How to Get Breastfeeding Off to the Best Start:

Getting breastfeeding off to the best start begins before birth. During your pregnancy taking a class that includes breastfeeding information, or taking a specific class for breastfeeding can help answer any questions you may have before beginning breastfeeding your baby. Check with your hospital or birth center and see if they have a lactation consultant on staff. Ask how long after you give birth before you can see the lactation consultant. If possible ask if the lactation consultant can see you in the delivery room, and then check in again within 6 hours of your birth. Breastfeeding problems often stem from things that went wrong in the first few hours of birth. If your baby needs a latch adjustment, or isn’t transferring breastmilk properly it’s best to see a lactation consultant immediately so that the problem can be fixed before any damage is done to your nipples, or your baby begins to lose weight.

Breastfeeding on Cue and Baby Led Feedings
Babies give signals or cues when they begin to get hungry. Most people assume that they need to wait until a baby begins to cry to feed them, but crying is actually one of the last feeding cues that you will see your baby give. A good time to begin a breastfeeding session (especially if you’re having a hard time with latch or duration of breastfeeding sessions) is during REM (Rapid Eye Movement) sleep. When a baby is in REM sleep you’ll see the eyelids start to flutter and the eyes move underneath the eyelid. Babies experiencing REM sleep may also open and close their mouths, as well as make a sucking movement mimicking breastfeeding. Breastfeeding your baby on cue will ensure that your baby is telling your body how much milk he or she needs it to make. Babies will give hunger cues more often when trying to build up their mother’s milk supply. They might do this before they go through a big growth spurt or if their mother’s milk supply has dropped for some reason. Breastfeeding as often as your baby wants is the best way to bring your milk in, and create a milk supply that’s perfect for your baby.

When your baby finishes nursing she or he should look relaxed, content, and his or her hands should be open. If your baby is still rooting, fussy, or has clenched fists, then you should offer the other side. If your baby is too upset to latch onto the breast you can try to other methods to calm your baby and then offer the breast again.

Skin to Skin
The WHO (World Health Organization) recommends mothers and babies be skin to skin immediately following birth. Placing baby skin to skin with the mother immediately after birth, or within thirty minutes after birth is very crucial to getting breastfeeding off to the best start possible. When baby is skin to skin with his or her mother, the baby is calm and relaxed. Babies who are skin to skin with their mothers stay warm, and cry less than babies who are not being held skin to skin. Mothers can recognize their baby’s needs and feeding cues and respond immediately. Babies who are held skin to skin also have lower levels of stress hormones, and breastfeeding sooner than newborns that are separated from their mothers after birth. (Bystrova, Windsrom, et al. 2007)

Mothers who hold their baby skin to skin after birth are more likely to make greater amounts of breastmilk, breastfeed longer, and breastfeeding without supplementing with formula. (Bystrova, Matthiesen, et al. 2007)

Rooming In

Rooming in is when the infant, and the mother remain together 24 hours a day throughout their hospital stay. The baby should only be removed from the room for less than an hour if he or she requires hospital procedures that cannot be completed in the room. (Hearing checks, circumcision, etc.) Rooming in with your baby is essential to successful breastfeeding. When you’re close to your baby you can respond to his or her feeding cues immediately. If your baby is in the nursery, a nurse may not notice early feeding cues, and by the time your baby is brought to you to nurse, he or she may be so hungry that she or he is too upset to have a good nursing session.

Studies show that mothers who room in with their babies make more milk, make more milk sooner, breastfeeding longer, and are more likely to breastfeeding exclusively when compared with mothers who have limited contact with their baby in the first few days after birth. (Bystrova, Matthiesen, et al 2007) Babies who room in are more likely to take in more breastmilk (Bystrova, Matthiesen, et al 2007), gain more weight per day (Yamauchi & Yamanouchi 1990), breastfeed exclusively (Mikiel-Kostyra, Mazur, and Wojdan-Godek, 2005) and are less likely to develop jaundice. (S Yafruddin et al, 1988)

Rooming in gives you unlimited opportunities to practice breastfeeding, which is exactly what a new mother and her baby need in the first few days after birth.

Unnecessary Supplements
No food or drink other than breastmilk should be given to your baby unless medically indicated. Even just one bottle of formula can severely reduce the mother’s milk supply. When a breastfed baby is given a supplement they extend the amount of time between feedings which signals the breast to stop making as much milk because the baby is not hungry enough to eat more often. If the baby is not gaining weight the baby needs to nurse more to boost his or her mother’s milk supply.

Medical needs for supplements:
-Severe dysmaturity
-Very low birth weight
-Inborn errors of metabolism
-Acute water loss
-Mother is severely ill
-Mother requires a medication that is contraindicated for breastfeeding.

Avoiding artificial nipples
Studies show that waiting to introduce pacifiers until at least 6 weeks benefits breastfeeding greatly. When a baby is given a pacifier in the first few days, they tend to spend too much time sucking on the pacifier when they would normally be sucking on the breast and stimulating milk production. You often hear new mom’s say that their baby is using them as a pacifier, and that’s exactly what you want, especially in the first few days. Anytime that the baby is sucking on the nipple it’s stimulating the milk supply and telling the breast that it needs to produce more milk. This also helps regulate your supply. Each baby knows how much milk he or she needs and the only way for the baby to communicate how much milk he or she needs is to spend time sucking on the breast. If your baby seems hungry and is upset, but is having trouble latching or does not seem to want to nurse, there may be another breastfeeding problem going on such as over active let down, or a latch or transfer problem that needs to be assessed and fixed by a lactation consultant. Giving your baby a pacifier may mask some of these breastfeeding problems because baby will happily suck on the pacifier instead of the breast, which although might calm the baby, will have a negative affect on your breastfeeding relationship down the road.

Lamaze International
World Health Organization