HELLO BABY HAVE A GOOD START! A guide to breastfeeding from and Introduction Dear reader, The birth of your baby is an experience that will change your life. From now on, you have to make numerous decisions about the care and nutrition of your newborn child. Amongst others, you have to also make a decision about breastfeeding. Breastfeeding can demonstrably improve your health and that of your baby. Besides, you will both develop a deep relationship that may have a very positive influence later in life. With the decision to breastfeed, you give your baby the purest, most natural and best nutrition – breast milk! Breastfeeding is the most natural thing in the world, but nevertheless it is a process that raises many questions and needs practice. This guide from ARDO was developed in close cooperation with the breastfeeding and lactation consultant IBCLC Marliese Pepe, and it should provide a comprehensive range of solutions to your questions and problems so that you and your baby can enjoy this intimate time. 2 Special consultant: Marliese Pepe, breastfeeding and lactation consultant IBCLC Copyright 2007 Ardo medical AG Switzerland 3 Table of contents Breastfeeding – the ideal start in life 6 7 7 8 8 8 9 9 10 Improved development and health for your baby Better health for you Breastfeeding difficulties Anatomy of the female breast Milk production What happens during pregnancy? Preparation of the breast Flat and inverted nipples After birth Interesting facts about breastfeeding 11 11 12 13 4 11 Unique composition of breast milk Initiation of milk formation Breast massage and breast compression Breast care Breastfeeding – how it is done 14 14 17 18 18 6 The right time Correct positioning Breastfeeding rhythm Breastfeeding frequency Weaning 14 Breastfeeding – in everyday life 20 21 21 21 Breastfeeding and work Breastfeeding and spare time Breastfeeding away from home Breastfeeding and nutrition Breastfeeding – when problems emerge 22 23 24 24 24 25 25 25 20 22 Not enough milk Engorgement & mastitis Sore nipples Flat and inverted nipples Breast milk leakage The tired inefficiently drinking baby The nipple-confused baby Ill or premature children Breastfeeding aids – the solution to many problems 26 26 26 27 27 29 Pumping with good feeling Choosing the right breast pump Storage of breast milk Defrosting and warming breast milk ARDO and Ameda breastfeeding aids – product outline Useful addresses for breastfeeding problems 32 32 International addresses of associations 5 Breastfeeding – the ideal start in life Breastfeeding is the best for your baby. Breast milk protects your baby from illness. Through breastfeeding, you and your baby develop a very deep relationship that has already started during pregnancy. Breastfeeding gives your baby the best start in life, prevents illnesses, reduces the costs of our health system, protects our environment, does not burden the household budget, reduces the daily amount of work and - on a long-term basis - gives you and your baby more free time to spend together. However, breastfeeding is a learning process, which means that mother and child have to practice. This requires knowledge, time and patience right at the start. With this brochure ARDO wants to give you an insight into the world of breastfeeding. ARDO and Ameda breastfeeding products help you in a fast and meaningful way and make daily life easier for you. Turn the pages of this brochure and find much information that you need as a breastfeeding woman. 6 Your baby needs support and safety from the start. Improved health and development for your baby Breast milk contains everything that your baby needs for healthy development. Extensive research has shown that breastfeeding is healthier than feeding the baby powdered milk through a bottle. Breast milk contains many substances that work actively against infections. The immune system of the child needs two years to completely mature. Therefore, breastfed children clearly have an advantage. Breast milk reduces the risk of different illnesses, such as inflammation of the middle ear, infections of the respiratory and the urinary tract, allergies, sudden infant death syndrome (SID), diarrhoea, nappy dermatitis, diabetes, bacterial meningitis, Crohn‘s disease (inflammation of the intestine), etc. Infant allergies are on the rise. If a baby is only breastfed during the first 6 months of its life, the allergy risk can be reduced by up to 50 %. Breastfeeding reduces the risk of a child suffering from obesity later in life. Moreover, many babies are allergic to artificial powdered milk (replacement feeding for babies). Breast milk is easily digestible and strengthens the digestive tract of the baby. Sucking at the breast benefits the development of the entire mouth area by preventing - amongst other things malocclusions and facilitating language learning. Better health for you Not only your baby benefits from breastfeeding. Breastfeeding hormones support the regression of the uterus to its normal size; they reduce loss of blood and the danger of an uterine infection. The hormones have a calming effect and strengthen the relationship between you and your baby. You learn to understand your baby faster and better. Moreover, studies show that breastfeeding reduces the rate of breast, uterine and ovarian cancer. On a longterm basis, the risk of osteoporosis is also lowered. Mothers who breastfeed lose weight faster after childbirth. Together and healthy in life. Breast milk is always available, easy to digest and is always at the right temperature. It is absolutely free. Studies show that breastfeeding saves a lot of time, money and effort compared to bottle-feeding once you and your baby become accustomed to it. Breast milk contains everything that your baby needs for optimal growth. Breastfeeding is fun, and it is beneficial for the mother as it reduces the risk of developing breast cancer. You will also get back in shape much faster. Breastfeeding difficulties Some mothers feel it to be a disadvantage being tied down by breastfeeding. However, after the 4th – 6th week of a baby‘s life, it can drink pumped breast milk (if you give your baby pumped milk sooner, there is a danger that your baby will get used to the bottle and the different sucking technique and will not drink from the breast any longer), and you can take some time off your 24hour job as a mother. We recommend using an Ameda breast pump. Breastfeeding is concerned with the quality of a baby’s nutrition, but it cannot compare to the quality of being a mother. However, hormonal changes mean that many things are easier for mothers who breastfeed. Together and healthy in life – with breast milk 7 Anatomy of the female breast The female breast consists for the most part of glandular, fat and connective tissue. Between 4 and 18 lactiferous ducts connect the mammary glands, which are made up of alveoli, to the nipples. The lactiferous ducts branch out in the vicinity of the areola. The areola contains nerve endings that regulate milk formation. This means that the more the areola and the nipple are stimulated, the more milk is produced. The more a baby sucks at the breast, the more milk is available. The areola also contains special sebaceous glands, called Montgomery glands. They release a substance that keeps the skin of the nipples and the areola smooth, and also has an antibacterial effect. It is triggered simultaneously several times at both breasts during breastfeeding. The mother can recognise the let-down reflex from the following signs: • tingling warm feeling or stinging in the breast • milk starts to run from the other breast • the baby swallows rapidly and regularly. Anxiety or stress may have a negative effect on oxytocin. The milk does not flow or flows slowly, despite being present in the breast. The size of a breast has no influence on the ability to breastfeed. Women with small breasts can also breastfeed successfully. Milk production Two hormones are basically responsible for milk production. Prolactin generates milk in the glands, and oxytocin makes the milk flow. Once a baby sucks at the breast, the milk vesicles and lactiferous glands contract. Milk flows out from the nipple. This process is termed milk ejection reflex or ‘let-down reflex’. 8 Time, a relaxed atmosphere and a bit of patience are the ideal conditions for successful breastfeeding. What happens during pregnancy? During pregnancy, the glandular tissue begins to grow. The areola swells and darkens which makes it easier for the baby to find the nipple after birth. In the 20th week of pregnancy, the breast already begins to produce colostrum, which is occasionally secreted during pregnancy. Preparation of the breast Preparation of the breast can begin after the 32nd week of pregnancy. At no time should the preparation process be painful. The process should include: • exposure of the breast to air and sun • mild ‘invigorating’ through soft rubbing of the nipple on clothes, e.g. by not wearing a bra • avoiding the use of soap during washing or showering to keep the natural skin protection of the Montgomery glands • gentle massage of the breasts once a day (no-risk pregnancy only) • integration of the nipple into love play Flat and inverted nipples It helps to check the form of the nipple during the pregnancy. Softly press together the breast at the areola close to the nipple. If the nipples do not emerge (inverted nipples) or remain flat (flat nipples), the baby may find it difficult to latch onto the breast properly. The nipples should bulge so that your baby can easily latch on. By wearing an Ameda Nipple Former directly underneath the bra (from the 32nd pregnancy week on), a soft and constant pressure is exerted on the areola. As a result, the nipples become erect and the baby can latch onto the breast. If premature childbirth is suspected, a nipple former should only be used following your physician’s instructions. The Ameda Nipple Former prepares flat and inverted nipples for breastfeeding. The ARDO Tulips Nipple Shield protects and can help your baby grasp the nipple. 9 If the baby is still not able to suck efficiently at the breast a few days after birth, an ARDO Tulips Nipple Shield can be used. Otherwise the milk can be expressed with, for example, an Ameda Breast Pump, and the baby can drink breast milk from the bottle. This way, it receives all the health benefits that breast milk has to offer. If your nipples don‘t bulge, contact an IBCLC lactation consultant or a midwife during pregnancy. After birth The first hours after birth are very important for the initiation of the breastfeeding relationship, as the search and suction reflex is very strong at this time. The best way to initiate the breastfeeding relationship is to place the baby naked on the stomach of the mother and leave it there until it sucks the breast. Some babies crawl on their own to the breast and latch on without any help. Bonding is an important event for you and your baby – take your time and together with your partner enjoy the first unforgettable moments in the company of your child. 10 Interesting facts about breastfeeding Unique composition of breast milk One drop of breast milk is made up of 4000 living cells. It adjusts to your baby‘s differing needs and constantly changes its composition. It depends on the baby’s age, the time of day and the respective meal. Sometimes its composition even changes during one breastfeeding session when the sugar and fat content in particular varies. At the beginning of the meal, the milk seems more watery (foremilk), and after the triggering of the milk-ejection reflex, it contains much more fat (hind milk) and has a creamywhite appearance. viscous and easily digestible milk. It contains many more proteins (particularly anti-bodies) and less fat than mature breast milk. These antibodies line the intestinal wall of the baby and protect it from infections. The first milk contains three times the concentration of sodium found in mature breast milk. Therefore, your healthy, full-term baby does not need many fluids in the first days of its life, which means that the colostrum already present is usually enough. Colostrum also stimulates bowel actions, meconium is excreted more quickly, and the danger of jaundice is reduced. Every drop of breast milk is precious – it contains 4000 living cells! Transition from colostrum to mature breast milk The gradual transition to mature breast milk occurs between the 2nd and 4th days after birth (sometimes between the 6th and the 7th days and with mothers of premature infants between the 10th and the 14th days). The start of this phase is termed initial milk letdown. It lasts about 14 days. The breasts become warmer, are heavier and the veins become visible. Breast glands often swell at this time, and the breasts feel hard and are painful. In this case, we recommend the use of ARDO Temperature Packs as a cold compress. Frequent breastfeeding of the baby and regular breast massage also have a soothing effect. Foremilk quenches the baby’s thirst while hind milk satisfies the infant’s hunger. Breast milk contains all the important vitamins, minerals and trace elements required for the optimal growth of the baby and meets all hygiene requirements. Initiation of milk formation First milk In the first days of a baby‘s life, colostrum (first milk) is formed. It‘s a yellow, 11 Mature breast milk After two weeks have passed, the breast milk will have adjusted in its consistency and quantity to the fast development of your baby. The breast milk is now referred to as ‘mature’. Afterwards you repeat the same procedure by placing your breast between your hands held vertically. Breast milk is always optimally adjusted to the age of your baby – your baby knows what‘s good! Breast massage and compression Breast massage promotes the blood circulation in the breasts - as well as the flow of milk - and has a positive influence on milk production. This massage should be briefly performed before any breastfeeding session, particularly in the first days and weeks after your baby’s birth to prevent engorgement. It is especially useful for the prevention of breast inflammation. Breast massage should be carried out gently and should never be painful. Hands should be washed thoroughly before any massage. Instructions: 1. Place your breast between your hands, which should be held horizontally, and move the gland tissue back and forward - as shown in the picture. 12 2. One hand supports the breast. Place three to four fingertips of your other hand flat on the breast and massage the gland tissue with circular movements. The fingertips are shifted 2-3 cm every now and then and the procedure is repeated until you have massaged the entire breast. 3. Use your fingers to gently caress the breast from the base of the areola to the nipple. Through this movement, you can bring the milk to flow. 5. The rhythmical repetition of step 4 around the areola can relax a tense breast or even empty it. Alternatively, you can express the breast milk using a gently- functioning breast pump (e.g. Ameda Elite or Ameda Lactaline). 4. Try to gently squeeze out a drop of milk by placing the thumb and the finger (as shown in the picture below) behind the areola and pressing slightly in direction of the chest. Then, by applying gentle pressure, move your thumb and finger towards the nipple without rubbing the skin. Breast care The breast needs no special hygienic measures during breastfeeding. Daily showers or washing are sufficient. However, avoid your nipples or areolas coming into contact with soap or shower gel, as they destroy the natural protection of the skin. After the breastfeeding session express a drop of breast milk as described and spread it over your nipple. In the case of sensitive, slightly reddened, dry or chapped nipples, special care products like high quality Lanolin nipple ointment may be used. You can wet your nipple with the resulting drop of breast milk and encourage your baby to suck the breast. 13 Breastfeeding – how it is done nipples and to regularly empty the breasts. The right time The sooner, the better! In most cases, it does not take long before the baby begins to search for your breast. Some babies suck energetically right from the start. Others suck or lick the nipple carefully. The most important requirement for successful breastfeeding is early and correct positioning. Correct positioning Through correct positioning from the start, you can prevent breastfeeding problems such as sore nipples, lack of milk etc., and after a few days’ practice you can happily enjoy breastfeeding. Pay attention to the following points: 1. Correct positioning of mother and baby A comfortable position for the mother and correct positioning of the baby contribute substantially to successful breastfeeding. Therefore, it is not that important whether you breastfeed lying down or seated. However, it is recommended that you change the breastfeeding positioning during the day to relieve the 14 A nursing pillow makes breastfeeding comfortable. It provides relief and you do not have to support the weight of your baby with your muscles, instead relaxing your arm on the pillow. The pillow serves as a support for the mother’s arm but is not a pillow for the head of the baby. By holding your baby, you can control the positioning better. In particular, this means that you have to hold your baby so that • it lies stomach to stomach with the mother (ear, shoulder and hip form one line) • the mouth is at the same height as the nipple • the arm of the mother is supported, and her shoulders are relaxed • the tip of the nose and the chin of the baby touch the breast throughout the breastfeeding session A nursing pillow provides comfort and allows you to relax while breastfeeding your baby The most common positions are explained as follows: Breastfeeding in a sitting position Dorsal posture The back of your baby rests on your lower arm, your hand supports its head, and the legs are stretched out behind you. The sucking of a newborn baby in this position can be easily measured and controlled. This position is particularly recommended at the beginning of the lactation period. It is especially suitable for breastfeeding twins, premature babies, after a Caesarean section or when your baby has a cold. The classic cradle hold The baby lies on its side in the arm of the mother (in the so-called ‘cradle hold’) so that its entire body is turned towards the mother. Her hand supports its bottom. Breastfeeding in a lying position Lying position You and your baby lie very close together on your sides, stomach to stomach. This breastfeeding position is especially recommended at night or when you want to relax while breastfeeding during the day. 2. Correct positioning of the breast The breast is held with the other hand, with four fingers supporting it from underneath. The thumb is positioned above the areola. 15 The skin is gently pushed forward to stretch the areola and to help the baby take a lot of breast tissue into its mouth during latch-on. As a consequence, the nipple is centred in the middle of the mouth, and the baby is quickly drawn close. The chin and the tip of the nose touch the breast, the nipple is deep in the palate of the baby and the upper and lower lips are folded outwards. If the baby has been correctly positioned a feed does not have to be limited in time. The baby is pulled towards the breast not the breast towards the baby! 3.The right way to grasp the nipple and the areola. Using the nipple to tickle the infant’s lower lip will make it open its mouth. If it hurts right at the start then the baby is probably not positioned correctly. 16 4. Releasing the baby gently from the breast When you want to remove your baby from the breast, we recommend loosening the vacuum first by sliding a finger between your breast and the corner of your baby’s mouth. However, in most cases, the baby, when it is full, let’s go of the breast on its own. Breastfeeding rhythm The breastfeeding rhythm constantly changes in the course of development. The best breastfeeding results are obtained when a healthy, full term baby is breastfed as needed. During the first days, the breastfeeding rhythm amounts to approximately 4 – 8 times a day. On the 3rd to 4th day after birth, the frequency can climb to between 12 and 14 times a day and often levels off to between 2.5 to 3 hours within 24 hours. It is normal for a baby to want to be breastfed even at night in the first weeks of life. During growth spurts (at the age of 2 to 3 weeks, six weeks and three and six months), the rhythm changes. High temperatures or restlessness and tension can change this rhythm too. The burp Contrary to widespread opinion, most breastfed babies do not have to burp. Compared to babies who are fed with a bottle, breastfed babies rarely swallow air during breastfeeding. However, babies who drink fast and avidly and who choke during breastfeeding are more likely to have air in their stomach. If your baby is restless after breastfeeding, pick it up and softly rub its back. Most of the time, the excess air escapes. Breastfed and full – and romping with Mummy is fun 17 Breastfeeding time The time taken for breastfeeding depends on the character and age of your baby. It can vary between 10 and 20 minutes per breast. Offer your baby both breasts. If the baby is full after feeding at one breast, offer it the other breast at the next breastfeeding session. Pay attention to your baby’s sucking noises and intensity. Short and fast movements at the beginning make the milk flow, and slower, more intense sucking means that the milk has begun to flow. The milk supply is sufficient when your baby gains at least 120 – 140g per week. Breast is best – long after the first steps! Weaning A mother can basically wean at any time. The weaning process takes approximately 14 days. Through slowly reducing the breastfeeding meal frequencies and lengths, the breast milk diminishes gradually. That means that the baby will be only briefly breastfed, or the breast will only yield a small quantity of milk before the mother feels an uncomfortable strain in her breast. Sage and peppermint tea and parsley help to reduce the quantity of milk produced. 18 How long should breastfeeding continue? Ideally, the baby should be fed exclusively with breast milk during the first 6 months. It contains everything that the baby needs for healthy growth. After 6 months, the baby should begin taking solid food as well. Breastfeeding is then gradually replaced by solids. The WHO (World Health Organisation) and UNICEF recommend continuing with breastfeeding up to the second year of life. Breastfeed for as long as you and your baby want to. Breastfeeding brings you and your baby into harmony 19 Breastfeeding in everyday life how you can express and store milk and other breastfeeding accessories on pages 26-31. Breastfeeding and work Returning to work is not necessarily a reason to wean. It is rather a reason to continue breastfeeding, as your child will miss you during your absence. Through breastfeeding, it can again ‘fill up’ with proximity. However, a certain degree of organisation is required. It is important that you inform your employer in advance that you want to breastfeed your baby. If you want to express your milk, you should start expressing approx. two weeks prior to the first day of work so that you can build up a supply. You can rent a pump or buy one. We recommend the compact Ameda Lactaline Personal Breast Pump. If you express at work, you can carry it in a separately available discrete backpack. You can keep the milk cool on your way home in the Ameda freezer carry bag. You can also express directly into an Ameda freezer bag, thus saving storage space. Breast pads like the ARDO LilyPadz are effective in preventing milk leakage. You will find further information about 20 For the mobile mother: Breastfeeding set ‘Mobile’ with the Ameda Lactaline breast pump and a wide range of breastfeeding accessories Swimming, sleeping without a bra, going out at work: no problem with ARDO LilyPadz, the re-useable breast pads for all everyday situations Your rights at work When you return to work and want to continue breastfeeding, you usually have the right to the time required for breastfeeding or expressing milk (legally guaranteed in certain countries). If in doubt, contact your breastfeeding or lactation consultant, midwife or the relevant institutions. Breastfeeding and spare time Try to find time for yourself in your 24hour job as a mother. Short rests and regular leisure activities are very important for your well-being, and ultimately also for your child. With an expressed milk supply you ensure that your baby is fed with breast milk even if you are absent. Breastfeeding away from home You can breastfeed wherever you please. For example, with a bit of practice, you can do without the nursing pillow, and be even more independent. Breastfeeding and nutrition Healthy and balanced nutrition is very important, particularly during breastfeeding. The calorie consumption increases by approx. 400 kcal. A breastfeeding mother can generally eat anything she wants. However, there is one important rule to be considered: food products that do not agree with her, which cause flatulence, regurgitation or indisposition can give the child stomach ache and should be avoided. Breastfeeding When Mummy is not around, Daddy can feed me too mothers should avoid nicotine and alcohol. However, as a general rule, there is nothing wrong with treating yourself to a glass of wine after a good meal after breastfeeding. Through breastfeeding, your demand for fluids is higher, and your fluid intake should be approximately 2 to 2.5 litres a day. There is also special ‘breastfeeding tea’, which can promote milk production. Fennel, lime blossom or alcohol-free beer have a similar effect. To reduce the amount of milk, it is recommended that you drink peppermint or sage tea and eat a bunch of parsley every day. Smoking during breastfeeding Milk production can be impaired by nicotine. You should not smoke while breastfeeding. If this is not possible, smoke only after breastfeeding and never in the presence of your baby. Try to reduce nicotine consumption as much as possible. 21 Breastfeeding – when problems emerge Not enough milk The weight gain of your child determines if you have enough milk or not. If it gains 120-140g per week you have enough milk. Almost every mother can breastfeed her child. However, insecurity, incorrect information or also fear sometimes lead new mothers to question their ability to breastfeed. Many mothers do not realise during pregnancy that breastfeeding starts immediately after birth and that it has to be learned. Good breastfeeding preparation can prevent many breastfeeding problems, in particular sore nipples. In this section, we want to encourage you and help you cope with certain difficulties. However, in the event of breastfeeding problems or uncertainties, do not hesitate to ask specialists for help. Trained IBCLC breastfeeding and lactation consultants work in clinics and hospitals and will gladly assist you, even after discharge. It is possible for your milk supply to be limited for a number of days if, for example, you are overtired or your child is going through a growth spurt. More breastfeeding, more frequent change of sides (ping-pong breastfeeding), enough rest, balanced nutrition and additional measures such as breastfeeding tea, lime blossom and fennel tea, alcoholfree beer, brewer‘s beer flakes and breastfeeding massage oil can stimulate milk production, and within 2 to 3 days, the milk supply will have adjusted to the baby’s demands. It is absolutely normal that after some weeks, your breasts don‘t feel as full as they used to between breastfeeding meals - this has nothing to do with the quantity of milk produced. However, if your baby does not gain enough weight and, during the first four weeks, does not have at least one bowel movement a day and does not wet nappies six times a day, do not hesitate to contact a breastfeeding specialist. Baby scale for weight check 22 Engorgement and mastitis (breast inflammation) During the entire breastfeeding period and especially in the first weeks at home, the breasts may harden and be painful after breastfeeding, and you could feel as if you have flu (e.g. fatigue, pains in the joints, headaches, fever). These symptoms point towards engorgement. We recommend that you act as soon as possible against engorgement and do the following: 1. Place a warm damp compress (e.g. ARDO Temperature Pack) on your breast for approximately 10 minutes before breastfeeding to make the milk flow better. 2. Position your child so that its chin points in the direction of the hardened area. 3. Massage the hardened area gently during breastfeeding. The Temperature Pack, applied when warm before breastfeeding stimulates the flow of milk. When applied cold after breastfeeding, it relieves engorgement. If the symptoms do not diminish within a few hours or if fever develops, contact an IBCLC breastfeeding and lactation consultant or midwife, as there may be danger of breast inflammation (mastitis). Contrary to belief, a woman with breast inflammation or who is taking antibiotics does not have to wean. 4. If the breast is still hardened after breastfeeding, use a gentle milk pump (e.g. Ameda Elite) to express while massaging the hardened area. 5. After breastfeeding/expressing, cool your breast for about 20 minutes with a cold compress (e.g. ARDO Temperature Pack). 6. Allow yourself enough rest (ideally, go to sleep together with your baby) and drink plenty of fluids. When breasts are hardened, express the milk preferably with a gentle breast pump – such as the Ameda Lactaline 23 Sore nipples Sensitive nipples in the first 2 to 3 days after birth are normal. If the discomfort continues, or if the nipples become sore or cracked or bleed, it is due in most cases to incorrect positioning. For example, the baby may have taken too much of the nipple and not enough of the areola into its mouth, the baby may not have opened its mouth sufficiently, its lips may be turned inwards, the mother may have bent forward during positioning instead of pulling the baby towards her, the baby may be lying on the pillow instead of being held in its mother’s arm, etc. (see page 14 to 17, ‘correct breastfeeding positions’). Sucking problems, thrush (a white fungal infection, which leaves white spots in the baby’s mouth) or a short fraenulum are rarely the cause of sore nipples. As sore nipples cause intense pain, seek the advice of a breastfeeding specialist as soon as possible. In addition, ARDO and Ameda breastfeeding products can help you. It is recommended that you wear an Ameda Nipple Protector inside a breastfeeding bra to protect the nipples from unnecessary friction. The Ameda Nipple Protector provides reliable protection. 24 A high quality lanolin product can prevent dry and sore nipples and promote selfhealing. There is no need to wash the breasts before breastfeeding. Flat and inverted nipples See page 9 -10 Breast milk leakage Breast milk may leak while breastfeeding. To stop milk leakage and to avoid wet spots on clothes, breast pads like the thin ARDO LilyPadz, made from breathable high-tech silicone, are available. The tired inefficiently drinking baby Some babies fall asleep during breastfeeding and do not drink efficiently. It often helps to change the breast when sucking noises become less noticeable or to change the baby and to reposition it. Alternatively, you can help the baby to suck more efficiently. You could try the following: 1. Breast massage before breastfeeding to make the milk flow. The nipple-confused baby Sucking on the breast differs fundamentally from sucking on the bottle. One meal given with the bottle can sometimes confuse the baby and it may no longer want to drink from the breast. The younger the baby, the greater the risk of nipple confusion. Therefore, many clinics and hospitals do not top up with the bottle but use an Ameda drink cup, for example, as an alternative. 2. Place the baby on its back, supporting it carefully and making sure that baby‘s feet touch a pad to give it the opportunity if reaching out with its hands. 3. Support the breast well during breastfeeding (see p. 15). 4. Support baby‘s chin with the index finger. 5. Listen to the baby’s gulping noises. 6. In the beginning and when the gulping noises diminish in frequency, strike the breast with the thumb or apply breast compression (pain-free squeezing of the breast) without changing the form of the nipples. By making the baby suck more efficiently, it obtains more breast milk with less effort. This procedure is also beneficial for ill or premature babies or after a difficult birth or Caesarean section. The Ameda drink cup for topping up with breast milk Ill and premature children In the case of a mother-child-separation or a preterm delivery, a child can also be fed with breast milk if the mother expresses her milk. Ameda breast pumps are the perfect choice. If the so expressed milk is not given immediately to the baby, it can be stored, cooled or frozen. It is important not to interrupt the cooling process during transport. For this purpose, convenient cool bags can be ordered from ARDO. 25 Breastfeeding aids - the solution to many problems The choice of the right breast pump In principle, there are two kinds of pumps - hand-operated and electrical pumps. For frequent expressing, an electrical breast pump is recommended. For occasional use, a hand pump may also be used. For long-term use, it might make sense to purchase a small electrical pump such as the Ameda Lactaline Personal, which also works with batteries. Happy to express! The use of a breast pump can be necessary if the newborn initially sucks weakly and milk production is not sufficiently stimulated. Also in the case of mother -child separation, e.g. work, premature birth or illness of the child, milk production can be built up and maintained through regular expressing. As a result, the baby can be fed with precious breast milk, and expressing is beneficial for subsequent breastfeeding. Occasionally, milk does not start flowing immediately. Fear and pain can block the milk ejection reflex. However, the milk ejection reflex can be promoted with a breast massage (see page 12-13) or relaxation exercises. The warmth of the ARDO Temperature Pack also has a stimulating effect. Double expressing increases milk quantity The simultaneous expressing of both breasts reduces the pumping time by half and evidently improves the milk quantity. 26 In our opinion, there are five essential technical features that should be considered when you make your choice of an electrical breast pump and the Ameda breast pumps offer you all these features. Vacuum and suction cycle with progressive individual adjustability This allows you to adapt the pump to your needs and to the usual suction cycle of your baby. A high cycle and simultaneous low vacuum simulates the weak but fast suction rate of the baby and the milk ejection reflex is triggered. Once the milk starts flowing, start to express effectively by increasing the vacuum and reducing the suction cycle according to your comfort level. The expressing should never be painful. The milk collection system should be sealed The closed milk collection system guarantees that no milk ends up in the pump. The Ameda Pumpset guarantees maximum protection and safety for mother and baby. A patented silicone diaphragm offers maximum protection from contamination of breast milk and also from dust and germs. The patented Ameda Pumpset is therefore the only set available worldwide that is certified by the FDA. Pumping: gentle, effective and harmonious You can regulate the operating strength of the pump and adapt it to your comfort level. A highly sophisticated suction curve makes expressing with Ameda breast pumps as effective and harmonious as possible for you at any level. It has been scientifically proven that breast pumps with a speed of 30 - 60 cycles and a vacuum of 0-330 mbar cover the recommended range. Separately available: large breast shell and a soft comfort shield Common breast shells press the lactiferous ducts of women with large nipples together, and milk can no longer flow. We therefore recommend the use of the Large Ameda Breast Shell. A soft shield, like the Ameda Flexishield, is recommended for sensitive nipples and stimulation of the milk ejection reflex. It makes expressing more comfortable and stimulates milk flow. The Pumpset converts into a one-handed breast pump Mothers in a transition period often express with an electrical pump. We recommend the hand pump if you only want to express occasionally and for brief absences. You can simply purchase a pump grip in addition to the existing pump set. The set is modestly priced and can quickly be converted into a hand pump (Ameda EHP). 27 Storage of breast milk Expressed Breast milk can be kept in the refrigerator (4 - 6° C) for three days. In order to stock up, the expressed breast milk can be stored for three months in the freezer compartment of the refrigerator and six months in the deep-freezer at a temperature of at least -20°C. For example, each portion (60 to 120 ml) is expressed preferably into special and separate freezer bags, cooled and frozen immediately afterwards. The special Ameda Freezer Bags are made out of high quality three-layer material and do not absorb foreign flavors. They are hygienic, practical and guarantee optimal storage of the breast milk. It is important to mark each freezer bag with the expressing date. Repeated expressing and storage In case of repeated expressing within 24 hours, the freshly expressed breast milk can be added to the already cooled milk. If the milk has already been deep frozen, it is best to cool the freshly expressed milk first in the refrigerator for half an hour, add it to the rest of the deep-frozen milk and then deep freeze it. Defrosting and warming breast milk Breast milk can be defrosted in the refrigerator or at room temperature and then placed in a warm water bath or held under running lukewarm water until the milk reaches 37˚C. Breast milk should not be warmed in the microwave. Breast milk may separate during defrosting into aqueous and fatty parts. Careful shaking of the milk will reunify these components. Small changes in color are not a cause for concern. They do not mean that the milk is bad; it can still be used . Defrosted breast milk should be used within 24 hours. Breast milk that has already been warmed up once must be thrown away. Ameda Freezer Bags preserve your precious breast milk up to six months 28 Breastfeeding products - Breast pumps ARDO your specialist for breastfeeding products Ameda Lactaline Personal Breast Pump The Lactaline Personal is the world‘s smallest, electric, interval double breast pump and offers ultimate mobility. It is easy to handle, small, quiet and efficient – the favorite breast pump for private use. The vacuum and cycle can be adjusted separately and continuously to meet the specific needs and requirements of the mother. The pump meets the highest hygienic standards and can also be battery operated. Ameda Elite Breast Pump Elite is the quiet, electric, interval double breast pump for professional use. It is a proven, cutting-edge model. The vacuum and cycle can be adjusted separately and continuously to meet the specific needs and requirements of the mother. The baby‘s natural sucking rhythm can thus be imitated perfectly. Patented Ameda Pumpset Studies prove: the Ameda silicone diaphragm creates a barrier protecting pump and breast milk from potential viruses and bacteria. Ameda One-Handed Breast Pump The One-Handed Breast Pump is designed for onehanded operation. The ergonomically designed and rotatable grip takes the effort out of expressing the breast milk and leaves a hand free for breast massage. 29 ARDO your specialist for breastfeeding products Breastfeeding products - Breast care 30 The Ameda Nipple Former helps women with inverted or flat nipples to prepare for breastfeeding. The ARDO LilyPadz are the only reusable and nonabsorbing breast pads made of breathable material. Applying light pressure to the nipple prevents milk leakage. Ardo LilyPadz are not visible under a bathingsuit or an evening dress. The Ameda Nipple Protector prevents unpleasant rubbing against clothes when nipples are sore or sensitive to touch. The ARDO Tulips Nipple Shield protects sore nipples and prevents direct contact during breastfeeding. Available in size M or L The ARDO Temperature Pack is used as a warm/cold breast compress before or after breastfeeding and/or expressing. The Flexishield is a soft breast shell insert. Its gentle massaging effect stimulates the milk flow and makes expressing more pleasant. Breastfeeding products - Accessories The Ameda EHP Combi-Kit converts the One-Handed Breast Pump (EHP) into a ‘Hygiene Pumpset’. Das Ameda ‘Hygiene Pumpset’ The milk flow is visible through the totally transparent ‘Hygiene Pumpset’, which encourages the milk discharge reflex. The Ameda Freezer Bag is used for the collection, hygienic storage and freezing of the breast milk. The Freezer Bag does not absorb foreign odors and optimally preserves the quality of the breast milk. The Large Ameda Breast Shell offers women with large breasts/nipples more comfort and optimum conditions for expressing. Travel Set Lactaline The Ameda Pump Grip converts the ‘Hygiene Pumpset’ into the One-Handed Breast Pump (EHP). The competitively priced Set with everything needed by a mother on the go. It includes the AMEDA Lactaline Personal Breast pump with `Hygiene double Pumpset`, cool box, milk bottles, frezzer bags…. ( cool box and backpack also available separately). 31 Useful addresses for breastfeeding problems International addresses of associations: VELB European Lactation Consultant Association, Postbox 139, Brünigstr. 12, 6055 Alpnach Dorf / Switzerland, Phone +41 (0)41 671 01 17, Fax +41 (0)41 671 01 71, [email protected], www.velb.org ILCA International Lactation Consultant Association, 1500 Sunday Drive, Suite 102, Raleigh, North Carolina, 27607 / USA, Phone (919) 861-5577, Fax (919) 7874916, [email protected], www.ilca.org BFHI WHO/UNICEF - The Baby-Friendly Hospital Initiative For more informations: http://www.unicef.org/programme/breastfeeding Our subsidiary in Germany: Ardo medical GmbH Argelsrieder Feld 10 82234 Oberpfaffenhofen Germany T +49 (0)8153 40 66 00 F +49 (0)8153 40 66 01 [email protected] www.ardomedical.de Our subsidiary in Netherland: Ardo medical BV Serenadestraat 8 1312 EL Almere Netherland T 036-5361600 F 036-5470445 [email protected] www.ardomedical.nl ARDO - your specialist for breastfeeding products Company stamp Ameda/ARDO Stockist Ardo medical AG Gewerbestrasse 19 6314 Unterägeri Switzerland T +41 (0)41 754 70 70 F +41 (0)41 754 70 71 [email protected] www.ardo.ch 11/2007 Richard Cassidy Limited Walsall, United Kingdom T+44(0)121 325 0300 T+44(0)1922 421488 [email protected] www.richardcassidy.co.uk
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