Breastfeeding

Breastfeeding is the normal way of providing young infants with the nutrients they need for healthy
growth and development. Virtually all mothers can breastfeed, provided they have accurate
information, and the support of their family, the health care system and society at large.

Colostrum, the yellowish, sticky breast milk produced at the end of pregnancy, is recommended by WHO
as the perfect food for the newborn, and feeding should be initiated within the first hour after birth.

Exclusive breastfeeding is recommended up to 6 months of age, with continued breastfeeding along

with appropriate complementary foods up to two years of age or beyond.

PROPER POSITIONING AND LATCH-ON SKILLS

There's a right way--and a wrong way--for baby to latch onto the breast. When baby latches on
correctly, mother's nipples don't get sore and baby is able to get plenty of milk. Everyone is happier.

The easiest way to learn about good latch-on is in a one-on-one session with a knowledgeable lactation
consultant, who can show you, rather than tell you, how to get baby latched-on correctly. Many
hospitals offer lactation services to postpartum mothers. You might also consider working with a
lactation consultant or La Leche League Leader in your community.

With proper latch-on, puts most of mother's areola into his mouth. (See illustration.) Mother's nipple (1)
goes to the back of baby's mouth. The baby's gums (2) compress the milk sinuses that lie about an inch
behind the nipple. The tongue (3) is forward, underneath the breast, over the lower gum, and its motion
helps baby draw out the milk.
GETTING POSITIONED

How you sit, how you hold your baby, and how you offer your breast all affect how baby latches on.
Ultimately, these facts determine how comfortable you will be during breastfeeding.
Mom's position (the cradle hold)
Sitting-upright in an armchair or rocking chair is the easiest position for breastfeeding. You can also sit
up in bed, but make sure that your back, shoulders, and knees are well-supported. You'll need several
pillows.

* Place one or more pillows behind your lower back, and/or shoulders so that you are comfortable
and relaxed.

* If you're in bed, put pillows under your knees.

* You'll need at least one pillow in your lap to bring baby up to the level of your breast, and another
under the arm that will support your baby as he breastfeeds.
 * If you are sitting in a chair, use a foot stool or something else to raise your lap so you don't have to
strain or lean over to get baby closer to your breast.

Why all the fuss about your comfort? Once baby is latched-on, you're going to be stuck in this position
for 20 to 30 minutes. You don't want to be all knotted up when baby finally falls asleep in your arms.
Back to top
Baby's position(the cradle hold)

Before you do anything else, be sure that your baby is awake and alert. A sleepy newborn can't nurse
effectively. Undress baby down to just her diaper, so that she has lots of stimulating skin contact while
nursing. Hold her in front of you and gently raise her from a lying-down position to one where she is
supported in front of your face. Call her name, talk to her gently, and repeat this until she is awake
enough to nurse. If your baby is fussing or crying, calm her down before offering the breast.

Babies as well as mothers should be comfortable during breastfeeding. Baby's breastfeeding reflexes
work best when baby is well supported with her body comfortably aligned.

* Use one or more pillows in your lap to bring baby up to the level of your breast. Don't expect your
arms alone to be able to hold her at breast height though an entire feeding. Use pillows and a foot
support to bring baby up and in toward you. The baby comes to the breast, not the breast to the baby.

* Nestle baby in your arm so that her neck rests in the bend of your elbow, her back along your
forearm, her buttocks in your hand.

* Turn baby on her side, so that she is facing you tummy to tummy. Pull her close to you, so that her
body wraps around yours. Her head and neck should be straight and in line with her body, not arched
backward or turned sideways. Baby should not have to turn her head or strain upward to reach your
nipple. The breast should be right there in front of her little mouth.

* What to do about those little arms flailing away? Tuck the lower arm under baby's body, into the
soft pocket of your midriff. You can hold the upper arm down with the thumb of the hand that is holding
her. If it's hard to control baby's body, try swaddling her in a blanket.

Variations on this position

The position described above for mother and baby is called the cradle hold. It's the most common way
that mothers hold babies while nursing. But there are times when you might choose another position.
When baby is having difficulty learning to latch on, try the Clutch Hold or the Reversed Cradle Hold for
more support and a better view of baby's mouth. The Side-Lying Position makes night-nursing and nap-
nursing easier. Mothers with a tender tummy from a cesarean sometimes prefer the clutch hold or the
side-lying position, to keep baby off their lap.
Offering the Breast

The hand that isn't holding the baby supports your breast. Supporting the breast with your hand keeps
the weight of it off baby's lower jaw and chin. This will help him stay latched-on correctly. Try these tips
for supporting your breast:

* First, squeeze out a few drops of colostrum or milk to moisten your nipple.
* Then cup your breast with your hand, palm and fingers underneath and thumb on top.
* Keep your fingers clear of the areola, the darker area around the nipple, so that baby can take a big
mouthful of breast.
* If your breasts are very large, use a rolled-up hand towel under your breast to help support its
weight.

Latch-on Basics: Breast and Baby Come Together

Open Wide. When the nipple touches baby's lips, his mouth will open quickly, seeking the breast. You
want to get your nipple into his mouth when it is as wide open as possible so that baby sucks on a good
mouthful of breast tissue, not just on the nubbin of your nipple. Babies' mouths close as quickly as they
open, so you have only a split-second to get baby and breast together. Here's what to do:

* Use your nipple to tickle baby's lower lip to encourage her to open her mouth wide--really wide.
* As the mouth opens to its widest point, direct your nipple into the center and use your arm behind
to pull baby in very close to you. Don't lean forward, pushing your breast toward your baby; pull her
close to your breast by moving your arm.

How to Get Baby to Open Her Mouth Wide

Baby's wide-open mouth is the most important part of latch-on. If baby takes the breast as her mouth is
closing, or if she slurps the nipple in through partially open lips, she won't get enough breast tissue in
her mouth. If baby sucks only on the nipple, mother will get very sore nipples and baby won't get
enough milk. You have to wait patiently for baby to open her mouth wide and then act quickly when she
does. Even if you have to start over several times,(and you will in the beginning it's worth working at
until you get it right. Try these tips:

* Talk to your baby and say "Open." Show her what to do by opening your own mouth wide. Babies
can imitate adult facial expressions.
* Help your baby open her mouth wider by using the index finger of the hand supporting your breast
to press firmly down on your baby's chin as you pull her on. You will probably need someone else to do
this for you at first.

If all has gone well, at this point baby will be successfully latched-on to the breast and will begin to suck
and swallow. If you're like most new mothers and babies, it may take several tries before you get going.
If baby is not latched on well, press down on the breast or gently insert a finger in the corner of baby's
mouth to break the suction and try it again.

Be patient, relax, and use these checkpoints to evaluate whether baby has a good latch:

* Mother should be relaxed, with baby well supported in her arms. If you end up sitting hunched over
during feedings and have a tired, sore back when you're done, you probably need another pillow in your
lap to get baby up to breast height. Lean back into the pillows behind you and be sure you're bringing
baby to the breast, not the breast to baby. Use an additional pillow to support the elbow of the arm that
is holding the baby. There are also breastfeeding pillows you can purchase that keep baby's body
aligned, yet raised to breast level. This is helpful for first-time moms who are overwhelmed with
positioning baby's body and getting baby to latch-on correctly.

* Make sure baby sucks the areola, not just the nipple. Your baby's gums should bypass the base of
the nipple and take in at least a one-inch radius of the areola as he latches on. If baby is sucking on only
the nipple, your nipples will be sore after just one or two feeding and miserable after many more.
Another reason it is so important that baby compress the areola is that the milk sinuses (the reservoirs
for milk) are located beneath the areola. If these sinuses are not compressed, your baby will not get
enough milk. Babies should suck areolas, not nipples.

* Baby's top and bottom lip should be turned out (everted). When baby takes the breast with mouth
open wide, he'll have a "fish mouth" look as he nurses. If his bottom lip is pulled inward instead of
outward, use the index finger of the hand that is supporting the breast to pull out that lower lip. (You
may need a helper to take a peek under the breast and do this for you while baby is latched-on.) Martha
Sears, who logged 18 years of breastfeeding 8 children dubs this technique the lower lip flip. This lower
lip flip may be all that's needed to keep baby from tight-mouthing your nipple.

* Baby's chin should be pressed into the breast with his nose resting on the breast, as well. You will
notice that baby is able to breathe out the sides of his nose, even when pressed against your breast.
Babies are designed that way. If your baby struggles, pull baby's bottom closer to you, or use your
thumb to press gently on the breast to make an airway.

* Wrong latch-on. Baby's lower lip should not be pursed inward, but should be turned outward.