Getting breastfeeding off to the best possible start
Getting breastfeeding off to the best possible start means choosing normal birth and selecting caregivers and places of birth that promote, protect, and support normal birth (like a Baby Friendly Hospital). Though you might have had many interventions during labour and yet baby managed to breastfeed just fine, normal, natural birth “set the stage” for problem-free breastfeeding (what nature intended), while a complicated, intervention-intensive labour and birth “set the stage” for problems.(1) This is why we have IBCLCs (International Board Certified Lactation Consultants®), to help babies overcome the possible results of our interference with nature. Good news is nature wants us to succeed. Lactation is not as fragile as many people think – otherwise the human race would never have survived!
Research shows that the best feeding option globally is the initiation of breastfeeding within the first hour of life, exclusive breastfeeding for a full six months, safe, age appropriate and adequate complementary foods from six months, and continued breastfeeding through the second year and/or beyond.(2)
Your decision to breastfeed was made either on personal experience or the attitude and experience of friends or family. I may not be able to convince you to breastfeed since about 1/3 – 1/2 of women choose to breastfeed before they become pregnant and about 1/2 – 2/3 during pregnancy, but I do hope I will be able to encourage you to breastfeed until your baby has outgrown the need.
Breastmilk is ALL babies need for the first 6 months of life. If you are healthy and baby is born full term and healthy, eating a well-balanced diet, will provide your baby with all the nutrients s/he needs, through breastmilk. Thus no extra supplement or water needed for baby.
Your body will be doing most of the work of breastfeeding but there may be a two week learning period, when interaction between mom and baby and mom’s body runs more and more smoothly – so DO not give up in the first 2 weeks! Seek help if things are not working.
Mothers need to make sure they have a support network ready to support them in breastfeeding, especially if they are not having their baby in a Baby Friendly accredited hospital. SUPPORT SUPPORT SUPPORT! If breastfeeding is difficult, especially during the first week, prompt and reliable assessment by an IBCLC is vital!
In their book “Breastfeeding Made Simple: Seven Natural Laws for Nursing Mothers” (1), Nancy Mohrbacher and Kathleen Kendall-Tackett say breastfeeding is a relationship. Instead of thinking about breastfeeding as a skill to master, (or a measure of your worth as a mother), instead think of breastfeeding as primarily a relationship. As mothers hold their babies (and a lot of holding is encouraged as skin-to-skin contact is our first step towards successful breastfeeding)(3), baby will be more comfortable in seeking the breast and breastfeeding will flow naturally out of this affectionate relationship. All relationships require work. Breastfeeding during the early weeks is HARD work, but after the “adjustment” period (about 40 days – remember in the Bible, it rained for 40 days and then the sun came out?), breastfeeding becomes a minor activity. We enter the “reward” period. Milk supply has established, breastfeeding is established and breastfeeding becomes easy and natural, like it is supposed to be.
The Ten Steps to Successful Breastfeeding(4) were presented to the world in the 1989 as the WHO/UNICEF Joint Statement on the Protection, Promotion and Support of Breastfeeding: The special role of the Maternity Services. The Innocenti Declaration in 1990 called upon the world to fully implement the Ten Steps in all maternities by 1995. More than two decades later, more than 150 countries have Baby-friendly hospitals. They have implemented the Ten Steps, and, with the addition of relevant parts of the International Code of Marketing of Breast-milk Substitutes they have also helped to resist the promotion of commercial infant formula to health care practitioners and the public.
TEN STEPS TO SUCCESSFUL BREASTFEEDING (4)
Every facility providing maternity services and care for newborn infants should:
1. Have a written breastfeeding policy that is routinely communicated to all health care staff.
2. Train all health care staff in skills necessary to implement this policy.
3. Inform all pregnant women about the benefits and management of breastfeeding.
4. Help mothers initiate breastfeeding within a half-hour of birth.
5. Show mothers how to breastfeed, and how to maintain lactation even if they should be separated from their infants.
6. Give newborn infants no food or drink other than breast milk unless medically indicated.
7. Practise rooming in – allow mothers and infants to remain together – 24 hours a day.
8. Encourage breastfeeding on demand.
9. Give no artificial teats or pacifiers (also called dummies or soothers) to breastfeeding infants.
10. Foster the establishment of breastfeeding support groups and refer mothers to them on discharge from the hospital.
What does this mean to us as expecting and/or new parents?
1. Seek a Baby Friendly Hospital for your baby’s birth. The first step of the Ten Steps to successful breastfeeding calls for Baby Friendly health facilities to have written breastfeeding policies that are displayed for all to read, indicating that staff is committed to implementing them. A policy defines what the staff and service are required to do as their routine practice, and should be mandatory. It helps parents to know what care they can expect to receive.
2. Having your baby in a Baby Friendly Hospital gives you the advantage of receiving support from health care staff trained in skills necessary to implement the rest of the Ten Steps to successful breastfeeding.
3. During your pregnancy, become informed about breastfeeding. Antenatal education should preferably include information about the importance of breastfeeding, importance of skin-to-skin contact immediately following birth, importance of rooming-in, how to recognise when babies are ready to breastfeed, importance of feeding on demand, how to assure enough milk and the positioning & attachment of baby. So by the time your baby is born you will be comfortable about breastfeeding and be confident about what you have to do.
4. Ensure that your health care provider knows you want to have your baby placed in skin-to-skin contact with you immediately following birth for at least an hour and/or until baby has had his/her first breastfeed. Skin to skin contact immediately after birth takes advantage of that first hour of alertness. It also helps to keep the baby warm, and to stabilize breathing and heart rate. Baby is also colonized with mom’s good bacteria. The first feed provides colostrum as the baby’s first immunization. Skin-to-skin contact help babies learn to suckle more effectively and it increases the duration of breastfeeding. Skin-to-skin contact helps breastfeeding to get started and helps mother and baby to get to know each other.
5. Some mothers have seen little breastfeeding among their family and friends. Knowing some main points about positioning and attachment can help breastfeeding to go well.
Some main points to look for regarding the position of a baby at the breast are:
- baby’s body needs to be in line with ear, shoulder and hip in a straight line, so that the neck is neither twisted nor bent forward or far back;
- baby’s body needs to be close to the mother’s body so the baby is brought to the breast rather than the breast taken to the baby;
- baby’s whole body needs to be supported;
- baby’s body needs to be facing the breast with the baby’s nose to the nipple as s/he comes to the breast.
Some main points to look for regarding the attachment of the baby to the breast are:
- baby’s chin touching the breast;
- baby’s mouth wide open;
- baby’s bottom lip turned outwards;
- more areola visible above than below baby’s mouth.
Some main signs of effective suckling are:
- baby takes slow, deep sucks and mom hears swallowing sounds;
- baby’s cheeks are full and not drawn in;
- baby feeds calmly;
- baby finishes feed by him/herself and seems satisfied;
- mother feels no pain.
Mothers also need to know how to maintain lactation if they should be separated from their infants. Mothers might need to express milk to relieve engorgement, soften the areola before baby latches, encourage baby to breastfeeding with milk on nipple or expressed into baby’s mouth, to obtain milk if baby can’t breastfeed yet or (as said) if mom and baby is separated.
If the mother is expressing milk for her baby, these points can help her to express:
- Encourage the milk to flow (get the milk to let-down)
- Find the milk ducts
- Compress the breast over the ducts
- Repeat in all parts of the breast
(More about expressing milk in a following post).
6. Ensure that your newborn baby receives no food or drink other than breast milk unless medically indicated. It is important to give newborn babies only breast milk because breast milk coats the baby’s system like paint to protect it. Other fluids or foods can wash away this protection and introduce infections to the baby. Supplements can also decrease the frequency or effectiveness of baby’s suckling at the breast, leading to a decreased amount of milk removed from the breasts, leading to a delayed milk production or a reduced milk supply.
7. When you are in the hospital AND when you are home, practise rooming-in. This allows mothers and infants to remain together 24 hours a day. Rooming-in is important because it helps a mother to learn the feeding cues of her baby and she becomes confident in caring for her baby. It helps to feed in response to those cues (demand feeding) rather than to feed by a clock and this is easier if baby is near. Cue feeding also helps develop a good milk supply. Babies who room-in with their mother sleep better and cry less. Babies who have to cry to be fed use up energy crying and may fall asleep without feeding well. Rooming-in has shown to help establish and maintain breastfeeding, reduce infection and facilitate the bonding process between mom and baby.
8. Breastfeeding your baby on demand. This means breastfeeding whenever baby or mother wants, with no restrictions on the length or frequency of feeds. Every mother and baby pair is different and unique. Breast storage capacity differs and how baby suckles at the breast differs. (More about this in a following post). So there are NO strict rules on how long and when a baby may or may not feed!
9. Do not give your breastfed baby any artificial teats or pacifiers (also called dummies or soothers). The use of artificial teats or pacifiers may interfere with the baby learning to breastfeed and affect milk production.
10. You will need support, information and encouragement to help you continue breastfeeding your baby. Family and friends can be a great source of support and encouragement. Find a knowledgeable breastfeeding person (like an International Board Certified Lactation Consultant or a La Leche League Leader) if you need information or help to overcome any breastfeeding problems.
We know that with the more of the ten steps in place, the more likely we are to achieve our breastfeeding goals. Taking those ten reliable ‘Baby Steps’ along the Ten Steps Path will take the relationship between you and your breastfed baby far!
1. Linda J. Smith, BSE, IBCLC. Impact of Birthing Practices on the Breastfeeding Dyad. J Midwifery Womens Health 2007;52:621–630)
2. WHO Model Chapter in Infant and Young Child Feeding
3. Nancy Mohrbacher, IBCLC, FILCA & Kathleen Kendall-Tackett, PhD, IBCLC. (2005) Breastfeeding Made Simple: Seven Natural Laws for Nursing Mothers. Oakland: New Harbinger Publications, Inc.
4. BABY-FRIENDLY HOSPITAL INITIATIVE Revised Updated and Expanded for Integrated Care SECTION 3 BREASTFEEDING PROMOTION AND SUPPORT IN A BABY-FRIENDLY HOSPITAL A 20-HOUR COURSE FOR MATERNITY STAFF