Breastfeeding Secrets Revealed: Position, Hold and Proper Latch

     New moms have told me that they wish they had been given more information on positioning and latch as well as the various holds associated with breastfeeding.  So I have decided to reveal these breastfeeding "secrets" here. 
1.  What is the secret to preparing for breastfeeding?
Holding the breast properly!  The c-hold is the proper way to support the breast when learning to breastfeed and should be practiced by expectant and new mothers because almost every new mom does it incorrectly.  How?  Moms tend to place the thumb on top (correct) but place the bottom fingers in the wrong place.  The bottom fingers need to be near the chest wall.  The index finger usually ends up on the bottom of the areola preventing baby from getting a deep latch.  Whether you are already breastfeeding or still expecting, check your c-hold in a mirror to make sure your fingers are out of the way. Also make sure the flap of your nursing bra is not in the way.  Remember, a new baby cannot support the weight of their own head, let alone your breast so support your breast properly and without hindering the latch.  If you are expectant mom, it is not proper to prepare for breastfeeding by toughening nipples, an antiquated practice that breaks down the keratin layer of the skin and is not helpful.  It is helpful to test nipples for inversion by placing the fingers 1" behind the nipple and gently pinching to see if the nipple inverts, goes flat or protrudes normally.  If it does not, consider using a breast pump to draw out nipples just prior to feeding.  A nipple shield is a last resort as it can cause a decrease in milk supply, but much better than using a bottle.

2.  What is the secret of a good latch? 

We will discuss proper body position in a few moments, but here are the basics of a good deep latch.

          1.  Support the breast in the c-hold discussed earlier.
          2.  Line the baby's nose up with your nipple.
          3.  Use your nipple to tickle the baby's lower lip in a downward motion to elicit the open mouth reflex.
          4.  Wait for a yawn or cry-wide mouth.
          5.  Swoop the baby's entire body towards you.
          6.  Bring the baby's bottom in closer to you.  This will dig in the chin and tilt the head slightly.
          7.  Support the breast for a newborn the entire feeding, but don't forget to relax your shoulders and make sure you have support for your arm as newborns can take 45 minutes to get in 20 minutes of swallowing.

3.  What position is the best to learn to breastfeed? 

The cross-cradle hold gives you the most control, but depending on whether you had a c-section, the football hold may be best for you.  We will address the football hold a little later.  In a proper cross-cradle hold you will hold the baby at the nape of the neck with the hand opposite the breast you are using.  Use a proper c-hold on the breast.  Sit back in the chair, put your feet up on a stationary footrest.  This brings your knees above your hips helping to keep you from the temptation of bringing the breast to the baby.  Always bring the baby to the breast.  Otherwise you end up with a sore back from improperly leaning into the baby.  Latching on in the cross-cradle or any position should be done in a one (1) two (2) motion.  Practice the proper latch techniques previously discussed. 1. Swoop the baby in as soon as you see a yawn or cry-wide mouth.  2.  Pull your elbow towards your ribs bringing the baby's bottom with it.  This draws the baby's bottom close helping him dig in his chin and tilt his head back keeping you from the temptation of pushing the breast tissue away with your thumb.  You shouldn't push down with your thumb as it raises the nipple toward the roof of his mouth causing nipple irritation.  When using a pillow, remember that it is there to support you while supporting the baby.  It is not meant to support the baby without your help, but a nursing pillow is an effective tool to keep mom in the proper position and save her from backache. 

4.  What is the secret to a good football hold? 

Much like the cross cradle hold, mom holds the nape of the baby's neck with her hand, but this time, the same hand on the same side as the breast she is using. Use the c-hold and ensure that the bottom fingers are well below the areola.  Support the breast with your hand or a rolled up burp rag during the entire feeding for a newborn who cannot support the weight of his own head.  Remember that your hand should be on the nape of the neck and not higher on the head for several reasons. One being that baby's tend to arch their back when you touch the top of their head. Sit back in the chair, put your feet up and have a pillow on that side of your lap for support. Your baby should be tucked under your arm like a football. His legs should be in a fetal position or and older baby might have them raised up resting his bottom and legs on the back of the chair. done in a one (1) two (2) motion. Practice the proper latch techniques and the swoop and tuck motion previously discussed.   Nursing pillows are essential in this position unless you have a very wide soft armrest on your chair.



5.  What is the secret to when the cradle hold should be used?
It is best to use the cross-cradle hold instead of the cradle hold when you are first learning to breastfeed because you have more control over the position of the baby's head with your hand than you do in the crook of the elbow.  But many moms are very comfortable in this position so moving to this position after the initial latch on as long as you support the breast for the newborn with a rolled up burp cloth is easy to accomplish.  Or once the baby has more control over his head or you are a smaller busted mom, you can use the cradle hold comfortably.  Just remember the latch positioning discussed previously.  Baby's nose should be on target with the nipple.  He should be tummy to tummy with mom.  His ears, shoulders and hips should be in a straight line as it is hard to swallow with your head turned.  Also remember to bring baby to the breast and not the other way around and to relax your shoulders and use something to support your arm.

6.  Do I need to learn to nurse lying down?

Is it important to learn the side-lying position?  In a word, YES!  The side lying position can be the answer for a stressed sleep-deprived mom or a mom who wants to increase her milk supply!  The proper technique for the side lying position is to have a pillow or two under your head and a pillow between your knees to stabilize your hips.  Baby's nose is on target with the nipple and the baby is drawn close with moms arm that is under her.  The bicep of this arm is partially used to support the breast for a larger busted mom as well.  Remember in all holds baby is tummy to tummy with you and not lying on his back with his head turned trying to swallow.  The side-lying position is perfect for co-sleeping at night or catching a nap with baby.  Taking your baby to bed with you if you perceive a dip in milk supply is a great way to get a boost as well.  

     Breastfeeding should not hurt!  If you have had previous trauma and are correcting an improper latch, there can be discomfort for the first 30-60 seconds, but then it should subside.  If it does not, break the suction by inserting a clean finger passed the gums and turning.  Then start the latch again from the beginning.  Don't let your toes curl and your teeth clench because you are a good mama.  The milk sinuses where the milk pools are located approximately one inch behind the nipple and not on the nipple for a reason.  The nerve ending are on the nipple.  Pain is telling you that your latch is incorrect.  Once the baby is in proper position with a deep latch, he will get more milk and you will have a more comfortable rewarding breastfeeding experience. 

     For more answers to breastfeeding questions visit our breastfeeding tips page or give us a call at 254-728-3627 9-5 M-F CST.

Breast Milk Allergy: Breastfeeding Myth Busted!

     The breastmilk allergy myth was further perpetuated on the TODAY show's #bornTODAY series this morning causing me to have to speak out against irresponsible and incomplete journalism. 
The Myth: Some babies are allergic to their mother's milk.
The Facts: Human milk is the most natural physiological substance that baby can ingest which is why breast milk can be used as a "clear liquid" if a baby is ill with a stomach virus and it is also why breast milk does not sting when placed in the eye as a remedy for conjunctivitis.  
     If a baby shows sensitivities related to feeding, it is usually a foreign protein that has been consumed by the mother and entered into mother's milk, and not the breast milk. The remedy for this is to remove the offending food from mother's diet for 3-4 weeks.  One example is dairy.  Dairy is difficult to digest and can take 10 days to two weeks to leave the mother's system and another 10 days to two weeks to leave the nursing baby's system making the process take 3-4 weeks.  This lapse in time is no reason to wean because as any formula feeding mother can attest, it may take much longer than that to find a formula your baby can tolerate.

Here are some references to help bust the breastmilk allergy myth!

Hudson, I. et al. A low allergen diet is a significant intervention in infantile colic: results of a community-based study. J Allergy Clin Immunol 1995; 96:886-92.

Mohrbacher, N., Stock, J. BREASTFEEDING ANSWER BOOK. Schaumburg, Illinois: LLLI, 1997; 97-99.

Salmon, M. Breast Milk: Nature's Perfect Formula. Demarest, New Jersey: Techkits, 1994; 32-3.

Newman, Jack: Pitman, Teresa, The Ultimate Breastfeeding Book of Answers, 2003; 150

Tanya Roberts
Lactation Connection

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Why Fenugreek Isn't Working for Breastfeeding

     The truth is fenugreek is a great tool to boost milk supply in most moms.  However, in the two decades that I have been helping nursing moms, I get this comment a lot, "Fenugreek didn't work for me."  How can it be that an herb with such great success stories doesn't work for a large number of mothers.  In most cases, the answer is in the quality, dosage or delivery method.

     Many moms buy Fenugreek at a local health food or grocery store in brands that are not stored or bottled in the best way to keep them at full potency.  Also, shelf life factors into this so buying from a store that doesn't cater to the largest market for Fenugreek, nursing mothers, will not have the best turn-around.  It is always a good practice to check the expiration date on any herb before using.  Fenugreek capsules work best when taken in a quality brand like Nature's Herbs or Nature's Way Fenugreek and in the appropriate dosage or combination.   The correct dosage is essential.  If you are under 150 lbs, start with three capsules, three times daily.  Yes, that is nine capsules per day.  Possible side effects of fenugreek for mom are loose stools and you may smell like maple, but who cares if you are taking this short term for a boost and the result is more milk!  If you stools are not loose or you are over 150 lbs, you can take up to 5 capsules three times daily.  This dosage is for Nature's Herbs as it is 620 mg per capsule.  Some brands only contain 500 mg.  You should see more milk in 48-72 hours.  Always finish the bottle which is about a 10 day supply.  Don't save it for later as once you open the bottle, it begins to loose freshness.  If you are still not getting a result, combine Fenugreek with Blessed Thistle.  Take 3 Fenugreek + 2 Blessed Thistle three times daily.  You can also use Alfalfa instead of Blessed Thistle.

Dr. Jack Newman, a lactation specialist at the International Breastfeeding Center in Toronto, writes about the effectiveness of blessed thistle and fenugreek when used together: “These two herbs seem to increase milk supply and increase the rate of milk flow.” He adds that their effects are additive: “Fenugreek and blessed thistle seem to work better if you take both, not just one or the other”. Dr. Newman notes that mothers generally notice an increase in milk production within 24-72 hours after starting the herbs.   The only problem is that the number of capsules taken can be daunting to new mothers.  We recommend St Francis Fenugreek Blessed Thistle which are a high potency blend of fenugreek and blessed thistle in the appropriate dosage with only one capsule taken twice daily!

     What about Fenugreek drinks?  Fenugreek Tea such as Mother's Milk Tea, Earth Mama Angel Baby Milkmaid Tea tea bags should be steeped for about 15 minutes to get the full amount of herb available.  It is more difficult to tell how much you taking so I only recommend using tea bags as a supplement to the capsules or for long-term intermittent use and not for a quick three day boost.
    The best way to get the correct herbal dosage is either a capsule with a single herb such as fenugeek or a single serve kcup lactation tea that serves the same amount of herbs every time.  Anna Naturals Nursing Mama Tea comes in single serve cup for kcup compatible brewers and is the best-tasting of all the herbal lactation teas we have found other than Milkmaker's Tea. Anna's lactation tea cup works in Keurig and other k cup style brewers.  Drink 3 cups daily for best results or use as a supplement in taking with Fenugreek or Blessed Thistle capsules if drinking sporadically.

     Remember, milk supply is usually a supply and demand issue.  Baby is not nursing frequently enough or emptying the breast well enough or you are not pumping for a full 15 minutes or every 3 hours while at work.  Another reason for low supply could be missing out on growth spurts.  If you miss a growth spurt,  add 3 extra nursing or 10-15 minute double pumping sessions with a quality double breast pump in each day for five days in a row to make up for the missed stimulation.  This simulates a growth spurt and studies show this extra hour of stimulation per day.  If you pump frequently, make sure to replace valves and backflow protectors frequently to ensure your pump is functioning optimally to maintain a healthy milks supply.

Some moms should not take Fenugreek.  If you are allergic to chickpeas, peanuts or other legumes do not take.  If you have low blood pressure or low blood sugar, this may be affected with Fenugreek.  If you have low potassium or asthma, Fenugreek may affect these conditions as well.  Also, if you have any bleeding disorders, Fenugreek can work as an anticoagulant so would have an adverse effect. If you could be pregnant, it should not be taken during pregnancy.  The good news is that there are great alternatives that will boost supply in most moms from companies like Legendairy Milk and Motherlove. The most popular in these brands are the Legendairy Milk Lactation Support Bundle, Legendairy Milk Cash Cow and Motherlove More Milk Plus. 

     In addition to everything else you are doing, make sure you are drinking to thirst and make your snacks count.  It never hurts to eat a lactation cookie instead of donuts for breakfast or candy for a snack.

   
While fenugreek alone may not increase milk supply, fenugreek and blessed thistle are a great lactation supplement when taken correctly. And for those with medical contraindications or allergies, other great lactation supplements are readily available.

Best wishes for a healthy milk supply!
Tanya



7 Stages of Breastfeeding: A Baby's Perspective

Just for fun in honor of World Breastfeeding Week 2013, I thought I would write something from baby's perspective as a breastfeeding tip for mom.  Here is one tip for every day of this week!
1.  Birth-day Initiation:  My stomach is the size of a marble.  I am loving being skin to skin with Mama and the reward of a swallow of golden colostrum!
2.  10-Day-itis:  After 10 days, I start my first growth spurt.  I want to eat every hour or two and can't get enough of this liquid gold.
3.  6 weeks:  Breastfeeding is easier for me, but pooping is harder.  I am going through another feeding frenzy and things seem to be changing!  I was pooping all the time, but now only once in a while!
4.  3 months:  Another growth spurt.  Love it!  I get to eat as often as I like and no one complains, but I do get a little distracted 'cause there is so much to see while I'm eating.
5.  6 months:  I'm learning to sit up and trying solid foods just for fun.  My mom always lets me nurse first so I don't get too full for my milk, but I think it's so I don't get green beans on her breast!
6.  The Groove:  My mom and I are in a groove, we are nursing whenever and wherever I am hungry.  I may not be nursing as often as I was the first six months, but I can down a meal in 20 minutes if I am not too busy learning new things!
7.  Weaning:  Mom is letting me wean myself.  I haven't decided when yet, but we are in no hurry.  I heard her tell dad that if she does decide to wean me by a certain time that she is only going to drop one feeding no closer than 3 to 5 days apart.  This way, her breasts and my brain have time to get used to the change.   I love my mommy!

Happy World Breastfeeding Week, Mamas!
Tanya Roberts, BSEd, LC
Lactation Connection
{The Nursing Mother's Milk Supply}

Supplementing the Breastfed Baby: Lactation Aid Feeding Tubes vs Supplemental Nursing System & Lact-Aid Nursing Trainer

     In my practice as a board certified lactation consultant, there were times when it was medically necessary to supplement.  Whether it was due to a poor suck or mismanaged milk supply, we need options when recovering from these issues and getting back to breastfeeding.  Many times, I would recommend finger-feeding with a syringe to keep moms from using a bottle nipple.  I would have rather recommended a Supplemental Nursing System which has a container with tubes that runs to the breast; but I didn't want to see mom spending the extra money when her budget was so tight.  At that time, the only options were the Supplemental Nursing System (SNS) by Medela and the Lact-Aid Nursing Trainer.   These cost mom $50 or more and had small tubes to be cleaned which were cumbersome.   Now, with more options available, Moms can use a short-term feeding tube which accomplishes the same thing and can be cleaned for a few days before disposing of it.  It is a small investment in comparison to the commercial systems.  While moms who are adopting babies and inducing lactation, rather than just building milk supply may still want a commercial unit; the Lactation Aid Feeding Tubes are the best course for the short term situation.  Thanks to IBCLC, physician and lactivist, Dr Jack Newman videos and instructions are available for using these feeding tubes.  You simply cut a slightly larger hole into a bottle nipple.  Insert the adapter end into the bottle and feed the tube into the babies mouth while he is latched on.  You may also use medical tape if you prefer to have the tube in place prior to latch.  These can be purchased from the International Breastfeeding Center in Canada, but due to the long ship time of up to three weeks, we have added them to our selections at Lactation Connection.  Sold in a two pack for under $10, these will last up to two weeks while mom is re-establishing milk supply or training a baby with a weak suck.  Each tube is in an individual sterile pack ready to use.  Instructions are included with the feeding tubes when purchased here:  https://www.lactationconnection.com/Jack-Newman-s-Lactation-Aid-Feeding-Tube-p/54-5036-2.htm
     Dr. Jack Newman also has a helpful instructional video on YouTube.  I encourage you to view it and encourage lactation consultants and breastfeeding counselors to recommend and use these feeding tubes for short term situations of supplementation. 
http://www.youtube.com/watch?v=ezGIkIkhC_o&feature
     It is also important to recognize the appropriate amount of supplementation.  Always assess milk supply first, then only give the difference of what mom is producing and the actual need of the baby.  This is to say that you supplement not how much the baby will drink, but the need of a baby of that weight.  Here is a link to a chart for appropriate milk intake to show how much to feed per pound of body weight:  https://www.lactationconnection.com/Feeding_s/1907.htm  For example, a 7lb baby who is older than 6 days needs 2.25oz eight times per day.  If mom is making 1.25, then the appropriate amount of supplementation is 1 oz. per feeding.  Contact you local lactation consultant for further instructions on supplementation or give us a call at 800-216-8151 9-5 M-F CST. 


Lactation Aid Images: 

Note:  Most lactation aid feeding tubes sold are slow flow.  They are 36" in length so that the flow is regulated.  Shorter tubes change the flow to a faster rate.  If you do need a faster flow for an older baby, medium flow lactation aid feeding tubes are now available at: https://www.lactationconnection.com/Jack-Newman-s-Lactation-Aid-Feeding-Tube-p/54-6036r.htm 

Happy Nourishing!

Tanya

Breastfeeding Essentials: Budget for Breastfeeding

     We all know that all you really need for breastfeeding is a boob and a baby, but I often get the question, "What do I need for breastfeeding?".   The answer is that it really depends on your situation and your budget.  Are you going to be working outside the home?  If you are mostly working in the home, do you have times that you need to be away from your baby for conferences, etc? 
     Formula costs about $150 per month so you budget for breastfeeding could be over $1000 and still be ahead, but most most do not spend that much.  If you work inside the home and are not separated from the baby, you can spend very little.
     The following is a checklist and depending on whether you are work at home mom or a mom who works outside the home, you will want to pick and choose the type of breast milk collection product you will need based on your situation.   I have been in the business of breastfeeding for 20 years and am very familiar with the major brands and products associated with breastfeeding so the product list below is one given with experience and based on what products I would buy for myself, my daughter or my daughter-in-law:
Nursing Pads
__2-3 packs of washable nursing pads
Breast Cream
__1 large tube of breast cream
Nursing Bras and Gowns
__2-3 quality nursing sleep bras
__2-3 daytime nursing bras with good support (non-underwire)
__2-3 nursing gowns
Breast Milk Collection and Storage
__1 quality double electric breast pump
__2-3 packs of breast milk bags
__3 packs of breast milk bottles for storage
     The best time to be fitted for a nursing bra is 3 weeks prior to delivery.  This is a great time to finalize your list and make sure your hospital bag is packed and ready.  Happy nurturing!

Nursing In Public: To Cover or Not to Cover

     There is an ongoing debate in the breastfeeding community about covering up while breastfeeding.  Many lactivists insist on nursing without a cover.  Others may even be rude to a nursing mother who is nursing in public.  A cover is a personal choice.  Nursing in public may be more comfortable to you while you are learning to latch on discreetly with a nursing cover.  Once you and your baby learn to latch well, a nursing top or other discreet top may work for you.  If you are in a group of women, it is actually helpful to nurse without a cover so that other women can learn from you.  One of the reasons our culture has a difficult time with the early days of breastfeeding is that we have never seen it done.  Although Spanish is my second language, in my 20 years of counseling nursing mothers I have had less Hispanic clients who needed help with latch due to the culture of women helping women. 
      If you choose to cover a nursing scarf makes an excellent nursing cover. It is fashionable, easily accessible and helps your baby stay on the task of nursing. 
   So cover, don't cover.  It is up to you.  Do whatever makes you, not just others feel comfortable.  The more comfortable you are, the longer you will breastfeed!

Here is to nursing anywhere and everywhere!

Tanya