Effective Breastfeeding

What is effective breastfeeding?

A baby who breastfeeds effectively cues (shows readiness) for feedings, is in a good feeding position, latches-on (attaches) deeply at the breast, and moves milk forward from the breast and into his or her mouth.

Feeding cues

To feed effectively, a baby has to wake up and let his/her mother know that he/she wants to eat often enough in 24 hours. Watch your baby and begin breastfeeding when you see him or her demonstrating any of these feeding cues:

• Licking

• Making sucking movements

• Rooting

• Bobbing the head against the mattress or your neck/shoulder

• Bringing hands to face or mouth

• Squawking

Crying is a late feeding cue, and many babies have difficulty latching once they become frustrated and begin to cry.

Feeding positions

It will be easier for your baby to accomplish latch-on if he/she is snugly in a good position for feeding. The most common feeding positions include the following:

• Cradle - the baby is held in the crook/elbow area of the arm on same side as breast to be used for feeding; mother supports breast with opposite hand; baby's body is rolled in toward mother's body so they are belly-to-belly.

• Cross-cradle - baby's head is supported by the hand opposite the breast to be used for feeding; mother supports breast with hand; baby is rolled in toward mother's body belly-to-belly.

• Football/clutch - baby's head is supported by the hand on the same side as breast to be used for feeding; baby's body is supported on a pillow and tucked under the arm on the same side as breast to be used for feeding.

• Side-lying using modified cradle - in this position, the baby lies next to the mother with mother's and baby's bodies facing each other. If a pillow under your arm is uncomfortable, try placing your baby in the crook of your arm. This way, you will not be likely to roll over on the baby should you doze off. This position also keeps the baby's head at a good angle to bring baby and breast together, with the baby's head higher than his/her tummy, which can be helpful for babies who are more likely to spit up.

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For all positions, bring your baby to the breast - not the breast to the baby - by sitting in a roomy and comfortable chair or sofa and using a bed pillow, sofa cushion, or special breastfeeding pillow on your lap to raise the baby. Your baby must be held in good alignment if he/she is to suck, swallow, and breathe during feedings. When in good alignment, you should be able to draw a straight line down your baby's body from earlobe to hip no matter which feeding position you use. You should not be able to see the baby's arm closest to your body when using a cradle or cross-cradle hold.

Deep latch-on

To help your baby achieve a deep latch, support your breast from underneath with your hand. A C-hold, with your thumb on top and your fingers underneath your breast - at least 1 1/2 to 2 inches behind the nipple - gives good support for the cradle or cross-cradle positions. A U-hold, in which you slide your hand so your thumb is on one side of the breast and your fingers on the other, is a variation of the C-hold often used when a baby is placed in the football (clutch) position for feeding. You may not have to continue to use a C or U hold if your breasts are smaller, but mothers with larger breasts often maintain the hold throughout the feeding.

To help your baby latch-on correctly, tickle baby's lip with your nipple and wait for him/her to open wide. Then bring the baby and your breast together in one swift motion. The baby should have a big mouthful of your breast, and his/her chin and nose should be touching your breast. Your baby's lips should be flanged outward like a trumpet or fish lips. The lips should not be pursed or rolled in. If you were to roll down your baby's lower lip, you should see baby's tongue gliding in front of the lower gum. The tongue should also "cup" your nipple and areola.

Do not press down near the areola with your thumb thinking this will help your baby breathe. This will pull your nipple from the back of your baby's mouth, where it needs to be. Babies' noses are designed to "smush" against their mother's breast as they feed. That is why their noses are flat - so they can latch-on deeply to the breast yet still be able to breathe. If you are concerned about your baby's ability to breathe, pull your baby's lower body in closer to you or lift your breast rather than pressing down on your breast.

It is called breastfeeding, not nipple-feeding, for a reason. If your baby's latch is shallow - not deep onto the areola, he/she may appear to be "hanging" on the nipple tip. When this occurs, the baby will not be able to remove milk from your breast very well. This would decrease the amount of milk your baby drinks, so feedings may take over 45 minutes and your baby may not gain weight as he/she should. Also, your nipples are more likely to become very sore or cracked.

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