Breastfeeding
Q. When to start breastfeeding?
A. Breastfeeding should begin within the first hour of a baby's life. Even in case of caesarean section it should be started as soon as possible. There is evidence that early skin-to-skin contact between mother and baby helps in bonding and stimulates breastfeeding behaviour in the baby. During first couple of days mother gets thick milk that comes as few drops. This is called colostrum. It is important to feed colostrum to the baby. This small volume of colostrum is sufficient for new-born baby for first few days. Mother usually starts getting good milk flow on third or fourth day.
Q. How often to feed the baby?
A. Initially for few days baby may take feeds roughly every two to three hours, so eight to twelve feeds in a day. Once the feeding is established it should be demand feeding. Baby may take feeds more often in some part of the day. Sometimes baby may sleep for longer hours. It is acceptable as long as the baby when awake is active, alert and feeding well. As the baby grows the frequency of feeding may decrease.
Q. What should be average duration of feeding?
A. Same as the frequency, the length of feeding is also decided by the baby. Most of the babies take feeds for ten to fifteen minutes on each breast. At times baby just wants to be pacified on the breast. It helps in superior oral-facial development and also stimulates adequate milk supply.
Q. Is it necessary to feed from both breasts every time?
A. Baby should be allowed to feed on one breast till the baby leaves. Once baby stops sucking, baby should be burped and then offered other breast. If baby is satisfied with feeding from one breast, then should be fed on alternate breast.
Q. Why should one not feed equal on both breasts every time?
A. The milk that comes initially is called fore-milk and the one that comes in later part is called hind-milk. Fore-milk has all qualities of milk except that it has low fat content. Hind milk has high fat content. Babies who are given hind-milk feel full for longer hours and they grow better. Secondly, it is important for mother to empty atleast one breast completely every time. This helps the mother getting more milk.
Q. How does the mother know that the baby is getting enough milk?
A. The most accurate of knowing that the baby is getting enough milk (nutrition) is appropriate weight gain. But, it is not suggested to check baby’s weight daily. A baby, who feels contended at the end of each feed, doesn’t take too long to finish feeds, is not generally cranky and urinating seven times or more in a day is by and large getting sufficient feeds.
Q. What is the best feeding position?
A. Correct positioning and technique for latching on are important to prevent nipple soreness and allow the baby to get enough milk. There are many positions described in book, but, one must feed in whichever position the mother and baby are comfortable. First the mother should choose the position of comfort for herself. She can be sitting, reclining on her back or even lying down but not sleeping, with the baby lying next to her. The baby shouldn’t be tightly swaddled. The first step is to open the baby or loosely swaddled. The mother can use breastfeeding pillow or can have sleeping pillows in her lap and put the baby on the pillow, supporting the back of the baby in such a way that the baby is facing her. Mother holds the baby in one hand, the same hand which side she is feeding. She holds the baby in such a way that the head of the baby is supported in her elbow bend. There is no need to squeeze nipple, the baby knows it well to keep nose off the breast.
Q. How do I know that my baby is latching on properly?
A. The baby is supposed to suck on areola and not on the nipple. In a good latch a large part of areola, in addition to nipple should be in baby’s mouth. The nipple should be angled towards the roof of the mouth, and the baby's lips should be flanged out. Ideally breastfeeding in a good position with a good latch on is a painless experience. Usually a small or flat or sometimes even inverted nipple is not a big concern. The baby can still latch on well with little extra effort. One can try pulling nipple out with the help of suction by a syringe before putting the baby on the breast. This over time helps in solving the issue of flat nipple.
Q. Till what age the mother should exclusively breastfeed the baby?
A. Breast milk supply increases in response to the baby's demand for milk. Most of the mothers can produce enough milk to meet the nutritional requirements of their baby till the age of six months. Hence, exclusive breastfeeding is recommended till the age of six months. This means no other liquid or drops should be given, except may be Vitamin D supplement. It is suggested to start supplementary feeds (semi solid feeds) at six months of age. Breastfeeding continues even after starting supplementary feeds and is given in between semi solid feeds till the age of one year.
Q. How can a working mother successfully breast feed a baby till the age of six months?
A. Mothers can express breast milk manually or by using manual breast pump, so that it can be used later in her absence. Expressed breast milk can be stored in a steel container at room temperature for eight hours, in refrigerator for longer hours or even eight days or frozen for months. The expressed breast milk can be given by spoon or bondla. Bottle feeding can cause nipple confusion and must be avoided.
Q. Why the baby shouldn’t be fed on bottle?
A. Feeding on the breast and on a bottle are entirely different processes. Feeding on mother is an exercise for a baby, while bottle feeding needs less effort. Once the bottle feed is given it is possible for the bay to prefer bottle and may stop sucking on breast. It is too big a risk to take. Secondly, infections are more common amongst bottle fed babies.
Q. If a mother is taking medicines for cold and cough, can she continue to breast feed the baby?
A. Mother can pass on common cold and cough to the baby through direct contact. Breast milk protects the baby against infection. Hence, it is advised that even if mother has mild infection, she should continue breastfeeding. Common pain killers, cold and cough medicines given to the mother are safe for the baby.
Q. Can a premature baby be successfully breastfed?
A. Premature babies who are fit to be with the mother in the room may initially have difficulty in sucking on breast. These babies can be given expressed breast milk with spoon or bondla until they start sucking well on the breast.
Q. Can a breastfeeding mother take a vaccine or medicines for common ailments?
A. Though, most over-the-counter and prescription drugs, except some psychiatric drugs are safe with the baby, breastfeeding mothers should inform their doctors about medicines they are taking. Mothers during this time can be given all required vaccines.
Q. How to deal with engorged breasts?
A. If mother has more milk than baby’s need, she can get breast engorgement. The first thing to do is to pump out some milk regularly to decrease discomfort. This also helps in decreasing milk production over time. Cold compress and Ibuprofen can help in relieving pain. If despite of these steps symptoms persist, mother needs to consult her doctor to rule out blocked duct or infection.