Medical Info: Three Steps to Successful Breastfeeding

Margaret J. James MN, ARNP, IBCLC

• The baby’s head must not be turned. We don’t eat our lunch with our heads turned to the side and neither should the baby. The ear, shoulder, and hip should form a straight line.
• Never put the breast into the baby’s mouth! Put the mouth onto the breast. Big difference!
• Nose and chin must touch the breast throughout the entire feeding session during the first 2– 3 weeks. Once the baby has learned to nurse, this is usually no longer an issue.

Position
There are many ways that the mother can hold the infant, but regardless of the specific position, the ear, shoulder, and hip must be in a straight line! The head must not be turned toward the breast. I find that the “cross-cradle” is the easiest for me to teach in the newborn period. The mother has the best control of the head and most mothers find it comfortable. Babies love being held so closely against the mother. To teach this to the mother, first ask which breast she prefers to use for this feeding session. Place the front diaper area under the other breast and the mother’s elbow on the baby’s buttocks and hand cradling the baby’s neck/lower part of head. This has the baby comfortably against the mother.

Latch
With her other hand, support the breast that will be used for the feeding. It is important that the fingers be behind the areola (dark area), not on it. Tickle the baby’s bottom lip with the nipple to elicit the rooting reflex.
When the baby has the mouth open wide, quickly draw the baby onto the breast so that the nose and chin are firmly planted on the breast. Baby won’t smother! With the rooting reflex, there will be a several sucks and these will place the mother’s nipple well to the back of the baby’s mouth. Have the mother feel her own hard palate (top inside of mouth) with her tongue. Then ask her to go back with her tongue to find her own soft palate (soft spot). “Way back there!” This is where the nipple needs to be in the baby’s mouth so that it will not hurt/damage the nipple when the baby is sucking. Most mothers are surprised to find how far back the nipple must be in the baby’s mouth. This simple exercise helps them understand the importance of bringing the baby onto the breast. Having the nipple at the back of the baby’s mouth not only causes little if any damage to the nipple, but it also elicits the suck reflex. Once the infant starts a nice sucking pattern, relax the hold on the baby’s neck and allow the nose and chin to gently touch the mother’s breast. If you think the infant can’t breathe, gently tuck the infant’s hips closer to the mother. (You adjust the nose at the
bottom!)

Milk Transfer
The baby should start a “suck-breathe-suck-breathe” pattern, swallowing every suck or two. As the infant swallows, you can see the muscles at the ear and throat wiggle and often hear a soft “ca” sound. The infant will do a pattern of about 5-20 “suck-swallow-breathe-suck-swallow-breathe” and then pause. The pause will be usually as long as the sucking pattern. It is important that the mother not relax her hold on the neck too much. When the nose comes off of the breast, the nipple is positioned closer to thehard palate and this will cause the nipple damage that is so very painful. If the mother starts experiencing pain, have her bring the nose firmly back on to the breast. This is also true if the baby bites and pulls on the nipple. By holding the baby’s neck (with thumb and forefinger at the ears), the mother has more control in teaching the baby how to nurse. It only takes one or two successful breastfeeding sessions for this little person to learn what good stuff is in store and they easily latch and transfer milk without the mom having to control the head. Many moms start successfully holding the baby’s head in the crook of her elbow after one or two pleasant feeding
sessions.

As long as the baby is sucking in a rhythmic cycle, allow the baby to stay at the breast. When the baby is doing more breathing than sucking, the breast is either almost empty (however, the breast aren’t “storage tanks”) or the baby is full. Gently take the baby off the breast (they have usually let go by themselves by this time), burp the baby and then offer the other breast. If the baby takes the other breast with gusto, he is hungry. If the baby lazily nurses, he is probably satisfied. If he has gone longer than two hours between feedings, he will probably take both breasts at the feeding.

Is My Baby Getting Enough?
A baby that is satisfied will usually sleep nicely between feedings and have four or more watery to soft yellow curd-like stools daily. This usually starts happening around day 3 of life. The baby is also voiding. By days 8-14, the baby will start going through the first growth spurt and start cluster feeding. This is normal and usually lasts for several days. Moms often doubt themselves at this time and need reassurance that this is
the way the baby communicates that more milk production is needed. Cluster feeding is when the baby nurses well, rest for 30-45 minutes and then starts smacking the lips and rooting for food. Feed the baby. This can
go on for several hours for up to a week and mothers become worried if they do not understand what is going on. Stools often slow down with this growth spurt (using all this good milk for growth). Be supportive during this time because a mom that has been successfully breastfeeding may stop at this time because her “milk isn’t satisfying” the baby. Breastfed babies usually gain back to their birthweight by 3 weeks. Often healthcare professionals are concerned when the birthweight isn’t regained by two weeks and suggest the mom supplement. Be patient. Supplementation should be the exception, not the rule for the breastfed baby.
If the weight gain is slower than your comfort level, increase the frequency of feeding. Moms need to nurse 8-12 times per day during the first few weeks. This is a big commitment, but well worth the time and effort!
Good luck!!! You can do it!!!

The following is a good web site for breastfeeding answers:
http://www.bflrc.com/

Medical Assistance is Needed During the First Few Weeks If…
1. The infant does not seem satisfied after feeding or is going longer than 4 hours between feedings
2. The infant is not stooling about 4 times per day (normal stools can be very watery for the breastfed infant)
3. The infant is not voiding (infants usually void once per day of life until 1 week, then about 5-7 times per day)
4. The infant is either fussy and does not rest between feedings or is too sleepy to wake up and feed
5. The infant is turning yellow (first the whites of the eyes, then the face and body)
6. The infant has a rectal temperature of 100.4
7. You have concerns or questions

Normal Infants…
Sneeze – Hiccup – Breath slow sometimes and fast other times – Sound slightly stuffy from time to time – Make cute little faces as they sleep – Have dry skin – Love to have skin to skin contact – and are all unique,
special little people.