Breastfeeding

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Find out why breastmilk is best for baby and how you can breastfeed successfully. Also get tips on how working moms can continue to give breastmilk to baby.

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  1. Breastfeed - Give Your Child a Headstart
  2. Breastfeeding for Working Mothers
  3. Breastfeeding - Commonly Asked Questions

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Give Your Child a Headstart

Breastfeeding Your Baby

Congratulations! Now that your baby has arrived, perhaps one of the most immediate decisions for you is whether to breastfeed.

At KK Women's and Children's Hospital, we are committed to promoting breastfeeding because of the benefits for both mother and child.

Breastmilk is the best food for your baby as it contains all the nutrition that your baby needs in his first 6 months.

Furthermore, through your milk, your child will acquire the immunity which you have developed against certain illnesses.

More significantly, breastfeeding enhances the bond between you and your baby. Mothers who breastfeed often feel a strong sense of closeness towards their babies and vice versa.

To help you enjoy these benefits, we have prepared this guide to help you breastfeed successfully. We hope that you will find it helpful and we welcome your feedback.

Benefits For The Baby

Complete nutrition. It contains all the nutrients babies need for the first 4 to 6 months of age.

Counters risk of infection. Colostrum, the early milk produced after birth, is rich in antibodies. These antibodies help the baby fight against infections e.g. diarrhoea and respiratory infections. Breastfed babies are also less prone to allergies, colic and constipation.

Comfort and security as your baby feeds from your breast.

Benefits For The Mother Convenience

There is no need for bottles, sterilisation or temperature check.

Cleanliness

Breastmilk is free of germs and washing your nipples with water once daily is sufficient.

Cost saving

Breastmilk does not cost money and saves you paying for formula feeds.

Contraction of the womb

When baby suckles, this reduces the chance of severe bleeding and speeds up the return of the womb to pre-pregnancy size.

Confidence

It builds the mother's confidence as she fulfills the child's emotional and physical needs.

Child spacing

Breastfeeding delays the return of menstruation and can help you plan your family if you are fully breastfeeding for the first 6 months.

Cancers

Risk of breast cancer is reduced in women who breastfeed.

Calories

During breastfeeding, calories are used up and the fat stored around the hips and thighs during pregnancy may be lost if a sensible diet is followed.

Preparation For Breastfeeding

You should be prepared physically, mentally and emotionally.

Physical preparation

  • Maintain a well-balanced diet during and after pregnancy. Increase intake of meats, vegetables and fruits.
  • Have a breast examination by your doctor / midwife to check if you need help.
  • Prepare your wardrobe for breastfeeding. Get a good support nursing bra by the 7th month of pregnancy. Acquire loose blouse / T-shirt or 2-piece clothing.

Mental and emotional preparation

  • Read updated materials on breastfeeding
  • Plan how long you would breastfeed your baby.
  • Attend a breastfeeding talk with your spouse as early as possible.
  • Know where to source for help if needed.
  • Have a positive attitude and be confident that you can and will succeed.

Tips For Successful Breastfeeding

Your baby's first feed should be as soon as possible after delivery, ideally within the first hour of birth.

Feed your baby according to his needs and allow him to feed for as long as he wants. A healthy baby usually has 8 - 10 feeds in a day or, once every 2 - 3 hours. Total breastfeeding with no supplement helps to establish your milk supply and reduce the chance of engorgement.

Some mothers may experience difficulties in breastfeeding such as attaching their babies or pain in the nipple. These can be reduced by ensuring that your baby is held correctly and attached in the appropriate manner.

Technique Of Attachment When Breastfeeding

The following is a step-by-step guide to attaching your baby to your breast.


Support your baby at your breast level with his body turned on the side and his mouth facing your nipple.


Support your breast with 4 fingers below and the thumb by the side, away from the areola.


Tease your baby's lower lip with your nipple to get him to open his mouth.


Bring your baby to the breast when he opens his mouth wide.


Make sure that your baby grasps as much of the areola (the dark ring surrounding the nipple) as possible.

You are holding your baby correctly if you observe the following signs:

  • Your baby's head and body are supported as your breast level.
  • Your baby's chin is touching your breast.
  • Your baby's mouth is wide open, covering the areola.
  • Your baby's gum is covered by his tongue.
  • Your baby's lips form a seal on your breast, with the lower lip turned out.

Below are three other positions which you may adopt when you breastfeed:

Side lying position

Football position

Modified cradle hold position
- Ideal for small infants and newborns

Signs of correct sucking:

  • No pain or discomfort in your nipple
  • Your baby's jaw is moving rhythmically
  • You are able to see or hear him swallowing the milk
  • Your baby's ears are wiggling
  • No clicking sound from your baby
  • Your baby's cheeks are not drawn in

Feeding

You are encouraged to allow your baby to finish his feed from the first breast and letting him detach himself. Refrain from terminating the feeding by actively removing your baby from your breast. Finishing a feed from each breast is satisfying for your baby because of the high caloric content of hind milk. Always offer the second breast to your baby. Alternate your breasts for subsequent feeds.

Burp your baby after a feed from each breast. Your baby may have swallowed some wind if he cried before the feed.

How do I know if my baby is getting enough milk

A baby who has enough is contented and wets about 6 to 8 nappies in 24 hours. Urine should look clear. Although during the first 2 days after birth, your baby may only wet 2 to 3 nappies in 24 hours. The number of wet nappies will increase by the 4th and 5th day with the increase in milk supply. Your baby may have 3 to 8 stools (usually loose and soft) per day. Older babies may pass their stools less frequently.

Observations during the first week

Minimum

Day Type of stools Stools Urine
1 Sticky green black 2 2
2 Soft green black 3 3
3 Less sticky greenish brown 3 4
4 Lighter greenish brown/ Mustard yellow 3 4
5 Soft/ loose mustard yellow 3 5

Your breasts may feel full before a feed and after feeding feel less full and soft. You may leak between feedings or leak on one side while feeding on the other.

During a feed, you will feel your baby sucking vigorously and hear him swallowing. As long as your baby is healthy, gaining weight and looks happy, he will be ok.

Caring For Your Breast

You are encouraged to clean your breast at least once a day for hygiene purposes. However, avoid using soap on your nipple and areola as this may cause dryness to the area.

Air dry your nipples after each feed before putting on your clothes. Change the wet nursing pad frequently.

Breastfeeding After A Caesarean Birth

Early initiation of breastfeeding after a caesarean birth is as important as it is after a normal delivery.

Breastfeed your baby as soon as possible after you have regained consciousness if you have undergone general anaesthesia.

If have undergone epidural or spinal anaesthesia for your caesarean section, you can breastfeed immediately after birth. Skin-to-skin contact with your baby in the operating theatre or recovery area can be performed if both you and your baby are well. This early contact will encourage your baby to search for the breast and initiate early breastfeeding.

If you are on an intravenous drip, ask for assistance when holding and positioning your baby. Having your husband or a family member around would be helpful too.

Prop yourself up on your bed or lie on your side to breastfeed your baby.

Once you are able to sit up, you are encouraged to adopt the football hold position when you breastfeed. This will help to keep your baby from causing discomfort to your wound.

If your baby cannot be breastfed for certain reasons, express your breastmilk to prevent engorgement and to initiate lactation. This will ensure that the valuable colostrum can still be given to your baby.

Expressing Breastmilk For Your Baby

In instances where you are not able to breastfeed your baby directly or if your baby is unable to breastfeed for some reasons, you can still provide your baby with breast milk when you begin expressing your breast milk as soon as possible.

Expressing helps to initiate and establish lactatiOn. It also helps to relieve blocked ducts. If your breast is engorged, expressing some milk will help to relieve the discomfort and enable your baby to grasp the areola properly.

How much milk will I expect to express?

During the first few days after birth, your breasts produce colostrums in small quantities from few drops to up to 30ml per expression. As you continue to express regularly, your milk volume will increase.

Preparation For Expressing Breastmilk

Ensure all equipments are sterilised before use.

In the hospital, expressing kits comprising of disposable pump kits and bottles are made available for you to use with the hospital grade electric pump. You will need to purchase your own breast pump before you go home.

Think about your baby to help stimulate milk flow.

Adopt a comfortable and relaxed position.

Breast Massage

Wash your hands and clean your breast with a wet towerl, paying attention to the nipple area to clear away any dried milk remains.

Massage your nipple and areola using your thumb and index finger.

Compress the breast with both hands and using the pulp of your fingers, massage the main area of the breast, covering all parts of the breast.

Ways Of Expressing Breastmilk

You can choose to express your milk by hand or by using a pump, which you can purchase or rent. You are encouraged to adopt the method that best suits you.

Expressing by hand

Place your forefinger and thumb at the edge of the areola and press back firmly against your breast. Then bring your fingers together and compress the areola using the finger pads.

You are encouraged to compress your breast following a rhythm when expressing milk.

Expressing by hand pumps

You are advised to use the hand held pump, which allows your control over the suction.

Expressing by battery-operated or electric pump

If you choose to use the battery-operated or electric pump, remember to begin with the minimum power before increasing the intensity to the point which you are comfortable with.

How Often And How Long Do I Need To Express

A newborn usually feeds every 2 to 3 hours. Ideally, the number of expressions per day should be the same as that of normal breast-feeding.

Express your breast milk approximately 8 to 10 times throughout the day and night.

Ensure that the flange of the pump is placed over the areola to form a complete seal, as your baby's mouth would when you breastfeed.

Pump continuously for 5 minutes, alternating each breast. Your breasts need about 10 to 15 minutes of expressing each side to stimulate milk production.

Each session should not last more than 30 minutes in order not to tire yourself.

When your milk supply is established, the length of time you need to express may vary. You will know your breasts are drained when they feel soft and lump free.

Sterilisation Of Storage Containers And Breast Pumps

  • Rinse all parts that come into contact with your breast milk.
  • Wash in soapy water and rinse thoroughly
  • Sterilise using steaming, boiling or chemical soaking method

Steaming

Follow the manufacturer's instruction.

Boiling

Submerge washed expressing kits in a container of clean water. Cover the container and allow water to boil. Let water boil for another 10 minutes. Allow water to cool after boiling and discard from container. Leave the sterilised kits covered in the container.

Chemical soaking method

Use a plastic container with a lid that can hold all the expressing kits. Follow manufacturer's instructions on use of sterilising agent and prepare the solution. Submerge and soak washed expressing kits for at least an hour, without adding anything in. Change the solution everyday.

  • Store all expressing kit in a clean dry container until your next expression
  • Wash your hands with soap and water before picking up the sterilised items.

Storing Your Expressed Breastmilk

When storing expressed milk, always remember to use a sterilised bottle.

You should also label all the containers with the date and time of collection.

Expressed milk can be stored in the following:

Location Temperature Duration
Room temperature 25°C 4 hours
Refrigerator at 4°C 48 hours
Separate door freezer -5 to -15°C 3 to 6 months
Deep freezer -18 to -20°C 6 to 12 months

Thawing expressed breastmilk

For quick thawing of frozen breastmilk, allow it to stand in warm water for 10 minutes.

Alternatively, you may choose to thaw the milk in the refrigerator. Milk thawed this way can be stored up to 24 hours if placed in the refrigerator.

You may warm the milk by standing it in a bowl of warm water before feeding your baby.

Shake the container before feeding.

Do not boil the milk or warm it in the microwave oven.

Excess milk left in the container after a feed should be discarded. Never refreeze milk that has been thawed.

Transportation Of Breastmilk

Carry the bottles of expressed breastmilk in a cooler box with ice packs or reusable ice blocks. Once you reach your destination, transfer the bottles into the refrigerator or freezer.

How to increase your milk supply

  • Begin to breastfeed as soon as possible
  • Encourage skin to skin contact with your baby
  • Breastfeed or Express breastmilk at least 8 times per day
  • Ensure you have adequate rest and rest especially while you are expressing
  • Take a well balanced diet, avoid skipping meals
  • Drinking at least 6 to 8 glasses of water a day

Working And Breastfeeding

You may adopt one of the following options to enable you to continue with breastfeeding while working.

Total breastfeeding

Express your milk while at work so that it may be given to your baby the next day. And you can breastfeed your baby directly when you are with him.

You may start introducing a bottle of expressed milk to your baby at about 4 weeks after birth. Use a softer, latex teat to facilitate the transition from breast to bottle. Gradually increase the number of expressed milk feeds at about 2 weeks before you start work.

Partial breastfeeding

Give your baby formula milk when you are at work and breastfeed when you are with him.

About 2 weeks before you start work, gradually wean off the breast feeds which you will not be feeding your baby and replace with formula.

    Solutions To Some Problems In Breastfeeding

    Sore Nipples

    These often occur when you first start breastfeeding. To prevent having sore nipples, ensure your baby is positioned correctly.

    • After feeding, express a little milk on your nipples and let them air dry.
    • You may want to go without a bra for a while everyday.
    • If soreness continues, express your milk by hand or a pump 6 to 8 times a day and give this milk to your baby.

    Full Breasts

    The early fullness usually subsides within a few days. If your breasts are very full, your baby may have trouble attaching to your breast. You may have to:

    • Massage your breasts
    • Express a little milk to soften the areola before feeding your baby.

    Engorgement

    This is the accumulation of milk in the breasts resulting in hardness, over distension, discomfort or pain.

    Engorgement may be minimised by demand feeding, including night feeding and early feeding from birth.

    You may adopt the following techniques to reduce the discomfort caused by engorgement:

    • Massage your nipple, areola and breast to clear any blockage.
    • Apply cold towels or cabbage leaves on the breasts in between feeding to reduce the swelling.
    • Express a little breastmilk before and after each feed to relieve the tension.
    • Analgesic (e.g. Panadol) may be taken to relieve the pain.

    Blocked Milk Ducts

    This occurs when the milk is not being 'emptied' efficiently. Blocked ducts may cause part of your breast to feel lumpy, hard or sore. To unblock the ducts:

    • Gently massage the nipple, areola and affected area before feeding to clear the blockage.
    • Apply cold towels or cabbage leaves on the affected area
    • Change your feeding position e.g. to football hold

    If any part of your breast is red and/or painful, and/or if you feel shivery or feverish, seek medical attention immediately. There may be a breast infection. Continue breastfeeding to empty the affected breast and to maintain your milk supply. In most cases, you should be able to continue to breastfeed your baby. If in doubt, consult your doctor or a lactation consultant immediately.

    Consulting A Breastfeeding Counsellor

    You should find breastfeeding a fulfilling experience as it enhances your relationship with your baby. Many women who breastfeed find that they are closer to their babies. You are encouraged to consult a breastfeeding counsellor if you have any enquiries or if you notice the following:

    • Your nipples are sore and painful
    • Your breasts are hard and painful
    • Your baby is extremely agitated when you breastfeed him

    For more information, please call:

    • KKH Lactation Service
      +65 6225 5554 
      (Our Call Centre Assistants will help you contact our Lactation Consultants to return your call or to arrange an appointment to see them at the Lactation Clinic.)
    • Breastfeeding Mothers' Support Group(s)
      +65 6339 3558
    • Joyful Parenting and Breastfeeding Hotline
      +65 6488 0286
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