Lactation Guide

LACTATION GUIDE

Ideally, breastfeeding should begin within the first few hours of delivery by allowing the baby to nurse or rest, skin-to-skin, on the mother’s chest. During this time, most infants are alert and interested in nursing.

During the initial few days post-delivery, a new mother produces small amounts of a yellowish milk called colostrum. The colostrum is rich in nutrients and provides all the calories that a baby needs for the first few days. Most women worry that this small quantity of colostrum will not be enough for their baby’s nutrition. However, it’s important to remember that the colostrum is present in small amounts (5-10 cc per feed), as the baby’s kidneys are not initially able to handle large volumes of fluid. It is higher in protein and minerals, and lower in fat, carbohydrates and some vitamins compared to mature breastmilk-perfect for your newborn and has immunoglobulins (mostly IgA) that provide anti-infective protection for the baby. It acts a laxative to help the baby pass meconium and is easily digested.

Some breastfeeding techniques recommended by our lactation experts to simplify the breastfeeding process are:

Watch out for early signs of hunger – Women are usually encouraged to attempt breastfeeding as soon as the infant begins to show the signs of hunger. The early signs of hunger mostly include awakening, sucking on the hands, lips, or tongue or searching for the breast (called rooting). Most newborns do not cry until they are very hungry. However, waiting to breastfeed until an infant starts crying is not recommended.

Allow your baby to feed on demand – In the first one or two weeks, infants will mostly breastfeed 8 to 12 times per day. Sometimes, infants will also want to nurse more frequently, as often as 30 to 60 minutes; while some others will have to be awakened and encouraged to nurse. During the first week of life, most doctors encourage parents to wake a sleeping infant to nurse if three hours have passed since the beginning of the previous feeding. Some babies will cluster feed, meaning that they feed very frequently for some feedings and then sleep for a longer period.

The length of time that an infant takes to finish breastfeeding varies, especially in the first few weeks post delivery. While some infants take as little as 5 minutes, some others need 20 minutes or more. Our lactation experts recommend that the infant is allowed to breastfeed for as long as desired actively. ‘Active’ breastfeeding means that the infant is regularly suckling and swallowing.

Most newborns signal that they are finished nursing by releasing the nipple and relaxing the hands and facial muscles. Infants younger than two or three months often fall asleep during nursing, sometimes even before they are finished. In such cases, it is reasonable to try and awaken the child and encourage the child to finish nursing. Once you have finished with one breast, offer the other with an understanding that the infant (especially, if older) may not be interested.

Switching sides – It is not necessary for you to switch sides in the middle of a nursing session. Thoroughly emptying of one breast allows the baby to consume hind milk, which has a higher fat content than the milk available at the start of a nursing session. At the next feeding session, start off your baby from the other side.

Monitor if your baby is getting enough – As long as a baby is active and content, there isn’t much cause for concern. Some clues to estimate if your baby is getting enough breastmilk include monitoring diapers (5-6 wet and 3-4 dirty diapers by week 1), monitoring weight and continuing milk supply.

Latching on generally, refers to the infant’s formation of a tight seal around the nipple and most of the areola with his or her mouth. A correct latch-on allows the infant to obtain an adequate amount of milk and helps to prevent nipple soreness and trauma. Some latching techniques for breastfeeding have been detailed by our lactation consultants for you and your baby to have painless and comfortable breastfeeding sessions.

  • Cradle your baby close to your breast – rather than learning forward to bring your breast to your baby. Support yourself with pillows if needed.
  • Support your newborn’s head with one hand and support your breast with the other hand. Make sure your breast is well supported. The right way to do this is by placing your thumb on the top of your breast, while your other four fingers must be positioned underneath your breasts. Make sure that your fingers are not touching the areola (the dark skin surrounding the nipple).
  • Tickle your newborn’s lower lip with your nipple, to encourage your baby’s mouth to open wide. Position, your baby, close to your chest and make sure that your baby’s entire body is facing yours. Then, guide your newborn as he or she latches on. Make sure that your baby’s lips are properly placed and that he or she can not only take in the nipple but also a big part of the areola.
  • As your newborn tries to get the hang of breastfeeding, your newborn’s nose and chin may brush against your breast. Sometimes, you may also see your baby’s jaw move. If you experience any pain, most probably the baby is not latched on to the breast properly. Reposition your baby and try again.
  • A newborn should be able to suckle and swallow properly, to consume enough amounts of milk. You should be able to hear the infant swallow. The infant’s jaw should move quickly to start the flow of milk, with a swallow heard after every one to three jaw movements. You can look and listen for a rhythmic sucking and swallowing pattern.
  • If you need to remove the baby from your breast, first release the suction by inserting a finger into the corner of your newborn’s mouth.

A woman may use one of the many positions to hold her infant while breastfeeding. There is no one ‘ideal’ position for every infant and woman. The best breastfeeding position is one that is comfortable for the mother and allows the newborn to latch-on, suckle, and swallow more easily. A woman may have numerous preferred positions depending on the baby’s size, the baby or mother’s medical condition(s), and feeding location.

In nearly all baby feeding positions, one hand is used to support the baby’s body while the other free hand supports and guides the breast to the newborn’s wide-open mouth. Also, the thumb on the free hand may be placed on top of the areola and the breast supported with the cupped fingers. Care should be taken to position the hand away from the nipple so that the thumb and fingers do not interfere with latching. Some common breastfeeding positions are:

Cradle hold – The cradle hold can be performed while the mother sits in a chair. While feeding the infant from the left breast, the infant’s head and body are supported by the mother’s left forearm. Some women use a pillow to support this arm. The baby’s stomach should be flat against the mother’s chest and the baby’s head should be in line with the body.

Cross-cradle hold – The cross-cradle hold too, can be done while the mother sits in a chair. In this position, the use of hands is opposite to that of the cradle hold while everything else remains the same. While feeding on the left breast, the infant’s head and body are supported by the mother’s right hand and forearm.

Football hold – The football newborn breastfeeding position allows a woman to see the baby at her breast easily. It is often preferred by women who have an abdominal incision, after a Cesarean section, or by women with large breasts or a small or premature baby. The baby is supported by a pillow as the mother sits, which should allow the baby’s head to be at the level of the mother’s breast. While feeding on the left breast, the baby’s body and legs are under the left arm, with the head supported on the mother’s left hand.

Side-lying hold – The side-lying hold allows the mother to nurse while lying down. When using this position, there should be no excess bedding around the newborn. To nurse from the left breast, it is essential that the woman lies on her left side. The baby’s head and body lie parallel to the woman’s body, with the baby’s mouth close to and facing the woman’s left breast. The woman may prefer to have a pillow beneath her head, with her left hand between her head and the pillow.

Laid-back or ‘biological nursing’ – In this breastfeeding position for newborns, the mother is semi-reclined with her arms and torso well supported, and the baby is placed on her stomach between the mother’s breasts. In this position, mothers are more comfortable, and their infants can latch easily, as the infant is positioned securely against the mother’s body and the infant’s reflexes assist in latching on. Also, mothers may find that they do not have to work as hard supporting their infants and tireless.l-has-fill”>

If you are unable to breastfeed your newborn directly for any reason, it is important to express milk during the times your baby normally would feed. This will help you to continue making milk. Here are some simple breast milk storage guidelines:

    • Before expressing or handling breast milk, wash your hands with soap and water. Apply a warm and moist compress to your breasts and gently massage your breasts and nipples. Sit quietly and think of a relaxing setting and visualise the milk flowing down.
    • Store the expressed milk in a clean, capped glass or hard plastic, BPA-free container. You can also use special plastic bags designed for milk collection and storage, but breast milk storage bags might tear, leak and become contaminated more easily. It is advisable to place the bags in a hard plastic food storage container with a tightly sealed lid. Don’t store breast milk in disposable bottle liners or plastic bags designed for general household use.
    • Wash all the collecting bottles and breast pump parts that touch your breasts or the milk. Use hot, soapy water or a dishwasher and rinse carefully. Air dry on a clean towel. If your baby is premature or ill, you would have to sterilise your pump parts.
    • Using waterproof labels and ink, label each container with the date you expressed the breast milk.
    • Place the containers in the back of the refrigerator or freezer, where the temperature is the coolest. If a refrigerator is unavailable, use an insulated cooler. Breast milk expands as it freezes, so don’t fill containers to the brim.
    • Breast milk that is freshly expressed should be ideally used within 4 hours. Freshly expressed breast milk can be stored in an insulated cooler with ice packs for up to one day, in the back of a refrigerator for five days and in the back of a deep freezer for 12 months.
    • You can also add freshly expressed breast milk to the refrigerated or frozen milk you expressed earlier in the same
    • day. However, thoroughly cool the freshly expressed breast milk in the refrigerator or a cooler with ice packs before adding it to previously chilled or frozen milk. Don’t add warm breast milk to frozen breast milk because it will cause the frozen milk to thaw partially.
    • Always thaw the oldest milk first. You can place the frozen container in the refrigerator the night before you intend to use it. You can also gently warm the milk by placing it under warm running water or in a bowl of warm water. Don’t heat a chilled bottle in the microwave or very quickly on the stove. Discard thawed milk that isn’t used within 24 hours.
    • The colour of your breast milk might vary, depending on your diet. Also, thawed breast milk might seem to have a different odour or consistency than freshly expressed milk. It’s still safe to feed to your baby.

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