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The Breastfeeding Bible

Off to the Breast Start

An all-important lesson of mothering is that if you're comfortable, your baby is likely to be, too. That certainly applies to nursing. Since milk and colostrum flow better when you're relaxed, be sure to get comfortable before you start a feeding. First, sit up in an armchair or a rocking chair, or in bed. Then place pillows behind your back, on your lap, and under the arm that you'll use to support your baby. If you're in a chair, use a footstool to raise your knees so you don't have to strain your back or your arms to hold Baby closer to your breast. (If you've had a cesarean section, you may need to nurse lying down; see the illustration on page 40. It's also important that you use enough pain medication if you're in pain. Pain increases tension, which can inhibit your milk flow, and your baby is likely to sense this tension, too.) Once you've prepared your body to breastfeed, next prepare your mind: Take a deep breath and imagine nourishing milk flowing into your child.

Now it's time to get Baby ready. Because newborns tend to be very sleepy, first undress him¿ -- and yourself in front -- so you have skin-to-skin contact; this will encourage a sleepy baby to nurse. Then place your baby on a pillow on your lap in the cradle hold, perhaps the most common nursing position (above):

1. CRADLE YOUR BABY IN ONE ARM, so that his neck rests in the crook of your elbow, his back along your forearm, and his bottom in your hand. Let the pillow on your lap support your arm and the baby's weight to help raise him to the level of your breast. If Baby rests too low on your lap, he will pull down on your breast, causing painful stretching and friction on your nipple, and you'll get a sore back. Add another pillow, if necessary, and be sure to use a footstool.

2. BRING BABY UP AND IN TOWARD YOU, rather than leaning forward toward him.

3. TURN HIS ENTIRE BODY SO HE'S LOOKING STRAIGHT AT YOUR BREAST. His head should not be arched backward or turned sideways in relation to the rest of his body, and he shouldn't have to strain his neck to reach your breast.

4. TUCK BABY'S LOWER ARM DOWN BETWEEN HIS BODY AND YOURS; you won't be able to get him in close enough if his arm is in the way. If his top arm interferes, hold it down against his hip with the thumb of the hand holding his bottom.

5. WRAP BABY'S BODY CLOSE AROUND YOU so that you're tummy-to-tummy; don't let his body dangle away from yours. Wrapping him around you relaxes his entire body, which also relaxes his sucking muscles. The clutch hold (also called the football hold; next page), is even better for wrapping Baby snugly around you, and works well if your infant likes to arch away.

6. WITH YOUR FREE HAND, CUP YOUR BREAST, supporting the weight of it with the palm and fingers underneath and the thumb on top. The "cigarette hold" -- holding the nipple between the index and middle fingers -- should be avoided. Eventually you'll be able to have one hand free while breastfeeding. But for now, while your baby is so small and new at this, it's best to continue supporting the weight of your breast throughout the feeding. Baby's suck will be stronger because he won't have to deal with the extra weight, and it will help keep him well latched-on by preventing the newborn's tendency to slip back and suck only on the nipple, rather than on the areola, the colored area around the nipple.

7. USING YOUR MILK-MOISTENED NIPPLE AS A TEASER, gently stroke your baby's lower lip to encourage him to open his mouth wide, as if yawning. Tickling the lower lip is the magic button for getting a baby's mouth to open wide; like a little bird's beak, it opens and then quickly closes.

8. WHEN YOU SEE YOUR BABY'S MOUTH OPEN TO ITS WIDEST, MOVE QUICKLY. The moment he opens wide, direct your nipple slightly upward and toward the center of his mouth, and, with a rapid arm movement, move his head in very close, so that his mouth will close down over your areola. Remember, pull Baby in toward you, don't lean forward toward him. We call this technique "RAM" -- an abbreviation of "rapid arm movement." "RAM Baby on" sounds startling at first, but it really helps mothers remember two important components of latching on: that they need to move their arm to draw their infant in closer, rather than lean forward, and that they must move quickly before the baby's mouth closes again. If you lean forward, pushing your breast to-ward your baby, you'll have a sore back by the end of the feeding, and if you move too slowly or hesitate until he's closed his mouth slightly, your baby will probably slurp just the nipple into his mouth, which will give you sore nipples.

Also keep in mind the golden rule of latching-on: Babies should suck areolas, not nipples. Your baby's gums should bypass the base of your nipple and take in about a one-inch radius of your areola. The reason for this is that the milk sinuses -- where milk is stored -- are located beneath your areola, and your baby has to compress these sinuses to get enough milk. If you "RAM Baby on" far enough back, his jaws will clench down on your areola -- rather than on just your nipple -- and he will probably reward you with a suck-swallow rhythm that tells you he's taking in a good amount of milk. A baby who's getting enough to eat will have six to eight wet diapers a day by four days after birth and at least two brownish-yellow bowel movements a day by the end of the first week.

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