CHENNAI: It’s no news that breastmilk is the ideal food for newborns. While traditionally, many
communities encourage mothers to breastfeed their children, it has received accentuated support from scientists, the medical fraternity and global organisations like World Health Organization (WHO) to break the barriers and misconceptions about this basic mother-child right. Dr Umaiyal Murugesan from Sri Kumaran, a speciality hospital, West Tambaram; vice president of IMA Tambaram and secretary of Kancheepuram Obstretics and Gynae society, answers worried questions that new mothers
often ask.
One of the most common questions from women on the first day of becoming a mother is “I don’t produce enough milk, what can I do?”
For a majority of women, milk production is less common on the initial few days of delivery. It normally takes a day or two for the milk production to get initiated and secretion to happen. It’s a new experience for the mother’s body as it is learning to produce milk. A mother’s first milk is called colostrum and is tremendously beneficial for newborns. Early contact, early suckling and early initiation of the flow of breastmilk can be helped by the support of staff nurse and health staff. A newborn should be put to the mother’s breast shortly after birth to keep skin-to-skin contact when they have the strongest instinct to suckle the mother’s nipples. A baby knows how to suckle, it’s an inborn reflex that most babies are born with. A baby should not be forced to suck on the nipple if they are not willing to. Early introduction of a milk bottle or powdered milk can ruin the child’s natural sucking reflex, and is one of the main reasons that infants can fail to breastfeed properly.
Often, the mother, grandmother, mother-in-law worry that the baby will be hungry or dehydrated before sufficient colostrum is produced by their mothers. I would say, don’t worry and go on to explain that newborn babies have stored up adequate energy that fully meet their limited needs at this very early stage of life.
No water, juice or formula milk is needed. Anything other than colostrum can have a negative impact on the baby’s health. Lack of colostrum may cause diarrhoea in the baby and the mother’s lactation can be interrupted because the baby loses its instinct to the breast feed.
Will breastfeeding be affected if one has a C-section?
Mothers who have had a caesarean section are like any other, and have no impact on lactation and feeding. Though initiation of breastfeeding can be tough for the first few hours, this can be overcome by experienced staff nurses. The antibiotics and other drugs that is commonly used after surgery will not cause any problems with breastfeeding. After regaining consciousness and with adequate pain killer support, the mother can start skin contact with the baby and initiate breastfeeding the right away. They can opt to feed in alternate positions for the first few days like in a lying down position, but after a few days especially after the first 48 hours, the pain will subside and they will start to feed like any other mother.
You advise exclusive breastfeeding for the first six months without any water. Won’t my baby feel hungry or thirsty? Will the baby gain enough weight?
The milk that is produced for one feed has two parts — the foremilk and hind milk. The term foremilk refers to the milk at the beginning of a feeding; hind milk refers to milk at the end of a feeding, which has a higher fat and protein content than the milk at the beginning of that particular feeding. The foremilk of breast milk is majority of water, and this is sufficient for babies less than six months old. There is no need to feed the baby water or other fluid. The hind milk with higher fat and protein help in weight gain for the child.
On the contrary, water can be hazardous for baby less than six months old. Water fills up the baby’s stomach and prevents it from taking-in breast milk. It is also difficult to guarantee the safety of drinking water and the hygienic condition of utensils. Even in a hot, dry environment, the baby can acquire adequate water through frequent breastfeeding. You can tell if the baby is provided with sufficient water by observing their urine. If the baby is passing yellowish urine six times a day, it means the baby has adequate water supply.
How often should I breastfeed per day? How long per session?
In the first few weeks, babies should be breastfed a minimum of eight to 12 times per day. At first, sessions might take up to 45 minutes, but as the baby gets more efficient, feedings can last somewhere closer to 10 to 20 minutes.
My two-week-old baby hasn’t been fed for four hours. Should I wake him up?
Not necessarily, if he is feeding more throughout the rest of the day. They will probably cluster feed which means they might want to feed every hour or so and then they will have a time where they sleep for longer. But if you have a newborn, who is not back up to birth weight, it’s very important to wake them up to feed. Newborns should eat at least 10-12 times per day, which means eating at least every
2-3 hours.
How long should my baby nurse at each feeding?
Ending a feeding session before your baby has finished can hinder their milk intake and overall weight gain and potentially affect your milk supply. But there isn’t a perfect number of minutes to nurse a newborn; in fact, I advise new moms not to watch the clock but rather to follow their baby’s cues. That said, noting the session start and stop times with a breastfeeding app can help you keep track of how frequently your baby has eaten in the last 24 hours. You could also note which side you started on, hunger cues, etc. The length of feedings can depend on many factors, and the rule of thumb is to allow your baby to nurse as long as they’re actively sucking and swallowing. After a feeding, your baby should seem satisfied and happy; they’ll have open or relaxed hands; they may even come off the breast themselves.
Is it true that after six months, the breastmilk will contain no nutrients just like water?
Breast milk is perfectly designed to nourish human babies, and almost all women can produce breast milk with the expected nutrient composition. The composition of breast milk can vary at different stages, from colostrum at birth, to mature milk later. And composition also changes within a feed from light foremilk at the beginning of a feed to quench the baby’s thirst, to richer hind milk to satisfy energy and nutrient needs. This is one of the miraculous qualities of human milk. The body adjusts the composition of milk to suit the babies changing needs. The composition in terms of energy, protein, and iron is quite similar before and after six months.
The percentage contribution varies from nutrient to nutrient. Immunity factors in breast milk also vary from time to time depending on exposure of the mother to various antigens. But it is untrue that breast milk has no nutrients after six months. The fact is that after six months the energy and nutrient needs of the baby can no longer be met by breast milk alone. This is why UNICEF and WHO recommend continued breast feeding with complementary foods after six months.
Once infants fail breast feed, formula has to be given. Some mothers feel that infants fed with formula often develop faster than breastfed babies, in terms of height and weight. The mothers therefore assume that formula is as good as breast milk. Does this have any scientific evidence?
There are two issues here.
If we compare the substitutes and breastmilk, how differently will they affect the children’s survival, growth, development and their entire life?
Compared to breastfed infants, non-breastfed infants below two months of age are six times more likely to die from acute respiratory infection (ARI) and diarrhoea. In children up to two years of age, non-breast-fed children are 1.5 times more likely to die than breast-fed infants. There is evidence that breastfeeding protects against Sudden Infant Death Syndrome (SIDS), allergies, ARI, ear infections. Formula also makes children more prone to infection, asthma, meningitis, obesity, and diabetes. This is because of the protective effect of human milk, as well as the fact that breastfeeding is simply the most hygienic and nutritious form of food for infants.
What are the risks of artificial feeding?
First and foremost, using breastmilk substitutes do not offer the benefits of breastfeeding to the children. Artificial baby milk can be harmful because it can be contaminated during its manufacture, preparation, and use, as shown by alarming examples all over the world. Even if the formula is prepared under the best hygienic conditions and therefore free from contamination, it can never be as good as breastmilk and makes children more prone to infection, asthma, meningitis, obesity, and diabetes, according to a number of studies in western countries.