You’ll probably hear a lot about positioning and attachment; that is, bringing your baby to the breast so he can latch on well, and then making sure he’s well attached to the breast so he can feed effectively. Getting this right is important. It not only ensures that your baby gets all the milk he needs, it also means you’ll have a good milk supply and will be far less likely to suffer from breast and nipple problems.
World health authorities recommend babies receive nothing but breastmilk for their first six months. Breastmilk provides everything babies need during this time; it continues to be their most important food throughout the first year and remains a valuable component of a mixed diet for the next year and beyond.
Mother’s milk
Although it’s usual to talk in terms of choosing to breastfeed, the reality is that breastfeeding actually chooses you. Breastfeeding is an integral part of the reproductive continuum, the final part of the conception-pregnancy-birth cycle. A woman’s body is designed to produce breastmilk for her baby, and with the right information and support almost everyone can breastfeed for as long as it suits her and her baby. Wanting to breastfeed your child is not about demanding something special and different. It’s simply what mothers do. It’s a fundamental human right — for both mother and baby.
Nothing like the real thing
Despite overwhelming evidence to the contrary, there’s a still common misconception that there’s very little difference between breastmilk and infant formulas, particularly in developed countries like Australia. The truth is that in comparing infant formula with breastmilk, you are not comparing anything near equals. While science has improved infant formulas considerably and modern hygiene makes their delivery less risky, there is no formula that comes close to breastmilk.
Breastmilk is a complex mix of ingredients that not only nourish and protect each baby but also help to regulate their growth and metabolism in a host of subtle ways. Not only is breastmilk a constantly adapting living fluid, changing to meet a baby’s developmental needs, but each mother and baby are a perfect (and unique) match. No two mothers’ milk is exactly the same. Breastmilk is also dose-responsive; that is, the more breastmilk a baby receives, the better its health and developmental outcomes. Breastfeeding, even for a short time, is valuable; longer-term breastfeeding is absolutely invaluable.
No additives required
World health authorities recommend that babies receive nothing but breastmilk for their first six months. Breastmilk provides everything babies need during this time; it continues to be their most important food throughout the first year and remains a valuable component of a mixed diet for the next year and beyond. It doesn’t lose its nutritional value with time. Breastmilk has just the right amount of fats, salts, sugars, calcium, iron and other nutrients. The small, soft curds of mature milk are digested easily, perfect for a baby’s sensitive digestive system. It satisfies both hunger and thirst. It’s always available and at just the right temperature.
The anti-infective properties of breastmilk continue to provide protection even after weaning. Research shows that when children are not fed on human milk they are more likely to suffer from a host of illnesses including gastrointestinal and respiratory infections, asthma, middle ear and urinary tract infections, necrotising enterocolitis (death of bowel tissue), insulin-dependent diabetes, inflammatory bowel disease, lymphoma and allergies. The action of breastfeeding also enhances eyesight, speech and jaw development.
Good for mothers, too
Just as breastfeeding has long-term health benefits for babies, there are significant benefits for mothers, too. Ongoing research shows breastfeeding may protect against postpartum haemorrhage, cancer of the breast and ovaries as well as osteoporosis. Menstruation normally doesn’t return for many months and a mother is generally infertile if she is breastfeeding exclusively and regularly during her baby’s first six months, and she has not recommenced her menstrual cycle. Breastfeeding aids the contraction of the uterus, helping it return to its pre-pregnant state.
From a mother’s perspective, the flexibility and convenience of breastfeeding make life easy. There is no risk of contamination, because breastmilk is delivered straight from breast to baby, and there are no storage problems. Mothers can breastfeed anywhere and are protected in doing so by anti-discrimination legislation.
The breastfeeding mother can return to paid work whenever she is ready, as long as she is given regular breaks to express milk or to breastfeed her baby. Employers who would like to implement breastfeeding-friendly policies can contact the Australian Breastfeeding Association for an information kit and apply for accreditation. Once the benefits to both employee and employer are appreciated, companies are increasingly supportive of breastfeeding workers and of helping to ensure a healthier and smarter workforce in the future. Breastfeeding is free. In contrast, there are costs involved in artificial feeding, not only in the purchase of the infant formula, but also in the resources needed to produce it and to provide it. Another cost rarely taken into account is the medical backup required because bottle-fed babies are significantly more likely to see a doctor or be hospitalised.
Breastfeeding is relaxing and pleasurable and helps a woman enjoy motherhood. The release of the hormone oxytocin while feeding helps the mother-baby bond and creates a sense of wellbeing. Knowing that you alone are able to provide all that your baby needs for the best start in life can be a liberating, empowering and uplifting experience.
What gets in the way?
Given the compelling reasons why every baby should be breastfed, why do so many mothers stop breastfeeding within the first few months? Breastfeeding may be the natural and normal way to feed a baby, but that doesn’t mean it’s culturally promoted. In a 2001 Australian Breastfeeding Association study of women’s experiences of breastfeeding, the thing they said they most wanted was a society in which the importance of, and support for, breastfeeding was universally acknowledged and in which there was a wider knowledge of how breastfeeding really works. Myth and misinformation abound and, sadly, most mothers receive very poor advice and little encouragement.
How breastfeeding works
Understanding how breasts make milk can help to avoid (or overcome) some of the problems commonly associated with breastfeeding. There are a few basic need-to-know points that are fundamental to getting breastfeeding right. They all pivot around the supply-equals-demand principle. A baby who feeds well and often is basic to a good milk supply. Fortunately, almost all babies are born with a strong instinct, known as the sucking reflex, and are keen to get started right away.
You’ll probably hear a lot about positioning and attachment; that is, bringing your baby to the breast so he can latch on well, and then making sure he is well attached to the breast so he can feed effectively. Getting this right is important. It not only ensures your baby gets all the milk he needs, but it also means you’ll have a good milk supply and will be far less likely to suffer from breast and nipple problems.
When your baby attaches to the breast and begins to feed, nerve impulses are carried to your brain, causing the release of hormones. One (prolactin) is involved in stimulating the milk-producing glands in the breast, while another (oxytocin) causes the ejection of milk. The skin covering the nipple contains nerve endings that are stimulated by your baby’s suckling. The stimulation causes the milk to be released. This release, commonly called the let-down reflex, makes the milk available to your baby.
While breastfeeding, the nipple and a good mouthful of breast are drawn into your baby’s mouth. Your nipple stretches so it’s far back in his mouth. His tongue forms a trough around the nipple so the action of his tongue and jaw compresses the breast tissue and rhythmical, undulating tongue movements express milk into the back of his mouth.
How much milk your breasts make depends on how often your baby breastfeeds and how much milk she takes. It’s the removal of the milk by the baby (or by expressing) that causes more milk to be produced. While the removal of milk from the breast is vital to the production of more milk for subsequent feeds, your breasts are never actually empty. Babies don’t really empty a breast; they stop feeding when they’ve had enough, while at the same time, your breasts are already at work making more milk.
Believing in yourself
Most women feel particularly vulnerable after the birth of a baby. Just when you need help most, it seems it’s most difficult to ask for it. It can be disconcerting to find that while you may be extremely competent in other things, you feel extremely incompetent in interpreting the cues of your own baby.
Breastfeeding and parenting are about having confidence, relying on your instincts and making your own decisions based on the right information balanced by what’s best for you and your family. Each baby is different and you and your baby will be learning about each other. Confidence can come from trusting your body to nurture your baby. Despite what you may have heard, it’s extremely rare for a woman not to be able to breastfeed. The shape and size of a breast aren’t important. There is no such thing as the "wrong" type of breasts or the "wrong" nipples.
Babies set the pace
It’s crucial to allow a baby to set the pace of feeds rather than time him by the clock. Some call this baby-led feeding routine, "feeding on demand", but experienced mothers know it’s really feeding according to need. Young babies feed often. It is usual for a young baby to want at least eight to 17 feeds in a 24-hour period (the average being 11). Some will be long, leisurely feeds, others little snacks, and some will be during the night. Few babies younger than eight weeks sleep for long periods between feeds and, if they do, this may be balanced by a period of more frequent feeding. Ideally, you should look for your baby’s feeding cues — restlessness, turning his head to search for the breast, opening his mouth or sucking his fist. Remember that crying is the very last sign a baby needs to be fed, not the first.
Unlike that of an adult, a baby’s stomach is extremely tiny and does not hold much. Breastmilk is very well absorbed, so it’s easy to understand why babies can’t go long between feeds. A lot of parents worry unnecessarily about whether their baby is getting enough milk. There are a few simple signs of an adequate milk supply.
First, based on the principle of what goes in must come out, a baby should have at least six to eight very wet cloth nappies in 24 hours, provided no other fluids or solids are being given. If you are using disposable nappies, particularly those containing "moisture-absorbing gel", you may use less than five nappies in 24 hours. However, the nappies should feel heavy after use. For the first week or so, babies may have a bowel motion at each nappy change. In the next few weeks, they will probably have two or more soft bowel motions a day. Infrequent (that is, not daily) bowel motions in a very young baby usually suggest he needs more breastmilk.
As the weeks go, babies may have fewer soiled nappies, varying with the individual from daily to once or twice a week. It’s all normal as long as the stools are soft and unformed.
Other signs your baby is getting enough milk include:
- Your baby should have a healthy skin colour relative to his ethnic makeup and good muscle tone. (If you gently "pinch" his skin, does it spring back into place?)
- Your baby should be alert and reasonably contented for some periods in the day, even if she has some fussy or very unsettled times as well. She will usually wake for night feeds. A tiny minority of babies sleep for a lengthy period during the night at an early age, while the majority wake during the night for quite some time. It’s very important to realise that "sleeping through" in young babies is defined as sleeping for five hours!
- There should be some weight gain and growth in length and head circumference. This might not mean piling on a set amount of weight every week, but gradual weight gain each month, together with other general growth in length and head circumference. Racial and family patterns can be factors in this growth pattern. Birthweight can also be a determinant — a baby does not necessarily stay on the same growth curve according to her birth weight. Over the first year, a large newborn may "grow down" to her genetically determined growth curve. Slow weight gain is more likely in a family where the parents are of small stature. However, a baby should show consistent growth over the first year.
A breastfeeding mentor
All new parents look for reassurance that what they’re going through with their baby is normal. Breastfeeding your baby is an exciting and rewarding experience for you both. However, as in all things that are worthwhile, there are usually both joys and difficulties. At either time, it helps if you are able to share your thoughts and feelings with empathetic people.
Having someone who can help and support you as you and your baby learn to breastfeed can be invaluable. Ideally, this would be someone who has successfully breastfed (that doesn’t mean she did so without problems) and who understands what you will be experiencing, and with whom you feel comfortable; someone who knows how breastfeeding works, has up-to-date knowledge and who is available to you, either by phone or in person, during those vital early weeks. You won’t need to be on the phone to her day and night, but it can be reassuring to know help is at hand if you need it.
If you don’t have a friend or family member who can provide positive and experienced support, it’s a good idea to connect with a breastfeeding mother-to-mother support group such as the Australian Breastfeeding Association. In a recent survey of mothers they said that, in hindsight, one of the things they wish they had done was to make personal contact with a breastfeeding support group before their baby’s birth. That way, there would have been someone to help whom they already knew and felt comfortable with.
Either face to face at local group activities or through one of the State Helplines, highly skilled and trained Australian Breastfeeding Association counsellors help thousands of mothers every year. As breastfeeding mothers themselves, they know breastfeeding may not always seem easy. Their experience can reassure new mothers and give them the knowledge to understand how breastfeeding works. For further information go to www.breastfeeding.asn.au, or telephone (09) 9885 0855.
