pregnancy post #2

today's topic.... breastfeeding!

i think this is such a huge topic and really important for new mom's to read and know. no matter who says what about breastfeeding or what your professors teach you about "baby instincts", breastfeeding will probably be one of the more difficult things with your new baby. all babies need to learn how to suck. yes, it is in their instinct to suck, but they need to learn how to suck on an actual object. in this case, mom's breast. i will also warn you, you probaby won't get a firm grip on breastfeeding until about one to two weeks after birth, maybe even longer! i get a lot of mom's who cry and get frustrated because their baby won't suck or latch properly. it is very very frustrating and be prepared to get frustrated and cry. it is all normal. and no, we nurses dont get upset with you. :) we all understand that it is hard and need lots of practice. it helps us too, though, if you understand that as well. it is very rare to have a newborn that can latch on correctly and have a "perfect" breastfeed right after birth. this is probably the most misunderstood concept to breastfeeding. you are new at it, baby is new at it. it takes time to find the right position that works for both you and your baby. also, does your baby have a short tongue? tight frenulum? is the baby under 37 weeks (37 weeks is when the baby learns how to suck in the womb)? what are the shape of your nipples? did you use drugs while pregnant? did you get an epidural? did you have breast augementation or reduction? all these and more play a factor in breastfeeding. but remember, you can do it! it is possible and you will have a wonderful experience breastfeeding. dont give up. and we nurses are here to help you. :) it will be one of the greatest experiences in your life.

in this post, i will go over the three most common positions to breastfeeding and what to look out for. be prepared for a loooong post.

it is very important that a newborn feeds every 2-3hrs for breastfeeding. (3-4 hours with formula). the first three days after birth, the mom makes what is called colostrum. this isnt your actual "milk" yet has many many important nutrients that help nourish your baby. BUT, if you plan on breastfeeding for a week or two to get this colostrum and then formula feed, i would recommend you do not breastfeed altogether. this is extremely important and i will get to it in a later post.

to have a proper latch in any position, the baby needs to open its mouth as wide as it can. latching is what we call when the baby has a firm suction onto the breast. it is best to have as much of the BREAST, not the nipple, in the baby's mouth. the second common misunderstanding is having the baby suckle only on the nipple. you can do this if you want, but 1. the baby will not get enough food. 2. you will be in serious pain. prepare for bleeding and cracked nipples. ouch! you want as much of the areola, "the dark part", of your breast in the baby's mouth. this also helps bring down the colostrum/milk.

the three most common positions:
1. football hold/clutch: this position i recommend the most. you have the most freedom with your hand to either move baby or massage your breasts. you hold the baby like you would a football, under your arm. you sit far upright as you can and have the baby resting on pillows, i want to stress the importance of having the baby's head level with your breast. you hold the baby from ear to ear with your thumb and forefinger. use the rest of your three fingers to support the baby's head. bring the baby up to your breast, never the breast to the baby. keep the baby close to your body as possible and NEVER push the baby's head toward your breast. always bring the baby to you by the using the palm of your hand from the baby's shoulders.

2. cross-clutch: in this position, the baby is across your chest. you are holding the baby's head with one hand feeding the baby on the opposite breast. i.e. baby's in your left hand, feeding on the right breast. same positioning with the baby's head and your hand as the football hold. important to have pillows supporting you and the baby. remember to have baby's chest against your chest, not on its side. again, have as much of your breast in the baby's mouth. baby should be level with your breast.

3. cradle hold: my least favorite. a lot of mom's use this because its a common way to hold baby, and grandmothers usually tell them its the proper way. it is the hardest to breastfeed in this position. i say this because the baby is lying in your arms with its head lying on your antecubital/elbow. its hard to position baby's head correctly in this way and baby usually will end up on the tip of your nipple. again, have baby chest to chest with you and as close to you as possible.

things to remember while breastfeeding:
1. babies can breathe.. they cannot suck if they cannot breathe. from mom's perspective, it looks like baby doesnt have enough room to breathe. but they infact have plenty of room to breathe, if they are sucking, they are breathing. there is usually a small slit inbetween the nares and your breast. that is enough for the baby to breathe. unless, of course, you have huge breasts. :) a common mistake is mom's will retract their breast because they fear baby is not breathing. this is not a good thing to do because iit pulls the breast out of the baby's mouth resulting in either loss of suction or sucking at the tip of the nipples. if ever in doubt, push down and into the baby's mouth. down and in, never away. also, DO NOT, i repeat, DO NOT pull away from baby when you have suction. break the suction first with your finger. i promise you the moms who just pull away have serious nipple pain. you dont want that. imagine a tight clothes pin on the end of your nipple. yea, you dont want that.
2. massage your breasts. this helps stimulate the milk and bring it down. think of your breast as a clock. massage 12,3, 6, and 9 o'clock. if you watch closely, your baby will do this too! its amazing. they will caress your breast and massage it! how cool is that! :)
3. mom's usually fear that baby isn't getting enough food because they cannot hand express colostrum. this is not true. your baby sucking is the best in bringing out your milk. dont worry that you cannot hand express colostrum or you cannot get much while pumping. pumping can only simulate. baby is best! also, about 5 millileters of colostrum equals 10-15 millileters of formula! colostrum is very very rich. if you doubt baby isnt getting enough, look at baby's weight. they loose some after birth, but if they loose more than 10%, they arent getting enough. also, does baby look satisfied? or is it continually rooting, sticking its tongue out, or sucking on its hand. these are signs baby isnt getting enough. and you can always supplement with formula.
4. breastfeed at least 15-20 mins. babies usually suck, rest, suck, rest. but resting shouldnt be more than 5- 10 seconds. they need to actively feed for 15 mins.
5. the more you take away, the more you will make. i said earlier that if you plan to breastfeed for a week, then dont breast at all. it is because you will continue to make milk. you dont want that if you are going to formula feed. also, it will increase the chances of engourgement. way to prevent milk from producing is to not feed, wear a tight bra, put something cold over your breast. DO NOT shower in warm water. warm water produces milk. if your breasts are full, its not a good idea to "release the milk" by pumping or feeding. put something cold over your breast.
6. contractions/cramping: breastfeeding signals your brain to produce oxytocin (mentioned in earlier post). you will feel contractions and have cramping. bring on the ibuprofen! :)

what ive covered here is usually what happens the first 1- 3 days after birth. its a lot, i know. after you leave the hospital is a whole other story. i will cover let down, engourgement, and second milk in a later post. :)