First time breast/chest feeders often struggle getting a comfortable latch.

How can I help?

Laid Back Breastfeeding (or Biological Nurturing)

Encourage the breast/chest feeder to recline. You can support their feet with a stool, an upended laundry basket, whatever helps to achieve a comfortable reclining position. This position works with gravity, which allows baby's innate reflexes to help him find the breast. This position improves eye contact as well as comfort, and makes it easy to avoid sore spots following birth trauma or C-Section.

IV fluids can cause extra swelling in the breast, making it difficult for a newborn to latch.

Pumping can actually make this problem worse, by creating more swelling.

A technique called 'Reverse Pressure Softening' can help.

Using the tips of the fingers, the breast/chest feeder presses in gently around the areola, until fluid moves back a bit, and the area softens enough for baby to latch on.

The first page of the handout is for providers only

Some breast/chest feeders complain about "nipple confusion"

when switching between breast and a bottle.

What should I tell them?

Breast Aversion: Caused when an infant is having difficulty at the breast and the breast/chest feeder tries to push or force the baby onto the breast. This can really backfire. Always wait until the dyad is calm and happy- it's never worth it to force a baby onto the breast.

When to Start Bottle Feeding? Ideally, at 4-6 weeks postpartum, when breastfeeding is "well established" meaning everything is going great and mom has a good milk supply. That's in an ideal world, but meet the needs of the family first.

What about Nipple Shields? Because nipple shields require fitting, a dyad should always see an IBCLC before using one. They can be helpful for getting a bottle fed baby back on the breast, or with inverted nipples. Shields should only be used for sore nipples/latch problems if all other assistance from an IBCLC hasn't resolved the issue, such as helping with positioning and latch. Milk transfer should be evaluated if a nipple shield is given, as the wrong size can interfere with milk transfer. While they can be beneficial in certain situations, they should be used judiciously as they can also make breastfeeding more challenging, especially in public.

If You See Something- Say Something

Aggressive Formula Marketing

Yes, it's becoming a problem once again

What is the weight gain

'rule of thumb'?

Weight gain expectations can be really subjective, especially in a preemie. Often there is no protocol for "fortification" (adding formula to breast milk). If mineral levels are off, there is evidence for fortifying. If the recommendation is due to a weight issue, ask the MD if the extra calories can be made up with increasing the amount of breast milk given rather than with fortification. The dyad should see an IBCLC.

For a full term infant, until 3-4 months of age, approximately 1 ounce per day is appropriate weight gain. From 4-6 months, daily average gain is about 1/2 ounce per day. Whenever there is a suspicion of inappropriate weight gain the dyad should be referred to an IBCLC.

Thank You to Susie McCulloch, IBCLC, for her support and advocacy of breast/chest feeding in Sonoma County. Susie is the IBCLC for Sonoma County WIC. Susie also wants to remind breast/chest feeding allys that hand pumps are free from WIC- participants just need to ask. WIC participants can also get support with breast pump flanges and flange sizing at WIC!