twenty Tear- Sheet Toolkit SOMETIMES YOU DON’T want a whole book. And sometimes you want to be able to tear something from a book! Here’s your chance. Each page in this section is complete on its own two sides, ready to be removed. You can put these sheets on your refrigerator or by your computer, or hand them to your family or day care provider— whatever you need. Online copies are available at llli.org. Early Breastfeeding • Laid- back breastfeeding and other ideas 449 Chapter 20. • Diaper log 451 • Waking a sleepy newborn 453 • Feeding cues 455 • Feeding the non- latching baby 457 • It isn’t just about the milk 459 • Door sign (hospital or home) 461 The Womanly Art of Breastfeeding, The Womanly Lale_9780345518446_3p_all_r6.indd 447 6/2/10 3:02:46 PM © 2010 La Leche League International, 448 the womanly art of breastfeeding • Refrigerator help sheet 463 • Fussy baby ideas 465 • What about partners? 467 • Your grandchild is breastfed? 469 • Breastfeeding— just good sense 471 • What mothers need to know 473 • Cleaning and scrubbing 475 Problem Solving • Medications 477 • Websites for moms and their caregivers 479 • Plugs and blebs 481 • Mastitis 483 • Gaining, gulping, grimacing 485 Working, Pumping, Bottles • Pumping log 487 • Milk storage 489 • Day care provider sheet— paced bottle- feeding 491 • Day care provider sheet— milk handling 493 Chapter 20. The Womanly Art of Breastfeeding, The Womanly Lale_9780345518446_3p_all_r6.indd 448 6/2/10 3:02:47 PM © 2010 La Leche League International, tear- sheet toolkit 449 Laid- back Breastfeeding laid- back breastfeeding, or Biological Nurturing, means getting comfortable with your baby and encouraging your own and your baby’s natural breastfeeding instincts. See biologicalnurturing.com for further information. • Dress yourself and your baby as you choose. • Find a bed or couch where you can lean back and be well supported— not fl at, but comfortably leaning back so that when you put your baby on your chest, gravity will keep him in position with his body molded to yours. • Have your head and shoulders well supported. Let your baby’s whole front touch your whole front. • Since you’re leaning back, you don’t have a lap, so your baby can rest on you in any position you like. Just make sure her whole front is against Chapter 20. you. • Let your baby’s cheek rest somewhere near your bare breast. • Help her as much as you like; help her do what she’s trying to do. You’re a team. • Hold your breast or not, as you like. • Relax and enjoy each other. n Art of Breastfeeding, The Womanly Lale_9780345518446_3p_all_r6.indd 449 6/2/10 3:02:48 PM © 2010 La Leche League International, tear- sheet toolkit 451 Early Days Diaper Log: The Bottom Line (If it comes out, it must have gone in!) count only poopy diapers that have contents at least as big as the “okay” circle you make with thumb and forefi nger. No need to count wet diapers. Poopy diapers tell more about how a baby is doing. Circle the X when your baby has an “okay” poopy diaper. If your baby is . Expect at least this many “okay” diapers 0–1 day old (fi rst 24 hours) Black sticky poopy diaper X 1 1–2 days old (second 24 hours) Brown sticky poopy diapers X X 2 2–3 days old (third 24 hours) Greenish poopy diapers X X X 3 3–4 days old (fourth 24 hours) Green to yellow poopy diapers X X X 3 4–5 days old (fi fth 24 hours) Yellow poopy diapers X X X 3 My breastfeeding helpers: Chapter 20. Baby’s health care provider _____________________________________ My health care provider ________________________________________ Local La Leche League Leader __________________________________ International Board Certifi ed Lactation Consultant __________________ n Art of Breastfeeding, The Womanly Lale_9780345518446_3p_all_r6.indd 451 6/2/10 3:02:49 PM © 2010 La Leche League International, tear- sheet toolkit 453 Waking a Sleepy Newborn If your newborn sleeps longer than three hours at a stretch, but • You had no birth medications • Your baby stays in physical contact with you • He feeds well when he feeds • His diapers are on track (see the Early Days Diaper Log) that’s probably just who he is. Keep an eye on his poopy diapers and his weight. If he’s not gaining well and he sleeps more than three hours at a stretch, aim for at least ten nursings each day until he wakes on his own and has at least four good poopy diapers each day. It will be easier to wake him to feed if you see some of the feeding cues listed on the next tear sheet. If he’s sleeping and you try to lift his arm and it drops like a rock when you let it go, he’ll be hard to wake. Try again in twenty minutes. Things to try: • Dim the lights, pull the drapes. It’s easier if he doesn’t have to squint. • Undress him partially or completely. Put him on your chest. • Stroke him and call his name. Rub his feet. • Lay him down and roll him gently from all the way on one side to all the way on his other side. • Hold him along your forearms, head in your hands, feet at your elbows, and lift him from nearly horizontal to nearly vertical and Chapter 20. back, as you talk to him. • Wipe his face with a damp cloth. • Put a little colostrum or milk in his mouth— just a bit, waiting for him to swallow before adding more. He might latch and nurse in his sleep in a laid- back breastfeeding position, or he might take sips from a spoon. Feed him in whatever way works for you. n Art of Breastfeeding, The Womanly Lale_9780345518446_3p_all_r6.indd 453 6/2/10 3:02:49 PM © 2010 La Leche League International, tear- sheet toolkit 455 Feeding Cues • A baby starts with subtle nursing cues— eyes moving beneath eye- lids, eyelids fl uttering before they even open, hands coming toward face, mouth movements. • Then she adds more obvious ones— rooting toward your chest, whimpering or squeaking. • If you offer to nurse now, she’ll probably take your breast gently and easily. • As her hunger builds, her body and mouth tense. She breathes fast or starts to cry. • Once she’s crying, she’ll have a harder time latching. Crying is a late sign of hunger. Calm her down before trying to feed her. • Breastfeeding is easier if you answer her requests instead of waiting for her demands. • Don’t wait for your breasts to feel full. A full breast has already started to slow down production. • Offer even if she’s not asking, anytime you like. Chapter 20. n Art of Breastfeeding, The Womanly Lale_9780345518446_3p_all_r6.indd 455 6/2/10 3:02:49 PM © 2010 La Leche League International, tear- sheet toolkit 457 Feeding the Non- Latching Baby: One Possible Approach Birth to 6 hours— skin contact • Keep the baby skin- to- skin and gently encourage him to breastfeed. • If birth was medicated— hand- express colostrum by end of fi rst two hours. By about 6 hours—begin regular hand expression • Continue keeping the baby in skin- to- skin contact with you. • Express drops of milk on your nipple to encourage him to latch on. • Hand express colostrum into a spoon, spoon- feed baby every 2–3 hours and when either of you wakes at night. • Removing milk from your breasts is as important as feeding the baby. As milk volume increases—hand-express or pump, use nipple shield, fi nger- feed or bottle • Continue as much skin- to- skin contact, laid- back, and holding as possible. • Pump at least 8–10 times in 24 hours (including at least once at night) fi nishing with hand expression. Massage before and/or during pump- ing, hand express afterward. • Consider a nipple shield to help the baby latch. • With increased milk volume, fi nger- feeding or a bottle may work. Chapter 20. By the end of the fi rst week—help, patience, confi dence • Continue skin- to- skin/holding as much as possible. • Express at least 8–10 times per 24 hours, tapering off as baby 458 the womanly art of breastfeeding begins to nurse. • You may want to express extra and store in the fridge to be a feeding or two ahead. Adding a couple of extra pumping sessions for a day or two will help. Art of Breastfeeding, The Womanly n • Stay in touch with your Leader or other breastfeeding support. Babies sometimes take weeks to breastfeed well. Keep your supply going. Lale_9780345518446_3p_all_r6.inddIf we can teach a tiger457 to jump through a fl aming hoop, we can help a baby6/2/10 3:02:49 PM do what he is designed to do! © 2010 La Leche League International, Lale_9780345518446_3p_all_r6.indd 458 6/2/10 3:02:49 PM tear- sheet toolkit 459 Hand Expression • Wake your breasts up— shake, massage, move them • Fingers on opposite sides of your areola • Press back toward chest • Compress fi ngers toward each other, drawing slightly toward nipple but not sliding skin • Release pressure, relax hand Repeat several times. Don’t expect anything immediately. Add massage whenever you like. Shift hand to a different position to move milk from other ducts. Colostrum: collect drops on plastic spoon, tip into baby’s mouth or col- lect with dropper. Milk: Express into pump funnel or large bowl. See video at newborns.stanford.edu/Breastfeeding/HandExpression .html. Chapter 20. Press. Compress. Release. n Art of Breastfeeding, The Womanly Lale_9780345518446_3p_all_r6.indd 459 6/2/10 3:02:49 PM © 2010 La Leche League International, tear- sheet toolkit 461 tear- sheet toolkit 461 Our Baby Is Here! Our Baby Is Here! _______________________________________________________ was born on _______________________________________________________ _______________________________________________________ was born on weighing _______________________________________________________ _______________________________________________________ Please knock quietly.weighing If we don’t answer the door, we hope you’ll understand.