Supporting Breastfeeding in your Clinic

Normal Breastfeeding Behaviour
A good milk supply needs two hormones: prolactin, which stimulates milk production and is released as milk and drained from the breast; and oxytocin, which is released during the ‘let-down’ reflex and ensures that baby can receive all the stored milk. Without a good attachment to the breast, babies often don’t stimulate a good let-down, and this affects the amount of milk being removed. The less milk removed, the less prolactin release, and the less milk made. 

Neonate (0-1month):

  • Should be fed ‘on cue’. These cues include squirming, mouthing, the rooting reflex, and lastly, crying
  • Babies should feed 8-12 times in any 24hour period
  • Babies should poo most nappy changes
  • Feeds may take up to an hour
  • Time between feeds starts from the beginning of one feed to the beginning of the next (although timing feeds is not recommended for most babies)

Signs of good milk transfer include:

  • weight/length/head circumference growth
  • baby appearing ‘drunk’ after a feed (fists uncurl)
  • Reasonably content
  • 5-6 heavily wet (and mostly soiled) nappies in 24 hours

Infant (>1month):
 
Exclusively breastfed babies may not poo for days, or may poo three times a day.  What is important is that it is unformed, sweet-smelling, and reasonably easy to pass.
At about six weeks the hormonally driven milk production cycle becomes much more reliant on the baby and how much milk is being removed from the breasts. The more the baby feeds, the more milk the breast will make. As supply switches to this baby-driven feedback system, the baby can seem to be a bit ‘fussy’ and want to feed more. This is a normal adjustment and generally settles by about week eight.
 
Babies can feed from one or both breasts per feed. What is important is that each breast is drained well. This ensures that baby is getting the ‘fattier’ milk towards the end of the feed, and emptying a breast is a strong driver of further milk production.
 
In Practice
As part of a chiropractic consult, we are in a fantastic position to positively influence a mother and baby’s breastfeeding success. The most important aspect in giving support from a health professionals perspective is to know what is normal. Reassuring a mother that what they are doing/how their baby is behaving is OK is often all they need to hear. Successful breastfeeding also relies on a healthy emotional and physical attachment between mother and baby. This requires a mother’s proximity, and appropriate responsiveness to her baby’s needs. Stress hormones produced by the mother will inhibit the release of oxytocin and prolactin, so keeping breastfeeding mothers subluxation-free is very important too
 
Assessment & Management

  • Look for dural tension between occiput and sacrum and release accordingly
  • Gently working the maxilla and sphenobasilar junction enhances attachment and suck
  • Assess for upper cervical complex and TMJ for dysfunction
  • Look for tongue and lip ties – and refer as appropriate
  • Restricted head movement or fussiness at the breast or on one side can indicate occipital condylar restriction
  • Encourage breastfeeding through questions, affirmation and resources
  • Ensure the mum is well nourished including with fish oils and probiotics
  • Encourage mum to rest when baby does, particularly in the first weeks
  • A willing practitioner supporting a willing mum can make all the difference 
  • Support a family regardless of how a mum chooses to feed

Home Care:

  • Skin to skin contact encourages the primitive reflexes that also help baby to correctly attach and allows for regulation of the baby’s heart rate, respiration, and temperature
  • Encourage breastfeeding mothers to empty the breast they are feeding from first, before offering the other side. This ensures good drainage and is a strong driver of milk production
  • Bathe with baby to settle
  • Ask for help when needed

Resources:

Written By Merlene Dilger, Chiropractor