• Sit comfortably with your back supported and feet raised to bring knees up, use a pillow to bring the baby up to the level of your breast.

  

• Position your baby so that his whole body is turned to face your breast ( tummy to tummy)

• Support the baby's back with your forearm and his neck and shoulders with your hand. Allow his head to tilt back slightly by applying pressure between the shoulders.

Support your breast with your thumb on one side, fingers on the other and your hand well away from the areola.

Step 1: Massage your breast before starting (see "Massage").

Step 2: Tickle your baby's lips with your nipple pointed upward and wait for him to open his mouth wide ( like a yawn) with his tongue down and out.

Step 3: Bring your baby towards the breast, chin first, catching the bottom lip on the breast approximately 1" (2.5cm) away from the base of the nipple.

Step 4: Guide the top lip up and over the nipple, landing on the breast just above the nipple.

A good latch should not hurt - if you feel nipple pain, unlatch the baby and try latching again. With a good latch, you should see the following:

• The chin should be pressed against the breast with the baby's head tilted back slightly (you will NOT see the baby's bottom lip).
• The nose can be lightly touching the breast ( it is NOT necessary to press down on the breast to create breathing space, as the baby will pull away from the breast if he / she cannot breathe, you can apply pressure between the shoulders vs. head to tilt his/her head back to improve latch).
• The feeding begins with little sucks progressing to sucks that become deep and slow; there should be a pause during the suck when the baby's mouth opens the widest. The longer the pause , the more milk baby is getting. On average, there should be at least 10 - 20 minutes in total of this deeper and slower type of suck at each feeding.
• You may hear gulping sounds or quiet sounds like a "ca" or "eh" when the baby swallows. You should not hear "clicking" or "smacking" with a good latch. If you are unable to identify swallowing, seek help from a breastfeeding professional.

If you need to take you baby off the breast (ie. nipple pain when latching), Keeping your baby close to the breast, insert your forefinger or pinkie finger into the corner of the baby's mouth, sliding your finger alongside of the breast far enough inside the mouth so that you hear a gentle "popping" sound (suction/ seal is broken). Quickly slide the baby away from your breast.

The first feeding should be as soon as possible after delivery. It is important that your baby feeds very frequently (every 1 - 3 hours) in the first few days. Newborns are often sleepy and need to be awakened and encouraged to feed. If your baby is unable to feed, pumping within the first 6 hours is recommended.

More Feedings = More Milk Produced

• After the first few days, your baby should be waking and showing signs of hunger on his own. If your baby is not waking on his own, you may need to wake him to ensure he is feeding at least 8 - 12 time in 24 hours.
• The length of feedings varies from baby to baby and from feeding to feeding. It is not the length of time at the breast that is important, but how effectively the baby is nursing. (You should see/hear consistent swallowing.)
• It is important that your baby feed long enough on the first breast to get the hindmilk, which is the higher calorie milk produced at the end of a feeding. Hindmilk helps the baby gain weight and be content between feedings (see "Breast Compression" to increase hindmilk).
• As time goes on, your baby may be satisfied after feeding on one breast, however, always offer both breast at each feed.

A baby who feeds well will show the following signs:

• Small sucks progressing to large deep sucks (open, pause, close) with identified swallowing.
• The baby will end the feeding by falling asleep at the breast or coming off the breast content.
• The baby will remain content between feeds.
• The baby is waking to feed 8-12 times in 24 hours.

NOTE: Babies can stay on the breast for long periods of time and not receive milk. This does not mean your baby is not getting enough milk, the breast can be a great pacifier. Seek help if you are unsure.

*International Lactation Consultant Association: Clinical Guidelines for the establishment of exclusive Breast Feeding. (2005).

Sources: International Lactation Consultant Association: Clinical Guidelines for the establishment of exclusive Breast Feeding. (2005)

Riordan J. Breastfeeding and Human Lactation (2004)

Mohrbacher N. and Stock J. The Breastfeeding Answer Book, Third Revised Ed. (2003).

* If your baby does not show these signs, contact a breastfeeding professional.
* The doctor/midwife should see breastfed babies within five to seven days after birth.*

• Normal hygiene is recommended for cleansing breasts.
• Change breast pads often and avoid breast pads with a plastic backing
• Make sure you are unlatching your baby correctly (see "How to Unlatch Your Baby")

Breast massage is a useful technique to stimulate letdown and to help improve plugged ducts.

• Support the breast using the "C- hold", or with one hand on top and one underneath.
• Apply gentle pressure by moving the fingers along the breast towards the nipple.
• Rotate around the breast to ensure all areas are massaged.

On day four, answer yes or no to the following statements: If you answer "yes" to any of the following during your breastfeeding experience, call a breastfeeding expert.

• You cannot tell the difference between sucking and swallowing
• You are experiencing sore nipples/breast pain
• You are using/thinking of using a supplement
• Your baby seems hungry all the time
• Your baby is having less than 3 bowel movements in a day
• Your baby is having less than 6 wet diapers a day
• You are not sure if breastfeeding is going well
• Your breasts remain hard and full after a feeding
• Your baby is not swallowing consistently during the feed
• You are using/thinking of using a nipple shield
• Your baby is sleepy & hard to wake for feedings

If you feel you may have any of the following:

Plugged ducts: Plugged ducts are lumps in your breast, which occur when your breast is not properly drained. To prevent plugged ducts, make sure you baby is latching well. Massaging you breast during feeding may help find plugged ducts.

Mastitis: Mastitis is a result of swelling and infection in the breast (usually by a plugged duct which is not relieved). Mastitis comes on quickly with flu - like muscular aching followed by fever, chills and a hot/reddened/tender area on the breast. If you have mastitis, DO NOT STOP BREASTFEEDING.

Niagara Health System:
Toll Free to all sites: 905-378-4847
Greater Niagara General Hospital Site 905-358-0171, Ext. 53705, clinic by appointment
St. Catharines General Hospital Site
905-684-7271, Ext. 43223, clinic by appointment
Welland County General Hospital Site
905-732-6111, Ext. 33351, clinic by appointment
West Lincoln Memorial Hospital, Grimsby
905-945-2250, Ext. 350
La Leche League
1-800-665-4324

For more information about breastfeeding support and community resources in the Niagara Region, call:
The Parent Talk Line 1-800-263-7248 or 905-688-8248 Ext. 7555 or refer to "Need Help With Breastfeeding" Resource Pamphlet.