With Thanks to Major Jarold “Tom” Johnson, CNM, IBCLC (Womac Army Medical Center, Ft. Bragg, NC) for writing this and letting me adapt it for inclusion on this website. This is FAQ is available as a handout in PDF format as well.
The evidence is clear that a helpful and supportive father is the key to breastfeeding success. Studies have repeatedly shown that new mothers value the support of their husband more than any other form of support available. Believe it or not, your husband is more helpful than midwives, nurses, lactation consultants, even your own mother. Unfortunately, men are rarely completely welcomed into the breastfeeding relationship. Most books written about men in breastfeeding limit the father’s role to preparing and passing the baby to mom. Fathers are capable of much, much more. Have your husband read this and invite him to help and support your desires to breastfeed.
The breastfeeding family is a lot like a cohesive military unit. No unit can succeed if its members are not all working together toward a common goal, and likewise, breastfeeding families must all work together to achieve their goals in breastfeeding. Each member your unit has a specialized task that only they can do, Mom will offer the baby the breast, the baby will feed himself, and Dad will serve as a coach or guide to help make sure everything goes well.
The Mother’s job is to put the baby “in the kitchen”. That means that mom has to offer the baby the breast. Breastfeeding is easiest, at least for the first few days or weeks, when the mother removes the baby’s clothes and put his naked chest right up against her bare chest, then covers the two with a blanket. When the mother and baby are in direct skin to skin contact and covered with a blanket, the baby stays warm, and the mother stays modest. Once the baby is “in the kitchen” all you really have to do is wait for him to do his job, when the time is right, he will feed himself. If you really feel the need you can coax him to nurse, you can talk to him, pet him, stroke his face and mouth and encourage him to feed, but ultimately the baby knows what he’s doing and all you really have to do is wait.
The Baby’s job is demanding, but the healthy newborn is well prepared at birth. The baby has to identify the breast, he will wrap his cute little hands around it, put it where he needs it to be, open his mouth VERY wide and take as much of the areola as he can deep into his mouth, and suck and swallow until satisfied. The more breast a baby takes in, the easier and more effective feeding will be. Remember, it is the baby’s job to feed himself. He is bright, energetic and ready to feed within an hour of being born. Some babies will wait for a while, but all babies will eat when they are ready, usually within the first 48 hours. But don’t rush him, being born is hard work and he is very tired after the adrenalin of birth wears off. If he sleeps from 4 hours of life until 24 hours of life, he is a normal newborn. Mom, all you really have to do is hold him close, keep him “in the kitchen” and allow him to do what he needs to do.
Dad, your job is to help get your baby to the breast. You are a powerful team member and your team will have a much better chance to succeed if you are actively involved. So get in there, roll up your sleeves and breastfeed. Don’t worry, I’ll show you how. I break it down into three simple steps. 1) When does the baby need to eat? 2) How does the baby eat? 3) When is the baby done eating? It really is that simple, so let’s dive in.
When does the Baby need to eat? First thing you have to understand is that in all my years working with families, I’ve never met a baby that read the rule book before birth. Contrary to traditional teaching, a baby does not eat for 10 minutes on each breast every 2-3 hours. That is nonsense; babies are not born with watches, and even if you give him one, he can’t read it anyway. When a baby has stress (hunger, cold, wet or dirty diapers, pain, or loneliness) he will show you some very predictable signs. He’ll curl up his hands and feet and bring them to the center. He’ll bend at the knees and cross his feet or put his heels together (that’s called centering behavior). He’ll start to turn his head and may suck on his hands. Eventually he’ll start to fuss and finally cry. All of these are stress signs. Sometimes he’ll be hungry, sometimes lonely; but when he does those things he is asking for you to pick him up and tend to his needs. Since you won’t know what he wants by looking at him, I always recommend you start in the kitchen. If he’s hungry, he’ll take the breast when you offer it. But never insist that a baby “has to be hungry” just because it’s been a while since he’s had the breast, and the opposite is true as well. Don’t automatically assume he can’t be hungry just because he only ate an hour ago. Babies are unpredictable, but when you offer the breast, he’ll eat if he’s hungry. As a general rule, newborns eat 8-12 times a day, usually in clustered groups of 3-4 times in a four hour period, they then take a 3-4 hour nap and start over again. Don’t count on it, but know that while no two babies eat on the same schedule, very rarely will a baby actually eat for 10 minutes on each breast every 2-3 hours, as most books would suggest.
How does the baby eat? This is a tough one; every baby is different, just like every person is different. But there are a few simple principles that you can follow. When baby is ready to eat and he’s in the kitchen, he will stretch out his hands, move the breast to where he wants it, open his mouth VERY wide, and take the breast deep into his mouth. He’ll latch on well, he’ll suckle in bursts of 10-15 rapid sucks followed by a short pause, you may hear a soft quiet swallowing sound, and then he’ll do it again. Sometimes he’ll appear to be sleeping, as he lies peacefully on the breast while holding the breast in his mouth. Don’t be fooled, babies don’t really sleep on the breast; they rest and wait for their drinks to settle in their stomach. Only college students and Army privates like to chug, everyone else takes a few sips then puts their drink down, then start again. Don’t expect him to chug his milk and eat non-stop, no one does that, he wouldn’t expect the same from you.
When your baby is on the breast you need to make sure he is latched on well and that he is transferring milk well from mom to baby. Every time your baby latches on, you will need to look for signs of a good latch, and here they are:
- Nose and Chin touching the breast – He should bury his face deep in the breast, never try to pull the breast away from his face because that will pull the nipple away from him mouth, or change the shape of the breast in his mouth. Never fear that he will suffocate on the breast. First, remember, he isn’t stupid, he won’t suffocate for one more drink of breast milk, if he can’t breathe, he’ll just turn his head or pull away. Second, have you ever noticed the creases on the side of your nose and how they tend to run up to your eyes? Have you ever noticed that there is a dimple on the side of your head where your eye sockets are? That is a continuous channel from the nose to the side of the head that I call “The Baby Snorkel System”. Air moves from his mouth, to his eyes, under his eyes and out the side of his head. If you don’t believe me put your face underwater, cover your face with your hands and blow air out of your nose, you’ll see the air move out of the side of your head.
- Full Round Cheeks without dimples – If his mouth is full of breast, his cheeks are full of breasts. If you see dimples on his cheeks or creases around his mouth, he does not have the breast deep in his mouth and he is creating a vacuum of empty space, and he is hurting your lovely bride.
- Wide Open Jaw – The infant has a small mouth and he has to open that mouth VERY wide to get all that breast tissue deep into his mouth. Measure the angle of his jaw, (Oh yeah! Finally, something you can measure). The angle from his nose, to his ear, to his chin should be greater than 60 degrees, but 90 degrees is even better. I use my fingers, put your index finger on the chin, your palm on his ear, and your middle finger on his nose, and measure that angle. 45 degrees is a closed and empty mouth.
- No Pain – NO PAIN! NO PAIN! NO PAIN! Did I mention it shouldn’t hurt to breastfeed? Traditionally, nipple pain in early breastfeeding was considered normal and unavoidable. That is a beast whose time is long past. New understanding of the anatomy of breast milk structures in the nipple and areola shows that there is no fat or cushion in the nipple and that all cushion is held back on the areola. When the infant pinches the nipple with his mouth or tongue your wife will be in pain, which is exactly the same thing that will happen if you pinch the nipple with your thumb and forefinger. Pinching the nipple is always a bad thing and mom wouldn’t let you do it either! If you can’t get away with it, neither should baby. Not only will the baby hurt his mother, but he will also not be able to effectively bring milk out. When you pinch the nipple, its like bending a straw, you can’t drink from it. Don’t let the baby pinch the nipple. If your wife has nipple pain, you need to fix the latch immediately, and if you can’t, you need to get in to see a lactation consultant as soon as possible.
- Flared Lips, Up and Down – In order for a baby to take the breast deep in his mouth he will have to flare his lips as he opens his mouth widely. His tongue will extend and push out his lower lip, and he will wrap his lips around the areola. If there is a latching problem it is often failure to flare the bottom lip. All that being said, when he is properly buried into the breast you can’t see his lips. Know that if everything else is okay, the lips are probably okay. But if there is pain, dimples in the cheeks, or a narrow jaw, you will need to help your baby open his mouth and push his bottom lip and tongue out.
But how do I do that? One may ask. Don’t worry, they taught you how to solve the problem when you were in basic training. Corrective action for the breastfeeding baby is the same as corrective action for the M-16 (or M-4). When a baby has a bad latch, it is almost always a double feed. You have two rounds in the chamber at the same time (in this case, breast and lower lip). Just like any other double feed, you’ll have to pull SPORTS (slap, pull, observe, release, tap, and shoot). If you remember your basic rifle marksmanship, you will know what to do without even asking.
S – Slap – Put your hand on the baby’s back and push him toward the breast.
P – Pull – Reach one finger between the chin and the breast and pull down on the baby’s chin to elicit a rooting reflex.
O – Observe – Does the jaw open, do the cheeks fill and round out, do the lips flare, and does the pain go away?
R – Release – let go of the chin and let the baby suckle and test the new latch.
T – Tap/Try again – Repeat the first four steps two or three times to see if you can correct the bad latch.
S – Shoot – Darn it! We have to take him off the breast and try again.
If you can’t fix the latch with the basics of SPORTS you are going to need remedial action. You’re going to have to drop the magazine (take the baby off the breast), clear the chamber (calm the child then elicit a rooting reflex off the breast to encourage a VERY wide open mouth), and reload (put him back to the breast).
Eventually these steps will almost always help solve a bad latch. Very rarely you may find that even though you do everything right your baby will not latch correctly. He may have chosen to sleep rather than eat, he may be over stimulated, or he may just need an experienced hand to help him out. Give him a break, let him rest for an hour or so, and try again. If he ever goes 24 hours without eating, get in to see a lactation consultant right away.
When is my baby finished eating? When baby is finished eating he will relax his hands, release the breast, pull away from the breast, and fall into a deep sleep that I call “The milk coma.” Remember, your baby can’t tell time. Some babies will finish the breast in 10-15 minutes; some will finish the breast in 45-60 minutes. Both babies will have taken the same amount of milk, and that amount is “ENOUGH”. There is no easy way for you to measure how much a baby eats when he is on the breast, but know that the actual amount of ounces he drinks is immaterial. What is important is that he goes to breast interested in feeding, and that he pulls away content, relaxed, and sleeping. A baby that is satisfied after feeding, growing steadily, healthy looking and generally happy, is getting “enough” to eat. The number one concern of new mothers is that they do not make enough milk. Dad, your job is to reassure her with your actions, your knowledge, and your confidence, that your baby is, in fact, getting plenty to eat. Try not to worry about it, keep offering the breast to the baby, and he will always get enough to eat.
So there you have it, breastfeeding from a man’s perspective. Fathers are powerful allies contributing to breastfeeding success. Do not allow yourself to be excluded from this time in your child’s life. Study and learn, roll up your sleeves and get in the game. Your family stands a much better chance of succeeding when you actively support breastfeeding and actively help your wife breastfeed.