Frequently asked question

The experience of breastfeeding is special for so many reasons: the joyful closeness and bonding with your baby, the cost savings, and the health benefits for both mother and baby. Every woman’s journey to motherhood is different, but one of the first decisions a new mom makes is how to feed her child. Here, you’ll find facts about breastfeeding and get practical tips on how to make breastfeeding work for you while getting the support you need.

a.     Provide appropriate, culturally sensitive and supportive labour companionship to mothers

b.    Encourage non-pharmacologic measures to help support women through labour (massage, aromatherapy, water injections, movement)

c.     Allow delivery to occure in the position preferred by the mother

d.    Dry the baby quickly, preserving the natural white cream (vernix) that soothes a baby’s new skin

e.     Place the baby bare skin-to-skin on mother’s bare chest, facing her and cover them together

f.      Allow the baby to seek the breast. The mother will stimulate the baby with her touch and may help position the baby closer to the nipple (Do not force the baby to the nipple)

g.    Keep the baby skin-to-skin with the mother until the first feeding is accomplished and as long as she desires thereafter

h.    Women who have surgical births should also have their infants skin-to-skin after delivery

i.      Delay intrusive or stressful procedures. The baby should be weighed, measured and given preventive medications AFTER the breastfeed

j.      No pre-lacteal liquids or feeds should be given unless there is a clear medical indication

A.   Colostrum is not good or even dangerous for babies. NO!

Colostrum is physiological and essential for the new born:

a.     First immunization- protects against intestinal and other infections

b.    Cleans up mucosa and reduce the severity of jaundice

 

B.    Infants need special teas or other fluids before breastfeeding. NO!

Any pre-lacteal feeds (feed given before breastfeeding has started) increase the infant’s risk of infection, reduce the likelihood of exclusive breastfeeding and shorten the duration of breastfeeding.

 

C.   Babies will not get enough food or fluid with only colostrums and breastmilk. NO!

Colostrum is sufficient for a baby’s first feeds. It is normal for a newborn to lose 3-6% of birth weight.

D.   Baby will get too cold. NO!

Babies are at safe temperatures when skin-to-skin with their mothers. Amazingly, the mother’s breast temperature rises 0.5 degrees C within 2 minutes of having the baby on her chest.

E.    Mothers are too exhausted after labour and delivery to feed their baby immediately. NO!

The surge of oxytocin that comes with skin-to-skin contact and breastfeeding helps to calm a mother after the birth of her baby.

F.    It is very important to suction the baby’s mouth, nose and oropharynx before the first breath to prevent inhaling birth fluids, especially if the baby had a bowel movement during the labour. NO!

Suctioning the normal healthy newborn does not reduce the occurrence of meconium aspiration and may injure the tissue of the mouth, throat or vocal cords. Gastric suction also interferce with breastfeeding.

G.   Vitamin K and medication to prevent gonorrhea eye infection must be given immediately after birth. NO!

The American College of Obstetrics and Gynaecology and the Academy of Breastfeeding Medicine state that these important preventive measures can be delayed for as long as an hour, until after the baby has breastfed, without risk to the infant. They should not in any case require separation of mother and baby.

H.   Women require pharmacologic intervention to cope with the pain of labour. Normally, NO!

Use of labour analgesia/anaesthesia may sedate the baby, hindering breast-seeking behavior and delaying initiation of breastfeeding for hours or days. Use of complementary therapies including having a companion during labour help women to cope with the pain and the obstetric outcome may be improved.

 

I.     It requires too much work and time to help the mother during this time. NO!

While the baby is on the mother’s chest, the both attendant can continue to do the usual assessment of mother and baby or other duties. The baby will find his or her own way to the breast.

Even women for whom replacement feeding is Acceptable, Feasible, Affordable Sustainable and Safe (AFASS) and who choose not to breastfeed, should have skin-to-skin contact with their babies. These mother-infant couples are particularly vulnerable. Skin-to-skin contact provides a special closeness, beginning the mother-child relationship.

If conditions are not AFASS, it is very important for mothers and infants to have skin-to-skin contact immediately after birth and to start breastfeeding in the first hour. For these babies, exclusive breastfeeding carries a lower risk of mother to child transmission of HIV than mixed feeding.

Remember: For women of unknown HIV status, exclusive breastfeeding is recommended. 

At the United Nations Millennium Summit in September 2000,b world leaders agreed on critical goals related to child mortality and hunger. Many of the poorest nations are lagging behind in reaching these MDGs. Initiating breastfeeding in the first hour can help achieve MDG#1 and #4. This was reconfirmed at the UN Standing Committee on Nutrition in 2003, where those assembled called for a global indicator for early initiation of breastfeeding.

MDG #1: Eradicate extreme poverty and hunger – reduce by half the proportion of people who suffer from hunger

Starting to breastfeed in the first hour of life is associated with increased rates of exclusive breastfeeding and longer duration of breastfeeding. This contributes significantly to meeting children’s nutritional needs during the first two years of life, thus preventing malnutrition and stunting which usually have their origin at this age.

MDG #4: Reduce child mortality- reduce by two-thirds the mortality rate among children under five

Most child deaths are caused by diarrhea and respiratory illness, which are more common and more serious with suboptimal breastfeeding. 8 about 45% of the deaths occur in the first month of life, which is a major barrier to attaining this MDG. Breastfeeding in the first hour could reduce newborn deaths and increasing optimal breastfeeding could reduce overall child mortality.

Preventing engorgement

• Fullness is normal in the early days. Over-fullness is not normal.

• Follow the practices:

- Facilitate skin-to-skin contact immediately after birth and initiate exclusive, unlimited breastfeeding within one hour after birth

- Show mothers who need help how to attach their baby at the breast - Show mothers how to express their milk

- Breastfeeding exclusively with no water or supplements - Keep mothers and babies together in a caring atmosphere - Encourage babies to feed at least 8-12 times in 24 hours during the early days

- Give no pacifiers, artificial teats, or bottles

 

Treating engorgement

• Remove the breast milk and promote continued lactation.

• Correct any problems with attachment.

• Gently express some milk to soften the areola and help the baby's attachment.

• Breastfeed more frequently.

• Apply cold compresses to the breasts after a breastfeed for comfort.

• Build the mother’s confidence and help her to be comfortable.

May be caused by infrequent breastfeeding, inadequate removal of milk or pressure on a part of the breast.

Treatment

• Improve milk flow:

- Check the baby's attachment and correct/improve if needed.

- Check for tight fitting clothing or pressure from fingers

- Support a large breast to assist milk flow

• Suggest:

- Breastfeed frequently. If necessary, express milk to avoid fullness.

- Gently massage towards the nipple.

- Apply a moist, warm cloth to the area before a breastfeed to help milk flow.

- Rest the mother not the breast.

- Anti-inflammatory treatment or analgesic if in pain.

 

Antibiotic therapy is indicated if:

- The mother has a fever for longer than 24 hours.

- The mother’s symptoms do not begin to subside after 24 hours of frequent and effective feeding and/or milk expression.

- The mother’s condition worsens.

• If a woman is HIV-positive and develops mastitis or an abscess she should:

- Avoid breastfeeding from the affected breast while the condition persists.

- Express the milk from that breast, which can be heat-treated and given to the baby.

- Rest, keep warm, and take fluids, pain relief and antibiotics.

Sore nipples

• Decide the cause, including observation of a feed. Examine the nipples and breasts.

• Reassure the mother.

• Treat the cause - poor attachment is the most common cause of sore nipples.

• Avoid limiting the frequency of feeds.

• Refer skin conditions, tongue-tie and other less common conditions to a suitably trained person.

The baby may not be hungry at this time. If a baby had a good feed recently of course, he or she may simply not be hungry and ready for another feed – if this was a breastfeed, the mother will know. But you may need to check if someone else gave a bottle feed for some reason.

 

The baby may be cold, ill, or small and weak. The baby may refuse to feed at all or may attach without suckling or may suckle very weakly or for only a short time.

 

• The mother may be holding the baby in a poor position, and the baby cannot attach

properly. In this case, the baby may seem hungry and want to feed, but be unable to attach effectively.

 

• The mother may move or shake the breast or the baby, which makes it difficult for the baby to stay attached.

 

• The mother’s breast may be engorged and hard, so it is difficult for the baby to attach to the breast.

 

• The milk may be flowing too fast, and the baby start to feed well but then come away

from the breast crying or choking.

 

• The baby may have a sore mouth or a blocked nose, and suckle for a short time and then pull away, perhaps crying with frustration.

 

• The baby may be in pain when held in a certain way, for example after a forceps delivery, if there is pressure to a bruise on the baby’s head, or if it hurts him to hold his head in a certain way.

 

• The baby may have learned to suckle on an artificial teat, and find it difficult to suckle on the breast.

 

• The mother may have used a different type of soap or have a new perfume on and the baby does not like the smell.

 

• If the milk supply is very low, the baby may not get any milk at first, and may stop

feeding because he or she is frustrated.

 

• Sometimes a baby feeds well from one breast but refuses the other breast. The baby may find being held in one position painful, or the milk flow may be different, or one breast may be engorged.

 

Management of reluctance to feed

• Remove or treat the cause if possible:

- Help the mother to position and attach the baby well.

- Help the mother to express some milk before feeding if the milk is coming too fast or if the breast is too engorged.

- Treat a sore mouth or thrush if you are able or refer the baby for medical help.

- Provide pain relief if the baby is in pain.

- Help the mother to hold the baby without causing pain, if the baby is bruised.

- Avoid using artificial teats or pacifiers. If needed, give feeds by cup.

- Stop using anything that is causing an unpleasant taste or smell to the breast.

• Encourage skin-to-skin contact between mother and baby in a calm environment when the baby is not hungry. This helps both the mother and baby to see the breast as a pleasant place to be. Then the baby can explore the breast and attach when he or she is ready. This may be an hour or more and may not happen on the first occasion there is skin-to-skin contact.

• Do not try to force the baby to the breast when the baby is crying. He or she needs to

associate the breast with comfort. It may be necessary to express the milk and feed it by

cup until the baby learns to breastfeed happily.

 

Prevention of reluctance to feed

• Many instances of breast refusal could be prevented by:

- Early and frequent skin-to-skin contact that helps the baby to learn that the breast is

a safe place from the first few hours.

- Helping the mother to learn the skill of positioning and attachment in a calm unhurried environment.

- Being patient while the baby learns to breastfeed.

- Caring for the baby in a gentle confident manner.

Doctors recommend that babies receive only breast milk for the first six months of life (this means no water, juice, formula, or other milk). The longer baby breastfeeds, the greater the benefits for both mother and baby. It’s best for babies to have breast milk through the first year of life, or for as long as both mother and baby wish. Ask your healthcare provider when to offer other foods to your baby. The World Health Organization (WHO) recommends breastfeeding for up to two years of age or longer.

You can tell your baby is getting enough milk by keeping track of the number of wet and dirty diapers. In the first few days, your baby will have fewer wet diapers. After your milk supply has increased, your baby should have more wet & dirty diapers. Baby’s stools will become runny, yellowish, and may look seedy. Talk to your healthcare provider if you have concerns about your baby's weight gain.

Baby is full when he:

  1. “Falls off” your breast, releasing the nipple.
  2. Falls asleep.
  3. Relaxes body and opens fists.

Milk in your breasts is produced by “supply and demand” or milk removal. As baby nurses and removes milk from your breast, more milk is made. Your body will make enough milk if you nurse your baby at least every 2 to 3 hours during the first 4 to 6 weeks. If you are not able to nurse your baby or have to miss a feeding, you can use a breast pump to keep up or even increase your milk supply.
If you watch the clock and only feed your baby at certain times, you may not make enough milk. Learn your baby’s early hunger signs, and nurse your baby when he or she is hungry. Some of the early hunger signs are smacking lips, sucking on hands or fingers, and turning to the breast.

There is no special diet for breastfeeding. Mothers make healthy breast milk even when their own diets are lacking. Keep yourself healthy by choosing a variety of foods, and by following your MyPyramid Plan for Moms. For more tips for breastfeeding moms, view these Web sites: Breastfeeding Tips for Moms, MyPyramid in Action: Tips for Breastfeeding Moms.

Sometimes certain foods in mom’s diet may make baby fussy. Milk products, nuts, eggs, wheat, chocolate, and coffee or tea with caffeine may be the cause. Should a certain food make your baby fussy, you may need to limit that food. Your thirst is the best signal of how much fluid to drink. In fact, excess fluids can decrease the amount of milk you make. So it’s best to follow your own thirst, and have healthy drinks like water, low fat or nonfat milk, or 100 percent fruit or vegetable juice every time you nurse your baby or pump. Urine that is clear or pale yellow is a sign that you’re getting enough fluids.

You can breastfeed your baby wherever you feel comfortable. Breastfeeding is the normal way to feed your baby. If you are away from home and need to feed your baby or pump, you can do this by wearing clothes that allow easy access to your breasts. Oklahoma and other states have laws that protect mothers who breastfeed in public.

Tips for breastfeeding in public:

  1. Wear loose fitting tops that you can raise up. The top can then rest around your baby’s head so your breast will not be seen. For a top with buttons, unbutton from the bottom just enough so your baby can be put to the breast.
  2. Practice at home in front of a mirror to see which tops work best for breastfeeding in public.
  3. Some mothers find baby slings, blankets, sweaters or jackets helpful.
  4. A nursing bra may help make nursing or pumping easier.
  5. Colostrum is mother’s first breast milk. It’s usually yellow in color, and can be either thick or thin. It has lots of antibodies that protect against infections. Small amounts are made during the last months of pregnancy and in the first days after birth. This meets your new baby’s need for small amounts of food often. Breast milk changes during the first two weeks from colostrum to mature milk, which has two parts, foremilk and hindmilk. Foremilk is thin and watery and helps to satisfy your baby’s thirst. As you nurse your baby, the foremilk changes to hindmilk, which is thicker and creamier and has more calories that help your baby to grow. The more your baby nurses, the more milk you will make.

    Normally breast size does not affect how much milk you make. Mothers with small breasts can make as much milk as those with larger breasts. If you have had breast surgery or implants, or have questions about the size or shape of your breasts or nipples, talk with your healthcare provider.

    Moms who smoke are encouraged to breastfeed and cut down on their smoking as much as possible. Be sure to smoke outside, away from your baby, and change clothes to keep baby from breathing the smoke on your clothing. Babies have a higher risk of having breathing problems and Sudden Infant Death Syndrome (SIDS) if their moms smoke. Breastfeeding lowers the risk of both of these health problems for your baby. Heavy smoking can also decrease your milk supply.

    Alcohol (beer, wine, liquor) passes easily into breast milk, and even small amounts can affect how you care for your baby. If you choose to drink alcohol, it’s best to limit to one or two small drinks a week and wait at least 2 hours after you drink to breastfeed.

    Breastfeeding shouldn’t hurt, but nipples can get sore if your baby doesn’t have a good latch. If pain lasts more than a few seconds, try breaking the suction, take baby off the breast and try again. Other causes of nipple soreness include breast engorgement, breast infection, the use of creams or ointments, and the misuse of nipple shields or breast pumps. Breastfeeding should be comfortable for you and your baby, but if you continue to have pain, talk with your healthcare provider.

    Breastfeeding is good for babies, mothers, workplaces and the earth and is the normal way to feed babies. Breastfeeding is good for babies because:

    1. Human milk (your breast milk) is the most complete form of nutrition and changes to meet your baby’s special needs.
    2. Human milk is easier on baby’s tummy and protects babies from many common health problems, like ear infections.
    3. Breastfed babies are less likely to have some long lasting health problems, such as diabetes.
    4. Breastfed babies are less likely to develop allergies and childhood cancers.
    5. Breastfeeding lowers risk of Sudden Infant Death Syndrome (SIDS).
    6. Human milk is even more important for babies who are born early and those with low birth weights (less than 5 ½ pounds).

    Breastfeeding is good for mothers because:

    1. Breastfeeding helps mothers recover more quickly after giving birth.
    2. Breastfeeding helps mothers return to their previous weight faster than mothers who feed formula. It burns an average of 500 extra calories a day.
    3. Breastfeeding may help mothers avoid long lasting health problems, such as breast cancer, heart disease and diabetes.
    4. Breastfeeding creates a special bond between mother and baby.

    Breastfeeding is good for everyone because:

    1. Breastfeeding saves families money.
    2. Workers who nurse their babies miss fewer days from work to care for a sick child because breastfed babies are healthier.
    3. Breastfeeding is good for the earth; it uses less energy and creates less waste.