For breastfeeding an adopted baby, a premature baby, or in any circumstances in which the newborn is unable to get enough nutrition from mother alone, it is advised using cups, breastfeeding supplementers, or syringes in lieu of supplemental bottles during the first few weeks when baby needs to learn to suck properly from mother's breast.
Cup feeding is a safe, low-tech method for supplementing a breastfed baby while avoiding the use of artificial nipples. Cup feeding has been used with newborns and even with premature infants. When a medical situation temporarily delays breastfeeding, or if baby must be supplemented during the first few days of life while learning to nurse effectively, cup feeding is an easy alternative o bottles. It may also work for the older baby who refuses bottles offered by dad or a substitute caregiver.
Use a small cup that holds just one or two ounces of human milk or formula. (Flexible plastic cups designed especially for feeding babies are available from lactation consultants and La Leche League International.) Fill the cup at least half full. Support baby upright on your lap, with a cloth diaper, towel, or bib under her chin to catch any drips. Swaddle her in a receiving blanket if her hands get in the way. Hold the cup to baby's lips and tilt it so that the liquid touches her lips. Allow baby to lap and swallow the milk. Don't pour it inter her mouth. Let baby set the pace. Refill the cup as needed or fill two or three before you start the feeding.
A supplementer consists of a plastic container to hold breast milk or formula, connected to a feeding tube to deliver it. The supplementer is suspended by a cord around mother's neck and rests between her breasts. Tiny flexible tubings extend from the supplementer and rest over mother's nipple. (Some supplementer systems, such as the Medela Supplemental Nutrition System, or SNS, have two tubings, one for each breast). While sucking at mother's breast baby draws the breast milk or formula from the supplementer through the tubing. Any milk present in the breast also comes to baby through mother's nipple.
Supplementers have the advantage of teaching baby to suck only from mother's breast, so as not to confuse him by presenting a variety of artificial nipples. As an added benefit, mother gets hormonal stimulation as baby sucks at her breast. A supplement should be obtained through a lactation consultant, who can supervise progress of the baby.
Syringes are helpful to supplement a breastfeeding newborn. One type of syringe that can be used is a periodontal syringe, which has a long, curved tip from which supplemental milk (either breast milk or formula) is syringed into the baby's mouthy during breastfeeding or during finger feeding if baby has trouble at the breast.
The syringe-and-finger-feeding method is especially helpful for fathers to supplement the primarily breastfed infant. Let baby suck on one and a half inches of your index finger (most fathers and women with large finger use the pinkie finger) and slide the tip of the syringe inside the corner of baby's mouth alongside your finger, squirting in the supplemental milk as your baby sucks. You can use a supplementer in similar fashion placing the tubing along the tip of your finger, so that when baby sucks he also gets milk or formula from the tubing. Once again, supervision from a lactation consultant is strongly recommended.
Breast and Nipple Care
Here are some items you should know about in caring for your breasts, especially your nipples.
Also called breast shells or milk cups, breast shields are two-part plastic cups that fit over mother's nipple and areola and are held in place by her bra. The pressure of the shell on the breast encourages the nipple to protrude through a hole in the inner part of the cup. Meanwhile, the outer part of the cup protects the nipple from contact with the bra fabric.
Lactation experts used to recommend that mothers with flat or inverted nipples wear breast shells prenatally and postnatally between feedings to encourage the nipples to stand out. However, research on breast shells has not shown that they are helpful. Most specialists believe that a baby who knows how to latch on properly can shape any kind of nipple to deliver milk.
Breast shields can be used to protect sensitive sore nipples from rubbing against clothing. The pressure from the shields encourages leaking, so milk may collect the shells between feedings. You should discard this milk, since germs can multiply rapidly in the warm environment inside your bra.
Rubber or silicone shields that fit over mother's nipple and the areola during feedings are sometimes recommended to protect sore or cracked nipples while they heal. It is wiser to prevent and correct improper positioning and latch-on than to rely on the use of nipple shields. Babies learn to latch on to the shield rather than the breast, and it can be very difficult to persuade them to take the breast without the shield. Breasts do not receive as much stimulation through a nipple shield, and this can compromise mother's milk supply. It is not recommended to use nipple shields, except in situations where a baby cannot latch onto the breast in any other way - for example; a tiny preemie whose mother has large nipples, or for a few days if mother's cracked nipples are not healing with the standard treatment.
A footstool makes life easier for the mother by lifting her lap to the correct and most comfortable height for breastfeeding. The nursing stool is especially designed for the breastfeeding mother and eliminates stress on a mother's back, legs, shoulders, and arms.
Pillows designed especially for the breastfeeding mother provide firm support for the baby in her lap and raise baby to breast height. They fit around mom's middle, and some also offer extra support for mom's lower back. Nursing pillows are especially bandy for mothers who are juggling twins at the breast and for mothers of babies who need extra support because they are premature or have low muscle tone.
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