Back to basics...

​Breastfeeding 101

The first few days:

• Breastfeeding should not hurt; it may feel a bit uncomfortable as your nipples become accustomed to being used so frequently but this should be minimal. No cracks, bleeding, purple nipples, white tips, creases on the nipples, etc ... these are all signs that you might need to adjust your baby’s latch and/or positioning or that your baby's tongue isn't functioning effectively.
• While you are waiting for your milk to come in it is important to feed on both breasts each feed and as often as your baby wants to. There is no exact amount of time you should do this for (although you will likely hear 10-15mins/breast); try to go with your baby’s cues, listen for swallows, and if in doubt you can hand express and spoon feed your colostrum to your baby after he/she breastfeeds.
• If your baby is jaundiced and/or sleepy it is important to ensure your baby gets a minimum of 8 feeds in 24 hours (it may be more like 10-12) and if you notice he/she is not feeding or isn't peeing enough be sure to notify your HCP (health care provider - Dr or midwife). If your baby is too sleepy to latch and suckle effectively you can hand express and give your baby this colostrum/milk (via spoon, syringe, cup, dropper).
• These first few days are often described as the hardest and most challenging days. As your baby goes from one day to the next he/she will want to feed more often. This is completely normal and is designed to help your milk come in. Don't be surprised if your baby wants to feed every hour or more/less. Once your milk "comes in" this will likely become more spaced out. During this time it is important to give your baby unlimited access to the breast. It's also a great to have supports in place during this time. For example: family/friends/doula to do housework, cooking or bring meals, etc and ensuring momma is fed and hydrated.
• Latching basics: most babies have the instinct to find their way to the breast and 'laid back breastfeeding' can work well for a lot of mommas. Some babies need a bit more direction and/or support. Below are some basic tips you can implement as necessary as a way to problem solve or rule out reasons for an inadequate latch and transfer of milk.
  • tummy to mommy - baby's body should be facing the same way his/her head is facing with their ear, shoulder and hip lined up
  • shoulders tucked close to mom
  • baby’s head tilted back slightly as if they're in a sniffing position
  • position baby so your nipple lines up with the baby's nose – they smell their way to the nipple. Even better is to angle your breast/nipple so the nipple is aiming up your baby's nose.
  • wait for baby to open his/her mouth nice and wide (and their tongue needs to be down) then bring baby to the breast chin first (not breast to the baby). Think of eating a really large burger and how you have to put the bottom bun in before you put your mouth up and around the rest of the burger in order for it to fit... same goes with your baby. Bring baby chin first then when he/she opens wide bring him/her up and around to get a nice big mouthful of areola. Some babies won't open as wide as you might want and that's ok. As long as once they're latched and sucking, there's no discomfort, there's audible swallowing (milk transfer) and they're not only sucking on the nipple/base of nipple.
  • your hand supports the base of baby’s neck and their shoulders; not the back of their head. Once latched you might find it more comfortable to bring your arm (same side as baby's head) around and support their head with the crook of your arm/elbow (not your forearm). Be sure to keep their head facing the breast with chin buried and nose free.
• Once latched; be sure baby has room to suck - meaning enough room for the jaw to open/close - their chin should not be on their chest. If he/she is in the optimal position the chin will be buried in the breast and the nose will be free to breathe easily. If this is not the case you can adjust baby by gently tucking/pulling the baby’s shoulders towards you nice and close. Sometimes it's helpful to move baby towards their feet a bit so that the head is in the midline and slightly tilted back. Don't expect large jaw motions with every suck, but once your milk is flowing you should notice nice long deep draws with your baby's jaw.
• It's also important to check baby's lips are flanged out to allow them to take as much breast tissue into their mouth as possible.
• If you move the corner of the baby’s bottom lip slightly you should see the tongue making the bottom seal. If you see the tongue behind the gum line it may be causing some discomfort, damage, or poor milk transfer. You both may benefit from some assistance with his/her tongue positioning and function.
• There should almost never be any clicking noises while the baby is latched and suckling
• Listen for swallows... it will sound like ‘kaah’ when the baby swallows to take a breath
• If your baby is frustrated at the breast, try massaging the breast to increase the flow of your colostrum and/or to help your baby transfer the thick sticky colostrum out of the breast. Do your best to stay calm when your baby is frustrated. If needed, take a moment and put him/her on your bare chest and hold them close. Once they’re calm you can see if they’ll head bob their way back to the breast or tolerate you directing them there.

The first few weeks:
Transitional milk to mature milk

• You will notice your milk changing from being yellow and sticky (colostrum) to less sticky but still yellowish and more volume (transitional milk) and then to white milk (mature milk).
• Typically you will notice an increase in supply and start to see more transitional milk around day 3-4 (however some moms will have their milk "come in" on day 2 and some on day 10). Keep feeding and seek additional support if you feel you need some.

Engorgement phase

• Breasts can be full, hard, lumpy, painful, and sometimes even warm to touch
• This can last for the first 2-3 weeks. This type of engorgement is partially inflammation and partially an increase in milk volume.
• It is Important to drain the breasts frequently so your body knows you need it and will continue to produce it. However, this doesn't automatically mean you need to pump to drain if your baby doesn't. The engorgement phase is like the teaching phase to show your body how much volume your baby needs. If baby is feeding effectively, has sufficient wet/soiled diapers, and is gaining weight, there is no need to pump on a regular basis. If you're unsure of how much and/or when to pump; be sure to ask your midwife, LC, or even poll your friends to see what worked best for them. Do your best to avoid google searching.
• Massage, heat before feeds & ice after/between feeds can be helpful. This can help the inflammatory part of the engorgement so your milk can drain from the breast easier. If it's quite painful you can use anti-inflammatories at your own discretion (medicinal, herbal, etc. If unsure check with your health care provider).
• You can also get engorgement beyond the first few weeks. This is a different kind of engorgement and is typically due to baby feeding less frequently or if the mother misses/skips a feeding without pumping. This type of engorgement is mainly excess milk volume and at times, a small amount of inflammation.

Take home tips:

• Feed baby when he/she shows hunger cues – rooting, lip smacking, crying (late cue)
• Make feedings effective... feed, burp, change diaper, offer breast again, burp, change position if needed, offer again, etc... Don’t just assume if baby falls asleep he/she is done the first time. It can be common for your baby to feed for a stint then fall asleep as if they are done, then 5-10 minutes later act hungry. This is normal and means they're ready for the next portion of their feed. Some babies feed their full volume in 5-7 minutes flat and some will require multiple latches and breaks over a longer period of time in order to get their full feed volume.
• Once your milk is in it's important to drain one breast as best as you can before switching sides. If baby feeds frequently you can feed more than once on the same side to help drain and allow baby to get more hindmilk. Some babies may only take one breast per feeding and this is perfectly ok, as long as they are having enough wet and soiled diapers per day and start to gain weight and maintain their weight along their chosen growth curve. On the other hand there are some babies who will need some or all of the second breast/side some feeds and some will drink both full sides each feed. Each mom has a different volume of milk they can store/produce per feed based on their mammary tissue and breast size/capacity. It may take some time to learn your baby's norm and your breasts' norm, so be patient.
• Hands on breastfeeding or breast compressions are helpful to get more milk transferred within a feed. They can also be very helpful to work out any lumps you find to avoid plugged ducts or mastitis. I suggest you wait until your flow has slowed to do compressions so as to avoid your baby feeling as if he/she is drowning. If, however, your supply is low and or you have a slower flow/letdown reflex, you might find compressions beneficial throughout the feed.
• Try feed baby a minimum of 8 times per 24 hours – this likely will not be regularly 3 hours at a time, but rather sometimes hourly, sometimes every 1, 2, 3 or 4 hours, etc.
• Unless you are concerned about jaundice, dehydration, or weight gain, don’t wake a sleeping baby at night time. This can allow them to get much needed rest, gain weight, allow you to rest, and help baby adjust their days/nights around the right way. During the day you can keep feeds more around 2-4h apart. If your baby wakes more frequently at night and sleeps well during the daytime; offer them a feed more frequently during the day (2-3hourly) in hopes they’ll switch the longer naps to the nighttime. An easy way to do this is to give them more regular access to the breast by holding them skin to skin and watching for their behavior to change throughout their sleep/wake/hunger cycles/cues.
• Soothers: if you're going to use a soother that's totally ok. However, be cautious to not miss hunger cues. Make sure you're using one that's a shape that encourages your baby to cup their tongue and suck deeply (e.g. gumdrop type soothers encourage this) vs those that encourage their tongue to thrust, pinch, or bite down (e.g. ones that have flat sides or very bulbous shape to them). There are some babies who will never take a soother and there are those who love to suck all the time. Both are ok. 

Disclaimer
Liquid Gold Breastfeeding & Lactation Support does not intend to dispense medical advice and the content on this website should not be considered medical advice or counsel. If you have a question about your health or the health of your child please consult your physician. The information provided here is anecdotal and of personal opinion only and should not be used as a substitute for medical help. If you are unsure of any above information also please feel free to fill in a contact form and we would be more than happy to answer any questions you may have on an individual basis.