References:
- NA
Breastfeeding Techniques
Two important aspects in breastfeeding is positioning and attachment (latching). Positioning is how the infant is positioned relative to the mother’s body and breast. Ideally, the position is tummy-to-tummy. This can be achieved with different positions:
- Cradle Hold: the baby’s head is placed on the crook of the arm, with that arm’s hand holding the baby’s bottom. The baby is turned to the side to allow tummy-to-tummy contact, then the baby is raised to the breast for feeding. The other arm may also be used to support the baby.
- Cross Cradle/Crossover Hold: an inversion of the cradle hold; the baby’s head is supported by the hand, while the buttocks of the baby is set in the crook of the arm, and their back runs along the forearm. The other hand can hold the breast.
- Side-lying Hold: the mother lies on her side, and so does the baby. The head is supported to be able to reach the breast for feeding. The mother should not perform this while sleepy or sleeping, as there is a major risk for rolling over the baby.
- Football/Clutch/Underarm Hold: primarily used for twins, it is a cross cradle hold but with the target breast on the same side as the arm holding the baby. The legs of the babies are tucked under the arm. This allows both arms to support the babies’ heads and back while each baby feeds from each breast.
Breast size does not affect breastfeeding capabilities
However, nipple inversion can reduce the efficiency of breastfeeding. For this, the syringe method (pull plunger suction), C-hold, U-hold, or Scissor-hold method (breast shaping), nipple rolling, and proper positioning can aid in revealing the nipple.
Proper latching can be achieved in a series of steps: offer the breast (with C-/U-/Scissor-hold to the infant, utilizing the rooting reflex. Wait for the infant’s mouth to open, and move the infant to the breast quickly. The mother positions the infant’s mouth so that the lower lips are just below the nipple and the chin touches her breast. Good latching has specific outlined characteristics by the DOH:
- The infant mouth is wide open with the lower lip turned outward, and the chin touching the breast.
- Most of the mother’s areola should be inside of the baby’s mouth. There should be more areola visible above the infant’s mouth than below, and the nipple should not be visible. There should also be no nipple pain felt by the mother.
- The baby is relaxed and happy.
Breast Hygiene
There is no need to wash the breasts or nipple before and after feeding. The mother can follow a regular washing schedule (once a day) but should avoid using soap on the nipple, as it has a drying effect.
The use of exclusive breastfeeding improves involution, reduces uterine pain (via the let-down reflex), and can serve as a natural form of contraception for the first six months (Lactational Amenorrhea Method) if done immediately, exclusively and regularly.
Signs of Effective Feeding
The infant should be visibly or audibly swallowing breastmilk. During feeding, the cheeks become full rather than drawn inward, and the infant releases the breast by themself when content.
Signs of Ineffective Feeding
- Infrequent Urination: at less than six times a day. A normal infant should urinate six to eight times every 24 hours.
- Poor Weight Gain: a weight gain of less than 500 grams per month. A normal infant should gain at least 500 grams monthly in the first six months.
- Breast Engorgement: an imbalance between milk supply and infant demand. This is not necessarily caused by ineffective feeding, but it is relieved by breastfeeding. Manual milk expression with a breast pump can also be used.
Expressed Breastfeeding
Milk expression is the manual collection of breastmilk. Expressed breastmilk is fed to the infant through cup feeding, not with an artificial nipple. Expressed breastmilk requires proper storage to retain its effectiveness as feed for the infant:
| Storage Method | Duration of Viability |
|---|---|
| Room Temperature | 8 hours |
| Refrigerator Body | 24 hours |
| Refrigerator Freezer | 1 month |
| Chest Freezer | 1 year |
If the expressed milk has been cooled or frozen, it is first mixed with warm water before being given to the infant.