Week 1Breast Feeding Education

Lee Ann (00:09):
Hi! I wanna welcome you to United Hospital Center's prenatal breastfeeding class. First of all, I want to congratulate you on your decision to breastfeed. This decision is probably one of the most important decisions you'll make because this decision will impact your baby and your health for the rest of your life.

Lee Ann (00:29):
First thing I want to ask you is have you made some goals on how long you want to breastfeed? If we look at our first slide, the American Academy of pediatrics recommends that you give your baby nothing but breast milk for the first six months of its life. That's correct the first six months. And then to continue giving breast milk up to a year and including when you're starting solids. So that first year is very important for your baby. And even after the first year, if you want to continue to breastfeed, to continue to breastfeed as long as you and your baby want to do so.

Lee Ann (01:08):
Some people will ask me, well, when should I wean my baby from breast milk? And that's totally up to you. If you know babies, a lot of times will self-wean themselves. When they're getting close to that two-year mark, and that's perfectly fine. If you want to continue longer than that, that's totally up to you.

Lee Ann (01:25):
If I were to ask you though, what would be your first goal? I would tell you if you look at the next slide, get through the first two weeks. Because honestly, I think a lot of moms come in with the expectation that breastfeeding is going to be natural and easy. And the truth is it's a learned thing for you and your baby. And the first couple of weeks can be stressful. So when you go home and your baby's crying and you feel like you want to pull your hair out, because you're not really sure what's going on. I just want you to take a breath and remember that this is all part of the process, learning how to position your baby, learning what the cues are for your baby's hunger, learning how to get the baby properly latched. This is all part of the learning process.

Lee Ann (02:19):
And you will have moments where you feel stressed and you'll have moments of frustration. But if you can get through those first couple of weeks onto week three and four, that process will get easier. So I would advise you to find friends and family. You can always call me or the nursing staff on OB for encouragement. If you have questions that we'll be there to answer those for you. To have friends who encourage you to get through those first couple of weeks, because that's vital. And it's really important that you're taking this class so that you'll know this first little things that you need to know to be successful at breastfeeding.

Lee Ann (03:00):
And the important thing is when your baby rests, you rest. So when they're taking a little nap, don't worry about the house being perfect, or getting all the dishes done, or the laundry done. You take time to rest along with the baby. That's really important.

Lee Ann (03:15):
Exclusive breastfeeding is really important too. And I know a lot of times sometimes the formula company kinda knows when you're having a baby, then they send you those little packs of formula in the mail. And it's very tempting to break that formula out and give the baby a little bit of that. If you're having one of those couple of nights where you haven't had a lot of sleep. But the truth is that the baby really needs nothing other than your breast milk. And it's really important because breast milk can't be duplicated. Only you can provide that for your baby, and it's a perfect food for your newborn. It's easily digested and it gets the baby off to a right start. So even though it's tempting, try to get through those first couple of weeks by just giving the baby breast milk.

Lee Ann (04:05):
Now, if there's a medical complication going on, if the baby's not gaining weight or not producing enough wetter, poopy diapers, that's a different story. But most times in most circumstances, that's not the case and you can produce enough breast milk for your baby. The next slide gives us just a picture of what those benefits are of breast milk. I think most moms kind of know all those benefits for breast milk, but I think if you really look at the statistics that breast milk really reduces your baby's risk for respiratory illness by 72%—that's a huge number. And then if you look at the other benefits, how your baby gets protection from GI upset and GI infections; all those things are so important for your newborn, even protection from type one and type two diabetes. These are things that you can't buy in a formula.

Lee Ann (05:02):
So this is something only you and your breast milk can produce for your baby. Most moms know those things, but if you look down to the second column, they don't really realize that by breastfeeding, you reduce your risk for breast cancer, sometimes up to 50%, and that's a huge number. And if you look down there at that last, you get protection from coronary heart disease and coronary heart problems by breastfeeding. We have probably not even touched the surface on what the benefits of breastfeeding do for you as a new mom. So when you're having those moments and thoughts about is breastfeeding really what I want to do, think about what those benefits will mean for you longterm and for your baby longterm. Just keep going. I promise you it'll get easier.

Lee Ann (05:54):
If we think about what the benefits of breastfeeding are, let's think about maybe what the risk of formula feeding can do. So we know that formula feeding increases the risk of childhood obesity, increases your baby's risk for allergies and respiratory infections. Most babies will have some stomach upset from formula feeding, and most moms will tell you they've gone through different formula types to try to find one that their baby tolerates. It increases the risk for diabetes and eczema skin problems. We also know that healthier babies means that parents miss less work, and guess what breastfeeding is free. We know parents that formula-feed spend somewhere between four and $6,000 a year on formula. Breastfeeding is economically and environmentally friendly. Your formula companies will spend about $6 billion a year to try to convince you that formula is as good as breastmilk, but guess what? No way. It's not.

Lee Ann (07:07):
The other thing I want you to to think about, and if you've taken our childbirth classes, that your labor will have an effect on how you breastfeed. So if you come into the labor process, having a long labor, having a lot of medication, having a C-section, delivering your baby before 39 weeks; this will also affect maybe how your breath feeding will progress. So it's always good to have a good conversation with your provider about maybe how your labor process will affect your breastfeeding. I know that if your baby, if you've had a long labor process, your baby may be tired also and may delay the breastfeeding process. So let's talk about, you know, making sure that we are able to do skin to skin after the delivery of the baby. If you're having to deliver the baby at 37 weeks, are there going to be some, is there going to be a possibility that the baby's separated from you. Knowing that ahead of time that these are things that may happen, can we also be able to have a successful breastfeeding by making sure that you have a good milk supply and making sure that I see you after delivery or that the nurses help you with pumping or expressing milk so that we can give breast milk to your baby.

Lee Ann (08:38):
So it's always good to have that conversation with your provider, making sure that if there's something that's going on, that's a little off the norm that we can help you with that process as well. If you do get an epidural, we know that epidurals, if we give them, when you're in the active stage of labor, usually do not interfere with the process of breastfeeding, especially if we can do the skin to skin.

Lee Ann (09:05):
And as our next slide shows skin to skin is one of the most important things we do for a baby. And we want that skin to skin to be for that full first hour after birth, or until the baby accomplishes his first feeding. We know how that skin is skin stabilizes the newborn, stabilizes their temperature, their heart rate, stabilizes their blood pressure—I mean their blood pressures and their blood sugars. And if I were to be able to write a prescription, what I would tell you why you're in the hospital, try to do skin to skin for your baby at least three times a day for about 20 minutes. Especially if your baby's a little bit sleepy and not interested in breastfeeding, take them down to their diaper. And usually if you do that 20 minutes of skin to skin, when the babies close to you, they begin to smell you and begin to get aroused and begin to wake up and start to feel interested in eating.

Lee Ann (10:05):
The next slide is very interesting because most people don't understand exactly how small a newborn stomach is. So we think at birth, a baby stomach is about the size of a small cherry and actually only holds about a teaspoon. So a newborn wants to eat really frequently because of that. And what we know you produce when your baby is nursing is about a teaspoon. That's what a good feeding is in the beginning. And that surprises a lot of people. I think they think a baby should be taking an ounce right off the bat when they come out. But that's not what their stomach is supposed to hold. It's only supposed to hold about five MLs or about a teaspoon or two. So if you look at the picture on the slide, a small marble, small cherry, that's what a baby should be holding at the first day or two of life.

Lee Ann (11:07):
Once they get about a day old, we go from a small cherry, maybe to the size of a Walnut. By the time they're three days old, it will be about the size of a ping pong ball. As your milks starts to come in, it will increase in volume. And we think by the end of five days comes along, they will be able to hold about an an ounce of formula. And I always say to people, when you think about what we do to a baby that's formula feeding, a lot of times we do give them an ounce when they're born. So let's think about what we're doing to a baby that's supposed to hold a teaspoon of breast milk, and a stomach is a stretchable organ, so we're giving them an ounce of formula right off the bat and for all of their life, as we're stretching out their stomach, when they're newborns, why do you think we now have a whole generation of obese children because we're never letting them be able to feel when they're hungry and allowing them to stop or wanting them to always have their stomach stretched to the capacity.

Lee Ann (12:24):
Your baby, as a newborn knows when it's full and it will stop. And people will ask me, well, how long am I supposed to nurse? Guess what, when your baby is done, your baby will stop. You've watched the baby and people become obsessed with the clock. And I tell them, you put your baby to breast. They will nurse until they're done. They have what's called hunger cues. And if you watch that, they'll begin to lick their lips. They'll begin to put their hands to their mouth. That's a hunger cue. When you see that you put them to the breast and then when they're done, you take them off. And some people say, well, they always act that way. And sometimes they do. And sometimes they will really frequently, but remember they're taking small amounts at a time. And sometimes I tell people it's kind of like snacking or snacking frequently.

Lee Ann (13:24):
And the first three days of their life, they're going to be really establishing your milk supply. So if you let them do that, they will establish a great milk supply for you. It feels a lot like you're, all you're doing in the first couple of weeks of their life is breastfeeding. And you are doing that pretty frequently. We know a baby nurses somewhere between 10 to 12 times a day and that's okay. And that will establish a good milk supply.

Lee Ann (13:51):
The colostrum that you produce in the first few days of life. And you really start producing that honestly in about the second trimester of pregnancy, is so important because it introduces what's called antibodies to the baby system. These antibodies are what gives the baby protection—protection against infection. It actually, there's a whole big science about how antibodies introduced into the baby's gut sets up their whole immune system.

Lee Ann (14:23):
And that's what these antibodies in the colostrum do. It also helps to act as a natural what's called laxative that helps the baby had a bowel movement and, helps them get rid of what's called the meconium. That's been sitting in their system for that whole nine months they've been inside you. And it coats their whole digestive system. So that now when the full milk comes in, they can digest those full nutrients that come with a full milk and they can get the most out of those nutrients to digest them properly. Colostrum has three times the protein and lots of what's called beta carotene, which you find in natural things, such as carrots and sweet potatoes. And this also gives the colostrum a very golden color. So we like to call it liquid gold. So it's very important for your baby.

Lee Ann (15:24):
So again, I want to say, just feed your baby when they're giving you those hunger cues. If it's been longer than four hours, then yes, I would tell you to try to wake the baby up. Your goal in the first couple of days would be to get at least eight feedings in, in a 24 hour period. Eight or more in 24, that's a good way to remember it. When you're waking a sleeping baby, a good thing to do is to take them down to their diaper, undress them. You can talk to them, massage their tummy, stoke their feet, rub their face, if you want to with a cool cloth. Always change positions. Those are some easy ways to arouse them from a sleepy state.

Lee Ann (16:08):
Now, if we look at the next slide, this talks about moms have different forms of nipples. I know that makes a difference. Some moms have nipples that will get erect very easily. Some moms have what we call inverted nipples, where the nipple actually goes back in, and this makes it a little difficult for the baby to latch on. If you look at this slide, there's a couple tools on there and you may have, if you've been given one in a baby shower or been shopping, seen something called a nipple shield, and that's what's in the slide or these hard shells also help to pull the nipples out. And these are some tools we can show you how to use that makes it a little bit easier for the baby to latch on. Some moms also have a little bit more of a flat nipple and you can use, what's called a pinch test to tell if that's something you have. And in the picture that shows what's happening, the mom pinches her nipple and it actually goes away instead of sticks out. And we do have this little device called a latch assist, and that's in the picture, which also helps a nipple to stay erect. And also a breast pump also helps with that too.

Lee Ann (17:27):
Most insurances will also assist you with getting a breast pump. So you can talk to your doctor and one of your prenatal classes, or ask the office, if they will assist you with your insurance forms to see about purchasing, through your insurance, a breast pump. Because most private insurances now do help with that and provide at least some assistance with purchasing of an electric breast pump. So the next thing we're going to talk about is latching and latching is probably one of the most important things, because if you get a correct latch, breastfeeding should not hurt. And I know most people say, Oh, it just hurts so bad. And you know, really honestly, breastfeeding should not hurt. And if you get a correct latch, it shouldn't hurt. And a good latch will also help you to produce more milk and help the baby to transition the milk out of the breast better.

Lee Ann (18:22):
So let's talk about how we do that. And I'm going to demonstrate that for you here just a minute, and I'm going to pick up the baby. And the best thing to do is you want to kind of, instead of hold the baby in the crook of your arm like this, you basically want to hold them in what's called a cross cradle hold. So you want to come from behind and you want to pretty firmly hold your baby behind the ears. Now this way you can kind of direct their head and it won't hurt them. Most babies don't like to have the back of their head pushed on, but they won't mind if you hold them behind the ear. And then if you take a hold of your breast from behind in kind of in a C form, you actually want to align your baby up so that the baby's nose is right across from your nipple and your baby's going to be right tummy-to-tummy.

Lee Ann (19:21):
So when you line the baby's nose up right across from your nipple and you wait for them to get what I call a rooting mouth. And it's almost like if you've seen pictures of a little bird with a big open mouth, and then you want them to have their chin kind of against your breast. And as their mouth is open, you want to bring them chin first and then push them into the breast, that way. So by doing that, lining them nose-to-nipple, they're going to kind of come underneath the nipple onto the breasts, not really straight on the nipple this way. And the reason you want to do that is because if you think about this is the nipple, you want the nipple to go to the baby's roof of the mouth instead of coming on straight. Because when they do that, they can pinch the nipple with the gums.

Lee Ann (20:22):
There is a bone underneath that gum. And if they get just the tip of the nipple. It will hurt you. You'll feel that pinching sensation. But if they get the nipple to the roof of their mouth, as they suck, what it will feel is more of a tugging sensation because the nipple will be between the soft palate and the tongue. Two soft surfaces. So as they suck that rhythm of the tongue will be underneath and then the soft palate will be at the top. So you shouldn't feel a pinching or more like a biding sensation. It should feel more like a rhythmic tugging. And that way as the chin is moving up against the breast, then the baby will be also massaging the breast. And that will also help with transfer of the milk. So remember belly to belly, nose, to nipple as the baby roots, bring the chin in, and don't be afraid to push the baby in as close as possible.

Lee Ann (21:27):
So signs of a good latch, you will see the baby's jaw and ear moving. You'll be able to feel that tug. The suck-suck-pause rhythm is what you'll see. The chin will be touching the breast and the nose will be out free and the baby will stay latched. Not coming off and on the breast.

Lee Ann (21:50):
Signs of an incorrect latch will be the baby's cheeks will be indenting like right here. You might see baby's head moving frequently. They won't be staying latched. And you might hear sounds of clicking or popping sounds. You'll have a painful latch, which later will maybe produce some trauma to the mom's nipples. And because the baby's not transferring milk well, you might find that you'll have a low milk supply and the baby won't be gaining weight like they should be. Everything always drills kind of back to that latch. If the latch isn't good, mom will be having painful latch, trauma to the nipples and the baby won't be gaining weight like it should. The next couple slides gives you an example of a cross cradle hold what we call a football hold.

Lee Ann (22:49):
And then the next slide shows us how that baby comes to the breast chin first. And you see mom is kind of compressed the breast. So once she gets that baby to the breast chin first, all she has to do is tip the head forward and the baby will have a great deep latch. The next slide shows the baby in what's called a latchable state. So we talked about, you know, those signs of hunger, where the baby's rooting, looking for something to suck. I'm sucking my fingers. I'm licking my lips. What you don't want to wait for is the baby to cry, because that was what we call a late hunger sign. Sometimes if they're crying, then when we try to get them latched, they're almost to the point they're too, too hungry. Then they get frustrated and then it becomes a frustration for mom and for baby.

Lee Ann (23:46):
You almost have to get them calmed back down before we can try this again. Now, something interesting. I usually what I see for most babies, they come out of the womb, very alert, ready to nurse within the first hour, after about hour five or so, they go into a little bit of a sleepy state. You know, birth is hard. Birth is exhausting. So they'll go into a little bit of a recovery period where they want to sleep. And maybe even that period will last up to 24 hours. They may wake to, you know, eat, and then they'll go back into a little bit of a sleepy period. But what happens usually after 24 hours and especially in the second night, they wake up and they want to eat constantly. We call it the second night syndrome. They want to eat all night long that night.

Lee Ann (24:35):
And moms are like, what is going on here? Am I, do I have enough milk? Is baby starving? Now, what do I do? And most moms begin to doubt that their babies are getting enough. And this is where they begin to think, do I need to give the baby some formula? Do I need to supplement? And the truth is, this is how babies get your milk to come in. They feed frequently, and this is what's causing a hormone change to happen in your body. So that that milk changes from colostrum to mature milk. Because honestly the hormone process takes about 72 hours. Now, most moms don't know this, but your baby has stored up for this time in the womb. Your baby, a normal, healthy newborn has three days of storage to get them through this period. So it's virtually almost impossible for your newborn to starve to death, even though they may act like they're starving to death.

Lee Ann (25:39):
So you just keep putting them to the breast and what's going to happen after that hormone reaches a certain level, that milk's going to come in. It's just going to almost come in all of a sudden, and your full milk will be there. So you just keep putting the baby to breast. I know it's maddening and you're tired and your partner's tired, but it will happen. I promise. And you can get through it. You just have to kind of power through it. The other thing they might want to do, and the next slide is, is offer a pacifier. And honestly, the question on the, on the slide says, do pacifiers hurt breastfeeding? And there's been studies that say that pacifiers offered in the early days, actually do decrease breast milk production. We know that. And so we've kind of tried to encourage moms not to use pacifiers while they're here in the hospital.

Lee Ann (26:42):
Now, I know there's sometimes that parents bring pacifiers themselves. And, I'm going to say that if your baby's showing signs that they want to suck and use a pacifier, the best thing to do is just put the baby back to breast. Using a pacifier should be deferred until that baby has really gotten very good at breastfeeding. And we think that's at least three weeks of age. We also do room in which allows you to be able to see those hunger signs and put the baby to breast early. We've done that for a long time. I think it works out great. And I think moms feel better when the baby's in the room with them and they can tell, you know, what's going on with their baby. So that's something that we've done for a long period of time.

Lee Ann (27:36):
Problems that can occur with breastfeeding. You know, there are some things that can happen. Mastitis is a breast infection that can happen. Usually you'll get a redness in one breast, anytime that you have a fever and you're breastfeeding, we would assume that that is mastitis. You would need to contact your provider to see whether or not he or she would recommend an antibiotic. It's not something that passes to the baby. You need to keep breastfeeding. Cracked or bleeding nipples is always usually a sign of a poor latch. So we need to see you about that, to see if we can help you with your latch. Decreased milk supply can also be a result of a poor latch or maybe not feeding the baby frequently enough. Typically, milk supply comes from emptying the breast, emptying the breast frequently enough, and that would be also having to do with the latch. Engorgement can come after the first couple of days if the baby's not latching well. So if that, you know, is a problem, we can also give you some tips on that. Treatment could be using some warm compresses or ice in between feedings. Pumping, if you have a pump could help to relieve that too.

Lee Ann (28:57):
After you're discharged some things to know, to look for to see that your baby's having a good latch and getting enough milk. One of the things I always tell moms is, do you hear that baby swallowing at the breast? Can you hear a suck-suck-suck sound. Is this is the baby swallowing? Babies lose weight in the hospital, which is totally normal. And as long as they don't lose more than 10% of their birth weight, they're fine. Our pediatricians always want to see you within three to five days after discharge so that they can check a weight. Most babies will get back to their birth weight, but at least two weeks of age.

Lee Ann (29:36):
While they're in the hospital, they'll have kind of a dark greenish bowel movements called meconium. But by a week of age, they should be having yellow seedy stools. And by then they should be having at least three to four seedy stools a day. In the hospital, they'll have one or two wet diapers a day, but by a week of age, they should be having up to six wet diapers a day. So if they're not having enough, wetter, poopy diapers, that should be a concern.

Lee Ann (30:03):
And they should be having times what's your milk is in that they act satisfied. Until then they may be fussy, but once your milk is in, they should be having times and periods where we laugh and we call it milk drunk. You'll feel them as their feeding start to relax against you. Their hands, once they're hungry, they'll be clenched. But as they start to feel full, they'll start to relax and you'll start to see them and feel them relax against you. Adequate weight gain, like we talked about.

Lee Ann (30:35):
And of course, if you need help, at the end of this video there will be able to put up my number where you can call for help and consultation. If you need some extra help in the first couple of weeks of breastfeeding.

Lee Ann (30:51):
The last slide is a little bit of help to know what to do, if you're going back to work and how much pumped milk you would need to pump. It kind of goes by the baby's weight. And we usually tell you that if you take your baby's weight and times of by 2.5, that'll tell you how many ounces a day a baby needs. And then you divide that by how many times they're feeding. And that will tell you how many ounces per feeding they're taking. Now most babies will max out at somewhere between 32 to 34 ounces a day.

Lee Ann (31:23):
So if you're going back to work at six to eight weeks, I usually recommend that you start to offer a bottle somewhere between four and six weeks so that they get used to taking a bottle. Most moms can't give the baby a bottle. It usually has to be someone else because they like to breastfeed when they smell you. And I wouldn't wait much longer than six weeks to introduce a bottle. So they do get used to taking a bottle because if you wait much longer than six weeks, then they may not want to take a bottle and they just want to breastfeed. So it's kind of a fine line in that.

Lee Ann (31:58):
And then the CDC does offer a great milk storage guides. Most breast milk you can leave out on in room temperature, somewhere between three and four hours. In the refrigerator, you can usually leave at four to six days and you can freeze breast milk up to six months. So there's lots of good storage guides out there on the CDC website, so that you'll know exactly how to store your breast milk.

Lee Ann (32:25):
So the last slide tells it all. Breast milk: it does a baby good. As you can see this baby says, he thinks it rocks. So congratulations again on your newborn and your decision to breastfeed. We're going to give, a link to the Stanford school of medicine that has some great videos, but this one is about how to get started with breastfeeding. It also shows you some great tips on latching. Thank you again for joining us. And if you have any questions, they're going to put up my number, give me a call and I'll be happy to answer any questions you have. Have a great day.