Human milk is widely recognized as the optimal source of nutrition for all infants. Breast milk promotes development of the infant's immune system and meets the nutritional requirements of an infant until approximately six months of age, when complementary foods and fluids are usually added to its diet.
There are many women who choose not to breastfeed. The possible reasons may include embarrassment, lack of knowledge about the benefits of breast milk, belief that formula is equal to breast milk, and myths about the "ease" of formula feeding compared to breastfeeding.
However, breastfeeding has got a lot of benefits not only for the mother but also for the child. For the following reasons, it is recommended that the mother breastfeeds the baby for at least 6 months without the formula food. And partial breastfeeding with formula food is recommended for the next 6 months.
Benefits of breastfeeding
• Better digestive tract function and protection from digestive tract infections, such as vomiting and diarrhea.
• A reduced risk of respiratory infections, ear infections, and wheezing.
• Some studies suggest that breastfeeding reduces the risk of obesity, cardiovascular disease, and autoimmune diseases, such as type 1 diabetes mellitus.
Compared to mothers who feed formula, women who breastfeed experience:
• Reduced blood loss after childbirth as a result of a hormone, oxytocin, which is released into the mother's bloodstream while breastfeeding.
• Reduced levels of stress as a result of several hormones released during breastfeeding.
• Increased weight loss after pregnancy (if breastfeeding continues for at least six months).
• Decreased risk of breast cancer.
Families who breastfeed experience:
• Reduced infant feeding costs by cutting down the cost of infant formula and associated supplies.
• Reduced costs related to healthcare, including doctor's visits, hospital costs, and lost time from work. Infants who are breastfed are less likely to become ill and less likely to be hospitalized, reducing the potential costs and anxieties of caring for an ill child.
When to start breastfeeding
Breastfeeding should begin within the first few hours of delivery, if possible, by allowing the baby to rest or nurse, skin-to-skin, on the mother's chest. During this time, most infants are alert and interested in nursing.
In some situations, the infant or the mother must be separated for several hours or even days after delivery. Pumping the breasts and then storing the milk for use is recommended to stimulate production of breast milk; this can be started optimally within the first 12 hours after delivery.
In the first few days after delivery, the woman produces a small amount of yellowish milk called colostrum. Colostrum is rich in nutrients and provides all the calories a baby needs for the first few days.
Women should not worry when only small amounts of colostrum are normally produced. Infants are born with an excess of fluid and sugar stores that they are able to use as the woman's milk supply increases.
It is normal to produce small amounts of milk in the beginning. With continued frequent breastfeeding, the amount of mature milk produced will increase within two or three days. Infants normally lose weight during the first few days of life and gradually regain this weight by two weeks after delivery.
Positioning during breastfeeding
A woman may use one of the several positions to hold her infant while breastfeeding. There is no such "best" position for every infant and woman; the best position is one that is comfortable for the woman and allows the infant to latch-on, suckle, and swallow easily. A woman may have several preferred positions depending upon the baby's size, the baby or mother's medical condition(s), and feeding location.
In all positions, the baby should not require turning his or her head to nurse; the baby's nose should be aligned with the mother's nipple. Turning the head in any direction makes it more difficult to coordinate suckling and swallowing, and can potentially make it more difficult for the baby to latch correctly.
Pillows or nursing supports can help to ensure that both the woman and the infant are comfortable. When the mother is sitting in a chair, a foot stool is helpful in supporting the infant's weight and preventing fatigue in the mother's arms, shoulders, and neck.
‘Latching on’ refers to the infant's formation of a tight seal around the nipple and most of the breast areola with his or her mouth. A correct latch-on allows the infant to obtain an adequate amount of milk and helps to prevent nipple soreness and trauma. Signs of a good latch-on include:
• The top and bottom lips should be open to at least 120 degree angle.
• The lower lip (and, to some extent, the upper lip) should be turned outward against the breast.
• The chin should be touching the breast while the nose should be close to the breast.
• The cheeks should be full.
• The tongue should extend over the lower lip during latch-on and remain below the areola during nursing. This is visible if the lower lip is pulled away.
When an infant is latched correctly, the woman may feel discomfort for the first few seconds, which should then decrease. Continuous discomfort may be a sign of a poor latch-on. To prevent further pain or nipple trauma, the woman should insert her clean finger into the infant's mouth to break the seal. The infant can then be repositioned and assisted with latch-on again.
Signs of poor latch-on include:
• The upper and lower lips are touching at the corners of the mouth.
• The cheeks are sunken.
• Clicking sounds are heard, corresponding to breaking suction.
• The tongue is not visible below the nipple (if the lower lip is pulled down).
• The nipple is creased after nursing.
An infant must be able to suckle and swallow correctly to consume an adequate amount of milk. It should be possible to hear the infant swallow. The infant's jaw should move quickly to start the flow of milk, with a swallow heard after every one to three jaw movements.
Frequency and Length of Breastfeeding
Women are encouraged to attempt breastfeeding as soon as the infant begins to show signs of hunger. Early signs of hunger include awakening, searching for the breast or sucking on the hands, lips, or tongue. Most infants do not cry until they are very hungry; waiting to breastfeed until an infant cries is not good for its health.
In the first 1 to 2 weeks, most infants breastfeed 8 to 12 times per day. Some infants need breastfeed frequently, as often as every 30 to 60 minutes, while others will have to be awakened and encouraged to nurse. A baby may be awakened by changing the diaper or tickling the feet.
Caring for an infant can be an exhausting experience. The length of time an infant needs to finish breastfeeding varies, especially in the first few weeks after delivery from as little as five minutes to 20 minutes or more. It is recommended that the infant be allowed to actively breastfeed for as long as desired. "Active" breastfeeding denotes that the infant is regularly suckling and swallowing.
Most infants signal that they are finished nursing by releasing the nipple and relaxing the facial muscles and hands. Some infants younger than 2 to 3 months often fall asleep during nursing, even before they are finished. In this case, they should be awakened and encouraged to finish nursing. After finishing one breast, offer the other side with the understanding that the infant (especially an older infant) may not be interested.
The baby’s urine, stool and weight should be monitored regularly in order to analyze how well the breastfeeding is going on in the initial days.
When not to breastfeed:
In rare cases, a woman's breasts may be incapable of providing a sufficient amount of breast milk.
Breastfeeding is not recommended for women or infants with the following conditions:
• Women who are HIV positive
• Women with human T-cell lymphotropic virus type I or II (HTLV)
• Women being treated with chemotherapy or radiation therapy
• Women who abuse drugs or alcohol
• Women with herpes simplex lesions on the breasts (ok to breastfeed if one breast has no lesions)
• Infants with classic galactosemia (galactose 1-phosphate uridyltransferase deficiency).
Breastfeeding is encouraged for women or infants with the following conditions:
• Women with hepatitis (A, B, or C)
• Women with past or current cytomegalovirus (CMV) infection
• Infants who develop jaundice.
Common Breastfeeding Problems:
Breastfeeding a healthy infant is often accompanied by different challenges. These challenges when combined with the normal anxieties of parenting a newborn infant can be difficult to deal with.
Problems associated with breastfeeding cause distress, mild discomfort or significant pain because of which many women stop breastfeeding after a few weeks. However, these problems can be treated effectively, allowing the woman to continue breastfeeding, which benefits her and her infant's health.
Some of the common breastfeeding problems are discussed as follows.
• Breast Engorgement
Engorgement refers to swelling within the breast tissue, which can be painful. Engorged breasts become firm, flushed, warm to the touch, and feel as if they are throbbing. Some women develop a slight fever.
The best treatment for engorgement is to empty the breasts frequently and completely by breastfeeding. If the breasts are engorged, expressing milk by hand or breast pump can help to soften the areola and allow the baby to latch on more easily. However, it is important to avoid over stimulating the breasts with hand and/or pump expression because this could worsen engorgement.
• Sore or Painful Nipples
The nipples normally become more sensitive during pregnancy, with the greatest sensitivity occurring around the fourth day after delivery. "Normal" nipple soreness occurs for the first 30 to 60 seconds of breastfeeding, but then improves.
This can also happen due to the baby sucking the nipple and not the breast as a result of bad positioning. In such a case, dislodge the baby by inserting the finger gently into his/her mouth to break the grip. Reposition the breast, so that the breast and not just the nipple go inside the baby’s mouth. Try different positions. Express milk and rub it on the nipples as this will help in healing. Use the less sore side to feed the baby.
• Thrush that does not Heal
White marks or sore nipples that don’t seem to heal are known as thrush. It can appear when either the mother or the baby have taken a course of antibiotics or may appear without any particular reason. In such a case, antibiotic treatment is required.
• Lumps in the Breast
Free movement of milk is stopped because of a block in some duct of the breast. This can happen because of a wrong sleeping position, sitting for a few hours with the seat belt across the breast or a tight bra. Massaging the area or using warm compress on the area helps to dissolve the lump. If possible, position the baby in such a way that his/her jaw is near the lump, so he/she can feed and help in dissolving the lump. Feed from the sore side, if it doesn't work express milk from the breast.
• Inflamed, Red Areas on the Breast
Inflamed, read areas on the breast accompanied with flu symptoms like temperature, aches, sore breast that is full is the indication of a condition is known as Mastitis. Mastitis is an inflammation of the breast when milk leaks into the breast tissue. In such a case, rest as much as possible, but continue to feed the baby, starting with the sore side. Use of warm and cold compress will reduce the swelling. If there is no improvement, consult the doctor.
• Bloody Nipple Discharge
A small percentage of women have bloody nipple discharge in the first few days after delivery, resulting in bright red or rusty colored colostrum. The condition is because of an increase in blood vessels in the breast ducts during pregnancy and typically resolves within a few days. It is not necessary to stop nursing or to substitute infant formula if blood is seen in the colostrum or breast milk, although a doctor consultation is required.
If the condition is not resolved within few days, then a doctor consultation and proper examination of the breast is required. This is important because, in rare cases, blood in the breast milk is a sign of breast cancer.
Blood may also appear in breast milk as a result of cracks in the nipple, trauma to the breast, or other conditions. Blood is often detected because the infant's stool becomes bloody. The color of the milk can range from pale pink to bright red. In any case, consult the doctor.
• Nipple Color Changes
Women who have Raynaud phenomenon or unusual cold sensitivity may develop a narrowing of the blood vessels of the nipple related to breastfeeding. This can cause the nipple to become painful and whitened (blanched) during, immediately after, and between feedings. Some women have a two-part color change (white and blue) while others have a three-color change (white, blue, and red).
Blanching or whitening can also occur as a result of nipple compression due to poor positioning and latch-on, and can be addressed by adjusting the position of nursing and latch-on. It can be managed by:
• Increasing the air temperature and wearing warm clothing. Reusable wool breast pads may be helpful.
• Applying a warm compress just before and after nursing.
• Stop smoking.
• Avoid medications that constrict blood vessels (e.g., pseudoephedrine, a decongestant).
A baby may refuse to be fed on the breast in case of:
• A change in the taste of milk because of a change in diet or medication.
• Because of using nipple cream.
• Because of stopping the use nipple shields.
• Because of undergoing dental treatment. or
• Because of the starting of the mother’s menstrual cycle.