Breastfeeding

Experts agree that breast milk is best because it gives babies complete nutrition plus immunological benefits.

If you choose to breastfeed, the staff of the Maternity Newborn Care Center will lend you support and encouragement and help you get started. In addition, a Certified Lactation Consultant is available at the maternity unit seven days a week to help you. Once you take your baby home, the lactation consultant is available for telephone follow–up and one–on–one consultations if needed. Call (908) 788-6335. (There is a fee involved for some follow-up services). There is also a monthly breastfeeding class for expectant parents, and a monthly breastfeeding support group, for continued support.

Waking a Sleepy Baby

Babies are often sleepy during the first week or so. They may not awaken often enough to feed: but remember that newborns need to eat 8 to 12 times every 24 hours. Sometimes they fall asleep once the feeding has begun. Here are a few suggestions for waking your baby. Some work better on certain babies than others. If one stops working - try another.

  • Undress the baby to his diaper to cool him off slightly.
  • Rub and massage the baby; the top of his head, the bottoms of his feet, up and down the spine, across his belly and up down the arms.
  • Change the position of the baby, from cradle hold to football hold and back again. Feed the baby in a more upright position.
  • Change his diaper.
  • Pump his legs in a "bicycle" motion.
  • Do "baby sit-ups", slowly rocking him from sitting to lying, back and forth.
  • Start to remove the nipple from his mouth. But be sure this doesn't cause baby to only suck the tip of the nipple. If it breaks the suction, reattach baby to the breast.
  • Talk to your baby!
  • Dim the room, as bright lights may make him close his eyes.

Hunger Cues

Babies give us several cues to show their readiness for breastfeeding. Tuning in to your baby's cues will make your feeding more successful and satisfying for both babies and parents.

  • Awakening
  • Soft sounds
  • Mouthing (licking lips, sticking tongue out, licking lips)
  • Rooting toward the breast (turning the head and opening the mouth)
  • Hand to mouth activity
  • Crying beginning softly and gradually growing in intensity

Try to catch your baby early in the cycle of feeding cues and begin breastfeeding.

Crying

Possible remedies:

  • Motion in any form
  • Walking
  • Baby swing
  • Rocking in rocking chair
  • Rocking side to side while standing
  • Ride in the car or in a stroller
  • Carry baby in infant sling
  • Over-the-counter gas-relief drops (ask your healthcare provider about these)
  • Singing
  • White sound (running water, vacuum, clothes dryer, hair dryer)
  • Recordings with heartbeat designed to simulate intrauterine sounds
  • Applying warmth to the abdomen (not hot, using a warm water bottle or warm herbal pack)
  • Snug swaddling (however, when swaddling for sleep, loosely swaddle so baby has access to his hands
  • Undressing the baby and allow him complete freedom of motion
  • Avoiding over-stimulation from noises, lights or motion
  • Distracting the baby with different sounds, sights or places
  • Placing gentle pressure on the baby's abdomen: Hold baby in the "colic hold" (facing floor, supported by your arm, heel of your hand putting pressure on the abdomen); Hold baby over your shoulder or knees; pump baby's legs in a "Bicycle" motion.
  • Keep a food diary to determine if a particular food bothers her.
  • Take a break, and let someone else try for a while!

Engorgement

The pain is memorable; fortunately, there are steps to try to relieve engorged breasts.

Before Feedings

  • Use relaxation techniques and imagery.
  • Reduce stress.
  • Take a warm shower.
  • Apply warmth or immerse breasts in pan of warm water.
  • Try cold compresses or cabbage leaves (below).
  • Massage breasts thoroughly with fingertips.
  • Hand express or pump 2 minutes to relieve fullness in areola.
  • Wake baby up well before feedings.
  • Unwrap baby's blankets, place a cool cloth on her forehead.
  • Stimulate baby's feet, rub up and down spine, rub head.

After Feedings

  • Pump breasts as needed to relieve excess fullness.
  • Apply ice or cabbage leaf to reduce edema.

The Cabbage Leaf Treatment

  • Wash chilled green cabbage leaves
  • Remove the base of hard vein and gently pound leaves
  • Wrap leaves around breast & areola leaving nipples exposed
  • Leave on 20 minutes
  • Remove wilted leaves
  • Reapply new cool leaves until milk begins to flow or areola area compressible enough to hand express or use a breast pump or baby is able to latch on.
  • Repeat only 2 - 3 times

Caution: Overuse can result in reduction or complete suppression of milk supply

Other Recommendations:

  • Nurse frequently (approximately every 2 hours around the clock).
  • Do not skip any feedings until the problem is resolved.
  • Nurse for 10 to 15 minutes on both breasts OR 15 to 25 minutes on one breast (Use a breast pump or hand express to relieve fullness in the opposite breast).
  • Do not give supplements of formula or water unless ordered by your physician.

Call the Lactation Consultant if you don't see improvement. (908) 788-6335

Faulty Latch-on

can be frustrating. Here are several recommendations:

  • No bottles or pacifiers until the problem is resolved.
  • Pull the nipple out prior to feeding: use a breast pump,try rolling the nipple between your fingers, or apply ice to the nipple only.
  • Dribble milk over nipple, or express a few drops so baby can taste it.
  • Work on suck training: Insert a finger into baby's mouth to the soft palate with pad of finger up; push down on back of the tongue and pull finger forward; repeat 3 times. Immediately put baby to breast.
  • Be sure you are positioning baby properly at the breast: you should be chest to chest with baby as close as possible; position baby so he is aligned from ear to shoulder to the iliac crest; (hipbone)
  • Hold him horizontal at your waist in flexed position; Support your breast with a hand behind the areola, fingers below, thumb on top.

for proper latch-on

  • Stroke nose-lips-chin, or apply slight downward pressure on chin.
  • When his mouth opens wide with lips flanged and tongue over lower gums, pull infant quickly to breast (do not bring breast to infant).
  • Place the nipple and at least 1" of areola in baby's mouth, keeping head snug at breast - nose and chin gently touching breast tissue.
  • If baby's nose is obstructed, slide him up slightly or tip head slightly to expose nose.

There are several Supplementation techniques you also may try. Please contact the Lactation Consultant at (908) 788-6335 for complete instructions.

Assuring let-down reflex

Establish a routine for nursing. Sit in the same place, drink water, listen to music, use visual imagery to prepare. Get comfortable.
If baby refuses to cooperate, try feeding him when he is drowsy.
A good estimate is to allow as long for a problem to clear up as it took to develop. Don't become discouraged!

Increasing The Supply Of Milk

  • Breastfeed more often.
  • Assure good positioning and deep latch-on for maximum stimulation.
  • Use a breast pump for 10 minutes after feedings.
  • Use a hospital-grade breast pump supplied with a bilateral kit.
  • Visit your hospitalized baby before pumping.
  • Rest for 10 or 15 minutes before pumping. Eat or drink something.
  • Apply warmth to breasts and massage before pumping.
  • Massage again after 5 minutes of pumping.
  • Pump for 10 to 15 minutes (using a double pump kit) every 2 to 3 hours or as needed.

Learn to condition your let-down reflex:

  • Play relaxing music; imagine your baby, or look at a picture of her; smell a piece of her clothing.
  • Always pump in same place.
  • Practice slow, deep, relaxed breathing.
  • Choose a quiet, relaxed place for pumping.
  • Reduce the stress and activity around you.
  • Increase your fluid intake.
  • Fenugreek tea or brewers yeast helps increase supply in some women.
  • Eat nutritious meals, continue to take prenatal vitamins.
  • Have a back rub to stimulate the nerves that serve the breasts.
  • Increase skin to skin contact with your baby; take a nap together.
  • Give yourself the opportunity for "Kangaroo" (skin-to-skin) contact with your premature baby if possible.
  • Keep a daily log with the number of pumping sessions. And remember: the amount you obtain over a 24 hour period is more important then each individual session.

Soreness

  • Sometimes even "experienced" breastfeeding mothers can experience soreness of the nipples. Many environmental factors - even a change in your laundry detergent - can cause changes in the breast that lead to discomfort. Don't give up! Here are some things to consider.
  • Check for signs of thrush: white patches in baby's mouth, diaper rash, red, flaky nipples, mother complains of burning nipples or vaginal yeast infection.
  • Be sure you are positioning baby properly; you should be chest to chest, with baby tucked in close.
  • Hold your hand in a "C" hold to support your breast, with your hand well behind the areola.
  • Work for proper latch-on: Stroke baby's face from nose to lip to chin until she opens wide; her lips will flange, and her tongue should be over her lower gums. Then pull her to the breast quickly, and the nipple and most of the areola will go in her mouth.
  • Change baby's position at each feeding (cradle, football, lying).
  • Apply hindmilk to nipples and allow to air dry. You may want to try using some pure lanolin.
  • Expose to sunlight after feedings or leave bra flaps open when you can.
  • Wear breast shells until nipples are healed, except when feeding.
  • Avoid any plastic in bras or nursing pads.
  • Feed baby frequently (every 2-3 hours).
  • Use your fingertip to break suction before removing baby from breast.
  • Make sure the nipple does not stick to bra flap (loosen with water if needed).
  • Treat both mother and infant for thrush if necessary.
  • If your skin is sensitive to detergent, rinse bras twice after washing.
  • Begin feeding on least sore side.
  • Do not allow baby to fall asleep while nursing.
  • Discourage baby from biting: React normally to sudden pain and discontinue that feeding; Keep your finger ready to place between gums when beginning to bite; Allow sucking on pacifier, teething ring, or a finger before feeding.
  • Do not use a "bicycle horn" type of breast pump.
  • Do not give any bottles until the problem is resolved.

Be sure to call the Lactation Consultant if your problems persist. (908) 788-6335

Storing Breast Milk

Choose a breast pump suitable for your needs; the Lactation Consultant can guide you in this choice.

FOR SHORT-TERM OR OCCASIONAL USE, consider
Hand expression; a hand cylinder pump - not a "bicycle horn" type; a battery-operated pump or inexpensive electric pump.

FOR LONG-TERM OR FREQUENT USE, consider
Renting a hospital-grade electric pump

  • Wash your hands before expressing (do not wash breasts).
  • Store milk in any clean container (for premature infants, you may need sterile container).
  • Date the container and time of expression - use oldest milk first.
  • Fresh breastmilk may be kept at room temperature for up to 8 hours.
  • Refrigerate up to 72 hours.
  • Freeze at 0 F. for up to 6 months (place in back of freezer, not in the door, where the temperature fluctuates).
  • Thaw in a pan of cool water or overnight in the refrigerator.
  • You may warm the milk in tepid water if desired before feeding.
  • Do not microwave - there is a danger of scalding baby and losing nutrients.
  • Thawed milk may be kept refrigerated for up to 24 hours.
  • Discard any milk left over in bottle after a feeding.
  • Wash breast pump parts in hot, soapy water, rinse well and allow to air dry, or wash in dishwasher.
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