1. Linda Quadvlieg
Student midwifery
Erasmus College / Haute Ecole Jette

2.  Experiences & intro
 Why breastfeeding, why not?
 How does it work
 When and how often to feed
 Is my baby getting enough?
 Latching on
 Postures
 LET’S PRACTICE!
 Expressing milk
 Challenges and problems
 Recap

3.  Anyone experience?
 Friends/family?
 Were you breastfed and why (not)?
 Expectations of fathers to be

4.  Patience
 Every breastfeeding story is different
 Breastfeeding is natural….
….but doesn’t always come naturally.
 Knowledge
 don’t let information overwhelm you
 what is your source of information?
 Practice
 Instinct and reflexes

8.  Mothermilk as the norm
 Formula milk as the alternative

9. For the baby For the mother
 Easily digested and well
absorbed
 Softer stools & less cramps
 Better jaw development
 Higher IQ
 Protects actively against
infections (antibodies)
 Protects against SIDS,
diabetes, leukemia, astma,
allergies, lymfoma, Hodgkin,
obesity
 Better bioavailability of iron
& calcium and less anemia
 Promotes emotional bonding
 Long term reduced risk for
 Breast cancer
 Ovarium cancer
 Osteoporosis
 Rheumatic arthritis
 Reduced blood loss in
postpartum
 Helps involution of uterus
 Less anemia
 Delays pregnancy
 Helps regain figure faster
 Saves time, energy and money
 Advantages in mothers with
(gestational) diabetes

10.  Physical discomfort, breastfeeding problems
 Convenience
 Pressures of employment/school
 Worries about breast shape
 Formula manufactures’ ads
 Poor training of doctors and nurses
 Family demands
 Non-supportive family/health professionals
 Embarrassment
 Lack of confidence in self
 Feeling that one cannot produce enough milk

11.  The WHO recommends:
 Exclusive breastfeeding until 6 months of age
 Introducing complementary foods combined with
breastfeeding
 Breastfeeding is beneficial for 2 years or longer

12. Breastfeeding explained in brief

13.  Anatomy of the breast
 Changes in the breast
 Milk production
 Milk ejection reflex
 Milk composition

14.  Parts
 Milk glands
 Milk ducts
 Nipple
 Areola
 Montgomery’s
glands
 Every breast
is different!
 Glands
 Storage capacity
 Left vs. right

16. Changes during pregnancy and postpartum

17.  Oxytocin release
 Enhanced:
 Hearing baby
 Thinking about baby
 Thinking about feeding
 When nursing moment is approaching
 Hindered:
 Pain
 Embarrassment
 Fear
 Stress

19.  Induced by oxytocin
 Muscle cells contract
 Makes the milk flow from
gland to ductus to nipple
 Hindered by stress factors
 Sucking of the baby adapts
 two phases
 Short & soft  longer & more powerful
 Takes about 2 minutes
 multiple times per feed
TIP!
How to stop the milk
flow when it’s not
supposed to?

21.  Prolactin:
 Increase with frequency
 Not duration
 Stable levels!
 Feedback inhibitor
of lactation (FIL)
 More milk out = more milk in
 Full breast = increase in FIL
 Important to empty breast

22.  98% of all pregnant woman are perfectly
capable to provide enough milk

23.  Colostrum is already there
 From 26 weeks
 Provides protective film in
digestive tract
 ‘first vaccination’
 More protective proteins
 More vitamin A
 Promotes healthy gut bacteria
 Laxation effect
 After 50-73 hours
 Change in substance milk
 Congestion days
 Changing stools day 3-4

24.  Breastmilk is never the same
 It differs
 From woman to woman
 Between morning and evening
 Depending on the age of your baby
 Depending on gestational age
 Within one feed: hindmilk and foremilk

25.  Available early in the
feeding
 Hydrates
 May lead to cramps
and green, yeasting
stools
 Becomes available
later during feeding
 Provides energy
 Satisfies baby
 More fat
 Richer / creamier

26. Find your rhythm

27.  When to feed
 Early hunger cues
 How often to feed
 How long to feed
 No time limit (usually 15-20 min)
 Until your baby let’s go
 How many breasts per feed

28.  Feeding on demand
 Rooming in
 Co-sleeping
 Be alert for hunger cues
 Pacifier?
 Latch on after early hunger cues
 Baby is alert / awake
 Baby is ready and calm

29.  Rooting reflex
 https://www.youtube.com/watch?v=v7_Y_jg2soc

31.  Late cue or crying for other reasons?
 Calm when picked up/soothed differently
 Sucks firmly when offered little finger?
 Diaper changed?

32.  No schedules but rhythm
 Baby and mother = couple
 On demand: no maximum number of feeds
 Mean frequency 8-12 per 24 hours
 Also at night  prolactine levels are higher
 Minimum 1/night

33.  Two breasts in first weeks
 Individual differences possible
 Storage capacity
 Baby is leading
 One breast completely and the other serves as
‘dessert’
 Never too much breastmilk…
 No limits as with formula milk
 ….but sometimes to much foremilk

34.  Demand and supply is ‘reset’
 Around day 10
 3 and 6 weeks
 3 and 6 months
 Are only temporary
 Feeding hourly is normal these days
 Rest for the mother
 Plenty of fluids
 After 1-4 days new balance

35.  First 6 weeks
 Time to teach and learn!
 Hunger cues
 Evidence?
 No pacifiers / bottles / teets unless
medical indication

36. Core business for the couple!

37.  A good latch:
 Avoids pain
 Avoids nipple cracks
 Improves milk transfer
 Makes a happy baby and a happy mother
 Is crucial to successful breastfeeding!

38.  Your baby has to learn
 Make use of his reflexes to learn
 Rooting
 Sucking
 Swallowing
 Support and correct your baby
 Correct timing
 Position your baby correctly
 Be patient
 Comfort your baby
 If it’s not good: relatch!

39.  Bring mother and baby in optimal position
 Stimulate rooting reflex
 Tickle the baby’s nose/upper lip with nipple
 Softly
 Repeatedly
 Wait for baby to open mouth wide
 Bring baby in softly and quickly
 Make sure the baby is latched on correctly
 Break suction with little finger and re-latch if needed

40.  Check these 5 important things!
 1. Position and comfort of the mother
 2. Position of the baby
 3. Mouth of the baby
 4. How is the baby sucking
 5. Areola and nipple

41.  Relaxed back and arms: use support
 Use foot rest
 Good chair
 Comfortable position
 Stress will hinder the milk ejection reflex
 Make it a moment!
 Shoulders are down and relaxed
 Watch your neck too
 Baby moves to the mother
 Keep the position
 Hold your breast in a C grip
 “sandwich”: enough breast
 Release when latched on

42.  Nose  nipple height
 Chin presses forwards in breast,
free from it’s chest
 Head
 free to move (no hands behind head)
 tilted back
 Baby’s body aligned from crown to toe
 belly to belly
 no hanging legs
 Keep your baby tight
 warm and supported
 palm between shoulder blades
 skin to skin = even better
 adjust after latch
 Baby’s hands  embrace the breast

43.  When mouth is wide open
 Wait before you latch on
 Tickle upper lip or cheek to stimulate
 At the breast
 Big corner between both lips
 Both lips are curled outside
 Not pulled inwards
 Tongue
 Is visible and out (covers lower gum)
 Takes in the areola
 If your baby cries it is directed upwards!

44.  No dimples in the cheek
 Movement of the whole jaw visible
 Movement to the ear
 Wiggling ears
 Firm grip on the breast
 Breast is not moving in and out
 A vacuum is created
 Listen whether baby swallows

45.  Asymmetrical latch
 Nipple is directed towards roof of the mouth
 Gums press on the milk duct sinuses
 Breastfeeding, not nipple feeding!

47. -What is correct?
-What needs
improvement?

48. -What is correct?
-What needs
improvement?

49. -What is correct?
-What needs
improvement?

50.  Good latch
 Baby’s mouth is
opened like a yawn
 Baby’s tongue is over
his lower gum
 Baby’s lips are curled
out like a fish
 Chin firmly touches
your breast
 Poor latch
 Baby’s mouth is
barely open
 Baby’s tongue is
behind lower gum
 Baby’s lips are curled
in
 Baby’s chin barely
touches your breast

51. Let’s build confidence here

52.  Four things to check
 1. Your breasts
 2. Feeding and baby’s behavior
 3. Diapers
 4. Weight evolution

53.  How do they feel?
 Any change after feeding?

54.  Rhythm: Sucking-swallowing-breathing
 http://www.breastfeedinginc.ca/content.php?pagename
=vid-gooddrink
 Swallowing
 Milk shoots in: 1 swallow per second
 Drinking well: 10 swallows per minute
 Satisfied after feeding?
 Does he let go?
 Relaxed / agitated
 Hands open?
 Latched on correctly?
 Look for professional help when in doubt

55.  Urine
 From day 4: at least 4 wet diapers per day
 Note the vertical detection stripe
 Stools
 From day 4 at least 4 stools until 4 weeks of age
 After 4 weeks as less as 1 per 10 days!

56.  Your baby WILL lose weight
 A loss of 5-7% of it’s birth weight is normal
 Weight gain
 at day 4
 Birthweight
 In two weeks

57. Let’s get practical

58.  Avoid problems by positioning well
 Use positions wisely when problems occur
 We are trying
them all!
 Mind:
 Belly to belly
 Back in one line
with the head

59.  Cradle = classic
 Cross cradle = good for starting
 One free hand to hold the breast
 Head can move freely

60.  More control over the baby
 When used?
 bigger breasts
 after caesarian
 inverted nipples
 to relieve sore nipple
 Mind here
 Feet free (baby pushes away)
 Support your arm
 Keep your baby close
 No bent wrists

61.  Just after giving birth
 Relieves the perineum/stitches
 Mother can rest and relax
 After a caesarian
 Protect the scar with a towel
or small pillow
 Attention here!
 Support in both backs
 Make a V
 Pull your baby close to you
 Roll over or roll further
for the other breast

62.  Biological nurturing
 http://www.breastfeedinginc.ca/content.php?pa
gename=vid-babyled
 Vertical position
 Abundant milk flow
 Mind here
 Support the forehead
of your baby
 Nose free
 Lower jaw sufficient grip

63.  Other options!
 Just mind the ‘rules’ about the positioning of
you and your baby

65.  Why expressing milk
 Manually expressing
 Pumping milk
 How to store and warm up the milk

66.  Use of medication
 Hospital admission
 Additional stimulation
 Supplementation = stimulation
 Improve shape of nipples
 And relief in case nipple cracks
 Combining work and breastfeeding
 Ability to store milk and skip feedings
 For ill or premature baby’s

68.  Electric
 High power
 Hospital use
 First days
 Example https://youtu.be/4YmQ7f9-648
 Battery pumps
 Lower power
 Home / work use
 Later in lactation period
 Hand pumps
 Sporadic use
 Less powerful

69.  Give it some time
 Pumping is different
 Size matters!
 Correct size breast shield
 Make yourself comfortable
 Again…relax
 Hands free?
 In your bra
 Right pump for
the right purpose
 Milk bar

70.  Cup feeding
 Syringe
 Finger feeding
 Lactation aid set
 Bottle feeding
 Why not?
 When good?

71.  Before you start
 Everything clean and sterilized
 Wash your hands
 Wash breasts with water only, once daily
 Clean recipients
 Wash and sterilize bottles/recipients
 Keep your milk cool
 Cool as soon as possible
 Transport cool too
 Store your milk
 Refrigerator: 2-4 days
 Up to 6 months in the deep freezer

73.  94% of all lactation problems are caused by a
wrong position of the baby and incorrect
latching on (Righard, 1998)
 Enough milk?
 Pain
 Nipple cracks
 Breast engorgement
 Breast infections
 After a caesarian section

74.  Check 4 things:
 Breasts
 Feeding
 Diapers
 Weight evolution
 Disadvantages in supplying with formula
 Consult a midwife or lactation specialist

75.  It should not hurt!
 It is ‘allowed’ to hurt
 Only in the beginning of each feeding
 During milk ejection
 It might hurt
 If your baby is latched on poorly
 Underlying problem
 Candida?

76.  After feeding:
 Express some milk
 Let dry
 Apply balm (protection and care)
 Optional:
 Multi-mum
 (Nipple shield)
 Let heal while you express your milk

77.  Between day 2-4
 Not everyone
 More with first babies
 Comfort measures
 Massage before drinking
 Apply warm compress before and cold after
 Cabbage compresses
 Comfort expressing helps!
 Might hinder good drinking
 Problems latching on
 Manually express milk to soften areola
 Difficult milk letdown
 Be careful for complications
 Blocked milk duct
 Possible during whole lactation period

78.  Blocked milk duct & mastitis
 Candida:
 Fungal infection
 Sharp deep pain in the breast
during feeding
 Very sensitive nipple
 Baby
 thrush in it’s mouth
 Diaper rash
 Treat baby AND mother
 Careful for re-infection

79.  Resting is important
 Assist mother to bring her her baby as much as
possible
 Effortless feeding positions
 Keep mother and baby close
 Skin to skin contact at maternity
 Not necessarily later milk production
 Stimulation as without caesarian

80. Time to round up

81.  Try to maintain ‘in balance’
 Get help if you need to
 Accept help
 Ask for help
 Arrange for home care
 Get as much rest as you can get
 Sleep when your baby sleeps
 Follow your baby

82.  Lactation experts
 Midwives with specialty MSc in lactation
 Pediatricians with specialty MSc in lactation
 In Belgium: www.bvl-borstvoeding.be
 Expertise in the postpartum period
 www.expertisecentrum-vollemaan.be
 A good start for a mother and baby
 EEH – emotionele erste Hilfe für Babies

83. - La Leche League
- http://www.lalecheleague.be/
- http://www.lllbelgique.org/
- Brussels Childbirth trust
http://bctbelgium.org/about-us/
- Video’s about latching on
http://www.breastfeedinginc.ca/

84.  Any questions?

85.  Patience and practice
 Every breastfeeding story is different
 Make your own story and your own choices
 Breastfeeding is natural….
….but doesn’t always come naturally.
 Be informed and prepared
 Get extra information if you need to