Some useful advice and facts regarding breast-feeds are given below.
1. Express some milk from the breast before feeding. It makes the areolar area soft and compressible for the baby.
2. Both breasts should be offered to the baby at one feed. The breast offered first should be completely emptied (emptying is a potent stimulus for milk production.)
3. The breast to be offered first should be alternated with feeds, i.e. if the left breast was offered first during the previous feed, the right breast should be offered first now. This ensures complete emptying of at least one breast at each feeding, which is very necessary for adequate milk production.
4. A suitable time for suckling at each breast is about 15 minutes after the 3rd day. On the 1st day, it is 5 minutes and on the 2nd, 10 minutes. However, it depends more on the baby. Some babies finish their milk requirements fast in just 3-4 minutes and then doze off. Others may do it a leisurely pace. However, suckling for more than 15 minutes is not advised as it may lead to soreness and cracked nipples.
5. When the baby has finished feeding, don’t pull it away from your breast. It will apply traction on the nipple and may make it sore. The best way to unlatch a baby is to insert your finger in the corner of the baby’s mouth in between the gums. This will release the grasp of the gums and then you can take the baby off the breast.
6. If the baby dozes off wTtile feeding, you can gently stimulate the baby by massaging behind the ears or rubbing the soles of the baby. If after 2-3 tries, the baby is still not feeding, stop and unlatch the baby.
7. There is no fixed time interval (say 3 hours or 4 hours) at which the baby has to be fed. Instead a flexible schedule is recommended, based chiefly on demand; i.e. to give the baby the milk when he starts demanding it. If more than 4 hours elapse, and the baby is still sleepy, it is better to try to awaken him gently and see whether he will accept feeds.
8. The milk produced in the initial 3-4 days is fluidly, yellow and very less in amount. It is called “colostrum”, which has a high content of nutrients and is invaluable to the child. It should always be given to the baby, without worrying about its quantity or quality.
9. During this phase, the mother starts doubting that she is not producing enough milk. All mothers produce colostrum (which as I have mentioned is physiologically less in amount) and all of them produce roughly the same amount in the initial 2-3 days. By the 4th day, the milk production starts increasing and adjusts itself to the baby’s needs in another few days.
10. It is during this time also that the mother turns towards the bottle to supplement her “inadequate” breast milk (which actually is adequate for the baby). The baby’s fluid and calorie requirements are less during the first 1-3 days, and so the “less” amount of milk i.e. the colostrum actually is sufficient for it. This is the critical point where all the trouble starts. Once the baby starts accepting bottle, the motivation of mother goes down. The baby finding the nipple of the bottle softer than the breast has to put less effort to suck milk from it, and so starts preferring it over the breast. The mother on seeing the baby prefer the bottle becomes discouraged and so it becomes difficult for her to breast-feed. Then there is an entity called “nipple confusion”. The baby’s gums compress the areola of the mother rather than the nipple, but with the bottle the baby compresses rhythmically the bottle’s nipple. This may lead to confusion in the baby’s mind and he may start chewing on the nipples of the mother’s breasts, and on finding no milk coming may become irritated. Therefore if you want to breast-feed, no bottles, even for some feeds, until you are confident and have a well-established milk supply.
11. An important pre-requisite for a nursing mother is that she should be mentally and physically relaxed. Tension and fatigue has an inhibitory effect on milk production. After delivery, don’t encourage long visits by well wishers. Instead try to rest, sleep or just relax with your baby by the side, thinking pleasurable thoughts about it.
12. The breast-feeding mother should consume adequate amounts of water and a wholesome diet. Wholesome diet doesn’t mean eating lots of fattening things like ghee, chocolates, cakes etc. but to eat cereals, dais, vegetables, eggs, meat, curd etc. Eating lot of fruits is a good thing. Drinking a lot of milk in the belief that it will indirectly “come out” from the breasts and so replace the milk taken by the baby is an erroneous belief. By all means drink milk (and lots of it), if you really relish it. But drinking it for the reason mentioned above is not correct.
13. There is a fine-tuning by nature between the production of milk and its demand by the baby. The amount of milk produced is not a “static” quantity e.g. one mother will produce only 500 cc per day while another will produce only 700 cc per day. Milk production increases according to the baby’s requirements. If the baby wants more, it sucks more, which empties the breast completely. This is the most potent stimulus to produce more milk. So more is the demand – more is the supply. However, if you supplement with bottle, the baby takes less milk from the breasts. The milk left behind in the breast sends a signal to produce less. Twins or even triplets can be wholly and successfully breast-fed. So don’t be anxious that milk is not enough. Just leave it to nature.
14. There may be an increase in the appetite of the baby, sometimes dramatically, particularly at 3, 6 and 12 weeks. The nursing mother should anticipate this and not think that her breast milk is not enough for the baby during these times. Similarly when the mother is discharged from the hospital, her breast milk may temporarily decrease for 2-3 days as she adjusts and adapts herself to living with the baby at home.
15. Mothers worry a lot about the adequacy of milk. The best way to judge adequacy is by the behaviour of the child. If the child appears content and sleeps off for 2-3 hours, then the amount of milk is sufficient. However if the baby is fretful, demands feeds every 1 hour and doesn’t seem satisfied, it is possible that the breast milk is less. Of course with time, the supply will increase (remember the more you suckle, the more is the production of milk) but temporarily, one has to offer top feeds once in a while to satisfy the baby. This shouldn’t worry the mother unduly because she knows that in due course of time; her supply will increase and be adequate for the child. Remember, more often than not, the child actually doesn’t demand feeds every hour, but the mother only perceives so in her mind. So it is better to be objective in this rather than letting subjective feelings cloud the judgement. The best way is to take the help of a clock and note exactly after how much time the baby starts demanding another feed. Another excellent way of judging the adequacy of breast milk production is by weight gain of the child. But this should be done every 1-2 weeks. Weighing the baby after every feed or everyday is of no use and creates unnecessary anxiety in the minds of the parents.
16. A mother, particularly one having her first child will face some problems off and on regarding breast-feeding. Some queries, doubts etc. will be in her mind. She requires help and support. Unfortunately, the doctors and nurses are too busy to individually explain to each mother the art of breast-feeding, and to reassure her off and on. Even if the mother says that her milk is not adequate, the doctors tend to take it lightly and the standard reply is, “Go on feeding, it will come.” This doctor’s attitude can easily be changed by the mother’s attitude towards breastfeeding. If the mother says, “Doctor, I sincerely want to breast-feed my baby, but am facing few problems in doing so. Kindly help me;” I am sure the doctor will make extra efforts to help her.
17. Entail the help of the husband in the care of the baby including breastfeeding. The husband may help in positioning and supporting the baby while breast-feeding and give reassurance to the nursing mother. Most husbands want to contribute in the care of the baby. But, because they are not accustomed mentally (due to their upbringing) to do so, they feel embarrassed and confused. It appears that rather than making their own decisions, they need some directions in this regard. Here the wives can gently guide them. For e.g. tell them to fetch clothes for the baby, boil bottles, prepare milk and do so many other routine chores of the baby. They will do it happily and at the same time feel satisfied that they, too, are contributing in their own way in the rearing of the baby.
18. Some mothers feel that their milk is too dilute. Some even feel that their milk is harmful to the baby (particularly if the baby vomits or has loose stools). Some feel that what they eat affects the quality of the milk produced. All these are myths. Milk is milk containing 99% water and 1% solids in the form of proteins, lactose, minerals, vitamins etc. Your thinking cannot alter the quality of the breast milk. Only if the mother is taking some medicines, it is better to ask the doctor whether it will have any effect on the breast-fed baby.