breastfeeding

August is National Breastfeeding Month, in this blog Dr. Bornstein writes about how to start breastfeeding and the benefits of breastfeeding. Breastfeeding is a natural and healthy way to feed a child. Until the past century, breastfeeding was the only way to give adequate nourishment to infants. With the advent of infant formula, the number of breast-fed infants and children has declined dramatically. However, with more understanding of the benefits of breastfeeding to both the infant and the mother, breastfeeding is being more encouraged as the optimal nutrition for infants. In 2017, the CDC reported that 84.1% of babies were breastfed, 46.9% were exclusively breastfed through 3 months, and 25.6% were exclusively breastfed through 6 months.

The optimal time to begin breastfeeding is immediately after birth. If the infant is healthy at birth, with a good heart rate, respiratory rate, tone color, and cry, then there is no reason to wait. Many infants will have an alert period for one to two hours after birth, then fall asleep for several hours after that. With early initiation of breastfeeding, the stimulation of the mother to produce milk can occur and the infant can get the benefits of receiving Colostrum, which is filled with antibodies for immunity.

Neonatal nurses and lactation specialists are readily available during the hospital stay to help observe the technique of the mother/infant pair and to instruct the mother about the best positions and techniques. They can also help with any problems that are occurring. This is a great resource. Many hospitals are becoming more responsive to the needs of breastfeeding mothers. Unfortunately, many are still behind the times. In some hospitals, the nurses will push supplementing with water, glucose-water, or formula. Many hospitals will keep babies in the nursery for a “transition” period for hours and hours. None of this is necessary. It is not necessary to supplement when breastfeeding. As a matter of fact, supplementing can cause problems for the infant. Nipple confusion can occur when a baby is switched between bottle and breast too early. This can cause difficulty with breastfeeding. With early discharge from the hospital these days, a mother and infant may go home before the milk comes in (usually at three to five days after birth). This can lead to a lot of frustration as family members may start pushing supplementation because they think the baby is starving. Many mothers that give up on breastfeeding do so during this most difficult time period. Because of this, a follow-up visit is necessary within two to four days after discharge from the hospital. The baby can be checked and concerns about breast-feeding can be discussed.

Remember, if babies were supposed to eat during the first few days after birth, then milk would come in the first few days after birth. Babies are born with extra fluid in their bodies that they need to lose after birth. That’s why they are so puffy at birth, and why they lose up to 10% of their birth weight in the first three to five days. If feeding is going well, then they will be back to birth weight at two weeks of age. Formula is available at birth, so the temptation is to start using it. If you can resist this temptation, the breastfeeding will go much better.

Benefits of Breastfeeding

There are many benefits to breastfeeding for both the mother and the child. Breast milk is made for human babies, cow’s milk for baby cows. As much as formulas try to emulate breastmilk, there are some things that just can’t be reproduced. It’s hard to emulate perfection. Whenever a person is exposed to an illness, their bodies respond by forming antibodies and immunoglobulins against these infections. This immunity is in the breastmilk. So, babies who are breast-fed will get fewer infections and when they do get infections, they will be much less severe than if the child was formula fed. Breast-fed babies also get less allergies, asthma and eczema. The breast milk is easy to digest, produces loose, easily passable stools, and is always readily available and sterile.

Nothing is as comforting to a baby as the close physical contact of breastfeeding. The mother benefits as well. A breastfeeding mother will produce a hormone called oxytocin, which will help the uterus stop bleeding and shrink to its pre-pregnancy size.  The food is always ready, available and sterile, so making a bottle while a baby is fussing is not an issue. Breastfeeding helps the mother lose weight and get back to pre-pregnancy weight more quickly. Breastfeeding can help prevent breast cancer, ovarian cancer, and hip fractures by helping to improve bone remineralization after birth. It can also aid in birth control for the first six months. If you start bottle-feeding, you can’t go to breastfeeding because the milk will have dried up. It is easy, however, to go from breastfeeding to bottle if necessary.

Breastfeeding Positions

There are three typical positions for breastfeeding. With a good comfortable position for the mother and the baby and a good latch-on technique, breastfeeding will typically go well.

The first position is the sitting position. The mother sits and places the baby’s head in the crook of her elbow. Mother and child should be chest to chest so that the baby’s head doesn’t have to turn to get to the breast. Touching the baby’s cheek with your finger or nipple can stimulate the rooting reflex of the baby. The rooting reflex is where a baby turns toward the stimulation and widely opens the mouth.  Quickly pull the baby onto the breast so that the nipple and areola are in the baby’s mouth. Don’t be shy about pulling the baby to the breast.  If only the nipple is in the mouth, this can cause pain and cracking. If the latch on was poor, slip a finger into the side of the baby’s mouth to break the suction and try again.

The second position is lying down. This can be helpful at night. The mother lies on her side using pillows against her back if necessary. The baby lays breast-level facing the mother so latch-on can occur.

The third position is called the football hold. This is very helpful for mothers who had a C-section, as this position keeps the baby away from the incision.  This is also a good position for twins. Hold the baby like a football with the head in your hand and the body along your arm.  Use the rooting reflex to promote good latch-on.

All of these and any other position that is comfortable and promotes good latch-on is fine. Take your time finding a comfortable position before you initiate latch-on.  It is a good idea to practice some ‘dry runs’ when the baby isn’t hungry.  Always start with the breast you finished with last time. Putting a safety pin on the bra strap can serve as a reminder.

Signs of Good Breastfeeding:

  • A common concern with breastfeeding is that the baby is not getting enough. With formula, it’s easy to measure the number of ounces. With breast milk, it’s not so easy. The best way to judge is by good weight gain. This can always be checked in the doctor’s office. Typically a baby will lose about 10% of their birth weight in the first three to five days. Then the milk will come in and the baby will gain about one ounce per day and be back to birth weight at two to three weeks of age.
  • With good feeding, there will typically be six urinations per day, and three to four stools per day by five to seven days of age. The stools should be watery, yellow, mustard-seedy stools.
  • A baby will typically nurse at least eight times a day with one and a half to three hour intervals during the day, and four to five hour intervals at night.
  • Good rhythmic sucking for ten minutes at each breast is a good sign.
  • A full baby will typically sleep at the end of breast-feeding or shortly thereafter.
  • At two to three weeks after delivery, the milk let down reflex should appear. There is a tight feeling (pins and needles) in the breast as the milk comes down. Milk may leak from either breast. Thinking of your baby or hearing a baby cry can initiate this reflex.

Breastfeeding can be extremely difficult and challenging to both mother and baby, but continue to be patient and seek help with professionals if needed. Breastfeeding is very rewarding and beneficial to both mom and baby.

Written by Dr. Michael Bornstein, who has over 28 years of experience as a pediatrician. 

Disclaimer: The contents of this article, including text and images, are for informational purposes only and do not constitute a medical service. Always seek the advice of a physician or other qualified health professional for medical advice, diagnosis, and treatment.