This article is an excerpt from the recently held talk on advocating breastfeeding to new mothers, conducted by Damai Service Hospital and our very own Dr Melanie Majaham was one of the speakers at the event.
A lot of noise is being made about breastfeeding; a lot more has to be made for mothers and families to be convinced (unfortunately) that breastfeeding is indeed the best feeding. What is natural must be allowed to happen. Statistics say that 14.5% of Malaysian mothers exclusively breastfeed their babies for the first 6 months. This is still a low number and there is an urgent need to spread the message even further. Let us get into the basics of breastfeeding and breastmilk. Read on to find out more about how to breastfeed and why you must feed.
What is Colostrum?
Colostrum is the first milk commonly referred to as liquid gold that is produced by the mother during her pregnancy and is continued to be produced throughout the first 3 to 5 days of life before being replaced with transitional milk. Colostrum feeding is essential because not only is it rich in calories, it also contains natural prebiotics which eases the baby in passing the first stools (meconium) sooner, thus, reducing jaundice in the new-born. It is rich in antibodies and protective white cells which provides baby’s first protection from infection.
What is the Golden Hour?
The Golden Hour is ideally the first hour after birth. It has to be made a priority for the mother and her baby to be in skin-to-skin contact with each other during this special period. Placing the baby skin-to-skin with mother helps to regulate baby’s temperature, heart rate and breathing rhythm. It also provides baby with ample opportunity for early initiation to breastfeeding, thus allowing baby to get full access to colostrum. The baby is exposed to naturally occurring bacteria on the mother’s skin which enhances the production of probiotics in the baby’s gut. On top of that, baby and mother are allowed their quiet bonding period and this helps the mother to become confident of caring for her baby. There is no hurry to have the baby cleaned up and any procedures can be deferred to after the first hour.
Mothers should let it be known to her doctors in advance if she wishes for this opportunity and this can usually be accommodated so long as there are no medical problems in both mother and baby.
What are the Benefits of Breastfeeding?
You might be aware of most of them, but it is still worth going through the endless list of benefits that breastfeeding has to offer for the mother who does it religiously.
- Mothers who breastfeed are at a lower risk of getting heart disease, ovarian and breast cancer
- It stimulates increased production of oxytocin that causes the womb to contract faster after delivery, thus reducing bleeding. The same hormone helps you relax – The more you feed the more oxytocin is produced (the feeling is similar to when a person falls in love!)
- Breastfeeding aids in faster loss of the weight gained during pregnancy – provided you take in around 1500-1800kcal of food per day when breastfeeding (overeating will not help)
- Breastfeeding is a natural contraceptive (yes, really) when the mother exclusively breastfeeds her baby for 6 months (topping up with formula will not help!)
- It is environmentally friendly – yes, you can’t deny that!
- Available 24×7, fresh from the breast and free refills for the baby at any time!
How is this milk produced? Let’s find out!
The basis is simple – supply increases with increased demand and vice-versa. Suckling of the breasts causes the pituitary to be stimulated. This results in production of prolactin and oxytocin which in turn cause secretion of milk.
So now we know what causes milk production, how can you tell if your baby is hungry? When must you feed?
Some of the signs of hunger include:
- Sucking of fingers
- Licking the lips
- Sucking on anything nearby e.g. blankets
- Rooting – opening mouth and turning towards one side
- Last of all, when the baby is very hungry, it resorts to crying.
It is advisable to keep an eye out for the first 4 signs and not to wait until the baby starts to cry. Once the baby is too hungry, it will be more difficult to latch-on the baby. Baby will need to be calmed down first. Once there is difficulty latching on and baby continues to cry frantically, the mother’s natural instinct to feed the baby will overcome her desire to breastfeed and she will end up reaching for the bottle. Once baby gets comfortable with the bottle, there will less breastfeeding resulting in less stimulation. Eventually, mother’s milk supply will start to dwindle leading to more and more formula feeding. Hence, it cannot be emphasized enough how important it is to recognise early hunger signs.
How often should you feed?
As and when the baby demands! The maximum time gap you can have between 2 feeds is 3 hours, even if the baby is asleep you have to feed her.
What are the different breastfeeding positions?
- Cradle position
- Football hold position
- Side-lying position
Latching on – how important is this?
As much as a mother will hope that her baby will instinctively and naturally latch-on to the breasts and start suckling with vigour, this doesn’t always occur. Many times, baby will refuse to latch-on or latches on incorrectly leading to much pain in the mother and reduced milk supply.
Before latching on, the mother should be in a comfortable position. Her breast should be supported by one hand without obstructing the nipple and areolar. The other hand/ arm should be supporting the baby’s head. Bring the baby to the breast and not vice versa. The nipple should be facing the baby’s nose and subsequently tickled against the baby’s upper lip. Once baby’s mouth opens up wide, the baby should be quickly brought closer to the breast enabling the baby to take a large mouthful of the areola (the dark area surrounding the nipple). Baby should never suckle the nipple alone as this will cause pain and inadequate milk let-down.
All this may seem like a lot of information to take-in but with practice and support, this will eventually get easier until it becomes second nature.
Matured breast milk
Matured milk is usually produced by the 2nd week of life. There are two types of milk that is secreted by the mammary glands – foremilk and hindmilk. Foremilk is the thinner watery form of breast milk, as the name suggests, it is the milk that comes out first when feeding. This is high in water content and this is one reason why babies do not need any external supply of water until they become 6 months of age. Hindmilk is rich in fat and creamier. This is what helps the baby put on weight over time. Feeding time at a single breast can vary anywhere between 20 minutes to 40 minutes. It is important to ensure the baby has fed fully at one breast and not keep shifting breasts – this will result in the baby only receiving the foremilk.
How do I know if baby is getting enough milk?
Ideally, mothers would wish to know exactly how much milk she is giving to her baby and whether this is enough. However, as breastfeeding is so natural, there is no real way to measure the amount. Mothers have to rely on several signs to decide if her breast milk is enough and these include:
- Feeds 8-12x/day on demand feeding (every 2-3 hours)
- After baby is 3-5 days of life and consistently breastfeeding,
- At least 2-5 stools/ day
- Wet diapers
- Disposables 5-6x/day
- Cloth 6-8x/day
- Baby feeds at least 10-20 min on each side
- Baby looks satisfied after feeding
- Breasts feels softer after feeding
- GOOD WEIGHT GAIN – it is normal to lose weight in the first week but baby will usually regain birth weight by 2nd week of life
However, in the first few days of life, while feeding colostrum and waiting for mother’s milk to “come-in”, very little colostrum is required.
It is hoped that as a mother approaches her delivery date, she will be armed with adequate knowledge on breastfeeding to enhance her confidence in her initial breastfeeding journey. If there is any difficulty in breastfeeding, do consult your paediatrician, lactation consultant or breastfeeding counsellor. Do not give up! Once the hurdle is overcome, breastfeeding will be an experience and a memory treasured forever.
To know more about Dr Melanie Majaham, kindly check here
Do you have any further questions regarding breastfeeding and paediatrics? Feel free to ask your questions in the comments section.