Breastfeeding Know-How – Tips for Making it Work

Breastfeeding can be a wonderful experience for you and your baby. It’s important not to get frustrated if you are having problems. What works for one mother and baby may not work for another, so just focus on finding a comfortable routine and positions for you and your baby. Here are some tips for making it work:

Get an early start

You should start nursing as early as you can after delivery (within an hour or two if it is possible), when your baby is awake and the sucking instinct is strong. At first your breasts contain a kind of milk called colostrum, which is thick and usually yellow or golden in color. Colostrum is gentle to your baby’s stomach and helps protect your baby from disease. Your milk supply will increase and the color will change to a bluish-white color during the next few days after your baby’s birth.

Use proper positioning for baby’s mouth and when holding baby.

• Support your breast with your thumb on top and four fingers underneath. Keep your fingers behind the areola (the darker skin around the nipple). You may need to support your breast during the whole feeding, especially in the early days or if your breasts are large.
• Brush or tickle your baby’s lips with your nipple to encourage the baby’s mouth to open wide.
• Hug the baby in close with his or her whole body facing yours. Your baby will take a mouthful of all of the nipple and most of the areola. The baby should never be latched onto the nipple only.
• Look for both of your baby’s lips to be turned out (not tucked in or under) and relaxed. If you can’t tell if the lower lip is out, press gently on the lower chin to pull the lower lip out.
• The tongue should be cupped under your breast.
• You may see your baby’s jaw move back and forth and hear low-pitched swallowing noises. Your baby’s nose and chin may touch your breast. Breastfeeding should not hurt. If it hurts, take the baby off of your breast and try again. The baby may not be latched on right. Break your baby’s suction to your breast by gently placing your finger in the corner of his/her mouth.

 

HOW TO BRING BABY TO BREAST: Tickle baby’s lips to encourage him to open wide. When open wide, pull him onto the breast chin first. When baby is latched on well, his/her nose and chin touch your breast.

PROPER POSITION OF BABY’S MOUTH AROUND NIPPLE: Note that baby’s lips are around the nipple AND the areola, and the nose and chin are touching the breast. Baby’s lips are turned out or “flanged,” not tucked in

BREASTFEEDING POSITIONS

Here are some positions in which you can hold your baby while breastfeeding. You can choose the one(s) that you and your baby feel most comfortable in. No matter which one you choose, make sure your baby’s mouth is near your nipple and he/she doesn’t have to turn his/her head to breastfeed. For most positions, your baby should be on his/her side with his/her whole body facing yours. This helps him/her to properly “latch on” to the nipple. Try using pillows under your arms, elbows, neck or back, or under the baby for support.

1. Cradle Hold (This is a commonly used position that is comfortable for most mothers. Hold your baby with his head on your forearm and his/her whole body facing yours.)
2. Cross Cradle or Transitional Hold This is good for premature babies or babies who are having problems latching on. Hold your baby along the opposite arm from the breast you are using. Support baby’s head with the palm of your hand at the base of his/her neck.
3. Clutch or “Football” Hold This is good for mothers with large breasts or inverted nipples. Hold your baby at your side, lying on his/her back, with his/her head at the level of your nipple. Support baby’s head with the palm of your hand at the base of his/her head.
4. Side-Lying Position This allows mother to rest or sleep while baby nurses. Good for mothers who had a Cesarean birth. Lie on your side with your baby facing you. Pull baby close and guide his/her mouth to your nipple.

Nurse on demand. Newborns need to nurse often. Breastfeed at least every 2 hours and when they show signs of hunger, such as being more alert or active, mouthing (putting hands or fists to mouth and making sucking motion with mouth), or rooting (turning head in search of nipple). Crying is a late sign of hunger. Most newborn babies want to breastfeed about 8 to 12 times in 24 hours.

Feed your baby only breast milk. Nursing babies don’t need water, sugar water or formula. Breastfeed exclusively for about the first six months. Giving other liquids reduces the baby’s intake of vitamins from breast milk.

Delay artificial nipples (bottle nipples and pacifiers). A newborn needs time to learn how to breastfeed. It is best to wait until the newborn develops a good sucking pattern before giving her or him a pacifier. Artificial nipples require a different sucking action than real ones. Sucking at a bottle can also confuse some babies when they are first learning how to breastfeed. If, after birth, your baby needs to be taken away from you for a length of time and has to be given formula, ask the nurse to use a syringe or cup when feeding him/her to avoid nipple confusion.

Breastfeed your sick baby during and after illness. Oftentimes sick babies will refuse to eat but will continue to breastfeed. Breast milk will give your baby needed nutrients and prevent dehydration.

Air dry your nipples. Right after birth, until your nipples toughen, air-dry them after each nursing to keep them from cracking. Cracking can lead to infection. If your nipples do crack, coat them with breast milk or a natural moisturizer, such as lanolin, to help them heal. It isn’t necessary to use soap on your nipples, and it may remove helpful natural oils that are secreted by the Montgomery glands, which are in the areola. Soap can cause drying and cracking and make the nipple more prone to soreness.

Watch for infection. Signs of breast infection include fever, irritation, and painful lumps and redness in the breast. You need to see a health care provider right away if you have any of these symptoms.

Promptly treat engorgement. It is normal for your breasts to become larger, heavier, and a little tender when they begin making greater quantities of milk on the 2nd to 6th day after birth. This normal breast fullness may turn into engorgement. When this happens, you should feed the baby often. Your body will, over time, adjust and produce only the amount of milk your baby needs. To relieve engorgement, you can put warm, wet washcloths on your breasts and take warm baths before breastfeeding. If the engorgement is severe, placing ice packs on the breasts between nursings may help. Talk with a health care provider if you have problems with breast engorgement.

Eat right and get enough rest. You may be thirstier and have a bigger appetite while you are breastfeeding. Drink enough non-caffeinated beverages to keep from being thirsty. Making milk will use about 500 extra calories a day. Women often try to improve their diets while they are pregnant. Continuing with an improved diet after your baby is born will help you stay healthy. But, even if you don’t always eat well, the quality of your milk won’t change much. Your body adjusts to make sure your baby’s milk supply is protected. Get as much rest as you can. This will help prevent breast infections, which are worsened by fatigue. If you are on a strict vegetarian diet, you may need to increase your vitamin B12 intake and should talk with your health care provider. Infants breastfed by women on this type of diet can show signs of not getting enough vitamin B12.

Getting Enough Milk

So the question is – How do I know that my baby is getting enough milk from breastfeeding?

Most new mothers are concerned about their babies getting enough milk. In the first few days, when you’re in the hospital your baby should stay with you in your room if there are no complications with the delivery or with your baby’s health. The baby will be sleepy. Don’t expect the baby to wake you up when he or she is hungry. You will have to wake the baby every one to two hours to feed him or her. At first you will be feeding your baby colostrum, your first milk that is precious thick yellowish milk. Even though it looks like only a small amount, this is the only food your baby needs. In the beginning, you can expect your baby to lose some weight. This is very normal and is not from breastfeeding. As long as the baby doesn’t lose more than 7 to 10% of his or her birth weight during the first three to five days, he is getting enough to eat. You can tell your baby is getting enough milk by keeping track of the number of wet and dirty diapers. In the first few days, when your milk is low in volume and high in nutrients, your baby will have only 1 or 2 wet diapers a day. After your milk supply has increased, your baby should have 5 to 6 wet diapers and 3 to 4 dirty diapers every day. Consult your pediatrician if you are concerned about your baby’s weight gain.  

Baby’s Age	Wet Diapers	Dirty Diapers Color and Texture
Day 1 (Birth)	1	Thick, tarry and black
Day 2	2	Thick, tarry and black
Day 3	3	Greenish yellow
Day 4	5-6	Greenish yellow
Day 5	5-6	Seedy, watery mustard color
Day 6	5-6	Seedy, watery mustard color
Day 7	5-6	Seedy, watery mustard color

After you and your baby go home from the hospital, your baby still needs to eat about every one to two hours and should need several diaper changes. You still may need to wake your baby to feed him or her because babies are usually sleepy for the first month. If you are having a hard time waking your baby, you can try undressing or wiping his or her face with a cool washcloth. As your milk comes in after the baby is born, there will be more and more diaper changes. The baby’s stools will become runny, yellowish, and may have little white bumpy “seeds.” Overall, you can feel confident that your baby is getting enough to eat because your breasts will regulate the amount of milk your baby needs. If your baby needs to eat more or more often, your breasts will increase the amount of milk they produce. To keep up your milk supply when you give bottles of expressed breast milk for feedings, pump your milk when your baby gets a bottle of breast milk.

Other signs that your baby is getting enough milk are:

• Steady weight gain, after the first week of age. From birth to three months, typical weight gain is four to eight ounces per week.
• Pale yellow urine, not deep yellow or orange.
• Sleeping well, yet baby is alert and looks healthy when awake.

Remember that the more often and effectively a baby nurses, the more milk there will be. Breasts produce and supply milk directly in response to the baby’s need or demand.

Problems

If you are still having problems breastfeeding after following these tips, it is important to talk with your health care provider or a breastfeeding support person such as a peer counselor or lactation consultant.