Breastfeeding

by

GillyLockhart

Feeding as Nature Intended It

If nature had its own way a baby would be with its mum pretty much 24/7, probably strapped to her so that it could feed properly on demand as and when it wanted.However in this day and age people feel a need for routines and schedules so as a result we try to slot babies into feeding patterns to suit around these schedules.Is this baby friendly or mum friendly or family friendly. Well for most women they need a sense of time frames and schedules as that's how our lives are today. It is not necessarily the right thing to do but if we continue as nature intended women of today feel they do nothing but feed 24/7. We have come to have expectations to have free time for us and to have time to attend to our needs.

Why Babies seem to want to be awake at night

Do you remember when you were pregnant and you lay down to try to go to sleep and your baby started to get active at that very moment. Well its what they are used to,,,they wake up the moment you stopped moving and they were no longer lulled to sleep. It was their active time when you wanted to sleep, so why would they immediately forget that when they are born. So yes they have turned night and day around while in utero. So learning that you want to sleep at night and expect them to want to sleep at night is a learning experience for babies.

Differences re breast and bottle feeding

In the very early days breast feeding can take a lot longer time than bottle feeding and here are the key areas why

When a baby bottle feeds it's less work for him/her to get it from the bottle. One initial suck and away they go, lots less effort is required than to breast feed. All the milk is in the bottle and parents seem to get comfort in the fact that they can see the milk draining away so they therefore know how much the baby is having.

With breast feeding the baby has to develop its jaw muscles as sucking on the breast requires a bit of energy and is generally more work. So in the early days yes babies get tired and they need to be encouraged to suck to help develop their jaw muscles. When they are encouraged to suck they take a greater amount and therefore have a longer break between feeds. This is the area that confuses new mums as they see their baby resting and snuggled up at their breast between sucks and assume he/ she has had enough when in reality most of they time they have not had enough they are just pausing for a rest and they are cosy snuggled up next to mum so tend to nap on the job. So the unsuspecting parents try to put the baby down to sleep and two minutes later the baby is wide awake and looking for more food. That's where help and guidance is key here so that parents don't get frustrated and they realise that they too quickly put the baby back to bed. Breast feeding in the early days can feel a bit labour intensive but it pays off once the baby realises that the best way forward is to feed while at the breast and nap once its tummy is full. This way the baby feels satisfied has a rest and gets time to digest the milk in its tummy and process wind and poops. When it feeds on and off all the time in my experience it is constantly processing and digesting milk and this causes a build up of wind and trapped air. So you could have a grumpy baby who has trapped wind and poor parents who have little to no idea this is the problem and they repeatedly put the baby back to feed thus adding to the trapped wind only giving it comfort while on the breast. Baby's suck for comfort it is not always a sign of hunger. It can indicate a sore tummy from trapped air and the baby wants to suck to make it feel better. Feeding in the early days can be frustrating for new parents as they do not understand that the as nature intended it way, a baby would be snuggled up to mum all the time literally so it would feed when it wanted and nap when it wanted and would not be put down to sleep. The problem here is us really,we want free time, time to rest and time to do our

own thing.

Try this exercise,,,,put your finger in your mouth and suck,,,that's what its like when a baby bottle feeds,,,,now put your mouth up against your lower arm and suck, this demonstrates the different mechanisms. This is similar to a baby breast feeding.

Foremilk and Hindmilk

It is generally believed that there are two forms of milk once your milk comes in and feeding is established.Remember initially it is colostrum that your baby gets. This is the wonder milk, which is so perfect for babys' . It passes on immunity from mum . But remember it is in small amounts. About a teaspoon at a time.Well once your milk comes in around day 3 it is believed that there is foremilk or milk stored in the breast and hindmilk which is milk produced while the baby sucks.The foremilk is believed to be like a drink for the baby and it is the hindmilk that is believed to be the milk richer in calories that fills baby up. Also remember that breast milk changes to suit the needs of the growing baby. So milk for a 3 month old is different to milk for a 6 month old as they both have different needs.So if you let your baby suck on demand and be at the breast as often as it wants for short periods it is believed that it may only get foremilk more than hindmilk. That is the milk stored in the breast which is more like a drink rather than the hindmilk which babies have to work for which is higher in calories and like their food. So it is reasonable to believe that if baby only ever gets foremilk then it will be hungry sooner and not be as satisfied.So in my opinion it is good practice to stimulate the baby at the breast to work and build up its jaw muscles so that it accesses the hindmilk, empties the breast tires itself out and gets skin to skin time with mum. When the baby empties the breast it allows it to drain and fill thus making mastitis less likely.( see

breast feeding problems)This should also be kept in mind when pumping milk (see expressing breast milk)

In my experience women who breastfeed are given a bit of conflicting advice from health professionals, family and friends. It should be kept in mind that ideas change and everyone has their own take on things. The most important thing is to see your baby thrive, that is if your baby has lots of wet and dirty nappies, is fairly contented, you are managing to get some rest and baby is gaining weight. Then you are doing something right so keep it up! Some people have fixed ideas about what they consider breast feeding to be and how it should fit around their lives. Remember these pointers

Babies have tiny tummy's so they need to feed often and that includes during the night.It is us who need routines, not babies.It is us who have difficulty resting during the day when baby is resting as we want to answer texts and emails etc.Babies need skin to skin time, they want to be close to mum its comforting. They do not want to be on their own in a moses basket.Breast feeding is time consuming and tiring but it has the best rewards ever.Remember your baby is only small for a very short space of time , savour this time with them. And remember its not forever.You will be tired and hormonal and wonder and worry and doubt everything, welcome to the world of being a new parent.But rest assured if your baby is thriving you are doing a great job. Watch its nappies. If milk is not going in there will be little coming out, so that is not a good sign. You want your baby to have wet and dirty nappies and not to go for long spells without feeding. This would mean they have no energy to feed and so they sleep. This is not a sign of a good baby as so many people seem to think.

Help at this stage can be crucial so that new parents understand what to expect. Sleep deprivation is the biggest problem in my experience. You have to get used to lots less sleep and you will it just takes time and can cause you to be emotional too.

Babies are demanding, it's how its meant to be but can be difficult for us when we are used to doing our own thing and having time to do it. Now someone else is the centre of your time. It;s about planning and being organised and getting rest and plenty of food and hydration.

But please take it from me , when it works well and you understand it all, there is nothing nicer than having your baby grow and develop from the milk you alone are supplying. You are giving your baby a great start in life.

© 2013

Common breast feeding questions

How much is the baby getting I cant see?

Well this is where a little detective work is needed. Is the baby sucking well while at the breast? Can you hear the baby swallowing Colostrum/milk? The key here is to concentrate on what the baby is doing and not switch off by watching television and having no idea whether the baby was comfort sucking or feeding. The key is to watch that the baby is actively sucking well and just having a little rest in between sucks,,,not having huge rests and little occasional sucks. The quality of the sucking is important. With good sucking the baby accesses milk. With inadequate sucking the baby could just be comforting and not actually feeding much at all.

Is the baby settling down to sleep after its feeds,,,and not waking 5 minutes later looking for more.

Does the baby have wet and dirty nappies,,,,this is a good indication ,,,plenty going in plenty coming out. If nappies are pretty dry good indication not much going in. However remember in the early days that babies get Colostrum and that is in small quantities . A baby gets about a teaspoon per feed but remember their tummy is tiny too. Think of Colostrum as concentrated goodness exactly what your baby needs to boost its immunity and nourish it

Is the babys' fontanelle,,,soft spot on its head depressed or dipped. This can be a sign of dehydration if it is dipped?

Is the baby keeping down its feeds?

It is normal for baby's to have small possets while winding and sometimes they will bring up a bit of milk with wind. Excessive vomiting should be looked into

With a little detective work you can be reassured that your baby is getting plenty of milk.

The baby will usually lose a bit of weight in the early days as it uses up so much energy to do all the functions that mum did for it before. It also needs to keep warm so it burns brown fat . All of this leads to weight loss but usually as long as the weight loss is within 10 % of its birth weight it is acceptable.

How long should I feed for and how often?

Well breast feeding is designed to be on demand but remember that the baby has to be encouraged to fill itself up at a feed and not to just sit there comfort sucking and not actually feeding at all,,,,this is common as its comfortable next to mum ,,its great to be snuggled in and come on who would turn down food on tap 24 hours per day as and when you want it. Baby's need to learn that mum does not want to sit with them attached for as long as they would like. That when the breast is offered its time to feed and not nap on the job. So encouragement is required as baby's in the early days can be quite sleepy as they have been through a lot being born.

In my opinion there are two forms of demand. As and when your baby wants feeding and this means falling asleep on the breast and usually small feeds often and ends up where women feel they are constantly feeding all the time and have no time for anything else and

Encouraging the baby to fill up and the letting it sleep and seeing how long it sleeps for. Can be 2-4 hourly and then feeding it when it wakes up.

In my opinion this is the better option as it gives mum some rest in between feeds and allows her nipples to have a break. Otherwise very quickly mum's can feel that their nipples are bruised and sore and can give up for that very reason. Very few mum's I have known want to feel that they are constantly feeding throughout 24 hours. Most want some sort of idea and framework as to the feeding. That is why I feel the second option is better for mums. Plus it allows them some rest time between feeds.But remember this is what mums want,in an ideal world a baby would just be attached to its mum and allowed to feed as and when it wants, its us who are not so keen on this idea as we want a structure to allow us to do other things as well.

I like to demonstrate this by giving two scenarios.

1st Scenario

Baby who feeds for about 20 mins in total (excluding and winding and changing nappies) then sleeps for about 3 hours

Baby who feeds for 40 mins then sleeps for about and hour and is rooting about looking for more.

Which one is correct???

Well the answer ,,we don't have enough information about either feed. In my opinion it is not the length of feed that is important but the quality of the sucking and encouraging the baby to suck while it is at the breast.A baby can be at the breast for an hour and be sleepy and hardly suck at all. That is not a good feed. A good feed should be determined by how well the baby feeds while it is there. Hearing it sucking and swallowing milk and keeping it stimulated to suck. While also remembering to stop for winding sessions along the way. So because of this feeding can appear to take a long time . However there can be a lot involved including changing nappy and winding.

Once a baby builds up its jaw muscles and becomes more awake then the feeding can get quicker and baby will fill up sooner as it will suck well and effectively. But don't expect miracles. Think of yourself doing sit ups? How many can you manage at one go? Exactly well remember a baby needs time to build up its jaw muscles. They are tired initially and need a bit of encouragement and by encouragement I do not mean stroking and massaging the baby so that it is even more comfortable and wants to sleep more.

What problems could I face when feeding?

Some good information here . NHS guidelines

http://www.nhs.uk/Conditions/pregnancy-and-baby/Pages/breastfeeding-problems.aspx

© 2013

What if you don't want to breast feed

Many times I have been confronted by women who are angry as they feel that health professionals or family and friends are so hell bent on promoting breast feeding that they forget about the women who don't want to breastfeed. Some women have told me they lie just so they don't feel singled out. I have always taken the stance that yes breast milk is the best thing for babies and it has lots of benefits but equally I believe that women should have freedom of choice and not made to feel that they are bad mothers because for whatever reason they do not want to or chose not to breastfeed.On lots of occasions I have found that when supported women can and will change their mind and do go on to breast feed and very successfully. They need someone to listen to them to talk to and to answer their questions, support them and alleviate their fears. Not so they feel bullied. It is those very women who through support carry on breast feeding longer than those who have no or little support.Now if you look at hospitals you can clearly see that bottle milk is hidden,,,no bottle milk products are advertised or even talked about. What message is this giving to women? Can women not be given the facts and be allowed to decide for themselves and their babies. In my experience when women are forced or bullied into doing something they are not happy about you usually end up with both an unhappy mum and an unhappy baby and the relationship is far from ideal and this in turn then affects the bonding process. Women are intelligent beings and they can and will make decisions on what is right for them if we give them the information in a factual and informative way. Yes we can argue that if this is the case what choices are the babies getting,,,who is speaking for them ,,,do they not have the right to breast milk ? Well the answer is yes however we are born and entrusted to parents who do the best they can. Some argue if bottle milk is available it is too easy for women to give in and give their baby a bottle ( since when was breast feeding meant to be a total struggle so that women feel they need to give in and in this case where is the support? This point could be argued forever however the crux of the matter to me is that women should be given the facts and given choices where possible. Lets not make new mums feel guilty,,,,new mums are very vulnerable and emotionally they become saturated very quickly. What ever happened to being there for all our mums and giving them support and encouragement.? New mums need support and encouragement to help them breastfeed successfully and in my opinion that is where the funding needs to go. That is what we should all be fighting for- Help for new mums. Support and teaching them how to cope and how to feed successfully so they can go on themselves after they have a basic understanding and awareness of how it all works. Tired exhausted emotional mums who have little to no idea of what they are doing give up breastfeeding as they think bottle feeding will be easier. Bottle feeding has its own list of problems but often seen as a way to cope. So lets help mums cope. They need good advice , support, encouragement and sleep!!!!!It should be that very support that we give emphasis too as too many new mums in this country have no family to rely on for support or encouragement. So they look to health professionals. Gone are the day of stays in hospital to learn the basics with your baby. It's home as soon as possible and then visits from a community midwife. Who yes do their best but with the amount of women on their books they are usually stretched to the limit and the amount of professionals who openly admit they have no time to do their job any more for the reams of paperwork.I think we have forgotten how vulnerable and hormonal women are in the early days and how they so desperately want to do 'everything right' for their baby. Well we need a support service in place and I would say that it is sadly lacking. So this is where the role of the maternity nurse or specialist postnatal teacher comes into play. Live in care to help new parents understand their babies and to give them support and guidance in the early days. So they feel they have the confidence to carry on. But lets also support mums who for whatever reason chose not to breastfeed and try to understand why they make these decisions and how we can give them even more support to at least try.Let's not single people out and make them feel like failures or unfit mothers. As this is how many seem to feel

Not enough Milk

This is a very very delicate subject as it can make vulnerable new mums feel inadequate, so it needs careful handling and reassurance.The first thing to consider is that not everyone wants to breast feed yet most health professionals take it as read that you will breast feed as its best for your baby. What if you really don't want to do it- the mind has a great way of taking over a situation and if someone really does not like breast feeding it can have a knock on effect on milk supply.Breast feeding has a psychological input too. It's not just a case of latching your baby on and it all happens.New mums are also tired through lack of sleep and they may have had a bit of a blood loss during delivery and so be a bit anaemic, not to mention post operative if they had a section. So add all this together and you have a mum who needs caring for. If she is not eating well and remembering to drink an adequate amount this will have a detrimental effect on the feeding. I have in many occasions found a new mum tidying up her home while the baby sleeps in an afternoon as she is having visitors, rather than have a sleep or feed and hydrate herself. Gone are the days when women stay in hospital for a few days to help them recover from the delivery. They are sent home and expected to get on with caring for a new baby with often little experience or idea where to start. This adds to the stress of the whole situation and before you know it you have a mum with no milk supply and it can simply be that she has not had time to remember to drink adequately. At each breast feed a new mum should have a glass of water handy and do her best to drink it all.

Breast feeding burns calories too so its important that a new mum eats well.

If friends and family ask how they can help get them to prepare food for the freezer for the early days when you come home from hospital. You will be glad of it! Or use the last few weeks of pregnancy constructively and stock up the freezer with meals for the days after the baby arrives.

I cannot stress enough the importance of this. New mums need to be reminded to look after themselves and if a family member or maternity nurse is on hand all the better.

Breast feeding is not just a case of putting the baby to the breast and hey presto it all works well and baby feeds. There is a huge psychological element here and someone who does not want to breast feed,,well it may be better to accept this rather than put yourself and your baby through a traumatic time. Whoever is helping to look after you,,,make sure they are supportive with whatever you decide. After all its your body its your baby and in the end your decision. No one should ever make you feel inadequate in any way shape or form. Health professionals promote breast feeding and should do their best to make you see what benefits there are for you and baby but they should never ever make you feel inadequate or pressurise you. There role is supportive and you need the support of an experienced person at times to help you achieve your goals.If you are tired emotional and upset at the start of a breast feed you can be guaranteed your baby will pick up on this. The baby is looking for cues and signs from its mother to stay safe and since gone are the days where we need to worry about predators coming to eat us,we worry about other things. The reaction of the baby is the same in all cases. WORRY IS WORRY and it puts baby on alert for flight and fight. So if we worry and get into a negative thought process the baby picks it up wonders what is wrong and wont feed as it is waiting to flee with its mum, out of danger.So during a breast feed the mum needs to try to stay as relaxed as possible and as positive as possible. She should be discouraged from negative comments. Like constantly asking the baby what is wrong is he/ she refuses to feed. Mum needs to stay in a positive frame of mind and it is best to settle a distressed baby rather than try to continue the feed as then both mum and baby get distressed.

In some cases, some women do genuinely not have enough milk . But this should be investigated as it can be something that could be easily solved. Sometimes a negative comment to a new mum goes a long way psychologically.People around a new mum need to stay positive and encouraging at all times as all new mums get emotional and tired and worried. Always seek help if you feel you have an inadequate milk supply.Someone who has had breast surgery may struggle as the breast may have scar tissue and this in itself can have a knock on effect. More so breast reductions where breast tissue and therefore ducts are removed.

Expressing Breast Milk

Remember this golden rule,,,,,the first time you try to express you may not get more than a few drops, or in fact nothing at all. Don't be put off by this. The reason for this is that pumping a breast is nothing like a baby suckling at your breast.

Firstly you may feel a bit strange that you are pumping your breast

Some people express very very early on even before the milk supply is in so remember colostrum is only a small volume anyway. There is some controversy around expressing early on however for some mums it is the only way to keep their babies having breast milk/ colostrum so should never be discouraged in my eyes. It can sometimes only take a few words from a well meaning person and the mum ends up not giving her baby breast milk which is such a shame for both mum and baby.

One girl I worked with had been put into a room to express for her baby along with a girl who had been expressing for some time. The new mum had no idea that she would only get a few drops to start with and felt that she was a failure as this other girl was getting a bottle full. It would only have taken a simple explanation to that mum to make her realise this was normal and that she would build up her supply. As it was she gave up and the baby was bottle fed.

When you express the natural let down reflex is being stifled a bit here as there is no baby to help with this process it feels for some like a cold clinical experience and some girls have told me they personally feel like a milking machine and don't like it too much.

You need to relax into it,,,,,read a book watch tv,,,anything but watch every drop of milk.

Remember equally expressing breast milk has a psychological input too, so you need to chill and relax and try not to get stressed out about the amount of milk you can see in the bottle.

Have a drink too as you need to keep up the amount of fluids you put in to your body,,if you don't put them in you wont get them out.

For some expressing can be the difference of carrying on breastfeeding or not. Some girls who maybe have bruised and sore nipples just need a rest for 24 hours and expressing from the breast allows this.

Most publications tell you that breast feeding should never be sore. I would disagree a little with this. Your nipples if a first time mum have never been used before and they have usually been kept away from the weather inside your bra so they have not toughened up. A baby can be a bit relentless and yes they should not latch onto the tip of the nipple but in the early days when everyone is unsure and learning, then its east for baby's to latch on wrongly and bruise it's mums nipple. Thats why positioning is very important.

If you surveyed new mums as I have done, very few would say breastfeeding is totally painless.

If you have a baby who is ill or in special care then expressing may be the only option open to you so that your baby can get breastmilk.

It is good to learn how to hand express breast milk but very few women use hand expressing as a means of collecting a volume of milk.For some mums who need to get back to work again expressing is an option if you want to continue with your baby having breast milk while you are at work.

It can also be a way of mum's letting dad have a go at feeding but at the same time it's still breast milk the baby is getting.

So for many mum's whatever the reason expressing breast milk can be an option.

The NHS have good clear guidelines re expressing milk

http://www.nhs.uk/conditions/pregnancy-and-baby/pages/expressing-storing-breast-milk.aspx

The current NICE guidleines follow re the Handling and storage of Breastmilk.

© 2013