BRINGING BEST OF THE ZOO TO EARTH PART TWO
FEED LIKE THE ZOO – BREASTFEEDING BASICS
Don’t worry, no photos of breastfeeding parts or babies!
Zookeeper tips for feeding like the zoo:
- Unlimited breast access. Feed the baby, not the clock!
- Positioning – think outside the solar system! Use a position that allows mom and baby to connect in a comfortable way and taps into baby’s reflexes to help him latch
- Hand express early and often for struggling babies – Jane Morton video
Latch and position – the “why” guide! Why they do what they do in the Zoo.
Positioning is about setting baby up with the right set of circumstances in order to latch.
So, how does baby latch?
- Watch the breastcrawl video
When moms and babies feed naturally, mom and baby recline comfortably with baby on top of mom, his chest to her chest. His face is in contact with mom’s breast and he has full access to his hands.
He squirms his way towards the breast and finds it by smelling, tasting, and feeling with his face, cheek, chin and hands. Then he roots until he feels the nipple just above his upper lip.
So – the right position for mom and baby is the position where baby can snuggle into mom, access the breast and use his innate reflexes to latch to the breast.
Zookeeper tip – avoid these two commonly taught Earth techniques:
- Stroking baby’s lower lip with the nipple then holding his face away from the breast until he opens wide
- Trapping baby’s hands so they don’t get in the way of latch
- Read the San Diego Breastfeeding Center’s article on newborn hands!
It is the feel of his face/cheek/chin in contact with the breast, and the nipple above his upper lip, that prompt him to open wide in order to eat! Holding his face away thwarts that reflex!
Hands are as important to eating for babies as they are to us. Baby uses his hands to knead mom’s breast, to help locate the nipple, to suck on in order to calm himself and organize his suck before latching, and to guide his latch.
PROVIDING BABY SUPPORT
Many people use pillows and boppies to position baby.
But the absolute best positioning tools are mom’s body and gravity.
LET GRAVITY BE YOUR FRIEND – RECLINE TO BREASTFEED
Find a comfortable position where gravity brings baby into your body and into your breast.
A good reclining position is:
- Not flat on your back
- Not all the way upright
- Somewhere cozy in between, like in a lazy boy recliner
Traditional upright positions, such as cross cradle and football, use pillows to support baby. Gravity pulls baby away from mom and away from breast.
To compensate, we apply pressure on baby’s neck and other places that make it harder for him to eat.
**Think about this – find a position where, if you let go of baby, he would fall into you!
Here is Tigger positioned upright:
When Tigger holds Baby Tigger in this cross-cradle position, gravity wants to pull Baby Tigger away.
See what happens when Tigger lets go?
Gravity pulls Baby Tigger towards the pillow. In an upright position, gravity is actively trying to pull Tigger and Baby Tigger apart!
But if Tigger reclines, he can turn gravity into his friend!
Here is Tigger reclining.
When Tigger lets go, gravity pulls Baby Tigger into him.
Don’t get rid of the pillows just yet, though!
Use the pillows to support mom’s arms. And use mom to support baby!
Baby needs to be supported and to feel secure, mom’s body makes the best support!
BABY POSITIONED PRONE ON MOM
Traditional positions have babies on their sides or backs. But babies are tummy feeders – they crawl to the breast and latch.
Baby should be facing mom, his chest in contact with her.
His body should be generally straight and not folded or curled in like a potato bug.
Baby Tigger isn’t really supported here:
His chest is not in contact with Tigger, he is not supported.
To help baby get nicely snuggled against mom, bring baby up closer to mom’s neck, then, once his chest is snuggled against her, help him slide down into position, keeping baby’s body in full contact with mom.
This is better! Notice there is no gap between baby Tigger’s chest and Tigger.
ZOOKEEPER EXERCISES – LEARNING HOW BABIES EAT!
Breastfeeding is eating! Babies eat just like we do!
The zookeeper has created some visual and hands on exercises to help learn the concepts behind how babies breastfeed.
Tools you will need for the Zookeeper exercises:
- Glass of water with straw
- Bottle of water
- Thick sandwich – or at least a fake one
- Section of 2×4 (16 inches or so) with a face drawn on one end and a diaper on the other
- Stuffed animal with “Kermit” like mouth
- Pez dispenser – I recommend a Tigger version, but any version will do
- A small cap from toothpaste, travel size lotion, rx bottle (in this photo I used a penny)
- a squidgy ball if you have one
- Apple (not pictured)
- Pregnant or lactating mom (also not pictured)
- Lazy boy recliner 🙂
- A Tigger or 2 – everyone should have at least one Tigger!
EXERCISES TO DISCOVER POSITIONING
Positioning is all about figuring out which position allows baby to snuggle against mom’s body and latch to the breast. It’s kind of like finding the right chair for the table – comfortable and at the right height and distance from the table.
**Granted, if you are still pregnant your belly is taking up the space where baby will go, so some of these may feel awkward, but they should still be helpful in getting an idea of how to find the reclining, or traditional upright position, that will work well for your body and breast type.
LOOK IN THE MIRROR – What’s the angle?
Comfortable latch has a lot to do with angles – the angle of the nipple, the angle of baby’s body, the angle of mom’s body.
Breasts come in all different shapes and sizes. And nipples point in all different directions – up, down, left, right, this way, that way.
How you sit – upright or reclined to varying degrees – will change how much space is available for a baby to fit on your body, and what direction your breasts hang and your nipples angle.
Since the goal is for baby to be able to latch to the breast, figuring out “how they’re hanging” (i.e. where your nipples angle) will help in figuring what position will allow baby to latch.
So, take off your shirt and take a peek in the mirror and see where they’re hanging!
Then put your shirt back on for the next exercise!
2X4 AND SMALL CAP
- 2×4 – about 16 inches or so. Draw a face with a mouth on one end. Put a diaper on the other
- Small cap – from a travel sized lotion, or a prescription bottle
Hold the cap against your breast with the flat face of the cap aiming in the direction that your nipple faces.
Sit down and get comfy.
Keeping the cap angled in the same direction as your nipple, in what positions can you put the 2×4 in such that the mouth will rest against the cap (i.e. your nipple) completely flat.
Most breastfeeding instructions tell moms to hold baby “tummy to tummy” – that works if your nipples point straight forward, but if they angle slightly downwards, slightly upwards, etc, and you place baby tummy to tummy, your nipple is going to get bent over and over again…..that’s not so comfortable!
In case you are wondering, the 2×4 is the baby, just not as cute :-). But it’s important to use something that cannot bend (unlike a stuffed Tigger or a Kermit) because the position where the 2×4 can rest flush against the cap without bending is the position where baby will be able to latch well.
This exercise is very helpful for moms who want to use standard positions like football and cross cradle. These positions can work, but often need to be adapted.
Play around with sitting upright – your pregnant belly can act like the boppy or nursing pillow.
In these photos, the board is not flush with the cap.
Baby could probably latch with these angles, but the nipple would be bent…..not a good thing!
Move yourself and the board to find the position where the mouth on the board fits against the cap.
Try a wide variety of the variations of semi-reclining, as well as some of the standard positions – cradle, cross cradle, football.
Look at the 2×4. The side facing you is baby’s belly, where is it angling?
This “baby” is tummy to tummy, but the cap angles down:
Are the cap and the mouth at the same height?
Even if this 2×4 were angled in the right direction, the cap is too low for the mouth of the board to reach – hint: the pillow is in the way!
If your nipples hang downwards like this, or rest against your belly, reclining will open up this space for baby!
In this photo, the angle is wrong, and the mouth too far away:
Look at where the end with the diaper is pointing. Does the board fit? In football hold, often there is not enough room for baby behind mom, and baby has to curl up to reach the breast.
As you move between sitting upright and reclining, you should notice that a lot of space opens up on your body (i.e. a place where a baby will fit nicely) when you are no longer sitting upright. The reclining position is made for snuggling babies!
Do the same thing with a semi-reclining position. What angle do you have to be at to get your nipples off your belly so baby can reach them? Remember, the cap must contact in the middle of the “face” end of the board, if there is to be enough space for baby.
The board is flush with the cap.
EXERCISES FOR HELPING WITH LATCH
For many babies, simply finding the right position and assisting them while they tap into their reflexes, is enough to get them latched and eating!
All these are a good set up for feeding!
However, some babies need a little help getting a big enough mouthful of breast.
GETTING A WIDE OPEN MOUTH
The first step to helping baby open his mouth is getting him positioned so that when he squirms into place, his body can align with mom’s body and breast, just the way the 2X4 did.
Starting up high with baby’s chest against mom’s can help him keep good contact as he snuggles down.
Once Baby Tigger has full body contact with big Tigger, he snuggles downwards.
As baby starts rooting and sucking, gently assist his position until he is low enough that his chin/cheek rest on the breast, his hands are free, often wrapped around the breast, and the nipple is just above his upper lip.
I used a penny instead of a cap for the second photo
Make sure to keep baby’s chest in contact with mom so he doesn’t curl in on himself or fall away from the breast.
If this happens, help baby uncurl, and regain chest to mom contact:
When baby rests against mom in that sweet, cozy position, baby feels for the soft breast with his cheek, face or chin, and roots for the feel of the nipple just above his upper lip.
Feeling these two things – breast with chin, nipple above upper lip will prompt baby to open his mouth wide and latch.
SHAPING THE BREAST TO FIT THE BABY
Some babies have difficulty getting enough breast in their mouth. Many moms like to shape their breasts to help.
Babies eat just the way we do! If something we want to eat is not shaped in a way that we can get it in our mouth, we re-shape it.
- Kermit or other stuffed animal with a mouth like Kermit’s
- Squidgy ball – use marker, penny or cap for nipple
- Sandwich or fake sandwich
- Watch somebody eat a sandwich
Think of your nipple as the top bun of a sandwich. The goal of a sandwich is not the top bun, it is the sandwich itself – that’s the area beneath the nipple, from baby’s perspective!
Watch someone eat a sandwich – where is the top bun just before they open their mouth?
See where the top bun is? It is in line with, or above, the upper lip. It is NOT centered on their mouth, nor is it near their lower lip.
Fingers on top and bottom shape the sandwich to line up with the mouth.
The fingers on the bottom are out of the way so they don’t get bitten. With baby, keeping the fingers on the bottom out of the way will allow him to get a good latch.
If the fingers are too close, he won’t be able to get a good latch:
And it will hurt!
Try this instead:
This is much better! Sandwich is still shaped, but finger safely out of the way!
If you need to shape your breast for baby, shape your breast as if you were shaping a sandwich – the fingers on either side of the breast are parallel with baby’s lips.
Sounds super simple, I know, but often, especially if you are using the cross cradle hold (the most often taught position) you will find that, due to the challenge of bending your arm enough, you are actually shaping your sandwich askew or even perpendicular to baby’s lips.
Shaping like this makes it more difficult for baby and more painful for mom.
HOAGIE SANDWICH VISUALIZATION (unless you can get someone to eat one too!)
Think of a very thick sandwich, like a hoagie. If you let go of the bottom of the sandwich too soon, it all falls out leaving nothing but the top bun.
If baby keeps losing his latch, it might help if you provide support on the bottom side of the sandwich (i.e. the side near baby’s chin) to keep the sandwich in place, just for a few minutes.
TIGHT, ROUND OR ENGORGED BREASTS.
BOBBING FOR APPLES VISUALIZATION
Some babies struggle to latch onto a tight, full or very rounded breast.
I find the bobbing for apples analogy helpful.
When you bob for an apple, the hard part (besides holding your breath) is getting your jaw around the apple.
Now, imagine someone cut a small chunk out of the apple, right where your bottom teeth and chin would go. You could grab it easy, right?
For some babies, mom’s breast is round and tight like an apple.
The problem is that the breast is too round on the side near the jaw.
No, I’m not suggesting you cut a wedge out of your breast :-)!
But you can achieve the same results by indenting the breast with the finger that is near baby’s chin. Shaping the breast on the “sandwich side” allows baby to grasp the breast, just like the wedge in the apple allows you to grab the apple.
ADJUSTING BABY TO FIT THE BREAST, GETTING A DRINK OF MILK
- Bottle of water
- Pez candy dispenser
- A drink with a straw
HEAD TILT EXERCISES
To latch and eat comfortably, baby needs to be able to open his mouth wide and stick out his tongue.
The more his head tilts back, the easier it is. The more his head bends forward, the harder it is.
Bend your head forward, put your chin on your chest, open your mouth and stick out your tongue. Then relax. What happens? Chances are, your tongue withdrew into your mouth and your mouth closed.
Now tilt your head back and stick out your tongue. Keeping your mouth open and keeping your tongue out is much easier, right?
When baby is latching, look down and see if his head is tilted back or bent forward. If his head is bent forward, shift his body a smidgeon in the direction of his feet and push in gently on his shoulder blades – this small adjustment can make a huge difference in comfort!
Gotta love Pez! Think of the pez as a tongue. It only comes out when the head is tilted back! There is no food unless the head tilts back!
BOTTLE OF WATER EXERCISE
Watch someone drink a bottle of water. When they tilt their head back, it looks comfortable, right? It’s easier for us to drink that way. And it’s easier for baby too.
Baby’s eat and drink just like we do!
IS BABY ACTUALLY GETTING FOOD?
Getting baby latched is only the first step. Like getting the sandwich in your mouth, or getting the food on a fork. The next step is the most important – actually eating the food!
How do you know if baby is getting any milk when he sucks?
By watching and listening for swallowing.
On the first day, baby will swallow every once in a while. Over the next few days, as more milk becomes available, baby should begin swallowing every one or two sucks.
So, how do you know how long to feed baby and when/if to switch to the other breast?
By watching and listening for swallowing.
Swallowing is eating. Not-swallowing is not eating.
For this, I like an Earth analogy – think of being at a restaurant.
Baby at the breast is like sitting at the table. Baby sucking is like ordering food.
Baby swallowing is baby eating. Baby not-swallowing is not eating.
Sometimes, baby not sucking and not-swallowing is like putting down the knife and fork to take a pause before continuing.
A gentle reminder will get him started again. A nice way for mom to “remind” baby is to massage her breast and express some milk into his mouth. It’s like when the waiter stops by, eyeballs your plate and asks if you’re finished.
If baby resumes sucking and swallowing, he is eating, no need to switch him to the other breast. You wouldn’t want the waiter taking away your plate of food before you finish!
When baby is at the breast but not swallowing much, this is like scraping the crumbs off the plate. No amount of “gentle reminding” will get you eating again because the plate is empty.(No, breasts are never truly empty, but the analogy works anyway!)
If you’re full, you’ll get up and ask for the bill. If not, you’ll stay at the table and wait for the next course.
When baby is no longer swallowing, but is still at the breast, he is sitting at the table waiting for the next course – the next breast.
So, how do you know when to switch breasts? When baby has finished the first one!
How many breasts will baby need at a feeding? However many it takes until he is finished.
When he stops swallowing, comes off the breast and turns your breast into a pillow, this is like getting up from the table and asking for the bill.
So, how long do you feed baby? Until he is finished eating and gets up and leaves the table.
Remember, swallowing is eating, not swallowing is not eating.
Being at the breast and not swallowing is baby waiting for the next course.
HOW TO DETERMINE IF BABY IS SWALLOWING
GLASS OF WATER WITH A STRAW EXERCISE
Watch someone drinking through a straw:
- Have them take short choppy sucks, then small sips and longer sips. Just by watching how far their jaw drops down – you can tell how big a mouthful they are taking, right?
- Stand beside them and listen. You can hear the small puff of air through the nose as they swallow.
There are 2 ways to determine that baby is actually swallowing breastmilk:
- By watching his jaw and seeing it drop down and hold – this is his mouth filling with milk
- By hearing the soft puff of air from his nose as he swallows
Dr. Newman has some excellent video clips of swallowing:
SIGNS OF A GOOD FEEDING:
- Baby’s brow and hands are relaxed when eating
- Baby comes off the breast on his own, appears content, sated
- Body and limbs are relaxed – I have the limp noodle test – I lift an arm and see if it is limp and relaxed like a wet noodle
SIGNS OF STRUGGLING:
- Tension between brows – furrowed brow
- Hands balled into tight fists, knuckles white
- Appears asleep but body and limbs are tense. Limp noodle test – lift baby’s arm, it is tense, not like a limp noodle
How to help if baby is struggling:
- Massage and breast compression while baby is latched. Jack Newman video clip.
- Hand express and feed expressed milk to baby. Jane Morton hand expression video.
PUTTING IT TOGETHER – QUICK REVIEW
When in doubt, this is a good place to start:
Tigger and Baby Tigger skin to skin.
Reclining – opens space up and allows gravity to be your friend. Not flat. Not upright, somewhere in between – where gravity is your friend, and baby knows his way!
Start here – chest to chest:
Baby Tigger in full body contact with Tigger
Baby Tigger snuggles/slides into position – no gap between Baby Tigger’s chest and Tigger
So cuddly, cozy! But remember, no rushing! He may take a short nap once you snuggle him skin to skin – do NOT rub him with cold washcloth, tickle, and nag! Give him time, once he’s ready, he’ll start to root and find the breast!
Finding the right angle:
It’s all about angles!
Setting up the latch:
Food is good!
And after dinner: