For most mothers feeding their newborn can pose problems especially if the baby is their first child. Ignorance of how to hold the infant when breastfeeding, how much milk to give, how to recognise cues from the infant when he/she is hungry, or has had enough milk, and fears that their breasts are too small to give baby sufficient milk, are some of the many problems they face in the first few weeks of nursing.
Consultant Neonatologist, University Neonatal Unit, De Soysa Hospital for Women, Colombo, and Senior Lecturer and Head, Department of Paediatrics, University of Colombo, Dr Nishani Lucas offers some simple guidelines on the correct positions new mothers should nurse their babies while debunking myths surrounding this simple natural act.
Excerpts of her interview with the Sunday Observer…
Q. Many new mothers are uncertain for how long they should breastfeed the newborn in the first few days of birth, and whether the baby has had enough. What are the signs to help them know baby has had enough?
 Dr. Nishani Lucas |
A. The length of the breastfeed depends on how soon the baby becomes full, which in turn depends on the breast capacity which varies between women. Breast capacity is not related to breast size.
Breast capacity is determined by the number of functioning alveoli whereas the breast size is determined by the amount of fat tissue in the breast.
Babies fed by a mother with a larger breast capacity will get a larger amount of breast milk at a given point of time so that the baby will get full in a shorter period of time, whereas babies fed by a mother with a smaller breast capacity will get a smaller amount of milk at a given point of time and will take longer to experience fullness.
Duration of a breastfeed varies between 10 to 20 minutes soon after birth. As the baby gets more skilled at suckling with age, the duration of the breastfeed reduces and may last only five minutes. The baby will pull away from the breast, appear satisfied and fall asleep once he/she has had enough.
Q. Some mothers believe that eating high fibre food is the cause of gas in their newborns. Do you agree?
A. No, the food mothers eat has nothing to do with gas in the newborns as fibre does not pass through breast milk.
The cause for gas in the newborn is swallowing air. This occurs when the baby is fed too frequently or due to an inadequate seal during feeding. Increasing tummy time and burping in the prone position would minimise the gas accumulation in the newborn.
Q. The insistence of health experts that babies should be allowed to breastfeed even when they are weaned and start on semi and solid foods, up to the age of two and beyond has sent mixed messages to mothers. They are confused about how long they need to breastfeed a toddler. What is your opinion on this problem?
A. Breastfeeding is recommended till two years and beyond as its benefits increase with the duration of breastfeeding. Breastfeeding should be continued until the baby refuses the breast. Breastfeeding should only be used for nutrition and should not be used as a pacifier or as a method to put the baby to sleep, which would cause longer dependence. Breast milk provides all the necessary nutrients and energy during the first six months of life after which good quality complementary feeding in the form of rice, vegetables, fruits, meat, fish and eggs should be used to fill the widening nutrient gap in addition to breast milk. The frequency of breastfeeding should reduce with age.
It starts off as 2-3 hourly soon after birth, and gradually declines to 3-4 hourly by the age of 4-6 months at which time complementary feeds should be started to substitute some of the milk feeds.
Breastfeeding is reduced to 4-6 hourly at 6 – 8 months, 6-8 hourly at 8-12 months and 8-12 hourly from 12- 23 months after starting complementary feeds in order to facilitate adequate nutrient intake to bridge the widening energy gap.
Q. Is after or before a meal a good time?
A.Baby should be given complementary food on an empty stomach to ensure he/she accepts new food. Breast milk should be given after the baby completes the complementary food meal, to ensure smooth and successful transition following exclusive breastfeeding. Spacing the feeds by breastfeeding about 3 hours before each meal would ensure that baby is hungry when complementary foods are offered.
Q. When a working mother wants to freeze her milk to use once she returns home from work, how does she calculate how much breast milk she should put into the feeding cup before storing it?
A. No calculation. She should put all the milk she can express, as milk flow is sustained by frequent emptying of the breast. Breast milk should be stored in cups with air tight lids which can be used for feeding the baby as well. Bottles should not be used.
Q. Regarding the diet of a breastfeeding mother, does she need vitamins and other supplements while breastfeeding?
A. No, she does not need any additional supplement to breastfeed. Normal balanced diet is all that is required. The quality of her breast milk is not affected by her nutritional status unless she is severely malnourished. However, she will need vitamin and mineral supplementation to replenish her supplies that are used up for lactation.
Q. What are some of the popular breastfeeding myths you’d like to debunk?
A. The idea that breastfeeding will make the breast sag is a myth. Breasts sag if the supporting connective tissues (Cooper’s ligaments) are damaged. Breasts increases in size during pregnancy and lactation.
Upgrading the size of brassieres to support the change in breast size which occurs with the different stages of pregnancy and lactation will preserve the breast shape and prevent sagging as well as avoid feeding issues. The size of the breast is determined by the amount of fatty tissue in the breast. Milk is produced by the alveoli which are the functional unit of the breast.
So, breast size has nothing to do with the amount of milk that can be produced. Another myth is regarding nipple size. Nipple inversion can be true or apparent. ‘Apparent’ nipple inversion poses no problem to breastfeeding as it only appears inverted and will not pose an additional challenge.
Even in ‘True’ inversion the nipple protrudes into the baby’s mouth when the baby suckles while creating negative pressure inside the baby’s mouth. Repeated suckling on the breast will condition the nipple to protrude faster after the baby initiates suckling. Therefore ‘True’ inversion may require a few days to establish breastfeeding. All it requires is a little patience after which breastfeeding will be established.
Q.Since many new mothers don’t understand the correct position they should hold the baby while nursing, please explain how this is done so baby can have the optimal benefits.
A.Baby should be held very close to the breast, his/her whole body in a straight line supported by the mother’s arm, turned towards the breast, while supporting the baby’s head at the nape of the neck. Baby should be put to the breast only when showing hunger cues like, looking around for food, putting hands in the mouth, sucking and pouting movements etc.
Wait for baby’s mouth to be wide open and latch on to the breast so that most of the areola is in the baby’s mouth. Baby will suckle 3-4 times and stop to swallow. Do not disturb the baby during this pause, as this will disturb the feeding. Wait patiently for the baby to resume feeding.
Q. How will they know when the baby has had enough if the baby falls asleep while feeding?
A. The breast feels heavy before feeds. If the breast is empty after the feed you know that baby has had enough.
Baby should unlatch from the breast after 10-15 minutes after emptying the breast and sleep for at least 1.5 hours in between feeds. If baby is waking up frequently or is continuously on the breast it may mean that the baby is not getting enough milk.
The best method to check the adequacy of milk is to weigh the baby within 2-3 days to check for excessive weight loss. (Babies can lose unto 5% of their weight in the first 24-48 hours and up to 10% during the first 4-5 days.) Passing clear urine more than 6 times a day after the first week also indicates good hydration.
Q. Your message to all new mothers on the importance of breast milk?
A. Breast milk is a gift that only a mother can give her child to help him/her enjoy increased intelligence and better health throughout life. It is one of the greatest acts of love that a mother can do. If you are faced with challenges don’t turn to formula milk.
Get skilled support from your local public health midwife or Lactation Management Centres in state hospitals which are walk-in centres dedicated to help babies irrespective of their place of birth, so that you can overcome your challenge and breastfeed your baby.