How to breastfeed?

People often say that although breastfeeding is natural why is it not always easy for some mothers and babies to do so successfully? Research has shown that 80% of mothers who gave up breastfeeding did not want to do so and with support they could've continued. This section is your virtual Breastfeeding Supporter for all your breastfeeding basic needs.

Positions

96% of breastfeeding problems can be resolved by simple changes to how you Position your baby then how they Attach to the breast.

Your baby works on their natural reflexes to coordinate themselves to latch at the breast. In the early days it is beneficial to lay back and find your baby’s Natural Breastfeeding Position then follow the steps below"

CLOSE – Hold your baby close to you.
HEAD FREE – Don’t hold the back of your baby’s head.
IN LINE – Ensure your baby’s head and body are in line and your baby isn’t twisiting their neck to feed.
NOSE TO NIPPLE – Line up your nipple with your baby’s nose, so when they open their mouth wide and tilt their head back the nipple will go into the roof of the mouth.
SUSTAINABLE– Make sure you are comfortable.

Remember the pneumonic CHINS

There are many positions you can place your baby in to start a comfortable feed as long as you have those 5 points in place.

Laid Back/Natural Breastfeeding/Biological Nurturing®

This is the most useful way to enable the baby to self latch in the early hours and days, using their natural instinctive behaviour. They feel secure because gravity is working with them, holding them to their mother's body in nice close contact. You don’t have to be laid right back, just reclining. If you are sitting in a chair, just bring your bottom forward and lean back, then place the baby on top of you in any angle as long as the nose is lined up with the nipple

Cross Cradle Hold:

Supporting the back of the baby’s neck with the thumb and forefinger, lining up their nose to nipple, then when the baby’s mouth opens wide bring them to the breast. Be aware babies can feel insecure in certain holds where gravity is pulling against them. Take into consideration the height from your breast to your lap and where your breast hangs naturally. It is always best to allow your baby to self attach without supporting your breast. For a larger breast however, it can be helpful to roll up a cloth/muslin to lift your breast away from your body, or use a flat hand on your chest to gently lift the breast tissue.

Cradle Hold:

A common hold adopted by mothers when they are confident feeders.

Support your baby in the crook of your arm and using your free hand, tickle

your baby’s top lip with the nipple, this encourages a wide gape and you can

bring your baby to your breast.

The Rugby Hold:

This is a popular hold with tiny babies or when the mother feels she needs to see the baby latching on. It can also help when a baby is reluctant to feed at one breast in the cradle hold. This enables your baby to stay in their preferred position, but feed from the other breast. Bear in mind when the baby grows this position isn’t helpful because the baby cannot be tucked under the arm and still have their nose to nipple. They tend to “overshoot” their latch, causing the nipple to enter the mouth centrally, or too low resulting in poor latch and nipple damage.

Side Lying:

You lay on your side, with baby facing you, with their nose, lined up

with your nipple, tucking their legs into your abdomen ensuring they

are close. It can be helpful for your partner, or helper to place baby

next to you when you have got into a comfortable position.

Sometimes its good to support yourself with a pillow behind your

back. Again consider where you place your baby in relation to where

you breast falls and the position of your nipple.

Tandem Feeding:

These are ideas for positioning twins or a baby and toddler for tandem feeding. With twins it can be useful to use a supporting cushion to enable you to position one baby using both hands, whilst the other can be lying on the cushion ready for their turn.

However always consider where your breast are naturally falling and ensure the cushion isn’t positioning the baby too far up the breast i.e. not nose to nipple.

Not every hold needs a name. The principles are to always consider how your baby fits against your body, ensuring you are both comfortable and the hold is secure. Remember you baby will grow and therefore adjustments will need to be made to your favourite positions as you travel through your breastfeeding journey.

See below link for safe sleeping tips:

https://www.unicef.org.uk/babyfriendly/baby-friendly-resources/leaflets-and-posters/caring-for-your-baby-at-night/

https://www.basisonline.org.uk/

https://www.youtube.com/watch?v=ZJan8xCNgY4

Continue

Attachment

96% of breastfeeding problems can be resolved by simple changes to how you

Position your baby then how they Attach to the breast.

What to ensure for effective Attachment:

Wait for the Gape.
Tongue down.
Lead with the chin.
Extending head back

What to expect in an effective Latch:

Chin is touching the breast.
Mouth is open wide.
Cheeks are full and round.
More areola visible above the top lip.
Slow rhythmic sucks and swallows with pauses.

At a ratio of 1:1 or 2:1.

Pain free feeding.

Is it working?

You and your baby have the answer to this

Signs of Effective Breastfeeding:

Day 1-2
- 1-2 or more wet nappies.
- 1 or more dirty nappies (black sticky meconium).
- 1st 24 hours 3-4 feeds.
- 2nd day 8-14 feeds in 24 hours.

Day 3-4
- 3 or more heavier wet nappies.
- 2 or more dirty nappies (changing colour to green).
- 8-10 feeds in 24 hours.
- Weight loss 5-7% of birthweight is normal.

Day 5
- At least 5- 6 heavy wet nappies.
- 2 or more dirty nappies (now mustard yellow at least £2 coin size, soft/runny).
- 8-10 feeds in 24 hours.
- Weight starting to gain.

Day 7+
- 6 or more heavy wet nappies.
- 2 or more dirty nappies.
- 8 -10 feeds in 24 hours.

Day 10-14
- 6 or more heavy wet nappies.
- 2 or more dirty nappies.
- 8 -10 feeds in 24 hours.
- Birthweight regained.

Effective Breastfeeding?

Baby is alert, pink and has good tone (not floppy).
Baby is generally calm and relaxed.
Starts feed with rapid sucks then moves to slow rhythmic suck/swallow pattern with pauses.
Baby is content after most feeds.
You always offer the second breast, or even a third or more! (baby may not always want it).
Your nipple is the same shape when the baby comes off. Elongated not pinched or lipstick shaped).
Your breasts are comfortable (there is no pain).
NO dummies/nipple shields or formula milk has been used.

When your midwife or health visitor visits they will be looking out for the above signs of effective feeding, but if you have any concerns with feeding and need support see the WHO can help? Section

Effective Breastfeeding The Older Baby?

Six weeks +

- May have less dirty nappies.
- May not have a dirty nappy every day.
- The above are fine as long as other indicators are normal:
  - Gaining weight well.
  - Plenty of wet nappies.
- If there are no dirty nappies for a week to 10 days it is unlikely to be constipation, if all else is well. It isn’t ideal however and could be due to:
  - Poor latch (get an experienced breastfeeding supporter to check).
  - Poor sucking function (see tongue tie).
  - Some sensitivity to mother’s diet occurring, perhaps from cows' milk products.
- Ensure your baby is actually drinking. Often when there is a poor weight gain in the older baby yet they appear to be feeding well, it can be that they are not actually drinking, just suckling. You need to listen for the swallows. Adjustment to position and attachment may be necessary.

- The older baby may cluster feed leading to greater calorie intake, because the closer the feeds the higher the Milk fat content:
  - When they have a growth spurt.
  - When they are changing their circadian rhythm and possibly having longer sleeps in the night.