The purpose of breast compression is to continue the flow of milk to
the baby when the baby is only sucking without drinking. Drinking
(“open mouth wide—pause—then close mouth” type of suck—see
also the video clips) means baby got a
mouthful of milk. If baby is no longer drinking on his own, mother may use
compressions to “turn sucks or nibbling into drinks”, and keep baby receiving
milk. Compressions simulate a letdown or milk ejection reflex (the sudden
rushing down of milk that mothers experience during the feeding or when they
hear a baby cry—though many women will not “feel” their let down). The
technique may be useful for:
1.
Poor weight gain in the baby
2.
Colic in the breastfed baby
3.
Frequent feedings and/or long feedings
4.
Sore nipples in the mother
5.
Recurrent blocked ducts and/or mastitis
6.
Encouraging the baby who falls asleep quickly to continue drinking not
just sucking
7.
A “lazy” baby, or baby who seems to want to just “pacify”.
Incidentally babies are not lazy, they respond to milk flow.
Compression is not necessary if everything is going well. When all is
going well, the mother should allow the baby to “finish” feeding on the first
side and offer the other side. How do you know the baby is
finished the first side? When he is just sucking (rapid sucks without pause)
and no longer drinking at the breast (“open mouth wide — pause
— then close mouth” type of suck). Compressions help baby to get the
milk.
Breast compression works particularly well in the first few days
to help the baby get more colostrum. Babies do not need much colostrum, but
they need some. A good latch and compression help them get it.
It may be
useful to know that:
1.
A baby who is well latched on gets milk more easily than one
who is not. A baby who is poorly latched on can get milk only when the flow of
milk is rapid. Thus, many mothers and babies do well with breastfeeding in
spite of a poor latch, because most mothers produce an abundance of milk.
However, the mother may pay a price for baby’s poor latching—for example:
sore nipples, a baby who is colicky, and/or a baby who is constantly on the
breast (but drinking only a small part of the time).
2.
In the first 3-6 weeks of life, many babies tend to fall asleep at the
breast when the flow of milk is slow, not necessarily when they have had
enough to eat and not because they are lazy or want to
pacify. After this age, they may start to pull away at the
breast when the flow of milk slows down. However, some pull at the breast even
when they are much younger, sometimes even in the first days and some babies
fall asleep even at 3 or 4 months when the milk flow is slow.
Breast compression—How to do it (Use with Protocol
to Manage Breastmilk Intake)
• Hold the
baby with one arm.
• Support your
breast with the other hand, encircling it by placing your thumb on one side of
the breast (thumb on the upper side of the breast is easiest), your other
fingers on the other, close to the chest wall.
• Watch for
the baby’s drinking, (see videos) though there is no need to be obsessive about catching
every suck. The baby gets substantial amounts of milk when he is drinking with
an “open mouth wide—pause—then close mouth” type of suck.
• When the
baby is nibbling at the breast and no longer drinking with the “open mouth
wide—pause—then close mouth” type of suck, compress the
breast to increase the internal pressure of the whole breast. Do not roll
your fingers along the breast toward the baby, just squeeze and hold. Not
so hard that it hurts and try not to change the shape of the areola (the darker
part of the breast near the baby’s mouth). With the compression, the baby
should start drinking again with the “open mouth wide—pause—then
close mouth” type of suck. Use compression while the baby is sucking but
not drinking!
• Keep the
pressure up until the baby is just sucking without drinking even with the
compression, and then release the pressure. Release the pressure if baby stops sucking or
if the baby goes back to sucking without drinking. Often the baby will stop
sucking altogether when the pressure is released, but will start again shortly
as milk starts to flow again. If the baby does not stop sucking with the
release of pressure, wait a short time before compressing again.
• The reason
for releasing the pressure is to allow your hand to rest, and to allow milk to
start flowing to the baby again. The baby, if he stops sucking when you release
the pressure, will start sucking again when he starts to taste milk.
• When the
baby starts sucking again, he may drink (“open mouth wide—pause—then
close mouth” type of suck). If not, compress again as above.
• Continue on
the first side until the baby does not drink even with the compression. You
should allow the baby to stay on the side for a short time longer, as you may
occasionally get another letdown reflex (milk ejection reflex) and the baby
will start drinking again, on his own. If the baby no longer drinks, however,
allow him to come off or take him off the breast.
• If the baby
wants more, offer the other side and repeat the process.
• You may
wish, unless you have sore nipples, to switch sides back and forth in this way
several times.
• Work on
improving the baby’s latch.
• Remember,
compress as the baby sucks but does not drink. Wait for baby to initiate the
sucking; it is best not to compress while baby has stopped sucking
altogether.
In our experience, the above works best, but if you find a way which
works better at keeping the baby drinking with an “open mouth wide—pause—then
close mouth” type of suck, use whatever works best for you and your baby. As
long as it does not hurt your breast to compress, and as long as the baby is
“drinking” (“open mouth wide—pause—then close mouth type” of
suck), breast compression is working.
You will not always need to do this. As breastfeeding improves, you
will be able to let things happen naturally. See the videos of how to latch a
baby on, how to know a baby is getting milk, how to use compression.
Breast Compression, February 2009©
Written and revised (under other names) by Jack Newman, MD, FRCPC,
1995-2005©
Revised by Jack Newman MD, FRCPC, IBCLC and Edith Kernerman, IBCLC,
2008, 2009©
All of our information sheets may be copied and
distributed without further permission on the condition that it is not used in ANY context that
violates the
WHO International Code on the Marketing of
Breastmilk Substitutes (1981)
and subsequent World
Health Assembly resolutions.