Breast­feed­ing ba­sics

Bet you never knew nurs­ing ba­bies was this com­plex! Take our no-stress guide to breast­feed­ing and ex­press­ing

Your Baby & Toddler - - CONTENTS -

IN THE FIRST YEAR of life, ba­bies grow faster than at any other time of their lives. An in­fant’s birth weight dou­bles af­ter about five months and triples by his first birth­day, by which time his length has in­creased by half. Ad­e­quate, appropriat­e nu­tri­tion is es­sen­tial to en­sure op­ti­mal growth and brain func­tion. For the first six months, ex­clu­sive breast­feed­ing pro­vides the suf­fi­cient amount of calo­ries, pro­tein, fat and carbohydra­tes that your baby’s grow­ing body needs. Reg­u­larly mea­sur­ing your baby’s weight and length, and plot­ting it on a growth chart de­ter­mines the ad­e­quacy of your baby’s food in­take.

BREAST­FEED­ING YOUR BABY

Breast milk is na­ture’s nu­tri­tional superfood. Not only does it pro­vide the best nu­tri­tion and pro­tec­tion for your baby, but it’s also al­ways avail­able at the right tem­per­a­ture and at a mo­ment’s no­tice.

The World Health Or­ga­ni­za­tion rec­om­mends ex­clu­sive breast­feed­ing for the first six months of a baby’s life.

THE FIRST FEW DAYS

Breast­feed­ing may be nat­u­ral, but it doesn’t al­ways seem to come nat­u­rally! In the first four hours af­ter de­liv­ery, your baby may ini­tially be very alert. This is when the suck­ing re­flex is strong­est and the best time to put your baby to your breast, so you can both start get­ting the hang of feed­ing. Breast­feed­ing is an in­tri­cate dance, and both Mom and Baby have to learn the steps. While you’re still in hos­pi­tal, it is im­por­tant to ask for help from the nurses, as latch­ing and po­si­tion­ing your baby can be tricky.

If you can’t nurse within the first few hours af­ter birth, en­sure that you have a sup­port­ive mid­wife or lac­ta­tion con­sul­tant to help you later on.

GET­TING STARTED

Once you’ve found a com­fort­able po­si­tion and your baby is latched cor­rectly, al­low him to feed for at least 15 min­utes on one breast – or un­til he falls asleep and un­latches – and then switch to the other breast. Burp­ing your baby be­fore switch­ing him en­sures that you rid him of ex­cess wind. If he has too much air in his stom­ach, he will feel fuller than he ac­tu­ally is. He may even be un­com­fort­able. Af­ter a short break, nap or nappy change, your baby may want a small “top-up” feed. This is per­fectly nor­mal, and you may find he needs a cou­ple of “cour­ses” be­fore he is to­tally sat­is­fied.

In the first cou­ple of days be­fore your milk comes in, your breasts will pro­vide your baby with colostrum, which is a thick, yel­low­ish sub­stance that is of­ten called “liq­uid gold”. This is be­cause colostrum is rich in an­ti­bod­ies and es­sen­tial nu­tri­ents.

Even if you don’t want to breast­feed in the long term, at least try to make sure your baby gets a few feeds worth of this rich liq­uid to give him the best start in life.

When your main milk comes in, don’t be sur­prised if it’s thin­ner and more blue in colour than colostrum.

Once breast­feed­ing is es­tab­lished, your baby should feed be­tween eight to 12 times in a 24-hour pe­riod. He may spend 20 to 45 min­utes, or even longer, suck­ling. »

STEP-BY-STEP GUIDE

Get com­fort­able on a bed or chair, and have some­one hand your baby to you. In the weeks to come, you will learn how to get com­fort­able with your baby in your arms, but for now, rely on nurses and your part­ner for help.

• Sup­port your back and arms with pil­lows, and place a pil­low on your lap to raise and sup­port your baby if nec­es­sary. Use one hand to sup­port your breast – place your fingers un­der the breast and thumb on top – then cradle your baby in the crook of your arm.

• Make sure your baby’s tummy is against yours, and that he is ly­ing on his side. His head shouldn’t be turned – en­sure that the head, neck and spine are all in a straight line.

• Latch your baby onto the nip­ple by tick­ling his lips with your nip­ple to make sure he opens his mouth wide, then quickly bring him to­wards your breast. The nip­ple should go into the back of his mouth.

• It is im­por­tant that you latch cor­rectly to pre­vent sore, cracked nip­ples and to en­sure your baby is tak­ing in enough food (and not too much air) and not hav­ing to work too hard for it.

MORE BREAST­FEED­ING PO­SI­TIONS

The most im­por­tant thing when you start breast­feed­ing is to get into a po­si­tion that’s com­fort­able, so that you can feed for as long as your baby needs. Here are two more po­si­tions to try. See which is best for you.

• Ly­ing down: Lie on your side in bed, so that your breast is at the same height as your baby’s mouth. Sup­port your head on a pil­low. Feed your baby from the lower breast. This po­si­tion is ideal for night feeds be­cause you can doze com­fort­ably while feed­ing.

• Foot­ball hold: Sit up and tuck your baby un­der your arm in a “foot­ball hold”, with his legs be­hind you and his mouth at your breast. You will need to sup­port him be­hind the neck. This hold is es­pe­cially com­fort­able if you’ve had a cae­sarean, or twins.

ES­TAB­LISH­ING A FEED­ING ROUTINE

Your milk usu­ally comes in on day three of your baby’s life, but it may take longer. Be­fore this, your baby has been get­ting tiny amounts of colostrum at each feed. Once breast­feed­ing is es­tab­lished, the sup­ply of milk al­ways meets the de­mand. But you will need to know how to get started and how to es­tab­lish and main­tain your milk sup­ply to be­gin with.

By the fourth day, you should be ex­pe­ri­enc­ing some breast full­ness or even en­gorge­ment. Plan to spend the next few days at home, so that you can feed when­ever your baby de­mands. Feed­ing reg­u­larly now will pre­vent your breasts from be­com­ing too full for your baby to latch prop­erly.

Let your baby feed for as long as he wants un­til he falls asleep or re­leases his latch. Then burp him and of­fer the other side. If he takes it, great. If not, that’s fine too. Even­tu­ally, most ba­bies nurse on both breasts, and your milk sup­ply will set­tle down.

IS YOUR BABY GET­TING ENOUGH?

Dur­ing the first four to six weeks, you may won­der if your baby’s get­ting enough milk, es­pe­cially if they want to nurse all the time or are rest­less af­ter feed­ing. It’s nat­u­ral for your baby to want to feed ev­ery two or three hours. Re­mem­ber, you should not be forc­ing your baby into a routine or fol­low­ing a sched­ule while you’re try­ing to get breast­feed­ing un­der way.

Lac­ta­tion con­sul­tants, clinic sis­ters and pae­di­a­tri­cians can tell whether your baby’s get­ting enough milk by how much weight he gains. Have a doc­tor or clinic sis­ter check your baby’s weight if you’re con­cerned. Well-fed ba­bies also wee and poo, so keep an eye on his nap­pies’ con­tents.

BREAST­FEED­ING PROB­LEMS: Cracked, bleed­ing or sore nip­ples

oc­cur be­cause of in­cor­rect po­si­tion­ing and latch­ing. What you can do

• Visit a breast­feed­ing con­sul­tant and have her show you ex­actly how you should latch your baby. If you are re­ally hav­ing dif­fi­culty feed­ing, you could ask a con­sul­tant to sit with you through a full feed, so she can point out any changes you need to make.

• Keep sore nip­ples as dry as pos­si­ble, and avoid us­ing soap on nip­ples. • Ex­press a lit­tle milk af­ter each feed, gen­tly rub it on the sore nip­ples, and let it dry. Ap­ply nip­ple cream if nec­es­sary.

Thrush

is a fun­gal in­fec­tion that may af­fect your baby’s mouth or bot­tom, or cause sore, ir­ri­tated nip­ples. White patches in­side your baby’s mouth or se­vere nappy rash that won’t heal is an in­di­ca­tion you both have thrush.

What you can do

• The in­fec­tion is passed back and forth be­tween the two of you, but it can eas­ily be cleared up by anti-fun­gal med­i­ca­tion (for both Mom and Baby) pre­scribed by your doc­tor.

En­gorge­ment

hap­pens be­cause of in­creased blood sup­ply to the breasts as well as swelling of the milk-se­cret­ing glands as your milk “comes in”. Post­na­tal full­ness will sub­side within a few days. Most prob­lems, such as a blocked duct and mas­ti­tis, oc­cur be­cause of in­fre­quent breast­feed­ing.

What you can do

• Feed your baby of­ten to main­tain good drainage of the breasts, and wear a sup­port­ive bra.

• Gen­tle mas­sage in a warm bath or shower may also help, as will ap­ply­ing cold, un­cooked cab­bage leaves to the breasts be­tween feeds.

• If you sud­denly feel a painful swelling in your breast, or de­velop flu-like symp­toms with sore breasts, con­tact your doc­tor.

Growth spurts

oc­cur when your baby is about 10 days, three weeks, six weeks, three months and again at six months old (com­ple­men­tary food can be of­fered at six months).

What you can do

• Feed on de­mand or more fre­quently. • Drink enough flu­ids, eat reg­u­larly and choose nu­tri­tious snacks that con­tain a com­bi­na­tion of whole­grains, fruit, veg­eta­bles, dairy prod­ucts and pro­tein in the form of meat, chicken, soya or fish.

• Rest as much as pos­si­ble.

EX­PRESS­ING MILK

There are times when you may have to ex­press your breast milk and bot­tle-feed. Here’s how to do it so baby can ben­e­fit from breast milk for as long as pos­si­ble.

Be­fore you get started

Like breast­feed­ing, feed­ing from a bot­tle is a skill your baby has to learn. It will take time for your baby to adapt to a bot­tle, so per­se­vere in your at­tempts un­til he ac­cepts a bot­tle. Try not to in­tro­duce a bot­tle un­til breast­feed­ing is es­tab­lished to avoid your baby hav­ing dif­fi­culty ad­just­ing to each tech­nique.

In the early days of en­gorge­ment, un­til sup­ply and de­mand set­tle down, a breast pump comes in handy to ex­press a lit­tle milk be­fore breast­feed­ing, so baby can latch a lit­tle eas­ier. You may find it help­ful to use a breast pump af­ter feeds to con­tinue stim­u­lat­ing your breasts when baby gets tired. Save the ex­pressed milk for top-ups.

From the start, you may need to ex­press a bit to stim­u­late milk pro­duc­tion, if your baby is not feed­ing ef­fec­tively.

You may also find your­self ex­press­ing ex­cess milk and stor­ing it for later, so that Dad can do a mid­night feed and give you a longer sleep. Af­ter a few months, many moms find that ex­press­ing milk gives them greater free­dom. Know­ing that there’s al­ways a stock of milk in the freezer al­lows you to run er­rands or go out in the even­ing with­out wor­ry­ing.

At about six weeks into your breast­feed­ing jour­ney, you and baby have more of an idea of how to do this in­tri­cate dance. Your milk sup­ply has set­tled down, and you have been given the go-ahead by your doc­tor to be­come more ac­tive, start driv­ing and go back to gym. It’s time to start re­gain­ing a bit of your life as your baby set­tles into more of a routine. In this case, pump­ing be­comes your best friend.

Hand ex­pres­sion The bonus with hand pump­ing is that it’s free, al­though you could need some ex­pert ad­vice from a lac­ta­tion con­sul­tant to learn how to do it ef­fec­tively. This method re­quires prac­tice and skill but also is only suit­able if you are sel­dom away from your baby – hand ex­press­ing is hardly go­ing to be the best op­tion if you’re back at work.

Man­ual pump You use your hand and wrist to op­er­ate a hand-held de­vice to pump milk. Many of the man­ual pumps on the mar­ket th­ese days are as ef­fec­tive as elec­tric ones at a frac­tion of the cost. They are also not as noisy, so they’re per­fect if you in­tend pump­ing from one breast while baby is latched to the other.

Au­to­matic elec­tric pumps Most moms opt for an elec­tric pump, which runs on bat­ter­ies or plugs in at the wall. If you are hav­ing mul­ti­ples, a good elec­tric pump is a must, as they are much eas­ier and more con­ve­nient to use.

You can choose one that pumps one breast at a time, or a dou­ble ver­sion that can pump both si­mul­ta­ne­ously (this col­lects more milk in less time). Pumps can be bought or rented, so con­sider ei­ther op­tion or find one that suits you.

Hos­pi­tal-grade elec­tric pumps

Th­ese can be rented from a lac­ta­tion con­sul­tant or a breast­feed­ing or­gan­i­sa­tion like La Leche League. Th­ese pumps should be con­sid­ered if your baby can’t feed from the breast (if he is pre­ma­ture and in the neona­tal in­ten­sive care unit) or if you are hav­ing mul­ti­ples, as they can be in­valu­able in es­tab­lish­ing and main­tain­ing milk sup­ply.

When should you pump?

For most women, go­ing back to work and con­tin­u­ing breast­feed­ing is the chal­lenge they face at around three months. In this in­stance, you will have to pump at work (and store your milk there) to keep your sup­ply up. Talk to your em­ployer about your in­ten­tion to con­tinue breast­feed­ing. A pri­vate, clean en­vi­ron­ment has to be pro­vided for you to pump in peace. Learn how to best store your milk, so Baby can con­tinue ben­e­fit­ing from it, and teach your child min­der how to de­frost and warm it prop­erly be­fore feed­ing Baby. What you pump at work on Mon­day can be fed to baby on Tues­day and so on.

Us­ing a bot­tle to feed your baby ex­pressed breast milk

Your baby may not take to drink­ing from a bot­tle at first. How you in­tro­duce him to it may mean the dif­fer­ence be­tween suc­cess and fail­ure. • Let some­one other than you in­tro­duce the bot­tle of ex­pressed breast milk to en­sure your baby takes it.

• Your baby as­so­ciates be­ing held in a pair of arms with be­ing breast­fed. Usu­ally he can smell your milk from that po­si­tion, too. This may cause con­fu­sion, so let him lie on some­one’s lap when they feed him a bot­tle.

• Feed your baby on the breast to sat­isfy his ini­tial hunger, then hand him over to the other per­son, and leave the room while he is of­fered the bot­tle.

• Keep the teat in your baby’s mouth even if he just chews on it. Once the milk starts to come out of the teat, he should start to suck. If your baby re­sists, warm the teat slightly, as he will not be used to the cold­ness of the teat. • If you are re­turn­ing to work, start in­tro­duc­ing your baby to the bot­tle a fair while be­fore you do. Leav­ing it for the day be­fore makes it even more stress­ful for you and your baby.

• To avoid your baby de­vel­op­ing a pref­er­ence for the bot­tle, breast­feed as of­ten as pos­si­ble, and only use a bot­tle when nec­es­sary.

• Be sure to wash and ster­ilise the bot­tles and teats care­fully af­ter each feed to pre­vent any bac­te­ria from form­ing in the bot­tles and teats.

Stor­ing your ex­pressed breast milk

Be­cause of its mix of vi­tal nu­tri­ents it’s im­por­tant to store ex­pressed breast milk prop­erly. Breast milk can be stored in clean glass or BPA-free bot­tles with tight­fit­ting lids. You can also use milk-stor­age bags, which are de­signed to be frozen and can be clearly la­belled.

Af­ter pump­ing

Once you’ve ex­pressed your breast milk – ei­ther by hand or by us­ing a man­ual or elec­tric breast pump – la­bel the date on the stor­age con­tainer. This is so that you can be sure it’s still safe to use.

De­pend­ing on where you’re go­ing to be stor­ing your breast milk, it has a dif­fer­ent shelf-life:

• Four to six hours at room tem­per­a­ture (19-26°C)

• 24 hours in a cooler with three ice packs (15°C)

• 48 hours in a fridge (4°C)

• Six to 12 months in a freezer

(-18 to -20°C)

• Use thawed breast milk within 24 hours.

Tips for freez­ing

• Don’t tighten the lids or caps on the bot­tles im­me­di­ately af­ter ex­press­ing. Rather wait un­til the milk is com­pletely frozen.

• Leave two cen­time­tres or so from the milk to the top of the con­tainer to al­low for ex­pan­sion when frozen.

• Store the milk in the back of the freezer – not in the door of the fridge.

• Re­mem­ber to la­bel each bot­tle or bag clearly with the date it was frozen, so that you can keep track of when it should be used by.

• Al­ways use a bowl of warm or boiled water to warm up your breast milk – it may be quicker, but don’t ever mi­crowave breast milk, as it breaks down the nu­tri­ents.

• Never re­freeze breast milk that has al­ready been thawed – and never add freshly ex­pressed breast milk to frozen, cool or thawed milk.

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