• Avoid soap -areola (brown area around the nipple) glands secrete oil
• Talk to your midwife if you have any worries re breasts/nipples eg previous surgery, inverted nipples. For inverted nipples may be able to use nipple formers (shells, niplette) to help bring the nipple out during your pregnancy.
• Bras leave till 36-37 weeks to have a fitting, buy 2 -3
• Breast pads may be needed if you leak a lot
• As your breasts get larger you may need a supportive top or bra for in bed and to hold pads in place if you leak at night
• Avoid underwire bras which can cause blocked ducts

Resources and help:

• See the breastfeeding directory pages on BabyWebNZ

• See the breastfeeding shopping equipment pages on BabyWebNZ
  

http://www.babywebnz.org/display/BabyWebNZ/Shopping_Breastfeeding+Equipment

• Books/videos
• Lactation consultant
• La Leche League
• LMC (Midwife)
• Plunket Parent Centres www.plunket.co.nz
  
• http://www.moh.govt.nz/moh.nsf/indexmh/breastfeeding-questions
  
• Partner, family and friends
  

• Mother comfortable
• Unwrap baby
• Arm of baby out of way of breast
• Babies chest to your chest, babies chin to breast
• Support breast with C hold of your hand
• Tickle lips of baby with your nipple for the rooting reflex, if the baby is opening it's mouth.
• Baby needs a wide mouth like a yawn
• Bring the Baby to the breast

See the breastfeeding directory on BabyWebNZ.

http://www.babywebnz.org/display/BabyWebNZ/directory_Breastfeeding

This breastfeeding directory is broken down into the following sub-categories:

• Breastfeeding clothes
  
• Breastfeeding equipment
  
• Education resources
  
• Support / Organisations

Sore Nipples:

• Could be due to incorrect latch or thrush
• Hindmilk on nipple may help, 100% pure lanolin, or sunshine

• Feed on demand
• Chilled cabbage leaves, heat, supportive bra
• Hand express small amount if having problems latching baby

• Massage during feeding

• Signs include flu like symptoms, sore red area
• Rest, fluids, Vit C, homeopathic, empty breast, may need antibiotics so see your LMC midwife or Dr.

Abscess

• See your LMC

• Giving other fluids (water, formula) to baby will reduce your supply of milk.
• Try to avoid artificial teats, nipple shields, dummies especially until breastfeeding established.
• Feed on demand 2-4hrly (8-12x in 24 hrs for newborn) let baby decide, if in doubt offer feed. Can not overfeed a breastfed baby.
• Babies need feeds at night esp 1st 6 weeks, may take 6 weeks - 1 year before baby will sleep through the night. Keep night feeds quiet with dull lighting. If you wake them up too much and they will then want to play.
• Let the baby finish first side wind/nappy change then offer the second side. Alternate sides you start on, as usually they take the most of the first side.
• In the early weeks it may take total of 45+ minutes to feed, then baby will get quicker at breastfeeding, eg 10-30 minutes, with time.
• Expect growth spurts about every 2 weeks for 1st 3 months, and at 6 months, and 1 year, during these times they feed a lot for 2-4 days.
• If your breasts become soft it does not mean the milk has gone.
• Signs that baby is getting enough is wet nappies 6-8 cloth, 5-6 disposable, gaining weight after initial weight loss (back to birth weight at approx day10 - 14) alert and well.

There are alot of advantages to breastfeeding your baby. If you are unable to breastfeed, or do not wish to, you should be provided with information on how to formula feed. There is information on the NZFSA website re making up formula.

Advice for parents regarding infant formula from the Ministry of Health and NZ Food Safety Authority http://www.nzfsa.govt.nz consumers/food-safety section.

Also see the NZFSA safe feeding for infants section, which provides information on;

• Cleaning and sterilising bottles and feeding equipment
  
• Guidelines for handling and storing expressed breast milk safely
  
• How to thaw and warm expressed breast milk safely
  
• Storing expressed breast milk while travelling
  
• How to store and prepare powdered formula safely
  
• Managing allergens when preparing milk 

Advantages of breastfeeding for the baby:

• Species specific, human milk is different from any other animals
• Easily digested, breastfed babies are seldom constipated and have less digestive discomfort problems
• Changes to suit the babies age, provides all a babies nutritional needs in 1st 6 months
• Alters from beginning to end of feed. Foremilk comes at the start, then comes hind milk which has more fat to help make your baby feel full and settled.

• Reduced chest, ear, urinary and gut infections
• Reduced incidence of meningitis

• Are reduced eg eczema and hay-fever

• Reduced incidence in breastfed babies

• Reduced incidence of Diabetes, heart disease, liver disease, various bowel diseases.
• Protection against lymphoma

• Improved retinal development

• Better speech
• Reduced incidence of crooked teeth

• Improved brain development. Higher intelligence test scores

• Closeness with mother and baby

• Always available
• No prep time esp important at night
• Correct temp
• Portable

• Less bleeding
• Uterus shrinks faster
• Weight loss

• Average time to have no periods postnatally is 10 months if breastfeed at least 6x each day
• Increased prolactin levels prevent stimulation of ovary: exclusive (ie no milk substitutes introduced) breastfeeding is 98% reliable 1st 6 months as a form of contraceptive if there are no periods.

• Relaxing effect

• Reduced ovarian & pre-menopausal breast cancer
• Reduced osteoporosis

• Once breastfeeding established most women find it pleasurable and enjoy the closeness they have with their child

• 1992 study showed saved $1000 /year by not having to buy formula, bottles etc
  
• Reduced hospital visits: one USA study showed 1st 4 months of life 77 hospital admissions for every 1000 bottlefeed infants verses 5/1000 for every breastfeed infant.
• Environment - formula production and cans cause waste

Signs of a good latch:

Most problems caused by incorrect latch

When latching to the breast to feed look for:

• Wide open mouth
• Lips curved out over areola
• Chin against breast, tip of nose touching breast
• Sucking rhythm changes to long sucks and swallows
• Sometimes can hear baby swallow, see movement of jaw
• NO PAIN, initial tenderness 1st few days due to hormonal changes
• If painful take baby off, breaking suction by putting your finger gently into the side of their mouth and try again.

• produced during late pregnancy and the 1st few days
  
• high in antibodies and protein, low volume

• hormonal changes and baby sucking brings in mature milk about day 3
• breasts feel fuller ie engorgement

• more milk removed leads to more made (Prolactin)
• let down reflex
• sucking also releases oxytocin which causes muscle fibers around breast glands (alveoli)to tighten thus milk is pushed out
• often a tingling feeling is felt with let down of milk
  

• Learn about how breastfeeding works. See the following 3D animated video on the everybody website explaining about how milk is produced http://www.everybody.co.nz/page-71dffeb8-97f6-4f83-b0e7-eb516268d715.aspx .
  

• Signs of baby wanting a feed: hand to mouth movements, fussiness, sucking action or sounds, cooing or sighing and nuzzling at breast
• Organise yourself before you begin to breastfeed- phone and water near by
• Tri-pillows are helpful
  
• May need to wear a breastfeeding bra for support, including to bed
• You may leak breastmilk and need breast-pads
• If you are going to away from your baby for any period of time consider buying a breast-pump to express milk off for baby

• DEMAND FEEDING: letting the baby feed when they want to. Babies may feed between 6-18 times in 24hrs, newborns usually feed 2-4 hrly.
• AREOLA: the dark area around the nipple.
• LATCHING: the baby is positioned on the breast ready for a feed.
• LET DOWN: milk is going from the milk cells into the ducts. May feel a tingly or a tightening sensation. Is caused by oxytocin hormone release when the baby sucks and sometimes when you think about your baby.
• COLOSTRUM: the milk which is produced in the first few days after birth of your baby. It is concentrated and high in antibodies which help fight infections.
• FOREMILK: milk at the start of a breastfeed.
• HINDMILK: milk at the end of a breastfeed which is higher in fat content.
• ENGORGEMENT: Fullness of the breast.
• EXPRESSING: using your hand or a pump to remove milk.
• MASTITUS: breast inflammation causing pain, swelling and flue like symptoms.