Used with permission from Mama Aroha

Used with permission from Mama Aroha

Breastfeeding support 

 

Before your baby arrives

What are the benefits of breastfeeding? 

Breastfeeding has many benefits. Many last a lifetime

For you
It helps you relax and encourages a close bond between you and your baby
It helps your uterus (womb) contract after birth, so there’s less blood loss
It can help you return to your pre-baby weight sooner
It usually delays periods for a while. This may help prevent you from becoming pregnant again. Check out the Lactation Amenorrhoea Method.
Less Postnatal Depression
Less risk of cervical, ovarian and breast cancer
Less risk of high blood pressure and heart disease
Less risk of brittle bones later in life

For your baby
It is the best food (super kai!) for a baby for the first six months
It is always ready and at the right temperature. No waiting required
Babies love being held close while breastfeeding
Less tummy bugs, chest infections, ear infections, urinary tract infections and less likelihood of sepsis and meningitis
Less risk of SUDI (Sudden Unexpected Death in Infancy)
Less risk of allergies, eczema, asthma, and reflux
Less risk of some childhood cancers, celiac disease, and Crohn’s disease
Breastfeeding helps your baby’s brain develop
Breastfeeding helps with good development of the jaw, teeth and speech
Less risk of heart disease, obesity and diabetes in later life

For your family
Saves time and money - no transport, shopping, prep or cleaning up required. No need to buy formula, bottles, teats and sterilising equipment
Go anywhere and feed anytime
No waste - which is good for the environment
Breastfeeding is normal for human babies

Facts about breastfeeding 

If every child was breastfed within an hour of birth, given only breast milk for their first six months of life, and continued breastfeeding up to the age of two years, about 800 000 child lives would be saved every year

Ten Facts About Breastfeeding

The World health Organisation (WHO) and United Nations Children’s Fund (UNICEF) recommend feeding babies only breastmilk (exclusive breastfeeding) up until 6 months of age and to continue breastfeeding for up to two years with complementary food and fluids.

Black RE, Victora CG, Walker SP, and the Maternal and Child Nutrition Study Group. Maternal and child undernutrition and overweight in low-income and middle-income countries. Lancet 2013; published online

Some useful sources of Breastfeeding Information  What are my rights around maternity leave?  What are my rights around breastfeeding?  How can I prepare for breastfeeding? 

Breastfeeding is instinctive for babies, but a learnt skill for mothers

  • Do all you can to learn about breastfeeding before your baby arrives.
  • Ask the women in your family/whanau about breastfeeding. There is often a wealth of experience and knowledge within families.
  • Going to the Birthing Centre Coffee Meetings, or a La Leche League meeting can be very helpful. Being around other women breastfeeding their babies is a very natural way to learn. It also helps establish supportive connections for later.
  • You can learn a lot about breastfeeding by going to antenatal classes.
  • Talk to your midwife during your antenatal visits, and discuss what will happen in the early days after the birth. If you have any worries (like inverted nipples), make sure your midwife knows and you have the opportunity to talk this through. You can ask her for your free copy of the ministry of health DVD – “Breastfeeding Naturally”.
  • Wearing maternity bras during your pregnancy will get them softened and comfortable for the early days of breastfeeding when breasts and nipples can be tender. Your glandular (milk making) breast tissue grows in pregnancy. About a bra cup size increase tells you that you have a normal amount of milk making tissue. This also tells you that you can make a normal amount of milk J Your breasts will get bigger too, after your baby is born. Tight bra’s are not helpful so make sure yours have some room.
  • There is no need to toughen up nipples for breastfeeding, but elasticity helps. A few drops of Extra Virgin Olive Oil applied regularly reduces cracking.
  • You can massage your breasts and express out a little bit of colostrum in the last weeks of pregnancy. This gets you used to handling your breasts and nipples and stimulates colostrum production. See How do I hand express my breastmilk? or see Antenatal Hand Expression 
    A good colostrum production will make life easier for both of you in the first days.
    You can also collect and freeze colostrum for when your baby comes. Storing Breastmilk
    You can discuss this with your midwife.
  • Talk to you partner and family about your goals and the importance of their support around breastfeeding. Partner support is the most significant factor for breastfeeding success.
  • Plan your maternity leave (as needed)
  • See a lactation Consultant for particular concerns
Do labour medications, or the type of birth, affect breastfeeding?  

Many of the medications used in hospitals, and a difficult birth, can result in a baby finding it difficult to feed well in the first few days. The milk may also be a delayed in coming in.

A natural, drug free birth, is the best start to breastfeeding. Planning for a natural birth and using drug free ways to cope with labour can be discussed with your LMC during your pregnancy.

Sometimes birth interventions are beyond our control. If this happens, lots of ‘skin to skin’ in the early days and hand expressing of colostrum to feed your baby is a the best way to help.

How can I get breastfeeding off to the best start? 
  • A natural un-medicated birth followed by uninterrupted skin to skin contact with your baby is the best start for breastfeeding
  • The early days are a unique, and occasionally challenging, time. 
  • Getting informed before your baby comes, about what to expect
  • The practical support of your partner is a great help.
  • During your stay at HBC the nurses, midwives and Lactation Consultants (as needed) will provide information and support.
  • see How can I prepare for breastfeeding?

Best Start For Your Baby.pdf

What are the challenges to getting breastfeeding of the the best start? 

Challenges to Breastfeeding

There are a number of things that can pose challenges to breastfeeding, many are outside our control. They include… no breast changes during pregnancy, inverted nipples, hormonal or metabolic conditions eg, Poly Cystic Ovarian syndrome, Insulin Dependent Diabetes, severe eating disorders, a high BMI, use of illegal or abuse of prescription drugs, previous breast surgery, being an older first time mum eg 35+ yrs. Also birth interventions. These include the use of syntocinon (This is usually given during inductions or to help strengthen contractions, and again after the birth to help the placenta come out, or because of bleeding) Also Intravenous fluids, Pethidine, an Epidural, or a forceps, ventouse or caesarean birth. A difficult birth, separation of a mum and baby, an unwell mum or baby, a baby smaller than 2500 gms, or born before 38 weeks, or a baby that is tongue tied can all be challenges for breastfeeding. Whew.

…however, there is good news… 

Every breastfeeding pair is unique and not everyone is affected by the same issues in the same way

If you and your baby have some of the ‘risk factors’ listed above there are many simple steps you can take to help, including… 

Before baby is born:
       Breast massage and Hand Expression of colostrum in the weeks before the baby is born,
       Collection and storage of colostrum, for use during the first days
       Applying Virgin Coconut Oil and Olive Oil to nipples
       Gaining extra length to nipples (if flat or inverted)
       A natural birth if possible

After the birth:
      Lots of Skin-To-Skin with baby. You could use a wrap and do continuous Skin-to-skin ‘kangaroo care style. This video shows how to do it safely https://tinyurl.com/ycrctub6
 Encouraging baby’s instincts and reflexes to feed through the Biological Position
        Early and frequent breastfeeds while using Breast Compressions
        Hand expression of colostrum after feeds or feed attempts
        Use of a breast pump for extra stimulation after feeds or feed attempts
        Giving supplements only if medically indicated
        Getting help from your midwife and/or a Lactation Consultant, for more ways to help

Even if breastfeeding has a challenging start, with time and support, for most people breastfeeding can become easy and enjoyable.

BFHI and making the most of things

Building a happy baby   I don't think I'll be able to breastfeed 

What if I have inverted nipples, have no breast growth in pregnancy and problems with my health or other issues?
It is likely you can still successfully breastfeed. Seeing a Lactation Consultant and learning all you can about breastfeeding before your baby is born is a good idea. See also 'Challenges to Breastfeeding'

Depending on your issues, you may want to find ways to encourage more length to your nipples, or stimulate your colostrum production and save it. Some mothers get a little frozen milk from another mum, in case they need a bit extra while getting their own milk production going well. (The World Health Organisation advises that donated breastmilk from a healthy woman is preferable to formula)

Having a plan for the first few days will help get breastfeeding off to the very best start.

Lots of skin-to-skin contact from the start, and extra, frequent breast stimulation by hand expression and/or pumping can give your milk production that extra ‘kick start’ it needs.

But even after a slow start, milk production can usually be built up to a good supply. Bodies are amazing, and often surprise us with what they are capable of.

Even when there are major challenges, if you have some glandular breast tissue you can make some milk for you baby. Even just a little bit will be really good for your baby.

The baby friendly initiative and making the most of things 

What's the problem with Infant Formula? 

Infant Formula is made from dried cow’s milk with additives. It is very different from human milk. It is not a living substance like breastmilk and does not provide the ongoing protection against germs.formula tin.jpg

Infant formula results in a different pH (acid balance) in a baby’s gut. This results in different types of bacteria living in the gut. Science is discovering that the type of bacteria living in and on us has a big part to play in our health, and even in how our genes work.

The Invisible Universe Of The Human Microbiome

Feeding Infant Formula results in less breastmilk fed to the baby, and a greater chance of…

  • A weaker immune system resulting in more allergies, eczema & asthma, diarrhoea & serious stomach problems, meningitis, ear, chest & bladder infections & some childhood cancers like leukaemia.
  • Crooked teeth
  • Worse eyesight
  • Not being as smart
  • More risk of Sudden Unexplained Death in Infancy (SUDI)
  • More Doctors appointments and more likely to be admitted to hospital 
  • And later in life have an increased risk of: obesity, heart disease, multiple sclerosis, diabetes and liver disease

And for Mum…

  • more bleeding after the baby
  • a slower return to pre pregnancy weight
  • less bonding with the baby
  • a greater risk of:
  • postnatal depression
  • breast, cervical & ovarian cancer
  • osteoporosis & hip fractures
  • high blood pressure & heart disease
  • less convenience
  • less money in your pocket

There are also risks to using formula.

  • Babies can react or become allergic to all types of infant formula
  • The powder or the water can be contaminated
  • Formula can be mixed up too strong or too dilute by not understanding or following the directions correctly. 
  • The markings on bottles are not always accurate.
  • It can be mixed up un-hygienically or become unhygienic if not used correctly

It is not recommended to give your baby extra fluid (either formula or water) as this can affect your supply, expose your baby to a foreign protein, and may make your baby less willing to take the breast.     

Occasionally it is medically indicated to give a baby a supplementary feed. If this is necessary, it will be discussed with you by the health professionals caring for you.

There are a few reasons why some women cannot breastfeed, or choose not to breastfeed.
Your LMC and Helensville Birthing Centre staff will support your choice of feeding and help you with what you need to know.

Effects of Just One Bottle.pdf

www.tensteps.org/pdf/21dangers-jun2012.pdf
www.ncbi.nlm.nih.gov/pmc/articles/PMC2812877/
www.infactcanada.ca/pdf/14-Risks-Small.pdf
www.health.govt.nz/your-health/pregnancy-and-kids/first-year/helpful-advice-during-first-year/formula-feeding/risks-formula-feeding
www.lactationtraining.com/resources/handouts-parents?task=document.viewdoc&id=164

What's the problem with dummies and teats? 

Teats and dummies interfere with breastfeeding. Babies suck differently on bottle teats and dummies because they are so different than breasts. Babies develop a different technique and strengthen different muscles. This different technique can cause sore nipples, and frustration for the baby trying to get milk when at the breast.

It is best to avoid teats and dummies for at least the first 4-6 weeks. If you really need to use one, find one that is big or long so your baby isn’t practicing a really shallow latch. Avoid those that look like a badly misshapen nipple (the so-called ‘orthodontic’ teats) unless you want your baby to expect and practice that!

Bottles, dummies and teats can be a source of thrush infections.

Are there foods I should avoid? What about allergies? 

    No. Your baby will have been enjoying all sorts of flavours during your pregnancy, as the fluid around your baby picks up the flavours of the food you eat. Your breastmilk will be the same. This is good for your baby’s development.
    ‘Everything in moderation’ is a good approach.

    It is a good idea to limit caffeine as this may make your baby wakeful.

Eat peanuts during pregnancy and breastfeeding to reduce peanut sensitisation in your child

 

Are there foods I should eat? 

No. Your breasts will always make good milk, just like your body always makes good blood. (breastmilk is made from your blood supply) 
Eating nutritious food makes good sense, for your own health
Making breastmilk uses up about 500 calories and 25gms of protein and tiny amounts of trace elements. 

What is The Baby Friendly Initiative? 

Helensville Birthing Centre is an accreditied Baby Friendly Birthing Centre

The Baby Friendly Intiative (A video - Canada)
Baby Friendly UK 


Getting Started

What is so important about Skin To Skin? 

Being 'Skin to Skin' helps stabilize your baby’s breathing, heart rate and temperature. It helps with bonding, breastfeeding and protecting your baby from infections. Your baby will be calmer and less likely to cry.

It helps the placenta come out, your breastfeeding hormones increase, and helps you feel calm and bond with your baby.

When your baby is skin to skin he/she will, using all five senses; sight, sound (your voice), taste and especially smell and touch, try to find your breast and latch on. Your baby will take short rests too. Many babies will manage this, all on their own, within the first hour after birth.

This can be a wonderful time for you and your baby to recover and get to know each other. A breastfeed during this first hour is especially good for your baby and your milk supply.

Some babies can be sleepy or have difficulty due to labour medications or a difficult birth. In this case it is good to express some of your milk and give it to your baby. (see Hand Expression)  

Skin to skin is beneficial at any time – not just straight after the birth
You can discuss Skin to Skin with your support people, so they know how important it is, and can help.

Keeping your baby skin to skin
Dr Nils Bergman on Skin to Skin
The importance of Skin to Skin 
Skin to Skin – for you and your baby at Helensville Birthing Centre

What can I expect in the first few days? 

A big change for baby
Your baby will want to be held a lot, and not sleep for long (if at all) in a bassinette. This is to be expected. It is not a ‘bad habit’. Skin to skin care, and your voice, helps reassure your baby he/she is safe.
Big changes for you
    Feeding ++++ Your baby will need to feed frequently, especially at night. Newborns feed the most between 9pm and 3am. During the second night, it may seem continuous. Feeding at this time is important. Colostrum volumes are very small, but perfect for baby’s small tummy. Lots of stimulation tells your breasts to produce more colostrum.
    Tiredness You will be tired from the labour and birth and from time spent in the night caring for your baby. Visitors will need to know that it is essential for you to sleep during the day
    Breastfeeding challenges…learning how to position yourself and baby comfortably, coping with the very frequent feeding, tender nipples, and helping a baby get colostrum (and supporting milk production), when feeding is tricky, are all common things. The milk usually comes in on the third day, but is sometimes delayed. 
    Mixed emotions
You may feel elated and in love with your baby. You may also feel tired, sore, and anxious at times. Day three especially, is known for the ‘baby blues’. 

What your baby knows about breastfeeding  10 Steps to Successful Breastfeeding  How do I help my baby with breastfeeding? 

Breastfeeding is instinctive for babies. But for mums it is more of a learned art, where confidence comes with practice. In a week or two it is usually heaps easier. 

Babies are born with many reflexes to help them find the breast, latch on and feed

  • Arm and leg circling
  • Head bobbing
  • Rooting – turning head from side to side, especially if anything touches the cheek
  • Gape – your baby will open his/her mouth and tilt the head back into the drinking position when something brushes the top lip
  • Extrusion – your baby will open his/her mouth and tongue will come forward when something brushes the bottom lip.
  • Suck – your baby will begin to suck when something touches the roof of the mouth

Your baby is able to make best use of these reflexes when on his/her tummy. Understanding this and working with your baby can get breastfeeding off to a great start.

  • Use your hands or arms to help your baby feel stable and secure. 
  • Babies find the breast by smell and feel, searching for the breast with their face. If they can’t feel with their face they will use their hands. Sucking on their fists, and massaging the nipple with their fists, is all a normal part of how a baby learns to feed.

A baby will often vocalise during this time. Your voice will be reassuring and encouraging to your baby.
It’s helpful if feeds are as often and as long as your baby wants.
It’s usual for a newborn baby to feed 8 – 12 feeds (or more) in each 24hr period. Most of the feeds will be at night to begin with because…

Newborn babies feed the most between 9pm and 3am!

How do I latch my baby on? 

Latching step by step...  
 1. Have your baby ‘skin to skin’ as much as possible, and respond to early cues.
It’s best if your baby is not wrapped up in a blanket when feeding, so that your baby’s body can get in really close and snug with yours, tummy to tummy. Your baby will also want to have his/her hands free.

 2. Set yourself up so you are comfortable and supported. A near to 45 degree slope works well. Have a pillow behind your back, so that your back is straight and not curled around in a C shape. This gives your baby lots of your body to have contact with, and it makes your nipples point out at a helpful angle. If the nipples point down, it can be tricky for your baby to latch on to. A small rolled up cloth under your breasts will lift them up a bit. 

            ­        position.jpg

3. Have your baby on his/her tummy on top of you with arms and legs in a crawling position. This way your baby will feel secure and able to use those inbuilt reflexes purposefully. 

postion b.jpgBreasts are circular. Babies can feed at all sorts of angles

4. You can 'shape' your breasts a little so that the nipple feels really obvious to your baby and so that he/she gets a big mouthful when landing on it…as long as you don’t move your breasts from where they naturally sit. This 'shaping' is much the same as how we shape a burger or sandwhich so we can get our mouth around it. Don’t try and put your nipple in your baby’s mouth, but help your baby take the nipple.

Talk to your baby to help him/her stay calm. Your baby will likely latch all on his/her own. Babies often wriggle and shuffle to adjust their position and latch, and babies like to have their feet in contact with something. Babies use their hands in purposeful ways to help themselves too.

If your baby isn’t able to latch give him some expressed colostrum (maybe on a spoon). Having some ready is helpful.

5.  If your breasts are very full, expressing a small amount of milk may soften the breast enough to help baby latch.

6.  Sometimes after having a little colostrum a baby is ready to try again. You can try different positions eg the side-lying position.

7.  If after about 15 minutes of trying the baby isn’t successful it is best to hand express and give your baby what is available on a spoon. It’s not helpful for either of you to get tired and stressed out.

If latching is often difficult get help from your midwife or a lactation consultant.
There are many different reasons why a baby can have difficulty feeding in the first few days….and none of them include negative personality traits!

Introduction to Laid Back Breastfeeding - youtube
Baby led latch how awaken your babys breastfeeding instincts
Laid Back Breastfeeding LLL.pdf
what happens when mothers lie back.pdf
Improving Latch By Improving Positioning: Introduction and Laid Back Breastfeeding
www.biologicalnurturing.com/index.html

see also How can I get a good latch?


Getting help

From my whanau 

Having a supportive partner and whanau/family is important for successful breastfeeding.
Breastfeeding is a learned skill and mums and babies take time to become expert.

It is helpful if support people attend antenatal classes with you, and learn about breastfeeding.
It’s helpful for everyone to get the same up-to-date information.

Even though they may not be able to do the breastfeeding, there are many ways other people can provide help. They can give important emotional support, reassurance, praise and practical help.
For example, they can...

  • Limit visitors in the early days so you can get enough rest
  • Encourage you to eat well and drink plenty of fluids
  • Encourage both you and your partner to rest whenever baby sleeps
  • Change, wind, bath, talk to or cuddle your baby
  • Prepare meals and do household chores. 
  • Be understanding and encouraging
From my midwife  

Your midwife will help with that important firsst feed soon after the birth
Hospital of Brithing Centre staff will give you help and support during your stay, alongside the care of you midwife
Your Lead Maternity Carer or Midwife will continue to provide help and support until your baby is four to six weeks old. You will be visited at home 5-10 times during that time.
Once you LMC has stopped visiting, you will be referred to a Well Child Provider of your choice, such as Plunket or Tamariki Ora services. 

From breastfeeding mums   From a HBC Lactation Consultant 
Plunketline and Healthline 

Plunketline ph 0800 933 922
Healthline  ph 0800 611 116


Gaining knowledge and skills

How do I carry/wear my baby? How do I use a wrap? 

Lots of close contact will help your baby thrivewearing.jpg
Finding ways to carry, or ‘wear’ your baby is both beneficial and practical
Caring for your baby in this way is sometimes referred to as Kangaroo Care
These videos' explain
Continuous Skin to Skin Care 
Carrying Your Baby Skin to Skin

This video shows many easy ways to use simple wraps.
It shows how to safely care for your baby in this way, so that you can also sleep.
Wrap designs for Skin to Skin care

How do I know when my baby needs to feed? What are feeding cues / hunger cues?  What are the common breastfeeding positions? 

Certain positions have become known by various names. The best position is what works for you and your baby – what is comfortable for both of you, and lets your baby drink well. 

'Biological / Laid Back / Baby Led /Natural Breastfeeding' Position
Biological or Laid-back position 
Introduction to Laid Back Breastfeeding - youtube
Laid Back Breastfeeding LLL.pdf
what happens when mothers lie back.pdf

'Cross Cradle / Transitional / Beginners' Hold
Cross cradle, Transitional or Beginners Hold 
 
Clarifying the Confusion Over Cross Cradle Hold.pdf
How to latch your baby to your left breast in a cross-cradle hold in 33 easy to master steps

Cradle or Madonna Hold  
Football or Rugby Hold 
Koala position 
Side lying position 

How do I get my baby to open wide?   How can I get a good latch?   What is a 'let down'? 

A 'let down' is when the cells in your breast contract and push milk out towards the nipple. It usually takes a few minutes of sucking or hand expression for it to happen. The nerves around the areola send a message to the brain to produce oxytocin. The oxytocin then flows all through your body. It is a ‘feel good’ hormone and good for your health in other ways. It can feel like a tingling sensation.

Anxiety, pain or stress slows the oxytocin being released. Deep breathing, thinking about your loved ones, favourite music, back and shoulder massages, and visualising the milk flowing helps.

If you have had lots of Syntocinon (synthetic oxytocin) in labour, your own natural oxytocin production can be a little low after birh.
Breast Compressions can help your baby get milk. 

What is normal? What can I expect? 

Breastfeeding Uncovered by Dr Amy Brown of Swanwea University 

How do I know if my baby is feeding well? 

A good feed…

  • Is comfortable for both of you.
  • Baby latches well and doesn’t slip off
  • Baby has a regular sucking pattern with swallows and pauses. When your baby swallows the chin will go down a little lower and then there will be a soft ‘ah’ sound.
  • You may feel thirsty during a feed and your uterus may contract giving you a few ‘after-pains’ – this means your breastfeeding hormones are working well.
  • Your baby becomes more relaxed as the feed continues.
  • Your nipple should not look misshapen afterwards.
  • Your breasts should feel softer after your baby has fed (except for the first few days before the milk has come in)

 

Should I feed off both sides each feed or just one? 

It depends. Sometimes a baby will have one side, sometimes two or three sides - or more, depending on what is needed.
“Finish the First Side First and always offer the second side” is the usual idea. Your baby is your guide.
So how do I know when the first side is ‘finished’?
 - Your baby may release the breast and look satisfied.
      Or
 - you may notice that despite sucking, there is not much swallowing going on.
    (this means that your baby has had most of what is available)
 - You can then use breast compressions, this helps get the remaining milk, which is nice and creamy.
 - If you sense that your baby is still hungry (eg there is still some tension in baby’s body) you may want to offer the other side.
   Slip your finger into your baby’s mouth to release the suction and take baby off.
   After a short opportunity to burp, you can then offer the other side.
 - If after the second side, your baby still seems hungry go back to the first side, because more milk will have already accumulated there.
 - Keep going in this way until baby is ‘done’. This is called ‘switch feeding’ and is a great way to increase milk production.

How long should my baby's feeds be? How often should my baby feed? 

How long? It varies. Something between 5 minutes and 30 mins is normal. 
Babies have different size feeds, just like grownups. Sometimes it is a quick drink to quench thirst or have a snack and sometimes it is a whole feast. This is normal. 

‘Watch your baby, not the clock’ The idea is to let baby feed until he/she seems done. 

How often? Babies usually need to feed at least 8 times each 24 hours

  • To begin with, babies need to feed very frequently because their tummy is so small (and colostrum and breastmilk is always digested quickly) This is also the way breasts get stimulated to make more milk.

The interval between feeding times can vary greatly – maybe from 30 minutes to 4 hours.

  • Babies also usually don’t feed at regularly spaced intervals but tend to go longer between feeds in the morning and then less time between feeds in the evening.

Having fixed ideas or trying to manipulate feeds can cause problems.
UNICEF on stretching out feed times

How often a baby needs to feed is also related to a mum’s milk storage capacity. This varies between women, and also between breasts. (You can’t tell by looking at the breasts).               

For one mum the production might slow right down (because her breasts are getting full) when there is maybe 40mls of milk stored. For another mum the production might only slow down when there is around 80mls stored.

Both these mums can make the same amount of milk over 24 hours, but the mum with the smaller storage will need to remove milk twice as often. Her baby’s feeds will probably be quicker, and even seem like ‘snack’ feeds. It doesn’t matter. In fact, the mother of this baby is likely to spend less time on winding, baby’s discomfort and mopping up sicky spills, than the mother whose baby has fewer, but huge, feeds.

Milk production slows as breasts fill, This is a necessary feedback system!

 

How do I know if my baby is getting enough?  

Newborns have tiny tummies. A one day-old baby’s tummy only holds about a teaspoon, so a few drops to a teaspoon of colostrum is ‘enough’ to start with.

Your baby’s wee and poo and weight gains can give you a good idea of how much your baby is getting. This is a chart of what you can expect.

poo chart.jpg

Mothers can experience a delay with their milk coming in. This is a temporary thing, but may cause a loss of confidence. When the milk comes in there is usually lots.

Some mothers worry that they don’t have enough milk if their baby is unsettled or feeding frequently, but this can be normal for babies.

Babies can have ‘growth spurts’ or ‘frequency days’ and need to feed more often to increase the milk production. This can happen every few weeks in the early stages of breastfeeding. Letting your baby feed often will soon increase the production.

….give me some numbers!

 …after the initial weeks, once breastmilk production has got ‘up to speed’ the average numbers for each 24 hours between 1 month old and 6 months old is about...

  • 750 mL of breastmilk (range 570-900 mL)
  • 10 feeds 
  • 75mls per feed
  • The un-stretched tummy of a 1 month old is about 40mls.
    The un-stretched tummy of a 6 month old is about 100mls
    (Tummies can stretch to hold more, but there may be discomfort and spilling)
  • 155-240 gms weight gain each week until four months old then 95-125 gms each week until six months old

- If you think you need to give your baby additional milk it’s a good idea to talk with your health professional.
- It’s best to give the smallest amount that your baby might need, while working on ways to increase your milk production.
 - Extra milk does not need to be given at each feed, or need to be the same volume each time. It can be given by spoon, cup, tube at the breast, or bottle.

If you are supplementing your baby’s feeds, or entirely bottle feeding, it is important to be guided by tummy sizes, normal breastfeeding volumes, normal length of breastfeeds (eg 15-20 mins) and your baby’s feeding and satisfaction cues. Calculations using formulas such as mls/kg/day are guides for when fluid requirements (often IV fluids) are needed and a baby’s normal feeding or satiation cues can’t be relied upon. 

Giving Infant Formula is usually not the answer.  It will decrease the time spent at the breast and interfere with supply and demand. This leads to slower milk production. The World Health Organisation says it is preferable to give breastmilk from another healthy mother, rather than Infant Formula.

 Is my baby getting enough milk? 

How do I help my baby get more milk? What are 'Breast Compression's'?  

Breast Compressions
This is using your hands to help the milk flow
It’s a ‘squeeze and hold’ technique or using the flat of your hand to create pressure to push the milk out It’s not massage or stroking It can be helpful to think of your breast as an icing bag and you are squeezing the icing out :)

icing bag.jpg

Breast Compressions are helpful when…

  • there are small colostrum or milk volumes
  • your baby is tiring
  • the milk flow slows
  • you want your baby to get the ‘last drops’ of creamy milk.

https://www.youtube.com/watch?v=25qhrc4Y0tU

this video shows compressions in action, but baby is almost hanging off the nipple to start with! Baby needs to be held closer, or mum needs to lean back
https://www.youtube.com/watch?v=wBrLYhABUlM

 

 

How do I put 'Breast Compression's', 'Switch Feeding', Supplementing and Pumping together?! 

This is not something a breastfeeding mum may need to give any thought to at all.  
But if you have good reason to believe your baby is not getting enough milk you may find reading this information helpful

Putting Switch Feeding, Breast Compressions, Supplementing and Pumping together - Step by Step

About milk production - What every breastfeeder needs to know  How do I hand express my breastmilk? 

How to Hand Express
- Wash your hands
- Gently massage your breasts and areola. Using warmth is helpful
- Put your finger and thumb on opposite sides of your breast about 2-3 cm away from the nipple
- Push back into your chest
- Roll finger and thumb together. Avoid pulling, squeezing or sliding
- Then relax your fingers and repeat

Repeat many times in a rhythmic way
It may take some time for milk to flow
In the early days there will only be drops
After a few minutes rotate the position of your fingers
Relaxing, visualising milk flowing, thinking about your baby, doing more massage and changing breasts all help the milk to flow.

Like most things, it gets easier with practice!
If you wish to collect your milk, use a clean container eg small bowl or cup 

How to hand express your breastmilk 
Storing Breastmilk

Should I use a breast pump? 

Many women successful breastfeed without ever using a breastpump. 
If you need to remove milk from your breast, using your hands to express your milk is effective and free. 
Using a breastpump can be helpful if you need to get milk out of your breasts often, it's your choice. 
You do not need to spend lots of money on an expensive machine. What is important is how frequently you remove milk, and how you use your hands. 

Using your hands when you pump
Using a Breast Pump.pdf

How do I store my breastmilk? 


Concerns

What do I do about sore or painful nipples? 
  • Nipples are sensitive during pregnancy and in the early days of breastfeeding due to the hormones. The sensitivity usually goes by about two weeks.
  • It can be normal to have some discomfort at the beginning of feeds as a baby latches and the nipple is stretched.
  • It’s not normal to have pain through the whole feed, or for the nipple to look misshapen after the feed.
  • Sometimes a baby may not get a big mouthful of breast, but be just on the nipple. This can lead to pain and nipple damage. And there are other reasons
  • Help your baby get a big mouthful of breast, not just the nipple
  • You can shape your breast, like you might squish a burger to get your mouth around it.
  • Trying a different position, especially getting your baby more on his/her tummy may help get a bigger mouthful
  • Once your baby is latched, you can sometimes pull on the chin and get a wider open mouth
  • Check that the nipple is not getting bent during feeds. Look for a nipple pointing to the side, or a crease at the base of the nipple the moment the nipple is released. This often happens when the ‘cross cradle’ position is used and the baby’s head gets tilted, or a little ‘around to the side’, or with the nose and not the chin being closest to the breast.
  • If you are taking your baby off the breast, make sure you break the suction with your finger first
  • Breastmilk left to dry on the nipple is healing, so is olive oil and coconut oil. Soaking or swabbing with saline (salty water) is helpful. Manuka Honey Breast pads promote healing and inhibit infections if the skin is broken.
  • You can take Panadol or Ibuprofen (hardly any gets through to the baby)
  • There is no need to buy nipple creams. There is little evidence that they are any help. Lanolin and hydrogel pads have been found to be associated with infections, particularly thrush. Breastmilk, olive oil, and coconut oil, have all been found to be helpful. Washing the nipples with mild soap and applying saline (1/2 tsp salt in a cup of water) has been found to reduce infection.
  • If your nipples are damaged - Manuka Honey gel pads are proven to promote wound healing and inhibit infection. Many mothers find them soothing, especially when cooled in the fridge first. (NB – the gel pad need to be first removed from the supporting rigid plastic disk) A saline soak and wet green tea bags are also helpful
  • Nipples do best when they are not squashed, and get some light and air. Smearing with perfumed creams, wrapping firmly and being kept in the dark is good for embalming Egyptian Mummies, not for nipples. 
  • If you have lots of pain, and / or nipple damage, don’t suffer, get help from your midwife or a lactation consultant. There are many different causes of sore nipples, and many ways to help.     
    Sore nipples or breasts 
    Care of Nipples.pdf
    Are there any cures for sore nipples.pdf
    Topical treatment for nipples.pdf
    Does Lanolin Increase the Risk For Infection -.pdf
I have burning, stabbing, shooting nipple pain. Could it be thrush?  What to do about uncomfortably full breasts? 
  • This can begin a few days after the birth
  • It's important to relieve the fullness as best you can
  • The best way to relieve this engorgement is to feed your baby often
  • You can wake your baby for a feed or hand express to relieve the fullness
  • If your breasts are too full for your baby to latch on well, express some milk before trying again.
  • You can use your fingers on the areola area to push back and hold for a moment or two immediately before latching. This will help push some of the swelling away and make it easier to latch. (This is called Reverse Pressure Softening)
  • After feeds use something cold on your breasts. Some women find putting chilled cabbage leaves on their breasts, for up to 20 minutes, helps
  • You can take 400mg of Ibuprofen every 8 hours, or paracetamol.
  • Wearing a supportive bra may help, or you may prefer to go bra-less
  • Spending some time massaging away from the nipple and towards the armpit can relieve a lot of swelling. There can be a lot of fluid (not milk) that needs to drain away through the lymph system. You might like to massage with some oil while lying on your back. In some cultures, this breast massage is a normal part of a woman’s care at this time. 
  • More about sore nipples or breasts 
I have painful breasts. Do I have a plugged duct or mastitis? 

I have a painful area in my breast

Sometimes an area of breast doesn’t drain well. Maybe your baby’s position wasn’t the best and your nipple was a little bent. If it’s persistent it is referred to as a blocked duct. Sometimes a plug of thick milk can cause a blockage in the nipple. You can see this as a white dot. It’s called a ‘bleb’. You can usually squeeze it out. It’s important to get the milk moving asap.

I have a painful area in my breast and I feel unwell

A painful area, often reddened, with flu-like symptoms is likely to be a breast infection (Mastitis). You may have a temperature and feel “dreadful”. This sometimes happens around 2-3 months, but can happen at other times. It can be caused by poor drainage of milk due to a poor latch, missed feeds, blocked ducts or fatigue & poor health. It is often related to sore and damaged nipples.

•      It is important to continue to remove milk – by breastfeeding, hand expression or pumping
•      Help your baby to get the best position and latch.
•      Relieve a blocked duct, if that’s an issue.
•      Express your breast after feeds if necessary to drain the breast well
•      Use gentle breast compressions behind a hard area to help milk drain
•      Use heat for comfort (if needed) before feeding and expressing
•      After pumping or expressing apply something cool
•      Get lots of rest. Stay in bed and feed baby very frequently
•      Eat well and drink plenty
•      If after about 12 hours you are not feeling better, consult your midwife or doctor. You may need antibiotics.

I have sore breasts
Do I have mastitis?

Why does my baby fight the breast? Why doesn’t my baby want to breastfeed? 

My baby fights the breast

Young babies have many reflexes to help them find the breast, latch on and begin sucking. Most of these are designed to work with gravity, ie with the baby on his tummy. In this position the arm and leg circling, the head rooting from side to side and the head bobbing are all very effective.
But when babies are on their side these same reflexes can look like pushing, punching, ‘head-butting’ and turning away. It seems like your baby is not wanting to feed! When in fact it is the opposite.
If your hands are holding your baby’s head or neck it can be uncomfortable for your baby, and difficult to drink well too, so he/she may fuss.
The remedy is to lean back so your baby is more on his tummy, and able to move his/her head. See Biological Position

My baby fusses and pulls off 

Babies are all about ‘flow’. If the flow is too fast or too slow they will fuss and pull off and sometimes cry.
 - If you suspect it is because the flow is a bit slow, squeeze and hold you breast while your baby feeds. This will help your baby get the milk faster. You can also change sides often as this makes more milk available.
- If you think it is because the flow is a bit fast for your baby it is best to lean back and have your baby more on top of you. That way your baby will cope with it better and not feel like he/she is drowning in it!
If your baby has a tongue restriction, both a slow flow and a fast flow will be more difficult to manage.   

There can be other reasons for a baby fussing at the breast.
Lots of help here http://kellymom.com/ages/newborn/nb-challenges/back-to-breast/

My baby struggles at the breast

What should my baby’s weight gains be? 
Roughly...

back to birth weight by 14 days then
155-240 gms each week until four months old then
95-125 gms each week until six months old then
50-80 gms each week until 1 year old

How can I increase my baby’s weight gain?  Do I have low milk supply? How can I make more milk? 

How to increase milk production
- Remove milk more often…by breastfeeding, hand expression or pumping.
- Help your baby get a good mouthful of breast
- Help your baby be in a good drinking position…in close, tummy to tummy, chin in breast, head back
- Squeeze and compress your breasts to help your baby get the milk
- Swap sides often
- Eat well, including protein and complex carbohydrates like oats
- Drink enough fluids
- Rest, relax, sleep
- Make sure you are not doing the things that slow production
- There are also herbs and medications that help
- If you are still concerned talk to your midwife, or a lactation consultant

Increasing low milk supply 
Hidden Hinderences to a Healthy Milk Supply

More Milk Out = More Milk Made
 
Emptier breasts make milk faster
Frequent milk removal = fast milk production

Fuller breasts make milk slower
Infrequent milk removal = slow milk production

How often a baby needs to feed is also related to a mum’s milk storage capacity. This varies between women, and also between breasts. (You can’t tell by looking at the breasts).               

For one mum the production might slow right down (because her breasts are getting full) when there is maybe 40mls of milk stored. For another mum the production might only slow down when there is around 80mls stored.

Both these mums can make the same amount of milk over 24 hours, but the mum with the smaller storage will need to remove milk twice as often. Her baby’s feeds will probably be quicker, and even seem like ‘snack’ feeds. It doesn’t matter. In fact, the mother of this baby is likely to spend less time on winding, baby’s discomfort and mopping up sicky spills, than the mother whose baby has fewer, but huge, feeds.

 Milk production slows as breasts fill, This is a necessary feedback system!

Why is my baby crying?  How do I know if my baby is getting enough hind-milk? 

There is no need to worry about hind milk. The fat content evens out between feeds and it’s the overall volume of milk that baby needs for growth, not just fat. 

Breast massage and compressions will increase the fat that a baby gets. Trying to get more fat by restricting a baby to one breast only per feed, or going back to the same breast for a specified time, will slow the overall milk production...and ultimately less fat too.

Up to 6 months, breastmilk is 7.4% fat, but after 12 months it is 10.7%!

Foremilk and Hindmilk - What does that mean?
Worries about Foremilk and Hindmilk 
http://kellymom.com/bf/got-milk/basics/foremilk-hindmilk/
http://www.llli.org/faq/foremilk.html

A Neurobehavioral Approach to Breastfeeding. Dr Nils Bergman, M.D., D.C.H., M.P.H., Ph.D.Cape Town, South Africa www.kangaroomothercare.com

Can I overfeed my breastfed baby?  I think I have too much milk 

I think I have too much milk
    Full breasts, leaking breasts, a strong let down causing your baby to cough and splutter, explosive frothy green poo, baby spilling lots, and appearing uncomfortable with gas, can all be caused by things other than having too much milk.
    Sometimes in the early weeks there can be a little ‘oversupply’ but it usually settles on its own. But if these things above are a problem, and your baby’s weight gains are massive, you may benefit from slowing the milk production.
    If you do need to reduce your production, an effective way is to feed your baby from one breast only each feed, or sometimes back to the same breast for number of hours eg. three or four. It’s best not to overdo this though, because you don’t want to reduce the milk production too much or risk mastitis. Restricting feeds in this way for a week is probably long enough.

 

How does milk production slow down? 

How milk production slows down.. 

Removing milk less often. This happens by…postponing feeds, making baby wait for feeds, feeding from one side only every feed, getting baby to suck on a dummy, baby has a long stretch of sleep (eg 5 hours) at night, trying to get into ‘a routine’ rather than responding to baby’s feeding cues, or trying ‘Sleep Training’.

Removing milk less efficiently. This happens by…limiting the feed time, baby not having a big mouthful of breast, baby not being in a comfortable position to swallow easily (chin not touching breast or maybe body is twisted), the position of the baby’s head is making the nipple is slightly bent (reducing milk flow), some tongue restriction due to a tight or short frenulum (tongue tie), or some other problem. Lots of anxiety and stress can make it difficult to ‘let down’ (because adrenalin inhibits oxytocin)

Other things that can slow milk production…
Dieting
Smoking & Alcohol
Lots of vigorous exercise
Being unwell
Hormonal contraception before milk production is really well established
Cold and flu medications designed to dry up secretions

All these things affect women and babies differently

My baby is tongue tied 

Tongue-tie or ankyloglossia is when the thin membrane under the tongue is short, thick or attached too far forward. A Lactation Consultant or Midwife can assess this. Tongue-tie can cause problems with a baby’s ability to feed, usually resulting in sore nipples and a poor milk intake.

Often a frenotomy, where that tight bit of membrane is released, is recommended. A frenotomy is done by scissors or laser and is very quick. It doesn’t seem to bother young babies very much and is thought to be best done the sooner the better.

WDHB's TT leaflet.pdf
www.unicef.org.uk - BabyFriendly - Tongue Tie

NZ tongue tie & Support - Facebook
NZ Tongue tie discussion - Facebook

 

Is Tongue Tie a fad? Where is the evidence for Frenotomy? 

Randomized controlled trials of tongue-tie or ankyloglossia

  1. Hogan M, Westcott C, Griffiths M. Randomized, controlled trial of division of tongue-tie in infants with feeding problems. J Paediatr Child Health. 2005;41:246-50.

  2. Dollberg S, Botzer E, Grunis E, Mimouni FB. Immediate nipple pain relief after frenotomy in breast-fed infants with ankyloglossia: a randomized, prospective study. J Pediatr Surg. 2006;41:1598-600.

  3. Buryk M, Bloom D, Shope T. Efficacy of neonatal release of ankyloglossia: a randomized trial. Pediatrics. 2011;128:280-8. (Free full text)

  4. Berry J, Griffiths M, Westcott C. A double-blind, randomized, controlled trial of tongue-tie division and its immediate effect on breastfeeding. Breastfeed Med. 2012;7:189-93.

  5. Emond A, Ingram J, Johnson D, Blair P, Whitelaw A, Copeland M, Sutcliffe A. Randomised controlled trial of early frenotomy in breastfed infants with mild-moderate tongue-tie. Arch Dis Child Fetal Neonatal Ed. 2014;99:F189-95. (Free full text.)

  6. Ovental A, Marom R, Botzer E, Batscha N, Dollberg S. Using topical benzocaine before lingual frenotomy did not reduce crying and should be discouraged. Acta Paediatr. 2014;103:780-2.

Systematic Reviews

  1. Francis DO, Chinnadurai S, Morad A, Epstein RA, Kohanim S, Krishnaswami S, Sathe NA, McPheeters ML.Treatments for Ankyloglossia and Ankyloglossia With Concomitant Lip-Tie [Internet]. Rockville (MD): Agency for Healthcare Research and Quality (US); 2015 May. (Free full text)

  2. Chinnadurai S, Francis DO, Epstein RA, Morad A, Kohanim S, McPheeters M. Treatment of ankyloglossia for reasons other than breastfeeding: a systematic review. Pediatrics. 2015;135:e1467-74.

  3. Francis DO, Krishnaswami S, McPheeters M. Treatment of ankyloglossia and breastfeeding outcomes: a systematic review. Pediatrics. 2015 Jun;135(6):e1458-66.

  4. Ito Y. Does frenotomy improve breast-feeding difficulties in infants with ankyloglossia? . Pediatr Int. 2014;56:497-505.

  5. Webb AN, Hao W, Hong P. The effect of tongue-tie division on breastfeeding and speech articulation: a systematic review. Int J Pediatr Otorhinolaryngol. 2013 May;77(5):635-46.

  6. Suter VG, Bornstein MM. Ankyloglossia: facts and myths in diagnosis and treatment. J Periodontol. 2009 Aug;80(8):1204-19.

  7. Segal LM, Stephenson R, Dawes M, Feldman P. Prevalence, diagnosis, and treatment of ankyloglossia: methodologic review. Can Fam Physician. 2007 Jun;53(6):1027-33. (Free Full Text)

 Follow-up studies

  1. Dollberg S, Marom R, Botzer E. Lingual frenotomy for breastfeeding difficulties: a prospective follow–upstudy. Breastfeed Med. 2014;9:286-9.

  2. Griffiths DM. Do tongue ties affect breastfeeding? J Hum Lact. 2004;20:409-14

 

Frenotomy for Speech dysfunction

  1. Ito Y, Shimizu T, Nakamura T, Takatama C. Effectiveness of tongue-tie division for speech disorder in children. Pediatr Int. 2015;57:222-6.

  2. Walls A, Pierce M, Wang H, Steehler A, Steehler M, Harley EH Jr. Parental perception of speech and tongue mobility in three-year olds after neonatal frenotomy. Int J Pediatr Otorhinolaryngol. 2014;78:128-31.

  3. Webb AN, Hao W, Hong P. The effect of tongue-tie division on breastfeeding and speech articulation: a systematic review. Int J Pediatr Otorhinolaryngol. 2013;77:635-46.

  4. Dollberg S, Manor Y, Makai E, Botzer E. Evaluation of speech intelligibility in children with tongue-tie. Acta Paediatr. 2011;100:e125-7

  5. Messner AH, Lalakea ML The effect of ankyloglossia on speech in children. Otolaryngol Head Neck Surg. 2002;127:539-45.

  6. Block JR. The role of the speech clinician in determining indications for frenulotomy in cases ofankyloglossia. N Y State Dent J. 1968;34:479-81.


Ankyloglossia and airway anatomy

  1. Mukai S, Mukai C, Asaoka K Congenital ankyloglossia with deviation of the epiglottis and larynx: symptoms and respiratory function in adults. Ann Otol Rhinol Laryngol. 1993;102:620-4.

 Mukai S, Mukai C, Asaoka K. Ankyloglossia with deviation of the epiglottis and larynx. Ann Otol Rhinol Laryngol Suppl. 1991 May;153:3-20

www.ncbi.nlm.nih.gov/pubmed
www.unicef.org.uk/babyfriendly/

Official Statements

Canadian Pediatric Society: Position statement: Ankyloglossia and breastfeeding
American Academy of Pediatrics: Congenital Tongue-Tie and its impact on breastfeeding
Israel Neonatal Society (Hebrew) 
Agency for Healthcare Research and Quality U.S. Department of Health and Human Services: Treatments for Ankyloglossia and Ankyloglossia With Concomitant Lip-Tie
American Academy of Pediatric Dentistry: Guideline on Management Considerations for Pediatric Oral Surgery and Oral Pathology by the AAPD
The Academy of Breastfeeding Medicine - Protocol # 11: Guidelines for the evaluation and management of neonatal ankyloglossia and its complications in the breastfeeding dyad 

 

https://tonguetieprofessionals.org/

www.alisonhazelbaker.com/blog/2015/9/1/modern-myths-about-tongue-tie-the-unnecessary-controversy-continues

My baby prefers one side 

Many newborn babies are born a little ‘wonky’. They have been growing in a very tight space, and so are sometimes a little tighter & stronger on one side of their face and neck than the other. You might notice your baby’s head keeps turning to one side. This is often called Torticollis. Sometimes the jaw is a little crooked too. This can make feeding off one side easier than the other.

Help your baby to find a position to feed well in. Plenty of tummy time and helping your baby alternate what side the head rests on when sleeping, and in the car seat, is a good idea.

Growing with good alignment pdf

A baby will fuss at the breast if the flow is slow. If the milk production on one side has become less, so will the flow.

If there is infection on that side, the taste may be different, causing a baby to fuss.

If concerned, see your midwife or lactation consultant

My baby has wind 

Wind occurs when air is swallowed during a feed. If there is an opportunity and perhaps a little movement, any air bubble will be released as a burp. But sometimes the air bubble will travel through the gut until it’s released as a fart.

A young baby’s gut is immature. It is possible that some babies are more bothered than others by all the new and sometimes uncomfortable sensations.

Breastfed babies are much less likely to be troubled by wind than non-breastfed babies.

Air is swallowed during a feed when the flow is fast, especially when the baby is beneath the flow. Feeding in the side lying position, or when you are leaning back so baby is more on top helps with this. Babies that don’t have a good latch & seal on the breast can also swallow more air.

The bottle feeding of infant formula can cause lots wind and discomfort because the feeds are often taken too fast. There is also discomfort due to the difficulties of digesting the foreign protein.

The influence of the practice of bottle feeding babies, along with the marketing of assorted ‘wind remedies’, has unfortunately caused a lot of expectation and anxiety around ‘wind’ for new parents.

When babies are carried, and fed small amounts frequently, ‘wind’ is much less of a problem

When newborns are unsettled it is likely the baby is needing more skin to skin time, and more feeding, rather than ‘winding’

My baby throws up 

‘Spitting up’ or ‘spilling’ is very common and often happens when babies are burped. Babies aren’t usually bothered by their spitting up.

Babies ‘spit up’ when they've taken more milk than their tummy can hold.

The un-stretched tummy of a 1 week old is about 20 mls.
The un-stretched tummy of a 1 month old is about 40mls.
The un-stretched tummy of a 6 month old is about 100mls
Tummies can stretch to hold more, but some discomfort is possible.

Smaller frequent feeds may result in less milk coming back up and will also mean the tummy contents are less acid.

Vomiting is forceful. If your baby is vomiting talk to your health professional.

A Neurobehavioral Approach to Breastfeeding. Dr Nils Bergman, M.D., D.C.H., M.P.H., Ph.D.Cape Town, South Africa www.kangaroomothercare.com
When will my baby sleep? 

My baby won’t sleep in the bassinette
    This is normal behaviour for a newborn baby. All your baby has ever known is being completely surrounded by your body. Every single moment there was your warm body contact, your smell, the sounds of your body, and its movement. But now everything is different and strange. Your baby will want to be close to you all the time.
    After a few days your baby will have adjusted somewhat and will often be ‘milk drunk’ after a feed. This makes settling in the bassinette a little more successful. 

  • Babies waking at night is normal
  • Babies tummies are small and need to feed often to get what they need
  • Sucking to sleep is normal
  • Babies wake for many reasons, and need help to get back to sleep
  • A night feed is usually needed to maintain milk production
  • Exclusively breastfeeding mothers usually have more sleep, and better quality sleep, than those formula or mixed feeding
  • In time, your baby will stop waking at night even if you do nothing 

 

Babies usually get the sleep they need - it just might not be as much as the parents would like them to have :) 

 

Caring for Your Baby at Night
All about sleep 
Advice from Elizabeth Pantley
Advice from Elizabthe Pantley pdf
Simple Ways to Calm a Crying Baby pdf
Why Not Cry it Out Part 1 pdf
Why Not Cry it Out Part 2 pdf

https://www.isisonline.org.uk/how_babies_sleep/normal_sleep_development/
http://kellymom.com/parenting/nighttime/comfortnursing/
http://kellymom.com/parenting/nighttime/sleep/
http://kellymom.com/parenting/nighttime/sleepstudies/
http://www.uppitysciencechick.com/nighttime_breastfeeding.pdf

What about 'Sleep Training'? 
  • Results may not last and training is likely to need to be repeated, eg after teething or illness
  • It may have negative consequences for breastfeeding
  • It may have longer term or ’bigger picture’ type consequences
  • The ‘Sleep Consultant’ industry is unregulated 

How_babies_sleep / sleep_training / research_evidence
How_babies_sleep / sleep_training / considerations

What about co-sleeping? 

Newborns feed the most at night and most babies continue to feed at night for a long time. Many mothers and babies co-sleep.

If you choose to bed share or co-sleep you can calculate your own baby’s risk here.   http://clients.teamdf.com/curekids/site/

There are ways to make co-sleeping safer 

The Safe Sleep Seven
Bed sharing and infant sleep
kellymom.com/parenting/nighttime/cosleeping
cosleeping.nd.edu


Other concerns 

My baby is a 'lazy feeder' 

My baby sucks for a few minutes and then falls asleep but as soon as I take him off he shows cues again!

     Babies will do this when the flow is slow, and are taking a break to conserve their energy. Sometimes a baby will look like they are asleep but if you notice the fists you will see them tightly clenched. This is a baby that is tense, and taking some ‘time out’ to rest. This is not a baby that is done feeding.

  • Squeezing and compressing your breast will get a little milk to flow and this usually gets a baby feeding again. This is so much more effective (and kinder) than blowing on, tickling or using other ways of harassing a baby to feed.
  • Continuing to compress your breasts while your baby sucks, will help your baby get milk.
  • Swap sides when there is an opportunity
  • Watch for those little fingers to unfurl and then the whole arm to become floppy and relaxed

If you have lots of milk and a strong let-down causing the milk to flow really fast, it is possible for a baby to have a feed very quickly (and then fall asleep). But in this situation you would notice very active feeding with lots of rapid, obvious swallows – not just sucking, then baby would take him/her-self off the breast looking full and satisfied…with a floppy and relaxed arm.

My baby is using me 'like a dummy' 
  • For a baby the breast is not just about food, but so much more. It is a place of warmth, comfort, reassurance and connection. It’s what a baby oves, so will want to be there often.
  • You can’t spoil your baby by offering the breast whenever cues are given. Frequent sucking at the breast, especially during the first weeks, is how a good milk production is established. Not letting your baby have the breast can delay this.
  • Dummies are an attempt to provide a breast substitute, not the other way around. The baby only ever uses the breast like a breast. 
  • see 'How do I help my baby get more milk'
My baby is 'snack feeding' 

My baby wants to feed all the time

- Babies often cluster feeds together and it can seem endless, like a breastfeeding marathon.
- Between 9pm and 3am is when newborns feed the most, but in an older baby its earlier in the evening or the late afternoon. This is totally normal and helps to increase your milk production.
- Newborns then feed the least between 3am and 9am. They often have some good stretches of sleep then, and then on to lunchtime. That may be your best opportunity for catching up on the Zzzz’s.

  • Using Breast Compressions and swapping sides when there are not many swallows, will help make the most of your baby’s time at the breast.

- 8 – 12 feeds (or more), taking about 30 minutes (each 24 hours) is a normal beginning breastfeeding pattern. - By responding to cues and feeding often, the sooner your milk production will meet your baby’s needs and then the feeds may become less frequent. The feeds are also likely to become quicker.
- 'Endless feeding' can be a symptom of a tongue tie. Or there could be other issues. If you are concerned, talk to your midwife or lactation consultant. 

My baby is 'comfort sucking' 

Sucking is comforting! Perhaps what you are noticing is that your baby I’s sucking is ‘fluttery ‘in nature. This is what happens when a baby is drifting off to sleep.

Or maybe you are noticing that your baby is sucking but not swallowing. This may be because most of the milk has been removed from that breast for the time being. Maybe it is time to use Breast Compressions or swap sides

Or maybe your baby is wanting to be at the breast when you feel your baby has had a good feed, and can’t be hungry. Maybe your baby is still hungry.

Or maybe your baby does want some comfort. This is not wrong. The breast is not just about food. Providing a little comfort in this way becomes one of the most rewarding (not to mention instant and highly effective) aspects of the breastfeeding experience.

Stretching out feed times 

Stretching out feed times is not a good idea.
UNICEF on stretching out feed times

Getting into a routine 

You will find that your baby's feeds, awake times and sleep times develop into something of a pattern. But no two days will be exactly the same. Your baby will be growing, developing and changing every day. 
Trying to manipulate feeding and sleeping times may not work, and may result in unintended consequences eg, less breastmilk production. 
The Importance of Relationship Building

Stretching out feed times
New reseach finks link between some baby books and postnatal depression
Babies and Sleep. A Matter of Choice

My baby feeds sooooo often!   I think my baby is reacting to something in my milk 

Windiness, tummy aches and unsettled behaviour are all a normal part of life with a young baby. It can be made worse by swallowing air if the milk flow is fast and/or if the latch not the best.

Your baby’s tummy and gut is immature and the best remedy is time. It’s usually nothing to do with the milk itself.  

But sometimes babies can be allergic and react to something in the milk. These babies seem to vomit a lot, have lots of mucousy green explosive poo’s, have really rashy, spotty skin and are unhappy and not growing so well. Sometimes eliminating certain foods from a mums’ diet can result in a baby’s symptoms improving.

http://kellymom.com/health/baby-health/food-sensitivity/

Stopping breastfeeding is not the answer. If your baby is this allergic to tiny particles of a protein that come through your milk, it could be very difficult to find an alternative milk that is not more of a problem. 

see also What about allergies       

What about allergies? 

The latest from The Centre for Food & Allergy Research (CFAR) - The Australasian Society for Clinical Immunology and Allergy (ASCIA) Guidelines is….

1. When your baby is ready, at around six months, but not before four months, start to introduce a variety of solid foods, starting with iron rich foods, while continuing breastfeeding.
2.  All babies should be given allergenic solid foods including peanut butter, cooked egg, dairy and wheat products in the first year of life. This includes infants at high risk of allergy.
3.  Hydrolysed (partially or extensively) infant formula are not recommended for prevention of allergic disease.

Although your baby is likely to be taking increasing amounts of solids, breastmilk remains an important food for your baby. 

New Recomendations for infant feeding
UNICEF - Allergies
Eat peanuts during pregnancy and breastfeeding to reduce peanut sensitisation in your child
A Joint Statement from the Scientific Advisory Committee on Nutrition and the Committee on Toxicity of Chemicals in food, Consumer products and the Environmentood 
Media Release - Great result for Infant Feeding Guidelines consensus

What about ‘Follow On’ formula? 

The World Health Organization says follow-on formula is not necessary, and is unsuitable as a breast-milk replacement from six months of age onwards. It says current formulations lead to a higher protein intake and lower intake of essential fatty acids, iron, zinc and B vitamins than recommended for adequate growth and development. You can read about it here…

Information concerning the use and marketing of Follow-Up Formula

Be aware. Claims manufacturers make are for marketing purposes, and may have no scientific basis. There is a lot of money to be made from parents of babies and young children!

When your baby is one year old, he/she can have regular cow’s milk (as well as breastmilk ideally) but there is no need for infant formula of any kind.

 

When should my baby start solids? 
  • From six months of age remains the World Health Organisation’s recommendation (manufacturers of food purees are always pushing for this to be changed)
  • Starting solids earlier isn’t necessary and it doesn’t help babies sleep better at night
  • Processed baby foods are often high in sugar. This is not good for your baby.
  • Breastmilk remains the most important food until at least a one year

some links to latest research 

New Recomendations for infant feeding
Media Release - Great result for Infant Feeding Guidelines consensus
UNICEF - Allergies
A Joint Statement from the Scientific Advisory Committee on Nutrition and the Committee on Toxicity of Chemicals in food, Consumer products and the Environmentood 

How long should I breastfeed for? 

The World health Organisation (WHO) and United Nations Children’s Fund (UNICEF) recommend feeding babies only breastmilk (exclusive breastfeeding) up until 6 months of age and to continue breastfeeding for up to two years with complementary food and fluids.


Food, Drink, Drugs, Medications, Milk Sharing

Can I drink alcohol and breastfeed? 

It is recommended to not drink alcohol while you are breastfeeding, as the alcohol goes into the milk. It takes a while to move out of your body. But when you no longer feel the effects of the alcohol it won’t be in your milk either.

If you have an occasion coming up where you know you will be drinking a fair bit, you can express milk before, to have available for your baby. Be sure there is a sober adult to care for your baby. 

Can I smoke and breastfeed? 

It is best to stop smoking during pregnancy and breastfeeding. But if you can’t, try and smoke less and avoid smoking before baby needs a feed. Smoking can reduce your milk supply and increase the effects of caffeine on your baby.  But it is still better to smoke and breastfeed, than not breastfeed at all.

Can I drink coffee or other caffeinated drinks and breastfeed? 

Caffeine is in coffee, tea and also in many fizzy drinks such as Coke, ‘V’, Red Bull etc. Caffeine can make your baby jittery, irritable and not sleep. One or two cups of caffeine a day is probably OK, but let your baby be your guide. High levels of caffeine can reduce the amount of iron in your milk.

Medications and breastfeeding  

Many medications can be taken while breastfeeding, because usually only a very small amount gets into the breastmilk. Some medications are more suitable than others, so can be substituted.

You can check things out yourself with free Apps
MommyMeds for Mothers www.infantrisk.com/apps
Lactmed https://itunes.apple.com/nz/app/lactmed/id441969514?mt=8
Infant Risk Centre

Milk Sharing 

When feeding babies, the World Health Organisation’s order of preference is… 

  •  Milk from own mother, by breastfeeding
  •  Milk from own mother, expressed
  •  Milk from a healthy donor or a milk bank
  •  Breastmilk substitute (infant Formula) 

Sometimes mothers may have a delay in producing enough of their own milk or have a low supply for a while. Some mothers in this situation choose to give their baby milk from another mother rather than Infant formula.

Breastmilk can contain viruses or traces of medications which could cause illness in a baby. The mother donating the milk can have a blood test to see if this is a problem.

For more information see www.healthpoint.co.nz scroll down to find the brochure ‘Sharing Breastmilk’
Also lots of information here www.eatsonfeets.org
NZ milk sharing sites… www.mothersmilknz.org.nz/mother-to-mother-milk-sharing.html
www.facebook.com/hm4hbnz
www.facebook.com/milksharingnz
www.facebook.com/piripoho


Adjusting

Looking after yourself 

coming soon!

Getting support 

coming soon!

I feel anxious and/or depressed 

Peripartum Distress

NZ has high rates of anxiety and depression during pregnancy and when the baby has arrived, for both men and women.

Depression in New Mothers
Postnatal Depression NZMOH
www.wellwomenfranklin.org.nz   Telephone 021 1588 134  If ph is not answered directly, leave a message. 
www.uppitysciencechick.com/ppdhandouts.html Lots of information on things that help
Mental Health.org Postnatal Depression
www.mothersmatter.co.nz
www.pada.nz
www.anxiety.org.nz
https://depression.org.nz/  FREE 24/7 HELPLINE: 0800 111 757 TEXT 4202
www.mentalhealth.org.nz/get-help/in-crisis/support-groups/

Breastfeeding has been shown to reduce stress and reduce the likelihood of postnatal depression - when it’s going well. If you are having difficulties, getting help with the problems promptly can protect your mental health.

New reseach finks link between some baby books and postnatal depression

Support for fathers 


Going back to work 

What are my rights around breastfeeding and working? 

Many women breastfeed & work
The Human Rights Act says it is illegal for someone to stop you breastfeeding at work, where you are studying, on public transport, in government departments, in public places and in restaurants and shops…anywhere you are entitled to be.
Your rights as a breastfeeding mother

There are changes to maternity leave entitlement from 1/7/17 Payrollhg

By law, your employer must give you unpaid breaks to breastfeed your baby or express milk at work, and must provide you with facilities to do this. More info.. 
www.moh.govt.nz - returning-to-work-english.pdf 
Breastfeeding Friendly Workplaces
The Department of Labour 0800 209 020

Using a pump once or twice while at work is one way to keep your milk production going well and provide milk for your baby. It’s an idea to practice pumping before you return to work.

How do I keep breastfeeding while working? 

Using a pump once or twice while at work is one way to keep your milk production going well and provide milk for your baby.

How much milk will my baby need?

It depends how long you are away from your baby. And how often your baby might want to feed (which can be a little more difficult to predict)

From about 1-2 weeks onwards, the ‘average
amount breastfed babies have in total each 24 hours is 750 mL, (range 570-900 mL)
number of feeds is ten
amount each feed about 75mls
The average amount of breastmilk per 24 hours gradually increases to become about 900 mls each 24 hours

A feed (full tummy) for a week old baby could be about 45-60 ml
A feed (full tummy) for a month old baby could be about 80-150 ml

Many babies will take only small amounts of breastmilk from a bottle or cup, but once back with mum, will feed lots. It’s not likely to matter.

Some helpful info kellymom.com/bf/pumpingmoms/pumping/milkcalc

Using a bottle

If you provide bottles for cargivers to feed your baby with while you are away it is helpful if they know how to give a feed that, as much as possible, is like breastfeeding. Explaining to your baby’s caregivers about ‘Paced Bottle Feeding’ will help. How to bottle feed a baby
That should help ensure that the volumes given are manageable for you to keep up with.
It will also lessen your baby’s frustration when back feeding at the breast.

Breastfeeding and Working 

 

What are my rights as a breastfeeding mother? Can I breastfeed at work?  
How do I use a Breast Pump? How do I pump more milk? 

There are many times when using hand expression or pumping can be helpful. These may include:

  • If your baby is having difficulty latching on, or getting milk from the breast
  • to stimulate milk production
  • relieving fullness or engorgement
  • if you have a premature baby
  • if you and your baby are separated for some reason
  • if you are returning to work or need to go out without your baby

 You can get milk by hand, or use a pump…whatever works best for you.

Using a breast pump.

There are all sorts of pumps available.
Regardless of what you use, you will get more milk if you use your hands to compress and squeeze your breasts. Some mums find they don’t get much when using a pump. Don’t worry, it’s not always a good indication of the amount available. It’s helpful to respond to your pump as if it’s your baby, so the oxytocin flows J

How to pump lots of breastmilk 

How long can I store my breastmilk? 

Breastmilk can be stored for days in the fridge and months in the freezer.
It’s better to have it at the back and bottom of the fridge, rather than the door.
It’s best to store breast milk in small quantities to avoid waste.

Thaw and heat the amount of milk needed for a feed by standing the container in warm water.
Frozen breastmilk should be used within 24 hours of defrosting.
Don’t use the microwave for thawing or heating breastmilk as this can alter special properties in the milk and may heat the milk unevenly.

Storing Breastmilk pdf

www.babyfriendly.org.nz - Storage of Breastmilk Factsheet.pdf

How do I give my baby a bottle? 

If you provide bottles for cargivers to feed your baby with while you are away it is helpful if they know how to give a feed that, as much as possible, is like breastfeeding. Explaining to your baby’s caregivers about ‘Paced Bottle Feeding’ will help. How to bottle feed a baby

That should help ensure that the volumes given are manageable for you to keep up with. 
It will also lessen your baby’s frustration when back feeding at the breast.

It's not necessary to use a bottle. Milk can also be given by cup (even newborns)


Please note: The page has been created by Debbie Tetlow RN IBCLC, for Helensville Birthing Centre. While every effort is made to provide evidence based and up-to-date information the opinions expressed, and the links, above are not necessarily those of Helensville Birthing Centre and inclusion does not necessarily indicate endorsement or recommendation.
Please emaiDebbie with any feedback. Thanks 

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