NEWBORN/CHILD

The Art of Breastfeeding
by Vinaya Gavini, M.D., F.A.A.P.

Why Breastfeeding?

Breastfeeding has important advantages to both the mother and the baby.
Breastfeeding can provide the best nutrients and immune support available to
your child from the beginning. A statement from the American Academy of
Pediatrics regarding breastfeeding:
"Human milk is the preferred feeding for all infants, including
premature and sick newborns...It is recommended that breastfeeding
continue for at least the first 12 months, and thereafter for as long as
mutually desired."

American Academy of Pediatrics

Over half of all infants are being breastfed today, according to the National
Immunization Survey conducted in 2001. The U.S. General Surgeon also
recommends Breastfeeding for the first 12 months of life.
Advantages for your Child

Your breast milk has the perfect combination of nutrients for your baby, including
the right amount of fat, sugar, water, proteins, hormones, enzymes and protective
antibodies. Breast milk is considered a living tissue protecting your baby against
allergies and diseases. Breast milk changes to suit your baby’s needs. Your
baby’s immune system is also strengthened by breast milk. The Mother passes
special cells to the baby, called white cells, which coat the baby’s intestines
preventing harmful bacteria entering the baby’s bloodstream. Breast milk
actually contains antibodies to fight bacteria, fungus and viral illnesses. Studies
show breastfed babies to have a lower incidence of allergies, eczema, colic, gas,
gastroenteritis, meningitis, diabetes, Crohn’s disease, celiac disease, speech
problems, cataracts, increased cholesterol, dental problems, childhood cancer,
pulmonary disease and more. Formula fed infants are sixteen times more prone
to illness in the first two months of life. Breastfeeding has also shown to increase
IQ scores by 8 points higher than formula fed babies. Additionally, breastfeeding
is clean, less expensive and convenient. Finally, breastfeeding provides important
closeness and bonding which helps children to develop trust.

Advantages for the Breastfeeding Mother

Breastfeeding has multiple advantages for the baby and Mother. First there are
short-term benefits. Right after birth, when the baby suckles the breast, a
chemical called oxytocin is released, which causes the uterus of the mother to
contract helping it to shrink in size. This chemical also helps to prevent
hemorrhage or excessive bleeding. Breastfeeding burns calories, thus helping the
mother get back to her pre-pregnancy weight. Also, there is a delay in the return
of menstrual cycles, which helps to decrease the chance of iron deficiency anemia
and provide some contraception. Women who are bottle feeding their babies
typically get their periods in six to eight weeks. However, women who are
breastfeeding may not get menses until 6 months after the birth of their baby.
Additionally, there are important long term benefits to breastfeeding also. The
breastfeeding mother has a decreased risk of developing uterine cancer, breast
cancer, ovarian cancer, heart disease and osteoporosis. An article in the New
England Journal of Medicine estimates that breastfeeding for a total of 6 to 24
months in a woman’s reproductive years lowers the risk of breast cancer by 11-
25%. Along with these health benefits of breastfeeding are also emotional
benefits. Breastfeeding provides a unique closeness of the infant and mother for
bonding. The hormone prolactin, produced when breastfeeding, produces
calmness in both the mother and child. Finally, there is a financial and practical
benefit to breastfeeding too. The breastfeeding mother never has to mix and
measure formula. Formula can be very expensive and time consuming, whereas
breast milk is always available and at the right temperature.

Starting Out Right

Breastfeeding is very natural, but babies do need to be taught how to do it. Some
babies seem to get the hang of it very quickly, while others need more practice.
The more you know about breastfeeding, the greater likelihood of success.
Reference books are always good to have on hand. The one we recommend is
The Womanly Art of Breastfeeding. There are also support groups and classes,
including the La Leche League. For information or meetings call 1-800-
LALECHE. Many doctor’s offices and hospitals offer classes. Each baby is
different, and each nursing experience is unique.

Basic Guidelines for Getting Started

Start Early - Babies have a sucking reflex, which is instinctive and is strongest at
birth. Also, babies are the most alert the first hour after birth. Your milk will not
be in this early, but practice for the baby while the breast is soft and easier to
grasp is important.

Feed Often – Babies will usually give cues when they are hungry, and in time
you will learn your baby’s cues. Newborns typically nurse 8-12 times a day. The
more you nurse, the sooner your milk comes in. Newborns tend to be sleepy and
you may even have to wake them up to feed. During the day you should offer the
breast every 2-3 hours, and at night every 4 hours for newborns. Once they can
hold more milk as they grow, they only need to breastfeed 6-8 times a day and
may sleep more at night.

Feeding on Demand – Babies can nurse as long as they are interested. Some will
nurse for short periods and others will nurse for longer periods. You should offer
both breasts at each feeding, nursing your baby 10-15 minutes on the first side.
The baby may or may not be interested in the other side. Make sure you switch
the starting side each time. You can remember which side by using a safety pin
or bracelet, and changing it with each feed.

Colostrum – This is a yellow fluid that is produced during the later part of your
pregnancy. This is the perfect first food for your baby, providing him with all his
nutritional needs for the first couple of days; and also providing antibodies and
immune factors to fight infection.

Getting the Right Supplies – Set up a comfortable place for nursing. You will
spend lots of time during the first weeks nursing your baby. Make sure you have
a nursing pillow so the baby is at the level of your breast. This will also help
from straining your neck. A comfortable chair is important so you can relax and
enjoy this special time with your baby. Also, get plenty of diapers, wipes and
burp clothes or cloth diapers for the baby. When you breastfeed it is a good idea
to have a bottle of water or something to drink on hand at all times for you. As a
breastfeeding mother you have increased nutritional needs.

Avoid supplement feeding – Babies can become confused during the early stages
of breastfeeding when artificial nipples are introduced. Also, giving formula can
decrease your milk supply. It takes the baby longer to digest formula than breast
milk. Thus, the baby is less likely to nurse as often as he normally would. The
use of supplemental formula increases the risk of allergies in your baby.

Expect Engorgement – Your milk will come in between the second and sixth
day after the baby’s birth. The baby will be getting colostrum until your milk
comes in. It will take about two weeks for your milk to gradually change from
colostrum into mature milk. When the milk does come in, your breast will
probably get engorged, swollen and hard. This can be very painful at first. The
breasts become very full because of some swollen tissue and additional blood that
has rushed to your breast. Some mothers only notice a small amount of
engorgement, while others notice more. Warm showers and nursing the baby
often will help to relieve this discomfort. Some women also find it helpful to use
warm or cold compresses between feedings, as well as massaging the breasts to
help relieve the hardness.

Taking care of the Breastfeeding Mother – Breastfeeding is a very rewarding
and challenging experience. In order to take good care of your baby, you must
take good care of yourself. Breastfeeding takes a lot of energy from the mother,
so lots of rest is important. Most practitioners recommend that you sleep when
your baby sleeps. Labor is also physically draining. Babies are born with extra
nutrients and breastfeed the first day mostly for comfort. It is natural for a baby
to become fussy on the third and fourth day, as they are hungry. Most women are
sent home from the hospital by the second or third day. It is important to relax
and help your baby learn how to breastfeed so you can both enjoy this experience.
You may need some pain medicine, like Tylenol, to help you to get through the
tough times. Additionally, a good balanced diet is important. Lactation
consultants are available in the hospital and for out patient consultation. If
breastfeeding is hurting, make sure the baby is latching on properly. There are
several good websites that you can visit which are listed at the end of this article.

Getting a Good Breast Pump – First, you must decide if you need a breast
pump. Some mothers do fine without one. However, most women especially
those who are planning to return to work need to invest in a good breast pump.
Also, there are some medical conditions which require the mother to suspend
from breastfeeding. These mothers can pump their milk, and give it to the baby in
a bottle. The situations in which pumping usually is required are: a premature or
sick baby who is unable to nurse, a mother who is going back to work, relief of
engorged or overfull breasts, and/or when mother’s milk supply is low and
requires additional stimulation to increase her supply. There are manual and
electric pumps. Working mothers will need a convenient, efficient and easy to
clean pump. Most working moms prefer an electric double pump due to the speed
of the process. Also, some mothers may want to have a breast pump on hand in
case of emergency or even if they just want an evening without baby. The breast
pump we recommend is Medela, “Pump in Style Advanced Breast Pump.” Please
visit our ecommerce site http://www.breastpumpwarehouse.com for good value
and service.

What to Do with Pumped Milk – Make sure your hands and the container used
to store the milk are clean. Breast milk can be safely stored for up to 24 hours at
60 degrees F (15 degrees C), just below room temperature. Milk can be
refrigerated for up to 8 days. Milk can also be stored in the freezer for 3 months.
If milk is frozen and thawed, it should never be refrozen for storage. You should
thaw the frozen milk under running water and not on the stove or in the
microwave oven, as that takes out the nutrients.

Latching On

First, position yourself and your baby correctly. You should be in a relaxed
position with as many pillows as necessary to prevent from straining your
muscles. If you are sitting up, make sure the baby is at the level of your nipple
and not lying in your lap, so you don’t have to lean forward. The baby should be
on his side with his chest facing you– chest to chest. There are different positions
for holding the baby. You should choose the position you are most comfortable
with. Hold the baby with one arm, and with the free hand offer your breast to
your baby. Your fingers will form a C around your breast, and should be behind
the areola, the darkened skin of the breast around the nipple. Tickle the babies’
lip with your nipple, and he should open his mouth to feed. Bring the bay to you,
instead of you chasing the baby. You may have to offer the breast a few times for
him to become interested. Center your nipple above the babies tongue. His
mouth should be open wide because the baby needs to get a large portion of the
areola and the nipple in his mouth. The babies’ gums should not be on your
nipple, they should be covering the areola. The baby should be pulled close
enough to you, so that the babies chin and tip of his nose touch your breast. Look
for a good sucking technique. There should be a rhythmic motion of his jaw and
you should hear him swallowing the milk. If the bay latches on incorrectly, take
him off and try again. Break the suction by putting your finger in the babies’
mouth on the side and either push on your breast or the babies’ cheek. This takes
practice both for the mother and the baby. Breastfeeding should not be painful.

Holding your Baby during Breastfeeding

It is good to vary the positions of breastfeeding to decrease nipple soreness.
Different positions put pressure in different angles on your breast helping to
prevent soreness.

Cradle – This is the most commonly use this position. The mother should be
sitting in a comfortable chair, in a relaxed position. The baby should be lying on
his side with his chest facing yours. The babies’ head should rest on your forearm
in the crook of your elbow. Your forearm supports his back, and you can hold his
thigh or buttocks in your hand. Use as many pillows as necessary to hold the
baby at the level of your nipple and remain comfortable.

Cross-Cradle – The baby is supported on pillows in the same set up as the
traditional cradle position. However, the baby is resting on pillows and not your
forearm. If you are going to feed on the right breast, your right hand supports the
right breast, and the fingers of your left hand support the babies’ head. You will
place you thumb and index fingers behind the babies’ head, so the head can rest in
the web of your hand. Again, bring the baby to your breast for him to latch on.
This position helps you to manipulate your breast and the baby if it is necessary.
Football Hold – A good position for babies having trouble latching on. Position
your baby at your side with his head resting in your hand and his legs under your
arm. Use pillows to bring the baby up to the level of your nipple. Pull the baby
in to the breast, and make sure he is not kicking the back of the chair. This
position gives a good view for the mother to see what is happening when the baby
latches on. This is also a nice position for mothers who have had a Cesarean
birth, as the baby is away from the incision.

Side Lying – A nice technique to give mom extra comfort. Mom should be
lying on her side with a pillow under her head. The baby should also be lying on
his side with his mouth in line with your nipple and his knees pulled close to your
body. Offer your breast to the baby by supporting the breast with your hand. You
can make a C with your fingers and thumb around the breast. Pull the baby in to
breastfeed. This position takes some practice, but is nice for nighttime feedings.

Nipple Care – Prevention and Healing Tips

The main cause of sore nipples is improper latch on. Breastfeeding should not
hurt. So it is important to work with your baby early on to prevent sore nipples.
Also, let your nipples dry after feedings. If you do have a sore nipple, then try
offering the other side the first few minutes of the feeding. Babies suck the most
vigorous the first few minutes of each feed. Changing positions can also help
with nipple soreness. Wash your breast with warm water daily, avoiding any
soaps or lotions, which can dry the skin. The breast pads you use should not have
any plastic lining, which prevents the breast from drying. If your breasts are
engorged or very large, it may help to express your breast until the milk flows
easily before the baby latches on. Rubbing a few drops of the breast milk into
your nipples after each feed will help to heel sore breast, as human breast milk has
healing properties due to the antibodies in it. Lanolin ointment is a good choice to
treat sore nipples. This ointment retains internal moisture of the breasts while
allowing the surface to dry. This is also safe to the baby, and does not need to be
removed prior to the next feed.

How much do I Breastfeed?

You may breast feed your baby approximately every 2 hours. During the first
month, you can breast feed your baby twice during the night. During the second
month, your baby can breast feed once during the night. If your baby wants to
breastfeed more often than these broad guidelines, it is acceptable as long as you
are not getting overtired in the process. Babies will nurse for both nourishment
and comfort. You can learn to breastfeed just about anywhere with practice. This
makes breastfeeding so convenient. Also, babies do have growth spurts, and may
feed more often during those times. Usually growth spurts do not last more than a
few days. If your baby wants to breast feed constantly you may need to see a
lactation consultant.

Is my Baby Getting Enough Milk?

There are a few medical problems which can prevent a mother from
breastfeeding. Some of those illnesses include serious maternal cardiac or kidney
disease, severe anemia or cancer. There are also some infections which can
prevent a mother from breastfeeding, which include tuberculosis, HIV and AIDS.
Drug abusers can pass their addiction to their babies and should obviously not
breastfeed. Occasionally a mother may have to temporarily suspend
breastfeeding due to an illness or infection. However, usually these mothers can
pump throughout the illness to keep their milk supply at the right level, and
resume feeding when appropriate. In some instances there are medical problems
in the infant that can also cause problems with nursing. However, usually the
mother can pump while the medical problem is treated. Usually infants who are
ill do better with breast milk because of the beneficial effects of the antibodies.
Finally, certain breast surgeries can affect your breast so that it may impair your
ability to breastfeed. Breast enhancement usually does not interfere with
breastfeeding. However, breast reduction usually will hinder your ability to
breast feed, as lactation ducts are removed.

What Medications are acceptable when Breast Feeding?
You can not breast feed while you are taking certain medications. Please contact
your health care provider to get more information.

Vinaya K. Gavini, M.D., F.A.A.P.
8550 N. Silvery Lane, Suite# 101, Dearborn Hts, MI 48127 (Tel: 313-730-7002);
47601 Grand River, Suite#C200, Novi, MI 48374 (Tel: 248-348-4200).

www.yourkidsdoctor.com

References:

La Leche League International. (1997). The Womanly Art of Breastfeeding (6th
ed.). New York: Plume-Penguin Group.
Newcomb, P. et al. Lactation and a reduced risk of postmenopausal breast
cancer. New England Journal of Medicine 1994; 330: 81.
Why Breastfeed? (Parenting Web, 2003)
http://www.parentingweb.com/lounge/whybf.htm
Exclusive Breastfeeding: The Gold Standard (World Alliance for Breastfeeding Action,
2004) http://www.waba.org.my/wbw/wbw04/wbw2004.html
Advantages of Breastfeeding (Breastyfeeding.com, 1998)
http://www.breastfeeding.com/all_about/all_about_more.html
Why Breastfeed? Did You Ever See a Smart Cow? (Breastfeeding Basics, opened
March, 2005) http://www.breastfeedingbasics.com/html/why_breastfeed.shtml
Breastfeeding Positions (Pregnancy info.net, opened March, 2005)
http://www.pregnancy-info.net/breastfeeding_positions.html
When not to Breastfeed (Pregnancy-info.net, opened, March, 2005)
http://www.pregnancy-info.net/when_not_to_breasfeed.html
Breastfeeding Benefits: How they Add Up (Breastfeeding Basics, opened March, 2005)
http://www.breastfeedingbasics.com/html/Benefits.shtml
Breaking the barriers to breastfeeding. Journal of American Dietics Association 2002,
101: 1213.

Breastfeeding – Best for Baby. Best for Mom. (National Women’s Health Information,
June 2004) http://www.4woman.gov/breastfeeding/index.htm
Breastfeeding and the Use of Human Milk (American Academy of Pediatrics, Policy
Statement, Pediatrics vol. 115 no. 2, Feb 2005)
A Well-Kept Secret: Breastfeeding’s Benefits to Mother (La Leche League, New
Beginnings, vol. 18 no. 4, July-August 2001, p. 124-127).
http://www.lalecheleague.org/NB/NBJulAug01p124.html
Breast Feeding: Hints to Help You Get Off to a Good Start (American Academy of
Family Physicians, September 2004) http://familydoctor.org/019.xml
You Can Still Breastfeed (Janes Breastfeeding Resources, opened March, 2005)
http://www.breastfeeding.co.uk/articles/newman21.html
How can I tell if my Newborn baby is getting enough milk? (Breastfeeding
Basics, opened March, 2005)

http://www.breastfeedingbasics.com/html/how_can_i_tell.shtml
When Breastfeeding Doesn’t Work Out (Breastfeeding Basics, opened March,
2005) http://www.breastfeedingbasics.com/html/when_breastfeeding_doesn.shtml
Establishing Your Milk Supply: Staring Out Right (Breastfeeding Basics, opened March,
2005) http://www.breastfeedingbasics.com/html/establishing.shtml
Breast Milk or Formula: Making the Right Choice for Your Baby (U.S. Food and Drug
Administration, FDA Consumer magazine, October 1995, rev. June 1996)