Reflexes
Rooting (searching, with wide-open mouth) suckling (jaw goes up and down while the tongue compresses the areola against the palate) swallowing reflex (as milk hits the oropharynx, the soft palate rises and shuts off the nasopharynx; the larynx rises, and the epiglottis falls, closing the trachea).
Skill
Don't assume this comes naturally; commonly, learning to breast feed is as hard as learning to drive and as anxiety-provoking. The best way to learn is from an experienced person in comfortable surroundings eg sitting in an upright chair, rather than inadequately propped-up in bed. Reassure that a few problematic feeds do not mean that the baby will starve, and that bottle feeding is needed. Most term babies have plenty of fuel reserves (earthquake infant-victims may survive for >1 week) and perseverance will almost always be rewarded. Furthermore, top-up bottle feeds may undermine confidence, and, by altering the GI milieu, diminish the benefits of breastfeeding.
A good time to start breastfeeding is just after birth (good bonding; PPH risk), but labour procedures may make this hard, eg intrapartum pethidine ± instrumental delivery, T° and BP measurements, washing, weighing, going to a postnatal ward. ™£It is never too late to put to the breast, provided lactation has been maintained.
Beware of intervening too quickly without observing the mother's efforts. Rather than saying that's completely wrong: do it like this try good: you and your baby are going to get on fine. One extra tip might be
From the baby's viewpoint, breastfeeding entails taking a large mouthful of breast-with-nipple, which he or she gets to work on with tongue and jaw. Ensure the baby is close to the mother with the shoulders as well as the head facing the breast which, if large, may need supporting (mother's fingers placed flat on the chest wall at the base of the breast: avoid the scissors grip which stops the baby from drawing the lactiferous sinuses into his mouth).
- Avoid forcing the nipple into the mouth; so do not place a hand over his occiput and press forwards. Cradle the head in the crook of the arm.
- Explain the signs of correct attachment:
- Mouth wide open, and chin touching the breast (nose hardly touching).
- The baby should be seen to be drawing in breast, not just nipple.
- Lower lip curled back, maximally gobbling the areola (so angle between lips >100°). (Don't worry about how much areola can be seen above the top lip: this gives little indication of where the tongue and lower jaw are.)
- Slow, rhythmic, and deep jaw movements, as well as sucking movements. The 1st few sucks may be fast, shallow, and non-nutritive: here the baby is inducing the let-down reflex, which promotes flow.
- When helping with placing, it is quite appropriate to tease the baby by brushing his lip over the nipple, and then away. This may induce a nice big gape. With one movement bring to the breast, aiming his tongue and lower jaw as far as possible from the base of the nipple so his tongue can scoop in the nipple and a good mouthful of breast.
- Keeping on the postnatal ward for a few days, and having the mother learn with an experienced, friendly midwife is very helpful.
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