SOUTH CANTERBURY BREASTFEEDING HANDBOOK
South Canterbury Breastfeeding Handbook 1
Version 5 Updated May 2019 South Canterbury Breastfeeding Handbook 2
Best Practice for Maternity Units 5 Attachment / Bonding 6 Definitions 7 The Importance of Skin To Skin Contact 8 The Importance of Rooming In 8 Sleeping Safely At Home 9 Baby Led / Cue Based Breastfeeding 9 Early Feeding Cues 10 Baby’s Stomach Size 11 The Composition of Breast Milk 12
When Your Milk ‘Comes In’ 13
Baby’s Output 14 How Does Using A Dummy / Pacifier Or A Bottle Affect 15 Breastfeeding Latching Your Baby On Well 16 Breastfeeding Positions 18 Breastfeeding Tips If You Have A Caesarean Birth 20 Expressing and Storing Breast Milk 21 Returning to work 24 Solutions For Common Breastfeeding Challenges 25 Tiredness 25 Sleepy Baby 25 Painful Shallow Latch and Nipple Pain 25 Unsettled Hungry Baby 25
South Canterbury Breastfeeding Handbook 3
(continued)
Engorgement 26 Mastitis 26 Low Milk Supply 26 Supplementation 27 Reflux 27 Teething 27 Inverted Nipples 27 Alcohol and Other Drugs 28 Covid 19 Breastfeeding advice for Women & Babies 29 Red Flags 30 Preparing Yourself for Breastfeeding Before Your Baby is Born 31 How Your Family and Friends Can Support You 32 Introducing Solids 33 Where to go for Breastfeeding Support in South Canterbury 34 La Leche League 35
“BreastfeedingWorks!” 36 Plunket Well Child Provider 40 Arowhenua Whanau Services 41 Breastfeeding Friendly Places Around South Canterbury 42 My Breastfeeding Diary 43
South Canterbury Breastfeeding Handbook 4
New Zealand is working towards restoring breastfeeding as the cultural norm. A Baby Friendly Hospital protects supports and promotes breastfeeding by following these 10 Steps:
1. They have a written breastfeeding policy that is routinely communicated to all health care staff 2. Train all health care staff in skills necessary to implement this policy 3. Inform all pregnant women about the benefits and management of breastfeeding 4. Help mothers initiate breastfeeding within an hour of birth 5. Show mothers how to breastfeed and how to maintain lactation even if they should be separated from their infants 6. Give newborn infants no food or drink other than breast milk unless medically indicated 7. Practice rooming-in – allow mothers and infants to remain together – 24 hours a day 8. Encourage breastfeeding on demand 9. Give no artificial teats or pacifiers (also called dummies or soothers) to breastfeeding infants 10. Foster the establishment of breastfeeding support groups and refer mothers to them on discharge from the hospital or clinic (A joint WHO/UNICEF Statement 1989)
The World Health Organisation strongly recommends exclusive breastfeeding for the first six months of life. At six months other foods should be introduced but breast- feeding is recommended to continue for up to two years or beyond.
Jean Todd Maternity Unit has been accreditated for BFHI since 2004.
South Canterbury Breastfeeding Handbook 5
“You’ve probably heard plenty about the nutrition and immunities in human milk. But if you talk to most experienced breastfeeding mothers, they’re more likely to focus on the way breastfeeding helps you and your baby feel connected and attached to each other, weaving an emotional cord to replace the umbilical cord” Womanly Art of Breastfeeding 8th Edition.
All the hormones that course through a mother’s body during and after the birth of a baby are there to help the mother and baby establish their relationship and bond. The levels of these hormones are higher in exclusively breastfeeding mothers. As a mother breastfeeds her baby she also tends to gaze at him or her and touch them lovingly which also helps to build this strong attachment, which will help the baby throughout his or her life.
Continued breastfeeding causes these hormone levels to remain high and help the mother to be more caring and tuned in to her baby. They also reduce stress hormones in both mother and baby and help baby to better deal with stress even as an adult.
Other hormones create the feelings of pleasure that we get when touching our babies (and others we love). Breastfeeding creates many opportunities for mothers to touch their babies and feel this joy which also enhances bonding.
Father who lives with his partner and their baby also has changes in his hormones that help him to bond with both his partner and baby which enhances their relationship.
When babies cry, instinctively a mother wants to respond to her baby and hold it close. This responsiveness helps the baby’s brain pathways to be wired up to know that the world is trustworthy and they can feel secure. Breastfeeding also help these pathways to be strengthened, because of the frequent touch and pleasure in the whole experience.
If a mother experiences post natal depression, breastfeeding helps mother and baby develop this bond faster and stronger than it might otherwise have been if they were not breastfeeding.
Sometimes, if there are breastfeeding difficulties at first, it can take time for breastfeeding to become enjoyable but it is worth persevering to get to this point.
South Canterbury Breastfeeding Handbook 6
Exclusive breastfeeding is when the infant has never had water, formula or other liquids or solid foods. Only breast milk, from the breast or expressed, and prescribed medicines have been given from birth.
Full breastfeeding is when the infant has taken breast milk only, and no other liquids or solids except a minimal amount of water or prescribed medicines, in the past 48 hours.
Partial breastfeeding is when the infant has taken some breast milk and some infant formula or other liquids or solids in the past 48 hours.
Artificial feeding is when the infant has had no breast milk but has had alternative liquid such as infant formula, with or without solid food, in the past 48 hours.
Importance of breast milk: • All your baby needs to eat and drink for the first six months • Meets all nutritional requirements • Helps protect your baby against colds, tummy bugs, infections and allergies • Helps your baby feel safe and secure • Is always available, the right temperature, thirst quenching and free from contamination • The longer you breastfeed, the better it is for you and your baby (Ministry of Health)
Risks of using Infant Formula: • It is NOT the nutritional equivalent of breast milk • It is expensive • Requires time for preparation and cleaning and sterilising equipment • Increases your risk of bone thinning, osteoporosis, breast cancer and ovarian cancer • Does not help you lose pregnancy weight like breastfeeding can because breastfeeding increases energy output (like exercise) • Does not give your baby any protection from infection or help your baby’s immune system to develop.
South Canterbury Breastfeeding Handbook 7
Immediately after the birth your baby will be placed skin to skin with you.
Skin to skin contact is important because: • It assists with bonding and helps stabilise baby’s heart rhythm, breathing and temperature • It encourages breastfeeding, a latch usually occurs within 60 minutes, as long as there is no influence from drugs given during labour • For babies who may take longer to ‘latch on’ continued skin to skin for as long as possible can help these babies to get started. • Releases colostrum ready for the baby • Babies cry less (being separated from their mother increases the baby’s stress).
It is useful to continue having skin to skin contact if your baby is having feeding difficulties or is unsettled. If you are not able to have skin to skin contact with your baby, the baby’s father or another family member can do this instead.
Having a baby stay in the mother’s room after the birth, (“rooming in”) is important for breastfeeding because: • Rooming in supports women to respond to early feeding cues • It helps mothers get to know their baby’s cues, providing a great start to your relationship • It helps to initiate breastfeeding • It decreases the risk of breast engorgement • Being separated is stressful for the mother and the baby • It encourages bonding • It improves the infant’s sleep
South Canterbury Breastfeeding Handbook 8
The Ministry of Health recommends baby sleeps in their own bed (cot or bassinet) in the same room as their parent or caregiver. Babies who sleep in the same room as parents for the first six months are at lower risk of SUDI (Sudden Unexpected Death in Infancy).
You might find it easiest to keep baby’s cot next to you so that you can reach him or her when needed. Baby needs to be face up, face clear and not able to fall or become wedged between surfaces.
Make sure your baby is healthy and strong. If you choose to sleep in bed with your baby, put them in their own baby bed beside you—for example, a pepi pod or wahakura. This will help keep your baby safe while they are asleep. Information about using a pepi pod or wahakura is available online at www.whakawhetu.co.nz and www.pepi pod.co.nz
Baby led breastfeeding (feeding on demand) means allowing your baby to feed whenever he or she wants. Be prepared to breastfeed often because frequent unrestricted breastfeeding helps to establish a good milk supply. • Timing feeds does not help you establish a good milk supply. Let baby lead the way. Your baby should feed at least 8 12 times per day although some babies feed more frequently, until lactation is established. • It usually takes six to eight weeks for you and baby to establish breastfeeding. • Your baby will go through growth spurts and will want to feed more often than usual. This is temporary and if you respond to this by breastfeeding more, your milk supply will increase. • Growth spurts commonly happen in the first few days and at around 7 10 days, 2 3 weeks, 4 6 weeks, 3 months, 4 months, 6 months and 9 months. This is only a rough guide; each baby is different. • Cluster feeds happen more regularly and babies may feed often for a 3 4 hour period most days, often in the evening. • Learn to recognise and respond to your baby’s feeding cues. Once home keep your baby close, especially at night. This will help you respond to early feeding cues quickly.
South Canterbury Breastfeeding Handbook 9
By watching your baby you will know when he or she is starting to get ready to feed before they begin crying and get too agitated to focus on feeding.
South Canterbury Breastfeeding Handbook 10
Your baby’s stomach is tiny at birth and cannot hold much milk, so in the beginning the average size of a breastfeed is very small. This may help you understand why babies feed so often.
Day 1: Approximately 5 7 mls per feed (1 teaspoon) Day 3: Approximately 22 27 mls per feed 1 Week: Approximately 45 60 mls per feed 1 Month Approximately 80 150 mls per feed
Day 1 Day 3 1 Week 1 Month
South Canterbury Breastfeeding Handbook 11
Breast milk changes from the start to finish of a breastfeed, from morning to night, and also from day 1 to the day you stop breastfeeding.
First milk: Colostrum is the first milk produced and may be present during pregnancy. This thicker milk is called ‘liquid gold’.
Colostrum: • Is high in protein and fats • Is high in antibodies • Is produced in small amounts – infants get an average of 7-14mL per feed • Coats the baby’s gut with a protective lining • Promotes the protective good bacteria in baby’s bowel. It stimulates baby’s digestive system and helps to expel the first (black) bowel motions
Mature milk begins to be produced 30-60 hours after birth. By 2 weeks your milk no longer contains colostrum. Mature milk is loaded with important nutrients for your baby, including oligosaccahrides, (which act like a natural prebiotic), enzymes, long chain fatty acids and immune building nutrients.
Mature milk contains: • 85% water • Antibodies • Protein • Carbohydrates • Vitamins and minerals, includ- ing enough iron, with the enzyme the baby needs to absorb it, for at least the first six months (and after, alongside solid foods)
The content of mature milk gradually varies during a feed. At the beginning of a feed the ‘foremilk’ is thin and blue looking and this type of milk is thirst quenching for the baby. As the feed progresses the milk becomes creamier and contains more fat. This ‘hindmilk’ is more satisfying for baby.
South Canterbury Breastfeeding Handbook 12
Between 36 and 72 hours after the birth you should begin to notice your breasts feeling fuller. They may also feel hard, sore and lumpy. These changes are due to the increased volume of milk being produced and an increased blood supply to the breasts in order to produce the milk. Your body will gradually adjust to the amount of milk that your baby needs.
To reduce any discomfort you may feel during this period: • Allow your baby to breastfeed frequently to ensure your breasts do not become over full or engorged. • Gently massage the breast to help with milk flow, particularly in areas that are lumpy. • Hand express to prevent breasts becoming too engorged. • Massage breasts and hand express in a hot shower. • If your breasts begin to feel overfull, wake your baby and feed him/her. • Breastfeeding frequently and being responsive to your baby’s cues should help with most issues. • Talk to your midwife or LMC if there is pain or discomfort.
Removing milk from the breast will also: • Prevent further complications such as mastitis and abscess formation; • Help with continued milk production. It will not make your engorgement increase.
South Canterbury Breastfeeding Handbook 13
Expected urine Expected bowel output motions Colour Day 1 1 1 Black (meconium) Day 2 2 2 Black Day 3 3 3 Black/brown (changing) Day 4 4 3+ Brown/yellow (changing) Day 5 5 3+ Yellow Day 6 6 8 (thereafter) 3+ Yellow
• It is difficult to gauge urine output when a baby is wearing disposables. • Constipation does not occur in breastfed babies, and many babies have frequent bowel motions in the first month. After this it is not unusual for a baby to go 1 10 days between bowel motions. • Loose bowel motions are normal for a breastfed baby. • Consistent green, watery bowel motions or other types of diarrhoea** may indicate that a baby is sensitive to a food or a medication. These may also indicate that a mother is changing breasts too soon, known as a foremilk/hind milk imbalance. • If a baby has diarrhoea, it is important to avoid baby becoming dehydrated by breastfeeding frequently. • If your baby’s bowel motion has any trace of blood, ring your midwife or GP as soon as possible.
**Diarrhoea means at least 12 watery stools a day that have an offensive odour.
The changes in baby bowel motions...
Meconium Transitional (day 3 4) 6 Week poo
South Canterbury Breastfeeding Handbook 14
Avoid using bottles or dummies/pacifiers because it is important for your baby to breastfeed as long and as often as they want. Dummies/pacifiers and bottles can cause nipple confu- sion or interfere with your milk supply. If you wish to use these items, do so with caution and wait until breastfeeding is established, at least six weeks. Dummies and pacifiers should never be used in place of breastfeeding.
Why avoid bottles?
Baby offered bottle
Anxious Fast flow mother baby uses bottle suck
Baby full Hungry Sleepy at crying baby next breastfeed
Reduced Mother sucking makes less time at milk breast
South Canterbury Breastfeeding Handbook 15
It is very important for a mother and baby to learn to breastfeed with a good latch early on. This will minimise sore, cracked nipples and ensure your baby feeds well. Both of you are learning and it can take time to get it working.
What a good ‘latch on’ looks like: • Baby is lying with his tummy against your tummy; his nose touching your nipple. • Hold the breast in its natural position. • If necessary you could sandwich the breast to an easier shape to fit baby’s mouth. To do this... Keep fingers well back from the nipple where baby’s mouth needs to be. • You could tilt your nipple toward baby’s nose to make the tissue beneath the breast more accessible; this is where baby’s tongue and jaw need to work. • Tickling baby’s lower lip stimulates baby’s ‘open mouth’ reflex, baby’s tongue should be down and out slightly. • Wait for a wide open mouth so baby can take in a good amount of breast .
South Canterbury Breastfeeding Handbook 16
Bring baby to breast: • Aim nipple towards the roof of baby’s mouth. • Chin first: when the chin touches the breast baby knows to open their mouth wide. The bottom lip is away from the base of the nipple so baby can scoop the breast in with his/her tongue. • Quickly guide the baby to the breast. Very young babies open their mouths for only a short time so you may need patience to get the timing right. • The top lip should be just above the nipple. Wide Open Mouth • Check baby’s mouth is wide against the breast with lips flanged out (not rolled in). This creates a good seal, baby’s chin and nose and cheeks should be touching the breast. • Baby’s tongue should be cupped under the breast and be over the lower gum line.
Baby’s lips when latched well may resemble a K shape.
South Canterbury Breastfeeding Handbook 17
Special attention must be paid to positioning, particularly during the first week or two of breastfeeding. This makes it easier for your baby to latch on and makes you comfortable and relaxed so that you can hold your baby close without straining any muscles.
Positioning and latching checklist: • You are comfortable and well supported and if sitting, sit straight up or slightly reclined. • Baby is comfortable and ready to take the breast. • Baby’s whole body is turned towards the breast and his/her ear, shoulder, and hip are in line. • Baby’s bottom is tucked in close to the mother’s body. • Baby needs to be able to feed without having to turn his/her head. • Baby needs to be able to feed without having to strain upwards or down- wards to reach the breast. • Baby is supported across shoulders and at the base of head so that ba- by feels secure and can feed well. • Baby’s head is back slightly.
Note: A crying baby will need to be calmed first.
Baby well supported across base of An example of the Football Hold with a his head. pillow being used to support baby.
South Canterbury Breastfeeding Handbook 18
Different positions:
Football Transitional Cradle Side Lying Hold Hold Hold Position Useful in early Useful when Most well known Can be more days, especially learning to position and you comfortable if you if you have had breastfeed. may use this once had a caesarean. a Caesarean Useful if your baby you have gained Allows the mother or your baby is having difficulty confidence using to rest while was premature. latching or has the transitional baby feeds. Preferred by some low muscle tone, a hold. women with larger weak rooting reflex, breasts. or a weak suck.
The mother sits The mother’s palm Mother sits up The mother and up with the baby’s is placed on baby’s with baby’s head baby lie on their body tucked under upper back with resting on forearm sides facing each her arm at her thumb behind (not in crook of other with the side with his one ear and index elbow). Baby is baby’s knees pulled bottom finger and other on his/her side in close. Pillows or resting on a fingers on baby’s facing mother, with rolled up towels pillow near her cheek and neck to stomach and legs can help make elbow. support head. against her body. this position more Position baby’s comfortable. nose to nipple with his head directly
You may also consider biological nurturing, which is laid back breastfeeding in semi reclined positions. The baby is positioned on the mother with their head near the breast so that they can self attach. For more information about reclined positions, please refer to the Biological Nurturing website. www.biologicalnurturing.com
South Canterbury Breastfeeding Handbook 19
After a caesarean birth you will be recovering from major surgery, you will experience more pain and discomfort, you may not have easy access to your baby, depend on others more and stay in hospital longer.
Consider: • The type of anaesthetic that is used during a caesarean. If a regional anaesthetic is used and both mother and baby are alert and healthy, the baby can breastfeed in theatre or when you are back in the ward (when the mother should be temporarily free from pain). If a general anaesthetic is used, the mother may breastfeed as soon as she is alert enough to hold her baby. • Ask for skin to skin with your baby immediately following surgery. This will help initiate breastfeeding. • The baby’s father having skin to skin contact when you cannot. • Avoiding breast milk substitutes in the early days unless medically indicated. • Breastfeeding in the side lying or football position to avoid the baby’s weight putting pressure on the incision. • Good regular pain relief
Biological Nurturing is laid back breastfeeding, mothers neither sit upright nor do they lie on their sides or flat on their back. Instead, they are in comfortable semi reclined positions where every part of their body is supported especially their shoulders and neck. Then they lie their baby on their body so that baby’s head is somewhere near the breast. In other words mothers make the breast available. Baby lies prone or on their tummy, their body not flat but tilted up. In this way mothers can position babies in ways that avoid putting pressure on the wound. Mother and baby enjoying skin to skin contact immediately after a C Section
South Canterbury Breastfeeding Handbook 20
If mums aren’t able to be with their baby to breastfeed, then giving the baby expressed milk is the next best option. Some pregnant woman may express colostrum in late pregnancy if they or their baby have special needs. Discuss with your midwife. Collecting breast milk – this can be by hand expressing, or using a hand or machine pump. You should wash your hands and use clean equipment. After using the pump take it to pieces, rinse in cold water, wash in warm soapy water, and rinse the soap off then air dry. Sterilizing is needed for bottles and teats but not for pump pieces.
Expressing by hand
KEY POINTS • The thumb and finger positioning is taken from the nipple, not the areola, as areola size varies between women.
• Avoid: squeezing the breast (can cause bruising), pulling out the nipple and breast (can cause tissue damage), sliding on the breast (can cause skin burns). South Canterbury Breastfeeding Handbook 21
Keeping expressed breast milk Breast milk is a unique, living, biodynamic fluid with active properties. It is best stored in the back of the refrigerator or freezer where there is less temperature fluctuation.
Warm milk should not be added to cold milk or frozen milk. Once it is all cold from being in the fridge the same day milk can be mixed together.
Freezing expressed breast milk • Ice cube trays. • In glass or plastic bottles, milk storage packets, or food quality plastic bags. • In amounts from 60mls to 200mls (small amounts can avoid wastage). • Leave an air space at the top of the bottle to allow for expansion upon freezing.
Labelling the milk • Label with the date of expression so that you use the oldest milk first. • If the milk is going to where there is other expressed breast milk (e.g. childcare) write the baby’s full name on the container.
Transporting expressed breast milk • Store in a chilly bin with ice packs in contact with the bottles of milk for no longer than 24 hours.
Thawing frozen expressed breast milk • Thaw slowly in the refrigerator or place the container in warm water until thawed. Breast milk stored in zip lock bag and labelled • Once thawed, it may be with baby’s name and date when milk expressed. kept in the refrigerator, but not refrozen. • If the cream has settled on top, swirl gently to mix.
Name, Date and Time of Expressing on all breast milk to be stored.
South Canterbury Breastfeeding Handbook 22
Using expressed breast milk • Use the oldest milk first. • Heat expressed breast milk by placing the container of frozen milk into a jug or bowl of hot water and slowly warm to body temperature. • Do NOT use a microwave oven to heat breast milk, because the milk heats unevenly and may burn the babies mouth and it kills immune properties in the milk • Test with a drip of the milk onto your inner wrist • Containers should be washed in hot soapy water and then rinsed carefully. • If a baby is under 3 months then bottles and teats also need to be sterilised (boiling, steam, or sterilising solution).
Storage of Breast Milk Storage Comments Time
Stored at room temperature 4 hours Cover containers and keep them as (less than 26oC) cool as possible (e.g. surround the closed container with a cool towel to help to keep the milk cooler) Refrigerated breast milk 48 hours Store milk in the back of the main (less than 4oC) body of the refrigerator Frozen breast milk stored in Store milk towards the back of the the: freezer, where the temperature is most constant freezer box within a 2 weeks refrigerator - separate door fridge/ freez- 3 to 6 er months - separate deep freeze 6 to 12 months
Source: Food and Nutrition Guidelines for Healthy Infants and Toddlers (Aged 0 2) Ministry of Health October 2015 See Video Clip Ministry of Health NZ Website www.health.govt.nz
Donor Milk Parents who make an informed choice to source Donor Milk for their babies will be supported. Discuss the risks and benefits with your midwife and ask for the SCDHB leaflet “Sharing Breast Milk”. You will be asked to sign a form acknowledging your choice to give your baby Donor Milk.
Websites: • Human Milk 4 Human Babies - New Zealand Aotearoa www.hm4hb.net • health.govt.nz • Facebook Page - Milk Sharing NZ Piripoho Aotearoa
South Canterbury Breastfeeding Handbook 23
Returning to work You can return to work and continue to breastfeed your baby. There are lots of ways to manage this. Here are some options to consider: • Expressing and storing your breast milk so that someone else can feed your baby while you are at work. • Having your baby looked after near your work, so that you can go in your breaks and breastfeed your baby. • Having your baby with you at work. • Having someone bring your baby to you at work for breast feeds.
Reasons to continue breastfeeding: - As well as meeting your baby’s needs for nutrition, breastmilk is packed with antibodies which are very important especially if your baby will be around other babies and children in a child care setting. This means less sickness for your baby and less days off work for you. It is particularly good if you can breastfeed your baby in this environment, so you are exposed to the bugs there and are able to make the specific antibodies needed to keep your baby healthy. - It is a lovely way to reconnect with your baby at the end of your day at work. If you’re feeling guilty or conflicted about going back to work, continuing breastfeeding will help you feel you’re still doing your best for your baby. - Breastfeeding may help your little one with the emotional adjustment of the big change in both of your lives of separation.
Options to consider so you can continue breastfeeding your baby: - Discuss with your employer alternative hours or a more flexible arrangement e.g. part-time hours, longer lunch hour, some work from home, taking your baby to work or someone bring- ing your baby into you for a breastfeed, shorter workdays, working alternate days. - Your employer legally needs to provide you time (Unpaid Breaks) and appropriate space to express where reasonable and realistic. Advise your employer that research shows their support of you breastfeeding is a win-win situation – you’ll feel positive about your work place, and your job satisfaction and output will increase. You will also have less time off due to a healthier child. - The intensive pumping that may be required for a young baby is not forever. Once your baby starts on solids these can be given by the caregiver and you may not need to pump as much breastmilk. Partial breastfeeding still gives you many of the benefits of breastfeeding so is an alternative to full weaning
It is good to keep your breastfeeding options open when you return to work. It’s far easier to tweak arrangements while still breastfeeding (if things are not working out as planned) than it is to restart breastfeeding if you have stopped before resuming work. You are welcome to talk through your options with the many breastfeeding support services in South Canterbury: SCDHB Breastfeeding Advisors, LMC Midwives, Plunket Nurses, Plunket Karitane Fam- ily Centre staff, La Leche League Leaders, “Breastfeeding Works” Peer Counsellors.
Helpful Web Sites: • The Breastfeeding Friendly Workplaces website • Employment New Zealand Parental Leave website • Breastfeeding and Working – HealthEd (Health Promotion Agency and Ministry of health
South Canterbury Breastfeeding Handbook 24
Breastfeeding can have challenges, but often there are solutions.
Tiredness Unsettled baby • Turn off the phone • Is your baby hungry? Babies feed frequently (particularly in the early • Restrict visiting evening and during growth spurts) • Sleep when baby sleeps • Feed whenever baby stirs in early days • Accept all support offered • Check positioning and deep latch • Take good care of yourself and make sure • Change sides often. If too much milk you eat well and drink according to your thirst. may need to use one side a feed.
Compressing your breast while baby Sleepy baby feeds may increase his intake. Do this by • Keep baby with you supporting your breast with one hand (baby held in other arm) with your thumb placed • Look for early waking signs on one side of the breast and your other • Unwrap baby to wake up fingers on the other side. • Aim for at least 8 feeds/day • If sleepy while feeding, sit baby up and Watch for the baby’s drinking, and when try burping baby. Or try blowing lightly in the baby is nibbling at the breast and no their face longer drinking compress the breast by just squeezing and holding (not so hard that it • Hold baby skin to skin hurts and try not to change the shape of the • Switch breasts to encourage baby to areola). wake and keep sucking Use compression while the baby is sucking but not drinking! Painful latch and nipple pain Keep the pressure up until the baby is just • Begin on least sore breast sucking without drinking even with the • De latch if any pinching or pain. Try to compression, and then release the only latch baby on when their mouth is pressure, then move your hand to a open wide. different spot and keep the pressure up if • Try latching again from further below the baby is not drinking well. 3cm from the nipple base (A deep latch is • Try skin to skin to help baby settle comfortable and you should only feel • Try a bath with your baby and tugging) Breastfeed. Mum and baby can both • Experiment with different positions relax. • Apply expressed milk to the area after feedings • Use moist wound healing by applying a pea sized portion of lanolin to the nipples after feedings.
South Canterbury Breastfeeding Handbook 25
Engorgement normal and happens to most people, like • Avoid long periods of time without their baby seems to want to feed a lot feeding or expressing when having a growth spurt, their baby • Feed your baby or express enough seems to want to breastfeed constantly in milk to make you comfortable (by hand the evening or they have stopped leaking in the shower or by pump) milk. Babies often appear to be hungry in • Warmth will help the milk flow the early days, but they are simply doing • Cool compresses after feeds what they should to stimulate the breasts • Chilled cabbage leaves may reduce to produce milk and this is normal breastfed inflammation (washed to remove baby behaviour. pesticides and cut-out any hard stalks)
If you are wondering whether you Mastitis have enough milk consider the You may have breast redness, pain and whole picture: • Have your baby’s bowel movements possibly feel unwell with fever • Rest and feed, to clear any blockage and urine been ‘normal’ (page 12)? • Has your baby been gaining weight • Apply hot wheat bag or hot water bottle before feeding. adequately? • Start on sore side first. • Are you breastfeeding frequently and • Express milk if it is too painful to feed does your baby seem to be swallowing • Drink plenty of fluids while breastfeeding? • See a health professional for pain relief • Are you comfortable and free from and antibiotics pain while breastfeeding? • Avoid weaning during mastitis • Does your baby appear hungrier than • Latch with baby’s chin at red/sore spot normal? • Massage any lumps while feeding. • Some ice wrapped in wet flannels for a few If you think you don’t have enough minutes after feeds is good pain relief. milk: • Check positioning and latch, and ba- by’s swallowing • Offer several sides at each feed. Breasts go into higher production when
they are emptied more • Express milk after feeding to increase your supply
• Rest and have a lot of skin-to-skin contact with baby Mastitis • Feed your baby frequently • Avoid long intervals between feeds Milk supply • Night feeds are important for babies Almost all women at some point will wonder if growth and for milk supply. they have enough milk, but they don’t need to worry. They often worry about something that is Bnor South Canterbury Breastfeeding Handbook 26
• Consider whether your baby is going Reflux through a growth spurt. This may This is the flowing back of the stomach’s happen at any time, but a rough guide contents into the oesophagus, causing suggests: in first few days at home and damage to the lining and is different to at around 7 10 days, 2 3 weeks, 4 6 “spilling”. This can cause feeding problems weeks, 3 months, 4 months, 6 months and mimics colic in some babies. and 9 months. Growth spurts do not Symptoms may include mean low milk supply, but are a normal, • Choking and coughing temporary process where your baby • Back arching and head turning (baby feeds more to increase your supply. may do this to reduce pain) • Talk to your Midwife, Plunket Nurse, • Intense crying and irritability during and Breastfeeding Advisor / Lactation after feedings Consultant, La Leche League Leader • Feeding resistance and/or refusal. Possible or Breastfeeding Peer Counsellor. contributing factors are allergy or cow’s milk protein sensitivity or oversupply in the Supplementation mother. When this is necessary it can support Management may involve keeping baby’s breastfeeding: “head above bottom” (even when sleeping • If a baby is not latching or is separated and changing nappy) and short, frequent from the mother, spoons or syringes can feedings. be used to feed small amounts in the Switching the baby with reflux from breast early days when the mother’s milk hasn’t milk to formula can make reflux worse as come in. Cups can be used once the formula stays in the stomach longer. baby is receiving more milk. • The best alternatives to Teething breastfeeding are listed in order: • Baby’s teeth may begin to erupt from 1. Expressed breast milk from the mother. about 4 months of age. 2. Breast milk from a healthy • Sore gums can make breastfeeding wet nurse or a human milk bank uncomfortable for the baby. (not currently available here). • Consider this if baby is drooling more 3. Infant formula. than usual. • Feed the supplement after a breastfeed • It may help to allow the baby to chew on to ensure your baby gets as much breast something cold before breastfeeding. milk as possible • Continue to breastfeed frequently Inverted nipples • If a mother is trying to build up her supply • These are nipples that cannot be she can use a tube at the breast to feed compressed outward and may not the supplement while her baby is latched protrude or become erect when at the breast. stimulated or cold. This may occur • Talk to your Midwife, Plunket Nurse, naturally or be brought on by Breastfeeding Advisor / Lactation engorgement. Consultant, La Leche League Leader • There are different types and degrees of or Breastfeeding Peer Counsellor. inverted nipples, which may respond differently to breastfeeding.
South Canterbury Breastfeeding Handbook 27
She can also time the breastfeed so that alcohol has left her system before she breastfeeds. She may need to express milk while drinking because her breasts feel full, but this milk
should be thrown away.
Tobacco Babies should be kept Smokefree at all times. Inverted Nipple If you or your partner smoke, it is not safe to • Many flat or inverted nipples will not sleep in bed with your baby. The best thing cause breastfeeding problems as you can do is quit and become Smokefree, babies don’t ‘nipple feed’, they BUT even if you can’t you should still continue breastfeed. to breastfeed. Smoking increases the risk of Strategies: SUDI, colic and Respiratory Infections. Keep • Use optimal latch on techniques. breastfeeding - the benefits far outweigh the • Stimulate nipples before feedings by effects of nicotine in your breast milk, so don’t rolling the nipples between thumb and feel you need to stop breastfeeding. Smoke index finger for a couple of minutes and away from baby - exposure to smoke can be try to firm nipple by quickly touching more damaging than the nicotine in your with a moist, cold cloth or ice wrapped breast milk so smoke outside, always wash in a cloth. your hands after smoking, wear a jacket while • Pull back slightly on the breast tissue smoking and remove it when you return during latch-on to make the area more inside. Smoke after breastfeeding - nicotine defined. levels peak in the blood and milk soon after • Use a breast pump or other suction smoking a cigarette and decreases over time device to draw out a nipple immediately (half the amount after 95 minutes). By the before putting baby to breast. time baby is ready to feed again there will be • See a lactation consultant for skilled less nicotine in the milk. Monitor baby’s help. weight and your milk supply - smoking can reduce breast milk supply in some women and Alcohol can inhibit the letdown reflex. • Alcohol passes easily into Breast milk and is in the milk at the same level as in Marijuana the mother’s blood. Levels of alcohol in • Marijuana can have a significant effect on the the milk will only go down with time. breastfed baby. If a mother is a heavy user of Babies cannot metabolise alcohol well. marijuana then breastfeeding should be They can be affected in ways such as avoided. making them drowsy or fussy. Alcohol • After occasional use a mother may give can affect motor development skills previously expressed clean milk and should because babies have rapid and not breastfeed for at least several hours. complex brain development. A breast- • The level of marijuana in breast milk will be feeding mum can express milk prior to higher than in mother’s bloodstream and can drinking alcohol so there is alcohol be detected in the baby's body for 2 or 3 free milk available. weeks.
South Canterbury Breastfeeding Handbook 28
Date: 19 June 2020
COVID-19 BREASTFEEDING ADVICE FOR PREGNANT WOMEN AND BABIES
Breastfeeding is important to human health at all times, but especially in times of emergency as breastfeeding provides immunological protections to the breastfed child. Most often babies who are breastfed remain healthy even when their parents or other family members are unwell with an infectious illness.
Women who become infected with COVID-19 shortly before giving birth and begin breastfeeding, and those who become infected while they are breastfeeding, will produce specific antibodies and other critical immune factors in their milk, to protect their breastfed infant and enhance their infant’s immune responses.
If the women become unwell while breastfeeding their baby, it is important not to interrupt direct breastfeeding as their baby will have been exposed to the virus already, and will benefit most from continued direct breastfeeding at the breast.
Confirmed or probable COVID-19
There is no evidence of transmission of the virus in breastmilk.
It is ok for women to breastfeed if they are a confirmed or probable COVID-19 case, as it is beneficial to for the baby and the mother to continue breastfeeding. To reduce spread while breastfeeding, hand washing before feeding is essential. A surgical mask should also be worn during breastfeeding, and avoid kissing and touching the baby’s face.
If the women’s well enough, they should continue to breastfeed directly, while using the necessary precautions. This includes washing hands before and after contact with the baby (including feeding), avoiding coughing or sneezing on them, and cleaning/disinfecting contaminated surfaces – as should be done in all cases where anyone with confirmed or suspected COVID-19 interacts with others, including children.
If they are too unwell to breastfeed, they should express their milk and give it to the baby via a clean spoon, cup or bottle – all while following the same infection prevention methods.
Please contact your LMC, WellChild provider, GP or the SCDHB Breastfeeding advisors with any questions or concerns.
South Canterbury Breastfeeding Handbook 29
See a health professional if: The baby: • Appears unwell • Shows signs of dehydration (sunken fontanelle (the soft spots in baby’s skull), appears lethargic, skin losing resiliency, dry mouth, dry eyes, weak cry) • Not waking by him/herself for feeds • Has less than 2 dirty nappies (before 6 weeks old) in a 24 hour period • Has less than 6 wet nappies (before 6 weeks old) in a 24 hour period • Is feeding less than 8 times in 24 hours (before 6 weeks old) • If baby’s behaviour has changed • Has not latched and suckled within 8 hours of birth
You: • Have a sore breast with red streaks or pus or blood in your milk • Feel ill (like the flu), or your sore breast hasn’t improved within 24 hours • Feel depressed or very unhappy • If you feel overwhelmed or super tired • If you think something is wrong, do not hesitate to ask for assistance from your midwife, GP, Plunket Nurse or Breastfeeding Advisor / Lactation Consultant.
South Canterbury Breastfeeding Handbook 30
Here are some tips on how you can prepare yourself for breastfeeding before baby arrives (even if it isn’t your first baby):
Before your baby is born: • Attend La Leche League / “BreastfeedingWorks!” meetings and talk to people who are breastfeeding now • Attend breastfeeding classes at South Canterbury District Health Board • Read breastfeeding books and information • Talk to a Midwife, Breastfeeding Advisor / Lactation Consultant, La Leche League Leader or “BreastfeedingWorks!” Counsellor • Let others know that breastfeeding is important to you and how they can support you after the baby arrives • Let your LMC or midwife know if you have any concerns about the shape of your nipples. If you are unsure and are comfortable with the idea, she can have a look at them, refer you if necessary to the Breastfeeding Advisor / Lactation Consultant. • Watch ‘Breastfeeding Naturally Video’ NZ Ministry of Health. Available to view on www.health.govt.nz or on the Ministry of Health YouTube Channel.
After your baby is born: • Contact a Midwife, Plunket Nurse, Breastfeeding Advisor / Lactation Consultant, La Leche League Leader or “BreastfeedingWorks!” Counsellor • Continue attending group meetings – La Leche League and/or “BreastfeedingWorks!” meetings, coffee groups • Talk to someone if problems occur. Do this early before a minor problem develops into a major concern
South Canterbury Breastfeeding Handbook 31
• Look after and play with the baby while you rest • Bath the baby • Do the housework, cooking and shopping • Have skin to skin contact when you are not available • Help you to be comfortable when breastfeeding by getting pillows when needed • They can also fetch the TV remote, telephone, water and snacks for you while you’re breastfeeding • Help feed baby solids from 6 months
Baby burping techniques: • Hold the baby upright with her head on your shoulder. Support the head and back while you gently pat baby’s back with your other hand. If baby still hasn’t burped after several minutes, continue feeding and don’t worry; no baby burps every time. When finished, burp baby again and keep the baby in an upright position for 10 to 15 minutes so the baby doesn’t spit up. • Sit the baby on your lap, supporting the baby’s chest and head with one hand while patting the baby’s back with your other hand. • Lay the baby on your lap with the baby’s back up. Support the baby’s head so it is higher than the chest, and gently pat or rotate your hand on their back.
South Canterbury Breastfeeding Handbook 32
Breast milk is all your baby needs for the first six months. Once baby is 6 months they should gradually begin to get solid foods alongside breastfeeding (or formula feeding if not breastfeeding). Breastfeeding never stops being good for your child and you might breastfeed your baby for a year, or two, or longer. Before complementary foods can be introduced, the infant must be physically and physiologically able to cope with these. This means that your baby is ready to chew, swallow, and digest solid foods. The gradual transition to solids can be achieved by starting off by giving a milk feed before giving other foods, which are used as a ‘top up’ at the end. Then when the infant is older (e.g. 8 9 months), other foods can begin to be offered before the milk feed. Appropriate first foods include good sources of iron such as iron fortified cereals, vegetables, age appropriate meats, and vegetarian alternatives. Babies do not need to receive specially prepared baby foods and can feed themselves with appropriate finger foods. It is recommended that fat, salt, sugar, honey and other sweeteners are not added to infants’ food. These supply minimal nutrient benefit and may accustom the infant to their taste. New foods should be introduced one at a time, allowing two to four days between each new food to establish that the infant does not have an allergy to that food. This is a great time for other family members to get involved in feeding the baby. Further information is available on the Ministry of Health NZ Website www.health.govt.nz or Baby Led Weaning Information at www.rapleyweaning.com/assets/blwleaflet
South Canterbury Breastfeeding Handbook 33
South Canterbury DHB At Jean Todd one of the services that we are proud to offer the woman of South Canterbury is our Breastfeeding Advisors Service. We are an experienced team of two who are very passionate and willing to help you and your baby whatever the situation or query may be. We also work very closely with all the other health professionals that may be involved in your care, from the hospital and the community, e.g. your, Obstetrician, Midwife, Paediatrician, Plunket or Tamariki Ora nurse, and your GP. It is a free service that you can use during your pregnancy and any time following this that you are breastfeeding your baby, up to any age and any stage. There is no limit to the number or length of time for your visit. Some people may require several visits others may only wish to seek advice via a telephone conversation. Whatever your situation is we can always help, nothing is too big, too small, or too complicated. Our service allows us to spend time with mothers and babies, listen to their stories, concerns and what has been happening to them, we sit down with you and make an individualized plan.
Jean Todd Maternity Unit Breastfeeding Advisors Pauline Hole Katie Forman Helen Howes Lactation Consultant Lactation Back up Consultant Lactation We offer the following free services Registered Consultant • Antenatal education sessions one on one Midwife Registered Midwife • Visits in hospital • Telephone Counselling • Home visits • Breastfeeding classes monthly 4th Friday of the month. Ring Jean Todd Reception to register on 687 2140
We can help you with: • Establishing a milk supply • Positioning & Attachment • A premature baby • An unsettled baby • Sore nipples • Blocked duct / mastitis • Baby weight issues • Weaning • Working and breastfeeding • Milk expression and storage • Twins or a baby with special needs • Other breastfeeding challenges
Referrals from Health Professionals or you may self refer Monday to Friday 8.00am to 4.30pm Phone 03 687 2100 Extn 8966 or 0274 910 865
South Canterbury Breastfeeding Handbook 34
La Leche League At La Leche League you will find out all about breastfeeding - it’s not just for when you have breastfeeding problems. Whether you are pregnant or already breastfeeding you’ll find great ideas and support at La Leche League.
La Leche League Timaru holds monthly discussions where mothers can get information and support, borrow books and meet other breastfeeding mums. A wide range of breast- feeding and parenting topics are discussed, including why breastfeed, looking after a new baby, overcoming breastfeeding difficulties, nutrition and weaning. The discussion topics are flexible depending on the needs of those present. We can discuss any other breast- feeding issues and answer your specific breastfeeding questions.
Our free lending library offers a selection of books about childbirth, breastfeeding, nutrition and parenting.
When? The third Wednesday each month 10am - 12pm (except January)
Where? Timaru Parents Centre Rooms, 38 Stafford Street, Timaru
Who? Pregnant women, mothers, babies / older siblings all welcome
You can also phone a Leader for any further information, breastfeeding questions or support.
Amy and Sarah are your local Leaders. Amy has two boys and loves to help other moth- ers achieve their breastfeeding goals. Amy’s number is (022) 013 4329 or (03) 684 6475. Sarah is the mother of three breastfed children and enjoys her involvement with La Leche League and talking with breastfeeding mums. Sarah can be contacted on (03) 684 9851.
Receiving friendly and informed support can make a world of difference for you and your baby.
Find La Leche League on Facebook ‘La Leche League Timaru’
South Canterbury Breastfeeding Handbook 35
South Canterbury Breastfeeding Handbook 36
South Canterbury Breastfeeding Handbook 37
South Canterbury Breastfeeding Handbook 38
South Canterbury Breastfeeding Handbook 39
Well Child Providers
Kia Ora and welcome to the Plunket Whanau The first 1000 days of a child’s life are the most important time in their development. During those days proper support can make the difference of a lifetime. You have started a new journey that will be full of joys, love and laughter however it may have moments of stress, tiredness and uncertainty. We want to assure you that no matter what time of the day or night our focus is to be there to support you. You can enroll your baby with the Plunket service any time from the early weeks of your pregnancy or the midwife can refer you.
A Well Child Check involves an assessment of your child’s health and development, the provision of health/community information and support with parenting. Well Child checks are provided by Plunket Nurses who are Registered Nurses with Postgraduate Certificate in Primary Health Care Nursing. Community Karitane (Health Workers) work alongside the Plunket Nurses to provide additional support. A Plunket Nurse can provide a Well Child service from when your baby is 2 weeks of age. If you have not heard from your Plunket Nurse by the time your baby is 4 weeks of age please phone: (03) 688– 3520 or email: [email protected] Website: www.plunket.org.nz
PlunketLine is a free 24hr telephone helpline 0800 933 922 (free to cell phones). A PlunketLine nurse will answer your call and talk with you about any concerns before or between your Plunket Nurse visits. PlunketLine also have trained lactation consultants who can provide video consulta- tions re breastfeeding.
Postnatal Adjustment Service (03) 684 4159 This is a service to support women and their families who are struggling with the adjustment to parenting or mild/moderate postnatal distress. Self referrals can be made antenatally or postnatally.
Plunket Karitane Family Centre (03) 684 4967 Located at 3 Dee Street, Timaru. Open Monday, Tuesday, Wednesday and Friday 8.30am - 4pm with staff available to provide information and practical support at no charge.
Breastfeeding Support and Assistance includes: • 1 on 1 observation of breastfeeds • Information in regard to positioning • Support to recognise the signals and cues your baby gives you re feeding, sleep and winding • Support re settling and sleep positions • Information re working and breastfeeding, expressing and storage of milk • Referral to other appropriate services.
There is a library of parenting / breastfeeding resources to borrow and also premature baby clothes and breast pumps for loan / hire. The Family Centre is also a warm welcoming comfortable place to feed and change your baby. First time Parent group parenting sessions run weekly. On Thursday only open 10am - 3pm for feeding and changing.
South Canterbury Breastfeeding Handbook 40
Tamariki Ora Well Child—Well Child for Tamariki
Providing a wide range of integrated services to all Mᾱori and non Mᾱori living
within the Aoraki region
This free service provides health checks, education, support and follow up services to all pepe/tamariki from birth to five years and their Whanau/families.
Contact Details Phone: (03) 615 5180 Fax: (03) 615 5181 Address: 94 King Street, Temuka Website: www.aws.health.nz
We can help:
• Support from birth to establish breastfeeding • One on one breastfeeding help • Positioning • Frequency of feeds/lengths of feeds • Breast care • Winding positions • Infant massage to enhance bonding and attachment • Information, education and support with attachment • Information, education and support with immunisations • Nutrition • Stress relief • Sleeping positions
South Canterbury Breastfeeding Handbook 41
These sites have committed to providing a supportive environment; warm, safe and comfortable; for breastfeeding: Timaru ⚫ Aigantighe Art Gallery ⚫ South Canterbury Museum ⚫ Fale Pasifika ⚫ Karitane Family Centre ⚫ Parents Centre Timaru ⚫ Mocca Cafe ⚫ Parkside Play Centre ⚫ Kowhai Kindergarten ⚫ Active Learners ⚫ Creative Corner ELC ⚫ The Village Café Highfield ⚫ ABC Marchwiel ⚫ Gleniti Play Centre ⚫ Sopheze On The Bay ⚫ Famlan Farm Park ⚫ Arthur Street Kitchen ⚫ Hanan Kindergarten ⚫ Shearers Quarters ⚫ West End Kindergarten ⚫ Glenview Kindergarten ⚫ Ranui Kindergarten ⚫ Waimataitai Kindergarten ⚫ Ti Kouka Kindergarten ⚫ Chipmunks ⚫ Kidstuff ⚫ Timaru Hospital ⚫ Timaru Library ⚫ Plunket Karitane Family Centre ⚫ Zest ⚫ North Haven Child Care Centre ⚫ CBAY ⚫ South Canterbury Free Kindergarten Association ⚫ Limelight Café ⚫ Sopheze Espresso @ Mega Mitre 10 ⚫ Sopheze Coffee Lounge on Stafford Street Temuka ⚫ 100% Homemade ⚫ Temuka Library ⚫ First Steps Opihi ⚫ Arowhenua Whanau Services ⚫ Rhona Day Kindergarten ⚫ Rata Kindergarten Geraldine ⚫ Geraldine Library ⚫ Hayward Cottage Montessori ⚫ Verde Café Deli Waimate & Districts ⚫ Waimate District Library ⚫ Waimate Child Care Centre ⚫ Café on Queen ⚫ Rainbow Dairy & Café ⚫ Waimate Community Centre ⚫ Rural Scholars ECE ⚫ Morven Playgroup/Coffee Group ⚫ John Street Kindergarten ⚫ Empire Tavern Fairlie ⚫ Mackenzie Kindergarten ⚫ Daz’s Coffee Lounge ⚫ Eat Fairlie Twizel ⚫ Shawtys Café Restaurant & Bar ⚫ Twizel Kindergarten ⚫ Poppies Café ⚫ The Musterer’s Hut Café ⚫ Twizel Community Library / Community Centre ⚫ Hydro Café Pleasant Point ⚫ Pleasant Point Playcentre Orari ⚫ Café Mes Amis
South Canterbury Breastfeeding Handbook 42
With breastfeeding it is best to follow your baby’s cues and trust your in- stincts. However, some mums find it helpful to keep a ‘diary’ in the early days. If you want, you can use this section to record things like when you last breastfed, which side you breastfed on, how often your baby poops or pees and any other notes you like.
South Canterbury Breastfeeding Handbook 43
Points to remember: • We have been given the opportunity to lie skin to skin for at least an hour as soon as possible after the birth. • Let the first experience in your baby’s mouth be your nipple. • Allow the baby to suckle for as long as baby wants on both breasts. • Your baby may then sleep for up to 6 hours – take this time to rest yourself. • Colostrum is all your baby needs If your baby has not latched and suckled within 6 hours of birth because the baby is sleepy, the baby should be woken at this time and then every 3 hours and actively helped to feed. If a latch is not achieved then hand expressing should begin.ble to breastfeed, but I have:
We are unable to breastfeed, but I have:
Been shown how to hand express Expressed colostrum regularly for my baby Fed the colostrum to my baby regularly by syringe, spoon or cup
If you feel you require extra assistance with breastfeeding, request services of the Lactation Consultant / Breastfeeding Advisor who specializes in breastfeeding and is able to set a plan best suited to your individual needs.
South Canterbury Breastfeeding Handbook 44
Points to remember: • Your baby may feed frequently today and especially overnight. You will feel tired – rest as much as possible. • As long as your baby is breastfeeding well, baby does not need any other food. • Allow your baby to suckle frequently. • Your nipples will be tender, but should not be damaged. • You may experience “period like” pains and an increase in bleeding from your vagina whilst breastfeeding. This is normal. • Your baby may pass urine only once or twice today and bowel motions are frequent and the colour may be changing from black to brown/yellow. • Feeling more independent with positioning and latching your baby today? Ask your LMC or staff for guidance/reassurance as necessary. • Colostrum helps keep jaundice levels down.
We are unable to breastfeed, but I am:
Continuing to regularly hand express colostrum, 2 3 hourly Using the electric breastpump and have been instructed how to use it and clean its parts and to store breast milk.
If you feel you require extra assistance with breastfeeding, request services of the Lactation Consultant / Breastfeeding Advisor who specializes in breastfeeding and is able to set a plan best suited to your individual needs.
South Canterbury Breastfeeding Handbook 45
Points to remember: • Your breasts may feel heavier and a little uncomfortable over the next 24 hours. • It is not uncommon to feel tired and tearful today – rest/sleep. Good food and fluids are important. • Your baby tends to settle for longer periods between feeds. • Nipples remain tender. • Remember to support your breast throughout the feed. • Your baby passes urine more frequently. • Frequent feeds or breast milk will help prevent increasing jaundice levels. • Your baby may feed frequently again overnight. • As your breasts become firmer, your milk supply increases. • If baby isn’t latching, you continue to express every 3 4 hours during the day and night.
If you feel you require extra assistance with breastfeeding, request services of the Lactation Consultant / Breastfeeding Advisor who specializes in breastfeeding and is able to set a plan best suited to your individual needs.
South Canterbury Breastfeeding Handbook 46
Points to remember: • Your breasts will feel heavy and may cause some discomfort – warm showers and hand expressing will help ease this. • If your milk has come in, breastfeeding may be all your baby will want. • Allowing baby to finish the first breast ensures she gets the rich hind milk, which is important for growth. • Always offer the other breast but your baby may not want to keep feeding. The average feed time when your milk has established is 17 minutes. 50% of babies feed for longer than this and 50% feed for less. All babies are different but prolonged feeding or very short feeds (less than 5 minutes) may indicate a problem with latching. to latch
My baby is still unable to latch
• I feel comfortable managing my own breastfeeding attempts I am totally independent with expressing • I am independent with feeding my baby despite difficulties • I am slowly gaining confidence, but am not yet independent My baby remains unwell/too sleepy to breastfeed • My supply has increased
If you feel you require extra assistance with breastfeeding, request services of the Lactation Consultant / Breastfeeding Advisor who specializes in breastfeeding and is able to set a plan best suited to your individual needs.
South Canterbury Breastfeeding Handbook 47
Points to remember: • Breasts usually feel more comfortable today. • Baby’s bowel motions at this stage are generally frequent, yellow, loose with a “mustard seeds” appearance.
For the baby who is unable to latch I am expressing regularly, day and night I am increasing the number of expressions (if supply isn’t meeting baby’s needs)
If you feel you require extra assistance with breastfeeding, request services of the Lactation Consultant / Breastfeeding Advisor who specializes in breastfeeding and is able to set a plan best suited to your individual needs.
South Canterbury Breastfeeding Handbook 48
• I am independently breastfeeding • My baby is settled between feeds • My baby is passing urine at least 6 times per day • My baby is passing a bowel motion at least 2 times per day • My baby is waking for feeds • I can hear baby swallowing when breastfeeding • My nipples continue to improve • My breasts are comfortable
My baby is still unable to suckle My breast milk supply is meeting my baby’s needs My breast milk is abundant My breast milk is not yet fully established
If you feel you require extra assistance with breastfeeding, request services of the Lactation Consultant / Breastfeeding Advisor who specializes in breastfeeding and is able to set a plan best suited to your individual needs.
South Canterbury Breastfeeding Handbook 49
Points to remember: • Rest/sleep at every opportunity • Babies have “frequency days” or so called “growth spurts”. Often Day 7 or Day 8 babies feed more frequently. This is normal. • Your breasts may seem smaller and softer by today. This is normal, they have become more efficient at making milk.
Feeding Pattern
My baby is feeding more frequently My baby settles between feeds My baby had at least 6 wet nappies today My baby had at least 3 dirty nappies today My baby wakes for feeds
By now you will be establishing a good feeding pattern and will be beginning to understand your baby, and what is normal. Your baby should be having at least 6 or more wet nappies per day and several bowel motions per day. This is a good indication that baby is getting enough food from you.
Baby maybe weighed by your midwife today. Baby’s generally lose up to 7% of birth weight.
If you feel you require extra assistance with breastfeeding, request services of the Lactation Consultant / Breastfeeding Advisor.
4 8 weeks Between days 28 56 of age your baby may cry for prolonged periods. Research shows us that this is the period of time when babies cry more than at any other time of life. Baby doe not want to just eat and sleep, so is unsettled. Unfortunately mothers often think it is because their baby is not getting enough milk. This period also coincides with a decrease in breast size, which is normal at this time.
Do not doubt your breast milk supply.
If you have concerns then do not hesitate to contact your midwife, Plunket Nurse, Lactation Consultant / Breastfeeding Advisor, La Leche League, “BreastfeedingWorks!” Peer Counsellor or the Karitane Family Centre for reassurance or advice.
South Canterbury Breastfeeding Handbook 50
Developed by the Breastfeeding Action Group
Sponsored by South Canterbury District Health Board
Adapted from the West Coast Breastfeeding Handbook
South Canterbury Breastfeeding Handbook 51
New Mothers
Do you need advice/help?
You may phone at any time, day or night. Your own midwife
Plunket Line 0800 933 922 (24/7)
Plunket Family Centre (03) 684 4967 Jean Todd Maternity Unit (03) 687 2145
Breastfeeding Advisor 0274 910 865/(03)687 2100 ext 8966
General Practitioner (GP)
La Leche League (03) 684 9851
BreastfeedingWorks 021 298 5271 Arowhenua Whanau Services (03) 615 5180 Smokefree Team 0800 111 880
www.lalecheleague.org.nz www.babyfriendly.org.nz www.health.govt.nz - breastfeeding www.scdhb.health.nz www.plunket.org.nz www.kellymom.com www.breastfednz.co.nz
Get your FREE Breastfeeding App from www.breastfednz.co.nz
South Canterbury Breastfeeding Handbook 52