When you have made a commitment to breastfeed your baby, you are ensuring that your child will have the best start in life as well as continuing the close relationship that began in the womb. Breastfeeding is as much of a commitment as the pregnancy was. It takes time to do it well, as well as perseverance to work out the kinks if you have trouble. Rest assured, there are very few problems that cannot be ironed out. Many women give up because they don’t have proper support to learn what to do with the bumps in the road.
We mammals have perfected the feeding of our young from our bodies. Our bodies know the exact balance of nutrients as well as the frequency with which to feed our babies. Our bodies even communicate with our offspring via hormonal messages so that they can signal us to produce more milk when they need it. Breastfeeding is a brain engineered process, just like childbirth. When our baby signals to us that they are hungry we think thoughts about them and their need to be fed. Our thought triggers a complex hormonal message to the maternal brain, which in turn signals the breasts to “send milk now”. The supply of milk responds directly to the needs of the baby which is why breastfeeding should be done “on demand”.
Preparation for Breastfeeding
When nearing the end of the pregnancy you can gently help your nipples to protrude into position for breastfeeding by simply pinching gently below the nipple with the forefinger and thumb. Then, holding onto the nipple, gently pull it out and turn it up and then down. Do this exercise several times with both nipples. If it is uncomfortable, be gentler as you perform the exercise. Gradually increase the number of exercises each day.
Avoid anything that is drying to the skin around the nipples, especially soap.
If possible, go bra-less for a certain portion of each day to allow the natural friction of your clothing, fresh air and sunlight to slightly toughen your nipples for breastfeeding.
The only washing that nipples need, even when breastfeeding, is your daily shower or bath. Spread some of your breast milk over the nipples after each feed. The milk has anti-septic properties as well as helping the nipple to stay moist, preventing them from drying and developing cracks.
Flat or Inverted nipples:
If you try the above nipple pulls and you find that your nipples react by retracting, then you may have inverted nipples. This is not uncommon in women who haven’t breastfed before. An effective technique for encouraging the nipple to protrude is the “Hoffman technique”. Draw an imaginary cross on the nipple. Place a thumb on each side of the nipple along one line of the cross, your thumbs should be directly at the base of the nipple, not the edge of the areola. Press in firmly against the breast tissue and pull the thumbs away from each other. You’ll be stretching out the nipple and loosening the tightness at the base, allowing the nipple to move up and outward. Dr. Hoffman recommends that you do this stretch five times in the morning along each line of your imaginary cross. This preparatory step makes it easier for you to grasp the nipple and do the pulling motion.
Positioning for breastfeeding
Breastfeeding is a natural instinctive behaviour that all mammals engage in. Many women have trouble with attachment in the beginning because the behaviour is not meant to be forced.
When a baby is born it has several instinctive behaviours which begin to manifest. From the moment of the first breath, which is prompted by air on the skin of the face, to the instinctive crawling movements which bring a baby into alignment with the breast, everything is there to ensure survival.
As a baby emerges from the vaginal canal it stimulates massive amounts of the love hormone, oxytocin, to be released into the body of both mother and baby. This causes you to essentially “fall in love” with each other. This motivates the mother to do anything in her power to protect and nurture. A mother who has just given birth has an instinctive need to bring the baby close to her breasts, skin to skin. If placed on the stomach or chest, between the breasts, the baby will instinctively crawl towards the breast as it smells the milk. If the mother is patient and waits till the baby makes this instinctive motion, the baby will open its mouth in the correct way to feed from the breast. When the baby opens its mouth and starts to move from side to side, it is time to put the nipple into the baby’s mouth.
The nipple is surrounded by the areola which has ducts underneath it. When these ducts are stimulated by pressure from the baby’s mouth, milk is pushed forward from the back of the breast where the milk is made. Two things come into play at this time. The stimulation of the baby’s mouth on the milk ducts of the areola, and the brain of the mother. The skin to skin stimulation causes the message to be sent to your brain that your baby is hungry, and because your brain is wired to do all it can to protect and nurture your child it produces milk which is pushed towards the tiny openings in the nipple.
In order for this to occur, you must be relaxed and calm and thinking nurturing thoughts about your baby, especially in the early days. Later after breastfeeding is established, this preparatory thought process may not be necessary.
In any position that you hold your baby, you should have good support for your back, shoulders and arms so that the baby can get the whole areola into its mouth.
To ensure good attachment unwrap the baby from any constricting blankets, curl your baby’s body around yours and position the baby’s head so that it is tilted back and the mouth naturally opens.
Lightly grasp the areola and squeeze it together gently and flop the nipple downwards into baby’s mouth. If she starts sucking, but the areola isn’t all the way in, break the suction with a clean finger inserted into the side of the baby’s mouth and try again.
Your goal is to empty the ducts evenly through the pressure of the baby’s mouth.
First food for Baby
When your baby is first born, what it receives from your breast is called collostrum.
Collostrum is a substance similar to milk but with much higher amounts of fats and sugars. It also contains very important immune boosting elements so that your baby can adjust more easily to life outside the pristine environment of the womb. It is a protective and extremely nourishing substance which makes your baby immune to everything you are immune to. This immunity carries through for as long as you are breastfeeding exclusively and the baby is not eating solids or any other booster bottles of milk.
After about 3 days the collostrum will slowly change from a thick orange colour to a light yellow and then a cream colour as your body starts to produce milk. When your milk comes in your breasts will feel swollen and firm and you will get a tingling feeling under your arms and at the sides of the breasts. This is called the “let down” reflex which tells you that your milk is being pushed from the back to the front of the breast.
Consistency of Mothers Milk
Your milk is like a three course meal with an appetiser, a main meal and dessert.
When the baby first starts sucking, for the first 5 minutes or so, it will receive mostly what has been stored in the ducts. This can be about 5 mls per breast of fairly watery thin milk which is excellent for appeasing thirst. As your baby continues to feed from the same breast, the milk gets thicker and more full of nutrients, until by the time the baby has been feeding for10-15 minutes the milk is like a dessert with carbohydrates, fats, proteins and all the nutrients to ensure that your baby grows and thrives. Your brain responds to the needs of your baby, producing the milk whenever it is needed and eventually producing it automatically at the times your baby would usually be hungry.
The more your areolas are stimulated by the skin to skin contact with the baby’s mouth, the more milk is produced.
The milk that comes last is called “hind milk” and is very important for the baby’s growth. If the baby doesn’t get enough hind milk it may not feel satisfied and may feel like feeding sooner.
Mastitis
Mastitis is a condition which can develop if a duct becomes blocked from uneven feeding pressure. If the baby does not put even pressure on the whole areola, one of the ducts may not be emptied, and the milk at the front may plug up the duct as it dries a little. This will cause a lump to start to form as the duct becomes swollen with milk. If the milk isn’t emptied within a day or so the breast may become sore and if it goes longer you may develop symptoms like flu with aches and fever. This is dangerous and can lead to a considerable amount of discomfort as well as the possibility of needing a doctor’s treatment for the infection which can develop.
The best way to prevent mastitis is to make sure that your baby is properly attached and completely empties the breast at each feed and daily hand massage of the breasts in the shower or bath while checking for lumps.
If there is too much milk to completely empty the breast, especially in the first 6 weeks, you can pump after the feed and store it in the freezer for up to 3 months. It can be frozen in an ice cube tray and the 5 ml cubes can be stored in a ziploc bag. These can be defrosted later for use by babysitters etc.
After 6 weeks or so your supply will settle down and become more manageable and you will be producing just what you baby needs, but do continue to do the daily breast massage, as a duct can develop a blockage at any time.
If after all of the preventative measures above, you still develop a blocked duct, you should hand express until it is soft and empty. Stand in the shower or over a washbasin, with warm water pouring over the breast to help soften the tissue. Using a thumb, apply firm pressure from the back of the lump towards the nipple. Continue until the lump is gone. When you get out of the shower, apply an ice pack to the affected area. You may need to have several sessions to completely deal with the problem.
Evening primrose oil on the affected nipple and taken orally can help greatly to clear the blockage and keep it clear.
While breastfeeding, do not wear underwire bras or restrictive foundation underwear as anything which puts pressure on the breast can cause a blockage. Go bra-less for a couple of hours each day to allow full blood circulation to the breast. At other times use a well-fitted nursing bra which has good support for the extra weight of the full-of-milk breast.
Other resources for information about Breastfeeding;
websites:
www.breastfeeding.asn.au
www.betterhealth.vic.gov.au/bhcv2/bhcarticles.nsf/pages/Breastfeeding
Books:
“Ina May’s Guide to Breastfeeding” by Ina May Gaskin
“The Womanly Art of Breastfeeding” released by La Leche League International
“Breastfeeding…Naturally” released by the Australian Breastfeeding Association