The Breastfeeding Bible

by William Sears, M.D. and Martha Sears, R.N.

The Breastfeeding Bible

If you’re considering breastfeeding your baby, chances are you already know something about all the good things mother’s milk does for infants. In addition to strengthening your child’s immune system, there’s growing evidence that breast milk increases IQ; reduces the risk for sudden infant death syndrome, obesity, and diabetes; and enhances the body’s overall ability to function. No doubt you’ve also found out how much money you can save by not buying formula. By choosing to breastfeed, you are tapping into one of the greatest natural resources there is.

But successful breastfeeding doesn’t necessarily happen naturally. It’s not always as simple as putting a lactating mother together with her hungry baby. You and your infant will need to learn comfortable positioning and an efficient latch-on technique, as well as how to feel relaxed and connected to one another during feedings. These skills will go a long way toward ensuring not only that your baby is well-fed, but that you both enjoy this experience.

William Sears, M.D., is a contributing editor of BabyTalk. Martha Sears, R.N., has been a lactation consultant for 14 years.

Lunch at First Sight

So how does this special bond begin? The first time your baby comes to your breast is right after she is born¿ — when she lies on your abdomen, skin-to-skin and covered with a warm towel. This is the perfect time for her to figure out what your breasts are for. When she’s ready, she’ll nuzzle at your breast and will probably lick and mouth your nipple. Soon, she’ll begin to suck.

Both you and your baby will benefit from uninterrupted bonding after birth. Studies have shown that in unmedicated deliveries in which mothers and babies are not separated, infants placed on their mothers make crawling motions toward the breast and often find it with minimal help. This is a time to simply relax and enjoy one another; there’s no need to practice everything you learned in your breastfeeding class right away. Some newborns take a few licks and a few sucks, pause, and then resume a few more gentle licks and sucks. In fact, sucking in frequent bursts with pauses in between is not uncommon for many newborns for the first few days.

This first feeding is important for several reasons. Sucking is familiar and comforting for babies¿ — as many suck on their thumb or hand in the womb — and helps Baby adjust to her new environment and feel a sense of connection to you. In addition, you will produce a wonderful substance called colostrum that your newborn drinks during the first two or three days. Colostrum is like a “supermilk” that’s rich in infection-fighting proteins. The more frequently and efficiently Baby sucks, the more colostrum she’ll get, and the sooner your mature milk will come in.

After nursing, your newborn will probably drift off into a deep sleep for several hours. You may still be ecstatic from bringing a new life into the world, but it’s good for you to yield to the need for sleep, too. As you doze off, imagine the pleasant experience of your baby nursing at your breasts. Filling your mind with positive images of breastfeeding will help get your milk flowing.

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.

Holding Your Own

The cradle hold isn’t the only option for nursing. Two other helpful breastfeeding positions are the clutch hold (also called the football hold) and the side-lying position. Both are good for the early days of recovery from a cesarean birth, since they avoid pressure on a new mom’s incision. Here’s how to do each:

CLUTCH OR FOOTBALL HOLD: This is a good nursing position for babies who have difficulty latching on or who arch their backs, squirm, or frequently detach themselves from the breast. It’s also useful for small or premature babies, since it’s the position that best allows you to see and correct Baby’s latch-on.

Start by sitting up in bed or in a comfortable armchair and positioning a pillow at whichever side you’ll be nursing on, wedging the pillow between you and the arm of the chair. Place Baby on the pillow alongside your body, with the lower part of her head and her neck and shoulders supported by your hand. Bend her legs upward so they’re lying against the pillow supporting your back, or against the back of the chair. Be sure that Baby cannot push her feet against the back of the chair, causing her to arch her back. Pull your baby in close to you, and once she’s sucking well, wedge a pillow underneath her back and head to help your arm hold her close. Lean back and enjoy the feeding.

SIDE-LYING HOLD: This position is basically the cradle hold, but with Baby and Mom lying on their sides facing one another. Before you start, place two pillows under your head, a pillow behind your back, another under your top leg, and a fifth pillow tucked behind your baby. Five pillows sounds like a lot, but remember that if you’re comfortable, your baby will likely be, too. Place your baby on her side facing you, tummy-to-tummy, and nestled in your arm. (If you’re recovering from a cesarean, ask someone to help you get positioned.) Position Baby so that her mouth is lined up with your nipple. Use the same latch-on techniques as described in the cradle hold.

Trouble-Shooting Tips

By teaching your baby efficient latch-on and by feeding on demand instead of on a rigid schedule, you can prevent most nursing nuisances, such as prolonged sore nipples, clogged milk ducts, engorgement, and mastitis. In addition, here are tried-and-true techniques we use every day to help new mothers avoid two of the most common breastfeeding problems.

CRACKED NIPPLES: Some newborns develop the habit of tight-mouthing the nipple — perhaps learned from sucking on their fist or wrist in the womb — which often leads to cracked, bleeding nipples. Before latch-on, cue your baby to open his mouth to its widest by using the index finger of the hand supporting your breast to press down firmly on his chin as you pull him onto your breast. (At first you may need someone else to do this for you.) Keep talking your baby through this important step in latching-on — “Open, Michael…open!” You can also show your baby by stopping for a moment to get his attention, then opening your own mouth wide and repeating “Open!”

PINCHING: If your baby’s lower lip is tucked inward, you will feel a pinching sensation. And if you continue the feeding this way, you’ll soon have very sore nipples. Try what we call the “lower-lip flip”: Using your index finger, press down on Baby’s chin to evert the lower lip, so that both of his lips encircle your areola fish-like instead of tightly turned inward. The lower-lip flip is the most useful trouble-shooting tip to prevent sore nipples, and it’s so easy to do. When we teach it to brand-new mothers while making rounds on the maternity ward, many moms exclaim, “It doesn’t hurt anymore!”

Since it’s often difficult to bend over and see the position of a baby’s lower lip while nursing (it’s easier in the clutch hold than in the cradle hold, however), someone else may have to do the lower-lip flip for you. You will soon feel the difference when Baby’s lips are well-positioned over your areola, and you’ll be able to do the lower-lip flip yourself as soon as you get the uncomfortable message that Baby has a lousy latch-on. Even if you have to start over several times until you both get it right, hang in there. This is good practice and helps him learn the best way to latch on.

The Importance of Support

If, in spite of your best efforts to follow this advice, you are still struggling, don’t give up. There is lots of good help out there for new mothers. Start by seeking hands-on consultation from a professional lactation specialist. In fact, you may want to arrange for someone to visit you as soon as you return home from the hospital. Many maternity hospitals and birthing centers now have lactation consultants on staff, or you can get a referral from La Leche League especially on the days when you feel like tossing in the nursing bra. Combining a network of emotional support with practical information makes it possible for almost all women to overcome obstacles and give their baby the best possible start.