Getting Started With Breastfeeding
Article by Stacey Zimmels BSC (Hons) MRSCSLT, MHCPC, MASLTIP
Breastfeeding is the natural way to feed our babies, but that doesn’t always mean that it comes naturally. It may require time, practice and patience in the early days. It can be useful to think about it as a new skill that you and your baby need to learn together. Knowing what to expect can really help you to be confident and successful as you begin your breastfeeding journey.
After birth:
When your baby is born, ideally you should have an extended period of uninterrupted skin to skin contact. This means that your baby is on your naked chest and doesn’t wear anything except a nappy. You can cover your baby with a blanket over the top if you think they are cold. Skin to skin contact has multiple benefits including regulation of your baby’s temperature and blood sugar. It keeps your baby calm, stabilising it’s heart rate and blood pressure and your baby will also cry less. It has also been shown that baby’s who have skin to skin contact are more likely to initiate and continue breastfeeding (1). If there is a medical reason that you are your baby need to be separated then you can have skin to skin contact once you’re reunited.
The first feed:
It is recommended that you breastfeed your baby as soon as possible after birth, ideally in the first hour (2). This coincides with a period of relative wakefulness in your baby, after which it is likely that they will become more sleepy. With your baby skin to skin you may notice that your baby starts to show early feeding cues (3), which you can respond to by supporting your baby to latch on to the breast.
There are a number of different positions that you can use to get your baby ready to latch, the laid back or biological nurturing position (4) is baby led and can be a natural next step from skin to skin (assuming you are lying reclined). Other positions include the cross cradle and rugby hold. Whichever position you use, ensure you hold your baby close to your body with the chin touching breast. You should notice your baby’s head tilt a little back. Your baby’s nose should be in line with the nipple and its head should be free to move backwards as it opens it’s mouth in a wide gape. At this stage you can gently guide your baby to the breast and latch them on.
You can tell that your baby is well latched if they have a large mouthful of breast tissue in their mouth with very little of the areola showing. A good latch should be pain free, although it is not unusual to feel a little discomfort as your baby initially latches for the first 20 seconds or so of each feed in the first few days.
Your first milk:
The first milk your baby receives is called colostrum. It is also known as ‘liquid gold’ both due to its yellowy golden colour and the high ‘value’ it delivers to your baby. It is full of immune factors and gives your baby a fantastic immune boosting start to life.
Here is the science bit… colostrum is especially high in secretory immunoglobulin A, which along with white blood cells called leucocyte, helps to fight and protect the body from infections. It also has a significant impact on the gut microbiome. One of the reasons is that it is full of human milk oligosaccharides which feed a very beneficial microbe known as bifidobacteria. This is found in abundance in the guts of breastfed babies (5).
This ‘liquid gold’ is high in impact and low in volume… and it is all your baby needs until your milk comes in.
Moving on:
So now that you have had your first feed, what next?
Lots and lots of feeds! Newborn babies feed frequently, up to 10-14 times in 24 hours can be normal. It is important to respond to all feeding cues as this will help you to build and maintain your milk supply. You can also expect that your baby will not feed in a set pattern. Your baby may have periods of intense bursts or clusters of feeding at certain times of the day or for a few days at a time. This is normal infant feeding behaviour. Offer both breasts to your baby at each feed. In the early days you may need to wake your baby who has fallen asleep to offer the second breast. Doing this will optimise your baby’s milk intake and your supply.
You will know that your baby is taking enough milk by learning to recognise the characteristic signs of milk transfer(6), they include observing your baby for slower deep sucks rather than fast and fluttery ones. These signs alongside your baby passing appropriate numbers of wet and dirty nappies (7) and meeting their weight milestones are all signs that your baby is drinking well and thriving.Now that your baby is here, take the time to have copious cuddles, to get to know them and to learn to feed together. If you are having any difficulties establishing breastfeeding please seek specialist breastfeeding support as soon as you can (8).
This post was written by, Stacey Zimmels who is a feeding and swallowing specialist speech therapist and International Board-Certified Lactation Consultant. Stacey has worked for almost 20 years supporting infants and children with a wide range of feeding and swallowing difficulties. Stacey is the Clinical Lead for a paediatric feeding service in an NHS tertiary hospital and also runs a private practice. You can find our more on her Instagram @feedeatspeak and website here.
References:
1. Moore ER, Bergman N, Anderson GC, Medley N. Early skin-to-skin contact for mothers and their healthy newborn infants. Cochrane Database of Systematic Reviews. 2016; Issue 11. Art. No.: CD003519.
2. WHO/UNICEF. Global strategy on infant and young child feeding. Geneva: World Health Organization; 2003. (https://www.who.int/nutrition/publications/infantfeeding/9241562218/en/)
3. https://metronorth.health.qld.gov.au/rbwh/wp-content/uploads/sites/2/2017/07/feeding-cues-term.pdf
4. http://www.nancymohrbacher.com/articles/2010/7/18/laid-back-breastfeeding.html
5. Stewart et al. Temporal development of the gut microbiome in early childhood from the TEDDY study. Nature. 2018; Oct; 583-588
6. https://youtu.be/rWAWMFk46SY
7. https://www.nct.org.uk/baby-toddler/nappies-and-poo/newborn-baby-poo-nappies-what-expect