Breastfeeding and lactation ( PART 1)

Postnatal period is very stressful time, where women face many breastfeeding issues. Every infant and child has the right to good nutrition according to the "Convention on the Rights of the Child".

WHO and UNICEF recommend:

• early initiation of breastfeeding within 1 hour of birth;

• exclusive breastfeeding for the first 6 months of life; and

• introduction of nutritionally-adequate and safe complementary (solid) foods at 6 months together with continued breastfeeding up to 2 years of age or beyond.

WHY BREASTFEED?

Mothers often get a lot of misinformation from various sources. There are many benefits to mother and baby.

1.Breastfeeding is not more physically exhausting than bottle feeding. On the contrary, breastfeeding offers the mother opportunities to sit or lie down during the day. Breastfeeding may act as an anti-stress technique: both mother and baby get comfort from breastfeeding.

2.Breastmilk is easy to carry around, it is always available and a baby fed breast-milk is less susceptible to infection than a baby fed breast-milk substitutes.

3. Breastfeeding helps in birth spacing.

4. It contains antibodies which prevent babies from infection.

5. it is easily digestible and contains perfect nutrients.

6. it helps in mother and child bonding.

7. It cost less than artificial feeding.

PREPARING FOR BREASTFEEDING.

1.All women who have given birth will produce milk, unless they have retained some fragment of the placenta.

2. The great majority of women are able to provide enough milk to breastfeed their babies exclusively for around six months and to carry on breastfeeding for as long as they want after they introduce the baby to solid foods.

3. The size of the breasts and the shape of the nipples are not important for breastfeeding success.

4. Antenatal preparation of the breasts and the nipples is not necessary.

TALK TO YOUR HEALTH PROVIDER AND DISCUSS YOUR CONCERN TO SOLVE YOR DOUBTS AND PROBLEMS, if there are any difficulties with breastfeeding, 99% can be resolved. Breastfeeding is a personal act, and that personal experiences influence the way mothers – and fathers – approach breastfeeding. Breastfeeding is a matter of confidence.

HOW TO BREASTFEED YOUR BABY?

When the baby is brought to the breast, place it so that its nose is level with the nipple, then tease its top lip by touching it with the nipple. This will stimulate the baby to open its mouth wide, gape and take a good mouthful of breast. The nipple and a good part of the areola will disappear into the baby’s mouth.

Good attachment looks like this:

1. The baby’s mouth is wide open and the lips are turned outwards. The lower lip especially can be seen to be curled right back and the baby’s chin is touching the mother’s breast.

2. The nipple will be deep into the baby’s mouth, with the tip touching the baby’s palate.

3. The baby suckles by making two simultaneous movements: the lower jaw goes up and down and a muscular wave (like peristalsis) goes from the tip to the back of the tongue. You can sometimes see the tongue above the lower lip. This action presses the milk out of the lactiferous sinuses, through the nipple into the back of the baby’s mouth.

4. The baby suckles with short quick movements at first, but changes the rhythm to a more continuous deep suckling as the milk flows. The baby pauses throughout with the pauses getting longer as the feed continues.

5. The baby’s cheeks will be rounded and not drawn in and sometimes the baby’s ears will move as it suckles.

Poor attachment:

1. The baby sucks or “chews” on the nipple only, with lips, gums or tongue.

2. The mouth is not wide open and the lips are sucked in.

3. The lips and gums press against the nipple instead of the areola.

4. The tongue may be misplaced, blocking the protrusion of the nipple into the baby’s mouth.

5. The cheeks are pulled in.

There is no one correct way to hold a baby and YOU and YOUR baby will work out what is most comfortable for both of YOU.

1.First mother should make herself comfortable, so that she can relax with the baby. If she feeds in a sitting position, ideally it should be on a low chair so that her feet are flat on the floor and her knees slightly raised. You may have traditional furniture or cushions used for breastfeeding. If so promote them. If a higher chair is used, a stool or some thick books should be there to rest her feet on. She must sit comfortably with her back supported and not lean forward. The important principle to remember is “bring the baby to the breast, not the breast to the baby”.

2. The baby should be held close towards her body, tummy against tummy, so that it does not have to turn the head to feed. The baby can be held diagonally, sideways, tucked under the mother ’s arm or whichever way the mother and baby are most comfortable and relaxed. The important point is the baby facing the breast without turning its head.

3. As she brings the baby to her breast the baby ’s nose should be level with the nipple and it will tilt its head back a little.

4. In some positions the mother can support its bottom with her hand. The head can rest on the mother ’s arm. In others she can support the head gently with her hand. Do not hold the head too firmly because the baby needs to be able to move its head freely to adjust its attachment at the breast. Some babies react strongly against their head being held, and may bend over backwards and “fight at the breast”

5.There is no need to press the breast away from the baby ’s nostrils with a finger. If the baby is well positioned and well attached, it will be able to breathe through the sides of the nostrils. The shape of its nose is custom-made for the purpose. The commonly used “scissor” position of the fingers may pull the breast out of the baby ’s mouth and prevent good attachment.

6.If a mother feels she needs to support her breast, she can cup her breast with her hand from underneath or place a flat hand against her ribcage.

1. Rubbing the nipple, or a finger, gently against the baby ’s cheek or lips will evoke the “rooting” reflex, so that the baby focuses on the breast.

2. Touching the baby ’s lips with her nipple will evoke the oral searching reflex, so that the baby opens the mouth wide and thrusts the tongue forward.

3. It is the baby who should come to the breast, and not the breast to the baby. Trying to steer the breast into the baby ’s mouth as if it were a bottle is unhelpful and should be avoided.

4.When it feeds, the baby’s chin should touch the mother’s breast. Usually, more of the top part of the areola is visible than the underneath part. Every woman is different. Some have very large areolas which will always show during breastfeeding while a small areola may disappear from sight completely during a feed. The most important signal for the mother is that feeding does not hurt, the baby’s mouth should feel comfortable at her breast. Pain is usually a sign of poor attachment.

how to check for correct position?

Is the mother relaxed, comfortable and free of pain when feeding?

Is the baby’s body close to the mother’s? Does the baby face the breast without turning the head?

Is the baby’s head slightly tilted back?

Does the baby’s chin touch the mother’s breast?

Does the baby breathe freely?

Is the mouth wide open?

Are the lips, especially the lower one, turned outward (not sucked in), with more of the areola covered below than above the mouth?

Is the tongue cupped under the breast?

The tongue may show between the lower lip and the breast.

Does the baby feed slowly and deeply, using tongue and lower jaw? (Muscles around the ear may move, but cheeks are not moving in and out.)

Can swallowing be seen or heard?

Is the baby calm and stays attached to the breast?

POINTS TO REMEMBER

1. Colostrum, the early milk, is tailored to meet the baby’s needs for the first few days and it should always be used. Although it may seem sparse, colostrum is all that the healthy full-term baby needs until mature milk “comes in”. Colostrum is energy-dense and rich in protective antibodies and the fat-soluble vitamins E and A.

2. Most healthy babies lose 5–10% of the birth weight in the first days of life. Most of this is a physiologically natural loss of water, due to the change of environment. Normally they regain birth weight within 5–10 days, but some babies do this within 3 days whilst others take as long as 3 weeks.

3. Physiologically, after the birth, the normal baby only needs colostrum and later breast-milk. Any other fluid, whether water (with or without dextrose, glucose or any other sugar), tea or breast-milk substitute are unnecessary and may do harm. They interfere with the baby’s appetite and feeding pattern and discourage it from suckling well at the breast.

4. Giving any other fluid before, after or in between breastfeeds will result in less milk being removed from the breast, and consequently less stimulation. The mother’s body reacts with a lowered endocrinological response and lowered activity in the milk producing cells, and eventually a lower milk production.

5. Some babies who are given bottles or a pacifier in the period after the birth, may develop a preference for the artificial teats. They will not be so eager for the breast and this can affect the Establishment of breastfeeding.

6. Breast-milk is never “too thin”. Its composition changes from the beginning to the end of a feed. The first milk, called “foremilk” looks more watery and bluish than cow’s milk. This quenches the baby’s thirst. As the feed continues the “hindmilk” which is rich in fat follows and provides the energy-dense part of the feed which satisfies the baby’s hunger. Fifty per cent of the energy in breast-milk comes from a unique pattern of fats which are ideal for brain and neurological development.

7. The vitamins and minerals in breast-milk are normally sufficient to meet the baby’s needs during the first six months. Supplements are not required and can even be hazardous EXCEPT VITAMIN D AND K.

8. Brest feeding should be on demand, each kids have there different requirement and pattern. The baby changes its feeding pattern, according to changing needs, daily or over time by feeding more or less often, for longer or shorter duration. Be led by the baby, it knows what it needs. You cannot force a baby to feed when it does not want to. The baby will feed best when you respond to its signals.

9.The baby can suckle as often and for as long as it wants. When the baby is well positioned and well attached, unrestricted breastfeeding will not damage a mother’s nipples. In fact it reduces the risk of sore and cracked nipples, prevents severe engorgement and helps keep the mother comfortable.

for more information and help meet our expert consultant.