More and more women are choosing totheir babies. This is a sensible decision because breast milk is the best sort of milk for a baby. A breastfed baby is less likely to become too tubby or to have stomach upsets. Even in the first couple of days after birth, when the breasts are producing little true milk, the nursing baby is getting colostrum, a thick, yellow fluid, that is not only nutritious but helps to protect him or her against infection.
Breastfeeding stimulates the release of twointo the mother’s bloodstream: prolactin and . Prolactin is responsible for the production of milk by the milk-forming cells in the breast. Oxytocin stimulates the muscles around these cells to contract, forcing the milk into the milk ducts. The ducts then carry the milk to the areola and out of the nipple. Although prolactin is present in the bloodstream for most of pregnancy, milk is not produced until after the birth. Nearly all women produce some milk, but its continued formation is dependent on the stimulation provided by the baby sucking on the nipple. Hence if a woman does not breastfeed she will find that her milk dries up of its own accord.
The baby’s sucking action also brings about the release of oxytocin.
As already stated, its effect is to pump the milk into the ducts. The release of milk into the ducts is known as the let-down reflex and can take up to a minute after the start of a feed. Many women are aware of it happening because they get a warm tingling feeling in their breasts.
The let-down reflex does not always work. It may be impaired by psychological factors – anxiety or embarrassment about, for example. It is important for those around the nursing mother, family and professionals, to cultivate a positive approach to help her through the early days.
Even whenseems to be going well, problems may still arise. Fortunately none of them is insoluble. Sore nipples, particularly at the beginning, are common. They may be a sign that the baby is not sucking properly at the nipple, or they may occur because the mother is trying so hard to succeed that she is letting her baby suck for longer than is wise. Once is well-established, babies can be allowed to suck for as long as they want. Many will use the nipple as a comforter and suck themselves to sleep. With practice a woman will soon learn when her baby has stopped drinking and is just sucking for comfort.
Sore nipples may become cracked, and this can be quite hard to treat, but they do get better in time. Soothing creams and sprays may help, but probably the best cure is to expose the nipple to the air as much as possible. Tight-fitting bras should be avoided and breast pads, worn to absorb excess milk, may add to the problem by making the whole area damp. Nevertheless, it is important to let the baby continue feeding at the cracked nipple, to stimulate the supply of milk. Offering the sore breast second, when the baby is not sucking so hard, or using a special rubber shield to protect the nipple, will make it less painful.
A breast pump, which can be used to express milk from the affected breast, is helpful for women with nipples too tender to stand even gentle suckling. The pump stimulates the milk supply and the expressed milk may then be given to the baby. A pump will also enable a woman to feed her baby even if it is premature. Often a premature baby is too small to suck at the breast, but breast milk from his or her own mother is still the best food for it, even better than milk sup-
plied by the mothers of full-term babies, because its composition is exactly right. Expressed milk can be given to the baby through a tube into the stomach until he or she is strong enough to take it direct from the breast.
Breast pumps may be hired or purchased. Electric pumps are the most efficient but they are expensive to buy or rent on a long-term basis. Hand pumps need some skill to use but most women get the knack quite easily.
Milk can also be expressed by hand without the use of a pump, but it is more difficult, and also tiring to get large amounts. Hand expression may suffice if the mother simply wishes to remove excess milk (perhaps because her breasts are uncomfortably full) rather than to collect enough to feed her baby.
A few breastfeeding mothers develop a condition known as mastitis. A milk duct gets blocked and infection sets in, causing pain. The treatment is to make sure the breast is emptied at every feed. To improve blood flow in the affected area a hot water bottle can be applied. Ice cubes will also result in a (reactive) hyperaemia (that is, cause the area to become congested with blood) after they have been removed. There is still inconclusive evidence on which of the two methods is the best. If these measures are ineffective and if a high temperature develops, antibiotics may be necessary. There is no reason to stop breastfeeding because the baby is not likely to catch the infection, and the antibiotics prescribed during breastfeeding will not be harmful. In fact, many experts believe that the worst thing a woman with mastitis can do is to wean her baby off the breast.
When a woman has just had a baby and is trying to get breastfeeding established she may not feel much like taking, but it is important that she does so – and not just to prevent thrombosis, mentioned earlier. After childbirth, all the muscles of the pelvis are overstretched; the abdominal wall is flabby and the pelvic floor tends to sag.
If a woman wants to regain her figure quickly and to avoid possible incontinence (caused by weak muscles around the urinary opening) she should start gentles the day after birth. The hospital or midwife will tell her which exercises to do and for how long. All are simple and take little time each day. Exercises to strengthen the pelvic floor can be done anywhere and in practically any position. Because they are so subtle and take little effort, nobody will notice that they are being done. They involve regularly contracting and relaxing the muscles of the pelvic floor. These muscles can be identified by deliberately stopping the flow of urine when emptying the bladder. As time passes, other more demanding exercises can be introduced into the routine, but the ones for the pelvic floor should be done daily for at least three months.