Mother's Milk - Breastfeeding 101 - part I

BREAST FEEDING 101

Positions

I remember seeing this poster and thinking, "oh thats easy, great, BFing sorted!" I kid you not, I honestly thought that was all there was to it. And it turns out this is just the tip of the iceberg. Never mind everything else you need to know, these positions are just the basics, I've even had to feed my baby upside down ... here's why you need to have options.

The important thing to remember when choosing a position is that you and baby need to be comfortable. Before you settle into it, decide whether you can comfortably carry that position for an hour and don't be afraid to break latch and start again. If at first you don't have enough pillows, the right chair, the right stool etc for a position, you'll have to settle for one of the other positions, till you buy the right 'equipment'. The diagrams always make it look so simple, like all you need is a pillow. Hahahaha. Well, it does happen eventually, but in those first few weeks I bought a new device almost everyday, and at least 6 more pillows.

Remember if you're comfortable, you'll be relaxed (very important for baby's energy and your milk supply), you'll be less likely to shift position and change your latch, and you shouldn't have any muscle ache later.

I always imagined feeding time to be a great time to catch up on reading... surprise surprise, you need both your hands and your eyes to BF! Have a look at the positions above, it is imperative in the first few weeks that you have one hand on baby and one holding your breast correctly in her mouth.

Also remember that different positions drain different areas of your breast, so if you want to prevent engorgement (without the cabbage) you will need to swap occasionally. And, if your ducts are blocked in a specific area, there will be occasionally be a position you need to stick to till its drained.



Getting ready

What you need:

Adequate lighting. Breast feeding demands precision and attention at first. You need to see obvious things like baby's latch and subtle things like the movement of her ears while she drinks. Make sure you have a nightlight this is bright enough to see this but also dim enough so baby can go back to sleep easily.

A stable chair with the correct seat height and correct arm height. You want to get as close to the position you need to have baby's mouth be at the level of your nipple while sitting back comfortably. Rocking chairs are not great at first because you want the back to support your weight and hold your position

A footstool. For this you can use anything till you find the correct height for you. My lactation consultant suggested phone books, I eventually used a few novels and now I use one of those plastic stools for potty training.

"Brestfriend" have a great (very costly) stool that adjusts to different levels

[Incidentally, the lactation consultant also gave me a great tip for passing stools. Use the stool while you're seated on the toilet, with your bum as far back as possible and leaning forward. And drink a cup of warm water before you go. Trust me this will come in handy for that inevitable BFing constipation or postnatal anal fissures or painful piles.]

Pillows. At first I was using a wooden rocking chair and needed pillows to cushion my back and under my arms. I was then advised to buy a plastic garden chair, which also needed the same cushioning. Both required a cushion or 2 to hold baby up to the right height. I used a scatter cushion on my lap then placed my long preggy over that.
Understandably this all took some preparation before I could settle down to feed, and sometimes I even needed someone to hand me the baby after I set up. You can appreciate how this won't work when you're doing it 8 times a day and in the middle of the night.

I finally discovered the greatest invention for BFing since boobs!

THE BRESTFRIEND!

I found the brestfriend completely by accident at Baby City, and it changed my life completely. It cleverly attaches around your waist at any level you choose and offers both back support and support for baby. There's a gimicky side pocket for your nipple cream and water I guess, but nothing dramatically useful. So now I need no-one to help me and my bed is covered with useless pillows! 

So if we put it all together we should have something that looks like this:

much better than:














In second image you can see the mommy is hunched so she can reach baby, her legs are crossed to get baby up to her nipple level, she has little back support leaving her neck over-flexed. The chair has arm support but its useless at that height, if she rests her arms there her shoulders will bunch up and won't be very comfortable.

You will also need small towel or towelling nappy to place under your breasts. Breastfeeding can be a messy business!

Latching

Great, now that we're sitting comfortably, we need to latch baby to breast. You probably all know by now that baby has to have most of the areola in her mouth. The anatomy works so that the nipple is actually down baby's throat and she can stimulate the milk ducts with her tongue. If the nipple is not far down enough, her tongue is going to create a type of chafe on your nipple, also known as cracked nipples! :( If she isn't draining your breasts correctly, you are also at risk of developing blocked ducts and mastitis (breast fever) :(


This method worked best for me after trying a few, and is still the method I use when I've been a bit lazy and my nipples have taken strain....

When holding your baby in a cross-cradle hold, feeding on your right breast and holding baby with your left hand

step 1: Hold baby with your thumb just behind her right ear and 2 or 3 fingers around the left ear. You need to be able to 'steer' baby onto your breast, so be firm, but not so firm that you won't feel her pulling back if she needs to. Cradle the rest of her body on the crook of your arm so that the front of her body is facing your waist.

step 2: Locate 8 o'clock position on your right areola if top of your areola is 12 o'clock. At about 1cm from your nipple, place your thumb in that position and hold your breast. You will notice that if you push firmly enough, the nipple will point outwards, great, thats what you want!

step 3: 'Steer' baby, chin first toward your nipple and 'place' the bottom lip of her open mouth about 1cm from your nipple

step 4: This is tricky, but after a little practice gets very easy: Sweep the nipple into baby's mouth with your right hand while simultaneously tilting baby's mouth over and onto your nipple. 

To do this your right thumb sweeps from 8 o'clock, in a straight line, to 4 o'clock, and your left hand takes baby over and onto your nipple.

step 5: This is important! Check that baby is puckering her lips over your areola. Check that most of your areola is in her mouth. Allow 10 seconds of pain or discomfort, but the latch should be painless after that. If any of these are incorrect take baby off your breast! Do not pull her off, your nipple will follow.. painfully! Instead place a finger in the corner of her mouth and apply gentle pressure to open the mouth, then remove the baby from your breast.

Don't be afraid or hesitant to de-latch your baby! You will both suffer in the long run if you don't. Just keep trying to get it right. 

step 6: Once your baby is latched painlessly, continue to support her head gently with your left hand, and with the right hand, grib the breast just before the areola begins and squeeze it gently into a burger type shape, holding your hand in a C. This puts less pressure on your nipple, and you should feel a little relief as you do it. Remember that you may compress the ducts under your fingers, so don't hold it too firmly.

step 7: Watch that your baby is actually drinking and not just comfort sucking by trying to listen for a (very subtle) gulping/swallowing sound and watching to see if her ears are moving with each swallow.

also see video http://www.drmomma.org/2010/08/breastfeeding-latch-trick.html

Correct Latch

What next?

Knowing when your baby has finished a round of feeding is easy. In the first few weeks, newborns simply fall asleep and stop drinking (later they more obviously, pull away). They may continue to suck, but you will no longer hear any swallowing noises. Before you delatch, try to wake baby first by stimulating her with touch or sound. Speak to her, tickle her toes, rub her head, whatever works for you, and allow her to continue drinking again. If she cannot wake up, don't worry, delatch, then burp her in whichever way you prefer. (more about burping later) You can then return her to the same breast or swap to the other side depending on what is needed. A good way is to feed baby in one position, then swap to a different position on the same breast in round 2, allowing most of the breast to be emptied. An empty breast feels like it felt pre-pregnancy, supple and soft. This may be obvious to you but I didn't have empty breasts till a physiotherapist had to drain them, simply because I thought they were supposed to feel like rugby balls when you were breastfeeding!

Remember that babies feed in courses, sometimes they have a 5 course meal, sometimes they want a quick snack, sometimes they want a few seconds of dessert. You can't predict what they will want but you can make sure that they haven't fallen asleep at the dinner table without finishing their meal.


Please feel free to share your breastfeeding make or break moments in the comment box...

  

  

Mother's Milk - A labour of love - My Story

I'm sorry to break it to you but... *big sigh* breastfeeding is flipping hard!

If you're anything like me, (I was dreaming about BFing since I had breasts, yes, I was broody at 12), then that moment that your baby first latches is overwhelmingly joyous. That joy soon becomes confusion and every so often overwhelming pain and despair. You may of course be one of the Very Very lucky ones, where BFing will be a breeze. I cried when I heard other new moms talk about feeding in their sleep, whipping out their boobs in public, and loving the experience. Not only did I feel like a failure, I also felt like I was the only mother in the world who would consider giving up just because I couldn't handle the pain. After all "BREAST IS BEST!". The world is so focussed on passing on this message to those who might actually be fooled by the pharmaceutical companies into believing that any formula could be better than God-given breast milk, that it forgets about those poor innocent moms on the brink of post natal depression, who feel as though they've failed all the children of the world by giving up.

Firstly... breast may be best, but it is not the be all and end all. If for any reason you find that you have to throw in the towel, its not the end of the world. Hundreds of mothers have gone the same route, and anyone who's breastfed will understand the pain you have endured. I remember the devastation I felt when I had to consider giving up, no one tells you how to handle it if you have to.

Secondly... there is so much help out there. If you get stuck, there's a person dying to come and help you around every corner. And I do mean dying to help you. In all my years working in the health profession, I have never come across a group of professionals so eager to help and so passionate about my well-being than people in the post natal field.

Thirdly... do it right from the start. If you fall, pick yourself up and start at the beginning. There is so much about BFing that they do not tell you, I wish they would spend half as much time teaching how to BF as they do shouting "BREAST IS BEST!"

Lastly... it gets better. Believe it or not it is very likely that you too will eventually be effortlessly whipping out your boob to feed your child with a smile on your face. I can't say how long it will be for you, for me it was 4 weeks which, in mommy terms, is the blink of an eye.




This is my story...



Prior to giving birth, the sum total of my BFing knowledge was what was skimmed over for a few minutes at the end of my antenatal classes (no, med school does not cover this topic either). No disrespect to my antenatal class, I would highly recommend, in fact, that you take this class. This, like most antenatal courses, is and should be focussed on the labour and delivery. In fact BFing is such a huge topic, it should really have its own course.

So armed with this knowledge, I took my newly emerged baby to my bosom, and waited for the angels to sing. They did, for a second, then she stopped sucking and I realised I had no idea what to do next. A nurse quickly popped my boob back in her mouth and wheeled us off to the ward. In hospital each feed was a fumble of areola, nipple, fingers, blanket and crying baby, till the nurse came and showed me how to do it by popping my boob into her mouth and walking away. The pain I felt was supposedly "normal" and by the time I was discharged I needed 2 sessions of physio lazer on my nipples just so I could go on feeding without tears.

The lazer worked so well that feeding became painless, and when I got home I obliviously carried on systematically ripping my nipples apart. By the time the pain started again, my nipples were cracked and bleeding, a fact I only discovered after noticing blood on my baby's lips (shock and horror I know!)  My midwife, Ciska, came riding to the rescue on day 3. She taught me a technique to get baby to latch better (not foolproof but better than I was doing) and left me with instructions on sunning my nipples and strict instructions to NOT stop feeding! It got better for 2 days then started again. My antenatal class teacher, Emma, was my next house visit, and she stayed for an hour, correcting my already failing latch, rearranging my room, sending hubby to buy a new feeding chair and teaching everyone at home how to support me. She also left me with an amazing device called a 'nipple shield', which took away the feeling of wanting to run away and hide at every feeding time.
By this time everyone at home, and some of the neighbours were already used to seeing me wonder around topless and dripping milk everywhere. Something I finally remedied by ordering nipple shells online (a great invention that protects your unbelievably sensitive nipples from the harsh fabric of your bra or breast pads).

I carried on feeding like this for about 3 days when I woke up with a fever and feeling like I had a bad case of flu. Knowing that fever in a BFing mother usually means mastitis, or breast infection, I lay my head in my milk soaked pillow and sobbed. Doctors are taught that mastitis means you need an antibiotic, i knew that antibiotics likely meant thrush for me and baby, and that would likely mean nipple thrush and that would be the end of BFing for us. I desperately called my homeopath, Dr Murray Rushmere, hoping for an alternative. He reassured me that not all mastitis is caused by a bacterial infection and that inflamed, blocked ducts could also cause a fever. He started me on 2 remedies and gave me the number of a woman whom I will eternally be grateful to. Ruth Katzman is a physiotherapist and lactation consultant. She arrived on the same day and treated me with ultrasound, massage and lazer, she taught me how to latch my baby correctly (this way is foolproof), she taught me how to go to the loo properly (I was also constipated since delivery, and yes, I wasn't going correctly), she taught me exactly what to do with the milk pump, and she showed me how to feed my baby with a cup so that I could give my cracked nipple a break. She came again the next day, did it all again and made sure that I was indeed feeding correctly.

A few days later, for the second time, I heard those angels sing, as my baby latched effortlessly and drank painlessly. I too now feed in my sleep and love the experience of BFing... thank heaven.

The next post is dedicated to what I wish someone had told me...

How to do it correctly from the start, and how to manage the few unfortunate situations I found myself in.

Twinkle Twinkle Little Star - a note about rest in first few days

Such peaceful sleep aaah

Like most proud new moms, I faced taking my baby home for the first time with mixed emotions. Don't get me wrong, I loved the hospital, the labour room, the ward, the wonderful staff... but the starched linen was getting a bit scratchy and mostly I was exhausted. You see what happens in a maternity ward is that your baby stays with you as long as you want, then when you feel u need a break (don't judge me, You WILL need a break), you ring for the nurse to wheel your baby off to the nursery. A few hours later they bring her back to feed... And only to feed, and you get to rest again. Sounds great right? Wrong.

From the second your baby is born, rest will always elude you. 'Visiting hours' become the time visitors avoid, so they "miss the rush", asking a midwife a question about baby's birthmark becomes an hour tutorial on paediatric dermatology, and nap time turns into time you have to quickly shower, change pads, change breastpads, have a salt bath, eat, try to poo, try to pee, apply nipple cream and have a quick emotional breakdown. So when our discharge forms were all signed and proud daddy stood waiting in the doorway, I was more than happy to say goodbye to the maternity staff and to be driven home (at 40km/h) in our balloon and bouquet laden car. Yay, I thought, finally some peace and quiet. And God laughed again...

What I failed to comprehend was that home had no visiting hours, no nursery to send baby to, no midwife to answer my questions... and no nap times! One of the biggest realisations was that, unlike the lovely nurse in the hospital nursery, I had no idea when my baby's sound meant she needed a feed. So instead of waking up to feed, I was waking up to sounds and spending a really long time trying to figure out if it even meant baby was hungry. Those first few weeks were disastrous, so bad in fact that in my sleep deprived delirium, I contemplated painting a sign on the door to the tune of "evil lives here!!!!!" in the hope of at least deterring some of my well-meaning baby gazers. I quickly changed my mind when I glanced in the mirror and the sobering realisation hit me that in that ghastly state, that sign wouldn't be far from the truth.

Here's the thing, you need your sleep. And if you can't get any sleep, you need your rest. Baby will still be there in 2 weeks, when, hopefully, you've managed to come out the other side not looking (and acting) like a demon. Let your visitors come then. Or arrange 'visiting hours' at home, in fact while you're at it, arrange a midwife/nursery in the form of your mother or nanny or neighbor for a few days, just to get you through the transition. Oh, and do not underestimate the power of a real midwife home visit after birth... it can save lives, it saved mine.

So about that rest thing... you know how they say "sleep when baby sleeps"? It's rubbish! (And you WILL want to kill the 4th know-it-all visitor who says that to you while you're holding a tray of biscuits and tea in your pajamas, and your baby sleeps.) While your baby sleeps you can finally try to poo, try to pee, bath in salt, express your milk, sterilise your pumps, massage your breasts, take your vitamins, eat, read your email, catch up on the 20 bbm messages on your phone, make dinner, entertain your visitors... oh and say a quick hello to your husband. And all this in the 2 hours you have between feeds and nappy changes. 24/7 will have a whole new meaning before you know it.

I wish someone had told me that my life would now work in increments of 3 hours, or at least periods between baby feed times. I would not have left sleep time up to chance, I would have divided up my day into 3 hour slots and first assigned at least 2 to sleep. The rest would go to all the other things like hygiene, social stuff, food etc. I also wish that someone would have told me that if I made sure my baby was full after each feed, she would sleep longer till the next one. It took my near post natal breakdown illiciting a midwife visit to teach me how to make sure my baby was full.

If you're breastfeeding, here's what you do.
While baby is feeding, she will usually start dozing off, this does not mean that she is full, do not lift your maternity bra flap and congratulate yourself yet. Make sure that she is stimulated throughout the feed. Rub her head, blow on her, tickle her toes, don't keep her too warm. Then when she really has stopped sucking, pick her up burp her, change her even, and put her back on your breast. You can keep doing this till your absolutely sure she has had enough. And only then can you slap on some nipple cream and put your baby confidently down to sleep.

The other problem I had was having my husband in bed with me. I really wanted him to be part of the parenting experience and have him and I lovingly share battle scars in the morning. The problem is thus..
1. you will be even more stressed out trying to keep baby quiet so as not to wake him,
2. men do not respond to baby sounds like we do, and his snoring through your sleep deprived pain will drive you crazy,
3. you will need the space for the 20 pillows you need to breastfeed at first
4. you will both have battle scars in the morning, and then darling, who will be dressing who's wounds do you think? Yes dear, I'm afraid you are still the sole carer of the overgrown, over dependant infant you call a partner.

If hubby is a hinderance let him sleep in the spare room, the lounge, the car, wherever. For the first few weeks its all about you and baby. Let your husband be strong enough to take care of you both, and if you need him to be near sometimes, don't be afraid to say it. Your emotional well being now is so much more important, and yet, so much more fragile than you will ever comprehend.

You are still really one organism, trying to make your way without an umbilical cord. Make sure that you're taken care of equally as well as your little cherub.

Once upon a time there was a baby

the most beautiful face in the world

Granted, all good stories about a baby should begin in the womb, but this blog is not about what they write about ad nauseam, its about what they DON'T tell you. In fact every single fact about pregnancy is so carefully etched into our brains that not only are we ready after 9months to deliver our own babies from our wombs, we're also ready to be handed a degree in obstetrics. Any gynae who's read 'what to expect when you're expecting' will tell you, there really isn't much more to it than that. No, this blog is not about the things you already know, its about what you think you know, what you think your mom knows, what you think you will know instinctively, what you think a weekend at antenatal classes should teach you... And what you will soon realise... They DO NOT tell you!

 As a newly expecting mom in this age of knowledge, I truly felt that I was prepared for welcoming this little 'bundle of joy' into the world. Did my job not after all involve telling other mothers what to do on a daily basis, had I not read 'what to expect' cover to cover 3 times, and had I not attended my antenatal classes religiously for a month? The truth is that only when that little one alights, from heaven, into YOUR arms, do you really start learning anything worth knowing. I hope that this blog teaches you something worth knowing... So to start our little fairytale, we have mommy and daddy, 10 months married and 9 months eagerly awaiting the arrival of our little angel. We have an as yet un-named cherub, lying comfortably and relatively uneventfully in mommy's womb... "A wonderfully boring pregnancy" is how our midwife put it. And we have a glorious day in February, when at 5am mommy wakes from dreaming about being in labour and finds a wet spot on the bed. Labour progresses beautifully, where, with the wonderful Ciska, angel and midwife extraordinaire, we deliver a beautiful 53cm long 3.26 kg baby at 4:35pm "Aaaah", thinks the mommy, "Now that the worst is over, I can settle down to enjoy my bundle of joy, I mean how hard can it be? I just, very cleverly, gave birth with nothing but laughing gas for relief (which by the way isnt called that for nothing, it's painkilling properties are a laugh and a half)... And ironically, somewhere in heaven, thunder rolls and a deep booming voice has a great big... LOL!