Getting Started With Breastfeeding After Birth

GETTING STARTED AFTER BIRTH:

• Breast Crawl
• Delay the Baby’s First Bath
• Getting a Good Latch
• Newborn Procedures
• Positions for Breastfeeding

The Breast Crawl

Is this a myth, or does it really happen? Guess what, it really does! The olfactory sense plays a crucial role in aiding an infant’s recognition of its mother’s nipple — the ‘smellscape’ of mother’s breast.

“Breastfeeding is a brain-based behavior of the newborn, an inborn ability that is regulated by the limbic system of the brain. Newborns [have] the behavioral capability to breastfeed. However, this capability is fragile, and requires the uninterrupted presence of the mother, with specific stimuli at critical periods working to reinforce the inborn ability. The behavior can easily be modified, modulated, or abolished.” – from Impact of Birthing Practices on Breastfeeding by Linda Smith.

Get more answers to these frequently asked questions about The Breast Crawl.

Delay the Baby’s First Bath

To find out why you don’t need to rush to bathe your newborn for the first time, check out my post Before Baby’s First Bath, Learn About These 9 Things.

Getting a Good Latch

Latch, latch, latch! This might be all you hear about or think about for a while. Which makes sense as the difference between a good latch and a bad one can mean the world to your breastfeeding comfort, baby’s ability to transfer milk, and overall success.

Strive for baby’s mouth to open as widely as possible (think of a baby bird with an open-gullet plea for worms), taking in as much of the breast as possible (depending on your anatomy, this may include the skin beyond the areola — breastfeeding isn’t called ‘nipple-feeding’ for a reason), and baby’s lips should splay apart in a ‘duck lips’ manner.

A good tip: don’t go for a ‘bulls-eye’ sort of aim — you want to point baby’s nose up rather than forward so he takes in the bottom half of the areola first.

For the baby to be able to push milk out with his tongue, the nipple needs to be drawn across the soft palate toward the back of the throat, with baby’s tongue remaining underneath.

The ‘comfort zone’ is where the nipple is drawn into the baby’s soft palate, which is farther back than the hard palate. If the baby only takes the nipple into the front of his mouth, the shallow latch may feel painful and pinchy for mom.

This video gives an inside look of what’s happening in a baby’s mouth as he latches and transfers milk.

Read more about how infant suckling works here.

It’s not quitting time when you get that good latch, though — now, you’ll have to make sure baby is transferring milk. Listen for a hitch in the suck pattern, or a little ‘click’ from the back of the throat (it may be barely audible). That noise is your baby swallowing milk!

The Steps For Latching

(quoted details from Andrea Eastman, MA, CCE, IBCLC):

1. Position yourself and baby.

• See the Breastfeeding Positions section below.

2. Present the breast.

• C-Hold: “[S]upporting mother’s breast with her thumb on top and her four fingers underneath…This is like holding a sandwich vertically while you try to take a bite out of it holding your mouth horizontally.”

• Scissors Hold: “In the scissors hold, mother supports her breast by holding it between her index finger and middle finger. Many books discourage this way of supporting the breast because it can be very tricky for a mother to keep her fingers far enough away from the areola to avoid interfering with baby’s latch. Mothers with long fingers may be able to use this hold successfully.”

• U-Hold: “To shape and stabilize her left breast, the mother can start with her left hand flat on her ribs, under her breast, with her index finger in the crease under her breast. If she now rotates her hand, her thumb will be on the outer aspect of her breast with her fingers on the inner aspect. Her breast will rest in the U formed by her thumb and index finger,” says Diane Wiessinger.
• Very useful in cradle/cross-cradle positions. Possibly ineffective for clutch/football and side-lying positions.

3. Try a latching technique.

• Asymmetric Latch-On: I believe this is the best all-around technique for most situations, and often a ‘magic cure’ for nipple pain related to shallow latch.
• Pay most attention to orientation of the lower jaw; focus on latching to the breast, not the nipple. Think of the baby’s jaws as reverse chopsticks — the top one doesn’t move, and the bottom one has free range.
• For this reason, you should avoid pressing on the baby’s head because then his nose and top jaw will touch the breast first, which the authors of The Breastfeeding Atlas describe as “like trying to bite an apple with your chin tucked into your chest.”

• Basic Latch-On: Start by learning early hunger cues; don’t wait until the baby is crying to attempt nursing. Open your mouth wide so the baby mimics you (they are capable of this from birth).
• Diane Wiessinger says, “One of the questions that I ask when working with new mothers is ‘Are baby’s lips flanged out?’ If she answers right away, I tell her to try pulling baby closer. To be able to see that easily and answer me so quickly tells me that baby is not close enough to her breast.”
• Bulls-Eye Latch-On: Tickle the baby’s chin and lips to induce the rooting reflex, then use RAM (below) to swiftly bring baby to the breast. The bad news – this technique can make it harder for a baby to draw out the milk because his jaws are too perfectly centered on the target.
• It’s not an effective technique for clutch/football and cross-cradle positions. Also, the baby is more likely to purse his lips, resulting in pinching and pain for the mother.
• Rapid Arm Movement (RAM) – This is somewhat controversial, but do whatever works. Many lactation consultants will do this to get a difficult baby to latch; though it works well when it does, obviously it’s not effective as a long-term method if the mother hasn’t tried or mastered the movement herself.

4. Do the Lower-Lip Flip.

• Though many breastfeeding guides may suggest it, don’t put pressure on a baby’s chin to get him to open up wider. This can have the negative affect of tensing his jaw or it can actually hurt him.
• Instead, Dr. Sears says to try this: “If his bottom lip is pulled inward instead of outward, use the index finger of the hand that is supporting the breast to pull out that lower lip. (You may need a helper to take a peek under the breast and do this for you while baby is latched-on.)”

Links:

• Find out how to tell if baby is latched effectively or not.
• Latch pictures with descriptions
• Latching videos from Dr. Jack Newman
• Laid-back nursing & biological nurturing can help
• Learn more about the how infant suckling works here.
• “The World of Latch-On: One Leader’s Journey” – Diane Wiessinger
• Why wouldn’t a baby latch?
• Why do baby’s hands always get in the way?

Realistic Expectations for the First Feeding

“Don’t rush the breastfeeding…Introduce your baby to the breast. This is a time for her to discover where her food will come from, not a time to fill her tummy. Newly born babies often just lick the nipple at first. Sucking in irregular bursts and pauses is the usual pattern for the first few hours…[or] the first few days.” – from The Breastfeeding Book

Is it okay to let baby latch and nurse even if she’s not trying to take milk? Yes, being available for non-nutritive (comfort) nursing is part of the job description and doing this will stimulate milk production.

“Sucking is good for the newly delivered baby. Crying is not. Sucking eases the tension that has built up during the stress of labor and birth. It is a familiar behavior, so it helps baby to adjust to her new environment.” – Dr. Bob Sears

Newborn Procedures

If you prefer, you can say “no” to these routine procedures that may or may not be necessary, case depending, but can invite unnatural complication and delay in the immediate mother-baby bonding moments in many situations:

• Circumcision (Learn about how circumcision can negatively disturb breastfeeding, especially as the surgery is typically done routinely in the early newborn days).

• Cord clamping early

• Dressing/wrapping the baby

• Drying the baby off

• Giving baby a bath too soon (read more about delaying the first bath in my post Reasons to Hold Off on Baby’s First Bath).

• Hepatitis B vaccine*
  • Do newborns need a vaccine for this sexually transmitted disease?
  • Serious side effects and deaths in 2013: here and here.
  • What to do about hospital harassment, threats, and bullying.

• Moving the mother away from the baby into a recovery room

• Nasal/Oropharyngeal suctioning – Babies are six times less likely to nurse effectively.

• Newborn screening test

• Silver nitrate eye drops/erythromycin ointment

• Vitamin K injection – See my section on Universal Vitamin Supplementation.

• Weighing/measuring immediately

American Breastfeeding Medicine describes in its clinical review for hospital births what should ideally be happening with birth aftercare (share this with your hospital if the staff could use a reminder): The Going Home Protocol.

*Click to get help with vaccine exemptions in New York, a state that is notoriously bullying in matters of what its residents are mandated to do with their bodies or those of their children.

“Separating infant and mother at birth, even shortly, for doing routine cares such as neonatal assessment, vitamin K injection and repairing mothers’ episiotomy, could lead to less interaction between mother and infant, decrease mother’s self confidence in successful breastfeeding, decrease the mother’s learning about infant feeding and postpone the stage 2 of lacto-genesis.” – “The effects of post-birth mother-infant skin to skin contact on first breastfeeding” by Talat Khadivzadeh, Aghdas Karimi

Breastfeeding Positions

Learn about the best positions to try for small babies, tall babies, young and old babies, polka-dotted and striped babies… Read my post Which Breastfeeding Position is Best for You? I Demonstrate…With Dolls!

Don’t miss the continuation of this series!

PREPARING BEFORE BIRTH (Read Part 1 here):

• Be Able to Recognize “The Booby Traps”
• Choosing a Pediatrician
• Know the Ten Steps to Successful Breastfeeding
• Breastfeeding After an Epidural
• What’s Colostrum?

Upcoming topics include:

THE FIRST SIX WEEKS

• Is My Baby Gaining Enough Weight?
• Should My Baby Be Sleeping Through the Night?
• This SUCKS–not just literally. Will it be like this forever?!

OTHER CONSIDERATIONS

• Cesarean Section
• Premature Birth & NICU
• Sleepiness After Birth
• Universal Vitamin Supplementation