This is the handout I give clients who are going to breastfeed.
While breastfeeding is natural, it doesn’t always feel natural learning how to do it. Here, I offer some basic information that might help you get off on the right foot.
- It can’t be said enough… early and often. Having your baby on your body from the beginning is the best way to learn the patterns and rhythms of your newborn. Even though most babies do not nurse for about a half hour or so, occasionally, so nurse sooner. When the baby is on location, initiating nursing is on his schedule, not the hospital’s.
- It is routine for hospitals to wrap babies in blankets, making them look like a burrito. I encourage women to unwrap their babies, put them skin to skin and cover both of you. Research does show that when a baby is skin to skin with mother, she retains her heat better than when she is in blankets alone.
- When you have your baby in your arms and are ready to bring him to your breast, there are two main positions to try… and I do recommend trying different positions because each one has its benefits.
Cradle Hold – Put the baby’s head into the crook of your elbow and your same hand on the baby’s bottom or holding a thigh. Babies all have a way of making this more difficult than you think it should be, so don’t be discouraged; just keep trying. At first it can be a three-person job! Pull the baby’s bottom arm around your waist and hope the top hand doesn’t go right into her mouth, blocking the nipple action you are trying to do. Some women find it easier to swaddle the baby tightly before nursing. That can keep little hands hidden, but if he isn’t swaddled tightly enough; the hands find their way out of the blanket and the whole tangle begins again. It’s really okay. You will find your own style with your baby. Having the baby’s belly against yours helps align his mouth with your nipple. We say, “Belly to Belly” – if you remember that, it can make this hold a lot easier.
Football Hold – The baby’s legs are going to wrap around your waist, her head will be in your same-sided hand. Having the head in your hand gives a different type of control over the nursing experience. Many women find this easier because they can see the baby’s mouth and can pull the baby closer than in the Cradle Hold. No matter which hold you are doing, do not lean into the baby; bring the baby to you. Now, the baby has receptors from the chin, across the cheeks and up around the temples and they need to be left alone because, as you touch them, the baby will think there’s a nipple there and turn his head in that direction. So, when you are holding the baby’s head in this position, your thumb and pinkie finger shouldn’t go closer than the hairline. This is not an exact science, so please don’t worry if your hand is further or closer than that; you and your baby will find your own way. With your opposite hand, compress your areola slightly to make it look like a “V” and then, when the baby opens her mouth wide, pull the baby into and onto your nipple.
NOTE! When learning to nurse, it is a trial and error experience that can last several weeks. Both you and the baby are learning at the same time and neither of you need judge each other. Patience will go far, especially when he’s screaming his head off hungry. Take a few moments, take a deep breath and try again. I promise, it will happen. If you need help, do not hesitate to ask for it! Your midwife, a La Leche League leader and Lactation Consultants are your first lines of defense and can help you overcome most obstacles without bottles. I tell women: If you think about giving your baby a bottle, that is your cue to call me.
- For the first day or two, your breasts will probably not change very much. However, if it is painful when you nurse, please call your midwife or your breastfeeding support person. (OBs aren’t versed at all in breastfeeding and Pediatricians are not knowledgeable unless they breastfed their own children successfully.) Nursing should not hurt! It can be uncomfortable or a strange sensation, but pain is your sign that something is wrong, usually with the baby’s mouth… either positioning or a suck issue. Both can be corrected with education.
- When your milk does begin to come in, you will watch your breasts grow several sizes from their normal shape. It’s important to know that most of the swelling is breast tissue, not milk filling them. Just as when a man has an erection, the tissue swells with blood, not semen; it is similar with the newly lactating breast. Therefore, attending to the tissue swelling is the focus for these next couple of days. Nursing continues as needed, but women can be so uncomfortable with the milk coming in that they give bottles for relief. Here, I’ll give hints for helping without bottles.
Heat before/Cold after is the main rule. Hot, wet washcloths before nursing helps to soften the breast, especially the nipple (which can get so swollen it cannot be grasped). I encourage women to keep at least four washcloths in a crock pot on low, exchanging two washcloths as they cool, back and forth, as the baby begins waking up. Hopefully before he’s screaming his head off, but even if he is, take the time you need to prepare.
After nursing, ice packs on the entire breast feel heavenly. Many women use frozen vegetables because they mold nicely on the breast. The ice helps relieve the tissue swelling, just as we ice a swollen ankle. You can put the ice packs on for 20 minutes and then off for 20 before putting them back on again. As needed between nursings, you can do as much of this routine as you like.
Cabbage leaves are a great home remedy that help the swelling diminish like magic. A chemical in the leaf relieves engorgement within a day or so. I encourage women to take the cabbage leaves off whole and put them in the freezer so when they use the leaf on their breast, it is also cold, taking care of the swelling with two methods at once. Use the cabbage leaves for 20 minutes out of every hour and only use them for two days because they can also diminish milk supply if used for too long.
Ibuprofen, by its nature, helps with swelling and pain at the same time. Many women find they need to augment with medication for pain and Ibuprofen is the best way to do that while nursing. I recommend 600 mg every 6 hours for 2 days. Ask your own care provider what he or she recommends.
Some women find homeopathics or herbs help with the swelling. Be sure to ask your holistic provider to tailor the care to you and your baby.
- What if your nipple is so engorged the baby cannot grasp the nipple? Many women find that, while using the heat before nursing, you can express some of your milk to soften the nipple. When hand expressing, be sure to put your thumb and forefinger behind the areola and press down and then towards the nipple (which, technically, is the very tip of the areola, the darker part of the breast). It can help if you are able to lean over in a filled-with-hot-water sink, letting gravity help you with expression. You can also do this in a hot shower, letting the water spray on your breasts as you hand express to soften your nipple. Be ready to nurse, though, because very shortly after expressing, the nipple will fill again.
- All of this can be extremely uncomfortable but really is important in helping you, ultimately, not be so engorged. The major discomfort should last no more than 2-3 days.
- DO NOT PUMP! Pumping will only make your breasts think you have another baby to nurse and will make even more milk. The small amounts of hand expression will not do this, but pumping should be a last resort, only to soften a bowling ball breast so the baby can grasp the nipple or to relieve a crying-in-pain mother. Pumping hurts, too, when the breast is that engorged, so really is a last resort.
- If there is ongoing pain or nipple damage, have a Lactation Consultant come and see if there might be a technical issue… the baby sucking on a lip, the baby not sucking properly, the baby having a tongue tie, etc. She will be able to diagnose the problem fairly quickly and get you on the road to recovery sooner than later.
- Find support through La Leche League meetings. They are awesome. If you don’t like one group, go to another. You’ll find one that fits you perfectly.
- Hang in there! You can do it. Nursing takes a lot of practice. But the practice pays off in a wonderful relationship with your child.