What to expect when you're expecting (174 page)

Nursing and the NICU Baby

If your baby has to be in the neonatal intensive care unit (NICU) for any reason and can’t go home with you, don’t give up on breastfeeding. Babies who are premature or have other problems do better on breast milk, even when they’re not ready to tackle a breast. Talk to your baby’s neonatologist and the nurse in charge to see how you can best feed your baby in this situation. If you can’t nurse directly, perhaps you can pump milk to be given to your baby via tube feeding or bottle. If even this isn’t possible, see if you can keep pumping milk to keep your supply up until your baby is ready to feed from you directly.

Go for empty. Ideally, at least one breast should be “emptied” at each feeding—and this is actually more important than being sure that baby feeds from both breasts. When a breast isn’t sufficiently drained, baby doesn’t get to the hind milk, which comes at the end of a feeding and contains more of the calories baby needs to gain weight than the milk that comes first (foremilk is baby’s thirst quencher; hind milk’s the body builder). Hind milk is also more satiating, which means it keeps baby’s tank fuller longer. So don’t pull the plug just because your baby has fed for 15 minutes on breast number one—wait until he or she seems ready to quit. Then offer the second breast, but don’t force it. Remember to start the next feeding on the breast that baby nursed from last and didn’t empty completely.

Breastfeeding Basics

1.
Pick a quiet location. Until you and baby have breastfeeding down pat, set yourselves up in an area that has few distractions and a low noise level.

2.
Have a beverage at your side so you can drink as baby drinks. Avoid anything hot (which could scald you or your baby if it spilled); if you’re not thirsting for a cold drink, opt instead for something lukewarm. Add a healthy snack, if it’s been a while since your last meal.

3.
As you become more comfortable with breastfeeding, you can keep a book or magazine handy to keep you busy during marathon feeding sessions. (But don’t forget to put your reading matter down periodically so you can interact with your nursing infant.) In the early weeks, turning on the TV could be too distracting. So can talking on the phone; turn down the ringer and let voice mail pick up messages—or have someone else answer.

4.
Get comfy. If you’re sitting up, a pillow across your lap can help raise your baby to a comfortable height. Make sure, too, that your arms are propped up on a pillow or chair arms. Trying to hold 6 to 8 pounds without support can lead to arm cramps and pain. And put up your legs, if you can.

5.
Position your baby on his or her side, facing your nipple. Make sure baby’s whole body is facing you—tummy to tummy—with ear, shoulder, and hip in a straight line. You don’t want your baby’s head turned to the side; rather, it should be straight in line with his or her body. (Imagine how difficult it would be for you to drink and swallow while turning your head to the side. It’s the same for your baby.) Proper positioning is essential to prevent nipple soreness and other breastfeeding problems.

Lactation specialists recommend two nursing positions during the first few weeks. The first is called the crossover hold: Hold your baby’s head with the opposite hand (if nursing on the right breast, hold your baby with your left hand). Rest your hand between your baby’s shoulder blades, your thumb behind one ear, your other fingers behind the other ear. Using your other hand, cup your breast, placing your thumb above your nipple and areola (the dark area) at the spot where your baby’s nose will touch your breast. Your index finger should be at the spot where your baby’s chin will touch the breast.
Lightly
compress your breast so your nipple points slightly toward your baby’s nose. You are now ready to have baby latch on (see step 6).

Crossover hold

Football hold

The second position is called the football hold. This position, also called the clutch hold, is especially useful if you’ve had a C-section and want to avoid placing your baby against your abdomen; or if your breasts are large; or if your baby is small or premature; or if you are nursing twins: Position your baby at your side in a semisitting position facing you, with his or her legs under your arm (your right arm if you’re nursing on the right breast). Support your baby’s head with your right hand and cup your breast as you would for the crossover hold.

As soon as you’re more comfortable with nursing, you can add the cradle hold, in which your baby’s head rests in the crook of your arm, and the side-lying hold, in which you and your baby lie on your sides, tummy to tummy. This position is a good choice when you’re nursing in the middle of the night.

6.
Gently tickle your baby’s lips with your nipple until his or her mouth is opened very wide, like a yawn. Some lactation specialists suggest directing your nipple toward your baby’s nose and then down to the upper lip to get your baby to open his or her mouth very wide. This prevents the lower lip from getting tucked in during nursing. If your baby turns his or her head away, gently stroke his or her cheek on the side nearest you. The rooting reflex will make baby turn his or her head toward your breast.

7.
Once that little mouth is opened wide, move your baby closer. Do not move your breast toward your baby. Many latching-on problems occur because mom is hunched over baby, trying to shove breast into mouth. Instead, keep your back straight and bring your baby to your breast.

8.
Don’t stuff your nipple in an unwilling mouth; let your baby take the initiative. It might take a couple of attempts before your baby opens his or her mouth wide enough to latch on properly.

9.
Be sure baby latches on to both the nipple and the areola that surrounds it. Sucking on just the nipple won’t compress the milk glands and can cause soreness and cracking. Also be sure that it’s the nipple and areola that the baby is busily milking. Some infants are so eager to suck that they will latch on to any part of the breast (even if no milk is delivered), causing a painful bruise.

10.
If your breast is blocking your baby’s nose,
lightly
depress the breast with your finger. Elevating baby slightly may also help provide a little breathing room. But as you maneuver, be sure not to loosen his or her grip on the areola.

11.
Check for swallowing. You can be sure that milk is flowing if there is a strong, steady, rhythmic motion visible in your baby’s cheek.

12.
If your baby has finished suckling but is still holding on to the breast, pulling it out abruptly can cause injury to your nipple. Instead, break the suction first by depressing the breast or by putting your finger into the corner of the baby’s mouth to let in some air.

Cradle hold

Side-lying hold

Keeping Track

To be sure each breast gets a chance to be stimulated, use a reminder such as a notation in your breastfeeding journal, a small scrunchie looped around your bra strap, or a bracelet on your wrist to indicate which side you nursed from last. At your next feeding, just start with the other side (and switch the scrunchie or bracelet to the other side, too).

Don’t let sleeping babies lie if it means that they’ll sleep through a feeding. Some babies, especially in the first few days of life, may not wake often enough for nourishment. If it’s been three hours since your newborn last fed, then it’s time for a wake-up call. Here’s one way to accomplish this. First, unwrap your baby if he or she is swaddled or heavily dressed; the cool air will help begin the waking process. Then try sitting baby up, one hand supporting the back and the other holding the chin, and rub the back gently. Massaging the arms and legs or dabbing a little cool water on the forehead may help, too. The moment baby stirs, quickly adopt the nursing position. Or lay your sleeping baby on your bare chest. Babies have a keen sense of smell, and the aroma of your breast may awaken him or her.