2torial #0617:
Learn2 Breast-feed Your Baby

Milk: It does a baby good

Once (perhaps when you were born), commercially prepared infant formula was all the rage among mothers of new babies. Now, many groups concerned with infant health (like the World Health Organization) recommend that babies be fed exclusively with breast milk until they are 4 to 6 months old, then nursed past their first birthday (with solid food gradually worked in to their diet).

It's up to you how long you want to breast-feed (even a very short amount of time is better than none at all). But it's easy to see why the experts are enthusiastic: Breast-feeding is marvelously healthy for both babies and mothers, and it may be the perfect way for the two of you to cement your relationship.

Why is breast-feeding so good for both mother and child?

• Breast milk supplies lactose, protein, and fat that babies can easily digest, as well as needed water, vitamins, and minerals.

• Breast milk contributes to a baby's health by supplying enzymes and antibodies that can't be duplicated in formulas. Breast-fed children are less likely to suffer from ear infections, allergies, diarrhea, and other ailments.

• Breast-feeding burns calories so mom gets her pre-pregnancy shape back quicker, and it triggers production of oxytocin, a hormone that helps shrink the uterus immediately following birth. It also reduces a woman's chances of developing certain cancers and osteoporosis.

All this and it's much cheaper than formula!

However, even though breast-feeding is natural, both you and your baby have to learn how to do it. The process can provoke a little anxiety on both sides. But take heart: nearly every woman can successfully breast-feed her child. With a little technical and emotional support, and some patience, so can you.

Note: Certain medications (including those for high blood pressure) may preclude your being able to nurse. Women with inverted nipples may also have difficulties establishing nursing. Review your medications with your doctor and talk to him or her if you have concerns about your ability to breast-feed.

Start early

Take these steps before and just after birth to get both you and your baby off to a good start.

Find a group. Other mothers who've breast-fed successfully can be your strongest supporters. Such organizations as La Leche League International offer classes, groups, and peer counseling for breast-feeding mothers. Ask your obstetrician, women's health center, or friends with children about breast-feeding resources in your area, or look in the phone book or on the Internet (type the words "breast-feeding resources" and the name of your town or region into a search engine).

Talk to the pros. Tell your doctor or midwife you're planning to breast-feed, and discuss any concerns he or she may have about your health. Ask him or her to recommend a lactation consultant. And find a pediatrician for your baby who supports breast-feeding. All these people can help you succeed, so get them on your side.

Nurse right away. If at all possible, let your baby start nursing within an hour or two of birth. Just-delivered babies are alert and already have a strong sucking reflex. If they're allowed to lick and nuzzle the breast (or even suckle if they like), breast-feeding gets off to a good start. The baby quickly forms a strong bond with mom, and your body gets the signal to start producing milk (which usually happens 3 to 7 days after delivery).

Make your wishes known. Let your obstetrician and the hospital's nursing staff know you want to breast-feed, and that it will help if the baby is:

• Placed in your arms soon after its birth

• Allowed to stay in your room during your hospital stay (rather than being removed to a nursery)

• Not given any additional water or formula unless there's a medical need for it

Ask for help in making yourself comfortable, and properly positioning the baby at your breast. Your hospital stay, however brief, is a good chance for you both to practice.

Late start? If for some reason you can't start breast-feeding right away, don't worry. Most mothers and children who have an initial delay still build a successful nursing relationship. Even if you're not nursing immediately, start expressing your own colostrum and milk, so the supply is ready when the demand hits. Ask a lactation consultant about how best to do this.

Position your baby

Neither you nor your baby should have to hold an uncomfortable position during nursing--one that tires you or makes it difficult to continue nursing for long. Here are some positions to try (learn them all, and you can use whichever is most appropriate at the time):

Cradle hold. Sit up straight, with a pillow behind you to support your back if needed. Cradle your baby in your bent arm, with his or her head resting in the bend of your elbow, mouth in front of your breast, and his or her tummy facing you. Your baby's ear, shoulder, and hip should be in a straight line (no neck or waist bending or twisting). Support your breast with your fingers below and your thumb above the areola (the dark halo around the nipple), and pull the baby in to your breast to latch on (see Step 3).

Football hold. This is a good hold for a variety of situations, from large breasts to a small baby. Position your baby face-up along your side, with his or her body between your arm and your body and your hand cradling his or her head. Support your breast as in the cradle hold, and pull the baby in close against your breast to latch.

Side-lying position. This is a good position if you're uncomfortable sitting up for any reason, or for midnight feedings. Position yourself and your baby on your sides, tummy to tummy. Lift your breast with your fingers and pull your baby in as he or she latches on.

Learn the latch

Nearly every breast-feeding problem, from sore nipples to insufficient milk, can be prevented or cured if the child is properly attached at the breast. This is called "latching on," and it's an important skill for both of you to learn.

Breast anatomy. Milk is produced in tiny sacs, called alveoli, in the breast. It flows into ducts located behind the areola and out through the nipple. The small bumps on the areola are called Montgomery glands. They produce a natural oil that cleans, lubricates, and protects the nipple.

The yawn. To get your baby latched on properly, cup your breast in your free hand, with the thumb above and the fingers below the nipple. Tickle the baby's lips with your nipple and wait until his or her mouth opens very wide, as if in a yawn. Then quickly pull the baby in to your chest.

With a proper latch, the nipple tip and about an inch (a couple of centimeters) of the areola are inside the baby's mouth. The baby's lips should make a seal with the breast, with the mouth muscles compressing the ducts behind the areola and squeezing milk out of the nipple. If the child is attached only at the nipple tip, he or she is squeezing the opening shut, not getting any milk, and probably hurting you.

If your baby doesn't latch on properly, work your index finger into the baby's mouth while you back the nipple out, so the baby is sucking on your finger. Then pull your finger out of the baby's mouth and try the latch again. Remember, if you and your baby don't seem to be mastering the latch, a lactation consultant can help you learn.

Once your baby is latched on properly, the jaws should move in a slow steady rhythm, and you'll hear the gulping sound that signals successful suckling.

Get into a rhythm

It might take anywhere from a few days to a couple of weeks for you and your baby to get into a regular nursing schedule.

How often? Since breast milk is easier for a baby to digest than formula, they tend to feed more often--eight to 16 times per day on average. It's most important that you nurse when your baby is ready. He or she will signal readiness by:

• Nuzzling your breast

• Opening his or her mouth wide

• Making sucking sounds or putting hand to mouth

• Crying

Note: Don't let your baby sleep without feeding for more than 4 hours a day during the first 2 or 3 weeks after birth. "Sleepy" babies can fall behind until they don't have the energy to nurse properly.

How long? Again, pay attention to your child rather than the clock. Some children nurse for only 10 minutes, some for 30 minutes or longer. Allow the baby to nurse all he or she wants at one breast before offering the other. The last milk in the breast, called "hindmilk," is particularly nourishing.

How much? Perhaps the most common concern of new mothers is whether their children are getting enough to eat. Remember that breast milk is produced upon demand: The more your baby needs, the more you'll make. In general, babies should:

• Regain their birth weight by the second or third week of life

• Gain about 4 to 8 ounces (112 to 224 grams) a week during the first 3 months, and 3 to 5 ounces (84 to 140 grams) a week between 4 and 6 months

• Wet at least six diapers with pale yellow urine (not deep yellow or orange), and have several small, soft bowel movements a day

• Sleep well, but be alert when awake

If your baby doesn't appear to be feeding well at the breast, talk to the child's pediatrician. Many problems can be resolved in ways that let you continue breast-feeding.

Take care of yourself

In a way, you're still eating for two, so what's safe to eat now? And what about your own health issues?

Diet. A well-balanced diet with about 500 extra calories a day, plus plenty of water (about 2 quarts or 2 liters a day) will help keep you both in good health. Continue taking any prenatal vitamin supplements, and ask your doctor about iron and calcium supplements.

Some babies have allergic reactions to certain foods in their mothers' diets, like spicy or gas-inducing foods or dairy products. Symptoms of allergies can include fussiness, diarrhea, rash, gas, and, sometimes, more frequent nursing. If these symptoms appear within a few hours each time you eat a certain food, stop eating it. Wait 2 weeks, then reintroduce the food to see if your baby reacts.

Medications and illness. Certain medications should not be taken while nursing, so consult your doctor about what's safe. However, if you get a cold or flu, continuing to breast-feed can protect your baby from getting sick, too, since you'll be passing antibodies to him or her through your breast milk.

Breast-feeding–related problems. Sore nipples and engorgement are the most common health issues affecting breast-feeding mothers, and both can be treated at home without interrupting breast-feeding. To avoid these problems:

• Feed the baby on demand (that is, whenever he or she wants to be fed).

• Don't give the baby any water or formula supplements unless it's medically necessary.

• If you miss a feeding, express your milk manually or with a breast pump.

• Don't use soap on your breasts when you bathe. Warm water will remove milk residue.

• Air-dry your nipples after each nursing, and lubricate them with breast milk or a natural lubricant like purified lanolin (Note: some babies may be allergic to lanolin). Avoid any other skin lotion. Also remember that your Montgomery glands will provide natural lubrication--so give nature a chance.

• Make sure your bra is dry, and change your nursing pads often if your breasts tend to leak.

• When your breasts are engorged, take warm baths or apply warm, wet compresses to them to relieve the pain; ask your doctor to recommend an over-the-counter pain medication.

• When you wean the baby, do so gradually so your milk production tapers off.

Blocked ducts, cracked nipples, and mastitis are more likely if your latch-ons aren't good or if you don't nurse or express milk regularly. If any of these these occur--especially mastitis--seek medical help.

As you launch into the first weeks of new motherhood, try to concentrate on caring for yourself and your baby. If you pay attention to both your needs and don't hesitate to ask for help from your breast-feeding counselor, pediatrician, or family, you should do just fine.

-end-