Sunday, July 25, 2021

Breast Feeding Your Newborn

This is an INFORMATION page, verified by physician

Breastfeeding is the best way to ensure a healthy start for both you and baby. Exclusive breast milk is the best source of nutrition for most infants in the first six months of life.

Most expectant mums plan on breastfeeding. But it is important to realise, it can take some time, practice and support to get it right. For some mums, breastfeeding may go smooth from the start. For others, it may seem neither natural nor easy. At first, there may be ups and downs and even some tears!

Being prepared about what to expect when it comes to feeding your newborn baby helps. Different people may give you different advice and all babies are individuals. In general stick to one piece of advice. If it is working for you and your baby, only change if there is a problem.

Having difficulties with breastfeeding? It is best to speak first with your midwife, obstetrician or paediatrician. They can then refer you to a lactation consultant. A lactation consultant can offer further assessment and support if needed.

Preparing to Breast Feed Your Infant

There are some things you can do in pregnancy to prepare yourself for breastfeeding.

Attending an antenatal course is a good start. This will give you the opportunity to learn about breastfeeding. Including getting the latch right and different ways to hold your baby to feed. Keep in mind that breastfeeding is a learned skill and it can take some time, practice and support to get it right.

Preparing your nursery? You may want to consider purchasing a boppy pillow (a ‘c’ shaped pillow that fits around you to help support the baby during feeding). And a comfortable chair for the bedroom where you can feed the baby at night time.

Getting professionally fitted at around 36 weeks for a nursing bra is a good idea if you have not already done so. You will also need to have breast pads ready for after delivery in case of leaking breast milk. This is especially important in the first few weeks. Buy some comfortable feeding singlet tops. These will provide support and easy overnight access for feeding. You can pack these in your hospital bag.

While in the comfort of home, wear a tee shirt without a bra. The slight friction between your clothing and nipples may help make your nipples less sensitive. Try gentle hand expressing of colostrum. It is important that this is not done until you are more than 37 weeks gestation. There is a theoretical risk that repeated nipple stimulation may stimulate hormone production that triggers uterine contraction. Check with your obstetrician first.

If you have diabetes in pregnancy, discuss with your obstetrician about the safe collection and storage of colostrum in case baby needs it. Babies of diabetic mothers may have low blood sugars initially.

What is Colostrum?

Colostrum is the yellowish translucent fluid your breasts secrete during the first few days of breastfeeding. It is the very first milk and is like “gold”. It contains the ideal nutrients for your newborn baby. Including easy to digest:

  • Proteins,
  • Vitamins,
  • Minerals
  • And antibodies to help protect your baby from disease

It is very easy to digest and a highly concentrated form of nutrition. It is high in protein and lower in fat and sugar than regular/mature breast milk. Only a little is needed with each feed, about 5 MLs or one teaspoon per feed on the first day of life.
Colostrum help keeps your baby’s blood sugar stable. Small amounts of colostrum allow your baby to safely learn to suck, swallow and breath during feeding. The colostrum also helps flush out the meconium from baby’s colon (link to Baby Poop). And can also help prevent baby from becoming jaundiced.

What is Regular/Mature Breast Milk?

With frequent regular feeding in the first few days of life colostrum will transition to regular breast milk. Which is more white or whitish-blue in colour. As your breast milk comes in your breasts may feel very full and tender.

Breast milk is the ideal nutrition for your newborn baby. Breast milk actually changes to keep up with baby’s nutritional needs, even within a feed. The initial milk at the start of a feed is called foremilk and is more watery, higher in lactose and in protein. The thicker hindmilk towards the end of a feed has more fat for energy and weight gain. If you store breast milk in the fridge you can see the hindmilk sitting as a thicker white layer on the top of more watery foremilk.

How Often Should I Feed My Baby in the First 24 Hours After Birth?

Ideally your baby should be put to your breast for a feed within the first hour of life. This usually happens as part of the skin to skin contact after birth. When baby is dried and placed naked on your bare skin on your chest. Your midwife or paediatrician will be able to help you with the initial latch.

Your baby may be very sleepy in the first 24 hours. Feed baby on demand. When they wake up and show signs of readiness to feed, but do not leave your baby longer than six hours without a feed.

In general, the more you feed baby at the breast, the quicker your breast milk will come in. Sometimes, your paediatrician may advise a different feeding frequency. Especially if your baby is born small for dates.

How Often Should I Breastfeed My Baby in the First Few Days?

From day 2 and the next few days following, you should aim to feed baby 8 to 12 times in a 24-hour period. So every 2-3 hours throughout the day and night. Keep an eye on the time from the start of the feed to the start of the next feed. Record this on a feeding chart, phone app or diary. Also record any wet or dirty diapers.

On the second and third nights your baby may want to feed through most of the night. This is normal and baby’s frequent and prolonged suckling will help stimulate your milk to come in.

How Long Should I Feed Baby for?

An average baby will take about 20 minutes to feed on one breast. Some may take as little as 10 minutes or as long as 40 minutes to empty one breast. Most newborn babies will only feed from one breast per feed. It is important to make sure they have fed fully off the first breast (usually 20-30 minutes and the sucking has slowed with long pauses between swallows) before offering the second breast.

If you start feeding on the left breast, the next feed should start with the right breast. Even if baby took both breasts the feed before and finished on the right and vice versa.

Wearing a hair tie or bracelet around your wrist and switching it over with each feed can help you remember which breast to start with for the next feed.

How will I know my baby is hungry?

It is important to look for early hunger cues in baby to help you know when baby is hungry before they get too distressed. The more upset they become, the harder it will be to get baby latched at the breast.

Early feeding cues include:

  • Sucking motions,
  • Smacking sounds,
  • Licking the lips and sticking out the tongue,
  • Rapid eye movements,
  • Sucking sounds,
  • Sucking on hand.

Crying is a late cue. Do not wait for baby to cry before you feed.

How Do I Know My Baby is Getting Enough Milk from Me?

Urine and stool (poo) output is a good indicator baby is getting enough colostrum/milk.

It is important to note the number of wet diapers and dirty diapers in each 24 hour period. Typically in the first 24 hours you should see at least one or two wet and dirty diapers.

(link to Jasmina’s chart for Newborn Poo).

After discharge from hospital your baby’s weight gain will be monitored. This is usually the best way to reassure baby is getting enough milk from the breast. It is usual for babies to lose some weight (sometimes up to 10% of birth weight eg, 3000 gram baby may lose up to 300grams) in the first few days of life. Your baby should regain their birth weight in the first two weeks of life. From then on, your baby will gain approximately one ounce/30 grams a day or 5-7 ounces per week if feeding well.

Worried about the weight of your baby? Still not sure if they’re getting enough milk? Contact your paediatrician or maternal health care nurse to discuss.

How Will I Know if My Baby is Latching Correctly?

Latching is the process of baby attaching to your breast to feed. It can be a challenge sometimes to master, but once you’ve got the hang of it, feeding time is far easier.

When latching baby, it is helpful to remember “nipple to nose”, “chin to breast” and “chest to chest”. Bring baby towards your breast (aiming nose toward nipple, and baby’s chest against your chest), rather than your breast to baby. Use your nipple to stroke baby’s upper lip so they open up wide. Then gently bring your baby onto the breast while supporting the back of the neck (don’t push the head forward).

For mum’s with larger breasts or for smaller babies having difficulty latching, an additional sandwich hold (U or C shape) may be required to help baby latch properly. Your midwife can show you how to do this.

A correctly latched baby will have pouted top and bottom lips (like a blowfish on a window). The mouth should be around the nipple and as much of the areoli as possible.

When baby is latched you should see and hear several sucks, a pause and then a swallow. It is important at the end of feeding, or if the latch is painful, to break the seal (which can be very strong between baby’s mouth and the breast). Use your clean little finger (keep fingernail short) to break the seal by placing it gently inside baby’s cheek.

Breastfeeding Pain

If breast feeding is painful your baby is probably not latched properly. Break the seal and re latch baby again.

Still painful? Or you notice your nipples are misshapen, grazed or bleeding after feeding? Make sure you ask the midwife to help you latch.

Ideally you should feel confident and comfortable with latching your baby before you’re sent home from hospital.

How Should I Hold My Baby to Feed?

The most common hold to feed baby is the cradle hold. With you sitting upright and baby held on their side across your lap, facing you. It is best to use the opposite hand/arm to hold baby for latching (i.e. use the right arm to hold if feeding on the left breast). When baby is latched properly you can then switch arms to cradle baby (i.e. left arm cradling baby while on left breast).

If you have had a c-section, have big breasts, or a small baby, the football hold may work better. This hold has baby tucked under your arm (on the same side as feeding). Holding head and neck in your hand, with his feet extended towards your back.

The side-lying position is often used after a c-section. In this hold, baby lies on the bed beside you and your turn on your side to baby facing you.

Should I Put My Baby On a Schedule?

In the first month to six weeks while you are establishing breast feeding, it is better to feed baby on demand then to a fixed schedule. It is important to watch closely for early feeding cues, signs your baby is getting hungry. Aim to feed your baby before they become upset with hunger. Eventually your baby will let you know what feeding schedule is likely to work for you both. Feeding on demand is the best way to ensure baby is feeding enough and has good weight gain.

It is good to help baby learn the difference between day and night feeds. Interact and talk with baby during daytime feeds. And at night keep lights low or off, and minimize interaction/stimulation.

My Breasts are Very Swollen, Hard and Painful, What Should I Do?

Your milk will normally come in between day 2 and day 5. This increase in breast milk, along with increased blood supply to the breasts and extra fluid in the breast tissue, leads to very swollen painful engorged breasts. This engorgement will usually settle down within the next few days to weeks.

Feeding baby every 2-3 hours can help with engorgement. Apply cold raw cabbage leaves in the bra. Or apply ice packs wrapped in a thin towel for 15 minutes between feeds can help. Just before feeding, apply some warmth to the breasts, with a warm wet towel or by having a shower. Gently massage the chest wall toward the nipple area in a circular motion.

Sometimes, when your breasts are very firm and swollen, it can be hard for your baby to latch on. If this is the case, try hand expressing a small amount of milk off, until the areoli is softer, so baby can then latch.

Noticed a new lump? An area of skin on the breast that is hot and red? Or have flu-like symptoms or fever? Contact your obstetrician. You may have an infection (link to Lisa’s section on mastitis).

Do I Need to Apply a Nipple Cream?

If your nipples look and feel fine you do not need to apply any creams. It is important to always let your nipples air dry after feeding before replacing your bra cup. And to regularly change your breast pads.

If your nipples are sore or cracked, rub colostrum or breast milk over the nipple and let this dry. There are over the counter nipple creams (for example Lanolin) that can also be used to help protect and repair the nipple. Speak with your midwife, obstetrician, or paediatrician if unsure about what to use.

It is important to get your baby’s latch reviewed if you have painful nipples. An incorrect latch is the usual cause for nipple pain.

Your paediatrician should also assess baby to make sure they do not have a tongue tie affecting the latch. And to make sure there is no sign of thrush (link to thrush in babies).

Should I Use a Breast Pump?

In general, it is better to avoid using a breast pump in the first month while you establish breastfeeding and your milk supply. Baby feeding at the breast is the best way to ensure your breasts make the right amount of milk. Over pumping may lead to excess milk production. This can increase your risk of engorgement.

Don’t rely on a breast pump to tell you how much milk supply you have. A pump is generally less efficient at removing milk than your baby. Meaning that it gives you a false sense of how much you are producing.

I Feel Cramps Every Time I Feed, Is this Normal?

Baby suckling at the breast causes the brain to produce oxytocin, which stimulates contraction of the uterus. These “after pains” or cramps are the uterine muscle contracting and reducing in size. You may also feel an increase in vaginal bleeding during a feed as any remaining blood clots from inside the uterus get expelled.

Afterpains can be worse with each subsequent pregnancy. Regular pain relief after birth for the first 48 hours can help.

What Can Partners Do to Help?

Partners can feel helpless when it comes to assisting their partner during breastfeeding. But, they have a really important role too. Partners can help make sure new mums get plenty of rest between feeds. Ensure mum has a full glass of water and a snack to have with each feed.

The arrival of baby is an exciting time. But keeping visitors to a minimum can help in the first few days. Especially while both mum and baby get some rest and establish breastfeeding.

I Have Inverted or Flat Nipples, Will I be Able to Feed Baby?

If you have inverted or flat nipples, speak with your obstetrician during pregnancy. There are special shields that can be worn in later pregnancy to help draw out your nipple before baby is born.

If baby is having difficulty latching after birth, ask your midwife to review your latch. Sometimes a lactation consultant may be called to assess and assist. If a nipple shield is recommended this will need to be purchased from an outside pharmacy and bought to the hospital. Your partner should be able to do this for you if needed.

What should I eat when I’m breast feeding?

It is important to eat a varied and healthy diet while feeding. You will need approximately 300-500 more calories per day to meet your energy needs. Eat everything you would normally, but in moderation.

Avoid drinking or smoking. Speak with your doctor before taking any medicines to make sure these are safe while feeding. Continue to take your antenatal vitamins or a breastfeeding vitamin supplement after birth. Remember to drink at least 8 to 10 glasses of water per day.

Vitamin D Supplementation for Baby

Breast milk is the best choice for baby. But it is low in vitamin D. Breastfed babies are dependent on daily sunlight exposure to maintain normal levels of Vitamin D. Even though we live in the sunny Caribbean, baby may not get enough Vitamin D from the sun. Especially as we are now sun-smart (cover-up, avoid the sun, high SPF sunscreens etc). Babies who have darker skin are even more at risk. They need longer exposure to sunlight to make the same amount of Vitamin D. Mothers may also be vitamin D deficient due to lack of sunlight exposure. Which in turn affects baby’s Vitamin D store at birth.

UK and American guidelines recommend that all breastfed babies, regardless of risk factors, receive 400 IU of Vitamin D as soon as possible after birth. This should be continued for the first year of life.

Vitamin D deficiency can affect bone development and lead to rickets (softening of bones and bow legs). It can also cause seizures. And may contribute to other long term health problems in adulthood.

400IU Vitamin D can be found in single Vitamin D supplement preparations. Usually in drop form, that you can put on the nipple during a feed or by clean finger. Or you can give a multivitamin supplement for baby. Both forms are available over the counter from supermarkets and pharmacies.

I’ve Got Mastitis – Should I Stop Breast Feeding?

Mastitis often happens if nipples become cracked. The cracking allows bacteria to get into a milk duct. You may have noticed a red segment on your breast which is hot and tender and you may feel flu-like and unwell. It’s very important to see your doctor urgently with these symptoms as you will need antibiotics.

Don’t stop breastfeeding. It’s really important that the milk is drained from the affected milk duct. Otherwise the infection can get worse. You may need support from a breastfeeding advisor to make sure that the affected duct drains properly while you are on antibiotics. You may need to adjust how you hold your baby. Massage the breast to drain the duct or express from the affected breast.

There is no need to stop feeding from the affected side. This in fact is the best way of draining the milk duct. The antibiotics may cause the baby to have loose poos but won’t do the baby any harm at all. Once the infection has gone talk to your breastfeeding advisor or doctor. They can help you find a better way to position your baby when they latch on to stop nipple cracking.

I Have a Breast Abscess – Should I Stop Breast Feeding?

A breast abscess is a very rare but serious condition and may need an operation to drain the infection. But you don’t have to stop breastfeeding if you don’t want to.
You should continue to feed your baby from the unaffected breast.

Every time you feed the baby you should express milk from the affected side and throw that milk away. You should not feed the baby from the affected side due to the risk of infection. As long as you continue to drain the affected breast the antibiotics will work and you will recover.

I’m Thinking of Stopping Breast Feeding

It is best for your baby to have breastmilk for 6 months before adding in other feeds such as formula milk or solid foods. But the reality is that breastfeeding doesn’t suit everyone. You may need to go back to work. Or you may be stopping the last night time feed before thinking about having another baby.

If you want to keep on feeding but need to return to work, it’s very reasonable to express from the other breast during each feed, then freeze that milk so that your childminder can give breast milk by cup or bottle during the day. If practical, you could come home in your lunch hour to feed your baby and continue the night time feeds.
Want to completely stop breastfeeding? Be prepared for a couple of days of discomfort as your breasts will fill up with milk. When this happens it’s important not to express or drain the breasts. This just stimulates the milk to still be produced. If it’s really uncomfortable try lying in a warm bath with warm flannels over your breasts. Allow the breasts to leak fluid. It may help to wear a bra in bed at this time to support your full breasts.

This phase only lasts a couple of days as long as you don’t stimulate the breasts to continue to produce milk.

Storage of Expressed Breast Milk

It is important to make sure you wash your hands well with soap and water before pumping. Collect the breast milk into either breast milk freezer storage bags or into clean (washed in hot soapy water and air dried or cleaned in a dishwasher) glass or plastic storage containers. Plastic should be BPA free, (avoid recycled plastic with numbers 3 or 7 on it) with tight-fitting lids.

Store milk in 2-4 oz increments, the younger your baby, the smaller increments. This will avoid wasting any unwanted defrosted milk. Do not fill containers to the top as the milk will need room to expand when frozen. When using the breast milk bags, squeeze out the air at the top and again leave room for the milk to expand.

Clearly name and date the containers or bags.

Expressed milk can be kept at room temperature (77 degrees F or lower) for four hours. Four days in a refrigerator, 3-6 months in a fridge freezer (freezer with a separate door above or below the refrigerator). Or 6-12 months in a deep freeze (chest freezer). Avoid storing milk in the door of a refrigerator or at the front of the freezer. Store milk towards the back to allow it to be kept at a consistent temperature.

Expressed milk leftover from feeding baby can remain for 2 hours at room temperature. It should then should be discarded.

cdc.gov/breastfeeding/recommendations/handling_breastmilk.htm

Thawing Expressed Breast Milk

Use the oldest milk first. Thaw in the refrigerator overnight or by sitting the bag or container in lukewarm water.

Never microwave breast milk. This destroys the nutrients in breast milk and can also create hot spots which can burn baby’s mouth.

Never refreeze thawed breast milk. Thawed breast milk can be stored in the refrigerator for 24 hours and kept at room temperature for maximum of 1-2 hours.

I’m Having Trouble with Breast Feeding. Where Can I Find Further Information and Support?

For further information on breast feeding see https://www.llli.org/ Le Leche League International.

Breast feeding support group in Cayman (link to list)

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about the author

Dr Sarah Newton

MBChB, FRACP (paeds), DCH

SPECIALIST GENERAL PAEDIATRICIAN & NEWBORN CARE

Born in New Zealand, Dr Newton is a general paediatrician with the Royal Australasian College of Physicians, tertiary level trained in highly respected paediatric and neonatal centres in Australia, New Zealand and Singapore. Her specific interests include neonatal care, complex diagnoses and developmental follow up.



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