Postnatal

Breast Feeding

Breast-feeding takes time and practice but the benefits last a lifetime.

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Preparing antenatally by joining La Leche League and attending their meetings or doing a preparing for breast-feeding course will pay dividends.

Your midwife will assess your breasts and nipples. Even women with inverted nipples can exclusively breast feed with preparation and assistance.

The importance of skin-to-skin contact and initiating breast-feeding within the first hour of delivery cannot be over emphasized. That is why at Birthright we aim to deliver your baby into your arms. Unless an immediate baby check is needed on clinical grounds or a pediatrician called to your delivery, we will leave you and your baby every opportunity to bond and feed.

The amniotic fluid that baby smears on your body as you cuddle him or her close is peculiar to you. Your taste and smell that baby is so familiar with. This is very reassuring for the baby whose world has changed from liquid to air, it has a sedating and calming effect on both you and baby as the two of you get to know each other and breast-feeding is initiated.

Visit:

www.babyfriendly.org.nz
www.lalecheleague.org.nz
www.breastfeeding.asn.au

Problems

The most common reasons for “giving up” are nipple pain and perceived insufficient supply.

There are many causes of nipple and breast pain.

The causes include:

  • Infant tongue-tie
  • Infant high palate
  • dermatological conditions e.g. eczema/dermatitis
  • infection e.g. thrush
  • neuro-vascular conditions e.g. vasospasm/Raynauds disease

If you have nipple pain think:

Pink Red Yellow White
Thrush Dermatitis Bacteria Vasospasm

Poor latching and positioning can aggravate tender nipples causing them to crack and bleed.

Correct latching techniques

1. Be comfortable and relaxed
You can breast feed lying down or sitting up.

When sitting up:

  • Keep your back straight and well supported with your feet firmly on the floor or a firm surface like books
  • Keep your body at right angles
  • Leaning forward or back changes the way your nipple presents to baby and can lead to nipple damage
  • A pillow under baby can help you keep baby at breast level without you straining your neck, shoulder, arm or back muscles

2. Remember tummy to tummy and nipple to nose.
There are many different positions to nurse your baby and one side will always feel easy than another.

You need to bring the baby to the breast rather than the breast to the baby.

Baby’s nose may rest on the breast while his/her chin should press into it.

Position baby on her/his side with their whole body facing you, tummy to tummy.
  • Cradle baby’s head in the crook of your arm, your forearm-supporting baby’s body and holding their buttock or thigh
  • Baby’s body from their ear to their hip should be in a straight line
  • Express a little milk onto the end of your nipple, in the first few days it is called colostrum and is clear or creamy. This is so baby can smell his/her food
  • Iif you gently touch baby’s lip with your nipple they will open their mouth wide and you bring baby in close to the breast so a DEEP COMFORTABLE latch is achieved. A deep latch is when a baby has your nipple and a good mouthful of your areola (the dark part around your nipple) in their mouth
  • You may need to repeat this a few times until baby is correctly latched
  • Check the shape of your nipple after baby comes off. It should be round not squashed or flattened
  • Remember to always break baby’s suction with your little finger by sliding it gently into the corner of baby’s mouth before taking baby off the breast

If your nipples are sore or tender discuss this with your midwife and get your technique observed.

Is baby getting enough?

Breast fed babies feed more frequently than formula fed infants and their weight gain is often slower.

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Baby is getting enough if baby has 6-8 wet naps in 24hrs plus dirty naps and is gaining 150gm or more a week.

Remember:

  • Normal babies get hungry and thirsty in the middle of the night
  • Newborns need feeding every 2-3hrs 24hrs a day. They have small stomachs
  • Anywhere between 8-16 breast feeds in 24hrs is considered normal
  • Baby Sucking is the most efficient way to increase your milk supply
Facts:
  • You always have more milk in your breasts in the morning
  • You will always have more milk one side than another, for most women this is the right side
  • You begin to produce more milk within 20-30mins of completely emptying your breasts
  • Breast feeding mothers need to increase their fluids having a minimum of 6-8 glasses of water a day. Alcohol is not recommended
  • The more you breast feed or express the more milk you will make
  • Foremilk is produced between feedings it is very high in protein and the milk baby gets first at a feed
  • Hind milk is calorie-rich and released with letdown as breastfeeding continues
  • Letdown or milk ejection reflex can be noted as a feeling of fullness or a tingling sensation

A baby’s facial features are designed for breast-feeding. Suckling or breastfeeding involves your baby’s lips, gums, tongue, cheeks, hard palate, soft palate and their jaw muscles. Thus the effort required to breast-feed helps develop strong healthy jaws gums and teeth. Their noses are “snubbed” so they can breathe easily while feeding. The chin recedes so the nose rests on the breast and the chin can press into the breast. You will notice baby has a rhythm of sucking, swallowing, breathing, sucking, swallowing, breathing. Effective stimulation of the nipple and adequate emptying of milk from the breast by baby releases prolactin and oxytocin which ensures a continuing supply of breast milk.

Normal babies cry.
Crying is a late sign of needing feeding.

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Early signs that baby is ready to feed are:

  • Baby stirring
  • Their eyelids fluttering open and shut
  • Sucking on their fingers
  • Searching with their mouth
  • When these early messages are ignored, baby will start crying

Breastfed babies who are well do not need other fluids.

Some babies need both breasts at a feed while others may be satisfied with one.

Tension, tiredness, stress and anxiety can affect your supply. Worrying may actually delay your milk letdown.

All babies have a period where they are unsettled.

Maternity Bras

Your bra needs to support your breast firmly without causing indentations in the breast tissue. The flaps should be able to be pulled down easily and make sure you can unhook and rehook the flap with one hand. Rule of thumb: you will go up two-cup sizes and one bra size.

Breast changes

During pregnancy you will notice changes in your breasts due to the changes in hormone levels.

  • Your breast, areola and nipple increase in size
  • The areola and nipple may become darker
  • Veins in your breast may become more noticeable
  • You may leak colostrum from around 24weeks

Once you have delivered the placenta, hormones stimulate milk production. One of these hormones Oxytocin also causes your uterus to contract thereby helping to prevent a post partum hemorrhage. Your breasts will begin to swell as milk fills the ducts.

Engorgement
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Between day two and day four when your “milk comes in”, your breasts may become pinkish/red warm, hard and even painful. This is caused by too much milk, blood and fluid in the breast - swelling the breast so the skin is stretched tight and looks shiny. Your nipples may flatten out and it can be difficult to latch baby.

  • Hand expressing a little helps to soften the nipple and areola and baby can latch more easily
  • You may wish to take panadol if they are very painful
  • If your breasts are lumpy and heavy at the end of a feed you will need to express either manually or with a pump so they are soft
  • Massage any lumps and apply heat, wheat bags are great for this.
  • Breast lumps that are not dealt with can lead to mastitis, which in the worse cases needs hospital admission and intravenous antibiotics
  • Do not wear too tight a bra as this can cause blocked ducts, which can also lead to mastitis
Mastitis

This is an infection in the breast tissue.

Symptoms include:

  • Breast redness, swelling, lumpiness
  • A flu like feeling
  • high temperatures, (antibiotics are needed if so)

Continue to breast feed on the affected side 2-3hrly. Completely emptying the breast each feed is the most effective way of preventing mastitis.

Storing breast milk:

  • Breast milk can be kept covered in the fridge for up to 24hrs
  • It can be frozen for 4months
  • Sterilize an ice cube tray and freeze the breast milk as ice cubes, when frozen put in a new zip lock bag and date
  • Sterilized plastic bags are available at the chemist is another option
  • Do not microwave breast milk this destroys nutrients. Heat in boiling water only
  • Any unused portion of stored breast milk must be thrown away at the end of a feed
Breast pumps

We recommend Ameda breast pumps, which can be bought directly from the importer. This ensures you get a quality product at a reduced cost.

“Purely Yours” – an electric double pump is easy to use and very efficient and portable.

If you are returning to work early, expressing and storing breast milk so the baby can continue to have breast milk is the preferable option.

You can continue giving your baby a morning and night breast-feed and then EBM expressed breast milk during the time you are working.

In New Zealand there is legislation that ensures you have a private place at your work to express.

Discuss returning to work and your options to continue breast-feeding with your Birthright Midwife.

Refer to: www.babyandme.co.nz
Or phone Gesina on 0274222963

Some Breast feeding websites for further information:

www.breastcrawl.org
www.plunket.org.nz

www.pediatrics.org
www.bfmed.org
www.bounty.co.nz
www.breastfeeding.asn.au
www.BFLRC.com
www.kiwifamilies.co.nz
www.lamaze.org

Our goal at Birthright is to provide you the best gynaecological care in a friendly and relaxed atmosphere, where you can talk to us about your needs.