 Hello everyone, so this is going to be part 3, in part 1 we discussed about you know early hunger queue and mother's preparation for breastfeeding, in part 2 we saw baby's position and also how to contour breast and how to bring baby, how to land baby on breast and how to latch the baby, okay. Now in this part 3 we are going to learn about different other you know counselling points which are again very, very important for baby to gain weight, okay. So here now what we will do, let us start just bring the baby in a position that I have explained earlier you know, again cross riddle hold, okay, baby is ready to kind of, baby is landed on a breast correctly with little bit of extension of neck, okay and the neck is kind of opposite of nipple, I am holding the breast in a U shape and contouring it and now you know baby is ready to latch, once baby latches on, I just examine the latch you know by pressing on the breast near lower ariola, okay. One thing again I keep reiterating it is that baby's head should be completely facing the breast, okay, it should not be facing up, okay, it should be completely facing the breast. So in this position what happens, the upper lip is coming at 3 o'clock position on left side and the lower lip is coming at 9 o'clock position you know at cross riddle hold on left side, okay. So here now again I pressed it, examine the latch, everything looks good, baby's mouth is 120 degree, lower lip is at the location of the lower ariola border, also both lips and chin are embedded into breast, now I bring the you know other hand and basically supporting the legs and my hands are again still kind of supporting baby's neck, okay. Now here now mother is ready to relax, okay, so what she does, she kind of bends you know her back is straight, you know she is relaxing it, okay, she is relaxed, very important to relax, okay, both the shoulder are close to her body, okay. Now what happens, many times especially in first you know few weeks or so baby tends to sleep a lot, okay. So when baby is kind of feeling well and say within 4 minutes, 5 minutes baby kind of went to sleep or baby stops. Now what I recommend is not to let kind of baby sleep on it for a long time, you know because what happens that you want to finish that feeling as fast as possible so that you can also get some rest, okay. So here in this position what I do in this situation, I tell mother to wake up the baby, okay. The way I wake up the baby is I tell mother either kind of you know with her fingers over this side, you know she can basically just behind of ears, she can stimulate that skin over there or she can basically around her baby's spine, she can stimulates around the spine, you know just kind of tickling the spine or another thing what she can do is basically with this finger, you know she can tickle baby's feet, okay. Now suppose if baby is not waking up with this all 3 things that you have done in that situation what I ask mother to remove baby from the breast, okay because what happens is baby has a good suction, so baby has held the breast very tight and baby is sleeping. So you do not want to pull the baby kind of you know just without opening the mouth because otherwise mother will get nipple sore. So what you can do with your little clean finger, you put finger in baby's mouth, okay. So what I am doing I am just showing it to you, here what I am doing I am just at the corner of the mouth I am putting the finger and releasing the suction, okay. So as soon as I release the suction, baby opens the mouth and then you pull the baby out. Do not pull the baby out just directly because that will cause nipple sore because it is held very tight, you know the arula is held very tight. So you do not want to pull the baby off, you remove the suction from the mouth by putting finger in baby's mouth and then just kind of pull the baby out slowly and gently, okay. And then again baby is sleeping, so you want to again put the baby in a sitting position as I mentioned earlier, you know. So again put your fingers in front of the jaw, okay. And baby's body is resting on the, you know on the palm and then the other hand is on the back of the baby and then just kind of bending it forward. So this is the position that I would like baby to kind of be awake. Many times what happens is that, you know when baby is attached and then in 5-7 minutes baby releases. There are many causes why baby release it, it is not necessary that baby has completely emptied the breast. I do not see that all the time actually because we do lot of physical examination that you know whether a high milk is there or not, I will talk about it in some time. But suppose if the baby releases the breast on his or her own then again we kind of in a burping position, now I do recommend burping, you know. Because what happens, not necessarily burping but just give some rest to the baby. So you know again I put the baby in a sitting position like that, kind of bend the body forward so that the stomach gets kind of pressed and then baby will immediately within a minute or so actually this is very powerful and we have seen in our unit in US that even small babies as soon as we put them in a sitting position they burp right away and they you know immediately they kind of open the eyes which is amazing because you want to wake up the baby as soon as possible and complete your feeding on both sides or even one side you know and not wait for too long because then it becomes too tiring for the mother. Okay so in this position baby opens the mouth, now one point after baby opens the mouth is what I tell mothers you put the baby kind of give the baby to grandma or father or put the baby kind of on the bed and this check whether you have a hind milk left or not so what is hind milk what is for milk let me explain that so what happens so we have milk in front of the breast and we have milk on the back of the breast okay the milk which is present in the front of the breast it is called for milk for milk is kind of watery milk it's translucent it is more on protein and it's more on water okay so when you say baby sucks milk initially it's the form milk which baby is getting okay after some time what happens the back part the back part of the breast starts getting empty and that milk is very thick it is loaded with fat it has some amount of protein also but is basically very thick it's opaque okay so what we tell or what I recommend to mother at you know many times we tell mothers that okay you completely empty one side but when I say that completely empty one side mothers it's very subjective because many times what mothers feel that they compared this side to other side and she feels that oh this side is heavy this side is light that means now I need to feed on other side so that is a subjective examination so I kind of stress on the objective examination so what is the objective examination I tell mother you check whether there is a form milk or high milk so how do you check it what you do is you tell the mother to press the breast kind of against the chest wall okay so you go backward backward then press it and then release it so you go again here I am going to show it on this side okay so here what I tell mother you go backward okay towards the chest wall so we call it press compress release press compress release now this is very very effective way of removing breast milk okay and in this you want to keep your fingers just two fingers away from nipple okay exactly where baby's lips are okay so again it's going to be you know press compress release it should not be milking so if you're milking that means it's wrong do not press only nipple because nothing will come if it's too close if you're pressing the breast from too close if you're pressing the breast from too far milk will not come and if that happens mother will feel that oh my god I don't have enough milk you know and then she will go into all kind of anxiety and her you know oxytocin will go down and she will not release milk okay so very very important how to teach mother how to express breast milk and then there are other different techniques how to improve breast milk supply which I will take that session later but again you know remember that here what we want to do is to just you know two fingers away put your fingers press compress release press towards the breast compress release okay all right so here now what I tell mothers that suppose if she's pressing the breast and manually expressing some milk just to see what kind of milk it is what I tell mothers to if it is translucent if it's kind of watery that means the hind milk is still there okay if mother feel that you know the thick milk is coming it's very thick it's opaque but it's coming in sprays it's coming like it's really pouring out that means that still hind milk is there okay but if she sees that milk is coming thick milk is coming but it's coming in just few drops that means it's over so if she gets translucent milk which is for milk watery milk or if she gets thick milk and spray I tell mother to go ahead and breastfeed on the same side okay so that is important that you you know you again put the baby on the same side latch the baby exactly the way I mentioned okay and continue breastfeeding on that side okay because we want each and every drop of the hind milk to go in baby's mouth because this hind milk has a very special kind of fat and this fat is very high in omega 3 okay specifically your DHA in your EPA those are those two fats which are important for baby's eye cube for brain also it is important for baby's heart and for eyes okay so you want if you want your babies to kind of put on that good amount of fat you know chubby babies you it's important that they get hind milk in lot more quantity that you know and do objective examination don't feel that oh no this is light so maybe I should go on the other side no you examine you see it yourself whether it is watery or whether it is thick and then you latch the baby and then you can do it okay so that is your very important question you know a point on front or front milk or the back milk okay now suppose now you finished your one side okay you burped the baby and you know that there is no milk on one side now you definitely want to offer the baby the other side the way you do it is basically you again kind of switch the side and you again bring the baby the same way that I mentioned many times if baby is full baby may not open the mouth but you you do not decide mothers do not decide whether she wants to give it or not she has to offer the other side okay let babies decide if baby is full they will not take it if baby is hungry within couple of minutes they will open them up and we will start latching on beautifully okay so this is important you make sure that your you know baby is breastfeeding on both the side let mother decide now I have to give you one example which you know I just recently kind of went to one tribal area where I saw lot of these babies were just nipple latching they were not elder latching they were just nipple latching so when babies were nipple latching what was happening they were just you know babies were just so hungry and this was like two months three months old baby had not put on weight for since birth and you know they were really really kind of hungry and you know very thin so what happens they breastfed on one side completely empty breast then we put the baby on other side she have completely emptied other side also then we made the baby sit again you know baby I mean a lot of babies actually they all were kind of feeding again on other side third time and then again on the fourth time so you know don't think that okay I have fed on one side and other side and now I don't have milk no more baby sucks more milk will come okay please remember that the latch is good if the high milk is going very well if the milk transferring is occurring you know the more baby gets out of you more milk you will get in the next feeding okay so never feel that I don't have enough milk we have so many situations where mothers were never pregnant but still were able to get milk you know after some process that you have to go through but if even mothers who have never been pregnant can get milk you know you've been through pregnancy you've been through that lactation stages so you will definitely get more milk so you know many times mothers said that I don't have enough milk I don't have enough milk in my opinion if you don't have enough milk it's most likely because the techniques are wrong and the latch is not good and baby is not being able to suck milk out okay and it's not it's not mothers fault to baby's fault it's basically it's just we have to learn the correct techniques of latching okay and other important points of giving high milk and completely emptying the breast and lot of other counseling points which I'll be discussing okay so this is here where we talked about basically you know giving I'm emptying your breast completely and then always offer the baby on the other side even after baby is done with second side you you kind of put the baby in a sitting position again see if baby wants to again check on the side if breast is empty or not if the breast is empty you go back again on the side you know give it till baby wants okay do you do not mothers do not decide whether she wants to breastfeed or not let baby decide whether how much milk baby wants to take okay in ketchup growth they've breastfeed a lot okay so many times what happens during certain age period they have lot of ketchup growth I would say more of about say two weeks you know six weeks and three months they have lot of ketchup to do and that's when they kind of breastfeed a lot more many times if mothers don't know this they feel that oh you know I'm not getting enough milk and baby needs more so they they tend to start formula or cows milk so if you can kind of counsel mothers beforehand you know and tell them that oh this is the period that baby may feel more hungry just feed the baby for a longer duration and for frequently if you can breastfeed you know your milk supply will increase so it's all supply and demand okay more demand more supply less demand less supply now many mothers have this habit of you know kind of not realizing this understanding this important counseling and they tend to start formula so what happens when they start formula obviously that demand of baby of milk is coming from formula so now baby is not sucking that much on the breast so now breast feels that oh you know now baby does not need so much breast milk and slowly slowly that breast milk is going to kind of dry up okay there is something called milk inhibitory factor milk inhibitory factor is when the milk stays in the breast and if it does not come out it tells them your cells that okay now we don't need to produce more milk because if you keep producing mothers mother will get the engorgement mother will get hardness of breast and then you know she will have all this complication so it tells basically its nature's way of protecting mother okay so remember that milk inhibitory factor it's there in the milk you need to remove that milk so that you know milk supply does not die down okay so that's why you know demand feeding you know whenever baby is hungry make sure that baby is emptying completely emptying the breast more milk comes out more milk will produce okay that's nature's way if you have one baby enough milk will be there for one baby if you have two babies there will be enough milk for two babies if you have three babies there will be enough milk for three babies okay it's just amount of milk that baby is kind of getting that amount of milk will be produced by nature okay so that's the power of nature okay so here now we are done with you know basically breastfeeding on both sides many times you know what we see is suppose if baby is coming kind of straight on like for example in this position what is happening baby's neck is not bent forward okay baby's neck is straight now this is the wrong position to bring the baby to latch on because in what this position what is happening the nose is getting pressed okay so when the nose is getting pressed you know mothers many mothers they kind of get scared but remember that when you're pressing your nose like this straight on you can still breathe you can breathe even when your nose is getting pressed if your nose is pressed like this then you can't breathe right so when when the nose is getting pressed it's basically pressing this way and we do not have to worry about baby not being breathing okay so that's important so do not get kind of worried because if you're worried mother will be worried and baby then she will not be able to bring the baby too close to the breast what in that situation you know what you can tell mother very slowly you know tell mother that suppose if the nose is getting pressed you basically just kind of lift the neck backward a little bit like this so what happens is then the chin is going more forward into the breast the nose is going backward okay away from the breast so if you can just kind of tell the mother to bend the neck a little bit backward tell mother not to pull the baby out because if you pull the baby out what will happen it will become nipple latch and nipple you know make doesn't come okay so this is that's the important point all right okay so this is this is done is like you know many times what mothers do is they kind of press the breast near the nose so that to keep the breast away mothers they don't need to do that because what happens when she is doing that look at her hand you know this hand will get very tired and she will you know she'll get very very tired with just extending her hand upward okay so you tell her nothing to worry about just pull the neck a little bit outward you know just pull the neck outward a little bit and then baby is all set okay so that was your one point of how to you know kind of kind of not allow baby to press the nose into the breast okay so this is one point which is over now suppose baby is done okay now baby is done baby is breastfed on both sides relax you know baby is kind of happy most of these babies in in early kind of newborn period they will immediately go back to sleep many babies you know they may play whatever baby wants you know you can do that how many times to breastfeed is another point which we have to kind of tell mothers because many times if they don't breastfeed frequently you know then baby will not put on a lot of weight okay so in that situation what you want to do you tell mothers during 24 hours I say that like I do recommend 10 to 12 times because our babies are born small and we want that catch-up growth in first three months remember that our babies they grow highest in first three months okay so if you can double that weight by two and a half three months as per WHO growth chart you know babies they double their weight by three months you know so if you can do that you will definitely you will have to feed more frequently okay so I would say as per demand okay and if during daytime the baby is not waking up at least in two hours you want to wake up the baby and at night time you know three to four times at night time and if this baby is not waking up at least feed the baby every three hours minimum okay so that is your nighttime feeding is very important because there is a hormone called prolactin okay and this prolactin hormone is produced in much higher quantity at night okay so babies who breastfeed a lot at night we see them growing very beautifully very chubby so do you know I mean they do need to feed at nighttime even toddlers actually I do recommend to feed them you know one at least two times at night because they do need nighttime feeding also you know during daytime you know many times what happens there is something called cluster feeding so in cluster feeding what happens many times in the evening time baby tend to breastfeed more often you know and they would feed every hour and mother feels oh my god I am not getting enough breast milk and baby is getting hungry no it is a cluster feeding okay so in cluster feeding what you want to do many times they feed like three four times five times in just few hours and then they sleep five hours stretch at night in those situations you do not want to wake up the baby okay you want you want to just see if baby has taken good 10 to 12 times in 24 hours and if baby wants to sleep for four five hours that is absolutely okay you do not need to wake up and do remember there is something called cluster feeding okay and it does happen in the during evening time okay so this is your complete 45 points that I discussed if you have any questions just feel free to ask us I will be showing now tutorial we have created cross-cruel tutorial and the latching tutorial and this tutorial will kind of take you systematically you know through each and every point so that you can pass you can not only learn but pass it on to mothers if you do not have direct access to them okay so many times you know these mothers they call us on portion helpline you know it is called 1-800 tissue portion helpline and we you know they call from all different parts of India and many times they even actually call on direct line from abroad and through tutorials you know when we pass on this message most of the time you know they all the problems are solved because this these tutorials have a totally kind of problem solving tutorials you know and since my mother already has a baby in front of her she knows where the issue is once they watch this tutorial they immediately kind of figure out where the issue is and once they fix that problem you know the problem is solved so do pass on this tutorial to all your family members tell them to subscribe to it and also keep the notification on because this is just one aspect of tutorial on breastfeeding but you know we have to talk as I mentioned earlier on all the different aspect of nutrition through life cycle okay so thank you very much I hope you enjoyed and do practice on model and the baby doll and also if you have any family members or any you know anybody that you know who is breastfeeding or who is trying or who is planning to breastfeed when baby delivers do help them okay thank you so much