Section 4: Breastfeeding Management and Troubleshooting - Good Positioning and Proper Latch
Many mothers experience breast pain or soreness when breastfeeding. This is often due to inadequate infant latching to the breast.
Signs of a successful latch include:54
- Audible swallowing noises without clicking noises from the infant’s mouth (may not be audible in the very early days, but should be visible)
- Infant nose aligned to nipple with head tilted backwards
- Full rounded cheeks, no dimpling cheeks
- Rhythmic jaw movements
Poor latches can cause cracks and tears in the nipple:
- An over-the-counter product, lanolin, can also be applied to the affected area and does not need to removed before nursing. This product is 100% natural and comes from the raw wool grease of sheep’s wool.
- All purpose nipple ointment (APNO) should only be prescribed by a physician at its prescription strength; it is important to make a differential diagnosis before treating any other potential underlying problems.
- The cream can be applied sparingly after each feeding, with no need to wash off.
Some mothers, especially those who have had Cesarean deliveries, may have difficulty finding a comfortable position to nurse in for a prolonged period of time. There are various holds a mother can try to find one best suited to her and her child. Good positioning is simply a way of holding or supporting the baby so that he has easy access to the breast, is naturally aligned along a straight line, and doesn't have to “hang on” while nursing (a baby that feels shaky in terms of positioning may clamp down in order to stay on the breast). A baby should also be able to move his jaw freely, swallow easily and move on and off the breast at will.
If a mother is experiencing difficulties with proper latch, pain while nursing, or having any other related issues, this would be a great time to refer her to an IBCLC for personalized, professional assistance.
A baby will usually feed most efficiently with a latch that has the nipple pulled well into the infant's mouth and pointed up towards the roof of the baby’s mouth, his tongue under the breast and covering his lower gumline, and more of the areola/breast covered by his lower jaw than the upper jaw (known as an asymmetric latch). Although it's hard to see with a small baby, his lips should be flanged out against the mother's breast.
Frequent breastfeeding should be encouraged. It is common for newborns to "wake up" on the second or third day of life and want to go to the breast often. They may exhibit cluster feeding behavior, nursing on and off for hours. This is normal newborn behavior.
Baby should be allowed to finish the first breast before switching. If only one breast is ‘drained’ per feeding, it is okay. This means to wait until baby falls asleep or comes off the breast on his own. Time on the breast is not a good indicator, and mothers should be taught to recognize the difference between short flutter sucks (which have their place in stimulating letdown) and deep, jaw-dropping good drinking. Milk is only being transferred during the latter, so if baby has a good session of deep sucking and swallowing, then lets go and drops off to sleep, that is a good time to switch breasts. But if the baby does only short bursts of flutter sucking, it really doesn’t matter how long that baby is on the breast because little or no milk is being transferred. If the baby is gaining weight, then this ‘comfort nursing’ is fine.
When a mother is expecting more than one baby, it is important that the mother nurse her babies as soon as she is able. Some multiple births require surgical delivery and some may take place prematurely. If this happens and she is unable to initiate breastfeeding soon after the birth, she can still perform hand expression or pump her breasts to initiate lactation. From the moment of birth, her body will begin the process of producing milk for both babies and it is important to express the milk that is beginning to be produced to establish a good milk supply. Supply and demand allows a mother to make sufficient milk for two infants.
Milk from mothers of premature babies is quite different from that of mothers of term babies. If the babies are early, they will especially need her milk. If both babies are born healthy, the mother may be able to breastfeed them on cue. The ideal setup is rooming in with the babies. If it should become necessary that the babies receive a supplement, the mother may want to look into other methods of feeding such as cup feeding, finger feeding, or using a spoon, medicine dropper or syringe. Bottle feeding sometimes can interfere with lactation due to the fact that some babies become accustomed to the artificial feeding, making it harder to reestablish breastfeeding. This applies to singleton premature infants as well.
Tips for life with breastfeeding twins:
- Breastfeed them together to save time during the first weeks, but it may be best to breastfeed them individually until the babies can latch and nurse well on their own. There are several different ways that the mother can position the babies in order to nurse them at the same time. One way is to place the babies in front of her with their legs overlapping, making an X across her lap. The other position is to place both babies in the clutch hold. She will need pillows at her side (and maybe one on her lap) and she will place the babies on the pillows with their legs going toward the back of the chair. Remember that if she is placing the babies in front of her, she must try to keep their whole bodies turned toward her, their chests against her chest. Their bodies must not be facing up. This is very important to avoid soreness and also to make sure that the babies are receiving enough milk.
- Alternate feeding each baby from both breasts. This evens out their particular needs and also gives them extra visual exercise.