The Mumbai Obstetric & Gynecological Society

The Mumbai Obstetric and Gynaecological Society www.mogsonline.org mogs

FAQs For Breastfeeding

Dr. Madhuri Mehendale and Dr. Shailesh Kore

UNICEF  STATISTICS ON INDIAN BREASTFEEDING SCENARIO

UNICEF  STATISTICS ON INDIAN BREASTFEEDING SCENARIO

Why Should India Scale Up Breastfeeding Rates?

If India were to universalize breastfeeding in coming years, new evidence tells us that it could reduce 156,000 child deaths (13% of under-5), 3,900,000 episodes of diarrhea, 3,436,560 episodes of pneumonia and 4915 deaths due to breast cancer annually. Over and above this it would add 4300 Crores to Indian economy, adding 3 points to IQ of all children, rich or poor. Breastfeeding can reduce obesity by 26%. It also reduces type 2 diabetes by 35% i.e. 1 out of 3 new cases can be prevented.(Breastfeeding Lancet series,2016;Indian road map.

Introduction

Mothers milk is a natural and a complete food for the baby.Breastfeeding offers many advantages to mother and the baby

Advantages to baby

  • Right nutrients in right proportion for optimal growth
  • Easily digestible
  • Germ free
  • Right temperature
  • Provides immunity
  • Protects against asthma and allergies
  • Makes child more intelligent
  • Stronger bonding with mother

Advantages to mother

  • Early expulsion of placenta
  • Uterus contracts faster to prepregnancy state
  • Convenient and require no preparation
  • Decreased risk of breast ,ovarian and uterine cancers
  • Helps to delay pregnancy.
  • Helps to lose weight faste

When will breast milk start coming ?What is colustrum ?

For the first few days after  baby's birth, colostrum,is produced a nutrient-rich "pre-milk" Benefits of colostrums

  1. Rich in antibodies (immunity) and protects baby against infections.Its the 1st vaccine of baby.
  2. Helps the baby to pass meconium and helps to reduce severity of physiological jaundice
  3. Helps to complete maturation of intestines
  4. Rich in Vitamin A and K

For some women, colostrum is thick and yellowish. For others, it is thin and watery. The flow of colostrum is slow so that a baby can learn to nurse — a process that involves coordination to suck, breathe, and swallow.After about 3 to 4 days of producing colostrum,  breasts will start to feel firmer. This is a sign that milk supply is increasing and changing from colostrum to breast milk.Sometimes a mother's milk may take longer than a few days to come in. This is perfectly normal and is usually no cause for concern, but make sure to let your doctor know.  Babies don't need much more than colostrum for the first few days.

When should  breastfeeding begin?

If possible, try to start nursing within an hour of your baby's birth. This timing takes advantage of the natural wakefulness of a newborn immediately after birth. After the initial period of being alert, a newborn will spend much of the next 24 hours sleeping. So it may be more difficult to get your baby to latch on after those first few hours.

Benefits of early initiation

  1. Baby is alert and eager to feed in the 1st hour
  2. Baby remains warm being in close touch with mother
  3. Ensures short and long term breastfeeding success
  4. Postpartum bleeding decreases
  5. Strong emotional bond begins to develop

A newborn baby placed on the mother's chest after birth will naturally "root" (squirm toward the breast, turn the head toward it, and make sucking motions with the mouth). To breastfeed, the baby will latch onto the breast by forming a tight seal with the mouth around the nipple and areola. Even  baby doesn't actually latch on at this time and just "practices," it's still good for baby (and mother) to get used to the idea of breastfeeding.

 Is it appropriate to follow the tradition of giving honey, sugar water etc. to the baby before the first breastfeed (Pre-lacteal feeds)?

Traditionally sometimes the baby is fed some fluid before the first breastfeed or during first 3-5 days of life (before the mother starts producing mature milk). This is known as ‘Pre-lacteal feed’. This custom is inappropriate, because it increases the risk of infection. This pre-lacteal feed may decrease the baby’s eagerness to suckle at the breast. Thus the first and the subsequent feeds may get delayed. This may lead to breastfeeding failure.

Where should the child be kept after delivery?

The child should be kept close to the mother (bedding in). It is not advisable to keep the child in a cradle or on a separate bed. The word ‘rooming in’ means that the mother and the baby are kept in the same room. The benefits of ‘bedding in’ are as follows:

  1. It promotes demand feeding.
  2. Baby stays warm
  3. Risk of infection is reduced.
  4. Helps let down of milk.
  5. Helps to develop a stronger emotional bond between the mother and the baby.
  6.  How frequently and how long should the baby be breastfed?

    It is necessary to feed the baby more frequently during the first seven days (at least 8-10 times in 24 hours.) In this period baby should be promoted to breastfeed every 1.5-2 hours by giving close skin to skin contact and recognising the early feeding cues.

    Only after child starts urinating frequently (more than 6 times in 24hours) and starts gaining weight that the baby can be fed on demand i.e whenever the baby wants and as long as she wants.

    Very few babies demand feed with a regularity of 2-3 hours. Some sleep during the day and keep their mothers awake at night. Some have the exact opposite schedule. Some babies do not follow any definite timetable. Some babies sleep for a long time and then after waking up feed very frequently for many hours and also urinate frequently. All these patterns should be considered as normal.

    The mother should adjust her daily routine to suit her baby’s needs.

    Some babies are fast feeders (finishing their breastfeed in 5-10 minutes, while slow feeders may continue to suckle for as long as 30-45 minutes. Mother should feed on one side as long as possible because the milk the comes initially is rich in water and sugar (foremilk), while the milk which comes in later part of the feed is rich in fats (hindmilk).

    It is necessary to feed the child frequently at night and there are no ill effects associated with this. In fact, the mother produces more milk during the quiet hours of night. It is not mandatory for the mother to breast feed in sitting position ; she can also feed while lying down. She may find it more comfortable.

    What are the signs of hunger?

    Crying is a late sign of hunger.

    Other signs that babies are hungry include

  • moving their heads from side to side
  • opening their mouths
  • placing their hands and fists to their mouths
  • puckering their lips as if to suck
  • nuzzling again their mothers' breasts
  • stretching
  • showing the rooting reflex (when a baby moves its mouth in the direction of something that's stroking or touching its cheek)

 What is "let-down"?

During the first few days to weeks after delivery, mother may feel a pins-and-needles or tingling sensation in her breasts just after her baby starts to suckle. Milk may seep from the other breast. This is called the let-down reflex, or milk-ejection reflex.

The let-down reflex happens when  baby's sucking (or a machine pumping) triggers nerves in the nipple. The nerves send a message to  brain telling it to release milk. The brain releases a hormone called oxytocin that causes tiny muscles in the breast to tighten and squeeze the milk out, or "let it down." Oxytocin also can cause  cramps in your uterus when  milk lets down. This is helpful in returning  uterus back to its original size. 

Let-down also can happen if a feeding is overdue or before starting nursing (some women have let-down from simply seeing their baby or hearing a baby cry). Or it can happen after your baby is latched on and has sucked a few times. Some women have multiple let-downs during a single feeding.Some women, however, never have a feeling of let-down, which is OK, too. Even if you don't feel it, you should still see milk coming from your nipple and hear and see your baby swallowing

How does the mother latch her baby correctly?

Many new mothers have trouble getting their baby to latch correctly. An incorrect latch can be frustrating for babies and very painful for mothers.

Here's how she can make sure your baby gets a good latch every time:

  1. Make sure  baby's mouth is opened wide and his or her tongue is down when latching on.
  2. Support her breast with her  hand, positioning the thumb on top and fingers at the bottom, keeping her thumb and fingers back far enough so that  baby has enough of the nipple and areola (the darker circle of skin around the nipple) to latch onto.
  3. Gently glide her nipple from the middle of the  baby's bottom lip down to his or her chin to help prompt the baby to open his or her mouth.
  4. When the baby opens his or her mouth wide and the tongue comes down, quickly bring your baby to your breast (not your breast to your baby). Baby should take as much of  areola into his or her mouth as possible.
  5. Make sure baby's nose is almost touching the breast (not pressed against it), his or her lips are turned out (or flanged), and you see and hear your baby swallowing. (You should be able to tell by seeing movement along your baby's lower jaw and even in your baby's ear and temple. Some babies may also make small noises when they swallow that sound like little clicks.)
  6. Have a nursing session observed by someone knowledgeable about breastfeeding.

When the baby is properly latched on, mother may have 30 to 60 seconds of latch-on pain (this is caused by the nipple and areola being pulled into the baby's mouth). Then the pain should ease. It will then feel like a tug when baby is sucking.

How can we tell if the baby is latched on wrong?

If  baby tends to suck on the tip of the nipple, without getting much of the areola, he or she is latched on incorrectly. Babies who tend to latch on wrong also fall sleep at the breast more often and may not seem satisfied because they may not be getting enough. If this happens, break the suction and reposition the baby onto mothers breast to include the nipple and areola.

 How can we tell if the baby is getting the milk?

Once a baby is latched onto the breast, he or she usually takes four to five sucks, followed by a 5- to 10-second pause. Baby's sucks will increase in number as the quantity of your milk increases. As the milk flow slows,  baby's pattern will probably change to three or four sucks and pauses that last longer than 10 seconds.

Most babies will release the breast on their own. If the baby doesn't release your breast but the sucks now seem limited to the front of his or her mouth, slip your finger in the side of baby's mouth (between the gums) and then turn your finger a quarter turn to break the suction. Then, try to burp the baby and switch him or her to the other breast.

Newborns will often fall asleep while breastfeeding. If this happens, try to wake your baby by tickling the feet, rubbing the back, or taking off some clothing. Sometimes burping your baby or changing the diaper also can be helpful

Is there more than one way to hold  baby while feeding?

Yes. You can try several different nursing positions (or holds) to figure out which one is the most comfortable for you and your baby.

They include the:

  • Cradle Hold: This is the traditional hold many mothers will try from the get-go, holding the baby across the chest and using the arm on the same side as the nursing breast to support the baby.

  • Clutch (or Football) Hold: This position holds the baby at your side, under your arm, and is good for the mom who's had a C-section (because the baby doesn't put pressure on the mother's belly), as well as for mothers with large breasts or those who had twins.

  • Cross-Cradle (or Crossover) Hold: Similar to the cradle hold, this position involves using the arm on the opposite side as the nursing breast to support the baby. Some mothers find that this hold makes it easier to control how their babies latch on.

  • Side-Lying Position: This position, in which mom lies on her side facing the baby, allows moms to get some rest during feedings and is also a common choice for mothers who've had C-sections.

How can you make breastfeeding more comfortable?

Again, it's mostly about finding a comfortable nursing position and proper latch-on — once these are done, it can make for a truly rewarding bonding experience.
Here are some instructions to mothers  to relax and enjoy the experience:

  • Keep a breastfeeding goodie bag or basket near all of your regular nursing areas at home (next to the bed, on the couch, etc.). Fill it with bottled water, some healthy snacks, a few magazines, your portable home phone or cellphone (so you don't have to get up to answer or make calls), plenty of burp cloths or cotton diapers for dribbles and spit-up, and the remote controls if you want to use a TV, DVD player, or stereo nearby.
  • Find the most comfortable seating arrangement and stick to it so that your baby gets comfortable with — and looks forward to — the routine. Many mothers like to sit in a glider or in a cozy chair with armrests.
  • Give your feet and back a break. Footstools and pillows can give extra support. Pillows that some women find helpful are the wraparound nursing pillows or the "husband" back pillows with arms on each side for nursing in bed

How long should one plan to breastfeed my baby?

That's a personal choice. It is recommended that babies be breastfed exclusively (without offering formula, water, juice, non-breast-milk, or food) for the first 6 months, and that breastfeeding continue until 12 months (and beyond) if it's working for both mother and baby.

Studies on infants show that breastfeeding can lower the occurrence or severity of diarrhea, ear infections, and bacterial meningitis. Breastfeeding also may protect children against sudden infant death syndrome (SIDS), diabetes, obesity, and asthma.

Breastfeeding also burns calories and helps shrink the uterus, so nursing moms might be able to return to their pre-pregnancy shape and weight quicker. And studies show that breastfeeding helps lower a woman's risk of breast cancer, high blood pressure, diabetes, and cardiovascular disease, and also may help decrease the risk of uterine and ovarian cancer.

How Can the mother tell if her baby Is Getting Enough ?

Two gold standards to know if baby is getting enough milk

1)If an exclusively breastfed baby is urinating at least 6-7 times in a day,i.e in any 24 hour period .it implies that she is getting enough

2)If there is at least half kilo weight gain every month

These tests to be used only after 2 weeks when breastfeeding is established

The Mother  can be assured that the baby is getting enough to eat if he or she:

  1. seems satisfied and content after eating
  2. produces about 4-6 wet diapers a day
  3. has regular bowel movements
  4. sleeps well
  5. is alert when awake
  6. is gaining weight

The baby may not be getting enough to eat if he or she:

  1. does not appear to be satisfied after feeding
  2. seems hungry often
  3. isn't making several wet and soiled diapers a day
  4. is fussy or cries a lot
  5. isn't gaining weight

Sucking for Comfort-If your baby seems to be getting enough milk, but continues to suck for an hour or more, your little one might be nursing for comfort rather than for nourishment. So, how do you know? Once your baby has fed well, he or she may stay on your breast but:

  • seem satisfied
  • stop sucking and swallowing
  • play with your nipple

If your baby is showing these signs of non-nutritive sucking (or pacifying), you may want to offer your infant his or her thumb or hand to suck on.

How often should one breastfeed?

Newborn should be nursing 8-12 times per day for about the first month.

Frequent feedings also will help stimulate  milk production during the first few weeks. By 1 to 2 months of age, a breastfed baby will probably nurse 7-9 times a day.

Before  milk supply is established, breastfeeding should be "on demand" (when your baby is hungry), which is generally every 1½ to 3 hours. As newborns get older, they'll nurse less often, and may develop a more reliable schedule. Some might feed every 90 minutes, whereas others might go 2 or 3 hours between feedings. Newborns should not go more than about 4 hours without feeding, even overnight.

.How long does it take to nurse?

That depends on both mother and  baby and many other factors, such as whether:

  1. the milk supply has come in completely
  2. the let-down reflex (which causes milk to flow from the nipple) is immediate or takes a few minutes into the feeding to start
  3. the milk flow is slow or fast
  4. the position of baby is correct on your breast
  5.  baby tends to get right down to business or dawdles a bit
  6.  baby is sleepy or easily distracted (which can be the case in older babies, especially)

How long babies nurse also depends on their age. As babies get older, they become more efficient, so they may take about 5-10 minutes on each side, whereas newborns may feed for up to 20 minutes on each breast.

Make sure the baby is latched on correctly from the beginning to ensure the most productive feeding possible. It's important that the baby nurses with a wide-open mouth and takes as much as possible of the areola in his or her mouth (not just the tip of the nipple).

How often should mother alternate breasts?

To keep up your milk supply in both breasts — and prevent painful engorgement in one — it's important to alternate breasts and try to give each one the same amount of nursing time throughout the day.

How to Burp  Baby?

When burping the baby, repeated gentle patting on your baby's back should do the trick — there's no need to pound hard. To prevent messy cleanups when  baby spits up or has a "wet burp," you might want to place a towel or bib under your baby's chin or on your shoulder.

Try experimenting with different positions for burping that are comfortable for mother and  baby. Many parents prefer to use one of these three methods:

  • Sit upright and hold baby against your chest.  Baby's chin should rest on mothers shoulder as she supports  the baby with one hand. With the other hand, gently pat baby's back. Sitting in a rocking chair and gently rocking with  baby while she  does this may also help.
  • Hold  baby sitting up, in mothers lap or across her knee.Support baby's chest and head with one hand by cradling  baby's chin in the palm of mother’s hand and resting the heel of mothers hand on  baby's chest (but be careful to grip  baby's chin, not throat). Use the other hand to pat baby's back gently.
  • Lay your baby on mothers lap on his or her belly. Support baby's head and make sure it's higher than his or her chest. Gently pat  baby's back.

If  baby seems fussy while feeding, stop the session, burp the baby, and then begin feeding again. Try burping baby each time mother switch breasts 

For the first 6 months or so, keep the baby in an upright position for 10 to 15 minutes (or longer if your baby spits up or has GERD) after feeding to help prevent the milk from coming back up. But don't worry if the baby spits sometimes.

How often should mother  burp her baby during feedings?

Let your baby breastfeed at one breast then switch to the other side. Try burping your baby when switching breasts and at the end of the feed. Often, the movement alone can be enough to cause a baby to burp.Some infants need more burping, others less, and it can vary from feeding to feeding depending on what the mother has been eating.

Is it normal to feel pain during or after nursing?

If the baby is latched on properly, mother may have 30 to 60 seconds of pain (from the nipple and areola being pulled into the baby's mouth), then the pain should ease. But if she continues to feel pain, stop feeding momentarily and reposition your baby on your breast. If the pain persists, something else might be going on.

If your baby consistently latches on wrong, sucking on your nipple without getting much of your areola in the mouth, you'll probably feel discomfort throughout each feeding. Some moms say it's painful or feels like a pinch as their babies nurse. And you'll probably have sore, cracked nipples in no time. Consulting with the doctor or lactation consultant can help with these situations.

Can mother still breastfeed if she has a breast infection?

Yes. Contrary to what many people think, you can continue to nurse your baby while treating your breast infection. In fact, continuing to breastfeed can help clear up the infection.

How can mother ease her breast or nipple pain?

When dealing with sore breasts or nipples, here are some pointers for avoiding pain in the future as well as making yourself more comfortable while your breasts heal:

  • Make sure the baby latches onto your breasts correctly every time.
  • Ask the doctor or lactation consultant to recommend a cream to put on the nipples in between feedings to help sore nipples heal.
  • At the end of a feeding, massage some breast milk on the nipples, and then allow them to air dry.
  • Consider wearing breast shields in between feedings (not to be confused with nipple shields, which are used duringbreastfeeding) to protect sore nipples. Breast shields are dome-shaped covers that prevent nipples from rubbing against clothing and help them heal faster.
  •  These shields are placed over the areola and nipple during a feeding to protect sore or cracked nipples. Nipple shields may interfere with a mother's milk supply, so it's important to only use them under the supervision of a doctor or lactation consultant.
  • Some women find it helpful to nurse more often but for shorter periods of time, rather than nurse for extended periods.
  • Try to nurse first on the side that's less sore.
  • Gently break suction when removing your baby from your breast. (Slip your finger in the side of your baby's mouth, between the gums, and then turn your finger a quarter turn to break the suction.)
  • Vary breastfeeding positions to help drain all areas of your breast.
  • Use wet or dry heat on breasts (a warm water bottle, heating pad, washcloth, or warm shower) right before feeding. (However, if mother has a yeast infection in her breast, she will need to keep her nipples dry because the yeast thrives on moisture.)
  • Put ice packs or cool compresses on engorged breasts after feedings.
  • Gently massage the sore area before nursing.
  • Get plenty of rest and fluids.
  • Some mothers with cracked or sore nipples find that pumping for 2 to 3 days allows their nipples to heal.

What should the mother do if breasts get hard and lumpy (engorgement) ? what causes this?

The mother starts producing milk (i.e. mature milk) from 3-5 days after delivery. Excessive production of milk or incomplete emptying of breasts (infrequent suckling or poor attachment) will cause heaviness, hardening and pain (engorgement). Engorgement restricted to a part of the breast will give a lumpy feel. Engorgement of the breast tissue normally present in the armpit will produce a lump there. Engorgement may sometimes be caused if the baby has overslept and not fed. Breasts become full and a little heavy just prior to a breastfeed (full breasts). Breasts will start getting engorged if not emptied for some more time (engorgement). Engorgement can be prevented by timely expression of milk. Unattended  engorgement  can lead to increasing pain,redness (mastitis).If neglected ,may progress to breast abscess

What should the breastfeeding mother eat?

Just as when you were pregnant, it's important to eat well while you're breastfeeding, with plenty of wholesome fruits, vegetables, whole grains, protein, and calcium-rich foods.

Diet doesn't have to be perfect. An estimated 300-500 extra calories per day as a breastfeeding mother. Breastfeeding might make you thirsty, so consider keeping a water bottle nearby so it's there when you need it.

Should she avoid certain foods?

Every baby is different. Some moms may find that if they eat beans, cauliflower, or broccoli, their little ones get gassy or fussy while other babies can tolerate these foods just fine. And some mothers can confirm that after they eat spicy foods, their babies don't seem to like the taste of their breast milk. Again, other babies may not mind if mom just enjoyed a bunch of hot chili peppers.

Just like during pregnancy, nursing moms should avoid or limit their intake of fish high in mercury, since high mercury levels can damage the developing nervous system.

Can I have caffeine?

As with alcohol, it's best to limit the amount of caffeine mother consumes while breastfeeding. One or two cups of coffee a day are fine, but more than one or two servings of caffeine per day may affect the baby's mood and/or sleep.

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