Learning Objectives
• Identify 3 components necessary for making a healthy milk supply • Demonstrate proper technique for positioning the baby at the breast • List 3 ways to know baby is getting sufficient breast milk • Identify situations in which the peer counselor should refer a mother experiencing concerns outside her scope of practice
What to Expect
• Anticipatory guidance helps mothers know what to expect • Prevents common concerns and improves confidence • Information is retained better when peer counselors
– Provide information in short, easy to remember segments – Focus on the basics – Affirm the mother often
Core Area #1 Making A Good Milk Supply
How Mothers Make Milk: Role of the Breast
• Milk production occurs in the alveoli • Milk is squeezed through the milk ducts • Milk is finally released through openings in the nipple
How Mothers Make Milk: Role of the Brain
• Baby’s suckling signals the brain to produce hormones
– Prolactin – Oxytocin
• Milk Ejection Reflex (MER) releases milk • The more MERs, the more milk for baby
How Mothers Make Milk: Role of the Baby
• Suckling signals the release of milk-producing hormones • When baby removes milk, more milk is made • Frequent milk removal (8-12 times every 24 hours) is needed for a healthy milk supply • If baby cannot remove milk, a pump is needed
Baby’s First Milk
• Colostrum – days 1-3
– Low in quantity – High in infection-fighting ingredients
• Higher volume milk – days 2-5 • Mature milk – by 2nd week
– Milk at beginning of feed is high in protein, low in fat – Milk later in feed is higher in fat
Facts About Milk Supply
• Breast size does not determine milk producing capability • Breasts are unique • Mother does not need to drink milk to make milk • Being worried or upset does not spoil milk • Some herbs and medications may affect milk supply
Core Area #2 Attaching Baby to the Breast
• Breasts can be tender in the first few days • Positioning and latching baby correctly can prevent soreness • The early days are a time to learn how to breastfeed • If breastfeeding is painful, the mother should seek help
Step 1: Get Comfortable
• Pillows everywhere • Sit up straight, not hunched over • Feet flat on the floor or supported with a book or box
Step 2: Position the Baby Facing the Breast
• Baby should not have to turn his head • Turn baby so his body faces the mother’s body (“chest to chest, chin to breast”) • Body should be in a straight line, not curled under
Step 3: Support the Breast
• Place fingers underneath breast, thumb on top, against the chest wall
Step 4: Connect
• Baby’s chin should touch breast; nose is aimed toward top of mom’s nipple • Touch baby’s upper lip and wait for open mouth • Quickly move baby onto breast • Baby is latched when
– Large part of dark area is covered by baby’s bottom lip – Baby’s lips are flanged – Mother is free from pain
Latching the Baby
What’s Wrong with this Picture?
What’s Wrong with this Picture?
What’s Wrong with this Picture?
What’s Wrong with this Picture?
Positioning Practice
Other Breastfeeding Positions
Core Area #3 Tips for Early Success
Watch the baby, not the clock
• Baby’s stomach is too small in the early days to hold much • Breast milk is digested within 1.5 hours • Breastfeed within an hour after delivery • Keep baby close so he can breastfeed frequently, 8-12 times every 24 hours • “Cluster” feeding is normal
Cues That Baby is Ready to Eat
• Common cues
– – – – Smacking lips Sucking on his hand Moving head around Rooting
• Crying is a late sign of hunger • Sleepy babies may need help to wake up
Allow Baby to Finish the First Breast First
• Babies have unique feeding styles • Not limiting feeds helps baby get plenty of fat so he feels full • Offer the first breast for as long as baby is drinking milk, watching for swallowing • Use breast compression to keep baby interested • After 30 minutes, offer second breast • End the feeding when baby is no longer drinking or releases his attachment on his own
Breast Compression
• When baby stops suckling/swallowing, gently squeeze breast • Hold for around 15-20 suck/swallow/breathe cycles • Release • Repeat
Avoid Bottles and Pacifiers
• Babies can find it hard to learn several skills at once • Give baby time to learn to breastfeed before offering other nipples • Some babies prefer bottle nipples because the milk flows faster • There is no way to tell which baby will prefer another nipple besides the breast
How to Know Breastfeeding is Going Well
• Baby feeds 8-12 times every 24 hours, including at night • Swallowing can be heard • Breasts soften during the feeding • Baby has plenty of wet and dirty diapers
– expect 3-5 urines and 3-4 poops per day by 3-5 days of age – expect 4-6 urines and 3-6 poops per day by 5-7 days of age
• Stools turn yellow and seedy by day 3
When to Contact Mothers
• Frequent calls every day or two to check on the mother and baby • Call within 24 hours if mother is having problems, and seek help from your designated WIC breastfeeding expert • Follow the mother’s cues for how often to call • Remember mothers value someone checking on them
Opening the Conversation with Mothers
• How is breastfeeding going? • What do you know about how your body makes milk? • Who has been helping you with breastfeeding? • How does breastfeeding feel to you? • What kind of visitors have you had? What do they say to you about breastfeeding? • How is your baby showing you he’s ready to eat?
“Being a peer counselor has allowed me the opportunity to help new moms do the best they can to give their babies the healthiest start possible. When a mom tells me how helpful I was, it makes me proud to have made a difference in her life.”
WIC Peer Counselor