Monday September 1st 2014

Breastfeeding basics

Mother’s milk is the perfect food for your baby. It contains all the necessary nutrients to help her grow and develop. While breastfeeding is a natural biological process, it may feel like rocket science in the early days! Be patient – learning the art of breastfeeding simply requires patience, determination and solid support from family and friends.

Only a small percentage of women are physically unable to breastfeed. Lack of support, inadequate knowledge and failure to nip problems in the bud when they arise are the main reasons why many mothers give up within weeks of birth.

A successful breastfeeding experience begins before birth. Start educating yourself about your mammary glands – go to antenatal classes, chat to a lactation consultant or midwife and contact your local La Leche League (www.lalecheleague.org or consult your telephone directory). The LLL also offers an excellent book, The Womanly Art of Breastfeeding, which is well worth a read.

Remember, it is a myth that you need to prepare your breasts for making milk. There is no need to “toughen them up” by scouring with a facecloth or applying special creams during pregnancy.

Eating well, getting enough sleep and finding at least one supportive female relative – preferably one who has breastfed babies herself – is all the preparation you need during pregnancy.

Before you bring baby home, identify a “feeding station” – a comfortable chair where you’ll spend hours bonding and breastfeeding. Have a little table, foot stool, pillows and a couple of books or magazines in place. Always take some snacks and a drink – water, rooibos tea or diluted juice (be cautious about acid fruit juices though) – and a snack, as breastfeeding is thirsty and hungry work.

Nan Jolly, a medical doctor and international board certified lactation consultant (IBCLC), says one of the problems is that most women just don’t know enough about breastfeeding and motherhood once baby arrives. If you are feeling nervous and find that general antenatal classes, books and magazines don’t allay your fears, then book a lactation expert in advance, for peace of mind.

Doctors and nurses generally don’t have adequate knowledge about lactation, so an IBCLC or your local La Leche League is the best expert.

If you’ve given birth in hospital, the midwives will assist you with your first breastfeeding attempts. Try to feed baby as soon as possible after birth, in order to facilitate bonding, stimulate your milk supply and make use of baby’s latching instinct.

The journey begins

During pregnancy or shortly after birth, you may notice a sticky, yellow liquid seeping from your breasts. This is called colostrum – a nutrient-packed substance which is high in calories and the perfect meal for your baby during the first few days.

Within a couple of days – usually three – your mature milk will come in. It is much thinner and may even be blue-tinged – but this is not because you have “weak” milk! Your mature milk comprises two types – foremilk and hindmilk. The thinner foremilk quenches your baby’s thirst and is released at the beginning of a feed. Hindmilk is thick, more nutrient-dense and provides her with excellent nutrition.

It is therefore very important to allow baby to suckle on one breast for as long as she needs to, in order to ensure that she receives enough hindmilk.

You will know that your milk is flowing when you feel a letdown reflex – a burning in the breast, under your arm or even just a vague tingling in the area. Some mothers don’t feel a letdown – but this is not uncommon. This sensation is a direct result of the hormone oxytocin, which promotes the production of milk.

To make breastfeeding easier, you need to ensure that you are in a comfortable position. Ask the midwife to show you the cradle or “Madonna” hold – the traditional feeding position – and the football hold, which may be easier if you have had a caesarean section.

Once positioned, you will need to ensure that baby is latched correctly. Latching baby the wrong way is one of the main reasons why mothers experience painful nipples or engorged breasts. Sort out the latch and these problems often magically disappear.

Ask the midwife to help you latch baby’s mouth to your breast – she will need to have all of the nipple and enough surrounding areola in her mouth to ensure adequate intake of milk and to prevent sore nipples.

A top tip for helping baby to latch correctly is to make use of her rooting reflex – tickle her cheek or brush her nose – she will turn her head towards the breast closest to her and open her mouth.

Do not schedule your feeds – no matter what hospital nurses, family or friends tell you. This can have disastrous results. Once you are home, feed baby on cue – this could be every two hours or even more. If you schedule feeds, especially during the first six weeks, this interferes with milk production, promotes breastfeeding problems and could result in a tired, hungry, unhappy baby and worried mother.

Breastmilk digests much more quickly than formula milk – baby may be hungry again within 30 minutes. For this reason, you need to clear your diary, especially in the early days – your job is to feed baby. Allow others to change nappies often, do the housework, cook food and do the shopping.

After breastfeeding is established within three months, your baby will settle into a feeding pattern of her own. She may sleep for a longer stretch, or want to “cluster feed” often during the early evening. To cope with her demands, always try to sleep when she sleeps. The housework can wait!

If baby is crying, seems frustrated, cannot sleep or your nipples are sore or breasts engorged, promptly call in a lactation consultant. Don’t struggle on your own – breastfeeding problems are best attended to immediately and if not, your confidence may suffer and you’ll be tempted to give up.

Feeding basics

Allow baby to nurse until she has had enough. She will either fall asleep or de-latch herself and you may then switch breasts. During the first few months, always burp her between switches, as she may drink less than she needs to if she has wind in her stomach.

Don’t be surprised if your baby doesn’t seem satisfied after nursing at both breasts – she might fall asleep and then suddenly wake up a few minutes later, demanding “dessert”. This is quite normal. Breastfed babies sometimes need more than two feedings per session. Once satisfied, she will fall into a contented sleep.

You may worry about whether or not you are producing enough milk. While all babies are different, the average breastfed infant should feed between 8 – 12 times over a period of 24 hours and will likely have at least five to six (or more) dirty or wet nappies in that time. She may feed for only 20 – 30 minutes during one session, or an hour during the next – this is perfectly normal.

If she is gaining weight, seems content and alert and is thriving, you’re doing just fine.

Potential problems

Engorged breasts, cracked or painful nipples, mastitis (breast infection) and thrush are all common – but preventable – ailments during breastfeeding.

Stock up on a small tube of Lansinoh ointment while pregnant. This excellent cream soothes painful nipples, promotes healing and does not need to be washed off before or after feeds.

To nip problems in the bud before then begin, adhere to the golden rules : position and latch correctly, don’t time feeds or work to a schedule and get plenty of rest, good food and support from your partner, a helpful female relative or close friends.

Engorged breasts are a typical feature of early breastfeeding. When your milk comes in, this uncomfortable condition can be very tiresome. Latching may also prove difficult.

To treat engorgement, feed baby on demand, hand express milk between feeds to aid the release of excess milk and use hot and cold compresses alternately. Cabbage leaves soaked in hot water may be placed inside your bra between feeds as well – these work very well to relieve engorgement.

If your nipples are cracked, bleeding or painful, wash them gently with warm water (do not use soap) and apply Lansinoh before and after feeds. You may also need to chat to your caregiver about a safe pain relieving medication to use temporarily while the nipples heal.

Most importantly, get help with your latch technique – this is almost always the main reason for nipple problems.

Some new mothers and their babies may also suffer from thrush. The typical symptoms of thrush are shooting pains in your breasts and very tender and sore nipples. If your baby has white patches inside her cheeks and on her tongue, which cannot be scraped off, then she may have thrush.

If either you or your baby has thrush, you will both need to be treated as you can infect each other.

Your caregiver will prescribe suitable medication to clear up the condition, but you can also help to prevent thrush by eating a healthy diet (lots of fresh fruit, vegetables, whole grains, nuts and seeds – if you are not allergic), wearing cotton underwear, wiping from front to back after visiting the bathroom, eating plain yoghurt containing live cultures and not using perfumed lotions.

Mastitis is a potentially serious condition requiring prompt medical treatment. This infection may cause very painful and taut breasts and you may notice that the skin is shiny or red. If you are fevered, feel chilly, tired and have aches, you must visit your caregiver immediately.

To prevent this painful infection, breastfeed regularly and avoid engorgement. You must, if possible, continue feeding your baby while you have mastitis, as this helps get rid of it and reduces the risk of developing an abscess. Antibiotics and pain medication will be prescribed.

Expressing your milk

If you are going back to work, your baby is in hospital, you have to be away from your baby or would like your partner to give your baby some feeds, you may need to express your milk.

It is best to try to breastfeed exclusively during the first six months, as this is the time during which breastfeeding is firmly established. Experts agree that breastfeeding exclusively for six months lowers the risks of allergies, infections and malnutrition – both over and under-nourishment.

There are a variety of breast pumps from which to choose, including hospital-grade electric pumps, manual pumps and mini-electric pumps. If you would rather hand express, remember that this takes more time, but is worth mastering.

Speak to a lactation consultant or consult a good website (www.kellymom.com) or book for assistance with hand expressing. My book on breastfeeding tips will soon be available for FREE download on this site, but if you’re in urgent need of help please email me : beth@wakawomen.com – and I’ll send you the manuscript right away.

Store your breastmilk in smallish quantities, as you will have to throw away what baby does not drink. Quantities of between 50ml – 100ml are suitable.

Use bottles, special breastmilk bags or ice trays to store milk in the fridge for up to three months. Your milk may also be stored in the fridge for 24 hours.

Place the container in a bowl or jug of boiling water to thaw it, then shake gently and check that the liquid is warm.

This article has been endorsed by Dr Nan Jolly, MB BCh, International Board Certified Lactation Consultant.

© Beth Cooper, 2010.

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