Perhaps you are expecting your first baby and are wondering if there is anything you can do to get breastfeeding off to a good start.   Perhaps you are expecting your 2nd or 3rd child and you had a challenging experience with breastfeeding previously and you are wondering if things can be different this time.

There is one easy and simple thing to do to get breastfeeding off to a good start…..stay skin to skin with your baby for the first hour or two after birth. 

Research has found that skin to skin contact between a mother and baby at birth reduces a baby’s crying and the baby is more likely to latch on and breastfeed well. Skin to skin contact helps a mother to breastfeed successfully and generally for a longer duration.

In our modern hospital birth environment there are delivery room routines and post partum routines that may disrupt the interaction between a mother and her baby.  Babies may be separated from their mothers, swaddled or dressed before being returned to their mother.  However this disrupts a set of innate behaviours that a baby, immediately placed skin to skin with its mother, displays. 

These behaviours include - looking at mum and the breast, uncurling fists and making grasping movements towards the nipple, crawling towards the nipple, touching and licking the nipple, suckling at the breast.   The baby’s instinct to suck is especially strong after birth and this can set a pattern for future feeds.
 
Both mother and baby benefit from skin to skin contact.  

• Mothers benefit as oxytocin is released, resulting in minimisation of blood loss, reduced anxiety and enhanced attachment to their baby.  Breastfeeding problems can be lessened and prevented and there can be a longer duration of breastfeeding.

• Babies benefit as they are in the “right place” for breastfeeding, they cry less, their body temperature is maintained, their blood glucose levels are more normal, innate behaviours are encouraged and they establish early effective suckling.
  

If you have a complicated birth or are affected by labour medications skin to skin can still be possible.  However, you may require extra support to initiate skin to skin and direct supervision to help you.

There are circumstances where a mother’s or baby’s medical needs take precedence and this early skin to skin contact is not possible.  All is certainly not lost and you can make up for this by keeping your baby skin to skin as often as you can, once you and your baby are able. 

It’s never too late to have your baby skin to skin with you and it is a useful strategy for helping solve breastfeeding problems.

If you want to look at this topic further you will find more information at http://www.cochrane.org/CD003519/PREG_early-skin-to-skin-contact-for-mothers-and-their-healthy-newborn-infants

Newborns may have wind if they swallow air when they feed or cry.  Babies will deal with their wind by burping. 

If your breastfed baby feeds calmly and quietly then they may not need to burp. Generally breastfed babies co-ordinate breathing and swallowing well.  This means that not as much air is swallowed when feeding and therefore they may not need to burp. 

Air can be swallowed while the baby is feeding in the following situations

·     you have a very strong or fast flow of milk

·     your baby may be a speedy feeder who gulps a lot when feeding

·     your baby may choke and splutter when feeding

·     your baby isn’t well attached to the breast

In these situations you may notice your baby does need to burp.  Babies can be unsettled during and after a feed until they have been burped.

Babies have a valve at the top of the stomach, that is inefficient in the early days and they will easily release the air behind it solely by a change in their position – lying down to sitting up, sitting up to being stretched out over your shoulder. 

There is no need to vigorously pat a baby on the back, gentle rubbing is all that is needed.  

It is also very normal for your baby to bring up a little milk when they burp.  Keep in mind that a little liquid goes a long way. Bringing up this milk after a feed is called possetting.

                                                                                                                            Here are some good positions to try.  You can also easily sit down and put the baby up over your shoulder rather than standing up.

When your baby feeds at the breast they are responding to milk flow. At first your baby will suck quickly in order to stimulate the milk to flow.  Once the milk has “let-down” or begins to flow, baby’s sucking rate will slow down as they cope with the higher volume of milk available.  You will notice the baby has a brief pause as their mouth opens wide and their sucking rate slows to about 1 suck per second.  When you see this you would say that the baby is “drinking” at the breast. 

If your baby is just nibbling at the breast – sucking rapidly and not pausing, then they are generally not drinking.  In the early weeks a baby who is not getting enough milk flow at the breast will become sleepy early in the feed or appear uninterested in feeding.  An older baby may pull away from the breast in response to slow milk flow.

Breast Compressions are very helpful to increase milk flow, and will keep a baby actively feeding at the breast.

First, it is important to ensure baby is well latched to the breast.  If the baby is poorly or shallowly latched to the breast they will generally only feed well when milk flow is rapid.

How do you do breast compressions?

·      Wait until baby shows the nibbling at the breast and is no longer drinking.

·      Use your free hand to squeeze the part of the breast that is closest to your chest wall.

·      Squeeze and hold, baby will turn nibbles into drinking. 

·      When baby stops sucking or goes back to nibbling, release the breast.

·      Make sure you keep your hand well back on the breast and not near the areola.  If your hand is too close to the areola, it can lead to a baby becoming shallowly latched.

·      Don’t compress so hard that it hurts or leaves a red mark on the breast.

·      You don’t need to move your hand on the breast, keep it in the same spot, as you are aiming to increase the overall pressure in the breast.

·      Use the whole length of your fingers to compress and not just the tip of the fingers, as this will spread the pressure.

·      Wait for the baby to start sucking before doing compressions.  You may need to help your baby wake up by blowing on their face, tickling under their chin, undressing them down to their nappy to feed.

Here is a youtube clip by Dr Jack Newman, a Canadian Paediatrician, discussing breast compression and showing how it improves sucking strength. Copy and paste it into your web browser.

https://www.youtube.com/watch?v=Oh-nnTps1Ls

Our breasts don’t come with indicators on them to show us how much milk a baby is drinking at each feed, so there must be a way of working out if a breastfeed baby is getting enough milk.  
There is….just remember that what goes in has to come out!  Keeping an eye on a baby’s nappy output will give a good indication if a baby is getting enough breastmilk.  
There are slightly different things to look for depending on the age of your baby.

  Day 1 to Day 5
At birth babies have small stomachs and the first milk they drink, colostrum, is produced in the breast in small quantities, a perfect amount for a newborn to handle.
As your baby takes their small, frequent feeds over the first few days, your milk volume is increasing.  You can see this in the nappy output.
Day 1 – 1 wet nappy
Day 2 – 2 wet nappies
Day 3 – 3 wet nappies
Day 4 – 4 wet nappies
Day 5 – 5 wet nappies

As well as wet nappies, babies will pass poo, this poo changes a lot in the early days.  The early poo is black, tar-like and sticky and is called meconium and it is what has been sitting in your baby’s bowel before birth.  The poo will change colour and consistency when your baby is breastfeeding well.
Day 1 – 1 sticky green-black poo
Day 2 – 2 green-black poos
Day 3 – 3 green-brown poos that are less sticky
Day 4 – 3-4 lighter greenish-brown or yellowish poos
Day 5 – 4 generally mustard-yellow poos, can be seedy or watery

  From Day 6 to about 6 weeks
If baby is getting enough milk, you will see at least 5 heavy, wet disposable nappies in 24hrs and about 4 mustard-yellow poos in 24hours.  When you count the poos, count the ones that are at least as big as a 50c piece.

  Beyond 6 weeks
Babies will settle into their own poo pattern and this can be 1-2 times a day, up to once a week!  The best guide to adequate breastmilk intake is now wet nappies, where you will see at least 5 heavy, wet disposable nappies in 24hours.  They will not be strong smelling or yellow stained, but will be clear.  If you are using cloth nappies, you can expect to see 6-8 thoroughly wet nappies in 24hours.

 

When I visit families in the early days, to help them with their breastfeeding difficulties, they often ask me why their baby doesn’t like to be put down in their bassinet, but is happier being held.  I ask them to consider the huge change the baby has undergone by being born. 

In utero they were in an environment that was at constant temperature, they were being fed continually via the umbilical cord, they listened to the sounds of mum’s  heartbeat, tummy sounds and muffled voice.  They were supported and cushioned by the amniotic fluid, they were cosy and curled up, they were rocked by mum as she moved around.

Once born, the baby now has to cope with gravity, wearing clothes, nappy changes, being handled by different people, food going into their mouth at intervals,  having intermittent closeness to mum and not as much rocking and swaying.

The early weeks with a newborn are a period of transition for them and our job as parents is to help them in this transition.  Often we can do this by holding our babies and comforting them as well as breastfeeding them frequently.  Some babies may need to feed 10-12 times in 24 hours.  Meeting a baby’s needs in these early weeks helps them to transition to life outside the womb. 
 
It is often said that the early weeks go by quickly, but to new parents they can feel long and difficult.  It is only with the benefit of hindsight that you can see that these early weeks are really very short and soon the baby will adjust to their environment and settle down.

If you want to read more about this transition phase for babies I have put a link at the end of this post to a more detailed article by Sarah Ockwell-Smith, who is a UK parenting expert and author who specialises in the psychology and science of parenting, ‘gentle parenting’ and attachment theory. 

http://sarahockwell-smith.com/2012/11/04/the-fourth-trimester-aka-why-your-newborn-baby-is-only-happy-in-your-arms/

Being able to express breastmilk without a breastpump is a terrific skill to learn.  You can hand express to relieve discomfort in the breast when the breasts are full, be able to express milk without having to carry a breastpump around and it is useful for expressing small amounts of milk at the end of a feed.  There is some evidence to suggest that if you are not able to directly feed your baby at the breast in the first few days after birth, hand expressing milk can help maximise your milk supply.

Hand expressing is a learned skill and with practice some mothers have found they do a better job than a hand held pump. 

One vital factor in expressing milk is to get the milk to flow.  Around each milk-making cell are tiny muscles that contract under the influence of oxytocin.  Oxytocin is released in response to stimulus on the nipple/areola.  When our babies directly feed at the breast the rapid sucking at the beginning of the feed causes oxytocin to be released. Your milk releasing, also known as Milk Ejection, fast becomes a conditioned reflex, so that often just thinking about your baby or getting ready to breastfeed gets the milk dripping.

When you first start expressing many mothers find it tricky and generally it’s because you need to condition the breasts to respond to another stimulus – the breastpump or your hands.  So if your efforts are not being rewarded, be reassured, that, with time and practice things generally improve.

To help get the milk flowing you can warm the breast first, with a warm pack or in the shower.  Follow this with some massage of the breast or stroking of the breast.

To hand express, place you fingers at the outer edges of the areola, or even a bit beyond (this ensures you are going to compress over the glandular tissue), push into the chest wall and then compress the fingers together.  Avoid sliding down towards the nipple.  You will discover there are “sweet spots” under you fingers that will reward you with more milk.  Work your fingers around the breast, swap hands if your hand is getting tired, swap to the other breast if the milk flow is slowing.  Thinking about your baby can help your milk to flow, having someone talk to you while you are expressing can take your mind off what you are doing and help you to relax and your milk to flow.

Here is a link to a terrific video about hand expressing, it’s by Jane Morton, a US Paediatrician who works with mums with hospitalized premature babies.

Jane demonstrates the steps to express milk by hand about 1½ minutes into the video.  The hand expressing technique is the same regardless of the age of your baby.

http://newborns.stanford.edu/Breastfeeding/HandExpression.html

There is no one perfect way, you often need to experiment and see what works for you.  Here I share one of the things I try with mums.

Many of the mums I visit are struggling to position and attach their babies to the breast.  They are finding breastfeeding painful and uncomfortable.  My job is to work with them and help them find more comfortable ways to feed their babies. 

Over recent years I have noticed a recurring theme, lots of mums who are finding it difficult are sitting upright or even leaning forward over their baby.  In these positions gravity is working to pull the baby away from the mum’s body, which is the opposite of what works best.   Mum is then having to work hard to hold the baby close to the breast, often pushing on the back of the baby’s head to get them to latch.  In the early newborn days, breastfeeding can be time consuming and as a result these mums are spending long periods of time in discomfort with shoulders, arms and wrists hurting as well as nipples! 

We then try this…..

First of all sit in your chair or sofa and get yourself comfortable.  Lean back and relax into the sofa, take away the pillow you had behind your back as it is pushing you forward.  Instead use the pillow to support under your elbow and this will help support your arm and reduce strain on your shoulder.   

As you lean back gravity is going to help you hold the baby, lessening the work for your arms.  The baby will be fully supported by your body as he/she lies against you.  Position the baby so they lie on top of your body, you will find the whole frontal aspect of your baby’s body will be in contact with you.  You may notice your baby lies diagonally across your body and your arm, on the same side as the breast you are feeding from, will come around and support your baby. 

The baby’s chin contacts the breast, the nipple sits above the top lip and these cues trigger baby’s mouth to open, the tongue to come forward and they latch onto the breast. 

Many mums are amazed at how their baby responds and attaches to the breast in this position.  It works because it taps into the baby’s inborn reflexes. 

I started to think about this after hearing UK Midwife Suzanne Colson speak and then began to put some of her research into practice with the mums I visit. 

Here is a link to her video to see this different approach in action.  http://www.biologicalnurturing.com/video/bn3clip.html

Suzanne also has other helpful information on her website, with a section especially for mothers.
http://www.biologicalnurturing.com/index.html