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UPCOMING ISSUES |
BREASTFEEDINGWeaning your child from breastfeeding
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------ Weaning your child from breastfeeding When you start to give your baby foods other than breast milk, it’s called weaning. Most parents consider weaning to mean completely stopping breastfeeding. Weaning is a natural stage in your baby’s development. Still, many mothers have mixed emotions. It’s normal to feel excited at the new independence you can both enjoy, as well as some sadness as your baby moves to another stage in her life. When should I wean my baby? How do I wean my baby? • If you can, it’s easiest for you and your baby if weaning is gradual—over several weeks, months or even longer. A sudden, abrupt wean should only be considered in extreme circumstances and is hard on both of you (see “Can’t I just stop breastfeeding?”). • The transition to weaning may be easier if you first introduce your baby to a cup instead of a bottle. Breastfed babies easily learn to drink from a cup as early as six months of age (try expressed breast milk). • Start off by substituting one feed, the least ‘favourite’ one of the day. Someone else may need to offer this feed for your baby to accept it. • When you’re ready to wean even more, substitute the next least favoured feed at the opposite time of the day. Continue this way, substituting one feed at a time. The pace of weaning is up to you and your baby, but in general, the slower the better. Wait at least a few days in between each new feed before substituting another one. • You may want to try a ‘partial’ wean instead. This means you substitute one or more feedings with a cup or bottle and breastfeed at other times. This can work well if you are going back to work but still want to breastfeed. When you do this, make sure you check your baby’s weight gain regularly. • If your breasts are uncomfortable while you are weaning, try expressing enough milk so that you are comfortable. Over-the-counter drugs like acetaminophen or ibuprofen can also help. Cold compresses or gel packs applied to your breasts can also be of some comfort. • You shouldn’t bind your breasts or drink less fluids while you’re weaning. Check your breasts regularly to make sure you aren’t developing a blocked duct, which will feel like a firm tender area of the breast. If you do, see your doctor or lactation consultant. These problems are more likely to occur during an abrupt wean. • Watch the cues you give to your baby. If you sit in the same chair you usually use when you’re nursing, he’ll likely want to breastfeed. He probably won’t be satisfied with a cup or a cuddle. • Some mothers choose what is called ‘infant-led weaning.’ This means watching your baby’s cues and weaning at his pace (that is, never refusing the breast but also not offering the breast when he is not interested). With infant-led weaning, breastfeeding may continue for two to four years. This type of weaning is practised by many non-western cultures. My baby is refusing the breast. Does that mean he’s ready to wean? Try making feeding time quiet and spend more time cuddling your child. Don’t ‘starve’ him, but instead, try offering the breast when he is sleepy. If you can’t figure out the reason for the strike, see your doctor. Remember that a nursing strike does not mean your baby is rejecting you. If this happens, be sure to pump your milk so you don’t develop a blocked duct. Can’t I just stop breastfeeding? Sometimes you may have no choice, such as if you are very sick, if you and your baby have to be separated for a long time, or if you have to take certain drugs, like chemotherapy. If that’s the case, try some of the suggestions above. If your breasts get uncomfortable, express your milk to avoid blocked ducts, mastitis or a breast abscess. Babies who are sick should not be abruptly weaned. What substitute foods should I use? • Under 12 months: iron-fortified infant formula. • 12 to 18 months: follow-up formula or whole milk (3.25%). • 18 to 24 months: whole milk. • Two years and over: whole or 2% milk. After 12 months of age, your baby should not take more than 24 ounces of milk products per day. Otherwise, he’ll fill up and won’t want to eat solid foods. Also, she may develop iron-deficiency anemia. If your baby has a milk allergy, talk to your doctor about appropriate substitute feedings. What about other foods? Introduce solid foods one at a time and in small amounts at the beginning. Some babies get very constipated if they are given too much solid food early on. You can also offer your baby small amounts of water once or twice a day, usually after six months of age. You can give 100 percent fruit juice, usually diluted with water, but it has no real advantage over water and should not exceed a few ounces per day (two to four ounces). Too much juice can lead to dental cavities, obesity or even poor weight gain and diarrhea. Your weaning experience is ultimately up to you and your baby. Try to follow his cues whenever possible. If you’re feeling ‘blue’ or if the baby is not taking what you consider to be enough other foods or liquids, you should see your doctor. For more information For more information about children’s health, visit www.caringforkids.cps.ca. ------- Breastfeeding builds relationships Like any relationship, breastfeeding takes time to develop into a comfortable partnership. In the beginning while breastfeeding may be harder than anticipated, many new mothers find motivation to overcome the initial challenges of learning to breastfeed from knowledge about the benefits of breast milk – human milk is the best food for human babies and it provides many health benefits. In Canada, breastfeeding an infant has become the norm. What remains illusive is the goal of ideal health for mothers and babies – long-term breastfeeding. Very gradually, especially with longer maternity leaves, an increasing number of women are breastfeeding their children into toddlerhood. When women breastfeed long term, they do so not only because human milk is the best food but also because of the relationship breastfeeding builds with their child. More and more expert bodies, such as the World Health Organization, the Canadian and American pediatric groups recommend that for ideal health of women and children, mothers should be supported in breastfeeding, exclusively, for the first six months. At about six months nutritious foods should be added to the child’s diet and breastfeeding should continue for two years or beyond. Worldwide, the average age at which children are weaned naturally is between three and four years. In North American culture, the focus on the goodness of the milk minimizes the meaning of the relationship and results in babies being weaned prematurely. For many families once the child starts on other foods, mothers are pressured to wean. After all, once the baby starts eating other food is there any point to giving human milk? The unequivocal answer is yes! There is no doubt in the goodness of human milk. If fact, at an international conference this summer, Stephen Buescher, a medical professor and specialist in pediatric infectious diseases classified human milk as an infant support system. The gastrointestinal and respiratory systems, middle ear, urinary tract and skin are amongst the body systems protected from infection. A major advantage of the human milk support system is the way its numerous properties fight infection without causing inflammation. Many of the body’s other defenses against infection cause inflammation. Human milk is the only treatment that prevents viral, bacterial and parasite infections – a truly amazing system. Even one feeding of formula changes the flora of the gut and resuming human milk may or may not return the bowel to normal. Beyond infancy, human milk adds significantly to the diet of the child, the anti-infective properties continue and, in fact, increase closer to weaning. Even though human milk is an amazing food and anti-infective agent what actually keeps women breastfeeding beyond the early months is what the act of breastfeeding adds to their relationship with their child. If you talk to mothers nursing toddlers they don’t typically talk about the benefits of human milk, they talk about what the relationship means to them. It is part of how they mother their child – it is more than just the milk. Research confirms that from the child’s point of view breastfeeding is comforting. New research discloses the stress relieving and pain relieving effects of nursing. At birth, nursing even small amounts of milk and skin-to-skin contact with their mother decreases stress, conserves energy and keeps babies warm and stable. For premature infants, nursing through painful procedures helps them to cope with pain. In older babies, breastfeeding helps comfort them through immunizations. The first two to three years of a child’s life are times of unparalleled development from the totally dependent newborn to a walking and talking toddler. Such intense development is enhanced when a child has an intense relationship and bond with another human being – usually their mother. Stress is easily reduced through nursing and reconnection with their source of security. Nursing is not the only way to comfort a child but it is a way that works well. Moms and their partners sometimes worry that if their child is so attached to Mom, will he be able to develop intense relationships with others? The truth is children who feel confident in themselves and their bond with another human being are best able to develop strong bonds with others – including Dad. Human milk is a precious advantage to children as a food and as a support system for their developing immunity. Breastfeeding can also nurture the connection between the mother and child. But so many mothers wean their child – usually because of social pressure or lack of support – before the time when breastfeeding becomes so easy and becomes part of what you do to nourish, connect with and comfort your child. ------ Returning to work while breastfeeding For many mothers, soon after have they overcome the early hurdles to establish their breastfeeding relationship with baby, they are asked, “When are you going back to work?” As though what they have been doing isn’t “work.” Continuing to breastfeed, even after going back to work, benefits more than just your baby. Breastfed babies are healthier, especially in daycare settings. Your family will spend less money on formula, medicine and time off looking after sick children. Your employer can expect less absenteeism from you dealing with sick children. Plan ahead during pregnancy to maximize the amount of leave available. Increasingly, governments around the world recognize the need to support families to care for their young children. Since 2000, maternal/paternal employment insurance benefits increased to 52 weeks coverage. Discuss your options with your employer. By law in BC, employers have a duty to accommodate you as a breastfeeding mother to breastfeed or express milk at work. Basic Principles Get off to a good start. Mothers who get breastfeeding well established are more likely to be able to continue breastfeeding after they return to work. Breastfeed lots! Delay regular separations from your baby for as long as possible. The older your baby is when you go back to work the more likely you will be able to maintain your milk supply, your baby will be more likely to remain interested in breastfeeding and you be less likely to need to pump. Consider part-time hours at least as a transition to full-time hours. Many women returning to full-time work earlier than four months are able to maintain their breastfeeding relationship, however there is a much higher incidence of premature introduction of solids and weaning. Maintain milk production. Frequent, effective milk removal is the most effective means of maintaining milk production. The younger your baby the more likely you will need to express your milk at work. Some women can nurse their babies during their breaks, others pump or express milk during their work day to maintain their milk supply and obtain milk for subsequent feedings. Some will partially wean their baby from the breast and give formula during their absence. As a biologically active substance, human milk stores remarkably well. A small, insulated cooler or thermos works well to transport cold or frozen milk. In daycare settings ensure the staff knows how to care for your milk. It does not have to be stored in a separate fridge. Feeding the baby. How to feed your baby when you are away depends on the age and stage of your baby. Common folklore advises mothers to start a bottle early so the baby will take a bottle when necessary. This advice often does not work and can jeopardize your milk supply. Some babies who have a regular bottle at too young an age will gradually refuse to take the breast. Even babies who have accepted a bottle in early infancy may reject it later on. Refusing the bottle can be a measure of your child’s secure attachment to you – you mean more to her than just food – a very powerful psychological milestone. Even reluctant feeders can be enticed to take the fluids they need. Babies are more likely to accept a bottle given by someone other than their mother and when held in a position that is not like the position they nurse in. For example, try holding baby upright in a sitting position facing towards or away from you. Older babies may take a cup and solids. Some will completely adjust their schedule, basically sleeping when mother is away and feeding during the night. This reverse rhythm nursing works for some (but not all) families. Flexibility. Women with more flexibility in their work environment can respond more easily to changes in their child’s needs and their milk supply. Flexibility in attitude also helps. Mothers sometimes think that “they can’t go back.” For example, if their milk supply is decreasing too rapidly and they are down to two breastfeedings a day, they may be reluctant to breastfeed more often. However, to maintain the breastfeeding relationship it is really helpful to spend extra time nursing when you can be with your baby. Weekends, evenings and days off are wonderful times to reconnect. Your baby is the very best breast pump. Lots of breastfeeding eases the transition for both of you and will help re-establish your supply. Support. You may be surprised at how much you miss your baby – this is normal. Tell your caregiver your plans and let him/her know how he/she can help you and your baby. The caregiver will need time, especially during the transition period, for extra cuddling to help your baby cope with this change in her life. You may need to breastfeed as soon as you pick up your child before driving home. Let your caregiver know when you will arrive so your baby is not fed just before you get there. A significant problem for mothers is role overload, the difficulty of responding to all of the demands requiring their time and energy. Breastfeeding problems are often unrelated to employment, but common to all mothers. Share with your partner and family the benefits of supporting you in your decision to continue breastfeeding. Women have successfully combined breastfeeding and working since time began. We all benefit when our children are as healthy as possible. Six months of exclusive breastfeeding, solids starting at about six months and continuing breastfeeding for as long as possible – provides ideal health for our kids. ------ Sorting through parenting advice What do you, as the mother of a new baby have in common with a pregnant woman, a mother of a toddler or a mother of a teenager? You will all receive advice, lots of advice, conflicting advice and often, unsolicited advice about how you should raise your child. Friends, family, strangers and a wide variety of health professionals will offer advice. Sorting through all the advice is daunting. When it comes to raising your baby consider three significant sources of information. The first person to learn from is your baby. Some of the most important lessons on mothering can be learned as a breastfeeding mother. The intimacy of the early months or years spent breastfeeding develops your sense of the child within. The relationship you develop and what you learn about your child can help you cope with the overwhelming amount of advice. These lessons also help you deal with the issues that arise as you go on to be the mother of a toddler and teen. One of the first things you learn is how much your child needs you, starting with the calming effect of the warmth of your skin immediately after birth. Cuddling and skin-to-skin contact in these early days conserves your baby’s energy and minimizes the stress of the transition of birth. In the early weeks, your baby’s intense need for human contact is readily met through breastfeeding. Your body provides all the food needed for the first six months of your child’s life. As you become the mother of a toddler or teen the intensity of their need for you will change as will the way they express this need. Sometimes your teenager may even suggest that he doesn’t really need you. However, the reassurance of your love and presence (but possibly not where his peers can see you) is a lifelong gift. Another thing you learn from your breastfeeding baby is to listen to his behaviour. The time you spend developing your relationship expands your expertise to understand your child. You sense when he has had enough – enough food, enough stimulation, enough stress. With your toddler, your mothering sense helps you provide new challenges and experiences while anticipating unnecessary risks. Your knowledge of your teen’s behaviour can help you sense concerns with peers and school. As breastfeeding mothers, we also learn that our children are not perfect. This is a good lesson because neither are we. Perfection is impossible and stressful. Recognizing this basic truth takes the pressure off. Babies grow and develop on their own unique timetables. Comparisons with other children are not helpful. The best growth and development occurs in supportive and challenging, but not overly stressful, environments. You also learn that babies are human infants. Babies are not manipulative, miniature adults nor are they puppies to be trained or demons to be tamed. As your baby experiences your efforts to provide her basic needs for human contact, warmth, food and a safe environment she learns to trust. Infant crying, as one of the few ways to express needs, is not manipulative. Helping your toddler understand and cope with the fact that “wants” and “needs” are not the same will make life pleasant when she becomes a teenager. The next experts to consider are you and your partner. You know a lot about mothering from own experience of being mothered – some things you may want to keep, some you may want to change. You know and will continue to develop your values and beliefs about what it means to be a good parent and the qualities you want to see in your children. The most powerful teaching tool is modelling– children learn what they experience and see, not what they are told. Respectful, trusting children experience respect and trust. Lastly, when considering advice on mothering your child, be it from your parents, your friends, your doctor or the newest book on parenting it may be helpful to consider some of these questions. What prepared this person, either professionally or personally, to provide advice on mothering? As Tine Thevenin writes in her book, Mothering and Fathering: Gender Differences in Child Rearing, many advice books for mothers are written by male physicians. Yet research shows us that men and women relate to their children differently. Women tend to nurture and hold children close. Fathers tend to challenge and encourage. Other questions include: What was this person’s experience dealing with your issue? Have they actually breastfed and raised a child? If your friend did not successfully breastfeed, is her information on breastfeeding likely to be accurate? Do you know and like their children? Mothering is a life-long task – with endless learning opportunities. As a nursing couple, your first learning opportunity is one of life’s most precious experiences – falling absolutely in love with another human being. ------ Understanding foremilk and hindmilk imbalance Frequently mothers are very worried that there is something wrong with their milk. They may want to have their milk tested or ask, “How do I know when my baby is getting the ‘good’ milk?” These mothers have heard about “foremilk/hindmilk imbalance.” If your baby cries a lot, does not seem very happy, seems hungry all the time but is gaining weight well, has green stools or spits up a lot more than is typical, you may have been told that you have “foremilk/hind milk imbalance.” This term does not really reflect what is happening and often makes mothers think there is something wrong with them or their milk. Be reassured – there is nothing wrong with your milk. Your milk is the same amazing food/medicine that other babies receive. It may just be that you have more milk than your baby needs. It is one of those situations where there is too much of a good thing. The milk is not out of balance – there is just lots of it! What happens when you have too much milk? The fat content of human milk increases throughout the baby’s feeding. Sometimes when a mother makes a lot of milk her baby has a full tummy after feeding for just a few minutes – before they get much of the higher fat milk. Though still getting excellent milk, it is thought that the baby is not nursing long enough to get enough of the fat in milk that helps the baby feel full and content. Other concerns occur. Lower fat milk goes through the baby’s body more quickly. Some babies (whose mothers have lots of milk) have more frequent bowel movements that are occasionally greenish in colour. These babies can cry a lot and may be labelled as colicky or as being lactose intolerant. This is really a bad rap for lactose. Human milk contains lactose, a disaccharide important for calcium absorption and brain grow and development. The lactose content stays pretty constant throughout the feeding; it is the fat content that changes the longer the baby feeds. What can be confusing is that some babies whose mothers have a lot of milk behave like babies who are hungry. Their mothers feel they can never put their babies down and may worry that they don’t have enough milk for their babies even though their breasts may feel full and leak. If a mother’s supply is down (common during a growth spurt) her baby typically fusses and cries to be fed frequently. The mother’s best response is to follow her baby’s cues and offer her breast more often. A few days of ‘power feeding’ will increase her milk supply and her baby will be happier. But what if the baby is fussing like a hungry baby but the mother has lots of milk? She still needs to respond to her baby’s cues but if she simply continues to feed more frequently sometimes the problem gets worse – she makes even more milk. Solutions Pumping off the first milk (so your baby gets the higher fat milk) is sometimes suggested and it can be a temporary solution. The problem is – the more you pump, the more milk you make. Another solution used by many mothers is to change how they feed their baby to decrease their overall supply. Sounds complicated? It’s not. What decreases milk production is leaving the breast full. Nature designed the system so that if your baby doesn’t nurse, eventually milk production stops. Obviously, you do not want to stop (and neither does your baby). The principle that works well is to nurse longer on the first breast before switching to the second breast. If, for example, your baby usually takes both breasts at a feeding, then let him feed longer (the whole feeding) from one breast. Offer the second breast at the next feeding. This program works because over a few days each breast will, in turn, stay fuller, longer. Staying fuller is what decreases milk production. For a few days you may feel a little uncomfortable. If you are really uncomfortable, mothers often find they can let their breasts leak or express off a little milk. Some mothers are already giving their babies only one breast at each feeding and still have lots of milk. They may find that for a few days they can give the baby the same breast for a couple of feedings before switching to the other breast. The same principle applies. Feed longer on the first breast before switching – it all depends on where your supply is when you start. Mothers and babies are different. Some babies need to take both breasts in order to get enough milk. Other babies could nurse on one breast for a few feedings. The important thing is for each mother and baby to get into synchrony with each other to fully enjoy the benefits of breast milk and breastfeeding. Once you and your baby are enjoying your breastfeeding relationship and you still find you have extra milk, consider becoming a breast milk donor by contacting the Milk Bank and BC Women’s Hospital. Call 604-875-2424 local 2282 for screening information. --------Breastfeeding
in public One of the most beautiful images I can imagine is that of a child snuggled up to his or her mother, nursing. With a very young child, typically the image is of a baby focused solely on feeding - eyes closed, tucked in as close as possible to mother's body, seemingly oblivious to the rest of the world. An older child might appear more reflective, taking time to stroke at mother's face or smile, nearly letting go of the breast. The mother while nursing may be totally engrossed in her child or involved in the activities around her. Where I work, these are common images. But sadly, generally around Vancouver, they aren't. And it is partly because these images are so uncommon as part of our daily experience that many women struggle to breastfeed. In contrast to my experience in Vancouver and while on vacation on one of the Gulf Islands, I was delighted to enjoy the natural event of a mother breastfeeding her child in public. In a restaurant dining room a young mother sat down with her seven- or eight-month-old son and another woman. The mother did a masterful job of anticipating her son's needs by providing a variety of toys, sips from a cup and some table foods. Both the family and the surrounding diners appeared to enjoy the ambiance of the ocean view, good food and peaceful environment. Then the mother very casually offered her son her breast. He, like the rest of the diners, simply carried on with his next course. He finished and went back to his toys at the table. No fuss, no muss, no complaints. This was simply an ordinary event - a normal part of the day. Why is it so remarkable? Because for many people living in Vancouver, a sight like this is unusual. The mother did not hide her baby under a blanket or carefully glance around to ensure no one would see or object. She did not excuse herself and feed her child in a washroom. She appeared to be comfortable doing what she had probably done without thinking every day for the past several months. Most mothers in Vancouver choose to breastfeed their babies. But given the thousands of babies born each year - babies who need to feed many times a day - I am left to wonder where they all are. Unfortunately, women are often still uncomfortable breastfeeding their children in public. As long as our culture contributes to mothers' uneasiness with breastfeeding, we as a society will not reap the numerous benefits provided by healthier, breastfed children. Our uncertainty about whether or not children should be breastfed in public or beyond early infancy, has contributed to a number of problems including a mother's increased difficulty with learning to breastfeed, premature weaning, social isolation of new mothers, and postpartum depression. For many women, the first opportunity to learn about breastfeeding comes when they are feeding their new baby. The shock of having this little life combined with the intensity of caring for him or her, can be made even more overwhelming when the new mother is trying to learn to breastfeed at the same time. In other cultures, women (and men) learn about caring for children - including feeding them - by seeing it happen around them throughout their lives. Having had the opportunity to observe others taking care of children, they avoid some of the culture shock that comes to so many new parents in our culture with the birth of their first baby. After new families survive the early realities of life with a newborn, they next face the difficulty of reintegrating into the world around them. Many new mothers find it difficult to just pack up their baby and breastfeed wherever and whenever the need arises. Often mothers worry about going out in case there is not a suitable, private place to which to escape, or they race home to breastfeed, or spend countless hours pumping milk to take with them. When breastfeeding becomes a hassle around which mothers must organize their day instead of something they do when necessary, they often stop breastfeeding before they or their children really want to. In the extreme, a mother may experience social isolation, which is a contributing factor to depression. That reality is slowly changing as we begin to see mothers become more comfortable feeding in public and continuing to breastfeed beyond early infancy. There is no doubt that human milk is the appropriate food for human children. Decades of research continue to confirm the obvious. Numerous health authorities urge women to breastfeed and recommend breastfeeding exclusively for six months after birth and continuing on after other foods are started at about six months. The World Health Organization states women should be "empowered" to breastfeed. Empowered women are women supported and respected for meeting their children's needs appropriately. They feel comfortable feeding their children wherever and whenever they need to. We will all be better off when breastfeeding becomes a common, uneventful occurrence. -------- 5
ways to easier breastfeeding Most pregnant mothers worry about breastfeeding. Sometimes they assume breastfeeding is 'just natural' and expect feedings will go well. Many mothers are surprised to discover that life with a newborn, including breastfeeding, is not simple. Planning in pregnancy can help. Attend to these five principles and the whole breastfeeding experience will be easier and more enjoyable. 1. Get off
to a good start Babies placed skin-to-skin with their mothers immediately after birth, become quiet and alert, their wide-open eyes searching for their mother. The warmth of the mother's body and the reassurance of her closeness and heart beat help to keep babies calm and to conserve their heat and their resources. Soon the baby searches for the breast, first with movements of his hands to mouth and then moving to latch to the breast. Babies left undisturbed will usually feed within the first hour or so. Keeping your baby skin-to-skin and covered with warm blankets for the first hours (and as long as you wish) will help make breastfeeding easier. 2. Give yourself
time to learn - prepare to make time With your partner, work out ways to simplify life for when you come home. Arrange your partner's holidays so he can enjoy this amazing phase of your baby's life (and support you). Some families refer to this as cocooning or nesting. Freeze meals that have already been prepared so that you don't have to worry about cooking. Decide which family members or friends can bring more food over (or do laundry!) when you run out. Sometimes it is difficult to ask for help. However, research also shows us that nice people live longer. If you let your family and friends help, you give them the opportunity to add years to their lives. New families are always amazed to discover how much time new babies take. Fathers do not need to feed their babies in order to bond with them - however families survive this intense experience better when fathers support mothers in breastfeeding. 3. Tune in
to your baby Babies too, take time to learn to breastfeed - especially if they have had a difficult birth or have been separated from their mothers. Learn as much as you can about typical newborn behaviours. Most babies are alert for feedings in the first couple of hours after birth. Next they have a deep recovery sleep. This is a good time for parents to sleep because most babies begin to wake and to feed frequently in the second 24 hours after birth - many of those feedings are during the night. Just as during pregnancy, many mothers notice how wakeful their newborn babies are at night. Gradually, babies will begin to sleep longer at night. All parents worry about their baby getting enough milk. Signals such as the number of wet diapers and bowel movements will help you figure this out. The number of wet diapers increases from one or two in the first day to six to eight on day four or five. Nature intends for your baby to have drops of colostrum for the first few feedings. This first milk is especially designed for your baby's needs. It is estimated that the volume of their tummy is the size of a chickpea at first. 4. Create
a positive environment Have a comfortable 'nest' to nurse in. As latching your baby gets easier, nursing in bed, especially at nighttime, means you can rest at the same time. In the day, it is helpful to have a place with everything you need easily at hand. 5. Deal with
the details Prevention of breastfeeding problems is ideal but if you have problems, deal with them early. Understand the basic principles. Babies who are well-latched to the breast do not damage mother's nipples. Simple techniques help babies latch well. Most mothers have some soreness in the first week but the nipple should not break down or become scabbed. Nipples look rounded, not flattened, when the baby releases the breast. If your nipple looks flattened at the tip or shaped like an "orthodontic nipple," then the baby has not latched well. If your nipples do get sore, they will heal when you help the baby latch better. Another difficulty that can often be avoided or minimized is engorgement. About the third or fourth day, when the milk supply is increasing, mothers find their breasts feel fuller. Some mothers feel very full - their breasts are hard and swollen - and find latching the baby is difficult. This is called engorgement. The best prevention is frequent, effective breastfeeding right from birth. However, if you experience engorgement, applying heat before feedings and ice after feedings will help. To soften the breast so you can feed your baby, apply warm packs, take a warm shower or submerge your breasts in a warm bath. Gently massage or express your milk. After the feeding, ice packs (a bag of frozen peas works well) on the breasts decrease the swelling. If you experience breastfeeding difficulties, get help early on. Call your health department, La Leche League leader, midwife or local breastfeeding clinic. "If in doubt, express it out." If for any reason you can't get your baby to feed, continue to express your milk until you can get help to resolve your breastfeeding problems. All mothers should learn to hand-express their milk before they leave the hospital. With very rare exceptions, breastfeeding works. Patience, time and support make an amazing difference. Even when there are lots of challenges, mothers and babies can work breastfeeding out together. -------- Breastfeeding:
how partners can help When mothers are asked who helped them succeed with breastfeeding, the most common answer is, "My partner!" Behind a successful breastfeeding mother is often a loving, involved partner. Women can breastfeed their babies on their own, but it is so much easier with a supportive partner. Fathers provide support in at least three significant ways - emotionally, practically and by being involved in baby care. Mothers often feel overwhelmed by the work involved with a new baby, the intensity of the experience and the lack of sleep. They feel like they lose themselves while meeting the needs of their baby. It can be a lonely experience. "Being there" for the baby is a lot easier for the new mother when her partner can "be there" for her by helping to provide basic comforts such as food, pillows, time and companionship. The practical skills of breastfeeding take time to learn. Most mothers struggle with some of the technical parts of the breastfeeding relationship: sore nipples, full breasts, and uncertainty about how well the baby is feeding. Women worry about being good enough mothers. Fathers are most helpful when they can listen to their partner's uncertainties and take over the household tasks to enable the mother to spend the necessary time figuring out how to breastfeed. When a mothers asks, "What should I do?" she may really be saying, "This is really hard. Do you think I'm doing okay?" She may be asking for reassurance more than answers and solutions. Feeling heard is key. Mothers need to feel that the people who love them believe in the importance of what they are doing and that they have confidence in them. Couples who understand the need to change the pace of life after birth will survive more easily. Fathers are key in helping to change the pace of the new family. Life is very different after birth. It is virtually impossible to do all of the things that used to be done. If feedings take an hour and there are at least eight of them in 24 hours, that, in itself, is a full-time job - and there are no weekends off! Holiday time planned for and taken after the baby's birth ensures fathers can manage crowd control (the visitors), provide simple meals, and take over crucial tasks in changing the pace of life in the newborn's home. A father's participation in the small day-to-day activities like laundry and dishes not only gives the mother time but also honours the time it takes to nurse the baby. Today's father is much more comfortable adopting this nurturing role with his partner - especially when he understands the tremendous benefits of breastfeeding his child. A peaceful walk together with the baby in a soft carrier may be one of the ways of reconnecting as a couple. Sharing the experience enhances the joy of it. Families develop their own styles to share baby care. The reality is that there is a lot of care to give. Many couples wonder how the father will bond with the baby if he cannot feed her. Bonding, or the process of falling in love, develops over time and through day-to-day caring and interactions. Feeding is only one way of spending time with a baby. Soothing, playing, cuddling, singing, talking, carrying, stroking, laughing together - there are innumerable ways of interacting. Baby care provides endless opportunities for interaction - bathing, changing, burping are but a few. A recent study in Canada found that fathers whose partners breastfed, envied the special relationship that breastfeeding gave to the mother and infant. But because they knew how important breast milk and breastfeeding are, these fathers were able to build their relationship with the baby in other ways so that breastfeeding was not compromised. They identified the child's need to breastfeed as most important, and trusted that their relationship would develop over time. If mothers need a break or if fathers want to feed the baby, many women find they can express milk for the baby. Once breastfeeding is well established, an occasional bottle of breast milk or formula is not as likely to interfere with breastfeeding. Other women find it is easier to just feed the baby rather than express milk. In North America, many families struggle to ensure that parenting is equal - that mothers and fathers are interchangeable. The reality is that, just as men and women are different, so are mothering and fathering. Women tend to hold children close. Men tend to play with and challenge their children. From the child's point of view this is a good thing. Differences in the two relationships enhance the child's world. Each parent adds to his/her child's life in special and different ways while contributing to the growth and emotional development of a unique human being. One of the real joys of becoming a mother or father is sharing the experience and marveling at the emergence of the parent in each other. -------- The
first hour after birth of baby Imagine the intense work of labour, completed. Lying on your abdomen is your beautiful, warm, moist baby becoming pinker as you gaze at her (or him). This baby may cry out to you as she breathes and expands her lungs for the first time or she may just quietly breathe. As she is quickly rubbed and dried off with a warm towel, you reach down to bring her closer to your face so you can really see this stranger that you have waited so long to meet. As the minutes tick by she starts to open her dark, sparkly eyes seeing you and her world for the very first time. This quiet, alert period is a peaceful time for the baby. Skin-to-skin contact with you stabilizes her temperature and helps her body adjust to the transition of birth. Even when you push again to deliver the placenta (and perhaps have some repairs made) holding your exquisitely beautiful baby works as a great analgesic. Soon she will start to explore with her mouth, perhaps bringing her hands to her mouth or beginning to root - opening her mouth and searching for your nipple. Her ability to open her mouth, latch and feed are optimal at this time. As your baby feeds, your body responds by releasing hormones that stimulate the feeding process. These same hormones also speed your recovery. Amazingly, even if your baby does not latch and feed, spontaneous massage-like movements of her hands against your breast stimulate a similar release of hormones helping to establish your milk. Throughout this time, your partner or the hospital staff will keep warm blankets over you and your baby. Left undisturbed, you and your baby begin the recovery process from birth. The nurse, midwife or physician can examine the baby while you hold or feed her. This scene is very different from what you would have experienced a few years ago and it is becoming the norm in many BC hospitals and when babies are born at home. Routinely, babies used to be delivered and quickly moved to a heated cot. Parents could barely see their baby. Typically, babies cried frantically. This intense crying at birth was thought to be normal. When returned to the mother, the baby was already, dressed, weighed and bundled in blankets for warmth. Though they might be offered the breast to feed, many babies could not latch well, partly due to the bundling, and partly because of the removal from the mother. The reason for this change in practice is not some kind of 'back-to-nature' movement. The science behind this change is compelling evidence that leaving mother and baby together, skin-to-skin in an unhurried environment after birth, has numerous advantages to mother and baby. For the baby, this contact helps to ease a difficult transition. Birth is stressful. Wrapped skin-to skin with mother the baby comes as close to her pre-birth environment as possible. The baby will feed better, have fewer stress hormones, be warmer, cry less and waste less energy than if she were taken away to be dressed, weighed and examined. In the early 1990s studies documented the newly born infant's ability to crawl up the mother's abdomen and find the breast. When left undisturbed, skin-to-skin with mother during this first hour of birth babies actually latched and fed better than if they were taken from the mother to be examined and wrapped up. Additionally, studies show an amazing synchrony between mothers and babies. Mother's body warms the baby. But if the baby gets too warm she loses heat to her mother to maintain a stable temperature. The intense crying of the separated infant at birth is now recognized as a separation distress call of the newborn. Babies may cry briefly at birth but when reunited with their mothers cry much less. Crying is stressful for the newly born infant attempting to make the internal changes necessary to adapt to life in the outside world. New studies find that the advantages of skin-to-skin contact in the first hour after birth last for many hours. Even several hours later, babies who were initially skin-to-skin with their mothers spent more time in quiet, restful sleep even when they were no longer in skin contact with their mother. These babies were less fussy and appeared less stressed than babies who were separated at birth. If the script for your birth varies from the one at the beginning of this article - perhaps your baby is stressed at birth or arrives by C-section birth, your experience of skin-to-skin will probably be delayed a little. As soon as possible you can still unwrap and undress your baby, place her skin-to-skin and give her the advantages of warmth, comfort, stability and closeness. If your baby comes to you bundled in a blanket feel free to unwrap the baby and put her skin-to-skin. Her body right against your skin is the most effective way to keep her warm - it works better than the most expensive hospital heating equipment. The bundle of blankets makes it very difficult for your baby to get close enough to get a good, effective latch. Skin-to-skin contact can also be a healing experience for you both. Until you are ready, your partner can keep the baby warm by holding her skin-to-skin against his chest. Hospital practices are changing. Most are moving towards evidence-based practices including honouring the rights of mothers and babies to stay together skin-to-skin as long as they wish to do so. If you have questions talk to your midwife or physician to clarify what your particular vision of the first hour after birth should look like. -------- The
most common breastfeeding concerns When my children were very young I provided breastfeeding support over the telephone. When they realized I was answering the questions of a breastfeeding mother they would say something like, "Tell them to breastfeed more often!" Surprisingly, this simple advice is often a good place to start for many of the most common breastfeeding concerns. Here are the most common breastfeeding concerns and some tips. Not enough
milk Many parents are not prepared for what "frequent feeds" looks like in real life. "Frequent feedings" is a euphemism for "camping out" at the breast. Your typical baby may cluster feedings together so that you are not sure if this is the same feeding or the next feeding. One feeding he might take one breast; the next, he might take both breasts and need to top up at the first one again. Keeping your baby close to you with lots of skin-to-skin contact can make frequent feedings easier. The intensity of these early feedings soon changes and your baby will not be feeding quite so frequently. However, babies continue to feed at least eight times in 24 hours for several weeks. These key points will tell you that your baby is getting enough milk: o Good output:
in the first two days your baby has one or two wet diapers and bowel movements.
After day three, your baby has five to six wet cloth diapers (four to
five disposable diapers) and has two or more bowel movements. The colour
of the bowel movements changes from black meconium at birth to seedy,
yellow stools about day three to five. If you have concerns about how much milk your baby is getting, get help quickly. Good help can make a difference. Engorgement
o Before
feeding apply warmth such as a shower or bath - submerge breasts in warm
water and let the milk leak out. Sore nipples
Tips for
a good latch: One of the ways to tell if the pain you feel is from a poor latch as opposed to just the initial soreness, is if the pain goes away after the first few sucks. A poor latch usually hurts throughout a feeding. Leaking
Plugged
ducts o Apply warm
compresses or immerse the breast in warm water. Plugs usually clear up in 24 to 48 hours of more frequent, effective breastfeeding. Mastitis
Time, patience,
persistence and support heal most breastfeeding concerns. If you have
any concerns that are not getting better get help. Good resources include:
-------- Weaning:
how and when to let go At some point in their breastfeeding relationship mothers have questions about weaning: "When and how should I wean my baby?" "How much breastfeeding is enough?" They want the best for their babies but are unsure how to meet their own and their babies' needs. Canadian culture is one just rediscovering the joys and advantages of breastfeeding. To make decisions about when and how to wean your breastfeeding child, it is helpful to separate cultural myth from evidence about what is "normal" and what is best for families. Answering the "when" question largely determines the "how." Take comfort knowing that all children wean from the breast. There comes a time when children 'are done'. Weaning is a natural process that begins when your baby starts to add other foods to his or her diet. Current recommendations from the World Health Organization are that, ideally, all babies should breastfeed exclusively for about six months and that breastfeeding should continue for two years and beyond. In Canada, many families are unaware that weaning is a developmental process like learning to walk or talk. Many of our practices and beliefs about weaning are culturally based. These beliefs and practices vary widely around the world. Children in Scandinavian countries, for example, wean from the breast much later than the average Canadian child. Is there something different about Canadian children? Of course not. The decision to wean has more to do with cultural beliefs and practices. Kathryn Dettwyler, an anthropologist and co-editor of Breastfeeding: Biocultural Perspectives writes that the "natural" age of weaning (the complete cessation of breastfeeding based on a variety of developmental milestones) is probably close to three years of age in well-nourished populations. She also indicates that human babies are designed to expect the immunological, emotional, cognitive and nutritional benefits of breastfeeding for at least two-and-a-half years. Canadian culture is changing. Women today are beginning to breastfeed longer than in the past. Breastfeeding mothers are protected under human rights legislation. Women returning to work are continuing to breastfeed. If fact, by law, employers have "a duty to accommodate" breastfeeding mothers to enable them to breastfeed or express milk. Changing cultural attitudes, longer maternity leave and legal acknowledgement of the rights of mothers and children are leading to more toddlers breastfeeding - weaning at a later age, an age more in line with biological needs. Child-led
weaning You will get hints from your child that her need to breastfeed is decreasing - that her busy life as a toddler is leading her development in lots of other directions. You may also find that the need to breastfeed ebbs and flows depending not only on the development of your child but also at times of stress. Accepting these changes of intensity helps your child fill her needs and then move forward developmentally. A gradual weaning process helps you and your child adjust physically and emotionally to the changes weaning involves. For you, gradual weaning means your breasts gradually decrease milk production preventing or minimizing uncomfortable fullness. For your child, gradual weaning makes an easier transition. Mother-led
weaning To the child, breastfeeding represents more than food. The 'food' part of breastfeeding can gradually be replaced with other age-appropriate foods and fluids. Mothers often find they can encourage weaning by anticipating their child's hunger by offering child-manageable nutritious snacks instead of offering the breast. Welcome your child to the social activity and company of mealtimes. Happy mealtimes enhance the weaning experience. The harder part is replacing your child's need for comfort. Sometimes families think that life will be easier when the child stops breastfeeding only to find that the child relied on breastfeeding for comfort. During the process of weaning, plan to spend lots of cuddling, playing, singing and simply having a good time together. Fathers and families can be very helpful. Distraction is another useful strategy. Replace nursing times by participating in other activities such as reading, playing and outdoor adventures. Sometimes children ask to nurse because it works well to get your attention. Timing is key. It is harder to appease a distressed child than to anticipate and prevent, as well as possible, the sources of distress. A strategy that works well for many families is 'don't offer, don't refuse.' If your child insists on nursing she is probably telling you she really needs to nurse. Meeting your child's needs helps the need go away. Flexibility helps. If you want to drop a breastfeeding consider replacing the feeding least important to your child. A good time to encourage weaning is when your child is healthy and in a 'good space.' Try to avoid too many changes when your child is already coping with other issues such family moves or a new caregiver. Even if your child has made significant steps towards weaning consider backing up the timetable if your child becomes ill or distressed. If weaning is abrupt, you may find you need to express you milk or let your child nurse to decrease your fullness. ------ Learning to breastfeed your newborn Your beautiful baby is finally in your arms. Having survived labour, your cherished dream is now a reality. If you are like most mothers, much of your energy during pregnancy has gone towards getting yourself through the birth process. Now the focus shifts dramatically to caring for, and feeding, your newly born baby. How do you even start? Fortunately, your baby, though just a beginner, comes especially equipped to feed well. What we now know about babies is that they are most likely to get off to a good start when we recognize their intense need for their mother and keep mothers and babies together with as much skin-to-skin contact as possible. There are many things you can do to help your baby’s first breastfeeding attempts go well. Babies left skin to skin with their mothers until they finish their first feeding are more likely to feed well, stay warm, cry less (and thus be less stressed) and conserve their energy. Responding to current research, the staff in most hospitals place your baby right up on your chest immediately after birth and leave you together at least until the first feeding is completed. Discuss this with you midwife or doctor ahead of time and remind the nurses in the birthing room that this is your plan. Your partner can help keep your baby warm by placing warm towels or blankets over you and your baby. It may be tempting to take your baby away from the security of your warm chest to weigh him or show him off to relatives. Not only will your baby be more likely to feed well but he will be more stable if he stays skin to skin with you at least until he finishes his first feeding. The evidence is clear – taking the baby away from your reassuring body is stressful for your baby. After the first couple of hours you will notice your baby falling into a deep sleep, a recovery sleep. Birth is hard work for both of you. Mothers do well when they take advantage of this time to rest themselves. You may be tempted to visit with family and friends but be forewarned, after a sleepy period in the first 24 hours babies begin to wake up – frequently! Most newborns wake up most frequently during the nights. This normal behaviour probably relates back to the time before birth when they slept more during the day while gently rocked by your movements and became more wakeful when you tried to sleep. Watch for the subtle feeding cues your baby makes. Mouthing, rooting (opening his mouth and turning his cheek when gently touched) and being awake are feeding cues. Crying is a late cue. If your baby is crying the chances are good that his early feeding cues were missed. If your baby spends lots of time skin to skin with you, it is much easier to see his feeding cues and this closeness also helps to stimulate your milk. Feeding him with just his diaper on and expressing some of your colostrum (liquid gold!) will help him to feed well. If he is having difficulty with the early feeds, you can express your milk by hand and he can lick the milk off your nipple or you can collect it with a dropper or spoon and give it to him. Sometimes, even when everything goes well, some mothers and babies struggle in the early days to breastfeed. One of the most common issues reported among breastfeeding moms is having difficulty latching. A good reference to take with you to the hospital is Baby’s Best Chance, a book published by the Province of British Columbia, Ministry of Children and Families. The drawings of latching and suggestions will be helpful. This book is available free from your local health department. Key pointers are to start sitting comfortably in a chair with your undressed baby as close to you as possible. With your baby’s chest and tummy against you, position him with your nipple towards his nose. Gently brush the spot just underneath your nipple against his mouth. When he opens his mouth as wide as a yawn, bring him in close. The nurses in the hospital spend most of their time helping new mothers and babies with breastfeeding. Ask for the help that you need. In hospital, learning everything you think you need to know can seem overwhelming. However, the only really important things you need to know are how to latch and feed your baby, how to tell that your baby is feeding well and where to get help if you need it. Other issues like bathing your baby are simply matters of common sense. One nice new discovery is about vervix, the white coating that you will see in your baby’s creases. We used to be in a hurry to wash it all off. Now we know there is no hurry – it is actually a protective coating of a balanced cream of antimicrobial compounds that helps protect the fetus and newborn from infection. Your stay in hospital is very short. Fortunately, your local community health nurse receives a fax from the hospital and will arrange to visit you at home. At home too, the key issues are about breastfeeding. Other valuable resources are mothers’ groups. La Leche Leaugue (LLL), a breastfeeding mother’s support group is an organization of experienced mothers with special education from this international group. LLL kept breastfeeding knowledge alive during the era when most women bottle-fed their babies. Check the resource lists at the back of this issue. Being a new mother is not easy in the beginning. Count on spending most of your time feeding, cuddling your baby and sleeping. Not much else can be accomplished. Arranging for help at home is key for survival. Time, patience and support from family, friends and the available resources will solve most breastfeeding issues. ------ Breastfeeding is best – even in a polluted world One of the most beautiful pictures imaginable is that of the blissfully full, breastfed baby asleep on her mother’s chest. Unfortunately, this image is used (sometimes inadvertently) to raise awareness of the pollutants in our world. Activists, citing studies on pollutants in breast milk, raise alarm bells about the safety of breast milk. New mothers hearing these news reports wonder if they are ‘contaminating’ their babies with their own milk. Is breastfeeding really safe in our polluted world? The simple answer is, unequivocally, “Yes.” But the issue is complex. A variety of pollutants including flame retardants known as polybrominated diphenyl ethers (PBDEs) and polychlorinated biphenyls (PCBs) can be found in human milk. PBDEs are found in electronics, plastic products, upholstery and many other products, and PCBs (though no longer in production) remain from industrial processing. These same pollutants are part of our “body burden” of pollutants. Since 1945, more that 300 new chemicals have been developed, many of them with risk of exposure not fully determined. These chemicals can be found in everyone’s body tissues. Many countries are taking action to reduce our exposure to some of these contaminants. Sweden and the European Union banned the use of flame retardants several years ago. It is well known that exposure to some of these contaminants during pregnancy can be toxic to the unborn baby’s nervous system. Though contaminants have been found in breast milk, no adverse affects have been seen in infants. In fact, as Alison Linnecar, international coordinator, Geneva Infant Feeding Association/International Baby Food Action Network, writes, “Breast milk may contain residues of chemicals that accumulate in all human bodies over the years, breastfeeding, because of its favourable effect on neurodevelopment, contributes to reducing the effects of these chemical residues that are passed to the unborn baby in the womb.” Studies have found that when formula-fed infants had the same exposure to pollutants during pregnancy they showed adverse effects while the breastfed infants did not. Scientists need to study our exposure to pollution and how well strategies are working to decrease our exposure. Breast milk is relatively easy to test. When we hear that even something as pure as mothers’ milk is contaminated, it gets our attention. Cord blood from newborns, biopsies of fatty tissue or even sperm could be tested to give the same information. Unfortunately, when we read studies focussing on human milk we essentially blame the mother rather than focusing on the source of the pollution. Contaminants in formula The point of this discussion is not to cause even more concern. Rather it is to look at this issue realistically. The World Health Organization concluded that in our polluted world human milk is still the safest and best food for human babies. So, if as a mother, a father or a grandparent you have concerns about pollutants it is important to ask the right question. The question is not “Should this baby breastfeed in our polluted world?”; rather, the question is, “What can we do to decrease pollution, and our own and our children’s exposure to it?” Breastfeeding is still best, especially in this polluted world. For more information check out the International Lactation Consultant Association (ILCA) Position on Breastfeeding, breast milk and environmental contaminant. |
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