Dr Clare Woodward - Family Doctor
Breast milk is the natural food for newborns. However, this does
not mean a mother naturally knows everything about it. It can take
practice for both the mother and the baby before breastfeeding
happens easily, but then it can be a very rewarding experience.
How does the body make breast milk?
The breasts are preparing from early on in pregnancy, and women
will notice the size of their breasts change. Before the baby is born
colostrum is being made. It is a creamy yellow colour. It is rich in
proteins and immunoglobulins (that guard against infection) and will
supply the baby with everything they need for the first 3 to 5 days.
Then the milk comes in. It is pale and more watery.
The breast tissue is composed of many little "sacs" called
alveoli. These drain via ducts into milk sinuses behind the nipple,
which hold the milk ready to be sucked out.
When the baby sucks at the nipple, a signal passes to the mother's
pituitary gland in her brain. This releases two hormones. Prolactin
signals to the alveoli to make milk. Oxytocin causes the alveoli to
contract and release milk into the sinuses. This causes a tingling
sensation, known as the "let down" reflex.
Reasons why breastfeeding is good:
- It helps encourage a special closeness between mother and
baby.
- It provides babies with everything they need in the first few
months. It provides the correct balance of iron and other
minerals, and other nutritional requirements.
- It provides immunoglobulins that guard against infection.
- It is cheap, convenient, and the correct temperature. One does
not sterilise bottles. There is no pollution or unnecessary
packaging or waste.
- It has a contraceptive effect when a mother is fully
breastfeeding. However, this must not be relied upon totally, and
another method must be used as well.
- It helps protect against infant allergies.
- It probably helps protect against cot death.
- It may help protect against a variety of childhood conditions
such as diabetes, cancer and some bowel disorders.
The technique of breastfeeding:
Breastfeeding does take practice, both by the mother and baby, and
it does not always happen easily at first. It can help to attend a
class on breastfeeding at a local hospital, if available, before the
baby is born. Once the baby is born it is important to have a lot of
help and support from midwives, a Plunket nurse, breastfeeding
consultants, or doctor. Some important points are:
- The mother must be in a relaxed comfortable position. This
helps the let down reflex and calms the baby.
- The baby usually lies on their side facing the mother, facing
chest to chest and chin to breast. A pillow may help hold the head
at the nipple level.
- When the baby is in the correct position the nipple may be
massaged so that there is a drop of milk on it, then touched to
the baby's lower lip. When the baby's mouth opens wide its head is
brought to the breast so that the mouth is wide around the nipple
and as much of the aereola as possible (the brown area around the
nipple). This is important for the milk to be drawn out properly.
- When correctly latched on, the baby will feed with a rhythmic
sucking-swallowing action, and there should be no pain.
- If there is any pain, ask for help. It is likely that the baby
is not latched on correctly.
- There are several different positions such as the mother lying
down, or the baby held under her arm, which may be more
comfortable if she has had a Caesarian section, has large breasts,
etc.
- Usually a newborn will feed at least eight times in 24 hours
for about 10-15 minutes each side. Usually one begins each feed
from alternate breasts to encourage even milk production.
Problems with breastfeeding:
Sore or cracked nipples
This often occurs when the baby is not positioned correctly and is
very painful. It is important to get help soon.
Expose the nipples to air or sun for a few minutes after each
feed. Keep the nipple dry and avoid soap. Begin feeding from the
breast that isn't so sore each feed.
If the nipple feels itchy and sore, there may be a thrush
infection. The baby may have white spots inside their mouth too. See
a doctor for treatment which is safe to use while breastfeeding.
Mastitis
This is an infection in the breast tissue. There will be a very
tender area of the breast which may be hard, red, and hot. The mother
may have fevers and feel unwell.
It is important to keep feeding or expressing milk, take
paracetamol to help reduce the pain and fever, and to see a doctor as
soon as possible. Antibiotics are prescribed to treat it.
Occasionally an abscess may form and this may need to be treated in
hospital.
Engorgement
Especially in the first weeks of breastfeeding, the breast may
become very full, heavy and painful. A warm shower or warm flannel
placed on the breast, followed by expressing a small amount of milk,
may help. Also, massaging a tender area while feeding, or feeding in
a different position, may ease the pressure.
Feed from the engorged breast often, but continue to feed from
both sides. It generally settles with time as the breastfeeding
develops a routine.
Not enough milk
If the baby is happy and well, latching on well, having 6 to 8 wet
nappies a day, and gaining weight then they will be getting enough
milk. If a mother is worried about any of these things it is
important to get help.
Breast milk is made to demand, so to increase the supply, just
feed the baby more often. It is also important for the mother to eat
and drink well, and be getting enough rest.
Inverted nipple
This is usually noticed during pregnancy and it is important todiscuss it early on with a health professional. It can sometimes be
rectified and breastfeeding established by using a plastic shell.
People who can help
- Your Midwife
- Family doctor
- Plunket nurse (see phone book)
- Plunket Family Centre (see phone book)
- NZ Plunket Phone Line 0800 933 922
- Breastfeeding consultant (ask your doctor or midwife)
- Parent's Centre (see phone book)
- La Leche League (see phone book)
