Though breastfeeding is instinctive and natural, it is not always easy. Check out our expert's tips on how to get breastfeeding off to a great start.
By Dr Sonali Santhanam
Breastfeeding is instinctive for both mother and baby. A newborn, when left undisturbed on a mother’s belly, can crawl up to the breast, find the nipple and self-attach.
New mothers have ample support at the hospital but they can feel overwhelmed with the new baby at home, especially in the first few weeks. If breastfeeding is going well, it is easier for mothers to start enjoying with their newborn while they recover. Very often this does not happen. Some roadblocks with respect to breastfeeding include nipple soreness, painful latch, low milk supply or oversupply, poor weight gain in babies and lack of sleep.
Understanding newborn behaviour and adjusting your expectations in the first few weeks can ease your transition to parenthood. Here are some pointers to get breastfeeding off to a good, pain-free and stress-free start.
1. Attend a breastfeeding class before your baby arrives
Understanding frequency and duration of breastfeeding, newborn sleep and wake cycles, and recognising hunger cues will help you get into a rhythm sooner. Being able to practice nursing positions and latching techniques on model babies in class should help you gain confidence and trouble shoot with ease in the early days.
2. Feed within the first hour of birth
Babies are generally alert and demonstrate instinctive feeding behaviour in the first hours after birth. The sooner you get your baby to breastfeed, the easier it is for baby to latch on instinctively and get more of the ‘first milk’, colostrum. Early initiation also jump-starts milk production with the release of oxytocin and prolactin. Studies have shown that early initiation of breastfeeding improves outcomes by bringing in milk sooner, stimulating baby’s feeding instincts and is associated with increased likelihood of exclusive breastfeeding for first 4 months.
3. Stay close to baby
Dr Nils Bergman describes the mother’s breast as the newborn’s natural habitat. As with any mammal, separation from its natural habitat triggers in the newborn a protest-despair response. The protest involves crying to be reunited with mother and the despair response is the withdrawal, fluctuation in heart rate and body temperature that follows. Rooming in with baby and periodically doing skin-to-skin contact will help the baby feel secure where she can hear your heart beat and stay warm.
4. Nurse with a SOFT touch
Bonding with a SOFT touch helps release oxytocin and facilitates milk production.
SOFT touch is:
Remember that milk let-down depends on release of oxytocin, which is called the ‘shy love hormone’. Hence, uninterrupted quiet time with your baby is a must. Ask visitors to delay their first visit until you have established a rhythm with your baby.
5. Pay attention to hunger cues
Your baby may pucker and smack her lips, turn her face from side to side, bring her hands to her mouth and even dive into your breast in search of the nipple. It is important to feed your baby at these first signs of hunger. Crying is a late sign and it is generally harder to get a crying baby to latch.
In the first 2 weeks, however, till your newborn regains his birth weight (babies lose 5-7% of their weight after birth), you may have to wake your baby to nurse every 2.5 hours. Once your baby has regained the birth weight, you can relax on this rule and start feeding on cue. Allow your baby to empty one side completely till the breast feels soft to ensure she gets the rich, fatty hind milk, then burp and switch sides.
6. Get comfortable
Babies feed often in the first few months and poor positioning could cause your back and shoulders to hurt. Nurse your baby sitting in a comfortable chair using a feeding pillow that reaches up to the breast. Place your feet up on a low stool to bring baby closer. When baby is latched on, your shoulders should be comfortably relaxed and lower back supported.
Alternatively, you can use a laid-back position to breastfeed in the early days where you are reclined to about 45 degrees and the baby is supported on your chest. This position also helps prevent traction on the nipple by the weight of the baby hanging under the breast. If you are unable to find a comfortable nursing position seek out a lactation specialist to help you as soon as possible.
7. Babies breastfeed, not nipple feed
The latch is everything when it comes to breastfeeding. If your baby gets a large mouthful of the breast, the nipples reach a comfortable spot in the baby’s mouth, so milk transfer is better and there is no pain. Conversely, if your baby is latched only on to the nipple, it can get pinched between the baby’s tongue and the hard roof of the mouth leading to painful, cracked nipples and poor milk transfer. Breastfeeding should not hurt and if pain persists throughout the feed, consult a lactation specialist. Sometimes, a consult might reveal a structural issue such as a high palate, tight frenulum or inverted nipples which requires special intervention.
Signs that your baby is latched well include:
1. Lips flanged out
2. More of the areola is visible on the top and less below
3. Chin is in contact with the breast
4. Nose is free
5. No clicking sounds or dimpling of cheeks
Usually, a well-attached baby suckles a few times and then pauses to swallow. If your baby falls asleep at the breast, a few breast compressions can get the milk flowing and keep baby interested through the feed. This method is preferred to the usual advice of tickling the baby’s ears and toes.
8. Feed on demand in the first 3 months
Sleep training and schedule feeding if initiated sooner than 4 months of age can compromise milk supply. Breastfeeding is a demand and supply process, and in the early days, babies have frequent growth spurts. During a growth spurt, the baby’s appetite increases and it can be challenging to keep up with this increased need. You may feel discouraged and be tempted to supplement with formula, but you can be assured that your milk supply will catch up if you demand feed. A lactation consultant can help you quantify milk supply objectively if you suspect pathologically low milk production, which can happen in case of hormonal imbalances.
9. Stay away from bottles and pacifiers
If you need to supplement baby in the early days with formula or expressed milk, it is best to use a syringe or a feeding cup. Introducing a bottle in the first 12 weeks can cause baby to develop a preference for the faster flow offered by the bottle. This might result in a nursing strike where the baby refuses to latch on directly. Coaxing the baby back to the breast will take patience and perseverance.
10. Enlist dad
Fathers can feel left out during this phase that revolves around the mother-baby dyad. A father’s positive and supportive attitude towards breastfeeding can really boost a mother’s confidence and encourage her to keep going on difficult days. Fathers can take turns with nappy changes, help with burping and swaddling, also do skin-to-skin contact and help mothers relax. Fathers must ensure mothers get adequate rest, eat well at regular intervals and keep stress levels low.
Breastfeeding isn’t meant to be difficult or painful but it is definitely no mean feat! It is, however, an extremely rewarding experience when all is well.
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