Breast feeding can be started after delivery as soon as both the mother and the baby are comfortable (particularly when the baby starts moving his head about with movement of his lips as if he is trying to ‘search’ for the nipple). Correct position and technique are necessary for optimal sucking with minimal nipple discomfort.
If the mother is sitting, the infant should be elevated to the height of the breast and turned so that he faces the mother and their abdomens touch. The mother’s arm supporting the baby should bring the baby’s mouth in line with her breast and near to it. The other free arm should support the breast from below by her fingers, while the thumb and the index finger should grasp the nipple and compress it so as to make it more protractile. The infant’s initial licking and mouthing helps the nipple in being more erect. Ideally, the mother should touch the nipple at the corner of the baby’s mouth and not directly stick it into the baby’s mouth. When the baby feels the nipple (or any stimulus including a finger touch at the corner of his mouth), it goes for it, depending upon his hunger. The baby tries to ‘catch’ the stimulus (in this case the nipple) in his mouth, a natural reflex called rooting. When the baby, with its mouth open finds the nipple and tries to grasp it, the mother should gently but rapidly, push as much nipple and areola as possible in the baby’s mouth.
The baby would apply rhythmic compressions on the areola (and not on the nipple, as it does in bottle-feeding) with its gums. Milk is stored in sinuses underneath the areola and these sinuses should be compressed rhythmically, so that the milk from them is squirted via the nipple into the baby’s mouth. The nipple acts like a conduit for the passage of milk. Chewing on the nipple or rhythmic compression of the nipple by the gums is not helpful in getting the milk, because milk from the breast doesn’t come from suction on the nipples, as in the case of bottle! Proper breast-feeding technique requires that the baby compresses the areola (rather than the nipples) with it gums. In fact, improper technique and positioning is chiefly responsible for soreness and cracked nipples (a common complaint of nursing mothers).
Some useful advice and facts regarding breast-feeds are given below.
1. A valuable suggestion is to express some milk from the sinuses before feeding. It makes the areolar area soft and compressible for the baby.
2. Both breasts should be offered to the baby at one feed. The breast offered first should be completely emptied (emptying is a potent stimulus for milk production).
3. The breast to be offered first should be alternated with feeds, i.e. if the left breast was offered first during the previous feed the right should be offered first now. This ensures complete emptying of at least one breast at each feeding, which is very necessary for adequate milk production.
4. The optimal period for suckling at each breast is about 15 minutes after the 3rd day. On the 1st day, it is 5 minutes and on the 2nd, 10 minutes. However, it depends more on the baby. Some babies finish their milk requirements fast in just 3-4 minutes and then doze off. Others may do it at a leisurely pace. However, suckling for more than 15 minutes is not advocated as it may lead to soreness and cracked nipples, plus the baby takes his milk during that time.
5. When the baby has finished feeding, don’t pull it away from your breast. It will apply traction on the nipple and may make it sore. The best way to unlatch a baby is to insert your finger in the corner of baby’s mouth in between the gums. This will release the grasp of the gums and then you can take the baby off the breast.
6. If the baby dozes off while feeding, you can gently stimulate the baby by massaging behind the ears or rubbing the soles of the baby. If after 2-3 tries, the baby is still not feeding, then stop and unlatch the baby.
7. There is no fixed time interval (say 3 hours or 4 hours) at which the baby has to be fed. Instead a flexible schedule is recommended, based chiefly on demand; i.e. to give the baby the milk when he starts demanding it. But if more than 4 hours elapse and the baby is still sleepy, it is better to try to awaken him gently and see whether he will accept feeds.
8. The milk produced in the initial 3-4 days is fluidly, yellow and very less in amount. It is called ‘colostrum’, which has a high content of nutrients and is invaluable to the child. It should always be given to the baby, without worrying about its quantity or quality.
9. During this phase, the mother starts doubting that she is not producing enough milk. All mothers produce colostrum (which as I have mentioned is physiologically less in amount) and all of them produce roughly the same amount in the initial 2-3 days. By the 4th of day, the milk production starts increasing and adjusts itself to the baby’s needs in another few days.
10. It is during this time that the mother turns towards the bottle to supplement her ‘inadequate’ breast milk (which is actually adequate for the baby). The baby’s fluid and calorie requirements are less during the first 1-3 days, and so the ‘less’ amount of milk is actually sufficient. This is the critical point where all the trouble starts. Once the baby starts accepting the bottle feed, the motivation of mother goes down. The baby finding the nipple of the bottle softer than the breast has to put less efforts to derive milk from it, and so starts preferring it over the breast. It appears that all human beings including a 1-day newborn seek the easy way out. The mother on seeing the baby prefer the bottle becomes so discouraged that it becomes very difficult for her to breast-feed. Then there is an entity called ‘nipple confusion’. The baby’s gum compresses the areola of the mother rather than the nipple, but with the bottle the baby compresses rhythmically the bottle’s nipple. This may lead to confusion in the baby’s mind and he may start chewing on the nipples of the mother’s breasts, and on finding no milk coming may become irritated. Therefore, if you want to breast-feed, no bottles, even for some feeds, until you are confident and have a well-established milk supply.
11. A very important prerequisite for a nursing mother is that she should be mentally and physically relaxed. Tension and fatigue has an inhibitory effect on milk production. After delivery, don’t encourage long visits by well wishers. Instead try to rest, sleep or just relax with your baby by the side, thinking pleasurable thoughts about it.
12. The breast-feeding mother should consume adequate amounts of water and a wholesome diet. Wholesome diet doesn’t mean eating lots of fattening things like ghee, chocolates, cakes etc. but to eat cereals, pulses, vegetables, eggs, meat, curd etc. Eating lot of fruits is a good thing. Drinking a lot of milk in the belief that it will indirectly ‘come out’ from the breasts and so replace the milk taken by the baby is an erroneous belief. By all means drink milk (and lots of it), if you really relish it. But drinking it for the reason mentioned above (while your inner self doesn’t really want to) is not recommended.
13. As discussed earlier in detail, there is a fine-tuning by nature between the production of milk and its demand by the baby. The amount of milk produced is not a ‘static’ quantity e.g. one mother will produce only 500 cc per day while another may produce only around 700 cc per day. Milk production increases according to the baby’s requirements. If the baby wants more, it sucks more, which empties the breast completely. This is the most potent stimulus to produce more milk. So more the demand, more is the supply.
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