at least one or two inches back from the areola. When shaping the breast, the index finger and thumb should be making a ‘U’ shape, not a ‘C’ - fingers in the ‘U’ shape allow the breast to more easily fit the mouth of the infant. When ready to feed, touch the nipple to the baby’s upper lip. Wait for the infant to open his/her mouth (like yawning) and tip his head up as he/she searches for the nipple. Bring the baby to the breast (not the breast to the baby) and ensure that the baby’s lower jaw is far below the nipple, not at the base of the nipple. When he/she does so, aim the nipple to the roof of the baby’s mouth, bringing the baby very close to you, chin first. The nipple should be placed in the back of mouth and the infant’s chin will be pressed into the breast. His/her nose will be touching the breast but do not worry, the baby is still able to breathe. To make sure the baby is breathing pay attention to the sounds he/she is making of swallowing and breathing.

Feeding Suggestions - In the first several weeks, start breastfeeding about every 2 hours. A newborn may feed 8-12 times per day or on demand (some babies can eat even every hour!). Around 4 months, this may decrease to 4-6 times per day, but the quantity of milk your baby eats will increase per feeding. Follow cues from the baby to know when he/she is satisfied. If the baby falls asleep, this does not necessarily mean he/she is finished. Tickle his/her feet or cheeks to wake up the baby and allow him/her to continue feeding. The baby will naturally stop suckling when he/she is satisfied. Cow’s milk, goat’s milk, soymilk or other dairy should not be given because your baby’s body cannot handle the kind of protein of these milks. No other drinks (water, juice, soda, etc.) should be fed to the baby. Other drinks are not going to provide the nutrients the baby needs to grow healthy.

Adequacy of Milk Supply - The majority of mothers have an adequate milk supply. In fact, many mothers overproduce milk - the more you continue to breast feed, the more milk your breasts will produce. . Many mothers, however, choose to stop breastfeeding because they feel that they cannot produce enough milk to keep up with an infant’s needs. One thing that is extremely important for new or expecting mothers to understand is the size of the infant’s stomach. A newborn infant’s stomach is about the size of a marble, and only holds 5-7mL of fluid; as the infant grows, its stomach will grow too. Infants need to feed frequently and feeds may be short (all infants are different and vary in the length/frequency of feeds). Frequent feeding is not only essential for the baby’s growth, but it also encourages the production of milk. Milk production works kind of like supply and demand - if there is regular, frequent infant demand, the breast will respond with plenty of supply! Another important thing to understand is that night feeding is essential and very normal (the hormone prolactin, which tells the breasts to make milk, is highest at night!). One easy way to be sure that your infant is getting enough milk is frequent wet diapers (at least 6 -8 every 24hours), with odorless, relatively colorless pee. Adequacy of the milk supply cannot be determined by the breast size, how much milk is expressed, the softness of the breast.

Painful Nipples - Tender nipples are common in the first few days of breastfeeding. However, if breastfeeding hurts the nipple, it usually due to improper latching of the infant onto the breast. If you feel any pain, gently place your pinky finger in your baby’s mouth to detach him/her from the breast and start all over again. Soon your baby will learn the correct way to latch every time. As discussed above in successful latching, it is important for the infant’s lower jaw is far below the base of the nipple; if it is not, the baby will be sucking directly on the nipple and this can lead to pain/discomfort. Alternating the breasts may alleviate soreness as well (offer the less sore side first). Using cool or warm compresses can held to aid nipple pain, as well as using vitamin A and D or purified lanolin ointments. If nipple pain prevents a mother from emptying her breast, it’s important to pump or hand express the milk to prevent engorgement - the pumped milk can be used to feed the infant. Regular vitamin E oil use should be avoided, as it can be toxic to the infant. If pain persists, your healthcare provider can watch a feed and make suggestions for mothers to improve the feeding mode..

Embarrassment about Public Feeding - One reason commonly cited by mothers for not breastfeeding is the embarrassment about public breastfeeding. There are currently no laws in the U.S. that prevent mothers from breastfeeding outside of the home (note: Illinois and Missouri do have some restrictions on public breastfeeding). It’s important for mothers to understand that it is their choice to breastfeed when, where and how they choose to - and that can include in public, covered or uncovered. Infants should be able to eat wherever any other person can. There are a number of movements to encourage mothers to breastfeed in public and breakdown the cultural barriers that deem it inappropriate. It’s important for individuals to support mothers who choose to breastfeed. Mothers can find breastfeeding support groups through LaLecheLeague International. For mothers who choose not to breastfeed in public, it’s important to find designated Baby Feeding rooms or private rooms where they and their infant can comfortably feed.

Final Words of Guidance - Formula feedings will reduce your baby's demand for breast milk, which will lower your milk production. To maintain your milk supply, it's important to pump anytime your baby has a formula feeding. Remember, the more you breast-feed your baby or pump while you're apart, the more milk you'll produce. It also helps to pump extra milk — either after or between breast-feeding sessions — and freeze it for future use. Drink plenty of fluids: Water and milk can help you stay hydrated, which promotes milk production. Limit soda, coffee and other caffeinated drinks, though. Too much caffeine may lead to irritability or interfere with your baby's sleep. If you choose to have an occasional alcoholic drink, avoid breast-feeding for two hours afterward. Don't smoke. Aside from the well-known dangers of smoking, smoking can reduce your milk supply and the nicotine in your breast milk may change the taste of the milk and interfere with your baby's sleep. If you smoke, ask your doctor for options to help you quit. In the meantime, avoid smoking just before or during a feeding. Take care of yourself. Eat plenty of fruits, vegetables, healthy fats and whole grains. Include physical activity in your daily routine. Also consider your birth control options. Birth control pills that contain estrogen may interfere with milk production. While you're breast-feeding, you may want to use condoms or other forms of birth control. Store your milk when you can. You can store breast milk under refrigeration in a plastic or glass bottle with a sealable top, or in a sterile, sealable bag. Store your breast milk in amounts that you use every day to avoid wasting it. For example, if your baby eats 4 ounces in a feeding, put 4 ounces of breast milk in the storage container. Be sure to properly label each container with the date & time of when it was pumped. The following are some general breast milk storage guidelines:

- At room temperature (less than 77°F) for 4 to 8 hours

- At the back of a refrigerator for 3 to 8 days

- At the back of a freezer for up to 3 months

As always, it’s important for mothers to discuss her and her infant’s needs with their primary healthcare provider. None of this advice is meant to replace the individualized recommendations of a physician, dietitian, or lactation expert. Breastfeeding is extremely important for both mother and baby, and proper support and education can usually lead to successful breastfeeding. Mothers who choose not to breastfeed should discuss the best alternative with their healthcare team. Many options exist including bottle feeding with a mother’s own milk, using donor milk, using formulas or some combination of these. It is equally as important for mothers to take care of themselves as well as their baby, so maintaining one’s health is paramount. For more questions about Breastfeeding or feeding children of all ages, just ASK THE SAGE!

Happy Feeding!

Kevin Klatt, Nutritionist + Assistant Site Manager

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