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Page: Methods and Considerations
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There are many books and videos for new mothers to advise them about breastfeeding. Advice and support can also be be obtained from a lactation consultant in hospitals or private practice, or from volunteer organizations of breastfeeding mothers such as the La Leche League.
Babies usually show they are hungry by crying, moaning or fussing. When babies' cheeks are stroked, the rooting instinct makes them move their face towards the stroking and open their mouth. Breastfeeding makes mothers thirsty, especially at first, when both mother and baby are inexperienced and when feeding sessions can last for up to an hour. Having water readily available helps mothers maintain proper hydration.
Latching on, feeding and positioning
When the baby's cheek is stroked with the nipple, the baby will open its mouth and turn towards it. So that the baby will latch on well, the nipple should be pushed into its mouth so that the baby has a mouthful of nipple and areola. The nipple should be at the back of the baby's throat. Inverted or flat nipples can be massaged so that the baby will have more to latch onto,. Many women wear nursing brassieres for easier access to the breast.
Pain in the nipple or breast is linked to incorrect breastfeeding techniques. Failure to latch on is one of the main reasons for ineffective feeding and can lead to infant health concerns. A 2006 study found that inadequate parental education, incorrect breastfeeding techniques, or both were associated with higher rates of preventable hospital admissions in newborns.
The baby may pull away from the nipple after a few minutes or after a much longer period of time. Sometimes the baby will re-latch on the same breast or mother may offer the other breast.
The length of feeds varies a lot. Regardless of the time taken, the breastfeeding woman should be comfortable.
* Upright: The sitting position with the back straight
* Mobile: The mother carries her nursling in a sling or other baby carrier while breastfeeding. Doing so permits the mother to incorporate breastfeeding into the varied work of daily life
* Lying down: Good for night feeds or for those who have had a caesarean section
o On her back: Mother is usually sitting slightly upright; particularly useful for tandem breastfeeding
o On her side: The mother and baby lie on their sides
* Hands and knees: The mother is on all fours with the baby underneath her (not usually recommended)
While most women breastfeed their child in the cradling position, there are many ways to hold the feeding baby. It depends on the mother and child's comfort and the feeding preference of the baby. Some babies prefer one breast to the other.
* Cradling positions:
o Cradle hold: The baby is held with its head in the woman's elbow horizontally across the abdomen, "tummy to tummy", with the woman in an upright and supported position image
o Cross-cradle hold: As above but the baby is held with its head in the woman's hand
* Football hold: The woman is upright and the baby is held securely under the mother's arm with the head cradled in her hands. This position is especially useful for feeding twins simultaneously image
* Feeding up hill: The baby lies stomach to stomach with the mother who is lying on her back; this is helpful for babies finding it difficult to feed
* Lying down:
o On its side: The mother and baby lie on their sides
o On its back: The baby is lying on its back (cushioned by something soft) with the mother on her hands and knees above the child (not usually recommended)
When tandem breastfeeding, the mother is unable to move the baby from one breast to another and comfort can be more of an issue. As tandem breastfeeding brings extra strain to the arms, especially as the babies grow, many mothers of twins recommend the use of more supporting pillows. Favoured positions include:
* Double cradle hold
* Double clutch hold image
* One clutched baby and one cradled baby
* Lying down
Exclusive breastfeeding
Exclusive breastfeeding is when an infant receives no other food or drink, or even water, besides breast milk (whether expressed or through breastfeeding).
International guidelines recommend that all infants be breastfed exclusively for the first six months of life. While each country has its own policy regarding infant feeding, it is generally accepted that newborns should be exclusively breastfed for around 6 months, and that breastfeeding should continue with the addition of appropriate foods, for two years or more. The practice of exclusive breastfeeding has dramatically reduced infant mortality in developing countries due to a reduction in diarrhea and infectious diseases.
Exclusively breastfed infants feed, anywhere from 6 to 14 times a day. Their requirements vary greatly. Newborns consume from 30 to 90 ml (1 to 3 US fluid ounces). After the age of four weeks, babies consume about 120ml (4 US fluid ounces) per feed. Each baby is different, and as it grows the amount will increase. It is important to recognise the baby's hunger signs and it is advised that the baby should dictate the number, frequency, and length of each feed, based on the assumption that it knows how much milk it needs. The supply of milk in the breast is determined by the frequency and length of these feeds or the amount of milk expressed. The birth weight of the baby may affect its feeding habits, and mothers may be influenced by what they perceive its requirements to be. For example, a baby born small for gestational age may lead a mother to believe that her child needs to feed more than if it larger; they should, however, go by the demands of the baby rather than what they feel is necessary.
It can be hard to accurately measure the amount of food a breastfed baby consumes, but babies normally feed to meet their own requirements. Babies that fail to eat enough may exhibit symptoms of failure to thrive. If necessary, it is possible to estimate output from wet and soiled nappies (diapers): 8 wet cloth or 5–6 wet disposable, and 2–5 soiled per 24 hours) suggests an acceptable amount of input for newborns older than 5–6 days old. After 2–3 months, stool frequency is a less accurate measure of adequate input as some normal infants may go up to 10 days between stools. Babies can also be weighed before and after feeds.
Expressing breast milk
When direct breastfeeding is not possible a baby can still be fed breast milk. By expressing (artificially removing and storing) her milk, a mother can enable her child to be fed with her milk while she is away. With manual massage or the use of a breast pump a woman can express her milk and keep it in a supplemental nursing system or a bottle ready for use. This bottle may be kept at room temperature for up to seven hours, refrigerated for up to eight days or frozen for up to four months. Research suggests that antioxidant activity in expressed breast milk decreases over time but it still remains in higher levels than in infant formula.
Expressing breast milk can keep up a mother's milk supply when she and her child are apart for long. If a sick baby is unable to feed, expressed milk can be fed through a nasogastric tube.
Expressed milk can also be used when a mother is having trouble breastfeeding, such as when a newborn causes grazing and bruising. When an older baby grows teeth and bites the nipple, the mother's reaction - a jump and a cry of pain - is usually enough to discourage the child from biting again.
It is generally advised to delay using a bottle in feeding expressed breast milk until the baby is about 4-6 weeks old and is good at sucking directly from the breast. This is to avoid nipple confusion and nursing strike, when the baby prefers to suck from bottle, which takes less effort, and so loses its desire to suck from the breast. If feeding expressed breast milk (EBM) must be done before 4-6 weeks of age, it is recommended that it be given by other means such as feeding spoons or feeding cups. Also, EBM should be given by someone other than the breastfeeding mother (or wet nurse), so that the baby can learn to associate direct feeding with the mother (or wet nurse) and associate bottle with other people.
Some women donate their expressed breast milk (EBM) to others, either directly or through a milk bank. Though some dislike the idea of feeding their own child with another woman's milk, others appreciate being able to give their baby the benefits of breast milk. Feeding expressed breast milk—either from donors or the baby's own mother—is the feeding method of choice for premature babies.
Mixed feeding
Predominant or mixed breastfeeding means feeding breast milk along with infant formula, baby food and even water, depending on the age of the child. Babies feed differently with artificial teats than from a breast. When feeding from the breast, the tongue massages the milk out rather than sucking, and the nipple does not go as far into the mouth; when feeding from a bottle, an infant will suck harder and the milk may come in more rapidly. Therefore, mixing breastfeeding and bottle-feeding (or using a pacifier) before the baby is used to feeding from its mother can induce the infant to prefer the bottle to the breast. Orthodontic teats, which are generally slightly longer, are closer to the nipple. Some mothers supplement feed with a small syringe or flexible cup to reduce the risk of artificial nipple preference.
Tandem breastfeeding
Feeding two infants simultaneously is called tandem breastfeeding (Sidenote: Feeding a child while being pregnant with another can also be considered a tandem breastfeeding condition for the nursing mother, as she also provides the nutrition for two). The most common need for tandem breastfeeding is after the birth of twins where both babies are fed at the same time. The appetite and feeding habits of each baby may not be the same, which could mean feeding each according to their own individual needs, while also trying to get them to breastfeed together to minimize time spent breastfeeding.
In cases of multiple births with three or more children, it can be extremely difficult for the mother to organise feeding around the appetites of all the babies. While breasts can produce large quantities of milk, according to the demand placed upon them, it is common for women to use alternatives, although many mothers have been able to breastfeed their infants successfully without them.
Tandem breastfeeding may also occur when a woman has a baby while breastfeeding an older child. During the late stages of pregnancy the milk will change to colostrum, and some older nurslings will continue to feed even with this change, while others may wean due to the change in taste or drop in supply.
Extended breastfeeding
Although some may find it controversial, some women breastfeed their children for as many as 3 to (rarely) 7 years from birth. This is called extended breastfeeding. Supporters of extended breastfeeding believe that all the benefits of human milk, nutritional, immunological and emotional, continue for as long as a child nurses. Often the older child will nurse infrequently or sporadically as a way of bonding with the mother. Detractors may believe that prolonging breastfeeding for several years can result in the child developing emotional or psycho-sexual problems, however there is no solid evidence to support these beliefs.
Shared breastfeeding
It is sometimes common for more than one woman to feed a child, such as in developing nations within Africa. This shared breastfeeding has been highlighted as a source of HIV infection in infants.
See also: wet nurse
Weaning
Weaning is the process of gradually introducing the infant to what will be its adult diet and withdrawing the supply of milk. The infant is considered to be fully weaned once it no longer receives any breast milk and begins to rely on solid foods for all its nutrition. Most mammals cease the production of the enzyme lactase at the end of weaning, becoming lactose intolerant. Many humans have a mutation that allows the production of lactase throughout life and can drink milk well beyond the age of weaning. Typically, this milk comes from domesticated animals.
In the past, bromocriptine was sometimes used to reduce the engorgement experienced by many women during weaning. However, it was discovered that when used for this purpose, this medication posed serious health risks to women, such as stroke, and the U.S. FDA withdrew this indication for the drug.
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Important notice:
The content is not intended to be a substitute for professional medical advice, diagnosis, or treatment. Always seek the advice of your physician or other
qualified health provider with any questions you may have regarding a medical condition.
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