B. PREPARING TO BREASTFEED

Once you decide to breastfeed, you can begin to prepare yourself. The time to do this is now while you are pregnant. Successful breastfeeding depends mostly on the confidence you have in your ability to breastfeed. An appropriate preparation is essential in order to develop this confidence. Receiving adequate support, even during pregnancy, will help your confidence when breastfeeding.


 

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a. Changes Occurring in Your Breasts

Your breasts were getting ready to breastfeed even before you thought about being a mother. Milk glands start to grow during the teenage years.

During pregnancy, the breast, areola, and nipple get bigger. The nipple and the areola become darker. The alveoli and the ducts increase in number and grow in size.

 

 

 

 

 

 

 

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b. The Breast and How It Works

You will notice a big change in your breasts when the baby is born. Once the placenta leaves the body, hormones stimulate the alveoli to produce milk. The milk passes through the lactiferous ducts and is stored in the small reservoirs situated under the areola causing the breasts to swell. You may feel that your breasts are full or even a little tight. If you breastfeed often, these sensations tend to go away.

When the baby is positioned correctly, movements of the mouth squeeze the reservoirs located just under the areola. The milk flows through several small openings located on the tip of the nipple. The position of the baby's mouth on the breast is very important to assure that the baby is breastfeeding well.

The following animation illustrates the production of milk.

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c. Breastfeeding Positions

There are several breastfeeding positions. Follow these suggestions for each position.

  • Your back and arms must be well supported. A pillow behind your back and under your arms will help.
  • The baby's body and head are raised up to your breast. Place a pillow under the baby.
  • The baby's chest must face and touch your chest. Place the baby on his/her side except for the football position.
  • For the football position, place the baby on his\her back or slightly turned towards the breast.
  • Your baby's nose must face the nipple. Bring the baby towards you instead of leaning forward or pushing your nipple into the baby's mouth.

Remember that it is important to change breastfeeding positions and to offer both breasts at every feeding.

The following pictures illustrate the main breastfeeding positions.

Alternate Arm Cradle Hold

This position works well, if you are learning to breastfeed:

  • The heel of your hand supports baby’s shoulders
  • The hand that holds the breast is on the same side the baby is nursing

 

Football Hold

This position works well:

  • If you are learning to breastfeed
  • If you have a small baby
  • If you have large breasts
  • If you had a Caesarean birth
  • If you are nursing both twins at the same time
  • Flex baby’s legs up behind your arm
  • Baby’s mouth is well under breast before you start

 

Cradle Hold

This position works well:

  • After you are comfortable with breastfeeding
  • Baby’s head rests on your forearm
  • Baby’s nostrils are in front of your nipple before you start to latch

 

Side-Lying Hold

This position works well:

  • If you find it too painful to sit
  • If you want to rest when you breastfeed
  • If you had a Caesarean birth
  • You and baby lie on your sides facing each other
  • Your hand is across baby’s shoulder blades
  • Bring baby towards your abdomen
  • Wait for the baby to extend his head with a wide mouth and latch without assistance

 

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d. Learning to Breastfeed

Begin breastfeeding as soon as possible after the delivery. The baby is most awake and ready to learn how to breastfeed during the first two hours after birth. Breastfeeding as soon as possible after delivery will favour skin to skin contact with your baby and will help you produce more milk.

Once you are in a comfortable position, you are ready to offer your breast to your baby. The cross cradle position may be the best position for the learning period.

Babies often suck better if their skin is in contact with the mother's skin. They will keep warm from being skin to skin with you. In the beginning, undress the baby down to just their diaper prior to feeds to help keep baby awake at the breast. Some infants find the breast and latch on correctly from the first tries. Others need help. The following pictures provide a few tips to help your baby accept the breast correctly.

The following video shows a baby well positioned on the breast.

 

Feed the baby before he or she gets upset or cries loudly. Crying is a late sign of hunger. The baby will show signs of hunger long before starting to cry.

 

Your baby can

  • have rapid eye movements under the eyelids when he/she begins waking up to drink.
  • make sucking and licking movements with his/her mouth.
  • put his/her hand in his/her mouth.
  • stretch and become more agitated.
  • make small noises.

A sign that the baby is hungry.

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e. Skin-to-Skin Contact

Skin-to-skin contact involves placing the baby wearing only a diaper, tummy down on his/her mother's bare chest immediately after birth and well into the firts month. Baby may be covered lightly with a blanket. Your partner or support person can also do skin-to-skin to know, comfort and nurture your baby.

Benefits:

  • Strengthens the mother-baby relationship;
  • Helps regulate the baby's body temperature, respirations and heart rate;
  • Promotes better breastfeeding;
  • Helps regulate the baby's blood sugar;
  • Provides pain relief to baby during painful procedures;
  • Encourages longer duration of breastfeeding, on average by an additional six weeks.
  • The benefits of skin-to-skin for bonding, soothing and breastfeeding continue well after the newborn period.
  • Premature babies also benefit from skin-to-skin. Sometimes this is called Kangaroo Care.

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f. Infant Feeding Cues:

Babies should be fed when they cue or indicate hunger. Crying is a late cue or indicator of hunger. Breastfeeding is much easier for both mother and baby if you are able to pick up on baby's early hunger cues.

Sample video from "Breastfeeding : Bringing baby to the breast" from http://www.videoallaitement.org/english.html

Common infant hunger cues include:

Early:

  • Increased alertness, moving during sleep or having REM sleep
  • Smacking or licking lips
  • Opening and closing mouth
  • Sucking on lips, tongue, hands, fingers, toes, toys, or clothing.

Active:

  • Rooting around on the chest of whoever is carrying him
  • Trying to position for nursing, either by lying back or pulling on your clothes
  • Fidgeting or squirming around a lot
  • Hitting you on the arm or chest repeatedly
  • Fussing or breathing fast

Late:

  • Moving head frantically from side to side
  • Crying
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Test Your Knowledge

 
 

The following exercise will help you acquire knowledge to make breastfeeding successful.

Click on the button that corresponds to the correct answer and check your answer by clicking on the "Check" button.

1

It is important to begin breastfeeding as soon as possible after the birth of your baby.

a) True
b) False
Right answer! Your baby is more alert and ready to start suckling at your breast during the first two hours following birth. Ideally, the baby should be given the breast within 30 minutes after birth. Beginning to breastfeed as soon as possible after the birth will help you to produce more milk. If baby is not effectively breastfeeding, skin to skin contact will help your milk production. Wrong answer! Your baby is more alert and ready to start suckling at your breast during the first two hours following birth. Ideally, the baby should be given the breast within 30 minutes after birth. Beginning to breastfeed as soon as possible after the birth will help you to produce more milk. If baby is not effectively breastfeeding, skin to skin contact will help your milk production.

Check your answer

2

You must breastfeed every four hours the first few days.

a) True
b) False
Right answer! During the first month, the baby will eat a minimum of 8 times a day. Babies are meant to feed frequently in the early days. It is common for babies to have many feedings in a a short period (culster feeding), and then sleep longer between feeds at other times. There are no set times to feed your baby. Wrong answer! During the first month, the baby will eat a minimum of 8 times a day. Babies are meant to feed frequently in the early days. It is common for babies to have many feedings in a a short period (culster feeding), and then sleep longer between feeds at other times. There are no set times to feed your baby.

Check your answer

3

Do not give a pacifier or bottle to a breastfed baby.

a) True
b) False
Right answer! Sucking on a bottle or pacifier and suckling from the breast is completely different. If you decide to use a bottle or pacifier, it is better to wait until your baby has learned to breastfeed. This usually happens around the 6th week. If you give a pacifier or bottle too soon, the baby may prefer this type of feeding and not want to suckle at the breast. This may cause pain when breastfeeding.Wrong answer! Sucking on a bottle or pacifier and suckling from the breast is completely different. If you decide to use a bottle or pacifier, it is better to wait until your baby has learned to breastfeed. This usually happens around the 6th week. If you give a pacifier or bottle too soon, the baby may prefer this type of feeding and not want to suckle at the breast. This may cause pain when breastfeeding.

Check your answer

4

Most mothers need help to learn how to breastfeed.

a) True
b) False
Right answer! Ask the nurse to help place the baby to your breast. Ask for help immediately if you are having problems. Once you are home, there are supports available in the community to help you with your breastfeeding. A public health nurse calls within 48 hours of going home. There are free Breastfeeding Support drop-ins in the community where you can attend with your baby to receive hands-on help from a certified lactation consultant.Wrong answer!Ask the nurse to help place the baby to your breast. Ask for help immediately if you are having problems. Once you are home, there are supports available in the community to help you with your breastfeeding. A public health nurse calls within 48 hours of going home. There are free Breastfeeding Support drop-ins in the community where you can attend with your baby to receive hands-on help from a certified lactation consultant.

Check your answer

5

You must always give water to breastfed babies.

a) True
b) False
Right answer! During the first six months, a healthy baby does not require any additional liquid or food. If you give additional liquids or foods to your baby, your milk production may be reduced and this could be harmful to your baby's health (e.g.: your baby may be at increased risk for allergies). Health Canada along with Ottawa Public Health (OPH), recommends that babies be exclusively breastfed for the first six months. Breastfeeding should continue with the introduction of solids, for up to two years and beyond. Wrong answer! During the first six months, a healthy baby does not require any additional liquid or food. If you give additional liquids or foods to your baby, your milk production may be reduced and this could be harmful to your baby's health (e.g.: your baby may be at increased risk for allergies). Health Canada along with Ottawa Public Health (OPH), recommends that babies be exclusively breastfed for the first six months. Breastfeeding should continue with the introduction of solids, for up to two years and beyond.

Check your answer
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g. Signs that the Baby Is Breastfeeding Well

New mothers often wonder if their baby is drinking enough milk. Although you cannot check the quantity of milk the baby is drinking, there are signs that indicate if the baby is drinking enough.

 

 

 

 

 

 

 

 

 

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1. The Baby's Suckling

At the beginning of the feeding, your baby's suckling will be shallow and quick. Once the milk begins to flow, the baby's suckling should become deep and slow. At one point there should be a pause and the baby should open its mouth wide. This is when the mouth fills with milk. The longer this pause, the more milk the baby gets.

You may :

  • Feel some initial pain for the first few sucks which should go away. If it continues, the baby may not be latched or positioned well. Ensure to receive professional help to assist to correctly breastfeed your baby.
  • Hear the baby swallow.

The next video shows a baby breastfeeding well.

Sample video from "Breastfeeding : Bringing baby to the breast" from http://www.videoallaitement.org/english.html

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2. Number of Wet and Soiled Diapers

By counting the number of wet and soiled diapers, you can check if your baby drinks enough milk.

 

  • at 1 day old has at least 1 wet diaper and at least 1 to 2 sticky dark green/black stools
  • at 2 days old has at least 2 wet diapers and at least 1 to 2 sticky dark green/black stools. ** This is easier to notice urine in cloth diapers. A facial tissue can be placed inside disposable diapers, if you are not sure.
  • at 3 days old has at least 3 heavy wet diapers and at least 3 brown/green/yellow stools. Occasional “red brick coloured” staining is normal until day 3.
  • at 4 days old has at least 4 heavy wet diapers and at least 3 brown/green/yellow stools.
  • at 5 days and older, as the milk supply increases, baby has at least 6 heavy wet diapers and at least 3 large soft yellow seedy stools per day.

A wet diaper is equivalent to 2 tablespoons or 30ml, and a heavy wet diaper is equivalent to 4-5 tablespoons or 60-75 ml.

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3. Weight Gain

The weight gain is a good indication that the baby is drinking enough milk. Here are a few clues.

  • Most breastfed babies will lose up to 7 percent of their birth weight during the first three days after birth.
  • Your baby should gain at least five to eight ounces (140 to 224 grams) per week during the first three months and at least 1 pound (16 oz or 448 g) per month between the third and the sixth month.
  • Your baby should have returned to his/her birth weight by the second week of age.

 

 

 

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4. Other Signs

There are other signs to indicate if the baby is drinking enough milk. Observe the following clues:

  • Your baby has a loud cry and moves a lot.
  • Your baby's mouth is wet and pink.
  • Your baby's eyes look bright and awake.
  • Your baby comes off the breast looking relaxed and sleepy.
  • Your breasts feel softer and less full after breastfeeding.

 

Ask for help immediately if your baby does not seem to be breastfeeding well.

 

 

 

 

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h. Breast Care

There is no special care required for your breasts during pregnancy. Good daily hygiene is sufficient. The Montgomery tubercules (glands) situated under the areola are responsible to prepare your breasts for breastfeeding. To support your breasts, wear a bra that fits well; preferably without underwire.

 

 

 

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1. General Breast Care

Basic care is important during breastfeeding

  • Wash your breasts daily. Avoid putting soap on your nipples, especially if they are sore. Soap may dry your nipples and cause them to crack.
  • Wear a well-adjusted bra that is not too tight. Do not wear a bra with underwires.
  • After breastfeeding, express some breast milk into the nipples and the areolas in order to protect the skin. Allow the milk to dry before putting on your bra.

 

 

 

 

 

 

 

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2. Hard Breasts

The breasts may become hard or engorged the first days after birth. This engorgement is caused by an accumulation of milk in the breasts. This happens during the inflow of milk usually three to four days after the birth of your baby. If your breasts become hard, the baby may have trouble feeding. The hardness should only last 1-2 days. Here is some advice to help soften your breasts.

During the first weeks, you may have to express breast milk if your breasts are too hard for the baby to latch on.

You will find more information on expressing breast milk in Module 8 entitled "Healthy Family".

Ask for help immediately if you:

  • cannot soften your breasts or have trouble breastfeeding.
  • have red or painful areas on your breasts.
  • have a fever.
  • ​feel ill.
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3. Sore Nipples

The nipples may become tender during the first few days birth. This situation should improve daily. Breastfeeding should not be painful. Check the following table if you have sore nipples.

Ask for help immediately if your nipples are sore even though the baby is well-positioned and feeding properly.

 

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i. Setting Goals for Breastfeeding

The ideal time for the first feeding is within the first two hours following birth. Breast milk is all the baby needs during the first six months. After six months, begin to introduce solid foods while continuing to breastfeed for up to two years and beyond.

Now is a good time to set your own goals for breastfeeding. You have the natural ability to breastfeed, but you must learn how to do it correctly.

By setting goals, you are learning what to do. You can also decide how you are going to do it. By setting your goals in advance, you can then decide how you will achieve them.

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j. Creating Breastfeeding Support

Although breastfeeding is the natural way to feed your baby, that doesn't mean that you will know how to do it right away. Most mothers need information and support while breastfeeding especially during the first two months.

 

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1. How Can a Breastfeeding Support Network Help Me?

It is good to plan your support network ahead of time. Think about friends, members of your family, professionals, and any other person who will be able to help. It is also a good idea to determine how these people can support you during breastfeeding.

With the help of a support group, you will have

  • someone to talk to about breastfeeding and from whom you can get help either in person or by phone.
  • someone in whom you will be able to confide anytime during the day or night; but most often during the night.
  • someone who will check up on you to see how you are making out.
  • someone who will take care of the baby while you take a bath, go to the hairdresser, or simply have a rest.
  • someone who will prepare some meals, do the cleaning, or get the groceries.
  • someone who will care for the other children if you have any. The other children, depending on their ages, can also be involved.
  • someone who will invite you, your baby, and your family for a meal or an outing.
  • someone who will babysit while you and your partner go out.

Keep in mind that your family and friends will offer advice whether you have asked or not. Some advice will be helpful, some not. Don't be afraid to ignore the advice that is not good for you. Thank them and do what you think is best for you and your baby.

 

 

 

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2. Who Can Be Part of My Support Network?

Now is time to create this support group so you will be ready when your baby is born. Here are a few suggestions.

  • Find one or two mothers who have enjoyed breastfeeding and who live near you. Ask them if they will give you moral support and help you if necessary.
  • Talk to your partner about sharing the workload once the baby arrives and explain why you will need his help.
  • Find out if there is a support group in your area. If possible, attend one or two meetings before the baby is born. This will allow you to establish contacts with mothers who have already lived the breastfeeding experience. 
  • Find other mothers to talk with and who will agree to exchange child care services. Find out how you can give each other time off when you need it.
  • Check to see if there are community groups or a Parent Resource Center in your area that feature day nursery services, mother-baby groups, or exercise programs you can join.
  • Talk about breastfeeding with your public health nurse. There are Breastfeeding Support Drop-ins in the community to assist you with your breastfeeding.
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