lactating mom

hi my name is lisa, i'm a registered nurse and i specialize and do lactation rightnow. i've been a nurse for 25 years and wewill talk a little bit more about breastfeeding now. ok the first thing that we're goingto talk about is the correct latch. the reason that thelatch is so important is because we don't want you to be too sore. you aregoing to get sore without the baby latching on correctly, and the other reason is that the babywon't get enough milk

unless they're latched on deep enough tothe breast, and correctly. one thing that i want you to alwaysremember is that baby is the movable object, not the breast. so first of all to get agood latch i want you to sit back in a comfortable position, and then go ahead and bring baby rightinto the breast. what we're looking for is a good, deep,asymmetrical latch. what i want to see, if this is the nipple, i want to see that baby enters into thebreast, and scoops up,

and takes more on the bottom side thanthe top. so baby will enter with their chin first,scooping up and onto the breast. what we see witha latch like this, is when baby pulls away, your nipple wouldlook nice and rounded like it's supposed to look, but if baby is on incorrectly andthey've taken more on the top than that bottom, your nipple will look kind of pinched, likeit has a stripe across the top of it, or like a new tube of lipstick whereit's high on top

and slanted towards the bottom. that's notwhat we want to see. definitely it should feel comfortablewhile you're breastfeeding, if it hurts initially it may bebecause of an improper latch initially, but it should not hurt passed a fewsucks, and you'll definitely feel a pulling, tugging sensation, but youshould not feel any pain. the next thing we're going to talk aboutis proper positioning. the reason that it's so good to knowdifferent positions is simply because if you are really soreyou'll want to know a different position to not continue to make that spot on yourbreast so sore.

as well as baby, if baby is nursing in the cradle hold, and the cradle hold onboth sides, and not getting enough milk you'll want to switch positions and go intothe football hold so that baby can pull more milk based on the position that they're at. thefour different positions are the cradle hold is simply like this,baby is cradled in between your arms breastfeeding thisway, and you've got this hand this free hand to help with baby atthe breast. the cross cradle hold, baby remains in the same position, but yourhand position changes.

your hand position will change from thishold, and you at this point will have more control ofyour baby. so this is the cross cradle hold and thenyou've got this free hand to help baby. in the football hold you're basicallytucking baby underneath your arm like a little football, and again holding it with the same handas where baby's facing, and it will give you a lot ofcontrol. so the two positions that i recommendright now would be the cross cradle hold,

and the football hold, and the reasonbeing is because you will have more control at this point. what you're looking for with both of thesepositions, either of these positions, is that the baby's ear, shoulder, and hip are in a nice, straight line. that'swhat we want to see. you and i, as we take a drink of water, we are in a straight line as we take a drink ofwater. a couple of common things that happen is that we hold baby around the head, and weput their head too tight into the breast.

if you allow your hands to be more alongthe baby's back and shoulders here, and just simply guide their head andhave control, then you can pull baby's head away fromthe breast, and baby's able to breathe that way, and then you'renot having to compress the breast with your hands to make sure the baby canbreathe. that's one thing that i want you to do, the other thing is from head to toe alsobaby should be in a nice straight line. another common thing to do is to putbaby's head up here into the breast, and if you cansee at this point how close baby's

ear is to the shoulder, we don't want to see that. we want tomake sure that baby is straight in a position, and it makes it much easier for baby toswallow. a common question for new moms to ask is,"is my baby getting enough milk?" that's hard to know sometimes right atfirst. the colostrum that you're producing nowmay not seem like a lot, but it is excellent for your babies. soit's really important that you attempt at the breast often, andallow baby to get all of the colostrum

that you have. here in the hospital we'll be bringing bythe yellow handout that will walk you day one through day seven. ifyou notice in your hand-out on day one, our goal is to get four to six good feedings in the first 24-hour period. day 2 what we're looking to get in in a 24-hour period is six to eight feedings i still want you to attempt every threehours

at the breast. it's very important thatyou can at least attempt every three hours, but if you only get in that number of good solid feeding that's okay. from daythree on, you're looking to get in eight to 12feedings in a 24-hour period. this is every two tothree hours, and at night if they're sleeping goodfor you that's perfect they can sleep once they'regaining weight. we could allow them to sleep a littlebit longer at night, which might be four to five hours,

but during the day i would certainlywake them up a little bit to make sure that you get in eight to 12 feedings. babies can clusterfeed, so that's very normal as well, so makesure that you're getting in those eight to 12. also on day one, it's mandatory that wehave one wet and one poopy diaper. day two we want to see two wet and twopoopy diapers. day three we want to see three wets and three poopies. it just keeps going up and up and uplike this, and that's the way we can tell

if enoughs going in by what's coming out. so make sure thatyou're offering the breast often, many times you'll hear swallows.the swallows on a baby sound very very faint, and sometimesthey're kind of hard to hear, but a little tiny motion, a littleswallowing motion, is what you're going to hear, a little swallowing sound is what you're going to hear. many timesas well to make sure that baby gets enough, youcan compress on your breast. all you would do for compression is tosimply squeeze in the middle of the

breast, and express some of that colostrum down. the colostrum is super thick, it's likecorn syrup or honey, so allowing yourself to compress and topush a little bit more will enable baby to get a few moreswallows during that feeding. now i told you thatyou're going to want to see a lot of wet and messy diapers. what's normal to see is the first few stools after birth is a thick, tarry meconium.

it looks kind of black, and thick, and tarry.it then moves into a transitional stool, which is kind of a green, thicker stool aswell, into a perfectly normal breastfed stool, which is loose, yellow, seedy, mustardy, that's what we expect to see. breast milkis so easily digested in the baby's belly, that that's why it moves through so easy andsimply, and that's why we see many loose stools.the next thing that we're going to talk

about is how to prevent getting sore andtender nipples, that's not fun for anyone. so what we need to do is first of allmake sure that the latch is correct. we talked about that initially, making sure that baby is very very deep ontothe breast and one thing to mention as well is thatyou should see baby's lips completely flanged out. the lower lip should be tucked andtouching the chin because they're so wide open with theirmouth,

so with sore and tender nipples, if youneed to break the suction, we talked about how to do that, and reposition and relatch baby, that's not a problem todo. go ahead and do that, or pull down onbabies chin and make sure that they're taking morein their mouth. also for sore nipples what you can do is change positions. we reviewed this alittle bit earlier, but by changing positions it will notallow the breast to become so sore in that one spot.

non-nutritive sucking is when ababy is up next to mom and is so comfortable next to mom that theykind of want to use you as a pacifier, we don't want this to happen. so when thebaby's up to the breast they should be sucking very good andvery deep with this deep jaw movement up here, with their lips flanged open really widethe whole time, and if they're not, if you feel like thatstrong suck has transitioned into a more consistent loose suck, then what you want to do is pull yourbaby away from your breast.

once you pull them away from thebreast they will either start rooting around again, or as you stroke along their cheek here or down their lips, they'llstart rooting and if they start rooting at this point then they want more food and you're able to put them back up to thebreast and get them what they need. but if they are content and happy anddone, they're not rooting in any way shape orform, then they would probably have been doing morenon-nutritive sucking at the breast. when you'regetting engorged and the milk is coming

in sometimes the breast can be prettyuncomfortable, and it also is hard for baby to latch on. it's like baby trying to latch onto anorange when they're so uncomfortable and full. so what we need to do is soften thenipple, around that nipple around the areola, so that baby isable to get a good deep latch. you can either pump for a fewminutes, if you were to pump it would softenaround the areola, it would produce a letdown for baby,

and it would allow baby to get that gooddeep latch. also you can hand express just simplyby putting your fingers back where the areola is and hand expressing, and compressing, andsqueezing some of that milk out there to make the nipple a little bit moresoft. after a breastfeeding i also want you tosqueeze around the nipple and get some of your colostrum out.the colostrum and your own breast milk has a lot of fats in it, and it is a very good healant and protectant. so if you were to squeeze a little

bit out afterwards and let yourself air dry, the airdrying will help to heal it from the inside out and it's a great way to heal sore nipples. the other thing that youcan do after you have gotten some of your own colostrum or your breast milk out onto the nippleis use a little bit of the lanseno cream. your nurses can bring that pure lanolincream in to you, and all you need is just a tiny little bit

that you can rub right around the nippleafter the feeding. that lanolin will help to prevent andheal against sore nipples as well. that is something that will work its wayinto the breast and you don't need to rub off before the next feeding. now remember if you have nipples that are sore, or cracked, or bleeding definitely contact one of us, we'd behappy to help you through that. that is something that we don't want tosee for either your sake or the baby's, they're simply not going to be able toget as much milk as they need to

if you are that sore. so we areavailable every day, we'd be happy to come in and help you if we need to. the next thing that we're going to talkabout is engorgement. engorgement can happen as your milk iscoming in. the milk usually comes in within day three to five, and after that some people feel thedifference with the milk coming in and can really tell that they're engorged because themilk becomes, the breast becomes full, and tight, and sore and others don'treally notice the difference but we need

to talk about what to do if you aretight and full. the easiest way to treat engorgementis to use some warm packs, either a warm washcloth right on your nipple and aereola. a veryeasy way actually is to jump in a warm shower. that warmth will open up all of the milkducts and allow the milk to come down. once you've done that it's going to beeasier for baby to latch on. if you needed to hand massage or handexpress to get some of the milk out right at theend of the nipple,

you can do that to allow baby an easierlatch as well as pumping. we talked a little bit about that beforebut if you pump for just a few minutes beforehand it'sgoing to soften it up around the areola, it's going to bringyour nipple out so it stands out and is a little bit easier for baby to latch, and it will produce a letdown so the milk will be right there readilyavailable for baby. so with engorgement, remember to useheat before and then afterwards we're going to usecold packs, so ice packs right around the breast can beused and that

ice will help with the swelling and thesoreness. if you are also really sore you may need to take atylenol or a motrin and that could help with the swelling,the pain, and relieve some of that engorgement as well. the other treatment for engorgement, itmay sound kind of silly, but what it is is cabbage leaves. all you do is buy a head of green cabbage at the store and it feels nice and cool because itshould be refrigerated. what you do is you take the cabbage leaf,break the spine of the cabbage leaf, there's a componentreleased through that,

put it on your breast underneath yourbra and that will help with engorgement. this is also how we tell people to dryup their milk supply as well. so you need to be cautious of that, andknow that you only want to put the cabbage leaf onto the breast three to four times a day for about 10minutes, and that will help to treat the engorgement. the last tip with engorgement that i wantto remind you of is if baby is doing very very well atthe breast, and sucking and latching well, and you've heard lots and lots of swallows from the baby,

and if at this point baby pulls awaynaturally from the breast because they're done, they've had enough milk, this is perfect.that's exactly what we want to see, but if you at this point are stilluncomfortable and your breasts still feel a little bit full i want youto pump right after the feeding. if you pumpright after the feeding it's all within that same stimulation and then you're able to get your breastsgood and comfortable. i don't want you to pump until you're completely empty,

but until you're good and comfortable yes.if you were to wait a half an hour later and pump, then what we would be doing isstimulating the breast to produce more milk. so at this point pump right aftera feeding if you need to do and while baby's eating make sure that you can massage and rub along their feet to keepbaby good and awake. three things, three ways that you can doit rubbing their feet, rubbing underneath their chinhere, and then also inbetween their

shoulder blades is a great way to keepbaby sucking well at the breast. the nextthing we're going to talk about is hand expression and this is very helpful in relieving engorgement. what i wantyou to do is place your finger and thumb about one to one-and-a-half inchesbehind the base of the nipple. i want you to gently lift and then pushthe breast back towards your chest while pressingyour fingers together towards the nipple and releasing and this is a rollingmotion.

repeat this rolling motion several timesuntil the milk begins to flow into the collection cup. i want you tocontinue working around your breast to reach all ofthe milk glands and then make sure that you repeat thison the other breast. now we can talk about how to take careof you. i want to make sure that you're drinking lots and lots of fluids andthis is going to help with your milk supply. i know that the nutritionists hasalready had a little bit of a clip on here about nutrition and the properthings to eat,

but i want to make sure that you know thatyou can eat anything as long as you eat it in moderation. if you don't eat too much dairy in one day, or too many hot spicy foods in one day, as long as everything's inmoderation and balancing it out with a lot of waterthen go ahead and eat anything you would like to. i want tocover a little bit about how to pump and store your milk. if you are engorged and making lots of milk,we talked a little bit about how pumping right after a feeding would be agreat time to relieve some of that

if you want to store it, breast milk isgood for five hours at room temperature and it's good for five days in therefrigerator. if at that point you're not going to useit, go ahead and put it either in a glass jelly jar, or we have special freezer bags that youcan buy downstairs in our lactation store, or you can use a little playtexnurser bag. make sure that you double or triple tie those up because they're notfreezer safe, and then i would still stick them in a ziplocfreezer bag after that.

they will store in the freezer for up tosix months, so make sure that you're storing thebreast milk towards the back of the freezer so it's not constantly beingexposed to the air as you're opening that freezer, and thenmake sure that you label your milk and use the oldest milk first. our numberto the lactation store is on your yellow log that we bringyou in at the hospital here, and the numbers at the very bottom hereit's also up on the screen. if you need to consult with one of uswe are happy to do that. we work every day and twice a week wesee patients from home.

so if you needed to come in to be seen,we do charge a consultation fee it's $35.00 we spend an hourand a half, however long really we need to spend with you to get theproblem taken care of. what we do is we weigh baby first to make sure they're gainingweight appropriately at home and then we help with a good feeling andweigh baby afterwards so we can tell exactly how much theytook in for that feeding. if needs be, we can talk about milksupply at that point if the baby hasn't taken in enough milk, so many things that we can do to helpyou.

a good thing with that is if you come inone time on an outpatient basis, you can then call as much as you need toand get as much help over the phone from one of us as you need to. let us know here in the hospital if youwould like to see us as well, like i said we're here every day and we want to make this as successful for you as you would like.