In 1997, the American Academy of Pediatrics published a policy statement on the advantages of breast milk to your baby and the advantages of breast feeding to you, the mother, and to the nation as a whole. There is strong evidence that feeding your baby breast milk provides a decreased incidence and/or the severity of:
Lower respiratory infections
Urinary tract infection
Late onset sepsis in premature infants
Breast milk provides your baby possible protection against:
Sudden infant death syndrome (SIDS)
Asthma and Allergic diseases
Other chronic digestive diseases
Benefits to the mother include:
Increased levels of oxytocin resulting in less post partum bleeding and more rapid uterine involution
Earlier return to prepregnant weight
Delayed resumption of ovulation with increased child spacing
Improved bone remineralization post partum with reduction of hip fractures in the post menopausal period
Reduced risk of ovarian cancer
Reduced risk of premenopausal breast cancer
Benefits to the nation include:
Reduced health care costs
Reduced employee absenteeism attributed to child illness
Reduced parental absence from work resulting in lost income
Financial savings to the family of the cost of formula for 1 year
Decrease in the environment burden of processing, transporting and disposing of formula products
Source: American Academy of Pediatrics. Breastfeeding and the Use of Human Milk. Pediatrics: Vol. 115 No. 2. February 2005. 496-506.
Getting Started Breast Feeding
Your breasts have been preparing for breast feeding during your pregnancy. Your areola is darkening, your nipples are becoming thickened and toughened, and your breasts are changing from non-lactating to lactating. An entire system is developing in your breasts for lactation. Your nipples are becoming more supple so that your baby can extend your nipple into the back part of his/her mouth to properly suckle. Please do these 2 tests to check and see if your nipples are graspable and will be able to be extended deep into your baby's mouth:
Stimulate your nipple with cold water, cold air, or your fingers and watch your nipple's response. Does you nipple extend and stay protruding or have no response to your stimulation? Does your nipple or part of your nipple retract and fold into your breast?
Then try the pinch test. Place your fingers about 1/2 to 1 inch behind your nipple and gently "pinch" your fingers together. Your fingers are the "jaws" of your baby. Does your nipple continue to protrude or does your nipple flatten or invert-retract into your breast?
Please contact your lactation consultant if your nipple does not protrude and continue to remain protruding in response to the 2 tests. A lactation consult to evaluate your nipples for graspability may be beneficial. Use of breast shells in the weeks of pregnancy and between nursings after delivery can be helpful.
Your breasts have been making colostrum (pre-milk) from about your 23rd week of pregnancy. Colostrum resembles melted butterscotch candy and is sticky and thick. Colostrum is loaded with protective antibodies and antivirals for your baby. Colostrum is very sweet and highly laxative and helps your baby excrete the first bowel movements of thick black meconium. Your baby will receive colostrum in the exact amount he/she needs at each nursing on the day you deliver and for following 3 to 5 days of age. Supplemental feedings are usually not needed.
Sometimes a baby will need supplemental feedings if a problem exists such as low blood sugar, elevated bilirubin, refusal to latch and breast feed, early gestation, low birth weight, or antibiotics. Your baby's physician, your staff nurse, or the lactation consultant will discuss this need with you. Your baby may not be fed formula without your consent, you will be involved in the decision. If formula is temporarily needed, the baby may be fed by cup or by bottle. Ask for information on your choice of cup or bottle feeding. If your baby needs supplemental feedings, ask your staff nurse for help with pumping your breasts to stimulate your milk supply even if your baby is nursing each feeding.
Between day 3 and 5 after delivery, your breasts will be in transition-changing from the production of colostrum to the production of breast milk. You will notice a gradual change in the fullness of your breasts. Initially you will notice that your breasts feel warmer to the touch and that the breast tissue will feel denser or thicker, if gently squeezed. As your baby requires more milk and demands more frequent nursings, your breasts will respond and produce more breast milk. Your breasts work on the principle of demand and supply, the more breast milk that your baby demands, the more breast milk your breasts will supply for feedings. The initial breast milk you will produce has a slightly golden whitish color. This is transitional milk and is a mixture of colostrum and breast milk. Mature breast milk is produced at about 1 to 2 weeks after delivery and the color changes from bluish-white to milky white as the fat content rises throughout the feeding. The color and taste of your breast milk is affected by your diet, medications and vitamins. Babies like the variety of breast milk flavors that your diet provides. Variety is "the spice of life". Breast milk will separate when stored, the fat or cream rises to the top of the container, shake well to mix before feeding to your baby.
Routine Breastfeeding Teaching for the Newborn
How often should I breastfeed?
Encourage your baby to feed at least every 3 hours, counting from the start of a feed to the next start. Your baby may feed as soon as 1 hour after finishing. Shorter more frequent feeds are beneficial for mom and baby in the first several days. If you baby is over 6 lbs, your baby may sleep for a 6-hour stretch at night.
How long should I breastfeed?
Your baby may nurse 5-30 minutes per breast or longer if demanded. Offer the second side as baby's choice -- feed or save -- then switch and start the next feeding on that second side. For twins: one baby nurses on one breast per feeding, 10-40 mnutes or longer, switch breasts per 24 hours.
What is a correct latch?
You will feel pulling, suction, pressure, and at first it may be uncomfortable, but not be painful and should feel comfortable as baby begins to consistently suckle. Watch for your baby's cheeks to puff out, with both top and bottom lips flanged out like a fish, notice TMJ or jaw joint movement -- you should see baby's jaw open wide, pause slightly then close. Use one hand supporting your breast and one hand around the baby's neck while learning. Maintaining a constant and firm but not painful breast squeeze during suckling helps the milk flow. When the baby pauses, gently encourage baby to begin suckling agian by pumping your breast with your hand.
Am I producing milk?
It takes most women 50-75 hours (up to 3 days) after childbirth for the breast milk to switch from teaspoons of wonderful colostrum to ounces of transitional breast milk. Within 5-12 days, you will be producing mature breast milk. When the baby feeds and the breast is stimulated, prolactin causes milk production and oxytocin causes the milk to eject from your breast and flow -- you may feel sleepy, thirsty and relaxed as you breastfeed. During the first seven days or so, you will notice either a gush of vaginal bleeding and/or your uterus cramping as you colostrum/milk flows to your baby. After seven days, you will actually feel your breast milk flowing.
How much should I drink?
Drink enough fluids, particularly water, to satisfy thirst. Sip 1-2 large glasses of liquid with every breastfeeding or pumping unless fluids are restricted by your physician.
Is my baby getting enough?
Keep a log and measure what is coming out. Monitor baby's output by counting urine and stools. Call baby's pediatrician and contact a lactation consultant if below expected amounts.
If you have a maternal history of breast reduction or breast surgery, previous poor milk supply, minimal breast changes during pregnancy, use of nipple shield, large blood loss, hormonal imbalance, polycystic ovarian syndrome, or baby with weight concerns or inadequate output:
Pump both of your breasts after every feeding with electric breast pump and double set up for 10-15 minutes until milk volume is well established (usually by 2 weeks)
Feed pumped breast milk to baby after nursing via baby cup or bottle (mother's choice)
We suggest the Avent bottle and 0 or #1 Aven tnipple if bottle is preferred
Moms may use formula for supplement if you choose, but supplementing with your own pumped milk is the best recommendation
If your baby has a weak suck, tongue thrust, is unable to latch or stay latched or is a very sleepy baby, finger-suck training can help -- (in the hospital) use hospital bottled wusgar water (D5W) or (at home) 1 pinch of sugar in 1 cup very warm tap water.
Interest: Stimulate your baby's interest by dabbing sugar water on baby's lips and wait for the baby to actively lick his/her lips, re-dab as needed.
Practice: Baby practices by sucking on parent's clean finger dipped in the sugar water -- nail short, positioned down on baby's tongue, no nail polish.
Transfer: After baby has a vigorous sucking pattern on the finger, dab the nipple with sugar water and gently transfer baby to the breast and breastfeed your baby.
For more information, call 1.866.CALL.MLH.