How to properly breastfeed a newborn?

The importance of the first attachment for mother and baby

Attachment to the breast is the logical end of the birth process, which gives a powerful impetus to the establishment and establishment of lactation. Ideally, attachment should take place immediately after the baby is born. The baby is born and cries, the midwife lays it “belly to belly” towards the mother, helping to find the nipple.

The mother's body is prepared and adjusted to breastfeeding if the newborn is attached immediately after birth. Sucking the breast gives a signal that labor is over, and the woman’s body’s task is to feed the baby with milk. Baby sucking at the breast activates nerve endings in the mother's body that are responsible for active contractions of the uterus, which leads to a reduced risk of developing postpartum complications.

Attachment is of particular importance for the baby. He receives the first drops of colostrum, which activate protective reserves. They help the child cope with pathogenic bacteria and allergens. Colostrum, containing a large amount of antibodies, protects the baby from diseases. It helps in populating the intestinal microflora with beneficial bifidobacteria.

The psychological role of early attachment is also important. During childbirth, the child is exposed to stress, finds himself in unfamiliar conditions, and the baby needs his mother to feel safe. Mom's touch, physical contact, and breast sucking help reduce postpartum stress and establish a tight emotional “mother-child” connection, which is called “imprinting.”

It has been established that breastfeeding increases the level of pleasure hormone in a woman’s blood -

endorphin, allowing you to relax and unwind even after a difficult birth.

Rules for first breastfeeding

In the first day, it is necessary to put the baby to the breast more often. This helps to calm down, survive the stress of childbirth, and is an impetus for the establishment of lactation. Now the baby eats a lot, sleeps and cries, but this does not indicate hunger, rather a reaction to stress. To calm your newborn, you need to pick him up and offer your breast.

The first feeding occurs a couple of hours after birth, when mother and baby have rested a little. To make breastfeeding enjoyable and not painful, you need to choose a suitable position - this contributes to the correct latch on the breast. At first, the mother experiments with feeding positions to find one in which she will be comfortable and the breast will be emptied as much as possible by the baby.

Milk appears on the second or third day after birth. Colostrum appears first. It is unique in composition, yellow in color, thick in consistency, similar to the composition of blood, and has a mild laxative effect, which helps cleanse the intestines of meconium.

The baby may lose weight in the first days - this is normal. Within 3-4 days of life, body weight can decrease by 10% (urine, meconium, fluid loss during breathing and through the skin are excreted). The newborn's stomach capacity is small and he only needs a couple of drops of colostrum to feel full.

A step-by-step scheme for solving problems with attaching a baby to the breast

It turned out to be a kind of instruction for a “dummies”, which allows you to better understand the problem and not “lose your head” in the first days after childbirth. You can print it out and give it to mothers in maternity hospitals along with diapers and other necessary things :)

Step 1

Attach the baby to your chest (preferably in a position under the arm, but you can also use a position lying down or sitting on the mother’s arm)

If baby latches on and starts to suckle, see Step 2

If the baby does not latch on, see Step 7

Step 2

Problems you may find (answer yes/no):

• Pain in the nipples or chest
• Very full breasts
• Long, frequent feedings
• Rare applications (less than once every 2-3 hours)
• Small weight gain
• The baby immediately falls asleep and stops sucking
• Restless child, baby crying under the chest
• The child is choking and gasping for air

If you answered “Yes” to at least one item, see Step 3

If you answered “No” to all points, see Step 5

Step 3

Place the child in the under-arm position:

• Check that you are supporting the child with your hand along the entire spine.
• Use your elbow to press your baby's lower spine toward your body.
• Support the baby's head under the back of the head without pressing the head to the chest. Fingers lie behind the ears.
• Support your chest in a “C” shape (thumb on top, all others below).
• Quickly guide your baby towards your breast when he opens his mouth wide.
• At the same time, point the nipple of the breast towards the upper palate.
• With a deep grip, the baby's chin is pressed tightly to the mother's chest, the nose does not bury itself in the chest.
• The head is thrown back a little.
• The baby's ear, shoulder and butt are on the same line.

Make sure your baby not only sucks, but also swallows. If the child does not swallow, see Step 4. If the child does swallow, see Step 5.

Step 4

Apply compression method:

• Place your hand near your chest and squeeze it.
• Squeeze until the baby begins to swallow.
• Do not squeeze unless the baby is sucking and resting.

If baby is not feeding well, see Step 6

Step 5

Make sure you understand:

• The difference between sucking and swallowing (it must be taken into account that the speed of swallowing decreases sharply when the front milk runs out and the baby begins to suck on the hind milk, which is released drop by drop)
• When to use the compression method or to offer another breast.

If your problems are resolved, then you did everything right. If problems still persist, see Steps 6 and 7.

Step 6

If you're not sure you're doing it right, look for a lactation consultant in your area.

Step 7

If the baby cannot attach to the breast:

• Try a vertical skin-to-skin position where your baby finds the breast on his own.
• It is important not to hold the child’s head with your hands, only in the area of ​​the shoulder blades.
• You can try standing up and rocking while you put your baby to the breast.
• You can try swaddling your baby.

If baby latches, go back to Step 3. If not, see Step 8.

Step 8

Know: this is temporary . This is not your fault. This may continue for several days, or maybe weeks. The baby is not refusing you, he is just confused (perhaps you are too) and needs time to understand how to suck properly. Focus on the positive aspects of your relationship with your child. And be sure to feed him.

1. Feed your baby on demand (not on a schedule).
2. React to the child’s first signals before the child bursts into tears (searching movements with his mouth, smacking his lips, turning his head, twisting his arms and legs, grunting, sticking out his tongue).
3. Use the skin-to-skin self-application technique.
4. Avoid overfilling the breast as baby will not be able to latch onto the areola (use back pressure technique to soften the areola)
5. Check the frenulum under your baby's tongue (if it is short, it may cause ineffective or traumatic breastfeeding). This can be done by a dentist.
6. Provide skin-to-skin contact with your baby more often, and arrange for co-sleeping and bathing with your baby.
7. Provide feeding (use finger feeding with a syringe for a couple of minutes to calm the baby and show that sucking helps get food, then try latching to the breast)
8. Do not force your baby to breastfeed; make sure that breastfeeding brings more positive emotions to your baby.
9. If the baby does not latch on, repeat finger feeding, then offer the breast again.
10. Express each breast for 15 minutes after each unsuccessful attempt to feed and supplement with a cup or spoon.

This scheme is based on the method of pediatrician Jack Newman “L-eat (The Elite Way to Latch)”, but does not repeat it completely, but has been modified by me (primarily the proposed feeding positions, the possibility of using the baby’s self-attachment to the breast).

See also:

Medical contraindications to breastfeeding a newborn.

The child has:

• low health score on the Apgar scale (below 7 points);
• prematurity (weight less than 1500 g);
• suffocation, respiratory distress syndrome;
• birth injuries;
• congenital developmental defects that prevent latching and sucking on the breast.

Mom:

• moderate to severe renal failure;
• severe blood loss during and in the postpartum period;
• lack of consciousness in the woman in labor;
• open form of tuberculosis;
• malignant neoplasms;
• HIV infection.

In most cases, the baby can be put to the breast after the condition of the mother and child has normalized.

Signs of proper breastfeeding

Much has been written about putting a baby to the breast, and it seems that the process of feeding a baby is laid down at the level of maternal instincts and problems cannot arise. But many mothers are faced with the fact that feeding is painful, the baby does not latch onto the breast, does not suck well, and the mother cannot attach the baby to the breast correctly.

Correct application:

• Lips at an angle of 120-150 degrees. The muscles of the mouth are relaxed, the lips are like a tube.
• The lower lip is turned outward.
• If the baby is attached correctly, the baby's lower lip and chin will sink into the chest. This can be seen when the chest is pulled back.
• The baby's mouth is wide open. The lower jaw is directed downwards.
• Sucking involves all the muscles from the chin to the temple.
• The cheeks are not retracted.
• The tongue lies on the lower gum; if you bend the lower lip, you can see how the tongue works.
• There are no sounds of smacking or clicking. Only the sounds of swallowing can be heard.
• After feeding, the nipple is not deformed, there are no bevels or flattening.
• The main sign is that feeding does not hurt.

Please note that not all signs are achievable due to the anatomical features of the baby (short frenulum, spasm of the muscles involved in sucking.

Breastfeeding: mistakes to avoid. Complications and ways to overcome them.

ATTACHMENT TO THE CHEST

• Turn the baby towards you, bring his nose closer to the nipple.
• Gently tilt the baby's head back a little; It is important to keep your mouth wide open.
• If your mouth doesn't open wide enough or doesn't open at all, you can touch your nipple to your lips to trigger a reflex reaction.
• Place your baby's lips firmly on the nipple, trying to get as much of the areola into the mouth as possible.
• Check to see if your baby sucks and swallows milk easily.

Application problems:

If you have problems putting your baby to the breast, you can:

• Lightly tickle the baby's lips to cause the mouth to open wide.
• Bring the baby's head as close to the chest as possible (until it touches the chin and lower jaw).
• Place the baby's lower lip as far as possible from the base of the nipple so that the baby covers a larger area of ​​the areola.

SIGNS OF CORRECT APPLICATION

• Does not cause discomfort or pain.
• The baby's chest lies calmly on the mother's chest; the child does not have to toss and turn.
• The areola of the nipple is practically invisible.
• The baby's tongue is under the nipple.
• You can see/hear the baby's swallowing movements.
• The baby's chin touches the breast of a nursing woman.
• The child's mouth is wide open, his lips are pulled back.
• The nipple is deep in the baby's mouth, with the tip at the very back of the mouth.
• The lips and gums are pressed against the area around the nipple (areola).
• The lower lip is placed further from the base of the nipple than the upper lip.

SIGNS OF IMPROPER ATTACHMENT TO THE BREAST

• The baby sucks or “chews” only the nipple.
• The tongue “works” on the tip of the nipple.
• The lips and gums press on the nipple instead of the areola.
• The child’s lips are “sucked” inward.

With this type of attachment, the baby does not receive enough milk, breast emptying is also incomplete, which can lead to negative consequences.

CONSEQUENCES OF IMPROPER ATTACHMENT TO THE BREAST

• Pain

It is important to ensure that the baby grasps not only the nipple, but also the areola.

• Weak sucking movements of the baby

Most often associated with improper latching of the nipple and areola.

• Poor feeding

A possible cause of difficulties with feeding is a short frenulum of the tongue, which requires examination of the child by a pediatrician.

PAINFUL NIPPLES

REASONS AND SOLUTIONS

• Normal appearance of the nipple after feeding.
• The nipple is “flattened” after feeding: shallow latching of the breast or short frenulum of the tongue.
• Hyperemia of the nipple: candidiasis.
• Change in nipple color (pallor, cyanosis): vasospasm or Raynaud's phenomenon.

RECOMMENDATIONS:

• First of all, check the quality of breastfeeding.
• Change positions at each feeding.
• After feeding, express a few drops of milk and gently rub into the nipples.
• Wear natural cotton underwear.
• Avoid tight synthetic underwear.
• Wear special bra pads to ensure nipple hygiene.
• When washing your breasts, avoid using potentially irritating detergents.
• Feed your baby more frequently to prevent breast engorgement and excessive sucking.
• Stimulate the milk production reflex before putting the baby to the breast.
• Before feeding, apply ice to the nipple.
• Nipples should be dry and not covered by clothing for as long as possible, at least at night.
• It is imperative to exclude inflammatory phenomena and infections, in particular candidiasis.
• You can use wound healing creams/ointments.
• Contact your doctor.

INSUFFICIENT QUANTITY OF MILK

RECOMMENDATIONS:

• First of all, check the quality of breastfeeding.
• Feed on demand and if the breast is not completely emptied, express the rest of the milk.
• Offer your baby both breasts during one feeding.
• Introduce nutritional formulas only after consulting a doctor if there is a confirmed deficiency in the child’s body weight gain.
• Limit your child's use of pacifiers and other breast substitutes.
• Rule out hormonal disorders.

EXCESS MILK

• Use only one breast at a time; Offer one breast to your baby until it is completely emptied for at least two hours before the next feeding.
• Express excess milk if pain and a feeling of “tension” appear in the mammary glands.
• Cool compresses can be used to reduce swelling.
• Feed your baby before he shows signs of extreme hunger to reduce the risk of aggressive and painful nipple latching.
• Contact your doctor.

MILK EJUSTMENT REFLEX

• Often combined with excess milk production; is an excessively strong reaction to the secretion of oxytocin when applied to the breast.
• It is recommended to gently grasp the nipple between your thumb and middle finger and squeeze lightly to control the flow of milk.
• If during feeding the milk flow is too fast or abundant and causes discomfort in the baby, you should interrupt feeding and express the excess milk.
• Feed strictly according to the child’s request; do not take long intervals between feedings.

ENGRASSION OF THE MAMMY GLANDS

• Enlargement of the mammary glands and increased sensitivity are the norm during lactation.
• Consolidation and tenderness of the mammary glands is a pathological engorgement, which may be associated with lactostasis and mastitis.
• It most often occurs on days 3-5 of the postpartum period, but can be observed at any other time, especially during long breaks in feeding.
• Breast engorgement is an indication for consulting a doctor in order to exclude lactostasis and mastitis, as well as for recommendations on further tactics.

RECOMMENDATIONS:

• Feeding should be frequent and for a long time, at the request of the child.
• Be sure to monitor the quality of breastfeeding.
• Be sure to completely empty your breasts either during feeding or during additional pumping.
• Avoid using pacifiers or feeding bottles.
• Before feeding, you can manually or using a breast pump express your breasts a little to soften the nipple and areola.
• Do not allow more than 4 hours between feedings or pumping.
• Cooling compresses can be used to reduce swelling and pain.
• Be sure to maintain adequate drinking regimen.
• Be sure to choose supportive underwear that is not tight or synthetic.

CLOGGED DUCTS

• When the ducts of the mammary gland are blocked, a painful/sensitive lump in the chest is observed, not accompanied by symptoms of general intoxication; without hyperthermia.
• Most often one-sided, asymmetrical.
• Caused by local lactostasis.
• May lead to an inflammatory reaction and mastitis.
• Requires a visit to a doctor.
• Feed or pump on the side of the blocked duct at least every 2 hours to ensure emptying.
• Try to regulate breastfeeding in such a way that the baby puts effort precisely on the area of ​​the chest in which there is stagnation.
• Gently circular massage movements from the base of the breast to the nipple
• Apply a warm compress to the area of ​​congestion ( with caution if infection is possible) .
• Avoid tight, constricting underwear.

MASTITIS

• Diffuse or local inflammation of breast tissue: pain, swelling, hyperemia.
• Signs of general intoxication, increased body temperature.
• Nausea, vomiting.
• Pathological discharge from the nipples (purulent, mixed with blood).
• REQUIRES MANDATORY IMMEDIATE APPLICATION TO A DOCTOR; INDEPENDENT TREATMENT IS NOT ACCEPTABLE.
• If the elevated temperature persists for more than a day, this should be regarded as an infectious process and antibacterial therapy should be prescribed.
• If, despite AB therapy, complaints persist, new foci of hyperemia and pain appear in the mammary glands, and also if fever with a sharp increase in temperature is observed, the formation of a mammary abscess should be excluded.
• If there is an admixture of pus in breast milk, feeding should be temporarily stopped; Breasts must be expressed frequently and with care.

PROBLEMS RELATED TO THE SHAPE OF NIPPLES

In addition to the normal/standard shape of the nipples, there are also

• Retracted
• Flat
• Too big

Any of these variations can lead to a deterioration in the baby's nipple latching and, accordingly, cause feeding complications.

• For flat/inverted nipples, special shields should be used to make it easier for the baby to attach to the breast.
• The pads must be processed (sterilized) after each feeding.
• With excessively large nipples, attachment improves over time, as the baby is able to better latch on to them as he grows and develops.

Can be recommended before starting feeding

• express some milk
• Apply ice to the nipple for a short time.

BREAST REFUSAL

CAUSES:

• Illness, pain, or use of sedatives: Infections
• TBI; consequences after intravenous extraction or application of forceps
• Stuffy nose in a child
• Inflammation in the mouth (candidiasis, teething)

RECOMMENDATIONS

• Seeking qualified medical help
• Treatment of infection
• Expressing milk and feeding your baby by cup or tube until he can breastfeed on his own
• For thrush - specific therapy
• During teething, it is important to convince the mother to be patient and continue feeding
• If a child has a stuffy nose - treatment
• It is recommended to feed the baby less time, but more often
• The mother should spend as much time as possible with the child
• Skin-to-skin contact is important, including outside feeding and during sleep.
• Be sure to breastfeed whenever the baby asks for it (including when the baby is sleepy or after cup feeding), and whenever the milk release reflex occurs.
• Avoid using pacifiers, bottles, pacifiers
• Avoid using perfumed hygiene products

Head AFO Dvornik E.V.

Pumping

If, after a hot flash, there is swelling in the chest, causing a fever, you need to wait a day from the start of the hot flash, often put the baby to the breast, and change breasts.

If there is no relief, the breasts are painful, swollen, the temperature has risen, then you need to express as much as possible no later than 9 pm and no earlier than 9 am.

Afterwards, 2-3 pumping sessions are required until the breasts are relieved and not empty. If you start actively pumping, this will lead to a large number of hot flashes with possible stagnation of milk - lactostasis.

How to teach a child

Swelling under the eyes of a child - causes of swelling

Weaning a baby to the breast should begin immediately after birth (if there are no contraindications). On the first day, he will not yet be able to fully suck or grasp the breast, but he will be able to get an idea of ​​maternal warmth. Reflexes will start immediately. For a woman, the accustoming stage is associated with setting up the process of milk production. Proper lactation (without interruptions and with a sufficient volume of nutrient fluid) will take time.

Important! In most newborns, the sucking reflex is well developed. During the first feeding, you need to pass the nipple across the lips 2-3 times so that the baby opens his mouth and captures the areola.

You should not force the baby or try to help him. The reflexive grip must be developed independently so that the baby can then receive the volume of milk he needs. The woman will only need to apply light pressure on the mammary gland to activate production. In the first few days you will have to feed using colostrum. You cannot supplement with the mixture if the natural way of eating is a priority.

Proper training assumes that the baby will need to be attached to the breast, taking into account all the features:

• body position is comfortable;
• the head should be at the same level with the body (not sunken);
• shoulders should not arch or sink;
• mouth at the level of the areola;
• lips should not close.

The position of a nursing mother can be any. It is allowed to sit, lie or stand. You need to hold the baby with one hand, with the other to guide the breast and support the nipple so that it does not fall out.

Important! In some cases, the baby may turn its head in search of the breast. It should not be fixed; it is recommended to carefully guide the head. This way he will understand what needs to be done next time.

If feeding is done correctly, then during sucking the woman will feel a slight tugging in the chest. This is due to the fact that the baby makes an effort to get milk. It is often noted that the newborn refuses the breast, cries, or behaves restlessly. This is a normal effect if, before the training, another method of feeding was practiced: through a tube or using a bottle. Failure is also typical for premature babies or after interruption of breastfeeding for a number of reasons. A cesarean section can also delay training, since local or general anesthesia is used during the process.

For quick contact you will need to interest the baby

Difficulty breastfeeding

The baby does not latch on to the breast

• baby turns his head
• grabs the chest several times and throws

These are manifestations of the search reflex.
What to do:

• pass the nipple over the baby's lips and cheeks
• express a couple of drops of colostrum and apply it to the areola and nipple
• hold the baby's head, help find the nipple.

Baby sucks poorly

• The child is restless due to hunger.
• sucks sluggishly, quickly falls asleep.

Occurs in weakened premature babies, during difficult births, and jaundice.
What to do:

• Wake up the baby for feeding (every 1.5-2 hours during the day, every 3-4 hours at night).
• skin-to-skin contact.
• help the baby find the breast.

If you can’t wake him up, you need to express each breast for 10-15 minutes.

Short bridle

Causes difficulty when sucking, you can hear clicking and smacking sounds.
What to do:

• See your dentist for a frenulum trimming

Tight breasts

Milk is difficult to separate and it is difficult to breastfeed
. What to do:

• increase application frequency.
• Before feeding, stretch your breasts and express some milk.

Nipple shape

Difficulties with inverted or flat nipples
What to do:

• pick a pose
• use nipple formers and silicone nipple covers.

Not enough milk

What to do:

• increase the volume of fluid consumed (2.5-3 l.)
• Drink a warm drink before feeding.
• apply to the breast more often, especially at night. Between 3-4 am, the hormone responsible for the amount of milk, prolactin, is produced.
• Monitor your nutrition and caloric intake. Eat 5-6 times a day in small portions.

A lot of milk

What to do:

• reduce the amount of liquid
• Express your breasts before feeding.
• express breasts after feeding to prevent congestion and mastitis.
• Use breast pads to protect clothing from leaks.

Dummy

Due to pacifier sucking, the baby is less likely to attach to the breast.
Less milk is produced. The child prefers the pacifier to the breast. What to do:

• Limit your child from sucking a pacifier
• offer breasts more often.

How to tell if your baby is full of breast milk

Breasts gain weight more slowly - this is normal. The main thing is that the baby sucks the entire portion of milk regularly. To understand whether your baby has enough nutrition, you need to analyze:

• the amount of urine per day - if 4 - 5 diapers are changed per day, completely wet, then everything is in order;
• regular daily bowel movements - from 5 to 8 times a day;
• emptying of the mammary gland after feeding;
• The stool becomes a light mustard color by the third day after birth.

A well-fed baby sleeps better at night, although this sign is not decisive.

The main thing in breastfeeding is the mother’s persistence, which helps maintain natural nutrition, which subsequently affects the baby’s immunity. Therefore, you need to continue teaching the child to eat mother's milk until he succeeds.

Top 15 tips for a nursing mother

• The first hours after birth are important for establishing lactation. Laying on your stomach will help with this.
• Underfeed formula while waiting for milk to come in.
• Avoid observance of hygiene rules to the point of fanaticism (Wash your hands with soap before feeding).
• Give breastfeeding on demand.
• Give up the pacifier.
• There is no need for additional soldering.
• Do not pump until your breasts are completely empty. Just until relief.
• Change breasts every 2 hours.
• Complementary foods should be introduced after 6 months.
• Learn and try different feeding positions.
• The optimal duration of feeding is 2-3 years.
• Ensure that your breast is latched correctly when feeding.
• Do not cancel night feedings.
• Mom's illness is not a reason to stop feeding.
• Use the services of lactation consultants.

Online consultation with a pediatrician (breastfeeding specialist)

Online consultation

During the consultation, you will be able to voice your problem, the doctor will clarify the situation, interpret the tests, answer your questions and give the necessary recommendations.