The vast majority of mothers are perfectly capable of breastfeeding their babies
exclusively for about six months. In fact, most mothers produce more than enough
milk. Unfortunately, outdated hospital routines based on bottle feeding still
predominate in too many health care institutions and make breastfeeding
difficult, even impossible, for too many mothers and babies. For breastfeeding
to be well and properly established, a good start in the early few days can be
crucial. Admittedly, even with a terrible start, many mothers and babies manage.
The trick to breastfeeding is getting the baby to latch on well. A baby who
latches on well, gets milk well. A baby who latches on poorly has more
difficulty getting milk, especially if the supply is low. A poor latch is
similar to giving a baby a bottle with a nipple hole that is too small—the
bottle is full of milk, but the baby will not get much. When a baby is latching
on poorly, he may also cause the mother nipple pain. And if he does not get milk
well, he will usually stay on the breast for long periods, thus aggravating the
pain. Unfortunately anyone can say that the baby is latched on well, even if he
isn’t. Too many people who should know better just don’t know what a good latch
is. Here are a few ways breastfeeding can be made easy:
1. A proper latch is crucial to success. This is the key to
successful breastfeeding . Unfortunately, too many mothers are being "helped" by
people who don’t know what a proper latch is. If you are being told your two day
old’s latch is good despite your having very sore nipples, be sceptical, and ask
for help from someone else who knows. Before you leave the hospital, you should
be shown that your baby is latched on properly, and that he is actually getting
milk from the breast and that you know how to know he is getting milk from the
breast (open mouth wide—pause—close mouth type of suck). See also the website
http://www.drjacknewman.com for videos
on how to latch a baby on (as well as other videos). If you and the baby are
leaving hospital not knowing this, get experienced help quickly (see Handout A:
When Latching). Some staff in the
hospital will tell mothers that if the breastfeeding is painful, the latch is
not good (usually true), so that the mother should take the baby off and latch
him on again. This is not a good idea. The pain usually settles, and the latch
should be fixed on the other side or at the next feeding. Taking the baby off
the breast and latching him on again and again only multiplies the pain and the
damage.
2. The baby should be at the breast immediately after birth.
The vast majority of newborns can be at the breast within minutes of birth.
Indeed, research has shown that, given the chance, many babies only minutes old
will crawl up to the breast from the mother’s abdomen, latch on and start
breastfeeding all by themselves. This process may take up to an hour or longer,
but the mother and baby should be given this time together to start learning
about each other. Babies who "self-attach" run into far fewer breastfeeding
problems. This process does not take any effort on the mother’s part, and the
excuse that it cannot be done because the mother is tired after labour is
nonsense, pure and simple. Incidentally, studies have also shown that
skin-to-skin contact between mothers and babies keeps the baby as warm as an
incubator (see section on skin to skin contact). Incidentally, many babies do
not latch on and breastfeed during this time. Generally, this is not a problem,
and there is no harm in waiting for the baby to start breastfeeding. The skin to
skin contact is good for the baby and the mother even if the baby does not latch
on.
3. The mother and baby should room in together. There is
absolutely no medical reason for healthy mothers and babies to be separated from
each other, even for short periods.
Health facilities that have routine separations of mothers and babies after
birth are years behind the times, and the reasons for the separation often have
to do with letting parents know who is in control (the hospital) and who is not
(the parents). Often, bogus reasons are given for separations. One example is
that the baby passed meconium before birth. A baby who passes meconium and is
fine a few minutes after birth will be fine and does not need to be in an
incubator for several hours’ "observation".
There is no evidence that mothers who are separated from their babies are
better rested. On the contrary, they are more rested and less stressed when they
are with their babies. Mothers and babies learn how to sleep in the same rhythm.
Thus, when the baby starts waking for a feed, the mother is also starting to
wake up naturally. This is not as tiring for the mother as being awakened from
deep sleep, as she often is if the baby is elsewhere when he wakes up. If the
mother is shown how to feed the baby while both are lying down side by side, the
mother is better rested.
The baby shows long before he starts crying that he is ready to feed. His
breathing may change, for example. Or he may start to stretch. The mother, being
in light sleep, will awaken, her milk will start to flow and the calm baby will
be content to nurse. A baby who has been crying for some time before being tried
on the breast may refuse to take the breast even if he is ravenous. Mothers and
babies should be encouraged to sleep side by side in hospital. This is a great
way for mothers to rest while the baby nurses. Breastfeeding should be relaxing,
not tiring.
4. Artificial nipples should not be given to the baby. There
seems to be some controversy about whether "nipple confusion" exists. Babies
will take whatever gives them a rapid flow of fluid and may refuse others that
do not. Thus, in the first few days, when the mother is normally producing only
a little milk (as nature intended), and the baby gets a bottle (as nature
intended?) from which he gets rapid flow, the baby will tend to prefer the rapid
flow method. You don’t have to be a rocket scientist to figure that one out,
though many health professionals, who are supposed to be helping you, don’t seem
to be able to manage it. Note, it is not the baby who is confused. Nipple
confusion includes a range of problems, including the baby not taking the breast
as well as he could and thus not getting milk well and/or the mother getting
sore nipples. Just because a baby will "take both" does not mean that the bottle
is not having a negative effect. Since there are now alternatives available if
the baby needs to be supplemented, (see Handout 5:
Using a Lactation Aid 2005 , and Handout
8:
Finger Feeding 2005) why use an
artificial nipple?
5. No restriction on length or frequency of breastfeedings.
A baby who drinks well will not be on the breast for hours at a time. Thus, if
he is, it is usually because he is not latching on well and not getting the milk
that is available. Get help to fix the baby’s latch, and use compression to get
the baby more milk (Handout 15:
Breast Compression). Compression works
very well in the first few days to get the colostrum flowing well. This, not a
pacifier, not a bottle, not taking the baby to the nursery, will help.
6. Supplements of water, sugar water, or formula are rarely needed.
Most supplements could be avoided by getting the baby to take the breast
properly and thus get the milk that is available. If you are being told you need
to supplement without someone having observed you breastfeeding, ask for someone
to help who knows what they are doing. There are rare indications for
supplementation, but often supplements are suggested for the convenience of the
hospital staff. If supplements are required, they should be given by lactation
aid at the breast (see Handout 5:
Using a Lactation Aid), not cup, finger
feeding, syringe or bottle. The best supplement is your own colostrum. It can be
mixed with 5% sugar water if you are not able to express much at first. Formula
is hardly ever necessary in the first few days.
7. Free formula samples and formula company literature are not gifts.
There is only one purpose for these "gifts" and that is to get you to use
formula. It is very effective, and it is unethical marketing. If you get any
from any health professional, you should be wondering about his/her knowledge of
breastfeeding and his/her commitment to breastfeeding. "But I need formula
because the baby is not getting enough!" Maybe, but, more likely, you weren’t
given good help and the baby is simply not getting the milk that is available.
Even if you need formula, nobody should be suggesting a particular brand and
giving you free samples. Get good help. Formula samples are not help.
Under some circumstances, it may be impossible to start breastfeeding early.
However, most “medical reasons” (maternal medication, for example) are not true
reasons for stopping or delaying breastfeeding, and you are getting
misinformation. Get good help. Premature babies can start breastfeeding much,
much earlier than they do in many health facilities. In fact, studies are now
quite definite that it is less stressful for a premature baby to breastfeed than
to bottle feed. Unfortunately, too many health professionals dealing with
premature babies do not seem to be aware of this.
