Learning Objectives

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Learning Objectives

• Identify 3 components necessary for making a
  healthy milk supply
• Demonstrate proper technique for positioning the
  baby at the breast
• List 3 ways to know baby is getting sufficient
  breast milk
• Identify situations in which the peer counselor
  should refer a mother experiencing concerns
  outside her scope of practice

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What to Expect

• Anticipatory guidance helps mothers know what to
  expect
• Prevents common concerns and improves confidence
• Information is retained better when peer
  counselors
• Provide information in short, easy to remember
  segments
• Focus on the basics
• Affirm the mother often

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Core Area 1Making A Good Milk Supply
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How Mothers Make MilkRole of the Breast

• Milk production occurs in the alveoli
• Milk is squeezed through the milk ducts
• Milk is finally released through openings in the
  nipple

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How Mothers Make MilkRole of the Brain

• Babys suckling signals the brain to produce
  hormones
• Prolactin
• Oxytocin
• Milk Ejection Reflex (MER) releases milk
• The more MERs, the more milk for baby

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How Mothers Make Milk Role of the Baby

• Suckling signals the release of milk-producing
  hormones
• When baby removes milk, more milk is made
• Frequent milk removal (8-12 times every 24
  hours) is needed for a healthy milk supply
• If baby cannot remove milk, a pump is needed

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Babys First Milk

• Colostrum days 1-3
• Low in quantity
• High in infection-fighting ingredients
• Higher volume milk days 2-5
• Mature milk by 2nd week
• Milk at beginning of feed is high in protein,
  low in fat
• Milk later in feed is higher in fat

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Facts About Milk Supply

• Breast size does not determine milk producing
  capability
• Breasts are unique
• Mother does not need to drink milk to make milk
• Being worried or upset does not spoil milk
• Some herbs and medications may affect milk supply

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Core Area 2Attaching Baby to the Breast

• Breasts can be tender in the first few days
• Positioning and latching baby correctly can
  prevent soreness
• The early days are a time to learn how to
  breastfeed
• If breastfeeding is painful, the mother should
  seek help

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Step 1 Get Comfortable

• Pillows everywhere
• Sit up straight, not hunched over
• Feet flat on the floor or supported with a book
  or box

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Step 2 Position the Baby Facing the Breast

• Baby should not have to turn his head
• Turn baby so his body faces the mothers body
  (chest to chest, chin to breast)
• Body should be in a straight line, not curled
  under

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Step 3 Support the Breast

• Place fingers underneath breast, thumb on top,
  against the chest wall

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Step 4 Connect

• Babys chin should touch breast nose is aimed
  toward top of moms nipple
• Touch babys upper lip and wait for open mouth
• Quickly move baby onto breast
• Baby is latched when
• Large part of dark area is covered by babys
  bottom lip
• Babys lips are flanged
• Mother is free from pain

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Latching the Baby
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Whats Wrong with this Picture?
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Whats Wrong with this Picture?
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Whats Wrong with this Picture?
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Whats Wrong with this Picture?
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Positioning Practice
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Other Breastfeeding Positions
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Core Area 3Tips for Early Success

• Watch the baby, not the clock
• Babys stomach is too small in the early days to
  hold much
• Breast milk is digested within 1.5 hours
• Breastfeed within an hour after delivery
• Keep baby close so he can breastfeed frequently,
  8-12 times every 24 hours
• Cluster feeding is normal

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Cues That Baby is Ready to Eat

• Common cues
• Smacking lips
• Sucking on his hand
• Moving head around
• Rooting
• Crying is a late sign of hunger
• Sleepy babies may need help to wake up

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Allow Baby to Finishthe First Breast First

• Babies have unique feeding styles
• Not limiting feeds helps baby get plenty of fat
  so he feels full
• Offer the first breast for as long as baby is
  drinking milk, watching for swallowing
• Use breast compression to keep baby interested
• After 30 minutes, offer second breast
• End the feeding when baby is no longer drinking
  or releases his attachment on his own

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Breast Compression

• When baby stops suckling/swallowing, gently
  squeeze breast
• Hold for around 15-20 suck/swallow/breathe
  cycles
• Release
• Repeat

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Avoid Bottles and Pacifiers

• Babies can find it hard to learn several skills
  at once
• Give baby time to learn to breastfeed before
  offering other nipples
• Some babies prefer bottle nipples because the
  milk flows faster
• There is no way to tell which baby will prefer
  another nipple besides the breast

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How to Know Breastfeeding is Going Well

• Baby feeds 8-12 times every 24 hours, including
  at night
• Swallowing can be heard
• Breasts soften during the feeding
• Baby has plenty of wet and dirty diapers
• expect 3-5 urines and 3-4 poops per day by 3-5
  days of age
• expect 4-6 urines and 3-6 poops per day by 5-7
  days of age
• Stools turn yellow and seedy by day 3

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When to Contact Mothers

• Frequent calls every day or two to check on the
  mother and baby
• Call within 24 hours if mother is having
  problems, and seek help from your designated WIC
  breastfeeding expert
• Follow the mothers cues for how often to call
• Remember mothers value someone checking on them

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Opening the Conversation with Mothers

• How is breastfeeding going?
• What do you know about how your body makes milk?
• Who has been helping you with breastfeeding?
• How does breastfeeding feel to you?
• What kind of visitors have you had? What do
  they say to you about breastfeeding?
• How is your baby showing you hes ready to eat?

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• Being a peer counselor has allowed methe
  opportunity to help new moms do the best they can
  to give their babies the healthiest start
  possible. When a mom tells me how helpful I was,
  it makes me proudto have made a difference in
  her life.
• WIC Peer Counselor