width= Understanding Breastfeeding

By: Dr. Michelle MD
 

Everyone knows that the natural way to nourish an infant is to breastfeed. The English word nursing is from the same source as nourishing. It seems like it should be as natural as pregnancy, labor and delivery. The problem is, breastfeeding doesnít always work out well for the mother and the baby. There are many factors involved which can influence the success or failure of nursing. Here is an overview of the subject.

Benefits of breastfeeding

Advantages to the mother
The greatest advantage to the mother is the special pleasure of watching the baby grow and thrive on her milk. Once the mother and baby are adjusted to each other nursing is fun. For many mothers, breastfeeding can be a very special bonding experience. From the first few minutes of the babyís life, the mother gets special benefits from nursing. As she nurses the new infant, her uterus contracts down vigorously from oxitocin, the hormone that is elaborated in response to the suckling. These contractions prevent hemorrhage after the birth and continue to help the uterus shrink to its proper size.

As they settle into their life together, the mother enjoys quiet time with her baby as they bond with each other. Many women lose weight rapidly after the pregnancy from the metabolic changes caused by nursing. Nursing is convenient; the milk is always ready, with no bottles to wash after feedings. Many women who nurse will not conceive for several months. This makes breastfeeding a natural form of child spacing.

Advantages to the baby.
Colostrum, the transparent first milk produced, provides the baby with high levels of protection from many types of infection. As the colostrum changes to real milk the level of protection decreases but there is still a constant supply of substances and cells that protect the baby. The bonding experience, with skin-to-skin contact has been shown to be beneficial to the babyís overall health. It has been claimed that breastfeeding leads to higher intelligence, lower chances of allergy, lower chances of obesity, and fewer ear infections. We know it is very good for most, but not all, babies. Unfortunately, some babies who breastfeed still get allergies, ear infections, and are sometimes obese in childhood. Regardless of all of these issues, breast milk is still the most perfect, naturally designed, ideal food for a young baby.

Maternal issues
Some mothers have inverted nipples which are difficult for the baby to latch on to. For first time mothers, it is a good idea to have a lactation consultant check the nipples in the end of the 8th month so problems such as inverted nipples can be corrected before the birth. If the inverted nipples are not corrected before the birth, a lactation consultant should be brought in to help get the baby on to the nipple.

Sore Nipples
Even when the baby is sucking well, many mothers experience sore nipples in the first few weeks of nursing. The key to avoiding this problem is to make sure that the infant is latched on to the nipple with a deep grasp including the top and the bottom of the nipple and most of the aureola. The pain of nursing should be only the first few sucks. If it continues to hurt, the nipple should be pushed deeper into the infantís mouth. If the pain is gone but it returns as the feeding progresses the nipple should again be pushed in, since the baby is probably sliding off as he relaxes. Lanolin creams and breast shells which air the nipple after feedings are useful. If the nipples have accommodated to the nursing and, at a later time they become sore, it is almost certain that they are infected with yeast. Additionally, it is quite possible that the baby has thrush, a yeast infection in the mouth. If this happens, both the mother and the baby should be treated.

Engorgement
When the milk first comes in, on day 2-3 in young mothers, the breasts can get very swollen and painful. This condition, known as engorgement, requires careful management to prevent infection. Most people know that the more the baby nurses, the more milk is produced. This does not apply to the problem of engorgement! When the milk first ďcomes inĒ there is often much more than the baby can consume. Most women produce at least enough for twins. The production stays on overdrive for about a week no matter how much the baby nurses. There is also a very uncomfortable swelling of the breasts which can block the milk flow and make the breasts painful and hard. Engorgement can also interfere with the babyís ability to latch on, causing sore nipples and a frustrated infant. Since the milk keeps coming in, even if the breasts are not emptied, there is no stopping it. Drainage is the most important task.

The best way to avoid the problem is to make sure the breasts are soft before and after each feeding. If they are too full to nurse, a pump should be used to drain out enough to make the latch on easier.

At the end of the feeding if the breasts are still full the pump should be used to drain out whatever is still there. The milk that is pumped out can be used for at least 6 months if it is stored in the back of the freezer in small baggies. The amount of milk that can be stored from pumping during these few days is truly astounding. After the milk production adjusts itself to the needs of the baby the pumping is much less productive.

Hot showers and hot compresses can help soften the breasts to promote milk flow. It has also been shown in real studies that green cabbage leaves can be used to reduce the swelling. The leaves should be wrapped around the breasts inside the bra and changed whenever they are wilted. Engorgement only lasts for a few days. When it subsides, the nursing becomes more comfortable.

Mastitis
When milk does not flow properly a tender cord like area in the breast forms. This blocked duct can develop into an infection causing pain and fever. Whenever a painful area develops, every effort should be made to get the area to drain by changing the babyís feeding position, using hot compresses and pumping. If the condition worsens and the mother feels ill, antibiotics are usually necessary.

The motherís diet
Mothers who are nursing need a good, well balanced diet that has adequate fat content. Low fat maternal diets cause the milk to be less nutritious. The diet should include calcium rich foods like milk or soy products. Nursing mothers should stay on the prenatal vitamins they were taking during pregnancy. If they are anemic, the mothers should continue taking iron.

If the baby is colicky, certain foods should be eliminated. These are; all juices, broccoli, cauliflower, cabbage, onion and green pepper. It is occasionally necessary to eliminate milk from the motherís diet. When this happens, she should take calcium supplements.

Nursing mothers need adequate hydration to maintain good milk supply. In hot weather a lot of water is needed just to keep the mother from losing her milk.

Infant issues
Premature infants often have to wait until they reach 36 week gestational age to have the energy and coordination to nurse. Many do well on pumped milk until that time. Some infants are born with poor muscle tone or other neuromuscular problems which can make nursing difficult. Severe tongue tie can interfere with nursing. This can be easily corrected surgically.

Breast feeding can often protect against food allergies but in some families it actually causes the problem. If the nursing baby develops eczema, a chronic runny nose or cough, or ear infections, food allergies can be the problem. Milk, eggs, soy, peanuts, tree nuts and fish are the most common allergenic foods. When allergies are severe in breast fed infants, these protein foods in the motherís diet could be causing the problems. In this rare situation manipulating the motherís diet can help the baby until he outgrows the sensitivity.

Frequently asked questions

When should I start nursing my baby?
To get off to a good start it is really a good idea to nurse in the delivery room. This first feeding familiarizes the baby with the motherís nipple. Even mothers who have had cesarean sections can and should nurse in the first few hours after delivery. When the first feeding is delayed, and bottles are given, the baby will sometimes reject the motherís nipple when she tries to feed. The longer the delay in the first breast feeding, the higher the chance of nipple confusion.

Do I have to nurse my baby?
Nursing is really fun when you get used to it. I usually try to encourage the new mother to nurse, but if things do not work out, formula feeding is not bad for the baby at all. Babies do well with either type of nourishment.

Can I take medication when I nurse?
Many medications, such as most painkillers, thyroid hormone, asthma medications, antihistamines and most antibiotics are OK for nursing mothers. Other medications should be checked out by the pediatrician or the pharmacist to make sure they are safe.

Can I give one bottle a day?
One bottle a day is usually OK, once the baby is accustomed to the nursing. During engorgement it is not a good idea to delay nursing since it can cause more swelling. After the engorgement settles down, giving the baby one bottle a day works well for most babies.

How long is a feeding?
Some babies are quick and finish in 10 minutes or less. Some babies are slow and need to stay on the breast for much longer. Some fall asleep and wake up a few minutes later and start again. In general the feeding should not have to be more than 45 minutes.

How often should I feed the baby?
Try to space the feedings to 2 Ĺ - 4 hour intervals. This will usually give 6 - 8 feeds a day. If the baby is demanding every hour try to burp him, soothe him, rock him and give a pacifier for him to suck on. When you let his stomach gradually empty for a couple of hours, the baby will have more room to fill up next time. Most babies need at least 6 feedings in a 24-hour day. If the baby is sleeping more than 4 hours during the day he should be woken to feed. At night we allow them to go longer between feedings.

How do I know that the baby is getting enough?
The best way to tell is by weighing the baby. If the baby, after the initial weight loss of the first few days of life, is gaining well, he is getting enough.

When do I encourage self settling?
At about 4 months of age the baby can be fed before falling asleep. Putting him into the crib awake allows him to learn how to self settle.

When should I start solid foods?
Introducing solids decreases the milk supply and allows hormone changes in the mother that can make her more fertile. If the baby is thriving you can delay starting solids till 9 - 12 months. If you do not start solids, the 9 - 10 month baby should be given something big that he cannot really bite off, like a bagel, just for practice. If the baby is hungry and not gaining well, solids can be added to his diet any time after 5 - 6 months.

What happens if the baby sleeps long hours at night?
When the feedings are more than 6 hours apart, the hormone changes can, in some mothers, cause staining and return of fertility. One feeding in the middle of the night keeps the hormones in balance for nursing.

What happens if I have to go to work?
The more hours you are away from the baby, the more chances you have of losing the nursing. Some babies reject the breast when they get used to bottles. Most working moms pump at work. Pumping works well for most women up to about 4 -6 months. For many mothers, the pumping is not the same as nursing, and the milk supply decreases. Shorter workdays, closer jobs and having the baby brought for feedings, are the best options.

What happens if I conceive?
Breast milk decreases in volume during early pregnancy. It is not usually necessary to stop nursing right away unless there is staining or threat of miscarriage. Most mothers can go to 3 feedings a day and then drop one feeding each week until the baby is weaned. Babies need either breast or formula till 1 year of age. Depending on the age of the baby, each feeding can be exchanged for formula or milk or solid feedings as the breast feeding is weaned.

When is the right age to wean?
The answer is, whenever the mother and the baby are ready. I have babies being nursed past three years of age, and some who wean themselves during infancy. Most are weaned when the mother becomes pregnant or at about 15 - 18 months.

It is important to remember that even though there are often problems with initiating breastfeeding, most of these subside in a couple of weeks. New mothers need a lot of reassurance and encouragement when nursing does not come easily. Lactation consultants can be very helpful when problems arise. The attitude of the husband and family is important when it comes to dealing with nursing issues. The more positive feedback she gets, the more a young mother will want to try. If, however, the baby cannot be nursed, the mother should be reassured that the baby will be fine on formula. There is no need to feel guilty. The baby will not remember what he is fed during infancy!

 
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