Breastfeeding
Breast feeding
"Ideally a baby should be breast fed for two years, or for a minimum of three to six months.."
Breast feeding is the BEST feeding for the baby. Breast feeding is the natural way of feeding. But it may not happen without effort for many, though in some it can happen naturally. It is like driving, some are natural drivers, while others have to work hard at it. If this is your second baby you will be influenced by what happened with the first. If the breast feeding went well, it is almost certainly will again work. If it was not a great success, you may have mixed feelings. Why not try again, if only for a couple of weeks. Generally lot of mothers succeed better with their second baby even if they had failed the first time. Breastfeeding your baby is very important
Why should I breast Feed? Breast milk is best for the proper growth of the baby. Breast milk is the first vaccine of the baby. It also helps the baby's brain development. In pregnancy fat is deposited in the body to be used during feeding. Mother's milk also has fat and lactose (carbohydrates) in it; so you lose weight faster, than a woman who is bottle feeding. Breast milk also protects the baby from allergies, and from disease. Since breast milk is always pure, breast fed babies had fewer bowel upsets. It gives the mother and the baby tremendous satisfaction and builds a happy bond between them. Besides, there is no bottles to sterilize, milk to be bought, milk to be kept warm, and other hassles. While the baby feeds, the muscles of the uterus contracts vigorously, thus speeding up the return of the uterus to its normal size and position. If you wear a good supportive bra while feeding, breastfeeding need not cause the breasts to sag. Breast can also sag with age or obesity, without ever nursing a child.
"The protective umbrella of breast milk ensures that child develops antibodies against many infections that child acquires as an infant or as a toddler."
Lactation in nursing mothers increases considerably by the consumption of germinated cereals and pulses. This naturally leads to the proper and quicker development of the child as well.
According to Ayurveda
According to Ayurveda, for a mother love and affection towards the baby, a happy state of mind, adequate rest and sleep and a good nutritious diet are essential for successful breastfeeding.
Certain plants and food preparation like kheer of Halim, Methi ladoo, Dates and poppy seeds roasted with little ghee and medicinal product made up of shatavari, musali, jeevanti etc. helps to improve the quality and quantity of milk.
"Jeera water (Cuminum cyminum) to lactating mothers. It works as galactagogue and enhances the mother's immunity."
Basic Facts
- Mother's milk is the ideal milk for the baby. All substitutes are not only inferior, but can be harmful.
- Colostrum, the first milk is vital for the baby, so breastfeeding should start in the delivery room itself, soon after your baby is born. Colostrum in the first few days , and the milk produced in your breasts later on is all that your baby needs for the first six months. No water is required even in a very hot day.
- Women of all ages with small or big breast can breastfeed their babies. Breast feed does not spoil a women's figure Women employed outside the home can also conveniently breastfeed.
- Basically the Indian diet (including vegetarian) is well balanced. Imbalances occur because certain families may be poor or due to misconceptions prevalent in several sections of our society. For example, some wrongly starve the pregnant mother so that the fetus remains small to facilitate an easier delivery; others overfeed her. Some families ignorantly start supplementing breastfeeding before the desired age of six months, others delay it till the child completes one year.
"Powder of Glycyrrhiza galbraith) Mulethi taken with sweeten milk act as a galactogogue."
Advantages of Breastfeeding To The Mother
- Loving Bond With Your Family.
- Calming Effect.
- Lowered Risk Of Bleeding After Delivery.
- Lower Risk Of Conception.
- Reduced Risk Of Cancer.
- Quicker Regaining Of Figure.
As far as the breast are concerned, having a baby alters the breasts- whether or not woman breastfeeds. Most changes, however, that seems in older women are partly due to age or due to an inborn tendency. Wearing a well fitting brassiere will ensure that the breast have a good shape.
- Convenience.
Advantage To Your Baby
- Complete Nutrition.
The absorption of zinc and iron from breast milk is unsurpassed by any other source in early infancy. This protects the baby against early zinc deficiency and iron deficiency anemia.
In later infancy, the ideal balance of amino acids provided by breast milk adds to the quantity of proteins in the total diet, which is frequently deficient in other sources of protein. That is why breast feeding is recommended well into the second year of your baby's life. Being a rich source of vitamin A, breast milk reduces the risk of Vitamin A deficiency and blindness.
Breastfed babies do not need any multivitamins or vitamin C drops. Take these vitamins yourself if you are not taking enough fruits, vegetables, and sprouts in your diet. Your breastfed baby also does not need digestive enzyme preparations, carminative mixtures, and gripe water. If the baby does colic.
- Protection Against Infections
If baby is on breastfeed and gets frequent motions, continue to breastfeed during diarrhea and other infections, help a baby to recover much more quickly. The protection against infection is provided by a host of substance present in mother's milk, like antibodies, white blood cells, bifidus factor, lactoferrin and several others.They protect the baby against many bacterial and viral infections.
- Fewer Allergic Disorders.
- Reduced Risk Of Cancer.
- Better Teeth.
Other factors being equal, your breastfed baby is likely to have a better configuration of the face and alignment of teeth. Caries in teeth are also less in breastfed children.
- Lowered Risk Of Type 2 Diabetes And Other Long Term Benefits.
Breastfed babies have lower risk of blood pressure, and have lower total cholesterol.Prevalence of overweight and type 2 Diabetes were lower among breastfed subjects.
- Protection Against Sudden Infant Death Syndrome (SIDS).
Sudden Infant Death Syndrome (SIDS) also called cot death is ascribed to death that takes place suddenly in healthy infants without any obvious cause. The risk of this tragic condition is probably reduced in breastfed babies and babies put to sleep on their backs. Use of soft pillows for the babies, smoking during pregnancy and second hand smoke and co-sleeping on a sofa may add to the risk.
- Enhanced Intelligence.
Research suggest that in the long run, breastfed children show higher performance in intelligence tests.
- Caters To Specific Requirements.
Milk of mother's who deliver prematurely (before the expected time) has different composition compared to that of mothers who deliver at the expected time. In either case, the milk produced is as per the requirement of the baby.
Tips for working mothers for breast milk storage
- Room Temperature : Freshly expressed breast milk can be kept at room temperature for up to six hours. If you can't use the milk that quickly or the room is especially warm transfer the milk to an insulated cooler, refrigerator or freezer.
- Insulated cooler : Freshly expressed breast milk can be stored in an insulated cooler with ice packs for up to one day. Then use the milk or transfer the containers to the refrigerator or freezer.
- Refrigerator : Freshly expressed breast milk can be stored in the back of the refrigerator (not at the door) for up to 5-8 days.
- Freezer : Freshly expressed breast milk can be stored in a standard refrigerator freezer for up to 3-6 months and in a chest freezer for up to 6-12 months. Place the milk in the back of the freezer, not at the door.
Expressed breast milk is an ideal way to feed your baby when you are away. Still, some research suggest that the longer you store breast milk - whether in the refrigerator or in the freezer - the greater it lose vitamin C. Other studies have shown that refrigeration beyond two days might reduce the bacteria killing properties of breast milk and long term freezer storage might lower the quality of fat in the breast milk. It is also important to note that breast milk expressed when a baby is a newborn born won't as completely meet the same baby,s needs when he is older . Keep in mind that storage guidelines might differ for preterm , sick for hospitalized baby.
Breast Crawl
Newborns when placed between the mother's breast soon after birth, have the natural ability to find the mother's breast on their own to take the first breast feed. This is called the 'Breast Crawl.' This helps in successful breastfeeding better bonding between mother and new born and also helps in early expulsion of placenta and reduce risk of bleeding after delivery.
How does the baby feed ?
The baby's gums press on the areola, this is , the dark area behind the nipples. The nipple get extended back towards the baby's gullet and the baby's tongue 'milks' it by pressing it against the roof of the baby's mouth or palate.
If the baby 'munches' on the nipple instead of areola, it will hurt.You should break the baby's suck by inserting a finger into the corner of his mouth, or pulling the chin down, and then pull in more of the breast so that the baby latches on properly, and its gum press on the areola and not on the nipple.
Since the baby has to 'munch' for each sip of milk, its jaw development improves. Also make it possible for the baby to pause in between, just to breathe or look around.
As opposed to this a bottle fed baby gets a continuous flow of milk through the bottle's nipple and tends to over drink. So the seeds of becoming overweight are sown right at the start.
Forerunner to Milk
Towards the end of pregnancy say in the last three months, women often notice a yellowish fluid escape from the breast. Even if they do not notice it, a few drops may appear and dry at the tip of the nipple, forming a crust or scab. This is called colostrum, or fore milk. It is fed to the baby before the milk comes in. Milk might take 2-4 days to come in. For about ten days it is still mixed with colostrum and looks rich and creamy. Earlier, older women regarded colostrum as unclean milk and forbade mothers from feeding it to the baby. Feeding colostrum to the baby is full of advantages. It definitely must be fed to the baby.
Colostrum
It is more protein than mature milk but has less carbohydrates and fat. The protein gives the baby a full feeling, so that it remains satisfied longer after a feed, enabling it to sleep and rest for long periods in the first days of life. At the same time, it also gives the mother time to rest. Antibodies are present in mature mother's milk; only there are many more in colostrum. Later the baby will produce its own antibodies, but in the first few months, it can't and depends on its mother for them. These antibodies protect the baby from number of bacteria and viral infections that the mother may have suffered from or has been immunized against among these being Pneumonia, whooping cough, E-coli gastritis, typhoid, flu, desentry, tetanus etc. however the extent of protection received by the baby may at times be complete and at other times may be partial. It is very important for the baby to get these antibodies from colostrum and mother's milk, until its body can manufacture its own antibodies or during what is called the 'immunity gap'.
Colostrum contains minerals like zinc and calcium and vitamin A, B 6, B 12, and Vitamin E. It also have a laxative effect and helps the baby to pass its first stool which is black and sticky. It has a higher cholesterol content then milk, which may be important at this stage for promoting the growth of the nervous system, and possibly later in life for helping the body to cope with cholesterol.
Mature Milk
The colostrum gradually changes into mature milk during the first few days. There is no sudden change. The more a baby feeds the sooner milk will be produced in large amounts. If the mother is feeding her baby infrequently, it may not come until forth or fifth day.In the mean time, you have a 'transition milk'
that is milky looking colostrum. Transition milk changes into mature milk.. Mature milk is thinner looking, whiter or bluish. In the first year of breast feeding, the protein present in the milk is gradually falls, regardless of mother's diet. This is because of baby grows fastest in the first six months when the protein in the breast milk is the highest.
"Allergy of Cow's or Buffalo's milk are common but not of breast milk, that is why exclusive breastfeeding for 6 months.."
Stools of breastfed babies
Breastfed babies normally pass very frequent stools, that are not wholly formed. some times with wind, a bit of stool may be passed. Bottle fed babies pass harder stools which may give rise to constipation.
Engorgement
A dramatic change occurs in the breasts when the milk comes in , a few days after delivery. The breast become larger than ever, hard, sensitive, full and uncomfortable. The change is due to the increased blood supply in the breast and the start of full milk production. This heavy uncomfortable state is known as engorgement and lost for 24-48 hours.
How to deal with engorgement
Emptying the breast will help relieve the discomfort, feed the baby more frequently or empty the breast with a breast pump or with manual expression. Cold compress used immediately after a feed will reduce the discomfort, it will cause the blood vessels to immediately contract. A warm bath before a feed will soften the breast and help soften the nipple stand out for feeding.
How to express milk
Milk can be expressed manually, with the hands or with help of a breast pump. Manual expression of milk can be achieved by placing both hands, against the chest and around the breast,, and massaging a lightly oiled breast from the chest, towards where the areola the dark area behind the nipple,meets with breast, and and pressing it will release milk.You can keep a towel to collect a drips.
Breast pumps are also available in the market to express breast milk. They have a bulb of rubber and the rest of it is made of a glass funnel. First the rubber bulb is pressed and the glass funnel is placed to cover the nipple and areola. Then the rubber bulb is released This creates a vacuum and results in expression.
To store breast milk
To manually express the milk for collection, in order to be fed later to the baby, do not oil the breast. Choose a time when you are not in a hurry. Wash your hands with soap and water and dry them on a towel kept aside for the purpose. Sit at the dinning table. Place a clean sterilized stainless steel serving bowl in front of you, express milk by massaging the breast in order to encourage the milk to flow down to the milk ducts. Once the flow has begin, press on either side of areola. Soon after feeding the baby from one breast, you can express from the second breast, or you can apply warmth to your breast by applying a warm towel before you begin to express.
Take care to see that the expressed milk is aimed at the bowl and does not spill outside it. When a considerable amount has been collected, pour it into a sterilized feeding bottle and store in refrigerator. You can also express milk with the breast pump. It will stay for 24 hours in the refrigerator. Before feeding, breast milk should not be boiled. Just stand the bottle in the hot water to warm the milk slightly and feed. While keeping in refrigerator the milk may separate into fat and water layers; that does not mean it has gone bad. If expressed milk has to be fed at night, express during the morning, when milk production is greater, after you have been nicely rested. Or express at night so that it can be fed at noon, the next day.
All equipment used for expression must be boiled. If they are sterilized by soaking in soaking in a sterilizing solution, they should be rinsed off with boiled water before use. Metal should not be put in a sterilizing solution.
If the baby's nose get blocked
If engorgement causes the breast to become very full and the soft breast tissue presses against the baby's nose, causing it to leave the breast tissue presses against the baby's nose, causing it to leave the breast in panic, do not press the breast down with a finger to free the baby's nose. It will cause the nipple to project upwards, which in turn lead to the nipple hitting against the roof of the baby's mouth and block the ducts on the tip of the nipple or cause the nipple to get sore or cracked.
Instead you should make a fist with your hand and place it under the breast, then gently raise the breast up to a little with your fist, so that the nipple is projected straight towards the baby's throat. This is also useful when the nipple retracts because of engorgement.
Choking Baby
If a mother has too much milk that flows too fast, the baby might choke on it In case this happens, the mother should express a little milk before feeding the baby. Sometimes the baby may choke if the mother's nipple are too big and long, so that they go past the hard palate. The baby turns its head away from the breast and cries, moving his arms and legs. In this case, the mother should hold the baby a little away from the breast.
"The stool of the breastfeed baby is normally loose."
Fore milk and Hind milk
The early part of a feed is made up of a fore milk which is low in fat, while the later part is the hind milk, and has four to five times the amount of fat and one and a half times as much proteins. Hence the fore milk is thin, whereas the hind milk is thicker. Many hungry baby's whose mother thinks that they are not producing enough milk, get only the thin, low calorie fore milk, and the mother stops feeding before the high fat hind milk is consumed by the baby. As a result, the baby actually looses weight or fails to gain weight and is therefore started on cow's milk or powdered milk.
Will My Milk Be Enough?
Since we cannot measure the number of ounces of milk a breast fed baby gets, many mothers wonder whether it is enough. Remember it is nature's food for the baby, the same nature that nourished the baby inside the womb and made it a form into a human being. Your milk is the best suited to your baby's needs, much that cow's milk is much needed to calf's need.
If the baby starts sucking her fingers, do not jump to the conclusion that she is not getting enough milk from you ?
1. Gain Weight : To check if the baby is getting enough nourishment, the doctor will weigh the baby when you go for a check-up. If your doctor says your baby is putting on weigh normally, it is obvious that your milk is sufficient. Most babies lose weight in the first few days after birth. They regain their birth weight when they are about 10 days old. A healthy baby gains between 1/2 to 1 kg / month or a minimum of 125 gm each week in the first few months of life.
2 . Observe a baby's urine; its light color indicates that the baby is getting her required quota of milk. The baby urinates 6-8 times or more in 24 hours. If you fail to count the number of times she passed urine. Look at the color of the urine. A light colored urine is an indication that she is getting enough breast milk. An occasional passage of dark urine can be ignored. However in the first few days the frequency of urine may be less, as the colostrum has less amount of water in it.. Also if the baby is kept wrapped all the time , she may sweat and thus may pass less urine.. The urine may also appear dark in color..
3 . There should be at least 4 wet diapers and 7-8 dry diapers.
4 . Some mother's breast feel heavy or congested 3 to 4 days after delivery. This means that the mother is not feeding the baby enough. She should offer the baby frequent feeds or express the milk for the next 2-3 feeds. If the heaviness is allowed to remain , the mother will feel more discomfort and the baby will have difficulty in suckling.
Are Drugs required to increase milk supply?
- Frequent suckling can provide enough milk, but make sure that the baby is not simultaneously fed by the bottle.
- If the elders at home wants you to take some special diet to increase your milk supply, you can do so.
Less Milk
- If you feel you are producing less milk, all you have to do is feed more often. Each time you feed, the body releases prolactin hormones, which further stimulates the formation of milk. If you skip a feed in the hope of storing more milk for the next feed, it will not work. For the less you feed, the more your milk supply will dwindle. The amount consumed at a feed can be determined by weighing the baby before and after the feed without a change of cloths. If you feel the milk is not enough, feed more often and persist. If you get panicky and mix breast with bottle, the battle is lost.It is also said that eating Jeera or cumin seeds, methi or fenugreek seeds increases the production of milk. You should check with your doctor about any medicine you take, even if it is an Aspirin, just to make sure it will not affect the milk supply.
- Hydrate yourself well
- Eat lactonic granules with milk or water.
- Tab Perinorm or Domperidom or Metoclopramide 10 mg T.D.S For 10 Days or longer.
- Frequent suckling can provide enough milk, but make sure that the baby is not simultaneously fed by the bottle.
- Shatavari powder with milk. B.D
- Lots of fluid
- Masoor dal
- Hot & Cold Compression
- Cumin Seeds + Rock sugar
- Eat jaggery
- Sesame, Fennel, Raw/ripe papaya, onion, peas, Arbi, groundnuts.
- Mom's Tea (Little Veda) : Tea blend to support healthy lactation. It contains rose petals, Nettle chamomile, Shatavari, fenugreek, cumin, Fennel, Moringa, Cinnamon, Carom seeds, ginger and Turmeric.
For mother
- 2 Nightgowns with front opening (To make it easier for you to breast feed) and a wrap for when you have visitor.
- Under- clothing including well-fitting bras.
When should my baby get her first Breastfeed?
As soon as the baby is born, the doctor will hand the baby to you. Hold the naked baby against your chest for direct skin to skin contact. Depending upon the temperature in the delivery room, both of you may be covered with light sheet, with or without a blanket. Most babies, especially those whose mothers have not been sedated are alert for 40 minutes to an hour after delivery. Take advantage of this period. Try to see if she might be interested in breastfeeding right away. You will find that some babies turn their heads to one side and start looking for the nipple. Some succeed in getting hold of the nipple and start suckling. You will be thrilled to see this happening. If she does not attempt this on her own, you can gently push her towards one breast and see if she wants to suckle. Do not force her if she is not interested.
Early contact with baby is important for bonding with her and for giving her the valuable 'colostrum' a rich thick yellowish liquid which contains more protein, salt and anti-bodies than later breast milk and is very important for the baby as it helps build her immunity.
It has been observed that the suckling reflex of the newborn is at its height 20-30 minutes after birth. If the infant is not fed at this time, the reflex diminishes rapidly to reappear adequately 40 hours later. It may be further delayed if the mother is 'over doped'. On the other hand, if the baby is put to the breast immediately after birth, she takes the breast properly and early weight loss, which is so common in newborn babies, is minimized.
Nursing soon after delivery also has a laxative effect on the meconium. The early evacuation of meconium tends to decrease the re absorption of bilirubin (the yellow pigment responsible for jaundice).The pigment is liberated by the breakdown of cast-off red blood cells present in the intestines. Decreased re absorption of bilirubin reduces the appearance of jaundice. Even if the jaundice does appear, effective evacuation of meconium reduces its severity.
After a normal delivery, you and your baby will be taken to your room. If you are not heavily sedated, keep your baby next to you in your bed. You may like to cuddle her if she is still awake. In private hospitals a baby cot is provided next to your bed. You can decide if you want to keep the baby all the time in your bed or partly in the cot and in the bed accordingly to your convenience.
Breastfeeding After C-Section or After Episiotomy ?
C-Section delivery under general anesthesia, you may be on drip, even then the baby should be given to you for breast feeding. After about 4 hours of operation, when you would have recovered from the effects of anesthesia. You will need the assistance of an hospital assistance or a close relative to give your child the first breast breastfeed. As you lie on your back, the nurse may place a baby on a pillow raised to a level of your breast, so she can conveniently reach it.
If you had an episiotomy your doctor will prescribe drugs to relieve the pain of the stitches. Doctors have found that if the baby is given to the mother soon after delivery for skin-to-skin contact, the mother gets so engorged in her baby that stitching is often done without taking recourse to drugs for suppressing pain.
What shall be duration of first breast feed?
It should be 10-45 minutes and may be from one or both breasts.
How is the milk produced in the breast?
The ability to breastfeed does not depend on the size of your breast. Milk is produced in the milk producing gland tissue (alveoli) inside the breast. The size of the breast depends upon the supporting tissue or fat in the breast.
As the baby suckles at the breast, the mother produces a hormone that helps milk production.This hormone is called prolactin. As the baby continues to suckle, the mother produces another hormone that helps the milk to come down from the alveoli to the dilated milk ducts (Lactiferous sinuses) which lie under the areola-the circular dark skin around the nipple). The second hormone is oxytocin, and the mechanism by which the milk comes down from the alveoli is called the let-down reflex. Breastfeeding immediately after birth stimulates the production of these hormones and of breast milk. Small swellings are present at the areola. These gland that produce an oily material to keep the nipple soft.
The milk produced in the alveoli flows into the milk ducts and collects under the dark portion of the breast called the areola. To get enough milk, the baby must therefore take enough of the breast into her mouth so as to empty the lactiferous sinuses with her tongue. Therefore, baby should breastfeed and not nipple-feed.
How to Feed
When the baby latches on to the breast to feed, and it hurts, it is possible the baby has not latched properly. If the baby's gum press on the nipple it will hurt. If the baby's gum correctly press on the dark area behind the nipple, the baby's sucking will not cause any discomfort. Correct sucking releases the flow of milk, and causes relief to the mother, especially if the breast are hard and sensitive from being overfull. The release of milk is accompanied by a tingling sensation of the breasts.
If the baby's sucking hurts, insert a finger in baby's mouth, between the gums, to break the suck. Then in order to avoid the baby's gums pressing of the nipple, put in more of the breast, so that correct latching on takes place, and the baby's gums press on the areola, the dark area behind the nipple, instead.
Feeding the colostrum and fore milk helps to teach the baby how to suck, so that when the milk comes in, sucking brings relief to the mother. If the colostrum is not given to the baby, and instead sugared water or bottled milk is repeatedly fed by the bottle, the baby will get used to getting a constant flow from the bottle's nipple without having to suck very much.
After a few days, when the milk comes in, the breasts are painful and sensitive. A baby who has had the colostrum will relieve this discomfort by sucking at the breast and emptying it. But a baby who has not sucked the breast before will take the time to learn, and during this learning process, cause considerable discomfort to the mother.
If you start one feed from the right breast, start the next feed from the left breast. Whichever side the baby starts to feed from, he is likely to empty, and while on the second breast he might fall asleep. If the baby always empties, say the right side and falls asleep while feeding on the left side, the left side will always remain a little full. Over the months it can sag with this extra weight. You can fix safety pin on your bra to remind you which side you last fed from, or keep switching bangle or ring from one hand to other, to remind you.
Feeding time
The baby should be fed as and when it demands a feed. Hospital routine may encourage breastfeeds every four hours, with two to three minutes each side the first day, building up to ten minutes by the fifth day. This regulated system is based on bottle feeding, and has no bearing on breast feeding.
In the first few days, the baby should be put to the breast for at least ten minutes on each side, increasing it to thirty minutes by the third day. The more complete the emptying of the breast, the more successful the establishment of lactation. The let down reflex or release of milk may take a few minutes to be established. It can be affected by embarrassment at nursing, fear of discomfort, contractions during feeding, etc. Hence, if the baby is removed too soon from the breast, the reflex will be that much weaker.
Relax when you Feed
It is important to relax when you feed, if you do not reflex it will interfere with the letting down of milk, that is, the release of milk does not take place when you are tense. It is therefore a good idea to retire to a quit, undisturbed corner with your baby, at feed time.You can carry with you a tall drink to savoir when feeding. If you are tense when feeding, the baby will sense it immediately and may not want to leave the breast as a result. It does not mean that, is hungry, what he is doing is sucking for comfort and security, so it is important to relax.
If you have a problem with space, you can fix a curtain in front of your bed for privacy, or you can use a light scarf to cover yourself and baby. If your cannot help being tense, express your milk and feed it to the baby from a sterilized feeding bottle.
Night feeds
Newborn babies are need to be fed frequently, because of their body weight and their fast rate of growth, until the baby weight around ten pounds. He/she will need to get up at night for a feed. Once the a baby weighs ten pounds he/she can sleep for about five hours without waking up for hunger.
Try and give the baby the last feed when you yourself go to bed at night. When the baby wakes up at night. you can feed the baby in bed, and let it drops off to sleep with you. Keep a nappy change and a torch close at hand. Instead of a torch you can keep a zero watt bulb on all night.
Do not delay the feed until the baby has cried itself hoarse. If the baby is allowed to cry when he/she is hungry, it will fry your nervous; besides when put to the breast, the baby will feed only for a short while and fall of sleep from exhaustion; only to wake up with hunger after an hour or so.
So when your baby wakes up for a feed at night, pick him/her up or have your husband pass him /her to you. Your husband can help in this way, at least three times a week. Keep the room darkened. Do not play or otherwise distract the baby. Sing a lullaby, which should be sung only at bed time. Let the baby learn to associate minimum activity at night time.
At least three times a week, go to bed early, if your baby regularly wakes up at night. Keep water at your bed side in case you get thirsty. If you find it difficult to go back to sleep, try to relax by totally letting go your body. Make sure your comfortable. Being angry will not help. If you are very tied, you can express breast milk during the day and put it in a sterilized bottle, and your husband can feed it at night. Baby may not readily take to the bottle's nipple but will gradually get used to it.
How frequently the baby be breastfed ? You must breastfeed whenever the baby wants to. This is called demand feeding. It helps to prevent engorgement of breast.
Burping the Baby
Put the baby on your shoulder and rub her back. You can also put her face down on your lap and rub her back gently.You need not wait too long for the baby to burp. Some babies do not swallow much air while feeding and so may not burp at all. However if the baby does not burp after about 2 minutes, you can put her on her stomach If she is awake. If you are lying down, and feeding the baby during the night, you need not sit up to burp the baby, You can make the baby sit up next to you using your body for support.
Babies should be made to burp once or twice during a feed. The baby can burp once while being changed from one breast to the other, and at the end of a feed.
If baby falls asleep while having a feed do not wake it for burping. Put it on his right side not on his back. This position will cause the air to come. If a baby cannot lifts its head and is made to lie on a stomach, it can smother on its vomit or aspire it into his airway.
If the baby falls asleep, while having a feed, do not wake it for burping. Put it on its side or stomach, not on its back.These positions will cause the air to come up automatically.The milk it brings up with a burp will run out of its mouth and not bother it.
Feeding your Baby
Your milk whether thin, thick, yellowish, blue or white is right for your baby. Breastfeeding is to be continued even if the mother is suffering from certain diseases like asthma, malaria, cold, typhoid or tuberculosis. It is important not to give any glucose water or other milk for the first few days, because the first yellowish milk (colostrum) produced then, though small in amount, enough to meet all the needs of the baby. Even if you have to work outside the home. It is dangerous to start bottle-feeding with the assumption that the baby should get used to it. Working mother can breastfeed successfully without ever using a bottle.
What are Prelacteal Feeds?
Giving water, honey, glucose or artificial milk to the newborns in the first few days after birth, before the free flow of milk from the breast are called prelacteal feeds. These can be harmful for you as well as your baby and should be avoided. If the prelacteal feeds are given, the baby may not suckle adequately at the breast, as her stomach is already full. Consequently she will not get colostrum. Such feed may also be contaminated and results in serious infections. Allergies are more common in babies given animal milk (including powder milk) in the first month of life.
If these feeds are given through a bottle the baby may not make the required effort to suckle and empty the breast. These either result in breastfeeding failour or may cause engorgement and infection of the breasts.
Can Certain Foods the Mother Takes Upset Her Baby?
Small amounts of certain substances present in the mothers diet may pass unchanged into her breast milk. Occasionally these may upset the baby and make her cry. It is more likely to happen if you have taken cow or buffalo milk or coffee. In general, it is difficult to advise a mother about which food to avoid.. If you notice that the baby is definitely upset when ever you eat or drink something and avoid taking that particular item. For instance, if you are drinking milk, this could be a possible cause of the so called 3 months colic or evening colic.. You can try to stop taking milk and milk products completely, including milk in tea. or other foods. for 2 weeks.If milk is the cause of colic, the baby will cry less.. In that case do not take milk, until the baby completes 6 months. If baby continues to cry in spite of the absence of milk from your diet, milk is not a cause of her colic.
Flavors of garlic,onion,asparagus and vanilla eaten by you can enter your breast milk..Surprisingly most babies seem to like these flavors.
Hiccups
Sometimes babies start hiccups after a feed.It is nothing to worry about, although some parents go anxious when they here baby's rather loud hiccups. It is normal and will pass.
Bonding
The more skin to skin contact your baby enjoys with your body when feeding, the more a bond will develop between you and the baby.You should hold the baby against your bare skin when feeding.If you haven't felt very motherly at birth, you are going to feel a gush of maternal affection as your baby gazes intently straight into your eyes when feeding. This is specially important if you have had Cesarean birth.
"You can feed in any position, by lying down, sitting or reclining as convenient for you. Position of the baby at breast should be corrected."
How to Position the Baby
To make sure that your baby is properly latched on, ensure the following :
- Your baby's entire body, including her neck, shoulder and abdomen, should be facing you and close to your body. Her chin should touch the breast.
- Her mouth should be wide open with her lips curled outwards.
- More of the areola should be visible above the baby's upper lip and less below the lower lip. But if areola is big, more of it will be visible, even if the baby is positioned properly.
- The baby should be taking slow deep sucks.
- After the feed,the baby should appear relaxed and satisfied.
- You should not feel any nipple pain.
- You should be able to hear your baby swallow, but this is not essential.
Position your baby correctly will ensure that she is breastfeeding and not nipple feeding. This means that the baby should be taking not only the nipple into her mouth, but part of the breast as well.
The most common position of a mother feeding a baby is sitting, with the baby supported by her arm, bend at her elbow. A pillow on the lap will provide support to the arm supporting the baby. Alternatively, when the mother is tired at night, she can lie down on her side and feed the baby.
It is important for mother to be relaxed in which ever position she adopts.Secondly the breast should fall towards the baby. If the breast is falling away from the baby, it will require for the baby to tug at the nipple and may cause soreness or cracks in the nipples.
The fact that breast milk collects in the dilated ducts that lie underneath the areola, the dark portion behind the underneath of breast.The breast should be put into baby's mouth , so that much of an areola, especially the portion below the nipple is not visible while the baby is suckling. Let the baby keep suckling from one breast even if she seems to have fallen asleep and her eyes are closed.. Offer the other breast only when the baby releases the first breast on her own. If the baby is satisfied with only one side. Offer her the other breast at the next feed..
Holding a baby on your lap may be difficult because of the soreness of your abdominal incision. You can have your bed gently put in an upright position, place a table on which you eat your food in front of you and have the baby placed on the table as you try to nurse.
Or place a pillow on the side of your lap , place the baby's head on the pillow and allow the rest of the baby's body to taper off towards the side of your waist, below your arm and feed, changing to the other breast after some times.
You can also feed lying on your side, while your hand supporting your head, with the baby lying below the breast, the head at the breast, and the rest of the baby's body tapering away from you, in the direction of the headboard or in the direction of your head.
How long should a breastfeed last in the first week or two ?
In the first day or two, the baby may suckle for a prolonged period but may demand a feed after 4 to 6 hours and sleep in between. After 2 days she may want the feed very often but may suckle for a shorter period. Towards the end of the week, she may settle down to 2 to 4 hourly feeds.
As the days pass the feeds are likely to become shorter, it can vary from less than 5 minutes to 20 or more minutes. Some babies are slow feeders. But they take the same total amount of milk as fast feeders. Do remember that suckling for a prolonged period does not cause sore nipples. But if the baby is taking more than 45 minutes after the first week, you should check whether you are positioning her properly.
Diet When Breast Feeding
Remember when you are pregnant or when feeding the baby, you need good nutrition; so it is wrong time to diet. A women who is feeding the baby needs more calories than a woman who is pregnant. In pregnancy a women needs 300 more calories than she normally would, where as a women feeding a baby would need 550 more calories.
Most women who feed their babies do feel ravenously hungry; a fact that shows you the importance of listening to your body and having faith in it. If you feel hungry, you must eat. A new born baby needs about 120 calories per kilo per day, and weighs about 3 kolos. Therefore the baby should get about 360 calories from milk .The mother uses more than 400 calories to nourish the baby.
In fact a lot of weight that you put on in pregnancy consist of deposits of fat, placed by nature, to be used up while feeding. If you continue to eat wisely, you can loose weight while feeding.
A women feeding a baby should avoid too many spices, since these could give a peculiar smell to the milk, making it repulsive to the baby. She should drink plenty of fluids in any form, be it a milk, soup, nimbu pani, or lassi to make up for the loss of fluid in milk. Less water does not reduce the amount of milk produced, but it makes the mother's urine very concentrated and therefore unsafe.
A women feeding a baby can have a normal non-spicy diet with greater concentration on pulses green vegetables and milk.
Our Traditional Recipes
A word about our traditional recipes of ladoos, panjiri, dry fruit or mewa, jaggery, or whatever else you may make, to feed a women who had just delivered a baby. They contain ingredients that are traditionally believed to be beneficial to a woman who has just delivered a baby.
The point is to have the traditional recipes in moderation. Eat about 2-4 tablespoons of panjiri or half or one ladoo with your early morning tea, when you know that activity will follow; or after a period of activity. Do not eat it as pudding after dinner and go to sleep. That is the best way to put on weight. Over eating of anything heavy can make you put on weight, so why blame panjiri ?
An interesting example illustrating the wisdom of our traditional practices comes to mind. In parts of south India, a woman who has delivered a baby is given water to drink, in which an iron rod has been boiled. This makes it a wonderful iron drink, a mineral women woman can always use, On account of monthly periods and childbearing women generally lack iron and therefore are often prescribed iron tablets.
Clarified Butter or Ghee
Ghee is highly overrated. Having a spoonful of ghee every day before the birth of baby is said to lubricate your vagina, nerves, making birth easier. This is totally false. The ghee eaten goes straight into the stomach where it gets absorbed by the digestive system.To make yourself supple and flexible you need exercise, not ghee.
Ghee will make you fat. Be active, so that your joints are not stiff. Three joints in the pelvis bones spread apart to permit the birth of the baby. If you are sitting on sofas all day and then lying on bed , it can make the delivery difficult, even though you may have had spoonfuls of ghee every day. Ghee along with inactivity will mean extra weight and stiff joints, making delivery difficult.
Earlier woman worked in fields, milked cows, churned butter or ground wheat, hence they could digest the ghee. Perhaps ghee was valued since it has Vitamin A and D that help your bone in various ways. Vitamin A for instance helps fight infections.
Instead of eating ghee, you can massage the perineum and the whole vaginal area with coconut oil daily in the last month of pregnancy.
What should a mother do if her baby is really not getting enough milk?
In such case, mother should stay close to the baby at all times. She should cuddled her as much as possible and make the baby sleep with her. She should offer breast to the baby when ever she shows an interest in suckling. But she should not force her. Some babies suckle better when they are sleepy. The idea is to stimulate the breast by frequent sucking.
The mother should also see that the baby is positioned properly on the breast with enough of areola, in her mouth. She should make sure that the child is not given any bottle feed. When ever the baby shows interest, she should breastfeed her and after that, if she is convinced that the baby is still hungry, she should express her breasts and offer that milk to the baby in a cup or a bondla. If this is not possible, the baby might be given half strength cow's ot buffalo milk from a cup or bondla after the breast fed.. Never replace a breastfeed with an artificial feed as far as possible.Diluted feed leaves the baby hungry, so she is more willing to try to suckle. But do ensure that the baby is not starving. Check the urine output and the weight gain;
Green motions do not necessarily mean that the baby is not getting enough milk. If the baby is gaining weight, is active and passes urine normally, the green motions are normal. The so called 'starvation stool' are seen in an emaciated child who passes traces of green mucus in place of normal stools. The baby does not gain weight and looks miserable.
Breast Size
The size of the breast in no way determine success of failour when feeding.Women with fairly small breast can feed as efficiently as women with large breasts. During pregnancy you will put on a kilo to a kilo and a half of weight on the breast, and as pregnancy advances, you will need a larger size bra. The size could increases by two sizes, that is , a woman normally wearing size 34 could need size 38 as she goes past her six months.
After the baby is born, when the milk comes into the breast after a few days. the breast becomes big, heavy and uncomfortable. In the first two or three months, the breast will remain fairly large. At times hardness and fullness may also be experienced when the baby skips a feed.
After eight to twelve weeks the breast will go back to their normal size and feel soft, just as they were before pregnancy.This does not means that you are no longer producing milk. You might still be feeding the baby , but this time the supply and demand balance is just right and no over production of milk or over filling of breast takes place.
When feeding goes on for many months, some women might find their breast smaller than before they become pregnant. It will take them time to put on the fat again and to regain their original size.
Feeding Bra
A feeding bra should be worn, so that the breast do not sag with the extra weight. A feeding bra should be at least one cup larger than the one you wear during the last weeks of pregnancy. Since the breast will become larger, when the milk comes in. Due to extra weight of breast, the bra should be well fitting and made of cotton., since cotton does not stretch, with the increase in size, and therefore gives better support. It also allows better absorbency and circulation of air, hence reducing chances of sore nipple. If a bra fits well but is tight below the breast, you can buy some extra bra hooks called extensions and fix at the back, to make the bra more comfortable.
The bra should not be too tight. It should not have bands at the top of the breasts, that cut into the skin when the front cup or flap opens for feeding. These can cause blocked ducts. You can remove the bra at night.
You can fold some cotton in an absorbent gents cotton handkerchief and place inside the bra to avoid your cloths getting wet from leakage when you have company.
Flat Nipples
If your nipples do not project as nipples normally do, and appears flat or dimpled., they are called flat or inverted nipples. Being flat, if your nipples project when you are cold, sexually aroused or when feeding the baby, they may not create any problem, when feeding. Lack of projection of nipple, when the baby sucks or when the nipples are otherwise stimulated, can cause a problem, because the baby will be unable to grasp it in its mouth. So before birth, try and manipulate the nipple to project by holding back the areola or the dark area behind the nipples.
In case the baby has a problem of grasping a nipple during a feed, express some milk from the breast first, so that it becomes softer and easier for the baby to grasp. Expression can be done by hand or by a breast pump. When offering the breast both the nipple and areola must be put well into the baby's mouth. Once the baby has latched on, the nipple will remain projected for the rest of the feed.
Also after manual expression of milk, if one drop of milk is left on the tip of the nipple, it will act as an appetizer for the baby. If the nipples are flat when the baby is born use a nipple shield (also used for sore nipples) to start feeding. It is available in rubber and silicon. It draws out the nipple. Once the nipple is drawn out, quickly remove the shield and place the baby directly on the breast.
Breast Preparation for Feeding
From the sixth month of pregnancy onward, certain breast preparation techniques have to be started, to ready the breast and nipples for feeding. Because of the manner in which the baby sucks, it is important to toughen the mother's nipples so that they can avoid sore or cracked nipples.
Everyday After the Sixth month
Take two mugs of water, hot and cold. Put small face towels in them. Start with one breast, Wipe the whole breast with the warm towel, then with cold towel. Do six times together, ending with a cold wipe. Repeat on the other breast. This will encourage a better blood supply and a better formation of milk producing cells.
With a dry towel clean the tip of the nipples. You may find dry scabs falling off. Don't worry about it. At times drop of colostrum get secreted unnoticed and dry at the tip of the nipple, forming a scab or flake.
Hold both the nipples as you hold a cigarette that is between your fore finger and middle finger. Now draw it in or out or forwards and backwards 50-100 times.
Each time the baby sucks, its gums press on the area dark behind the nipple, and the nipple get extended way back towards the baby,s throat, from where milk goes straight down the baby's gullet.This would be one sip of milk. The whole process is repeated for the second sip of milk. So you are acquainting the nipple with the action of feeding when doing the preparation.
Then hold the areola, the dark area behind the nipple , between the fore finger and thumb and press. Do it twice. You might notice a few drops of fluid appearing at the tip of the nipple. Don't worry if you do not notice any. It will appear gradually over the weeks.
Wipe off the drops of fluid and lightly apply any natural oil on the nipple and areola. You can use coconut oil, ghee or groundnut oil. Synthetic based oils, that is petroleum based oils are best avoided, also scented oils.
When Feeding
The body has its own system of secreting lubrication from the Montgomery's tubercle (little prominence around the areola), to keep the nipples supple and oiled. However during a bath when soap is used , it gets washed away. So women find rubbing oil useful. Continue to use the same oil when feeding. That is after a feed, apply little oil on nipple and areola, in a thin film. Before the next feed, clean the nipple and areola with a small piece of cotton soaked in water, that has been boiled.. So keep bits of cotton soaked in a covered bowel of boiled water. Use a fresh piece of cotton for each breast. You are not only wiping out the oil, but also stale breast milk, perspiration, and threads from garments.
If you experience mild contractions when feeding, use your breathing for lablour to deal with it. These are caused because feeding releases oxytocin hormone which contracts the uterus and helps it to involute to its normal size. Therefor involution of the uterus is more efficient when you breastfeed.
Sore Nipples, Its Causes
When you want to stop feeding, if you pull and drag the baby off the breast, it might give you sore nipples. So instead you must break baby's suction by putting the tip of your fingers in the corner of the mouth, and then take him off the breast. Or pull the chin of the baby downwards.
If you press your breast down with fingers, by forming a big dent on the breast, in order to prevent the baby's nose from getting blocked, the act of pressing the breast down will cause the nipple to project upwards and hit the roof of the baby's mouth when it feeds. This hitting of the nipple on the hard palate will cause it to sore. Instead of denting the breast in this fashion, place a fist under the breast and raise it slightly. so that the nipple projects straight towards the baby's throat.
Soreness may also happen if the baby munches on nipple instead of the areola the dark area behind. Make sure the baby is latched on properly; by pressing both the nipples and areola well into the baby's mouth.
Soreness sometimes occurs if the nipples are frequently washed with soap. Water is sufficient to wash them with.
Pressure applied at the same point, constantly can lead to soreness. If therefore help to change positions during a feed and to adopt different positions for different feeds, so that pressure is applied to different points on the breast.
Soreness can be caused by baby sucking too long after the breast has been emptied. The baby takes approximately twenty minutes to empty a breast; after he /she only indulges in comfort sucking. Restrict comfort sucking.
Masse Breast Cream Topical : This medication is used as a moisturizer to treat or prevent dry, rough, scaly, itchy skin and minor skin irritations (e.g., diaper rash, skin burns from radiation therapy
/ Regular cleaning
How to Help Heal Sore Nipples
Soggy nipples, that is nipple that remain wet for long periods are more prone to soreness. It therefore helps to expose your nipples to air and sunlight as much as possible, until the soreness heals. You can wear a loose garment without a bra or you can wear a tea strainer without a handle inside your bra, to promote healing.
Avoid using creams on cracked nipples. Dry cornflour can be dusted on them instead. It is also very helpful to express some milk after a feed and rub it on a sore nipple where it should be left to dry. This quickens healing considerably. Avoid the use of water proof-backed bra pads. Do not remove any crust appearing on the nipple. It is a part of healing process.
Always offer the less sore side first. That will establish the flow on the sore side before he baby takes it, thus making it less painful. You can use breathing for labour to be able to handle the pain.
Apply warm ghee over the sore nipple.
As Aspirin or small alcoholic drink taken shortly before a feed will help reduce a pain. It can be taken if the pain begins to interfere with the let down or release of milk.
You can try using a cold compress on your nipples before feeding. Apply ice cubes rapped in a towel or hanky. You can wear a bloating paper on an ever-dry nappy-liner inside the bra to keep the nipples dry.
Sometimes a sore nipple may bleed. There is no harm if the baby swallows tiny amounts of blood with the milk. This can be quite frightening, especially when the baby burps after a feed, and along with the curdled milk brings up a little blood.. However this is harmless to the baby.Continue to treat your sore nipples and carry on feeding.
There may be a risk of infection of sore nipples, if the baby has thrush, that is , white spots on the tongue that do not wipe away. Thrush must be treated medically. You can take the baby off the breast for a few feeds until the skin has heeled.. The milk can be expressed, and fed to the baby from a spoon or from a sterilized feeding bottle.
A nipple shield can be used. It is a rubber shield that fits over the nipple and areola and prevents direct suction on the nipple.
Blocked Duct
A blocked duct appears in the form of a tender red looking lump on the breast or areola. It feels sore and can be accompanied by a hot and shivery feeling. It can be caused by a pressure on the breast, as from a light bra. Or you may be holding baby too tightly against the breast or your arm may be pressing on the side of the breast when lying in an uncomfortable position.
It can also be caused during engorgement by inadequate emptying by one duct in particular. This or any of the above factor , can cause a milk duct to get blocked, so that it does not empty properly causing a tender lump to appear.
How to deal with a blocked duct
Gentle but firm massage of the lump towards the nipple during a feed and after, if the block is still there, will help. A hot water bottle should ease a pain, also a hot wet compress applied hourly. Do not stop feeding.Offer an affected breast first for a first few feeds, to ensure a vigorous sucking, and drainage of the blocked duct. Lean forward over the baby as you feed, so that gravity also operate. Give the baby extra feeds. Express a remaining milk after the feed.
Check the tight bras, specially if your bra has a band across the top of the breast, when the flap is open.
Get plenty of rest. Actually go to bed for a day. it will make you feel better, and make sure blocked duct does not lead to mastitis.
Exercise of the arms, shoulders and upper half of the body., may help disperse the painful swelling caused by a blocked duct.
Non Infectious Mastitis
The symptoms are similar to those of a blocked duct. The infected area is red, swollen hot and painful, with shiny skin. The mother may feel nausea and shivering as in flu.
It may be caused by milk leaking from a blocked duct into the surrounding tissues and blood stream. The treatment for these is the same as the treatment for blocked ducts, with the addition of an antibiotic.
There is no danger in continuing feeding, as the organism is responsible for this sort of breast infection are not harmful and rarely present in breast milk. This sort of sporadic mastitis often occurs after several weeks of feeding and occasionally without a duct being blocked.
Infective Mastitis
It normally occurs in first two weeks of feeding. Its symptoms are that the whole breast is red, hot, tender and swollen and the mother feels feverish and ill. The milk becomes infected by a germ carried in the baby's nose, from the hospital nursery. The infection evolves the milk duct.
If the milk is infected, the baby may have to be taken off the affected breast temporarily.The baby can be fed from the non- infected breast or be given powdered milk, or cow's milk. The beast should be emptied regularly and the milk discarded until the bacteria count in the milk comes down to a safe limits.
In the mean time take rest and plenty of fluids, also arm swinging exercise will help.
Breast Abscess
Failour to treat mastitis or unnecessary weaning following mastitis may lead to mastitis may lead to breast abscess. A women must not stop feeding or expressing milk when she gets mastitis. It is hard, red and painful.
It requires treatment by antibiotics or surgical drainage. The baby may have to be taken off the affected breast. He can feed from the other breast until treatment is completed.
If a breast abscess is accompanied by a sore nipple, a nipple shield may be recommended by your doctor. The nipple shield fits over the nipple, and prevents direct force on the nipple. However, if the breast abscess is near the nipple, and the nipple shield also covers the abscess when worn, it can be very painful. Therefore avoid a nipple shield if the abscess is too close to the nipple.
The milk from the affected breast may be temporarily expressed and discarded. However if the doctor feels that infection from the abscess is not present in the milk, he may not advise you to take the baby off the breast.
Cap Augumentin 625 mg TDS. Tab Lactobacillus BD. Hot fomentation. Inj Mixogen IM Stat and another after 12 hours. Tan Oestrogen TDS for three days. Remove breast milk manually. Tan blong (vit B6) TDS for 3 days.
Prevention of Mastitis
To avoid mastitis, lactating mother should check her breast for blocked ducts daily. The examination should preferably done when the breast are relatively soft and empty.They should be checked for red patches. Fingers should be lightly swept over the breasts to check of any unusual hardness.
The appearance of a red patch or lumpy hardness in the breast means that a women is heading for a blocked duct. The moment signs of a blocked duct noticed, the baby should be allowed to suck at that breast as soon as possible. While the baby is feeding, massaging the lump towards the nipple help to unblock the duct.
To prevent blocked ducts and engorgement, keep the breast well drained. This can be done by feeding the baby regularly and frequently, and by expressing any surplus milk that makes the breast uncomfortable. It can be done with your hands or with the aid of a breast pump.
Sometimes, the mother becoming cold , probably leads to blocked ducts, because it causes circulatory changes in the breasts, or because of the changes in temperature that it causes in the mammary gland, it changes its bacterial environment. Hence mother who are feeding should be comfortably warm and not take long swims.
To stop Lactation
Tab Blong TDS for 10 days
Tab Mixogen TDS
Inj Mixogen IM Stat.
When not to breastfeed
Mothers suffering from tuberculosis, chronic nephritis (kidney trouble) or severe psychiatric disorders will be asked not to breastfeed; also, mothers who have suffered from some malignancy disease. Some patients of epilepsy may be discouraged from feeding if they are on a drug that can be excreted in breast milk..
Feeding when ill
Cold ,flu, fever should not require you to stop feeding, however do let the doctor know that you are nursing the baby, when doctor prescribes you medicine. Feeding should continue as long as possible, so that the baby could get the maximum advantage of the immunities present in the mother's milk
When feeding antibiotics such as tetracycline, and streptomycin, steroids and sulpha- containing drugs should be avoided. Some laxatives may cause colic and diarrhea in the baby. Anti-thyroid drugs may cause goiter. Anti-coagulants and large doses of aspirin can cause bleeding problems in the baby. Sedatives and tranquilizers such as valium can cause drowsiness and feeding problems.
Expressing Breast Milk
To begin with, it is better to get the help of another person, to stimulate the easy flow of milk. For this massage the breasts gently towards the nipples. Sit down, fold your arms on a table in front of you and rest your head on your arms, let the breast hang loose. Request the helper to rub your back firmly up and down with her knuckles. Let her rub on either side of the spine, from the neck to the should blades, for 2 minutes.
Now take a clean cup. Wash your hands. hold the cup near the breast. Put you thumb on the areola above the nipple, about an inch or 2.5 cm behind the nipple, and your first finger on the areola below the nipple, opposite the thumb. Push the thumb and fingers inwards towards the chest wall. Then press the areola between the finger and thumb and release. Again push, press and release. No milk will come out for a few moments. But after you press a few times, drops of milk will start to come. Press the areola in the same way from the sides to make sure that the milk is expressed from the all segments of the breast. Express one breast for 5 minutes. Then express the other side. Repeat again with both sides. You can use either hand for either breast.
The 'warm bottle method' of removing breast Milk
This is a practical method to relieve engorgement, especially when the breast is painful and expression by hand is difficult. Find a large bottle (700 ml to 1 litre) with a wide neck (3 cm in diameter), if possible. Pour a little hot water into the bottle to start warming it. Then fill the bottle almost to the top with hot water.. Let it stand for a few minutes to warm the bottle. wrap the bottle in a cloth and pour the hot water out.. Cool the neck of the bottle and put it over the nipple. Touching the skin all around to make an air tight seal. Hold the bottle steady. After a few minutes, the bottle will cool and exert a gentle suction that pulls the nipple into the neck of the bottle. The milk then starts flow and collects in the bottle. When the flow of the milk slows, release the suction and remove the bottle.. Pour out the milk and repeat the process with the other breast. After sometimes the severe pain in the breasts becomes less and hand expression or suckling becomes easier.
It is possible that you may pull away from the bottle because of a sudden feeling of suction. In that case, pour hot water into the bottle again, and repeat the whole process.
Manual as well electric and battery operated breast pumps are available in the market.
Expressed breast milk can be stored for at least 4 hours at room temperature. It can be kept in the fridge for 24 hours. If the milk separates, it can be shaken and given to the baby.
To stop feeding suddenly
If, for some reasons, you have to stop feeding abruptly, do it under your doctors supervision. The doctor will give you safe drug called Bromocriptine that will dry up the milk. If you simply stop feeding abruptly, you may subject your self discomfort. It is best to taper off feeding gradually.
Problem that may encounter During Breastfeeding:
Preventing And Treating Engorged Breast.
You may get congestion of the breast after 3. to 4 days.
Treatment :
(a) As soon as you feel that your breast are becoming taut, remove some milk by expressing it with your hands. These days breast pumps (electric as well as manual) are available to help express milk from the breasts.
(b) Unrestricted feeding or demand feeding a baby would also help to prevent engorgement.
(c) Hot water fomentation is helpful.
(d) You must take enough rest.
(e) If your breast develop an infection, an 8 to 10 days course of antibiotics may be needed. Even then it is safe to continue breastfeeding the baby. If you do not want to do so , continue expressing the milk from them.
(f) If an abscess does form, surgical help may be required. You should start breastfeeding from the operated side as soon as possible. This does not delay healing of the wound.
(g) If your breast are engorged you could get a fever, but it is unlikely to be high. The fever is not accompanied by the symptoms like chills, 'a general feeling of being unwell' and body ache and does not last more than a day or two. If it does, your doctor may consider the possibility of an infection that may need antibiotics. In the presence of infection, the mother feels unwell and may also have a chill.
Blocked or Plugged Ducts.
The milk is produced in he alveoli of the breast. This flows down the milk ducts and collects under the dark portion of the breast called the areola. Sometimes thicken milk may block a particular duct. The milk starts collecting behind this obstruction and this leads to the formation of a hard lump. In case of only a blocked duct, the mother does not have any fever and looks otherwise well..
Treatment :
A blocked duct must be treated. Otherwise infection can set in, leading to mastitis and breast abscess. In mastitis, a portion of the breast feels hot, swollen and becomes painful. In an abscess, the swelling when examined, appears to be full of fluid.
A lump due to a blocked duct should be gently massaged towards the nipple to help empty that part of the breast. The baby should be fed more frequently from the breast. If you have been feeding lying down (which is otherwise correct) try feeding in a sitting position. You can also try holding a baby under your arm, instead of across the front. All this may help to remove milk more efficiently from the blocked segment of the breast.
Breastfeeding with 'Flat' Nipples or Inverted Nipples.
Successful breastfeeding does not depends on the size of the breast or the size of the nipples. Just touch or gently rub your nipple with your fingers. If it become slightly more prominent, it is protractile.
A flat or a small nipple that becomes prominent (even a little) on being touched is normal. So the size of 'resting' nipple is not important.
In rare case, a nipple does not protract. If you try and pull it out, it goes deeper into the breast. This is an inverted or retracted nipple. The baby has even more difficulty from an engorged breast with an inverted nipple. In such a case , the mother should express the milk until the breast feels soft.
This helps the baby to take enough of breast in her mouth.
Treatment :
Some mothers with inverted nipple may need the help of a disposable syringe. The nozzle end of a 10 ml plastic disposable syringe is cut off (step one). The piston is introduced into the ragged cut end side (step two). The mother then applies the smooth end to her breast and pulls on the piston gently and holds it in that position for about a minute. (step three). The protrudes out into the syringe. The mother reduces the traction while releasing the syringe. The nipple stays protruded for some time; and the baby is immediately put to the breast. As the nipple is easily taken into the mouth, the baby is able to suckle in a proper position.
The nipple retracts again after a while, but not to the same extend. The procedure can be repeated several times a day for a couple of days. This corrects the retraction permanently in almost all cases.
Sore or Cracked Nipples.
Some mother get sore or cracked nipples in the first week of breastfeeding because of incorrect positioning of the baby on the breast.The baby does not have enough of the breast in her mouth and she suckles only the nipple, thus hurting it. Do remember that frequent or prolonged suckling does not cause sore nipples.
Another possible cause of sore nipple is introducing the child to artificial 'nipple' like the teat of the bottle, a pacifier or a nipple shield in the first weeks of life. This can affect proper suckling at the breast, resulting in sore nipples.
Also if mother takes the baby off the breast without first breaking the suction (by putting the finger between the breast and the baby's mouth), she may get sore nipples.
Treatment :
Breast feeding must be continued despite sore or cracked nipples. However, the baby should be positioned properly on the breast with enough of the breast in her mouth.
Ensure that the nipples are dry after each feed. Expose the nipples to air ( and also the sun if possible) and apply a drop of hind milk to the cracked nipples.
The soreness settles down within a few days. If the soreness persist or if suddenly appears after a week or two of delivery, it is usually due to a fungal infection. The area around the nipple feels itchy and the pain seems to shot down into the breast. The baby may also have thrush (white curd like patch inside the mouth that are not easy to remove). Your doctor will prescribe a local application for the nipples as well as the baby's mouth. Sometimes you may also need to be given an oral medication.
It is important to remember that a little tenderness of the nipples, when you begin to breastfeed, is quite normal in the first 2-3 days after delivery.
Do not wash breast before and after feed. Daily bathing is enough. Never wash your nipples with soap. Frequent washing or cleaning of the breast is likely to remove the anti-bacterial lubricating oil produced by the Montgomery's glands present in the areola. This can lead to dryness and thus lead to soreness of nipples.
Avoid using creams or ointments sold in the market for the prevention or treatment of sore or cracked nipples. They may actually add to the problem.
Leaking Breast.
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Breast may sometimes leak, between feeds, in the first few weeks of delivery. This usually stops on its own and is good as it indicates that the mother is getting good quantities of milk.
Treatment :
Small pieces of any toweling material can be kept between the bra and the breast. These should be changed often as the wetness can cause sore nipples.
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