BREASTFEEDING

Lactation Failure: Myth or Reality

Mother’s milk is the universally acknowledged ideal and complete food for her and the baby. Breastfeeding is instinctive and most mothers adopt to it naturally. However, at the slightest problem they encounter, they switch over easily to top milk. Normal healthy newborns do not require any type of pre lacteal feeds, as colostrum is sufficient to meet the needs of the newborn baby. The administration of pre lacteal feeds interferes with sucking and prolactin production and ultimately undermines your confidence in your ability to breastfeed.

• The commonest reason when you feel that you are having insufficient milk     is because your baby cries a lot. From the clinicians viewpoint, it is necessary to ascertain whether the baby is getting sufficient milk or not or whether there is a genuine problem.

• Babies cry for a variety of others reasons (feeling cold, being in a wet diaper,colic,etc) and not only because of inadequate feeds.

• Your baby who is on exclusive breastfeeds and is showing appropriate weight gain 18 – 30 grams a day or 500 – 1000 gms per month and who passes urine at least 6 – 8 times in a day,1 is definitely getting sufficient  milk and you requires only positive support and a reiteration of the adequacy of your milk for your baby.

Special situations arise when you may have a query about continuation of breastfeeding.

(i) Common Maternal illness:

During most common illness like common cold, bacterial infections, flu, fever etc. you should continue breastfeeding. This, infact, benefits the baby. If you are breastfeeding, by the time you show the symptoms of an illness, your baby has already been exposed to it. So continue breastfeeding. During your illness you have started producing antibodies (fighter cells). These pass on to your baby through your milk. Thus providing adequate protection against the illness.

But in some cases you may be advised not to breastfeed the baby:

• Mothers with untreated tuberculosis cannot breastfeed till the treatment begins for both the mother and the baby.

• Mothers with hepatitis B infection can breastfeed their babies  if the baby has received the hepatitis B vaccine in the first few days of birth.

For such babies milk from the human milk banks     can be given.

(ii) Mastitis:

Mastitis       is the infection of a blocked milk duct. This can causes swelling, redness and pain in the breast. If this occurs consult your doctor. Lots of rest, warm compresses, antibiotics, adequate breast support and breastfeeding is required. Continue feeding, as the infection doesn’t contaminate your breast milk. Frequent nursing helps in draining your breast thereby preventing the spread.

(iii) Cracked / Sore nipples:

Also called sore nipples, in early days, is due to improper positioning of your baby. Therefore proper postures      during breastfeeding should be adopted. Proper care of the sore nipples         should be taken.

(iv) Inverted nipples:

This, if present,  in the last months of pregnancy should be corrected with the doctor’s advice. If feeding is not possible then breast milk can be given to the baby after expressing the milk  .

(v) Twins:

If you have twins, it is possible to breast-feed  them at the same time, having one baby at each breast. You can hold one baby at each side, called the “football hold,” or you can cradle them both in front of you with their bodies crossing each other, as they would have been in ruterus. Alternate the breast, each baby uses at each feeding or at least once a day. If you have any difficulty, please consult your Gynaecologist or Paediatrician.

(vi) Breast feeding after ceaserian section:

Nursing after caeserian section is little painful in the beginning. With the help from a relative nurse one should start breast-feeding within 4 – 6 hours. It is preferable to put the baby on breast directly and help the baby to suck on the breast. OR the mother can turn to one side gently and nurse the baby by "rooming in"     First 24 hours, she can take the posture, which is comfortable to her and baby for breast-feeding.

(vii) Premature Babies:

Many premature babies are unable to breast feed, directly in the beginning.      8 –10 times/day and collect it in clean bowl, wati or cup for feeding your baby. This will enable adequate secretion when your baby is able to   suck the breast in future. Human milk has been shown to be very beneficial to premature and sick newborn by helping growth and preventing many diseases.

(viii) Breast feeding in a HIV positive Mother:

The recent is to avoid breastfeeding in HIV positive mothers. But this is NOT practical in developing countries like India.

• You need to be patient when your baby is first introduced to semi solids
• You should not force the baby for eating.
• Your baby may often spit the food , this does not mean that he/she is not hungry or does not like food . This is because the ability to swallow develops very slowly.
•  Try to have flexible schedules based on signs of hunger in your baby.
•  After the first few weeks, a healthy infant will develop a self-regulated feeding schedule.
•  The total number of feeds per day will slowly decrease to about 6. By the time the infant is 6 months old. However each infant has his/her own routine which may vary. This may differ in different 
• Qualities of weaning food while being breastfed, weaning food provides additional energy and nutrients to your baby.
• All good weaning food should have:
• High energy content.
• Should be easily digestible.
• Should be semi solid (not very thick) in consistency.
• Should be clean and freshly prepared.
•  Should be inexpensive, easy to prepare and tasty. Remember, what you can't swallow cannot be swallowed baby. 

Guidelines During Weaning

•  It is important to continue breastfeed, while weaning.
•  Introduce one food at a time. Let your child get use to it.
•  Begin with a  very small quantity.
• Use thinner consistency before and then gradually increase the consistency to solids as your baby learns to push the food back with help of the tongue.
•  If your baby does not like the food, try mixing it with something else.
•  Variety in choice of food is essential.
•  Try new flavours.
• The quantity of each feed should increase as the frequency decreases.
•  Avoid distractions while feeding.

(i) Cereals

Cereals contain 7 to 12% of protein, 75% of carbohydrate and some amount of fat. A thick creamy porridge can be prepared by mixing the cereals with milk / mixture of milk and water. You can also add a little oil / fat / sugar to make it richer in calories and easier to swallow and digest.Cereals like wheat, bajra, jowar, maize, rice, ragi, suji (rawa/semolina) can be used to prepare porridge.

(ii) Pulses

• Soak the cereals or pulses overnight.
• Tie them in a wet cloth until it sprouts (about 2 days).
• Dry or roast them.
• Make flour of the dried or roasted cereals or pulses.
• Keep them in an airtight container for further use.
• Advantages of malted foods:
•  As the caloric content is in the malted foods, small       amounts can give more Calories and nutrients.
• Sprouting increases the content of Vit. B and Vit. C.
•  As it is precooked, it can be stored and can be used      immediately when required.

•  Milk and dairy products

• This milk contains high amount of Vit.B6 and calcium,    some amount of Vit.A and Vit.C, but very little iron.
• Fat content of the buffalo’s milk is twice that of human milk and cow’s milk.
• Goat’s milk does not have Vit.B12.

 Milk can be given by diluting it with boiled and cooled water in the proportion of 2:1, initially. Sugar may be added to make it palatable and increase its caloric contents. It can be given in a bottle / by cup and spoon.

• Fruits

Commonly given are banana, guava, melons, mango, and citrus fruits and any other commonly available in your area. Before giving any fruits to your baby wash it with clean water, peel carefully, de seed it and then mash it. Fruit juices should be strained and diluted with boiled water, in equal amount in earlier stages.The amount of fruit juice feed should be increased graudually by decreasing the dilution.

• Vegetables

Strained green leafy vegetables, spinach, mashed potatoes, tomatoes and gourds can be started by 5-6 months.

• Oils and fats

Oils make the food palatable, soft and helps in absorption of Vit.A.They can be mixed with porridge and mashed pulses.

• Foods of animal origin

All of them are rich in protein, Vit. B12, and iron. They are also easily digestible if cooked properly. Egg yolk can be given from 4 – 6 months. Avoid egg white for 8 – 10 months as it may cause allergic reaction. Egg yolk can be added to the porridge Cooked ground and strained fish and meat can be given from 7-8 months. Fish should be either baked or boiled or steamed but not fried. Meat can be given in the form of soups.

Human Milk Banking
A human milk bank is an institution established for the purpose of collecting, screening, processing, storing and distributing donated human milk for the babies with mother who are not in a position to breast feed.

In Mumbai(India)the milk bank facility is available at:
Sion hospital
Wadia hospital

Donors of Breast Milk

• The mothers expressing milk to feed their own pre-term sick babies.
  
• Mothers who are following up in the follow up clinics whose breast milk is in excess of their baby’s demand and are willing to donate.
• These donors are screened for the diseases like Hepatitis B, Syphilis and HIV.

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