Breastfeeding

GOOD POSITIONING AND ALIGNMENT: Have the mother sit up as much as possible. Add enough pillows so that the baby's mouth is at the height of the nipple and the mother can relax her biceps. Roll the baby toward the mother so that they are "tummy to tummy, chest to chest, nose and chin must touch the breast."

SKIN TO SKIN: Babies learn better and are more stimulated during a feeding if you nurse the baby in a diaper only in direct contact with mom's skin, rather than fully dressed, especially when the baby is learning to breastfeed.

NOSE ACROSS FROM NIPPLE: Ensure that the baby's neck is not bent with its chin on its chest before latching on. Particularly with the football hold, move the baby way back so its nose is across from the nipple when the breast is in a relaxed (not pulled) position. This is an Asymmetrical Latch.

HOLD BABY'S HEAD: In the beginning, babies benefit by having help to achieve an excellent latch. Holding the head behind the ears also allows control over the timing. Hold the baby just a little away from the breast so you can see when the baby opens wide. If the baby consistently arches away from the breast, honor that, then gently encourage another try.

SHAPE THE BREAST IN ALIGNMENT WITH MOUTH: Would you take a bite of a big bagel sandwich if it was perpendicular to your mouth? No matter what the nipple looks like, by "pinching" the breast into a definitive shape, the baby knows where to put his gums. Usually the margin of the areola is a good guide for the thumb and forefinger. Use only a "C" or "U" hold, depending whether the baby's mouth is vertical or horizontal. Beware that you place your fingers other than where the baby's gums need to go!

EXPRESS COLOSTRUM: This is a perfect time to learn to express colostrum. The taste can tantalize a baby into rooting behavior and good suckling.

BRUSH, WAIT, AND SWING: BRUSH the lips with the nipple to encourage the rooting reflex. WAIT for the wide mouth, then plant the lower lip and SWING the nose around to touch the breast. The last thing to flip into the mouth is the nipple.

DON'T LET GO: A common mistake is to immediately let go of the "pinched" breast. Don't do this until you believe that the baby is committed to suckling; otherwise the breast becomes more ambiguous in the mouth.

INVESTIGATE: We think the baby's mouth was wide open, but we need to be certain. Carefully push the breast in until you can see the corner of the baby's mouth. Both lips should be flanged and the angle of the jaw should be 140 degrees. If it's not that wide, fix it! Either attempt to relatch with wide mouth as described above, or as the baby is sucking, apply counter pressure to the back of the head while pulling down on the chin. Do this until you feel the jaw relax. It may take several attempts.

DOUBLE-CHECK THE LATCH: If you had to fix the latch, visually inspect the jaw angle to make sure that you've achieved your goal. Also, whenever the baby takes a long pause during the feeding and starts to nurse again, double-check the latch to ensure the jaw angle is 140 degrees. If not, fix it.

THE PERFECT LATCH: The baby's head is tilted slightly back with chin well in against the breast and held in firmly against the shoulders, thus keeping the baby uncurled. The angle of the jaw is 130 to 140 degrees.

OTHER CONSIDERATIONS

Patience and time: Learning takes time; try again later if necessary. Baby may be sleepy the first 24 hours and not nurse well. By the second day baby needs to nurse because his reserves are down.

          Suck training: Babies can get the suck organized by sucking on a finger for a minute or two. Stimulate the palate as necessary. The tongue should be cupped around the finger and should be pulling back.

          Excessively sleepy or disinterested baby: Use colostrum to invigorate the baby as needed. Thoroughly wake the baby before latching.

          Excessive tension or clamping: Gentle jaw massage and oral assessment may be revealing.

          Excessive spitting up of mucus/fluid: Baby probably doesn't feel like eating.

          Try a different position or the other breast after making a good effort using the tips above. Nurse for a minimum of 10 minutes per breast so that baby will get both foremilk and hindmilk. If the baby comes off the breast after 5 minutes, put him back on the same breast. Nursing at one breast for a long feeding is fine if using one breast per feeding. The baby is done feeding when he is contented, satisfied, and no longer swallows with breast compression. He should be having has lots of wet diapers and 4 to 8 bowel movements each day. Additional water is not needed.

          If no latch is achieved by 12 hours postpartum, mom should begin double pumping (both breasts at the same time for 15 minutes) every three hours.

          If latch is not achieved in the first 24 hours, seek immediate assistance from your care provider. Options are available to continue to practice breastfeeding and supplementing at the same time.

WORKING MOTHERS: If returning to work or school, double pumping will encourage better milk production. This means pumping both breasts simultaneously using a breast pump, such as Ameda or Medela.

Erin McCarter, RN, LE, shared these great breastfeeding helps at the IMC Summer Retreat, July 2006.

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