a guide to successful breastfeeding

7/30/2019 A Guide to Successful Breastfeeding

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“Caring for you and your lil’ ones”

www.momslittleones.com013-3639567 (Rita)

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“We care for you and your lil’ ones” Page 1

A Guide to Successful Breastfeeding

TABLE OF CONTENTS

INTRODUCTION:ALetterToMom..................................................................................2BreastmilkvsFormulamilk ...............................................................................................3Howthebreastworks........................................................................................................3Whatiscolostrum?............................................................................................................4BreastfeedSOON .............................................................................................................5BreastfeedOFTEN............................................................................................................5Here’swhatwillhappenwithyou,yourbaby,andyourmilkinthefirstfewweeks: ..........6Here’swhatwillhappenwithyourbabyinthefirstfewweeks:.........................................7LatchingonandPositioning..............................................................................................7TheRootingReflex ...........................................................................................................9CauseofCommonBreastfeedingProblems.....................................................................9SoreNipples...................................................................................................................... 9NippleConfusion.............................................................................................................10Breastfeedingvs.ontheBreast ......................................................................................10TheLazyFeeder.............................................................................................................11Burping............................................................................................................................11LactatingMother’sDietandFluidIntake.........................................................................11BottleRefusal..................................................................................................................12TemporarySeparationorSuspensionofBreastfeeding .................................................12

HandExpression.........................................................................................................12Manuallyoperatedbreastpumps................................................................................13Smallelectricbreastpumps ........................................................................................13Hospitalgradebreastpumps ......................................................................................13

HowtostoreexpressedBreastmilk.................................................................................13MethodofStorage...................................................................................................14

DefrostingandWarmingMilk ..........................................................................................14MisuseofBreastpumps...................................................................................................15PumpingTips ..................................................................................................................15

Assistingthemilkejection(let-down)reflex: ............................................................... 15Howtopumpforasupply:...........................................................................................16

Tipsforyouifyou’rereturningtowork ............................................................................17HowdoIknowifmybabyisgettingenough?.................................................................17GrowthSpurts .................................................................................................................18Whentogetadviceandhelp?(RedFlags/WarningBells)..............................................19GettingHelp ....................................................................................................................19

ReferencesandAcknowledgements...............................................................................19





INTRODUCTION: A Letter To Mom

DearMommy,

Thankyouforbringingmeintothisworld.IamcontentandhappyeverytimeIhearyourvoice,feelyourwarmth,comfortandprotection.Pleaseletmestaywithyouallthetimesothatyoucanbreastfeedmeondemand.Pleasedon’twaituntilIcrybecauseI’llbeaveryfussybabybythen.

YourcolostrumisallIneed.Youcanprovidemewarmth,security,foodanddrink. I do not need any pacifiers, bottles or water. There is no need fortoppinguporsupplementingwithformulamilk.Themoreyoubreast-feedme,themoremilkyouwillhave,mommy.

PleasebepatientwithmeasIlearnhowtofeed.Iwilltrytobepatienttoo(I

knowIcanbeapainsometimes).I’msorryforstressingyouout!Ireallydon’tmeanit.Itmaytakeawhileforbreastfeedingtogetestablished.Itwillgivemethe best start in this big wide world! If you find feeding uncomfortable orchallenging,pleaseask the nurseor lactation counselor for help toget melatchedonproperly.PleasedonotwatchtheclocktoseewhetheritistimeformynextfeedortoseehowlongIfeed.

As you continue to breastfeed, I will get protection against infections, heartdisease,diabetes,eczemaandasthma.Itwillhelpmyjawandbraindevelop.Ireallywanttogrowuptobestrong,intelligentandhealthy.

IwantyoutoknowthatIappreciateallthatyouhavedone.YourbreastmilkisalwaystheBESTmilkforme.Iloveyourprecious“goldendrops”!Butmostofall,ILOVEYOU,mommy!

Hugsandkisses,

YourBreastfedBaby(theabovepictureismybaby Alyshaat15months–sheisstillabreastfedbaby)





DEAR READER,Heartiestcongratulationsonthebirthofyourpreciouslittleone!Ifyouarereadingthis,Itakeitthatyouhaveeitherdecidedorhavekeeninterest

tobreastfeed. Thisguide is intendedtoempowerand hopefullyassist you andyourfamiliesinyourdecisiontobreastfeed.(Note:Ihaveused“him”and“his”torefertoyourbaby–mysincereapologiesi yourbabyisagirl)

f

Firstofall,letmetellyouWHY YOU SHOULD BREASTFEED.Breastmilk isa physiologicallyproduced fluidnaturally intendedforthehumanbaby. Health authorities agree that breastmilk offers superior infant nutrition.Scientistsarecontinuouslydiscoveringnewpropertiesofbreastmilk.Therefore,itisarrogantforcompaniesproducinginfantformulatodescribetheirproductsas

being“closetobreastmilk”,whenbreastmilkisalivingsubstanceaboutwhichwestill have a lot to learn. The truth is, no matter how much these milk powdercompanies spend on their “research and development” their products are nowherenearbreastmilk(howcancow’smilkbelikenedtohumanmilk!)–ittakessimplelogictofigurethatoneout!Breastmilk vs Formula milk Breastmilk contains antibodies and immunities, which are passed from you toyourbaby tohelp fight infections. Inadditionto its immunity-enhancingquality,breastmilk changes in composition depending on your baby’s needs. Formulamilkremainsthesameregardlesstheneedsofthebaby.Howso?

1. Breastmilk changes with the baby’s age:breastmilkforprematurebabieshasparticularhigh protein level; similarlybreastmilk for an8 month oldbabyishigherincaloriesthanfora1monthold;

2. Breastmilk changes with the weather: in very hot climate, breastmilkcontainsmorewater;incoldclimate,breastmilkcontainsmorefat;

3. Breastmilk changes in taste depending on what the mother eats: So,yourbabyisexposedtodifferenttastesthroughouthisearlymonths(wouldyouliketoeatexactlythesamefooddayindayoutfor6months?Idon’tthinkso!)

How the breast works

Thebreastgrowsalveoli,whicharemilk-producingglandsduringpregnancy.Thealveoli are like the leaves on a tree, growing on branch-like structures. Milkproduced in the alveoli passes through ducts into the sinuses just behind thenipples.





When the baby putspressure on the areola regionwhere the sinuses are, thenervessend amessage to the brain tosecrete two hormones:oxytocin,whichcauses the milk to be ejected (the “let down” reflex) and prolactin, whichstimulatesthebreasttomakemoremilk.

Itisextremelyrareforawomantobeunabletobreastfeed.Evenwomenwithbreast surgery have been known to breastfeed successfully. Flat or invertednipplesshouldnotcauseconcernifhelpissoughtfromthebeginning.

Nipple

Lactiferous Sinus

Nipple Opening

Ducts

Fig.1 Anatomy of the Breast

Alveoli

What is colostrum?

Thisisthe“liquidgold”thatisproducedforthefirst10daysorso.Itisveryrichinproteinsandantibodies.Although it isvery small inquantity compared to latermilkproduction,itisallyourbabyneedsforhisfirst2-3days.





Breastfeed SOON

Earlyinitiationofbreastfeedinghastheseadvantages:

• The problems of breast engorgement when the milk “comes in” are

reducedoreliminated;• Throughearlyfeedingofcolostrums,whichhasalaxativeeffect, bilirubin

iseliminatedinthebowelmovements,reducingtheincidenceofjaundice;

• Thebaby’ssuckingreflex,whichisstrongest20-30minutesafterbirth,issatisfiedearly,thereforecontributingtobettersuckingatthebreast;

• Thebabyreceivestheimmunologicalbenefitsearlier;

• Bondingbetweenmotherandbabyisenhanced.

Breastfeed OFTEN

There is really only one way to breastfeed – ON DEMAND. No clocks, nowatches!Yournewborn baby’sstomach isnot muchbigger thanahard boiled egg.So,pleasedon’texpecthimtodrinkawholelotandsleepforhoursinthebeginning,evenifyouhaveplentifulsupplyofmilk.Offerthebreastwheneverhecriesorwantstosuck.Thismaybeevery2hoursOReveneveryhalfanhour.Tip:Itisbestnottowaituntilhecries,asacryingbabyisan“angry”baby.Hemaybefretfulatthebreastbecausehe’stoohungry.Ifthebabyiscalm,useyourfingerandtouchhischeeks.Ifhegoesforit,hewantshisfeed!

Fig. 2 Baby’s Stomach Capacity





Here’s what will happen with you, your baby, and your milk in the first fewweeks:

(Extracted from AAFP guide www.4woman.gov)Milk appearance and amount You (the mom)

BirthYourmilkwillappearyelloworgolden.Theamountwillbesmall,butitgivesyourbabyahealthydoseofprotectionagainstdiseases.

Youwillbetiredandexcited.Thisisagoodtimeforyoutofeedyourbaby.

First12-24hours

Yourbabywilldrinkabout1teaspoonofyourmilkateachfeeding.Youmaynotseethemilk,butithaswhatyourbabyneedsandintherightamounts.

Continuerestingandgettingtoknowyourbaby.Yourbreastsmaybealittletenderatfirst.If

breastfeedinghurts,askforhelpfromsomeonewhohasexperiencehelpingbreastfeedingmothers.Breastfeedingshouldnothurt.

Days2-5

Yourmaturemilkcomesin.Itwilllookbluishwhite,butmaystilllookalittleyelloworgoldenforabout2weeks.

Yourbreastswillfeelfullandmayleak.(Youmayusedisposableorwashablepadsinyourbratoabsorbthemilk.)Ifyourbreastsbecomeswollenandhard,removealittlemilkfromyourbreastsbeforefeedingyourbaby.Betweenfeedings,useicepackstoreduceswelling(sometimescalled"engorgement"),whichwillgoawayin1-2days.Breastfeedingyourbabyhelpsreducetheswelling.

First4-6weeks

Yourmilkgraduallystartstolookbluishwhiteatthebeginningofafeedingandcreamywhitetowardtheendofafeeding.Thecolormayvaryalittlefromdaytoday.Somefoodsyoueatcanchangethecolourofyourmilk,butthiswon’tharmyourbaby.

Yourbodygetsusedtobreastfeedingsoyourbreastswillbesofterandtheleakingwillslowdown.Don’t worry.Themilkisstillthere.

http://www.4woman.gov/

http://www.4woman.gov/





Here’s what will happen with your baby in the first few weeks:

The Baby

BirthYourbabywillprobablybeawakeandalertinthefirsthourafterbirthandthisisagoodtimeforhimorhertobreastfeed.

First12-24hours

Asyourbabywakesup,heorshewillhaveastronginstincttosuckandfeedveryoften.Itisnormalforsomebabiestosleepheavily.Laboranddeliveryarehardworkforthebaby.Somebabiesmaybetoosleepytolatchonwellatfirst.Feedingsmaybeshortandirregular.Yourbabywilllovethetasteofyourmilk.Manybabiesliketoeatorlick,nuzzle,pause,savor,doze,theneatagain.Askthenursesnottogiveyourbabyanyformulaorwaterunlessneededformedicalreasons.

Days2-5

Yourbabywillfeedalot,atleast8-12timesin24hours.Yourbaby’sstomachislittle,solotsoffeedingsarenormal.Breastfedbabiesdon’teatonaschedule.Itisokayifyourbabyeatsevery1-2hours.Feedingswillprobablytakeabout15-20minutesoneachside,butallbabiesaredifferent.Yourbabymighttakeonlyonesideatatimeorseemtolikeonesidebetter.Afterdelivery,itisnormalforababytolosealittleweight.Yourbabywillregainhisorherbirthweightbyabout10daysto2weeksofage.

First4-6weeks

Feedingsmaytakelesstimeandbefartherapart.Mostbreastfeedingbabiesliketonurseoften,becauseitiscomfortinganditkeepsthemclosetoyou.Yourbabywillbebetteratbreastfeedingandhavealargerstomachtoholdmoremilk.

Latching on and Positioning

Mostbreastfeedingproblems startwith poor positioning anda poor latch. Youshouldreallytrytowatchavideoonthesubjectbeforethebabyisborn(somehospitalshaveamother’sroomwherethevideoonbreastfeedingisavailablefor

viewing). If you have already had the baby and you are not sure of how topositionthebabyforagoodlatch,hereissomeadvice:

1. Supportyourbreastwithyour thumbontopand fourfingersunderneath.Keepyour fingersbehindtheareola(thedarkerskinaroundthenipple).Youmayneedtosupportyourbreastduringthewholefeeding,especiallyintheearlydaysorifyourbreastsarelarge.





2. Brush or tickle the baby’s lipswith yournipple to encourage the baby’smouthtoopenwide.

3. Hugthebabyinclosewithhisorherwholebodyfacingyours.Whenthebabyopenshismouthwide,quicklyandsmoothlypushhisheadwellonto

thebreast.Youshouldalwaysthinkofbringingyourbabytoyourbreastandnotyourbreasttothebaby.

4. Yourbabywilltakeamouthfulofallofthenippleandmostoftheareola.Thebabyshouldneverbelatchedontothenippleonly.Remember,baby’sbreastfeednotnipplefeed!

5. Lookforbothofyourbaby’slipstobeturned/flangedout(nottuckedinorunder)relaxedandhismouthshouldcovermostoralloftheareola.Ifyoucan’ttellifthelowerlipisout,pressgentlyonthelowerchin to pull the lower lip out.The tongueshould be cupped under yourbreast.

6. Youmayseeyourbaby’sjawmovebackandforthandhearlow-pitchedswallowing noises. Your baby’s nose and chin may touch against yourbreast.

Breastfeeding should not hurt. If it hurts, it’s wrong! Take the baby off of yourbreast and try again. The baby may not be latched on correctly. Break yourbaby’ssuctiontoyourbreastbygentlyplacingyourlittlefingerinthecornerofhismouth.Takeasmanytimesasyouneedtodoitright.Pleasebepatient. I cannotemphasize enough that a poor latch is the cause of most breastfeeding problems.

As you get more proficient in feeding him in this position, you can try otherpositions.Iwouldrecommendyoulearnhowtofeedlyingdown,sothatyoucanrest when you feed(alsorecommended formoms whohavehad ac-section).Whateverpositionyouuse,thebabymustbelatchedonproperly,otherwiseyouwillhavesorenipplesandbabywillnotgetenoughmilk.Here are some of the various positions, which you can hold your baby whilebreastfeeding:

Cradle Hold: Acommonlyusedpositionthatiscomfortableformostmothers.Holdyourbabywithhisheadonyourforearmandhis/herwholebodyfacingyours.

Cross Cradle or Transitional Hold: Thisisgoodforprematurebabiesorbabieswhoarehavingtroublelatchingon.Holdyourbabyalongtheoppositearmfromthebreastyouareusing.Supportbaby’sheadwiththepalmofyourhandatthebaseofhishead.





Clutch or "Football" Hold: Thispositionisgoodformotherswithlargebreastsorinvertednipples.Holdyourbabyatyourside,lyingonhisback,withhisheadatthelevelofyournipple.Supportbaby’sheadwiththepalmofyourhandatthebaseofhishead.

Side-Lying Position: Thispositionallowsmotherstorestorsleepwhilebabynurses.Especiallygoodformotherswhohavehadcesareanbirths.Lieonyoursidewithbabyfacingyou.Pullbabycloseandguidehis/hermouthtoyournipple.

If you have a problem with flat or inverted nipple, please consult a breastfeedingcounselor.Itisadvisabletoseekhelpearlier(beforeorduringpregnancy)astherearedevices(byMedelaandAvent)availableandmethodsthatcancurethisproblem.The

AventNiplette™forexample,providesapainlessandpermanentcure.

The Rooting ReflexThenewborninfanthasarootingreflex,whichmeansthathewillturnhisheadtowhatevertoucheshischeek.Therefore,itisimportantthatyoudonotstrokehisfacewhenyouarefeedinghim.Ifyoudo,hemayturntowardsthatsideandhewillnothaveagoodlatch.Likewise,youcanmakeuseofthisrootingreflextomakehimturntowardsyouwhentryingtopositionhim,bystrokingthecheekclosesttoyou.Cause of Common Breastfeeding Problems

Mostcommonproblemsareduetothefollowing:

• Delayedinitiationofbreastfeeding

• Infrequentortimedfeedings

• Supplementingwithabottle(whetherformula,waterorotherfluids)

• Poorlatch

• Useofapacifieroramotorizedrocker

• Missed night feedings (whether baby fed by formula or expressedbreastmilk)

Sore Nipples Asorenippleisasignofapoor latch.Whenbaby isfeeding,his lipsshouldbeflangedoutandheshouldtakeinmostoralloftheareola(see“Latching-on andPositioning” above).Youcanhelphimgetabetterlatchbygentlypullinghischindownandhisupperlipup.





Ifyouhavesorenipples,avoidusingwaterproofbrapads.Whenathome,thebestwaytoairdrythenipplesaretoleavetheflapsofthenursingbradown.Ifyouworryaboutleakage,youcantuckasmalltowelundereachsidetocatchthedrips. Or, you can use breastshells with holes for ventilation. Avoid using

breastshellswithonlyasmallholeatthetop,asthesedonotenablethenipplestodryproperly.Expressingalittlemilkandwipingitontothenipplesattheendofafeedhelpspromotefasterhealing.Therearealsocreams,whichyoucanusetocuresorenipples.Nipple Confusion

This normally happens to infants who have been offered bottles or pacifiers. Artificialteatsareknowntocausethebabytosuckineffectivelyatthebreast.Thesuckingmotionswhenbreastfeedingandbottle-feedingareentirelydifferenteg.ifyouputyourfingerinyourmouthandsuckandthentrytosuckonahalfblown

balloon.Manybabieswhohavehadbottlewillsuckonthebreastthesamewayasabottle.Thiswillresult inthemotherhavingsorenipples.Moreimportantly,thebabywillnotbedrainingthemilksinuseseffectivelythusgivingthemotheranimpression that she does not have enough milk. As a result, she gives himanotherbottle.Andthisiswheretheproblemstarts….If you have to supplement your baby, you can use a Supplementary NursingSystem/LactationAid(Medelamakesone)thatallowsyoutofeedsupplementsoffthebreast,oroffafingertoavoidnippleconfusion. Alternatively,youcanuseacupfeeder,asmallcup,spoon,feedingsyringeetctofeedbaby.Youwillbeamazedhowwellayoungbabylearnshowtocupfeed.Ifyouareunsureabouthowtogoaboutdoingthis,pleaseaskyourcounselor. Astudy in1985shows that95%ofbabieswillbecomenippleconfused ifgivenanartificialteatinthefirstthreetofourweeks.Therefore,itisadvisabletowaittillbabyisbreastfeedingwelloratleast4weeksoldbeforeintroducingthebottle. Breastfeeding vs. on the Breast

Ispecificallywanttomentionthisasitisacommonproblemamongnewmothersespecially. Being on the breast is not the same as breastfeeding. When yourbaby is no longer drinking (swallowing), you can switch to the other breast.

Offeringthebreastforindefinitesucklingisnotaneffectivewaytostimulatemilkproduction.Itisfarbettertochangebreasts,andthenbackagainratherthantoletthe baby suck for a long time when he is no longer swallowing. One wordofcautionthough:DONOTswitchsidesbeforebaby“finishes”(ie.Whennolongerswallowingevenaftermanysucks).Otherwise,heisonlygetting the “foremilk”which is low in calories and proteins and he may not be gaining weight welldespitethelargenumberofwetdiapers.





Ifbabykeepswantingtonursebutdropsofftosleepatthebreast“forcomfort”,hemaybehavinganineffectivesuck.Youmayneedtoreassessyour positioningand latch.

The Lazy Feeder

Ifyourbabyisnotgainingwellandisdroppingofftosleeponthebreast,hemayneed a little bit of arousing. Swaddling babies generally tends to make themsleepy.So,unwrapbabyandtrytohaveskin-to-skincontact.Toavoidchills,youcanalwaysputtheblanketonafterhegoesonthebreast.Massagingbaby’sfeetsometimeswillwakesleepybabies.Burping

Itisreallynotnecessarytoalwaysburpthebaby.Somemothersarerather

obsessiveaboutburping.Ifthebabyburpsafterafewattempts,fine,ifnot,he’sstillfine!Lactating Mother’s Diet and Fluid Intake

Alactatingmothershouldeatawellbalanceddietandeatnaturalfoodsinsteadofhighlyprocessedfoods.Manycultureshavesuggestionsaboutfoodstoeatortoavoidwhilebreastfeeding. However, research shows thatamother’smilk isaffectedonlyslightlybythefoodsinherdiet.Generally,abreastfeedingmotherneedsaround300-500caloriesmorethanshenormallyneedsinordertomaintainherweight.Womenoftentrytoimprovetheirdietswhiletheyarepregnant.Continuingwithanimproveddietafteryourbabyisborn will help you stay healthy, which will help your mood and energy level.However, even if you do not always eat well, the quality of your milk will notchange much. Your body adjusts to make sure your baby’s milk supply isprotected.Youmaynoticehowever,thatyoumaybethirstierandhaveabiggerappetitewhileyouarebreastfeeding.Increasingfluidintakecanhelpmilkproduction.The“drinktothirst”ruleisagoodonetofollow.Often,alactatingmotherwithanewborntocareformayforgettodrinkwhensheisthirsty.Thismaycausehermilksupplytodeplete.Trytoavoidcaffeinatedbeverageswhileyouarebreastfeedingorreduceintake.

Word of advice:Pleasedonotbeobsessedaboutlosingweightafterpregnancy.Donotworry;alactatingmothernormallygetsbackinshapefaster.Neverskipmeals(itisbadforyou).Youcannotexpecttocareforyourbabyifyoudon’tcareforyourselffirst!





Bottle Refusal

Mostmothersstartintroducingthebottle(withexpressedbreastmilk)whenthey

havetoreturntowork.However,somebabiesrefusetotakethebottle.Youcantrysomeorthodonticteats,whicharebettersuitedtobreastfedbabies.Awideneckbottleisalsorecommendable.Youcanalsotrygentlyrockingthebabywhileofferingthebottleortrytofeedhimwhenheissleepy.Itisbettertohavesomeoneelsefeedherthebottlebecauseyourbabywillnormallyrecognizeyoursmellandimmediatelyrefusethebottle!Word of advice:Ifyouarereturningtowork,youshouldstarttrainingyourbabyandbabysitter1or2weeksearlier.Thiswillensureasmoothtransitionforyouandbaby. Temporary Separation or Suspension of Breastfeeding

Forwhateverreasons,whenyoucan’torwon’tbreastfeedyourbabytemporarily,butneedtomaintainthesupply(eithertobefedtobabynoworlater),youwouldneedtoexpressyourmilkaboutthesamenumberoftimesasyourbabynormallyfeeds.Youshouldexpressuntilyou’reonlygettingdroplets.Hand Expression

Positionthethumbabovethenippleandthefirsttwofingersunderit,justawayfromtheareola.Pushstraightintothechestwall.Rollthumbandfingersforwardatthesametime.Avoidsqueezingthenipple.Ifyouhavelargebreasts,youmayuseyourotherhandtosupportyourbreast.“Theknack inhandexpression is finding exactlywhere the lactiferous sinusesare,andhowdeep.Imagineapeainsideathinstraw,andeachbreasthavingaclusterof10-20straws,eachwithapeainside.Thesinusesaresofterthanpeas,more like little milk-filled p llows or tiny cylindrical squirt guns. When you'velocated the pillow,press themilkoutwith your thumbon top andforefingerormiddlefingerunderneath,startingthemovementonthechest-sideofthebulgeandrollingacrossthepillowtowardthenippleside.Thepillowsdon'tmoveinside thestraw.Anotherwayof maginingthesinusesis weakspotsinagardenhosethatbulgeoutwithcollectedwater-i yousteponthebulge,i squirts.Thetrickis

tofindthebulges-they'reonlyabout1/4"long.

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Start your search wi h your fingers around the edge of the areola, about 1.5inchesbackfromthenippletip.Goclosertothenippleorbackawayfromi till youfindthem.Theymaybeonthesurfaceordeep inthebreast,like thecoreof anapple.Useenoughpressuretosquirtoutmilkifi 'sthere.Onceyou'vefoundthem,you'llbeamazedhoweasyi istopressoutmilk.Itusuallyspraysacrosstheroomi yourfingersareintherightplace ”.(www.bflrc.com)

http://www.bflrc.com/

http://www.bflrc.com/





Manually operated breast pumps

Therearemanystylesavailable.Besuretobuyonethatdoesn’tuseyourfingers

orwrists,asyouwilltireeasilywiththesemodels.Onesusingarmmusclesarebyfarthebest.Itisimportanttochooseapumpthathasavalvebetweenthebreast shield part and the bottle part, as ones without valves have variablenegativepressuresdependingonthefullnessofthebottleandmaycausenippledamage.Manymothersbecomeveryproficientwithhandpumpsandareabletoexpress large quantities of milk, although most find them adequate only foroccasionaluse.Small electric breast pumps

These may be battery-operated or mains and battery operated and are very

convenientbecauseoftheirportability.Besuretobuyonethatisfullyautomatic(not requiring themother to release theair suction) as incorrect cycle time bymanualcontrolcancausedamagetothenipples.Again,thepresenceofavalveisimportant.Hospital grade breast pumps

Theseare,withoutadoubt,themostefficientmeansofexpressingmilk.Useofadouble-pumpingkitwillenablethemothertoreducepumpingtimebyhalf,aswellas increasemilk production. Studyshows that simultaneousbreaststimulationincreasestheprolactinlevelsthusincreasingmilkproduction.Thesepumpsareexpensivetobuybutaregenerallyofferedforhomerentals.There are professional pumps which have similar features meant for activemotherswhicharemoreaffordable.Pleaseconsultyourbreastfeedingcounselor.How to store expressed Breastmilk

There are several containers available for storing breastmilk. These includespecially designed and pre-sterilised plastic bags, plastic bottles or glasscontainers. There are advantages to each. Here are some general rules ofthumb:

• Alwaysstorebreastmilk inamountsequal towhatyourbabywill takeatonefeeding

• You may continue to add small amounts of milk to the same containerthroughout the day. Chill in refrigerator until evening and freeze inappropriateamounts.

• If youaregoingto freezeyourmilk, leave somespaceat the topof thecontainerbecausebreastmilkexpandsasitfreezes.





• Youmayaddfreshmilktoalreadyfrozenmilkbutyoumustfirstrefrigerateallfreshlyexpressedmilkuntilcoldandthenaddtoalreadyfrozenmilk.Thenewlyaddedmilkmustbeofalesseramountthanthealreadyfrozenmilk.

• Whenusingplasticbags,usethosedesignedforbreastmilkcollection.• Label/Markeach containerwith the dateandtime. If the containerdoes

nothavemeasurementscales,marktheamounttoo(oz.orml)

Method of Storage Term Babies Preterm/Sick BabiesRoomTemperature 4-8hours 2-4hours

Refrigerator 24-48hours 12-24hours

Freezer 3months 3months

DeepFreezer(-20) 1year 1year

Defrosting and Warming Milk Todefrostmilk:

• Placemilkinrefrigeratorthenightbeforeyou’regoingtouseit.Thisusuallytakes12hours.

• Or,placethemilkinapanofwarmwater.DONOTusehotwaterorthemicrowave,astheywilldestroysomeofthemilksimmunologicalcomponents.

• Alternatively,forworkingmothers,youmayplaceseveralmilkbottles(accordingtoyourbaby’sneedsfortheday)incontaineroftapwaterbeforeleavingforworkuntilitisthawedthenplaceitintotherefrigerator.Whenit’stimeforthebaby’sfeed,takeonebottleoutatatimeandplace

incontainerofwarmwaterandfeed.CAUTION:NEVERmicrowaveBreastmilk!Thismethodcanchangethemilk’scompositionandhasthepotentialtoburnyourbabyPointtonote:

• Fatinbreastmilkwillseparateandrisetothetop.Bygentlyswirlingthecontainer,youcanmixanyfatthatmayhaveseparated.

• Neverrefreezethawedbreastmilk

• Thecolor,consistencyandodorofyourmilkmayvarydependingonyourdiet

• Althoughyoucanfreezebreastmilkfor3-6months,werecommendtousefrozenbreastmilkona“firstin,firstout”basisasthecompositionofthebreastmilkchangesaccordingtoyourbaby’sage.





Misuse of Breastpumps

Manymothersaretemptedtoexpressbreastmilksothatsomeoneelsecanfeedthebaby,whiletheyrest,gooutorspendtimewithothersiblings.Thisisfine

providedthattheexpressedmilkiseithercup-fed,fingerorspoonfedtoaninfantunder 4 weeks old, as babies this young often can’t go back to the breasteffectively.Babiesolderthan4weekscangenerallylearntosuckfromboththebreastandbottle,withoutnipple confusion.Somebabies, however,won’teventake a bottle by this time! In this case, you can finger, spoon or cup feed(provided that you are only doing it occasionally because babies do need tosuck!)Breastpumps should not be used exclusively, as nothing is as efficient as ababy’s suck. Mother’s who breastfeed infrequently often reports a gradualdecreaseinmilksupply,even iftheyarepumpingthesamenumberoftimesand

forthesamedurationastheirbabieswerefeeding.Exclusiveuse ofbreastpumpswithnodirect breastfeedingoftenresults in themother’smilk“dryingup”afterafewweeks. Pumping Tips

Assisting the milk ejection (let-down) reflex:

If you are pumping away from your baby, audiotape of your baby’s cry orphotographofbabywillhelp!(MostmobilephonesandPDAshavea recordingfunction-itcanreallydowonders!)Otherpracticaltipsinclude:

1. Gentlymassagethebreasts insmallcircles foraminuteorso.Massagethemilkproducingcellsandductsbypressing the breastfirmlywith theflatofthefingersintothechestwall,beginningatthetop.Movefingersinacircularmotion,concentratingononespotatatimeforafewsecondsbefore moving on to another spot. Spiral around the breast toward theareola as you massage. The motion is similar to that used in a breastexamination.

2. Strokethebreastareafromthetopofthebreasttothenipple,usingalighttickletouch.Continuethestrokingmotiontohelpyourelax,whichinturnwillstimulatethemilkejectionreflex.

3. Shake the breast while leaning forward to let gravity help with the milkejection.

4. Applyheatpadfor10minutesbeforepumping(ifpractical)5. Stimulate the tips of the nipples with clean fingers for 20-30 seconds

beforepumping;forsinglepumping,youmaycontinuetodothisontheotherbreastwhilepumping.

6. Drinkingaglassofwaterbeforeapumpingsession





How to pump for a supply:

Ifyouarebreastfeedingexclusivelyandyouneedtobuildasurplussupplyinthefreezerforusewhenyouareoutwithbaby,youcandooneormoreofthe

following:

If baby has Irregular FeedingSchedule

OR If baby has regular FeedingSchedule

1. For the first feed in the morning(when your milk is plentiful), feedbaby on one side and pump on theother.Whenyoufinish,(ie.Whenthebaby stops swallowing and is onlysucking),youcanswitcharoundandfeed for another 10-15 minutes and

again pump on the side which youhavejustfed.Youmayexperienceasecond let-down and more milk willbe drunk by the baby as well ascollected by the pump. If you don’texperience a second let down,don’tworry,theextrastimulationwillmeanmoremilklater

1.Pumponbothsidesfor15minuteshalfwaybetweenthe1standexpected2ndfeedsoftheday.

2. Keep the expressed breastmilk inthe freezer. Baby may get hungryearlierforhisnextfeed;feedhimand

DONOTpumpforthisfeed.

2.Keep theexpressedbreastmilk asstock.Feedbabyasusualforhis2ndfeed. He will be hungry earlier, so

feedhimearlierforhisthirdfeed.3. If you need to build up a supplyquickly, you may repeat the feedingand pumping in a later feed.Otherwise,it’sbesttodoitjustonceaday.

3.Youmaywanttorepeatthislaterinthe day, but it is generally better tobuild your supply over a slightlylonger period of time. Why? So thatyou and baby won’t notice thediminishedquantity.

NOTE: Itisadvisabletostoretheexpressedbreastmilk(EBM)intheamountthat baby is taking per feed.You must NOT add freshly expressedmilk toalready frozen milk, as this will defrost some of the frozen milk and maycontributetobacterialcontamination.However,youcanchilltheEBMuntilitisverycoldandTHENadd/combinewithfrozenmilk.Youmayusespeciallydesigned milk bags (which are pre-sterilized), reusable milk bottles orcontainers for collecting EBM. Be sure to mark the DATE and TIME ofexpressionsothatyoucanalwaysusetheoldestmilkfirst(firstin,firstoutbasis). For marking, Iwould recommend usingmasking tape as it is easilyremovedanddoesnotleavemarksonbottles/containers.





Helpful tip: Ifusingdisposablemilkstoragebags,youreallydon’tneedfancyclipsandlabels.Rubberbandsandmaskingtapewilldo.Ifyoudouseaclip,makesureyourollthetopofthebagseveraltimesbeforefasteningit.

Tips for you if you’re returning to work

1. Makepreparationsandplanningbeforereturningtoworkeg.Creatingmilkstock,trainingbabysitteretc

2. Ensuresufficientexpressedbreastmilk3. Trytogoeasyonyourselfanddon’tforgettotakemoreshortrests4. Eatanutritiousandbalanceddietanddrinkplentyoffluids5. Wakeup30minutesearlierandfeedbabyevenifheisstillhalfasleep.6. Haveagoodbreakfastandfeedbabyjustbeforeyouleaveforwork.This

willease/relievetheseparationanxietybetweenyouandbaby.7. Toensurethatbabyisnotfullwhenyoureturnhome,askthebabysitterto

feedyourbabywithjustasmallamountofexpressedbreastmilk.Whenyouarrivehome,yourbreastmaybeheavywithmilkandyoumaywanttofeedyourbabyimmediately.

8. Feedbabywithin1hourafterarrivinghome.Tip:Iwouldadviceyoutotendtoyourselffirsteg,changefromofficeattire,takeashower,eatbeforefeedingyourbabyashemay“cling”toyouforawhile!

9. Inthefirstweekatwork,youmayneedtoexpressfrequently.Afteracoupleofdaysyourbreastwilladjusttoyournewscheduleandyouwillbemorecomfortable.Youneedonlyhavetoexpresstwiceatwork(10amand2pmoratlunchbreak)

10. Nevergowithoutexpressingformorethan3-4hours.Thismaycauseengorgement.Massagegentlywhileyouexpressyourmilkandyouwillfeelmorecomfortable.

11. Shouldyourbreaststarttoleakunexpectedly,applyfirmpressureusingthepalmonyournippleforaminute.Foldingyourarmsacrossyourbreastswillhelptostoptheleakage.

12. Wearnursingpadsinsideyourbratoabsorbanyleakage.GO BACK TO WORK & CONTINUE TO BREASTFEED FOR 6 MONTHS TO

1 YEAR

How do I know if my baby is getting enough?

Forexclusivelybreastfedbabies,youcantellby:

1. Baby’s sucking:you mayhearyourbaby swallow as he feeds. Youcanobserve your baby’s sucking. If he is pausing after each suck, he isdrinkingamouthfulofmilkeverytime.Afewminutesofthistypeofsuckwillmeanhehashadasubstantialfeed.





2. Bowel movements:

Inthe1stfewdays,thebowelmovementis dark green and sticky.Thisiscalled meconium. From about the 3rd day, his bowel movements will

become lighter and more yellow incolour,untileventuallyitbecomes tanto mustard colour, with the consistency of a thick cream soup. Babiesunder 6weeksold haveat least 2 to 5 bowelmovements in a24hourperiod.Ifthefrequencyislow,thenthebowelmovementsshouldbemoresubstantial. If the bowel movements are just small blobs on the diaper,thenbabyshouldhavemanymorebowelmovement.

Ifbabyhasfewandsignificantamountsofbowelmovementsbutishavingmanywetdiapers(seebelow)andhisstoolsarewateryandgreenish,hemay be suffering from foremilk-hindmilk imbalance, or “oversupplysyndrome”.Thismeansthatyoumaybeswitchingbreaststooquickly.So,

yourbabyisonlygettingwateryforemilkatthebeginningofafeedandnotthehindmilkthatcomeslateroninafeeding.Inthiscase,youwillneedtolet him nurse until one breast is completely soft and when baby hasstopped swallowing, before switching to the other breast. If you have areally high supply, youmayevenhave to feed himonlyone breastperfeeding.

Occasionally,babiesolderthan3weeksmaygofordayswithoutabowelmovementandwithoutsignsofconstipation.Ifthebabyisgainingwellandcontent,thisisnormal.

3. Wet Diapers:

Withtheexceptionof the f1stfewdaysbeforethemilk“comesin”,whenthere may only be 2-3 moderately wet diapers a day, babies under 6weeks old should have 5-6 heavy wet disposable diapers (or 7-8 clothdiapers)ina24hourperiod.Ifyouarenotsureofwhataheavywetdiapershouldfeellike,pour3to4tablespoonsofwaterontoadrydiaperandfeelthe weight. Older babies may have fewer wetdiapersas their bladdersmature,butthesediaperswillbeheavier.Thebaby’surineshouldalwaysbelightincolourandmildsmelling.

4. Yourbabyiscontentfor1to2hoursbetweenmostfeedings(thisvaries)5. Yourbabyisgaining120-200gmperweek(thisvariesbetweenbabies)

Growth SpurtsYourbabywillhavetimesofrapidgrowth.Theseareusuallyaround:

• 2weeks,6weeks,3monthsand6months

(Atthesestagestheytendtofeedmoreintermsofquantityandfrequency)



“W f d lil’ ” P 19


When to get advice and help? (Red Flags/Warning Bells)

Gethelpimmediatelyif:

1. BabyhasveryfewwetdiapersafterDay3;2. Babyhasweakandshallowsuckandissleepyonthebreast;3. BabystillhasdarkgreenstoolsonDay5;4. Babydropsofftosleeponthebreastwithoutanyvigoroussucking.

Getting Help

If you experience problems with breastfeeding that you cannot resolveyourself,gethelpbeforeyoudecidetoGIVE UP.Mostproblemsareoften

veryeasilyresolvedwiththecorrectadvice.Theearlieryougethelp,theeasieritistosolvetheproblemsthatyoumaybefacing.

I would like to strongly urge any mother encountering difficulties withbreastfeeding to join and consult a local breastfeedingsupport group atthehospitalsthatyoudeliveredyourbaby(publicorprivatehospitals).

Otherwise, you may always contact me, Rita at 013-3639567([email protected]) or Shima ([email protected] ). Wewilltryourlevelbesttohelp.Ifwecan’t,wepromisetofindsomeonewhocan. We will also refer to the experts. Please know that you are NOTalone!

Helpful Tip: Itisbesttoassociateyourselfwithothernursingmomsthatyoumayknow duringyourpregnancyso that youat least haveaheadstartonyourjourneytobreastfeeding!

References and Acknowledgements

(Someportionsofthearticlesandpictureswereusedandeditedforthisbooklet):

1. JabatanKesihatanWilayahPersekutuanKualaLumpur(JKWP)2. MalaysianLactationAdvisorsandConsultantsAssociation(PPPLM)3. MalaysianNursingMothersAssociation(PPPIM)4. HongKongNursingMothersAssociation5. Parentplace.comarticlesonbreastfeeding(www.parentplace.com)6. MedelaInc.website(www.medela.com)

Pleasereadotherusefularticlesonmywebsite:www.momslittleones.com



http://www.parentplace.com/

http://www.medela.com/



http://www.medela.com/

http://www.parentplace.com/



a guide to successful breastfeeding

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