Archive for July, 2008
Recommendations
A balanced, varied diet and drinking plenty of fluids (at least eight glasses of water a day) is very important during breastfeeding, to ensure that mother and baby are in the best of health. Breastfeeding requires at least an additional 500 calories per day. Much of this energy can be derived from fat stores laid down during pregnancy. However, remembering to eat when you are hungry, and drink when thirsty is essential.
Some substances pass into breast milk from the mothers body. Although generally less than 1% of any drug will pass through, it is wise to reduce or avoid your intake of anything likely to unsettle or irritate your baby. For example, nicotine, alcohol, caffeine or illegal drugs can affect feeding, sleeping and digestion. Mothers taking medication for an existing condition should always seek the advice of their doctor. It is essential when consulting health professionals to tell them that you are breastfeeding, so that advice and treatment is appropriate.
The frequency of feeds can increase during a baby’s growth spurts, which commonly occur at around two weeks, six weeks, three months and six months, although every baby is different. It may take 24-48 hours for the milk supply to catch up with the increase in demand, so rest where possible, eat well and drink plenty of fluids during this time.
If you want to combine breastfeeding with using bottles of formula milk, it is important to get breastfeeding fully established first to ensure that your own milk supply is not affected. It is more difficult to change from bottle-feeding with formula milk to breastfeeding than the other way around. As an alternative to introducing formula (which is nutritionally different because it is made from cow’s milk), many mothers use breast pumps to express milk into bottles. This supply can be kept in the fridge for a maximum of 24 hours, or stored in a freezer for up to three months for later use. It should never be re-frozen once thawed.
Working mothers can also find pumps useful for expressing milk during the day. If you spend much of the day away from your baby, your milk supply may change. Using a pump can help to keep the supply up and the expressed milk can be used for the baby’s feeds while you are at work.
Breastfeeding works on a supply-and-demand basis and it need not be difficult to combine working outside the home with breastfeeding your child. Breast pumps are available to rent or to buy; contact your midwife, maternity unit or support groups such as the National Childbirth Trust or La Leche League for more information. They can also offer breastfeeding advice to mothers returning to work.
The production of prolactin during breastfeeding suppresses the release of eggs from the ovary in some women. However, this contraceptive effect is only true if you are fully breastfeeding a baby aged less than six months.
This means that you must:
* be breastfeeding at regular intervals, day and night (feeds no longer than six hours apart),
* be giving your baby no other food or drink, so no breastfeeds are missed, and
* have had no normal periods since the baby’s birth.
Even if you fulfil these conditions, there is still a chance you could get pregnant. Most family planning clinics and GPs advise taking extra precautions, such as the use of condoms, the progestogen-only pill (POP) or IUD (the coil).
Advantages
The immune system of a new baby takes time to mature and to produce antibodies. Breast milk contains a lot of the mother’s antibodies to a range of infections, so the baby gets some valuable protection against infection until their own immune system can take over.
For some infections, immunity continues after breastfeeding stops, and even combining breast milk with some formula still helps to reduce the risk of infections. Evidence suggests that breastfeeding for at least the first six months of the child’s life provides significant benefits for both mother and baby:
* it provides the baby with milk that is perfectly suited to the baby’s needs - the composition of breast milk changes over time to provide the baby with the nutrients needed as they grow,
* it is free, convenient, the right temperature, and easy for the baby to digest,
* there is no need for sterilising, or expensive equipment,
* the baby is less likely to have more allergies such as asthma and eczema if they have been fed only breast milk,
* fewer breastfed babies get diabetes in childhood,
* fewer breastfed babies get respiratory-tract infections, middle-ear infections and gastroenteritis,
* in the long term, the mother is less likely to develop certain types of cancer of the ovary and breast,
* breastfeeding helps the uterus return to its pre-pregnancy size after the birth - the release of certain hormones as the baby starts to feed encourages the uterus to contract,
* it encourages the mother to sit, relax and enjoy the closeness and bonding with her baby that breastfeeding can provide - in the early days after the birth, it can be useful to set aside some time to rest when the baby sleeps,
* it can help with weight loss and premenstrual syndrome - studies show that breastfeeding women burn more calories compared to mothers who do not breastfeed, and
* breastfeeding also offers some protection against the bone disease osteoporosis. It is thought that the body uses calcium in a more efficient way when producing breast milk.
What to do
In most cases breastfeeding should be started as soon as possible after birth when the baby is particularly receptive. Exceptions to this guidance include situations where the baby is unable to breastfeed immediately after birth, such as when a baby is born prematurely or needs special care or after a caesarean section.
Newborns usually get hungry every 2-3 hours, but as babies grow and take more milk they often need less frequent feeding - the main thing is to feed them when they’re hungry and offer them a feed if you think they want one. The best way to produce more milk is to feed your baby more often. The more you feed your baby, the more milk you will make. Make sure you get plenty of rest and eat well, although you do not need a special diet in order to produce enough milk.
Positioning and attachment
When breastfeeding, it is important to find a feeding position that feels comfortable for you. You might want to try:
* sitting down - if you sit down to breastfeed, try to make sure that your back is straight and supported. Your arms and back, and the baby, should also be supported, using pillows is necessary. Your feet should be flat, so place a book or footstool under them if you need to. Make sure your lap is as flat as possible. Lay your baby across your lap, with their head resting either on your forearm (right arm for feeding from your right breast) or using your opposite hand and wrist to support their upper back and neck.
* lying down - you may like to lie on your side to breastfeed, with your head and upper back supported by pillows. Lie well over on your side, with one pillow supporting your back and another one between your legs. Tuck your baby in close to your body, and support them with your free hand.
Whichever position you prefer, remember to keep your baby close to you, and facing you they shouldn’t need to twist or stretch. Their head, shoulders and body should be in a straight line. Remember that your baby should always be ‘tummy to mummy’. Some other breastfeeding tips include:
* Always bring your baby to your breast and not the other way round. Baby to breast, not breast to baby.
* The baby’s nose should be level with the nipple, to encourage a slight tilting of the chin for optimum swallowing. The chin and lower jaw should reach the breast first. Move the baby towards the breast so that their mouth touches the nipple and encourages the mouth to open wide. Remember nose to nipple.
* If you need to support your breast, place your fingers flat on your ribcage, where the breast and ribs meet, with your thumb uppermost. Remember to keep your breast still - do not move your breast towards the baby’s mouth.
* The nipple should not be pulled out of shape in any way as it goes into the baby’s open mouth.
* Once the tongue has come forward, aim your baby’s bottom lip as far away as possible from the base of the nipple. This helps the baby to scoop in as much breast as possible when its mouth is open.
* The whole nipple and much of the areola (darker tissue surrounding the nipple) should be in the baby’s mouth. This will allow the jaws to pump the store of milk behind the nipple.
A correct latch (feeding position) will provide the baby with a good flow of milk, and also prevents the nipples from becoming sore. There are some key signs that your baby is properly attached to your breast:
* their bottom lip is curled back,
* their chin is touching the breast,
* their mouth is wide open,
* your areola is showing more above his top lip that under his bottom lip, and
* their sucking pattern changes to long deep sucks.
Breastfeeding may feel uncomfortable at first, but this usually eases as the feed continues, and should cease altogether after the first week or two. If not, you should ask your midwife, health visitor, or breastfeeding counsellor to check whether your baby is positioned correctly. If you think your baby’s attachment may be incorrect, you can try using the tip of your little finger to break the seal between lip and nipple, and then re-positioning. An initial short burst of sucking should give way to strong, steady jaw movements with no sound other than swallowing.
In order to ensure that both breasts are used almost equally, most mothers either offer both breasts at each feed, or switch mid-feed. Starting each new feed on alternate breasts can be an easy way to make sure they both get used. One breast can be offered until the baby finishes feeding, and then the feed topped-up with milk from the other breast.
Some babies may need help in bringing up wind after a feed. To relieve the discomfort, gently rub the baby’s back whilst holding them along your forearm, upright against your chest, sitting on your lap, or lying face down on your lap.
How it works
Following the delivery of the placenta after childbirth, levels of the hormones oestrogen and progesterone drop quickly. The body starts to release a hormone called prolactin, which stimulates the body to produce breast milk.
Special cells in the breast (acini cells) make milk, which is then stored in the breast. When the baby touches the breast a hormone called oxytocin is released, beginning a process known as milk let-down or ejection reflex. This pushes the milk to the areola (nipple and surrounding area), and releases it as the baby feeds. When you first start breastfeeding, let-down happens without you having much control over it. Later it becomes a reflex action in response to the baby’s cry or just by thinking about the baby or feeding.
To make breastfeeding easier, you should start as soon as possible after birth. It is important when you are learning about breastfeeding to ask for help with positioning and attachment to help prevent discomfort. The baby needs to be able to take enough of the nipple and surrounding area (areola) into the mouth to stimulate release of the milk.
Babies have a strong suckling instinct even when they are newborns. Whichever way you feed your baby, spending some time with skin-to-skin contact as soon as possible after the birth is very important. As long as you and the baby are both well enough, you should be able to hold your baby almost straight away. If you have had to spend some time apart, spending that time together when you can, still has benefits for both of you. It helps by:
* allowing you and your baby to bond,
* steadying the baby’s breathing,
* calming the baby and keeping them warm, and
* getting breastfeeding off to a good start.
Your baby will need to be fed as often as they are hungry to help establish your milk supply. Every time that you feed your baby, messages are sent to your brain, which then sends messages to your breast to produce more milk.
For the first few days after birth, the breasts produce a yellowish substance called colostrum. This is rich in fats and protein and easy for the baby to digest. Colostrum also contains infection-fighting antibodies (immunoglobulins), which strengthen the baby’s immune system.
The baby will feed frequently on colostrum until a supply of mature breast milk is established (this can take up to ten days). Mature milk has a more watery appearance. At the beginning of a feed it is almost blue in colour and becomes white by the end of a feed as the fat content increases.
Breasts produce two kinds of milk needed by the baby, in perfect quantities:
* foremilk - is thin and watery, and quenches the baby’s thirst. It is the first milk to come out at the start of a feed, and it is low in fat, but high in milk sugar (lactose).
* hindmilk - as the feed continues, the fat content increases, and the milk starts to consist of hindmilk. This is rich in fat, provides calories for energy, and promotes the growth of the baby. As the baby grows, it is important that they receive the hindmilk in order to meet their nutritional needs.
Allow your baby to feed from one breast until they decides to stop. After a short break, offer the other breast. Your baby may not need milk from the second breast at first, but is more likely to need it as they grow. Start the next feed on this side.
Breast size bears no relation to how much milk you can produce. A woman with small breasts can produce just as much milk as a woman with large breasts.
Feeds usually vary in length, from anything between a few minutes to up to one hour, and there is no ideal length of feed. The average length of a feed is influenced by:
* whether the baby is positioned at the breast correctly,
* the speed of milk let-down and rate of flow,
* the quantity of milk available, and
* the baby’s age.
For some mothers, breastfeeding comes easily, while for others it may present more of a challenge. If you are finding breastfeeding difficult or painful, ask your GP, midwife, breastfeeding counsellor, or health visitor for advice as soon as you can.
Introduction
Breast milk is the ideal food for a baby. It is nutritionally balanced, with the perfect amount of proteins, carbohydrates, fats, vitamins and iron to help the baby to grow. It contains antibodies that help to protect your baby from infection, and changes to suit the different needs of the baby as they grow.
The UK government supports the World Health Organisation recommendation that:
* breast milk is the best form of nutrition for infants,
* exclusive breastfeeding is recommended for the first 6 months (26 weeks) of an infants life, as it provides all the nutrients a baby needs,
* breastfeeding (and breast milk substitutes, if used) should continue for a minimum of the first six months (and should continue as solid food is introduced),
* mothers who are unable to, or choose not to, breastfeed, should discuss other options with their midwife or GP while pregnant. It is important for mothers who do not breastfeed to get the support and information they need to make sure their baby gets the nutrition they need.
Breastfeeding is the completely natural way to feed your baby. It also has short-term and long-term health benefits for both mother and child. For mothers, breastfeeding helps to:
* strengthen your bones,
* lower your risk of getting ovarian or breast cancer, and
* get your pre-pregnancy figure back more quickly.
For babies, breastfeeding:
* protects against diarrhoea, gastroenteritis, ear and chest infections,
* reduces the risk of diabetes or eczema, and
* means their nappies are less smelly.
The experience of breastfeeding can be a very satisfying and relaxing one, promoting closeness between mother and child. Support from family, friends and health professionals is also important, particularly for first time mothers, or women who find breastfeeding difficult to establish.
If you have any concerns regarding breastfeeding, or need to find out how to breastfeed properly, there are many sources of help, advice and support available, including your midwife, self-help groups, telephone helplines and breastfeeding counsellors.
Complications
In more severe cases of infectious mastitis, an abscess can develop in the breast. An abscess is a pus-filled hollow space that can appear on the skin or inside the body.
The abscess can be treated by draining the pus out of the breast.
For more information on breast abscesses see the ‘related articles’ section
Medicine guides
The list below is a combination of the generic and brand names of medicines available in the UK. Each name provides a link to a separate website (Medicine Guides) where you can find detailed information about the medicine. The information is provided as part of an on-going medicine information project between NHS Direct, Datapharm Communications Ltd and other organisations.
The medicines listed below hold a UK licence to allow their use in the treatment of this condition. Unlicensed medicines are not included.
The list is continually reviewed and updated but it may not be complete as the project is still in progress and guides for new medicines may still be in development.
If you are taking one of these medicines for a different condition, or your medicine for this condition is not mentioned here at all, speak to your prescriber, GP or pharmacist, or contact NHS Direct on 0845 46 47.
* Paracetamol
* Ibuprofen
Self-care techniques for non-infectious mastitis
Self-care techniques for non-infectious mastitis
Most cases of non-infectious mastitis can be treated with a number of self-care techniques. These are outlined below.
* Make sure that you get plenty of rest and drink lots of fluids.
* The over-the-counter painkiller paracetamol can help reduce symptoms of fever and pain; though a small amount of paracetamol can enter the breast milk it is too low a dose to harm your baby. (Aspirin is not safe to take while breastfeeding).
* Try feeding your baby more often, or express between feeds if your breasts still feel full.
* Feed from the affected breast first in order to drain it as much as possible.
* Gently express after finishing a feed, so your breasts can be fully drained.
* Make sure that your baby is properly positioned and attached to your breasts - your midwife or health visitor should be able to advise you.
* You may want to experiment with feeding your baby in different positions to see if this makes feeding more effective and efficient.
* Warming your breast with some warm water can help soften the breast making it easier for your baby to feed.
* Stroking a wide tooth comb over the red area towards the nipple can help the milk flow.
* Avoid wearing tight-fitting clothing or a bra until your symptoms improve.
If symptoms still do not improve, or worsen, despite trying these techniques then you should return to your GP for additional advice or treatment.
Infectious mastitis
Infectious mastitis will need to be treated using a combination of the techniques outline above and antibiotic tablets (oral antibiotics).
Antibiotics can enter the breast milk and make your baby irritable and restless. They may also begin producing runny stools. These effects are only temporary, will resolve once you finish your dose, and will pose no risk to your baby.
Obviously, if you are not breastfeeding then you will only need to take the antibiotics
Diagnosis
Your GP should be able to make a confident diagnosis of mastitis based on a physical examination and by asking you about your symptoms.
If your symptoms are particularly severe, or do not respond to treatment, your GP may take a small sample of your breast milk for further testing. These tests can often identify whether a bacterial infection has taken place, and identify the particular bacteria, which can help aid treatment.
As mastitis is usually due to problems with breastfeeding, your GP and/or your midwife may ask you to demonstrate your breastfeeding technique.
You should not feel that this means you are being tested or blamed. Breastfeeding is like anything else - it can take time, practice and sometimes advice to get it right.