Breastfeeding and how to offer the bottle

      FEEDING

Breastfeed asap: After the baby is born, try and get them to hand you the baby asap for a feed - this is when they are most eager to latch on.  Feeds may be very often (like every 20 mins) to begin with! 

Take and wear a pair of pyjamas, so that you can easily lift the pyjama top to feed. 

Keep the baby in bed with you or in a bassinet near you – if they want to take the baby away for any reason make sure Dad goes along otherwise they often let baby cry without soothing baby at all.

Burp baby after every feed – do it like religion! - else won’t feed properly the next time.  To burp, hold baby high up so that rib cage is just above your shoulder. Rub or pat back continuously. Stop and switch shoulder – a change of position often gets a burp. The fathers are often very good at getting burps out of babies!

If you don’t manage to get a burp, let baby sleep on his/her left side and let the bassinet be at an incline if possible with baby’s head highest – or use a pillow under babe’s head for the same effect.

Be prepared for terrible soreness of nipples (agony) in week two or so, but hang in there it gets better when you toughen up in a few weeks’ time.  Use lanolin daily (and at night).  Don’t worry you are not doing it wrong, it is just that for some reason nobody talks about this agony, possibly because it passes in a matter of weeks.  Once you toughen up (when baby is approximately 6 or 7 weeks old) breastfeeding is the easiest thing in the world.

What constitutes a full feed: One side and then as much as the baby wants from the other side. Start the next feed from the second side.

Let baby feed for as long as s/he likes from one side so that s/he gets the initial watery foremilk, and then the rich calorific hindmilk which comes later in the feed.

To make sure the baby is feeding properly, see that the whole jaw should be moving, slowly, then rapidly and deeply for a few sucks when there is a letdown of milk, then the baby may rest and suck slowly for a bit, then faster again, etc.

Let baby come off the breast on his/her own. If the baby falls asleep, and seems to have fed quite well and vigorously, then you can take the baby off, and burp the baby, and try offering the other side. The baby make take just a little, or else start feeding properly again. Some babies can feed for 40 minutes on one side alone to begin with!!

Breastfeeding positions: With both A and Z I found the initial weeks of breastfeeding very difficult, and almost gave up. Luckily, I had access to an excellent world-renowned infant feeding specialist team in Oxford - Sally Inch and Chloe Fischer, and they helped sort it all out for me. Here are their instructions verbatim:

1. Find somewhere at home that will provide you with a straight back and an almost flat lap.
2. Use a pillow to take the baby’s weight especially while learning.
3. Sit with your back well supported and straight and your trunk facing forwards.
4. Support the baby on the pillow in such a way that his/her nose (not mouth) is opposite the nipple before the feed begins.
5. Lie the baby’s body in such a way that the baby comes up to the breast from below, so that the baby’s upper eye could make eye contact with the mother’s.
6. Support the breast by placing the fingers flat on the ribcage at the junction of the breast and ribs, with the thumb uppermost, thus firming the inner tissue – and keep the breast still.
7. Move the baby against the breast so that his/her mouth/top lip touches the nipple in order to elicit the gape.
8. Having elicited the gape, move the baby quickly to the breast so that his/her mouth makes contact with the breast at the height of the gape.
9. Support the baby’s heads and shoulders in such a way that the head is free to extend slightly as the baby is brought to the breast, so that the chin and lower jaw reach the breast first.
10. Bring the baby in, across his/her shoulders, so that s/he is ‘uncurled’. This will have the effect of bringing his/her tongue closer to the breast.
11. Aim the baby’s bottom lip and jaw as far away as possible from the base of the nipple when the baby gapes, so that s/he scoops in as much breast as possible with his/her tongue.
12. Wrap the baby so that his/her arms are lying parallel with his/her body before s/he is brought to the breast, so that s/he can be closer to the breast.
13. Change hands, and hold the baby with the hand opposite the breast being fed from, while learning. i.e. for right breast, use left hand to hold baby, and vice-versa.
14. If you find one side easier to deal with than the other, then hold baby under your arm on the less easy side, so as to do the same job with the same hands for both breasts.

When trying to get baby off a breast if you feel the latch is incorrect, then make sure you break the suction seal by inserting the soft side of your finger into the corner of baby’s mouth, then easing your nipple out using your finger all the while.  Do not just yank - it is agony.

You know the baby is really feeding well, when:

The breast will feel like it has been drained, won’t be so full, and will be softer after a feed.

The baby is contented for a couple of hours after a feed. (With a newborn this may not happen, and the baby may want to feed very often. However, the feeds do space out more at about 8-12 weeks.)

The baby does 1 or 2 yellow seedy potties every day (some babies only go once every few days though, but there should be seeds of excess lipids in the potties to indicate the baby is getting plenty of the rich hindmilk)

Plenty of wet nappies each day.

While getting to grips with breastfeeding – the first few weeks with baby– you need to be completely uninhibited, so have people you are not comfortable with wait outside and see you when you are not feeding. 

Do not hurry feeding for anyone / phone calls – all of that can wait or ask someone to put the phone on speaker but don’t try balancing a phone and feeding your newborn– getting to grips with feeding your baby is all-important.  Too many women give up early on simply because baby is having difficulty learning how to feed.  It is worth the extra effort of letting baby practice as much as needed early on.  I was a little over-confident with Z, and so used only one hand to feed, and was reading books with the other hand. She did not get good feeds poor baby, and we realized that I had forgotten how to deal with a newborn. Watching TV may be ok, but two hands are required for a newborn.

If baby is in a frenzy, calm baby down by patting, cuddling, etc then put baby back at the breast. 

If you are like me (and I am an unabashed ‘Lactivist’) then Do NOT listen to people who say ‘just give the baby a bottle’. Formula is not even half as good as mother’s milk.  Mother’s milk is like a daily vaccination for your child, and helps build baby’s brain.  The more baby suckles, the more milk you make (supply/demand) so skipping feeds is not advisable. The more you remove, the more you replace. Even if the feeding is not going too well, if you have the energy to pump out milk, you will replace this milk – your body does it automatically. It is true that the hormones and flow are greater with a baby at your breast than a silly pump, so even if you are pumping, keep putting your baby to your breast several times a day and don’t give up – one fine day you won’t need the wretched pump. Your baby will get the hang of it.

Express and freeze some milk if baby is not draining the breast properly or if you are engorged (say in the early days). It is good to express because the breast is more difficult for baby to take if it is hard and distended. Pump a bit out, and offer baby a slightly softer nipple, easier for the baby to work on.

Don’t listen to negative people who say things like ‘you don’t have enough milk’. Explain to them that the more milk that is removed from a breast, the more milk is made. It is as simple as that, so letting a baby feed for a long time and frequently ensures a healthy supply.

Later on (when you are very confident about breastfeeding):

Sitting up in bed with a pillow propped behind you is comfortable – with one knee up and baby propped between the upright thigh and breast, with baby’s head in the crook of your arm (your elbow/arm resting on your upright thigh)- switch sides when baby has more or less drained that breast (baby swallows less often, and you know it is time to switch side).  Bend other leg so that it is upright, and lower the other one.  Again let your arm rest on your upright thigh and bear some of the weight of the baby’s head so that your arm does not get tired.  Make sure your back is upright and against the headboard of the bed.

If sitting in a chair you could just cross your legs and again let your legs provide some support to your arm while feeding.

After 3 months you need to go into a darkened room to feed baby properly – he/she will be distracted by light and noises.  However, baby will be quite efficient at this stage, so feeds will be relatively quick.  Again, some people give up at this age thinking baby is not interested.  Baby is just more distractable, and mother’s milk is still far superior to cow’s milk or goat’s milk.

Bottles

If the nurses give the baby a feed in their easy-to-glug soft rubber nippled bottles, not to worry, just make sure you offer baby nothing but the breast the next time he/she is hungry.  Do not cave in and reach for the bottle if baby protests – just pat baby, calm baby, and again offer the breast – express a bit into baby’s mouth so the baby understands that there is more where that came from.  Pretend the breast is the only option, and it will work for you. Only worry if baby seems to be getting dehydrated / listless, depressed soft spot on head, etc. Then get the latch right and in the meantime give expressed milk in bottles.

How to offer a bottle: Don’t teach baby lazy habits by just shoving the nipple of the bottle into the baby’s little mouth. If you do this, it could be painful later because the baby will try taking just the nipple when breastfeeding instead of the wide gape needed for successful feeding.

The breastfeeding clinic advised teasing the baby’s top lip with the bottle, then waiting for a wide gape, and offering the baby the bottle just under the top lip. Let the baby use it’s tongue to draw in the bottle teat and make sure the whole nipple and the base goes into the baby’s mouth – not just the nipple. If the baby tries to focus on just the nipple, stop feeding, and start over. This will help make the child switch back and forth between bottle and breast easily.

Teach your husband and mother, and any other caregivers how to offer the bottle properly.

Also my little addition to this is: ask Dad or anyone else who is giving baby a bottle to hold baby in the breastfeeding position, and let the bottle come from where the breast would be – i.e. from more or less the chest outwards so the baby had to turn inwards just as with the breast.

Stay hydrated: Drink lots of water – one full glass half an hour before breastfeeding (at least).  Blocked milk ducts (painful swellings) are often due to lack of sufficient water – drink more.  Massage blocked duct while feeding / pump out that breast / warm water on it in the shower all help.