27 Sep Born to breastfeed
By Hettie Grove – Author of Born to Breastfeed, Born to be Breastfed, SA certified lactation consultant (SACLC)
You have heard it all, the benefits of breastfeeding, the risks of not breastfeeding….! Your breastfeeding plan has been written. Breastfeeding started when you were still in your mother’s womb. Your body is now ready and prepared. Your mind is set and you have birth plan A and B. Your first visit to a Certified Lactation Consultant went well and you have attended her breastfeeding class. You even have her number on speed dial. You are so, so ready to hold your baby and start skin to skin contact.
Your baby is born…. It is skin to skin and pure bliss. Watching the nine instinctive stages…. you are absolutely in awe to see how your baby performs the breast crawl. While sniffing your baby’s odour and baby smelling his mom starts the whole process. You fall in love with each other. The moment you hold him, keep smelling your precious baby! Sniffing your baby will help your body to start the lactation process. Keeping the baby in the breastaurant, will help him to adjust after the process of being born. Baby has left his Jacuzzi, which was his home the last 40 weeks. Birth is not the easiest thing in life, not for mother nor baby. Skin to skin and breastfeeding helps your baby to adjust in the transition to the extra uterine life.
Remember after birth everything is on baby’s time. Don’t feel rushed during the babymoon, let your baby set the pace. Try slow down a bit and enjoy the baby days. You will never experience these times ever again.
Lactation starts early and your body is primed to breastfeed. The moment the placenta detaches from the uterine wall the hormones cascade and these changes will help you to breastfeed well. You have trusted your body to grow your baby and nourish him well, start trusting your body to nourish him after the birth. Your body will provide enough milk for your baby. You need to partake in this process. It’s a two-way process. The breast takes over from the umbilical cord and starts to nourish your baby immediately after birth.
Birth plays a part in breastfeeding but it’s not the alpha and the omega. Keeping your baby skin to skin will help and play a tremendous role in the process of lactation. This will help both of you if the birth was not what you planned.
GETTING OFF TO A GOOD START
The first two weeks will help with the amount of milk you produce later on. Have a zero tolerance for separation, keep your baby with you all the time. This sets you up for the best journey ever. During these two weeks babies want to feed often, they are hardwired to feed often. Mothers are hardwired to respond to their cues and demands. This will really help to build receptors in your brain and breast for a good supply later.
Babies often have a good feed after birth and fall asleep. Most mommies and healthcare workers worry about this – with pretty good reason as the blood sugar level may drop. Keeping your baby skin to skin will prevent the blood sugar dropping. Keeping him in the breastaurant will help him to smell the breast, which will wake him to feed. If he does not want to feed hand express after two hours, in a spoon and decant in a syringe. You don’t want to waste liquid gold. I suggest hand expression in a spoon because colostrum (the first milk produced from about 16 to 22 weeks of pregnancy) is very dense almost like syrup which was in a refrigerator. Colostrum is produced in small amounts at a time. The amount is also very small due to the baby’s stomach capacity that is small. Hand expressing is more effective than a pump. Expressing in a spoon you easily get the small amount of colostrum that your baby needs. Five millilitres is more than enough. Expressing this, if the baby is in a deep sleep, will stimulate your breast for later supply.
Hand expressing is easy, its cheap and always available. Research has shown that when a mother hand expresses first before using a pump she will have a better supply.
Your first lesson in breastfeeding happened in nursery school when you started to use glue and paste pieces of paper. Remember the glue bottle you squeezed at the top and your hands were full of glue and it was a disaster. Breastfeeding is the same it is breastfeeding not nipple feeding. You need to have a good, deep, comfortable latch and this should not hurt. If it is hurting the latch is not right. Your baby needs to be tummy to mommy, very close with no spaces between the two of you. His mouth need to be completely open with lips curled out almost like a little fish mouth. If it hurts unlatch the baby by inserting your small finger into the corner of his mouth to break the suction. Do not pull the baby off as it will hurt your nipple. If it hurts call your certified lactation consultant. Don’t wait till everything starts going south – the sooner your latch can be fixed the easier the road ahead for breastfeeding.
Remember babies are hardwired to breastfeed and mommies learn to breastfeed. Both baby and mommy need to build muscle memory. Babies learn during pregnancy, they learn about familiar sounds, smells and some may even start to build motor memory for sucking their tongue, lips or hands. When born, babies are very primitive with a few survival reflexes and motor memory for milk feeding.
One of these reflexes is the crawl reflex, which is the reason for the breast crawl. The rooting reflex is also described as the search reflex and enables the baby to locate his food source. The oral grasp reflex supports the learning of finding the nipple and taking the nipple in their mouth. When your nipple touches your baby’s palate at the comfort zone where the sucking reflex occurs. The comfort zone is the area where the hard and soft palates join.
Babies have this amazing ability where they learn to coordinate a suck and swallow with breathing. While babies learn to feed, the sequence coordination is a lot of motor learning and produces muscle memory. Unfortunately, this is not a given because of intervention. These reflexes may be viewed as the small wheels of a bicycle and helps a baby to build this memory to feed well. Motivation is a big factor in learning and babes are born with this motivation to eat.
The greater the difficulty of the task, the greater the need for specific practice of the task. This in the end builds the motor and the muscle memory. Giving the baby a bottle or an artificial teat may lead to difficulty with breastfeeding because the flow is different and baby needs to go back and forth from the breast and bottle. It’s almost like starting to drive, it’s much easier driving an automatic car than a manual one. When you learn with an automatic car (the bottle) it’s hard to go and drive a manual (breast). However, if you start on a manual it’s easy to drive the automatic car. Rather feed your baby with a cup or a syringe if you need to feed the baby.
Let us revisit the anatomy of your breast. Your breast size doesn’t have an impact on your breastfeeding ability. Breast contains fatty tissue and breast tissue. Every pregnancy causes more breast tissue to be formed. Thus with every pregnancy more milk making cells are produced. Your breasts continues to grow till you are thirty-five.
Think of your breasts as a broccoli tree. The small little flowerets of the broccoli are a milk making cell or an alveolus. Around this little cell is a structure that resembles an elastic band. As the milk cells fill up with milk, this elastic band structure stretches and ejects the milk into the ductules where it flows towards the nipple. These ductules branches like the broccoli into bigger ducts that open on the nipple. Each nipple pore has a few openings and milk starts to spray out into the baby’s mouth.
It sounds so easy but it is hard work, here is the difference: the baby compresses and sucks on the breast. If you do hand expression you compress the breast whereas the breast pump will suck on the breast. Milk ejection does not happen randomly. The physiology of breastfeeding is like a new shampoo bottle with a spray top. You need to pump a few times before the shampoo appears. The same with the breast. The baby needs to suck a few times sending messages via the spinal cord to the brain. The brain in response to this message sends hormones to the alveoli to produce milk. The alveolus fills up and expands and the milk ejection reflex (when the little elastic bands ejects the milk) or let down occurs and milk starts to flow.
Think about the fact that if you needed to go to a funeral tomorrow you don’t doubt that your body will make enough tears. It’s a natural process when you are sad you can cry and tears will be produced. When you get to the funeral you will cry tears. If the baby starts to suck you will produce milk, which is the way your body works. So if you can trust your tears, you can then trust your breasts.
Day two is quite an intense day because all of a sudden the baby realises he’s not in the Jacuzzi anymore. Hunger pains, different voices and noises, uncomfortable clothing, a dry atmosphere and no food on tap. He wants to be on the boob all the time, and as soon as you put him down he wants to feed again. Couple this with healthcare workers saying “your baby is hungry, your milk is not in” and “his blood sugar is really low let’s give him a top up of formula”. Mothers start doubting their ability because they think that healthcare workers know better. One bottle won’t make a difference, they think. Unfortunately, it does. It delays the producing of copious amounts of milk, it interferes with the latch as there is no such thing as a slow flow bottle, it sensitizes your baby with different proteins than what we find in breast milk. And it paves the way for cessation of breast milk.
Babies learn to latch on a soft breast. When your breasts start to produce copious amounts of milk they may struggle to latch on your breasts. Imagine your breast is a balloon. As your breast fills up it’s like the balloon filling up with air. The nipple of the balloon will be easy to latch on but as it fills up the nipple flattens. The same happens with your breast. You may want to use reverse pressure softening to soften the areola or express a bit with your hand. This will help the baby to latch easier. They might also struggle with the fast flow, they are used to working hard for food versus a milk fountain. This will also be relieved by expressing a little before feeding.
If your baby can’t be with you after birth for various reasons and may be in the NNICU, the best thing you can do for your breast milk production and your baby is to start doing hand expression into a spoon and store the milk in a syringe. Start with a nice breast massage. (If you are still pregnant and reading this, start with breast massages during your last trimester). This will help later because you are already used to doing it. After massaging your breasts, you can start with hand expressing for at least a good few minutes on the one side. Move over to the other side. After this you may even try a pump. Research has proven hand expression is more efficient in the first few days than a pump. Take care with a pump because of the viscosity of the colostrum and the small amount available. You are wasting more precious gold with a pump. If your baby is not with you, express every two hours during the day and after the last expressing session of the day set your alarm for five hours and start the process. This is the best you can do for your baby.
Pumping breast milk only assures you of one thing and that is how much you have pumped. It is artificial. Your baby provides you with a lot of stimulation that you can’t get with a pump. Although some people are exclusive pumpers, mothers need to remember a few things that help you to produce more breast milk when the baby sucks from the breast. Skin to skin helps to increase the milk supply. Lovingly looking at your baby also increases your milk making hormones which will fill your baby’s stomach. A pump, even the Rolls Royce of pumps is still artificial. Smell your baby’s blanket, look at a video clip, talk to someone you love (this absorbs your attention), cover the pump with a blanket, drink something hot or something you really like. All of these will actually help you to have a better yield of breast milk.
If baby is healthy and with you, please don’t express if there is no medical reason. Rather feed your baby from the breast. Doing both is like having a roller skate on one foot and an ice skate on the other. You won’t get very far. For mother and baby, it’s better to learn one way at a time before learning another.
Although breast milk production still works on supply and demand we now know that there is much more to that phrase. Research shows that breast storage capacity has an important role in establishing and maintaining milk supply. What does this imply? Simply, the emptier the breast, the more and faster the milk will be produced.
Think about an automatic icemaker in a refrigerator generating ice blocks which drop into a basket. A mechanical arm is positioned over the basket, so that as the amount of ice in the basket increases, the arm raises up and slows the flow of water to reduce the rate at which the ice is produced. When the basket is full the arm is at its highest point and completely shuts off the flow of water. No more ice is made till the ice blocks are removed.
Breasts are exactly the same. Breastmilk contains a specific protein, the feedback inhibiting lactation (FIL) protein. If the breasts are full there are lots of this FIL and this slows down the production of milk. If the breasts are empty, there are less of this FIL and the breast milk production is increased. Emptier breasts produce more breast milk faster and full breasts decrease milk production.
A word of warning: do not assume that a baby is actually removing milk when he is at the breast. A baby with a poor suck or a problem will leave most of the milk in the breast and this will decrease the milk supply.
You know your baby is getting enough milk when
- Baby is drinking often – 8 to 12 times in a 24-hour period
- Baby is content after a feed looking “milk drunk”
- There are audible swallowing sounds
- Rhythmic jaw movement from the chin to the ear
- Baby is gaining weight
- Baby is passing at least 6 wet nappies in a 24-hour period after day 6
- Your breasts feel softer after a feed than before a feed.
The only rules in breastfeeding
- Feed the baby often
- Keep your baby with you, don’t allow any separation
- Move the milk
- Protect the supply, if the mom is not with the baby, express
- It’s your baby
- You know your baby best, if in doubt check it out
- Nobody knows everything
- Do not schedule feeds
- Do not wait for the baby to cry before you feed him. Feed the baby as soon as he displays feeding cues
- One position at the breast is success. More is just variety, there are 360 different positions.
If the latch hurts or you are unsure, call a Certified Lactation Consultant. Do not wait. The sooner you fix the problem, the better the journey. It’s your journey. Do not let anybody try to convince you otherwise. You can do it. Enjoy the journey!