# Presentation: 664765

## Slide 1

## 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

## 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

## Core Area #1Making A Good Milk Supply

## How Mothers Make Milk:Role 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

## How Mothers Make Milk:Role of the Brain

- Baby’s suckling signals the brain to produce hormones
- Prolactin* *
- Oxytocin
- Milk Ejection Reflex (MER) releases milk
- The more MERs, the more milk for baby

## 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

## Baby’s 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

## 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

## Core Area #2Attaching 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

## Step 1: Get Comfortable

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

## Step 2: Position the Baby Facing the Breast

- Baby should not have to turn his head
- Turn baby so his body faces the mother’s body (“chest to chest, chin to breast”)
- Body should be in a straight line, not curled under

## Step 3: Support the Breast

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

## Step 4: Connect

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

## Latching the Baby

## What’s Wrong with this Picture?

## What’s Wrong with this Picture?

## What’s Wrong with this Picture?

## What’s Wrong with this Picture?

## Positioning Practice

## Other Breastfeeding Positions

## Core Area #3Tips for Early Success

- Watch the baby, not the clock
- Baby’s 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

## 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

## Allow Baby to Finishthe 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

## Breast Compression

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

## 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

## 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

## 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 mother’s cues for how often to call
- Remember mothers value someone checking on them

## 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 he’s ready to eat?

## “Being a peer counselor has allowed methe 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 proudto have made a difference in her life.”
WIC Peer Counselor

- WIC Peer Counselor