Breastfeeding seems like a simple enough procedure for experienced mothers but may be difficult for first time mothers. It takes time to master. No two nipples are the same and no two babies prefer to feed in a similar manner. Both the baby and the mother need practice and need adequate support to begin and maintain breastfeeding.

Beginning breastfeeding

Breast milk is made by the breast in response to the baby sucking at the breast. The more milk the baby sucks from the breast, more milk that is secreted by the breasts.

Some steps help in a good start to breast feeding. These include:-

1. Starting breastfeeding as soon as possible after birth of the baby
2. Use of an on-site lactation consultant to help the new mother begin breast feeding as soon as possible after birth
3. Preventing the staff from giving any other food or water to the infant after birth
4. Practice of rooming in. Rooming in involves allowing the bay to stay in the mother’s rooms all day and night so that she can practice breastfeeding often.
5. Avoiding giving pacifiers and artificial pacifiers or artificial nipples

Latching and starting breastfeeding

The first indication that the baby wants to be fed is usually licking of the lips or making smacking noises.

When awake the baby moves his or her head from side to side to look for the breast with his or her mouth and lips. This is an instinct in the baby.

If the mother brings a finger near the baby’s cheek and strokes it gently the baby turns her head to the finger looking for the nipple. This is called the rooting reflex.

Once the baby finds the breast he or she “latches” onto the breast. Steps for latching are:-

• The mother needs to hold the baby against her chest. The baby needs to be held upright with his or her head under the mother’s chin. The bare skin of the baby should be in contact with the bare skin of the mother’s chest.
• The neck and the shoulders of the newborn baby need to be supported. One hand is placed under the head and upper back of the baby while the other is placed under the hips and buttocks of the baby.
• The baby’s head needs to be moved back slightly to make it easy to suck and swallow. When the mouth of the baby is open the tongue is down to allow the nipple of the breast to slide in.
• The baby usually feels the breast over its cheek and turns his or her head towards it with the mouth wide open. This is mediated via the rooting reflex. The mother may help guide the baby’s mouth to the nipple.
• The latching position ensures that whole of the nipple and the dark area around the nipple (the areola) is in the baby’s mouth and his or her chin presses into the mother’s breast. The baby’s lip is puckered out like she is kissing. The nose of the baby should be allowed to be free so that he or she can breathe while feeding.
• Signs of a good latch include points like no pain and uncomfortable feeling for the mother, no pinching sensation, the baby appears to be comfortable, little of the areola is visible, the baby’s tongue is under the nipple and the baby can be heard to swallow in between breathing.

Is breastfeeding painful?

During the early days of breastfeeding there may be pain and a pinching sensation as the baby sucks on the nipple. Usually with time the sensation goes away and there is a slight dragging feeling as the milk is ejected.    

If the pain persists, the latching may be wrong or the baby may be sucking on only the nipple rather than the whole of the breast. In these cases the baby needs to be gently prised away from the nipple and the process of latching needs to be repeated.

 

Babies with difficulty latching or sucking who are not taking enough breast milk or not gaining weight may need help of a lactation expert or a paediatrician.

Frequency of breastfeeding

Breastfeeding should be as often as a newborn baby demands. Breastfeeding should be initiated soon after birth and continued for at least 8 to 12 times every 24 hours. This helps the mother’s breast make adequate milk.

For the first few days after birth the newborn needs to be breastfed every hour or two in the daytime and a couple of times at night. If the baby is asleep he or she should be woken up for a feed if 4 hours have elapsed after the last feed.

Every baby has its own schedule that gradually develops over time. The baby usually gives cues to signal when he or she wants to be fed. This may begin with lip smacking, making sucking noises and sucking on his or her own finger or fist or an offered finger of an adult.

As he or she gets hungrier this may result in a crying to be fed. Once the baby is crying or is upset, getting a good latch is difficult unless the baby calms down. Thus it is important not to let the baby progress to the cry-phase.

Feeding schedules may vary from sleeping hours and waking hours.

Duration of each feed

Usually a baby takes around 15 to 20 minutes or longer to empty each breast. When the baby feels full, he or she will let her mother know, fall asleep or leave the nipple on her own.

The initial milk that comes is called the fore milk and this is thinner and more watery. This helps to quench the thirst of the baby. After the initial phase the milk is thicker and is called the hind milk. This satisfies the hunger of the baby.

Babies need both fore and hind milk. Mothers should ensure that both the fore milk and the hind milk is given to the baby before turning the baby to the other breast.

To assess the adequacy of feed several signs can be adopted. This includes number of soiled diapers and weight gain.

This chart shows the minimum number of diapers for most babies.
It is fine if your baby has more.

How long to breastfeed for?

Most leading health organizations recommend that infants must be breastfed exclusively for the first 6 months. This means that babies are not given any foods or liquids other than breast milk for the first 6 months.

This comes from organizations including the American Academy of Pediatrics, American Academy of Family Physicians, American College of Obstetricians and Gynecologists, American College of Nurse-Midwives, American Dietetic Association and American Public Health Association.

Breastfeeding should be continued for at least 12 months and may be continued thereafter as long as the mother and baby want.