The establishment of breastfeeding

A truly “tailor-made” baby milk

Breast milk provides everything a child needs to help him build and protect him against disease.

Its composition is very particular. It contains proteins, the right amounts of which are ideal for the body of the newborn: amino acids and good unsaturated fatty acids. Its lactose sugar is adapted to the needs of the brain. Finally, its stock of hormones and enzymes is exactly what it takes to make living matter.

Breast milk is constantly changing according to the needs of the infant. Over the months, but also from one feed to another and during the same feed.

From the first breast milk to “mature” milk: the different phases

Thus, from the 1st to the 15th day, colostrum appears, a yellowish liquid, thick, very nourishing and very easy to digest. Laxative, it allows the newborn to eliminate meconium (the first stools).

From the 5th to the 15th day, it gradually gives way to a transitional milk (fluid and orange) which gains in fat and sugars every day, until it reaches its composition of mature milk (sometimes bluish and translucent).

It is the best defense against infections. From the first five days, colostrum “boosts” the newborn with highly protective proteins, called immunoglobulins (IgA, IgM, IgE, produced by a category of white blood cells). These antibodies and white blood cells unite to protect the baby’s digestive tract and respiratory tract against microbial attack. The “secretory IgA”, in particular, are as many specific antibodies which neutralize the bacteria and viruses encountered by the mother and therefore by her baby. They continuously adapt to the bacterial and viral environment of the mother and that of her child.

An early breastfeeding to promote the flow of milk

When the delivery has gone well, the newborn must suck as quickly as possible and therefore be put to the breast while the mother is still in the delivery room.

How to properly set up breastfeeding?

The sucking reflex is most intense in the hours following birth. After the 6th hour, this reflex gradually decreases, only to reappear two days later. During this time, the latching will be much more difficult, both for the mother and for the child.

The ideal is to put the newborn baby on his mother’s tummy after having covered it so that he does not feel cold. He will crawl towards the breast, guided by its smell, and be able to suck or, at least, have a first skin-to-skin contact with his mother. If he does not get there on his own, the mother will take the initiative to place him on the breast herself. This contact will facilitate subsequent breastfeeding. If the mother is on an IV after giving birth, the healthcare team should help her get comfortable. Even if you have not chosen to breastfeed, there is nothing preventing you from putting your baby to the breast for that first feed after giving birth. He will only benefit from it and you can then bottle-feed him.

The early breastfeeding promotes the flow of milk. The sucking of the nipple by the child triggers the hypothalamic-pituitary reflex which governs the production and ejection of milk. The earlier the breastfeeding, the sooner the mother will have milk and the better things will turn out. It is between the 3rd and 6th day after childbirth that the milk secretion is put in place. Two signs bear witness to this: the significant increase in blood flow to the breasts and that in the volume of milk produced (we speak of “milk flow” or “milk flow”).

It also has an effect on delivery. Oxytocin, the milk excretion hormone, promotes uterine contractions. If the child is put to the breast from birth, then sucking helps in the elimination of the placenta.

Good conditions for successful breastfeeding

If you took a shower in the morning, you don’t need to clean your breasts. If possible, avoid Neither soap nor products likely to mask the natural smell of the breast which reassures the child.

Getting comfortable to breastfeed: the right positions

Make yourself as comfortable as possible in your bed or an armchair. To breastfeed, you have to feel good. Remember that your newborn baby will suck an average of eight to twelve times each day.

In a semi-reclined position backwards: Sit back in your seat and lean on the armrest, or rest your elbow on a cushion. Regardless of the position, you should not have to support your baby’s weight throughout the feed.

It should be high enough to end up exactly facing the breast. You need to bring it close to you, and not the other way around, in order to spare your back and your breasts. Position your baby face to face with your head and body against you. This continuous ventral contact created by gravity promotes the expression of his archaic reflexes and makes him suck more easily.

Lying down : Ideal when you are tired, day or night, but also after a cesarean. Lie on your side, legs bent, as relaxed as possible. Be sure to do this position only if the feed is completely painless. Your baby is still learning and needs close proximity to your body to suck properly.

Position your baby’s head and body in front of you. Bring it close enough that you don’t have to push your chest forward.

To suck effectively, your baby should have his mouth level with the nipple, his tummy tucked against yours. In the traditional position (called “the Madonna” or “lullaby”), it must be facing your body, the stomach and navel pressed on you, the face facing the breast, with the chin pressed against it. If it is properly positioned, its mouth will position itself correctly. It must surround the nipple well and press on the areola. If he has to turn his head, it will be very uncomfortable. This type of position is easier to do when the baby is bigger and more expert either after a few days or weeks of breastfeeding.

Should we clear his nose? Do not be afraid, even if he buries it in your bosom, he cannot choke under any circumstances. If his chin is well against the areola and his head barely raised, he will not be embarrassed. Some mothers like to create a small breathing channel. They then press gently near the nipple. And once the baby understands that he can breathe freely while sucking, he will orient his head in such a way as to reproduce this effect.

Some mothers sandwich their breasts to free the baby’s nose when latching on. Others press down on the baby’s bottom to help them tune into their position.

Let him suckle until he is full. Studies show that usual feedings last on average between 12 and 67 minutes (Kent et al., 2006). It is therefore not necessary to decide to cut short a feeding. The more your baby will breastfeed and the more milk he will receive, the faster your milk secretion will calibrate and the faster he will adopt his own rhythm, thus being more efficient.

Breastfeeding on demand

How many times a day does a newborn baby suckle?

There is no rule about how often to feed. When the baby is born at term, without health or weight problems, it is good to offer to breastfeed him as soon as he signals to you discreetly and to let him stop when he wants to.

Within 72 hours of his birth, putting him to the breast soothes him, allows him to rehydrate and gain strength. In addition, the repeated stimulation of the nipples promotes the flow of milk.

From the 4th day, the number and duration of feedings vary between children and from day to day, according to their needs. Many mothers expect a rhythm to set in. They find, however, that the best way to allow their babies to start to space their feedings is by not trying to regulate them. Thus, each day brings the baby more milk and more maturity in his breastfeeding too.

If you really need an idea of ​​the number of feeds for a newborn, count 8 to 12 feeds per 24 hours.

How do you know if your baby is feeding enough?

It is normal to ask the question. Especially since the beginning of the feeding, the child must wait for the milk to arrive well. During the first few days of breastfeeding, this waiting time sometimes goes on for a little too long for his liking and he gets angry. No need to weigh it before and after each feeding, however, it would quickly become a subject of stress.

There are signs in your body that everything is going well. Thus, an “effective” breastfeed causes feelings of heat, tingling in the requested breast, while the other breast sinks a little. You also feel uterine contractions. Your nipple is erect after a feed and you are thirsty. In addition, your breast is softer after a feed.

To be reassured, watch your child. It is his behavior which will prove to you that he “takes” well:

• a drinking baby swallows. Visible or audible swallowing is expected.
• He sleeps well and doesn’t cry all the time. A child who does not eat enough is cranky and has trouble sleeping. Be careful, however, a child who is tired of sucking in vain can also fall asleep from exhaustion. If your baby is doing well, if he is awake and not losing weight, don’t worry: he is full!
• It wets at least 6 layers per 24 hours after D5. A child who does not drink enough cannot urinate enough. Her diapers are barely wet. On the other hand, except in the early days when he has a bowel movement after each feeding, do not worry if he does not have one every day. With breast milk, two or three days without a bowel movement does not mean the baby is sick.

The ejection of milk, a fragile mechanism

The ejection of milk is particularly subject to emotions of all kinds. Indeed, the hypothalamus, the gland which controls the production of hormones essential for the manufacture of milk, is in the same region of the brain as the limbic system, seat of the affectivity. The mother needs to be in an environment favoring the secretion of oxytocin to start breastfeeding well.

In order for them to flourish, certain rules must be respected:

• allow mother and child to stay together. In some maternities, they are separated for the night. This can compromise the success of the breastfeeding. We must let them get to know each other. For this, it is good that the mother participates in the care of the newborn, changes it and washes it if she wishes.
• establish good breastfeeding conditions. In the maternity ward, mother and child are often tired and nervous, particularly at the end of the day, after visits, when they need peace and quiet to find each other. Limiting visits is therefore a good thing.

At home, you don’t necessarily want to breastfeed in front of your family or friends. But it’s not always easy to express it. Fall back behind your child’s desires. If he is hungry when you are too surrounded to breastfeed him in peace, just explain that he needs to be alone with you for everything to run smoothly. Ask your friends to leave the room for a few moments.

Are you home? They will understand perfectly well that you need to isolate yourself during the feeding time.

Knowing how to react in the event of a complication

In the first days after childbirth, the breasts are swollen and tense. This corresponds to an increased flow of blood and not, as one might think, to breasts overflowing with milk. To relieve them, there is no point in squeezing or massaging them. The best remedy is to simply suck the newborn baby as often as possible.

What to do in the event of a crevasse?

Crevasses are painful cracks that appear in the nipples. If they occur, it is necessary to intervene on several levels:

• Better position your baby. In the majority of cases, cracks are due to poor positioning. The child is stretching the nipple too much. For these lesions to disappear, he will have to be put to the breast correctly. The Biological nurturing® approach greatly helps to resolve these difficulties.
• If the skin is stretched, it may crack. Many mothers then apply a drop of milk to the nipple just after feeding while others apply a dab of lanolin which creates a protective fatty film on the nipple. You can also spread a few drops of milk on the nipples.
• The use of silicone breast tips should be avoided as much as possible, which, if they do not immediately resolve the problems (many mothers report that the pain experience is the same with or without), can add others: child who falls asleep very quickly while breastfeeding, who does not drink enough, insufficiently drained breasts and risks of engorgement and the key to difficulties in establishing a good lactation. If you are using nipple tips, get help from someone specializing in breastfeeding as quickly as possible to get rid of them quickly.

What to do in case of congestion?

In case of engorgement, the breast swells suddenly, blushes, becomes painful. The young mother may have a low fever but this is not systematic. Engorgement often occurs during the first few days of breastfeeding. It is caused by the onset of secretory activity, uncontrolled milk production and mammary gland edema, that is, the tissues are infiltrated with fluid which must be evacuated. You can continue to breastfeed, but it may be painful.

To promote the disappearance of the edema and facilitate the ejection of milk, do not hesitate to gently massage your areolas and nipples. The ideal is to do it in a hot shower, which will relieve the pain a little, and to empty the breasts manually.

La mastitis, or lymphangitis

Mastitis is inflammation resulting from poorly treated engorgement. The breast becomes covered with red streaks and becomes even more painful. The body temperature rises. It is important to treat it quickly because it is particularly painful and we want to avoid a complication. Multiply the number of feedings. First, suck on the painful breast to unclog it as quickly as possible. We relieve mastitis with massages, and poultices, hot or cold according to his preference.

If these measures remain ineffective, do not hesitate to consult the doctor within 48 hours. He will then prescribe an anti-inflammatory treatment, or even antibiotics to be taken for ten several days.

Small milk “production” problems

Milk production may not be in step with the newborn baby’s needs.

What to do when you have too much milk?

If you have too much milk, your breasts are swollen, a little sore. To relieve them, you should express your milk as often as necessary with a breast pump just to soften them. If the quantities are small, you can refrigerate or freeze your milk. We always like to have a little milk in reserve in case it is necessary to give milk in his absence. If the quantities are large, contact the lactarium closest to your home. The donation of milk is a civic and generous gesture that benefits sick and vulnerable children such as premature babies.

Not enough milk? How to boost lactation

If you don’t have enough milk, before you worry, you should first make sure. Does it wet 6 diapers per 24 hours? A weigh-in at the doctor’s or PMI will likely confirm that all is well. This proves that everything is working normally. If not, react.

• Stay ahead of your baby’s requests and increase the number of feedings
• Compress your breast as your baby feeds to drink more
• Resist the bottle of commercial infant formula supplement. If you feel that your baby is not having enough, try expressing your milk to give him a little bonus after feeding.

If the concern persists, take stock with a breastfeeding specialist: here is a list (http://www.consultants-lactation.org/)