Hope you enjoyed your summer! We have had some great times together since the “self isolation” rules were set in place. I’m looking forward to the kids back in school and a little nervous about it, all at the same time. The house is going to be quiet.

I thought I’d talk a bit about oral restricted tissues or “tongue ties”. I feel like we see this as an issue in about 75% of our home visits.  Unfortunately in Edmonton right now there are very few specially trained practitioners that do a FULL release (anterior and posterior).  It’s not only about the appearance but about the function of the tongue. There are tongue ties that aren’t visible to the eye but are present and cause problems.  There are also obvious tongue ties that anyone can see by looking but if the function of the tongue is normal there is no need to intervene.  

Tongue ties can be controversial.  Please note that an International Board Certified Lactation Consultant (IBCLC) can NOT diagnose a tongue tie! We can only assess oral function and refer to a healthcare professional. 

Mychelle and I have extensive training with assessing normal oral function and identifying tethered oral tissues.  One of the assessment tools we always use is the The Hazelbaker Assessment Tool for Lingual Frenulum Function (HATLFF).  We were trained to use the HATLFF by Dr. Hazelbaker herself! We do, however, use multiple assessment tools to do a complete oral exam at each visit.  

From personal experience, when my son was born 10 years ago I didn’t really know about tongue ties.  I had enough knowledge as a Labour and Delivery Registered Nurse to know what a good latch was and how to achieve various breastfeeding positions. Breastfeeding was something I knew I wanted to do but I had so much pain. Toe curling pain.  The pain was so bad I dreaded the next feed. I tried all the nipple creams available. At one point we thought it could be yeast. I don’t recall if anyone looked in his mouth.  I wish I had the knowledge that I do now! However I persevered, breastfeeding my son until he was 18 months old because I am stubborn and I wanted him to have breastmilk.  I would never wish that pain on anyone.  So how did I find out he has a tongue tie? His orthodontist recently said, “He has quite a tongue tie!!!!!” My mouth dropped.

What is a frenulum?

A frenulum is the membrane underneath the tongue connecting it to the bottom of the mouth.  

What is a tongue tie?

A tongue tie is when the frenulum is too short, which affects tongue movement.  A baby needs to be able to stick their tongue out and move it high enough to breastfeed effectively, otherwise it is almost impossible to breastfeed.  

Signs of a tongue tie

• Shallow latch

• Your nipples are painful

• Gassy baby/reflux

• You feel as though you aren’t making enough milk 

• Slow weight gain

• Frequent feeding

• Baby might latch well then slide off

• Short feeds that are tiring for them  

• Very long feeds in order to get enough milk

• Persistent, painful feeds often described as chomping, grinding

• After feeds your nipple may look flattened or lipstick-shaped

• Tongue may be heart-shaped or forked in appearance

• Baby can’t open wide to latch to the breast

• Clicking/smacking sound while breast or bottle feeding

• Cough or choke on the “letdown”

• Frustration at the breast if milk supply is low or if flow slows

It is so important to work with an IBCLC before and after treatment of a tongue tie. If you choose to have your baby diagnosed we will refer you to the most trusted and experienced professionals in the city. While you are awaiting your appointment, your number one priority is protecting your milk supply, We will give you advice on how to best do that.  Mychelle and I will teach oral exercises to be done before and after treatment and ensure you are prepared for the treatment day by reviewing the procedure.  After a tongue tie release, babies need to learn how to use their “new” tongues and often you are starting from the beginning with latch and positioning.  We will be there for you after the treatment to ensure latch, positioning and post care exercises are done correctly and also to teach suck training exercises.  

It is important to note that not all babies treated for tongue tie will breastfeed with ease!  Keep it in the back of your mind that it might not work and be prepared to explore other avenues if need be (we have suggestions for that too). If this is something you have been anxious about or have struggled with previous babies, you are not alone! Many other moms struggle with this “under discussed” issue and we have the information you need to support and assist you!

Melissa, RN, IBCLC

Photography credit: Littles and Lenses

In 2017, I had my first baby, Lucca. He struggled to latch and I nursed hourly around the clock. By day 5, my milk still didn't seem to have come in despite nursing on demand and pumping. My midwife referred me to a lactation consultant and I was then diagnosed with Breast Hypoplasia, also known as Insufficient Glandular Tissue (IGT). This meant that I would never be able to make enough milk to feed my babies, no matter what I did. I was beyond devastated. Luckily, I had lots of support, he received a tongue tie revision and I had access to donor milk, so I was able to successfully nurse him until he was 8 months old, with supplementation, medication and an supplemental nursing system (SNS).

Photography credit: Littles and Lenses

Fast forward to 2019, I had my second son, Matteo. I was much more empowered with information (as I was now a Certified Lactation Educator and Birth Doula at Beautiful Blessings) and had 500+ oz of frozen donor milk ready to go (thanks to two amazing mothers in my life), had expressed colostrum in the freezer, an SNS and a robust nursing and supplementation plan. When Matteo was born, he had a tongue tie which was corrected on day 10 and I was able to start my medications immediately. I supplemented until day 5 with my own frozen colostrum on a spoon. From there, I continued to feed on demand and offer donor milk and formula, as needed. We went on to experience challenges including issues with him having a high palate and a horrible, month long bout of mastitis, but we pulled through.

I am so proud to say that I am still nursing Matteo at almost 13 months old, with no medication and little to no supplementation. I am now working towards becoming a Le Leche Leader as I am very passionate about supporting breastfeeding/chestfeeding individuals, particularly if they are dealing with low supply or hypoplasia.

“I am happy that I reached my breastfeeding goals and I am excited to continue our journey”

- Lauren Calleja Birth Doula, CLE

Photography credit: Jillian Henry Photography

With having had 3 kids I can say that my experience breast feeding them was as different as they are. Before having kids I had a bit of an advantage, or so I thought, having had 2 older sisters with 6 kids between them and 4 years of labour and delivery experience as a nurse. I was encouraging and teaching new moms how to make this unique connection before I had gone through the steps myself.

I knew I wanted to give breastfeeding my all because it was what I knew the most about. I knew it had many benefits for my baby and hopefully me! I wanted the connection, the weight loss, the immunity for my baby and the lack of expense (vs formula feeding).

My first baby threw all my confidence out the window by coming early. Once he was born I was given a pump and told how to use it, clean it and encouraged to pump every 2-4 hours to bring my milk in and have a supply the nurses could use to feed my son through his naso-gastric tube. His blood sugars were low at birth so they needed him to start eating. His first feeds of formula he rejected making me strangely proud! My milk came in (and didn’t stop!) with all of my pumping and my son kept it down and increased feeds just as expected. I was given a nipple shield that I had never seen before, the next addition to my challenges! I had to learn how this big chunk of plastic was supposed to fit into my premies mouth (and function without choking him when it filled up!) while learning how and when to hold him, when to pump, when to go home and when be at the hospital…

The first lesson for me in motherhood was to keep my expectations very flexible!

I had not prepared for anything I was facing and had to use all the help I could get which was difficult to accept with my independent (controlling?) personality. As for the benefits I had hoped for, the “bond” was there from birth and it would have been regardless of what I fed him. His health was good though every “cold” was a cough or wheeze and I’ll never know if that might have been different if he had been full term. I did lose the weight and saved money without needing formula that first 8 (?) months. He did start to nurse without the shield after a few months and after that all ran smoothly but during those months I did a mix of previously pumped and frozen milk and the nipple shield.  I also pumped and brought a bottle to places that I thought would just be easier to keep my shirt on!

I felt protective of my new little love. I liked that when he cried I was the one with the answer. We went to some BBQs that summer and family events I intentionally did not bring a pumped bottle just so he would have to be with me. I felt like I missed out on so many tiny moments in those first few weeks that I wanted him in my arms as much as possible (see..control..).

Looking back on it all, and especially after having two more kids, I wish I could go back and tell myself “Just do what works for you!”. I spent so much time worrying if I was doing the right or best thing and I could have saved myself so much stress if I just relaxed and did what worked, what felt right.  Those were the most empowering actions that brought me so much pride. That and watching those babies chunk up from all that milk! 

After note- all my kids ate every 1.5-2 hrs. It was embarrassing that in one visit I had to feed…again. People would say “Didn’t you just feed him/her?” Sometimes I would leave early just to avoid the possible judgement.

Breastfeeding is a small action with a steep learning curve and a huge weight of expectation. Your mental health is as important as your baby’s physical health. What would that look like on a growth curve??! What percentile is your mental health in?

Lindy Akins

Hoping all you mamas are doing okay and making it through life during a pandemic.

Just a little of an update on how my family has been doing. My daughter just had her 8th birthday and we opened our doors to another family that is close to us and has been pretty strict with the isolation guidelines. Boy, was that ever a fun day! I missed my friends so much. I’m looking forward to and hoping for more “freedom” in the coming days.  Looking forward to drinks on the patio, playground dates and camping together! I’m also counting down the days to no “school”! 16 days to go, in case you weren’t already counting! I have to say that my kids have managed pretty well at home. My son Jack is in grade 4 and he despises doing schoolwork and it is a chore for both of us to get it done.  But he loves being home and staying in his housecoat all day. He’s done lots of cooking with me, built a treehouse with my husband and earned money helping my mom with yard work. I'd say he’s learning lots of life skills. My middle daughter, Molly, is in grade 2 and loves learning and loves doing her schoolwork on the computer. It’s so cute listening to her read stories to her teacher and the conversations she has with her friends on Kids Messenger. She also enjoys being in her pyjamas all day! My youngest, Hannah, is in kindergarten so she’s already used to being home most days. She’s enjoying having her siblings home all the time and keeps herself busy playing/crafting all day.  We’ve kinda (100%) stopped doing the assigned activities from her teacher (sshhhh) and life is way easier. This mama is not creative and does not enjoy crafts!! She went to an amazing preschool that prepared her so well. She’s ready for grade 1! (and yes, I have the teachers approval). Of course they all miss their friends but they also understand that this “new normal” isn’t forever and we need to keep ourselves and everyone else safe.   

How are all of you? I would love to hear how you are all coping and the positives that are coming from being home. Our days are starting to warm up and often we get this question:

Does my breastfed baby need water? 

The simple answer is, a breastfed baby does not need extra water or fluids. No matter how warm it gets breast milk is food and drink. If the newborn baby is thirsty, continue to feed on demand. Research shows that even in extremely hot countries, breast milk alone is good for keeping a baby hydrated.  

• Breast milk is over 90% water

• Our bodies are so smart! In hot weather, our bodies make milk that has a higher water content

• Babies might fill up on water, which has no nutrients or calories

• Giving anything other than breastmilk can affect milk supply

• Water may interfere with breastfeeding, and can actually contribute to weight loss and jaundice.  

• Although very rare, if babies under the age of 1 drink too much water, it can lead to water intoxication which can lead to brain seizures.

So mama’s, drink lots of water!  It is normal for your baby to have lots of short feeds on a hot day. This is because breastmilk is higher in water at the start of a feed therefore thirst quenching. It is okay to start giving a little water around 6 months of age, when your baby starts sampling solids, but always offer breast milk first.

Enjoy June!

Melissa, RN, Lactation Consultant

When I finally became pregnant, I didn’t think that I would become what I call a “breastfeeding warrior”. I simply thought I would feed the babies and do whatever was in their best interest.

My journey started when I was 24; I was with my ex husband, who had paraplegia. Our fertility journey began with in vitro fertilization due to his disability. If I had a crystal ball, I would have realized that my own fertility journey was beginning due to the course of events that were about to unfold. It was easier to let him shoulder the reason for our infertility at that time.

With two fresh embryo transfers, and one frozen, we were still without a pregnancy. Being 26 at the time, we decided to move on. I remember the fertility doctors commenting that I had “sluggish ovaries” since I was producing a minimal amount of eggs even on the highest dose of FSH. At 28, the marriage ended and while I recovered, I looked forward to becoming a mother “naturally”.

With a new partner, we began trying to conceive when I was 30. Due to my scars from my first journey with infertility, part of choosing my new partner was his family’s fertility history. One of six children, with each sister being a mother. I was excited to finally become a mother.

So began my second infertility journey. Eventually, the twins were conceived via Clomid and IUI. I carried the twins to 37 weeks and 4 days. I was 33 and had been on an almost decade long journey with infertility. Along with this came crippling anxiety, irrational fears, and constant worry about the babies.

Being pregnant with twins, I rationally knew that I might need help with feeding them. I was very open to receiving help and supplement what I could not produce. I was eager to get the babies out since I began to worry about squished cords, etc. The moment they were born, the real anxiety set in and I realized they were much safer inside me. Hence, I was very particular who could hold them, nevermind feeding them!

After my cesarean section, in the recovery room, a baby was put on each breast and my breastfeeding journey began. I was surprised at how much it hurt. I wasn’t anticipating pain. After a couple days in the hospital, my nipples were both scabbed over, I remember cringing when they latched; my sister encouraged me that it would pass. In the hospital, my son was losing weight, tremorous, and fussy. My daughter had jaundice and needed treatment. A nurse came in one night and helped me with the hospital pump, weighed the babies, and based on my son’s weight loss, suggested that we supplement. I remember, at that moment, my babies were 2 days old and I already felt like a failure. It hit me that not only did I not want them to have formula, I had a hard time with anyone giving it to them. 

After my daughter received treatment for jaundice, we were on our way home. The first 3 months is a blur. All I remember is being awake, babies on my breasts, cluster feeding, and quickly losing my mind. I was determined to exclusively nurse the twins. No one slept. No one was sane. We did use formula at times. Especially for my son who seemed to be starving. My husband was determined to make them sleep. I recall one night he fed my son so much formula in hopes of him sleeping, that my son vomited everywhere and we were back to square one. My anger in this moment was immeasurable. I couldn’t seem to nurse them or supplement them without feeling some sort of failure.

I sought help from a lactation consultant. I finally felt relief weighing the twins before and after nursing, knowing that I was producing, but they needed a little more. I kept a bracelet on my wrist to remind myself which baby was on which breast last. The problem was that my daughter was more efficient, and my son was smaller. I was bouncing them from breast to breast hoping they were getting enough. I was also pumping like a crazy person. Working on building a stash, just in case. But I didn’t want to use the stash to feed them. It was official: I had lost my mind. I saw my consultant on a fairly regular basis. I was taking motilium to increase my supply which also increased my appetite. I was doing everything I could in order to continue to nurse the babies.

At 4 months, I was at a consultation and she suggested a new plan: assign one breast to a baby for 24 hours, then switch. Within a week, the babies were gaining, and I was starting to feel an ounce of success. At this point, it was like a cloud lifted and breastfeeding became easy.

At 6 months, after an average of 4 hours of sleep (for me) in 24 hours...in increments, it was time to bring in a sleep consultant. When the twins were 7 months, my daughter was finally sleeping through the night and my son was feeding once. This was the first time that I ever felt engorged. I woke up in the middle of the night and I could feel the “flower petals” of milk in my breasts and I was shocked at the feeling. Everyone talked about the let down and I never felt it. Until 7 months postpartum. I was still pumping, but this time once a day. The collection of milk in the freezer went to two friends. One who was unable to nurse and the other was unable to pump and was back to work.

The encouragement I received from people was “stop nursing” or “use formula”. Only one person was supportive. My sister, a labor and delivery nurse. I was shocked at the overall lack of support. No one knew how to help me. I’m glad I pushed on, but I learned some valuable lessons.

Breastfeeding was the unexpected hill that I died on. I paid a very big price for it. My mental health suffered greatly; I have PTSD from the lack of sleep and the deep postpartum depression I was in. When the babies were two, I finally got help. Once I got help, I realized that I probably should have been admitted when the babies were about 3 months. The help came much too late to avoid long term consequences. I am grateful that I pressed on since it eventually became easy, but I still wonder if my mental health would have been better if I accepted the help and let it go. However, now, in a state of clarity, I look back with pride and love of breastfeeding my children. I breastfed for 19 months. I feel like when the babies turned one, I lost most support. My sister remained supportive which I will always appreciate, but it seems like society expects an end to it on a child’s first birthday. I would have kept going if I felt like I had more support. Everyone had a comment like “oh you’re still nursing?” My breastfeeding also wasn't subtle - I always tandem nursed and as the babies got older, it was a full shirt off experience. I received many comments when I nursed. Some about the size of my breasts, some about their age. I felt like it was time to end it. 

At the time, I didn’t know how anyone could support me. I encourage partners and other support people to help a nursing mother get sleep. Bring the baby to her to nurse and take away to burp and calm, so she can get some sleep. Keep comments at bay, unless they’re of support. Don’t just suggest they quit. Suggest lactation consultants; give positive encouragement. I tell struggling mothers that it does get easier, because it does. It was emotional, difficult and beautiful. I am so proud of myself that I persevered! My babies and I experienced that journey together. It didn’t have to be the hill that I died on, but I’m glad it was. For my 35th birthday, the babies were almost 18 months, I honoured our journey with a nursing photoshoot. This is my favourite picture ever taken of us. It makes me teary looking at it, 3 years later. I am so grateful I got this opportunity.

Adelle Stelmaschuk

Hi Everyone,

I just wanted to write a note about Covid-19 and Breastfeeding. There is a lot of confusing and contradictory information in the world right now.  I have researched the most credible sources such as the Centers for Disease Control and Prevention (CDC), International Lactation Consultant Association (ILCA), World Health Organization (WHO) & Academy of Breastfeeding Medicine (ABM). I’m hoping this will be useful to you in some way. Of course, there seems to be new information about Covid-19 emerging daily;  the information below is current as of today.  

COVID-19:

• It is a respiratory virus.

• Primary mode of transmission is through respiratory droplets when an infected person coughs or sneezes.

• Is NOT found in breastmilk.

• There is no evidence of vertical transmission (passage of a pathogen from mother to baby during the period immediately before or after birth through placenta, breastmilk or direct contact.).

• Is highly infectious! On average, 1 person who has the virus infects about 2.5 people. 

• Up to 44% of transmission occurs during the pre-symptomatic stage (a person who does not know they are sick but they are shedding the virus and transmitting to others).

Limit transmission by:

• Handwashing often with soap and water- it is the most effective tool

• Avoid touching face and eyes

• Cleaning surfaces of frequently used areas

• Wearing masks to limit exposure to droplets that a person may be exhale (controversy remains over the effectiveness of masks)

• Physical distancing aka social distancing to interrupt chain of transmission

The concern among infants is due to their immature immune system. Breast milk provides protection against many illnesses and is the best source of nutrition for most infants.

The recommendation from the CDC & WHO is that mothers with COVID-19 CAN breastfeed.  Mothers should :

• Practice respiratory hygiene/cough etiquette (cover nose/mouth with a tissue when coughing or sneezing, when coughing use a mask, use disposable tissues and discard after use, practice hand hygiene after having contact with respiratory secretions)

• Wash hands before and after touching baby

• Routinely clean and disinfect surfaces they touch

If a mother with COVID-19 is too unwell to directly breastfeed she should be supported to safely provide her baby with breastmilk in other ways such as :

• Expressing milk with hands or pump to establish and maintain milk supply. Wash hands before touching any pump or bottle parts and before expressing breast milk.

• Follow recommendations for proper pump cleaning

• Relactation

• Donor human milk

If you are from Edmonton, AB area here is a great resource from Alberta Health Services.   

Prenatal and Postpartum Information Covid-19

I hope this helps clear up any misinformation. We are in this for the long haul! We will be dealing with issues and the aftermath from COVID-19 for months to come and need to be thinking of how to best support families in the short and long term.  We will get through this together! 

In the meantime, STAY HOME! Stay safe and stay healthy. Be humble and listen to the experts!

Wishing you love and patience,

Melissa & Mychelle 

Lindy (Editor in Chief)

COVID-19 Resources:

CDC Coronavirus Pregnancy & Breastfeeding

WHO Breastfeeding Covid-19

ABM Coronavirus

ILCA Covid-19 and Lactation

Hey all you lovely ladies,

It’s Melissa from Little Nursing Company. How is everyone? I hope you are all staying healthy and safe. Wow, what a time we are living in right now! So much uncertainty it’s overwhelming. I’ve been watching Frozen 2, on repeat, with my girls and the song “Into the Unknown” is SO relevant for 2020 thus far.  Mychelle and I are still working at an Edmonton labour and delivery hospital and are experiencing first hand the demands of this virus! 

I’ve been wanting to write for a while now but have been struggling to prioritize what is worth reading during these stressful times! I considered writing a blog on how breastmilk is the best choice for your baby, as it gives immune protection. Who doesn’t want the best immune protection right now?!!   But why “beat a dead horse?” Everyone is aware of that and now is not the time to make any mama feel unsupported for choices made. I thought of writing specifically about HMOs (human milk oligosaccharides) found in breastmilk. There is fascinating new research about how HMOs keep your baby healthy. But that didn’t seem right either.  How about tips on how to help a mother relactate…. Some moms who have stopped breastfeeding might want to start up again during these uncertain times?   

I had all these topics on my mind but just couldn’t sit down and write.  Until a good friend of mine said “keep it short and supportive- less is more right now.”-LA

So all I have for you this month is a couple self care tips, that don’t even involve breastfeeding. Just surviving as humans :)

1. Go outside! Go for a walk or if it's warm enough, just sit outside with a coffee. The Vitamin D on your face is guaranteed to lighten your day

2. FaceTime friends and loved ones to combat loneliness

3. Do the thing that has been on your “when I have time” list: binge watching a series, cleaning out the fridge, organizing photos

4. Spend “quality” time with your kids/family- bring out the puzzles/games/books/movies. And genuinely take the time to enjoy being together

5. Have a relaxing bath

6. Allow and release all the feelings during this time; with yourself and your kids, so it doesn’t remain in the body

7. Do nothing! And don’t feel guilty about it! 

These self care tips are as much a reminder for you as they are for me. 

Somehow I managed to get out of my “slump” and had a pretty good day, the best one so far! The kids and I baked cinnamon buns, started a puzzle and I enjoyed the best coffee & Bailey’s on the deck in the warm sun.

Please let us know if you would like more infant feeding and/or breastfeeding information on the topics mentioned above. 

Thanks for reading, you’ve got this and you are not as alone as you might feel!

Melissa, RN, IBCLC

“Taking care of yourself is part of taking care of your kids”- Unknown Source

One of the top concerns of breastfeeding moms is latching pain! It is also one of the biggest reasons Edmonton mothers quit breastfeeding and rightfully so, it hurts! No one wants extra pain when you are already so exhausted with a new baby. 

So let’s talk about it for a bit...What does “latching on” mean?  Does a traumatic or difficult birth affect latching on? What could you do if the baby doesn’t latch?  What is a good latch anyway? We can help if you want to ask these questions directly to an Alberta registered nurse. Contact Us.

“Latching on” simply means the baby taking the breast into his or her mouth. However, sometimes it's not this simple!  Not all babies are the same; not all breasts are the same; not all nipples are the same.  Sometimes the baby prefers one position on one breast and another position for the other; sometimes the baby prefers only one breast and not the other and sometimes the mother prefers one position over the other. The baby could be tongue tied or extra sleepy or have a tiny mouth.  There are so many reasons why latching can be difficult.

A good latch for a breastfeeding baby is taking a large mouthful of nipple and areola, bringing the nipple to the very back of their mouth and massaging the areola with the tongue.

A good latch is not only pain free but it also means the baby is getting more milk.  A mother might have an abundant milk supply and her baby is growing but overtime a poor latch can lead to decreased milk supply.  A poor latch might also result in nipple pain and damage, long feeds with low weight gain or long term low milk supply.

This can have a traumatic or difficult birth experience can definitely have an effect on bonding and breastfeeding.  Being able to recognize this is a huge step in the right direction. Also, forgive yourself! You have been through a lot too!   

Many babies won’t latch after a difficult birth and you may not want them too. Here are some ideas to help with bonding:

• Remain skin to skin for as long as possible.  Smell, touch and enjoy each other!

• If you are home, take a warm bath together alone.  Enjoy the time together.

• Limit visitors or simply tell them you need time with your baby. If he/she won’t latch, be patient. Try not to get upset or frustrated. 

Three “MUST-DO’S” if baby won’t latch:

• Hand express colostrum! By removing colostrum from your breasts it is telling your body to produce more now and also to continue making milk for the future.  In the first 1-2 days you’ll want to hand express every 2-3 hours around the clock. If your “milk” is in on day 3 you can choose to continue hand expressing or try pumping. Continue with breast massage and breast compression to encourage more milk. 

• Feed your baby! In the early days, this can be with a spoon, a medicine cup or a syringe. 

• Stay skin to skin! Direct skin to skin contact helps with bonding and keeps your baby warm. It also keeps their heartbeat and breathing steady while his/her food source is close by! It feels amazing!

Tips to achieve a good latch 

• Your nipple level to baby’s nose

• Ensure the neck is extended so the chin touches the breast first

• Tickle the babe’s top lip with your nipple 

• Be patient and wait for the wide open mouth

• Once opened like a yawn, bring your baby in extra close and seal the latch. Picture your nipple at the back and roof of your baby’s mouth

• Top and bottom lip should be flanged out, not tucked in

• Do not hold the back of the head.  Your hand can go at the shoulder blades for stability

Getting support with your latch is very important. Ask your nurses/midwives/doctors for help while you are in the hospital.  Sometimes hospitals will have a lactation consultant on staff. Don’t be afraid to ask for help as many times as you need. There are community supports such as Le Leche League and private practice lactation consultants to contact once you are home.  

Check out youtube videos such as:

How to Breastfeed - Deep Latch Technique

Global Health Media- Attaching Your Baby at the Breast

International Breastfeeding Centre- Breastfeeding Videos

Melissa Alexander RN, IBCLC, Mychelle Gagne RN, IBCLC

Edited by: Lindy Akins RN & mother of 3 breastfed babes

References

Biancuzzo, M. (2003). Breastfeeding the newborn: clinical strategies for nurses. St. Louis, MO: Mosby.

Brown, A. B. (2018). The positive breastfeeding book: everything you need to feed your baby with confidence. London: Pinter & Martin.

Newman, J., & Pitman, T. (2014). Dr. Jack Newmans guide to breastfeeding. London: Pinter & Martin.

Wiessinger, D., West, D., & Pitman, T. (2011). The womanly art of breastfeeding. London, England: Pinter & Martin.

1. Feed Early and Often

Attempt to feed your baby within the first 2 hours of delivery. The best way for this to be successful is to keep baby skin to skin with it’s mother until a feed has taken place. Direct skin to skin contact; no blanket, bras or clothes in between. The mother has colostrum after delivery up until around day 2-3 postpartum. Colostrum has been given the nickname “liquid gold” because it is rich in vitamins, minerals, disease-fighting proteins and so much more. Evidence indicates that early breastfeeding increases the likelihood of EXCLUSIVE breastfeeding for the first four months of life and overall duration of breastfeeding.

Unfortunately labour and delivery does not always go as planned. Don’t fret if you miss out on the early feed or the skin to skin- do it as soon as you can! If you are separated from your infant, hand expression is very useful in these times so that the baby can receive your milk. If possible, hand express as often as your newborn would feed or at least every 2-3 hours in the first couple days. Remember most babies will feed 10-12 times in a 24 hour period at this time. This is a great way to be able to provide colostrum and protect your milk supply. Consult with a Little Nursing Co Lactation Consultant if you are having difficulties and need some help. We are registered nurses and lactation consultants.

2. Night Feeds

Prolactin (pro meaning “for” and actin meaning “milk”) is the hormone that is necessary for the production of breastmilk. Prolactin levels DOUBLE when the your baby is suckling. And baseline levels are higher at night. So, higher levels + suckling= more milk production overall. Therefore, telling your body to MAKE MORE MILK!!

I know it’s exhausting to be up around the clock but feeding your baby at night is vital to your long term milk supply (and also help reduce engorgement). It is understandable that you want a good night’s rest, however it is unrealistic in the newborn period. Newborns should be waking to feed in the night, that is NORMAL! To make night time feeds easier, try to rest during the day and keep your baby close enough to you in the night that you aren’t fully waking to feed. In the early days avoid going longer than 3 hours between feeds. Those night feeds will pay off I promise! In the coming weeks you’ll have an abundant milk supply and your baby will be satisfied and growing.

3. Feeding on Demand

So, what does feeding “on demand” mean? It means, let your baby breastfeed until he/she is satisfied. Try not to watch the clock for length of feed or the interval between feeds. Watch your baby for signs of satiety which include: cessation of audible swallowing, increased “comfort sucking;” coming off or falling asleep at the breast; disappearance of hunger cues; arms and legs relaxed. Breastfeeding “on demand” leads to successful lactation and better infant appetite control. That is they don’t overeat.

Watch for those EARLY hunger cues! Did you know that crying is a LATE sign of hunger? Early signs are rooting, sucking motions, sticking out the tongue, hands to mouth. This is the optimal time for latching and feeding. It also gives you a chance to get that perfect latch while your newborn is not too hungry. High demands from your baby + increased supply from mom = more milk produced! The is how the supply and demand cycle works.

4. Hand Expression and Breast Compression

What is hand expression? Basically, it is expressing milk from your breasts with your hands. You may feel uncomfortable at first, as many of us don’t spend much time touching our breasts. There is no right or wrong way and don’t worry if you don’t get much milk out at first. That is normal with colostrum. Once you get your rhythm, milk will come easier and quicker. Every woman should learn how to hand express, just in case you need it! It is free and requires no equipment. Some women even prefer it to pumping. Hand expression can be done prior to, during and following the breastfeed. When milk is removed more often, your breasts feel soft and comfortable and produce milk faster. Frequent milk removal is the key to maintaining milk production whether you are breastfeeding or expressing. Here is a great Stanford video on Hand Expression of Breastmilk

What is breast compression? Breast compression can encourage your baby to keep actively feeding when their sucking has slowed down. Compressions are useful for sleepy babies, babies that don’t have a strong suck due to illness or cleft palate, or for babies who are not gaining enough weight. With your fingers underneath and your thumb on top, cup your breast using a C shape. Make sure all fingers are positioned away from your areola. You can go as far back as close to the chest wall. Gently squeeze your breast and this will give a little extra milk to encourage your infant to continue to feed. Move your hand around your breast to empty all the milk ducts until your breasts feel soft and you are comfortable. So many times I have seen mothers tickling their babies feet or stroking their head to wake them up to finish a feed. Teaching mothers breast compression and watching it work is so exciting! Breast compression can also be done during hand expression to increase your output. Visit Canadian Breastfeeding Foundation for more information on breast compression.

Melissa Alexander RN, IBCLC, Mychelle Gagne RN, IBCLC

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