Over the last 40 years I have helped thousands of families learn how to breastfeed more comfortably and I have found certain little tricks be particularly helpful. These are only my suggestions, but they are based on many years of experience working with families who are having breastfeeding difficulties. These guidelines may not necessarily apply to mothers and babies who are already successfully breastfeeding in their own unique ways. Mothers and babies usually know best.
Breastfeeding Standing Up
Perhaps, you have never tried breast-feeding standing up. This is often the very easiest way of doing it. First of all, practice holding your little baby under one arm, with one hand. This will help you feel more confident at supporting your baby. Tuck your elbow in, to snuggle the baby closer. Cup the head as though you were holding a baseball or egg. Don’t grip it, just cradle the head carefully. I know some people are told to hold the neck and not touch the head. This is incorrect because the baby’s neck muscles are still too weak to support its head.
When you feel confident in holding the baby under your arm, start to move the baby across your chest until the head is on the outside of the other breast. The baby should lie on the side with the arms hugging either side of the breast. The chin should be beyond the nipple. Now, take your free hand and shape the breast from underneath. We call this the U Hold. Don’t use the C Hold. In this way, it matches the shape of his mouth and it is easier for the baby to latch on deeply.
Your baby can smell the breast and may move his head and roots around but does not understand what he sees. He will only open his mouth when something touches his lips. Therefore, lift the baby close and touch his upper lip against your nipple.
When the mouth opens, draw him quickly onto the breast, making sure the lower lip is flanged outwards and the quickly sweep the chin forwards, tucking it deeper into the breast. This extends the neck and allows a deeper latch. As you tilt the chin up, the nose moves away from the breast, now just snuggle your baby closer.
Continue to hold the breast from underneath but you can move your fingers closer to your chest and compress more breast tissue, if needed. Continue to use your full arm to hold the baby in place. If the nipple is “pinchy”, put pressure over the shoulder blades and hold the baby closer in. When the baby is correctly latched and has grasped enough nipple, it should feel comfortable.
Breastfeeding Sitting Down
Now that you have learnt how to breastfeed standing up, you can do the same thing sitting down. First of all, you need a good 12 inch foot stool, a supportive chair and a bedroom pillow. Breastfeeding pillows are often too large and bulky. Sit back properly, in the chair with your knees up and the pillow on your lap. This will bring the baby level with your breast. Use both hands to put your baby on the pillow, lying on his side, with his chin level with your nipple. Put his arms around your breast and use your whole arm to support his head and body in a straight line. Remember to cradle his head in the palm of your hand and tilt his chin upwards.
Once you feel as though he is aligned correctly, pick up your breast, using the U hold as taught and press his body towards the nipple, brushing your nipple against the top lip. When the mouth opens a bit, quickly draw him on. Don’t worry if it is not a really wide mouth because you can help push more nipple into his mouth as you snuggle him in closer and further compress your breast. Remember to put gentle pressure across the shoulders.
Some babies close their eyes when feeding. They are not asleep.
Some babies take pauses between suckling, this is normal. They have to catch their breath. They are not asleep, just resting, safely in your arms. When a baby is truly asleep, the muscle tone relaxes, and the baby falls off the breast.
Breastfeeding usually takes about 10 to 15 minutes on each side to provide a full meal. You can switch to the other side again, if he is still hungry.
I encourage mothers to use both breasts at every feed. The concept of front milk and hindmilk is a myth. Milk production is not skim milk, 1%, 2% homo milk, cream, cheese, yogurt!! Breast milk is like wonderful milkshake. Any rich creamy hindmilk that was left behind will blend with the new milk being made for the next feed. It is not lost.
Some mothers make milk very rapidly and their babies drink quicker than you realize. 3 to 5 minutes might be all it takes. Sometimes you must switch sides sooner than you thought. Babies usually know when they have had enough, but sometimes they get wriggly at the breast and pull off due to a burp, not because they have finished.
How Not to Burp your Baby
When a baby starts to pull off the breast or starts to get wriggly, they may need a burp. Parents are taught many ways to burp their baby. Hospital nurses, midwives, community health nurses, doctors, grannies, and friends all have different suggestions. Bending forwards and tapping back, shaking, wobbling, thumping or stroking back upwards, bicycling the legs are just a few maneuvers that mothers are routinely taught.
Do not confuse burping up air with spitting up milk. Most babies do not need any help to burp or bring up air. They just need to be held gently in an upright position to let the air come out naturally. Rubbing the back has no effect whatever on bringing up air from the stomach! If nothing happens then there was no air to burp out. Remember, babies are born with no lid on their stomachs therefore swallowed milk can easily flow upwards causing what we call a spit up. Shaking, bending, and tapping are great ways to make babies spit up milk and should be avoided.
Babies like to be held upright and cuddled for 10 to 15 minutes after every feeding to help the milk settle down. Try not to change the diaper to quickly.
Fussy babies love to be snuggled or swaddled, held softly, upright and shushed. The “shush-shush-shush” sound is trying to replicate the sound of the heart beats that they were used to hearing in the womb. It often works very well.
Bottle Feeding Breastfeeding Babies
Sometimes, babies need to be bottle fed. Perhaps, the mother has difficulty with her lactation, she might not be making enough milk for the baby, or else the baby is having difficulties breastfeeding and is unable to drink enough milk directly at the breast. The best way of handling this situation is to breastfeed on demand, first, if possible. Give your baby as much milk as you can within a reasonable period of time. 10-15 minutes per breast is good or else switch sides twice.
Then Dad or another support person should offer a bottle of extra food after every breastfeeding and give as much as your baby wants. In my experience, the Dr. Brown Number 1 narrow nipple is the best designed bottle for breastfeeding difficulties. It is vented with a narrow nipple, which can fully slip deep into the baby’s mouth and enables the lower jaw to compress the teat, in a natural manner. (Disclosure: I do not have any financial connections with this company). Paced bottle feeding video is a useful resource.
Support the baby’s head and tilt the chin slightly upwards. Do not feed the baby in the crook of your arm until the neck muscles are much stronger, in about a month.
Always give as much food as the baby wants. Use your own expressed breast milk, donor breast milk and/or commercial infant formula. Any left-over milk can be stored in the fridge for the next time. Do not leave it out on the counter.
All bottles and breast pump equipment need to be washed carefully with soap and water before being drained dry. Unless you have a premature or sick baby, nothing needs to be sterilized.
Sometimes, breastfeeding is not possible and therefore, it is very important to know how else to initiate lactation and maintain you milk supply.
Hand expression is the best way of initiating lactation in the early days following delivery. There are several online resources that teach hand expression. Look at the patient resources on this website. Dr. Jane Morton at Stanford University has a clear demonstration. Try hand expression after every breastfeeding for about 5 minutes per side.
Mechanical breast pumps are useful. I recommend using a single kit to start with. Try 5 minutes each side, after most feeds. Use hot compresses on the breast first and gently massage the breast before trying to pump. This helps to facilitate the let-down reflex.
Collect all the milk and store it in the fridge for the next meal.
Verity Livingstone MD, MBBS, FCFP, FABM
Medical Director Vancouver Breastfeeding Centre
Clinical Professor Department of Family Practice
University of British Columbia