An overview of breastfeeding

AN OVERVIEW
OF BREASTFEEDING
BREASTFEEDING
Breastfeeding is widely believed to be the most beneficial method of feeding
for the health and well being of most infants. It is the natural next step in
the continuum of pregnancy. Though breastfeeding is natural, technique is a
learned skill. As with any skill, the keys to successful breastfeeding are
knowledge, practice and patience. It is important to get started correctly and
know well in advance how to identify and avoid possible problems. Most
breastfeeding problems occur during the first few weeks as mother and baby begin
establishing nursing patterns. It is an important investment for the mothers
and babys continued good health. Breast milk is the best source of nutrition
for an infant. It provides all the nutrition needs during the first six to
twelve months of life.


Breastfeeding offers newborns emotional as well as nutritional benefits.

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Skin-to-skin contact helps to reduce the stress babies experience as they enter
the world from the security of the womb. Tension quickly subsides as the sight
of the mothers face and the familiar sounds of her breathing, voice, and
heartbeat comfort the baby. This begins the important process of mother and baby
bonding.


Breast Milk Production
Milk is produced and stored in the glandular tissues called alveoli of the
breasts. It collects in the pockets known as lactiferous sinuses located beneath
the areola until it is released by a babys sucking. Stimulation of the
nipples cause the mothers pituitary gland, located in the brain, to secret
prolactin. This initiates and maintains milk production.


The first milk the newborn receives at each feeding is the milk that has
collected in the lactiferous sinuses between feedings. This low fat foremilk is
high in protein and satisfies the newborns thirst. As breastfeeding
continues, a second hormone called oxytocin is secreted. Oxytocin causes the
tissue around the alveoli to contract, thus squeezing high fat hindmilk down the
ducts and into the pockets where it is available to satisfy the newborns
hunger. Many mothers experience a tingling or rushing sensation in the breast as
this let down or milk ejection reflex (MER) occurs. Other mothers notice
only that sucking becomes longer and slower and that the newborn begins to
swallow rhythmically. Keys to establishing a quick letdown are relaxation and
confidence that the mothers body is doing exactly what it was designed to do.


Composition of Breast Milk
During pregnancy, the mothers body produces a substance called Colostrum.

This clear to creamy to golden yellow substance is found in the breasts during
pregnancy. Between the third and sixth day after birth, hormonal patterns of the
mother change rapidly. These changes cause colostrum to change to a transitional
form of breast milk. During this time, the amount of protein and immune factors
in the milk gradually decrease while fat, lactose and calories in the milk
increase. By the tenth day after birth, the mother produces mature breast milk,
which is also commonly referred to as human milk.


Health Advantages Of Breastfeeding Your Baby
Colostrum is the perfect starter food for babies. It is high in protein, zinc
and other minerals. It contains less fat, carbohydrates and calories than breast
milk. Colostrum acts as a natural laxative to clear the meconium (first stool)
from the babys intestine. This decreases the chances of jaundice. It also
contains the natural sugar lactose, which helps stabilize the newborns blood
sugar level, preventing hypoglycemia. Lactose is used in tissues of the brain
and spinal cord, and it provides the infant with energy. Bacteria in the infants
intestines feed on lactose and produce B vitamins. Lactose may also help the
infant absorb essential nutrients such as calcium, phosphorus and magnesium.


Breast milk from most women has the same nutrients. The proteins in human
breast milk are mostly whey and casein. Cows milk contains more casein, and
human breast milk contains more whey. Whey is more easily tolerated by an infants
digestive system. The fat in human breast milk is easily absorbed by an infants
digestive system. An enzyme called lipoprotein lipase helps an infant absorb the
fat in breast milk. A mothers breast milk contains essential fats and
cholesterol. Both are needed by infants to make tissues of the nervous system.

The amount of fat in breast milk rises significantly at the end of a breast
feeding session. This may be natures way of making an infant feel full and
stop feeding.


Breast milk contains only a small amount of iron, but the iron in breast milk
is easily absorbed. Fifty percent of the iron in breast milk is absorbed
compared with only four to ten percent of the iron in cows milk or commercial
infant formulas.


Colostrum and breast milk are rich in antibodies and have anti-infective
factors. These help protect the newborn infant from viruses and bacteria that
the infant was exposed to in the birth canal. They also help protect the infants
immature digestive tract from infection. Breast milk promotes the growth of
bacteria that all humans normally have in the digestive tract. Breast milk
contains immune factors to help an infant fight infection and help prevent the
infant from developing possible food allergies.


While cows milk and formula mixtures can trigger allergic reactions and are
often difficult for a newborn to digest, a mothers milk is perfectly designed
specifically for her baby. Since human breast milk is more easily digested than
formula, nursing usually results in fewer instances of colic, diarrhea and
constipation. Studies show that breast fed babies have fewer ear and digestive
tract infections; experience less vomiting and acute respiratory illness; and
are at lower risk for childhood diabetes, lymphomas and Crohns disease.

According to the American Academy of Pediatrics and American Dietetic
Association, among others, breastfeeding improves infants general health,
growth, and development and significantly decreases risk for a large of number
of acute and chronic diseases. Studies also show that breastfeeding decreases
the incidents and / or the severity of lower respiratory infection, bacterial
meningitis, botulism, urinary tract infections and necrotizing enterocolitis.

But also according to the academy, a number of other studies show a possible
protective effect of breastfeeding against sudden infant death syndrome (SIDS),
insulin dependent diabetes mellitus, ulcerative colitis and other allergic
diseases. Breastfeeding also has been related to possible enhancement of
cognitive development.


Proper Steps to Latching On
Correctly latching on is the key to a pleasant, rewarding breastfeeding
experience. Nursing behavior patterns are established early. Once set, bad
habits are difficult to correct. Here are the steps recommended to get off to
the right start:
Step 1
For most women, sitting up in bed or in a comfortable chair is easiest. Make
sure the baby is comfortable and feels secure and supported. The baby should be
nestled in the mothers arm at the level of the breast, his head and trunk in
a straight line to prevent having to strain or turn to attach to the breast. Do
not tilt the babys head down, as it will be difficult for them to swallow in
that position.


Step 2
Hold breast with your fingers underneath and thumb on top, making sure that
all are placed well away from the areola. Then manually express a couple of
drops to entice the baby to take the breast.


Step 3
Gently tickle the babys lower lip with the nipple to encourage the baby to
open his mouth wide. Once the babys mouth has opened wide enough, gently pull
him in close to the breast. The key to successful latch on and preventing nipple
soreness is teaching the baby to take a large portion of the areola into his
mouth.


As mentioned earlier, milk collects in the pockets beneath the areola. To
empty these effectively, the babys mouth must be positioned over them. If the
baby sucks only on the nipple, little milk will be drawn out, and this will
cause the nipple to become sore. If the baby does not latch on properly right
away, continue to encourage an open mouth and pull the baby close to the breast
again. These steps may be repeated several times until the baby gets the idea.


The mother should not feel any pain while breastfeeding. If discomfort is
felt, gently break the suction by inserting a finger into the corner of the babys
mouth between the gums then try again. Latch on discomfort is sometimes common
in the first week or two, but any pain should subside within a few seconds.


Burping
In the very early days of breastfeeding, most babies will swallow little or
no air and may not burp at all after feeding. Breastfed babies generally swallow
less air than bottle-fed babies. After the baby has finished feeding on one
side, the mother should burp them before offering the other breast.


Effective burping techniques require placing firm pressure on the babys
tummy. Lean the babys weight against the heel of your hand as they sit on
your lap, or drape the baby over your shoulder or on one knee, and firmly pat or
rub his/her back. If the baby does not burp within a minute or so, just continue
with the feeding and try again when finished.


Frequency of Feedings
Babies need to be nursed as often as they indicate the desire to breastfeed.

The mother should watch for her babys cues. Rooting, brushing his hand across
his face, or making little sucking motions are all indications that it is time
to breastfeed. Babies will demonstrate feeding cues for up to thirty minutes
before they start to cry. Crying can cause the baby to have an uncoordinated
suck, making it more difficult to initiate feeding.


Most babies need to breastfeed at least eight to twelve times in twenty-four
hours for the first few weeks. Once mother and baby are synchronized, the
frequency and duration of feedings per day may decrease. This process takes
about six weeks.


Beneficial Effects of Breastfeeding for the Mother
Babies are not the only beneficiaries of the breast feeding experience. The
mother benefits significantly in many ways. When a newborn is put to the breast
immediately after birth, the resulting release of the hormone oxytocin into the
mothers system speeds delivery of the placenta and constricts uterine blood
vessels to minimize blood loss. Repeated release of oxytocin through nursing
helps the uterus contract and return to its pre-pregnancy size sooner.


The milk producing hormone, prolactin, is another wonderful by-product of
breastfeeding. Prolactin is commonly called the mothering hormone. It has
a relaxing effect on the mother and stimulates maternal instincts. The ongoing
production of breast milk burns calories, therefore women who nurse often lose
their pregnancy pounds faster. Women who breastfeed have been shown to have less
incidence of pre-menopausal breast cancer, cervical cancer and osteoporosis.


Moms who breastfeed their babies may also enjoy no bottle cleaning, no
formula preparation and an enhancement of the unique bond between mother and
child. Add to these primary advantages the practical facts that breast milk is
always the right temperature, absolutely fresh, perfectly clean, instantly
available and you have the most nutritious, convenient feeding system there is.


Costs of Breastfeeding versus Formula
Breastfeeding may bring direct economic benefits to the family by
significantly reducing or eliminating the cost of purchasing infant formula.

Formula prices rose more than one hundred and seventy percent during the 1990s.

Several studies compared breastfeeding and formula costs. A study reported in
the 1997 medical journal article, for example, found that feeding an infant
formula costs approximately $300 to $460 extra a year than breastfeeding the
infant. This differential included the cost of extra food that mothers require
for lactation.


As breastfed infants have been shown to be less likely to catch common
infectious illnesses than formula-fed infants, it is possible that mothers who
breastfeed may have to miss fewer days from work to care for a sick child than
mothers who are formula feeding. Attributing costs to time and wages lost by
mothers (and fathers) attending to a sick child should be considered when
estimating the possible economic benefits of breastfeeding.


Diet while Breastfeeding
Breast milk from most women contains basically the same nutrients. There
could be small differences, based on what a woman eats and how her body produces
breast milk. If the mother eats a poor diet, this can decrease both the amount
of milk produced and the nutrients found in the milk. Women who are
breastfeeding should consume an extra five hundred calories per day above their
maintenance calories. A healthy, well balanced diet, high in protein and complex
carbohydrates, similar to the one consumed during pregnancy, is all that is
necessary, with the exception of five hundred extra calories per day.


Occasionally, a baby may be sensitive to something in the mothers diet.

The most common sensitivities are to protein antigens that are found in cows
milk, soy, wheat, fish, corn, eggs, and nuts. If the mother believes the baby is
reacting to something in her diet, she should eliminate that food for two to
three weeks, then try it again.


The Law of Supply and Demand
Milk production works on the principle of supply and demand. The more a baby
breastfeeds, the more milk a mother will produce, totally meeting the babys
needs. It is the frequency of breastfeeding as well as the amount of milk
removed from the breast that stimulates further milk production. Babies who are
given supplemental bottles of water or formula breastfeed less frequently,
ultimately decreasing the milk supply. Supplements, in bottles, should be
avoided for three to four weeks, unless medically indicated, until the milk
supply is well established and the baby is latching on to the breast without
difficulty. Babies need to be breastfed at least eight to twelve times in
twenty-four hours the first two to four weeks, or until well above birth weight.


Working and Breastfeeding
It is essentially important for working mothers to remember that milk
production is based upon the principle of supply and demand. The key to
maintaining a sufficient milk supply is to breastfeed often.


If the baby is under four months old, the mother should express milk during
the workweek when the baby would normally breastfeed at home. Additionally, the
mother should breastfeed in the morning just before going to work, again as soon
as possible after work, frequently during the evening and whenever the baby
wakes at night. Breastfeeding at night causes the prolactin level to rise, thus
helping the mother to relax and enjoy a good nights sleep. Mothers should
breastfeed their baby as often as possible during days off from work. This will
help increase the supply for the next week.


In addition to understanding and mastering the art of breastfeeding, working
mothers face added challenges imposed by their schedules. First and foremost,
the mother should take full advantage of maternity leave to establish a good
supply before going back to work. Fatigue is a working mothers biggest enemy.

The working mother should set a schedule that will slowly put her back into the
work force, giving both mother and baby time to adjust to the change in routine.


Storing Breast Milk
Breast milk varies in color, consistency and odor, depending on the mothers
diet and storage container. Because breast milk is not homogenized, the cream
will separate and rise to the top of the container. Breastmilk may be safely
stored by carefully following these steps:
1. Wash hands well with soap and water before touching breasts or any milk
containers. Avoid touching the inside of bottles or caps.


2. Pump or express milk into a clean collection cup.


3. Transfer the milk into a clean storage container. If pumped directly into
a storage container, it will lessen the chances of contamination.


4. Label the container with the date and amount of milk collected. (oldest
milk should always be used first)
5. To inhibit the growth of bacteria, breastmilk that is not used within 8-10
hours should be refrigerated. If milk is to be stored for more than 5-7 days,
freezing is recommended.


6. For longer storage, freeze breastmilk. Frozen milk may be stored in a
refrigerator freezer for six months or in a deep freeze for up to twelve months.

When freezing, fill the container only full to allow room for expansion.

Never refreeze breastmilk!
Weaning
Around the world, babies are breastfed an average of two to three years.

There is, however, no perfect time to wean. Weaning is an individual decision
for each mother and baby. Most babies will not show signs of wanting to wean
before eight to nine months at the earliest. The American Academy of Pediatrics
recommends breastfeeding exclusively for the first six months, gradually
introducing new foods after that time. It is recommended that breastfeeding
continue for at least twelve months, and thereafter as long as mutually desired.

When a mother or her baby decide to wean, it should be done gradually to prevent
the discomfort of engorgement and to help maintain the babys sense of
security. Dropping one feeding every few days and replacing it with formula of
cows milk (depending on the age of the baby), will allow the mothers
breasts to adjust to the decreased demand in comfort. Most mothers drop the late
night or early feeding last since this feeding is often the special snuggle time
with the baby.







References
American Academy of Pediatrics, Work Group on Breastfeeding; 1997,
Breastfeeding and the Use of Human Milk, Journal of Pediatrics, Volume 100, pp.

1035-1039
Crummette, B.D., and Munton, M.T.; 1980, Mothers Decision about Infant
Nutrition, Pediatric Nursing, 6:16
Evans, H.E., and Glass, L.; 1979, Breastfeeding: Advantages and Potential
Problems, Pediatric Analysis, 8:110
Health Answers Medical Reference Library Breast milk @
www.healthanswers.com/MedEnc
Klaus, M.H., and Kennell, J.H.; 1982, Parent Infant Bonding, 2nd edition,
St. Louis: The C.V. Mosby Company
Lawrence, R.A.; 1980, Breastfeeding, St. Louis: The C.V. Mosby Company
Palma, P.A., and Adock, E.W.; 1981, Human Milk and Breastfeeding, American
Family Physician, 24:173
Ross, L.; 1981, Weaning Practices, J. Nurse Midwifery, 26(1): 9-14
Whaley, L.F., and Wong, D.L.; 1979, Nursing of Infants and Children, St.

Louis: The C.V. Mosby Company
Category: Miscellaneous