Breastfeeding has many benefits for both mum and baby.
There are many different positions for breastfeeding but all you need to remember is the acronym CHINS*.
Baby needs to be close to mum so that he can scoop enough breast into his mouth
Baby needs to be able to tilt his head back when attaching to the breast. This is to allow his chin to lead as he comes on to the breast
The baby’s head and body need to be in a straight line so that he doesn’t have to twist his neck. This makes swallowing easier
Nose to nipple
Mums nipple should be just below babies nose so that as he roots and tilts his head backwards the nipple will slip under his top lip upwards and backwards to rest on the baby’s palate
The position should be comfortable for both mum and baby for the duration of the feed
*CHINS was developed in 2010 by Dr Lynette Shotton at Northumbria University.
Recognising effective attachment
There are several queues to look out for that will help mum to recognise when their baby has effectively latched on to the breast:
- Chin touching breast
- Mouth wide open
- Cheeks full and rounded
- More areola visible above top lip
- Rhythmic suck / swallow with pauses
- Feeding is should be pain-free
A sensitive two way relationship between a mother and her baby. A mother responds to her baby when:
- Baby shows feeding cues – rooting, moving their eyes, wriggling, waving sucking fists, blanket and making murmuring noises
- Baby is distressed – tired or lonely
- Her breasts are full
- She simply wants to sit and cuddle
Your midwife will listen to any concerns you may have about feeding your baby and support you to gain confidence by:
- Making sure you understand what is responsive feeding
- Showing you how to hold your baby for feeding
- Informing you how to access help when at home
An effective establishment of breastfeeding in the first few day’s with baby, significantly increases your chances of maintaining and continuing a good breastfeeding routine.
However, some babies may experience initial feeding difficulties, or challenges maintaining their blood sugar and for medical reasons they may require supplementation.
In these cases, some mothers may wish to make an informed choice to express colostrum before delivery to support in breastfeeding and to avoid the use of formula.
Ask your midwife about colostrum harvesting from 36-week gestation and to get a colostrum harvesting pack.
The below video from UNICEF also explains how you can hand express.
Expressing your milk
How to hand express
The UNICEF UK baby friendly initiative recommends that all mothers are sown how to express.
This is a useful skill that can be used in the following situations:
– Expressing small lots of colostrum to tempt the sleepy baby in the early stages of breast feeding
– When breasts are full, making it hard for babies to atta
– To help clear a blocked duct
– Or if you are separated from your baby, for example when your baby is on the neonatal unit.
So when you’re expressing start by doing anything that relaxes you. A cuddle with your little one, skin-to-skin, bit of massage, anything that helps you relax.
So sometimes it can be kneading around the breast, stroking whatever feels right. Whatever feels comfortable to you.
If expressing for a premature baby, massaging is important to ensure a good milk let down. However, if just expressing to soften your breast, just a small amount of massage with suffice.
Once you’ve done that for some time, if you make a ‘C’ shape with your hand. The thumb and finger. Gently feel back from the nipple about 2-3 centimetres. Hold that for a few seconds and then release. Compress hold and release.
Now in the early days of colostrum, this wont come straight away, it can take some time.
So just keep working that one area, it will appear as little beads, as the milk comes in you’ll see it will flow much more easily.
Sometimes you may need to move forward a little bit, then back a little bit, the main thing is working that one area until it fully subsides.
Then what you can do is rotate around the breast and work on the next area compressing, holding and releasing.
That key thing is you’re doing that key compressing right with your thumb and finger are and you’re making sure you’re not sliding, that’s really important.
When you slide along the skin it’s not as effecting and you can cause trauma to the skin. So work in the one area, keep that thumb and finger opposite each other is just perfect.
Ask your midwife or health visitor to talk you through how to hand express.
If you are expressing for a baby who is in the neonatal unit, try to express near to your baby or have a photo or piece of babies clothing to hand as this will help boost your milk making hormones.
Storing expressed breast milk
Expressed milk can be stored at room temperature for just six hours.
The department of health (DOH) advices that milk can be stored in the fridge for five days or in the freezer for:
- Freezer -18° = six months
- Defrosted in fridge (use within 12 hours)
- Defrosted at room temp (use immediately)
Responsive formula feeding
If you are giving your baby formula, there are also a number of queues that should help you to ensure baby feels safe and is feeding correctly:
- Observe feeding cues
- Hold baby close
- Encourage rooting
- Invite baby to take teat
- Pace the feed
- Never force a full feed
- Limit who feeds the baby
Making up a formula feed safely
- Boil kettle with at least 1 litre of fresh cold tap water
- Leave to cool for no > 30 mins (70 degrees)
- Clean and disinfect surface you are going to use.
- Wash your hands thoroughly
- Shake off any excess sterilising solution
- Stand the bottle on a clean surface.
- Keep the teat and cap on upturned lid of steriliser
- Follow manufacturer’s instructions
- Pour correct amount of water into bottle within 30 mins
- Loosely fill scoop with formula and level off (Using flat edge of clean dry knife or leveller provided)
- Hold the edge of the teat and put it on bottle
- Screw the retaining ring onto bottle
- Cover teat with cap and shake until powder dissolves
Before feeding baby
- Cool holding bottom half of bottle under cold running water
- Move bottle about under tap to ensure even cooling
- Test temp on inside of your wrist before giving to baby
- It should be body temperature
- Discard any leftover formula after one hour