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Breastfeeding - Answers to common questions

Parentree-editors 2008-08-17 04:16:39

Here are answers for some common questions about breastfeeding.

Benefits of breastfeeding - for the baby

  • Breastmilk contains the right amount of carbohydrates, proteins, fats, and other supplements (minerals, vitamins) that are required for the baby
  • Breastmilk also contains antibodies from the mother, to help the baby develop immunity1, 2
  • Breastmilk is easier to digest than formula or cow's milk2
  • Breastmilk reduces the chances of diarrhoea and ear infections in babies3
  • Breastmlilk help reduce the chances of allergies like asthma, eczema, hay fever in babies4
  • Breastfeeding reduces the risk of obesity as the child grows up5

Benefits of breastfeeding - for the mother

  • Breastfeeding uses up calories and helps Indian mothers lose the weight gained from their pregnancy
  • Breastfeeding also allows the mothers some time to relax, in the middle of their hectic schedules
  • Breastfeeding fosters the lifelong love and bonding between a mother and her child
  • Breastfeeding helps the uterus return to its normal size after giving birth and thus reduces the duration of post-delivery bleeding2
  • Studies show decreased risk of breast cancer in mothers who breastfeed6,7
  • Studies show decreased risk of ovarian cancer in mothers who breastfed8
  • Studies show decreased risk of heart disease and diabetes in mothers who breastfed20

When should I start breastfeeding and what is colostrum?

  • Start breastfeeding within an hour of birth1,2
  • For the first few days after giving birth, a mother's body produces colostrum, a thick yellow milk. It is critical that colostrum be fed to Indian babies1
  • Colostrum contains2:
    • More antibodies than regular breastmilk that mothers produce
    • More proteins
    • More white blood cells
    • More vitamins
    • Hormones to help the intestine mature
  • Colostrum thus gives the baby immunity against the first few diseases he may be vulnerable to
  • Colostrum also clears the dark stools from the baby's stomach (meconium)2. These are tarry and black and will pass in the first few days.

How long should I breastfeed?

  • The Indian Academy of Pediatrics and the Ministry of Women and Child Development of India and the World Health Organization,  strongly recommend that mothers breastfeed exclusively for the first six months. Breastmilk contains all the nutrients which the baby needs to grow. These include proteins, fat, carbohydrates, sugar, vitamins,  nutrient, water and also antibodies that protect the child
  • From 6 months to 1 years, breastfeeding should remain the primary source of nutrition for the baby but should be complemented with other foods.
  • A number of Indian mothers wean their babies off breastmilk at the age of 1 year, but breastfeeding can continue into the 2nd year also. Unless you have a health condition that forces you, there is no other natural reason to stop. When to stop and wean your baby from breastmilk is a decision you have to make.

Is my baby drinking enough milk?

  • A number of Indian mothers will ask themselves, if their baby is getting enough milk from their breasts. This is a natural maternal instinct. Most mothers will produce enough milk but there can be cases where poor latching or other conditions may result in the baby not getting enough milk.
  • The best signs that your baby is getting enough milk (in the first few days) are2 -
    • Regular weight gain and growth
    • Stools which are not solid or dry
    • Regular, consistent, diluted urination. 
    • After the first couple of days, your baby should have 6 - 8 wet diapers per day with 3 - 4 dirty ones.
  • Some warning signs that should make you think further are given below2
    • Frequent crying after feeding, because baby is not satisfied
    • Interrupted sleeping patterns
    • Very frequent and long breastfeeds 
    • Refusal to feed
  • Always consult your doctor if you have doubts. Do not hesitate. It is better to be safe than sorry.

Can I use medicines when breastfeeding?

  • Virtually everything a mother eats can find its way into the milk given to the baby
  • Talk to your doctor before taking any medicines when you are lactating

I have small breasts. Will I be able to breastfeed?

  • Yes. Breast size has little do with the ability to produce milk.
  • Women of all breast sizes can produce milk and breastfeed.

I heard I do not need contraception when I breastfeed. Is it true?

  • Studies show that breastfeeding has a strong natural contraceptive effect on the mother especially when menstruation has not resumed9
  • But this protection is not complete and 5 - 10% can get pregnant9
  • For complete protection, an artificial contraception method maybe required. But talk to your doctor first. Some contraception methods that use drugs can have an effect on lactation

Does breastfeeding hurt? Will my nipples be sore?

  • Usually your breasts will feel tender for the first few days. But it should not hurt continuously if the position of the baby and the baby's mouth are correct.
  • Check that the baby has properly latched on. The baby's mouth should cover as much of the areola as possible and not just your nipple.
  • Try different positions and alternating breasts
  • Express a few drops of milk before feeding the baby. This will prevent the baby from clamping down hard as he waits for milk to come.
  • You can also rub a drop or two of breast milk around your nipples, after feeding the baby
  • Get some air on your nipples and breasts, especially after feeding
  • You can try gently rubbing pure lanolin on your breasts
  • Don't put soap or other chemicals on your breasts
  • Get comfortable bras which are not too tight
  • Nursing pads (used to absorb any leakage from your breasts) may trap in moisture and should be changed often. Moisture can make your nipples feel worse.
  • If the soreness continues or if your nipples crack, see your doctor.
  • There are other conditions that can cause your breast to hurt
    • Engorgement
    • Blocked ducts
    • Mastitis
    • Thrush

Engorgement - My breasts feel hard and painful

  • This usually happens when your breasts start producing a lot of milk (usually in the 1st week when your milk "comes in"). Sometimes it also happens when the breastfeeding pattern suddenly drops, leaving a lot of milk in the body, such as during weaning.
  • To get over it, feed your baby as much as she wants
  • Ensure your baby has latched on correctly and is getting his fill
  • Wear a comfortable bra
  • Cold compresses of your breast can help. Some women also put cold cabbage leaves on their breasts for some of the time.
  • If engorgement lasts for more than a day or two, talk to your doctor.

Blocked ducts

  • Your breast has multiple ducts to supply milk. Sometime one of them may not get drained fully. A blocked duct feels like a lump and is red, tender and sore.
  • As much as possible try to empty the affected breast first.
  • Use hot compresses on the affected breast
  • Wear comfortable bras that do not press down on the affected breast
  • To try and avoid this condition, let the baby nurse from different positions around the areola so all the ducts drain in turn.

Mastitis

  • Mastitis is a breast infection.  Your breast is inflamed and swollen. and is red, sore, tender and painful. You will also have a fever with flu-like symptoms. This usually follows a blocked duct which remains blocked and then gets infected.
  • As much as possible, try to empty the affected breast first.
  • Use hot compresses on the affected breast
  • Wear comfortable bras that do not press down on the affected breast
  • Get a lot of rest, to take care of your flu-like symptoms
  • Talk to your doctor as you will need medical advise and antibiotics

Thrush

  • Thrush is a yeast (fungal) infection of the breast
  • You may have thrush:
    • If sore nipples last for more than a few days
    • If you suddenly develop sore nipples after a long period of nursing without any problems
    • If your nipples are red, itching, flaky, blistery and burning
    • If you have shooting, stinging pains during or after feeding
  • The baby may also show signs of oral thrush like white spots in their mouth
  • The baby may also show signs of thrush by a diaper rash that does not go away
  • Go see a doctor if you suspect thrush. You and/or your baby may need a full diagnosis and medication.
  • If you have confirmed thrush, wash the clothes that come in contact with the yeast in hot water.
  • Do not pump your milk and store it in the fridge.
  • Get some air (or sunlight) on your nipples and breasts, especially after feeding.
  • Maintain high levels of personal hygiene for yourself and your baby
  • If you baby has oral thrush, be very careful about what he puts in his mouth. Clean anything that he puts in his mouth with hot water.

I have flat nipples. Can I breastfeed?

  • Yes, the baby gets milk from the areola (dark black circle behind your nipple) and the nipple.
  • You can help you baby find what she wants by squeezing out your breast a bit, thus sticking the areola out at the baby
  • Try different positions for the baby
  • As the baby suckles, the breasts will soften and  it may slowly suck out the nipple also
  • If you are having trouble, express milk and feed it to the baby using a spoon or a cup. Not a bottle. Using a bottle with a nipple, will make it difficult to bring the baby back to the breast. Expressing milk will help soften the breast.
  • Express a little milk before starting feeding and drip it slowly on your breast and let it flow into the infant's mouth. This will show him that yummy breast milk is available and may entice him to suckle.
  • Even if you are having difficulty, keep giving the baby skin-to-skin contact with your breast often.
  • Nipple shields are commonly recommended by many for this condition. However, they bring their own problems as they can reduce milk supply in the long term and may result in underfeeding of the baby. Try other natural means of encouraging breastfeeding including talking to a lactation consultant before using a nipple shield. Once used, it maybe difficult to wean the infant from the nipple shield. Nipple shields should not be used as the first resort because they also mask the real underlying problem.
  • Some other techniques like breast shells and Hoffman's exercises were prevalent earlier. Research shows that breast shells actually reduced breastfeeding success rates while Hoffman's exercises seems to have no noticeable beneficial effect10. These techniques are no longer recommended for use.

I have inverted nipples. Can I breastfeed?

  • Yes, the baby gets milk from the areola (dark black circle behind your nipple) and the nipple.
  • You can help you baby find what she wants by squeezing out your breast a bit, thus sticking the areola out at the baby. Your fingers should be well behind the areola.
  • Talk to your doctor or lactation consultant at the hospital. They can quickly fashion you a nipple puller using a small plastic syringe. You can use it to pull out your nipple before a feed.
  • Try different positions for the baby
  • As the baby suckles, the breasts will soften and it will slowly suck out the nipple also
  • If you are having trouble, express  milk and feed it to the baby using a spoon or a cup. Not a bottle. Using a bottle with a nipple, will make it difficult to bring the baby back to the breast. Expressing milk will help soften the breast.
  • Express a little milk before starting feeding and drip it slowly on your breast and let it flow into the infant's mouth. This will show him that yummy breast milk is available and may entice him to suckle.
  • Even if you are having difficulty, keep giving the baby skin-to-skin contact with your breast often.
  • Nipple shields are commonly recommended by many for this condition. However, they bring their own problems as they can reduce milk supply in the long term and may result in underfeeding of the baby. Try other natural means of encouraging breastfeeding including talking to a lactation consultant before using a nipple shield. Once used, it maybe difficult to wean the infant from the nipple shield. Nipple shields should not be used as the first resort because they also mask the real underlying problem.
  • Some other techniques like breast shells and Hoffman's exercises were prevalent earlier. Research shows that breast shells actually reduced breastfeeding success rates while Hoffman's exercises seems to have no noticeable beneficial effect10,11. These techniques are no longer recommended for use.

Can I drink coffee and tea when I breastfeed?

  • For Indian moms who are lactating, moderate consumption of 1 - 2 glasses (8oz, ~250 ml each) of regular coffee per day, may be acceptable
  • Caffeine from regular coffee and tea can pass into breastmilk, in very small quantities12
  • Numerous studies have reported symptoms like jitteriness, restlessness, irritability, poor sleep patterns etc, in babies of mothers who consume a lot of caffeine every day13
  • The general medical advice is to moderate consumption of caffeine containing beverages like coffee, tea, colas that contain caffeine etc.,
  • The American Association of Pediatics suggests a limit of 2 - 3 cups (8oz, ~250ml) per day, of brewed American coffee per day during breastfeeding14. A cup of brewed American coffee can contain 100 - 240 mg of caffeine15. This works out to anywhere between 300 - 720mg of caffeine per day.
  • According to the Indian Coffee Board, regular coffee (roast and ground arabica beans) typically has 120 - 150mg of caffeine in each glass (8 oz, ~250ml)16
  • But keep in mind that caffeine content in coffee can vary widely depending on the blend and the treatment. For example, Robusta beans contain more caffeine than arabica
  • Tea (without milk) contains about 65 - 130 mg of caffeine in an 8oz, 250ml glass15.  This is about half as much as coffee.
  • Please remember also that various other foods and liquids contain caffeine. These include tea, carbonated soft drinks, chocolate  etc., All should be considered together when assessing caffeine intake.
  • The International Food Information Council provides the following information on caffeine content17
    • Some soft drinks - Typically 24 mg with a range of 20 to 40 mg per 250ml
    • Energy drinks - Typically 80 mg
    • Milk chocolate - Typically 6 mg with a range of 1 - 15 mg per 30 grams
    • Dark chocolate - Typically 20 mg, with a range of 6 - 35 mg per 30 grams
    • Chocolate syrup - Typically 4 mg per 30ml
  • Talk to your doctor for more information about caffeine consumption

Can I give my baby a pacifier?

  • Most doctors advise that babies should not be given pacifiers before they learn to breastfeed
  • It may affect the baby's ability or willingness to learn how to suckle.
  • Once the baby is breastfeeding regularly, you can use one as you see fit.

Can I use fenugreek or other herbal supplements to increase milk production?

  • Fenugreek (Methi, Venthayam, Menthulu) is often recommended to increase milk production. While there is no strong scientific evidence, there is historical and anecdotal evidence to suggest that fenugreek may help. However, you should check with your doctor before using it.
  • Fenugreek is often used in diabetes treatment as it has been shown to reduce blood sugar18.  When you are using it, be on the alert for symptoms of low sugar.
  • Fenugreek has also historically been used to induce pregnancy, so pregnant women should not be consuming fenugreek19.
  • Numerous other herbal remedies are available in India claiming various effects. Some may be true and some may be myths. There is very little scientific evidence to backup most of the claims.  In a number of cases, it is hard to be sure of the exact ingredients and the process of making the supplement.
  • Please check with your doctor before consuming any herbs or herbal supplements.

References

1. Indian Academy of Pediatrics, IAP Policy on Infant Feeding

2. "Breastfeeding Counselling, A Training Course, Trainer's Guide", World Health Organization CDD Programme, UNICEF

3. Scariati, Paula D., Grummer-Strawn, Laurence M., Fein, Sara Beck "A Longitudinal Analysis of Infant Morbidity and the Extent of Breastfeeding in the United States", Pediatrics 1997 99: e5

4. Kull, I, Wickman, M, Lilja, G, Nordvall, S L, Pershagen, G "Breast feeding and allergic diseases in infants--a prospective birth cohort study", Archives of Disease in Childhood 2002 87: 478-481

5. Rüdiger von Kries, Berthold Koletzko, Thorsten Sauerwald, Erika von Mutius, Dietmar Barnert, Veit Grunert, Hubertus von Voss, "Breast feeding and obesity: cross sectional study" British Medical Journal 1999;319:147-150

6. Tim Byers, Saxon Graham, Thomas Rzepka , and James Marshall,"Lactation and Breast Cancer: Evidence for a Negative Association in Premenopausal Women", American Journal of Epidemiology, 121: 664-674

7. Laufey Tryggvadóttir , Hrafn Tulinius , Jórunn E. Eyfjord , and Trausti Sigurvinsson "Breastfeeding and Reduced Risk of Breast Cancer in an Icelandic Cohort Study" American Journal of Epidemiology. 154: 37-42

8. Marta L. Gwinn , Nancy C. Lee , Philip H. Rhodes , Peter M. Layde and George L. Rubin . "Pregnancy, breast feeding, and oral contraceptives and the risk of epithelial ovarian cancer", Journal of Clinical Epidemiology , Volume 43 , Issue 6 , Pages 559 - 568

9. Prema, K, Naidu, AN, Kumari, SN, "Lactation and fertility" American Journal of Clinical Nutrition 1979 32: 1298-1303

10. J. M. Alexander, A. M. Grant, and M. J. Campbell, "Randomised controlled trial of breast shells and Hoffman's exercises for inverted and non-protractile nipples" BMJ. 1992 April 18; 304(6833): 1030–1032

11. "Preparing for breast feeding: treatment of inverted and non-protractile nipples in pregnancy. The MAIN Trial Collaborative Group", Midwifery. 1994 Dec;10(4):200-14

12. Berlin, Cheston M., Jr, Denson, H. Mark, Daniel, Catherine H., Ward, Robert M. "Disposition of Dietary Caffeine in Milk, Saliva, and Plasma of Lactating Women"
Pediatrics 1984 73: 59-63

13. "Caffeine", LactMed database, US National Library of Medicine, National Institutes of Health

14. Committee on Drugs, "The Transfer of Drugs and Other Chemicals Into Human Milk", Pediatrics 2001 108: 776-789

15. Eric H. Chudler "Caffeine", University of Washington

16. India Coffee Board "Coffee-Part of a healthy, balanced diet", Coffee & Health, October 2006

17. Reprinted from the International Food Information Council Foundation and Association of Women’s Health, Obstetric, and Neonatal Nurses, August 2002

18. Sharma RD, Raghuram TC, Rao NS. "Effect of fenugreek seeds on blood glucose and serum lipids in type I diabetes", Eur J Clin Nutr. 1990 Apr;44(4):301-6

19. National Center for Complementary and Alternative Medicine "Fenugreek", National Institutes of Health, D364, April 2008

20. Schwarz, Eleanor Bimla MD, MS; Ray, Roberta M. MS; Stuebe, Alison M. MD, MSc; Allison, Matthew A. MD, MPH; Ness, Roberta B. MD, MPH; Freiberg, Matthew S. MD, MSc; Cauley, Jane A. DrPH., "Duration of Lactation and Risk Factors for Maternal Cardiovascular Disease", Obstetrics & Gynecology: May 2009 - Volume 113 - Issue 5 - pp 974-982, doi: 10.1097/01.AOG.0000346884.67796.ca


Comments

 Former member 2013-04-29 16:40:30

 

Hi, This is a great post. There is a new Center that has opened up in Chennai called Baby Bliss. At Baby Bliss, they ensure a Healthy Baby & Happy Mom while getting pregnant, during pregnancy (prenatal care) and post pregnancy (post natal care). Check out their website at www.haselfrebabybliss.com

ramya83
2011-02-06 19:40:57

 

after 8 days if your baby is having more than 10-15 wet nappies she is getting enough milk At the age of 1 month the second round of confusion starts. the duration of feeding has by now diminished to not more then 10-15 min.(of course you should know that she has grown bigger and stronger and will be able to feed faster. second she will start putting her hand in to her mouth. this is normal developmental pattern. after 5 months she is going to put her hand in to her mouth . both are not signs of poor milk. third most of your babies would have stated to cry for 3-4 hours in the evening or night. all three of them do not indicate poor milk supply. if a baby ahs incresed by 600-900 gms she is growing fine

ramya83
2011-02-06 19:33:30

 

this are a few doubts i have encountered in my practise First breast milk on day 1 will be just around 3 ml of yellowish fluid, on day 2 it will be even worse, 10 drops of white fluid. third day will be around 5 ml of milk , forth day will be 15 ml and from fifth day any mother will start lacting in full.this is the normal way your milk production will be initially few things will impede laction. poor nutrition and stress (physical, emotional and some times medication) a baby is going to cry before passing urine and motion. the same case after they have passed the same. she is going to cry when she feels cold, when she is hungry. even the only form of communication will be cry and not smile (you would have to wait for 1 moth for that). she will cry throughout the night in the first 6 weeks (its quite normal dont panic) so first things NOT all cry is for hunger.this way of milk flow is normal and enough for your baby

Apurva
2010-03-25 18:19:17

 

nice efforts..... very informative blog....

keerthy
2010-03-19 09:18:44

 

can anybody tell me if electrical breast pump r safe?n which brand 2 go for

mango_mama
2009-08-26 14:00:09

 

Maha, Also see this article on Parentree. http://www.parentree.in/Parentree-editors/journal-236/Breastfeeding-tips-for-new-moms.html

mango_mama
2009-08-26 13:58:39

 

The more you breastfeed and empty your breasts, the more milk your body will make. Am assuming that you are still breastfeeding but supplementing with formula. You could alternate feeds--one formula and one breast. Remember since you have less milk supply right now, for now, for the breastmilk feed, you might need to put on breast more often. Oh yes, do talk to your doc or hospital for buying or perhaps even renting a good breast pump. Initially you could pump the milk and give breastmilk in a bottle. Pumps are supposed to be very helpful in increasing milk supply and after a month or so could start nursing. Also, methi seeds are supposed to increase milk supply. See if methi or fenugreek capsules are available with a chemist. Or just soak the methi seeds and eat them or drink their water. Stay relaxed. Actually, as long as you are giving a few feeds, it is still beneficial for the child. Try your best but do not fret too much. Btw, with my first child, I too had low milk supply but was determined. I exclusively pumped and fed in a bottle for the first couple of months and then stopped and landed up breastfeeding her for 18 months (when I conceived my second, I stopped). If you want to pump after discussing with your doc, do buy or rent a good quality pump. I have been in your shoes and realize how it feels. Take care of yourself and good luck.

maha
2009-08-26 13:20:58

 

My baby is 3 months old. I could breast feed him for only one month after which he was also not sucking and my milk secretion also got reduced. he is on the intake of formula. can anyone suggest how to increase the milk supply and make him drink

 

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