Breast Feeding

INFORMATION FOR MOTHERS

ADVANTAGES OF BREAST FEEDING - FOR BABIES

It Is the best food for the mental and physical development of the baby.
It protects the baby from:

• Diarrhoea;
• Coughs and colds;
• Respiratory infections;
• Ear infections;
• Sudden infant death.

It develops close bonding between mother and child.
Baby will not get:

• A sore bottom;
• Stomach ache;
• Constipation;
• Too fat.
  

It develops better:

• Jaws;
• Speech;
• Teeth.

Breast milk contains fats of the right kind needed for the growth of the baby's brain

FOR THE MOTHER

Breast feeding helps get:

• Your weight back to normal after delivery;
• Your womb back to normal after delivery.

Breast feeding gives:

• Pride and satisfaction to the mother;
• Breast feeding does not put extra burden on your budget as it does not cost money.

Breast feeding means a mother can feed her baby:

• Anytime;
• Anywhere;
• Without any preparation.

Breast feeding mother develops a loving relationship with her baby.

Breast feeding delays pregnancy, if the baby is fed every 2-3 hours, mornings and evenings.

Remember - almost all mothers can breast feed - only 1 or 2 in every 100 may have problems.

STRUCTURE OF THE BREAST
PROLACTIN REFLEX
OXYTOCIN REFLEX

Anxiety pain or doubts stop this reflex

PREPARATION OF BREAST DURING PREGNANCY

• The nipple may be massaged 3 or 4 times daily during the last 2 months of pregnancy.
• Olive oil or any other oil can serve the purpose.
• Wash or sponge the breast or nipple to prevent crust formation.
• Proper support by a well fitted brassiere helps the mother to maintain her figure.

BREAST CARE DURING LACTATION CLOTHING

Some Dos:

• Wear a well fitted brassiere preferably open in front;
• Select a well fitting dress opening in front;
• Place a clear folded handkerchief or cotton pads in the brassiere to protect against leaking of breast-milk.

Some Do Nots:

• Padded nylon brassieres should not be used as they prevent nipple drying;
• The mother's clothing should not be too tight over the breast to make her uncomfortable.

HYGIENE:

• The breast should be washed once a day preferably while taking a shower;
• Let the breast air dry naturally after breast-feeding;
• Always wash your hands before taking care of the baby.

SUCKING REFLEXES IN THE BABY

• The Rooting Reflex:
  The baby finds the mother's nipple with this reflex. When anything touches the baby's cheeks or side of mouth, a hungry baby turns his/her head towards the touch.
• The Sucking Reflex:
  When anything goes into the baby's mouth far enough, he/she sucks it.
• The Swallowing Reflex:
  If the baby's mouth fills with milk he/she swallows it naturally.
  

How does a baby suck?
Act of sucking by the baby:

• Stretching the nipple and areola to form a teat.
  Pressing the stretched areola with jaws and tongue against the palate to press the milk out of the lactiferous sinus beneath the areola.

How to put the baby on the breast correctly?

• The mother should sit somewhere comfortably. A low seat is usually the best.
• The baby should be held properly so that he/she faces the breast and baby's stomach is against the mother's body.
• Do not just turn the baby's head. The baby on the whole should face the breast.
• Hold the baby at the back of his/her shoulder, not at the back of his/her head.
• The mother should first touch the side of his/her cheek or mouth to stimulate the Rooting Reflex.
• The mother should wait until the baby opens his/her mouth to feed.
• The mother should offer her nipple with the areola to the baby and not just the nipple.

POSITIONING OF THE BABY

Usually three positions are adopted by the mother while nursing the baby.

Madonna or cradle hold:

• When the mother nurses the baby held in front of her;
• If the mother wants to breast feed from the right breast, the baby's head lies in the crook of her right arm;
• Her right hand supports the buttocks of her baby;
• With her left hand, she presses the breast around the areola to aid in expression of milk.

Foot Ball hold:

• The mother rests her arm and elbow towards her back on a pillow by her side;
• She rests the baby on her arm;
• The baby's head is supported by her hand;
• The baby's buttocks are supported by the crook of the mother's arm and the mother's hip;
• The breast is held by the opposite hand to help express milk for the baby and to allow the baby to suck at a comfortable angle.

Side by side:

• This position is useful when the mother wants to feed the baby in a lying down position;
• The baby is fed from the side facing the mother;
• The mother then holds the breast on the side facing the baby with the opposite hand directing the nipple and areola towards the infant's mouth.
• Any method, which the mother and baby find comfortable, is recommended.

COMPARISON BETWEEN GOOD POSITION AND BAD POSITION OF BREAST FEEDING

When should the first feed be given to the baby?
Breast feeding should be started as soon as possible after delivery, preferably at the delivery table or within 1-2 hours of birth.

Advantages:

• The baby gets valuable colostrum or first watery milk;
• Baby adapts more easily to breast feeding;
• It develops a strong bond of love and affection between the mother and the child from the beginning.

The newborn must room in with his/her mother to promote breast feeding and enhance mother-child bonding.

What is colostrum and how is it beneficial?
Colostrum is the first watery bright yellowish milk of the mother. It should be given to the baby because:

• It is very high in protein content;
• It contains natural minute bodies (antibodies) which protect the baby from infection;
• Usually colostrum protects the baby from diarrhoea, T.B. and to some extent from polio and skin infection.

When to feed the baby?
Allow the baby to be breast fed whenever he/she wants milk because more often the baby sucks, more milk is produced.

The baby will cry when he/she needs to be fed. In the beginning, do not fix a precise time for breast feeding. Usually, during the first few days, the baby is breast fed even every two hours. Later on, the interval increases as baby settles down to his/her required needs.

If the baby sleeps for more than two hours after the last feed, then wake up the baby if your breasts feel heavy.

How long to feed the baby?

Although the infant obtains 85-90% of his/her feeding in the first 5-8 minutes of vigorous sucking, he/she should be allowed to nurse for at least 10-20 minutes at a time.

Research has shown that slow feeders take the same total amount of milk as fast feeders. If you stop a slow feeder before he/she is ready, he/she may not take enough milk. He/she may not get the energy that is needed to grow well.

Which foods have an effect on breast milk secretion?
Almost every category of food having nutritional value is a lactogogue, which means food that helps to produce more milk.

However, in different regions, culturally some foods are avoided by the mothers after delivery, which include rice, "dal", eggs, roots, leafy vegetables, brinjals, onions, sour, food, fish, meat, mustard oil, etc. In fact these foods do not cause any problems, rather they are important for the mother's diet.

When and how to burp the breast fed baby?
Mother should burp the breast fed baby after each feed before laying her in the crib.

Method for Burping:
The baby should be held over the shoulder or seated erect in mother's lap or lying face downward and gently patted or stroked on the back. Thereby, the air that the baby has swallowed will rise to the top of his/her stomach and be expelled.

Should a baby be fed from one breast or both?
Start nursing the baby on the first breast and after the most vigorous sucking has finished, switch the baby to the second breast for the last minutes of feeding. Then at your next nursing session, start the baby on the second breast; let the baby again nurse vigorously and finish on the first breast.

Advantages:

• Both the breasts are stimulated so as to produce milk twice as often;
• The baby gets access to twice as much milk;
• The baby's sucking needs may be satisfied without the risk of nipple injury;
• Many mothers have a 'favourite' side. However, if the baby sucks more from one side than the other, the 'neglected' breast may stop producing milk.

What is rubber nipple pacifier confusion?
A rubber teat is already long, so the baby does not have to pull it out. When he/she changes to mother's breast, he/she tries to suck on the nipple as if it is the same rubber nipple. Since he/she does not pull it out, he/she cannot suck it properly and thus develops nipple pacifier confusion.

CONSEQUENCES OF SUCKING THE TIP OF THE NIPPLE

When a baby sucks only the tip of the nipple:

• The baby fails to express the milk because he/she does not press on the lactiferous sinus;
• The mother feels pain and the nipple skin may be damaged;
• The baby fails to stimulate the nipple enough to trigger the two necessary hormones of the brain;
• The baby is frustrated and fusses, and refuses to be breast fed;
  The mother thinks that the baby is unsatisfied as she does not have enough milk.

BREAST FEEDING AND BOWEL PATTERN:

A breast fed baby may have either of the two types of bowel pattern.

It is common for a breast fed baby not to pass stool for few days. This should not alarm you because it is not constipation.

It is a sign that breast milk is the perfect food. Breast milk is almost completely absorbed into the baby's body and therefore, there is very little waste. Breast fed babies usually pass very small, soft, frequent stools. It is uncommon for them to pass hard stools. Many babies may seem to strain while passing stool. This is also normal and not a sign that the baby is constipated.

What should be the maximum or minimum period of breast feeding?

Breast milk should be fed to the baby for as long as possible.

Minimum period of breast feeding is atleast one year. Although breast milk continues to be important for growth in the second year of life also.

Weaning Off Breast Feeding:

Stopping breast feeding should not be sudden. If a mother wants to stop breast feeding, she should do it gradually.

Can contraceptive pills be taken while the baby is breast fed?

Some pills reduce the amount of breast milk like combination pills of Oestrogen, Progestron. However, there are pills which do not suppress the milk, rather increase it, like Progestron pills which contain Progestron only.

Injectible contraceptives, e.g. Depoprovera do not decrease the milk supply and so this method of contraception can be selected during lactation.

Physical methods like Intra-uterine Devices (IUD), condoms, diaphragms, etc. can be used safely.

PREGNANCY, LACTATION AND MENSTRUATION:

• Medically, it is quite safe to breast feed the baby during a new pregnancy;
• Mothers should understand that breast feeding during pregnancy is not harmful to either of the babies for the first few months of pregnancy;
• If she weans the older child, she should do it very gradually. Sudden weaning is harmful and can make the older child ill;
• She must take extra care of her diet because now she is feeding for three people.
• Mother's breast can become tender with new pregnancy. The hormonal changes may decrease the supply of milk.

Remember it is quite safe to breast feed during menstruation.

How can a mother know that her infant is hungry?
Usually an infant or newborn shows that he/she is hungry by any one of the following signs:

• He/she becomes restless;
• He/she cries;
• He/she moves his/her head in search of food;
• He/she makes sucking movements which bring no relief and are likely to end in crying. A well-fed, contented baby usually goes to sleep for several hours after being fed, awakening when he/she needs food or is uncomfortable

Usually an infant cries for two reasons:

• Hunger;
• Soiled diapers.

How can a mother confirm that the baby is taking enough milk?
With the help of a doctor, LHV/midwife, a mother can find out that her baby is taking enough milk by the following tests:

a) The Wetness Test: The mother should note how often the baby urinates:

• The baby should urinate six or more times a day;
• The urine should be colourless or pale yellow. If the mother is not giving water or other drinks, then this test is fairly confirmatory;
• If the baby cries after urinating six or more times daily then it means there is some other problem with the baby.

b) The Weight Test:

• Weigh the baby and check his/her weight gain on a growth chart;
• A healthy baby should gain between half and one kilo per month or a minimum of 125 gms each week.
  

  Please Note:

  Routinely, a baby should be weighed every month or two and a proper record be maintained as this weight gain is a sure way to monitor the baby's health.

  If your baby's weight gain is proper, then do not worry because you have enough milk. Do not start a milk supplement or solid food before the fourth month.

  WHAT CAN A MOTHER DO IF SHE HAS ALREADY STARTED BOTTLE FEEDING HER INFANT?
  If the initiation of breast feeding has been delayed, or the early use of bottles may mean that the mother is producing less milk than what her baby's appetite demands.

  In this case, the mother can build up her milk supply and eventually eliminate the need for supplementary bottles.

  The mother should begin each feeding by breast feeding and nursing should occur very frequently.

  Supplementary bottles should be gradually eliminated until they are no longer necessary.

  HOW TO INCREASE A MOTHER'S MILK SUPPLY?
  Babies sometimes become fussy during growth spurts when they require more milk. The problem is not that the mother's supply is decreasing, but she should increase her milk supply.

  The mother can be advised as follows:

• Nurse the baby more often, every hour if necessary;
• She (mother) should rest more often;
• Try to cut back on tiring outside activities;
• Eat properly both in quality and quantity, especially if she (mother) is malnourished;
• Drink plenty of fluids;
• The mother should keep the baby near her and handle him/her herself as much as possible;
• The mother should feed the baby during night also;
• The mother should feed the baby longer than before from each breast;
• If the mother knows of a locally valued lactogogue, she should take that too;
• Sometimes a doctor needs to be consulted if the mother's milk supply is not increasing.

  What are the few problems encountered by a mother during breast feeding?
  Flat Nipple: Some women have short, flat nipples. Flat nipples are most common in first pregnancy. Most nipples are protractile (you can pull them out) and quite long. In a non-protractile nipple there will be difficulty in feeding.

  Treatment: Flat nipples should have been discovered in ante-natal visit by LHV/midwife on examination of breasts and proper measures should be advised at that time.

  Ante-natal: During antenatal period, the mother should press her nipples and pull them gently. She should do this several minutes every day. By this manoeuvre, her nipples will grow longer as it mimics the sucking action of the baby.

  While nursing: After the baby is born, nipples can be stretched still further. The mother should squeeze the areola before putting the nipple in the baby's mouth. If the breast is very full, first express some milk before doing this.

  Engorged breast
  The breast usually becomes swollen when the amount of milk produced is more and baby is too weak to suck to empty the breast.

  Signs and Symptoms:

• If the breast is not emptied normally, then it will become full and swollen with milk (it becomes engorged).

• Even the baby is not able to suck because the skin of the breast becomes tight and the baby cannot put the areola in his/her mouth;
• Sucking also becomes painful for the baby.

Prevention and treatment of engorged breast:

• Do not let the baby miss a feed;
• Mother should wake even a sleeping baby when she feels the need to breast feed the baby;
• Express milk by breast pump or hand expression to remove excess milk and make the breast soft so that the baby can grasp it easily;
• Take hot showers;
• Let the baby begin nursing on the fuller breast first;
• Rest.
• Well supporting Brassiers should be worn.

  Cracked or Sore Nipples:
  Nipples soreness is more pronounced at the beginning of breast feeding or during early lactation, i.e on the second or third day. Once the let-down reflex initiates milk flow, tenderness usually lessens.

  Causes:

• appropriate nursing technique;
• Friction due to strong sucking at the initiation of lactation;
• Incorrect positioning during breast feeding;
• Engorgement;
• Irritants such as soaps and lotions.

  Some remedies are:

• Nurse the baby before he/she is very hungry to avoid hard sucking;
• Massage the breast to stimulate let-down reflex;
• Start feeding on the less painful breast;
• Alternate position for each feeding;
• Check to make sure that baby has both nipple and areola in his/her mouth;
• With water, wash the residue of the baby's saliva from the breast after feeding. Let the nipple dry thoroughly before covering it;
• Between feedings, expose nipple to the air or wear a loose blouse that allows the air to circulate;
• Wear cotton brassiere and clothes as they help keep the nipples dry;
• When nipples are dry, apply pure lanolin vitamin E oil or breast milk.

Breast Infection:

Mastitis causes a reddened tender area in the breast that may be accompanied by a slight fever and feel like aches and pains. It is usually preceded by clogged ducts or engorgement:

• The mother should see her doctor promptly;
• The mother should nurse more frequently as the inflamed area needs to be kept empty;
• Begin breast feeding with the affected breast;
• Apply moist hot packs to the breast;
• Take mild analgesics;
• Take appropriate antibiotics.

Breast Abscess:
Breast abscess causes fever and a clearly defined, red, hot, painful area in the breast. It may follow breast infection, especially if nursing is discontinued during infection.

• The mother must continue breast feeding on the unaffected side.
• She may pump her breast on affected side and discard the milk.
• She must see her doctor immediately.

Prior to hospital discharge, the mother should receive specific education in normal breast feeding routines, provided either individually, in group classes or via take home written material and or audio visual aids.

Aga Khan University Hospital, Karachi
P.O Box 3500, Stadium Road, Karachi-74800, Pakistan.