Breastfeeding Basics R������ N������� 2008 This booklet is intended for the use of parents of healthy, full term infants. If your baby has medical concerns or is in NICU, please ask for specifi c recommendations from your health care provider. Breastfeeding is the normal, natural way to feed your baby. The keys to success are early, frequent feeding and proper positioning and latch of the baby at the breast. Avoidance of artifi cial nipples and supplemental feedings in the early days also helps ensure a positive outcome. Manufactured infant milk (formula) contains nutrients that are foreign to the human and are mixed in proportions that are not suitable to humans. Formula is unable to provide many nutrients found in breast milk. Babies feed diff erently from a bo� le than they do from a breast. Infants who are not breastfed are at greater risk for: infections, respiratory illness, allergic disorders. Mothers who do not breastfeed are at greater risk for: breast and ovarian cancer and osteoporosis. Families who do not breastfeed spend more money on infant food, medicine, have more visits to the physician’s offi ce with sick children, and more hospital admissions. Revised November 2008 Breastfeeding Basics How the Breast Works ................................................. 2 Questions and Answers ............................................ 24 Ge�ing Off to a Good Start ......................................... 3 Where to Get Breastfeeding Help ............................ 27 Feeding the Baby .......................................................... 4 Bibliography ............................................................... 28 Signs that Your Baby is Breastfeeding Well ............... 8 Ways to Increase Milk Transfer to Baby .................. 10 Baby’s Output ............................................................. 11 Baby’s Weight Gain .................................................... 12 General Breast Care ................................................... 13 Tips to Help with Breastfeeding .............................. 14 Caring for Nipples that are Sore .............................. 16 Expressing Breast Milk by Hand ............................. 18 Breast Pumps .............................................................. 20 Storing and Feeding Breast Milk ............................. 22 H���������, K�������, P��� R���� D������� H����� U��� Breastfeeding Basics 1 How The Breast Works Breastfeeding works on the principle of supply and When the baby latches on to the breast, he/she demand. The amount of milk removed from the compresses the milk ducts under the alveoli and draws breast determines the amount of milk produced. Milk out the small amount of milk that collects there between production occurs between feedings as well as during feedings. This suckling causes the release of two feedings. How o�en, how long, and how well the baby hormones: prolactin and oxytocin. Prolactin tells the feeds at the breast will impact how much milk will be alveoli (the milk producing cells) to make more milk and made. oxytocin causes the alveoli to squeeze the milk out into the ducts and down toward the nipple. At the beginning of a feeding, the breast produces fore milk. This is higher in lactose and fluid. The hind milk that the baby receives later in the feeding is higher in fat and calories. It is important to let the baby finish the first side completely to ensure he/she receives the hind milk areola needed to feel satisfied and for adequate weight gain. nipple Breastfeeding is a skill and may take time to learn. This booklet offers information to help you and your baby get started. Call your local public health office if you have ducts any questions. alveoli (c)Medela AG, Switzerland, 20062 2 Breastfeeding Basics H���������, K�������, P��� R���� D������� H����� U��� Ge�ing Off to a Good Start • 1. Breastfeed Early - Breastfeed as soon as possible • 4. Breastfeed Only - Give your baby only breast a�er birth. Your baby is most awake and ready milk. No extra drinks or food are needed for a to learn how to breastfeed during the first 2 hours healthy baby for the first 6 months of life. Extra a�er birth. Breastfeeding early will also help you drinks or foods before this time will slow down to make more milk. your milk supply and may affect your baby’s health (for example, your baby may develop an increased • 2. Breastfeed Right - In the hospital, ask your risk for allergies). nurse to help you put your baby on to your breast. Get help right away if you are having Do not give your baby soothers or bo�les. If you breastfeeding problems. See the back of this book decide to use these, it is best to wait until your baby for places to get help when you are at home. has learned to breastfeed. This o�en happens by 4 - 6 weeks. Giving a soother or bo�le too early can • 3. Breastfeed O�en - In the first month, most cause your baby to have problems latching onto your babies will breastfeed well at least 8 times a day. breast and could make breastfeeding painful or even This can be every 1 1/2 - 3 hours. It is common impossible. for babies to have many feedings in a short period, and then sleep longer between feeds at other times. There are no set times to feed your baby. Feed your baby when he/she is showing signs of hunger (see next page). H���������, K�������, P��� R���� D������� H����� U��� Breastfeeding Basics 3 Feeding the Baby Ge�ing Ready Breastfeeding Positions Feeding Cues: When preparing to feed your baby, check that: Baby shows one or more signs of being ready to feed, • Your back and arms are well supported. A pillow even if still very sleepy. behind your back and under your arms will help. • Fast eye movements under the eyelids as he/she • Your baby’s head and body are raised up to your begins to wake up to feed. breast. A pillow under your baby will help. • Sucking and licking movements of the mouth. Cradle Hold • Pu�ing hands into the mouth. • Place your baby on his/her side on your lap. • Stretching and increased body movements. • Your baby’s chest is facing and touching your chest. • Making small sounds. • Your baby’s nose is directly in front of your nipple. You will have the opportunity to notice these cues if the • Place your opposite hand on the baby’s neck and baby shares your room. They will start these activities in shoulders. their sleep. If you wait until you hear the baby actively crying, ge�ing the baby latched may be more difficult. • Bring baby to you using the opposite hand, the baby’s head should be slightly tipped back. Get comfortable and find a position that works well for • When comfortably latched, ‘cradle’ the baby with the you. Get clothing, yours and baby’s, out of the way. Skin arm on the nursing side. to skin contact increases baby’s ability to breastfeed. 4 Breastfeeding Basics H���������, K�������, P��� R���� D������� H����� U��� Football Hold “Cradle Hold” • Place your baby on his/her back or slightly turned to the breast. • Your baby is lying beside you, your baby’s nose is directly under your nipple. • Place your nursing side hand under the baby’s neck and shoulders. • Bring baby to you using the nursing side hand, the baby’s head should be slightly tipped back. “Football Position” Once you are in the proper position, you are ready to get the baby ‘latched on’. Please note that breastfeeding while lying down may take longer to learn. H���������, K�������, P��� R���� D������� H����� U��� Breastfeeding Basics 5 Latch On While holding the baby in position with one hand, Touch baby’s upper lip with your nipple. Wait for wide support your breast with your other hand. Cup the breast “ahh” mouth, (1st image) tongue on floor of mouth and in a “C” shape by pu�ing your four fingers around your roll your breast onto his/her tongue so that your nipple breast with your thumb on the other side. Keep hand is the last part to enter his/her mouth. (2nd image) As and fingers closer to the rib cage so that baby’s chin can his/her upper lip comes over the nipple, bring baby’s be touching the breast. shoulders extra close so you are moving the baby to breast, not moving the breast to baby. “Your View of Latch-on, Baby at Le� Breast” © 2000 Diane Wiessinger, MS. IBCLC 6 Breastfeeding Basics H���������, K�������, P��� R���� D������� H����� U��� Comfortable? Baby should be so close that his/her cheeks Feed on the first breast as long as baby is actively nursing touch your breast and hide his/her mouth. If you could, before offering the second breast. When baby is finished you would see (3rd image): the first side, he no longer has strong “deep and slow” • Mouth open wide sucks and your breast feels so�er, offer the second breast. • Lower lip rolled back toward chin Baby may only feed a short time on the second breast. At the next feeding, offer this ‘second’ breast that you did not • Lower lip farther from nipple than upper lip offer first at the last feeding. This is o�en the breast that • Baby’s head slightly tipped back, chin firmly on the feels the fullest. breast, nose lightly touching or free of breast If the latch feels comfortable and no damage is done to If you want to take baby off your breast, slip your finger your nipple, it is a good latch. Resist the urge to peek as into the corner of baby’s mouth and between the gums to poking about trying to see can unlatch your baby. break the suction. RELAX!! Once baby is on the breast well, put your feet up and get comfortable. H���������, K�������, P��� R���� D������� H����� U��� Breastfeeding Basics 7 Signs That Your Baby Is Breastfeeding Well Feedings: Signs that baby is ge�ing milk How O�en and For How Long? Infant: • Expect at least 8 feedings in 24 hours • Sustained, rhythmic suck/swallow pa�ern with • Some babies like to breastfeed every 2 - 3 hours, day occasional pauses and night • Swallowing you can hear • Other babies will feed every hour for 4 - 6 feeds, then • Relaxed arms and hands sleep 4 - 6 hours • Moist mouth • If necessary, wake a sleepy infant for feedings until • Satisfied a�er feedings your milk supply is established and baby is gaining weight • Wet and dirty diapers (see page 11) • You can expect the baby to feed less o�en as he/she gets older except during growth spurts.