Below is information and key resources to help mothers stay fit during pregnancy, prepare for the birth, breastfeed and help with a colicky baby:

Breastfeeding your baby

All Maternal Midwife and Lactation Consultant
Christina Warran
Two offices:

CONSULTANT PAEDIATRICS
101/26-28 Gibbs St
Phone: (02) 9524 8639

SYDNEY PAEDIATRICS
56a Gloucester Rd
Hurtsville NSW

Phone: (02) 9586 1600

www.allmaternal.com.au

Breastfeeding - The first few months

New mothers, especially first time mums can find themselves obsessing about their baby’s feeding. Is she hungry? Has she had enough? She seemed to have more yesterday than she has had today.

One of the best ways to reassure yourself that your baby’s feeding is fine is to count wet nappies and bowel movements rather than the amount of intake at any one sitting. If your baby is growing, you will usually have at least five wet nappies and two or more soiled nappies each day. If your baby is also settling well after each feed, then it’s likely that she is perfectly happy with the amount of intake.

Not everyone can breastfeed, but the World Health Organisation recommends that if you can, mothers should breastfeed alone for the first six months before beginning to supplement your baby’s diet with solids. Breast milk provides ideal nourishment for your baby and also helps you bond and lose any extra weight you’ve gained during pregnancy. Breast milk is very easy for your baby to digest and provides protection against a number of infections including ear infections, diarrhoea and fevers.

Breast Milk Supply

Establishing the optimal milk supply for your baby is important but can take time. Breast engorgement can happen at any time during your breastfeeding stage and is very common. It happens most often when there is more milk in your breast than your baby needs and not enough milk is expressed from the breasts. This can lead to breasts that may swell, throb and in some cases cause extreme pain. Untreated breast engorgement can lead to mastitis (inflammation of the breast) and you should consult a doctor if you suspect this has occurred.

For short term relief of engorgement pain, applying a cold pack on the breast can be effective for some mothers. Mamá y bebé's breastfeeding support bra with gel pack inserts can be frozen for this purpose.

Feeding your baby often (as many as 12 times in 24 hours) is the best way to naturally reduce breast engorgement. Having your baby feed twice on each breast before changing breasts will also settle the breasts supply to match your baby’s needs. Oversupply will usually rectify itself within four to six weeks and until then expressing some milk before feeding is the best way to ensure your baby receives a regular flow in the first few weeks.

Blocked milk ducts can cause painful lumps on the breast which can often coincide or be confused with breast engorgement. Blocked ducts are most often caused by pressure such as a tight bra or the breast being held too tightly while feeding. Most blocked ducts and lumps will rectify during breastfeeding but if they don’t reduce and remain untreated, mastitis can occur.

For more immediate relief of tender lumps caused by blocked ducts, applying a hot pack or taking a hot shower can help. Mamá y bebé's breastfeeding support bra with gel pack inserts can be heated for this purpose.

Additional Information to assist Mothers with Breastfeeding

(Reference: Mater Mothers Breastfeeding Support Centre)

Breast milk is the nutritionally ideal food for babies. Babies who are born full term, who are unwell, or born prematurely all benefit from their mother’s milk. The composition of the milk is constantly changing to ensure that your baby will receive what they need at any given time. Breast milk is easily digested and provides babies with essential vitamins, minerals, essential fats, carbohydrates and proteins. It contains antibodies and other living cells that work to protect them from disease. Breast milk contains hormones, growth factors and enzymes. Every component works together to make breast milk superior and ideally suited to each baby.

Breastfeeding works on supply and demand. Every time your baby feeds, your body starts to make the next feed. The more your baby feeds, the more milk you make. You do not have to wait a set time for your breasts to fill up.

Developing your breastfeeding technique

Breastfeeding Position

In those first few days, it’s important that you find a position and body posture that is comfortable for you and your baby. Back, shoulder and neck strain are common and can be alleviated by finding and sticking to a comfortable, well supported position. There is no universal ‘best’ position but a steep backed chair, good cushion or feeding pillow can all help to provide support. If you have large breasts, you may find the cradle hold the easiest.

The baby’s head usually rests on your forearm, so try and make sure your elbows are supported. Ensuring your feet are flat on the floor will prevent further forces pulling on your core and back. If

Baby’s Position

Hold your baby diagonally across your body (head up), keeping her head, neck and body in a straight line. Position your baby’s nose next to your nipple so that as her mouth opens to suckle, her head will tilt back slightly.

Most babies seek out the nipple when hungry which is called the rooting reflex. However, if your baby is a bit hesitant, you can encourage her by rubbing your nipple over her cheek and lips and usually she will instinctively turn to find it.

Attaching your baby to your Nipple

Attaching is the term given to the way your baby suckles on your nipple. If your baby does this correctly, it will stimulate your milk supply to make sure she gets enough nourishment and also help reduce sore and cracked nipples.

To assist attachment, try and make sure your baby opens her mouth wide and closes it fully around your areola. To avoid trauma and grazing of your nipple, try to bring your baby into your breast, and aim your nipple towards the roof of your baby’s mouth making it easier to close her mouth around the areola.

Making sure your baby’s mouth is wide open also enables her tongue and jaw muscles to work more easily. He chin will be touching your breast, but her nose should be clear so she can continue to breathe easily.

When your baby is attached properly, she will have more of the underneath part of the areola in her mouth than the top. If she is using her jaw muscles correctly, you will likely notice that her temples and ears are moving.

If your baby is not attached properly, your nipple may look misshapen or lopsided when your baby finishes feeding. Sore nipples are most commonly caused by poor attachment and this can cause considerable discomfort if poor attachment continues for weeks or more.

Changing your Breastfeeding Position

If you do find that your baby has settled into a position that is causing you any pain, identify whether you need to change your posture or whether it is your baby’s mouth position that needs to be changed. Break the suction between your baby and nipple by gently inserting your pinkie into her mouth and between her jaws. Change position then reattach your baby.

Changing Breasts

It’s best to let your baby finish at one breast before you offer her another. This helps you to better judge how much milk your baby has taken.

Finishing your feed

When your baby has had enough milk, she will turn away or fall asleep. However you may have a particularly sleepy baby and falling asleep may not mean that she has taken enough milk. If you think this may be the case, you should consult a health professional who may advise you to wake your baby to continue the feed for longer.

Burping

Most babies need a little help to burp from time to time after feeding. Place your baby over your shoulder or on your lap, ensuring her head is supported. Gently rub her back using circular motions for a few minutes or until burping has finished. If she doesn’t burp but is settled, it is usually fine to put her to bed.

Useful tips

1.Take your time. Rushing only causes stress for you and your baby.

2.Ensure your breast is free of clothing and your baby is unwrapped and preferably has skin to skin contact with you.

3.Hold your baby close to you with their chest facing yours and their lower arm wrapped around your body.

4.If necessary, you can support and shape the breast in a U hold, (i.e. with your fingers opposite your baby’s lips), with most of your hand underneath the breast and fingers well back from the areola (the darkened area around the nipple).

5.Your baby’s nose should be level with your nipple.

6.Bring your baby to your breast when their mouth gapes wide. Take your baby to the breast not your breast to the baby. They need to take a larger amount of the areola into the mouth on the side nearest to their chin and lower jaw. Direct the nipple to the baby’s nose when latching and then ‘plant’ the lower rim of the baby’s mouth well below the nipple and fold the breast into the baby’s mouth.

7.If your baby is on the breast properly you should not feel pain. There should be no stinging, burning, or pinching of the nipple during the feed. At the start you could feel uncomfortable for 10 to 15 seconds. If the pain persists, take your baby off the breast by inserting your little finger in between their gums to break the seal.

8.Your baby’s chin and cheek should be against the breast with the nose free. It should not be necessary to hold your breast away from your baby’s nose.

9.Some signs of a correct latch are that your baby has a wide open mouth like a yawn when latching and once latched their chin is very close into the breast tissue. As your baby is sucking you may experience a painless drawing sensation and you will see full movement of your baby’s lower jaw. After the feed your nipple should appear as it did before your baby latched, just softer around the areola. The nipple should not be white, squashed, ridged or damaged when it comes out of your baby’s mouth.

10.Allow sucking to continue until your baby removes themself from the breast. If it becomes necessary to take your baby off the breast, try this method. Slip your little finger into the corner of your baby’s mouth to release the suction or gently pull down on their jaw. Please ask for help if you have any problems.

Feeding to need or baby led feeding

Look for and respond to early feeding cues that will show you that your baby is ready to feed, such as moving around, sucking or lip movements, changes in facial expression or searching with their fist for their mouth. Crying is a late feeding cue. Some newborns, if left to cry will become fractious and more difficult to attach to the breast.

Breastfed babies feed according to hunger. Allow your baby to stay on the breast until they have had enough and fall asleep or come off the breast. You may notice that your baby may wish to suck more often in the early days until your milk "comes in" (usually on the third or fourth day). Allow your baby to feed as often as they wish.

Sucking time may vary from feed to feed. The most important thing to remember is to allow your baby to feed on the first breast until their rhythmic or nutritive sucking stops and they lose interest in the breast. Soften one side first before offering the second breast. This helps your baby to have the fat rich milk which comes towards the end of the feed. This milk helps babies settle for longer periods and gain more weight.

Babies often cluster feed—if they have a longer break between feeds they then often have several feeds in close succession. Some babies (premature babies, small babies and babies who are sleepy due to jaundice) may not display these feeding cues as distinctly. It is recommended that babies are woken around six times in the first few days. If you are having difficulty waking and feeding your baby please seek advice from your midwife.

Babies will generally feed between 8 and 12 times a day.

Frequently asked questions—expressing and storing breast milk

When will I need to express milk for my baby?

There may be times when you need to express breast milk for your baby. This may be if you are going out, returning to work, if your baby is sick, preterm or unable to suck at the breast.

If possible, breastfeed your baby within the first half hour after birth. If your baby is preterm or unwell and is not able to suck at the breast it is important to commence expressing as soon as possible after the birth to provide colostrum for your baby.

Midwives are able to assist you to hand express or use an electric breast pump to express your colostrum. Do not expect a large quantity of colostrum as it is very concentrated and has a small volume initially. Regular expressing acts as breast stimulation to assist the breasts as they build milk volume over the next few days. Express for about 10 minutes each breast eight times per day, with no longer than a five hour break at any one time (usually overnight). Overnight expression is encouraged, as prolactin levels are higher overnight.

These expression times do not have to be regular so you can be flexible. Electric breast pumps can be bought or hired.

How do I express?

You can either express by hand, or use a hand operated, battery operated or electric pump, available from Australian Breastfeeding Association group, some chemists, or baby equipment hire companies.

Always wash your hands well before handling your breasts. Have a clean towel ready to catch the drips and a clean wide mouthed container for the breast milk. In the first few days colostrum may be hand expressed, and the drops drawn up with a syringe. This may require some assistance.

A warm face washer on the breasts may help the milk to let-down. Gentle massage of the breast towards the nipple is also helpful.

If possible, it is best to feed your baby before expressing. This way you can express at the end of a feed taking advantage of the flow of milk your baby has started. Remember not to aim to express large amounts at once (unless your baby is not going to the breast at all). Express small amounts at one sitting several times over the day.

Your midwife can assist you to work out how much breast milk you will need to express for your baby.

How do I hand express?

1.Position your thumb and first two fingers about 2.5–4 cm behind the nipple. Place your thumb pad above the nipple and the finger pads below the nipple forming the letter "C" with the hand as shown below.

2.Push straight into the chest wall.

3.Roll thumb and fingers forward as if making thumb and fingerprints at the same time.

4.Repeat rhythmically to drain the breast. Position, push, roll, position, push, roll…

5.Rotate your thumb and finger position to milk the other ducts.

Avoid:

• squeezing the breast—this may cause bruising

• pulling out the nipple—this can cause tissue damage

• sliding on the breast—this can cause skin burns.

How do I store expressed breast milk?

Extra care is needed when storing breast milk for sick and premature babies in hospital. If your baby remains in hospital we advise that breast milk be stored in the fridge for no more that 48 hours. However if your baby is at home with you breast milk may be stored in your fridge at 0–4° C for five days before use. Label all containers with the date you expressed the milk and use the oldest milk first. Always store breast milk in the back of the fridge where it is the coldest, never on the fridge door.

Breast milk can be kept frozen:

• for two weeks in a freezer compartment inside the fridge

• for three months in the freezer section of the fridge with a separate door

• for 6 to 12 months in a deep freeze (-18° C or lower).

Remember, breast milk will always expand when frozen so only fill the container 3/4 full. Fresh expressed breast milk may be added to frozen breast milk provided the expressed breast milk is cooled first and returned immediately to the freezer. Any cold expressed milk not used within 48 hours may be frozen. Label all containers with the date you expressed the milk and use the oldest milk first. Breast milk can be put in the fridge or frozen in glass or plastic baby bottles, cups with tight fitting lids, jars, ice cube trays that are sealed in two plastic bags, or sterile breast milk freezer bags (available from your chemist). All containers used for collection and storage of breast milk must be clean.

How do I thaw frozen breast milk?

Frozen breast milk may be thawed quickly for immediate use, or thawed in the fridge. To thaw quickly, place the container of breast milk under cold running water, gradually increasing the temperature to warm until the milk is liquid. Throw away any unused breast milk thawed quickly within four hours of thawing. Breast milk thawed in the fridge should be discarded after 24-hours. Prior to use, warm cold or thawed milk in a jug of warm water until it is body temperature.

Never heat breast milk in a microwave as the milk is heated unevenly and hot spots in the milk can burn your baby. Microwaving also destroys some of the milk’s goodness.

Sore or damaged nipples

A certain amount of nipple sensitivity in the early days of breastfeeding is normal. Damaged or grazed nipples are not normal and usually mean your baby has not latched properly. If you have grazed or cracked nipples, ask your midwife to guide you when you are latching your baby to the breast. Once you are home, if nipple damage or soreness becomes worse please seek help from any of the organisations listed in the back of this booklet as soon as possible.

The nipple area produces its own natural oils. Nipple creams can block the openings from the ducts on your nipples causing blocked ducts and increasing the possibility of mastitis. As breast milk contains special factors which aid in skin healing, expressed breast milk is the ideal treatment for sore nipples.

Gently rub expressed breast milk onto the nipple after feeds and allow the milk to dry before replacing your bra. To prevent infection always wash your hands after nappy changes and before you handle your breasts.

Prevention of engorgement

Engorgement (full, painful, hard, shiny breasts) rarely occurs when a mother allows her baby to breastfeed at any time of the day and night. Correct positioning and attachment will also help to prevent engorgement.

If your breasts do become overfull and uncomfortable

• continue to feed your baby when they’re hungry

• remove your bra when your baby is feeding

• hand express a little milk before a feed, softening the areola to assist your baby to latch well

• continue allowing your baby to soften one breast first before offering the second breast. Express the second breast to a comfort level if it is uncomfortable after the feed

• wear a supporting bra between feeds e.g. a nursing bra or crop top. Make sure that your bra is not too tight

• apply covered cold packs for 10–15 minutes after feeds for comfort (only while your breasts are engorged).

Prevention of mastitis

A hot, red painful inflammation of the breast tissue usually caused by a blocked duct in the breast is called mastitis. To find blockages early it is a good idea to check your breast regularly. Note any lumps, flushed areas or tender areas. Quick treatment can prevent mastitis.

Tips for prevention of mastitis:

• It is extremely important to empty the sore, tender (affected) breast as much as possible. Feeding your baby is the best way to do this. Point your baby’s chin towards the flushed area for better drainage. You may need to use the ‘football’ or ‘rugby’ hold if the flushed area is on the side of your armpit.

• If you cannot feed your baby, then express the breast. This is not the time to wean.

• Apply moist heat (shower, washers) to the affected area before you feed.

• Start feeding on the affected side for two feeds. Do not limit the sucking time on this breast. You may need to express the other breast for comfort.

• Gently massage the affected area with the pads of your fingers while feeding or expressing.

Factors which can lead to mastitis include:

• being overtired, skipping meals and not looking after yourself

• sudden changes in feeding patterns such as your baby missing a feed or sleeping through the night

• nipple damage (cracks, grazes) caused by poor attachment

• poor attachment resulting in the breast not draining well

• untreated engorgement.

Symptoms of mastitis include soreness, redness and a hot area on the breast, together with flu-like symptoms such as fever, tiredness, aching joints and sometimes nausea and vomiting.

If you develop these symptoms follow the five steps for blocked ducts in the prevention of mastitis section and also:

• get plenty of rest, eat healthy foods and accept any offers of help

• seek medical advice if symptoms continue for 12–24-hours or if you have high temperatures or feel unwell. Your doctor will start you on an antibiotic which treats mastitis and will not harm your baby. All of the antibiotic tablets must be taken to prevent the mastitis returning. Do not stop part way through the course of antibiotics.

Breastfeeding and your diet

Now is not the time to diet! Breastfeeding helps you lose weight after your baby is born. Breastfeeding women should eat a well balanced nutritious diet. It is important not to skip meals, but to eat a generous amount of fruits and vegetables, whole and grain breads and cereals, calcium and protein rich foods. You may become hungrier when you are breastfeeding.

It is best to satisfy your hunger with nutritious foods. No one food has been proven to upset babies or cause wind. The best advice is to eat all foods in moderation, unless there is a family history of food allergies or intolerance. The natural variation in your diet will change the flavour of the breast milk for your baby, which may better prepare your baby for solids after six months of age.

Breastfeeding mothers need enough fluids to stay hydrated. Drink to satisfy your thirst. Increasing the amount of fluid you drink does little to increase your milk supply. A minimal intake of caffeine is recommended for breastfeeding mothers. The younger the baby is the longer it will take any caffeine to be metabolised by their body. Excessive caffeine intake may make your baby wakeful and fussy. Remember caffeine can be found in tea, coffee, soft drinks, energy drinks, some medications, herbal preparations, as well as foods containing coffee or chocolate. Contrary to popular opinion alcohol does not increase milk supply but rather decreases milk let down and milk supply.

Current research recommends minimal alcohol intake while breastfeeding, no more than one to two alcoholic drinks per week. It is also recommended to wait two to three hours after drinking alcohol before breastfeeding your baby.

Breast Feeding in Public

In Australia and New Zealand, mothers are legally entitled to breastfeed their children wherever they like. However, some mothers may feel uncomfortable breastfeeding in public. Fortunately in Australian and New Zealand, many public places such as large government buildings, shopping centres, sports complexes and train stations for example, have parents rooms which are usually well equipped and comfortable. However, should your baby be hungry, it can often be impossible to find a suitable place for you to breastfeed in private. Mamá y bebé provides a specialist nursing cover product which allows you to breastfeed discretely in the presence of others while maintaining eye contact with your baby. If you do use a cover other than a specialist nursing cover to breastfeed, it’s important to ensure your baby can breathe easily and is not stifled though overheating.

Breast Feeding Problems

Many mothers experience feeding problems and there are a number of places that can offer assistance.

The Australian Breastfeeding Association (www.breastfeeding.asn.au) is a group dedicated to supporting breastfeeding women in Australia. They have trained counsellors and a phone and email advisor service.

Lactation Consultants of Australia and New Zealand (LCANZ) is the peak body representing Lactation professionals in New Zealand and Australia. Their website (www.lcanz.org) has the contact details of support groups and lactation consultants across New Zealand and Australia.

References

Mater Mothers’ Breastfeeding Support Centre
Raymond Terrace, South Brisbane, Queensland 4101

Telephone 07 3163 8111
Facsimile 07 3163 3980

Website www.mater.org.au

Mother and Baby