08 Nov Frequently asked questions about breastfeeding

By Hettie Grove – SA certified location consultant

      Q. Must I prepare my nipples while I am pregnant?

A. Your breasts actually do it automatically. The areola enlarges and become darker. The bump like areas on your areola are secreting a substance which will clean your breast and also lubricate your breasts. No need to use creams and potions on your breast. Be careful not to wash with a strong soap.

      Q. When should my baby have his first feed

A. Research by Annemarie Widstrom concluded that the baby needs to pass through the nine instinctive stages which take approximately 75 minutes before the baby latches on to the breast. One would like the baby to crawl to the breast as soon as possible after the birth. Ask for no separation between mom and baby. Should your baby be separated, start with hand breast expression as soon as possible into a teaspoon, decant into a syringe and ask the staff to take it to the baby.

      Q. How soon should I bath my baby?

A. Delay the bath as long as possible, the amniotic fluid smell helps your baby to find the breast directly after the birth. The vernix is also a protective substance which helps to keep the baby’s skin healthy and intact.

      Q. How often should I feed my baby?

A. As often as your baby wants. Breast babies should feed about 8-10 times in a twenty four hour period. Keep your baby skin to skin in the “breastaurant” and watch for feeding signs like rooting – baby turning his head towards the breast with a gaping mouth, smacking of the lips, making tongue movements. Crying is often a late sign of hunger.

      Q. Should I schedule my baby?

A. The first two weeks is the milk calibration period. That means the more often the baby drinks the more milk you will supply later. This initial period of two weeks is so important because it has an influence on your supply later.

      Q. If my breasts are full and hard won’t I stimulate more milk to be made?

A. Full breasts in the initial weeks can decrease your milk supply so you should try and express for comfort. Mothers have a unique little substance in their breast milk called the feedback inhibiting lactation protein (FIL). So, if one’s breasts are full there are lots of this FIL – which tells the brain that the breasts are full and it should decrease supply. If the breast is emptier this FIL will tell the brain there is too little and production needs to increase.

      Q. How will I know if my baby is getting enough milk?

A. If your baby has at least 6 wee nappies from day six, looks content, one stool a day the size of a credit card and gaining weight you may rest assured he is getting enough.

      Q. What food must I exclude from my diet while breastfeeding?

A. Generally, you can eat anything in moderation. Milk is made from your blood and there is no tube from the stomach to the breast. Your baby is already used to what you eat from when you were pregnant. A healthy balanced meal with some snacks and enough water to keep your hydration up is necessary.

      Q. Will Coke, Stoney or milk stout increase my milk supply?

A. The only way to increase milk supply is to drain the breasts more frequently. Baby only consumes about 65% of the milk in your breast so you can try and hand express a bit after a feed to increase your supply. If you are worried about a low supply call a Certified Lactation Consultant to distinguish between a real low supply and a perceived low supply.

      Q. What latching position should I use?

 A. Difficult answer as no one position will suit everyone. If you had the wonderful opportunity to experience the breast crawl and self-attachment it would be much easier. But in reality, it does not always happen. Breastfeeding is almost like learning to ride a bike and is not always instinctive. The baby is hardwired to breastfeed but circumstances might not be perfect. Optimal positioning is of utmost importance in the first few weeks. If the baby latches well, the breasts are comfortable, the baby is getting enough but most importantly the baby is fed well.

A few pointers to get you off to a great start.

• The golden rule is comfortable and relaxed. This is easy to say but not as easy to do as people are bustling in and out of your room and you might be quite shy.
• Get enough pillows and support for your back, arms and feet so that you can comfortably hold your baby.
• Keep your baby close to you, tummy to mommy to prevent the baby turning his head to the breast.
• You can bring the baby’s nose to your nipple, and when the baby opens his mouth wide, connect him into the breast. Remember you bring the baby to you not take the breast to the baby .
• Support his back with your hands forming a second neck for your baby. Don’t touch the back of the baby’s head as this will cause him to pull his head backwards.
• If it hurts, unlatch the baby and try again. When unlatching the baby don’t pull him off but gently slip a finger in the corner of his mouth to break the suction first.
• Be patient we are on baby time not mommy time.
• Practice makes perfect and breastfeeding gets easier and a lot less work.
• If your breasts hurt please call a certified lactation consultant. It might be tender but not sore.

There are separate ways to latch your baby and each mother and baby dyad will be different. Some mothers will always use the same position and others will experiment with all the various positions, till they find a comfortable latch.

The Laid back position is quite a favourite in the early days, and with an oversupply, it might help tremendously because it will permit mom to rest while her baby is drinking.

• This is as easy, as its described finding a comfortable spot in the house on a chair or a bed, to be well supported.
• Put your baby on your chest, bear in mind gravity will help to keep him in this position.
• There should be no spaces between you and the baby.
• You will both will be molded as one.
• Let your baby’s cheek rest close to your bare breast.
• Breastfeeding is team work let baby helps you with, you can hold your breast or not.
• In this position both can rest and enjoy the moment – it passes all too fast.

Sometimes you need to alter the position into an indescribable position. Most commonly the cross-cradle position will be used in the first few weeks where mom uses one hand to form a second neck and the other hand to manoeuver the breast. Remember to bring the baby to the boob. Make sure you are comfortable and connect with your baby while feeding, you might even cradle your baby in the cradle hold. Lots of mommy’s latch in the cross cradle hold and when baby start sucking well, move to the cradle hold.

Sometimes baby favours one of the breasts, then we will advise a football hold with baby under the arm tummy to mommy and the opposite version of the cross-cradle hold. Side lying might also be a god way to start after a caesar. With mommy and baby both on their sides facing each other. Again, tummy to mommy, no spaces in between and the mother supporting baby with her arm and baby’s nose to the nipple.

      Q. What happens while a baby breastfeeds?

A. The baby has an unique suck-swallow-breathe cycle. The nipple, areola and underlying breast tissue are drawn deeply into the infant’s mouth. The baby’s lips are curled outwards around the mother’s breast and are minimally involved. The tip of the tongue is maintained over the lower gum while the tongue grooves around the areola of the breast. Your highly elastic nipple elongates 2-3 times longer to form into a teat by the suction created in the baby’s mouth. The nipple extends back near the hard and soft palate the so-called comfort space. The nipple is held between the upper gum and tongue that covers the lower gum. The tongue presses upward in a wave beginning at the tip and moving backwards. The jaw simultaneously elevates, and compresses the areola against the infant’s alveolar ridge. Milk is delivered into the central groove of the tongue.  If there is enough milk to trigger a swallow, the infant’s vocal folds close, the epiglottis tilts over the airway, the larynx is drawn upward under the base of the tongue and then the soft palate elevates to seal the back of the nose.  Once the milk has safely passed the oesophagus, the soft palate returns to its resting position against the back of the tongue and the airway reopens.

      Q. How would I know that my baby is really sucking effectively?

     A. Baby should show a

• Rhythmic suck/swallow rhythm with occasional rest periods
• Audible swallowing
• Good jaw movement noticeable from the chin to the ear
• No lip-smacking or clicking sounds
• Your baby will look “milk drunk” and relaxed after a feed

• You would experience
  • A strong sucking feeling that is not painful (important to remember that the initial latch might feel sensitive, but the sensation does fade a few seconds into feeding)
  • Thirst
  • Uterine contractions or increased bleeding during or after feeds during the first week and more in moms who already had a baby
  • Breasts feeling less full