B Feeding 1 and 2

Question 1

First 24 hours how do they nurse

Answer 1

Aren’t necessarily hungry, but they have a strong desire to suck. Use that to feed them.

Question 2

Second 24 hours how do they nurse

Answer 2

.

Question 3

After first 48 hours how do they nurse

Answer 3

.

Question 4

Mastitis?

Answer 4

See the handouts

Question 5

Are babies born hungry?

Answer 5

They have been fed 24/7 at the time of birth. They don’t understand about their stomach and don’t understand the pain hunger vs fullness. They have a need to suck, we use this to get them feed.

Question 6

Whats better a $200 medical grade electric pump or a baby

Answer 6

7 lb baby beats the pump.

6 days in a small trickle into the pump is a normal amount to get out of it.

Question 7

Crying babies are normal even when not hunger.

Answer 7

They could be fussy or just not in a good mood.

Question 8

How long should I Bfeed

Answer 8

Like running a marathon, think less about how long would you go, but try to focus on if you’re willing to do everything to be ready for the first month.

Question 9

How to make the baby the priority

Answer 9

Limit visitors the first month. Take it day by day and week by week …

Question 10

AAP recommendations

Answer 10

All babies should be milk for the first 6 months. and it should be the major part of their diet for at least a year of age.

Question 11

WHO Recommendations

Answer 11

All babies should be breast fed until the age of 2

Question 12

After second tri colostrum is being produced in all pregnant women. Why’s it good

Answer 12

Babies eat teaspoons at a time.
It seals the digestion tract
honey colored, thick amber liquid
protects against against viruses and bacteria
acts as a laxative to remove meconium (stuff they poop) and reduces the intensity of jaundice in baby.
a few moms will leak colostrum before birth.

It will slowly transition to transitional milk - it has a lot more liquid in it.

Will feed them will for the first 2 - 3 days

Question 13

Meconium - Black stuff that baby poops

Answer 13

lots of red blood cells and they are breaking down the ones from mom (which is how they got oxygen).

Question 14

how much water weight will they lose?

Answer 14

10% weight loss, but being less because they are fed well is better.

Question 15

Milk types

Answer 15

First part of feeding is foremilk, it makes you hungrier and get water.

Hind milk is what comes after and it will makes the baby satiated.

mix foremilk and hindmilk together give babies 20 calories per ounce.

Question 16

What foods should be avoided while bfeeding

Answer 16

Alcohol - takes about 60 - 90 mins to get into bmilk
(a glass of wine every 3 days might be okay)
Don’t nurse until you no longer feel.

Caffeine
1-2 max, 1 morning 1 afternoon. Regular amount.
Babies don’t get rid of caffeine in their system very well.

Chocolate
Never been proven, but don’t eat a ton. Okay to have a brownie.

Question 17

Recommended books

Answer 17

Medications and Mother’s Milk

Marijuana & Breastfeeding

Question 18

Before taking any meds

Answer 18

Ask your baby’s doctor

Mosts antibiotics are safe with nursing
most anti depressants are safe with nursing

L5 is absolutely don’t feed with it

Question 19

Majijuana

Answer 19

Stores in the fat
it will enter breast milk
it will give a baby a positive tox screen
It’s not considered compatible nor is it recommended.

Many other drugs are a hard no for breast feeding.

Question 20

Foods to avoid

Answer 20

Moms that eat a varied diet will lead to less picky eaters

Foods that break down in a stomach isn’t what goes into the milk. So something that would upset your stomach may not upset the baby’s stomach.

Dairy, soy and peanuts
Rid it from the diet for 3 weeks and see if irratabity
If baby has blood in stool, that’s a reason to test it.

Sushi is fine. Watch for mercury levels.

Question 21

Breast fed babies have less illness

Answer 21

Stats are
3-4 ear infections more without it
60% less illness with it
diarrhea is 3-4 times more common in formula fed babies

bacterial infections are 16 times more common in formula fed and 10 times more likely to go to doc for bacterial infection

50% less likely to die to sids

Reduced allergies

39% reduced risk of on set child diabetes

colitis and crohns disease reduced in adulthood

19% reduced risk of leukemia

Question 22

overfeeding is easier with a bottle

Answer 22

Babies will suck even when full, they don’t know they are full.

bottle flows with any pressure to nipple

baby can not pacify on a bottle

baby must protect their airflow with their tongue up and back of the mouth

a baby that needs to suck will still get food from the bottle

Babies are much more fussy in the evening
they could be over stimulated and can’t fall asleep.

Question 23

Tongue action on the breast vs bottle

Answer 23

Best to only do breast for the first month because they need to suckle by messaging the milk out.

Tongue at bottom of nipple and works the milk up out into their mouth.

Question 24

formula feeding

Answer 24

$2000/year in the first year of baby’s life.

Question 25

Advantages for mother

Answer 25

Uterus shrinks down to pre pregnancy size sooner

delayed return of menses (6 mo avg)

reduced breast cancer (28%) and ovarian cancer (21%)

Reduced osteoporosis

reduced risk of diabetes (12%)

decreased cardiovascular risk later in life

burns calories 200-300

Question 26

disadvantages for moms

Answer 26

does it hurt
shouldn’t. if they aren’t getting milk they sometimes bit down on the tip

if you have toe curling pain, get a pro to help

sore nipples is not a normal part of nursing.

breast reductions require extra steps

rarely will a mom not be in a place where they aren’t making enough milk

Question 27

Every mom makes more milk in response to the demand on the breast

Answer 27

2 babies, the body will do it

9lb baby, the body wall do the needful.

more milk removal will get more produced.

Question 28

what do babies need the most

Answer 28

They need touch

others can hold, rock, sing, dance, cuddle, massage, bathe, walk and comfort.

hold baby to skin.
stabilizes temp, blood pressure, blood sugar.

if mom’s holding baby, they smell milk and they want to eat again.

Question 29

do breasts fill up?

Answer 29

Breasts never fill up and never run out

Question 30

pregnancy hormones suppress milk creation

Answer 30

no matter how the baby is delivered, doesn’t change

when placenta is removed, it tells the body by a drop in hormones that tell it to make milk

Question 31

after first 2 days

Answer 31

breasts engorged with more fluids in the area, but that’s not your milk glands

think of them like sweat glands.
not sweating doesn’t mean your sweat glands are full.

Question 32

helping with swelling

Answer 32

Get the baby nursing well and flush the system

ice will help if really swollen

cabbage will help she said

heat will help the ductile system but NOT in the first 3 day

Question 33

lotions don’t use because of smell

Answer 33

use olive oil and rub it on the nipple and breasts before using breast pumps. helps for sliding on the breasts.

no coconut oil around babies because it’s an allergen

nipple cream is like chapstick
but cracked bleeding nipples are not going to be fixed, need to get

nipple creams edible so its fine, but a preventative.

breastmilk will actually help clean it and help it heal.

Question 34

breast friend pillow

Answer 34

flat and firm pillow will work great.

Question 35

food poisoning or flu okay to feed?

Answer 35

neither will effect. very few ill

Question 36

prolactin is hormone, what causes it to start to make milk

Answer 36

Babies have to suckle to cause it

Question 37

oxytocin

Answer 37

makes glands contract in the breasts and starts the milk ejection reflex

outside things can effect it, tea, etc.

Question 38

milk ejection reflex

Answer 38

referred to as let down - milk coming out, drawing sensation on the breast.

typically occurs after 30 secs of suckling

avg 6-8 let downs in total

most mothers do not FEEL the let down in the first few weeks

some describe it as a tingling or drawing sensation

first let down is usually the fastest with the most milk - this is because there is some pre made in advance

subsequent let downs are slower and have less volume milk. Baby will need to work harder.
- richer milk, flows slower and takes more work to get it out from the kiddo.

Question 39

latching

Answer 39

deeper and more appropriate the latch gets them the most potential for milk

needs to use their tongue correctly to suckle properly.

head needs to be dipped head back
chin deep into breast

open their mouth using a reflex
nipple stroke downward on the top lip going down with the nipple. and wait, they will sort of open, then you may have to do it again until they are open.

if they slide off onto the nipple, it will hurt for about 30 secs but that’s wrong…

cheat move is to use the hand, flat and indent the breast is about the location of the chin will touch.

push baby in from upper back and neck
DO NOT PUSH their HEAD. Only back and neck, at base of skull so head drops back.

Question 40

cradle hold

Answer 40

first month you won’t be using this

Ear is on bend of elbow
you can pin the top arm with your thumb
the inside shoulder is going to push on the bottom or ribs

chin hits at inside of breath, indent boob with straight index finger.

Use nipple to stroke baby’s mouth

as the baby opens up, tuck the baby up to it like your holding the football into the breast.

Question 41

cross cradle hold

Answer 41

same starting position as cradle

Horseshoe hold around back of baby’s neck (NOT THE BABY’s HEAD)

stiff V with thumb and index. put fingers up and under breast and indent breast.

stroke, then when baby opens, tuck the baby into the Breast.

Question 42

tips

Answer 42

Make sure you hold the breast with the V so that they stay latched.

stand in front of mirror and for 30 seconds. figure out how your fingers should go.

Question 43

at hospital they will set up with baby on pillows

Answer 43

always hold baby back and neck to base of skull with hand.

make sure they are sitting up a little bit, not flat on they back

Question 44

coach work

Answer 44

Hold baby from bottom with one hand and back of neck and back

Question 45

homework

Answer 45

coach:
Football hold
football hold / clutch position

Mom:
stand in front of mirror and for 30 seconds. figure out how your fingers should go.

both:
read the week by week.

Question 46

side lying position

Answer 46

probably not going to do because it’s tough until baby is 3 mos

Question 47

biological or laid back nursing

Answer 47

mom is lying slightly elevated.

30 degrees

put baby in miss America sash position

will use this if you have cesarean birth

no indenting needed for this position.
baby should be able to bury chin easier

Question 48

goals

Answer 48

first is feed the baby

want it to be getting easier and faster over time

email questions

give feedback on week one

Question 49

swaddling specifics

Answer 49

if the arms aren’t in the correct position (NOT AT THEIR SIDES) it’s not good for the baby

Not swaddling their arms isn’t actually appropriate because at that point it’s not swaddling

You swaddle for the 3 months or until they move the legs up and over like they want to rotate on to their sides and bellys.

Question 50

Not getting out of bed to change baby diaper

Answer 50

don’t do it. not easy for moms leaning over belly in sitting position. poop or pee is going to happen so doing it in the bed is very likely

Question 51

latching

Answer 51

indenting the inside of the breast is the key to getting the chin in nice and deep or it won’t work.
hand is on the base of head and holding neck
head is dropped back
nose is slightly away so the chin is super deep
never shove baby into breast

Question 52

Getting things started

First 2 weeks

Answer 52

1 thing is to focus on getting the baby eating well

First 2 weeks and waking baby up for feedings
Doesn’t need to be ever X mins/hours.

Aiming for 8 feedings (just feedings. still needs holding, diapers, cleaning)
If my day starts at 6AM
60 mins for a single feeding
can be an hour and half feeding easy
tummy time to wake them up for feeding
change diaper after feeding as they will always poop while feeding.
nourish mom during feedings too

bed at 10PM

Things you need to do for yourself:

• need to eat
• need to sleep
• need to shower/brush teeth daily

And need to get prepared so none of us need to leave.

• need to get food and fully stock us
• Friends can leave a meal and then ask to stay. First 2 weeks we wont have time to hang out.
• get lots of snacks
• while nursing food and water

Washing baby clothes

• cribs linen
• bath towels and wash cloths
• stuff we know we’re going to use in the first 2 weeks
• onsies
• breast feeding gowns

Recommend creating a daily schedule to do things we need to do:

• car smogging
• car maintenance
• gas

Vaginal discharge for up to 10 weeks

• You’ll need something for heavy pads
• disposable underwear
• then you’ll go to a smaller pad
• no tampons for 6 weeks

Reference book:

• Kathleen huggins - Nursing mothers companion
• make sure that a book is written by a lactation consultant for a companion book.
• don’t rely on the internet

Some products we will need at the hospital:

• breast pads are meant to keep your clothing dry from leaking.
• disposible ones, there are some reusable washable pads
• She recommends the washable pads. They look better. There was a study done on paper pads cause inflammation
• take 3 pairs of pads at the hospital
• nipple cream - just moisture and promotes healing
• She uses it philanthropically - lanolin is a good one
• tender care they quit making.
• she recommends nipple cream for the first 3 or 4 days
• she wants us to hand express some colostrum and rub it into the breast, air dry it, then slather on some nipple cream.
• if any irritation it will make it heal really really quick
• hydro-gel pads - those who don’t like the feel of lanolin. you can use them, between feedings, rinse them off and let them dry before putting them back on. lasts like 2 days before needs replacement.
• two-3 nursing bras minimum. should be a cups size larger than 36 weeks size
• You want a nursing bra that feels wonderful, Bravado Silk? is one of the most commonly loved bras. Original bravado lasts a long time.
• no underwires for a few months
• try them on somewhere, confirm you can unhook it with one had. You have a baby in the other arm.
• when it opens you need to be able to see the entire breasts
• check it out at health links
• nursing gowns are recommended. a regular night gown can be opened on the front like a jacket is perfectly fine
• nursing stools, kidkraft stool, my breast friend stool for holding feet higher while sitting and breast feed.
• dimensions are in handouts

Question 53

hand expressing the breast

Answer 53

press two fingers on aoras and squeeze the ducts under the skin up out the nipple. turn and repeat.

Question 54

Need like 3 nests at the home

Answer 54

• need a table
• need a chair
• ?
• ?

Question 55

Places to nurse

Answer 55

Don’t use rocking chairs
dont do it in the bed
don’t do it in the couch

you need to be really supporting

chairs from office is sometimes okay

you need to be well supported up
or
completely back at like 30 degrees up

after 2 weeks the glider will work, but it won’t work in the first 2 weeks.

a camping chair will work, but may need a pillow under your butt.

firm and flat pillows for baby are best. NOT ROUND
my breast friend is the recommended one
it should be attached below the breast for room for baby below it.

tummy time for boppy pillow
can also use the breast friend pillow for a min or two for them to do tummy time while you drink something

Question 56

Identify help

Answer 56

We can hire a post partem dula

some family

Question 57

visitors

Answer 57

Visitors are there to help, not for the baby

Failing at breastfeeding is very high because of this

• babies can be over stimulated
• no visitors for the first month

Question 58

handling the visitors issue

Answer 58

Make photos

technology, use it. photos, facebook instagram

overstimulated babies don’t eat very well.

Question 59

vaginal birth
vs
cesarean

Answer 59

VB
they clean face, suction and check for umbilical cord.
if everything’s okay, they put the baby on mom for skin to skin

antibiotic ointment on eyes
vitamin k shot in thigh
need to weigh and measure baby

best for baby’s health to go right to mom’s chest

you’ll be doing this while delivering the placenta
5-6 mins on avg

when he starts rooting around, slowly move him to the miss America sash position, the baby will 85% of the time self latch
after 20 mins can’t do it, then you can start setting him up with a cross cradle hold.

first hour or so is the time they are most alert after birth
first 24 hours just let them practice as often as they can (baby)

they will do the 3 things done right before they move us to post partem dept. then baby will will come back to chest to chest.

Question 60

cesarean

Answer 60

Moms will have apprx 40 mins of surgery left after baby is out

mom will then be transferred to recovery room

your partner can do the skin to skin with baby until mom is brought to recovery room

put baby skin to skin as soon as they are reunited

dad can’t cut the cord because it’s a sterile field for this operation

you may not feel like you can breath well because of the epidermal or spinal block. at that point mom can give baby to me to hold chest to chest.

sometimes they are shut down a bit after all the things. they will come out of their shell if you just do skin to skin and want to eat.

Whoever is holding the baby skin to skin, you’ll be looking for feeding queues

feeding queue in hospital is:

• puts hand to mouth
• start licking
• head movements and eyes open
• rooting
• they may have just ate 20 mins before, still give them the breast
• we all need lots of practicing.
• if they fall asleep, take them off. try some switch nursing. don’t worry about over feeding them

If struggling to get baby to latch
* Nurses are also very helpful
*

Question 61

first 24 hours

Answer 61

lots of skin to skin
lots of latching and feedings
if they haven’t latched in the first 24 hours ask nurse for help
ask for lactation specialist (see if wendy is on)
call our instructor if shes around while we’re there. shell give her number to us

Question 62

minimum

Answer 62

need at least 8 feedings (may not be full hours)
* time from start one feeding to the start of the next is how often feedings are
* night 2 will require lots more.
* sleep for an hour, then one spouse has him, then swap while the other sleeps for an hour.
* baby asked to eat at 6 30, 830, 1045, 1pm
if she wants to sleep later in the after noon, thats okay since we have 4 down already.
then 4pm, then 615 and 9pm, need atleast one more
If I have a healthy full term baby that’s not jondus and more than 6 lbs, then it’s okay with 7 for now and he’ll wake you for feeding.

Question 63

what usually happens

Answer 63

get home from hospital
gets hard
baby up all night
missed many queues for feeding, family comes by, didn’t sleep
need to wake baby up to get back on track

daytime feedings are going to be very active.

if you don’t wake a baby, they will usually want to eat 70% of their time at night

Question 64

6am - 11pm daytime feedings

Answer 64

usually just diaper for daytime feedings

if at night and they are going to bed, that’s when baby should having one extra layer than mom.

house should be around 70-72 degrees in house.

skin to skin will help them be more alert during feedings

Question 65

to keep them feeding efficiently

Answer 65

normally we want to see a suck suck draw ( kissing sound or pause) the draw or pause is when they start swallowing

the rhythim is important. the throat moving and ears have nothing to do with it for accuracy

when they do the flutter sucking, We need to indent the breast and tuck them into the breast

if they need multiple nudges, break the sucking
use index finger inbetween the gums, DONT fish hook them, but then pull them off. then they usually want more because they wake up. Then move them to the other breast.

Break feeding if they require multiple nudges again then switch to tummy time

leave him there for like a min. for tummy time. If he's really hungry, burp him: hold his jaw, lean him forward and burp him for a min or two
tummy time
then left breast
right breast 
diaper change
tummy time
burping

nurse him as long as he swallows and rinse and repeat

Question 66

lets say by day 13

Answer 66

lets say he’s a rock star hungry

and he’s eating

if he’s s

Question 67

angry baby during this situation

Answer 67

a screaming baby will usually breast

let him suck your finger

rock him left to right skin to skin to try to sooth him and calm him down. then go right to the breast

feed often, and feed well.

Question 68

night time

Answer 68

don’t do a ton of switching in the middle of the night

don’t do tummy time

feed
burp and diaper change

feed other breast
burp
swaddle and bed

Question 69

sleep phases

Answer 69

every 90 mins they have a light sleep phase

Question 70

in the evening you wont have a lot of easy milk

Answer 70

richer milk at night in preparation of sleep time

Question 71

number of feedings need to be recorded

Answer 71

apps good but don’t worry about feeding times

recommending paper for the first few weeks

Question 72

read handouts the week before on baby’s changes
the week the baby is on
the week after baby is on now

Answer 72

This will help us understand how baby’s needs are going to be changing.

Question 73

lactation consulting

Answer 73

zoom isn't good
she recommends seeing someone in person
there are scales at kerri's work. 
we can weigh him there
11-14 days of age they should be back to their birth weight

Question 74

first 2 weeks babies are using all their energy to eat

Answer 74

you might get 30 seconds with wide eyes

when they are quiet alert, they will tell me when they are ready to play.

when their movements are calm. that’s when they are ready

Question 75

at 2weeks what to do

Answer 75

Kerri needs to start pumping to put milk in the freezer

usually pump 1 or 2 times a day.

best time to pump is AFTER first feeding in the morning. baby may not have endurance are coordination to get do the work to

needs a hands free pumping bustea

• simple wishes, back is velcro. better so it adjusts as you get thinner to fit you everytime. The madila ones the holes are really small and not as good
• call insurance and find out what they offer the new madila or a spectra

the bottle companies don’t have a lot of R&D so they aren’t known to be that great

Question 76

freeze milk in milk storage bags

Answer 76

zip up the top and pour the milk in
label amount and date
freeze them flat on a plate in the freezer
put them into a gallon zip lock
label the gallon bags first week, etc. this way we can keep the oldest milk together

moms want to have at least 100oz of frozen milk before going to work

don’t ever put frozen milk in the door or along the wall, it defrosts it.

seomtimes moms will put it in the fridge overnight to defrost OR
put it into a bowl of hot water, never microwave it or boil it

Question 77

how long should we store milk

Answer 77

rule of 4s
freshly pumped milk can be at room temp (under 75deg) for 4 hours. Not in bag, not in car.

4 days in fridge (can’t freeze after this, it’s done after 4)
needs to be frozen in the first 24 hours

4 months if you have a deep freezer

can store room temp for 3-8 hours optimal it’s good at 4 hours

fridge 3-8 days optimal is 3

3-6 months for fridge freezer

Question 78

starting on a bottle

Answer 78

wait until 4 weeks old

religiously give 1 bottle every 4-5 days for practice

offer only 2 oz at first. heat more milk if baby wants more

baby should eat 1 oz of milk for ever 2.5 lbs they weigh

once a bottle is in a baby’s mouth, you only have 1 hour to use it or throw it away. the bacteria back flow is present.

2 reheats maximum because both formula and milk will create bacteria at that point even without touching baby

Question 79

picking pumps

Answer 79

pumps suck and babies message

check out pumpingessentials.com
they are a go between between us and the insurance. may not work with our ins.

manual pumps, madila harmony. they aren’t very effective
people use it to relief pressure when baby isn’t there to suckle
usually an oz or two every 20 mins

if you use a hakka, use it after feeding baby

rental pump
2000 to buy, 90/month 1, 75 month after
usually deserved for babies with jaundice

pumps for working mom
lots of these work, but don’t work well. marketed as pump while vaccuming

Nursing in public
just have a shirt you can pull up and put the baby under shirt. Most moms can’t nurse for the first few weeks
nursing aprons good for pediatricians office, airplanes
nursing slings usually need to be used 12 times before knowing they won’t work.

check to make sure baby is high enough so that you can kiss their head. or they may have their airway closed.

Question 80

diaper change

Answer 80

Take their toes to nose to get the gas out

doesn’t need to happen during changes, but after feedings you will stroke with olive oil your 2 index and middle finger tips. baby’s lower right to their lower left to work gas out, clockwise while looking at baby.