Breastfeeding – Class Notes – 90 minutes

Supplies Needed: Breastfeeding Video, Doll to demonstrate positions, cards for breastfeeding myths. Outline for Breastfeeding 90 on flip chart. Poster of breast anatomy, poster of latch. Breastfeeding booklets to hand out: Motherwear and Medela.

Introductions. 10 minutes

Sometimes people have an idealized view of breastfeeding as a simple, instinctive, natural process. It is that, in some ways. But it is also a skill that needs to be learned. Just as we all had to learn to walk, and to talk, a new mother and her baby also need to learn how to breastfeed. In order to establish a good breastfeeding relationship, it is helpful to educate yourself about breastfeeding in advance, and then to seek out support after the baby is born to ensure that you get off to a good start. Sometimes the first few weeks are shaky, but for most women, once they get past that early period, then they can breastfeed successfully, easily meeting all the baby’s nutritional needs for the first six months of its life.

Go around, and have everyone share what experience they have with breastfeeding: family? Friends? Women in malls?

Anatomy and Physiology: 5 minutes (Lecture with Diagram / Drawing on Board)

It is helpful to known a little about breast anatomy and milk production before beginning breastfeeding. Some vocabulary: the dark area around your nipples is called the areola. Inside your breasts are alveoli, milk-producing cells that release milk into the ducts, then into the sinuses surrounding your nipples. When the baby nurses, the sucking action compresses these sinuses, releasing milk into his mouth through the openings in your nipples. Note that you don’t have just one hole in the tip of your nipple, like a rubber nipple, you actually have multiple openings the milk comes through.

Before the baby’s birth, your body begins producing colostrum, a creamy substance rich in protein, vitamins A and E, and antibodies.

For the first few days, your child will be receiving colostrum when s/he nurses: it’s low in volume, but invaluable nonetheless.

When the placenta detaches after birth, the drop in estrogen and progesterone signals the body to start producing the hormone prolactin, which guides the body in milk production. The mature milk begins to be produced around 3-5 days after birth.

Prolactin makes sure there’s a supply of foremilk available in your breasts to satisfy the baby when he begins to nurse. His suckling signals the body to produce more milk. After he nurses for a few minutes, he stimulates oxytocin production and the milk ejection reflex (“letdown”), which releases the higher-fat hindmilk. (Many women feel this letdown, as a warmth or tingling in their breasts. Others do not feel it.)

If it’s been a few hours since you nursed, your breasts might feel very full with foremilk. Some women believe that if they don’t always have that full sensation, then they’re not making enough milk. Remember that the body produces the nutritious hindmilk on a supply and demand basis. Even if your breasts don’t “feel full”, when your baby begins nursing, the milk will be there.

Breastfeeding Myths and Truths. 15 minutes.

We’re going to play a little game, which examines some of the issues around breastfeeding: some concerns you might have, some old-wives tales, some reasons why breastfeeding is healthiest for you and your baby. I’ll give you each an index card, then your job will be to read it out loud, then come and place it in the: Truth category, or the False category and tell us a little bit about why you put it there. Then I’ll give you a little more information on each topic. The goal here is not to get everything right, but to discuss what our cultural perceptions are of breastfeeding.

Positions: We’re going to talk about three positions for breastfeeding, including the cradle hold, football hold, and side-lying. No matter what position you use, make sure that:

· You are comfortable. You should always bring the baby up to your breast, rather than bringing your breast down to baby by bending over. Putting pillows under your arms, or under the baby may help with this.

· You and the baby should be belly-to-belly. He lies on his side in your arms, and his chest faces and touches your chest.

· Baby should be lying straight, with ears, shoulders, and hips in a straight line. This will be much more comfortable for him than letting his belly flop away from you.

· Make sure you can support your breast and your baby to ensure a good latch. (see below)

Demonstrate positions, have everyone practice cradle hold. [In 3 hour class, have them practice all three, and go around and check them] 5 minute talk. 5 minute practice.

Latching-On: A breastfeeding baby should not just be sucking on your nipple like you would suck on a straw: this would cause very sore nipples for you, and poor nutrition for the baby.

A breastfeeding baby should take your whole nipple and a portion of your areola into his mouth. To make sure your baby latches on well: tickle his lips with your nipple until he opens his mouth very wide (“baby bird”), then pull him forward onto your breast. When he begins sucking, his mouth should be wide-open, covering part of the areola, with his lips spread outward, and his tongue troughed below the nipple. [Demonstrate flanged lips.]

Sucking should be a rhythmic, wavelike motion, with audible swallowing (after your mature milk has come in.) You shouldn’t hear a “lip smacking” sound as he nurses. It is common to hear baby suck several times before a swallow, so his pattern may be suck-suck-suck-swallow, then a pause, then he begins again. 5 minutes.

Video showing positions and latch. 15 minutes.

Hunger Cues: how do you tell if your baby is hungry? One clear way is by testing the rooting reflex. If a newborn baby is hungry, and you stroke his cheek, moving from near the ear toward the mouth, he will turn his head toward your finger, and open up his mouth to grab hold. (This reflex is what helps him to find the nipple and turn toward it.)

In general, early hunger cues from the baby are: sucking his hand or anything he can reach, thrusting his tongue forward repeatedly, wiggling and other motor activity. Fussing and crying are late hunger cues. Many women find the baby is happier if his early cues are recognized and feeding starts then, rather than waiting until he fusses or cries. Sometimes by that point, some babies are too upset to nurse. 2minutes.

How often? How long? How do you tell when you’re done? (Ask them. Write bold notes on board) A newborn should be fed at least 8-10 times a day, at least every three hours. Many babies will want to feed more often than this, up to once every hour-and-a-half. Many professionals recommend feeding on demand, whenever the baby seems hungry. (Note, there are books that advocate scheduling your baby’s feedings. Use these sources with caution. The more moderate view are probably perfectly appropriate, but some of the more extreme, more rigid systems have led to a few cases of infants who fail to gain weight and develop properly.)

The more often you nurse, the more milk you will produce.

Breastfeeding station.

Each feeding should be a minimum of five minutes at each breast. This ensures that the letdown reflex will occur, and the baby will get the more nutritious hindmilk. A typical feeding would be 10-15 minutes at each breast.

Nurse until the baby either falls asleep, pauses more than he sucks, or pulls away from the breast. When you want to remove a baby from your breast, first break the suction by slipping a finger in the corner of the baby’s mouth. Do not pull the baby away without breaking suction first, as this will lead to sore nipples.

Then burp the baby, and switch sides. 5 minutes

Burping the Baby: (Demonstration) Breastfed babies often do not need to burp after feeding. However, it’s usually a good idea to give them an opportunity to burp, especially if their tummies feel tight, or they seem to be squirming and uncomfortable. Put them in a position which puts a little pressure on their belly (either laying over your shoulder, or sitting up, or lying on their belly in your lap), and rub their back for a little while. If they don’t burp, that’s fine. You don’t need to bounce them up and down and pat vigorously in an effort to create a burp.

Spitting Up. Some babies will spit up a little milk when you burp them (some babies spit up off and on all day for no particular reason). This is normal, and doesn’t mean that the baby is allergic to milk, or that the baby is sick or anything. If they spit up _a lot_ and it is concerning to you, you can check with the baby’s doctor for advice.

Switching Sides: After the baby has finished on one side (or after 15 minutes), switch him to the other side. This ensures good milk production in both breasts, and helps him develop well.

On the next feeding, start on the other side. (Some women put a safety pin in their bra to remind them which side to start the next feeding on.)

How do I know if I have enough milk?

· Assume you do. 99% of women make enough milk to feed their babies.

· Is baby pooping and peeing? After day 5 or so, you should see about 6-10 wet diapers a day, and at least 2 bowel movements (may be a b.m. with every feeding!).

· Is the baby gaining weight? It is normal for a baby to lose 10% of his birth weight in the first few days after birth. As long as he gains again after that, he’s getting enough milk.

· If you are concerned about your milk supply, remember that it works on supply and demand. Give it more demand (i.e. nurse your baby more often!) and your milk supply will increase. Eat well, drink lots, and rest, and you will produce milk. Taking a 24 hour cure can also help with milk production. Snuggle up, skin-to-skin, in bed with your baby for 24 hours, nursing as much as he wants to.

First Nursing: One of the factors most important to long-term breastfeeding success is to initiate (begin) breastfeeding in the first hour after the baby’s birth. Most babies have an awake and alert period in this first hour, and interested in feeding.

Technique is not important here. It’s just important to begin that connecting and bonding process. Ideally, you and the baby should be skin-to skin, his belly against yours (cover the rest of him up with a blanket to keep him warm.

Because of the importance of this feeding, you can request that medical staff wait until the end of this hour for such interventions as eye treatment, weighing and measuring the baby, first baths, etc. [Please note: this feeding is important, but if for some reason you are unable to nurse in the baby’s first hour, this shouldn’t cause any long-term problems.) 2 min

Birth Plan: 2 minutes. To ensure the best start to your breastfeeding relationship, request the following: 24 hour rooming-in (baby stays in mom’s hospital room rather than in nursery), feeding on demand (you feed your baby whenever he seems hungry, not following a schedule), no formula or water for the baby, no artificial nipples for the baby, and minimal intervention in the first hour after birth.

Early Days of Breastfeeding: For the first few days, the mother’s body produces colostrum, which is low volume, but high in nutrients and antibodies. She will begin to produce mature milk starting around day 3 to day 5. The more mom nurses the baby, the more milk production is stimulated.

Some babies will have a rough day on day 3 to 5. They may be fussy and act hungry, or they may be sleepy. They may not have bowel movements or urinate as much. This is generally not a cause for concern. It is usually simply because the mother’s milk has not come in yet, and the baby is not getting much volume of liquid. Nurse frequently, and your milk should be in full production within a few days. 2 min

Early Weeks of Breastfeeding 5 minutes.

Sore Nipples: It is not unusual for the mom to develop sore nipples in the first few weeks of breastfeeding. If your nipples are sore, seek out a lactation consultant (see resource list for contact info) or experienced moms to be certain that you have a good latch, good positioning, and that the baby seems to be nursing well. If everything seems fine, this is likely to be a temporary problem that will improve soon.

To help prevent sore nipples, and help sore nipples heal: Don’t wash your breasts with soap, just use clear water: your breasts produce natural lubrication, which soap washes away.

Hold your baby close, belly to belly. Make sure he’s latched well. Switch sides, and vary positions. Break suction before moving baby away from breast. After the baby is done nursing, express a little breastmilk, and rub it into your nipples. The vitamin E in the milk acts as a moisturizer.

Expose the nipples to fresh air for at least 15 minutes a day, and expose them to sunlight through a window if possible.

Most importantly: Nurse more often, for less time at each nursing.

To cope with sore nipple pain: Usually it will only hurt for the first minute or so that you’re nursing. Use labor breathing techniques to help relax. Start on the least sore side first.

Engorgement: Sometimes, before your milk production regulates itself, you may have times when your breasts are very full with foremilk; so full that they are hard, swollen, and painful. If this happens, soften them with: warm showers, warm washcloths or heating pads, or pumping or expressing a little milk. Once you have softened your breasts enough that the baby can latch on, nurse the baby. Again, nurse more often, but for less time at each feeding.

Long-Term: Once breastfeeding has been established, it is the only food that your baby needs for the first six months of his life. There is no need to supplement with water, or formula, or solid foods. After six months, you can begin adding in solid foods.

The American Academy of Pediatrics recommends nursing exclusively for six months, then continuing to nurse along with solids until the baby is at least one year old. After that, they say nursing can continue for as long as the mother and baby desire it.

The World Health Organization recommends nursing until at least two years of age, and there are many cultures worldwide where children are nursed beyond that age.

Many babies experience growth spurts at around age 6 weeks, 3 months, and 6 months. At these times, it may seem like they want to nurse non-stop to meet their increased nutritional needs. Just nurse them when they’re hungry, and know that soon your milk production will increase to meet the increased demand.

Pumping, Storing, Babysitters, and Going Back to Work  5 minutes.

Breastfeeding does not have to be an all-or-nothing proposal. Many people breastfeed for a portion of the baby’s feedings, pump and bottle-feed breastmilk for some feedings, and use formula for other feedings. Breastmilk is better for your baby than formula, so the more feedings that include breastmilk, the better. We’ll talk a little today about pumping and storing breastmilk to feed your baby, and I encourage you to seek out more information on this, by reviewing the information in the booklet, handouts that come with your breastpump, and the books listed in the reference section of the breastfeeding guide (page 31). There are lots of ways to make breastfeeding work for you and your family, and you don’t have to give up breastfeeding completely until you and the baby are ready to do so. If you reach a point where it’s difficult to pump to meet all your baby’s needs, and you switch to using formula primarily, you can still include breastfeeding: for example, some women nurse their babies only at bedtime as part of the bedtime ritual. Their milk supply adapts to this lowered demand.

There are several different types of breastpumps available. Take a look at the Medela guide over break for more details on all of these. Generally, if you plan to breastfeed you baby the majority of the time, and will only be pumping occasionally, you can get a small handheld pump, either manual, or battery-operated; pumping with these can take up to 30 minutes. If you plan on pumping every day, or multiple times a day, you’ll want an electric pump, possibly one that can pump both breasts at the same time. This can reduce your pumping time to 10 to 15 minutes.

Storage: Make sure your pump is kept clean. For storage, use glass or plastic containers that can be washed in the dishwasher, or specially designed disposable plastic bags. You can safely keep your milk for up to 8 hours at room temperature, for eight days in the back of the refrigerator, or two weeks in the back of your freezer section. ETC. on food safety (not thawing and re-freezing, etc.)

Using: Thaw or warm breastmilk by placing it under cool running water, then gradually increase the water temperature until milk is warm, or by placing it in a container of warm water. Do not use the microwave to thaw breastmilk, or to warm formula, as it can lead to “hot spots.” Warm only as much as you expect the baby to eat; you can always warm more if he’s still hungry.

Bottles: there are several different brands of bottles and nipples on the market. If your child doesn’t do well with one brand, try another. Try to delay introducing artificial nipples till the baby is at least six weeks old and nursing is well-established. Starting it earlier can lead to nipple confusion and inefficient nursing. (ETC on breastfeeding is harder work than bottlefeeding for baby…)

Talk about how feasible it is to breastfeed…

Nutrition