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Breast Feeding

Human breast milk is tailor-made for a baby: it contains just the right amount of protein, carbohydrates, minerals and vitamins to sustain your growing baby. Don’t be put off by the bluish, watery appearance, or worry that it can’t possibly be “good enough” because it’s not as creamy as cow’s milk: your milk is rich in every foodstuff that your baby needs.

Apart from its nutritional worth, breast-feeding makes sound sense for the following reasons:

  • Breast-fed babies are less prone to illness than bottle-fed babies. There are fewer cases of gastroenteritis, chest infection, and measles and this is directly attributable to the antibodies that the baby receives. All babies receive some antibodies from their mother’s placental blood, via the umbilical cord, but in the case of breast-fed babies these are supplemented by antibodies in both the colostrumand in the mother’s milk. In your baby’s first few days of life they exert a protective influence on the intestine (reducing the likelihood of intestinal disturbance), and because they are also absorbed into the bloodstream they form part of the body’s protection against infections. Some antibodies, such as those against poliomyelitis, are in the breast milk, so the mother can actively protect her newborn while she is breast-feeding. She does, however, have to repeat this immunization when the baby’s 3-9 months old.
  • Breast milk is more easily, and quickly, digested than cow’s milk. Breast-fed babies don’t get constipated: they may pass stools infrequently but this is because the food is so efficiently and completely used up. The stools that they do pass are always soft and comparatively odorless, and don’t contain the bacteria which generally cause ammonia dermatitis, so your baby is less prone to nappy rash.
  • Breast-fed babies rarely become over-weight. Each baby has its own appetite and metabolic rate — it won’t be the same as the baby next door, so don’t worry if your baby is fatter or thinner than your neighbor’s. She’ll be the right weight for her own body.
  • Breast-feeding is the most convenient method. The milk is always at the right temperature, you don’t have to waste your time sterilizing bottles and making up formula, and you save money by not having to buy all the equipment. Breast-fed babies have less wind, sleep longer, posset less and the posset smells less unpleasant.
  • Breast-feeding is good for your figure. Research has shown that most of the fat that is gained in pregnancy is shed if a woman breast-feeds. During breast-feeding a hormone called oxytocin is released and this encourages the uterus to return to its normal size, as well as stimulating the production of milk . Your pelvis returns to normal more quickly and so does your waistline. Contrary to popular belief, breast-feeding does not affect the shape or size of your breasts. Breasts may get bigger, smaller, or sag after pregnancy, but none of these changes is contingent upon breast-feeding: they are due to being pregnant.
  • Breast cancer is rarer in pans of the world where breast-feeding is traditional. Breast-feeding may provide some protection against the disease.
  • If you breast-feed your baby your body will respond by producing the hormone prolactin, which activates the production of milk. It also suppresses ovulation. Although it is unlikely that you will conceive while breast-feeding, you should never rely on this as a means of contraception. See your doctor for advice.

Supply and demand

All mothers are anatomically equipped to feed their babies and there is no such thing as mother’s milk which does not suit a baby: the milk the breasts produce is the baby’s natural food and she will not reject it. Nor is there such a thing as a mother physically incapable of feeding her baby: the size of your breasts bears no relation to the amount of milk that you can produce. Milk is produced in deeply buried glands, not in the fatty tissue of the breasts, so don’t worry if your breasts are rather small: they are adequate. The actual amount of milk that you produce is dependent on how much your baby takes, hence the expression supply and demand.

For example, if your baby’s appetite is not very great then your breasts will not produce very much milk because they’re not being stimulated by your baby to do so. If, however, your baby is an eager feeder, your breasts will respond and produce more. The amount of milk available for your baby will fluctuate throughout the whole time that you breast-feed, according to how much your baby takes. Even if your baby is hungry half an hour after being fed, don’t worry. Your breasts will have produced some milk for your baby to feed on, and they’ll soon build up a supply for her new needs. When the need for more feeds slows down the breasts will correspondingly produce less.

A newborn baby requires between two and three fluid ounces of milk per pound of body weight, so a seven pound baby will need between fourteen and twenty-one fluid ounces per day. Your breasts can manufacture one-and-a-half to two fluid ounces of milk in three hours, in each breast, so your daily output of twenty-four to thirty-two ounces is ample.

Preparing to breast-feed

You should make the decision whether to breast-feed your baby or not well before delivery so that you can prepare and plan for it. At one time women were advised to harden their nipples by, among other things, rolling them between their fingertips or even scrubbing them with a nail brush. Hardening up is no longer considered essential. The only time you have to take special action is if you have an inverted nipple. In such cases the nipple is completely flat so the baby has nothing to latch on to. This condition is quite rare but if you do have an inverted nipple you will be encouraged to wear breast shells to make the nipple protrude more. Most women, no matter how small their nipples, are perfectly able to feed their babies.

If you are having your baby in hospital, tell the nursing staff that you intend to breast-feed as soon as you are admitted. Be very firm about asking for help from them. Don’t be intimidated by busy nurses who seem to have no time for you. Demand to see the staff nurse or sister if necessary. Ask her to sit with you for an entire feed, and to give a running commentary of what you should be doing and shouldn’t be doing. The best way to learn is to have someone who knows a lot about breast-feeding watching and encouraging you. With the restricted family size that we tend to have now very few girls see anybody breast-feed.

The first contact It is good for both you and your baby to try suckling as soon as the baby is born. If you are in hospital you can ask for the baby to be put to your breast in the delivery room and there are two important reasons for doing so: suckling naturally stimulates the production of oxytocin, a hormone which, among other things , makes the uterus contract and expel the placenta soon after birth. Suckling also helps to form a very strong bond between mother and baby immediately after birth. Incidentally, you needn’t worry about your baby choking. The natural reflex to suck is very strong, and she is able to swallow at birth.

Colostrum

During the seventy-two hours after delivery the breasts don’t produce milk. Instead they manufacture a thin, yellow fluid called colostrum. This is made up of water, protein and minerals and it takes care of all your baby’s nutritional needs during the first days of life before the milk comes in. Colostrum also contains invaluable antibodies which protect the baby against diseases like polio and influenza, and intestinal and respiratory infections. It has an additional laxative effect which stimulates the excretion of meconium. Your baby should be put regularly to the breast in the first days, both to feed on the colostrum and to get used to fixing on the breast. If you’re in a hospital where they have “rooming in” (where the baby is left with the mother all the time), and where they actually encourage demand feeding, so much the better. Every time your baby cries you can put her to the breast but for only a couple of minutes each side at first so that the nipples don’t get sore. If your baby is automatically put into the hospital nursery tell the staff that you want your baby brought to you for feeding and that she’s not to be bottle-fed.

The let-down reflex When your baby suckles at the breast the pituitary gland in the brain is stimulated to release two hormones: prolactin and oxytocin. Prolact in activates the actual manufacture of milk in the milk glands; oxytocin is responsible for the milk being passed from the milk glands to the milk reservoirs behind the areola. This process happens within seconds and is known as the let-down or draught reflex. You may feel this reflex very powerfully: in fact, the very sight or sound of your baby may trigger it off, and milk may actually shoot out of your nipples in anticipation of feeding.

How to hold the baby

Cradle your baby in your arm, with the head in the crook of your elbow, and her back and bottom supported by your hand. Never bend or strain forward to lower the nipple into your baby’s mouth. I she’s too far away from the nipple when held in your arm try laying your baby on a pillow on your lap, still supporting the head in the crook of your arm. Alternatively, cross your legs and use your knee as a prop for the arm that’s holding the baby. Leave your baby’s arm free to touch your breast — she’ll enjoy the sensation of your being warm and close.

The rooting reflex

The first few times you put your baby to the breast she may need some encouragement and help to actually find the nipple. Cradle your baby in your arms and gently stroke the cheek nearest the breast. This will elicit the tooting reflex. Your baby will immediately turn towards your breast, mouth open and ready. If you put your nipple in now she will happily clamp both lips around the areola and settle down to suckle. Many babies lick the nipple before they take it into their mouths and it sometimes helps to express some colostrum as an added incentive.

After a few days your baby will need no artificial stimulation and will happily turn and latch on to the breast as soon as she is picked up and held close to your body. Never try to guide your baby’s head to the nipple by holding both your baby’s cheeks between your fingers, or by squeezing the mouth open. The baby will become ye!), confused by the conflicting stimuli of both cheeks being touched and will turn from side-to-side in a desperate bid to find the nipple.

Putting the baby to the breast

Each time you put your baby to the breast (also called “fixing”) try to get your nipple well inside the baby’s mouth. This is important for two reasons. Firstly, unless she takes a good proportion of the areola into the mouth the milk will not be successfully sucked from your breast. Your baby extracts milk from the breast in a kind of chomping, sucking motion: the baby’s mouth forms a seal around the areola, and as she sucks, the tongue pushes the nipple up against the roof of the mouth. The milk is then drawn out in a rhythmic combination of sucking and squeezing. It can only be successful if the baby can exert pressure on the milk ducts behind the areola.

Secondly, if you position the nipple well into the baby’s mouth, you minimize the chances of developing sore or cracked nipples. Your baby has a very strong sucking action and if only the nipple is in her mouth she will effectively shut off the openings of the milk ducts and little milk will get out. Your nipples will become extremely sore and your milk supply will eventually be reduced because the milk is not being drawn off. The baby will quite naturally become frustrated and bad-tempered with hunger.

Bonding

Once your baby is happily sucking at your breast, settle down and look at your baby. If the baby’s eyes are open make eye contact. Smile, talk and chat softly while she is feeding so that she associates the pleasure of feeding with the sight of your face. the sound of your voice and the smell of your skin.

How long on each breast

Your baby’s sucking will be strongest in the first live minutes when she will take eighty per cent of the feed. As a general rule, keep your baby on the breast for as long as she shows interest in sucking, but not usually longer than ten minutes or so on each breast. Your breast will probably have emptied by this time, and your baby may just be enjoying the sensation of sucking. You’ll find that your baby will lose interest in her own individual way: it may be that she starts to play with your breast, slipping her mouth on and off the nipple: she may turn away: she may fall asleep. When she appears to have had enough of one breast gently take the baby off your nipple (sec right) and put her on to the other breast. If your baby does fall asleep after feeding from both breasts she’s probably had enough: you’ll soon learn whether this is the case or whether she’s going to wake, hungry again, after ten minutes, or so. Similarly. if your baby appears to have taken all she wants from just one breast. don’t worry. You can start the next feed uff on the breast she didn’t drink from.

Removing the baby from the breast

Never pull your baby off the breast — you’ll only hurt your nipple. To get the baby off loosen her mouth by pressing gently but firmly on her chin. Alternatively, slip your finger down between the areola and your baby’s cheek and put your little finger into the corner of the baby’s mouth. Both these techniques will make her mouth open and your breast will slip out easily instead of being dragged off by suction. In the first few days this is very important because the nipple is rather soft and needs a chance to harden.

Breast-feeding positions

You can feed our baby in whatever position you choose, as long as your baby can fix on to the nipple and as long as you are comfortable and relaxed. Some of the most popular methods are shown right. Experiment with them and use whichever feels most natural. Do try to change positions throughout the day – this will ensure that your baby doesn’t only exert pressure on one pan of the areola, and minimizes the risk of a blocked milk duct.

If you are going to sit down and feed your baby, make sure that you are in a comfortable position, with your arms and back supported with cushions or pillows if necessary.

It’s also quite nice to lie in bed to feed your baby, especially in the first few weeks and at night, and there’s no reason why you shouldn’t do this. Lie on your side, propped with pillows if that’s more comfortable, and gently cradle the baby’s head and body alongside you. You may need to lay a small baby on a pillow so that she’s at the right height for your nipple, but a larger baby should be able to lie on the bed next to you. Make sure that the muscles under your arm aren’t strained or taut as this will slow down the flow of milk. An alternative method is to lay your baby on a pillow under your arm, with her feet tucked behind you. Your hand can support your baby’s head as she faces your breast.

The position you choose initially may be affected by the delivery you have. For example, if you’ve had an episiotomy you’ll probably find it extremely uncomfortable sitting down, so any position feeding on your side will be more suitable. Similarly, if you’ve had a Caesarian section your stomach may be too tender for your baby to lie on so try the position with your baby’s feet tucked under your arm. Alternatively, use the position with your baby lying on the bed alongside you.

Ensuring a good milk supply

  • Rest as much as you can, particularly during the first weeks. This really is a situation where you should sit rather than stand, and lie rather than sit.
  • Your milk flow will be affected if you are tense so go through your ante-natal relaxation routines and make sure that you have a period to yourself every day when you can lie down.
  • Go to bed as early as you can. You will be quite tired anyway and your sleep patterns will probably be broken by your baby.
  • As far as the house is concerned, let the housework go. Don’t do anything but the most urgent things.
  • Whenever you can, give yourself a few treats; have a glass of wine to relax with at the end of the day.
  • Make sure that your diet is well-balanced and fairly rich in protein. Don’t cat a lot of highly refined and processed carbohydrates (cakes, biscuits, sweets, chocolates, etc.).
  • You may need some iron supplements and possibly some vitamin supplements, so ask your doctor about this.
  • You should drink about six pints of fluid every day that you are breast-feeding; some women find that they even need a drink by them while they are actually feeding.
  • Most of your milk is produced in the morning when you are rested so if you consistently rush about or become tense during the day you’ll find by evening that your supply is poor.
  • If your baby doesn’t take all the milk available in the early feeds of the day express the remainder off. This will ensure that the supply is topped up throughout the day.
  • Get help and support from everyone around you who is positive and optimistic. Use your midwife and health visitor; speak to friends who have had babies and get reassuring advice from them.
  • If you are unable to give your baby a feed because you’re away or because you’re ill, express the milk off to keep the supply going.
  • Avoid using the contraceptive pill for the first five months after delivery as it decreases the supply of milk. Discuss the alternative methods with your doctor.

Frequency of feeds

Babies need frequent feeding because of their body size. Breast-fed babies may need more feeds than bottle-fed babies because they absorb their milk more quickly.

Babies should be fed on demand, and parents will quickly learn to recognize the cries that mean their baby is hungry. Newborn babies may need to be fed every two hours, having as many as eight to ten feeds a day. By about one month, babies are usually taking food every three hours, and at two to three months approximately every four hours. However, every baby is different because each has its own needs and appetites.

Most babies sleep through the night after their late evening feed by the time they are three months old, but you shouldn’t even consider dropping the night feed unless your baby indicates willingness by sleeping through.

Supplementary bottles

Even although you are committed to demand feeding there are occasions when you may have to give supplementary bottles; for example, if you have a very sore nipple or a blocked duct. If this does occur, feed your baby from the unaffected breast first to satisfy some of the hunger and then give the bottle. You will also have to give supplementary bottles if there is any risk of the baby being underfed, but if you are demand feeding this is unlikely.

Whenever you have to give a bottle make sure that you sterilize all the equipment and make up the formula according to the instructions given . The amount of formula you should use will be specified on the container, according to your baby’s weight.

There are certain disadvantages related to supplementary bottles. Babies used to the nipple tend to dislike plastic teats. Unfortunately, if she rejects the bottle you won’t know if your baby just dislikes the teat, or if she’s not hungry. However, if you persist, she’ll eventually get used to the bottle, especially if she’s hungry, but by this time you may well find that she doesn’t want to go back to the breast. This is because it requires less effort to get milk from the bottle than from the breast.

Relief bottles

These are bottles of your own expressed milk which can be given to your baby when you are ill, extremely tired, or are leaving the baby with someone else. Expressed milk can be frozen and kept for up to six months.

 

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