'Breast is best'. This trite but true saying describes the fact that breast milk has been perfectly designed by mother nature for human babies. It is a cheap, safe, pre-sterilised source of food which contains just the right balance of nutrients for your baby's growing needs. In fact we now recognise that the composition of human breast milk alters as the baby develops, reflecting her/his changing requirements. In addition, it contains antibodies passed on from the mother to protect against harmful organisms and to build up baby's resistance to disease. Most women find breastfeeding to be an enjoyable and satisfying experience; a time to get to know and bond with their newborn child. Suckling after the birth stimulates the release of a pituitary hormone called oxytocin, which causes the uterus to contract and return to its normal state. Another advantage of breastfeeding is that it will speed up your weight loss after pregnancy, helping you to regain your pre-pregnancy figure.
If you are still unconvinced, there are further benefits seen in breastfed infants. Sudden infant death syndrome (SIDS) is less common in breastfed babies. The longer an infant is breastfed, the lower the cholesterol level will be as an adult and the lower the incidence of atherosclerosis. The minerals iron and zinc are much better absorbed from breast milk than formula. Breastfed babies have fewer food allergies, far fewer illnesses and about a third of the rate of hospital admission than bottle fed babies. It is even postulated that children who were breastfed are more intelligent than their bottle fed counterparts, possibly because of the presence of the fatty acid DHA in breast milk, which is an important component of much of the brain's gray matter.
Most women are capable of breastfeeding their baby if they have the right advice and help available. Breastfeeding is not necessarily something you or your baby will know how to do instinctively. Learning the correct techniques of attaching and feeding your baby and what to do if problems arise, will ensure successful breastfeeding. So, while you are in hospital ask for help if you need it. Many hospitals have a lactation consultant sister for precisely this purpose.
Please don't get bogged down in the sea of conflicting advice you may receive from grandma and aunty and the lady next door; seek well-informed help. Even if it's for only a few weeks or months, breastfeeding has great advantages for you and your baby. Some women can successfully combine working and breastfeeding by expressing milk (see below).
Finally, before we move on to the nuts and bolts of breastfeeding, we recognize that there will always be mothers who choose not to breastfeed, or who find it too difficult and stressful, or impractical, particularly if they want or need to go back to work. Above all, you should not feel guilty. By far the most important thing for your baby is to be in a safe, happy, loving and secure environment with whatever works best for both of you.
If you wish to breastfeed, some preparation during pregnancy can be helpful to produce supple, stretchy nipples that are accustomed to being handled. Ensure that you have a correctly fitting bra to accommodate the breast enlargement which usually accompanies pregnancy. While you are under the shower gently pull out the nipples and roll them between thumb and forefinger. Pat the breasts and nipples dry; avoid harsh rubbing with rough towels and don't use soap or anything drying on the nipples. Expose the breasts to the air for short periods of time. After the birth, put the baby to the breast as soon as possible and offer feeds frequently to encourage an adequate and early milk supply. Begin a feed with the breast you finished on last feed; for example left to right, right to left and so on. Let the baby feed on one breast until he slows or stops sucking and then offer the second breast until he stops sucking or goes to sleep. Some babies may only feed from one breast at each feed.
Rather than the rigid four-hourly feeding schedule that used to be the fashion, these days demand feeding is the norm. That is, feeding the baby as often as she desires. This could mean anything from two to six hourly with a range of around four to eight feeds per day. Many women lack confidence in their milk supply and wonder if their baby is getting enough. A definite sign is if your baby is gaining weight. After the first week the average weight gain is 150 to 200 grams per week for the first four months, dropping to around 90 to 150 grams per week for the next four. Certainly, if you have a happy, contented baby then she is also sure to be getting enough to eat. The converse of this is not necessarily true, as unfortunately many babies can be just irritable, grizzly little human beings in the initial stages! Lastly, another good sign is if baby has six to eight wet nappies a day. There is no such thing as your breast milk being substandard or not good enough; and remember that breast milk production is all about supply and demand. The more your baby feeds the more milk you will produce and vice versa.
Learning how to express breast milk can be very useful if you wish to return to work, or to go out without your baby. It is a useful way to increase your milk supply, or to rest your breast in the case of cracked nipples for example. You may choose to express by hand or using various types of breast pumps. With clean hands gently massage the breast to stimulate a "let-down". Use a sterilized container or breast pump. If hand expressing, grasp the outer part of the areola (the coloured area around the nipple) between your thumb and first or second fingers. Gently squeeze your fingers together pressing inward toward the centre of the breast. Repeat this rhythmically moving your fingers around the areola to ensure that all areas of the breast are emptied. When the flow of milk has slowed change over to the other breast. By swapping back and forth from one breast to the other you will obtain the milk more quickly and easily. Breast milk can be stored in a sterile container in the refrigerator for up to 24 hours or for up to three months in the freezer. Frozen milk should be thawed quickly but not in boiling water, and thawed milk should never be refrozen. Never heat breast milk in a microwave oven - you destroy its nutrients.
Dietary recommendations for breastfeeding mothers
Many nursing mothers will find that they get ravenously hungry, particularly in the early stages, and it is important to consume the right foods.
- Include often - large amounts of raw fruits and vegetables; salmon and sardines with the bones; eggs, poultry and grass fed meat (optional); nuts and seeds; plenty of fluids (10 glasses daily) like water, herbal tea and vegetable juices.
- Minimize alcohol intake, as the concentration of alcohol in the breast milk can reach 90 percent of blood alcohol levels.
- Also check before taking any medications, including over-the-counter preparations, that they are safe when combined with breastfeeding.
- Inverted nipples
Nipples come in all shapes and sizes. Some women have flat or inverted nipples which are harder for the baby to grasp, but breastfeeding is still possible. If you have inverted nipples it is worth trying some simple measures from about the sixteenth week of pregnancy. Gently draw out the entire nipple between the thumb and forefinger. Rotate the fingers around the nipple to stretch and break down adhesions which tend to tether the nipple inwards inside the breast. It is also beneficial to get your partner to gently suck the nipple to help draw them outwards. Plastic nipple shields may also help.
Many women will experience tender, swollen, engorged breasts around two to five days following the birth after the milk has 'come in'. There are a number of things you can do to lessen the discomfort. Minimize engorgement by feeding your baby frequently after the birth without limiting the time at the breast. Consider waking your baby for a feed if your breasts are becoming full and uncomfortable. Warm compresses are helpful before a feed, and cold packs after a feed will often relieve discomfort. Refrigerated, washed cabbage leaves as compresses have been used with success. It may be necessary to express a little before a feed if the baby is having trouble attaching. If the baby is too full or sleepy to feed properly express just enough to make the breast softer and more comfortable. Expressing too often or too much will only exacerbate the problem by stimulating increased milk production. With engorgement there is an increased risk of developing mastitis (see below), so seek advice if you notice any reddened patches or tender lumps.
- Sore nipples
Correct attachment of the baby on the breast and care in taking the baby from the breast helps avoid nipple soreness. Position the baby properly. A pillow on your lap will enable you to keep her level with your breast. Her mouth should be directly opposite your nipple, her chest against your chest. Tickle her lips with the nipple until she opens her mouth wide. Guide the nipple over her tongue so that she takes a good mouthful of nipple and areola. Her chin should be touching or almost touching the breast and the bottom lip turned out in a pouting manner rather than sucked in. To remove the baby from the breast place your little finger in the corner of her mouth to break the suction. If you have sore nipples you should actually feed your baby more frequently so that she is less impatient at feed times and sucks more gently. Before a feed apply a warm compress, then express some milk to encourage a let down and lubricate the nipple. Offer the baby the less sore side first and ensure correct attachment. After the feed express a few drops of hind milk, smear on the nipple and allow to dry by leaving the bra open for a few minutes. Warm the nipples briefly using a hair dryer or ray lamp but take care not to burn yourself. Keep the nipples dry and change nursing pads frequently. Avoid using soap, shampoo, methylated spirits or rough towels on the nipples.
- Cracked nipples
If left untreated, sore nipples may develop fissures or cracks. This can be made worse by conditions such as thrush or dermatitis. The cracks are sometimes too fine to be seen. Feeding is usually painful and may cause bleeding. Follow the advice given above for sore nipples. If it is too painful to feed you may need to take the baby off the breast and express instead to keep up the milk supply. The expressed milk can then be fed to the baby. When recommencing breastfeeding, do so gradually with short feeds spaced out throughout the day. Your doctor may prescribe pain relief for you if required. Good creams and oils for cracked/sore nipples are: castor oil; Deri-Sal cream; MooGoo cream.
Orthodox medical treatment
Dermatitis can be helped by using a half percent hydrocortisone cream for several days. If any sign of infection develops in the cracked nipple, an antibiotic cream should be applied. Inflamazone cream is also very good. As a last resort try a nipple shield preferably under supervision.
Mastitis results from a blocked milk duct such that milk banks up behind the blockage. The first sign is usually some redness over part of the breast. This area may subsequently become lumpy, swollen and tender. You may also begin to feel feverish with flu-like symptoms. It is important to keep the affected breast as empty as possible and clear the blockage by regular breastfeeding or hand expression if necessary. Hot compresses can be applied before a feed. Offer the affected breast first, as the baby will be sucking more vigorously at the beginning of the feed. Gently massage the lumpy area towards the nipple during and after feeds. A cold pack can be soothing. Rest as much as possible. If the lump or tender area are not starting to resolve after 12 hours see your doctor, as the stagnant milk behind the blockage can easily become infected. An antibiotic will generally be prescribed along with a pain relieving drug if necessary, but breastfeeding can and should be continued while you are taking these medications.
Recommended supplements for breast feeding
- MSM Plus Vitamin C
Take 1/2 teaspoon powder twice daily in juice – MSM (organic sulfur) assists with recurrent infections and helps improve general well being.
- Vitamin D
Many breast feeding women do not have sufficient levels of vitamin D in their bloodstream. This can negatively impact the immune health of the mother and baby.