The question of whether or not to breastfeed a baby is one that can occupy a good deal of a mother-to-be’s thoughts during pregnancy. It is essential to make the decision during pregnancy rather than when your hungry infant is already in your arms.
From the medical angle, there are very few reasons for advising against breastfeeding. If the mother has a severe heart or kidney disease, or active tuberculosis, her obstetrician will advise her to bottle-feed.
A severe degree of inversion (or in-drawing) of the nipples is likely to make breastfeeding difficult. It is to be hoped, however, that treatment during pregnancy for this condition will have done much to correct the problem.
There are no conditions in a baby that preclude breastfeeding. Even the smallest and most immature babies, and those with a congenital defect affecting the lips and mouth, will benefit from breast milk. If a baby is unable to suck, the milk can be expressed manually from the breast and given to him in other ways.
- ADVANTAGES AND DISADVANTAGES
- HOW COW’S MILK AND HUMAN MILK VARY
- THE HUMAN BREAST
- Milk Production
- Draught Reflex
- After Pains
- THE TECHNIQUE OF BREASTFEEDING
- Timing of Feeds
- Surroundings and Position for Feeding
- Nursing Bra
- Rooting’ Reflex
- Length of Feed
- Excess Milk
- Complementary Feeding
- Changing Breasts
- IS THE MILK SUITABLE?
- CARE OF THE BREASTS
- GENERAL HEALTH
- BREASTFEEDING PROBLEMS
- Engorgement of Breasts
- Cracked Nipples
- Breast Abscess
- Inverted Nipples
ADVANTAGES AND DISADVANTAGES
Breastfeeding has several very important advantages for a baby. The milk is one hundred per cent suitable and also has the bonus value of containing antibodies to various diseases which the mother has had in the past. Breastfed babies are also far less likely to suffer from gastroenteritis (a serious condition in young babies) and rarely get nappy-.
From the mother’s viewpoint, breastfeeding is a natural conclusion to pregnancy and delivery and helps with the involution (returning to normal) of the uterus. In addition there are no frequent and time-consuming milk-preparing sessions – the baby’s food is always available at the right time, consistency and temperature. Finally, there is that indefinable, but vital, bonding between mother and baby which arises so much more readily and quickly within the intimacy of breastfeeding.
The disadvantages of breastfeeding are all on the mother’s side. Distaste for the whole process, together with, perhaps, a certain degree of embarrassment, or even revulsion, can be a potent reason for. Fortunately, with today’s excellent artificial milks, a baby will not go hungry if his mother decides against breastfeeding. One advantage that is commonly mentioned in relation to bottle-feeding, is that it can seem so much more scientific because the mother knows exactly how much milk the baby is taking. With breastfeeding, of course, a contented baby is the mother’s only guide to a satisfactory intake.
HOW COW’S MILK AND HUMAN MILK VARY
A most important factor when deciding whether or not to breastfeed must be the understanding of how breast milk and cow’s milk differ, and why breast milk is more suitable for a baby in the early days of life. (Even a short time – two to three weeks of breastfeeding will be beneficial to a baby)
Milk, in common with other foods, is made up of three main constituents: protein, fat and carbohydrate. Cow’s milk contains over twice the amount of protein found in breast milk. The main protein in cow’s milk is casein, and there is more than five times the amount of this substance in cow’s milk than in human milk.
From the point of view of the baby’s digestive system, casein, which forms curds in the tummy, is relatively indigestible. Although the fat content of cow’s milk is similar to that of human milk, the actual fat droplets in human milk are smaller. Once again, this part of breast milk is more easily digested by the baby.
Breast milk contains a higher proportion of carbohydrate than does cow’s milk. This is mainly in the form of lactose, which is easily assimilated by a baby’s immature digestive system. Cow’s milk also differs in the amount of vitamins and minerals, and, lastly, completely lacks those important antibodies found solely in human milk.
Much work has been done in trying to render artificial milks as similar to human milk as possible. The resulting milks are excellent, but they can never completely and satisfactorily replace the human breast as a source of ideal food for a baby.
THE HUMAN BREAST
The human breast, like most other parts of the human body, is a miracle of adaptation to a specific purpose. At puberty, around ten to fourteen years old, the breasts enlarge and grow into their adult size and shape. The size is very dependent on the amount of fatty tissue in the breast. Embedded in this fatty tissue are the milk-secreting glands. It is untrue that small breasts (which merely have less fatty tissue) preclude the ability to breastfeed.
The ducts from the glands join together to form the lactiferous (milk-bearing) ducts which then open on to the surface of the nipple. The size and shape of the nipple is of great importance to the success of breastfeeding. Ideally the nipple should be long and erect enough to reach to the back of the roof of the baby’s mouth. The nipple itself is surrounded by a darker area of specialized tissue, known as the areola. The pressure of the baby’s lips on this areola squeezes the milk into his mouth from the lactiferous ducts just under the areola.
During pregnancy the breasts enlarge and may become a little tender, and the areola darkens. These changes occur under the influence of various. A well-supporting bra is essential at this stage, and you may find that you need a larger size than usual.
Towards the end of pregnancy a thin, yellowish, sticky fluid called colostrum is secreted by the breast. Some hospitals will advise you to express colostrum from your breasts during pregnancy by massaging with your fingers. Manual expression of the breasts is a useful art to master as you may need to do it after the baby is born, if for example he or she is in a special care unit and cannot be put to the breast. During pregnancy, however, it is not strictly necessary, and many mothers think it better to save the colostrum for the baby. Do not attempt manual expression of the breasts without first being shown how to do it by the midwife.
Colostrum continues to be secreted during the first day or two following a baby’s birth. It has a high protein content, and also supplies the baby with valuable antibodies to any disease which the mother may previously have contracted. So for this reason many doctors and midwives encourage mothers to put their babies briefly to the breast soon after birth. At the same time the mother and baby begin a life-long acquaintance, and the essential bonding gets off to a good start. A mother’s breasts continue to secrete colostrum for forty-eight to seventy-two hours after the birth. Then, under the action of hormonal changes in the body, the milk begins to come in.
Quite unlike the yellowish, creamy colour of cow’s milk, breast milk is rather watery looking and of a bluish colour. It is, however, exactly tailored to a baby’s needs.
As the milk comes into the breasts before each feed you will often be aware of a tingling sensation around the areola, and milk will sometimes leak from the breasts. This is a reflex action, under the influence of a hormone known as the draught or let-down reflex.
As the baby settles at the breast for his feed in the early days after his birth, you may be aware of cramping pains in the lower part of your tummy. These are known as ‘after pains’ and are due to a further action of the hormone,, which causes the draught reflex. Under the action of oxytocin, the womb contracts down to its normal pre-pregnancy size.
THE TECHNIQUE OF BREASTFEEDING
Timing of Feeds
With the advent of the civilized society of the Western world, many mothers now have to learn again the natural art of breastfeeding their babies. Perhaps one of the most vexing questions to new mothers, is how often should their babies be fed. Ideas have fluctuated over the years from the rigid timetable advocated by Truby King to complete demand-feeding whenever the baby.
A compromise between the two extremes is probably the best approach. In the early days following the birth, a baby is put to the breast frequently, about every two hours. But as the days go by, he sleeps longer and longer between feeds, until he and his mother work out a routine that suits them both. Usually, this routine settles down to feeding approximately every four hours-making a total of six feeds in all during the twenty-four hours.
Surroundings and Position for Feeding
Ideally, the room in which a baby is fed should be quiet and warm. The mother should make herself as comfortable and relaxed as possible. A low armless chair is ideal. A cushion or pillow to support the elbow of the arm holding the baby certainly helps to ease any strain and a footstool puts the finishing touch to comfort.
A nursing bra is highly recommended for breastfeeding and there are several good ones available. They mainly fall into two types – the type that has a front opening and the type with a flap over the nipple. Both are satisfactory.
When you pick up your restless hungry baby for his feed, you will feel the milk rushing into both breasts. As your finger touches baby’s cheek, or as his face brushes your nipple, you will notice that his mouth opens and his face turns towards the source of the food. This process, known as the rooting reflex, is present in all mature newborn babies.
Length of Feed
Most babies are satisfied with approximately ten minutes at each breast, although there is a good deal of individual variation in this. After ten minutes at the first breast, the mother should change sides. Sucking at an empty breast can frustrate a baby and cause sore cracked nipples.
Some mothers, who have an excess of milk, may find it helpful to express a little of the milk before putting their baby to the breast. This will ensure that a baby does not splutter and choke on a too rapid flow of milk. Remember that in order to maintain a good supply of milk, the breasts should be completely emptied at the end of each feed. If you feel that there is still some milk left after your baby has sucked for ten minutes on each side and appears contented, you should express the remaining milk by hand as shown by the midwife. The two great stimuli to the continuation of a good milk supply are complete emptying of the breasts at each feed, and the baby’s sucking.
An occasional bottle-feed given to a breastfed baby – either when you especially want to be out when one of his feeds is due, or when you find that your milk supply is low – will do no harm at all. Keep at least one packet of baby-milk in the store cupboard, in case this situation arises.
Occasionally, mothers may find it difficult to persuade their babies that it is time to change to the other breast. By sliding a little finger gently in between the corner of his mouth and the nipple, the air-tight seal around his lips can be broken.
IS THE MILK SUITABLE?
If a baby is gaining weight slowly but steadily, is contented and developing well, you can be sure that however thin and watery-looking your milk is, it is adequate. The quantity may be small, but the quality is always right for each individual baby.
It is obviously more difficult with breastfeeding than with bottle-feeding, to determine the amount of milk that the baby takes at each feed. One way of establishing this is to test-weigh the baby before and after each feed.
Test-weighing is a useful procedure if there is any doubt or anxiety about how much milk the baby is receiving. The principle of test-weighing is very simple – all that is required is an accurate set of scales. The baby is weighed immediately before a feed and then immediately after he has finished the feed. If he soils or wets his nappy during the feed, this must not be changed until after he has been weighed for the second time. The difference between the before and after weights will show the amount of breast milk he has taken. Consult your health visitor or midwife about this.
From the time they are one month old, breastfed babies need vitamin A, D and C supplements. Dried milk supplements may also be necessary for one reason or another if the mother’s milk supply is slightly insufficient-perhaps after a bout of influenza, for example.
CARE OF THE BREASTS
A little lanolin cream applied to the nipple area will help to keep this soft and supple. A well fitting bra should be worn both night and day during the whole period of breastfeeding.
Breastfeeding does not necessitate drinking vast quantities of fluid, neither does it preclude a mother from eating her favourite foods, although some foods, such as onions or prunes, for example, may make a baby restless. The doctor will ensure that the mother is not given any drugs which may be absorbed into the breast milk and thus affect the baby. The one thing that a mother must ensure is plenty of rest-and this means rest from mental and emotional anxieties as well.
The most common time foris immediately after the return home from hospital. This is when the world – in the shape of cooking, housework and, perhaps, other children rushes in. Your rest periods are eroded, and you feel tired and tense when the time comes to feed the baby. It needs a determined effort to ignore all the interruptions and relax at feed times but this is really essential.
Engorgement of Breasts
Engorged breasts are enlarged, swollen and hot and tender to the touch. This condition most commonly occurs in the first day or two after the milk comes in. Frequent sucking, or expressing the milk, will do much to relieve this. If the engorgement becomes severe, the doctor will prescribe small amounts of oestrogen to reduce the milk supply a little.
The cause of this painful condition can be an over-eager baby who chews on the nipple instead of grasping it properly around the areola. The treatment for a cracked nipple is rest for that breast for at least twenty-four hours, plus expressing the milk in order to ensure a continuation of the supply. If the condition is allowed to worsen it may cause a breast abscess.
This occurs when an infection creeps in through a cracked nipple and affects a section of the breast. The breast then becomes swollen, red and painful. Urgent medical attention is necessary. With rapid antibiotic treatment the condition can be resolved. without the necessity for discontinuing breastfeeding.
Inverted nipples can cause difficulties at the onset of breastfeeding as the baby is unable to grasp the nipple firmly. Treatment during pregnancy by easing the nipple out with the fingers and by wearing plastic breast shields under a bra will correct all but the most inverted nipples.
The time of return of monthly periods is very variable after the birth of a baby, and can be anything from three weeks to six months. Breastfeeding usually inhibits the menstrual flow, but successful breastfeeding can, and does, take place with normal menstruation. Do remember that “menstruation” means “ovulation”, and that breastfeeding is no bar to pregnancy. Adequate pregnancy precautions are, therefore, necessary. If you want to use a contraceptive pill whilst breastfeeding, you will need medical advice as to which one is the most suitable.