Breastfeeding Advice and Tips

Last week I spoke about how for baby's, fed is best and I don't want this post to retract from that, but I do feel it is my job, both professionally and personally to support women who choose to breastfeed and want to breastfeed. It ended up being one of my main roles as a community midwife and this week is technically my final week as a community midwife so to commemorate the 7 months in community, I thought it would be great to put all the breastfeeding tips and tricks down on paper for a cheat sheet of where to come if anyone is ever struggling in the future. 

I would like to start by saying that of course, written text isn't a substitute for professional or personalised care but it can act great as a reminder tool or for some reassurance. As a community midwife, I give all my women a labour pack a magazine called "Mothers and Other Guide" which shows great visuals of breastfeeding especially. 

Feeding a Newborn

Newborns have very small stomachs. On day 0 to 3, there stomach's are the size of a marble. These slowly increase over time as they stretch with more and more feeding. Due to this, the fill and empty quite quickly. We recommend feeding baby on demand, as baby shows feeding cues, but at least 3 hourly. 

Feeding cues include, waking up, rooting where baby turns their head when stroking the cheek, sucking hands and feet and stretching. When baby is crying and getting agitated, this is usually signs that feeding cues have been missed. You will learn your baby's feeding cues as time passes. 

If your baby doesn't wake by 3 hours after the start of the last feed, we recommend waking them up. You can do this by tickling their feet, changing their nappy and undressing them. If all else fails, you can undress them and so skin-to-skin. Skin-to-skin is also great for bonding and releases oxytocin which in turn causes milk supply to increase.

A good breast feed is anything over 15 minutes. If a baby feeds for less than 15 minutes, we recommend waking them back up and if they won't relatch, to offer them the opposite breast. 

Positioning and Attachment

Start with the basics. Newborns can feed for long periods of time so it's important for the mother to get comfortable first. Make sure to get into a good position, without feeling embarrassed or hiding. Use lots of pillows for support and try to relax as much as possible. 

Make sure to bring baby up and onto the breast. You don't want to be contorting your body to reach the baby, because that can be very uncomfortable and cause bad posture. Likewise, try to relax your shoulders down. If you are tense and shoulders are raised, this can cause a lot of pain. 

The CHIN acronym is crucial in breastfeeding. It stands for close, head free, in line and nose-to-nipple. When positioning baby, baby should be belly-to-belly with the mum. This ensures that the baby's head isn't twisted at the neck, keeping the body and head in line. If there is a twist, swallowing can be more difficult. A lot of people tend to put the nipple straight into the baby's mouth...incorrect. Instead, it should be nose-to-nipple, which usually means bringing the baby further down. Finally, allow the baby's head to be free. This means they can tilt their head back and also allows them to pull away if for any reason they need a break or more space to breathe.

Only bring baby to the breast when they have a big wide open mouth. A crying mouth is not an open mouth. Rubbing the nipple to the nose can trigger this response. 

Signs of a Good Latch 

A good latch is vital to successful breastfeeding. There a some clear signs of a good latch. Baby should have nice full cheeks, that aren't sunken in. The sucking should be quite silent; if you can hear the sucks, it usually means the baby is getting too much air. The chin should be touching the breast, with more of the areola visible above than below and lips should be turned out. 

Breastfeeding may hurt for the first 30 - 60 seconds but it shouldn't hurt for longer than this. If it is still painful after this time, baby isn't latched correctly so you should put your little finger in baby's mouth to break the seal and then quickly pull baby off the breast to reposition and relatch.  

Sucking pattern is important too. It is normal for breastfed baby's to suck-suck-swallow. They should have pauses which allow them to swallow. If they don't have the pauses, it's unlikely they are getting enough milk to require them to swallow any milk. 

Breastfeeding Successfully

Sucking patterns also change throughout a feed. They usually begin with deep and slower sucks and then towards the end of a feed, they become faster and shorter. These latter sucks are called flutter sucks and signify the end of a feed. 

It is important that baby gets both the foremilk and hindmilk therefore baby should be fed from the same breast for a full feed, not switching during a feed. The switch usually occurs at around 10 minutes into a feed, then the richer, sweeter hindmilk is released. Try to alternate breasts between feeds. Often, people move a ring or a bobble to help remember which breast is due next. 

After breastfeeding, your nipples may look longer but they should be a similar shape. They shouldn't be triangular or wedge shaped. If you notice them changing shape, this means baby isn't latched correctly. 

Of course, it's hard to scientifically prove how much milk baby is getting when breastfeeding. The best way to decide if baby is being settled is when baby gets weighed on day 5. Up to 8% weight loss from birth weight is normal, as most baby's do loose weight. If baby looses more than this, a feeding plan will be implemented, usually including topping up. This doesn't necessarily mean formula!

Troubleshooting 

Breastfeeding provides nutrients, which requires nutrients. Make sure you are eating and drinking plenty. Staying hydrated is most important for a good milk supply. If you're still struggling with supply, you can pump immediately after a feed to help increase it. Milk is produced based on a supply and demand mechanism, so the more you feed or pump, the more you products.

Inverted nipples doesn't mean you can't breastfeed. Many women successfully breastfeed for months using nipple shields, however current information recommends not using these. A good alternative is to use a breast pump at the start of the feed to draw out the nipple. Using this for just a few minutes, will allow baby to latch easier. 

It isn't unusual for some babies to have a preference on which breast they prefer to feed from. This is usually more so to do with the position of the baby in utero and that the have a preference on which way they turn their head. Instead of giving up on that side and making your breasts quite uneven, try the rugby ball position. Position the baby as if you were going to feed across the body on the "preferred" side, then slide baby across so you are holding baby underneath you arm. 

If baby isn't opening their mouth wide to allow them to latch, you can try hand expressing a few drops of colostrum or milk. This often gives them something to smell or even to taste, to show them where the milk is. 

If you are really struggling, tried all the tips and got professional help, make sure your baby is checked for tongue tie. Tongue tie can frequently cause breastfeeding pain and weight loss. If neither of these are a problem, the tongue doesn't need to be cut as it isn't affecting the baby's well being. 

I hope that helps healthcare professionals looking for a little reminder, whilst also targeting new breastfeeding mother's who are looking for a little bit of advice. Have you got any