BREAST FEEDING Breastfeeding is part nutrition and part nurturing. The American Academy of Pediatrics, the American Academy of Family Practice and many other professional organizations recommend breastfeeding for first 12 months, but any amount of breastfeeding is beneficial to your baby.

Anatomy of Breast

Physiology of Lactation

Composition of Breast Milk

Constituents of Breast Milk

Advantages of Breastfeeding

Contraindications to Breastfeeding

Before Delivery: Preparing for Breastfeeding Massage breasts and rub nipples gently Avoid using soap on nipples Expose nipples to air and briefly to sunlight Let nipples rub against clothing Natural changes in your breast prepare you for breastfeeding. Here are some general suggestions that may help prepare the nipple and breast for proper positioning & good latch-on. However, research has not shown that prenatal breast and nipple preparation prevents or reduces nipple soreness. 32 33 32

Flat or Inverted Nipples Begin treatment late in pregnancy Stop if causes uterine contractions Breast shells Wear 1 hour a day and gradually increase to several hours Dry area under nipple often Flat or Inverted Nipples may cause challenges with breastfeeding To check for flat or inverted nipples: -Place your thumb above and forefinger below your breast on the edge of your areola and gently compress your areola. This simulates the action of your baby’s mouth on your areola during feeding -The nipple should protrude or stick out. If it flattens or indents, you may have a flat or inverted nipple. This may make breastfeeding difficult because your baby cannot grasp enough of your areola in her mouth to suckle well. Caution: Stimulation of nipples sometimes causes uterine contractions and could cause premature labor for woman at risk. Discuss this treatment with your obstetrician. Discontinue nipple stimulation if it causes contractions unless you are at 37+ weeks. Breast Shells -These 2 piece plastic dome shaped shells are placed over the areola to draw out the nipple. They work by exerting a continuous, gentle pressure on the areola causing the nipple to protrude through the opening in the inner plastic ring. -Wear these shells in the last trimester of your pregnancy . -Keep area beneath shells dry. You may choose shells that have air holes for increased ventilation. -Continue wearing shells after your baby is born if the nipple problem persists -For a short time after removing the shells, your nipple will protrude more than usual-perhaps enough to help your baby latch on more successfully. 33 34 33

Breastfeeding Your Infant Wash your hands Position yourself comfortably and correctly Use pillows or towels for support Uncover the breast you wish to offer first Be comfortable! -It’s easiest to try breastfeeding first sitting up -Sit in a bed, armchair, or rocking chair. -Place pillows behind your back, under your elbow, and in your lap to support your baby. -You may find that a footstool brings your knees up and makes you more comfortable. - Hold baby at breast level. Support your breasts if they are large and support baby’s head. Support keeps the your nipple from pulling away from baby, making the nipple sore. You should not feel tugging. Use your elbow & forearm on the side the baby will breastfeed from to will support baby’s head, neck & back. Use that same hand to hold baby’s bottom or thigh. Correct Holds: Cradle Hold, Cross Cradle Hold, Football Hold, Side Lying Improper positioning: Can cause of nipple soreness Restricts milk flow Presses back on the areola & breast Incorrect Breast Support “V-hold” or “Cigarette hold” Holding the bottom thigh will help mom to roll baby inward to wrap around her trunk in a C shape Baby’s ear, shoulder & hips will be aligned with his legs Baby’s chin & the tip of his nose should be touching breast Incorrect Body Positioning: Baby lies on his back Baby head turned to the side Baby’s head tipped back away from breast These positions cause pulling & tugging on the nipple which can lead to nipple soreness and injury

The Side-lying Position Lie on your side Use pillows Tummy-to-tummy Baby’s mouth in line with nipple Good position for c-section Moms or to doze while breastfeeding 20 21 20

The Football Position Baby’s legs are under your arm Use pillows Helpful for baby’s who are having trouble latching on Good position for mothers who had c-section 19 20 19

The Cradle Position Tummy-to-tummy Baby’s head in crook of your elbow Shoulders, hips, in straight line Level with breast Pillow in lap will help 18 19 18

Offering Your Breast to Baby Fingers underneath, thumb on top of breast Fingers well behind areola -Always alternate the breast you start with. Babies usually nurse more vigorously at the first breast. This will make sure that both breasts get an equal amount of stimulation. You may use a safety pin on your bra strap to remind you which side to begin with, or palpate your breasts and begin with the side that feels more full. -Cup your breasts with your free hand, supporting it with your fingers underneath and thumb on top. 21 22 21

Rooting Reflex and Latch-On Position baby correctly at breast with mouth directly in front of nipple Use nipple to tickle baby’s lips until mouth opens wide Support baby’s head Baby’s mouth is open wide enough to take in nipple and most of areola Babies are born with a reflex that causes them to open their mouths wide when properly stimulated. To stimulate the rooting reflex, brush the baby’s lips gently. If your baby does not open her mouth wide, be patient and keep brushing her lips. Some babies respond more quickly if just their bottom lip is lightly brushed or tickled. Be patient. The baby is learning about breastfeeding just like you are. Wait until baby’s mouth is WIDE open, center you nipple in her mouth and quickly pull her to breast. It is very important that your baby opens her mouth wide and takes in as much of the nipple as possible. This will prevent pain and nipple soreness. Latch-on occurs when the baby compresses the areola and draws nipple into mouth. The infant needs to compress milk sinuses under areola to release milk. If baby grasps the nipple only, the milk sinuses will not be compressed to release milk. Swallowing occurs in response to the presence of milk. Why do nipples get sore? Try the following finger demonstration: Place your index finger in your mouth to the first knuckle and then suck on it. Your tongue rubs the end of your finger. This is what happens to your nipple when your baby does not get enough of your breast in your mouth. Now, put your finger in your mouth back to the second joint and suck as before. This time there is no rubbing. The tongue comes up under the finger, compressing it against the roof of the mouth, and does not touch the end at all. This clearly demonstrates why getting the breast farther back into the baby’s mouth can make the difference between sore nipples and comfortable breastfeeding.

Open wide… Quickly center your nipple in his mouth and pull him toward you Baby’s lower jaw far back from the nipple Baby’s chin on breast Nose may be on breast . When your baby opens his mouth WIDE (like a yawn) quickly center your nipple in his mouth and pull him toward you with the arm that is holding him. -With a good latch-on, your baby’s lower jaw (which does most of the work of nursing) should be as far back from the nipple as possible. -The baby should be pulled in so close that his chin is pressed into the mother’s breast. -his nose may be on the breast as well. -Some mothers are afraid to pull their babies this close, because they worry that the baby won’t be able to breathe. But a baby’s nostrils are flared so that he can breathe even when his nose rests against the breast. 24 25 24

Coming off the breast Watch baby for cues that he is finished May spontaneously come off the breast May fall asleep Allow baby to determine when he is done Foremilk and hindmilk If you need to stop the feeding early, break suction by inserting finger into corner of baby’s mouth Burping -Babies usually nurse for a total of twenty to thirty minutes at a feeding – 10 to 15 minutes on each breast. But all babies are different -- some nurse for shorter periods, others for longer periods. -The same baby may nurse longer at one feeding than at another -Watery foremilk contains protein while hindmilk contains fat and calories. Only the baby knows if he’s had the right amount of both and is satisfied. -If you need to take you baby off the breast before he is finished, break the suction to avoid damage to sensitive breast tissue. 26 27 26

Is baby getting enough to eat? Baby feeds frequently 10-15 minutes on each breast per feeding Adequate wet diapers Adequate stools Baby is gaining weight Before your milk comes in, your baby will get colostrum which provides all the nourishment the baby needs, plus important antibodies to protect him against infections. Your baby is getting enough to eat if: She eats 8-12 times in 24 hours During each feeding, she actively sucks on each breast for 10-15 minutes Adequate wet diapers 2-3 per day by day 3; 6 or more/day by day 6 after birth Stools Baby’s stools will be meconium first day or two After 3rd or 4th day, should have about 3 bowel movements per day for the first few months Appearance is generally loose, yellow, and seedy with mild smell As baby gets older stools may decrease in frequency Weight gain Initially, all babies a bit of birth weight (5-7%) but should regain it by 2 weeks Baby should gain about 1 pound a month Ask pediatrician about Vitamin D supplementation. The size of a women’s breast have nothing to do with how much milk her body can make. To maintain your milk supply, empty your breast at regular intervals. To maintain milk supply, you must have repeated stimulation of the nipple and areola to produce prolactin and oxytocin. The more you breastfeed, the more milk you will produce. 30 31 30

Care of the Nursing Mother

Problems in Breastfeeding Maternal Problems Breast Engorgement Mastitis Breast abscess Lactation Overabundance Insufficient supply Nipples Inverted or Flat nipples Sore or Cracked nipples

Problems in Breastfeeding (Cont.) Neonatal problems Absence of sucking power Anatomical Problems Infection Sleepy or Lethargic child

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