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The first golden hour

The way your baby is cared for and nurtured immediately after birth significantly impacts their transition from the womb to life outside. In a culture that commonly separates mothers and babies for routine procedures such as cleaning, weighing and measuring, most babies are missing that critical time of being skin to skin with their mothers, which has short and long term consequences for all.

As these procedures are not necessary to maintain or enhance the wellbeing of either mother or baby, there is no reason why they cannot be delayed beyond the first critical hour. The first hour should be focused on baby’s first breastfeed and mother-baby and family bonding. Unless mother or baby is in need of medical assistance, hospital protocols should support this time of new beginnings for both vaginal and caesarean births.

I personally have requested for skin to skin straight after birth and the new born checks are not executed till much later. I was able to bond with Jo2 and Jo3 for at least an hour before the nurses carried them for their newborn checks.

What Is An Undisturbed First Hour?

Babies are born and immediately placed tummy down on their mother’s stomach. A warm blanket should be placed over both mother and baby, to keep mother warm. This slows the production of adrenaline hormone in her so as to not interfere with oxytocin and prolactin hormones being produced (essential for bonding and breastfeeding). At this time, the mother’s needs are simple: warmth and a quiet, calm environment. It is important to remember that she is still in labour – the placenta and membranes are still to be birthed, and her uterus needs to contract down.

At this time, the mother’s needs are simple: warmth and a quiet, calm environment. It is important to remember that she is still in labour – the placenta and membranes are still to be birthed, and her uterus needs to contract down.

Here are 6 important reasons why the first hour after birth should be undisturbed:

#1: Baby-Led Initiation of Breastfeeding

It is quite common these days for hospital staff to want baby to begin breastfeeding within the first hour. In addition to the importance of early feeding for mother-baby attachment and bonding, it also helps to expel the placenta more quickly and easily, reducing the risk of postpartum haemorrhage. It’s common for caregivers to assist baby to latch onto the nipple, which is unnecessary in most cases. When babies who have not been exposed to medications are placed skin to skin with their mothers and left undisturbed, they will instinctually crawl to their mother’s breast and attach themselves to the nipple. This is now known as the ‘breast crawl’ and was first observed by Swedish researchers in the 1980s. Further observation discovered that babies are born with innate instincts that assist them in finding their mother’s nipple, like all newborn mammals. I have noticed that it takes about 30 mins for Jo3 to have the latching instinct so mummies just take your time and do not panic if your baby doesn’t appear to want to latch immediately.

#2: Body System Regulation

Babies who are left skin to skin with their mothers for the first hours immediately after birth are better able to regulate their temperature and respiration. Newborns aren’t able to adjust their body temperature as well as older children and adults as they don’t have the same insulating fat levels. They have spent nine months in an environment that is perfectly temperature controlled. If babies lose too much heat, they have to use more energy and oxygen than they can spare to try and keep their temperature stable An undisturbed first hour with skin to skin also reduces the risk of hypoglycaemia (low blood sugar levels). Newborn babies can produce glucose from their body stores of energy until they are breastfeeding well and are more likely to do so when they remain skin to skin with their mothers.

#3: Promotes Mother-Baby Attachment

Prolonged skin to skin after birth allows mother and baby to get to know each other. Mothers who have skin to skin contact after birth are more likely to feel confident and comfortable in meeting their babies’ needs than those who had none. Attachment is critical to newborn survival and mothers are hard wired to look after their young. Oxytocin receptors in a woman’s brain increase during pregnancy, so when her baby is born, she is more responsive to this hormone that promotes maternal behaviour. Oxytocin is produced in large amounts when breastfeeding and holding babies close skin to skin. Mothers who had early skin to skin with their babies are more likely to demonstrate bonding behaviours later in their child’s life, such as kissing, holding, positive speaking and so on. Skin-to-skin is becoming a reality for more c-section mothers and do as much skin to skin as you can in the first few days will really promote and help with your breastfeeding journey.

#4: Improves Breastfeeding Success Rates

Breastfeeding initiation and duration is likely to be more successful with babies who have early skin to skin contact. The World Health Organization recommends exclusive breastfeeding for babies in the first six months to achieve optimal growth, development and health. Creating the right conditions for the initiation of breastfeeding would help promote longer durations of breastfeeding for many women. Babies who are left to self attach usually have a better chance of proper tongue positioning when latching. This can increase long term breastfeeding as mothers experience more ease and fewer problems when latching is not an issue.

#5: Protects Against The Effects of Separation

Babies are born ready to interact with their mothers – a newborn baby who has not been exposed to excessive medication will be very alert and gaze intently into their mother’s face, recognising her smell, sound of her voice and the touch of her skin. Remaining with their mother is key to a baby’s survival and separation is life threatening. Babies are born with a mammal’s primal instinct to stay within the safe habitat of mother, where there is warmth, safety and nourishment. When babies are separated from their mother they will protest loudly, drawing their mother’s attention to their distress. Babies undergo what is literally a cold turkey withdrawal from the sensory stimulation of their mother’s body. If they are not reunited with their mother despite their protests, they will go into a despair state – essentially giving up and becoming quiet and still. This is partly a survival instinct to avoid attracting predators, and their body systems slow down to preserve energy and heat.

#6: Boost Your Baby’s Immunity

Naturally when babies are born, they emerge from a near-sterile environment in the uterus and are seeded by their mother’s bacteria. This essentially trains the baby’s cells to understand what is ‘good’ and ‘bad’ bacteria. This kickstarts their immune system to fight off infections and protects from disease in the future. Research indicates that if babies aren’t given this opportunity to be exposed to their mother’s bacteria, either because they are not born vaginally, held skin to skin or breastfed, then the baby’s immune system may not reach its full potential and can increase the child’s risk of disease in the future. Skin to skin contact and early breastfeeding is an excellent way to help increase your baby’s exposure to bacteria if you need a caesarean section for medical reasons.

Here are the 9 stages of the golden hour

golden hour

 

Why is skin to skin important

 

Immediate skin to skin for a minimum of one hour after birth is one of the most effective methods for promoting exclusive breastfeeding.  Babies who have early skin to skin are more likely to be exclusively breastfed at discharge, exclusively breastfed after discharge, and  breastfed for longer durations.Reasons why skin to skin is important for baby and mother:

  • Keeps mother and baby together.
  • Promotes bonding between mother and baby.
  • Provides for earlier initiation of the first breastfeeding experience.
  • Reduces crying.
  • Helps baby maintain body temperature better than a hospital warmer, as your body will alter your own temperature to warm or cool the baby to maintain a normal temperature.
  • Helps regulate baby’s breathing and heart rate.
  • Helps keep baby’s blood sugar level stable.
  • Decreases pain for baby from any procedures done while skin-to-skin.
  • Reduces postpartum haemorrhage in mother.
  • Can reduce maternal stress and postpartum depression.
  • Increases the probability of breastfeeding as well as the length of time you will breastfeed your baby beyond the hospital time.

Skin-to-skin right after birth:

  • Mother is in a slightly reclined position.
  • Baby is placed on mother’s abdomen, dried, and covered with a blanket until the cord is clamped.
  • Once the cord is clamped, baby is placed chest-to-chest with mother and remains there uninterrupted for at least one hour and preferably until the first breastfeeding is completed. This provides optimal physiological stability.
  • Baby’s face is easily visible and uncovered, neck is straight, knees are bent.
  • Baby may be naked or diapered.
  • Baby can be dried during process of placing skin-to-skin then baby and mother are covered by a warmed blanket.
  • Other tests like Apgar scoring can be done while baby is being held skin-to-skin.
  • Baby’s measurements can be delayed for up to six hours – they are not going to change dramatically in that time frame.
  • Time in a warmer will not be needed since mother’s body will keep baby warm.
  • Baby and mother are monitored by nursing staff during skin to skin.
  • Mother notices baby’s feeding cues, like rooting or sucking on hands, and can guide baby to breast for first feeding.
  • Skin to skin can continue as mother and baby are moved from the labor suite to the postpartum setting with proper observation for safety.

Continued skin to skin:

  • Regardless the birth setting – hospital, birth center or home – skin to skin can be part of the normal care of the newborn.
  • The more that mother and baby are together, the easier it is for mother to recognise baby’s early feeding cues. More frequently baby will breastfeed, and a greater milk volume will be stimulated.
  • Mothers who “room-in” in the hospital will tend to practice skin to skin more frequently.
  • Mothers who practice skin to skin report greater confidence in their ability to feed and care for their baby.
  • Babies who “room-in” have more quiet sleep than those who are separated.

Remember that skin to skin can continue past the birth period and early postpartum.  Many mothers have found that snuggling baby skin-to-skin can be soothing at any time and any age.

Credit:

Belly Belly Australia

https://www.llli.org/breastfeeding-info/skin-skin-care/

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Tips on getting a good breastfeeding latch

Breastfeeding may be the most natural way to feed your baby, but it can take time and practice for you both to get the hang of it. Understanding how a good breastfeeding latch (also known as breastfeeding attachment) should look and feel can be a huge help in getting feeding established.

There’s no right or wrong way to hold and feed your baby, and each mum and baby will find their own preferred position to feed in. What’s important is that you both feel comfortable. Knowing a few different breastfeeding positions and techniques can be helpful because life often requires us to be versatile, especially as your baby gets bigger and you start to go out and about more.

A Proper Latch

Before breastfeeding, a mother needs to get into a comfortable position as feeding may take 5 minutes to an hour. Use cushions to support the back to prevent it from getting strained. Not only will it help with the back, it will also help the baby to latch properly. To start feeding, bring the baby towards the nipple; do not bend towards the baby, as it will result in a poor latch and will hurt in the process.

Holding your breast in a “U” shape will help the baby with good latching. It also makes it easy for the baby to latch on. Keep hands 2 inches away from the nipple. Support the neck of the baby with hand and gently bring the baby towards the breast.

Aim your nipple towards the upper lip of the baby and not towards the center. If the baby does not latch on the breast, try rubbing the nipple on its upper lip. This way the baby’s head will tilt back. If the baby does not open its mouth, do not force it in but instead gently rub breast against its mouth. Squeezing a little milk out and then rubbing will also help the baby open its mouth.

Make sure that mother and the baby are chest to chest with its nose slightly above the breast. As the baby latches on to the breast, ensure that the nipple and areola (the dark area surrounding the nipple) are in the baby’s mouth. This is considered to be a good latch!

Basic Steps for Latching Positioning

  1. Position yourself comfortablywith back support, pillows supporting your arms and in your lap with your feet supported.  Whatever feels most comfortable to you!
  2. Position baby close to youwith his hips flexed, so that he does not have to turn his head to reach your breast. His mouth and nose should be facing your nipple (rather than having to turn his head to face your nipple).
  3. Support your breastif needed so it is not pressing on your baby’s chin. Your baby’s chin should drive into your breast.
  4. Attach or latch baby onto your breast.Encourage him to open his mouth wide, and pull him close by supporting his back (rather than the back of his head) so that his chin drives into your breast. It helps to tickle his upper lip/nose with your nipple. This will encourage him to open his mouth wide and latch onto your breast. His nose will be touching your breast. Your hand forms a “second neck” for your baby by lightly supporting his neck (not his head).
  5. Enjoy!If you are feeling pain, detach baby gently and try again.

As you and your baby become more experienced and comfortable with breastfeeding, you’ll find that you can alter your positions in many ways, even from feeding to feeding. As long as you’re comfortable and the baby is nursing successfully, do what works best for you.

How to help your baby latch on the breast

1: Check your latching position

Before you start, and whichever breastfeeding position you choose, make sure your baby’s head, neck and spine are aligned, not twisted. His chin should be up, not dropped towards his chest. Make sure you feel comfortable too – you could use pillows or cushions to support your back, arms or baby.1

2: Encourage your baby to open his mouth

Hold your baby close, your nipple level with his nose. Touch your nipple gently against his upper lip to encourage him to open his mouth wide. The wider his mouth is, the easier it will be to get a good latch on.

3: Bring your baby to your breast   

Once your baby has opened his mouth wide and has brought his tongue over his bottom gum, bring him on to your breast, aiming your nipple towards the top of his mouth. Your baby’s chin should be the first thing that touches your breast. He should take a large portion of your areola into his mouth, with his bottom lip and jaw covering more of the underneath of the areola.  It’s OK if you see part of your areola isn’t inside his mouth – we all have different-sized areolae and different-sized babies! Some mums find that gently shaping their breast at the same time as bringing their baby on to feed helps. Experiment and see what works.

4: Keep your baby close during latch on

Remember mums all have different breast shapes and nipple positions, so you may not always have that ‘textbook’ latch. Whenever possible, keep your baby close to you, with his chin in contact with your breast. Newborn baby’s noses are turned up so they can breathe easily while attached to the breast, and can learn to coordinate sucking and breathing with ease.

5: Look and listen

As your baby feeds, your nipple will be against the roof of his mouth, cupped gently by his tongue underneath. The latch should not feel uncomfortable – it should be more of a tugging sensation. Watch your baby – at first he’ll do short, rapid sucks to stimulate your milk flow (let-down reflex). Once milk starts flowing, he’ll suck more slowly and deeply with some pauses, which may indicate he’s taking in milk – a good sign! You should see his jaw moving, and may also hear sucking and swallowing as he feeds. These are all good signs, but it’s also important to check your baby is producing plenty of wet and dirty nappies and gaining weight as expected.

6: How to break your baby’s latch on the breast

If your baby’s latch is shallow or painful, or he starts chomping on your nipple or brushing the end of it with his tongue, remove him from your breast and try again. Ease your clean finger gently inside the corner of his mouth to break his suction if you need to.

How To Confirm If Your Latch Is Good?

Knowing the right breastfeeding latching tips and being aware of common latching signs can make the problem of baby not latching go away in no time. It will make breastfeeding a seamless and hassle-free process. Here are the signs of proper breastfeeding latching amongst babies:

  • No pain – If the breastfeeding process feels smooth and less painful, then you’ve latched your baby on properly.
  • Comfortable positioning – Put pillows behind your lower back for added support. If you’re breastfeeding your baby in bed, put some pillows below your knees for cushioning and support.
  • Nipple inside baby’s mouth – When you’re breastfeeding correctly, the entire nipple should be inside the baby’s mouth
  • Tummy-to-tummy position – Position your baby in a way that her tummy faces yours during the breastfeeding process.
  • Head and neck alignment – Make sure the baby’s neck and head align in the same direction so that there’s no discomfort faced when bringing the baby close to your nipple.
  • Breast support – Support your breast in a way that baby’s chin drives into your breast and not the other way around.
  • Close positioning – Position your baby close to your nipples so that she doesn’t have to bend or turn her head to reach your breast.
  • Mouth and nose facing nipple – Your baby’s mouth and nose should face the nipple with the nose touching the breast during the breastfeeding process.
  • A level head and bottom – Your baby’s head should be at level with the bottom of his body during the breastfeeding process.
  • Wide mouth – Encourage your baby to open his mouth wide during the breastfeeding process.

The cheeks of the baby will look full, its chin must rest on the breast, and nose must be free and above the breast. The baby does not make any noise except for swallowing. After the feeding, there will be no change in the shape of the nipple and the baby will look satisfied, any previous irritation disappears, and the baby might even fall asleep.

There will be no movement in the lower jaw of the baby. Instead of an up and down movement, there will be circular movements in the baby’s mouth. With good latching, the baby will be relaxed. If the baby is still restless then the latch is not done properly and will have to be redone.

Here’s a video on how to get on a good latch for new mothers.

 

Here’s a another awesome video on how to latch

Remember, breastfeeding should not be painful.  A good latch will help keep discomfort to a minimum.  When the baby has not latched on well, other problems can develop including cracked and sore nipples.  Once you get accustomed to positioning your baby and helping him/her get a good latch, breastfeeding can be a wonderful, pain-free bonding experience between you and your baby.

If you are still experiencing any nipple pain, dryness or discomfort, try a nipple cream.

If you need further assistance, many hospitals have lactation consultants. Seek to work with a lactation consultant at the hospital or birthing center in which you deliver. If you are already home you can speak with your healthcare provider. You can also call a breastfeeding helpline or contact an independent lactation consultant. Join our breastfeeding community to ask fellow mummies for support too!

Last but not least like what Kelly mom mentions

No matter what latch and positioning look like, the true measure is in the answers to these two questions:

  1. Is it effective?
  2. Is it comfortable?

Even if latch and positioning look perfect (and, yes, even if a lactation consultant told you they were fine), pain (particularly after the first two weeks) and/or ineffective milk transfer indicate that something needs to change, and the first suspect is ineffective latch/positioning.
If baby is transferring milk and gaining weight well, and mom is not hurting, then latch and positioning are – by definition – good, even if they look nothing like the “textbook” latch and positioning that you’ve seen in books.

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“Rules and regulations have no place in the mother-baby relationship. Each mother and baby dyad is different and what works well for one mother and baby may not work well for another mother and baby. The important thing to do is to look at the mother and baby as individuals.”– Andrea Eastman, MA, CCE, IBCLC in The Mother-Baby Dance

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Nipple Confusion and its solution

If anyone ever deserved a break, it’s a nursing mom, so your desire to have your little one take breast milk from a bottle every now and again so that you can get out of the house and go for a much-needed walk (or at least take a shower or a nap) is completely understandable. But are you worried that your little one won’t take to the bottle easily? Heard one too many “nipple confusion” sagas from friends and lactation specialists? Or has that theory been discounted by the paediatrician and your mother-in-law, leaving you more confused than ever?

What is nipple confusion during breastfeeding?

First a quick definition. Nipple confusion is when babies used to sucking from bottles have a hard time getting back on the breast. They may have difficulty latching on, and may protest the different size or texture.Nipple confusion sometimes occurs in young infants who are breast fed, given a bottle and given a pacifier all within a few days of birth. Sucking on a breast a bottle nipple and pacifier all require differ sucking techniques.By being required to use two or three different sucking techniques and young infants become confused about which technique works for which type of nipple.

A hungry infant who has difficulty sucking becomes quickly frustrated making feeding your baby difficult and frustrating both for you and you child.  While not all young infants suffer from nipple confusion, enough do that it poses a real problem for many new parents.

Is nipple confusion real?

Most babies have no problem switching from breast to bottle and back again. Others, particularly those who take a little longer perfecting the art of suckling at the breast, do find it hard to transition from breast to bottle, and then back to breast. Which is why most experts agree that you should wait until your newborn gets the hang of breastfeeding(about three weeks) before you break out the bottle.

If breastfeeding hasn’t hit its groove by the three-week mark, wait a little longer before introducing the bottle.

Why do you need to hold off before you switch off? If you don’t wait until your baby has perfected her breastfeeding skill, there’s a risk she’ll give up breastfeeding sooner than you’d like.

Does your baby know the difference between breast and bottle?

Newborns catch on pretty quickly they don’t have to work nearly as hard to get milk from a bottle with a rubber (or silicone) nipple as from your breast. To breastfeed, your baby needs to master the fine art of taking your nipple far back into her mouth and then using her tongue to pump out the milk (which can take a minute or so before it starts flowing). With a tilted bottle, a baby has gravity on her side: She can suck with her lips and get all the milk she wants right away. So the baby suffering from nipple confusion may not be befuddled so much as opinionated. She prefers the bottle. And why wouldn’t she? It’s the quicker, easier route to a full belly.

The main reason for developing nipple confusion for bottle feeding

Nipple confusion happened due to 1 main reason which is:

Bottle feeding for a breastfed baby is completely different from natural breastfeeding.

No matter what is in the bottle, either you introduce breastmilk of formula.

It is about the device “your breast vs the bottle”, where your baby sucks the milk in 2 different ways.

Add on this, the difference in:

  • Mouth muscles used while sucking from breast are more than in the baby bottle.
  • His tongue moves in a different way in each situation.
  • The elasticity of breast skin vs the bottle teat.
  • The milk flow rate from the breast “slower” vs from the baby bottle”faster”.

The result of nipple confusion may be:

  • Breast refusal which means breastfeeding discontinue.
  • Bottle refusal is an issue if you are going to pump

Note

Usually, breastfeeding mothers face the nipple confusion issue when they tend to pump/express breastmilk before returning back to work or study.

Hence, here are the cautions to take to avoid and fix the nipple confusion during mixing between breast and bottle feeding.

When to introduce the bottle

Give breast-only feeding the recommended three weeks for your milk supply to get well established and for your newborn to really master the technique, and then feel free to give yourself that longed-for break.

Tips for introducing the bottle

Some babies take to bottle-feeding right away, others protest. If you’ve got a stubborn bottle feeder on your hands, be ready to offer a choice of formula, nipple sizes and style, and formula-feeding times until he decides which one he prefers. If your baby balks at breast or bottle, here’s a game plan for handling that nipple confusion (or preference!):

What to do if your baby won’t take a bottle

Go back to square one. Revisit the basics of latching on and remind your baby how soothing breastfeeding can be by cuddling her skin-to-skin. It may require a few sessions of fumbling at the breast before she gets back on track, but it’ll be worth it!

Make it easier. Get your milk flowing (either manually or by pumping your breast milk) before your baby starts to eat, so she doesn’t have to work that hard for the milk. (Just pump enough to get things dripping; you’re not looking to fill a bottle just yet.)

Time it right. She should be in the mood for a meal (aka hungry) so she’s motivated to give it a try…but not so famished that she can’t get her baby brain around relearning an old trick. If she’s starving, she may not have the patience to latch on or suck hard enough to get the milk she wants—and that might lead to a full-blown frenzy of frustration, which can throw both of you off track.

Back off on the faux nipples. If the whole switching process has given your baby a bad case of nipple confusion, just stick with breastfeeding till she’s got it down solid. (This means you’ll need to put away the pacifiers too, just in case she’s gotten too fond of sucking for satisfaction with her lips.)

What to do if your baby prefers breastfeeding

Let Daddy do the feeding. Sometimes a baby is just too attached to Mom’s nipple, so hitting the bottle while Mom is so close by (yet buttoned-up) seems wrong. But it may be a different story if someone else is bringing on the bottle — whether it’s Dad, Grandma, or your best pal. But don’t worry that you’ll always need a Mommy stand-in at feeding time — once your wee one gets the hang of the bottle, she won’t care who gives it to her!

Try different nipples types. If one nipple doesn’t succeed, try, try another one. Just watch the flow rate. The milk should comes out fast enough that your baby doesn’t get frustrated…but not so fast that she can’t keep up with the flow. A drop a second when you turn the bottle upside-down is just right.

Make bottle feeding as much like breastfeeding as you can.Interact with your baby. Switch arms halfway through so she has something different to look at. Burp her. But remember that while some newborns want bottle feeding to be just like breastfeeding, others take to it better if the experience is completely different. So if that’s the case with yours, try a different location or even a different position.

To avoid nipple confusion

  • No bottle introduction “or pacifier” through the first month of age.
  • Avoid giving your breastfed baby a pacifier. It is enough to introduce one artificial nipple at a time which is the bottle nipple.
  • Start introducing the bottle 3 weeks before back to work to give him a space to learn the new skill.

How to fix nipple confusion?

You can do that by decreasing the gap as much as you can between breast and bottle.The whole idea of how to fix nipple confusion is to mimic the natural process of breastfeeding.

While you try to introduce the artificial nipple, do your best to decrease the difference between the natural nipple of you and the synthetic bottle nipple.

Breastfed baby breast refusal may be due to the type of bottle

The ordinary classic baby bottle has 2 huge disadvantage regarding nipple confusion:

  1. It is light in weight
  2. It has a narrow/small bottle nipple.

And for that, it is much easier for your breastfed baby to get his milk from the regular bottle rather than your heavy, wide breast. By the time, he would prefer this small/light nipple rather than your breast. So, it is far from your heavy, wide breast nipple.

How to fix that?

Pick the wide base baby bottle which has a wide nipple to mimic the size of your breast. Also, the wide neck bottles are closer to your breast regarding its weight. And remember that your breast is like a heavy sandwich for your breastfed baby to latch on to it.

Nipple confusion makes your baby refusing the breast due to the flow rate

The breast milk ejection from the breast is a time-consuming process. This process is mediated through lactation hormones “Oxytocin and Prolactin.” Your breastfed baby may take around 2 mins to receive the breast milk during natural breastfeeding.

But the milk comes easily and quickly in the case of bottle feeding.

How to fix that issue?

Thus, try to choose the slow flow rate teat to make the process takes much time. Add on that; the fast flow bottle nipple “teat” may make your baby get choked.

Another way to mimic the slow milk rate of breastfeeding is to apply pauses while bottle feeding to do it, don’t let your baby for the whole 10 mins of feeding latched on to the bottle.

The gravity is making the milk flow rate from a bottle much faster than the breast.

So, what to do instead?

During bottle feeding, you can control the flow by making pauses “10 sec every 2 mins”. These pauses would stretch the time needed to finish the milk from the bottle.

By doing that, you mimic breastfeeding session regarding the duration and flow rate. And your baby can switch between both ways of feeding without feeling that huge difference.

Did your breastfed baby latch on the bottle properly?

Baby good latch during breastfeeding is something crucial for maintaining a successful breastfeeding journey.As your baby used to latch deeply while natural breastfeeding, he should do so on the baby bottle also. Shallow latch on the bottle is a probable cause of nipple confusion.

What is the solution for that bottle shallow latch?

Simply, be sure that your baby is catching the wide base of the bottle rather than the tip. Like what happens in the normal latching process while breastfeeding, where your baby is catching the most of your areola within his mouth.

How to achieve that?

First, you should stimulate your breastfed newborn for the wide mouth opening.This could be done by raising the bottle at a higher level than his mouth.

Then hit his nose with the tip of the baby bottle tip.

Naturally, he would widen his mouth opening to catch the bottle nipple.

The second step is to pick the widest mouth opening and insert gently and deeply the bottle. You can control this process by grabbing your baby’s head using your hand.

How to balance breastfeeding and bottle-feeding

Bottle or breast feeding doesn’t have to be an all-or-nothing choice. By spacing out feedings, finding a formula baby likes almost as much as mom’s breast milk, and making sure nursing time includes lots of skin-on-skin bonding, you’ll be able to enjoy the flexibility of both.

sources

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Can I still breastfeed with Flat or Inverted nipple?

flat nipple

Inverted Nipples & Breastfeeding

Nipples come in all shapes and sizes and not all nipples point out away from the breast. Some nipples are flat while others are inverted nipple and pull into the breast. Or, nipples may fall somewhere in between.

The amount of fat in your breast, the length of your milk ducts, and the density of connective tissue beneath your nipples all play a role in whether or not your nipples protrude, lie flat, or are inverted.

The shape of your nipples may also change during pregnancy. Sometimes, flat nipples push out during pregnancy and the first week or so after the baby is born.

It’s not uncommon for a woman to worry about breastfeeding with flat nipples. The good news is that with a little extra time and patience, breastfeeding with flat nipples is possible.

How to know if you have truly flat or inverted nipple

Many nipples will stiffen and protrude when stimulated. You can check to see if your nipples are truly flat or inverted. If you’re able to coax your nipples out, then chances are your baby will be able to, too.

Here’s how to check:

  1. Place your thumb and forefinger on the edges of your areola, which is the dark area around your nipple.
  2. Squeeze gently.
  3. Repeat on your other breast.
What is an inverted nipple? Difference between inverted, flat, and regular nipples.
Different type of nipples

If your nipple is truly flat or inverted, it will flatten or retract into your breast instead of pushing out.

If your nipple protrudes, that’s great. If it does not protrude or become erect, it is considered flat. If it retracts or disappears, it is truly inverted. Nipples that are severely flat or inverted will not respond to stimulation or cold by becoming erect. If you perform the pinch test and your nipples protrude, they aren’t truly inverted and will probably not cause any problems when you nurse your baby.

Testing for flat or truly inverted nipple

A truly inverted nipple is caused by adhesions at the base of the nipple that bind the skin to the underlying tissue. While the skin does become more elastic during the third trimester of pregnancy in preparation for nursing, some of the cells in the nipple and areola may stay attached. Sometimes the stress of vigorous nursing will cause the adhesion to lift up rather than stretching or breaking loose, and this can cause cracks in the nipple tissue and pain for the mother.

Because the breasts function independently of each other, it is not unusual for a mother to have one flat or inverted nipple, or to have one nipple that protrudes more than the other. For the same reason, it is not unusual for a mother to produce more milk from one breast than the other.

Another simple way to tell if you have inverted nipple is that if your nipple protrudes at all—naturally or when stimulated by touch or temperature—you do not have an inverted nipple.

The Hoffman Technique

The most common manual treatment for inverted nipples is the Hoffman Technique, but it’s important to note that studies show conflicting evidence as to whether or not this technique works—and for how long

Here’s how to try it yourself:

  1. Place your thumbs at the base of either side of your nipple and press firmly into your breast tissue.
  2. While pressing down, pull your thumbs away from each other.
  3. Move your thumbs all around the nipple and repeat.
  4. Repeat once per day.

The Hoffman Technique is a manual exercise that may help break adhesions at the base of the nipple that keep it inverted. Place the thumbs of both hands opposite each other at the base of the nipple and gently but firmly pull the thumbs away from each other. Do this up and down and sideways. Repeat this exercise twice a day at first, then work up to five times a day. You can do this during pregnancy to prepare your nipples, as well as after your baby is born in order to draw them out.

Hoffman Technique

Is it a deal breaker if I have inverted nipple?

An inverted nipple is definitely not a deal breaker for you!

““Remember that babies BREASTfeed, not NIPPLEfeed” — La Leche League

When breastfeeding, baby should open up wide enough that he/she takes a good portion of the breast into his/her mouth, bypassing the nipple entirely. Because of this, in most cases, inverted nipples alone will not cause problems with breastfeeding.

When Inverted Nipples May Interfere With Breastfeeding

Inverted nipples can make it more difficult for some women to breastfeed. In rare cases, a mother can experience persistent sore nipples because the baby compresses the buried nipple rather than compressing the milk ducts. The result is little milk for baby, and a painful experience for mother.

Breastfeeding is more likely to be a challenge for women with inverted nipples based on: 

  1. Degree of inversion: If mummy has a slight inversion—the most moderate case—a baby with a normal suck is unlikely to have a problem feeding. If mama has moderate to severe inversion—when the nipple retracts deeply into the areola—baby may have more trouble compressing the milk ducts. The good news is that breastfeeding is usually possible, no matter how inverted the nipples are. Consult a IBCLC lactation consultant for help establishing a proper latch and have patience with yourself and baby.
  2. Other latching issues: When combined with other latching issues, like tongue tie or lip tie, mama and baby are much more likely to have problems with breastfeeding.

Suction devices

Studies support the use of suction devices—shells, cups, and nipple extractors—for drawing out inverted nipples. They are worn for longer periods of time (over the course of the day, for example), and are meant to loosen the nipple tissue to help nipples stay erect for longer periods of time.

Try an automatic double electric breast pump, which uses uniform suction from the center of the nipple to draw it out rather than compressing the areola. Over time, the suction usually works to break the adhesions that are holding the nipple in.

A nipple shield—a thin, flexible silicone shield that’s shaped like a nipple and has holes in the tip to allow milk to flow to the baby—can also help. These devices are used during feedings to help draw the nipple out. (Consult a lactation consultant before attempting to use the shield, as it can frustrate the baby and lead to further problems if not used correctly.)

Breast shells are another wearable item that can assist nipple profusion, but unlike the shield, are not used during feeding. Instead, they are worn inside your bra for about an hour before feedings to draw out the nipple.

Other #SLBHacks for Inverted NIpples

  1. Regular nipple stimulation: Before feedings, roll your nipple between your thumb and index finger for 1-2 minutes. Follow up with a damp cold cloth or with ice that has been wrapped in cloth. Keep in mind, you don’t want to ice the nipple to numbness as this can inhibit your let-down reflex.
  2. Manually pulling back breast tissue: As baby goes to latch, place your thumb on top of your areola and your other four fingers underneath it. Pull the breast tissue towards the chest to help the nipple protrude.
  3. Reverse pressure softening: Before baby latches, place all five fingers around the base of the nipple. Push towards the chest for 1-3 minutes. This may help the nipple protrude and trigger milk flow.
  4. Ensure baby gets a deep latch. When baby is latching, hold him/her close and align baby’s nose with your nipple. Pull your breast tissue back, tickle baby’s lips with your nipple, and wait for baby to open wide. (
  5. Get help. A certified lactation consultant can help. You can also attend La Leche League Singapore or Breastfeeding Mother Support Group or feel free to join SLB’s Breastfeeding Facebook Support Group. These are free of charge and is a place for breastfeeding support. Reach out sooner rather than later to avoid unnecessary stress and frustration for both mummy and baby.

Last by not least

Nipple inversion can make breastfeeding more challenging for some mummies, but it doesn’t make it impossible. If you’re having trouble, give yourself some grace—breastfeeding is hard! If you can get help and stick with it, the benefits are great. But occasionally, breastfeeding becomes too much stress for you or baby, and it just doesn’t work out. .

Carrot Cake Lactation Overnight Oats


Print Recipe


Carrot Cake Lactation Overnight Oats

Booster : carrot, flaxseed, brewer's yeast, oats

Course Breakfast

Prep Time 5 minutes
Passive Time 2 hours

Servings
Serving


Ingredients

Course Breakfast

Prep Time 5 minutes
Passive Time 2 hours

Servings
Serving


Ingredients


Instructions
  1. Mix all ingredients together (except for the pecans and coconut) in a bowl or mason jar.

  2. Add the pecans and coconut on top, cover with a lid, and set in refrigerator overnight. Enjoy in the morning!


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Peanut Butter Banana Overnight Oats

Print Recipe
Peanut Butter Banana Overnight Oats
Boosters: Oats, Flaxseed, Brewer's Yeast
Course Breakfast
Prep Time 5 minutes
Passive Time 2 hours
Servings
people
Ingredients
Course Breakfast
Prep Time 5 minutes
Passive Time 2 hours
Servings
people
Ingredients
Instructions
  1. 1. First, mash 1/2 banana in a large bowl. Then add the rest of the wet ingredients and mix until smooth.
  2. 2. Add in dry ingredients and mix again.
  3. 3. Place in the refrigerator, covered, for at least 2 hours or overnight. Serve cold.
Recipe Notes

Feel free to double this recipe.
**It should stay good refrigerated for up to 3-4 days.
**Depending on how thick you like your overnight oats, you may add a splash of almond milk before serving.

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Choosing the right breastshield for you

Did you know that breast shields ( flanges) come in different sizes? Many mummy experience inefficient pumping session, and the reason is usually because of wrong breast shield size. Many breast pumps ship with size 27mm or 28mm in Singapore; however, that doesn’t mean that everyone will fit that size (we don’t all wear the same sized shoes, after all). There are breast shields on the market ranging in size from 15mm to 36mm!

Follow this simple guide to determine your breast shield size but first thing first

Pump for 5 minutes, and then measure

It’s a common misunderstanding to measure your nipple before you start pumping, but you actually have to measure the nipple after you pump. The reason is simple. The nipple swells while pumping, and since the rate of swelling varies between women, it’s important to take this swollen measurement to select a comfortable shield size. Grab the shield that came with your pump, assemble it to the milk collection kit and then pump on a low setting for 5 minutes, so the nipple swells. You might even express milk while doing this (if this is your first time pumping, be sure to use the lowest vacuum setting to avoid any pain or discomfort).

Measure the diameter of the nipple at the base of the nipple

 

After your nipple has swollen, measure the diameter of the nipple at the base of the nipple. Be careful not to include any areola in the measurement. Gently lay a ruler onto the areola next to the base of the nipple so the measurement lines are visible when looking straight at the breast. This can be tricky so some women find that doing it in front of a mirror or using a smart phone in selfie mode is helpful.

Select a shield size 2-3mm larger than your nipple diameter

To allow the nipple to move freely within the flange while pumping and to avoid any pain or discomfort (or worse – blisters!) from rubbing, select a shield size that is 2-3mm larger than the diameter of your nipple. For example, if your nipple measures at 18mm, you would want to try the 20mm shield. It’s important not to go too large either because excess areola can be drawn into the flange, causing discomfort, pain, or even constriction of milk flow.

Signs your breast shield may be too small

  • Painful rubbing of nipple in flange.
  • Nipple not moving freely inside of flange.
  • Redness of the nipple.
  • Whiteness of the nipple and/or a white ring around the base of the nipple.
  • Little milk is being expressed.
  • General discomfort while pumping.

Signs your breast shield may be too large

  • Excess areola is drawn into the flange or even up and around the nipple. Note that a small amount of areola may enter the flange for some women; however, it should never be uncomfortable or painful.
  • Sensation of pulling and/or pulling pain.
  • Nipple is pulled to the end of the flange.
  • Shield falls from the breast while pumping.
  • Little milk is being expressed.
  • General discomfort while pumping.

Size that is just nice

  • A properly sized breast shield should be very comfortable.
  • You should barely be able to feel it while pumping.
  • Just a gentle tugging sensation on the nipple and nowhere else.
  • You should not see any excess areola being drawn into the flange
  • Should not feel a pulling sensation or pain while using your breast pump.
  • After your pumping session, your nipple should be free of any redness or whiteness.
  • Pumping should be pain-free

 

Additional factors impacting breast shield size

Although the above instructions provide a good indication of the size of breast shield you will need, there are few things to consider:

  • Every woman’s body responds differently to pumping. It is possible your measurements before pumping might change during pumping, therefore we suggest taking measurements of the swollen nipple 5 minutes after pumping.
  • Your measurements might be different throughout the day. For example, you might be fuller in the morning after going a few hours without pumping and/or feeding at night, warranting a larger size. You might also be smaller in the evening after consistent pumping or feeding throughout the day.
  • You might be larger at the beginning of a pumping session, and smaller after some milk has been expressed.
  • Your measurements might change after your milk supply is well-established (about 10 weeks postpartum).
  • One breast may need a different sized breast shield than the other.

However, you should not follow this guideline blindly because the info graphic merely relies on nipple diameter only. In addition to nipple diameter, you should also consider the following factors:

  • Check how your nipple moves while pumping.

The nipple should move freely and it should not rub the side wall of the flange. You may see a little bit of areola gets pulled, but not the whole areola. And your nipple should not hit the back wall of the breast shield.

  • Comfort

Even if you think you already choose the best breast shield size, but you feel uncomfortable / painful while pumping, that means something is not right. Try to size up or down. Nipple redness / or sore feeling after pumping is also an alarm that you may need to choose different breast shield size.

  • Effectiveness of pumping

If you feel you breast is not emptied after pumping, you may suspect that you don’t use the correct breast shield size (note: various factors can affect this, breast shield size is just one of possible reason).

  • Breast tissue / elasticity

Some women has a very elastic tissue so that the skin will get pulled easier. In this case, it is possible that pumping makes nipple get elongated so much until it hits the back wall of the flange. For this case, using breast shield with longer ‘tunnel’, or using smaller insert in bigger breast shield may help.

 

Nipple Ruler

We also found Nipple Ruler by pumpables.co

Simply print it out, fold along the line, and carefully cut out the circles.

The nipple ruler works on both US Letter and A4 paper sizes. Make sure you select “full size” or “100%” in your print menu (don’t “scale to fit”). You can also print it on larger sizes like US Legal or A7, but you might have to trim off the extra

 

At the end of your pumping session, use the circles to measure the diameter of your nipple at the base. You should select a size that is snug, but not constricting, around your nipple.

Here’s another Nipple Ruler we found from MayMom

If you have more questions or need further help with breast shield sizing, reach out to a Certified Lactation Consultant. In the long run, it’s worth taking the time to determine the breast shield size that’s right for you. You’ll benefit by maximising your pumping sessions so you can get back to what matters most – the little one you’re pumping for!

Reference
https://pumpables.co/measure/
https://spectra-baby.com.au/measuring-nipple-correct-flange-size/
https://www.medelabreastfeedingus.com/article/143/breast-shield-sizing:-how-to-get-the-best-fit

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Breastfeeding Newborns

The First Week

How often should baby be nursing?

Frequent nursing encourages good milk supply and reduces engorgement. Aim for nursing at least 8 – 12 times per day (24 hours). You CAN’T nurse too often–you CAN nurse too little.

Go on demand feeding. Nurse at the first signs of hunger (stirring, rooting, hands in mouth)–don’t wait until baby is crying. Allow baby unlimited time at the breast when sucking actively, then offer the second breast. Some newborns are excessively sleepy at first–wake baby to nurse if 2 hours (during the day) or 4 hours (at night) have passed without nursing.

Is baby getting enough milk?

Weight gain: Normal newborns may lose up to 7% of birth weight in the first few days. After mom’s milk comes in, the average breastfed baby gains about 170 g/week. Take baby for a weight check at the end of the first week or beginning of the second week. Consult with baby’s doctor if baby is not gaining as expected.

Dirty diapers: In the early days, baby typically has one dirty diaper for each day of life (1 on day one, 2 on day two…). After day 4, stools should be yellow and baby should have at least 3-4 stools daily that are the size  of about2.5 cm or larger. Some babies stool every time they nurse, or even more often–this is normal, too. The normal stool of a breastfed baby is loose (soft to runny) and may be seedy or curdy.

Wet diapers: In the early days, baby typically has one wet diaper for each day of life (1 on day one, 2 on day two…). Once mom’s milk comes in, expect 5-6+ wet diapers every 24 hours. To feel what a sufficiently wet diaper is like, pour 3 tablespoons (45 mL) of water into a clean diaper. A piece of tissue in a disposable diaper will help you determine if the diaper is wet.

Breast changes

Your milk should start to “come in” (increase in quantity and change from colostrum to mature milk) between days 2 and 5. To minimize engorgement: nurse often, don’t skip feedings (even at night), ensure good latch/positioning, and let baby finish the first breast before offering the other side.

Call your doctor if:

  • Baby is having no wet or dirty diapers
  • Baby has dark coloured urine after day 3 (should be pale yellow to clear)
  • Baby has dark coloured stools after day 4 (should be mustard yellow, with no meconium)
  • Baby has fewer wet/soiled diapers or nurses less frequently than the goals listed here
  • You has symptoms of mastitis (sore breast with fever, chills, flu-like aching)

Supplement

Get Singapore Lactation Bakes’s Cookies 1-2 weeks in advance and put in your hospital bag. Skin to skin and latch baby immediately after birth and you may start having the lactation cookies. 10-12 cookies per day promotes more let downs or fuller breast. Pump or latch baby immediately when you feel the let downs or fuller breast to encourage more milk productions.

Weeks Two through Six

How often should baby be nursing?

Frequent nursing in the early weeks is important for establishing a good milk supply. Most newborns need to nurse 8 – 12+ times per day (24 hours). You CAN’T nurse too often—you CAN nurse too little.

Nurse at the first signs of hunger (stirring, rooting, hands in mouth) and don’t wait until baby is crying. Allow baby unlimited time at the breast when sucking actively, then offer the second breast. Some newborns are excessively sleepy, wake baby to nurse every 2 hours during the day or 4 hours during the night if baby doesn’t wake up to nurse. Once baby has established a good weight gain pattern, you can stop waking baby and nurse on baby’s cues alone.

The following things are normal:

  • Frequent and/or long feedings.
  • Varying nursing pattern from day to day.
  • Cluster nursing (very frequent to constant nursing) for several hours—usually evenings—each day. This may coincide with the normal “fussy time” that most babies have in the early months.
  • Growth spurts, where baby nurses more often than usual for several days and may act very fussy. Common growth spurt times in the early weeks are the first few days at home, 7 – 10 days, 2 – 3 weeks and 4 – 6 weeks.

Is baby getting enough milk?

Weight gain: The average breastfed newborn gains 6 ounces/week (170 grams/week). Consult with baby’s doctor and your lactation consultant if baby is not gaining as expected.

Dirty diapers: Expect 3-4+ stools daily that are the size of about 2.5 cm or larger. Some babies stool every time or even more often when they nurse this is this is normal . The normal stool of a breastfed baby is yellow and loose (soft to runny) and may be seedy or curdy. After 4 – 6 weeks, some babies stool less frequently, with stools as infrequent as one every 7-10 days. As long as baby is gaining weight well, this is normal.

Wet diapers: Expect 5-6+ wet diapers every 24 hours. To feel what a sufficiently wet diaper is like, pour 3 tablespoons (45 mL) of water into a clean diaper. A piece of tissue in a disposable diaper will help you determine if the diaper is wet. After 6 weeks, wet diapers may drop to 4-5/day but amount of urine will increase to 4-6+ tablespoons (60-90+ mL) as baby’s bladder capacity grows.

Milk supply

Some moms worry about milk supply. As long as baby is gaining well on mom’s milk alone, then milk supply is good. Between weight checks, a sufficient number of wet and dirty diapers will indicate that baby is getting enough milk.

Boosting Milk supply

Take cookies, muffins, herbs  (called ‘galactagogues’) to stimulate the hormones that govern their milk supply. Eat food that boost milk will help too. By finding your milk booster, you will need to trial and error as different body reacts differently to different food.

 

Reference:

Kelly mom  https://kellymom.com/hot-topics/newborn-nursing/