Breastfeeding: What you need to know


The hormonal basis of breastfeeding

The breasts prepare themselves for lactation during the nine months of pregnancy under the influence of hormones like oestrogen (stimulation development of milk ducts), progesterone (stimulates development of milk glands) and prolactin (triggers milk production).

After delivery, the oestrogen and progesterone levels decrease. When the baby suckles, in response to nipple stimulation, the pituitary gland in the brain releases the hormone prolactin, which produces milk, and the hormone oxytocin, which promotes milk ‘let down’ or ejection. Thus, suckling is essential to milk production and release. More frequently the mother suckles, better is her milk output. Milk output is a matter of demand and supply. The more the needs of the baby, and more frequently that the baby feeds, more the milk production.

The hormone oxytocin, also known as the love hormone, produced during breast feeding, is responsible for the bonding and the maternal instinct to a large extent. It also helps the uterus to contract and come back to its original pre pregnancy size and reduces bleeding. These hormones have a soothing effect on the mother and baby, which relaxes the twosome too.

Root reflex and suck reflex

Babies have primitive reflexes to help them survive. When the mother gently touches the baby’s cheek or lips with her nipple, the baby instinctively turns to the nipple with mouth open. That is known as the ‘rooting reflex’. The baby is now ready to suck.

Positioning and Latching on

The position of the mother and baby vis-a-vis each other is very important. It is important to get the perfect latch. The mother should give her whole breast in the baby’s mouth (which should be wide open), rather than just her nipple. A good latch on is very important to prevent nipple soreness and cracks.

Patience and persistence are the key to a successful ‘tuning’ between mother and baby. If the baby is sick or premature, he/she may not be able to suckle well and may need expressed feeds.

Foremilk and hindmilk

The milk which is first drawn during feeding is known as the foremilk. It is more watery and contain less fat and satisfies the baby’s thirst.

Hindmilk is the milk which follows during feeding. It is higher in fat and calories. It is important to satisfy the baby’s hunger, and for his health and growth.

If you feed only for a short time at one breast, the baby only gets the foremilk and gets hungry soon, demanding frequent feeds and cries often. Hence, feed the baby adequately at one breast before switching to the other one or unlatching your baby.

Recommendations for breastfeeding

Exclusive breastfeeding until 6 months of age, and as much breastfeeding as possible, till one year of age, along with supplementary feeds. Breast feeding should be continued upto the age of two years and beyond, if desired.

WHO recommendation

The vast majority of mothers can and should breastfeed, just as the vast majority of infants can and should be breastfed. Only under exceptional circumstances can a mother’s milk be considered unsuitable for her infant. For those few health situations where infants cannot, or should not, be breastfed, the choice of the best alternative – expressed breast milk from an infant’s own mother, breast milk from a healthy wet-nurse or a human-milk bank, or a breast milk substitute fed with a cup, which is a safer method than a feeding bottle and teat – depends on individual circumstances.

The WHO recommends exclusive breastfeeding for the first six months of life, after which “infants should receive nutritionally adequate and safe complementary foods while breastfeeding continues for up to two years of age or beyond.

UNICEF, WHO and WABA along with the scientific community strongly recommend initiating breastfeeding within half an hour of birth. Evidence shows that early initiation can prevent 22% of all deaths among babies below one month in developing countries. Every newborn, when placed on the mother’s abdomen, has ability to find its mother’s breast all on its own and to decide when to take the first breastfeed. This is known as the ‘Breast Crawl’.

Mother’s nutrition while she is breastfeeding

A nursing mother produces 750 ml of milk per day, containing 300 milligrams of calcium.

About 500 calories per day are lost in breast milk and the mother needs to add that to her daily intake.

The mother produces milk from the nutrients in her blood and hence, she needs a wholesome balanced diet. Plenty of fruits and vegetables with whole grain breads and cereals, along with dairy products are recommended.

Water intake should be high as a lot of water goes into milk production.

Protein requirement increases greatly as milk contains high amount of protein.

Iron is important as the new mother has been through pregnancy and delivery, both of which drain her iron stores.

Eating smaller portions more frequently is important to prevent decrease in sugar levels.

Top feeds vs breastfeeding

Infant formulae can never be the same as breast milk as the composition of breast milk is not completely known and it changes as per the baby’s needs.

Cow’s milk

Infants fed whole cow’s milk don’t get enough vitamin E, ironiron, lactose and essential fatty acids.

They also get too much protein, sodium, and potassium. These levels may be too high for the infant’s system to handle. Also, whole cow’s milk protein and fat are more difficult for an infant to digest and absorb. And your baby may develop allergy to cow milk protein.

Buffalo’s milk

The fat and solute content is higher and can overload his delicate digestive tract. Constipation is more common in bottle fed babies (Any kind of milk substitute).

There are certain conditions wherein a mother cannot or should not breastfeed for various reasons.

Conditions when breastfeeding is not recommended

Certain infections in the mother such as active tuberculosis, HIV infection, HTLV -1 infection (which causes some types of cancer) When the baby is suffering from a condition called galactosemia (a rare genetic disorder in which the infant cannot digest lactose and galactose)

When the mother is on certain medications such as anticancer chemotherapy, radioactive iodine treatment, lithium, etc.

Substance abuse by the mother (cocaine, heroin, LSD)

Tips for the breastfeeding mother

Get educated about breastfeeding in your pregnancy itself to save yourself trouble after delivery.

Initiate nursing as soon as possible, within half an hour of delivery if possible.

Keep a flexible, ‘on demand’ schedule.

Make yourself comfortable, whatever position you choose.

Sleep when your baby sleeps.

Get enough rest and ask for help with chores.

Do not restrict the duration or frequency of feeds.

Learn to pick up feeding ‘cues’ from your baby.

Feed one breast at a time, giving adequate time. Give the other breast when he unlatches himself.

Burp your baby after every feed.

Seek help from a lactation consultant if faced with any difficulty.

Difficulty in lactation which may lead to failure to feed:

Nipple confusion (feeding using bottle… baby may get used to the bottle and turn down the breast)

Stressors – mental as well as physical, which can suppress pituitary hormones

Attitude of the mother … lack of confidence and negative thoughts due to myths and

improper education

Inverted nipples, sore nipples

Engorged breasts

Weak or premature baby (who is unable to suck effectively)

Adding top feeds (which decreases demand and consequently supply)

Sick mother (not enough milk)

Support from the spouse and family are very important to boost her confidence and help her physically cope up with the challenges of motherhood in a positive manner.

How to know milk supply is adequate

1. Your baby seems relaxed and satisfied and your breast feels soft and supple after feeding

2. Your baby is gaining weight and is adequately hydrated

3. He/she is wetting her diapers about 6 to 8 times a day (varies widely), after the first few days

Some common myths related to breast feeding

1. Smaller breasts won’t get enough milk.

Truth: Size has nothing to do with it.

2. If I squeeze to check, and there are only a few drops of milk coming out, it means I am not

producing enough milk.

Truth: Milk pours well after a while of suckling. Hence, this is a wrong way to check if you are

producing enough milk.

3. You should not feed your baby if your nipples are bleeding.

Truth: Swallowed blood does not harm your baby. He/she may pass it as stools or vomit it out.

4. Colostrum is harmful to my baby.

On the contrary, it has protective antibodies for your little one and is high in proteins.

5. Milk output is not enough in the first few days.

Truth: Baby’s stomach capacity is small and thus his needs are low in the first few days.

6. The mother should wash her breasts each time she breastfeeds.

Truth: Repeated washing removes protective oils over the nipples, leading to dryness and soreness.

7. My baby should have a fixed feeding schedule, otherwise he/she will not gain weight.

Truth: Feeding schedules vary greatly and a healthy baby will demand feeds as per his/her needs. Be flexible and relaxed, unless there are warning signs.

Dr Suman Bijlani
The author is a leading gynaecologist and obstetrician consulting at the SL Raheja Fortis and Kohinoor Hospitals

Image: Wikimedia Commons