Breastfeeding

Reviewed by Dr Stuart Crisp, paediatric specialist registrar

Breastfeeding is a personal decision for the mother to make.

How to get started
The first step towards successful breastfeeding is to make the decision before having a baby. It is a good idea to talk to someone with experience, seek information, read books and magazines or surf the Internet.

Breastfeeding can begin immediately after the baby is born. In most maternity wards babies can be put on their mother's stomach straight after birth. This first close contact greatly promotes breastfeeding. Immediately after birth the baby is often awake. It eagerly searches for the breast and wants to suckle. The baby can be helped by carefully supporting it under the soles of its feet so it can crawl or push itself up from the stomach and all the way to the breast. It will eagerly search for the breast and start suckling as soon as it is there.

It is important that the breasts are stimulated as soon as possible, as the quantity of milk depends on how often the baby suckles.

How is the baby placed at the breast?
First, the mother should get as comfortable as possible so that the back and arms are supported. Then the baby should be laid close to the mother. The baby should be lying with its stomach facing its mother's stomach with its head bent a little backwards. This way its nose is automatically free of the breast.

How to get the baby to suckle
Most babies are eager to suckle as soon as they feel the nipple against their cheek. If the baby is not reacting or is too sleepy, the suckle reflex can be stimulated by gently stroking the baby's cheek and lips with the fingertips. The baby will then turn its head and search for the nipple with an open mouth. Do not stroke both cheeks as it will confuse the baby! The same sort of stimulation can be used if you find that the baby is either drinking slowly or is falling asleep at the breast.

The baby has to be at one breast as long as possible before moving on to the other breast. Many people say that 20 minutes is long enough before switching sides.

Is the baby suckling as it should?
For the baby to suckle properly, the nipple has to be well inside the baby's mouth. The whole nipple and its brown circle has to disappear into the baby's mouth or the baby will not be able to create a vacuum between its tongue and the soft back part of its palate. If the baby only suckles the tip of the nipple it will not empty the breast and the nipples will become sore. To get the baby to suckle once again, carefully put the tip of the little finger in the corner of its mouth. Then the baby will let go of the nipple and feeding can start again. Let the baby open its mouth wide (stroke its cheek) to begin suckling.

How do you get the baby to let go of the nipple?
It is a good idea to get into the habit of taking the baby gently away from the breast.

If the baby is pulled away in the middle of feeding, the mother's nipples will become sore quite quickly. Instead, put the tip of the little finger in the corner of the baby's mouth and he or she will automatically open his or her mouth. This will break the vacuum the baby creates in its mouth to suckle.

How does the milk get produced?
The amount of milk produced depends on how often the baby suckles. When you feed the baby, the suckling motion causes hormones to be released into the bloodstream from the pituitary gland in the brain. The hormones released are oxytocin and prolactin. Oxytocin causes the mammary glands in the mothers' breast to contract, so milk is released and flows to the baby. Many women experience this as a pulling sensation or a weight on their breast when the baby begins suckling. The prolactin controls the amount of milk produced. The more the baby is fed, the more prolactin is released and the more milk produced. This means that how often the baby suckles controls how much milk is produced.

How do you know if the baby is getting enough milk?
Good clues to be aware of include:

• the baby wets six to eight nappies a day.
• the baby gains 100-200g each week (around 400-800g each month).
• the baby drinks as often as every two to three hours (around 8-12 times a day).
• the baby looks normal, has a nice colour and smooth skin, reacts normally, is strong and moves normally.

. If the baby is gaining weight properly and wets the right number of nappies every day there is no need to worry, even if he or she wants to be fed often. All babies are different and some have a greater need for feeding and contact.

Many new mothers are worried in case they don't have enough milk. The amount of milk is not dependent on the size of your breasts, as both small and large breasts contain almost the same amount of mammary glands. Only the fatty tissue varies. On the other hand, it is important to believe in yourself and to want to feed. Your body has the capability to feed, so if it is not a success it is caused by outside factors.

What if the baby is sleepy and doesn't want to drink?
Some babies want to sleep all day. They drink a little at a time and not very often. If the baby does not gain weight and does not wet six to eight nappies a day, he or she should be woken up and stimulated to drink every two hours, every day.

Change the breast every 10 minutes to maintain the baby's interest and to get them to drink as much as possible. It helps to hold the baby a lot, stroke its entire body and massage him or her gently. Caressing or talking to your baby stimulates them to wake up.

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