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Lactation Course for Nurses at Rainbow Children’s Hospital
Rainbow Children’s Hospital is conducting a 20 hours certification course for nurses at a part of the Breastfeeding Support Group. To know more about the course, please connect with us at Click here
Importance and benefits of Breastfeeding
Being a mother can be wonderful yet scary at the same time. There are so many expectations that it can be overwhelming at times. In moments like these is when every mother deserves a strong support system. This is what we hope to achieve through the Breastfeeding Club and Breastfeeding Support Group. We aim to make this a safe space for open dialogue regarding breastfeeding.
- Breastfeeding… this is a process of feeding your infant or toddler with breast milk directly from female breast and this is called lactation as well.
- It is the best and highly-followed way to provide nutrients to children for their healthy growth and development.
- When infant and during early childhood, the baby needs adequate nutrition to endure there is proper growth, health and development to their full potential.
- Poor levels in nutrition may increase the risk of falling sick frequently and can be directly or indirectly responsible for one third of the estimated deaths that caused to children under the age of 5.
- Adequate Nutrition starts right after birth- i.e. in the initial 1 hour.
Importance of BreastFeeding
From the moment you bring your little one into this world, several people will ask you if you are breastfeeding your baby. They will tell you that you have to do it and that it is important. But here's a little secret, most people don't truly know why it is important. The common assumption is that breastfeeding is what all mothers should do. More than making it a blind rule, we want to help you understand the importance of breastfeeding your child.
- 3 in every 5 newborns are not breastfed right in the first hour after their birth.
- When it comes to exclusive breastfeeding till the age of 6 months, only 41% of infants are breastfed across the globe.
- Over 820 000 children could be saved yearly if all children under the age of 23 months were breastfed optimally.
- Every year, around 45% of child deaths are due to malnutrition.
- In the year 2020, across the world, 149 million children under 5 were estimated to be stunted (too short for age), 45 million were estimated to be wasted (too thin for height), and 38.9 million were overweight or obese.
A. Benefits to Infant/Child:
Being a breastfeeding mother is a true superpower. Your body is wonderfully producing all the sustenance that your little one needs to thrive from day one. Breast milk benefits your baby in more ways than one. There are several benefits it has for babies, nutrition is only one of them. Here are a few key benefits.
- It contains everything a baby needs for first 6 months of life.
- Breastmilk is physiological
- Microbiologically and Biochemically superior
- Sweetest milk
- High Lactose content
- Low protein as compared to cow’s milk but made more of whey protein which is easily digestible.
- Low solute load hence gentle on immature infant’s kidney.
- Microbiologically it is sterile and least chance of contamination.
- It protects infants against various infections such as upper respiratory infections including otitis media and gastro-intestinal infections.
- Breast milk comprises immunoglobulins and Secretory IgA which offer surface protection to respiratory and GI tracts.
- It supplies passive immunity.
- It consists Lactoferrin which is bacteriostatic and inhibits E.coli.
- Its elements Peroxidases and Lipases kill bacteria, Bile Salt Stimulated Lipase (BSSL) kills amoeba and giardia, and Para- amino Benzoic acid (PABA) is important in protection against malaria.
- Amino acids, that are present in the breast milk help in the development of the brain.
- The ratio of Cysteine and Methionine is high and that plays a key role CNS development.
- Rich in Taurine: important neurotransmitter and neuromodulator for brain and retina.
- Breastmilk rich in EFA and LCPUFAs
- Arachidonic and Docosa Hexanoic acid (DHA) are important for Neural and visual development- reduces dyslexia and hyperactivity.
- Breastmilk contains growth regulating factors, growth promoting factors and growth modulators like TSH, thyroxine, GHRF, insulin, Somatostatin, Nerve growth factor
- Breastfed children: score higher on cognitive and IQ tests at school age, and also on tests of visual acuity.
- Also exclusively breastfed preterm have shown higher IQ score and lesser neurological sequelaes with better cognitive abilities.
- Lower incidence of sudden infant death syndrome (SIDS)
- Lower risk of the two most common inflammatory bowel diseases (Crohn’s disease, ulcerative colitis)
- Significantly protected against asthma and eczema,
- Lower risk of obesity in childhood and in adolescence
- Good dental hygiene: have fewer cavities and are less likely to require braces.
- Suffer less often from some forms of cancer (e.g., Hodgkin’s disease, childhood leukemia)
- Lower risk of juvenile onset diabetes.
B. Benefits to mother:
Here is a fact that most people don't know - breastfeeding benefits the mother just as much as it benefits the baby. Yes, by breastfeeding, you are not only providing your baby with nutrition and protection, but you are also taking care of yourself. Now do you see why we say that being a breastfeeding mom is a superpower?
- Breastfeeding offers a range of benefits for mothers as well as their children.
- Women who have breastfed are less likely to develop ovarian and premenopausal breast cancers.
- The more months a woman has spent breastfeeding, the greater the beneficial effect.
- Breastfed mother have lower rate of Type 2 Diabetes and high blood pressure.
- Breastfeeding reduces osteoporosis.
- Breastfeeding mothers enjoy a quicker recovery after childbirth, with reduced risk of postpartum bleeding.
- Exclusive breastfeeding may reduce the risk of anemia by delaying the return of the menstrual cycle for 20 to 30 weeks.
- Mothers who breastfeed are more likely to return to their pre-pregnancy weight than mothers who formula feed.
- Breastfeeding reduces the risk for long-term obesity.
- Natural contraception: Exclusive breastfeeding for the first 6 months postpartum, in the absence of menses, is 98 percent effective in preventing pregnancy.
- Breastfeeding mothers are reported to be more confident and less anxious than bottle-feeding mothers.
- Reduces post-partum depression
- Breastfeeding contributes to feelings of attachment between a mother and her child: mother-infant bonding.
C. Benefits to society/ Epidemiological benefits:
Did you know that breastfeeding is a matter of public health? Yes, studies have proven that communities with a higher rate of breastfed babies have better health. There are fewer diseases risk seen in these communities. The overall health of the community is better with just the simple process of breastfeeding.
- Convenient
- Economical
- Safe for environment
- It is estimated that a breastfed child is 14 times less likely to die from diarrhoea, 4 times less likely to die from Respiratory disease and 2.5 times less likely to die from other infections than a non-breastfed infant
Common Breastfeeding Conditions
Breastfeeding is not always easy. Every breastfeeding mother suffers from at least one condition that makes the process a little tough. But the rewards of breastfeeding are greater. We would like you to understand the different common conditions seen in breastfeeding women and what can be done to address them.
Fullness of Breasts
- Commonly seen 3-5 days after delivery when breast milk “comes in”
- Breasts feel heavy, hot and hard. Sometimes lumpy
- Milk flows well
Cause- Normal fullness
- Management- Frequent feeds with good attachment
- Resolves after the production of milk adjusts with the baby’s needs
Breasts are swollen, oedematous and skin looks red and shiny
- Affects both breasts diffusely. Painful
- May have fever that subsides in 24 hours
- Nipples become flat and stretched making latching difficult
- Milk does not flow well
Cause
- Delayed initiation of breastfeeding
- Infrequent feeds
- Poor attachment/ineffective suckling
Management
- Milk expression- Manual or Breast pump till the breasts are softer so that baby can attach better
- Frequent feeds
- Pain relief with paracetamol
- Warm compress/ warm shower before expression to allow the milk flow. Cold compress after feeding or expression to relieve congestion
- Breast support
Condition
- A tender localized lump in one breast with redness of skin overlying the lump.
- Untreated, can lead to Mastitis
Cause
- Failure to remove milk from one part of the breast due to poor attachment, tight clothing, trauma to the breast
Management
- Gently massage over the lump before feeding
- Frequent feeding from the affected breast
- Changing position of the baby
Condition
- Hard swelling, redness and severe pain
- Mostly affect only a part of one breast
- Mother has fever and feels sick
- Usually 2-3 weeks postpartum but can occur anytime
Cause - Milk stasis causes non infective inflammation
- Long gaps between feeds ( when mother resumes employment or when baby sleeps through the night)
- Incomplete feeds ( poor attachment/latching)
- Trauma
- Nipple fissure
Management
- Mother should take rest
- Should not stop breastfeeding – start feeding from the unaffected breast to allow the milk let down followed by frequent feeding from the affected breast
- Alternate warm and cold compress to the affected breast
- Analgesics- Paracetamol or ibuprofen
- Antibiotics if no relief in 24 hours
Condition
- Infective Inflammation of breast tissue
- Painful swelling of one breast, full of fluid, skin discoloration, fever
Cause
- Usually secondary to Mastitis which has not been effectively managed
Management
- Drainage of the affected breast (incisional drainage or syringe drainage)
- Antibiotics and analgesics
- Continue feeding from the affected breast
Condition
- Severe pain during suckling.
- Nipple becomes squashed from side to side at the end of a feed
- Visible pressure line at the tip of nipple or at the base
Cause
- poor attachment or poor suckling leading to pulling over the nipple pressing against the hard palate of the baby
Management
- Proper attachment-- almost always instant relief from pain. If latching is poor, break the suction at the beginning and feed after proper latching
- Breast cushions between the feeds to prevent friction.
- Rubbing the breast milk over the nipple and areola at the end of breastfeed prevents soreness and heals the fissure
- Air dry the nipples in between feeds. Avoid using harsh soaps or cleansers
- Feed from the normal breast first, use breast pump or manual expression to empty the affected breast, this allows the nipple to heal and prevent engorgement
Condition
- Symptoms in Mother- Sore nipples with pain continuing between feeds. Pain not relieved by improved attachment
- Red or flaky rash over the areola with itching and depigmentation
- Symptoms in Baby- white spots inside cheeks or over the tongue that cannot be removed easily
- Some babies feel distressed when they try to attach or feed, suggesting a sore mouth
- There may be an associated red rash over the nappy area (Diaper dermatitis)
Cause
- Fungal infection Candida albicans , Often following the use of antibiotics in mother or baby
Management
- Both mother and baby should be treated with Gentian violet paint or Nystatin
Condition
- Flat nipples are protractile- if mother pulls them out, they stretch in the same way as in baby’s mouth
- Inverted nipples are mostly non protractile- does not stretch when pulled and the tip goes in. Makes it difficult to latch.
- Large or long nipple makes it difficult for the baby to take most breast tissue into the mouth
Management
- Milk expression and feeding with cup
- Express milk into the baby's mouth, and touch the lips to stimulate the rooting reflex and encourage the baby to open his or her mouth wider.
- Breast pump to get the milk flowing and pull the nipples out as much as possible before placing baby at the breast for a feed
- Nipple shields are thin, silicone shields that fit over the nipple that help the nipple protrude more, which makes latching easier
- For inverted/ flat nipples, a mother can use a 20 ml syringe, with the adaptor end cut off and the plunger put in backwards to stretch out the nipple just before a feed
Condition
- Breast augmentation, lift and reduction procedures potentially affect nerves and ducts within the breast, thus affecting lactation
- Breast implants below the muscle affect milk production
- The amount of milk made will depend on the number of connected ducts and functionality of the nerves that enable lactation, as well as other factors apart from the surgery, such as hormones and milk expression
- Partial / total mastectomy can reduce the capability to breastfeed or produce breast milk
- A single breast can produce enough breast milk for healthy infant growth.
Management
Prenatal support:
- Talk with mothers who have had breast surgery about the type of surgery, placement of incisions, and underlying reasons for the surgery to understand the potential for reduced milk production.
- Examine mothers’ breasts to identify possible insufficient glandular tissue and provide anticipatory guidance for breastfeeding support.
Postpartum support:
- Closely monitor infants of mothers who have had breast surgery to be sure that the infant receives optimal nutrition for growth.
- When mothers present with insufficient milk production postpartum, inquire about prior breast surgery as part of your assessment.
- Refer to an International Board Certified Lactation Consultant (IBCLC) to teach mothers who have had breast surgery how to stimulate production and/or how to supplement with pasteurized donor human milk or formula
Myths and Facts
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Babies are born with the reflex to look for their mother’s breast. Breast feeding a natural process, however many mothers need practical support with positioning their baby for breastfeeding and making sure their baby is correctly attached to the breast. Breastfeeding takes time and practice for both mothers and babies. Breastfeeding is also time intensive, so mothers need space and support at home and work.
Many mothers experience discomfort in the first few days after birth when they are learning to breastfeed. But with the right support with positioning their baby for breastfeeding and making sure their baby is correctly attached to the breast, sore nipples can be avoided. If a mother faces breastfeeding challenges like sore nipples, support from a lactation consultant or other skilled professional can help them overcome the issue.
Washing your nipples before breastfeeding isn’t necessary. When babies are born, they are already very familiar with their own mother’s smells and sounds. The nipples produce a substance that the baby smells and has ‘good bacteria’ that helps to build babies’ own healthy immune system for life.
Doctors, nurses and midwives often encourage the practice of ‘skin-to-skin’ – also known as kangaroo mother care – immediately after birth. Bringing your baby in direct contact, so their skin is against yours, is a very important practice that helps them to find and attach to the breast. If you can practice this within one hour after birth and then frequently after, it helps to establish breastfeeding. If the mother cannot do this, then the partner or another family member can step in. Fact: Simply stated: ‘the more you feed, the more milk you make’.
Like everybody else, breastfeeding mothers need to eat a balanced diet. In general, there is no need to change food habits. Babies are exposed to their mother’s food preferences from the time they are in the womb. If a mother perceives that her baby reacts to a specific food she eats, it is best to consult a specialist.
Exercise is healthy, also for breastfeeding mothers. There is no evidence that it affects the amount and taste of your milk.
It is easier to get breastfeeding started if you begin in the first hour after birth because a baby’s reflexes are very strong at that time. They are ready to learn to feed at the breast. If you do not latch your baby on right after birth, do it as soon as possible in your situation. If you need help putting your baby to the breast, ask for support from a qualified lactation consultant or other skilled professional. Frequent skin-to-skin contact and putting your baby to the breast will help to get breastfeeding going.
Almost all mothers produce the right amount of milk for their babies. Breastmilk production is determined by how well the baby is latched on to the breast, the frequency of breastfeeding and how well the baby is removing milk with each feeding. To keep breastmilk production going, continue offering the breast to your baby as often as possible. Breastfeeding isn’t a ‘one woman’ job and mothers need support. Support like ongoing breastfeeding guidance from health care providers, help at home, and staying healthy by eating and drinking well.
Some of you may not make milk for the first 3 to 5 days after delivery however you make a thick concentrated liquid called Colostrum. This is rich in all the nutrients that are required for the new born baby.
Breast milk is easier to digest than formula milk which is probably why your baby is requiring frequent feeds. Needing a feed every 2 to 3 hours is normal for new born babies.
Studies have shown that even malnourished women are able to produce milk of sufficient quality and quantity to support a growing infant. Most cases low weight gain are related to insufficient milk intake or an underlying health problem in the baby.
Depending on the kind of illness, mothers can usually continue breastfeeding when they’re sick. You need to make sure you get the right treatment, and to rest, eat and drink well. In many cases, the antibodies your body makes to treat your disease or illness will pass on to your baby, building his or her own defences.
It’s important to inform your doctor that you are breastfeeding and to read the instructions with any medications you buy over the counter. It might be necessary to take medications at a specific time or in a specific dosage, or to take an alternative formulation. You should also tell the baby’s doctor about any medications that you’re taking
All babies are different. Some are clingy and some are not, no matter how they are fed. This is an absolute myth however formula fed babies may sleep longer. Breastfeeding provides not only the best nutrition for infants, but is also important for their developing brain. Breastfed babies are held a lot and because of this, breastfeeding has been shown to enhance bonding with their mother.
There’s no evidence that it is more difficult to stop breastfeeding after one year, but there is evidence that breastfeeding up to two years is beneficial for both mothers and children.
Many mothers continue breastfeeding after going back to work. If you have the right to time and a place to breastfeed during working hours, you may be able to go home and breastfeed, ask a family member or friend to bring your baby to you, or to express your milk and take it home. If you decide to give your baby a breastmilk substitute for some feeds, it still very good. to continue breastfeeding whenever you are with your baby