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EDUCATION CORNER
    Kick Counter

    Breastfeeding and lactation

    Breast milk is the best gift a mother can give to her baby. It is the ideal food for the baby for the first six months of life, as it has the perfect combination of nutrients, minerals, and antibodies for the growth and development of the baby. The best part is that breastfeeding means that your baby will have the supply of perfect food, at the perfect temperature, whenever they demand it, free of cost.


    WHO recommends Exclusive Breastfeeding should be initiated within half an hour of birth and continued for the first six months of life. Exclusive breastfeeding provides optimal nutrition and promotes normal child growth and development.


    It is the first vaccination for the baby, as breastfed babies are less likely to develop infections because of the protective factors found in it. Breastfeeding reduces the risk of allergies in the baby along with a lower risk of diabetes, obesity and heart diseases in later life. Breastfeeding also ensures better mental development of the baby. 

    Further, breast milk is eco-friendly, most hygienic and have immense economic benefits.


    Benefits for mother:  


    • Lowers the risk of postpartum hemorrhage by promoting uterine involution(regaining the normal size) 
    • Protection against next pregnancy -natural contraceptive 
    • Lowers risk of ovarian and breast cancers 
    • Emotional bonding between mother and child- emotional well being  
    • Weight loss after pregnancy 
    • Most convenient and time-saving 


    Breastfeeding is most beneficial for baby, mother, and society but it requires its own warm chain support, in the form of proper guidance and support to the new lactating mothers, by breaking the myths and detrimental practices in the name of modernization.


    Breastfeeding is a skill that can be easily mastered. It requires little effort by the mother along with her determination to breastfeed her baby and once established it is the most convenient and effective way of feeding. The first thick yellow milk is called colostrum and is rich in proteins and antibodies. The earlier breastfeeding is initiated, it is more successfully established. 


    Proper positioning and attachment of the baby during breastfeeding is the most important factor in determining effective breastfeeding. Most of the problems are associated with improper attachment (latching). If the baby is well attached to the breast, the problems like sore nipples are less likely and the baby gets satisfied easily. 


    Signs of correct positioning: 


    • Baby’s head and body should be straight.  
    • Baby’s body should be turned towards the mother, close to her, facing the breast. 
    • Baby’s whole body should be supported by the mother. Do not hold the baby’s head allow it to find the best position for attachment. 
    • Bring the baby to the breast not the breast to the baby. 


    Signs of correct attachment: 


    • Baby’s chin is close to the breast 
    • Baby’s mouth is wide open and lower lip is turned outwards 
    • More areola is visible above the baby’s mouth than below 
    • Baby’s cheeks should not be sucking in and there should be no clicking sound. 
    • There should be no pain in the nipple area during breastfeeding 


    The confidence of the mother and a good attachment of the baby is the key to successful breastfeeding and a satisfied baby.


    Different positions of breastfeeding:




    When to begin and how often to feed: 


    Breastfeeding should be started within 1/2 to 1 hour of birth and first feed should always be breast milk (colostrum) Some babies are satiated in 5-10 min while some take longer. However, if breastfeeding lasts for more than half an hour or is shorter than 14 min there must be some problem. By the first week of life, most babies develop a pattern of 8-12 feeds in 24 hour. 


    Is the baby feeding enough: 


    The reliable signs of the baby getting enough milk are:- 

    • Adequate weight gain  
    • Baby is passing urine 6-8 times in a day 


    Further, the key things a mother should ensure that the baby is feeding at least 8 times a day, the baby is alert and contented and passing stools normally. Tips to improve the breast milk supply of the mother: 


    • Keep the baby close to the mother, it improves the mother-baby bonding 
    • more the baby suckles at the breast, the more milk is produced. 
    • Allow the baby to breastfeed on demand in the correct position. 
    • Night feeding enhances milk production 
    • Avoid using bottle, pre-lacteals, and pacifiers, as it decreases the baby’s suckling and decreases milk production.

    Managing the problems of breastfeeding:


    Breastfeeding, once established properly, is a wonderful experience both for the mother and the baby. But mothers face many problems during breastfeeding which may lead to stoppage of breastfeeding. Most of these problems are preventable or treatable.Timely assessment and counseling by a lactation consultant and boosting the mother’s confidence can easily rectify the issue:-


    • Flat nipples: length of the nipple is not important for latching as areola and the breast tissue can easily be pulled into a teat while feeding. Reassurance and proper counseling that she can breastfeed
    • Inverted nipples: mother can breastfeed with a little help. Inverted Syringe method can be used for making the nipple. May require consultation of a lactation specialist
    • Sore / cracked nipple: it results due to incorrect latching of the baby. If the suckle only the breast and not the areola, it doesn't get enough milk and injures the nipple. Frequent washing with soap and water, pulling the baby off the nipple and fungal infection can also cause this. It can be easily managed by ensuring proper latching and applying the hind milk to the area. A consultation from a lactation consultant is advisable.
    • Nipple confusion/ poor latching: this occurs when the baby is given bottle feeding with breastfeeding. The method of sucking in the bottle feeding is different from breastfeeding so the baby starts refusing to breastfeed due to confusion and opting for the easier method. It is a serious problem and it is better prevented as it hampers breastfeeding.
    • Engorgement of the breast: it is a frequent problem and occurs due to the use of pre lacteals or top feeding, delayed initiation of breastfeeding and long intervals between feedings. Breast become tight, shiny and painful. This can be managed early by frequent and correct attachment of the baby to the breast and lactational counseling 
    • Blocked ducts: thick milk blocks the milk duct and leads to painful and hard swelling in the breast. This can be prevented by regular in proper position and avoiding anything that obstructs the milk flow like tight clothing etc. Breast massaging and hot compresses are done to manage this condition along with a continuation of breastfeeding but early medical attention should be taken as it can lead to a breast infection or mastitis.
    • Mastitis and breast abscess: If blockage of ducts or engorgement persists then breast infection may develop. It should be treated promptly. The treatment included control of swelling and pain, emotional support to the woman and the reassurance that it is safe to continue breastfeeding from the affected breast. Effective removal of milk is the most important part of the treatment along with antibiotics if indicated. A lactational consultant is advised.
    • Leakage of milk from breasts: It commonly occurs when it is time to feed, during prolonged feeding intervals. It is difficult to control and usually reduces by the first few weeks. The reassurance of the mother is required. 
    • Not enough milk: Breastfeeding is a natural process and almost all mothers have enough breast milk to feed one or even two babies. It only depends on the confidence of the mother and effective suckling and frequent breastfeeding of the baby. Even the poor nutritional status of the mother does not affect the milk supply.


    Mothers who feel they do not have enough milk production are advised to take lactational consultancy and support.


    Preparing mothers for breastfeeding during the antenatal period


    If a mother is properly informed and counseled about breastfeeding and its advantages in the antenatal period, the success rate of breastfeeding increases. Antenatal lactational counselling enhances the mother’s confidence and ensures early initiation of effective breastfeeding.


    Mothers diet


    A breastfeeding mother should get the right amount of calories to feed herself and her baby as both will take nutrients and calories from it.


    • Extra protein (25 grams of protein) for a total of about 70-80 grams per day is required for proper cell growth and the immune system of a baby. The sources of protein include milk, egg, fish, nuts, and yogurt.
    • Calcium is also very important for baby’s bones, so milk and milk products should be included in your diet.
    • Eat fruits and vegetables as they are rich in a variety of vitamins and minerals. They are also rich in fiber which is required for digestion. 
    • Eat a variety of foods so as to make your diet a balanced diet
    • Drink plenty of water as the body will need a lot of fluid. You can also add fruit juice to your daily diet
    • Avoid or limit junk food
    • Take vitamins and supplements as advised.


    References:


    https://www.who.int/nutrition/topics/exclusive_breastfeeding/en/ 

    https://www.nhs.uk/conditions/pregnancy-and-baby/problems-breastfeeding/


    Frequently Asked Questions

    Breast milk is an ideal food for the neonates due to its following benefits: 

    • Superior nutrition
    • Immunity booster for the baby
    • Promote the mental growth of the baby

    Breastfeeding a baby requires appropriate positioning and attachment technique.

    Once the breastfeeding is initiated the sucking of the baby can be noticed.

    Bottle feeding is harmful and may hamper breastfeeding. Almost all mothers can produce enough milk for one or even two babies, provided the baby latches effectively and feed on demand. 

    But if you still feel the baby is not getting enough you first take lactational counselling as the disadvantages of top feeding are huge.


    Reasons for less breast milk production can be: 

    • Waiting too long to start breastfeeding
    • Not breastfeeding often
    • Supplementing breastfeeding with formula feeding
    • Ineffective latch
    • Use of certain medications 

    Following ways can boost breast milk production:

    • Starting breastfeeding as soon as possible
    • Breastfeed often
    • Ensure a proper latch
    • Empty each breast completely during each feeding session
    • Avoid alcohol and smoking

    Hyperlink to the “Mother’s diet during lactation” section

    The baby should only be given breast milk for the first 6 months and weaning should start gradually along with breastfeeding from 6month onwards. Breastfeeding should be continued at least until 2 years of age of the baby. It can be stopped thereafter with a slow and gradual increase in complementary food. 

    A baby may take some amount of air along with breastfeeding. This may settle as gas bubbles in the stomach and causes discomfort and a feeling of fullness to the baby.

    So, it is necessary for the baby to burp out this air after a feeding session. A baby can be made to burp by keeping the baby in the following positions and doing the mentioned maneuvers

    Hold your baby firmly against your shoulder and rub her back with the holding her lower body with the other. 

    Place your baby across your lap with tummy-down and her stomach on one of your legs and head on the other. Hold the baby securely and rub her back. 

    A baby may take some amount of air along with breastfeeding. This may settle as gas bubbles in the stomach and causes discomfort and a feeling of fullness to the baby.

    So, it is necessary for the baby to burp out this air after a feeding session. A baby can be made to burp by keeping the baby in the following positions and doing the mentioned maneuvers

    • Hold your baby firmly against your shoulder and rub her back with the holding her lower body with the other. 
    • Place your baby across your lap with tummy-down and her stomach on one of your legs and head on the other. Hold the baby securely and rub her back. 

    Breast size has no link with breastfeeding. The fat in the woman's breasts determines its size. But this is not at all related to the quantity of her breast milk. So, there is nothing to worry about breastfeeding even if you have small breasts. 

    It is absolutely normal to have excess milk production in your breasts that can cause milk overflow. It can last until a few days after the pregnancy and resolves on its own. 

    However, if it continues and causes inadequate feeding of the baby, the mother should use breast pumps to take out excess milk or feed the baby completely until the breast becomes empty.

    A breast pump is used to pump milk from the breasts so that it can be stored to feed the baby when required Like in cases of latching problems, office going mother, feeding in public places or feeding of twin babies.

    As your maternity leaves are winding up, you might be struck with a thought that you’ve been breastfeeding your little one several times a day and you want to ensure breast milk benefit after you return from work. 

    Here are some tips for breast milk storage: -

    • Room Temperature: The newly expressed breast milk should be kept at room temperature for at least 6 hours. If you’re not feeding the milk immediately or at room temperature, then you can put it into an insulated cooler or refrigerator to keep it fresh. 
    • Insulated Cooler: The fresh breast milk can be kept in insulated coolers along with ice packs for about 1 day or so. Make sure to utilize the milk or move the container to the refrigerator. 
    • Refrigerator: The fresh breast milk should be kept in the back of the refrigerator if not consumed immediately (not at the door) for about 6 to 8 days.
    • Freezer: The breast milk should be kept in a standard refrigerator freezer for about 3 to 6 months. Make sure to put the milk in the backside of the freezer, and not in the doors. 
    • Remember to always stock the milk in steel containers. Do not utilize a bottle for keeping the milk. 
    • Stored milk can also be fed to babies with the help of a spoon.