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 to discuss 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)