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Breastfeeding
is the natural, physiologic way of feeding infants and young children, and
human milk is the milk made specifically for human infants.
Formulas made from cow’s milk or soybeans (most formulas, even
“designer formulas”) 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
ensure breastfeeding is a happy experience for both mother and
baby.
The
vast majority of mothers are perfectly capable of breastfeeding
their babies exclusively
for about six months. In fact, most mothers produce more
than enough milk. Unfortunately, outdated hospital
routines based on bottle feeding still
predominate in too many health care institutions and
make breastfeeding difficult, even impossible, for too many
mothers and babies. For breastfeeding to be well and properly
established, a good start in the 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 more difficulty getting milk, especially
if the supply is low. A poor latch is similar to giving a baby a
bottle with a nipple hole that 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. Unfortunately anyone
can say that the baby is latched on well, even if he isn’t. Too many
people who should know better just don’t know
what a good latch is. Here are a few ways breastfeeding can be
made easy:
1. 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 sceptical, and
ask for help from someone else 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 mouth wide—pause—close
mouth type of suck). See
also videos
on how to latch a baby on (as well as other videos).
If you and the baby are leaving hospital not knowing this, get
experienced help quickly (see handout When Latching).
Some staff in the hospital will tell mothers that if the
breastfeeding is painful, the latch is not good (usually true),
so that the mother should take the baby off and latch him on
again. This is not
a good idea. The
pain usually settles, and the latch should be fixed on the other
side or at the next feeding.
Taking the baby off the breast and latching him on again
and again only multiplies the pain and the damage.
2. The baby should be at the breast immediately
after birth. The vast majority of newborns
can be at the breast within minutes of birth. Indeed, research
has shown that, given the chance, many babies only minutes old
will crawl up to the breast from the mother’s abdomen, latch
on 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 (see section on skin to
skin contact). Incidentally,
many babies do not latch on and breastfeeding during this time.
Generally, this is not a problem, and there is no harm in
waiting for the baby to start breastfeeding.
The skin to skin contact is good for the baby and the
mother even if the baby does not latch on.
3. 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 that
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 that 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.
If the mother is shown how to feed the baby while
both are lying down side by side, the mother is better
rested.
- 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.
4. Artificial nipples should not be given to
the baby. There seems to be some
controversy about whether "nipple confusion" exists.
Babies will take whatever gives them a rapid flow of fluid and
may refuse others that do not. Thus, in the first few days, when
the mother is normally producing only a little milk (as nature
intended), and the baby gets a bottle (as nature intended?) from
which he gets rapid flow, the baby 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.
Note, it is not the baby who is confused. Nipple
confusion includes a range of problems, including 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?
5. 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 that is available. Get help to fix the baby’s latch, and
use compression to get the baby more milk (handout #15, Breast
Compression). Compression works very well in the first few
days to get the colostrum flowing well.
This, not
a pacifier, not a bottle, not
taking the baby to the nursery, will help.
6. 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 thus
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 often supplements
are suggested for the convenience of the hospital staff. If
supplements are required, they should be given by lactation aid at
the breast (see handout #5), not cup, finger feeding,
syringe or bottle. The best supplement is your own colostrum. It
can be mixed with 5% sugar water if you are not able to express
much at first. Formula is hardly ever necessary in the first few
days.
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 it is 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 the milk that
is available. Even if you need formula, nobody should be
suggesting a particular brand and giving you free samples. 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 less
stressful 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.
Questions?
(416)
813-5757 (option 3) or drjacknewman@sympatico.ca or
my book Dr. Jack Newman’s Guide to Breastfeeding (called The Ultimate
Breastfeeding Book of Answers in
the USA)
Handout
#1. Breastfeeding—Starting
Out Right. Revised January 2005
Written by Jack Newman, MD, FRCPC. ©
2005
This
handout may be copied and distributed without further
permission,
on the condition that it
is not used in any context in which the WHO code on the
marketing of breastmilk substitutes is violated.
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