Sophieticated: 4.0 - Breastfeeding

Sources

Guide to Breastfeeding by Wong Boh Boi
Successful Breastfeeding by Kang Phaik Gaik
The New Contented Little Baby Book by Gina Ford
Your Baby’s First Year by American Academy of Pediatrics

Contents:

(4.0) Breastfeeding – Few things to take note

(4.1) 10 Steps for Successful Breastfeeding @ TMC

(4.2) Myths About Breastfeeding

(4.3) Changes to Your Breasts

(4.4) Infant Feeding Amounts for the First 5 Days After Birth (Full-term Infants)

(4.5) Color of milk

(4.6) Preparing to Breastfeed

(4.7) Start Off Right

(4.8) Correct Latching

(4.9) Correct Positioning

(4.10) How to Increase Your Milk Supply

(4.11) Feeding on Demand Vs Scheduled Feeding

(4.12) Gastro-Oesophageal Reflux

(4.13) Breastfeeding Colic

(4.14) Supplementary or Complementary Feeds

(4.15) Getting to Know Your Baby's Feeding Patterns

(4.16) Caring for Your Breasts

(4.17) Weaning Off the Breast Process

(4.18) Breastfeeding and Child Spacing

(4.19) Tandem Feeding

(4.20) Herper Simplex Infection

(4.21) Types of Jaundice

(4.22) Food that Promotes Lactation

(4.23) Weaning Completely

(4.0) Breastfeeding – Few things to take note

The more baby suckles, the more milk you will produce. Successful breastfeeding depends on a good latch and frequent feeding. (pg 36)
Human milk major ingredients are sugar (lactose), easily digestible protein (whey and casein), and fat (digestible fatty acids)
To protect baby against such conditions as ear infections (otitis media), allergies, vomiting, diarrhea, pneumonia, wheezing, bronchiolitis, and meningitis.
Recent information indicates that breastfeeding plays a significant role in the prevention of overweight and diabetes, both in childhood and in later years.
In addition, breastmilk contains numerous minerals and vitamins, as well as enzymes that aid the digestive and absorptive process. (pg 96)
Normal bathing and gentle drying is the best way to care for your breast during pregnancy.
Lotions and ointments to soften breasts are not necessary and may clog the skin pores.
Salves, particularly those containing vitamins or hormones, are unnecessary and could cause problems for your baby if used while breastfeeding. (pg 100)
The nose, lips, and chin are all close to the breast allowing for effective breastfeeding. His jaws should close around the areola, not the nipple. His lips will separate and the gums will encircle the areola. His tongue will form a trough around the nipple and, in a wavelike motion, compress the milk reservoirs and empty the milk ducts. (pg 102)
Avoid bottles and pacifiers for the first several weeks until you feel that breastfeeding is going well.
Wear a proper bra (without any underwire) (pg 12)
Avoid distracting your baby, especially a newborn, by stroking him while he is nursing. Let him focus.
The longer a mother waits between feedings, the more foremilk is allowed to collect and the longer it will take before her baby receives the hindmilk.
The high lactose level found in the foremilk is important for energy and brain development and also quenches the baby's thirst. The hind milk is important for growth and helps the baby feel full.

(4.1) 10 Steps for Successful Breastfeeding @ TMC

Early initiation.
A piping hot drink.
Gentle circular massage of the massage.
Early stimulation by expressing for babies unable to suckle.
Promote maximum mother-and-infant contact unless medically advised otherwise.
Correct techniques, latching and positioning.
Facilitate breastfeeding 8-12 times per 24 hours. Nurse infant on demand every 2-3 hours or whenever baby shows signs of hunger – such as increased activity, mouthing, rooting, crying or increased alertness. Allow baby to suckle for about 10-15 minutes on each side or until fully satisfied. Feed on one side first and then the other side once the matured milk is in.
Wake non-demanding newborn to feed if 4 hours have elapsed since the last feeding.
Encourage rooming in.
Extra support and supervision for mothers doing total breastfeeding. (pg 13)
Positive feelings stimulate better milk flow: So mothers should aim to be confident and relaxed, have loving thoughts of baby and never doubt their ability to nourish baby. (pg 35)

(4.2) Myths About Breastfeeding

Breastfeeding is painful and difficult to learn.
Breastfed babies cry more than bottle-fed babies.
Breastfeeding tends to isolate mother and baby from the rest of the family members.
Breastfeeding is embarrassing.
Breastfeeding spoils a baby and weaning is difficult.
The quality of the breast milk depends on your mood.
A breastfeeding mother may have to give up food she likes, become tied down and be unable to work.
Breastfed babies need more water.
Breast milk lacks iron.
Women in some communities believe that sexual intercourse harms the quality of their milk. (pg 14)

(4.3) Changes to Your Breasts

Areola: It is darker pigmented area around the nipple that becomes much darker and more pronounced as pregnancy progresses. It is believed to be for the baby to focus (like ‘light house’ at the ocean), as the baby sees the breast in black and white. It is supposed to stimulate the baby’s brain.
Montgomery Glands: The surface of the areola is covered with numerous pappilae, or small bumps, that are known as Montgomery glands. There are between 12-20 of them. Their importance is their antibacterial property which helps keep your breasts clean and sterile. These are small oil-producing glands that provide lubrication and alter the pH of the skin, to discourage the growth of bacteria on the skin of the nipple and areola. (pg 19-20). Soaps can be harsh and drying for your nipples. Simply rinse breasts with plain water each time you shower.
Nipples: There are many types of nipples in the market. Antenatally, it is important to check your nipple for protractility. Visual inspection is usually not adequate. Therefore, palpation of the nipples is important. (pg 20) Gently press backwards into your chest. Your nipple should protrude. If your nipple retracts, you have an inverted nipple. You will need to be referred to a lactation consultant for advice on how to prepare your breast and use devices to improve the state of the inverted nipples to facilitate breastfeeding after birth. It is not recommended rolling or pulling of nipples before 37 weeks of pregnancy, as nipple stimulation can trigger premature contraction.
Niplettes: You must be consistent in using it over a period of time in order for it to be helpful. If you use the niplette correctly over time, your nipples when corrected will remain protruded. The result is permanent and leads to successful breastfeeding. The product description recommends using it early in your second trimester. It’s quite comfortable and it’s so tiny that you can even wear it under your bra and it would not be noticeable at all. (pg 33-34)
Breast Size and Milk Production: A mother with small breasts can have a storage capacity of 110ml in her right breast and 81ml in her left breast. The maximum milk store is about 20% of the baby’s intake. Feeding has to be more frequent for smaller breasts. With bigger breasts of storage capacity (say, 200ml on right and 150ml on the left), the maximum milk store storage capacity is 90% of the baby’s need in 24 hours. (pg 21)
Colostrum: On the very first days after delivery, mothers’ breasts secrete a thick and sticky substance called colostrum. Because it is so viscous and there is so little of it, mothers don’t think of it as milk. However, it is so rich that just a few teaspoonfuls are enough for the newborn’s needs. It is uniquely suited for its purpose. Colostrum is rich in proteins, immunoglobulins, antibodies, vitamins and minerals. It acts as a laxative, stimulating babies to pass out meconium. Too much bilirubin in meconium and delayed passage of meconium give rise to jaundice. Babies subsist adequately on colostrum in the first few days. During this critical period, you should be putting your baby to your breasts frequently and on demand. This will stimulate lactation.
Transitional Milk: 4-5 days following delivery, the baby will have used up his fat reserves. In composition, the transitional milk contains more fat than colostrum, but is less thick. It is creamy white in color. It satisfies the babies’ hunger and quenches thirst.
Mature Milk: After one week, mature milk begins with bluish white and watery milk. It is aptly termed ‘foremilk’. This quenches the baby’s thirst. As he continues suckling at the same breast, he reaches the hindmilk, which contains more fat, protein and calories, and is rich in antibodies. The hindmilk satisfies baby’s hunger and helps him to gain weight.
Let the baby suckle from the first breast until he is satisfied, burp him and then offer him the second breast. Achieving a good let-down will ensure that baby receives more hindmilk. (pg 15-18)
Try feeding your baby in more than one position. Begin by sitting up, then lying down. This changes the segments of the breast that are drained most optimally at each feeding.
Massage gently your breast from under the arm and down the nipple. This will help reduce soreness and ease milk flow.

(4.4) Infant Feeding Amounts for the First 5 Days After Birth (Full-term Infants)

Day-1 takes few drops to 5 cc per feeding, few drops to 1 oz (5-100ml) total intake in 24 hours (minimum 1 wet diaper, minimum 1 black tarry stool)
Day-2 takes 5-15ml per feeding, 1-4 oz (50-120ml) total intake in 24 hours (minimum 2 wet diapers, minimum 2 or more black tarry stools)
Day-3 takes 15-30ml per feeding, 4-8 oz (200ml) total intake in 24 hours (minimum 3 wet diapers, minimum some green stool)
Day-4 takes 30-45ml per feeding, 8-12 oz (400ml) total intake in 24 hours (minimum 4 wet diapers, minimum 4 loose yellow stools)
Day-5 takes 45-60ml per feeding, 12-18 oz (600+ ml) total intake in 24 hours (minimum 6 wet diapers, minimum 3 or more yellow stools)
Day-6 to 6-month baby takes 25 oz (average 750ml) total intake in 24 hours (minimum 6 or more wet diapers, minimum 3 or more loose yellow stools) (pg 38)

(4.5) Color of milk

Red-orange milk is associated with orange colored soda and dessert, because of food dyes.
Green milk is associated with green colored beverages, kelp and other forms of seaweed, especially in tablet or capsule form. Natural vitamins from health foods can lead to green milk and green urine.
Black milk is associated with minocycline hydrochloride therapy, used to treat acne. (pg 26)

(4.6) Preparing to Breastfeed

Be mentally prepared: Read up and attend breastfeeding talks; Learn from others; Initiate breastfeeding asap; Emotional changes.
Emotional Changes: Some women call the postpartum period an emotional roller-coaster. Sometimes, you will find yourself weepy for no reason; and thinking the bluest and most ghoulish thoughts. You may feel fragile, or you may question your husband’s love, or you may think your in-laws and your mother are making your life difficult. In short, you wonder if you are losing your mind. After delivery, the high levels of progesterone and oestrogen, needed during pregnancy, suddenly drop in the first 72 hours. This sudden crash is hard to adjust to and women get what is commonly called ‘baby blues’ or ‘Postnatal blue’. In its severest form, it is called Postpartum Depression (PPD). Prolonged for more than 2 weeks, symptoms include sudden bouts of weepiness, fatigue, insomnia, lack of appetite, anxiety and irritability. Research suggests that only 5-9% of all women develop PPD, so it is rare. If you experience down moments after delivery, remind yourself (or ask your husband to remind you) that you are merely suffering a temporary backwash of hormones and that you are fully capable of breastfeeding your baby.
Be physically prepared: Eat sensibly during pregnancy; Take lactation food after delivery; Talk with family for their support; Prepare your breasts by massaging lightly during shower; Examine nipples; Visit a Lactation Consultant; Choosing a pro-breastfeeding obstetrician right from your first trimester; Shop 3-4 comfortable nursing bras with good support without under wires, as these metal bands may jut into milk ducts and cause blockage. (pg 21-27)

(4.7) Start Off Right

Many of the following arrangements must be settled before the due date. Because things happen at a dizzy pace once contractions start, you would not want to be worrying your head about details. Many couples simply allow the hospital staff and doctors to make decisions for them, thinking that they must know best. The is true; but you need to communicate your desires to them as well, so that they can help you to achieve the kind of delivery that you want and also help you to initiate breastfeeding asap.
Choose right hospital with in-house lactation; Choose pro-breastfeeding obstetrician; Choose pro-breastfeeding pediatrician; Prepare delivery suite – indicate on your letter of admission to the hospital on your informed choice that the baby will be exclusively breastfed; Before delivery, communicate your preference to the staff that the baby be put on your breast within first hour of birth in the delivery suite itself, and not be delayed until the mother is transferred to the ward; After delivery, both mother and baby are encourage to have skin-to-skin contact in the delivery suite until the first breastfeeding is achieved.
Minimize interventions and minimize separation time; indicate exclusive breastfeeding unless mother is not able to breastfeed for medical reasons, the doctor may prescribe supplementary feeding (first choice would be to use the mother’s expressed breastmilk) – to be spoonfed or cupfed to the baby or administered with a syringe – let the baby to lap it up and do not pour milk into the baby’s mouth.
The mother’s top priority in the hospital after delivering her baby is to learn to latch her baby on properly. (pg 37-47)

(4.8) Correct Latching

Help babies to latch on properly once or twice and they will master it. But this also means that if you introduce the wrong way of latching, they will become used to it and then it will be difficult to break them off the habit later.
Settle Baby: Check that baby is clean and comfortable. Soothe him first if he’s crying. If he’s sleepy, wake him up by talking to him, changing his diaper or stroking his face and rubbing his chest, hands, feet and back. When you stroke his cheek and his mouth turns towards your finger as if he wants to suckle it, this is called the rooting reflex – he’s ready to feed. During this first feed, keep his hands wrapped in a receiving blanket so that they do not get in the way until the latch is secured.
Settle Yourself: Find a comfortable sitting position with pillows supporting your back well and your arms. If you have just undergone a C-section and your wound hurts too much for you to sit up, lie on your side and have a nurse or husband to position the baby properly. Do not lean over the baby. Always bring the baby to your breast and not the breast to the baby.
Position the Baby: If you are sitting up, hold the baby at breast level. Support baby’s buttocks with your forearm and the lower part of his head and neck with your hand (cross-cradle hold). Hold his feet close to your body. Turn your baby sideways to that his face and body are turned towards your chest. His nose and mouth should be facing your nipple.
Position your Breast: Use your other hand to support your breast with your thumb on one side and your four fingers on the other (U-hold). Keep your hand clear of the areola. Guide your nipple so that it tickles baby’s nose and lower lip. His rooting reflex kicks in and he will open his mouth, bring him onto the breast. Aim the nipple at the roof of the mouth and make sure that he takes a big mouthful of breast tissue (including the nipple and areola).
Check the Latch: Your breast releases milk when the areola is fully inside baby’s mouth, forming a teat which he compresses with his palate and his tongue in order to draw out the milk. It is important to check that the areola is inside baby’s mouth and on top of baby’s tongue. See that baby’s lips are turned outward and his lower lip covers the base of the areola. If the latch is imperfect, do not pull your nipple out of baby’s mouth. Instead, break free by inserting your finger at the corner of the mouth between the gums to break the suction and by gently pressing down his chin so that he opens his mouth and release your nipple. If baby’s mouth is not opening wide enough after the latch, gently press down baby’s chin with your thumb to get his mouth open wide.
Check Baby’s Position: When a baby has latched on, his head falls back a little such that his chin is touching your breast and his nose is free for breathing.
How to unlatch: To break contact, do not pull your nipple free, either press down gently on his chin, or insert a finger at the corner of his mouth between his gums to break the suction. Then remove your nipple gently.
Check Baby’s Suckling: You should feel the tugging or compression on the areola and not the nipple. If he’s sucking, you should be able to see his jaw moving in a rhythmic motion and his ears may wiggle too. Your nipple should not be feeling painful. There should be only some suckling vacuuming pressure. With older babies, you can clearly hear them swallowing. Your should not be hearing a clicking noise and baby’s cheeks should be rounded and not drawn in – this would mean that baby’s tongue is positioned wrongly.
Appearance of Nipple after Feeding: The nipple should appear round and should not be flattened or creased if baby has latched well on the breast.
Nipple Care: After each feed, use your hand to manually express a little milk, rub it on your nipple and air dry to soothe the nipple and prevent it from drying and cracking. There is no need to use soap or water to wash.
Important note: A poorly attached baby may suckle often but not be satisfied and will not put on weight well. The mother may be misled into thinking that she does not have enough milk and may supplement with formula. Some mothers are told that they do not have enough milk when, in fact, their babies are not properly latched on and so cannot draw out the available milk efficiently. Thus, it’s important to check that baby has taken the areola into his mouth and he is making the appropriate sucking movements. Good attachment also minimizes problems like sore and cracked nipples, which can lead to engorgement and insufficient milk supply. (pg 49-54)
Other signs of let-down: uterine cramps the first few days after delivery; sensations of let-down; leakage of milk from the opposite breast during breastfeeding; the breast feeling full before and soft after feeding; or the appearance of milk in or around the baby's mouth after feeding.

(4.9) Correct Positioning

It is crucial to the successful emptying of the breast, leading to the continued production of the milk. If your baby us not positioned properly, your breast will not empty properly.
Craddle Hold: This is the commonly used position for good-sized babies and mothers with normal nipples. It is done in a sitting position. Elevate your feet a little with a footstool. First, sit comfortably, using cushion to support your arm holding baby if necessary. Then place your baby length-wise facing you chest-to-chest. Support your baby at your breast level. Cradle his head near the crook of your arm and support his back with your forearm. Support his buttocks or upper thigh with another pillow and then start to stimulate his rooting reflex with your nipple. Support and offer your breast with your other hand. Always bring the baby to your breast and not the other way round. Once your baby is suckling properly, release your hand. It is not necessary to hold onto your breast all the time while your baby is suckling. Your shoulder and arm should be relaxed.
Cross-cradle Position: This position is ideal during the newborn period, or for small or premature baby, as well as mothers with short nipples. Get into a comfortable sitting position; put a pillow on your lap to help elevate a small baby. Using the hand opposite the breast you intend to feed from, support baby’s buttocks with your forearm and the lower part of his head and neck with your hand. Use your other hand to guide your breast towards baby’s mouth. Remember to hold the baby at breast level with his face and body turned towards you.
Football/Clutch Hold Position: This is done in a sitting position. But the baby is at your side instead of in front. This position is ideal for women breastfeeding twins – one baby at each breast. It is also recommended for women who find it uncomfortable to have a weight bearing down upon their Caesarean incision or who have short nipples. Begin by supporting your back with a pillow. Position two more pillows at your side to support your baby and your arm. With your forearm at baby’s buttocks and your hand supporting the lower part of his head and neck, tuck baby under your arm so that his head is at your breast and his legs are behind you.
Side-Lying Position: This is a good way to feed after a Caesarean operation and at night. Lie on your side with a pillow under your head and another pillow behind your back and one more between your bent knees. The baby lies on his side facing you. He is not flat on his back with his head turned towards your breast. A rolled blanket behind baby’s back will keep him on his side. If baby is new to breastfeeding, check his latch. Make sure that his head is tilted such that his chin is touching your breast and his nose is unobstructed. (pg 57-59)
Lying On Your Back: Use this method only if the let-down is too rapid as your baby may be unable to coordinate suckling and swallowing. Lie on your back with pillows under your head, or sit. Then place your baby with his face towards your breast, his mouth opposite your nipple and his body across your chest and tummy. Then support his head with your hand and his body with your arm, to feed him. (pg 32)

(4.10) How to Increase Your Milk Supply

Increase the Number of Feeds: Breast milk production is best enhanced by putting your baby to your breast at regular frequent intervals, can be up to every 2-3 hourly in the early day. “The more baby sucks, the more milk you will produce.” Once your baby is attached and positioned correctly, the prolactin (milk-producing hormones) and oxytocin are produced automatically in response to your baby’s suckling. Breastfeeding at night yields the greatest volume, as the prolactin level is released at its greatest in response to your baby’s suckling. Milk production in the first 3 months is influenced by endocrine (prolactin hormone). After 3 months, the production is influenced by emptying of the breasts (autocrine process). The storage capacity also affects milk production. For example, 22ml per breast per hour if the breast is not completely drained. When the breast is completely drained, you have 56ml per breast per hour. Always allow your baby to finish the first breast in his own time (25-35 minutes) before changing to the other breast. Offer both breasts at each feed so that demand is high and therefore, supply kicks in. You milk supply does not increase as your body produces only upon demand.
Correct Positioning and Latching: If your baby is positioned awkwardly (not put directly opposite the nipple etc) or if you are in an uncomfortable position, the feeding session is not likely to be a successful one, which in turn results in a breast that is still full. Your milk supply does not increase as your body produces only upon demand.
Top-up Feeds and Expressed Milk Feeds: After a full feed, give your baby a shorter top-up feed for about half an hour or slightly less. The amount of milk produced during this period should satisfy the baby and encourage a build-up in supply. If your baby refuses the top-up feed, express the breast milk by hand or by pump. Stimulate the breasts to produce more milk. Massaging the breasts also helps the milk to flow. As the milk has been expressed and the breasts emptied, it sends a message to your body that there is a demand for more milk.
Balanced Nutrition and Rest: A well-balanced diet plus 8-10 glasses of liquids a day does help to improve the quality of milk. Relaxation is ideal for the let-down reflex to work. Prior to and/or during feeds, engage in some breathing exercises, have a warm bath and always massage your breasts to further encourage milk flow.
Prescription Drugs: Only to be prescribed by a medical practitioner. (pg 33-34)

(4.12) Gastro-Oesophageal Reflux

50% of 2-month-old babies regurgitate twice a day.
Reflux improves from about 5-7 months of age and is usually resolved by 12 months.
Signs and Symptoms: Vomiting (occurs more frequently within the first hour after feeding); Sleep disturbances (waking up frequently at night or screaming after being laid down following a feed); Respiratory symptoms (including choking, coughing and constant sniffles); Crying and irritable all the time while being fed or after feeding; Back arching and neck extension; Feeding difficulties, frequent demand for feeding or overt breast refusal; Windy baby; Failure to thrive due to calorie loss.
Treatment: Change the feeding posture; Put a pillow on the changing mat and roll your baby over to change; Carry your baby in a sling or place him in a stroller, with the baby’s head raised; Raise the head of cot 20-40 degrees for half an hour to avoid downward pressure on the abdomen, which can worsen the reflux; Carry your baby over the shoulder for half an hour before bed time.
Feeding: Sit in a more upright position; Sit on your lap or cuddle into the side of a sofa; Give small frequent feeds on one side; If required, top up within the hour, from the same breast; Feed your baby while he is sleepy, if he refuses your breast; Medication prescribed by doctor; Surgical intervention is rare. (pg 36-37)

(4.13) Breastfeeding Colic

Colic is severe abdominal pain. Baby’s cry is high pitched like a scream, his face is flushed and his legs are drawn up. The crying can last for a few hours. It usually occurs around a specific time of the day, like the evening. It starts when the baby is 2-3 weeks old and disappears when the baby reaches around 3 months old. Colic is more common in bottle-fed babies, but can happen to breastfed infants too.
Doctor may prescribe colic drops for the baby before feeding.
Massage his stomach in a clockwise direction when he is awake, but not when he is crying or sleeping.
Cuddle him and put pressure on his tummy to ease his pain. (pg 103)
Cause: Mothers tend to switch their babies from one breast to another without letting them finish one side properly first. This results in babies getting very few calories as they have yet to feed on the hind milk, which is fat content. So when your baby takes in a lot of fore milk without the hind milk, he tends to throw up or vomit. His stools may be greenish, gassy, expulsive and extremely watery.
Solution: Allow baby to feed on one breast before offering him the other breast. Babies do know when they have had enough. Should your baby refuse your other breast, you can express the milk and add it to your milk bank.
Another reason: He may be getting too much milk too quickly. Known as the overactive letdown reflex, baby swallows more air and may cough, choke and struggle at the breast. Some may even refuse to suckle.
Solution: Try to carry him more upright and, if possible, stem the flow of milk with a cold towel at short intervals while feeding him. (pg 37-38)

(4.14) Supplementary or Complementary Feeds

These are feeds of formula, cow’s milk or glucose water given before the mother’s milk ‘comes in’. It is now known that complementary feeds are not necessary. They can make your baby fussy and interfere with breastfeeding later. He becomes frustrated on the breast, as the flow from the breast is little in the first three days. Even as few as two complementary feeds a day can cause breastfeeding failure.
Colostrum is all that a normal baby needs at that time. A newborn has enough reserves to see him through the first 3-4 days of life.
If there are medical reasons, give supplements only via a cup, spoon or syringe, or use a lactation supplementor. The first choice of supplementation is mother’s colostrum or milk.
A normal baby is born with a store of water that keeps him well hydrated until the milk comes in. He does not need drinks of water or glucose water, and they interfere with breastfeeding. A baby does not need extra water even in hot weather.
Under such climatic conditions, breast milk takes on a different quality to compensate for and quench your baby’s thirst.
Water may be given when your baby is older and sweats more. The best way to find out whether your baby has sufficient fluid is to monitor his urine. He has sufficient hydration if he urinates 6-8 times a day. (pg 38-39)

(4.15) Getting to Know Your Baby's Feeding Patterns

Barracudas – Prompt grasp, vigorous sucking for 10-20 minutes. They usually become less eager as time goes on. It hurts at first but will pass.
Excited Ineffectives - become frantic at the sight of breast. They grasp it, lose it, and start screaming in frustration. They must be calmed down several times during each feeding. Feed him as soon as he wakes up. If the milk tends to spray from breast as the baby struggles, it may help to manually express a few drops first to slow the stream.
Procrastinators - can't be bothered with nursing until the milk supply increases. These babies should not be given bottles of water or formula. You should continue to put them to nurse at the breast. For a baby who resists nursing for the first few days, you can use an electric pump between feedings to stimulate milk production.
Gourmets or Mouthers - insist on playing with the nipple, tasting the milk first and smacking their lips before digging in. If hurried or prodded, they become furious and scream in protest. The best solution is tolerance. After a few minutes of playing, they do settle down and nurse well.
Buffet or Restlers - prefer to nurse for a few minutes, rest a few minutes, and resume nursing. Some fall asleep on the breast, nap for half an hour or so, and then awaken ready for dessert. These babies cannot be hurried. It’s best just to schedule extra time for feedings and remain as flexible as possible. (pg 114-115)

(4.16) Caring for Your Breasts

(A) Sore Nipples: Due to incorrect latching; Incorrect removal of nipple after feeding; Incorrect pumping; Teething babies

Feed on the less sore nipple first.
Do not allow the baby to use your nipple as a pacifier.
When he has finished drinking, unlatch him gently.
Sometimes, changing position, like using the football hold instead of the cradle hold, can ease the pressure on your nipple.
Apply breastmilk generously on the nipple after feeds and air dry.
You can apply up to 5 layers of breastmilk to soothe and promote healing of the nipple. (pg 70-71)
During your bath or shower, wash your breasts only with water, not soap.
Creams, lotions, and more vigorous rubbing actually may aggravate the problem.
Edible breastfeeding cream can be used to avoid too much cleaning of the breasts.
In humid climates, the best treatments for cracked nipples are sunlight, heat, and keeping the area dry.
Breast shells are useful in helping to prevent your clothing from causing friction against your sore nipples.
Don't wear plastic breast shields or plastic-lines nursing pads, which hold in moisture; instead, expose your breasts to the air as much as possible.
Wear nipple shields as a last resort can temporarily help you nurse your baby without causing further pain and discomfort to your nipples.
In a dry climate, you might want to apply purified hypoallergenic lanolin.
In severe cases, express milk for 1-2 days until nipples have healed, or if you cannot tolerate the idea of feeding directly. (pg 41)
When using an electric pump, use the lower suction strength. You can gradually increase the suction strength after your nipples become more accustomed. There should not be pain in your nipples during or after expressing. If there is pain, stop the machine and re-position your nipple such that it is clear of the sides of the breast shield. Check that the breast shields are the correct size – neither too big nor too small.
If your nipples are sore, switch to using manual expressing, which is gentler on your nipples.

(B) Cracked or Bleeding Nipples: Cracked nipples are dry and may bleed. This tends too affect mothers who have short, flat or inverted nipples. It is caused by improper latching or removal of the nipple too hastily from the baby’s mouth.

Apply breastmilk or nipple cream after each feed.
For the next feeding session, put baby on the less sore nipple first and change feeding positions.
Keep the feeds short.
Manually express milk for a day or two to ‘rest’ your nipple if it is bleeding or too painful for baby to latch on. You need to express to maintain milk supply.
You may want to wear breast shells in your bra to keep the fabric from rubbing your nipples.
Alternatively, you can use hydrogel dressing to soothe and promote healing. (pg 72)

(C) Engorgement: Breasts are swollen, hard and painful. It is a common problem which usually occurs 3-5 days after delivery, but you should not accept it as a normal effect of breastfeeding. It is caused by increased blood and milk supply, delay in breastfeeding, infrequent feeding or improper latching.

It can be prevented by good and regular milk drainage. In other words, feed, feed and feed your baby.
Rest more often.
If milk is leaking, relieve engorgement by massaging the breasts using small circular movements; start from the perimeter of the breast towards the nipple. Then, press down and stroke towards the nipple. Clasping the edge of the areola gently between the thumb and your fingers, press your breast inwards towards your chest. Express a little milk out to relieve the tension around the areola. This will soften the breast and enable the baby to latch better on the breast.
If the breast is hard and painful, and milk is not leaking, you can soothe it and reduce swelling by applying chilled cabbage leave (10 minutes in the freezer) or cold packs on the affected breast for about 30-60 minutes. Avoid applying cabbage on the nipple and areola. When the breast softens, massage and feed baby. Change the cabbage leaves every 2 hours or when they become limp. The enzymes in cabbage suppress milk production, so do not apply too often. (pg 72-73)
Taking a warm shower usually increases vascularity, thus enhancing milk flow. (pg 43)
Having a breast massage and manual expression of milk before feeding, softens the areola and helps your baby latch on more smoothly, resulting in successful emptying of the breasts and preventing the onset of engorgement.
Some mothers find that the Johannesburg salute (a form of chest and breast exercise) can be useful as a preventive measure.
An electrical or manual pump may also be used to reduce the congestion.

(D) Plugged Ducts: This happens when there is an interruption in the breastfeeding routine, for example, when you skip a few feeds, or you fail to express milk regularly. Even tiredness and stress can cause blocked ducts. It can happen at any stage of breastfeeding, whether in the first few weeks or even 6 months later. A blocked duct manifests as tenderness on an area of your breast. You can even feel a lump there. Milk flow is poor even though your breasts feel full.

Give your breast a thorough massage to clear milk stasis.
On the lump or sore area, press down with your fingers onto your chest and massage the lump with circular motions. Then, while still maintaining pressure, push towards your nipple to drain milk along the milk ducts.
Feed the baby more regularly during this period or express.
Avoid wearing tight bra or under-wired bra.
Avoid putting pressure on one spot for long periods.
Avoid skipping of feeds, which can also lead to incomplete drainage.
Make sure that you are not suffering from fatigue while trying to unblock or ‘milk’ the plugged duct.
If left untreated, blockage will adversely affect your milk supply and may even become infected.

(E) Mastitis: This happens when a blocked duct becomes infected. There are 2 types of mastitis. Non-infectious mastitis shows as redness, swelling and a feeling of heat on the affected area of the breast. Infectious mastitis is caused by bacteria; the woman will develop fever, flu-like symptoms, body chills and aches.

Mastitis comes on suddenly, usually after 10 days into postpartum.
Keep the affected breast as empty as possible by frequent feeding on the affected side first, but not ‘neglecting’ the other breast.
Treat mastitis like you would with blocked ducts – massage the breast, press down on the plug and massage, then drain towards the nipple.
Feed baby frequently.
If you massage but fail to relieve the blockage or clear the lump in 12 hours, it is good to consult a Lactation Consultant; she will be able to help you massage more effectively.
In cases of fever, the mothers should see a doctor and be prescribed breastfeeding-friendly antibiotics. Some doctors may suggest that you stop breastfeeding, but there is no need to stop, so inform him of your desire to continue. Take prescribed painkillers and a good rest.
Rest and plenty of fluids are key to treating mastitis.
Continue to feed baby or express to relieve engorgement and prevent further blockage.
Change feeding positions to let gravity help empty the breast. For example, if the blockage is on the armpit side of the left breast, lie on the right side and lean over to feed the baby from the left breast.
Apply moist warm heat to the affected area before a feed.
Have cold packs or washed and chilled cabbage leaves applied to the breast after each feed to relieve the pain. These may be changed every 2 hours or when they turn limp.
Remember that this is not the time to wean. (pg 45)

(F) Recurrent Mastitis

This can occur if you delay treatment to the original mastitis. But other reasons for this condition include inadequate treatment, an underlying breast disease, cysts, tumuors, chronic bacterial infection and fungal infection (candida). (pg 45)

(G) Candida Mastitis: The woman experiences a burning or throbbing pain along the milk duct system during and after feeding. Sometimes, the pain radiates from the nipple to the shoulder. The nipple itself may look normal or pinkish. Baby’s mouth may be infected with white patches. It is caused by the microorganism Candida Albicans.

It is a fungal infection with predisposing factors that include previous use of antibiotics, vaginal candidiasis and oral candidiasis in infants, as an infection occurring at one site affects the other as well.
Consult the doctor. He can prescribe anti-fungal gel to be applied on the mother’s nipple and in baby’s mouth. Apply the gel after feeding. For more severe cases, the doctor may prescribe oral medication for the mother.
Continue to breastfeed.
Rinse and air-dry your nipples after each feed.
The diapered area of the baby is also treated if infected.
You may also be advised to wash all clothing that is in contact with the baby, in hot water. (pg 46)

(H) Breast Abscess: Infectious mastitis may lead to an abscess. The breast is hard, red and painful. The woman experiences fever and flu-like symptoms. The lump may be so painful that she cannot even massage it. In this case, she should see a doctor.

It is a pus-filled cavity surrounded by inflamed tissue. This is a complication of mastitis resulting from delayed or inadequate treatment.
To treat this condition, complete emptying of breasts frequently.
Aspiration with a needle or incision at the area of congestion can be attempted to drain the breasts.
Continued breastfeeding is advised unless the milk is purulent.
If the breast is too painful for you to feed baby, hand express to relieve engorgement and take prescribed painkillers. You can continue feeding the baby on the unaffected breast.
Be sure to rest well and take plenty of fluids.
When the breast is better, you can resume feeding to build up the supply again. It usually lasts only a few days.

(I) Galactocoele

It is known as milk-retention cysts that may be caused by the blockage of ducts.
This condition presents itself as a smooth round lump.
It can be accurately diagnosed by ultrasound and the treatment is to aspirate or excise the actual cyst.
The milk first flows as pure milk, followed by a thick, creamy cheesy and oily version.
This is due to the absorption of fluid in it.
There is no need to stop breastfeeding. (pg 44)

(J) White Bleb on the Nipple: This shows as a white dot on the nipple caused by a plug of thickened milk under the skin. Some women feel pain but others do not.

Ensure that your current breastfeeding position is correct. Trying different positions in breastfeeding may not solve the problem.
If it does not hurt, there is no need to intervene, but monitor that it does not hamper milk flow. If milk flow is poor, it may lead to blocked ducts.
For painful milk blister, do not attempt to burst it using your fingernail. Bacteria under your nails may cause infection. Instead, sterilize a needle and prick the blister superficially through the skin. Then drain.
If you find it difficult to accomplish this by yourself, you can consult a Lactation Consultant. GPs generally do not perform this function.
You may let your baby unblock it by his suckling.
Blebs may reappear and you have to have them reopened. Always keep the open site clean, to avoid infection.

(K) Blanching of the Nipple

It is due to circulatory problems.
Check your baby’s position as trauma may also be a cause.
Remedies include feeding in a warmer room and drinking a small cup of hot tea (which contains vasodilator theophyline) before a feed. (pg 45)

(L) Eczema of the Nipple and Areola

The affected area becomes red, sore and dry, with a burning sensation and flaky rash.
For this condition, remove the irritant causing it. Avoid using soap, ointment, nipple shields or breast pads, and treat the eczema with a mild steroid cream.
There is no need to stop breastfeeding. (pg 46)

(M) Breast Rejection

Some babies in the first few weeks of life, and at 3-4 months, may suddenly reject the breast for several feedings – for a day or more.
Contributing factors for this condition of the newborn include drugs given during labor that now affect your baby, the type of delivery, poor coordination, preference for one breast, learning to prefer the bottle, feeling the effects of illnesses such as earache, nasal block and exhaustion. It is possible too that an older baby who has been breastfed for a while may suddenly reject the breast too as he is teething and has no inclination to nurse.
On the mother’s side, poor positioning, incorrect latching, breast infection, fast milk flow, slow let-down, the effects of an illness, maternal smells due to dietary indiscretion or using soap and perfume, the return of menstruation, oral contraception and even a new pregnancy, are factors that can lead to your baby rejecting the breast. Common causes of inadequate milk also result from inadequate sleep, tending to family needs, your job and social demands.
To manage this, pin the cause down and treat it accordingly. Alternate feeding positions to try and fool your baby into accepting a breast.
Adopt proper breastfeeding techniques, positioning and latching.
Provide a more conducive environment such as a darkened room, rest well, avoid wearing perfumes and, if necessary, resort to cup, spoon, syringe or bottle-feeding during this period (especially if both your breasts are rejected by your baby), as a temporary treatment. (pg 46-47)

(N) Biting

Biting is another aspect of refusing the breast. It is not unusual for 8-10 month old babies to bite but this condition is usually temporary.
Cutting their first tooth between 6-8 months can lead to irritability and tender gums.
The baby finds that rubbing and chewing his gums reduce pain. Offer him alternatives like a cold teething ring or teething gel.
If your baby has only been breastfed for less than 6 months before this condition occurs, it is advisable to persist in breastfeeding him.
If your biting baby is older than 6 months, weaning can be considered to solve the problem as a last resort.
Most biting is done before the milk starts to flow or after the bulk of the feed has been taken. Once successful tip for mothers is to watch your baby as he feeds, for that ‘I’m about to bite’ look in his eyes. When you see that, break suction as soon as your baby has finished sucking effectively.
Alternatively, take him off your breast when he bites and say ‘No’ firmly.
Try to stimulate a let-down, before putting your baby to the breast.
Sing, rock or dance to distract and entertain him while waiting for a slow let-down.
Provide babies of 6 months and older with firm foods or toys for chewing.
Treat bitten nipples the same way as sore nipples. (pg 47-48)

(4.17) Weaning Off the Breast Process

First, omit the least favored feed of the day and replaced it with something else such as drink, a story or a game.
Do not offer your breast if your baby has forgotten about it, but do not refuse him if he insists and tugs at you.
Do consider the age of your baby before you wean him off totally.
It is also a good idea to set specific rules at feeding times, such as only offering one breast during each feed.
Offer alternative fluids and foods that please his eyes.
Avoid strongly flavored foods.
Try to wean your baby directly to a cup, so you can skip the stage of having to wean him again from bottle.
Effects of Weaning Off the Breast: Weaning gradually decreases the risk of engorgement, blocked ducts and mastitis.
Slow weaning allows the adipose tissue to replace milk-producing tissue over a longer period.
Watch out for signs of breast duct infection, and express milk for comfort only if you have to.
Use cold packs and cabbage leaves on your breasts to ease any discomfort.
It is normal for milk to persist in the breast for months or even years after weaning it.
It may also take some time for the breasts to take on their mature, post-pregnancy proportions.
It is important to note that some mothers may experience regret or negative feelings, even after planned weaning. (pg 48)

(4.18) Breastfeeding and Child Spacing

In most breastfeeding women, menstruation returns before conception takes place again. But there have been cases of women who ovulate and conceive, before they start to menstruate again.
Before the baby is 6 months, fewer than 2% of mothers who breastfeed are likely to conceive before they menstruate.
After the age of 6 months, 10-15% of women may conceive before they menstruate. Therefore, some form of family planning is necessary as a new pregnancy too soon may change the milk quality and deplete the mother’s energy reserves.
This form of family planning is known as the Lactational Amenorrhea Method or LAM. For LAM to work successfully, a woman who wishes to use breastfeeding for child spacing should breastfeed exclusively or almost exclusively for the first 6 months. She should also breastfeed frequently, with no long intervals in between. She should breastfeed her baby on demand during night and day, from 8-10 times in each 24-hour period, and no more than 6 hours between feeds.
It is important to note that LAM is only effective before a mother’s period returns, and before she gives the baby supplements. If her period arrives or if she gives regular supplements to her baby, another form of family planning has to be practiced. (pg 14-15)

(4.19) Tandem Feeding

It refers to the breastfeeding of both a newborn and his sibling.
The newborn needs should be met first, and that sore nipples may result from breastfeeding your older child throughout your pregnancy.
Explain the concept of waiting to older toddler. Help older children understand the needs of the baby.
Breastfeeding can lead to uterine contraction while feeding the older child. If this is the case, you should cease breastfeeding as there is the risk of miscarriage.
It is important to maintain normal hygiene, have regular baths, and change to clean breast pads every 3-4 hours. It is also important to have clean clothing.
If the toddler is having solids, ensure that his mouth is clean, as particles of food in the mouth while suckling on the breasts, can reflux back and lead to blockage of the duct.
If the older child is ill, limit one breast to each child to avoid cross-infection like thrush. (pg 48-49)

(4.20) Herper Simplex Infection

Any lesion on the breast should be taken to be infectious for the initial five days. The baby is at risk from the infection if he is fed directly from the breast, so milk should be expressed to maintained lactation, and fed to the baby after a time lapse (with a spoon, a cup or a syringe).
If you have the infection before the lesion developed, the milk contains the viral antibodies. Keep it for a few hours before feeding so that the amount of virus in the milk can decrease due to milk’s antiviral properties.
If the lesion is not on the breast and the baby does not come into contact with it, breastfeeding can continue. The mother should wash her hands carefully before feeding.
There are 2 types: HS I (cold sore) and HS II (genital herpes). Herpes Simplex is caused by contact with sores, and can be serious in newborns up to four weeks of age.
Breastfeeding can continue if the mother develops a sore, but any sore must be covered up to avoid coming into contact with the baby.
If the sore is on the nipples or areola, express until the sore has dried.
If your hands or pumps touch the sores, the milk expressed should be discarded.
Until the sores are dry, and if you have touched them, it is important to remember to wash your hands thoroughly before holding your baby.
Cover sores with clean dressing or covering and avoid kissing when there is a cold sore around the mouth. (pg 49)

(4.21) Types of Jaundice

First 24-hour (Pathological Jaundice): After birth, a baby gets jaundice when there is a rapid breakdown of his red blood cells as his liver is not mature enough to break down the excessive bilirubin.
Starting on the 2nd-5th day after birth (Physiologic Jaundice): More than 50% of newborns may develop jaundice, due to a rise in the blood level of bilirubin. Bilirubin us initially fat-soluable (indirect bilirubin). This is usually present in optimally breastfed infants as well as artificially fed infants. This condition usually lasts 10 days.
Your baby should be observed and monitored by a pediatrician. Frequent passage of meconium is crucial in preventing deconjugation and reabsorption of bilirubin from the gut into the serum. Breastfeed frequently. Ensure good latching and positioning. Increase the baby’s stooling. The compression technique may be tried when your baby is sleepy, with breast massage, to increase milk volume. If stooling is fewer than 3-4 times a day, or nursing is not active, expressed breast milk is to be used as supplementary feeds. It also helps to increase milk production.
After 5th day (late onset or Breast Milk Jaundice): This affects less than 4% of all breastfed babies. It is prolonged physiologic jaundice that can last up to 2-3 months, with the serum of unconjugated bilirubin lasting up to 4 months. This condition peaks around 10 days, to more than 14 days. It peaks from the 7th-10th day, when colostrum is taken over by mature milk. It is normal, and there is no need to stop breastfeeding. If the jaundice becomes very severe, doctors usually issue a 24-hour breastfeeding stoppage, and have baby fed on infant formula. The mother should continue to express her milk to prevent engorgement and to maintain a regular flow and volume of milk.
Prevention of Jaundice: Avoid jaundice-producing drugs and exposure to chemicals during pregnancy, labor and delivery. Nurse soon after birth and frequently thereafter. Expose the baby’s skin to sufficient sunlight daily (applies only to temperate countries in winter). In tropical countries, expose baby to indirect sunlight for 20 minutes or so.

(4.22) Food that Promotes Lactation

(A) Green Papaya and Fish Bone Soup

The bones of ngoh he (Threadfin fish). Buy about 500g
A medium sized green papaya (it must be green, because the sap is the key to promoting lactation). Ger the large Hong Kong or Malaysian variety, not the small Hawaiian type. Remove the skin and seeds of the papaya. Cut into chunks.
Ginger (2 slices)
Red dates (10, optional)

Method:

Boil a medium-sized pot of water.
Add the ginger to reduce the fishy smell.
Add the fish and boil for half an hour.
Add papaya to the soup and boil for 15 minutes only. Do not over-boil.
Drink the soup. There is no need to eat the ingredients.
You can add the red dates for additional sweetness. Traditional Chinese medicine practitioners believe that red dates provide ‘heatiness’ which balances the ‘cooling’ effects of the green papaya.

(B) Pork Ribs with Black Beans Soup

Pork ribs (500g)
Black beans (1 cup), soak for few hours
Peanuts (1 cup, optional), soak for few hours
Salt

Method:

Boil medium-sized pot of water.
Put the pork rubs in to boil for half an hour.
Add the black beans and peanuts. Boil until the beans, nuts and meat are soft.
Add salt to taste.
You can drink this as a soup as often as you like. This recipe is not as fast acting as Green Papaya and Fish soup, but it provides variety. Black beans and peanuts are also a good source of protein.

(C) Banana Smoothie

1 ripe banana, cut into small pieces
1 cup of milk for breastfeeding mothers (200ml)
Sugar (1 teaspoon)

Method:

Put banana, milk and sugar into blender and blend for 30 seconds.
Add ice and it is ready to drink.

(D) Steamed Tofu with Egg and Minced Chicken

Soft tofu (1 block)
1 egg
Minced chicken (200g)
Salt/soya sauce (optional)

Method:

Mash tofu into fine pieces
Beat the egg
Mix tofu, egg and minced chicken together in a microwaveable bowl.
Add salt or soya sauce for taste.
Steam for 10-15 minutes. Or microwave for 10 minutes.
Serve hot. This recipe is delicious and rich in protein. Protein is good for promoting lactation.

Fenugreek – Boil a pot of water in the morning and add two tablespoons of fenugreek granules. Drink the fenugreek brew as much and as often as you like. Alternatively, you can get fenugreek in tablet form from pharmacies. Take according to instructions.

Benedictine D.O.M. – Plan to take it after your baby’s night feed and omit feeding the baby in the first 2 hours thereafter. (pg 112-116)

(4.23) Weaning Completely

In many cases, babies wean themselves naturally, i.e. they lose interest in the breast. Take this as your cue to cut down breastfeeding. Weaning should always be done gradually. This prevents problems of engorgement in mother’s breasts and also minimizes baby’s unhappiness. Plan ahead and reduce feeds slowly, starting with day feeds. Night feeds are a bit harder to eliminate, as baby loves that time of coziness at the breast before she drifts off to sleep; so leave this to the last.

Sophieticated

Pages

Tuesday, October 20, 2015

4.0 - Breastfeeding

No comments:

Post a Comment