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New Parents : Breast-feeding Your Baby Why breast is best (part 1)

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Q: Can I get breast-feeding advice before the birth and will I get help in the hospital?
A: If you are planning to breast-feed, ask your midwife or doctor about specific breast-feeding support or classes available in your area prior to the birth, since having additional information beforehand is extremely useful and will help you in the first few weeks when you are trying to get breast-feeding established.

You should get breast-feeding support while in the hospital, and this may come from a variety of sources. The nursing staff is the first line of support followed by lactation consultants. Some babies will breast-feed well without problems, while others take a little time to learn, so ask for help and assistance when you need it. There are a few tips to remember to help you get a good start:

  • Skin-to-skin contact at birth is recommended to encourage milk production.

  • Good positioning and attachment at the breast is very important. Hold your baby close to you and facing your breast, with her head, shoulders, and body in a straight line (see Getting started), and make sure that her nose or her top lip is opposite your nipple, so she is able to latch on easily.

  • Ensure your baby can reach the breast easily, without having to stretch or turn.

  • Always move your baby toward the breast rather than your breast toward the baby.

  • Feed your baby on demand, allowing her to feed as often as needed for as long as she wants.

  • Avoid supplements of water or formula unless there is a medical reason for this that has been fully explained to you.

  • Avoid giving your baby bottles or pacifiers while you are establishing feeding because this can create “nipple confusion” since real nipples and artificial bottle nipples require different sucking techniques.

  • Try to relax and enjoy your baby's feedings.

Q: Should I put my baby to the breast as soon as she is handed to me after the birth?
A: Holding your baby close to you as soon as possible after the birth is recommended, partly to encourage breast-feeding, and skin-to-skin contact is advised so that your baby is close to the breast. Your baby may root for the nipple and some babies will just latch on instinctively, while other babies may only sniff and lick the nipple. Try not to get discouraged if your baby does not latch on immediately because babies can be very sleepy after labor and delivery and they are born with enough nutrients to last several hours after birth before getting hungry.
Q: What is colostrum?
A: Colostrum, commonly called the first milk, is a watery, white/yellow substance produced by the breasts for the first few days after delivery. Most women do not notice it until after the birth, although it starts being produced from as early as 20 weeks in pregnancy and may leak during pregnancy. Although colostrum is not abundant, it has a high concentration of nutrients. Colostrum is high in protein and vitamin K and it also contains antibodies and white blood cells to protect your baby against infection. Colostrum helps your baby to excrete waste products and lines your baby's gastrointestinal tract with a protective layer that helps to make it less permeable to foreign substances from the mother which may trigger allergies in the baby.
Q: Help! My breasts are like huge beach balls. Will they stay like this if I continue breast-feeding?
A: Between three and six days after birth, your breasts prepare to increase their milk production and may be tender, throbbing, lumpy, and uncomfortably full. This is due to the blood and lymphatic flow to the breasts increasing and a larger volume of milk being produced. This is normal, but if milk isn't effectively removed at each feeding, the breasts can become swollen, or engorged. This should be temporary, as long as your baby latches on well and feeds on demand as long as she needs. Some mothers find it helpful to massage the breast during feedings to encourage milk flow. A supportive nursing bra can relieve the discomfort as can alternating hot and cold flannels.
Q: When will my milk come in?
A: After the birth, your body produces the hormone prolactin, which tells your brain to produce milk. Most women start to produce breast milk between 2–3 days after birth if nipple stimulation and sucking has been frequent enough. When your milk comes in may also depend on the type of birth you had; some studies suggest that milk production is delayed with a cesarean. A delay can also occur if a woman is on medication, such as insulin. Also, although this is a natural process, certain factors can affect when, and how much, milk is produced, such as a woman's thoughts on breast-feeding, how relaxed she feels, and if she is experiencing stress or anxiety.
Q: There are so many different formulas around nowadays—is breast really still the best?
A: It's true that there are many types of formula, with each one striving to be as close to breast milk as possible. However, there are some nutrients and antibodies present in breast milk that cannot be artificially produced. Breast milk contains everything a baby needs for the first six months. As well as promoting the benefits of their own brand, all formula brands also acknowledge that breast-feeding is the best option.
Q: I'm expecting twins—can I still breast-feed?
A: Lots of women successfully breast-feed twins, although it may take extra planning, since life is easier if both babies adopt the same routine and are fed together. Most women think that they won't produce enough milk to satisfy twins; however, milk production works on a supply and demand basis, so the more your babies nurse, the more milk you produce. You can either fully breast-feed with both babies latching on, or express milk (see Expressing breast milk) and alternate when each baby latches on. Expressed milk may be cup-fed to minimize the risk of a baby preferring an artificial nipple to the real thing. 
Q: I've heard that it's harder to breast-feed immediately after a cesarean—is this true?
A: Women who undergo a cesarean are likely to be in more pain than those who have had a vaginal birth, and studies have also shown that postoperative pain can affect breast-feeding. Also, following major surgery, it's not easy to move around for a day or so. These factors make feeding more challenging initially. However, most hospitals provide good post-delivery pain relief, which helps women breast-feed. Adopting feeding positions that don't put pressure on your wound also helps (see Breastfeeding after a Caesarean). Even if breast-feeding does not happen in the first 24 hours, it is important to allow skin-to-skin contact between you and your baby as soon as possible.
Q: Will I need a special bra?
A: It is important that your breast is free during feeding. With a normal bra, you would have to remove a garment, so yes, it is advisable to purchase at least two nursing bras. Nowadays there are lots of attractive bras available. The bra should have a zipper or drop-cup fastening to allow one cup at a time to be undone. Ask a trained assistant to measure you, since a badly fitting bra can contribute to problems such as mastitis. It's best to wait until 36 weeks before choosing a bra since your breasts continue to grow. The average increase is around two cup sizes.
Q: Breast-feeding is such a struggle. What are we doing wrong?
A: Although breast-feeding is supposed to be a natural process, for some mothers and babies it can be a challenge. There are a few basic guidelines to help you relax your baby and get her to latch on properly (see Latching on). First, try not to force the nipple into your baby's mouth. Instead, wait for your baby to lean toward the nipple. For this to happen, your baby must be turned toward you with her head, shoulders, and body in a straight line (see Comfortable feeding positions). Your baby's lower lip should be below your nipple. To soothe your baby, you can try stroking her lip with your nipple, or squeeze a few drops of milk onto her lips. If your baby wants to feed, she will open her mouth to receive the nipple. If so, draw her closer so that she can latch on across the nipple and around the areola (the darker skin around the nipple). Once she is in the right position, you shouldn't be able to see any of your nipple, just a small area of the areola. It should also feel comfortable. Although you shouldn't force the nipple on your baby, you can move her toward the breast so that her mouth touches the nipple and is encouraged to open wide. Avoid bending forward, since this can give you a backache and may encourage a poor feeding technique.

There are key signs that your baby is properly latched on. These are that the bottom lip is curled back, the chin touches the breast, the mouth is wide open, your areola shows more above her top lip than under her bottom lip, and the sucking pattern changes to long deep sucks.

Q: How often should I breast-feed my baby?
A: This is commonly asked by mothers since they feel that the baby should have a routine or pattern. However, it is best not to schedule feeding times and force your baby into a pattern of, say, every 3–4 hours. All babies, but particularly breast-fed ones, should be fed on demand. All babies are different and you will soon become familiar with your baby's signs of hunger. For example, your baby may “root,” or search, for the nipple, may not settle, and may cry or whimper. A newborn can only hold about 1–2 ounces of milk in their stomach, so some babies may be hungry after an hour, while others may hold out a bit longer. If your baby soils a diaper just after a feeding, it is likely that she will become hungry again sooner, usually within an hour of the feeding. It is also important to allow your baby to feed as long as possible on each breast before changing side, to ensure that she gets the full benefits of the milk.
Q: What can I do to help my baby get enough milk?
A: There are steps you can take to ensure successful breast-feeding and that your baby gets enough milk.
  • Hold your baby close to you as soon as possible after the birth. She will start to “root” for your nipple when she is ready to feed.

  • Feed your baby as often as she demands in the first few hours and days after the birth. This will enable your body to synchronize with your baby's needs. Feeding on demand in this way also helps your milk to come in around days 2–3.

  • Check that your baby is latched on correctly (see Latching on). When your baby is in the correct position, you will both feel comfortable and relaxed. If the baby is not latched on correctly, it may be painful for you, and you are more likely to stop breast-feeding earlier.

  • Allow your baby to feed on one side as long as possible. This is because the consistency of breast milk changes during the feeding. The first part, or foremilk, is lower in fat compared to the hindmilk. The longer she feeds, the more milk you will produce.

  • Avoid giving your baby a bottle and/or a pacifier until breast-feeding is well established as this may lead to nipple confusion. In some cases, the baby may find it hard to latch on, or reject the nipple in favor of an artificial nipple. If this continues, your milk production will fall.

  • Some women believe they should not exercise since it may affect milk production, but this is not the case. Studies have shown that even high-intensity exercise does not affect breast milk production.

Q: How will I be able to tell that my baby has had enough milk?
A: Although you can't measure the exact amount of milk your baby gets, the breasts work on a supply and demand basis, so your body responds to your baby's sucks and the amount of milk she takes and produces more according to her needs. Usually, babies feed for at least 10 minutes each feeding in the first few days after the birth and you may need to offer both breasts before she is satisfied. You can tell that your baby is feeding well because her lower jaw will move steadily while she is on the breast. When she is full, she will fall asleep or release the nipple and be contentedly awake. Your breasts may feel softer and less tense after a feeding. Another sign is the amount of wet and dirty diapers she produces. If you think that your baby is not satisfied, ask your midwife or doctor for advice and support before using formula.
Q: I get wet patches on my clothes and find breast-feeding so messy. Do you have any advice?
A: Your breasts leak when they are full and overflow, or when the letdown reflex kicks in, for instance when another baby in the room cries or when you feed from the other breast. To avoid this, try expressing to stop your breasts from becoming too full. Breast pads can help: there are disposable and washable ones available but remove the plastic liner as it tends to keep the nipple damp which may cause soreness. If one breast leaks when your baby is feeding on the other, put a plastic, washable breast shell inside your bra before you start to feed. If the shell is sterilized, you can save the milk it collects and freeze it. This can be given to your baby later. When you're out, carry a change of clothes, bra, and breast pads. If you feel a letdown, cross your arms and hug yourself, pressing gently against your breasts, which may stop the flow. You will probably leak most in the first few weeks of breast-feeding, while you are establishing the right supply for your baby. Many women find that the problem disappears after the first six weeks.
Q: Do I have to watch what I eat and drink if I'm breast-feeding?
A: Yes. Generally, it is important to remember that your baby receives all the nutrition she needs through your breast milk, so having a well-balanced diet is really important. However, there are certain foods and drinks that will affect your baby's digestion. For example, if you eat lots of fruits, such as grapes and oranges, it can cause loose stools or diarrhea in your baby. You are advised to avoid high amounts of salt since this can cause your baby to become dehydrated. It is also advisable to avoid alcohol. Not only can it make your baby quite sleepy, but there have been studies linking this to crib death.
Q: Can all women breast-feed? My mom says she wasn't able to.
A: The majority of women are able to breast-feed. You may find that the system of maternity care hindered your mother's breast-feeding, since there was a time when mothers were told to feed only every four hours. Learning as much as you can about breast-feeding in advance makes you more likely to succeed. A common myth is that breast size affects the ability to feed, but this is not the case. Breast surgery may affect breast-feeding, but even after the most invasive surgery, it is possible that a portion of the original glands and ducts remain intact. Hopefully you will feel confident enough to give breast-feeding a try.
Q: I want to go back to work six weeks after the birth. Is it worth starting to breast-feed?
A: Yes, most certainly. Even if you only breast-fed for the first week, your baby would benefit from the colostrum. So continuing breast-feeding up to six weeks is good. It is estimated that around 40 percent of women stop breast-feeding at six weeks, which may also coincide with the fact that they may be nearing the end of their maternity leave and must now return to the workplace. Once back at work, you can express your milk, either at break or lunchtime, depending on the facilities, or in the mornings and evenings at home.
Q: What are the benefits of expressing milk?
A: Expressing breast milk (squeezing milk out of your breasts) enables your baby to receive all the benefits of breast-feeding if you are unable to be with your baby for every feeding. Mothers express their milk for many reasons. Some like to give their baby breast milk from a bottle if they are going out when a feeding would take place, while others who go back to work express several feedings' worth so they can continue to breast-feed their baby. Mothers of premature babies being cared for in a neonatal care unit might express all their baby's feedings.
Q: When can I start expressing?
A: You can start expressing as soon as is practical after your baby is born. Also, studies have shown that expressing as soon as possible can greatly increase long-term milk production. For mothers who breast-feed and are returning to work, expressing should start at least a week before so that the baby can get used to receiving the milk from a bottle or cup. Once you start expressing, if possible, you should express around every three hours, including once in the night when prolactin levels are highest, aiming to express 6–8 times in a 24-hour period. As breast milk is made on a supply and demand basis, the better your baby feeds, or the more often you express, the more milk you will make for your baby. An Australian study found that women who express milk are more likely to continue breast-feeding for up to six months.
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