Baby & Me

Transcript: Nurturing Beginnings – Breastfeeding Support and Guidance

Hi, welcome to the Nurturing Beginnings course at Tahoe Forest Hospital. We’re so glad you’re here. My name is Nellie and I’m one of the lactation care coordinators on our team.

As a baby friendly hospital, we support breastfeeding to promote the health and well-being of both mom and baby. Thinking about this topic prenatally can help families feel prepared for this exciting new season and know what to expect in the early days with your newborn. We hope this class provides helpful information on benefits of breastfeeding.

Our team is here to support you and your family no matter the feeding method that you choose. In our time here together that we are going to cover a few topics.

The first will be the evidence-based benefits of breastfeeding for both mom and for baby. The importance of early skin-to-skin and early initiation of breastfeeding when your newborn arrives. Instructions on how to do hand expression, and what it looks like to latch your baby.

We’ll also review infant hunger cues and what they mean, the value of rooming in as a baby friendly hospital, and the reasons we discourage use of artificial nipples and pacifiers in the first week.

For the purpose of this video, I will be using the term breastfeeding to encompass chest feeding as well. Pregnant women have many influences surrounding them during pregnancy and once their newborn arrives- from health care professionals to friends and neighbors to social media. It can be a lot of information to process.

We want new families to have access to up-to-date and evidence-based practices regarding breastfeeding. The World Health Organization and the American Academy of Pediatrics both recommend exclusive breastfeeding for your newborn’s first six months. There’s no need for any other liquids, including teas or water during this time. Your milk is all they need.

They also recommend continuing to breastfeed after the introduction of solids for at least 2 years and beyond. These recommendations are in place due to the health benefits for both mom and for baby.

In the time immediately following giving birth to your baby, breastfeeding helps decrease mom’s risk of bleeding by producing uterine contractions. Further down the line, breastfeeding decreases mom’s risk of ovarian cancer, some types of breast cancer, type 2 diabetes, and heart disease.

Benefits for baby in the early days include that breast milk has the highest nutritional value. That means it is easy to digest. It reduces inflammation and it helps support their brand new immune system. This can lead to fewer sick visits for your little one.

Evidence has also shown that there is a decreased risk for developing diabetes, asthma, allergies, eczema, ear infections, respiratory infections, and childhood leukemia as your baby grows. Research has also found that there is a correlation between duration of breastfeeding and a decreased risk for SIDS.

Oxytocin is the love hormone and it is released while breastfeeding. This promotes bonding for both mom and baby. Research has shown a decreased risk of postpartum depression for moms when breastfeeding is going well and they feel supported. A lovely benefit for all is that breastfeeding is free.

Whether your newborn arrives via vaginal delivery or a C-section, the team at Tahoe Forest Hospital supports uninterrupted skin-to-skin for you and your newborn in the first hour after birth, unless separation is medically necessary. Skin-to-skin with partners is great.

We love and encourage skin-to-skin because it helps regulate baby’s body temperature, their blood sugars, their heart rate, and their respiratory rate. Their nervous system feels safe and secure when they are skin-to-skin with their parents. That leads to less crying and more bonding.

The priority in this first hour of life is for your newborn to explore and familiarize themselves with the brand new world. Being skin-to-skin on mom’s chest after delivery promotes close proximity to the breast to initiate early breastfeeding. This early initiation of breastfeeding is important for baby’s nutrition and also to begin building up mom’s milk supply.

The very first milk is called colostrum. It’s a small volume. It’s yellow in color and it’s sticky in consistency. Often at the end of pregnancy, moms can hand express a small amount of colostrum as their due date approaches. With your OB’s approval, you can start hand expressing and collecting colostrum in the days leading up to your delivery.

Now, we are going to watch a video by Dr. Jane Morton, the former director of breastfeeding medicine at Stamford University. She’ll give a demonstration on how and when to do hand expression and also how to latch your baby. Let’s take a look.

Breastfeeding in the first hour: it’s in your hands. By Dr. Jane Morton.

When you’re counting down the last days before delivery, learn how to make the first hours after delivery count. For breastfeeding to become a relaxing and fun part of your future, nursing needs to be comfortable for you and easy for your baby. And you need to make plenty of milk.

This doesn’t always happen automatically, but by understanding what to do in the first hours, you can get there. Instead of seeing how things go and not realizing this is the best time to prevent problems, know that breastfeeding can be in your hands when you understand three key points before delivery.

What is a good latch? How can I help my baby if needed? And how can I make more milk sooner?

Your baby is already learning to breastfeed. Powerful scents or smells in the warm amniotic fluid surrounding your baby, which are very different in each mother, program the unborn baby to learn mouthing behavior. After birth, the identical scents in your milk stimulate him to search for your breasts.

What most people don’t understand is that the first few hours after you deliver are super important hours. um that in fact you never get back again. So, we want to take full advantage of them. So the first thing we’ll talk about is attachment. And what that means is how a baby latches onto a breast and how it gets milk out of the breast.

So when a baby is latched onto the breast well, the nipple is positioned and protected far back in the roof of his mouth. The reason that’s important is because then the massaging action of his jaw and tongue is not on the nipple but below the nipple. So he’s massaging right here. This is how he can effectively get milk out of the breast.

If he’s not latched on well and the nipple is right by the lips, then he doesn’t get milk out of the breast and it hurts and it doesn’t send a signal to the breast to make more milk unless he effectively gets milk out. After your baby is born, your obstetrician or your midwife will take your baby and place him skin-to-skin right on your breast to recover, maybe even before the cord is cut.

And babies normally take a period of time to recover from the delivery itself and to wake up and explore and find your breast. Scoot over to your breast. latch on hopefully comfortably and learn how to nurse effectively. Okay? But if he doesn’t, I don’t want you to worry about that.

If he doesn’t learn how to nurse effectively in the first hour, you can take advantage of that first hour by making sure your production is protected by getting the milk out of your breast, even offering it to your baby. Mhm. And you can also use your hands to help a baby learn how to latch onto the breast. Okay.

How can I help my baby latch if needed? If he’s still struggling after a few hours to latch on to the breast, I want to show you some how to position him to make it easier for him to latch on to the breast.

Take this arm and run it along his back with a nice tight C at the base of his skull. Just like that. So that he you’re kind of able to direct  him on where to go.

So we’ll start off with nipple to nose. Always making sure that when he nurses his head is tipped up. So his chin is pushing into the breast more than his nose. That way the nipple goes straight to the top of his mouth instead of if we had him too high down, the nipple would point down towards his tongue and that would hurt and make it impossible to get the nipple back there.

When you’re nursing off of your left breast, you’ll use your left hand. And for the same position that you hold a cuff, keep your hand just like that. Nice C. Then you turn your hand under and make a C with your breast. Comfortable C. Just like that. You’ll turn your breast into more of an oval rather than a circle.

So, an oval will help his mouth when he opens his mouth wide, he’ll be able to latch on right down here so he can massage milk out. Look, all of a sudden, we’re kind of getting milk. If he was latched on too high up to your nipple, he wouldn’t get anything. But if he’s right down here, then he can get milk out of your breast. This way, the breast is sort of sandwiched in a way that fits into his mouth well.

But if you held your breast in the wrong way like this, then you could see that to get his lower lip down here, it would be much harder for him. It would be like trying to put a sandwich in the wrong way. So instead, hold your breast like this, and then he can just tip his head up, open his jaw, and we can get the nipple right back to that protected spot.

The next thing you do is you just rub his upper lip, wait till he has a nice wide mouth. And when he has a nice wide mouth, then you would bring him in swiftly onto the breast. And when he starts nursing and you’re sure it’s comfortable, remember to keep his chin pushed in more than his nose and it’s perfectly comfortable, then you relax the C on his on your breast and carefully bring your hand out and wrap it around him and sit back and enjoy.

In any position, you’ll want to make sure your nipple is far back and angled towards the top of your baby’s mouth. His mouth covers more of the dark area below the nipple than above. With his head tipped up, his chin pushes into the breast. And your baby has long stretches of sucking and swallowing. With a bad latch, the baby’s tongue and jaw will rub and hurt the nipple.

Use your hands to help your baby get a good latch with the lower lip far below the base of the nipple. Try different positions to see what’s most comfortable as breastfeeding should not be painful.

In this cross chest hold, run your arm along his back with your hand snugly supporting his head at the base of his skull. Position him nipple to nose. Now wait for wide mouth before bringing him to the breast. Chin first.

Wait for him to suck before relaxing the hold on your breast. Keeping his head tipped up. Remember to wait for a yawning mouth, not a little fish mouth.

In a football hold, tuck him far back at your side with your arm along his back, head tipped up, nipple to nose. Support your breast with fingers parallel to his lips. Rub his upper lip and wait for that gaping mouth before bringing him in chin first. Listen for swallows.

Babies who have difficulty with latch early on become champions over time when milk increases around the third to fourth day and flows easily and with the experience of spending lots of time close to your breast. Ask for help and put a lot of effort into building your production without relying only on your baby.

How can I make more milk sooner? Let’s go back to the first hour and let’s say that this baby, for whatever reason, maybe he was separated from you or maybe he was just too sleepy, for whatever reason he was not able to latch on to your breast. The one thing we need to remember is that the first hour is super important as far as establishing a really robust milk production because this is the hour to signal your breast to make plenty of milk.

So, if your baby is on the breast, but you’re not even sure if he’s nursing very well, you can use your hands to get milk out of your breast. So, let’s learn how to do that.

Let’s go back to make a C just like that with your hand. Just the way you hold a cup. Take the cup out. And now you can just put your hand any way it feels
comfortable. And what you’re going to do is you’re going to just push back towards your rib cage. And then you’re going to bring the your finger and your pointing finger together just like that. And then relax.

So you can push back, compress, and relax. Push back, compress, and relax. And you’re very lucky because you get so much milk out. Some mothers don’t get a lot of milk out and that’s okay. This action is really what stimulates the production. So that’s just fine.

Now let’s say that you wanted to save some of this for your baby. What we can do and your partner can help you is take a nice clean spoon and push back and then relax. Push back and relax. Push back and relax. And then we have a nice spoonful of dessert that we can give your little baby.

Then what you can do is you can swaddle your baby a little bit so his arms don’t hit the spoon and bring this in and just let it sit on his lower lip. And what he’ll start doing if you just give him just a drip is he’ll start tasting it and with it just like a kitty cat, he’ll start licking it and swallowing it.

The hormones of delivery generally make hand expression in the first hour easier than on the next day. Making plenty of milk doesn’t happen automatically. The powerful and critical signal to your breast to make more milk sooner is milk removal in the first hour and then every 2 to 3 hours over the next several days. So never worry about collecting every drop, you’ll just make more.

Feed your baby whenever he appears ready, way before he cries. He’ll be less likely to get too little milk or to lose too much weight or to become too jaundiced. If you nurse very frequently and offer dessert from a spoon. In the first 3 days, you’ll never overfeed first milk. You’ll know when he’s full. days before your due date, practice the technique of hand expression.

Now, what we’ve talked about is how you can help your baby latch on comfortably and effectively and also what to do if it doesn’t work perfectly in the first hour. So, now you really understand how important it is to use your hands.

On that first day of life, the newborn stomach is the size of a cherry. So, the small volume of colostrum is enough. The sticky consistency as well as the small volume helped infant learn how to swallow and feed. Often, no supplementation is needed in this time. However, we do have donor breast milk and liquid formula by family’s request available on the OB unit.

We do encourage avoiding unnecessary supplementation during this period to help support mom’s milk supply. Your newborn stomach will grow and expand as mom’s milk volume expands as well. The transition from colostrum to mature milk usually happens by day three or four with your first experience breastfeeding and between days 2 and three with subsequent experiences.

When mom’s milk makes the shift from colostrum to mature milk, she can experience engorgement. This can be uncomfortable. A small amount of hand expression in warm compresses before feeding can help soften the breast so your infant can latch well and feed. Cool compresses after feeding can help alleviate some of the swelling and provide comfort. Moms usually experience encouragement after they have gone home from the hospital.

So, when should you feed your baby in these early days? We recommend feeding 8 to 12 times in 24 hours using your infant’s hunger cues as your guide. Holding your infant skin-to-skin as often as possible allows parents to observe early hunger cues. The early cues include rapid eye movement while sleeping, opening their mouth, and turning their head.

The next stage of cues include stretching their arms, body movements, and taking their hand to their mouth. Late hunger cues include crying, agitation, and turning red. If your newborn is showing these later hunger cues, so them first skin-to-skin to help them feel more regulated before feeding. This will lead to a better feeding experience for both parties.

When your newborn is feeding efficiently and comfortably from mom, they can feed on demand for as often as they would like for as long as they would like. We want to make sure they have a good latch so that it is comfortable for mom and so that baby is getting a good milk transfer. Having a good latch will prevent nipple damage and pain for mom.

Feeding frequently in these early days helps to establish your milk supply for your breastfeeding journey ahead. It’s very common for newborns to get sleepy while breastfeeding. Gently tickling them to keep them stimulated and active at the breast is a helpful idea. Also, using hand expression, burping your baby, and changing positions can keep them feeding actively.

Just as your infant will show you hunger cues, they will also show you satiety cues. This looks like your newborn releasing the nipple at the end of a feed, turning away from the breast. They’ll have open and floppy hands, or be in a very deep sleep.

So, what does it mean to room in at a baby from the hospital? This means that you and your newborn will share a room for the duration of your hospital stay. If medically necessary, your newborn may need to go to the nursery. However, frequent contact with parents is both encouraged and supported if needed.

This close proximity allows parents to learn their hunger cues sooner. Infants often cry less and are soothed faster due to the close proximity to their parents. The quicker response to your newborn cues helps your baby to feed sooner and promotes that transition from colostrum to mature milk.

Many parents are curious about when to introduce artificial nipples and pacifiers. As a baby friendly hospital, we discourage the use of pacifiers and artificial nipples until breastfeeding is well established. This is usually around 3 to 4 weeks. The reason behind this is that pacifier use can interfere with Q- based feedings.

Infants can sometimes skip feeds if they’re using a pacifier and unable to show their parents their hunger cues. This can lead to slower weight gain as well as decreasing mom’s milk supply. In addition, when infants are introduced to artificial nipples, such as a bottle before breastfeeding is well established, it can cause difficulties with your infant latching comfortably.

Your newborn is latching well with no pain. Mom has a solid milk supply. Your newborn is feeding frequently, 8 to 12 times daily at least, and gaining weight.

So, what does it look like when breastfeeding is well established? Your infant will be latching well with no pain for mom. Mom’s milk supply will have increased. Your baby will be feeding frequently, at least 8 to 12 times daily, but showing signs of contentedness after a feed, and your newborn will be gaining weight adequately.

Watching the diaper count for your newborn will also be a reassuring sign that breastfeeding is established and that they are feeding well. In the first week of life, we look for the same amount of wet diapers as infant is days old. So, when your baby is 3 days old, we’re looking for three wet diapers or three urinations in a 24-hour period.

For their poop output, we are looking for the black sticky meconium to transition to a brownish green color and then land in a mustardy seedy yellow color to show that they are passing milk through their system. Well, after about 1 week, we are looking for 6 to eight wet diapers in a 24-hour period moving forward.

And one final note on introducing artificial nipples such a  bottles, we would do recommend introducing them around 3 to six weeks. If you plan to use them regularly and then practicing using them consistently.

You are kicking off such an exciting new season and it is a huge transition for everyone. Reach out if you need help. Lean into your support systems and find your tribe.

Other prenatal resources available to you include the Guide through Pregnancy. You can access it through this link or through the OB office. You also can call the front desk at the OB hospital and set up a tour to come and see the unit and get an idea of what to expect when you’re there.

After your little one arrives, we do have weekly mama’s meetups. Please check the wellness calendar for up-to-date location and meeting times. It will also be on your discharge packet as you leave the hospital. and we look forward to seeing you there. We can do weight checks, offer lactation support and social connection at these weekly meetings.

Our lactation care coordination team is happy to chat with you over the phone or meet in person if you have any questions or concerns you’d like to discuss prenatally. Just give us a call. We look forward to seeing you and your family soon. My name is Nellie with the lactation care coordination team at Tahoe Forest Hospital. Thanks for watching.