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Breastfeeding Support

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Attatchment Issues.

Position Of Baby.

"Nipple to Nose, Chest too belly"

During the early weeks optimal positioning is especially important.

When you and your baby are well positioned, your nipples stay

healthy and your baby can feed most efficiently.When you are

positioning your baby make sure the baby is up at breast level and

the babies nose is parallel to the nipple, the babies chin should be the

first thing that touches the breast.

The contact of the chin against the breast can assist in keeping

the babies mouth open. Especially important for those babies

that have a knack at closing their mouths quickly.

The babies nose should be just making contact with the

breast tissue. You should be hearing swallowing thru out the

feeding and the breast should feel a lot softer after the feed.

The baby needs to be facing the breast without having to

skew its head, YOU try swallowing with your head turned,

that painful sensation is what your baby feels also.

When Considering positioning a baby at the breast some important consideration is how you are positioned. You should be seated comfortably and able to relax whilst feeding without allowing the hard worked for perfect attatchment is affected. Pillows (V-shaped Pillows are great or purpose design breastfeeding pillows that mould around you and are adjustable), good chair with unobtrusive arms.

Position yourself comfortably with back support, pillows supporting your arms and in your lap and your feet supported by a footrest or a telephone book.

Position baby close to you, with his/her hips flexed, so that s/he does not have to turn his/her head to reach your breast. His/her mouth and nose should be facing your nipple.

Types of positioning

Cradle Position/ Madonna Hold

cradle hold The cradle position is most commonly used after the first few weeks. The cross-cradle position (see below) gives you more control. You will benefit However by becoming adept at a few positions to reduce your risk of mastitis and increasing your ability at feeding in any situation or environment.

To feed your baby while cradling or holding him across your lap, s/he should be lying on his/ her side, resting on his/her shoulder and hip with his/ her mouth level with your nipple. Use pillows lifting your baby and supporting your elbows to bring your baby up to nipple height especially during the first few weeks. Your baby's head will be on your forearm and his back will be along your inner arm and palm. When you look down, you should see his side. His mouth should be covering at least a half inch of the dark area around your nipple (areola. Be sure his ear, shoulder and hips should be in a straight line.

As a newborn, your baby's head and bottom should be level with each other.

At the shop we are more than happy to assist you and give you advice on any breastfeeding problem or try the links page for further breastfeedding support resources.

Football / Twin Style / Clutch Position

In this position you support your baby's head in your hand and his/her back along your arm beside you. S/He is facing you, with his/her mouth at nipple height. Your baby's legs and feet are tucked under your arm with his/her hips flexed and his/her legs resting along side your back rest so the soles of his/her feet are pointed toward the ceiling. (This keeps him from being able to push against your chair.) Pillows again help bring the baby to the correct height.

This is a good position for a mother who has had a Caesarean birth, as it keeps the baby away from the incision. Most newborns are very comfortable in this position. It also helps when a mother has a forceful milk ejection reflex (let down) because the baby can handle the flow more easily.

Side Lying Position

Many mothers find lying down to nurse a comfortable position, especially at night. Both mother and baby lie on their sides facing each other. You can use pillows behind your back and behind or between your knees to help get comfortable. A pillow or rolled blanket behind the baby's back will keep your baby from rolling away from you. The baby can be cradled in your arm with his back along your forearm. Having his/her hips flexed and his/her ear, shoulder and hip in one line helps your baby get milk more easily. Some mothers find that practicing with this position during the daytime is very helpful

On Supporting your breast.

Supporting your breast from underneath with your 4 fingers flat against your ribcage, the index finger rests against the crease between rib and breast. The thumb just lightly rests where comfortable. The thumb can assist in the flanging of the upper lip of the mouth on attatchment.

Is My Baby On?

How to tell your baby is attatched.

We know that poor attatchment leads to maternal pain and trauma (bleeding nipples, blisters and escoriation. We also know that it reduces the babies intake and can effect the womans supply so it is paramount to ensure your baby is attatched correctly.

Here are some things to assist you.

The Babies nose is just or nearly touching your breast, that is, no further away than a credit card edge

The Babies lips are flanged (Do not press deeply on the breast to see this as this can break the feed.

at least ½ inch of your breast around the base of your nipple is in his mouth.

The Babies cheeks are not indented or Dimpled as if sucking through a straw, this would indicate only a small opening of the mouth.

Most of the movement on the breast is made by the lower jaw, the top lip makes relatively little movement. (another indication of the openess of the babies mouth.)

It doesn't hurt! (Occassionally women that have very sensitive breast (they may not enjoy their being handled normally)) will feel discomfort.

Look at the nipple after the feed to confirm the nipple is erect and cylindrical not tapered blanched or pulled.

MASTITIS

Mastitis, or inflammation of the breast, is a relatively common problem for breastfeeding mothers. Flu like symptoms are often the first sign followed by an area of the nipple or breast becomes painful, red, and or hard sometimes this occurs without the flu like symptoms othertimes these symptoms may follow. . Experts cannot agree on whether all cases of mastitis represent a true infection. Sometimes, mastitis may be caused by the breast becoming over-full, or blocked because of milk over-supply, ineffective breastfeeding, missed feeds, restrictive clothing, or bruising.

The pooled milk that is trapped in the breast can trigger chemical changes that cause pain and redness. This inflammation responds well to extra rest for the mother, and thorough emptying of the affected breast.

Some experts suggest using heat and others suggest cold compresses during mastitis. Use of heat should be brief, perhaps just before pumping or breastfeeding in order to prevent more inflammation. Cold may help reduce swelling.

Mastitis is most common in the first few weeks postpartum, although it can happen at any time, especially if a mother is over-tired, or if she smokes. Cracked nipples put a woman more at risk for infective mastitis. When the skin is broken, germs from the hospital environment, from the mother’s skin, or from the baby’s mouth may penetrate the breast. A woman should call the doctor if she experiences intense pain or fever.

Some experts advise rest, hot or cold compresses, and breast emptying for 12 hours. Then, if the symptoms don’t resolve, antibiotics are prescribed. Others begin antibiotic at the first sign of mastitis. Your doctor can guide you, and he or she will chose medications that are considered compatible with breastfeeding. If you begin antibiotic therapy, it is very important to complete your full prescription in order to prevent recurrences. Please note that

some mothers who are on antibiotics may develop yeast infections, and will need to be treated for this. Because of the nature of antibiotics some women will also choose to commence replenishment of good natural bacteria to compensate for their depletion through the course of antibiotics. Please consult a qualified health professional and/or natural therapist before commencing any treatment.

The most important thing to do if you get mastitis is to continue to breastfeed.

Emptying the breast is the best way to obtain relief and help the healing process. Abrupt weaning may cause complications such as breast abscesses. Consider speaking to a breastfeeding support person, such as an Lactation consultant if you develop mastitis in order to find out about simple ways to prevent it in the future.

In rare cases, mastitis may result from a more serious type of underlying breast problem. Because women often are treated over the phone for this condition, it is important to see the doctor if you have repeated episodes of mastitis that are always located in the same area of the breast, or if lumps, pain, and redness don’t resolve after treatment. Ultrasound is a safe and effective method to identify abscesses or tumors in the lactating breast. Breastfeeding can continue during treatment for abscesses.

Poor or Inadequate Milk Supply

Milk SupplyBy Barbara Wilson-Clay, BSEd, IBCLC

Concern over low milk supply is the number one reason mothers give for discontinuing breastfeeding. Because we live in a bottle-feeding culture, it can be difficult for first-time mothers to trust in a process they cannot easily measure. It is reassuring to learn that most women are physically capable of making enough milk for their babies to be healthy and happy.

The first few weeks after giving birth are a critical time for establishing the milk supply. During this time, frequent, thorough emptying of the breasts sets and controls the level of milk production. The milk supply can rapidly drop if the baby is too weak or small to adequately stimulate this process, or is not latched on well. The milk supply will also be affected if engorgement is not relieved or if the baby is not breastfeeding often enough. Giving the baby a bottle at night so the new mother can sleep may sound reasonable, but it often leads to a low milk supply down the road. A better way to help the new mother is to encourage her to rest with her baby at the breast, provide her with good nutrition, and free her from household duties so she can get breastfeeding off to a good start.

Most mothers find that they have plenty of milk for their babies, even as baby grows into an active toddler. Sometimes, in spite of good support and the mother’s best efforts, there is a real problem with milk supply. In rare cases, hormonal imbalances during adolescence have affected breast growth and development. Conditions such as Polycystic Ovarian Syndrome, thyroid disorders, chest surgery, or invasive breast surgery can create problems with full milk production. Severe dietary restrictions during pregnancy and lactation can affect some women’s milk supplies, as can smoking or overuse of alcohol.

Excessive loss of blood during delivery and anemia can both reduce milk production until the mother recovers. If a fragment of the placenta remains in the uterus it will prevent full milk production until it is passed or removed. Some medical conditions such as diabetes can delay full milk production for several weeks. Typically, lack of frequent and effective removal of milk from the breasts, along with infections, fatigue and excessive stress are the major causes of early problems with milk supply. Some medications, especially head cold remedies, may dramatically reduce milk supply.

It is important to remember that babies fuss for reasons other than hunger, but any mother with concerns about her milk supply deserves the reassurance of a weight check to make sure her infant is growing well.

If a problem does exist, remember that most causes of low milk supply can be corrected with assessment and help from your lactation consultant. Your doctor can select antibiotics that are safe for the nursing infant to treat any infections. Low milk supply generally improves with more rest, improved diet, reduction of stress, and improved management of lactation. Your physician and lactation consultant can suggest herbs or prescription medications that may boost your milk production, and breast pumping Breast Pump Pages is often suggested to re-stimulate the milk supply.

Editors:

Kathleen B. Bruce, BSN, IBCLC

Catherine Watson Genna, BS, IBCLC

Mary Bibb, BA, IBCLC

References:

W Fawzi, M Forman, A Levy, et al: Maternal anthropometry and infant feeding practices in Israel in relation to growth in infancy: The North African Infant Feeding Study, Am J Clin Nutr 1997; 65:1731-40.

T. Hale, Conference Presentation, Medford, Or, 2001.

S Henly, C Anderson, M Avery, et al: Anemia and insufficient milk in first time mothers, Birth 1995; 22:87-92.

K Hoover: Insufficient Milk Supply, in Core Curriculum for Lactation Consultant Practice, ed. by M. Walker, Jones and Bartlett, Boston, 2002. Pg. 219-229.J Hopkinson, R Schanler, J Fraley, et al: Milk production by mothers of premature infants: Influence of cigarette smoking, Pediatrics 1992; 90:934-938.

K Huggins, E Petok, O Mireles: Markers of lactation insufficiency: A study of 34 mothers, in: K. Auerbach, Ed. Current Issues in Clinical Lactation 2000. Jones and Bartlett, Sudbury, MA. Pp. 25-35.

N Hurst: Lactation after augmentation mammoplasty, Obstetrics and Gynecology; 87(1): 30-34.

R. Lawrence and R Lawrence: Breastfeeding: A guide for the medical profession, 5th edition, Mosby, St Louis, 1999, Pp. 412, Pp 507-540.

J Mennella, G Beauchamp: The transfer of alcohol to human milk, New England J Med 1991; 325:981-4.

M Neifert, J Seacat, and W Jobe: Lactation failure due to insufficient glandular development of the breast, Pediatrics 1985; 76(5): 823-827.

S Neubauer, S Ferris, C Chase, et al: Delayed lactogenesis in women with insulin-dependent diabetes mellitus, American J Clinical Nutrition 1993; 58:54-60.

Expressing Milk For Your Premature Baby

Breastfeeding a preemieBy Paula P. Meier, R.N., DNSc, FAAN, Rush-Presbyterian St. Luke's

Medical Center.Mothers' milk provides important health benefits for premature infants, so whether you've decided to express milk for a short time or to breastfeed for several months, your milk is an important part of your baby's treatment plan. Many people think that giving birth prematurely limits a mother's ability to make enough milk, but this is not true. The extra stress, discomfort, and fatigue that go along with the birth of a premature baby can cause a slow start with milk production. In the first few days after giving birth, mothers may make just drops of milk each time they use the breast pump, so it is easy to get discouraged. Remember, these drops are like a medicine for your baby, because they provide protection from infection. And-- this slow start usually gives way to an adequate milk supply by the fifth or sixth day after birth. Answers to the following common questions will help you get started with milk expression for your premature baby.

What Type of Breast Pump Should I Use?

Studies have evaluated the different kinds of breast pumps available to new mothers. The findings show that mothers who are expressing milk for premature babies should use a hospital-grade electric breast pump-ideally with a double collection kit, so that both breasts can be emptied at the same time. This type of pump is the most effective in stimulating release of the milk-making hormone, prolactin, which results in the greatest amount of milk. Mothers sometimes report that they have received a battery-operated or a less-powerful electric pump as a "baby shower" gift, and want to use it to express milk for their premature baby. While this type of pump is suitable for a mother who uses it only once or twice a day and breastfeeds a full-term baby the rest of the time, it does not provide enough stimulation to establish and maintain a good milk supply for a mother who is pumping for a premature baby. If you have received one of these pumps as a gift, you will be able to use it later-after your baby comes home and is feeding.well from the breast. But, in the first few weeks after premature delivery, you should plan to rent a hospital-grade electric pump.

How Often Should I Use the Pump?

During your first week or two of milk expression you should use the pump as frequently as 8-10 times daily-about as often as a healthy, full-term baby would feed at the breast in the early days after birth. The purpose of this frequent pumping is to stimulate prolactin during the time that your body is beginning to make milk in plentiful amounts. While you may get only drops of milk at first, frequent pumping is important in building an abundant, long-lasting milk supply. You may not see the results of your pumping immediately, but your efforts should pay off toward the end of the first week of milk expression. Do not set a clock to wake up at night to pump. However, if you wake up on your own-as many mothers do-an extra night-time pumping may help boost your milk supply. You may want to call the nursery, check in on your baby, and use the pump before going back to sleep.

How Long Should a Pumping Last?

In the first few days after birth, most mothers express very small amounts of milk-from a few drops to a few teaspoons-at each pumping. During this time, a pumping session should last from 10-15 minutes, which is enough time to stimulate the release of prolactin. However, after the milk has "come in" several days later, and you produce more than half an ounce at each expression, you should use the pump until your milk has stopped flowing for at least 1-2 minutes. The last droplets of milk released during pumping contain very high levels of fat, which provides most of the calories in your milk. If you stop pumping after 10 or 15 minutes while your milk is still flowing, your baby may not receive these valuable fat calories. Also, your breasts need to be emptied as much as possible--meaning that milk flow has stopped-otherwise your body thinks that the milk left in the breasts isn't needed, and less will be produced. A few mothers say that the milk never "stops" flowing while they pump. As a general rule, you should not pump for more than 30 minutes, even if milk continues to flow. Also, if you pump for this long at each milk expression, you do not need to pump as frequently as a mother who can express her breasts in less time.

What is a "Normal" Amount of Milk?

Nearly all mothers of premature babies worry about whether they are producing a "normal" amount of milk. Many things affect the amount of milk a mother produces-especially in the first few days after giving birth. A mother of a full-term breastfeeding baby produces only about an ounce of milk during the first 24 hours after birth, but by the 3rd or 4th day is making several times that amount. Mothers of prematures frequently take a longer time to go from a few drops to an ounce or more at a pumping. This condition is referred to as a delayed onset of lactation, and is related more to pregnancy complications-such as bedrest, medications for high blood pressure and premature labor, and Cesarean deliveries-rather than to premature birth itself. No one knows exactly why this is the case, but researchers think that the milk-making hormones or tissues in the breast may be affected temporarily by these complications and medications. A slower onset of milk production does not necessarily mean that a mother will not make enough milk for her baby-only that it may take her a few extra days in the beginning to catch up with mothers who have had uncomplicated deliveries. Ideally, by the end of the second week of pumping, you'll be producing at least 500 ml (about two cups) of milk each day. This is the amount of milk that your baby will need at the time of hospital discharge. Thereafter, you will want to maintain or even increase this amount so that you have enough milk to feed your baby after discharge hospital discharge.

Can I Do Anything to Increase My Milk Supply?

Fatigue, pain, and stress-all of which are common among mothers of prematures-cause the body to release a substance that interferes with prolactin. While it may be difficult for you to overcome all of these barriers, most of these do diminish or become more manageable over time. Some things have been shown to increase the milk supply. First, try to spend as much time in the nursery with your baby as possible during these early days, if that is where you are the most relaxed. Family members often feel that mothers should stay at home and rest after giving birth prematurely, but mothers report that being separated from their babies causes even greater stress. When you are in the nursery, request a comfortable chair, and use the breast pump at your baby's bedside where you can see and touch your baby. When you are not in the nursery, pump where you can see your baby's picture. If your baby's condition permits, ask to hold your baby in Kangaroo--or skin-to-skin-Care. Don't be afraid to take pain medications that your doctor has prescribed. These medications can be used safely with breastfeeding, and pain relief is important to milk production. In some instances, prescription medications may be used to stimulate prolactin and increase the milk supply. Typically these medications are used after the second week of lactation, and require a prescription from your obstetrical care provider.

Written by Paula P. Meier, R.N., DNSc, FAAN, Rush-Presbyterian St. Luke's Medical Center.