Feeding Your Newborn

Breastfeeding

As new parents, it is your responsibility to make sure your baby will get off to a good nutritional start. With your choice to breastfeed you have joined the majority of American women who feel this is the best and most ideal way of feeding your baby. Almost as important as getting your baby off to a good nutritional start is the contribution that breastfeeding makes toward the infant’s emotional development. Breastfeeding will also promote wellness in your infant due to the presence of antibodies in breast milk.
There is no doubt that breast milk contains all the nutrients required and is perfectly matched for your baby’s needs for proper growth and development. Studies prove that breast milk provides optimal health and benefits the newborn for as long as you choose to breastfeed. Your choice to breastfeed, though, is just that your choice. It is an entirely personal decision. Do not let others make up your mind for you. You will hear pros and cons from other women, from your mother to the friendly woman in the grocery store, about their life experiences with breastfeeding. Some of what you will hear will make you cringe and may sway you to not try even if you thought this might be something you wanted to do. Other women will make you feel that you will be a terrible mother if you do not choose to breastfeed. Look deep inside yourself and decide what it is YOU want to do. Whatever you decide, it will be the right decision because you made it yourself.

Once you make your decision and if you choose to breastfeed, then there are three things you should do:

1. Talk to your healthcare professional about your decision.

2. Become well-informed about breastfeeding through information you can obtain from your physician’s office, or take classes on breastfeeding from your physician’s office or hospital.

3. Find yourself a knowledgeable contact and support person who can answer questions and listen to you if you have any nursing questions or problems.

Benefits

Both popular and medical opinions agree that there are many benefits to breastfeeding for both mother and baby:
For Baby - Breast Milk Benefits:

• Easily digested

• Perfectly matched nutrition

• Filled with antibodies that protect against infection

For Mother - Breastfeeding Benefits:

• Convenient

• Economical

• Helpful with the process of the uterus returning to its normal size

Benefits to Both Baby and Mother:

• A beautiful and intimate way a mother can bond with her baby

• Contributes to a very special and loving relationship

Anatomy of the Breast

The breasts are delicate organs made of glandular, connective, and fatty tissue. The nipple contains 15 to 25 tiny openings through which the milk can flow. These tiny openings are surrounded by muscular tissue that cause the nipple to stand erect when stimulated. Surrounding the nipple is an area of darker skin called the areola. This area will become darker and larger in size during pregnancy due to hormonal changes. The areola contains pimple-like structures near its border that are called Montgomery glands. These glands secrete a substance that helps to lubricate and cleanse the area.

Physiology of the Breast

Stimulation of the nipple by the baby’s sucking sends messages to the tiny pituitary gland in the brain. It in turn secretes a hormone called prolactin. Prolactin stimulates the milk gland cells within the breast to begin producing milk.
The second hormone that is released is known as oxytocin. This hormone causes the cells around the milk glands to contract and squeezes the milk down the milk ducts. The milk pools behind the nipple and beneath the areola, in the milk sinuses. This response is known as let-down or milk ejection reflex.
The sensations you may notice are as follows:

• Tingling sensation

• Warm upper body sensation 

• Feeling your breasts become full

It may take a minute to several minutes until the milk ejection reflex occurs. Please know that emotional upsets, fatigue, or tension can slow down the let-down response. Some mothers only know that their milk has let down by seeing milk in the baby’s mouth.
Things that cause the milk to let-down are the following:

• Your baby crying

• Thought of your baby

• Smell of a baby or baby products

• Seeing other babies

By 16 weeks of pregnancy, your breasts are fully capable of producing milk. Some women will notice drops of fluid on the nipple during these early months. This fluid, known as colostrum, is the “first milk.” It is what the baby will receive until your higher volume milk is produced which takes 3 days after delivery.
Colostrum is described as follows:

• A thick, yellowish fluid commonly called “Liquid Gold” 

• Very high in protein

• Easily digested

• Serves as a laxative and helps clear the baby’s intestinal track

• Beneficial in loosening mucous in baby 

• Provides protection by containing antibodies and passive immunities

• Coats the stomach and intestines and protects any invading organisms

Preparation of the Breasts for Nursing

Healthcare professionals may differ in their opinions on preparations of the nipples for breastfeeding. In the past some women were told they had to “toughen-up” their nipples before delivering to get them ready for nursing. There is little evidence that toughening helps. Excessive stimulation of the nipples causes the uterus to contract. You may want to check with your healthcare provider as to their recommendations for preparation.
What is known in helping prepare your breasts is that you should do the following:

• Expose both breasts to room air a few minutes every day.

• Avoid soap to the nipple and areola; this will only cause dryness.

• Wear a good supportive bra during pregnancy.

• Allow your breasts to air dry after showering and also during the day if you are leaking colostrum.

If leaking colostrum, you may want to purchase breast pads. The pads may be either disposable or washable. Do not use a “mini-pad” inside your bra. The sticky area on it prevents air from being able to circulate and may cause nipple soreness. 
Have someone knowledgeable about nursing bras to help you with the purchase of a well-fitting bra.
Be careful about underwire bras. The wires may place pressure on the ducts and cause a blockage of milk.

Supply and Demand

As long as your baby nurses frequently and is allowed to finish the feeding completely, then he or she will have all the milk needed for proper growth and development. Milk production is regulated by supply and demand. The concept being the more milk that is removed, the more milk that is made. The less milk that is removed, the less milk that is made.

Nipple Problems

Occasionally, a mother will exhibit a flat or inverted nipple. These problems can be corrected and should not discourage someone from trying to nurse. Early detection and correction can help to promote a positive nursing experience. Ask your healthcare professional if you are suspicious of a nipple problem. A simple test you can do is the “pinch test.” When pinching or stimulating the nipples, they should stand erect and not stay flat or be drawn inward.

Breastfeeding Relationship

A good breastfeeding relationship takes time. As a new mom, you tend to have unrealistic expectations of yourself and your newborn. It is easy to become discouraged if things are not going well. Although a lot of reactions and responses are innate, breastfeeding is a learned experience and it will take time for you and the baby to be comfortable with one another. Readiness is important, and there are three “C’s” you must review with yourself every time you start breastfeeding.

Calm
This is a good time to use any breathing techniques learned in childbirth classes. Your emotions are tied in very closely to the let-down response and the baby can sense if you are uptight, so relax and breathe!

Comfortable
Have pillows all around you in a comfortable chair for support and elevate your legs - either with a little stool or a stack of newspapers. This will take pressure off of your bottom and help with your comfort level. The first few days at home, take the phone off the hook and tape a “DO NOT RING” note across the doorbell so that you will not be interrupted.

Close
You must hold and position the baby close to you. Proper positioning and latch-on are the key to successful breastfeeding. Remember, even though breastfeeding is a natural process, it is also a learned process. It is important for you to take a breastfeeding class. Classes can assist your breastfeeding experience by teaching you how! Your instructor will review position and proper latch-on techniques that are important for you in getting off to a good start.) See your hospital or clinic about available classes.

Breastfeeding: When and How

Initiate breastfeeding as soon after the delivery as possible. While in the hospital, learn as much as you can from your nurse about your baby. ASK QUESTIONS!  Have the nurse watch you latch the baby on so you can go home feeling comfortable and confident that you know and understand the proper techniques. There are different positions to hold your baby while nursing. This will prevent the same position pressure points on your nipples, and help with more breast-emptying throughout the day. These positions are as follows:
Watch for the early hunger cues such as lip smacking, mouth opening, and hand to mouth. In the early days, some babies are sleepy and often do not cry when they are hungry, so stay attentive to the cues. After the first sleepy week, crying is a late cue.

Correct Latch-On

Getting the baby to latch-on correctly is one of the most important steps in successful breastfeeding. The baby must open his/her mouth wide enough to get at least 1 inch of the areola tissue in his/her mouth. It is the compression of the milk sinuses that are located beneath the areola that will allow the milk to be drawn out through the nipple as the baby sucks and let-down occurs.
Latch-On: The baby is positioned on the breast with all the nipple and at least an inch of the areola in his/her mouth. The baby’s lips are flanged out. It is the compression of the milk sinuses located beneath the areola and the baby’s tongue resting on top of the lower gum which will allow the baby to draw the milk out through the nipple. If the baby latches on to just the nipple only, you will become sore and the baby will not get very much milk.

The Following Guidelines Will Help You To Properly Position and Latch The Baby To Your Breast:

• Prepare yourself by washing your hands, getting comfortable, and deciding on a position.

• Align the baby so that he/she is tummy to tummy with you.

• Hold your breast in a “C” position and gently lift and support the breast. Make sure your fingers are well away from the areola tissue.

• Gently stroke the baby’s lower lip with your nipple to elicit the rooting response.

• Keep repeating this motion until the baby opens his/her mouth the widest. Do not allow the baby to latch on to your nipple! This will cause your nipples to break down and become sore and cracked. It is very painful if the baby only sucks on the nipple!

When the baby opens wide, quickly pull him/her toward your breast and latch on.

Signs of a good latch-on:
 - All of nipple and at least 1 inch of areola is in baby’s mouth
 - Lips flanged out
 - Tongue over lower gum
 - Baby stays on breast

Burping

To take the baby off the breast, slide your finger into the corner of the baby’s mouth, between his/her mouth and your breast, to break the suction. Do not pull the baby off your breast. This will traumatize your nipples and lead them to becoming sore and cracked. It is important to burp the baby between breasts and after the feeding to get rid of any air swallowed during the feeding.
Effective Ways Of Burping Are As Follows:

• Over the shoulder 

• Lying belly down across your lap

• Sitting in your lap with chin supported

Usually the pressure on the baby’s belly is enough to bring up the air. Pat the baby’s back gently or stroke the back with an upward motion. Sometimes babies will not burp. If they did not get a lot of air in the stomach during the feeding, it is likely that they will not. After a few minutes resume with the feeding.

Guidelines and Technical Points for Frequency and Duration of Feedings:

• A baby needs and naturally requests 8-12 feedings in a 24-hour period.

• Approximately every 2-3 hours with one 4-5 hour stretch (hopefully at night!)

• may cluster feed - your baby may want several feedings in a row.

• It is important to feed your baby when they request

• Each cluster feed counts toward the 8-12 in a 24-hour period.

In early sleepy days, the baby tends not to request feeds often enough.

notice hunger cues

• wake the baby by 2 1/2 hours from the beginning of last feed 

• keep baby interested and awake

• anticipate longer intervals occurring at night (hopefully)

• Nurse until baby shows signs of being full. 

• self-detaches

• sucking less vigorously 

• breast is emptied in 7-10 minute

nutritive sucking important to listen for:

• First three days may be difficult to hear swallowing with the small amounts of colostrum but can be heard. It sounds like a soft “Ca-Ca” or a soft expiration.

• After larger milk volume arrives, you will hear definite suck to swallow ratio changes.

• Offer both breasts each feeding as this is important for stimulation in milk production.

• keep baby interested and awake

if they choose to take only one breast at a feeding, make sure you then begin with the other breast at the next feeding

Alternate the breast with which you begin each feeding. To help you remember this, use a safety pin on your bra strap. This will help with proper milk removal from the breasts.

If you follow these steps you will insure proper milk removal completely and regularly, increase milk production, reduce breast engorgement and nipple tenderness, and maximize infant weight gain. The first sleepy week or two may be a challenge for you to keep them interested in the feeding.

Note - Take cues from the baby he/she Will let you know!

How Do l Know The Baby Is Getting Enough To Eat?

The most common concern that you will have is whether the baby is getting enough to eat. Unfortunately there are no ounce markers on the breast for you to see the exact amounts your baby is taking on. This can be unnerving at times. There are many clues that indicate that everything is going well.

Be Attentive To The Following:

• Baby eating every 2-3 hours during the day
   -sleeping no longer than 3 hours between feeds during the day
   -may have one 4-5 hour stretch at night

• Baby wetting diapers
   -1 diaper in the first 24 hours after delivery
   -3 on the second and third day of life
   -5 to 6 wet paper diapers (or 6 to 8 cloth diapers) of urine that is light yellow in color once milk is in

• Baby will be passing meconium for first few days

• Stool changing to mustard color, runny, and seedy in texture once the milk is in 
   -2 to 4 of these stools per day

If you have any concerns about how the baby is doing, call your baby’s doctor. Most offices will allow you to bring them in for a weight check. Sometimes that is all you need to make you feel better! Weight gain is an important clue to your baby’s doctor that the baby is feeding properly.

Other Positive Signs Are The Following:

• Audible swallowing - actually hearing the milk being swallowed

• Breast feels less full after feeding

• Baby satisfied-falls away from the breast at the end of feeding

• Baby content between most feedings

Baby weight gain of 4-7 ounces per week once milk is in (expect initial weight loss after delivery - should be back to birth weight by week two).

Time Of Awareness and Perseverance

Engorgement

Two to three days postpartum, your breasts may become engorged. This is caused by an increased flow of blood to the breast, swelling of the surrounding tissue, and the accumulation of milk. The breasts will be swollen and uncomfortable for some women and they may experience a throbbing sensation and discomfort with the milk ejection reflex, or let-down. Some women will become only slightly full. As with labor, we are all different in our experiences. Engorgement usually lessens within 24 to 48 hours.

Some Effective Treatment Measures For Breastfeeding Mothers

• Wear a supportive bra even at night, but make sure it is not too tight (this tends to suppress milk production).

• Apply warm compresses or stand in shower to initiate let-down.

• Nurse frequently.

• Manually express or pump milk to soften the areola and nipple - the baby cannot latch-on if it is too hard (common problem with breast engorgement).

• Apply cold compresses to breasts after nursing to relieve the swelling and soothe the discomfort.

Allowing yourself to become engorged beyond the initial engorgement should be avoided if at all possible. If the baby refuses to eat, or you have to skip a feeding, then pump or manually express your milk. Engorgement sends signals to the brain to slow down milk production and can cause other problems as listed below. As mentioned earlier, milk production is regulated by supply and demand. If you slow down your feedings, you will see a significant decrease in your milk production.

Sore Nipples

There is no doubt that sore nipples tend to discourage you from this wonderful bonding experience. Expect some tenderness by the second to third day, but it should resolve by day seven to ten. Usually, extreme soreness is due to improper positioning and latch-on which can be relatively easy to fix. If you cannot identify the problem, call a knowledgeable friend or a lactation consultant. Do not let the problem get worse. Remember, breastfeeding should feel good-it should not hurt.

Cracked Nipples

This problem is usually due to improper positioning and latch-on or traumatic removal from the breast. Excessively dry tissue is another reason for this problem. Treatments of cracked nipples include correcting the positioning and latch-on, and proper breaking of suction before removing the baby from the breast. Rub some expressed breast milk into the area and allow to dry. You can also talk to your doctor about applying lanolin into the affected area.

Blocked Ducts

These are felt as lumps under the skin and in the substance of the breast and are sore to the touch.
These May Be Caused By The Following:

• Change in frequency of feeding or skipping feedings

• Nursing only from one breast

• Over-abundant milk supply

• Heavy breast not well supported

• A tight bra or underwire bra that puts too much pressure over a duct

Treatment of Blocked Ducts includes the following:

• Warm shower or compress to affected area

• Frequent feedings

• Massaging of affected area toward nipple while nursing

• Placement of the baby in a position where the baby’s chin is facing the blockage

Mastitis

If the blocked duct persists and does not become relieved, it can turn into a breast infection. It is not the breast milk that becomes infected but the tissue surrounding the blockage. This needs immediate medical attention. Treatments consist of nursing frequently, applying warm compresses, massaging while nursing, getting plenty of rest, and drinking fluids. Antibiotic therapy can also be used.
Remember to inform the baby’s doctor if you are placed on medications!

Dietary Requirements For The Mother

Nutritional requirements are similar to those of pregnancy as far as keeping your diet well-balanced. A nursing mother needs an additional 500 to 600 calories per day. Milk production is independent of what you eat the first 4 weeks because it derives the calories it needs for production from the fat accumulated during the pregnancy. If you do not eat properly from the beginning, you will find yourself being very fatigued. The baby gets what it needs - you are the one who suffers.
Another important aspect of nursing is that you will find yourself very thirsty. The best advice is to drink to thirst. You must listen to what your body needs. The body takes water from your system to make breast milk. If you do not drink at least 6-8 glasses of fluids per day, you may find yourself being constipated. When you sit down to nurse, have water or juice so you get your daily requirements. No foods are universally restricted from your diet. Your baby will let you know! Gastric disturbances may be felt by the baby if you consume large quantities of a particular food. Examples would be cabbage, onions, garlic, or beans. If the baby exhibits a diaper rash, it may also be due to something you ingested. Food affects the milk 4 to 24 hours after it is eaten. So think back and try to discover the culprit. If dairy is the culprit, it may take two weeks for it to stop bothering the baby once it is eliminated from mom’s diet.
Supplemental Feedings For Your Baby
It is a well-known fact that introducing bottles too soon after birth can cause nipple confusion. Most of your doctors will agree that until your milk is well established and you have developed a good breastfeeding relationship, a supplemental feeding of water or formula is not necessary. There are some extenuating circumstances in which your pediatrician would prescribe a supplemental feeding. All babies are different and have different needs. This does not mean you will not be successful at breastfeeding.
After your milk is well established, it is a great idea for your partner to feed the baby a bottle. It can be either pumped breast milk or formula. Whatever you decide, along with your baby’s doctor, will be fine. Try to exclusively breastfeed for the first 3-4 weeks. Most literature agrees that 3-4 weeks is a good recommended time to start introducing a first bottle. Do not overdo the bottle, though. The baby could develop bottle preference at any age if too many bottles are given.
Storage Of Breast Milk
Make sure when storing breast milk that you label and date the container so that you can be sure that your baby is receiving breast milk that is not outdated. You can use plastic bottles or bowls for storage of breast milk. Never microwave or boil breast milk. Microwaving could cause “hot spots” in the milk because microwaves heat unevenly and could potentially burn the baby’s mouth and throat. Also, it can alter the protein make-up of the breast milk and may destroy the antibody composition of the milk. All you need to do is run it under warm, tap water. You can also place it in a bowl of warm water to thaw or warm the milk, bringing it to room temperature. Make sure to shake the thawed breast milk well. It will separate upon storage and the creamy portion of the milk needs to be redistributed.

Common Concerns

• My breasts are too small.
 -Breast size has nothing to do with milk production. Do not let anyone tell you
  otherwise.

• How can my partner find me the least bit attractive?
 -Sexuality and recapturing closeness as a couple both take time. You and your partner both may feel overwhelmed. Some women are embarrassed about all the changes to their bodies and feel unattractive and distant toward their partner. Men, do not take this temporary diminished interest in you as a rejection. Talk and laugh with each other, and make time for yourselves. Communication is the key!

• My breasts leak all the time! 
 - It is not uncommon for you to be out in public and hear another baby cry, causing your milk to let-down. Applying gentle pressure to the nipple will usually stop the flow of milk. Disposable or washable breast pads are available to protect your clothes from wet spots! Change them as needed to avoid the breakdown of nipple tissue. Leakage is less problematical as time goes on.

Father’s Concerns - A Note To Dads

The extreme closeness of a nursing mother and baby may contribute to feelings of isolation in a new father. Feelings of uselessness and being deprived of one of the most enjoyable ways of relating to the baby often surface the first few weeks. You will find most of the attention will be directed toward the mother and the baby and you may become the “gofer.” There are ways that you can become close to the baby even if you are not taking part in the feeding aspect. Diapering, bathing, and cuddling are great ways to be involved. Your touch is very important to your baby and he/she will learn much from it.
Fatherhood is an addition to your life. It will demand an enormous lifestyle change for you and your partner, yet it is the most rewarding time of your life. Be patient with yourself and your partner. You are now a DAD.

Going Back to Work and Continuing to Breastfeed

In the past, employers have recognized six weeks as a reasonable time to recover from the delivery of the baby. On occasion, your doctor may require that you stay home longer because of a special medical problem. Financial considerations may require that you return to work earlier.
Breastfeeding mothers can do the following:
Pump their milk and save it when away from their babies;
Breastfeed when they are with the baby and wean to formula when they are away; or 
Wean baby completely, though the baby would benefit greatly from receiving even some breast milk every day.
There are great breast pumps on the market today that can help support your decision to continue to breastfeed. Check with your hospital or lactation center for breast pump rental and purchase prices. Your employer may be flexible and have several options for you. You should explore the possibilities as soon as possible.

Formula Feeding

Even though there are many advantages to breastfeeding, formula feeding is an acceptable alternative for many mothers. Scientific advances make it possible to prepare formulas, made from cow’s milk or soy proteins, that provide safe substitutes for breast milk.
There are a few mothers who may not be able to produce milk. Certain breast reduction surgeries with nipple relocation are examples of this situation. Studies have shown, though, that there have been some such women successful in breastfeeding by producing milk or using a supplemental device. Virtually all medications you take are transferred through the breast milk to your infant. Therefore, if you are on cancer treatment drugs, certain antibiotics such as tetracycline, or antidepressants such as lithium, you should consult your physician and your baby’s doctor.

Your pediatrician or family physician will start your baby on the formula that is right for him/her. Initially your baby will want to eat every 2-4 hours. Your nurse and doctor will instruct you on the appropriate amounts of formula your baby will need and how often. Before you are discharged from the hospital, make sure that all of your questions are answered.

The following steps will help you in feeding your baby from a bottle:

• Make sure you have plenty of bottles and nipples and a bottle brush to clean all of the bottle parts.

• Wash the top of the can with soapy water then rinse well with water to remove any dirt from the lid.

• Always check the can and know what you are preparing.

• Sometimes we think we grabbed “ready to feed” at the store but it is actually “concentrate.”

• Check the expiration date on the can.

• Make certain that the bottles and nipples are thoroughly cleaned and rinsed.

• If you cannot prepare all the bottles at that time, then cover the can and store it in the refrigerator. Prepare the rest within 48 hours of opening it. If you do not use it in the allotted time, throw it out.

• Before feeding the baby, make sure that the temperature of the formula is what the baby prefers. Never microwave formula. This could burn the baby’s mouth. Microwaves heat evenly, and there could be a hot spot in the formula. If you need to warm it for the baby, just place the filled bottle under warm running tap water to take the chill off.

• Tilt the bottle to check the nipple hole. If the formula is running out, then the hole is too big and the baby could choke. Throw that nipple away. If nothing comes out and the baby seems dissatisfied, then the hole may not be large enough. The formula should drip from the tilted bottle with ease.

• Never prop the bottle and leave your baby for any length of time.  This could cause your baby to choke.

• If your baby does not finish the entire bottle, you must throw whatever is left away. Bacteria will grow very quickly in the leftover formula because saliva from your baby’s mouth is transferred into the bottle during the feeding.

• Take your time with the feeding, letting your baby look around and discover the world. This is a wonderful time to learn about your baby and your baby to learn about you, so hold him/her close and enjoy!

The Choice Is Yours!

In the end, how you feed your baby is your choice. Millions of children have been raised using both techniques without any major long-term effects. What’s important is for you to feel comfortable with how you feed your baby. Do what’s best for you - not what everyone else wants you to do!

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