Saturday, March 14, 2015

Getting Breastfeeding Off to a Great Start

Skin to skin family bonding after birth!
by Glenni Lorick, IBCLC

You know that you want to breastfeed your baby, but maybe you've heard stories about mothers who didn't make enough milk or who had a variety of problems. Many (not all) breastfeeding problems can be avoided by getting off to the right start. Today we're going to examine what that looks like!

Immediate Skin-to-Skin

The first step to a long term breastfeeding relationship is skin-to-skin contact right after birth. Let the nursing staff know that as soon as baby is born you want him placed directly on your chest. They can do all of the procedures that they need to do with baby right there on your chest. He doesn't need to be placed under a warmer because your chest is the perfect warmer for him!

Skin to skin before baby is bathed is best!
Baby will be placed on your chest naked and a warm blanket will be used to cover both of you. Some hospitals will allow you to delay eyedrops until after the first feed. It is important to note here that if there are any complications with mother or baby, this may not be possible. 

If you labor without any medication, your baby may actually latch on by himself with no help from you at all after birth. However, if you do have an epidural or even a C-section, your baby will still be ready to nurse within the first 30-45 minutes after birth.

Baby on top of mom for feed.
Research shows the following benefits for immediate skin to skin contact:

  • It helps regulate baby's body temperature
  • It helps regulate baby's breathing
  • It helps to raise baby's glucose levels
  • It facilitates breastfeeding

Positioning Baby for First Feed

If you are in a reclined position, baby may just lay right on top of you either horizontally or vertically. Baby will most likely be able to latch on with little or no help from you! 

If you feel like sitting up  instead of lying down, then you might find a reverse cradle hold or a football hold will help provide the support baby needs to stay on the breast. 

The goal of the first feed is to let baby achieve the best latch possible with as little intervention as possible. 

Baby lying horizontally with mom reclining.
Listen for swallows during the first feed.  The sound almost like tiny sighs. You should see movement all through baby's jaw, and you will see her throat move as she swallows. Even though your milk isn't in yet, your baby is getting colostrum that will form a protective seal for her intestinal tract and provide her valuable immunity. 

Let baby stay latched as long as he wants to. If he comes off and is interested in nursing on the other side, then switch sides. If not, then you will just nurse on the other side next feed.

During the First Few Days

A good latch with very little areola showing.
Every time you nurse your newborn during the first few days of life, you are creating prolactin receptors on each of your milk glands. Research indicates that early frequent feeds are a key indicator for successful long-term production of milk. You need to nurse your baby every 2-3 hours around the clock from beginning of feed to beginning of feed. The first four days or so, your newborn needs to nurse AT LEAST 10-12 times in a 24 hour period. Some babies may nurse even more!

Usually mothers who nurse frequently in the first few days have their milk come in by the fourth or fifth day. At that point baby still needs to nurse at least 8 times a day, but many will continue nursing 10 or more times in a 24 hour period. 

Upper and lower lips should be flanged.
When you nurse be sure that baby has a good latch. Latch him on with his chin low on your areola. Support your breast using a C-hold with your thumb on top and your fingers on the bottom below the areola, aiming the nipple up toward the back of baby's mouth. Wait for him to open his mouth as wide as he can, then pull him on tight. Your partner can tuck a rolled up blanket behind the hand that is supporting him for extra support. You should note that his lips are flanged , and you should see very little areola (unless you just have really big areolas!)

If It Hurts

If a baby has a good latch, your nipples will not crack or bleed. You may experience some tenderness as you get used to breastfeeding, but if your toes are curling and it's all you can do to let your baby near your breasts, then something is definitely wrong! If you are still in the hospital ask to see a lactation consultant as soon as possible. If you are home, call for the next possible appointment. It could be a problem with baby's oral anatomy or it could be that baby's latch just needs to be adjusted, or maybe your baby just needs a little bit of suck training. But get help immediately to resolve whatever issue you're having so that you and your little one can have a terrific breastfeeding experience!

Feed your baby early and often!

Special thanks to all the ANM mamas who shared these precious photos with us!!

Thursday, March 5, 2015

Using a SNS to Save (or Create) a Breastfeeding Relationship

by Glenni Lorick, IBCLC

Did you know that adoptive mothers can nurse? And mothers who have problems with supply can nurse? And mothers who have premature babies with very week sucks can breastfeed? In fact, any woman who wants to breastfeed her baby can do so with an amazing device called a Supplemental Nursing System.

A mother can put formula, donor breast milk or her own milk in the bottle and attach the two tubes to the breast right at the nipple using paper tape (included with the SNS). The tubing can be closed off via a slit in the cap so that no milk will flow until it is released.

When the baby latches on and begins to suck, the mother can release the tubing allowing the supplement to flow. The specific method of use depends upon the mother's own milk supply, the baby's condition, and the reasons she is using the SNS.

Preemie or Special Needs Baby

The mother of a Premature or special needs baby will not be able to rely on her baby to establish a good milk supply. She will need to pump frequently in the early days (8-12 times a day for the first 4 days) in order to create an abundance of prolactin receptors on each milk gland. Once milk comes in, she will need to continue to pump at least 8 times a day for the next few weeks. Most exclusively pumping moms find that they settle into a routine of pumping 5-8 times a day by the time baby is a few weeks old. The SNS will allow mom to feed the pumped milk directly at the breast. Although the baby's suckling may produce some stimulation, it will not be sufficient at first. As a premature baby grows and gets stronger, his mother will find herself having to pump less and less for stimulation. Usually premature babies can wean off the SNS around the time of their actual due date or shortly thereafter.

When a premature baby first begins to feed with the SNS, mom needs to have the flow open from the beginning. Premature babies can burn a lot of calories nursing - valuable calories that they need to grow. The SNS (or a similar product like the Lact-Aid) makes it much easier to get the milk needed with much less effort. As baby grows, Mom can begin the feed with the tubing closed, then open it as the feed progresses and baby stops actively sucking and swallowing.

Infants with special needs like a cleft lip, Down Syndrome or any other condition that makes suckling difficult or ineffective may be able still have a breastfeeding relationship using the SNS. It truly varies from baby to baby, and a mother with a special needs baby really needs to work closely with an International Board Certified Lactation Consultant (IBCLC).

Mom with a Low Milk Supply

The SNS is a true blessing for mothers who struggle with milk supply because it allows the mother to supplement the baby right at her breast. This is vital because the active suckling of the baby actually helps stimulate Mom to make more milk.  Instead of nursing, then supplementing with a bottle if baby isn't getting enough, the SNS allows the entire feeding to happen at the breast. Whether her low supply is due to breast surgery, hypoplastic breasts, PCOS or any other condition, the SNS can help any mother feed her baby entirely at the breast.

If a mother is struggling with supply she needs to begin the feed with the SNS closed. I recommend nursing on one breast until baby stops actively sucking and swallowing, then switching to the other breast with the SNS still closed. After baby has nursed on both breasts and is no longer swallowing, return to the first breast, but open the SNS so that baby receives the supplement flowing through the tube as he nurses. This will help the baby to continue actively sucking and swallowing and actually enable him to suck deeply enough to receive some of the hind milk. It is up to Mom whether he needs to burp and switch sides again. But if he is getting more than 1 oz. of supplement, it is a really good idea to split it between the two breasts so that he is nursing 2 times on each breast
From the San Diego Breastfeeding Center. 
Photo: Barbara Robertson, IBCLC

Adoptive Moms

Just because you didn't conceive and give birth to your baby doesn't mean that you can't breastfeed him! In fact, some adoptive mothers even begin to make breastmilk by following this protocol set forth by Dr. Jack Newman. The SNS is an integral part of adoptive breastfeeding. Some adoptive mothers are able to obtain breast milk from a donor or a milk bank. NEVER pay for breast milk from an individual. If you do choose to use a donor, make sure it is someone you know and trust.

An adoptive mother will set up the SNS tubing on both breasts and begin the feed with the tube open so that baby will receive milk throughout the feed. In fact, the SNS actually helps stimulate her body to make milk. Generally, however, adoptive moms do end up needing the SNS for all feedings. is

Whether a mother is using it short term or long term. with a premature baby, a special needs baby or an adoptive baby, the fact is that a SNS is a true Godsend for the mom who cannot otherwise have a fulfilling breastfeeding relationship.