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Guidelines For The Nursing Mother

by Kathleen Huggins, R.N., M.S.

SINCE THE BEGINNING OF HUMANKIND, WOMEN HAVE PUT THEIR INFANTS TO BREAST.. Extending the physical bond that begins at conception, they have nourished and protected their young with their bodies. These tender moments, in return, have brought pleasure and fulfillment to the task of mothering. If you are now pregnant, you are probably looking forward to the time in which you will nourish, comfort, and protect your child in the same way as others before you–at the breast.

Perhaps you already feel committed to the idea of nursing. For you, there is no question that you’ll breastfeed your baby. Or perhaps, like many women, you have some uncertainties, but still feel it’s worth a try. Your outlook depends on many things–the value you place on breastfeeding, how your partner feels about it, how your friends have fed their babies, your lifestyle, your feelings about yourself and your body.

You probably also have some notions about what nursing will be like. Perhaps you think it will be easy and convenient. Maybe you worry that it might not fit in with your activities and plans. You may have concerns about your ability to nurse. Probably you know of other women who tried to nurse but soon gave up. Whatever your attitudes, expectations, and concerns about breastfeeding, these may become powerful determinants in your ultimate success or failure to nurse your baby happily.

Is Breastfeeding Really Better?

You may be under the impression that the decision to breastfeed or bottle-feed is simply a matter of personal preference. Don’t let anyone fool you into believing that breast milk and formula are equally good–they are not. Without a doubt, mother’s milk alone promotes optimum health and development for babies. It is uniquely designed to meet the complete nutritional needs of the growing human infant. It also protects the infant against illness throughout the entire first year and beyond, as long as nursing continues.

Although babies do grow on processed infant formulas, formula manufacturers are continually challenged to include all of the nutrients in breast milk that scientists are gradually identifying as important to infant growth and development. But artificial infant milks, whether based on cow’s milk or soybeans, will never be able to duplicate nature’s formula. Human milk contains proteins that promote brain development and specific immunities against human illness. In contrast, cow milk contains proteins that favor muscular growth and specific immunities to bovine disease. Babies, like all young mammals, do best with milk from their own species. Babies on a formula diet are at greater risk for illness and hospitalization. Diarrheal infections, respiratory illnesses, and ear infections are more frequent and serious among these babies. Formula-fed infants also have higher incidences of colic, constipation, and allergic disorders. In fact, a significant number of babies are allergic to formulas, both those based on cow milk and those based on soy. There is also new evidence that artificially fed infants more often experience learning disorders and lower levels of intellectual functioning.

Bottle feeding with formula more commonly leads to overfeeding and obesity, which may well persist into childhood, adolescence, and adulthood. Tooth decay, malocclusion (improper meeting of the upper and lower teeth), and distortion of the facial muscles may also directly result from sucking on bottles.

Some studies suggest the benefits of breastfeeding also extend into adulthood. Breastfed babies have lower cholesterol levels, on average, when they become adults. Although asthma rates are not significantly different between breastfed and non-breastfed babies, there is a lower rate of asthma in adults who were breastfed. Babies have a smaller chance of developing diabetes and cancer of the lymph glands if they are breastfed. For all of these reasons, the American Academy of Pediatrics recommends that infants be offered only breast milk for the first four to six months after birth, and that breastfeeding continue throughout the entire first year.

Establishing a close bond and meeting the emotional needs of a child are certainly an essential part of mothering. The nursing woman is thought to produce hormones that promote a physiologic bonding between mother and child. And in what better way can a baby be nurtured, comforted, and made to feel secure than snuggled within his mother’s loving arms, against the warmth of her breast? Although some rationalize that bottle-feeding mothers can capture a similar warm feeding relationship, in reality they do not. This is partly because bottle feeding doesn’t require much human contact. The bottle-fed baby generally receives less stroking, caressing, and rocking than the breastfed baby. He is talked to less often and he spends more time in his crib away from his parents. Although it is unknown how prevalent the practice of propping bottles for the young infant is, probably the overwhelming majority of babies who are able to hold their own bottles become almost entirely responsible for feeding themselves.

In the Beginning

Throughout the first two hours after birth, the infant is usually alert and eager to suck. At this time he is most ready for his first nursing.

Colostrum. It is not unusual to hear a first-time mother tell a nurse, “I don’t think I have anything yet to feed the baby.” Although small in amount, colostrum. is available in the breast in quantities close to the stomach capacity of the newborn. This “liquid gold,” which is often yellow but may be clear, resembles blood more than milk in that it contains protective white blood cells capable of attacking harmful bacteria. Colostrum also acts to “seal” the inside of the baby’s intestines, preventing the invasion of bacteria, and provides the baby with high levels of antibodies from the mother. Not only does colostrum thus offer protection from sickness, but it is the ideal food for the newborn’s first few days of life. It is high in protein and low in sugar and fat, making it easy to digest. Colostrum is also beneficial in stimulating the baby’s first bowel movement. The black, tarry stool, called meconium, contains bilirubin, the substance that causes newborn jaundice. Colostrum in frequent doses helps eliminate bilirubin from the body and may lessen the incidence and severity of jaundice.

In the hospital this first nursing may take place in the delivery room, the birthing room, or the recovery area. With minimal assistance from your nurse or partner, the baby will probably latch on eagerly to the breast and suck. He will be more willing if he is unbundled; snuggled within your arm and next to your body, he is unlikely to get too cold (unless perhaps the room is air-conditioned). The purple color of his hands and feet is normal; it is caused by changes in blood circulation that take place at delivery. If you or the nurse is concerned about the cold, place a blanket over the baby after he has begun to nurse.

Many specialists believe that when the first nursing is delayed much beyond the first two hours, the infant may be somewhat reluctant to take the breast thereafter. Nursing without delay also boosts the confidence of the mother, and stimulates the action of hormones that cause the uterus to contract and remain firm after delivery. These contractions may help speed delivery of the placenta and minimize blood loss afterward (breastfeeding alone is insufficient, however, in the case of postpartum hemorrhage, when prompt intervention by the medical staff is essential). During the first few days after birth, some mothers feel these contractions, or “afterpains,” while nursing. Mothers who have had other children may be especially uncomfortable with afterpains.

Should you not have the opportunity to nurse right after delivery, or if you can’t persuade your baby to take the breast, don’t get discouraged. Many mothers have established successful nursing hours or days after giving birth.

Just the breast. When you have finished your first nursing in the hospital, let the nurses know (if you have not done so previously) that you prefer your baby be given no supplementary bottles of water or formula and no pacifiers. Water or formula is unnecessary and may confuse your baby while he is learning to breastfeed.

Newborns do not normally require any fluids other than colostrum (the exception is the baby who has low blood sugar–because her mother is diabetic, her birth weight was low, or she underwent unusual stress during labor or delivery). Supplemental feedings, moreover, can be harmful: they may cause the baby to lose interest in the breast and to nurse less frequently than needed. This is because bottle nipples may (1) lessen the baby’s instinctive efforts to open her mouth wide, (2) condition her to wait to suck until she feels the firm bottle nipple in her mouth, and (3) encourage her to push her tongue forward–the opposite of what she needs to do while nursing. The baby who has sucked on bottle nipples may also become frustrated while nursing, since milk does not flow as rapidly from the breast as it does from the bottle.

Some hospitals now have policies against giving bottles to nursing newborns, but not all do. To be sure all the nurses know of your preference, ask them to place a sign on the baby’s crib like this one: To all my nurses:

While I’m here and learning to breastfeed, PLEASE, NO BOTTLES OR PACIFIERS. My mom will be happy to nurse me whenever I fuss.

Thanks!! Baby Reynolds

Time at the breast. Many doctors and nurses tell mothers that to prevent sore nipples they should limit their nursing time during the first several days. Probably nothing else about breastfeeding is as poorly understood as the causes of sore nipples. It may be explained that keeping feedings short will prevent soreness and will help “toughen” the nipples. Actually, sore nipples usually result from improper positioning of the baby on the breast, not from long nursings. Another myth often heard by new mothers is that the breast “empties” in a prescribed number of minutes. Most newborns require 10 to 45 minutes to complete a feeding. As long as your positioning is correct and nursing is comfortable, there is no need to restrict your nursing time. Besides being unnecessary, limiting nursing time may frustrate the baby and lead to increased engorgement when milk production begins.

Positioning at the breast. A baby is correctly positioned at the breast when his gums are on top of the areola, the dark area around the nipples. In this position he will compress the sinuses located beneath the areola to draw out milk. If he instead latches on only to the nipple and starts “chewing,” the nipple will probably become sore and cracked, and perhaps even bleed. The baby will also be unable to com press the sinuses beneath the areola and may therefore get too little milk.

Probably the most important skill for you to master, initially, is that of getting the baby on the breast correctly. Some mothers can do this easily, but many need practice. It helps to unwrap the baby first. This will encourage his interest in latching on and make it easier for you to check his position.

The “cradle” or “cuddle” hold, in which the baby’s head is held in the crook of the mother’s arm, is considered the classic breastfeeding position. I have come to believe that for most new mothers and babies this position is usually not the easiest or most effective for getting a baby well latched on to the breast. In the first few weeks after birth, a baby hasn’t developed enough muscular coordination to easily latch on without help; she needs a good deal of direction from her mother. But it is difficult to direct a newborn’s head accurately with the inside of one’s forearm. Although most mothers sooner or later begin using the cradle hold for most of their daytime nursings, in the early days of breastfeeding the cross-over and football holds are generally more useful.

The cross-over hold. Take time to position yourself comfortably. If you are nursing in a hospital bed, sit up as straight as possible with a pillow behind you. As soon as you are able, sit in a chair with arms (most couches are too deep). Place one or two pillows on your lap so that the baby is lying on his side at the level of your breast. Instead of holding his head in the bend of your elbow as in the cradle hold, hold him with the opposite arm, so that your hand rests between the shoulder blades and supports the back of his neck and head. Place your thumb behind and below one ear and your other fingers behind and just below the other. Position the baby’s face directly in front of your breast, instead of pushing your breast sideways toward the baby.

If you’re starting on the left breast, hold it with your left hand so that your thumb is positioned about 11/2 inches from the nipple, at the spot where the baby’s nose will touch the breast, or at about two o’clock if you imagine a clock face printed on the breast. Your index finger should be at the same distance from the nipple, at the spot where the baby’s chin will touch the breast, or at about eight o’clock. Compress the breast at the margin of the areola with your thumb and index finger, so that your hand forms almost a U-shape. Compressed this way, your breast should closely match the shape of your baby’s mouth, so that he can take in more of the breast.

With the baby and breast in position, you are ready to proceed. Your goal is first to stimulate the baby to “root,” and then to bring him onto the breast. Touch the baby’s lips to your nipple until he opens wide. When he opens his mouth really wide-0and not before–quickly bring him onto the breast. Do not lean toward the baby; bring his shoulders and head to you. When you pull the baby in, keep the areola compressed until he begins sucking. The two mistakes mothers tend to make is letting go of the breast before the baby is well latched on and not pulling the baby on far enough. You may need to repeat these steps several times before the baby latches on correctly. Once the baby is actively nursing, you’ll probably need to support the breast for him, by gently pressing your fingers against the underside. If your breasts are small, though, you may be able to let go of your breast or even switch arms and continue nursing using the cradle hold. Football hold. The football hold is a great position when–

  • You have had a cesarean birth and want to avoid placing the baby against your abdomen.
  • You need more visibility in getting the baby to latch on.
  • Your breasts are large.
  • You are nursing a small baby, especially if he is premature.
  • You are nursing twins.

Sit in a comfortable armchair with a pillow at your side to help support your arm and lift the baby. Support the baby in a semi-sitting position facing you, with her bottom at the back of the chair. Your arm closest to your baby should support her back, with your hand holding her neck and head. Place your thumb behind and below one ear and your other fingers behind the other. The top of the baby’s head should be as high as the top of your breast.

Support your breast with your free hand so that your thumb is about 1 1/2 inches from the nipple at twelve o’clock and your index finger is the same distance from the nipple at six o’clock. Compress the areola with your thumb and index finger, so that your hand forms a C-shape. This will more closely match your breast to the shape of your baby’s mouth, so she can take in more of the breast. As with the cross-over hold, stimulate the baby to open her mouth wide, and bring her onto the breast.

Side-lying position. The side-lying position is an especially good choice for nursing when–

  • You must be flat after a cesarean birth.
  • You are uncomfortable sitting up.
  • You need help from someone else to get the baby latched on.
  • The baby is sleepy and reluctant to begin nursing or stay awake very long.
  • You are nursing during the night.
  • You and your baby lie on your sides, tummy to tummy, as with the cuddle hold. Place your fingers beneath the breast and lift upward, then pull the baby in close after he roots with a wide open mouth.

Ending the feeding. Waiting until your baby lets go of the nipple is the ideal way to end a feeding. If the baby does not come off the breast by himself after 20 to 25 minutes on a side, and you want to switch breasts or rest awhile, you can take him off by first breaking the suction. Even if he is not actively sucking, his hold on the nipple is tremendously strong. To release the suction, pull down on his chin or insert your finger into the corner of his mouth, pushing your finger between his gums until you hear or feel the release. You can also try placing your finger on the corner of the baby’s mouth and pulling the skin gently towards his ear.

After taking the baby off the breast, leave your bra flaps down so that the air can dry your nipples. Air drying helps to maintain healthy nipples.

Excerpt reprinted with permission from foxcontent.com