Beyond birth – Breastfeeding your baby

42 weeks, www.42weeks.ie, AIMS Ireland

As we get closer to the end of our pregnancy the full realisation that we will become a mother starts to dawn! A lot of the early pregnancy can be taken up with planning where we will have our baby and coming to terms with being pregnant, including pregnancy related nausea. For most women the second trimester offers an opportunity to blossom and bloom and to research further how they will give birth and to prepare for this event with antenatal classes and pregnancy exercise classes such as antenatal yoga. At some point in the third trimester most women start to focus more on what will happen after the birth. This can make us susceptible to baby advertising and some serious commercialism! Baby clothes, nappies, furniture, buggies, slings, cots, carriers . . . the list is endless. We all love buying or borrowing things for our new arrival, but one of the most important things we can do at this time is give consideration to breastfeeding.

The normal way of feeding your baby
Breastfeeding is the normal way of feeding and nurturing an infant. The Department of Health and the World Health Organisation recommend that for the full term healthy baby exclusive breastfeeding should continue for at least six months followed by breastfeeding as part of a mixed diet until the age of two or beyond. For the majority of the babies in the world, this happens naturally as women share breastfeeding experiences and stories from the time they are small girls. Breastfeeding is as common and normal an event as washing your face in the morning! In our culture this is not the case and so the normality of breastfeeding has to be re learned for the majority of us.

The research shows us that those women who have good breastfeeding support from family members, their community and health care professionals tend to find the breastfeeding experience easier and are more motivated to breastfeed for longer periods. The most common reasons given for giving up breastfeeding after the first few weeks are perceived insufficient milk supply and lack of support. So how can you ensure that you know whether you have enough milk for your baby and that you have adequate support? The first issue relates to good breastfeeding management, but the second issue relates to finding a good support network, and getting good unbiased evidenced based information on breastfeeding from the get go.

How to get reliable breastfeeding information and support
Not all breastfeeding information is necessarily equal. Many websites, commercial organisations and individuals appear to offer breastfeeding advice, but sometimes the information they give is highly selective to validate their particular personal point of view or their personal experience. In the case of organisations, the breastfeeding information may be designed to encourage mothers who intend to breastfeed to visit websites that are actually funded by companies who market artificial milk. You would be surprised what you can get if you just google breastfeeding!

Always validate the source of your breastfeeding information. Ask yourself, is this unbiased genuine breastfeeding support? Is there a hidden message here about artificial milk substitutes? Has the information been provided by someone who is a genuine expert in breastfeeding? Has this person breastfed before? If so, was it exclusively and was it for six months?

Reliable sources of information and support on breastfeeding in Ireland are:
La Leche League of Ireland. They have been supporting mothers to breastfeed for over 40 years and have regular groups around the country, which you can attend in person or call for information and support. They have a huge number of publications around all aspects of breastfeeding and parenting and hold an annual two-day conference on breastfeeding. They have a national support line and are available for calls seven days a week within waking hours. There is no charge for this service. Their counsellors are fully trained and have all breastfed themselves for a period of at least 9 months. They also have a Facebook page (La Leche League of Ireland) and a website that offers up to date information and support www.lalecheleagueireland.com

Cuidiu. The Irish Childbirth Trust. They have group meetings and coffee mornings around the country and also have a network of trained breastfeeding counsellors that offer one to one support in groups, in person or on the phone. They have a Facebook page and a website where you can get information and support www.cuidiu.ie

Friends of Breastfeeding. They are a group offering mothers peer support rather than a counselling service. They have coffee mornings in many locations around the country and have recently started a buddy support pilot where individual mothers can ask to have a breastfeeding buddy assigned to them to help them in the early days of breastfeeding. Their website is www.friendsofbreastfeeding.ie

Local Public Health Clinics. Some, but not all public health nurses hold breastfeeding clinics, but these tend to be limited to younger babies and focus primarily on weight and health concerns, rather than on the normality of breastfeeding. The HSE have a good website that gives information on breastfeeding www.breastfeeding.ie

Private support services This includes attending antenatal breastfeeding courses usually run by a midwife who is a lactation consultant, or hiring a private lactation consultant to come and work with you and your baby. There is an Association of Lactation Consultants in Ireland known as ALCI and they have a website with a list of registered lactation consultants who you can engage on a one to one basis. www.alcireland.ie

Hospital breastfeeding support. Some maternity units offer breastfeeding classes antenatally and breastfeeding clinics postnatally. These are usually free and are often offered by units that are part of the Baby Friendly Hospital Initiative.

How to prepare for breastfeeding
In the old days women were told that they had to prepare their breasts for breastfeeding by scrubbing them daily and toughening up the nipples. OUCH! Thankfully that type of thinking went out with the ark! There is no need for you to do anything to physically prepare your breasts for breastfeeding; your hormones will take care of all of that for you. As your pregnancy progresses you will notice your breasts getting larger and the areola becoming bigger and darker. Some mothers also notice that towards the end of the pregnancy they are producing colostrum. However, what is useful to do by way of preparation is to attend one of your local support groups so that you can get to know other breastfeeding mothers in your area and also feel familiar with the breastfeeding counsellors, so that if you need support after your baby is born these people will not be another unknown face.

Mothers who know in advance that they will be having an elective Caesarean birth, that their baby will be delivered early or who have inverted nipples may want to chat to the lactation team in the unit in which they are having their baby or to their midwife if they are having a baby at home.

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Knowing what is normal in the early days
Other great ways to prepare is to know what is normal in the early days of breastfeeding. For example, it is completely normal for your baby to not feed very much on the first day after birth, as babies are often tired. Being born is hard work! Your baby is born with a nice layer of body fluid especially designed to take it through the first couple of days when you will not have much milk yet. In the first couple of days your baby’s stomach is the size of a hazelnut and is designed to receive colostrum, which is full of amazing properties that provide your baby with valuable immunity and which also enhances a newborn’s ability to use alternative brain fuels and improves gut function allowing nutrients to be absorbed more quickly.

This is a strange time for your baby as in-utero your baby feeds continuously and getting used to intermittent feeding is a whole new concept for him or her. The early days of small frequent colostrum feeds help your baby prepare for feeding with your milk when it comes in. By day three your milk is in the form that we expect milk to be (i.e white!). It will start to come in and you may feel some discomfort and engorgement. It’s worth noting that engorgement is not a case of your breasts being like two containers that are filled to the brim with milk, but its also that the different tissues within the breast become slightly swollen and contribute to that feeling of engorgement. For mothers who have had a Caesarean birth it may be day five before the milk fully comes in.

Babies will feed between 4 and 6 times in the first 24 hours and between 8 to 12 times in a 24 hour period afterwards. This will by no means be at REGULAR intervals. It is quite normal for babies to feed in clusters at the end of the day, just when you are the most tired and your milk supply is at it lowest. The best way of dealing with this is just to sit down, feed your baby and enjoy it. Maybe this is a good time to watch your favourite box set! The golden rule is learning to know your baby’s feeding cues and feed whenever your baby indicates she or he wants it. Many a mother has spent many a fruitless hour trying to analyse why a baby wants to feed so frequently in the evening, more than likely your baby is just making more milk for the next day. More sucking equals more milk made. Trust your baby that he or she is hard wired to feed. As someone once told me your baby doesn’t have a clue as to whether it has been born in to a three-bedroom semi detached house in Dublin 8 or in a cave. Either way his or her needs are the same; warmth, food and love. Breastfeeding satisfies all three.

It is best to avoid artificial soothers or bottles either with breast milk or artificial milk as these can limit the amount of breast milk your baby has access to and this in turn can limit your supply. Most women do not have a full supply until around 6 weeks when they will be producing 1.1 litres of milk a day.

Is my baby getting enough?
You can ensure that your baby is getting enough milk by knowing your baby’s feeding cues and offering feeds whenever he “asks” ensuring that he or she is offered both breasts at every feed, checking that he is swallowing deeply at each feed and by ensuring that he has enough wet and dirty nappies.

Day 1 = 1 wet and 2 tarry black poo nappies
Day 2 = 2 wet and up to two tarry black poo nappies
Day 3 = 3 wet and 3 green brown or yellow poo nappies
Day 4 = 4 wet and 3 green brown or yellow poo nappies
Day 5 to 4 weeks = 6 wet nappies and 3 yellow seedy poo nappies
Week 5 to start of solids = 6 wet nappies and one large yellow poo every 1 to 7 days.

In terms of weight, babies often lose up to 10% of their birth weight especially if you received IV fluids during your labour. This is usually regained by 2 weeks after birth. On average after the first two weeks babies tend to put on 150g = 200g per week.

Growth spurts
Your baby needs to stimulate your breasts to produce more milk to satisfy his growing needs. He does this on a daily basis via suckling, but in addition to this at around 10 days, 21 days, six weeks and about 3 months babies have a growth spurt and feed what seems like incessantly for a 24 hour period or so. This further stimulates your breasts to produce more milk for a growth spurt and is completely normal.

Photo courtesy of officemum.ie

Photo courtesy of officemum.ie

What does breastfeeding give me and my baby?
Breastfeeding provides your baby with normal nutrition and immunity from birth onwards. It is a unique substance designed specifically for your baby. Breast milk changes through time to suit exactly what your baby needs. For example the milk is different during different times of the day, during different seasons and climates and at different times of your baby’s development. Breast milk changes to provide minute by minute immunity to your baby as necessary. So if you as the mother come into contact with a pathogen, the antibodies you build automatically pass through to your milk and to your baby to provide them with real time immunity. Breastfeeding can save lives in that it provides babies with a lower risk of sudden infant death syndrome and with a higher immunity from life threatening gastro intestinal diseases. Artificial infant foods offer a higher than normal risk of sudden infant death syndrome and lower immunity to life threatening gastro intestinal diseases.

Babies who are NOT breastfed have:
50% higher incidence of ear infections
Increased risk and severity of a large number of infections. These infections include meningitis and pneumonia
Increased risk of developing allergic eczema
Increased risk of developing asthma
Increased risk for developing MS
Increased risk for developing childhood leukaemia
Increased risk for developing rheumatoid arthritis
Increased risk of becoming obese as adults
Increased risk of Type 1 insulin Dependent diabetes
Increased risk of IBS

Women who DO NOT breastfeed have:
Increased risk of blood loss after birth
Increased risk of sub-involution after birth
Increased risk of pre menopausal breast cancer
Increased risk of pre menopausal ovarian cancer
Increased risk of osteoporosis
Increased risk arthritis

Our next breastfeeding article will look at how the management of your labour and immediate postpartum can affect breastfeeding and what you can do to ensure you get maximum support in the immediate postpartum.

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