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Every child should be breastfed, and should receive only breast milk for the first four months of life. Infants who are not breastfed are twice as likely to die as those who are. The breasts have undergone many changes during pregnancy so that the mother's milk will also be ready when the baby is born. The more a baby is fed at the breasts, the more milk the breasts produce. Artificial milk should only be used when absolutely necessary.
There are many reasons why breast-feeding is better than bottle feeding. They include:
· Breast milk is the most natural food for a baby, and is the easiest food to digest. Cow's milk, on the other hand, does not have the right combination of vitamins, nutrients, and fats, and sometimes a human baby cannot even digest it. If infant formulas are not mixed correctly, they can be too weak and will not nourish the baby properly. Also, the breast milk changes as the baby matures to meet the baby's complete nutritional needs at that time.· As long as the mother's nipples are clean, breast milk is always clean and free from germs that cause infection, and is always at the right temperature. Even if the mother is sick, her breast milk is safe for the baby. But if formula is mixed with contaminated water or in a dirty bottle, it can give the baby diarrhoea.
· Breast milk contains substances called antibodies which protect the baby from many types of infections and other illnesses, especially during the first six months. Formulas and the milk of animals do not contain these antibodies. That is why babies who get only breast milk are healthier and have fewer attacks of diarrhoea than babies who are fed with artificial milk.
· Touching and looking at the baby during breastfeeding makes both mother and baby feel close and secure.
· Having the baby suck the breast immediately after birth helps the womb contract and push out the placenta. During the first few days after the baby is born, the baby's sucking helps the womb return to its normal size.
· If a woman gives only breast milk to her baby and breastfeeds on demand (whenever the infant wants to eat), ovulation and menstruation are delayed for about six months. The mother is therefore protected from getting pregnant again (see description of Lactational Amenorrhoea Method in Chapter 17).
· Breast milk is free, and it is always available. Artificial milk is expensive and is not always available. It takes time to prepare artificial milk to bottle feed the baby, and few homes can afford the equipment and fuel to sterilise the feeding bottles properly.
WHEN TO START
Breastfeeding should start as soon as the baby is born. Immediately after delivery, the mother should be given her baby to hold and put to her breast. The baby's sucking has two advantages. First, it stimulates the womb to contract and therefore helps stop bleeding. Second, it stimulates the milk to begin to flow from the breast.
For the first couple of days, the breasts will produce only the thick yellowish fluid called colostrum. In many cultures, people believe that colostrum is useless or even harmful to the baby, so women don't breastfeed during this time. In fact, colostrum is very good for babies; it is rich in antibodies, protein, minerals, and important vitamins. Women often say they have no milk during this period, but they should be encouraged not to worry. The baby does not need much food or other liquids during the first two or three days. Early sucking also helps prepare the nipples for when the baby gets hungry and begins to suck hard. Usually, by the end of the second or third day, milk begins to flow from the breasts. The more often and the harder it sucks the baby sucks, the more the milk flows.
During the first few days, breast-feeding may cause some painful cramping of the womb and short flows of blood from the vagina. Although it is uncomfortable, this actually helps the womb return to its normal size and reduces overall blood loss. This discomfort soon stops (see Box 15.1).
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Box 15.1: Comfort Measures for Breastfeeding Mothers During the first few days, breastfeeding may be uncomfortable for the mother. She should be reassured that this discomfort soon passes. The following measures can also help: · Breastfeed as soon as possible after delivery, or as soon as the baby is alert and interested · Hold the baby in different positions while breastfeeding |
HOW OFTEN TO BREASTFEED
How often the baby is fed will depend on both the mother and the baby. There are no firm rules. It is more natural to feed the baby when he or she is hungry, rather than according to a certain time schedule. In the beginning, the baby may want to feed as often as 10-12 times a day, including at least three or four times during the night. This is demanding, but small frequent feedings are better for the baby. Also, the more often the baby breastfeeds, the more milk the mother produces.
HOW LONG TO BREASTFEED
Breastfeeding can continue for as long as the mother feels comfortable doing it. In many countries, babies breastfeed for a year or more. For the first four months, the baby needs only breast milk. There is no need for any other food or liquid, not even water; breast milk contains everything the baby needs. After that time, the baby will need other foods in addition to breast milk. Breastfeeding should continue for another 12-18 months while the child gets more and more solid foods. New foods must be introduced gradually.
Mothers give many reasons why they do not think they can breastfeed. Some of them include:
· "My breasts are too small and cannot produce enough milk to satisfy the baby". The amount of milk produced by the breasts does not depend on their size.Rather, it depends on how often and for how long the baby breastfeeds, and how soon after birth breastfeeding begins.
· "Breastfeeding ties me down too much". Certainly, for working mothers, breastfeeding poses some challenges. But even if the mother breastfeeds only a few times a day after starting back to work, the baby continues to receive the benefits of breastfeeding and is usually healthier. Pumping milk from the breasts can help ensure that they continue to produce enough milk. If facilities are available, breast milk can be refrigerated or frozen and given to the infant later.
· "Breastfeeding can be tiring". That's true, and breastfeeding may seem like a burden, especially when a woman is already tired after a day's work. But preparing an artificial formula properly before giving it to the baby can be just as tiring. Also, many women find the process of breastfeeding relaxing; it gives them time to be close to the baby.
· "I'm sick and have to stop". If a woman gets sick, breastfeeding should continue for as long as possible. The baby probably will not catch the mother's illness. In fact, the baby receives protection from the mother because of the antibodies passed on through the breast milk. A sick baby may eat less, but breast milk is still the best food and the one the baby can digest most easily.
· "My baby must be weaned because I'm pregnant again". Instead, if the mother's diet is adequate and she gets plenty of rest, she can continue to breastfeed for as long as she produces milk and feels able to do so.
Even with the most willing mother and contented baby, problems may arise during breastfeeding. It is useful to know what might happen and how to prevent or cope with problems.
CRACKED OR SORE NIPPLES: This problem is usually the result of having the baby in a poor position for breastfeeding. For example, it may happen when the baby does not have the area around the nipple (the areola) as well as the nipple itself in the mouth. It can also happen when the baby sucks for a very long time in the same position, when the breasts are too full, when there is friction against tight and ill-fitting brassieres, or if the mother uses irritating soaps or other substances on the nipples. If a woman has cracked and sore nipples, she should be given the following advice:
1. Start feeding on the less painful breast.2. If the baby has already breastfed for a long time and is only sucking for comfort, stop breastfeeding and comfort the baby some other way.
3. Always check to make sure that the areola, as well as the entire nipple, is in the baby's mouth.
4. Air dry the nipples carefully before covering them up.
5. Apply breast milk to the dry nipple. Breast milk has natural antibodies that will help prevent infection. Again, the breast should be thoroughly air dried before being covered up again.
6. Change positions during breastfeeding so that the baby latches on to different areas of the areola (see Figure 15.1).
Figure 15.1: Positions for Breastfeeding
Holding the baby in different positions while breastfeeding can help make the process more comfortable, and prevent problems like cracked or sore nipples. It is also important to make sure the dark area around the nipple, as well as the nipple itself, is in the baby's mouth.
Figure 15.1.A: Positions for
Breastfeeding
Figure 15.1.B: Positions for
Breastfeeding
Figure 15.1.C: Positions for
Breastfeeding
Figure 15.1.D: Positions for
Breastfeeding
BREAST ENGORGEMENT: The breasts can get too full if the baby does not feed often enough or does not thoroughly empty all parts of the breasts. Engorged breasts can be quite painful and cause fever. To prevent breast engorgement, the woman should breastfeed the baby often and be sure that at each feeding, both breasts are emptied. Changing positions during breastfeeding will also help empty the breasts. If necessary, the breast milk can be pumped from the breast to relieve engorgement.
If the baby has trouble attaching to the nipple because the breasts are engorged and the nipple has flattened, warm soaks or a warm shower and gentle rubbing of the nipple will help the milk begin to flow to relieve engorgement. Then the nipple and areola will be softer so that the baby will be able to suck more easily.
INFECTED BREASTS: Sometimes breasts become infected and cause fever and pain. Infection usually follows breast engorgement or cracked nipples. The woman may need medical treatment. Most importantly, she should continue to breastfeed on both breasts. The baby cannot catch the infection and breast-feeding will help relieve the problem.
BREAST ABSCESS: An abscess is an infection that forms a collection of white pus. Breast abscesses are rare but serious, and will need treatment in a clinic where the abscess can be cut open and drained. During this time the woman should stop feeding the baby from that breast for a while. If the pain allows, milk may be gently squeezed from the breast at regular intervals. The baby may be fed from the healthy breast until the infected one is healed.
FLAT OR INVERTED NIPPLES: If a woman has nipples that turn inward or remain flat rather than standing up, she should be reassured that she will also be able to breastfeed. The sucking of the baby will pull the nipple out. It may take longer for the baby to suck at first, but usually the problem does not last.
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Summary: Breastfeeding Every child should be breastfed. Breastfeeding should start immediately after birth, and the baby should receive only breastmilk for the first four months. Infants who are not breastfed are more likely to become ill and die than those who are. Some advantages of breastfeeding are: Breast milk is natural and easy to digest. Sometimes complications can arise; for the most part, they are not serious enough to stop breastfeeding altogether. They include: Cracked or sore nipples: Make sure the entire nipple as well as the dark area around it is in the baby's mouth; change the baby's position frequently. Breast abscess: Treat the infected breast. Feed the baby from the healthy breast. |
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