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Family Health Magazine - CHILDBIRTH

Getting a Latch on Breastfeeding
Detailed advice for the first weeks

Many women have difficulty with breastfeeding, especially at first. For a new mother, there is much to learn in the weeks after baby arrives. Common breastfeeding problems include latching difficulty, breast engorgement as the milk comes in, and being unsure about having enough milk. In the first few weeks of breastfeeding, understanding the details of good technique can help.

Latching difficulty

Latching means the way a baby attaches to the breast to nurse. It can be done in many ways. Women hear all sorts of different advice depending on who they consult and where they look. For instance, plentiful advice can be found on the Internet. Most of it is highly complicated, and based on personal experience. Hearing stories from other moms can help, but sometimes all the conflicting advice can be confusing.

Research has been done on how a baby should be latched for ideal milk transfer. So, here is some simple advice that you can apply in every latching position.

• Press on your baby’s back, not the head. Put your hand between the baby’s shoulder blades, and support the head behind the ears with your thumb and index finger.
• Your baby’s head should tilt slightly back when breastfeeding. Try taking a drink of water with your head tilted forward towards your chest – it is very difficult! The same applies to babies. They like to have their heads tilted back, as it is the best position to allow them to eat and breathe at the same time.
• The latch must be deep. A shallow latch is the number one cause of sore nipples. Sore nipples happen when the baby’s tongue rubs against the nipple, so place the nipple farther away from the baby’s tongue. This means your nipple should be at the top of the baby’s mouth, and deep inside. Once your baby is latched, you can check whether the latch is deep enough. Look at your areola, which is the dark circle around your nipple. You should be able to see some of the areola above the baby’s top lip. A large portion of it should be in the baby’s mouth. Your baby’s chin will be squished into the breast, and the nose free to breathe. Latching is by far the hardest step, almost like learning a new sport. You must learn where to place your arms and coordinate your motions with what your baby is doing (see details in ‘Steps to simplify latching’).
• Your baby’s mouth should be wide open. This is a struggle for many moms. Amazingly, the best way to achieve this is to spend time opening and closing your mouth while your baby is watching. Babies mimic other people from the day they are born. Although you may feel silly, if you do it often in that first week, your baby will learn to open that mouth!
• Still having pain with latching after trying all of that? If you think your latch is correct but your nipples still hurt, get some help from a lactation consultant. This expert has special training on breastfeeding, and is often a nurse, doctor or midwife. Do not hesitate to ask for help. The sooner you do, the more quickly you can ease the pain.

Breast engorgement

Milk supply takes a few days to really start flowing. It usually comes in when your baby is three to five days old. Your breasts will change dramatically. Many women find their breasts are sore, and have difficulty with latching during this period. The following tips can simplify breastfeeding while engorged.

• Heat and ice are your friends. Apply heat and massage your breasts before breastfeeding, pumping, or hand expressing. Use a clean disposable diaper to apply heat by running hot water over the diaper. It will absorb the moisture and stay warm for quite a while. The diapers are a good shape to cover the breast. Massage all over the breast, especially focusing on any hard areas. You must massage firmly to get the milk moving. Afterward, apply cold. Run some diapers under water and put them in the freezer.
• Make a sandwich for your baby. Squeeze your breast into a sandwich (see point 2 in ‘Steps to simplify latching’ below). This is key, as it is hard for your baby to get a good seal when your breasts are engorged. If your breasts just will not squish down, massage some milk backwards by pressing back into your chest for a few seconds or minutes. If this does not work, pumping or hand expressing can remove a little of the milk.
• Hand express. This is a great way to release some milk without a breast pump. The trick is to place your fingers on the edge of your areola and pull or squeeze backwards into your chest wall. Then roll your fingers forward towards the nipple. It takes practice. At first only a few drops will come out. Stick with it and you can become quite efficient! Remember to use heat before expressing, and ice afterward.

Milk supply

Understandably, many women worry about milk supply, especially in the first few weeks. You can figure out whether you have enough milk in a few simple ways, and address any issues.

1. Your baby is peeing and pooping. In the first few days after birth, your baby will only pee or poop a few times per day. By day four, there should be five or six wet diapers and three to four poops. After the first week, your baby should be peeing and pooping a lot, around six or seven times a day. This is a good sign that your baby is getting enough milk. Baby poop should change in colour from black to yellow by day five. However, a wide range of poop colours can be normal.
2. Babies lose weight at first. It is very normal for babies to lose seven to 10 per cent of their birth weight at first. They often do not gain it back until they are two weeks old. Do not panic if your baby loses a bit of weight.
3. Get help early. If you think you do not have enough milk, get help early, especially if you have nipple pain or latching difficulties. The most accurate way to know if your baby is getting enough milk is to see a lactation consultant.

This expert will weigh your baby before and after breastfeeding on a very accurate weigh-scale. Some community health units and doctor’s offices provide the same service. Do not rely on your scale at home, as it will not be accurate enough.

Breastfeeding is an art, and can be difficult to learn. Though the first weeks can be a struggle, it does get easier and faster as time goes on. Babies and mothers learn how to be more efficient. It is truly like learning a new sport – it takes practice, hard work, determination, and a lot of patience, but is worth it in the end. Breastfeeding becomes a rewarding and relaxing experience that both mother and baby can enjoy.

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