Dr Rahul Sen | Specialist care for birth and beyond | Sydney, Australia

Rooms : Edgecliff 02 9363 9474
Macquarie Street 02 9221 2600

An Overview

Breastfeeding gives your child the very best start in life, but it is not always easy, especially when you are doing it for the first time.  It is often the case that breast-feeding represents a greater challenge to new mothers than the birth itself.  Attachment and settling are the main problems.  The midwives looking after you will help you with attachment and feeding.  You often receive quite contradictory advice on techniques and strategy.  That simply reflects the fact that there are many different ways of doing things.  My advice is to try everything and see what works for you.

Remember that Lansinoh and nipple shields can be a lifesaver for some women.  I can prescribe Motilium for you if your milk supply needs to be increased.  Some women experience vasospasm of the nipple when feeding, which can be very painful.  Nifedipine and complementary therapies can be very effective treatments.

If you are breast feeding for the second time you may well experience intense cramping “after pains” with feeding that you did not have the first time.  These will usually settle after about one week.  Taking pain relief tablets, such as Panadol and Voltaren, just before feeds, can be of real help for the first few days

I am also mindful that not all mothers are able to or want to breast feed, so if you have had a bad experience with feeding previously or you do not want to breast feed then please let me know.  I can prescribe Dostinex to suppress your milk supply if necessary.

My midwife, Michele, will contact you after your return home.  She will usually arrange to visit you at home.  Please do not hesitate to contact Michele by email, phone, or text message if you need her help.  Michele provides an exceptional service, that has been of tremendous benefit to many women, especially those who have experienced difficulty with feeding or settling.  Please remember that Michele can only provide a single home visit, and is not contactable on some days, and cannot provide an emergency service.

In addition to the support from Michele you may need assistance from a lactation consultant or mothercraft nurse.  There are drop-in classes available at the hospital, but for extra support at home I recommend the following:

Lactation Consultants:

  • Kylie McDonald: 0410 187 537  kylie.mcdonald@optusnet.com.au
  • Katrina Tucker: 0421 332 302 (and baby massage Instructor)
  • Linda Mosey: 9326 6826 or 0412 988 973
  • Lynne Hall: 0419 245 966
  • Amanda Purwa-Jones: 0407 774 145

Mothercraft Nurses:

  • Anna Rosen: 0400 823 489 
  • Debra Cross: 0415 381 671 (also provides a doula service)

Breastfeeding – Tips for New Mothers

Breastfeeding and breastmilk is very important. It benefits the health and well-being of mothers and babies, their families, society and the environment. Not breastfeeding increases the risk of a number of illnesses and health conditions. Breastmilk alone is perfectly suited for babies for the first six months after which appropriate family foods are introduced. Breastmilk continues to be the main food for the first twelve months. Cow’s milk is suitable from twelve months of age. Mothers will slowly stop breastfeeding when they are ready, many continue well into baby’s second year,

The Early Days

  • Skin to skin contact as soon as possible after birth is very important for your baby. It helps your baby know who you are and encourages breastfeeding behaviours.
  • Offer the breast as soon as your baby looks interested. Newborns are very alert and will seek the breast in the first few hours.
  • After an early good feed some babies are very sleepy; this helps mum recover from the birth.
  • The small amounts of colostrum available at this stage are important for baby’s immune system.
  • Within a couple of days most babies will start to get hungry and breastfeed between eight and twelve times in a 24 hour period: many of those feeds at night.
  • Breasts can become very firm and lumpy for a few days. Feed regularly and change your baby’s position at the breast. Expressing milk softens the areola and helps with attachment. If uncomfortable, use cold compresses, gentle massage and pain relief according to the manufacturer’s directions.
  • Ask your midwife to sit with you and talk through a feed as correct positioning and correct attachment will prevent problems.
  • It will take time and patience to learn this new skill.
  • Keeping baby close day and night will increase your confidence and understanding of their hunger and tired signs.
  • If your baby is not with you because he/she needs to be in the neonatal or special care nursery, ask for help with learning how to express. This will stimulate your supply and provide milk for your baby. Information on expressing and storing breastmilk is also important. Whenever possible try to have skin to skin contact (kangaroo care) with your baby.

Hunger Signs (cues)

  • Stirring from sleep with yawning and stretching.
  • Mouthing and licking lips.
  • Bringing hands to mouth.
  • Crying is a sign of distress and will occur if response to other signals is slow.

Which Breast and “How Long”

  • Alternate the breast you start with at each feed.
  • In the first few days try to keep the stimulation even for both breasts. Once the supply increases aim to drain one breast well at each feed.
  • Offer the second side if the baby looks interested.
  • Most babies will come off themselves when ready; there is no need to time feeds.
  • As baby gets older and more efficient the feeds will shorten.

Positioning

  • Wash your hands.
  • Get comfortable, support your back.
  • Unwrap your baby for closer contact.
  • Turn your baby on his or her side facing you.
  • With your hand support your baby’s neck and shoulders rather than the head.
  • Use your forearm to keep your baby close to your body.
  • Baby’s chin needs to be touching the areola and the nose in line with the nipple.

Attachment

  • Wait for baby to open his/her mouth very wide. You may need to stroke baby’s lips with your nipple or express a little milk into baby’s mouth.
  • Direct your nipple to the roof of your baby’s mouth. Keep your fingers as far back as possible to be sure your baby takes in plenty of breast tissue and not just the nipple.
  • The first sucking is rapid, followed by a slower suck/swallow pattern with regular pauses.
  • Nipple shape should not be distorted when your baby comes off – if it is, there may be an attachment problem.
  • Nipple tenderness can be normal in the first few days, but continuous nipple pain, cracks and bleeding are not – ask for help.

First Breastmilk: colostrum

  • Produced from around 16 weeks of pregnancy it can be clear to yellow or orange in colour. It has little fat, sugar or water.
  • The high levels of immune defence factors stimulate the baby’s immature immune system.
  • It satisfies baby’s hunger and thirst, there can be a few drops or as much as 5–15 mls.
  • It is a natural laxative to help your baby pass meconium and reduce the chances of developing jaundice.

Mature Breastmilk

  • Milk volume increases (or ‘comes in’) from three to five days, and matures over two to four weeks. Your full firm breasts will soon settle.
  • Milk at the start of the feed can look a ‘watery’ whitish blue colour – it satisfies baby’s thirst.
  • Towards the end of the feed it looks creamy as the fat concentration increases. These extra calories will satisfy baby’s hunger.

Night Feeding

  • Many babies in the first few months will naturally sleep more during the day become wakeful in the late afternoon/evening and want to catch up on their breastfeeds.
  • Most babies will always have at least one or two breastfeeds overnight to maintain adequate growth and their mother’s milk supply.

Some Issues to Consider

  • Most women make plenty of milk for their baby if they feed according to baby’s needs rather than a schedule.
  • Breastmilk is digested very quickly and babies have small stomachs. There is generally no recognisable pattern at first.
  • Avoid giving a bottle feed of formula to help an “unsettled” baby or help establish a “routine”. This may have unwanted side effects.
  • Trying to alter a baby’s natural pattern or substituting breastfeeds with formula can lead to engorged breasts, mastitis or a reduction in milk supply. There is also a risk of the baby developing allergies or other health issues.
  • Some babies will not breastfeed effectively because of the differences in the sucking action required for a teat or dummy.
  • If you have any concerns about your breastfeeding it is important to talk to a health professional skilled in breastfeeding or an Australian Breastfeeding Association Counsellor.

Reference: www.seslhd.nsw.gov.au

Early Childhood Centre Nurse

You will be given the phone number of your local Early Childhood Centre and advised to call and make an appointment for a visit for your child with the family health nurse. Generally first visits are either done in your home or at the centre a few weeks after your baby’s birth. There is often a long wait, so please ring to book your visit as soon as possible after the birth.

After that all visits are in the early childhood centre. The nurse will be able to advise you regarding all aspects of care of your baby. They will also provide comprehensive assessments of your child’s growth and development and offer support to parents who are experiencing difficulties with parenting. The nurse will encourage you to attend the centre regularly, so you can access the information sessions and the parents groups (mothers groups).

Remember to take your baby’s blue book, so that your baby’s weight and progress can be recorded.