Breastfeeding
Page Contents:
Some Commonly Overlooked Breastfeeding Basics, Written by, Lois Wattis, RN, RM, IPM, FACM, IBCLC
The High Cost of Artificial Feeding, Written by, Claire Hall, Midwife - Australia
Tips for Breast Feeding Success, Written by, Claire Hall, Midwife - Australia
SOME COMMONLY OVERLOOKED BREASTFEEDING BASICS
Written by, Lois Wattis, RN, RM, IPM, FACM, IBCLC - Australia
(COPYRIGHT: Lois Wattis www.birthjourney.com)
Most women are well aware of the benefits of breastfeeding and start by offering their baby colostrum from birth. Each mother/baby combination is unique as the nurturing process unfolds developing into their personal journey. Hospital and parenting practices have changed over the years, informational resources and advice abounds, and parents often become very confused as they endeavour to provide the best for their child.
“Many of the hospital practices in the past led to mothers weaning their babies from the breast within days or weeks of going home from hospital. Your mother or grandmother will have had their babies under this system and may not understand why you are being taught different ways of caring for your baby. They may be surprised that you are able to have your baby at your bedside or in your bed in hospital. They are sure to share their experiences with you and may lament the restrictions and rules enforced when they were new mothers.” (Cox, 2004 p12)
In this article I will share a few breastfeeding basics which I believe are often overlooked in the plethora of information and advice that new parents receive. This article addresses the challenge of learning to breastfeed, feeding anewborn baby and how to know what constitutes a normal breastfeed, and some typical changes to breastfeeding patterns as baby grows.
The experience of breastfeeding
Some women have an unrealistic expectation that breastfeeding will “just happen” and may experience surprise, disappointment and frustration in the early hours and days of motherhood. Sometimes it all just seems to be too hard!
Breastfeeding is like learning to drive a car. It doesn’t matter how much you want to drive a car, or how often you sit in the passenger seat carefully watching how to steer and change gears and use the clutch and the accelerator. Everyone learning to drive will bunny hop the car, and grind the gears, and find the co-ordination of the pedals and the gears in combination with all other aspects of driving is a challenging new skill to master. Later it will all become ‘second nature’ and hardly require concentration to co-ordinate the actions at all, but in the beginning it requires some effort and may involve some frustrations as co-ordination develops.
“Breastfeeding is a learned skill. You learn by observing others (which doesn’t always happen in our society) and by experience and practice. You and your baby are a unique unit, and you will very quickly become the expert, as you learn to respond to baby’s cues” Rebecca Glover, 1997.
“Breastfeeding is not simply the transfer of milk from your breasts to your baby. It is also the transfer of smell, skin touch, warmth and feelings as you and your baby gaze at and stroke each other during this delightful interaction many times a day. Skin-to- skin contact is a basic human need.” (Cox, 2004, p12)
“Breastfeeding is often seen as just a way to give babies milk – nutrition. It is in fact when babies receive a host of sensory input – nurture. It has been known for many years that body contact from a constant caregiver is essential to the normal development of human beings.” Cox, 2004, p27)
Breastfeeding is the culmination of the process of growing and birthing your baby. This extraordinary continuum has ensured the survival and development of our species. Modern women may doubt their own capacity to complete the nurture of their child from conception to toddlerhood and beyond, but scientific discoveries continue to confirm the wondrous properties and unique benefits of human breast milk.
Milk, in the form of colostrum, is present from about the fourth month of pregnancy onwards. At birth, the delivery of the placenta triggers a reduction in the woman’s progesterone levels that removes the inhibition of milk production and allows the elevated levels of prolactin to function. Increased amounts of blood and lymph in the breast form the nutrients for milk production. These fluids cause the breasts to become fuller, heavier, and sometimes tender. As regular, frequent breastfeedings progress, this normal fullness diminishes. By about two weeks postpartum, when lactation is established, the breasts become comfortable soft and pliable, even when they are full with milk. Regular frequent feedings will maintain this condition (Lauwers & Swisher, 2005, p308).
Breastfeeding a Newborn Baby
Forget the clock
Be guided by your baby’s cues as to when he wants to feed and for how long. During the first few days when baby’s breastfeeds provide colostrum the feedings may be frequent and irregular. Colostrum is highly concentrated, and baby’s stomach capacity is small so the quantity of colostrum required to satisfy his needs is also small. Alternating sides each time the baby goes to the breast will stimulate the breasts, assisting the transition from colostrum to breast milk production (lactogenesis).
Feeding Frenzy
Around day 2-3 baby often wants to feed more frequently, maybe 1-2 hourly. Baby has passed lots of meconium poos, emptying out his gastro-intestinal tract, and his stomach capacity is gradually increasing in size in preparation for milk feeds. He’s hungry!!! So feed him. This is nature’s way of ‘calling in the milk’ and your body will respond accordingly. Skin-to-skin contact with your baby, allowing baby to smell, hear and touch you and avoiding separations so you can respond to his feeding cues immediately will facilitate your ‘milk coming in’ – putting an end to the Day 2-3 feeding frenzy.
The milk arrives
Your breasts feel heavy, warm and may leak prior to or during feeds. Nature often overcompensates in the beginning, but it will settle down. Now it is advisable to feed your baby from one breast per feed, aiming to drain each breast a number of times during each 24 hour period. Baby will let you know when he’s had enough. As baby grows he may drain the first breast and still want more, so the feed may be completed on the second breast. In this case start the next feed on the breast with which you finished the last feed.
How do I know how long to feed my baby?
In general, the baby’s needs should determine feeding length. When the flow of milk diminishes from one breast, the sucking rate will move from the long, drawing nutritive suck to a faster, gentler suck. The baby’s eyes will close, his fists will relax, and his hands will come away from his face. He may release the breast and let it slide out of his mouth. Allowing the baby to remove himself from the breast will ensure that he has received the high-fat hindmilk needed for optimal growth. Limiting the time spent on the breast may result in the baby’s receiving foremilk from both breasts and becoming too full to obtain a significant amount of hindmilk from either breast. This form of high volume, low fat feeding can result in poor weight gain and colic-like symptoms. Flexibility on the mothers part will allow for variations in the baby’s nursing style, hunger, and daily temperament (Lauwers & Swisher, 2005, p308).
Each breastfeed is usually comprised of a few instalments. Just as an adult varies the size of meals eaten according to hunger, and meals may be comprised of several courses, babies vary their feeds too. Young babies particularly need to take each ‘meal’ in a few stages, with rest times in between each stage to allow partial digestion. This will mean baby may go to the breast two or more times PER FEED.
Consider when you go out for a meal at a nice restaurant. You order your entree, and eat is quite quickly and enthusiastically, because you were hungry! Mmmm, that feels better, and some time elapses before your main course arrives. Your initial hunger is curbed so that’s OK. Your main meal arrives and you steadily consume it, less quickly than the entree, but enjoying it just the same. You feel full. Nevertheless, you still have a look at the sweets menu. OK, lets have sweets – you’re ready for it by the time it arrives. Now you feel really satisfied and you relax into some after dinner conversation. A bit later you may want coffee and maybe after dinner mints too… but of course you don’t do that every meal – just sometimes. The whole dinner process usually takes about an hour or so – reasonable and acceptable, right?
Isn’t it reasonable and acceptable for a young baby’s feed to be consumed over a similar timeframe and in several instalments if that is what baby demonstrates by his cues that he needs? Some feeds will be completed in less time and fewer instalments according to baby’s needs. Be flexible, and respond to your baby’s early feeding cues and your baby will be contented and thrive – and sleep well between feeds.
Your tiny baby will breastfeed eight to twelve times in 24 hours, taking from 45 to 60 minutes for each feed, including nappy changes and cuddles. Feed times will take at least eight hours each day. Small babies usually have a long wakeful time during each 24 hours. Most often this is in the evening from about five o’clock to nine or ten o’clock. (Cox, 2004, p41).
Generally, mothers should allow the baby to remain at the breast until he spontaneously releases the breast on his own. If the baby tends to ‘linger’ at the breast, the mother can watch for a change from nutritive to non-nutritive sucking. Non-nutritive sucking does not provide the stimulation necessary for increasing milk production. If the mother removes him from the breast at this time it should not significantly affect milk quantity. However, mothers should be encouraged to gauge their individual baby’s needs. Some babies need more comfort sucking at the breast than others need. During the first month of life, the baby establishes patterns of milk intake that will continue through the next twelve months (Mitoulas, 2002). Parents need to avoid strict schedules and allow the baby to lead his feedings. This supports the individual nature of infant needs and the importance of baby-led feedings. Each baby’s own rhythm will reflect his feeding patterns (Lauwers & Swisher, 2005, p308)
Just when you think you know what to expect – it changes!
Be prepared for your baby to change his pattern of feeding from time to time. This usually coincides with a growth spurt, and baby will demand feeds more frequently for a day or two. To facilitate the process of increasing your supply you may need to abandon whatever plans you had for that day and ‘just feed the baby’. If you’ve missed a lot of sleep overnight go back to bed with your baby and feed him as he demands, and your body will respond by increasing your milk supply within 24-48 hours. Giving supplementary feeds during this time will interfere with your body’s response to the process, so AVOID giving formula feeds. Rest and good nutrition are the keys to increasing your supply to meet your baby’s growing needs – so look after yourself! Typically ‘feeding frenzies’ occur at 2-3 days (“calling your milk in”); usually again around 2 or 3 weeks, sometimes again at around 6 weeks, very commonly around 3 months and around 6 months of age.
Interestingly, when breastfeeding women are having problems with insufficient breastmilk supply and they review when the problem first arose, it usually coincides with one of the typical growth spurt ages – around 3 days, 3 weeks, 6 weeks, 3 or 6 months. If mothers are prepared for growth spurt feeding behaviours they are more likely to cope with it appropriately and continue to successfully breastfeed their babies.
Growth Spurts
A mother may periodically notice an increase in the frequency with which her baby wishes to feed. All babies experience periods of sudden growth during their early months. They react to these growth spurts by feeding more frequently. Such periods of increased feeding usually last only a few days. Growth spurts can occur at any time, although there are predictable ages. Mothers who have a robust supply of milk through frequent breastfeeding in the early postpartum days easily carry through during these times of feeding frequency until the growth spurt has passed (Dewey, 1991- in Lauwers and Swisher, 2005, p309)
Enjoy your unique breastfeeding experience as you nurture your special little person in the best possible way!
References:
Cox, S. (2004). Breastfeeding with confidence – A do-it-yourself guide. Finch, Sydney
Glover, R. (1997). The Key to Successful Breastfeeding (brochure) Perth.
Lauwers, J & Swisher, A. (2005) Counseling the Nursing Mother – A lactation consultant’s guide. Jones & Bartlett, London
Other good information sources include:
www.breastfeeding.asn.au – Australian Breastfeeding Association
www.lalecheleague.org - International La Leche League
www.promom.org - Promotion of Mothers Milk Inc.
Lois Wattis, RN, RM, IPM, FACM, IBCLC - Australia
Web: www.birthjourney.com
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The high cost of artificial feeding
Written by Claire Hall, Midwife - Australia
I do not accept the commonly held position that artificial baby formula is a suitable substitute for breast milk. Breast Milk is completely natural and it is what we as humans were designed to have. It is perfect in every way. Rather than try and prove that it is the best choice, it should be considered the only choice. It is artificial formula that has to prove it is a suitable substitute, and I’m afraid that it doesn’t even come close. In fact, the World Health Organisation lists it as only the 4th best option for your baby. Number One is breast feeding of course, followed by expression and feeding the baby, followed by having another woman breast feed your Baby or the use of milk from a “Breast Milk Bank.”(4) Even this human milk that has been pasteurised is of superior quality to artificial formulas. Of course, if in an extremely rare case numbers 1, 2 & 3 were unavailable to me, then I would be very glad to have formulas so that my Baby wouldn’t starve.
Breast Milk has all the correct nutritional needs in the right form and the right amount just as your baby needs them – fats and fatty acids, carbohydrates, protein, vitamins, minerals and trace elements, anti-infective factors such as leucocytes and immunoglobulins, hormones and growth factors.(2) The bioactive components (such as enzymes) found in breast milk promote growth and development of the newborn that continue after the baby ingests the breast milk.(1) A prominent amino acid found in breast milk may function as a neurotransmitter which plays an important role in early brain maturation. Studies suggest that children who were artificially fed have a lower IQ than their breast fed counterparts.(1) Breast milk also changes in composition as your babies needs change.(4) We should also keep in mind benefits such as increased bonding, hormone production that makes Mum feel good and help her body recover from the birth, reduced bleeding and increased weight loss.(5) In contrast, there are several health risks (for both Mother and Baby) in using artificial formulas to feed your Baby, such as –
Artificial formulas lack the immunological and other health-promoting factors present in human milk. Artificially fed infants are denied the benefits of “autoimmunisation”, whereby the breast produces antibodies or organisms to which the infant is/has been exposed.(1) The baby who is artificially fed from birth is 5 times more likely to be hospitalised with gastroenteritis (vomiting and diarrhoea) within the first 3 months of life, twice as likely to suffer with chest infections in the first 7 years of life, and twice as likely to suffer ear infections within the first year of life.(2) Recent research also shows that artificially fed infants are also more susceptible to urinary tract infections. Artificial infant milks may help respiratory pathogens become established and children who are fed artificially are more likely to develop ear infections, eczema and to manifest allergic signs such as disturbed sleep.(1)
1. Artificial formulas contain nutrients that are foreign or in non-physiologic proportions. This leads to digestion and absorption problems.(1)
2. Premature infants are 20 times more likely to develop necrotising enterocolitis (a serious life threatening bowel disease).(1,2)
3. Artificial feeding is implicated in some diseases which develop in childhood such as asthma, celiac disease, diabetes and lymphoma. Adults who develop inflammatory bowel disease are more likely to have been artificially fed.(1) .
4. The act of bottle-feeding differs from that of breastfeeding in ways that may contribute to health problems in some babies. A Baby receives less oxygen while being fed from a bottle than from the breast. Bottle feeding is also associated with oral malocclusion. (Malocclusion is an irregular contact of the teeth of the upper jaw with the teeth of the lower jaw. This would include overbites, underbites, and crossbites.)(1)
5. Mothers who bottle feed are more likely to develop osteoporosis, premenopausal breast cancer and ovarian cancer.(1.2)
6. Artificially feeding your Baby is an expensive exercise considering the cost of the formula, bottles, teats, washing and sterilising equipment and increased medical expenses.
.
A Word About Contaminates
It is certainly true that numerous toxins (such as DDT, DDE, various herbicides and pesticides) can also enter breast milk. (1) Unfortunately, this is a fact of life – the cows that produce the milk to make artificial formulas are also exposed to the same chemicals. Pesticide residues have also been found in lanolin nipple ointment.(1) The risk of pollution exists for everyone, not just for breastfeeding babies. Environmental pollution is worsening and we must continue our active efforts to diminish contaminants in our environment (and subsequently human milk). Meanwhile avoid fish high in mercury, (see “Eating For Two”) try to eat high quality organic vegetables and fruits where possible, eat low fat foods and cut fat from meat. Avoid using pesticides in the home and eliminate or limit exposure to household chemicals. Try to avoid crash dieting that can cause a sudden release of fat (and therefore stored toxins) into your bloodstream and milk.(1)
In Conclusion
It is worth quoting a website called “Beautiful Birthing Doula’s” to sum up the artificial vs. breast feeding debate.
“Dr. Nancy Wight, a neonatologist practising in California, asks why a rational adult, when presented with the choice between health and illness, would choose illness. She says "choice" between breast and bottle is "is really a sham, … the love of consumer freedom has led women to believe that the choice between artificial feeding and breastfeeding is merely a matter of personal inclination." Wight says plenty of research indicates women would have been convinced to breastfeed if they were told about how important it is, but despite proven benefits for both the mother and the infant, physicians traditionally are reluctant to take a stand for fear of making their bottle-feeding patients feel guilty. She points out physicians don't hesitate to make their parents feel guilty if they fail to have their children wear helmets, use car seats and seat belts, or receive vaccinations. They use guilt to help their adult patients lose weight, exercise more, stop smoking, drinking, and taking drugs. She wonders why breastfeeding as a health issue differs from the rest and says doctors should continue to promote what is best for infants "and let the guilt fall where it may." (5)
References:
1. Riordan J., & Auerbach K., Breastfeeding and Human Lactation, 1993, Jones and Bartlett Publishers, London
2. Fraser D., Cooper M., (ed), Myles Textbook for Midwives, 2003, Curchill Livingstone, London
3. www.asac.ab.ca/biIssues.html
4. www.childthai.org/ciec/c013.htm
5. www.breastfeeding.asn.au/bfinfo/general.html
Claire Hall, Midwife - Australia
Email: charisbirthsupport@bigpond.com
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TIPS FOR BREAST FEEDING SUCCESS
Written by Claire Hall, Midwife - Australia
1. Assist skin to skin contact as soon as possible after birth and allow your baby to adjust to life outside the uterus on your stomach/chest. Watch for signs that your baby wants to breastfeed and give him the time to crawl to the breast and attach himself. He will lick, smell, suckle and massage with his hands before attaching. He will usually attach himself (without your assistance) within the first hour of birth.
2. Ensure that the room is warm, you are comfortable and your skin to skin contact is uninterrupted. Other people can cuddle your Baby after he has had time to adjust to the outside world and he is fully comforted and secure with Mum
3. Be careful to keep stimulus to a minimum in the birthing room. A quiet environment, dim lighting and no perfumes. It is best to let Baby smell his Mother and his own amniotic fluid.
4. Any drugs given during labour (particularly pain relieving drugs) can alter the behaviour of the newborn baby and compromise his crucial role in the initiation of lactation. Babies have a wide range of behaviour following spontaneous birth, and are not all ready to feed at the same time. Unless or until more evidence is available, interventions aimed at either delaying or speeding up the time of the first feed should be avoided.
5. Breastfeed frequently, whenever your baby is hungry or in need of comfort, both day & night.
6. Continue breastfeeding even if the mother or the baby becomes ill.
7. Breastfeed exclusively for the first six months. (The only nutritional requirements of your baby for the first 6 months are contained in breast milk, and “additions” to the diet reduce the amount of nutritious milk intake)
8. After the first six months, when supplemental foods are introduced, breastfeeding should precede each supplemental feeding.
9. Continue to breastfeed for up to two years and beyond
10. Avoid using bottles, pacifiers (dummies) or other artificial nipples
11. Mothers should eat and drink sufficient quantities to satisfy their hunger and thirst.
IS MY BABY GETTING ENOUGH BREAST MILK?
One of the most common questions I get about breast feeding (apart from attachment issues) is “How can I tell if he’s getting enough?” How a Baby feeds is as individual as your Baby. Some babies enjoy a long slow feed over about 45 min. Others have had sufficient in 15 minutes. It is hard as a Mother not to let emotions overtake your sense of reason. (Speaking from personal experience) Timing a feed is not an effective method of ascertaining if your Baby has had enough. In the past, Child Health Nurses weighed your Baby before and after a feed to see “how much milk he ingested”. Not only was this highly inaccurate, but it assumed that Medical Science knew exactly how much milk your individual Baby required at that individual feed. This placed unfair comparisons on Mothers and many Babies were started on “complimentary formula feeds” to supplement their Mother’s supply. Convinced they didn’t have enough milk; most Mothers gave up breast feeding all together.
So How Can You Tell?
As with most questions about your babies health – look at your Baby. Ask yourself –
1. Is he satisfied after a feed? Does he settle for a sleep?
2. Is he having at least 6-8 very wet nappies a day?
3. Does his urine have a strong odour, indicating dehydration? Are there urates (a red sediment that can look like blood) in his nappy?
4. Is he healthy looking? Bright and happy?
5. Is he growing and putting on weight?
By answering these questions about your Baby, you can easily tell if he’s “getting enough”. Most of our worry is completely unnecessary. Babies do not like to starve themselves, and they usually take enough milk from your breast to satisfy their needs and no more.
STORING AND USING EXPRESSED BREAST MILK
(Taken from the NHMRC Infant Feeding guidelines for health workers)
Storing
Freshly expressed breast milk that is put into a closed container, will last 6—8 hrs at room temperature, (max 26oC) and 3—5 days in the refrigerator if it is stored at the back (where it is coldest).
If you wish to freeze your breast milk, it will last...
2 weeks in a freezer compartment that is situated inside the refrigerator
3 months in the freezer section of the refrigerator (where freezer has a separate door to the fridge)
6—12 months in a deep freeze (-18oC or lower)
Some women find it helpful to freeze their breast milk in ice cube trays. Once it is frozen, they transfer the “milk blocks” to a zip-lock bag and date it.
Using Expressed Breast Milk. . .
When you wish to thaw your breast milk, the best way is to take it out well before you need it and thaw it in the refrigerator.
If the breast milk is thawed in the refrigerator, it will last 4 hours at room temperature (i.e. once you take it out of the fridge), and 24 hours if left in the refrigerator.
Once your breast milk is thawed, do not refreeze. DISCARD WHEN ALLOWABLE TIME HAS PASSED.
If you choose to thaw your breast milk outside of the refrigerator in a warm cup of water, you must use it immediately. If you place the thawed breast milk into the refrigerator immediately that it is thawed (i.e. before feeding), it will last another 4 hours.
If there is any left once the baby has finished feeding, discard it.
Claire Hall, Midwife - Australia
Email: charisbirthsupport@bigpond.com
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Some Commonly Overlooked Breastfeeding Basics, Written by, Lois Wattis, RN, RM, IPM, FACM, IBCLC
The High Cost of Artificial Feeding, Written by, Claire Hall, Midwife - Australia
Tips for Breast Feeding Success, Written by, Claire Hall, Midwife - Australia
SOME COMMONLY OVERLOOKED BREASTFEEDING BASICS
Written by, Lois Wattis, RN, RM, IPM, FACM, IBCLC - Australia
(COPYRIGHT: Lois Wattis www.birthjourney.com)
Most women are well aware of the benefits of breastfeeding and start by offering their baby colostrum from birth. Each mother/baby combination is unique as the nurturing process unfolds developing into their personal journey. Hospital and parenting practices have changed over the years, informational resources and advice abounds, and parents often become very confused as they endeavour to provide the best for their child.
“Many of the hospital practices in the past led to mothers weaning their babies from the breast within days or weeks of going home from hospital. Your mother or grandmother will have had their babies under this system and may not understand why you are being taught different ways of caring for your baby. They may be surprised that you are able to have your baby at your bedside or in your bed in hospital. They are sure to share their experiences with you and may lament the restrictions and rules enforced when they were new mothers.” (Cox, 2004 p12)
In this article I will share a few breastfeeding basics which I believe are often overlooked in the plethora of information and advice that new parents receive. This article addresses the challenge of learning to breastfeed, feeding anewborn baby and how to know what constitutes a normal breastfeed, and some typical changes to breastfeeding patterns as baby grows.
The experience of breastfeeding
Some women have an unrealistic expectation that breastfeeding will “just happen” and may experience surprise, disappointment and frustration in the early hours and days of motherhood. Sometimes it all just seems to be too hard!
Breastfeeding is like learning to drive a car. It doesn’t matter how much you want to drive a car, or how often you sit in the passenger seat carefully watching how to steer and change gears and use the clutch and the accelerator. Everyone learning to drive will bunny hop the car, and grind the gears, and find the co-ordination of the pedals and the gears in combination with all other aspects of driving is a challenging new skill to master. Later it will all become ‘second nature’ and hardly require concentration to co-ordinate the actions at all, but in the beginning it requires some effort and may involve some frustrations as co-ordination develops.
“Breastfeeding is a learned skill. You learn by observing others (which doesn’t always happen in our society) and by experience and practice. You and your baby are a unique unit, and you will very quickly become the expert, as you learn to respond to baby’s cues” Rebecca Glover, 1997.
“Breastfeeding is not simply the transfer of milk from your breasts to your baby. It is also the transfer of smell, skin touch, warmth and feelings as you and your baby gaze at and stroke each other during this delightful interaction many times a day. Skin-to- skin contact is a basic human need.” (Cox, 2004, p12)
“Breastfeeding is often seen as just a way to give babies milk – nutrition. It is in fact when babies receive a host of sensory input – nurture. It has been known for many years that body contact from a constant caregiver is essential to the normal development of human beings.” Cox, 2004, p27)
Breastfeeding is the culmination of the process of growing and birthing your baby. This extraordinary continuum has ensured the survival and development of our species. Modern women may doubt their own capacity to complete the nurture of their child from conception to toddlerhood and beyond, but scientific discoveries continue to confirm the wondrous properties and unique benefits of human breast milk.
Milk, in the form of colostrum, is present from about the fourth month of pregnancy onwards. At birth, the delivery of the placenta triggers a reduction in the woman’s progesterone levels that removes the inhibition of milk production and allows the elevated levels of prolactin to function. Increased amounts of blood and lymph in the breast form the nutrients for milk production. These fluids cause the breasts to become fuller, heavier, and sometimes tender. As regular, frequent breastfeedings progress, this normal fullness diminishes. By about two weeks postpartum, when lactation is established, the breasts become comfortable soft and pliable, even when they are full with milk. Regular frequent feedings will maintain this condition (Lauwers & Swisher, 2005, p308).
Breastfeeding a Newborn Baby
Forget the clock
Be guided by your baby’s cues as to when he wants to feed and for how long. During the first few days when baby’s breastfeeds provide colostrum the feedings may be frequent and irregular. Colostrum is highly concentrated, and baby’s stomach capacity is small so the quantity of colostrum required to satisfy his needs is also small. Alternating sides each time the baby goes to the breast will stimulate the breasts, assisting the transition from colostrum to breast milk production (lactogenesis).
Feeding Frenzy
Around day 2-3 baby often wants to feed more frequently, maybe 1-2 hourly. Baby has passed lots of meconium poos, emptying out his gastro-intestinal tract, and his stomach capacity is gradually increasing in size in preparation for milk feeds. He’s hungry!!! So feed him. This is nature’s way of ‘calling in the milk’ and your body will respond accordingly. Skin-to-skin contact with your baby, allowing baby to smell, hear and touch you and avoiding separations so you can respond to his feeding cues immediately will facilitate your ‘milk coming in’ – putting an end to the Day 2-3 feeding frenzy.
The milk arrives
Your breasts feel heavy, warm and may leak prior to or during feeds. Nature often overcompensates in the beginning, but it will settle down. Now it is advisable to feed your baby from one breast per feed, aiming to drain each breast a number of times during each 24 hour period. Baby will let you know when he’s had enough. As baby grows he may drain the first breast and still want more, so the feed may be completed on the second breast. In this case start the next feed on the breast with which you finished the last feed.
How do I know how long to feed my baby?
In general, the baby’s needs should determine feeding length. When the flow of milk diminishes from one breast, the sucking rate will move from the long, drawing nutritive suck to a faster, gentler suck. The baby’s eyes will close, his fists will relax, and his hands will come away from his face. He may release the breast and let it slide out of his mouth. Allowing the baby to remove himself from the breast will ensure that he has received the high-fat hindmilk needed for optimal growth. Limiting the time spent on the breast may result in the baby’s receiving foremilk from both breasts and becoming too full to obtain a significant amount of hindmilk from either breast. This form of high volume, low fat feeding can result in poor weight gain and colic-like symptoms. Flexibility on the mothers part will allow for variations in the baby’s nursing style, hunger, and daily temperament (Lauwers & Swisher, 2005, p308).
Each breastfeed is usually comprised of a few instalments. Just as an adult varies the size of meals eaten according to hunger, and meals may be comprised of several courses, babies vary their feeds too. Young babies particularly need to take each ‘meal’ in a few stages, with rest times in between each stage to allow partial digestion. This will mean baby may go to the breast two or more times PER FEED.
Consider when you go out for a meal at a nice restaurant. You order your entree, and eat is quite quickly and enthusiastically, because you were hungry! Mmmm, that feels better, and some time elapses before your main course arrives. Your initial hunger is curbed so that’s OK. Your main meal arrives and you steadily consume it, less quickly than the entree, but enjoying it just the same. You feel full. Nevertheless, you still have a look at the sweets menu. OK, lets have sweets – you’re ready for it by the time it arrives. Now you feel really satisfied and you relax into some after dinner conversation. A bit later you may want coffee and maybe after dinner mints too… but of course you don’t do that every meal – just sometimes. The whole dinner process usually takes about an hour or so – reasonable and acceptable, right?
Isn’t it reasonable and acceptable for a young baby’s feed to be consumed over a similar timeframe and in several instalments if that is what baby demonstrates by his cues that he needs? Some feeds will be completed in less time and fewer instalments according to baby’s needs. Be flexible, and respond to your baby’s early feeding cues and your baby will be contented and thrive – and sleep well between feeds.
Your tiny baby will breastfeed eight to twelve times in 24 hours, taking from 45 to 60 minutes for each feed, including nappy changes and cuddles. Feed times will take at least eight hours each day. Small babies usually have a long wakeful time during each 24 hours. Most often this is in the evening from about five o’clock to nine or ten o’clock. (Cox, 2004, p41).
Generally, mothers should allow the baby to remain at the breast until he spontaneously releases the breast on his own. If the baby tends to ‘linger’ at the breast, the mother can watch for a change from nutritive to non-nutritive sucking. Non-nutritive sucking does not provide the stimulation necessary for increasing milk production. If the mother removes him from the breast at this time it should not significantly affect milk quantity. However, mothers should be encouraged to gauge their individual baby’s needs. Some babies need more comfort sucking at the breast than others need. During the first month of life, the baby establishes patterns of milk intake that will continue through the next twelve months (Mitoulas, 2002). Parents need to avoid strict schedules and allow the baby to lead his feedings. This supports the individual nature of infant needs and the importance of baby-led feedings. Each baby’s own rhythm will reflect his feeding patterns (Lauwers & Swisher, 2005, p308)
Just when you think you know what to expect – it changes!
Be prepared for your baby to change his pattern of feeding from time to time. This usually coincides with a growth spurt, and baby will demand feeds more frequently for a day or two. To facilitate the process of increasing your supply you may need to abandon whatever plans you had for that day and ‘just feed the baby’. If you’ve missed a lot of sleep overnight go back to bed with your baby and feed him as he demands, and your body will respond by increasing your milk supply within 24-48 hours. Giving supplementary feeds during this time will interfere with your body’s response to the process, so AVOID giving formula feeds. Rest and good nutrition are the keys to increasing your supply to meet your baby’s growing needs – so look after yourself! Typically ‘feeding frenzies’ occur at 2-3 days (“calling your milk in”); usually again around 2 or 3 weeks, sometimes again at around 6 weeks, very commonly around 3 months and around 6 months of age.
Interestingly, when breastfeeding women are having problems with insufficient breastmilk supply and they review when the problem first arose, it usually coincides with one of the typical growth spurt ages – around 3 days, 3 weeks, 6 weeks, 3 or 6 months. If mothers are prepared for growth spurt feeding behaviours they are more likely to cope with it appropriately and continue to successfully breastfeed their babies.
Growth Spurts
A mother may periodically notice an increase in the frequency with which her baby wishes to feed. All babies experience periods of sudden growth during their early months. They react to these growth spurts by feeding more frequently. Such periods of increased feeding usually last only a few days. Growth spurts can occur at any time, although there are predictable ages. Mothers who have a robust supply of milk through frequent breastfeeding in the early postpartum days easily carry through during these times of feeding frequency until the growth spurt has passed (Dewey, 1991- in Lauwers and Swisher, 2005, p309)
Enjoy your unique breastfeeding experience as you nurture your special little person in the best possible way!
References:
Cox, S. (2004). Breastfeeding with confidence – A do-it-yourself guide. Finch, Sydney
Glover, R. (1997). The Key to Successful Breastfeeding (brochure) Perth.
Lauwers, J & Swisher, A. (2005) Counseling the Nursing Mother – A lactation consultant’s guide. Jones & Bartlett, London
Other good information sources include:
www.breastfeeding.asn.au – Australian Breastfeeding Association
www.lalecheleague.org - International La Leche League
www.promom.org - Promotion of Mothers Milk Inc.
Lois Wattis, RN, RM, IPM, FACM, IBCLC - Australia
Web: www.birthjourney.com
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The high cost of artificial feeding
Written by Claire Hall, Midwife - Australia
I do not accept the commonly held position that artificial baby formula is a suitable substitute for breast milk. Breast Milk is completely natural and it is what we as humans were designed to have. It is perfect in every way. Rather than try and prove that it is the best choice, it should be considered the only choice. It is artificial formula that has to prove it is a suitable substitute, and I’m afraid that it doesn’t even come close. In fact, the World Health Organisation lists it as only the 4th best option for your baby. Number One is breast feeding of course, followed by expression and feeding the baby, followed by having another woman breast feed your Baby or the use of milk from a “Breast Milk Bank.”(4) Even this human milk that has been pasteurised is of superior quality to artificial formulas. Of course, if in an extremely rare case numbers 1, 2 & 3 were unavailable to me, then I would be very glad to have formulas so that my Baby wouldn’t starve.
Breast Milk has all the correct nutritional needs in the right form and the right amount just as your baby needs them – fats and fatty acids, carbohydrates, protein, vitamins, minerals and trace elements, anti-infective factors such as leucocytes and immunoglobulins, hormones and growth factors.(2) The bioactive components (such as enzymes) found in breast milk promote growth and development of the newborn that continue after the baby ingests the breast milk.(1) A prominent amino acid found in breast milk may function as a neurotransmitter which plays an important role in early brain maturation. Studies suggest that children who were artificially fed have a lower IQ than their breast fed counterparts.(1) Breast milk also changes in composition as your babies needs change.(4) We should also keep in mind benefits such as increased bonding, hormone production that makes Mum feel good and help her body recover from the birth, reduced bleeding and increased weight loss.(5) In contrast, there are several health risks (for both Mother and Baby) in using artificial formulas to feed your Baby, such as –
Artificial formulas lack the immunological and other health-promoting factors present in human milk. Artificially fed infants are denied the benefits of “autoimmunisation”, whereby the breast produces antibodies or organisms to which the infant is/has been exposed.(1) The baby who is artificially fed from birth is 5 times more likely to be hospitalised with gastroenteritis (vomiting and diarrhoea) within the first 3 months of life, twice as likely to suffer with chest infections in the first 7 years of life, and twice as likely to suffer ear infections within the first year of life.(2) Recent research also shows that artificially fed infants are also more susceptible to urinary tract infections. Artificial infant milks may help respiratory pathogens become established and children who are fed artificially are more likely to develop ear infections, eczema and to manifest allergic signs such as disturbed sleep.(1)
1. Artificial formulas contain nutrients that are foreign or in non-physiologic proportions. This leads to digestion and absorption problems.(1)
2. Premature infants are 20 times more likely to develop necrotising enterocolitis (a serious life threatening bowel disease).(1,2)
3. Artificial feeding is implicated in some diseases which develop in childhood such as asthma, celiac disease, diabetes and lymphoma. Adults who develop inflammatory bowel disease are more likely to have been artificially fed.(1) .
4. The act of bottle-feeding differs from that of breastfeeding in ways that may contribute to health problems in some babies. A Baby receives less oxygen while being fed from a bottle than from the breast. Bottle feeding is also associated with oral malocclusion. (Malocclusion is an irregular contact of the teeth of the upper jaw with the teeth of the lower jaw. This would include overbites, underbites, and crossbites.)(1)
5. Mothers who bottle feed are more likely to develop osteoporosis, premenopausal breast cancer and ovarian cancer.(1.2)
6. Artificially feeding your Baby is an expensive exercise considering the cost of the formula, bottles, teats, washing and sterilising equipment and increased medical expenses.
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A Word About Contaminates
It is certainly true that numerous toxins (such as DDT, DDE, various herbicides and pesticides) can also enter breast milk. (1) Unfortunately, this is a fact of life – the cows that produce the milk to make artificial formulas are also exposed to the same chemicals. Pesticide residues have also been found in lanolin nipple ointment.(1) The risk of pollution exists for everyone, not just for breastfeeding babies. Environmental pollution is worsening and we must continue our active efforts to diminish contaminants in our environment (and subsequently human milk). Meanwhile avoid fish high in mercury, (see “Eating For Two”) try to eat high quality organic vegetables and fruits where possible, eat low fat foods and cut fat from meat. Avoid using pesticides in the home and eliminate or limit exposure to household chemicals. Try to avoid crash dieting that can cause a sudden release of fat (and therefore stored toxins) into your bloodstream and milk.(1)
In Conclusion
It is worth quoting a website called “Beautiful Birthing Doula’s” to sum up the artificial vs. breast feeding debate.
“Dr. Nancy Wight, a neonatologist practising in California, asks why a rational adult, when presented with the choice between health and illness, would choose illness. She says "choice" between breast and bottle is "is really a sham, … the love of consumer freedom has led women to believe that the choice between artificial feeding and breastfeeding is merely a matter of personal inclination." Wight says plenty of research indicates women would have been convinced to breastfeed if they were told about how important it is, but despite proven benefits for both the mother and the infant, physicians traditionally are reluctant to take a stand for fear of making their bottle-feeding patients feel guilty. She points out physicians don't hesitate to make their parents feel guilty if they fail to have their children wear helmets, use car seats and seat belts, or receive vaccinations. They use guilt to help their adult patients lose weight, exercise more, stop smoking, drinking, and taking drugs. She wonders why breastfeeding as a health issue differs from the rest and says doctors should continue to promote what is best for infants "and let the guilt fall where it may." (5)
References:
1. Riordan J., & Auerbach K., Breastfeeding and Human Lactation, 1993, Jones and Bartlett Publishers, London
2. Fraser D., Cooper M., (ed), Myles Textbook for Midwives, 2003, Curchill Livingstone, London
3. www.asac.ab.ca/biIssues.html
4. www.childthai.org/ciec/c013.htm
5. www.breastfeeding.asn.au/bfinfo/general.html
Claire Hall, Midwife - Australia
Email: charisbirthsupport@bigpond.com
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TIPS FOR BREAST FEEDING SUCCESS
Written by Claire Hall, Midwife - Australia
1. Assist skin to skin contact as soon as possible after birth and allow your baby to adjust to life outside the uterus on your stomach/chest. Watch for signs that your baby wants to breastfeed and give him the time to crawl to the breast and attach himself. He will lick, smell, suckle and massage with his hands before attaching. He will usually attach himself (without your assistance) within the first hour of birth.
2. Ensure that the room is warm, you are comfortable and your skin to skin contact is uninterrupted. Other people can cuddle your Baby after he has had time to adjust to the outside world and he is fully comforted and secure with Mum
3. Be careful to keep stimulus to a minimum in the birthing room. A quiet environment, dim lighting and no perfumes. It is best to let Baby smell his Mother and his own amniotic fluid.
4. Any drugs given during labour (particularly pain relieving drugs) can alter the behaviour of the newborn baby and compromise his crucial role in the initiation of lactation. Babies have a wide range of behaviour following spontaneous birth, and are not all ready to feed at the same time. Unless or until more evidence is available, interventions aimed at either delaying or speeding up the time of the first feed should be avoided.
5. Breastfeed frequently, whenever your baby is hungry or in need of comfort, both day & night.
6. Continue breastfeeding even if the mother or the baby becomes ill.
7. Breastfeed exclusively for the first six months. (The only nutritional requirements of your baby for the first 6 months are contained in breast milk, and “additions” to the diet reduce the amount of nutritious milk intake)
8. After the first six months, when supplemental foods are introduced, breastfeeding should precede each supplemental feeding.
9. Continue to breastfeed for up to two years and beyond
10. Avoid using bottles, pacifiers (dummies) or other artificial nipples
11. Mothers should eat and drink sufficient quantities to satisfy their hunger and thirst.
IS MY BABY GETTING ENOUGH BREAST MILK?
One of the most common questions I get about breast feeding (apart from attachment issues) is “How can I tell if he’s getting enough?” How a Baby feeds is as individual as your Baby. Some babies enjoy a long slow feed over about 45 min. Others have had sufficient in 15 minutes. It is hard as a Mother not to let emotions overtake your sense of reason. (Speaking from personal experience) Timing a feed is not an effective method of ascertaining if your Baby has had enough. In the past, Child Health Nurses weighed your Baby before and after a feed to see “how much milk he ingested”. Not only was this highly inaccurate, but it assumed that Medical Science knew exactly how much milk your individual Baby required at that individual feed. This placed unfair comparisons on Mothers and many Babies were started on “complimentary formula feeds” to supplement their Mother’s supply. Convinced they didn’t have enough milk; most Mothers gave up breast feeding all together.
So How Can You Tell?
As with most questions about your babies health – look at your Baby. Ask yourself –
1. Is he satisfied after a feed? Does he settle for a sleep?
2. Is he having at least 6-8 very wet nappies a day?
3. Does his urine have a strong odour, indicating dehydration? Are there urates (a red sediment that can look like blood) in his nappy?
4. Is he healthy looking? Bright and happy?
5. Is he growing and putting on weight?
By answering these questions about your Baby, you can easily tell if he’s “getting enough”. Most of our worry is completely unnecessary. Babies do not like to starve themselves, and they usually take enough milk from your breast to satisfy their needs and no more.
STORING AND USING EXPRESSED BREAST MILK
(Taken from the NHMRC Infant Feeding guidelines for health workers)
Storing
Freshly expressed breast milk that is put into a closed container, will last 6—8 hrs at room temperature, (max 26oC) and 3—5 days in the refrigerator if it is stored at the back (where it is coldest).
If you wish to freeze your breast milk, it will last...
2 weeks in a freezer compartment that is situated inside the refrigerator
3 months in the freezer section of the refrigerator (where freezer has a separate door to the fridge)
6—12 months in a deep freeze (-18oC or lower)
Some women find it helpful to freeze their breast milk in ice cube trays. Once it is frozen, they transfer the “milk blocks” to a zip-lock bag and date it.
Using Expressed Breast Milk. . .
When you wish to thaw your breast milk, the best way is to take it out well before you need it and thaw it in the refrigerator.
If the breast milk is thawed in the refrigerator, it will last 4 hours at room temperature (i.e. once you take it out of the fridge), and 24 hours if left in the refrigerator.
Once your breast milk is thawed, do not refreeze. DISCARD WHEN ALLOWABLE TIME HAS PASSED.
If you choose to thaw your breast milk outside of the refrigerator in a warm cup of water, you must use it immediately. If you place the thawed breast milk into the refrigerator immediately that it is thawed (i.e. before feeding), it will last another 4 hours.
If there is any left once the baby has finished feeding, discard it.
Claire Hall, Midwife - Australia
Email: charisbirthsupport@bigpond.com
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