HOW TO BREASTFEED: NURSING 101
(Updated with 2020 guidelines)
In our complete breastfeeding guide, we cover:
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One of the big decisions that you’ll have to make as a new mom is about your baby’s nutrition.
You’ll need to decide whether you want to breastfeed or not.
If you decide not to, you’ll need to give baby a specially formulated milk formula.
While it’s a very personal choice and we have no desire to make anyone feel guilty, we’re going to unashamedly promote breastfeeding here because... it’s better!
That said, we recognize that there are a few women (up to 12% according to this study) who cannot breastfeed or have no desire to do so.
Either way, it’s your decision and nobody else’s.
We recognize though that the early weeks with your baby can be daunting, especially if this is your first time to breastfeed.
That’s why we’ve put together this comprehensive guide, which we hope will be of help to you on your breastfeeding journey.
It’s a common myth that breastfeeding is something that you should instinctively know how to do. This is not true.
While some mothers and babies seem to get the hang of it at the first try, for many, it’s a skill that has to be learned.
It’s something that other women with experience in it can teach you. So, don’t be afraid to ask!
After birth, everything can seem a little scary, especially if your labor and birth didn’t go according to plan.
You’ll be given this little person to hold at a time when you’re tired and perhaps sore from the delivery. Your emotions may be mixed, especially up to the fifth day when your hormones are all over the place.
Just remember at this time that the only essential things you need to do are to look after yourself, be with your baby as much as possible, and get breastfeeding established.
Benefits of Breastfeeding
Many studies have shown over and over that breast milk is superior to any other milk you can feed your baby.
It not only provides the best nutrition, but it also supplies antibodies for the baby’s immunity. It regulates growth, development, and metabolism in the early months .
It even helps to make the gut less “leaky” so that nutrients can be absorbed properly.
Colostrum, the first milk that’s produced, is high in antibodies, some that provide immunoprotection by stopping germs from sticking to the gastrointestinal tract.
It also contains antibodies acquired from the mother that are specific to her environment .
Breastfeeding sets up a favorable gut microbiome in the baby. This not only protects him from germs but has also been shown to reduce the incidence of asthma and obesity later on in the child’s life . What a great start to give your little one!
Breast milk also contains hormones and growth factors. It is thought that these positively affect growth and development.
They also help with self-regulation of food intake. For example, ghrelin stimulates appetite and is found in the foremilk.
Leptin suppresses appetite, and “tells” the infant when to stop drinking. It’s different for formula fed babies who tend just to finish the whole bottle.
Breastfeeding also has benefits for you. In the first week or so after delivery, you may notice cramping in your uterus similar to period pain.
That’s because the stimulation of baby suckling causes your body to release oxytocin, a hormone that causes your uterus to contract. This will help it get back into its pre-pregnancy shape and will help stop the bleeding.
Feeding provides a special bonding time between you and your baby. The benefits of skin-to-skin contact cannot be overemphasized .
In the Beginning
Straight after your baby has been delivered, a midwife or lactation consultant should help put your baby to the breast.
This will not only give baby his first dose of nutrient-rich colostrum but will help stop the bleeding from your uterus.
Once back in the ward, they will help you step by step with baby’s first proper feed, showing you how to hold him and how to get him to latch.
Feeding your baby is going to take up a lot of time in the beginning. He may suck from 10 to 40 minutes at each feed, every two to four hours.
Smaller babies tend to need more frequent feeds than bigger ones. Most newborns will demand a feed around 12 times a day, but after the first few days settle into feeding about seven times a day.
Don’t be concerned when your baby loses between 5 and 10% of his birth weight in the first three days . He should begin putting on weight after that.
Your first milk will be a watery yellowish fluid. This is the colostrum that your body produces before your milk comes in.
This “superfood” is exactly what baby needs in the first few days because it contains antibodies plus all the protein, fat, vitamins, and minerals necessary for your baby’s growth.
Colostrum is also a mild laxative, and it helps to clean out the sticky blackish meconium that makes up the first stool.
Third Day Onwards
On about the third day, your breasts will start to produce proper milk.
Your breasts will feel full and will get larger when this happens. Try to feed baby whenever he demands it as this will help ensure that you set up a good milk supply.
Remember, the more baby suck, the more milk you’ll produce. It’s a case of “supply and demand”.
In the first weeks, your baby may feed every three hours or so, so make sure you have a comfortable chair to sit in and that your baby is latched on properly otherwise your back and nipples will get sore.
There are no rules about how you should hold your baby to feed him, but it is important that you are both comfortable.
It helps to support your back and arms with pillows or a feeding cushion. Baby should be lifted to the height of your breast rather than you leaning forward to reach him.
Some people find it more comfortable to put their feet up as well.
Hold your baby with his head close to the breast, making sure he doesn’t need to turn his head to reach.
The front of his body should face the front of yours. There are a few different positions you can try:
Madonna and Child: Sit in a chair with baby across your lap. Most women feed like this.
Sit in a chair with baby under your arm and his feet against the back of the chair. He will lie against your side.
This is useful for night feeds. Lie down on your side with your baby facing you and also lying on his side.
This position is used when you have a lot of milk, and baby cannot cope with the flow. Lie on your back with your head and shoulders raised on some pillows. Baby lies across your stomach on his tummy.
How to Latch
Brush baby’s lips with the nipple until he opens his mouth very wide.
Draw him chin first onto your breast so that the base of the nipple is in his mouth and the nipple is aimed at the roof of his mouth. He should close his mouth over the nipple and begin to suck.
If it’s very painful, it’s wrong, and you should start again. The important thing is that the whole nipple and areola are in baby’s mouth, not just the tip of the nipple.
If you need to unlatch baby and try again, don’t just pull him off as this will hurt you. Gently slide your little finger into the corner of his mouth to break the suction.
Here are a few tips to help you with latching:
- 1Before latching, hold your breast with your thumb on top and the other four fingers underneath. Hold it so that there’s enough of the areola and nipple showing for baby to latch onto.
- 2Slide the nipple from the center of baby’s bottom lip and down the chin to encourage him to open his mouth wide. When it’s open, bring him to the breast rather than moving the breast towards him.
- 3He must take in as much of the areola as he can. This is the key to not getting sore nipples.
- 4Baby’s lips must be turned out and his tongue under the breast.
- 5Once he’s sucking, you should hear him swallowing and be able to see movement where his ears and temples join.
- 6Ensure that his nose is clear of the breast so he can breathe.
- 7Once he’s latched on and starts to suck, you may feel a tingling in your breasts as they “let down” the milk. Milk may drip from your other breast in the early weeks as he drinks, so you might want to keep a washcloth or toweling nappy handy for this.
Dealing with Sore Nipples
Some mothers experience nipple soreness for about the first two weeks of nursing as their inverted or flat nipple(s) are gradually drawn out by baby’s suckling.
To prevent soreness:
How to Know if Baby is Hungry
There are many little cues that you can learn to pick up on that show when your baby is hungry.
Crying is a late sign of hunger, and it’s better to feed baby before he begins to cry. Crying causes him to swallow air and will also make it more challenging to get him to latch.
Here are some of the earlier signs of a hungry baby:
What if Baby Doesn’t Show It’s Hungry?
Some babies, especially ones that are smaller or premature, want to sleep rather than feed.
They may not show their hunger, but they still need to drink.
In this case, you’ll need to wake your baby every 2 hours in the first 4 weeks, and every 3-4 hours at night.
Wake him by picking him up, unwrapping him and talking to him. Once he is gaining weight consistently (a minimum of 4 oz / 110 grams a week in the first 4 months), then you can stop waking him and let him set his own schedule.
Worried She Isn’t Getting Enough?
It can be difficult to know if you have enough milk and if baby is getting enough. She may NOT be getting enough if:
Concerned That You Don’t Have Enough Milk?
Firstly, it’s impossible for your milk to be “too weak”. Your body will naturally make it in a perfectly balanced way.
It may look watery compared to cow’s milk or formula, but it’s supposed to be like that.
It is possible though to not make enough milk. It’s not usually a physical abnormality but often is due to circumstances that can be fixed.
Here’s how to increase your chances of making enough milk:
Concerned That You Have Too Much Milk?
Your breasts may become engorged with too much milk. They will feel very full and even painful.
When baby feeds, there will be too much for him to empty completely. It’s important to relieve this as soon as possible to prevent mastitis.
Severe engorgement signals to the body to slow down with milk production, so if it’s prolonged, it may reduce your milk supply and cause you to have insufficient milk later.
Is it Possible to Overfeed a Breastfed Baby?
Overfeeding a breastfed baby isn’t common, but it is certainly possible. If your baby is healthy, content, gaining weight within the parameters yet spitting up sometimes, he is probably not overfed.
However, if he’s putting on a lot of weight, has symptoms such as excess stomach gas and greenish watery stools, he may be drinking too much. Spitting up a lot is another sign.
Babies don’t always come off the breast when they’ve had enough to drink.
Some of them use the breast as a pacifier and will stay on it for hours if you allow them to.
Some enjoy sleeping in their mother’s arms with the nipple in their mouth, and if they’re removed, they begin to cry.
In these cases, it’s best to give the baby a pacifier after a feed so that your nipples don’t get sore and so that you can have a break.
This will also prevent overfeeding. You’ll know he’s had enough to drink if your breasts are softer on both sides after a feed.
Breast Milk Storage
Expressing milk means that you can have time off while your partner or someone else feed the baby.
It gets your baby used to be fed by others as well in case you have to go out or go back to work.
Breast pumps are extremely useful if you want to express milk so that someone else can look after your baby for a time.
They’re also used to express milk for babies who are not yet able to latch, such as premature ones.
Using a breast pump is a skill that you will get better at with practice. Be patient with yourself and don’t despair if you don’t get much milk out at first.
Remember, your let-down reflex is usually triggered by contact with your baby, so it may take a little longer to kick in when using a breast pump.
Applying warmth to the area may help with let down.
There are some things you can do to stimulate your breasts to let down more milk when pumping. Express at the times that your baby would typically drink so that your breasts become accustomed to the routine.
You’ll probably need at least 8 sessions in 24 hours at first.
Express for about 15 minutes the first time, and don’t worry if there’s not a lot of milk at first.
Some people like to express about an hour after a feed, while others like to express directly after every second feed. Do what works best for you.
Once you’ve found a suitable schedule, try to stick to it so that your body gets used to the times.
It’s not a good idea to extend the time between sessions to try to get more milk. The trick is to express often and regularly.
Hygiene is very important when expressing, so always wash your hands and breasts with soap and water before starting. The pump parts will need to be sterilized every day and cleaned after each use.
For hygiene reasons, don’t ever borrow someone else’s breast pump or use a second hand one.
Nipple shields are very thin, very soft devices made with rubber or silicone. They are made to cover the areola and nipple area when breastfeeding in special situations. They have a hole at the top to allow the breastmilk to flow through.
Nipple shields are useful if your baby is having difficulty latching on. Premature babies, for instance, sometimes manage better with a small sized nipple shield.
Babies who are born with tongue tie also often can’t latch properly and are helped by a nipple shield.
These shields are also used if there are problems with the nipples themselves. For instance, women with flat or inverted nipples can use them to draw out the nipples, making it easier for baby to latch.
It must be remembered though that baby should never latch onto the nipple itself, but onto the surrounding areola. If the nipples are cracked and too painful for breastfeeding, nipple shields can be used for a short time while the nipples heal.
Nipple shields should only be used under the supervision of a lactation consultant or doctor.
If not handled properly, they can cause low milk supply and breast problems.
It’s vital to get the right size for yourself as an improper fit can block the flow of milk. Baby’s milk intake should be carefully monitored by weighing or checking for wet nappies.
The breasts are not always completely drained when using nipple shields, so a breast pump should be used after a feed to do this so that milk supply is maintained.
You may be wondering if you really need special nursing bras. They certainly make feeding easier. Your bra size will change anyway, so you’ll need a few new bras.
Breastfeeding ones are much more discreet to unfasten in public. They also have space for a breast pad to catch any leakage. A properly fitting bra will prevent your ducts from becoming blocked and therefore prevent mastitis.
What About Winding Baby?
It’s not necessary to spend a lot of time trying to “burp” baby. After a feed, sit him up over your shoulder for a few minutes.
If he has any wind, he’ll probably bring it up in that time. If he falls asleep during a feed, don’t disturb him to wind him.
Many new dads feel powerless to help with breastfeeding, and some feel a little left out. The truth is that Dad’s role is vital for successful breastfeeding.
He can be Mom’s biggest cheerleader and encourage her when she feels like giving up, reminding her of the benefits. He can also put negative relatives in their place.
Many babies settle down and sleep best in their father’s arms. Skin to skin contact is important, and many babies love lying on Dad’s chest where they can hear his heartbeat.
This gives Mom a chance to have a much-needed break and an opportunity to do a few things for herself. It also strengthens the bond between father and child.
Dads can take their babies for a walk in the stroller or baby sling, or even for a drive in the car chair to help them to settle when they’re irritable.
Fathers can also help by bringing Mom a warm beverage or something to eat while she’s feeding.
If the idea is agreeable to both, Mom can express some bottles of milk for Dad to take over one of the night feeds, giving her some much-needed sleep.
Breastfeeding in Public
While breastfeeding in public is legal, there are still a few individuals who make it difficult for mothers to do so.
However, you shouldn’t let this put you off. Provided you’re discreet and do it in a way that ensures your privacy, there’s no reason why you shouldn’t breastfeed your little one when you are out and about.
If you haven’t done it before, it’s a good idea to practice at home first in front of the mirror. This will give you an idea of how much skin you’re showing, how easy it is to unclip your bra, and what clothes are best.
Wear clothes that will make the task easier for you. There are tops especially designed for nursing that have a hidden opening.
Alternatively, a loose top is easy to lift up over baby on one side, and the extra fabric conceals your tummy.
If you used fabric belly bands during your pregnancy, they would also be useful now for covering your post-pregnancy stomach when your top is lifted.
Choose a place where you’ll be able to sit comfortably with your back supported, such as a corner booth in a quiet restaurant, or a park area where you can lean against a tree.
You’ll be most exposed at the beginning of a feed when you latch baby on, so this is the time to turn away from anyone nearby.
Once baby is latched, drape your top over him and turn back around into a comfortable position.
Have a response planned for anyone who makes negative remarks or tries to get you to move.
For instance, you might politely suggest that if the person is offended, they might move to another seat where they can’t see you.
Diet During Breastfeeding
Your diet during breastfeeding will be similar to what you had when you were pregnant. You’ll need extra calories, but if you’re carrying excess weight from your pregnancy, your body will use this for your milk supply.
If you don’t have extra weight, you’ll need an additional 500 calories a day for the first six months .
Focus on getting a nutrient-rich diet and avoiding junk food.
Protein is important, so include a protein at each meal such as eggs, fish, poultry, beans, nuts, or seeds.
Have at least five vegetable servings a day and try to get as many different colors in as possible. A couple of serves of fresh fruit a day will give you enough vitamin C and will increase your fiber intake.
Your carbohydrates should be sourced from whole grains, for example, whole wheat bread and cereals, oatmeal and other grains.
Make sure you drink enough water throughout the day. You should avoid alcohol while breastfeeding completely, but if you do drink a glass of wine you should wait for three hours before feeding or expressing . The alcohol will not stay in your milk for longer than that.
The same goes for caffeine. It is passed on through your milk but doesn’t affect most babies. However, if you notice that your baby isn’t sleeping properly, then you need to cut down on caffeine beverages.
You can eat most foods while breastfeeding but keep an eye open for any colic or diarrhea after you eat certain foods. Some mothers prefer to avoid gas-forming foods like cabbage.
Nursing Supplies Shopping List
While all you need to breastfeed are yourself and your baby, here are the accessories you are most likely to need:
We hope you’re feeling more reassured and confident as you approach this special time with your baby.
Remember that there are lactation consultants available to help and support you as you breastfeed.
Don’t hesitate to call one if you have any concerns.