Shaken Baby Syndrome

A large number of child deaths are reported in South Africa each year. A lot of deaths relate to neglect, abuse or murder. Despite this, there's a knowledge gap in relation to understanding the issue....

Amniotic fluid problems

The importance of amniotic fluid Amniotic fluid is essential for pregnancy and foetal development. Amniotic fluid is a watery substances residing inside a casing called the amniotic membrane or sac. ...

Choosing a pre-school

Becoming a parent is a momentous; life-changing event filled with hopes, expectations and naturally some fears. Parents often learn and grow alongside their children, as they face the challenges of pa...

Newborn reflexes

Although newborn babies are physically helpless and vulnerable at birth, they have a number of amazing innate abilities or reflexes. Reflexes are involuntary movements or actions, designed to protect ...

Mastitis

Mastitis is an inflammation of the breast that can lead to infection. The word “mastitis” is derived from the Greek word “mastos” meaning “breasts”, while the suffix “-itis” denotes “inflammation”. Ma...

Pelvic floor exercises

Although your new baby will probably bring you immense emotional satisfaction, physically you may feel uncomfortable and strange in your own skin. After 9 months of pregnancy and hormonal changes, you...

Colic

Babies cry because they need to communicate something and most parents, especially new moms, find it distressing to see or hear an unhappy baby. In time, you will learn to recognize the various causes...

Antenatal Classes

Antenatal classes are informative sessions provided to prepare expecting parents for the birth of their child and the early days of being a parent.Most antenatal classes are run by Midwives and occasi...

Strap-in-the-Future

The Decade of Action for Road Safety 2011-2020 was launched on the 11 May 2011. It is a global declaration of war against road crashes and fatalities. According to Mr Sibusiso Ndebele, MP Minister of ...

  • Shaken Baby Syndrome

    Tuesday, 21 July 2015 16:28
  • Amniotic fluid problems

    Thursday, 14 May 2015 12:54
  • Choosing a pre-school

    Friday, 10 April 2015 17:50
  • Newborn reflexes

    Tuesday, 03 March 2015 15:49
  • Mastitis

    Tuesday, 03 March 2015 15:41
  • Pelvic floor exercises

    Wednesday, 11 February 2015 17:20
  • Colic

    Wednesday, 11 February 2015 17:11
  • Antenatal Classes

    Monday, 03 June 2013 09:34
  • Strap-in-the-Future

    Thursday, 30 June 2011 13:52

Breast Feeding

‘Breast is best’ is a well-known phrase and it was coined because breast milk contains everything a baby needs: water, protein, fat, carbohydrate, minerals, vitamins and iron. It is convenient and provides the baby with antibodies.

 

During pregnancy, your body increases its production of a hormone called prolactin. This hormone stimulates the cells in breasts to produce milk. The amount of prolactin also increases when you are nursing your baby. The size of your breasts does not affect the amount of milk the body produces. The baby’s nursing controls milk production. The more baby breastfeeds, the more milk will be made.

 

Oxytocin is another hormone that increases during pregnancy. This hormone causes tiny muscle cells within the breasts to contract and squeeze milk down the milk ducts toward the nipples. This process, called the let-down reflex, occurs each time you nurse. Sometimes just thinking about breastfeeding or hearing a baby cry (even if it is not one’s own) stimulates the let-down reflex. Some mothers need baby to suckle before the let-down reflex engages.

 

Milk production usually comes in 3 days after baby is born. Before this the body makes a yellowish, sticky substance called colostrum that is produced at the end of pregnancy. It is rich in proteins and antibodies that help to protect the newborn baby from infections. True milk is twice as rich in fat and sugar as colostrum and is so nutritious that the infant soon begins to gain weight. Babies tend to lose weight after birth, but they soon start putting it back on again.

Breastfeeding is a skill both mom and baby need to master. Practice and patience are key elements for successful breastfeeding. You can start learning about breastfeeding whilst you are pregnant. Read up about breastfeeding, sign up for a breastfeeding class. Learn as much as you can. Surround yourself with a support system.

 

The first feeding after delivery

Breastfeeding should be initiated as soon as possible following the birth of your baby. Research has shown that in the 2 hours following birth, infants are alert and they have a strong sucking reflex. It is at this time that your baby will lick or nuzzle your nipple and may even latch on. Early feeds have an imprinting effect and help to get breastfeeding off to a good start. The colostrum that the newborn receives will provide nutrients to prevent a low blood sugar level.

 

If baby was born vaginally, nurse in bed or in a chair, either by

·         Lying down with baby facing the breast

·         Hold baby in the cradle position, with the head in the crook of your arm. Firmly support the baby’s back and buttocks. When feeding this way, make sure that baby’s entire body is facing the breast, not the ceiling

 

If baby was born via a Cesarean-section, nurse by either

·         Sitting up, use one or two extra pillows to support baby and the incision

·         Lie down on one’s side with baby facing one

·         Use a side-sitting or football hold

 

Always take the time to make yourself comfortable. Ask for help, it may take several feedings before becoming a skilled nursing team.

 

Latching-on

Touching the nipple to the centre of baby’s lips stimulates baby to open his/her mouth widely. This is called the rooting reflex. As baby opens his/her mouth, pull baby gently forward onto the nipple and the areola. When a baby is properly positioned, the nipple and areola are pulled well into the baby’s mouth. Babies use their lips, gums, and tongues to get the milk to flow from the breast. This is known as suckling. Simply sucking on the nipple will not draw milk and it may result in sore nipples.

 

When a baby first nurses there will be a tugging sensation. If the latch-on hurts, the latch-on may be incorrect. Break the latch by slipping your finger into the corner of baby’s mouth, reposition and try again. It may take several attempts. Correct latch on is very important as it:

·         Makes milk flow better

·         Prevents sore nipples

·         Keeps baby satisfied

·         Stimulates a good milk supply

·         Helps to prevent overly full (engorged) breasts

 

If baby is latched-on correctly and pain is still being experienced, contact a lactation consultant; or speak to a clinic sister or to a paediatrician.

 

A word on pain

Most women experience nipple pain and engorgement when beginning to breastfeed. Engorgement is the term used to describe swollen and painful breasts which occur 2-3 days after birth. Nipples often do feel sore during and after breastfeeding. Some experts recommend leaving milk on the nipple after feeding and allowing it to dry. This is thought to protect the nipple. Keeping the nipples dry is important to prevent cracking and infection. Exposing breasts to outside air and sunshine works wonders. Do this after each feeding session.

 

Engorgement

Breast engorgement occurs when the breasts produce more milk than the amount that is being expelled. When this occurs the entire breast, nipple, and areola (pigmented region surrounding the nipple) swell and cause discomfort. Symptoms include:

·         Hard, warm, throbbing breasts

·         Flattened nipples (which makes it difficult for baby to latch-on)

·         Slightly swollen axillary (underarm) lymph nodes

 

Tips to help prevent and relieve engorgement

The best treatment is to allow baby to nurse. Alternatively, using cold, refrigerated cabbage leaves may help. You could also lie in a really full, hot bath, ensuring that the water covers your breasts and gently press down on each breast until relief is felt. This procedure allows milk to flow out of over-full breasts. This is also a good way to clear blocked ducts.

 

Attempt to hand express milk before feedings (if breasts are engorged) as this will assist baby with latching on correctly. This is very important. If baby can’t latch on well, he/she will not be able to get enough milk out, leading to worsening of the engorgement, which may develop into mastitis, a breast infection, sore nipples and a hungry baby. Remember to express only enough to reduce the pressure. Excess expression may lead to more milk production.

 

Cracked nipples

A crack or split in your nipple can be excruciating. To prevent cracked nipples, position baby better by ensuring that baby’s lips and gums are on the areola and not only on the nipple. Also, vary baby’s position at each feeding. For cracked nipples, apply 100% lanolin after feeding, but not too much. Lanisoh is good one to use. Do not use lanolin if one is allergic to wool. Do not wear plastic breast shields or plastic-lined nursing pads. These will hold in the moisture.

 

Mastitis

Mastitis is an inflammation of the breast which is caused by a blockage of milk in the ducts of the breast. It usually only affects one breast. Common symptoms are:

·         The breast is tender, warm to the touch with a red patch or streaks

·         Headache

·         Flu-like symptoms, fatigue and body aches

·         A fever, above 37.5 °C

If you are presenting all of the above symptoms, see your doctor. You will need antibiotics to clear the infection. You will be able to continue breastfeeding, in fact it is recommended. Also remember to ask for interflora in order to avoid thrush.

 

The Rule of Thumb

Many moms worry if the amount of breast milk baby is receiving is enough. It would be wonderful if boobs came with millilitre markings so that moms could tell exactly how much milk baby was getting.  A newborn baby should nurse every 2 to 3 hours, and should have 6 to 8 really wet diapers per day. You should be able to hear baby sucking and see a slow steady jaw movement. Baby should be active and alert and should have regained birth weight by 3 weeks of age. If baby is not breastfeeding frequently and there are no wet nappies, contact your health care provider immediately.

 

Newborn babies normally breastfeed every 1½ to 2 ½ hours during the first month. This equates to 8-12 times every 24 hours. Breast milk is digested more quickly than formula so breastfeeding is needed more frequently. A good sign that baby is getting enough milk is if baby is gaining weight appropriately. It is very important to visit Baby Wellness Clinics on a regular basis. Not only does baby get measured and receive vaccinations, but one can ask lots of questions.

 

Breastfeeding mothers must take note of the length of time their baby spends nursing on each breast. A baby receives thinner breast milk known as foremilk (with a lower fat content) at the beginning of a feed. This milk acts as a thirst quencher. Thicker milk, called hindmilk, has a higher fat content and is more filling. To complete a feeding cycle, baby needs to spend 15-20 minutes on each breast. Allowing the baby to completely empty the breast ensures that he/she gets an adequate amount of hindmilk.  Recent research has shown that the composition of hindmilk and foremilk changes each breastfeeding. If you feel as though you have empty breasts (usually experienced  between 17h00-18h00) at the beginning of the feed, rest assured that the composition of the milk is predominately hindmilk which will fill baby up.

 

Remember to begin the next feeding on the breast that baby took second.

 

Learning to read baby’s hunger cues

Early cues

·         Rooting reflex

·         Nuzzling the breast

·         Sucking on his/her lips, tongue, fingers or fist

·         Opening mouth wide and moving his/her head around

·         Smacking of lips

Late cues

·         Fussing and crying

 

Feed baby as soon as you notice early hunger cues. Don’t wait until the crying stage. Even if it has only been 30 minutes since the last feed, it’s OK to offer the breast whenever baby seems hungry.

During the first few weeks, your baby will want to breastfeed around the clock. This is perfectly normal. Some mothers find that bringing the baby into bed at night or keeping the cot in the same room, allows them to meet the child’s needs while losing minimal rest. Other mothers prefer to keep the baby in a separate bedroom, and have a comfortable chair there. Some newborns can be sleepy and hard to wake. Do not let baby sleep through feedings until your milk supply has been developed. This usually takes 2-3 weeks. If baby is not demanding to be fed, wake him/her if 4 hours have passed since the last feeding.

 

Comfortable nursing requires correct positioning of the baby at the breast. Some guidelines are given to help develop your own technique.

 

Positioning of baby

Cradle hold

Sit in a comfortable chair. Place your baby on your abdomen, tummy-to-tummy. The baby’s head is cradled in the crook of your arm and the face to your breast. If you are breastfeeding on the left hand side, hold babies head in your right hand so that you can guide baby’s mouth to the nipple with ease. The infant’s head, back, and legs should all be in a straight line. This position can be held for the entire duration of the feeding. If you feel your nipple starting to hurt halfway into the feeding, check to see if your baby has slipped down and if the knees are starting to face the ceiling instead of being tucked in next to your side.

 

Football hold

Cradle the back of your baby’s head in your hand, with the body under your breast and toward the elbow. Place a pillow under your elbow to help you support your baby’s bottom. Use your other hand to support your breast. This position allows you to control the baby’s head and assures good positioning to latch on.

 

Side lying

Lie on your side with one arm supporting your head. Your baby can lie beside you with the head facing your breast. Pull the baby in snugly and place a pillow behind him or her.

 

If you and baby are really struggling to get the hang of breastfeeding, contact a certified lactation consultant. They are usually very friendly and will come to your home. For a list of consultants, click here.

 

Around the second week, it may seem that your baby wants to nurse all the time. This is due to your baby entering a growth spurt. It is normal for your baby to nurse every 30 or 60 minutes, and stay at the breast for longer periods. This increase in nursing is normal and your body will respond by producing more milk; it takes a few days.

 

Babies are often more niggly at 6 o’clock and they may not breastfeed as well as during the rest of the day. This has been dubbed as the 6 o’clock syndrome or otherwise is affectionately known as suicide hour. It normally begins at 18h00 and ends at 20h00.

 

Remember to look after yourself. Your body needs energy to produce enough milk. Be sure you get adequate nutrition, rest, and sleep. It is a good idea to have a drink on hand before sitting down to breastfeed. Many women get very thirsty whilst breastfeeding. Be careful when drinking hot drinks near baby; newborns sometimes will kick or jerk unexpectedly.

 

Exclusive breastfeeding is recommended up to 6 months of age, with continued breastfeeding along with appropriate complementary foods up to 2 years of age.

 

Worried about a low milk supply?

Remember that the more you nurse, the more milk you produce. Breastfeed often. Night feedings are important in order to build a good milk supply in the first few weeks. Growth spurts generally occur at 2, 4 or 6 weeks and again at 3 months and 6  months. Baby will feed more frequently during growth spurts. In fact, it may seem that baby is feeding all the time. If you are not producing enough milk, the first step is to invest in a good quality electric breast pump. Do contact a lactation consultant before deciding to introduce top-up formula bottles as this will negatively impact on milk production.

 

To breastfeed or not

Breastfeeding is a very personal choice and many people have strong feelings about it. There are three approaches:

1.       To breastfeed exclusively

2.       To breastfeed and supplement with formula

3.       To formula feed exclusively

 

Breastfeeding exclusively

Unfortunately, not all hospitals in South Africa allow newborn babies to suckle in the first hour after birth, even though the World Health Organisation recommends it. And more often than not, newborns are given top-up bottles of formula whilst in hospital. But this is not the end of the road for moms who would like to breastfeed exclusively. Babies can learn to breastfeed even after being introduced to a bottle and a dummy. If you are hellbent on breastfeeding and baby received top-ups in hospital, resist supplementing and trust your body to produce adequate amounts of milk. Remember, the more you feed, the more milk your body will produce.  Supplementing your baby’s diet with formula feeding will only trick your body into believing the current supply of breast milk is adequate.

 

Anecdote

I had decided that I really wanted to breastfeed my baby. When she was brought to me 6 hours after her birth I attempted to breastfeed her. My milk had not come in yet but the colostrum was flowing freely.

 

One of the nurses said that my nipples were inverted and introduced Chloe and me to a nipple shield. It was a tricky piece of plastic that sometimes came off in mid-feed. Chloe seemed to manage. I was worried about how much milk Chloe was getting as I was told that the nipple shield interfered with the amount of breast milk I produced. The paediatrician advised that Chloe should be given top ups of 20ml of formula, which the nurses did. Chloe was bottle-fed and breast-fed with a nipple shield, both made from silicone, whilst in hospital.

 

Once I was discharged, I phoned a lactation consultant to assist me in breastfeeding exclusively without the use of the nipple shield. After an hour of coaching, I was holding Chloe in a better position. The lactation consultant came back once on the first day and I phoned her with any concerns that I had. Breastfeeding progressed well. I did experience sore and cracked nipples but continued to breastfeed. I initially used lanolin ointment until my Mom suggested Friar’s Balsam, which worked like a treat!

 

I breastfed Chloe exclusively for 7 months. By this time I had returned to work and expressed milk in the storage cupboard – the only place where I could do so in relative peace. I wish that I had saved more milk in the early days as you can freeze breast milk for up to 6 months.

 

I later discovered that Chloe had an upper frenulum – she had an extra piece of skin joining her gum and lip which is said to cause painful breastfeeding.

 

There is a lot of conflicting advice. Listen to what others have to say but in the end do what works for you and baby.

 

Useful links

http://www.breastfeeding.com