Newborn - Thriving under 5 - Plunket
New babies bring many changes to the family/wha¯nau. When caring for your baby you might get lots of different and sometimes conflicting advice. If you have any questions or concerns talk to your midwife, Plunket staff, other Well Child Health Provider or your doctor.
The Baby Friendly Hospital Initiative
Whether your baby is born in hospital or at home, your LMC ( Lead Maternity Caregiver) will encourage you to breastfeed your baby, and will help you to get off to a good start if you decide to breastfeed. The Baby Friendly Hospital Initiative, set up jointly by the World Health Organisation (WHO) and the United Nations International
Children’s Fund (UNICEF) in 1992, has produced a summary of guidelines for professionals. This is available through your midwife or maternity hospital. The guidelines support mothers to breastfeed and describe the breastfeeding support you can expect while in hospital. In many hospitals, lactation consultants with specialist experience can be called to assist mothers who experience difficulty in breastfeeding. For women who decide to use a breastmilk substitute, they will be given unbiased information and advice. Midwives continue to play a leading role in promoting breastfeeding in both hospital and at home. Once your Plunket nurse or other Well Child Health Provider takes over responsibility for your care and that of the baby, you will find them equally committed to ensuring that you can continue to breastfeed successfully.
Breastmilk is the perfect food for baby and provides your baby with all that is needed for healthy growth and development. Breastmilk is designed specifically to give your baby all the nutritional needs for the first six months and to provide protection against some infections. Once baby has started on solids it is recommended to continue to breastfeed until one year or longer.
• Breastfeeding provides a means for you and your baby to get to know each other.
• Breastmilk is easily digested and reduces the incidence of constipation, diarrhoea or nappy rash.
• Breastmilk is free and always at the right temperature.
• Breastmilk contains antibodies which help fight some infections like colds, coughs, chicken pox, and measles.
• Breastmilk protects against conditions triggered by allergy such as eczema and asthma.
• Breastmilk helps protect your baby against infections such as gastroenteritis, middle ear infections and some respiratory conditions.
• Breastmilk may help prevent Type 1 (Juvenile onset) diabetes.
• Research shows that women who breastfeed are less likely to develop breast and ovarian cancer.
How Your Breasts Produce Milk
The breast is divided into sections or lobes, which contain bundles of milk producing glands. These are stimulated (by hormones) to produce milk. The first milk is colostrum, which contains large amounts of proteins and antibodies, which are important to help build a strong immune system. It also acts as a laxative, which helps to clear out meconium (the first dark-green motions) from the baby’s bowels. Newborn babies take only a teaspoon or two of colostrum/milk per feed in the first few days, since their stomach is very small and colostrum is a very rich food. After about three days colostrum is replaced by transitional milk then mature milk. When your baby feeds, the nipple and areola are taken into the baby’s mouth. With suckling hormones stimulate the glands to let-down milk firstly a blue-white watery milk (foremilk) then hindmilk. Your baby should have at least six really wet nappies a day and be gaining weight over time. Overall weight gain is important, not one weight on its own.
Starting to Breastfeed
Early initiation of breastfeeding is important for successful breastfeeding. You will usually be able to have skin to skin contact soon after birth. Many babies are alert and start to suck immediately.
Choose a comfortable well supported sitting or lying position to avoid getting a stiff back, shoulder or neck muscles, or cracked nipples from poor attachment.
Position baby across your front, hold her with her chest and tummy facing you (“baby’s chest to your chest”, “baby’s chin to your breast”) and her nose opposite the nipple. Bring your baby to the breast, not the breast to your baby.
Baby at the breast
Having baby correctly attached to the breast is very important for successful breastfeeding.
• When bringing your baby to the breast support her neck and shoulder between your spread out fingers and thumb. This helps raise her chin off her chest so that she can open her mouth wide and allows her nose to be clear.
• The nipple should be lined up with the nose. Her bottom lip should make contact with the areola (the dark area around the nipple), well away from the base of the nipple. Baby’s lips should be flared (turned outward).
• When baby is feeding she should have a suck swallow pattern (long drawing sucks followed by shorter sucks) with pauses in between. You can see her ears wiggle as her jaw moves. Feeding may be uncomfortable for the first few seconds after your baby first attaches as the nipple is pulled into the back of baby’s mouth. However, if it continues to be painful it may be that baby’s position is not quite right. Take your baby off the breast by putting a finger in the corner of her mouth to release the suction and try again. Remember! Breastfeeding is natural BUT it is not always easy to begin with. It is a learned skill. For some women it can take up to six weeks before breastfeeding is fully established.
Frequency of feeds
There are no hard and fast rules. Follow your baby’s cues for feeding. These might be
• Hand sucking
Crying is usually the last cue for feeding. It is common for newborn babies to feed frequently. Sometimes baby may sleep for a longer period during the day. It is common for babies to feed more frequently in the evening. If baby is sleeping for long periods during the day, not waking for feeds, not feeding well, not having many feeds or is too tired to feed it is important to urgently contact your midwife, doctor, Plunket nurse or other Well Child Health Provider.
Duration of feeds
Don’t worry about timing your baby’s feeds. Like adults, babies may take different amounts of food at different times of the day.
• At the beginning of the feed your baby takes in the lower calorie foremilk which quenches the thirst. Mothers may think their milk is watery and may unnecessarily give up feeding because of this.
• As feeding continues the milk changes to a high calorie hindmilk which satisfies hunger and promotes growth.
• Allow your baby to suckle until satisfied at the first breast. When your baby starts playing at the breast you can offer the other breast.
• If your baby does not want any more milk, start with the other breast at the next feed.
• If baby falls asleep in the middle of a feed, changing her nappy, taking off a layer of her clothing or stroking her may wake her enough to finish the feed
• Many two-day-old babies are very hungry and wakeful. This is normal.
• When the weather is hot you may find your baby wants to feed more often because she is thirsty.
Signs to watch for when feeding
• baby is attaching well
• you can hear her sucking and swallowing on the breast
• she is having at least 6 really wet nappies
• is gaining weight
• feeding does not hurt.
If you have concerns about your feeding talk to your midwife, Plunket nurse, Plunket Karitane Family Centre, other Well Child Health Provider, lactation consultant or doctor.
Growth spurts when breastfeeding
At times (often around 2, 4, 6 and 12 weeks) your baby may want to breastfeed more often. These times of extra feeding usually last two or three days and are due to her increased growth. This is normal. As your baby takes more milk through extra feeds, she will soon settle. This feeding lasts for 12 to 36 and sometimes 48 hours but brings in an abundant milk supply.
Keeping up your milk supply
• The more your baby takes, the more milk you make. Baby’s suckling stimulates your breasts to produce more milk. If baby is not feeding well or you start to use formula, your baby will be taking less from you and your milk supply will decrease.
• Breastfeeding mothers need three meals a day, plus snacks and plenty of fluids. Drink when you are thirsty.
• Stress and tiredness can affect your milk supply. Trying to rest and relax as much as possible may help.
• If your baby cries after feeding, the problem may be tiredness or wind and not hunger.
Spicy or “Gassy” foods
Spicy or gas-producing foods eaten by breastfeeding mothers do not bother most babies. A few babies will develop gas or become colicky when their mothers eat certain foods. However, there are no certain foods that create problems for all babies. Unless you notice that your baby becomes unsettled every time you eat a certain food, there is no need to avoid any particular foods.-
If you are a Vegetarian
If you are a vegetarian, you may like to discuss your diet with your midwife/Plunket staff or discuss seeing a dietician to ensure you are getting enough vitamins and minerals. Providing vegetarian women are eating well balanced diets, they are likely to have adequate intakes to maintain infant and maternal health. Women eating vegan or macrobiotic diets may not have enough vitamin B12 and may require supplements of vitamin B12.
If you are going to be away from your baby when a feed is due, you may wish to express milk and leave it for her. It is best to express after a breastfeed so that more milk will be made by the time your baby wants her next feed. Usually the easiest time to express is in the morning. The amount you express may vary and differs between mothers. Freshly expressed milk can be stored in the fridge in a sterile container for 48 hours. Defrosted milk can be stored in the fridge for 24 hours. If frozen it can be stored for 3-4 months in a freezer or 6 months in a deep freezer. Milk can be expressed by hand, or with a pump.
To hand express:
• Support your breast with one hand and use the other to stroke downwards from the top towards the areola.between your thumb and forefinger, pressing deeply to force the milk out.
• Move your fingers and thumb around the outer sides of your breast. You might find a hand pump or an electric pump easier and more effective than expressing by hand. Remember nothing is as effective at getting milk from your breast as your baby.
Cleaning equipment for expressing
It is important to clean and sterilise the equipment, teats, and bottles/cups. If you are using a breast pump, clean it with washing up detergent, water and a brush. If you are feeding by bottle clean the teat and bottle with washing up detergent and water, then rub the inside of the teat with salt and rinse it. Sterilise the breast pump, the bottle/cup and container to be stored in by boiling them for 5 minutes (teats boiled for three minutes) or use a sterilising solution. When baby is over three months, equipment does not need to be sterilised, just cleaned thoroughly.
Keeping milk in the fridge
Put the expressed breastmilk in a sterilized bottle or sterilised plastic container with a tight fitting lid. It will keep at room temperature for 2 hours and in the fridge for up to 2 days. Milk should be stored in the back of the fridge where it is the coldest. Do not add freshly expressed breast milk to cold expressed milk until it has cooled to the same temperature.
Keeping milk in the freezer
Expressed milk will keep in a freezer box inside the fridge for 2 weeks, freezer for 3-4 months stored as far back as possible, or deep freeze for 6 months. The milk will probably separate into layers, but when thawed will mix again. Do not add freshly expressed milk to already frozen milk as it warms the frozen milk.
Thawing/defrosting and heating breastmilk
Hold expressed milk (that is in a tightly covered sterilised container) under a tap and let cold water flow over the outside of the container. Increase the temperature of the water to warm until the milk is at body temperature. Use the milk immediately and throw away any left over after the feed. It is not safe to reheat or refreeze milk. Microwave heating can destroy important qualities of breastmilk. It can also cause uneven heating that can burn baby’s mouth.
For these reasons it is safer not to use a microwave for heating milk.
Some breastfeeding problems and solutions
Sore and cracked nipples
The main cause of sore nipples is incorrect positioning of the baby at the breast. To improve how baby is attached try putting baby on to the breast as described on page 25. If you cannot improve her position yourself, or your nipples are not healing you can get help from your midwife, Lead Maternity Carer (LMC), Plunket staff, other Well Child Health provider, the La Leche League, or a lactation consultant.
To help heal sore and cracked nipples:
• Express a few drops of breastmilk, gently spread it on the nipples, and allow to dry.
• Leave nipples uncovered or loosely covered between feeds to help them heal.
• Avoid using soap on the nipple.
• Pain may be helped by taking Paracetamol as directed on the packet; prolonged (for more than a couple of days) or excessive use may be harmful, see your health professional if pain continues. Pain may also be caused by blocked ducts or nipple and breast infections (see below).
Engorgement/ breast fullness
Breast fullness occurs usually 24-48 hours after birth. This means that the breasts have become distended and are hot and painful to touch. To relieve breast fullness and engorgement you can try:
• Frequent feeding. Make sure baby is attached well to avoid sore, cracked nipples.
• If the areola is too swollen, gently express enough milk to enable your baby to get onto the breast correctly.
• Using different feeding positions or feeding lying down.
• Warm showers before feeding
• Applying cool face cloths (flannel) on the breast between feeds.
• Wearing a comfortable, non-restrictive, supportive bra.
• Using Paracetamol for pain as directed on the packet (see your health professional if pain continues).