When your baby bobs his or her head on your chest and starts moving toward the nipple, ease him or her down to face the breast. Support his or her buttocks with your elbow while your forearm supports the back and the palm of your hand supports the shoulders. Make sure the web between your thumb and first finger is at the nape of the baby's neck; your thumb is on one side of head and one or the rest of your fingers support the other side of the head. Notice that the baby's ear, shoulder and hip are in a straight line and the legs are curled around your waist. Your arm should support the baby's weight and a pillow can support your arm. Your other hand supports the breast with your fingers far away from the areola (the darker part of the breast). This is called the "cross cradle hold." If it is hard to support the breast, try putting a rolled facecloth under the breast.
Some mothers prefer the "clutch" or "football hold," a nice position for babies who weigh more than eight pounds. Bring the baby's hip to your hip with your elbow supporting the other hip and your arm supporting his or her side. The palm of your hand supports the shoulders. The web between your thumb and first finger is at the nape of the baby's neck, thumb on one side of head and one or the rest of the fingers supporting the other side of his or her head. Your arm supports the baby's weight and a pillow can support your arm. Your other hand supports the breast with your fingers away from the areola (the darker part of the breast). If it is hard to support the breast, try putting a rolled facecloth under the breast.
Support the baby's head and tilt it back slightly. Brush the bottom lip with the tip of your nipple to make the baby open wide as a yawn. With the baby's chin lifted and leading the latch, nose in line with your nipple, bring the baby to your breast. The chin will touch first and be deep into the breast with the nose not quite touching. Notice that the baby's neck is straight, making it easy for baby to swallow. A swallow sounds like an "ah" or a little puff of air. When the baby is latched well, you will hear a few swallows of colostrum. When your milk changes to mature milk (about day three or four), you will hear a swallow with about every four to five suckles. Keep the baby close to you, supporting the shoulders and back and bracing the buttocks against your side.
When your baby is latched well, it feels like a tug or a pull, but never painful. If there is any pinching or pain, be sure the baby's lips are rolled out and bring the baby closer to your body. If this does not help, re-latch. Most of the time if it hurts, it has something to do with positioning. Ask your nurse for help or once you go home, call the Warm Line at 1-800-711-7011 for help from a nurse or lactation consultant.
If the baby is not latched in five minutes, stop. You can hand express in the first 24 hours. If your baby is more than 24 hours old, pump. Keeping the baby skin-to-skin, you can feed him or her the expressed breast milk.
Let the baby nurse as long as he or she is actively sucking and swallowing. You can watch the jaw move all the way to the ear and hear soft puffs of air. When the swallowing slows, massage your breast to move more milk into the baby's mouth and bring baby closer to you with the palm of your hand. When the swallowing stops, slide your little finger into the baby's mouth to release the suction and protect your nipple. Your nipple should have the same shape (gumdrop) as before the feeding. If it looks creased, like a used lipstick, be sure the baby opens wide and takes in more breast tissue at the next feeding. Breastfed babies take less air, so you only have to burp your baby for a few minutes. Offer the second breast if baby is still awake and showing feeding cues.
Babies will take about one to three teaspoons of the first milk, colostrum, at any one feeding in the first days. Feedings last about 10 to 20 minutes. It is healthy for your baby to nurse every 90 minutes to three hours from the beginning of the last nursing. But, since breast milk is more easily digested, feed your baby on cue rather than by the clock or a schedule.
Wet diapers and stools are one of the ways you can tell if your baby is taking in enough breast milk. This breastfeeding care plan (Spanish breastfeeding care plan) can help you keep track in the first busy days. Keep track of the color of the baby's stool, which will change in the first four days. This is another way to know your baby is taking in enough. Count any stool that looks like a tablespoon or more. Bring the log to the first pediatric visit or lactation consultation.
Weight gain is the best way to tell if your baby is getting enough. It is normal for babies to lose about 7 to 8 percent of their weight in the first five days and return to birth weight by 10 to 14 days. You will establish a milk supply for baby in the first three weeks. The more the baby eats, the more your body produces. That is why we and the American Academy of Pediatrics advise you to exclusively breastfeed your baby, avoiding formula, bottles and pacifiers in the first three to four weeks if all is going well. Then your supply will meet your baby's needs as long as you choose to nurse.
When your milk changes to mature milk, your breasts may feel very full and firm. If the baby cannot latch and/or you have pain, you can:
You can also try a technique called "reverse pressure softening" to reduce swelling of the areola. This briefly moves the swelling backward into your breast and helps the nipple soften and go deeper into the baby's mouth during breastfeeding. This technique should never cause you pain.
To do reverse pressure softening, you should:
Do this right before every feeding. It may take two to four days before your breasts feel comfortable. Make pumping sessions short.
If your breasts are heavy and hard and your nipples are flattened out, you might be unable to express milk by hand.
If your baby is nursing enough to make the breasts soft, you do not need to pump. However, you may need to remove breast milk if:
We recommend that you wait three weeks before giving your baby a bottle if breastfeeding is going well. There are many ways to feed breastfeeding babies without using bottles and rubber nipples. If you have questions, ask your nurse or call the Warm Line at 1-800-711-7011.
If your baby is healthy, follow these instructions for pumping and storing your breast milk at home:
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