How to breast-feed

Breast-feeding is wondrous, but it's also sound science. It helps to understand the science to know why proper technique is necessary. After delivery, as estrogen and progesterone levels drop, the level of the milkmaking hormone prolactin rises, and your baby's suckling stimulates nerve impulses that set off a biochemical response which keeps it high. Prolactin not only aids milk secretion, but also has a calming effect on the mother.

Milk is produced in your breasts but isn't available to your baby until it is "let down" into the milk ducts. When your baby suckles, she triggers your letdown reflex which releases milk into the ducts. When this happens, you may feel a tingling sensation, which some women describe as pins and needles. Each breast nipple contains 15 to 20 milk duct openings. When the baby continues to suckle on the areola (the pigmented area surrounding the nipple), the breast releases milk into his mouth. During pregnancy, the breast's areola enlarges and turns from pink to reddish brown. Although the milk is released from the nipple, the baby nurses from the areola.

You know that your milk has let down when your baby's suckling slows and his swallowing increases. At this point, your other breast may start leaking, and if you've given birth in the last few weeks, you may feel your uterus contract. Breastmilk is actually composed of two milks: foremilk and hindmilk. You produce the bluish-white foremilk between feedings. The foremilk, which your baby receives first, quenches her thirst. The higher-fat hindmilk is produced during the feeding. The hindmilk satisfies your baby's hunger -- it's important to allow your baby to stay on each breast until she is satisfied.

In the first few weeks your breasts will feel hard as they adjust to producing milk. Later, as they become more efficient, they'll soften. Don't worry that, since your breasts are soft, you're no longer producing enough milk. Nursing promotes milk production. The more your baby nurses, the more abundant your milk will be.

Latching on and off

Proper positioning of the baby's mouth on the breast, known as latching on, ensures that your baby receives adequate nutrition and that you won't get sore, cracked nipples. To stimulate the baby's natural urge to suck, lightly stroke his cheek. He'll turn his head in the direction of the cheek you stroked. Or tickle his lower lip with your nipple.

Help your baby latch on by compressing your breast between your thumb and fingers, keeping your fingers away from the areola. By cupping the breast, you shape the areola to match the oval shape of the infant's mouth. Brush the nipple to the baby's mouth. When he opens his mouth wide, draw your baby to your breast so that his mouth covers most of your areola. The baby sucks on your areola, not on your nipple. If your baby is latched on correctly, nursing shouldn't hurt. If it does hurt and you see that your baby is sucking on the nipple rather than the areola, help him latch off and try again. To stop your baby from nursing, gently put your finger in the corner of his mouth to break the suction. If you simply pull your baby away, you'll hit the ceiling with pain.

Breast-feeding positions

Breast-feeding is a time to relax with your baby. Get comfortable and use pillows to help support your arm and the baby. Vary positions to avoid sore nipples and to ensure draining from all the milk ducts. The following instructions are for feeding on the right breast. Reverse for the left breast.

The cradle position
This position allows you to nurse discreetly in public. Place your baby's head in the crook of your right arm so that baby is lying horizontally, with her mouth level with your areola. Turn the baby so that her stomach, chest, and knees are against your body. Place your baby's lower arm around your waist.

The side-lying position
When you master this position you'll be able to sleep and nurse at the same time. Lie on your right side, and place the baby so that his mouth is level with the areola on your bottom (right) breast. Use your bottom (right) arm to hold your baby in position. Take care not to lie on your baby's arm.

The football hold
This position is especially useful for smaller babies or for a mother with large breasts. Hold your baby under your right arm, with your hand supporting the baby's head and neck. Your baby will be facing you and should be close to your body. Cup your right breast with your left hand and offer it to your baby.

Feeding schedule -- What schedule?

Feeding a newborn usually takes five to twenty minutes per breast, but thirty minutes per breast is not unusual. Don't look at your watch to see if your baby has finished feeding. Let her feed for as long as she likes or until she falls asleep.

Give your newborn frequent, unrestricted opportunities to breast-feed -- a minimum of eight feedings in twenty-four hours. Since human milk can be digested within two hours, night feedings are essential. To stimulate and maintain your milk production, let your baby suckle at both breasts in turn at each feeding. For the subsequent feeding, let him start with the breast offered last. Can't remember which side to start on? Some women put a safety-pin on the bra strap of the breast with which the baby should start.

Feeding during growth spurts

When your baby suddenly nurses more frequently, she is probably going through a growth spurt. Typically, these growth spurts occur around two weeks, four to six weeks, three months, and six months. Help your milk production increase to satisfy your baby's hunger by resting, eating well, and nursing more often.

Burping

Some breast-fed babies never need burping. But if your baby tends to gulp back your milk, he may need to burp after each breast. Place him over your shoulder or legs and gently rub his back until he burps. Do not hit his back. And don't be surprised if the shoulder you're burping him on suddenly feels wet. Regurgitation is common with burping. You'll get in the habit of placing a towel or receiving blanket over your shoulder or leg before you burp the baby.

Expressing milk

You may want to express your milk if you're suffering from engorgement, or if you have to miss a feeding and want to keep up your milk supply. To express your milk manually, use a large, clean bowl to collect the milk. Wash your hands, then place your thumb and forefinger on opposite sides of your breast where the areola meets the paler flesh. First push the areola back toward your chest wall with thumb and forefinger, then pull it forward while gently squeezing. Repeat, moving your hand around the areola.

If you would rather use a breast pump, manual ones are available at your pharmacy. Bulb (bicycle horn) pumps are not recommended because they can cause nipple trauma and are difficult to clean. If your baby is premature and requires long-term milk expression or you are returning to work in the first few months, battery-operated or electric pumps are recommended. Look for a full-strength pump that has a Y-connector for both breasts and a regular rhythmic pumping action. You can rent one from lactation consultants, public-health departments, or medical supply stores.

After you have collected your breastmilk, pour it into a bottle or plastic disposable bottle liner and store it in the refrigerator for up to two days. If you plan to freeze your breastmilk, use a glass or rigid plastic container, or a plastic storage bag, specially designed for freezing human milk and available from your pharmacy. Freezing milk in a bottle liner is risky because the seams may burst during freezing or leak during thawing. You can store breastmilk in the freezer compartment of your refrigerator for up to two weeks, for two months in a refrigerator with a separate freezer compartment, and in a deep freezer for up to six months.

Serve refrigerated breastmilk as you would formula. Defrost frozen breastmilk in the refrigerator, then shake well before warming. Never use a microwave to warm breastmilk.

Supplemental bottles

Nursing mothers should not provide supplemental bottles until the breastfeeding relationship is well-established, unless there is some initial concern about depriving the newborn of essential nutrition. Giving your baby supplemental bottles too early will only contribute to your breast engorgement, sore nipples, and poor milk production. Since sucking on the nipple of a bottle requires a different technique, using both at the beginning may confuse your baby. If she's only breast-feeding, your baby will perfect her sucking techniques. But once breast-feeding is established, you will be able to return to work, if you wish, while maintaining breast-feeding and supplementing occasionally with bottles.

Pacifiers/Soothers

The World Health Organization suggests that breast-fed babies not be given a pacifier or soother during the first few weeks because it may distract them from breast-feeding. As with supplemental bottles, your baby develops a sucking technique with a soother that's different from the one needed to breast-feed. Many babies who nurse satisfy their sucking needs at the breast; however, a soother may let you get rest between feedings.

Is your baby nursing well?

The Canadian Paediatric Society offers these checkpoints for knowing that your baby is feeding well.

• You hear short swallowing sounds (making a caw sound) which gradually lengthen and deepen as your milk is released.

• Your areola, and your baby's jaw muscles move evenly as your baby sucks. You'll be able to see the movement of your baby's jaw right up to the ears.

• Your baby is content or asleep after feeding. The nursing process doesn't hurt you.

Your baby is not feeding well when:

• You hear a lot of lip smacking.

• You notice there's very little swallowing.

• Your baby isn't content after eating. The nursing process is painful for you.

Is your baby drinking enough?

Without a way to measure how much a breast-feeding baby is drinking, many parents feel anxious that he might not be getting enough. You can be assured that your baby is receiving adequate nutrition if, after the first week, when milk production has increased:

• You see your baby swallowing during a feeding, and he seems content and satisfied after feeding.

• Your baby nurses well at least eight times a day during the first few months.

• His bowel movements are soft or liquid and occur once or more daily for the first month. They are probably yellow or a green shade.

• His urine is pale yellow. He has six to eight wet diapers daily. (It's hard to determine if a diaper is wet when you use disposable diapers.)

• Your doctor feels your baby's weight gain is adequate.