Management of breastfeeding
Breasts and nipples are altered by pregnancy.Increased sebum secretion obviates the need for cream to lubricate the nipple.Women who have inverted and non-protractile nipples often find that they improve spontaneously during pregnancy.if not,help given with attaching the baby to the breast after birth often results in successful breastfeeding.Neither the wearing of Woolwich shells nor Hoffmann's exercises are of any value and should not be recommended,nor should any other unevaluated commercially available device.education of the mother is likely to be more use than any other physical exercises.if she understands how breastfeeding works,and has as opportunity to observe babies feeding.She will be better prepared for feeding her own.
The first feed
Unless individual circumstances dictate otherwise,the mother should have her baby with her immediately after birth.Early and extended contact will ensure the cues that indicate that the baby is ready to feed will not to be missed.early feeding contributes to the success of breastfeeding but the time of the first feed should,to a large extent,depend on the needs of the baby.Some may demonstrate a desire to feed almost as soon as they are an hour or so old.The first feed should be supervised by the midwife.If it proceeds without pain and if the baby is allowed to terminate the feed spontaneously,both mother and baby will have been helped to begin the learning process necessary for good breastfeeding in a happy and positive way.
The next feed
All mothers should be offered help with the next feed also.Once the baby is feeding satisfactorily the mother should be told about the cause,and therefore prevention,of sore nipples.She should be urged to seek help if problems do arise.She should be told about the changes in the pattern of feeds the reasons for the variation in the length of feeds will enable her to greet these changes with confidence.helping mothers to understand that breastfeeding is a learned,not an instinctive,skill will enable them to be patient with themselves and their babies during this time.It is likely that mothers who receive the right help and education at the start will require less support and remedial intervention later.
Positioning the mother
There are two main positions for the mother to adopt while she is breastfeeding.The first is lying on her side and this may be appropriate at different times during her lactation.If she has had cesarean section,or if her perineum is very painful,this may be the only position she can tolerate in the first few days after birth.it is likely that she will need assistance in placing the baby as the breast in position,because she will only have one free hand.When feeding from the lower breast it may be helpful if she raises her body slightly by tucking the end of a pillow under her ribs.Once she can do this unaided she may find this a comfortable and convenient position for the night feeds,enabling her to get more sleep.The second position is sitting up.In the early days it is particularly important that the mother's back is upright and at a right angle to her lap.This is not possible if she sitting in bed with her legs,stretched out in front of her,or if she is sitting in a chair with a deep backward-sloping seat and a sloping back.both lying on her side and sitting correctly in a chair enhance the shape of the breast and also allow ample room in which to maneuver the baby.
Positioning the baby
The baby's body should be turned towards the mother's body.So that he is coming up to her breast at the same angle as her breast is coming down to him.Thus the more his mother's breast points down,the more on his back she needs to be.If the baby's nose is opposite his mother's nipple before he is brought to be breast and his neck is slightly extended,the baby's mouth will be in the correct relationship to the nipple.
Attaching the baby to the breast:
The baby should be supported across his shoulders,so that the slight extension of his neck can be maintained.His head may be supported by the extended fingers of the supporting hand or on his mother's forearm.It may be helpful to wrap the baby in a small sheet so that his hands are by his side.If the baby's mouth is moved gently but persistently against his mother's nipple he will open his mouth wide.As he gapes he needs to be moved quickly to the breast.The intension is to aim the bottom lip as far away from the base of the nipple as is possible.This allows the baby to draw breast tissue as well the nipple into his mouth with his tongue.