It is very important to ensure that the infant is latched on correctly to the breast, and for many mothers this can be the first stumbling block in establishing breastfeeding. Getting the latch correct at each feed is vital. Mothers should be encouraged to ask for help for the first few feeds to get started. If the mother experiences pain when feeding, she can then take the infant off the breast and try again.
The latch is the same whatever the position the infant feeds in – a wide open mouth (like a yawn), tickle the infants lip with the nipple to encourage rooting, bring infant to the breast (chin first). If the infants latch doesn’t look right then take him/her off and try again (ensure the suction is broken before doing so). Always break the suction at the end of a feed by using the little finger in the corner of the infants mouth even if he/she is asleep as damage is often done at this time. Remove hands from the breast when the infant is latched on to prevent pressure on ducts which can lead them to get blocked.
Correct positioning when feeding is very important as infants feed regularly and mothers need to be well supported during feeding times. Mothers need to comfortable to hold their infant close to the breast without causing neck, shoulder, back or muscle strain. Sitting up to breastfeed is usually more comfortable for mothers – sitting upright with good support for her arms, back and feet. There are a variety of different positions to choose, so try out a few and decide which best suits the mother best. Changing positions can help reduce the incidence of tender/cracked nipples, blocked milk ducts, engorgement.
Engorgement can occur around day 3-5 after delivery for some mothers. It can make latching on difficult, as the breast, especially around the nipple/areolar area, becomes flattened and taut. This is due to swelling of the breast. This can result in the infant becoming fussy or even refusing the breast. Simple measures, such as hand expressing or using a breast pump to alleviate this fullness before feeding can make all the difference. For some mothers if this is not dealt with correctly, it can lead onto blocked ducts and even mastitis. To help prevent this, there are a few treatment methods a mothers can do – apply heat and massage before feeding e.g. heated towel (avoid prolonged heat as it can increase swelling and inflammation), massage by gently kneading the breast with fingertips, massaging from chest wall towards nipple are in a circular motion, frequent feeding emptying each breast fully and cold compression after e.g. cold pack.
Breastfed babies feed frequently as breastmilk is digested more rapidly than formula milk (in 1.5 hours). Breastfeeding 8 – 12 times a day is normal for newborn infants, especially in the first week in order for them to get enough milk as your full milk supply is only coming in. The breasts respond to a supply and demand principle so the more the infant demands feed the more milk the breasts will supply. Avoiding supplementary feeding in order to establish a good supply in the early weeks and preventing nipple confusion for infants.
Some newborns are sleepy and can in the first few days be slow to feed or even refuse the breast. The mother should be reassured during this time. If this happens, offer the breast at each feed, however short the feed as it is a good idea to familiarise the infant with your smell and bonding. However, it is important for the mother to get her milk supply established at this time by stimulating the breasts after each feed, to ensure your supply is plentiful (supply and demand principle).
The Health Services Executive has developed some helpful guidelines for breastfeeding mothers wishing to express1. The guidelines are as follows: