Aug 1, 2020

August 1 to 7, 2020 is marked as breastfeeding week to encourage and promote the health of the nursing mother and her newborn. Having a newborn is a joy to the family. Breastfeeding is a key to create a healthy planet and this year 2020 out theme is ‘support breastfeeding for a healthier planet’.

Why do need babies’ breast milk?

Breast milk builds immunity and prevents the baby from infections. The larger amount of breast milk the infant ingests, the greater immunity it gains . The rate of brain growth is the greatest in the last trimester of pregnancy and continues throughout the first year of life.

• Lactose in human milk supplies quick energy to the infant’s rapidly growing brain.
• Taurine is another constituent of breast milk that fosters brain growth and visual development.
• The amounts of vitamins A, D, E, K, B6, B12, and minerals like sodium, zinc, calcium, magnesium vary in breast milk from one mother to another.

However, these contribute to the increase of vision and also prevent calcium deficits like rickets.

• The anti-infective properties of human milk decisively help to prevent allergy, asthma, diarrhea and gastrointestinal infections in the newborn.

Scientific findings have highlighted the downfall of breast and uterine cancer among breastfed mothers. Further, it enhances mother-baby attachment and bonding.

A passage of viral infection is possible during breastfeeding. A nursing mother who has been infected with the viral infection must undergo counselling from the treating doctor or registered nurse about feeding the newborn. During this current pandemic of the COVID 19 – it has been scientifically noted that there is no transmission of the virus from mother to newborn through breastmilk.

Early feedings: Earlier the feeding, better the results. There is no time in particular to initiate breastfeeding. On the first day soon after the birth of the baby, it should be breastfed within thirty minutes or within an hour of birth. Following this, breastfeeding should be continued once every hour for the next 3 to 4 hours, every 2–3 hours until 12 hours of age and at least 8 times or more every 24 hours during the hospital stay.

• In mothers with cesarean birth once the mother is alert she can begin breastfeeding immediately.

The transition of milk in breastfeeding:

The first three days of milk is thick yellow and is called colostrums. It provides a boost of antibodies to the newborn. Usually 5th day onwards mothers milk can be called mature milk which has more calories than colostrum. A mother should breastfeed at least 10 to 20 minutes from each breast.

The milk at the beginning of the feed is high in lactose and is good for brain growth. The milk at the end of the feed is thick and high in fat and is essential for weight gain. A mother produces around 500ml of milk each day, it can vary up to 780 to 900 ml per day, especially in multiple births. Breast milk consists of 87.5 % water which also satisfies the thirst of the baby.

The flavour of breast milk depends on the type of food eaten by the mother. Occasionally changes in the color of the milk are found, based on the mother’s diet. The quantity and quality of milk is low in mothers with malnutrition or a lower BMI (<18.5kg/m2).

Positions during Breastfeeding:

Mother can adopt any position to feed her baby as long as the baby’s mouth and breast and the nipple maintain a good seal (Perfect LATCH ON). Side-lying positions are not encouraged because of the chances of aspiration. Commonly used positions are cross-cradle, cradle hold, and football methods. The first few days especially after an operative delivery the mother may need pillows to support the mother and the baby during the feed. The mother may need to keep a watch on the baby throughout the feed and burp after each feeding. While positioning, the baby should be slightly inclined to the side or its head may be placed above the level of the body to prevent aspiration.

Stay away from bottle feeding to avoid nipple confusion and to prevent the infection. Cup or Pallida feeding is preferable over bottles in unavoidable circumstances.

Typical signs of baby hunger are:

• Wiggling, moving arms or legs, fingers to mouth, restlessness.
• Crying intermittently or frequently.
• Excessively long or short feedings, sucking their fists or blanket, comes off the nipple frequently.
• Eagerly takes formula or pumped milk from a bottle right after a feed.

Crying is a late sign of hunger. Feed the baby at the earliest sign of hunger.

Tips to establish the milk supply

• Massage the breast before feeding
• Breastfeed the baby minimum 8 to 12 hrs per day.
• Feed the baby effectively within 3-5 hours of the last feed.
• Use the breast pump or hand expression to express milk twice in the night.
• Express the milk manually from the second breast when a baby is fed sufficiently from one breast at a time.
• Practice skin to skin contact of mother and baby.
• Monitor the diaper output.
• The milk supply is highest during the night in comparison to the day due to the high prolactin hormone surge in the night.
• Slight music, relaxation during feeding enhances the milk supply.

Reasons for low milk supply

Very few women who have hormonal problems, have an improper growth of breast tissues or have had surgical procedures where mammary tissues of the breast have been removed - are unable to make sufficient milk for one baby. Other possible reasons for poor milk supply are smoking, daily consumption of alcohol, and malnutrition.

Do not directly heat the milk on the stove or in the oven. Instead, warm the milk by keeping it over warm water.

Management of feeding-related problems:

Painful nipples:

• Rinse the skin with clean water and apply freshly expressed milk on the cracked nipples, which may aid healing and prevent bacterial infections.
• A nipple shield can be used until the pain resolves.
• Nipple creams and gels can be used under supervision.
• Avoid soap or antiseptic solution repeatedly to clean the breast.

Milk stasis or engorgement:

It is an uncomfortable breast fullness that can occur at any time when the baby is not fed often or the milk is not expressed.

• Feed the baby frequently and effectively
• Position well during feeding so that baby may be able to grasp the whole nipple which makes it easier.
• Use a breast pump to express milk
• Apply moist heat or take a shower before a feed and cold application after a feed.
• Keep cabbage leaves on the engorged breast for 15 to 20 minutes,2-3 times per day. Wash leaves before using. Overuse of leaves may dry up the milk.
• Avoid too tight brasiers or maternity feeding braziers if available.

Inverted and flat nipple:

• Stimulate and shape the nipple just before the feed.
• For flat nipples, apply a cold cloth to help the nipple evert.
• A silicone nipple shield can be placed on the inverted nipple.

Breast and nipple rashes and infections:

• Take frequent showers
• Expose breast to sunlight and air
• Rinse nipple-areola area with warm water after each feeding
• Wear cotton bras.
• Meet your doctor on time

Take home massage:

Breast milk is the food of love. The golden TRIAD for effective and successful breastfeeding is – Perfect LATCH-ON, feeding colostrum and skin to skin mother and newborn contact.

A positive mindset goes a long way in making breastfeeding sustainable.

Reference: Jan Riordan,EdD,RN,IBCLC,FAAN. Breastfeeding and Human Lactation third edition.
Acknowledgment: Dr Joylene D Almeida, Consultant Obstetrician, and Gynecologist.