Positioning the Baby at the Breast

1. You must be comfortable and well supported; either sitting upright or lying down with you breast falling gently towards your baby. 2. Turn your baby on its side so that its whole body and legs are in a straight line facing your breast and nipple. Tuck baby's legs around your body. 3. Support your baby across the shoulders with your arm and hand underneath the baby so the baby's whole body can be moved to the breast not just the head. 4. Make sure your baby's mouth is opposite your nipple with your nipple closer to the baby's nose than to their chin. 5. Make sure your baby's neck is straight with the chin not tucked into the chest. The baby is then able to scoop in a mouthful of breast with the lower jaw. 6. You may need to shape your breast gently to match the baby's mouth, but there is no need to squash or pinch up your breast. 7. You might need to tease your baby's mouth open. Wait for the baby to open its mouth WIDE - WAIT until it is. 8. Bring the baby to the breast - NOT the breast to the baby. 9. The baby will look "off centre" on the areola with more breast tissue near the lower jaw and areola visible under the baby's nose. 10. The first few suckles the baby makes may be uncomfortable, until the milk releases. Then you see the baby's sucking becoming slow and rhythmical and the baby will swallow regularly. 11. Learn to "FEEL THE FEED" so you become familiar with the sensation of feeding. 12. Look at your nipple shape when the baby comes off the breast. It should be lengthened but NOT squashed or pinched. Sore nipples will be caused by incorrect positioning.

Individual Differences
Many babies become very wakeful just before your milk volume increases (comes in). Around about the second to third day. They will want to feed or be near you all the time but don't panic - this is very normal baby behaviour and may last several hours.

DAY ONE After the initial period of alertness at delivery babies recover and rest. - sleepy baby is normal. Not too interested in feeding. Colostrum meets baby's needs.

DAY TWO Baby wakes up, becoming more active. Feeds more often. An alert wakeful baby. Feeds more often to stimulate the increase in milk.

DAY THREE Baby seems to feed non-stop. Likes to stay in mother's arms. A tired mum is normal. Baby easier to settle if tucked up safely with mum. Try other settling techniques.

DAY FOUR Baby more settled. Looks content after feeds. Milk 'in' and flowing well. Baby may posit after feeds and poo a lot as milk volume temporarily.

You may want to feed your baby lying down or tucked under your arm. All the guidelines still apply.

Length of Feed
This will also vary. Your baby may take anywhere between 5 minutes to 50 minutes to enjoy a breastfeed. As long as your nipples are comfortable and your baby is suckling then the length is unimportant. How your Milk Changes through a Feed You will be able to see your baby trigger the release of your 'let-down" by several short shallow sucks. Once the milk flows the baby's sucking will become slower, deeper and more rhythmical, (suck / swallow /suck / swallow / short pause). This change becomes more obvious when your milk comes in. As the feed progresses and the volume of milk decreases then the baby will need to do more sucking to fill its mouth with milk to trigger a swallow. The pattern will then be suck/suck/suck/ swallow/longer pause. When the breast flow is low the pauses become much longer and the baby swallows only occasionally. At this stage you will also see that your baby is becoming relaxed and sleepy. The whole body is relaxed and their arms are floppy. This is often when that baby will release the nipple and slip quietly off the breast. However you will be able to "read" the baby's body language so can gently ease the baby off your breast when you are ready. Do this by tucking the baby in close to you and slipping a clean, short nailed finger into the baby's mouth between their gums. One Breast or Two There are no rules about this - your baby and you have individual differences -both between each mother and between each breast. When your breasts are learning about your baby in the early few days it helps if you allow the baby to stay on the first breast while the baby is sucking effectively and the feed is comfortable for you. When the baby comes off consider offering either the first breast again or the second breast - depending on the fullness of the breast. Throughout the first week this may change at each feed as your milk volume is changing in response to your baby's needs.

Start of feed - * "let-down"

the end of a feed

The baby may suck at the breast for a couple of minutes before the "let-down" occurs. The concentration of milk increases throughout as the volume decreases. The 'Let-Down' Reflex Your milk is stored within the milk sacs in your breast. The 'let-down' reflex occurs when the tiny muscle fibres surrounding these milk sacs contract at intervals throughout the feed. Some women experience a sensation of thirst or a feeling of relaxation when this first happens. Other women, after the ( breasts have settled down, describe a feeling of tingling and tightening; still others feel nothing. 'Let-down' is very important in breastfeeding and you can enhance it by relaxing through the feed. Gently massaging your breasts and nipples can stimulate the release of the hormones that causes 'let-down'. This is especially helpful prior to expressing your milk if you and your baby are separated. The breasts 'let-down' 1 to 2 minutes into the feed. However because emotions play a part, 'let-down' may occur before a feed too, when you are thinking about your baby.

Going Home
Your Baby Baby will need at least six breastfeeds in 24 hours, but may take 12 feeds. Always look at a 24 hour period when assessing your baby not just the day or the night. Your baby is getting enough breastmilk if the baby is having 5 - 1 0 good wet nappies in 24 hours looks alert and bright eyed is sleeping somewhere in the 24 hours period. Babies can feed a lot in one part of the day then have a long sleep ( 3 - 6 hours) during another part. Your baby will slowly develop a pattern. Some do this more slowly than others. Your Breasts Your breasts should be settling down. They are likely to feel full before a feed and they should soften as the feed progresses. By about 4 - 6 weeks your breasts will have returned to the softness they had before your milk came in. The feeling of fullness will have gone. This does not mean that you have less milk - it means that your breasts have adjusted. This is about the time when you may notice tingling and firmness as your milk 'lets-down' for a feed. You may be offering your baby either one breast or both breasts at each feed. Or sometimes one and sometimes both breasts. Because each mother and baby pair is individuals there is no rule. As long as your breast are comfortable at the end of the feed and your baby is thriving then the pattern you and your baby have worked out is the right one for you. It helps to gently lift your breast towards the end of the feed to further soften the lower part of your breast. Remember to take care of yourself at home. When you find a comfortable feeding place arrange to have something to eat and drink always nearby. You will be extra hungry and thirsty so learn to snack when your baby feeds.

Points to Remember
1. Check your breasts after each feed and at least once a day once home for any firm or tender areas. If your nipples hurt - check * position of the baby during the breastfeed * shape of your nipple when the baby comes off * signs of damage to the skin Your nipples need no special care. The breastmilk left o n by the baby has a protective effect. Fresh air also helps. The baby's feeding pattern will vary over the first few weeks. Babies will want to feed more or less often as their need change. They will often have a frequency day (growth spurt) around about 10 days, 6 weeks and 3-4 months. I

2.

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It is normal to take some w e e k s for you and your baby to establish a breastfeeding relationship. For some mothers this means that it t a k e s time to develop confidence in understanding their baby's needs.

Tips for Breastfeeding Mothers

Important Phone Numbers

Royal Hospital for Women 24 hour Counselling Services Karitane Tresillian 7 Day a Week Breastfeeding Helpline (02) 9794 1852 (02) 9787 0855 (02) 9382 6111

jfMHSMBreastfeeding Associations^!

(02) 8853 4999

Royal Hospital for Women, Randwick. Adapted from The Newbery National Childbirth Trust with assistance from the Lusby family. 2005

RHW
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