Breast­feed­ing 101

It’s the most nat­u­ral thing in the world, but that doesn’t mean breast­feed­ing comes nat­u­rally. Linda Britz, a lac­ta­tion spe­cial­ist, nurs­ing sis­ter and mid­wife, says get­ting it right takes a bit of prac­tice…

Your Pregnancy - - Pregnancy Files -

BREAST­FEED­ING IS KNOWN as the gold stan­dard to feed a baby, but it is about so much more than nu­tri­tion. It rep­re­sents the com­mon lan­guage of moth­er­ing; it is about in­ti­macy and a re­la­tion­ship with your baby. Breast­milk is per­fectly de­signed, with all the nu­tri­ents your baby re­quires for growth and phys­i­cal devel­op­ment (es­pe­cially his brain), and nour­ishes both body and soul. The best thing about breast­feed­ing is that your body nat­u­rally pro­duces milk from be­fore birth and the process is con­tin­ued as your baby is born to breast­feed. You just need to be avail­able to your baby. Most ba­bies know ex­actly what they need to do, so be guided by your baby and have con­fi­dence in your body’s abil­ity to nour­ish your baby. This doesn’t mean that you shouldn’t also get clued up on how to go about the dance of breast­feed­ing. Em­power your­self with good knowl­edge that in­stils you with con­fi­dence, and sur­round your­self with peo­ple who will sup­port you, from your part­ner and fam­ily mem­bers to health­care pro­fes­sion­als. Ask for help, if and when you need it. Have a breast­feed­ing plan, and make a com­mit­ment to face the chal­lenges you may face along the way.

THE GOLDEN HOUR

The first hour af­ter the birth of your baby is a once-in-a-life­time op­por­tu­nity – a sa­cred mo­ment when a fam­ily is formed and your baby’s first im­pres­sion of life out­side the womb is made. The best way to start is heart to heart! As soon as your baby is born, place your baby on your chest, in skin-to-skin con­tact. Your body will nat­u­rally in­crease in temperature to warm your baby – even bet­ter than an in­cu­ba­tor. Your baby should only be sep­a­rated from you if there is a good med­i­cal rea­son. Rou­tine pro­ce­dures and ob­ser­va­tions can be done ei­ther while your baby is on your chest, or at a later time. This mo­ment should be un­in­ter­rupted. Skin-to-skin con­tact not only pro­motes bond­ing, but is also a mul­ti­sen­sory ex­pe­ri­ence for your baby. Be­sides the pow­er­ful sense of touch and hu­man con­tact, which con­firms your baby’s out-of-womb habi­tat on your breast area, the sense of smell is well de­vel­oped and very strong. Each mother and baby has a unique scent, and once your baby recog­nises yours, it pro­vides se­cu­rity and com­fort. Your baby’s sense of sight is also very im­por­tant, al­though un­der­de­vel­oped. You will have a nat­u­ral de­sire to look at your baby. As he makes eye con­tact with you, and stares back, the love hor­mone oxy­tocin floods your brain, start­ing the dance of breast­feed­ing. Your baby’s suck re­flex is at its most in­tense dur­ing the first hour af­ter birth. Al­low your baby his own time and be guided by him.

Re­search has now iden­ti­fied nine ob­serv­able new­born stages that are in­stinc­tive for a baby who is placed in skin-to-skin con­tact with his mother, af­ter birth: STAGE 1 The birth cry A dis­tinct cry as baby’s lungs fill with air. STAGE 2 Re­lax­ation Baby is skin-to-skin with his mom and re­laxed. STAGE 3 Awak­en­ing Around three min­utes af­ter birth, small wave-like move­ments in the baby’s head and shoul­ders are no­ticed. Baby’s eyes are usu­ally open. STAGE 4 Ac­tiv­ity The new­born baby starts to make suck­ing move­ments as the root­ing be­comes more ob­vi­ous. Baby looks at the breast and at mom. He will also make “coo­ing” sounds to cap­ture the mother’s full at­ten­tion. STAGE 5 Rest He may rest at in­ter­vals and con­tinue to make suck­ing move­ments in his own time. STAGE 6 Crawl­ing About 35 min­utes af­ter birth, the baby starts to leap, crawl, slide and push him­self to­wards the breast to reach the nip­ple. STAGE 7 Fa­mil­iari­sa­tion Baby licks the nip­ple and touches and mas­sages the breast. This is usu­ally about 45 min­utes af­ter birth and can con­tinue for a fur­ther 20 min­utes. STAGE 8 Suck­ling Baby takes the nip­ple into his mouth and at­taches well onto the breast, and suck­les. STAGE 9 Sleep Baby (and often mom too) falls into a rest­ful sleep, about 90 min­utes to two hours af­ter birth.

COLOSTRUM – YOUR BABY’S FIRST MILK

The milk that your breasts will make for the first few days is called colostrum and is es­pe­cially de­signed for your new­born baby. It is often known as a su­per­food. (A su­per­food is nu­tri­ent-dense and has su­pe­rior health ben­e­fits.) Colostrum is rich in calo­ries and pro­tein, and is a sweet, golden milk that’s packed with an­ti­bod­ies to help pro­tect your baby from in­fec­tions, giv­ing your baby’s im­ma­ture im­mune sys­tem a boost. It changes and ad­justs ac­cord­ing to your baby’s age and re­quire­ments. Breast­milk con­stituents change through­out the day, ev­ery week, and in the months ahead, to suit your baby – it’s al­most tai­lor made for your baby.

WHEN THE MILK COMES IN

In the first week af­ter birth, usu­ally around day three or four, your breasts will be­gin to feel fuller and heav­ier. The hor­mone pro­lactin nat­u­rally rises to pro­duce co­pi­ous amounts of milk, nec­es­sary for your baby. It is im­por­tant to feed your baby fre­quently and ef­fec­tively to main­tain good drainage of your breasts and man­age the fill­ing. Warm baths or show­ers, gen­tle mas­sage and the ap­pli­ca­tions of cold cab­bage leaves help re­lieve swelling. This lasts for around 24 to 48 hours, af­ter which it set­tles to meet your baby’s de­mand.

GET A GOOD LATCH

Breast­feed­ing is a skill that needs to be prac­tised by both mom and baby in the early days af­ter birth, and the cor­rect latch is key to prevent­ing sore­ness and any nip­ple dis­com­fort. In the first few weeks, cup and sup­port your breast in your hand to latch on and through­out the feed­ings, to help it go more smoothly. Be sure your fin­gers are well be­hind the are­ola. Your thumb and in­dex fin­ger should form a C or U. Get com­fort­able. Good po­si­tion­ing and sup­port with pil­lows, to keep baby at the right height, will en­sure the cor­rect latch and pre­vent nip­ple sore­ness or pain. Re­mem­ber that it is a nat­u­ral response and an in­stinc­tive root­ing re­flex by your baby to open his mouth wide as you tickle his top lip with your nip­ple. When he does this, lift him gen­tly but firmly to­wards you to take a good mouth­ful of breast tis­sue – your baby needs to take in your nip­ple and are­ola (the darker skin around your nip­ple). Give your­self time to prac­tise, gain con­fi­dence and mas­ter this new task.

SIGNS OF A GOOD LATCH

Your baby is fac­ing you “tummy to mummy”, so that he doesn’t need to turn his head to reach your nip­ple. Your baby has taken a deep mouth­ful of breast into his mouth, chin first, well over the are­ola area. Your baby is pulled in close to you, and kept close with the sup­port of your arms on pil­lows. Your baby is ac­tively swal­low­ing, with in­ter­vals of a suck, swal­low and breath rhythm. Your baby is com­fort­able and you feel a deep (not painful) pull as he suck­les.

GET INTO PO­SI­TION

There are many breast­feed­ing po­si­tions, and not one of them is wrong. You need to find which one is com­fort­able and ef­fec­tive for you and your baby. The cross cra­dle hold: This is the most com­mon and is re­ally help­ful when mas­ter­ing the latch-on. Hold your baby

along the op­po­site arm to the breast you are feed­ing from. Face him “tummy to mummy”. Sup­port the base of his neck with your fin­gers, us­ing your palm to sup­port his shoul­der and back. Firmly and quickly lift him to­wards you. Sup­port your breast with the same side hand. The cra­dle or Madonna hold: This is most com­monly used once you no longer need to guide him to the breast. Sup­port your baby’s head in the crook of your el­bow. This arm sup­ports his back with his bot­tom in your hand. The side-ly­ing hold: This is a great po­si­tion to rest, but should only be at­tempted once you are con­fi­dent in your feed­ing and have mas­tered your latchon. Both you and baby are ly­ing down, fac­ing each other. The foot­ball hold: This is great for moms with large breasts and a good po­si­tion for twins to feed com­fort­ably. Your baby’s body is tucked un­der­neath your arm on the same side that you are feed­ing.

IF YOU HAD A C-SEC­TION?

Some labours are com­pli­cated, and there may be a good rea­son that a cae­sarean sec­tion is booked to birth your baby. The hor­mone oxy­tocin is ac­tive in labour and is re­spon­si­ble not only for the surges of con­trac­tions, but also helps ini­ti­ate move­ment and flow of the first new­born milk through the ducts to the nip­ple. As a re­sult of a C-sec­tion, how­ever, there may be a de­lay in your milk com­ing in, and so your baby may work re­ally hard to stim­u­late your breasts. Re­search shows that rou­tinely do­ing your breast care for a few weeks be­fore the birth of your baby is ben­e­fi­cial to the process. Con­tin­u­ing af­ter birth will also en­cour­age good drainage of the breasts and a steady milk sup­ply. It is im­por­tant to get skin-to-skin con­tact with your baby dur­ing the pro­ce­dure in theatre, as soon as pos­si­ble af­ter birth. Chat to your gy­nae­col­o­gist about this be­fore the time. Keep­ing baby with you de­creases any sen­sa­tions of pain and stress, even stress lev­els in baby. It sta­bilises your baby’s breath­ing and oxy­gen lev­els, de­creases cry­ing and in­creases the quiet-alert state. It can also cre­ate a pos­i­tive me­mory and out­come for you re­gard­ing the birth, and help you feel re­laxed, calm and con­tent. Even though there may be a slow start to the breast­feed­ing, the ob­sta­cles can be over­come.

DE­MAND FEED­ING IS IM­POR­TANT FOR NEW­BORNS

Don’t time your feeds in the new­born weeks, or try to place your baby on a feed­ing sched­ule – feed him when­ever he is hun­gry. Early fre­quent feed­ing con­trib­utes to a longer du­ra­tion of breast­feed­ing. It al­lows your new baby to re­ceive all the im­muno­log­i­cal ad­van­tages of the colostrum, and pro­tects your baby from pos­si­ble in­fec­tions. Dur­ing the first weeks af­ter birth, it is im­por­tant to al­low your baby to feed often, and ef­fec­tively re­move milk from your breasts. Al­though a breast­feed­ing mother’s breasts are never empty, drained breasts re­fill quickly. The suck­ing stim­u­la­tion in­creases the pro­lactin re­cep­tors in the breast and en­cour­ages an abun­dant milk pro­duc­tion. Pro­lactin is the milk-mak­ing hor­mone and is often re­ferred to as the moth­er­ing hor­mone, as it is re­spon­si­ble, in part, for the in­tense feel­ing of need­ing to be with your baby. This en­hances at­tach­ment and bond­ing. A feed­ing pat­tern will start to emerge within the first six weeks of life. You both need time to get to know one an­other, so try to en­joy the process.

The World Health Or­gan­i­sa­tion (WHO) mother rec­om­mends that a for the ex­clu­sively breast­feeds and then, first six months of life of to­gether with the in­tro­duc­tion (solids), com­ple­men­tary foods two con­tin­ues for a fur­ther years and be­yond

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