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 with La Leche League International, including the Manual Expression of Breastmilk: Marmet Technique Though breastfeeding is natural, technique is a learned skill. It is important to get started correctly, even before your baby is born. You need to know well in advance how to identify and avoid possible problems, and where to turn if difficulties do arise. Many breastfeeding problems may occur when you establish your nursing patterns. With proper and prompt attention, the majority of these problems disappear as quickly as they develop. Plan to learn as much as you can about breastfeeding. You will be making an important investment in your and your baby's continued good health. An abundance of valuable reference material is available to help you get started. The most important contact before and during your breastfeeding experience is with certified lactation consultants and/or support organizations such as La Leche League International (LLL) and the Nursing Mothers' Council. By attending League meetings, for example, you will have the opportunity to meet and compare notes with other breastfeeding mothers. As your questions are answered, you will receive the helpful tips and reassurances you need to make your breastfeeding experience even more rewarding. As with any skill, the keys to successful breastfeeding are practice and patience. Learn all you can and then surround yourself with people who will offer you the encouragement you need. Be easy on yourself. Relax and enjoy this special and wondrous experience. A Simple Nipple Test
Because flat or inverted nipples can make it difficult for your baby to latch-on properly, you might want to find out if you have this condition by doing this simple test. Place your thumb and index finger on the areola, the dark area surrounding the nipple. At the base of the nipple, compress gently but firmly. If your nipple flattens or retracts (inverts) into the breast, you can begin wearing breast shells during the last couple weeks of pregnancy. These plastic shells are worn under the bra and create slight pressure at the base of the nipple, drawing it out. It is important to do this "pinch test" because although some nipples appear erect, they will invert when the areola is compressed.
After birth, if baby still has difficulty attaching to your breast, contact a breastfeeding specialist, La Leche League leader, or the Nursing Mothers' Council.
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A normal nipple remains erect. |
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An inverted nipple. |
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A flat nipple. |
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Breast Shells can help draw out flat or inverted nipples. |
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How Your Breasts Produce Milk Milk is produced and stored in the glandular tissue (alveoli) of your breasts. It collects in pockets (lactiferous sinuses) located beneath the areola (the dark area around the nipple) until it is released by a baby's sucking. Stimulation of the nipples causes the mother's pituitary gland, located in the brain, to secrete prolactin, which initiates and maintains milk production. The first milk your baby receives at each feeding is the milk that has collected in the pockets between feedings. This low-fat foremilk is high in protein and satisfies the baby's thirst. As breastfeeding continues, a second hormone called oxytocin is secreted. Oxytocin causes the tissue around the alveoli to contract, thus squeezing the high-fat hindmilk down the ducts and into the pockets where it is available to satisfy your baby's hunger.  Many mothers experience a tingling or rushing sensation in the breasts as this "let down," or milk ejection reflex (MER), occurs. Other mothers notice only that sucking becomes longer and slower, and that baby begins to swallow rhythmically. Keys to establishing a quick let-down are relaxation and confidence that your body is doing exactly what it was designed to do: feeding your baby the world's best baby milk -- produced by you! Breastfeed Immediately
Successful breastfeeding is the combined result of practice, patience, and proper positioning. Breastfeeding as soon as possible -- preferably within an hour after birth -- will get you and your baby off to a good start. Prompt breastfeeding can also help prevent engorgement -- an uncomfortable, "full" feeling in the breasts caused by swollen lymph nodes, extra blood and excess milk. Keeping your infant with you during your hospital stay will help you get to know and immediately respond to baby's cues. In addition to beginning the important cycle of milk supply and demand, early breastfeeding allows your baby to receive the benefits of colostrum. Rich in nutrients and antibodies, colostrum is the first milk you produce and is your baby's perfect starter food.
Immediately after birth, your baby will be in a quiet alert state and generally receptive to breastfeeding. (If your baby isn't ready the very first time you try to breastfeed, try again within the next half hour or so.) Within a couple of hours, your baby will become quite sleepy; drowsiness may last for several days. Avoiding Artificial Nipple Preference/Confusion Your baby begins to learn and practice the correct breastfeeding suck with the very first nursing experience. When both breast and bottle are offered in the early days, your baby may become "nipple confused" or may simply prefer the bottle nipple. Breastfeeding is an active process for the baby; bottlefeeding, however, is passive and requires a different type of suck. A baby who is bottle-fed early can have difficulty transferring learning to the breast. Avoid using any rubber teats (nipples) or pacifiers (soothers, dummies) during the first weeks. If your baby needs supplementation for a medical reason, use a cup. Even a tiny baby can drink from a small medicine or paper cup! The Law of Supply and Demand Milk production works on the principle of supply and demand. The more your baby breastfeeds, the more milk you will produce, totally meeting your baby's needs. It is the frequency of breastfeeding, as well as the milk removed from the breast, that stimulates further milk production. Babies who are given supplemental bottles of water or formula breastfeed less frequently, ultimately decreasing the milk supply. Supplements, unless medically indicated, should be avoided for three to four weeks, until your milk supply is well-established and your baby is latching-on to the breast without difficulty. Babies need to be breastfed at least 8 to 12 times in 24 hours the first two to four weeks, or until they are well above birth weight.
Attaching Baby to the Breast Latching the baby on correctly is the key to a pleasant, rewarding breastfeeding experience. Nursing behavior patterns are established early. Once set, bad habits are difficult to correct. Make sure you and your baby get off to a good start. A variety of reading materials and videos are helpful, but there is nothing like hands-on assistance from an experienced health care provider. Don't hesitate to ask for help the first few times. If you are still having difficulty by the time you leave the hospital, contact a breastfeeding specialist or a La Leche League leader.
Step 1
For most women, sitting up in bed or in a comfortable chair is easiest for breastfeeding. Make sure you are relaxed before you put the baby to breast. Use pillows on your lap, under your arms and behind your back. Putting your feet on a footstool to raise your knees slightly above your hips will eliminate back strain and put your body at the right angle.
Make sure your baby is comfortable and feels secure and supported. Nestle the baby in your arm at the level of your breast with his head and shoulders supported by your forearm just below your elbow, with your other hand holding his bottom. A nursing pillow can also help support your baby comfortably, while providing a resting place for your arms. The baby should be turned toward you, chest to chest, his head and trunk in a straight line, so that he doesn't have to strain or turn his head to attach to the breast. Tuck the baby's lower arm into the pocket between the two of you; if necessary, hold his upper arm down gently with the thumb of your supporting hand. Be careful not to tilt the baby's head down, as it will be difficult for him to swallow in that position. A very slight extension of the baby's head, with his chin touching your breast, will help keep his nose clear without your having to press on your breast tissue.
Positioning Styles
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Proper positioning is important for prevention of sore nipples. This is an example of the transverse/crossover hold. |
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The proper way to hold the baby is chest-to-chest, at the level of the breast. Baby's head should be in the crook of your arm and your hand should hold baby's buttocks. |
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The football hold is a good position for latch-on problems, or for premature or Cesarean birth babies. |
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The lying down position is especially useful after a Cesarean birth. |
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Two alternative positions are the clutch (football) hold, and lying down. The clutch is especially helpful if you are having difficulty getting the baby attached to the breast or if you have had a Cesarean birth. Step 2 Hold your breast with your fingers underneath and thumb on top, making sure all of your fingers are placed well away from the areola. It is sometimes helpful if you roll your nipple between your fingers for a couple of seconds to help it become more erect. Then manually express a couple of drops of colostrum to entice the baby to take the breast. A woman with large breasts may find it comfortable to help support the weight with a rolled washcloth or diaper under the breast. Step 3 Gently tickle the baby's lower lip with your nipple to encourage him to open his mouth wide. The moment he opens wide, almost like a yawn, quickly pull him in close to you. Do not lean forward, trying to put your breast into the baby's mouth. Instead, pull the baby toward you so that he has a large mouthful of breast tissue. His chin should be pressing into your breast; his nose should be just touching your breast. Keep supporting your breast with your hand until the baby is latched-on and is sucking well. Women with large breasts may have to support their breast throughout the entire feeding; smaller-breasted women may not need support. The key to successful latch-on and preventing nipple soreness is to teach your baby to take a large portion of the areola into his mouth. Latching the baby on.
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Tickle baby's lower lip with your nipple until he or she opens wide. |
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Once baby's mouth is opened wide, quickly pull baby onto your breast. |
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Baby should have as much areola (the dark area around nipple) in his or her mouth as possible, not just the nipple. |
As mentioned earlier, your milk collects in the pockets located beneath the areola. To empty these reservoirs effectively, the baby's mouth must be positioned over them. If the baby sucks only on the nipple, little milk will be drawn out, and you will become quite sore. If your baby doesn't latch-on properly right away, continue to encourage him to open his mouth wide and then pull him close to you again. Don't be afraid to repeat these steps several times until your baby gets the idea. If you feel any pain after your baby starts sucking rhythmically, stop, and break the suction by inserting your finger into the corner of his mouth between the gums, then try again. Latch-on discomfort is common in the first week or two, while the baby is learning correct positioning and sucking. Take a deep breath, relax, and enjoy breastfeeding! You may even find yourself drifting off to sleep -- a good sign the prolactin and oxytocin are flowing. Grab a little catnap while you are at it! Breastfeeding Styles Just as babies have different personalities, so too do they exhibit a variety of breastfeeding styles. Some babies latch-on and start sucking immediately, getting right down to business. Others take the slow and easy approach, simply enjoying this special time with mom. Breastfeeding is not only a mode of providing nutrition, it is also a special way of nurturing your baby. Although the terms "breastfeeding" and "nursing" are used interchangeably, breastfeeding could be used to describe the nutritive sucking that your baby does while feeding. Nursing describes the non-nutritive, sleepy type of suck your baby does when simply relaxing and enjoying being at the breast. Nutritive sucking is a slow, long, drawing, rhythmic sucking accompanied by swallowing. Non-nutritive sucking is lighter, faster and less intense. Swallowing is minimal or absent. Babies will often suck quickly and intensely at the breast when they first attach, a sort of "priming the pump" to initiate the let-down before they settle into the rhythmic deep sucking that characterizes breastfeeding. Manually Expressing Breast Milk -- The Marmet Technique
Expressing milk by hand can be done to relieve engorged breasts or to stimulate let down of milk when you are ready to begin nursing. The Marmet Technique, developed by Drs. William and Martha Sears with the La Leche League International, is an easy way to express breast milk.
Start by positioning the thumb above the nipple and the first two fingers below the nipple, about 1" to 1-1/2" from the nipple, although not necessarily at the outer edges of the areola. Use this measurement as a guide, since breasts and areolas vary in size from one woman to another. Be sure the hand forms the letter "C" and the finger pads are at 6 and 12 o'clock in line with the nipple. This way, the fingers are positioned so that the milk reservoirs lie beneath them. (Avoid cupping the breast.)
Push straight into the chest wall, avoiding spreading fingers apart. For large breasts, first lift and then push into the chest wall. Roll thumb and fingers forward at the same time. This rolling motion compresses and empties milk reservoirs without injuring sensitive breast tissue.
Repeat rhythmically to completely drain reservoirs. Rotate the thumb and fingers to milk other reservoirs, using both hands on each breast.
Avoid these motions: Massage the milk-producing cells and ducts by pressing the breast firmly with the flat of the fingers into the chest wall, beginning at the top. Move fingers in a circular motion, concentrating on one spot at a time for a few seconds before moving on to another spot. Spiral around the breast toward the areola as you massage. The motion is similar to that used in a breast examination.
Marmet Technique copyright 1978, revised 1979, 1981 and 1988. Used with permission of Chele Marmet and The Lacatation Institute, 1616 Ventura Blvd., Suite 223,
Encino, CA 91436.
This Article was Posted With the Permission of Medela, Inc.
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