In this section, you will find information on positioning and attachment, responsive feeding, effective feeding, the benefits of breastfeeding, importance of skin-to-skin and expressing for a premature baby.
There are four key principles when positioning your baby for feeding that can help them to attach to the breast effectively. There are several different positions that can be used when feeding your baby such as
- Cradle hold
- Cross-cradle hold
- Under arm hold, football hold or rugby hold
- Side lying position
- Reclining position
(Pictures from UNICEF)
The key principles should always apply, regardless of which position you choose to use. The acronym CHINS can be useful when remembering the principles of positioning.
Close- Hold your baby in close to you so they can scoop enough breast into the mouth
Head free- Instinctively, your baby will tilt their head back with their chin leading as they attach to the breast. A hand or finger on the back of baby’s head will prevent them from doing this movement
In line- Your baby’s ear, shoulder and hip should be in a straight line. This is so they don’t have to twist which would make feeding and swallowing hard
Nose to nipple- Your nipple should sit just below your baby’s nose. As your baby tilts their head back, the nipple will slip just under the top lip and be aimed towards the back of the roof of the mouth at the soft palate
Sustainable- The position should be sustainable and comfortable throughout the duration of the feed.
Attachment
- Feeds should be comfortable and pain free
- Baby’s mouth is wide open
- Baby’s chin indents the breast and bottom lip is well away from the base of the nipple
- Baby’s cheeks are round and full
- Suckling is appropriate to age of the baby (usually rapid initially, then deep rhythmic with pauses and audible swallows)
- Areola- if any visible then more will be visible above baby’s top lip
- Baby is content and stays on the breast
Unicef UK Baby Friendly Initiative | Positioning and attachment- video
Responsive feeding is responding to your baby’s feeding cues as well as your own desire to feed your baby. Your baby may demonstrate early feeding cues such as
- Stirring
- Mouth opening
- Turning head seeking/rooting
- Hand to mouth
Feeds are not only for nutrition, but also for love, comfort and reassurance between you and your baby. You may want to feed your baby if they are upset, hungry, unwell or provide them with reassurance in an unfamiliar environment.
You may want to feed your baby for your own needs. For example, if your breasts are feeling engorged, you are going out or you want to rest and have a cuddle with your baby. As a result, breastfeeds can vary in length and can be at all different times of the day/night. It is important to remember that a breastfed baby cannot be overfed. This is due to a component in breast milk called peptides which helps a baby to know when they are full.
Effective feeding is important as it ensures adequate milk transfer at every feed. It also helps to protect your milk supply and can help prevent issues such as engorgement, sore nipples, blocked ducts and mastitis.
Signs of effective attachment include:
- 8-12 feeds in 24 hours
- Feeds that last between 5-40 minutes
- Baby stays on the breast and is content
- Suck/swallow pattern (1-2 sucks per swallow)
- Baby’s urine and stool output
- Weight (It is very common for babies to lose up to 10% of their birth weight in the first few days of life. Most babies will have regained their birth weight by 3 weeks of age)
- Breast and nipples are comfortable
Your body will make antibodies against any foreign organisms that it encounters past and present. These antibodies will transfer from your breastmilk to your baby to help protect them. This is to help build your baby’s immune system so they can fight off any infections. Some people will often refer to breastmilk as baby’s “first vaccine”. Breastfeeding has shown to significantly reduce hospital admissions from common infections in the first 2 years of life. It can also help reduce the risk of:
- Gastro-enteritis
- Severe respiratory infection
- Ear infection
- Urinary tract infection
- Obesity (up to 25%)
- Diabetes
- Asthma
- Heart disease
- Leukaemia
- Sudden infant death syndrome
Your breastmilk is tailor made to your baby. For example, if it is a hot day outside your breastmilk will become watery to help quench baby’s thirst. The World Health Organisation recommends exclusively breastfeeding your baby for the first 6 months of life and after then continued breastfeeding until 2 years and beyond alongside the introduction of solid foods.
Breastfeeding also has many different health benefits for you. It can help reduce the risk of
- Breast and ovarian cancer
- Osteoporosis
- Cardiovascular disease
- Obesity
As we know, breastfeeding helps to increase oxytocin which after birth helps the womb to contract and minimise blood loss. Any quantity of breastmilk given will provide benefits for you and your baby. These benefits increase the longer you breastfeed your baby for.
Uninterrupted skin-to-skin is recommended after birth (for both vaginal and caesarean birth) for at least one hour or until after the first feed. This is because it initiates instinctual behaviours for both mum and baby. This will help stimulate the hormones oxytocin and prolactin and enable baby to follow a unique process (9 stages of skin-to-skin contact) to help them achieve their first breastfeed. If skin-to-skin is unable to be facilitated immediately after birth, then it is recommended to commence skin-to-skin as soon as it is possible.
Skin-to-skin has many other benefits such as
- Calms and relaxes mum and baby
- Regulates baby’s heart rate, breathing and temperature
- Stimulates digestion and encourages feeding
- Enables colonisation of the baby’s skin with the mother’s friendly bacteria
- Stimulation of milk producing hormones to help support feeding
- Bonding
Skin-to-skin contact - Baby Friendly Initiative
The 9 stages of skin-to-skin contact after birth
Having a baby who is premature or unwell can be very emotional and overwhelming. Your breastmilk can support your baby’s growth and help protect them from infections. If your baby is born premature, your body will produce colostrum for a longer period. This will offer more protection to your baby and is easier for them to digest. Any amount of colostrum you can give to your baby will help give them the best start in life.
It is recommended to hand express in the first few days following birth.
- Hand express 1-2 hours following birth
- Aim to express 8-10 times in 24 hours and at least once at night (times in between expressing don’t need to be regular. The number of times you express in 24 hours can help your milk supply)
You may want to use a pump to express your milk. There are many different types of pumps available. There are electric pumps available to use which can be found on the postnatal ward. Please ask a midwife, nurse, nursey nurse or maternity support worker to show you how to use one. Double pumping can be useful as it saves time and can help to increase your milk supply. It is important to use the correct size breast funnel (part of the equipment which fits over the breast) to prevent any discomfort and protect your milk supply.
It is important to rest and take care of yourself as some days can be harder than others. Spend time with your baby and where possible in skin-to-skin contact, as this can help to increase the hormones responsible for milk production. Expressing when next to your baby can help to increase your oxytocin. If you can’t be close to your baby, having a something that smells of your baby or a picture can also help.
It can be difficult to express during the night, however it is important for your milk supply. You could try and cluster pump (expressing two to three times within a couple of hours) as this can help increase the number of times you can express in a 24-hour period. This can be at any time of the day but may be helpful in the evening or before going to bed. Try not to leave long gaps in between expressing, as this can affect your milk supply in the future.
