Notes From "Breastfeeding Basics" Discussion Meeting

As part of my training to become a breastfeeding counsellor today I ran a discussion meeting on the topic of "breastfeeding basics" in my local Australian Breastfeeding Association Group. Below are the notes I wrote in preparation for the meeting (based on information taken for Breastfeeding...Naturally a wonderfully easy to read and informative book about breastfeeding which all ABA subscribers receive free when they join).

To help demonstrate positioning and attachment I bought some rubber stress balls made to look like breasts and donated these to the group for future use. They were VERY popular with the children. The dolls are used in Breastfeeding Education Classes in our region to demonstrate to parents-to-be the different ways to hold a baby to the breast (and also to give the parents-to-be an opporunity to try it for themselves)

Breastfeeding Basics Discussion Meeting (14/09/09) 10am-12pm.

Welcome: introduce myself. Mention that S is a trained counsellor available to answer questions and help to any mothers in need of breastfeeding management assistance throughout the meeting.
Housekeeping:
Code of ethics at meetings (3 most relevant exerts to our meetings):

• "Personal attitudes towards such matters as politics, religion, nationality, race or social standing are not allowed to influence dealings with any mother".
• " No Australian Breastfeeding Association meeting shall be used for the promotion of political, religious, racial or other causes; nor shall political, religious or racial views be expressed in Australian Breastfeeding Association written matter, or when representing the Association in public".
• "Discussion of particular doctors, hospitals, nurses or health centres is to be discouraged, either at meetings, or in conversations".

OHS issues to consider at S’s house:

• Keep hot drinks out of reach of children,
• Children running around adult feet,
• Toys on floor, tripping hazard,
• Many people (?) in a small space,
• Keeping prams out of doorways and walkways.

Introduce topic:“breastfeeding basics”.

• Child’s attachment to the breast,
• How to tell if you have adequate milk supply,
• The “let down” reflex
• Basics of how your milk is made.

Introductions & Ice-breaker:
Introduce ourselves by saying our names, our children’s names and ages and answering an ice-breaker question: “what was one of your favourite breastfeeding moments?”

Small Groups Work:
Open Questions for Discussion for Attachment and Positioning Group:

• Imagine that you are writing a “how to breastfeed manual”. What tips for getting a baby to latch-on or attach would you include?
• Have you had experience with baby-led attachment? If so, what do you recall? If not, what have you heard about baby-led attachment?
• What positions have you breastfed in? What is your favourite position to breastfeed?

“Let Down” Reflex Group:
What are some of the signs you have noticed during a feed that let you know your milk has “let down”?

• Some women experience a tingling sensation when they get let-down. Has this been your experience?
• What have you found triggers your let down?
  

Supply & Demand Group:

• Has your milk supply changed over time? If so, what factors do you think influenced these changes?
• Some children favour one breast over the other. Has this been your experience?
• Have you found your supply and feeding experiences from one breast to be different to your supply and feeding experiences on the other breast? If so, why do you think that might be?

How to Tell if You Have Adequate Supply Group:

• How does your baby let you know he or she is getting enough milk?
• Have you had supply issues (eg. Over-supply of milk or a need to increase milk supply)? If so, what was it that brought it to your attention?
• What did you do or what would you do if you discovered you had milk supply issues?
  

-Re-group as one big group and hear what each group discussed.
-After each sub-topic is covered any important information left-off, add from summaries on each topic:

Attachment and Positioning Group
“Positioning” in breastfeeding refers to how you bring your baby to your breast and positioning to ensure he or she attaches (or “latches on”) to your breast correctly.
Steps:

• Get comfortable
• Remove obstacles between you and baby (clothes, wrapping baby/covering arms)
• Position your baby (baby on her side, mouth in line with nipple, your hand should support her shoulders and neck, pull your baby in close, align her body at a slight angle, with her chin closer to your breast than her nose, her hips, tummy and chest should be against your body. Mouth and nose should be directly opposite your nipple.) Chest to chest, chin to breast.
• Encourage your baby (brush baby’s mouth with nipple and underside of areola, avoid chasing his mouth with nipple or lifting your breast, try to keep nipple in its natural position)
• Bring your baby to the breast (when baby’s mouth is wide open, tongue well forward over bottom gum quickly but gently bring baby to breast. Aim nipple towards roof of mouth, over his tongue, baby should take as much of the nipple and areola as possible, with most being on the chin side of the nipple)

Positioning and Attachment checklist:

• Baby’s mouth over the nipple and well onto areola
• Tongue forward cupping the nipple and areola
• Baby has more of the chin-side of the areola in her mouth than the side nearest her nose
• Lips will be turned out “flanged” over the breast
• Chin pressed against breast
• Head tipped back slightly
• Nose clear so she can breathe easy
• Baby will be close enough not to need to strain to hold on to the breast
• Breasts won’t feel painful beyond initial stretching of nipple

(For this part, S loaned me some sheets with diagrams showing poor and correct attachment)

If it hurts: place a clean finger at the corner of your baby’s mouth to break the suction, take your nipple out of her mouth and start again.

Baby-led attachment:
Baby-led attachment is where your baby follows his or her instincts to get to your breast:

• Get comfortable
• Calm mother and calm baby
• Skin to skin contact
• Hold baby to your body in a way that feels right (many mothers choose to hold their babies upright on their chest)
• Support baby’s head as she begins to bob around in search of the nipple. She will start to slide, crawl, fall or even throw herself towards one of your breasts, allow him or her to move freely.
• When she is ready she will dig her chin into your breast, reach up with an open mouth, and attach to the breast. You may find it helps to pull your baby’s bottom closer to your body, or to give even more firm support to her back and shoulders at this time.

“Let Down” Reflex Group

Skin covering nipple contains nerve endings which are stimulated by your child’s rapid sucking at the start of a feed. This stimulation causes your milk to pushed out of cells in your breast, down your milk ducts, toward the nipple. This is called the milk-ejection reflex, but we often hear of it being referred to as “let-down”. Does anyone want to take a guess at how long this process takes? ... It all happens in about 60 seconds.

Let down can be accompanied by a tingling sensation. In the early days after birth you might feel your uterus contracting during let-down and your milk may leak from your other breast. For those of us who don’t notice or experience those signs of let-down, we can generally tell the milk has been ejected from the breast by our child’s suckling which changes to a slower suck and swallow action.

Let down can also be triggered by the sight, sound or even thought of your baby.

(For this part S loaned me a hand out with the anatomy of a breast on it).

Supply & Demand Group

How much milk you make depends on how often your child feeds and how much milk your child takes. When milk is removed from the breast it causes more milk to be produced.

There is a special protein known as a peptide in your milk which regulates how much milk is made. This peptide builds up as your breasts fill up, this sends a message to your breasts that there is almost enough milk and they slow production as a result. The more milk removed from the breast the lower levels of this peptide become, which sends the message to your breasts that it’s time to make more milk.

Each breast works independently, so will make different amounts of milk from each other despite being on the same woman.

Even straight after a feed your breasts are not empty, they’re never empty. Does anyone want to guess approximately what percentage out of 100 of milk is taken from the breast in one feed? ... 65% Your breasts have already started making more milk by the time your child has finished his or her feed. Breastfeeding...Naturally puts it best by saying that your breasts are not at all like jugs that can only hold a certain amount of milk, they’re more like the magic pudding, automatically refilling whenever it’s eaten!

How to Tell if You Have Adequate Supply Group
Because breastmilk is designed to be digested by your baby’s system you will find your baby feeds frequently. Also, young baby’s stomachs are small (day 10 stomach is size of a golf ball). It is normal for a young baby to need 8–12 feeds in a 24-hour period. During the night it is normal for babies to feed. Even at 9 weeks of age 60% of babies feed during the night.

Feeding your baby according to need (“demand” feeding) will help build and maintain your milk supply.

• 6 to 8 pale, very wet cloth nappies in 24 hours/5 wet disposable nappies in 24 hours
• Good skin tone (when you pinch his skin does it spring back into place?) and colour
• A very young baby will usually poo daily, as weeks pass the frequency will decrease to once or twice a week. Poo should be soft and unformed.
• Alert, reasonable content for parts of the day, waking for night feeds.
• Gradual weight gain, growth in length and head circumference each month (it's important not to look at weight gain as the only sign of adequate milk supply, some babies grow slower than others and are still getting enough milk)
• Very undemanding babies who have little active awake time should be woken for feeds (at least 3 hourly during the day and once during the night).

Conclusion: thank everyone for coming, let them know where they can find more information (ABA booklet series, Breastfeeding...Naturally book, the group library) remind group that S is available for questions and breastfeeding management assistance.