Newborns are born “programmed” to suckle; human beings are mammals. Most babies have no difficulty latching onto their mother’s breast and expressing milk.
However, some babies have a hard time doing this: they reject the breast, they cannot latch on, or even latch on, they are not latching effectively and they cannot get the milk they need. What do we do in these cases? It has a solution?
The importance of skin-to-skin contact
The benefits of skin-to-skin immediately after childbirth have been fully studied. This first hour after birth is known as golden hour (or “golden hour”). Staying in skin-to-skin contact with their mother after birth helps newborns to adapt to extrauterine life: they better regulate their temperature, reduce their caloric expenditure and improve their oxygenation.
In addition, it favors the mother / child bond and the release of oxytocin, which in turn favors the uterus to contract and the ejection of colostrum. When it comes to breastfeeding , skin-to-skin contact after delivery increases the chances of success .
In this first hour (some experts extend this period to the first two hours of life), the newborn is able to locate its mother’s breast, crawl until it reaches it, and latch on; It is what is known as spontaneous hitch . It takes an average of 40 minutes to do it.
Some babies, however, don’t quite make it. In this case, it is convenient that a professional trained in breastfeeding helps us to make a targeted latch: we place the baby close to the nipple (brushing the nipple on the nose and philtrum) and help it latch on. The vast majority of babies take their mother’s breast in these first moments in one way or another.
Why won’t my baby latch on?
As we have seen, most newborns are able to latch onto their mother’s breast after delivery. However, a few babies do not succeed. In other cases, babies who latched on without problem as soon as they were born are later unable to do so again. In what cases does this happen? Why it happens?
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Mother-child separation . The usual thing in most hospitals is that mother and child make skin to skin after delivery. In the case of caesarean sections, more and more centers are also doing skin-to-skin. However, sometimes there are circumstances that force the mother and the child to separate for a time: birth complication, illness of the mother or the baby, very premature or low-weight babies … In these cases, there could be more difficulties to that are later hooked to the chest.
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“Sleepy” babies . After those first two hours after delivery, in which the newborn is awake and active and latches easily to the breast, the phase of sleep known as physiological lethargy of recovery from childbirth arrives, in which the newborn stays asleep for a long period of time, some between 8 and 12 hours. It is important here that they continue to have easy access to the breast so that they can latch on when needed. In the following days, babies usually wake up every few times to suckle, it is usual that they demand between 8 and 12 feedings a day. However, there are some sleepy babies who wake up less than they need and, depending on the circumstances of each one (premature or term baby, birth weight, weight loss …), The pediatrician may recommend waking him up every so often to eat. In addition to placing him close to the chest so that the smell stimulates him, it may be useful to undress him , change his diaper and / or give him a soft Go massage on the back or the soles of the feet .
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Anatomical problems to hook . The orofacial anatomy of the newborn is designed so that it suckles without difficulty. Thus, for example, they have a tongue that occupies the entire mouth and is capable of undulating movements to pump the milk from the ducts towards the nipple, a flat nose that allows it to breathe while it is attached to its mother’s breast, small lumps in the inner part of the lips that facilitate the attachment to the breast and some fat pads on the cheeks that help the suction.
However, some babies have different anatomical features that make breastfeeding difficult . Here we find ankyloglossia (tongue “anchored” by a too short lingual frenulum), retrognathia (retracted lower jaw) or malformations such as cleft palate and cleft lip. Premature, very low birth weight, and hypotonic babies also find it more difficult to breastfeed.
- Problems in the mother. In other cases, the baby cannot latch onto the mother’s breast because it is too full (breast engorgement). In this case, the reverse softening pressure is very useful as it displaces the edema and makes the nipple softer, allowing the baby to latch on better.
Contrary to popular belief, flat or inverted nipples need not be a problem for breastfeeding. Only true inverted nipples (those in which the fibers that make the nipple protrude are absent) may not make breastfeeding possible.
How to encourage the baby to latch on to the breast
1. Golden hour, skin to skin after childbirth
How could it be otherwise, this is our number 1. This helps to start breastfeeding early, increases the chances of having a correct latch on and engorgement pain is less frequent.
2. Skin to skin at any other time
Outside of the immediate postpartum, doing skin-to-skin with our baby also favors attachment. It has to be skin to real skin: mother without a shirt or bra, a baby in a diaper. The smell of the mother, the smell of milk and a substance released by the Montgomery glands (those little bumps on the areola) favor the latch on of the baby. It can also be useful to place ourselves in a biological rearing position (mother semi-sitting with the baby’s belly on her) to allow the baby to crawl towards the breast and latch on spontaneously.
3. Avoid teats
The use of pacifiers or nipples can, in some cases, lead to teat-nipple confusion . And it is that the breast is grasped in a very different way to how the pacifier is grasped or sucked from a bottle. Some babies with latching difficulties should be given supplements (which can be expressed breast milk or, if not possible, starter formula). In these cases, the supplement can be given with a syringe, finger feeding, a cup or, if it is given with a bottle, using the Kassig technique, to avoid interfering with breast suction.
4. Directed hitch
As we have discussed, sometimes the baby does not latch on by itself and we have to help it. To do this, we will brush his nose and upper part of the lip with the nipple to trigger the search reflex. In some cases, especially if the chest is very large, we can hold it in a C shape and gently compress it, offering it as a sandwich. Expressing a few drops of milk by hand can also help. When the baby opens his mouth wide, we will bring him closer to the breast, trying to get him to grasp as much of the areola as possible.
5. Find the most suitable posture
Some babies latch on better in one position than another. In the case of babies with frenulum or retrognathia, for example, the piggyback position is very useful. Some babies with tongue tie, however, will need to have their frenulum cut (frenotomy) to achieve a good latch on to the breast and proper expression of milk. The mother also plays a very important role and must find the position that is most comfortable for her. For example, after a cesarean section, the lying position may be the most suitable for breastfeeding the first few days.
6. Nipple shields?
In general they are used much more than they should be, but in specific cases and almost always temporarily they can be useful. Some babies with a frenulum, premature babies, or specific cases of flat or inverted nipples may benefit from wearing them. They can also help us in those cases in which the baby has been separated from the mother and has taken a bottle for a while.
And finally, I want to emphasize the importance of knowing how to ask for help. Breastfeeding is not always easy and health professionals are increasingly involved with it. If you have difficulties for your baby to latch on , do not hesitate to consult as in most cases it can be solved.
In Babies and more | Eleven Common Breastfeeding Problems and How to Fix Them, According to a Lactation Consultant
