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The ABCs of Breastfeeding

Position

In preparation for a breastfeeding session, it is important that you have clean, washed hands and are in a comfortable position. A feeding can be done in either an upright or lying down position. Supporting your baby with pillows to bring him up to the level of your breasts will decrease strain on your arm, shoulder and back muscles.

Once you are comfortable, be sure that the baby and you are tummy-to-tummy - that he is completely turned toward you. With the pillow support and the tummy-to-tummy position, the infant's mouth will be directly in front of your nipple and areola (the dark part of skin surrounding the nipple tip). Now you are in a position for proper latch-on.

Latch-on

With the hand that is not holding the baby, shape your breast by forming the letter "C" with your free hand. Do this by placing the four palm fingers under your breast and your thumb on top, about an inch or so behind the areola. This technique of "cupping" your breast will help to shape the nipple and areola so that it will go easily into the baby's mouth for effective latch-on. Remember to keep the "C" hold wide. Do not collapse it by bringing the thumb and the fingers closer, as this might make your pointed nipple recede a little.

To get the baby to open her mouth wide for latch-on, stroke the middle of her lips (especially the lower lip) with your nipple tip to elicit the rooting reflex. Once she opens her mouth, direct your nipple so that it is centered in the baby's mouth. Be sure to get your nipple/areola above her tongue, which ideally should be lying slightly beyond her lower gum line and not touching the roof of her mouth.

Encourage your baby to get as much of the nipple and areola into her mouth as possible. She may not be able to get the entire areola into her mouth, but she should latch on to more than just the nipple tip. (The extent of latch-on depends on the size of the baby's mouth and your areola.) When your baby has an adequate amount of the nipple and areola in her mouth, her lips should be seen to form a "V" with lips flared outward onto the breast rather than tightly pursed inward. This is important not only for your comfort but also for effective breastfeeding. When a baby sucks on only the nipple tip, it can hurt you, cause cracks in the nipple, and prevent the baby from getting enough milk.

If the latch-on position and the sucking response are successful, your baby will not easily fall off the breast. You will see her jaws in motion and the breast tissue near the nipple/areola actually pulled in with the rhythm of her sucking. When the volume of milk increases, your baby will nurse in bursts of four to 10 sucks in a row, followed by a pause during which the nipple/areola stays in her mouth. A baby may slow down or pause in her sucking rate to swallow the milk. With colostrum, your baby will probably suck two or four times in a row before obtaining enough fluid in her mouth to cause her to swallow. It is important to try to notice the swallowing to be sure that she is taking milk in; you can sense this by a quiet "gulp" or a sound like a puff of air coming from her.

Switching Sides

When you want to switch sides, slide your finger into her mouth between her gums. This will partially open her mouth, breaking the high-pressure suction and preventing trauma to your nipple. Then burp the baby, change to the opposite side, and begin again. In the beginning it can be difficult to teach a baby to latch on correctly. It is important for your baby to suck properly - both for your comfort and for efficient breastfeeding. It may take several attempts before your baby opens her mouth wide enough and latches on properly, but persistence and patience on your part will teach her how to do this correctly and minimize your discomfort. As you both learn, it will get easier.

How Long and How Frequently to Feed?

No one can tell you exactly how long on each side your baby may want to breastfeed. Here are some general guidelines that will assist you. You should encourage your baby to breastfeed at least every two to three hours during the daytime. A four-to-five-hour interval between breastfeeding may occur at night, but repeated long intervals without a feeding can hamper weight gain.

During the first few days you may notice that your baby appears to be sleepy. If your baby seems sleepy and not interested in feeding, try changing the diaper or unwrapping him from a swaddled blanket to expose him to the air in the room. Mild stimulation, such as light massage and skin-to-skin contact, also will help arouse your baby. If you cannot arouse him for a feeding, hold her skin-to-skin and wait. Try to feed again in one hour or observe him for hunger cues, such as hand-to-mouth motions, finger sucking, fussiness, arching of the back and stretching, or simply a quiet, alert state.

Once your baby appears alert and interested, find a comfortable position to begin feeding. Keep in mind the proper latch-on techniques discussed earlier. Once your baby is feeding, allow him to feed until he seems satisfied. Begin with the breast you ended with during the last feeding. Observe your baby's sucking and swallowing and how he occasionally rests before beginning to suck again (the bursts and pauses). At the onset of a feeding, these pauses are usually 10 to 15 seconds long. The average feeding per side is about 15 to 20 minutes after the milk comes in. But your baby may be different in the pace he sets. Let him lead the way! Note: If he is nursing very frequently, the duration of the feedings will be shorter (like snacking); this is okay.

When your baby becomes increasingly satisfied, the sucking will slow down and the rests will get longer. Then you can insert a clean finger between your baby's gums and gently break the suction. Try to burp him (some babies may not burp). Always offer the second breast. If the baby still seems hungry after taking the second side, you can continue the feeding by going back to the first breast. This is called switch nursing.

If, when switching sides, the baby does not resume active feeding after about four to five minutes, he likely got satisfied from the first side. This is common in the early weeks and has been shown not to be a problem for infant growth and intake. You may feel "lopsided" for a couple of hours, but just start the next feeding on the "full" side.

After the feeding session is completed, the baby may still seem hungry. Overall, you will want to breastfeed your baby between eight and 12 times every 24 hours. These feedings may occur around the clock every two-and-a-half to three hours or closer together. It is perfectly normal for breastfed infants to want and need to be fed this frequently because human milk digests through their system significantly faster than commercial formula.

Cluster Feeding

Sometimes, especially in the first few weeks of life, your baby may want to feed more often. This is called "cluster feeding," when your baby demands to be breastfed very often over a short period of time (e.g., every 30 to 60 minutes for roughly five minutes a side). Then she may sleep for an extended period. This does not mean that your milk isn't enough for her. She is just making sure the supply will increase to keep up with her growth. You will discover that if you let her set the pace, she will breastfeed perhaps three or four sessions that way but will then settle down and sleep for a while. Watch her behavior rather than the clock, and you will discover when your baby is awake, alert, and giving cues that she is ready to feed.

Adequate Milk Supply

Another common concern among breastfeeding mothers is whether babies need a supplement with water or formula. If breastfeeding is going well, babies usually are satisfied by breast milk alone. Some mothers wish to feed their babies both breast milk and an occasional bottle of formula. We recommend that breastfeeding be the only source of feeding for your baby during the first three to four weeks (unless other feeds are medically indicated) to allow your body to build up an adequate supply of breast milk.

Many mothers may also wonder if a breastfed baby needs to have supplementary water during hot summer weather. Supplementary water for breastfed infants is not necessary.

Expressing Breast Milk

You may choose to collect and store your breast milk for your baby if you expect to be away during a feeding. Use either hand expression or a breast pump to collect your milk. Begin by washing your hands and massaging your breasts several times. Place both hands around your breast, against your chest, and apply gentle pressure as you move your hands toward your nipple. Continue to massage around your entire breast. Applying a warm washcloth may help your milk to let down. Breast milk should be collected and stored in a clean plastic or glass container. Pre-sterilized, disposable nurser bags can be convenient for storage but can split and leak upon thawing; therefore, they are not recommended for long-term storage. Only specially made mother's milk storage bags (these have a special layering of plastic and nylon to prevent splitting) are recommended. These can be purchased from the major breast pump rental stations. Baby bottles with a tight-fitting cap are also effective.

Breast milk may be stored for up to five days in a 40º F refrigerator, for six months in a 0º F freezer if self-defrosting (frost-free type), or for nine to 12 months in a regular freezer.

One of the best times to collect breast milk is after a feeding, especially in the morning since this is when your milk supply tends to be higher. If your baby has a long interval between some feedings, you can take advantage of this time to collect additional breast milk.

Remember, when you are away from your baby, you also may wish to express milk either for future feedings or to relieve breast fullness. Many types of manual, battery-operated, and electric breast pumps are available. To select the best pump for your needs, consult a nurse or lactation consultant after your baby is born.

Above content provided by Beth Israel Deaconess Medical Center. For advice about your medical care, consult your doctor.

Posted March 2012

Contact Information

Department of Obstetrics and Gynecology
Beth Israel Deaconess Medical Center
East Campus
330 Brookline Avenue
Boston, MA 02215
617-667-0475

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