Breastfeeding basics

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

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.