A FEW SMALL CHANGES CAN GO A LONG WAY!!!!

Like most things in life, changing the way we do things in even the simplest manner, can make a significant, positive difference. The same holds true for Breastfeeding.  I have been working in the Breastfeeding world for over 15 years and have seen how our practice and knowledge shared with patients has evolved.  I am a firm believer in “if it works, keep doing it, if it doesn’t, let’s find a better way.”

I thought I would take this opportunity to blog about some of the ‘tips and tricks’ that really make a huge difference for Breastfeeding moms, yet they are quite suttle in their doing. These suttle adjustments and slight changes in a way mom holds her breast or positions her baby can make all the difference in the world.

Tip #1) Areolar Sandwiching combined with Nipple Tipping

I use this technique time and time again when a mother is having a difficult time getting her baby to latch, and maintain a latch at the breast. Moms are generally taught to cup their breast like the letter C (which is correct) BUT to keep their fingers well away from the areola. Using this technique, I prefer mom’s to bring their C-hold to around the border of the areola and to make an exaggerated ledge out of the areolar tissue. Sometimes this is referred to as ‘aerolar sandwiching’.  Then with their thumb, they pull back slightly on the breast tissue thinking of tipping the nipple up. This technique helps to accomplish a few things. Firstly, when you ‘sandwich’ the areola, you allow baby to take a bigger mouthful of breast tissue when latching him boldly to the breast. When you tip the nipple up, you ensure that baby will capture more from the underside of the breast (which is what we want all babies to do!!!)  and the nipple will also touch the roof of his mouth faster which will help to elicit the suck reflex. I encourage my mom’s to keep their thumb in the nipple tipping position until baby begins to sustain his suck/swallow pattern. Once this happens, she can back her hand away and continue to support the breast throughout the remainder of the feed (if she desires). I can confidently say that I almost have a 100% latching success rate using this technique!!!

Tip #2) The ‘Snuggle and Slide’

I love using this technique because it accomplishes so many things in one simple action. And it also sounds really cute!!! I encourage all Breastfeeding mom’s to use the ‘snuggle and slide’ after baby has comfortably latched and let-down is achieved and then periodically throughout the feed if baby starts to slow down. The Snuggle and Slide consists of mom snuggling her baby in a bit closer to her chest (baby should always be tummy-mummy if she is using the cross cradle-hold) and then pulling baby’s shoulders and bum in a bit more across her chest. Almost think of it as wrapping baby’s body slightly around your torso. But we always want to ensure that baby is in an asymmetric position (almost diagonal) across the chest.  What this does is threefold. Firstly, it will take baby’s nose off the breast if he is having a difficult time breathing. Second, it offers more extension in his neck, which will help to open his airway and allow him to coordinate his suck-swallow-breathe pattern more easily and prevent him from falling asleep.  Thirdly, It will drop more weight of the breast onto baby’s lower jaw, which will ensure better drainage and therefore more efficient feeding.

Tip #3) Breast Compression While Breastfeeding

Rhythmically compressing the breast while baby is slowing down his suck/swallow pattern can make a big difference in how the milk flows and entice a baby to continue transferring milk. The technique I like moms to use involves encircling the entire top portion of the breast with her hand. This means placing her thumb on the outside of the breast and having her 4 fingers more-so on the inside of her breast. She needs to start with compressing up high on her breast. Pretty much from where the breast tissue begins.  She needs to firmly compress and hold for approx 5-6 seconds before releasing her hand. Then she slowly walks her hand down the breast and continues to compress and hold making sure she doesn’t compress to close to baby’s mouth. This can disrupt the latch and cause baby to lose suction on the breast. This technique assists with the ‘compression’ action of breastfeeding and encourages the milk to flow more readily. Breast compression works especially well with pre-term, jaundiced, and bottle-fed babies. But I do encourage all breastfeeding mom’s to use this technique when their babies swallows start to slow down. It‘s important to remember that the compression is slow and steady, not fast and pulsating. The milk ducts are located around the entire breast, just like the spokes on a bicycle wheel.  We know that babies respond best to milk that flows more readily into their mouths.  That’s why encircling the breast with one’s entire hand, is the best and most effective way to encourage more milk to flow.

Tip #5) Pushing back into the Chest Wall while Hand Expressing.......not rolling fingers forward!!!

I believe that hand expression is an essential skill that all nursing mother’s should have. You never know when you maybe without your breastpump and find yourself in a woman’s washroom hovering over the sink dripping milk everywhere because your breasts are about to explode. This has happened to me on numerous occasions when I thought I would be home in time to feed my daughter. Thank goodness I knew how to hand express. It was a little sad though watching all my precious milk go down the drain!!!

When a baby breastfeeds, he uses 2 actions; compression on the milk ducts and suction to draw the milk out. So when you want to hand express your breastmilk, it’s important to maintain compression on the milk ducts at all times.  I realize that most of us are more visual learners (especially our post-partum mother’s) but I will do my best to describe what I mean. Before you begin expressing, first massage the breast for a few minutes. It helps to do this with a warm wet facecloth. Position your fingers on the border of your areola, then push straight back into your chest wall. You have to press quite firmly. Now keep that firm pressure and think about pulsing your fingers slightly forward but staying well behind the nipple.  DO NOT ROLL THE FINGERS FORWARD. If you roll forward, you lose compression on the ducts and will only expel a minimal amount of milk. You can also do more damage by pinching on the nipple when rolling the fingers forward. The ‘pushing back into the chest wall’ and pulsing forward method, works optimally for removing milk in a timely, comfortable manner. Sometimes you have to change the angle of your fingers to compress on different milk ducts. I also recommend hand expressing from one side for a few minutes, then switching to the other side for a few minutes, then repeat once or twice more. Mother’s are truly amazed when I show them this technique and can’t believe how changing something so small can make a HUGE difference. It can really empower a mom who has believed that she has no/minimal milk to see that yes, there is milk in her breasts and she alone can remove it!!!

Well I think that about covers most of the tips and tricks I have to share with you for today. I hope you have found them useful and will be able to incorporate them into your practice. Or perhaps, you are already using some of these techniques!  As I have said before, knowledge is empowering and I hope that I have shared and empowered you with a little more today that can make a big difference for you and our Breastfeeding mothers.

Thank you!!!

Leanne Rzepa RN BN IBCLC

 

 

 

Posted on August 22, 2015 .