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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.

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.

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.

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.

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.

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.

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.

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

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.

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.

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

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.

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.

This exercise will help you verify your knowledge about breastfeeding. You will also find answers to some of your questions.

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

1

Most women are able to breastfeed. a) True b) False Right answer! Most women are capable of breastfeeding and can breastfeed. One of the most important things is wanting to breastfeed your baby. Certain circumstances can prevent mothers from breastfeeding: Mothers who are addicted to drugs and alcohol, mothers receiving treatment for cancer, or mothers who are infected with HIV. Wrong answer! MMost women are capable of breastfeeding and can breastfeed. One of the most important things is wanting to breastfeed your baby. Certain circumstances can prevent mothers from breastfeeding: Mothers who are addicted to drugs and alcohol, mothers receiving treatment for cancer, or mothers who are infected with HIV.

2

Mothers with small breasts produce less milk than mothers with big breasts. a) True b) False Right answer! The size of the breasts is not important. Big or small, they can produce all the milk the baby requires. What counts is to start breastfeeding as soon as possible after birth. The more you breastfeed, the more milk you will produce, supply equals the demand!Wrong answer! The size of the breasts is not important. Big or small, they can produce all the milk the baby requires. What counts is to start breastfeeding as soon as possible after birth. The more you breastfeed, the more milk you will produce, supply equals the demand!

3

Women with flat or inverted nipples cannot breastfeed. a) True b) False Right answer! The baby does not suck the nipple but sucks the whole breast. It is breastfeeding, not nipple feeding. Although it is easier for the baby to suck at the breast when the nipple stands out, it is not necessary. Generally, most problems may be eliminated when breastfeeding is well initiated. It is important to receive help with the breastfeeding.Wrong answer! The baby does not suck the nipple but sucks the whole breast. It is breastfeeding, not nipple feeding. Although it is easier for the baby to suck at the breast when the nipple stands out, it is not necessary. Generally, most problems may be eliminated when breastfeeding is well initiated. It is important to receive help with the breastfeeding.

4

Breastfeeding causes the breasts to "sag". a) True b) False Right answer! This is the biggest myth surrounding breastfeeding. It is the hormones of pregnancy that cause the breasts to sag and not breastfeeding. The solution is to wear a good support bra. You will notice that your breasts will return to their normal shape and size once you stop breastfeeding. Wrong answer! This is the biggest myth surrounding breastfeeding. It is the hormones of pregnancy that cause the breasts to sag and not breastfeeding. The solution is to wear a good support bra. You will notice that your breasts will return to their normal shape and size once you stop breastfeeding.

5

Breastfeeding takes a lot of time. a) True b) False Right answer! In reality, many mothers find that breastfeeding gives them more freedom than formula feeding. The activities of all new mothers are limited to feeding and caring for the baby and being tired. The first few weeks of your new life with your baby are a time of change and joy. This is true for all new moms! Wrong answer! In reality, many mothers find that breastfeeding gives them more freedom than formula feeding. The activities of all new mothers are limited to feeding and caring for the baby and being tired. The first few weeks of your new life with your baby are a time of change and joy. This is true for all new moms!

6

A mother who is breastfeeding must watch what she eats. a) True b) False Right answer! A breastfeeding mother must have a balanced diet but nothing obliges her to eat certain foods or prevents her from eating others. In certain cases the baby may be bothered by what the mother has eaten, but this is unusual. When the baby has colic, gas, or cries, modifying the breastfeeding is a better solution than changing the mother's diet. Wrong answer! A breastfeeding mother must have a balanced diet but nothing obliges her to eat certain foods or prevents her from eating others. In certain cases the baby may be bothered by what the mother has eaten, but this is unusual. When the baby has colic, gas, or cries, modifying the breastfeeding is a better solution than changing the mother's diet.

7

Mothers who smoke can breastfeed their babies. a) True b) False Right answer! However, we strongly recommend you quit smoking as soon as you find out that you are pregnant. A mother, who is unable to quit smoking, should still breastfeed. It is proven that breastfeeding reduces the negative effects of tobacco on the baby's lungs and can protect against respiratory illness. Breastfeeding is good for the baby and the mother. It is better if the mother does not smoke but if she can't stop or reduce her consumption, it is better to smoke and breastfeed than to smoke and not breastfeed. Smoking should be done outside and after the breastfeeding to limit the amount of nicotine in the breastmilk. Nicotine replacement therapy is safe while breastfeeding (e.g.: Nicorette gum, the patch).Wrong answer! However, we strongly recommend you quit smoking as soon as you find out that you are pregnant. A mother, who is unable to quit smoking, should still breastfeed. It is proven that breastfeeding reduces the negative effects of tobacco on the baby's lungs and can protect against respiratory illness. Breastfeeding is good for the baby and the mother. It is better if the mother does not smoke but if she can't stop or reduce her consumption, it is better to smoke and breastfeed than to smoke and not breastfeed. Smoking should be done outside and after the breastfeeding to limit the amount of nicotine in the breastmilk. Nicotine replacement therapy is safe while breastfeeding (e.g.: Nicorette gum, the patch).

8

A woman who is breastfeeding can become pregnant. a) True b) False Right answer! Breastfeeding provides good protection during the first six months following delivery. This protection is only reliable if the baby is under six months of age, is breastfed exclusively (which means no other liquids other then breastmilk), if there are no long interruptions between feedings (baby should not go longer than 4 hours between feedings in the day, and no more than one six hour stretch between feedings at night), and if the mother has not started her period. To avoid a pregnancy, you should use a more appropriate method of contraception while you are breastfeeding. As birth control pills may reduce your milk supply, it is recommended to wait to start them until after your baby is six weeks old. Follow-up with your health care provider. Wrong answer! Breastfeeding is not an effective method of birth control, but it can be a good method to separate births. Breastfeeding provides a good protection during the first six months following delivery. This protection is only reliable if the baby is under six months of age, is breastfed exclusively (which means no other liquids other then breastmilk), if there are no long interruptions between feedings (baby should not go longer than 4 hours between feedings in the day, and no more than one six hour stretch between feedings at night), and if the mother has not started her period. To avoid a pregnancy, you should use a more appropriate method of contraception while you are breastfeeding. As birth control pills may reduce your milk supply, it is recommended to wait to start them until after your baby is six weeks old. Follow-up with your health care provider.

9

If a woman breastfeeds, her partner is excluded from providing care to the baby. a) True b) False Right answer! In the beginning when you and the baby are establishing the milk production, there are many other things that your partner can do to help you. He can take the baby in his arms, sing a lullaby, change, bath, console, and walk the baby as well as other things. This will help him to develop a close relationship with the baby.Wrong answer! In the beginning when you and the baby are establishing the milk production, there are many other things that your partner can do to help you. He can take the baby in his arms, sing a lullaby, change, bath, console, and walk the baby as well as other things. This will help him to develop a close relationship with the baby.

10

It is possible to continue breastfeeding even after returning to work or to school. a) True b) False Right answer! Many mothers can benefit from a twelve month maternity leave. However, students, part-time workers, and self-employed mothers may not have access to this paid leave. If you must return to work or to school, it is still possible to breastfeed with the help of your partner, a babysitter, a relative, or a friend. When returning to work or school after any length of maternity leave, you can still continue to breastfeed. Wrong answer! Many mothers can benefit from a twelve month maternity leave. However, students, part-time workers, and self-employed mothers may not have access to this paid leave. If you must return to work or to school, it is still possible to breastfeed with the help of your partner, a babysitter, a relative, or a friend. When returning to work or school after any length of maternity leave, you can still continue to breastfeed.