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Breastfeeding: The First Few Weeks of Life


Colostrum We know that a mother produces colostrum in pregnancy and continues to do so for up to 10 days or so after her baby is born.  We know that newborn babies require nothing other than colostrum and that though it is not there in plentiful amounts it is adequate for baby’s growth and health[1].  Yet, how often do we hear that a mother must begin expressing her milk because she probably won’t have enough?  We know that a baby who is well latched with an asymmetric latch will get the colostrum that is there, and a poorly latched baby won’t[2], and yet we see thousands of mothers in our clinic who have been taught to latch baby symmetrically.  Instead of adjusting the latch for better milk

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transfer mothers are being told to pump.  And incidentally, colostrum does not respond well to a pump, it responds better to hand expression.  And so when mothers can pump nothing,  they are told they have no milk.  Best to adjust the latch and use breast compressions[3] and watch for baby’s drinking (don’t listen, you are unlikely to hear a baby drinking at that age)[4].


Engorgement
Contrary to popular belief engorgement is not a sign mother has a lot of milk.  Engorgement is a sign things have gone wrong.  And worse off, if the engorgement is severe enough it can cause depletion in mother’s milk significantly on that breast, perhaps even for the breastfeeding experience of that baby.  To avoid this, latch asymmetrically and deeply.  Ensure baby drinks well, use breast compressions (see the video clip and info sheet at www.nbci.ca for the “how to”) to ensure the milk continues to flow.  Keep baby skin to skin so mother will be able to read baby’s early cues and thus the necessary frequency of feeding that needs to happen (no timing how long per side or how long in between feeding, no counting sucks or drinking, no schedules[5]—just following baby’s early cues and keeping baby drinking) and that will suffice.  If mother does become engorged then using RPS [6],[7](Reverse Pressure Softening), developed by Jean Cotterman, will allow the baby to latch on immediately and drain the breast, see www.nbci.ca for the info sheet on engorgement.  It is very important not to pump engorged breasts, nor to massage downward toward the nipple.  Once baby is on, use breast compressions (which are always stationary) to keep baby drinking.

 

Sore Nipples We also know that a well-latched baby should not cause mother pain[8] and yet women are told around the world to put up with the pain, or grin and bear it because it is supposed to hurt.  A troubling practice is one where the mother is told to unlatch baby and re-latch over and over until she gets it right—this repeated activity can cause damage to the nipple and is not only painful, mothers become so dejected by doing it.  Instead, it’s best to adjust the latch mother has already by ensuring the nose stays far away from the breast and keep baby drinking.  Of course, if mother felt that the latch was absolutely unbearable and she could get a better one if she tried again, by all means.   Mothers are also told to prepare their nipples (a completely non-evidenced informed practice!!) and to apply various creams and ointments on their nipples: petroleum jelly, lanolin-based creams, nipple balms—none has been supported by research.  Some make matters worse.  Again, simly by adjusting the latch the pain is dealt with—if not, there is something else going on.

[Lastly, if the above measures have failed to reduce soreness,] check for tongue tie [9],[10],[11].


[1] GamePlan for Protecting and Supporting Breastfeeding in the First 24 hours of Life and Beyond. Kernerman, E. 2010

[2] L-eat Latch and Transfer Tool, Kernerman, E. Park, E, Newman, J, Kouba, J. 2010

[3] Breast compressions info sheet, www.nbci.ca

[4] L-eat Latch and Transfer Tool, Kernerman, E. Park, E, Newman, J, Kouba, J. 2010

[5] Kent JC, Mitoulas LR, Cregan MD, et al. Volume and frequency of breastfeedings and fat content of breastmilk throughout the day. Pediatrics. 2006;117(3):e387-95

[6] Engorgement info sheet, www.nbci.ca

[7] Cotterman KJ. Reverse Pressure Softening: A Simple Tool to Prepare Areola for Easier Latching During Engorgement. J Hum Lact 2004 20: 227-237.

[8] Righard L Alade MO. Effect of delivery room routines on success of first breast-feed. The Lancet 1990; 336:1105-07

[10] Dollberg S, Botzer E, Grunis E, Mimouni FB. Immediate nipple pain relief after frenotomy in breast-fed infants with ankyloglossia: a randomized, prospective study. J Pediatr Surg. 2006; 41(9):1598-600.

[11] Geddes DT, Langton DB, Gollow I, et al. Frenulotomy for breastfeeding infants with ankyloglossia: effect on milk removal and sucking mechanism as imaged by ultrasound. Pediatrics. 2008; 122(1):e188-94

 

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  1. March 27th, 2011 at 22:56 | #1

    Hi! I saw a portion of this article as a comment on my blog and I wondered if you intended to comment fully? Please do so! I welcome comments. Thanks for visiting…

  2. avatar
    Nicole
    March 28th, 2011 at 00:03 | #2

    Edith – thanks for the brief overview!! I love the nbci website and send all my clients there for information.
    Can you expand on the advice not to break the latch and try again? If it is obviously a bad latch (for example a very shallow latch), how would a mother be able to adjust it well enough? How do we balance her need to not feel dejected by trying again, with the damage that will be done by maintaining a bad latch for the whole feed? And, how do we balance the damage done by a bad latch with the damage done by repeatedly relatching to try and get a good latch? This is the one piece of advice from your group that I have always struggled to understand…

  3. avatar
    Christie B
    March 28th, 2011 at 14:44 | #3

    I have the same question as Nicole. It was definitely helpful for me and my baby (now 6 weeks) to just break the occasional bad latch and have her practice opening wide. She had such a strong jaw and I have rather large breasts so adjusting the latch seemed much harder for us. How do you find a balance?

  4. March 28th, 2011 at 18:21 | #4

    Edith, I think I figured it out. people are clicking on the highlighted term, asymmetrical latch and it takes them to my site where I have a picture and description of a good latch! got lots more hits today than usual!
    Renee

  5. March 28th, 2011 at 20:59 | #5

    Thank-you Edith for a very informative post. I also appreciate the links–it is helpful to see the asymmetrical latch. (Thanks Renee for your site!)

  6. April 5th, 2011 at 16:17 | #6

    Christie and Nicole:
    Yes, a bit of a conundrum. This is the guideline I use: If the mother is convinced she can do a “better” latch (“better” sounds so judgmental, but I am referring to words she might use) or a less painful latch, then by all means, she should try again. If however, she might still not quite “get” what we are pointing out about what to aim for–deep, asymmetric, head in a tipping-back position, head and body turned slightly away from mother (not tummy to tummy chest to chest unless mother is very very small breasted)so baby is in line with the direction of the breast, baby brought to breast, breast kept where it is–then keep what you have and adjust from there to make asymmetric–gently letting the head fall back so nose falls away from the breast, gently pushing between baby’s shoulder blades, mother squeezing baby’s body with her elbow.

    Now, let’s say the latch is great in every way except not deep. The lovely asymmetric latch on Renee’s site is one where I would say all looks great except it could be deeper. So, two tricks: if baby is already latched and it is not very deep or deep enough AND mother has 1] pain, 2] trauma, 3] will have vasospasm after the feeding, or 4] baby is not transferring milk, then these are reasons to adjust by either: 1] pulling down the chin–this must be done while baby is mid-suck. Or the more complicated, harder to do 2] step 1 and quickly slip your finger under baby’s upper lip and gently push a bit of breast tissue in while ensuring baby stays asymmetric. The problem with step 2 is that it takes even more skill than step 1, so do your practicing on a willing pain free mother first!

    So, if deemed necessary to get baby on deeper and neither of the above work, then re-latch one must. The problem is, if mother does any bending of baby’s neck whatsoever (i.e. scooping around or bringing the nose near the breast even for a second), then the jaw will close even a tiny bit and baby will not get on deeply enough. So, it is critical that mother latches baby from the beginning with the head in a tipping-back position so the jaw stays open and is not forced to close down. Hope that makes sense and answers your questions!
    E.

  1. March 30th, 2011 at 05:32 | #1
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