Breastfeeding is the natural, physiologic way of feeding
infants and young children milk, and human milk is the milk
made specifically for human infants. Formulas made from
cow’s milk or soy beans (most of them) are only
superficially similar, and advertising which states
otherwise is misleading. Breastfeeding should be easy and
trouble free for most mothers. A good start helps to assure
breastfeeding is a happy experience for both mother and
baby.
The vast majority of mothers are perfectly capable of
breastfeeding their babies exclusively for four to six
months. In fact, most mothers produce more than enough milk.
Unfortunately, outdated hospital routines based on bottle
feeding still predominate in many health care institutions
and make breastfeeding difficult, even impossible, for some
mothers and babies. For breastfeeding to be well and
properly established, a good early few days can be crucial.
Admittedly, even with a terrible start, many mothers and
babies manage.
The trick to breastfeeding is getting the baby to latch on
well. A baby who latches on well, gets milk well. A baby who
latches on poorly has difficulty getting milk, especially if
the supply is low. A poor latch is similar to giving a baby
a bottle with a nipple hole which is too small—the bottle is
full of milk, but the baby will not get much. When a baby is
latching on poorly, he may also cause the mother nipple
pain. And if he does not get milk well, he will usually stay
on the breast for long periods, thus aggravating the pain.
Here are a few ways breastfeeding can be made easy:
1. The baby should be at the breast immediately after
birth. The vast majority of newborns can be put to
breast within minutes of birth. Indeed, research has shown
that, given the chance, babies only minutes old will often
crawl up to the breast from the mother’s abdomen, and start
breastfeeding all by themselves. This process may take up to
an hour or longer, but the mother and baby should be given
this time together to start learning about each other.
Babies who "self-attach" run into far fewer breastfeeding
problems. This process does not take any effort on the
mother’s part, and the excuse that it cannot be done because
the mother is tired after labour is nonsense, pure and
simple. Incidentally, studies have also shown that skin to
skin contact between mothers and babies keeps the baby as
warm as an incubator.
2. The mother and baby should room in together. There
is absolutely no medical reason for healthy mothers and
babies to be separated from each other, even for short
periods. Health facilities which have routine separations of
mothers and babies after birth are years behind the times,
and the reasons for the separation often have to do with
letting parents know who is in control (the hospital) and
who is not (the parents). Often bogus reasons are given for
separations. One example is the baby passed meconium before
birth. A baby who passes meconium and is fine a few minutes
after birth will be fine and does not need to be in an
incubator for several hours’ "observation".
There is no evidence that mothers who are separated from
their babies are better rested. On the contrary, they are
more rested and less stressed when they are with their
babies. Mothers and babies learn how to sleep in the same
rhythm. Thus, when the baby starts waking for a feed, the
mother is also starting to wake up naturally. This is not as
tiring for the mother as being awakened from deep sleep, as
she often is if the baby is elsewhere when he wakes up.
The baby shows long before he starts crying that he is ready
to feed. His breathing may change, for example. Or he may
start to stretch. The mother, being in light sleep, will
awaken, her milk will start to flow and the calm baby will
be content to nurse. A baby who has been crying for some
time before being tried on the breast may refuse to take the
breast even if he is ravenous. Mothers and babies should be
encouraged to sleep side by side in hospital. This is a
great way for mothers to rest while the baby nurses.
Breastfeeding should be relaxing, not tiring.
3. Artificial nipples should not be given to the baby.
There seems to be some controversy about whether "nipple
confusion" exists. Babies will take whatever method gives
them a rapid flow of fluid and may refuse others that do
not. Thus, in the first few days, when the mother is
producing only a little milk (as nature intended), and the
baby gets a bottle (as nature intended?) from which he gets
rapid flow, he will tend to prefer the rapid flow method.
You don’t have to be a rocket scientist to figure that one
out, though many health professionals, who are supposed to
be helping you, don’t seem to be able to manage it. Nipple
confusion includes not just the baby refusing the breast,
but also the baby not taking the breast as well as he could
and thus not getting milk well and /or the mother getting
sore nipples. Just because a baby will "take both" does not
mean that the bottle is not having a negative effect. Since
there are now alternatives available if the baby needs to be
supplemented (see handout #5 Using a Lactation Aid, and
handout #8 Finger Feeding) why use an artificial nipple?
4. No restriction on length or frequency of
breastfeedings. A baby who drinks well will not be on
the breast for hours at a time. Thus, if he is, it is
usually because he is not latching on well and not getting
the milk which is available. Get help to fix the baby’s
latch, and use compression to get the baby more milk
(handout #15 Breast Compression). This, not a pacifier, not
a bottle, not taking the baby to the nursery, will help.
5. Supplements of water, sugar water, or formula are
rarely needed. Most supplements could be avoided by
getting the baby to take the breast properly and get the
milk that is available. If you are being told you need to
supplement without someone having observed you
breastfeeding, ask for someone to help who knows what they
are doing. There are rare indications for supplementation,
but usually supplements are suggested for the convenience of
the hospital staff. If supplements are required, they should
be given by lactation aid (see handout #5), not cup, finger
feeding, syringe or bottle. The best supplement is your own
colostrum. It can be mixed with sugar water if you are not
able to express much at first. Formula is hardly ever
necessary in the first few days.
6. A proper latch is crucial to success. This is the
key to successful breastfeeding. Unfortunately, too many
mothers are being "helped" by people who don’t know what a
proper latch is. If you are being told your two day old’s
latch is good despite your having very sore nipples, be
skeptical, and ask for help from someone who knows.
Before you leave the hospital, you should be shown that your
baby is latched on properly, and that he is actually getting
milk from the breast and that you know how to know he is
getting milk from the breast (open—pause—close type of
suck). If you and the baby are leaving hospital not knowing
this, get help quickly.
7. Free formula samples and formula company literature
are not gifts. There is only one purpose for these
"gifts" and that is to get you to use formula. It is very
effective, and very unethical, marketing. If you get any
from any health professional, you should be wondering about
his/her knowledge of breastfeeding and his/her commitment to
breastfeeding. "But I need formula because the baby is not
getting enough!". Maybe, but, more likely, you weren’t given
good help and the baby is simply not getting your milk well.
Get good help. Formula samples are not help.
Under some circumstances, it may be impossible to start
breastfeeding early. However, most medical reasons (maternal
medication, for example) are not true reasons for stopping
or delaying breastfeeding, and you are getting
misinformation. Get good help. Premature babies can start
breastfeeding much, much earlier than they do in many health
facilities. In fact, studies are now quite definite that it
is easier for a premature baby to breastfeed than to bottle
feed. Unfortunately, too many health professionals dealing
with premature babies do not seem to be aware of this.
Handout #1. Breastfeeding Starting Out Right. Revised
January 1998 Written by Jack Newman, MD, FRCPC
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