Feeding is a vital function in the baby's development and growth, for that reason it is usually one of the first concerns of the parents.
The baby's growth is very quick in the first months and his organism doesn't still have any body reserves; for that reason it is necessary that the feeding gives him all the nutritious substances that he requires.
For the baby the feeding time is very pleasant, it satisfies a pressing need, but it also provides a series of sensations that provide him with total well-being. In the mother's arms, he perceives her corporal scent and the sounds of the heart that he finds familiar, he can see her loving face while he listens to tender words of acceptance and affection, he smells and savors the milk that makes him feel well and he discovers an entire world of new sensations when touching his mother's skin and clothes.
To breastfeed the baby means to offer him live food that covers all his nutritious needs and protects him of possible infections and allergies.
Organizations such as the WHO or UNICEF promote nursing around the world because the different investigations that have been carried out confirm the enormous benefits that it contributes, among which we can highlight the following ones:
It protects the baby from intestinal, breathing and ear infections until his immunologic system takes charge of this protection.
• It adapts to the baby's nutritious needs and to his digestive system.
• It has the ideal temperature at any time.
• It remains aseptic and it provides the baby with antibodies that will reduce the risk of allergies and intolerances. When the baby suffers some type of allergy, nursing diminishes its seriousness.
The colostrum is the first milk that the breast segregates. This thick, sweet and yellowish liquid is very rich in immunoglobulin and it appears during the first three or four days after giving birth.
The hormones . When the placenta is expelled, the production of estrogens and progesterone diminishes drastically and the mother's body increases the levels of prolactin and oxitocyn.
The prolactin is the hormone responsible for the production of milk and the oxitocyn is in charge of making the liquid come out of the breast.
When the baby sucks, he stimulates the nervous endings of the nipple that send signs to the hypothalamus so that the pituitary gland of the brain releases prolactin. This hormone transfers signs to the alveolus of the breasts in charge of producing the milk. Through the blood comes the oxitocyn that provokes the muscular contraction around the alveolus forcing them to send the milk through the galactophorus ducts to the lactiferous breasts where the baby sucks and obtains the milk.
Maternal milk adapts to the baby's needs throughout each taking. At the beginning it contains more water and lactose and, little by little it thickens, increasing the quantity of fatty substances. If the baby only takes the initial milk, it goes quickly through the intestine and all the nutrients are not absorbed, for that reason it is necessary to wait until one breast empties before changing to the other one. One notices that the breast has emptied when it is not tense, it can empty in about 10 to 20 minutes, according to the suction intensity.
The milk has a different composition in each woman, even the milk of one woman changes its components from one day to the other and during the same day. For example, the fatty content is lower during the night and it increases during the day.
The best thing that the mother can do to guarantee the production of milk it is to make sure that her breasts empty regularly. The milk contains a chemical substance that acts as an inhibitor and, when the milk stays too long in the breast, it provokes a decrease in the production.
There is not a fixed period of time for each breast because each baby sucks in with different intensity. In general, the first day after the childbirth he usually sucks 5 minutes of each breast and the second day he doubles this time. The secretion of milk is not completely regular until after 15 days, so it is better that he suckles of both. Later on, it is possible that he is satiated with one breast and it will be necessary to offer him the other one in the following taking.
At the beginning the baby has short periods of sleep and he usually wakes up being hungry, both by day and at night. It is advisable to space the takings with a minimum of two hours because in a shorter period there is no time to digest the milk and to be hungry again.
The frequency of the takings is marked by the baby and the best thing is to give him the breast when he requests it, this way the feeding adapts to the baby's needs respecting his personal rhythm and his sleep periods.
During the first month he usually makes from 6 to 8 takings a day. As time goes by, they diminish down to 5, and later to 4 daily. It is important to try to have him ingest more quantity at the end of the afternoon so that we can also increase the hours between takings at night. When the baby weights 5 or 6 kilos he can go 6 to 7 hours without taking food because he will already have body reserves. With four months he can sleep the whole night and make four or five takings during the day.
The breastfeeding process
The newly born one has a series of reflexes that help him to best adapt to his new environment. One of these reflexes is that of suction, for that reason the baby sucks as soon as he notices any close touch on his lips. But although he has this reflex, he doesn't eat correctly because he swallows air, lets go of the nipple from time to time without wanting it and leaves milk in the corners of the lips. For this reason it is indispensable to follow some minimum rules so that the nursling eats in an appropriate and pleasant way.
Before beginning the taking we should get ready all that we are going to use and place it near us. The hygiene of the hands and the nipples are indispensable and, if the mother suspects that she can catch a cold, she should wear a handkerchief or mask on her mouth.
It is advisable that the mother rests a while before giving the breast to the baby because any edginess contributes to reduce the production of milk.
It is necessary to avoid that something or somebody interrupts during the breastfeeding that if it is possible should always be carried out in the same place, in a calm and quiet atmosphere. The posture should be comfortable for the mother and for the baby, so that he can easily reach the nipple.
The mother can sit down on the bed or a low seat, with the back straight and the arm that holds the baby supported on some cushions. The feet can be placed on a low stool and she should place another cushion on the knees so that the baby is comfortable.
Once sitting, the mother holds the baby in her lap so that the mouth is to the height of the nipple and the head is on her forearm. It is necessary to offer the nipple to the baby without hurries, when the mother touches his cheek he will turn with his open mouth willing to begin the suction.
The baby should embrace with his mouth the nipple and great part of the areola so that the suction is correct. The mother can hold the breast placing the thumb above the breast and the rest of fingers under it, but without touching the areola. With this posture she provides the space between her breast and the baby's nose so that the baby can breathe normally and the exit of the milk is facilitated.
At the beginning of the taking the baby suckles in a regular and continuous way, with short and quick suctions. As he gets satiated, his suctions become more lingering and slower. In occasions he pauses, but it doesn't mean that he has finished, we can use these pauses to help him expel the air. When he feels satisfied, besides stopping the suction, he will withdraw his mouth of the breast.
HOW TO HELP THE BABY TO EXPEL AIR
After the taking, or during it, we have to help the baby to expel any air he has ingested.
Newborn: we should place his face on our shoulder while we gently rub his back or pat him on the back.
After three months:
- Keep him seated and well held while leaning to the front and while we rub softly his back.
- Place the baby on the adult's lap with the arm under his chest and the hand under the abdomen while we rub his back or pat him softly on the back
The baby's appetite varies from one taking to the other, but this should not worry the parents, he takes what needs. It is not necessary to weigh him after each taking, once he recovers the weight at birth, during the first month he will gain between 100 and 150 grams per week and about 150 and 200 weekly grams the three following months.
The nursing should begin as soon as possible, if there is the possibility, the best moment it is in the delivery room even if epidural anesthesia has been applied.
The later the breastfeeding begins, the more difficult it will be for the baby to get used to the breast but, even if the feeding is delayed for a few days, the colostrum won't get lost and the baby will be able to suckle with success.
At the beginning of the nursing it is not advisable to use baby bottles and pacifiers because they confuse the newborn. Some babies suckle well although they use them but in many cases the small ones may have difficulties with the nursing when they are given a pacifier or baby bottle.
The breasts during this period
The mother's body gets ready for the nursing throughout the pregnancy and, when she decides to give breast, she should also get ready for the nursing.
During the last month of pregnancy it is important to moisturize and to nurture the skin of the nipples and the aureola and to massage the breast to get them used to the stimulation that they will receive throughout the nursing. The massage should be in circles, soft at the beginning and progressively more intense until a small colostrum secretion takes place.
When the nursing has already begun, the care of the breasts should continue. The skin of the nipple and the aureola should be nurtured and moisturized after the shower and, if needed, between takings. Using an unscented cream that won't bother the baby because the skin absorbs it quickly, however, when washing the area before the taking any remains left should be eliminated. Before the baby suckles, the mother can massage in a circular way the top part of the chest and pull the nipple so that it stands out, mainly when the nipples are very sensitive.
The collection of milk
If the mother has a lot of milk and she needs to avoid that the breast is filled excessively or to empty part of the breast because the baby has not suckled well, she can use protective disks to collect or to extract the milk regularly and to keep it in the refrigerator up to 24 hours in a sterilized baby bottle.
• The protective disks can be used when the milk goes up between takings. They can also be left on to collect the milk when it spurts spontaneously.
It is necessary to clean and sterilize the disks just after using them and the milk should not remain in them more than 30 minutes.
To obtain and to collect the milk with a manual or electric pump is an appropriate measure when the baby doesn't suckle correctly or when he is hospitalized because he is premature or another problem that impedes him from taking the breast normally.
The collectors stimulate the ascent of the milk and they favor the continuity of the production. The collection in the sterilized baby bottle should be made following rigorous hygienic conditions.
The nipples usually ache frequently, these nuisances can appear in the first days or after the second or third week.
In general, this is because the posture adopted during the takings is not the correct one. The nipple should be centered in the baby's mouth so that it occupies, besides the nipple, great part of the aureola. If the suction is too quick, one can make it slower holding the baby's chin smoothly. Also to avoid the aggressive suction at the beginning of the taking, the mother can extract some milk before beginning.
The hypersensitivity of the nipples usually diminishes as the baby learns how to suckle correctly, nevertheless, it is important that the nipples stay clean and dry besides using some lanolin cream with vitamins A and D.
As in the previous case, they are usually due to the baby's bad posture when he only catches the tip of the nipple and suctions without taking any milk irritating the skin. When the irritation is strong, the nipples crack and they begin to bleed, which requires a suspension of the nursing until they close. In the meantime the mother can extract the milk every three hours and offer it to the baby in a baby bottle.
It is necessary to maintain total hygiene in the area, to dry the injuries well and to apply moisturizing cream, vitamin E in oil or some cream that the doctor recommends.
When the nipples are sunken down, the baby has difficulty in suckling efficiently, but we should not give up on breastfeeding because the nipple helps in this process but is not indispensable to breast feed.
Normally, the doctor will recommend specific exercises during the pregnancy before giving breast to prepare the nipples. When the nursing has begun, the massages are indispensable and the use of silicon nipple covers may assist in the suckling.
• Infection by sores
It can happen that in the baby's mouth there is a fungus called Candida albicans is located that produces an infection or sore causing reddening, flaking and ache in the nipples.
The origin of these nuisances is proven if the baby has white stains inside the mouth, mainly in the tongue or the gums. It is indispensable to maintain the nipples dry and to ask the doctor to prescribes some antifungal cream. Some homemade remedy, as applying natural yogurt, alleviates the problem because it contains bacteria that combats this fungus.
It is an infection of the breasts and it requires the consultation with the doctor so that he prescribes an antibiotic. This infection provokes reddening, pain and hypersensitivity of the area, it also causes high fever, muscular pains and even nauseas and vomits.
Unless the doctor indicates it so for some complication, it is not necessary to interrupt the nursing because the problem is located in the breast without affecting the milk.
• Obstructed conduits
This problem occurs when one or several conduits are blocked and they don't let the milk to go through. A hard and painful bump can appear that is noticed when touching.
The mother has to avoid the retention of milk giving breast frequently and beginning the taking with the aching breast. When there is a longer time between takings, she can extract the milk to empty the breast. It is advisable to apply humid heat and to massage the breast softly before beginning the taking.
It is an inflammation of the mammary glands that provokes the appearance of a red and painful area in the breast that is quite tense.
It usually produces fever and it requires a medical consultation so that he prescribes a treatment. The baby can continue suckling of the other breast during the 3 or 4 days that the problem usually lasts.
Basic norms for breastfeeding
So that the nursing is successful in the short and medium term, it is indispensable that the mother follows some basic norms:
? To maintain a healthy, balanced and complete diet, rich in vitamins and minerals.
? To rest and to sleep as necessary, avoiding stressing situations.
? To take liquids, mainly water.
? To avoid tobacco, alcohol, caffeine and other harmful substances for the baby and the mother.
? To consult to the doctor before taking a medication.
The mother's diet during the nursing should be very similar to that of the last months of pregnancy, including a larger amount of milk products that are easy to digest.
She should eat three main meals plus a mid morning and a mid afternoon snack.
Eggs, meat and fish supply proteins, the fruit and the greens mainly provide vitamins and mineral salts and the starches supply vitamin B.
In each meal she can eat fruit without abusing of the citrics, plums, pineapple, etc., as they can have laxative effects.
It is good to take liquids (milk, teas, natural juices, etc.) mainly water to facilitate the nursing, to calm the thirst and to eliminate the sensation of dryness in the mouth.
In the first weeks of nursing it is necessary to moderate the consumption of some foods such as vegetables, peas or cabbages because they can hinder the baby's digestion.
The flavor of foods such as leek, garlic, onion, celery, pepper or asparagus passes on to the milk and it can displease the baby. In many occasions, the gases or the too liquid faeces of the baby are corrected by diminishing the quantity of salads, of vegetables, of juices and fruits in the mother's diet.
After the first weeks, the mother's diet can contain all type of foods, trying to moderate the consumption of those mentioned previously.
The mother, in no case, should take medications without a medical prescription. Tranquilizers, sleeping pills, pain relievers or laxatives pass their effects to the milk and they harm the baby.
Also alcohol and noxious substances of tobacco, coffee or tea provoke in the baby from colic or excitability to breathing difficulties and other alterations in his health.
Nursing after a Caesarean operation
Although it has been necessary to carry out a Caesarean operation, the mother can breastfeed the baby as soon as her general evolution allows it. The sooner she begins, the more the mother and the baby will benefit.
The doctor will inform the mother of the effects of the sedatives in the baby. Many pediatricians, even the American Academy of Pediatrics, recommend the nursing from the first moment because the benefits are bigger than the effects of these substances that are usually limited to a possible state of drowsiness.
In the event of Caesarean operation the position during the taking should vary because the weight and the baby's movements can bother the mother.
The mother can choose one of these postures:
? To sit down with a big pillow in the lap and to place on it the baby.
? Lying on the bed so that the baby's legs don't press in the area of the incision.
? Placing the baby on a pillow so that the head is on the mother's lap and the legs under her armpit towards her back.
Weaning the baby
There are mothers that make the decision of not giving breast to their babies, in these cases the doctor administers a medicine shortly after of the childbirth to interrupt the production of milk.
However the most frequent thing is that the maternal nursing is suppressed in a progressive way by adding a feeding with the help of adapted milk in a baby bottle.
To begin the weaning, the first step should be to help the baby to get used to the contact of the bottle nipple and the suction that it is different to that of the breast, besides adapting to the flavor of the artificial milk. We will do this at a time when the baby is in good health, and the baby bottles will supplement the taking of the breast substituting them little by little. The last takings to suppress will be that of the morning because the breasts are full with milk and that of the night because it is necessary to empty them.
The father's collaboration in the weaning process is very important since he can take charge of giving the adapted milk and to serve as an affective support for the mother and the baby that will go through a difficult separation for both.
The choice of the moment for weaning belongs to the mother and all the reasons that move her to make the decision are valid.
The pediatrician will guide the parents on the adapted milk to use and the steps to follow in terms of the baby's evolution.
The doctor can also prescribe the mother a medicine to reduce the production of milk, besides recommending the reduction of liquids in her diet.
SELF CHECK QUIZ
SECTION 2 - BLOCK 3
1. The maternal milk is a live food because it contains germs that have not been included in adapted milks.
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2. Maternal milk changes its composition during the day and even during a taking.
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3. The more the baby suckles, the more he stimulates the inhibition of milk production.
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4. After gaining some weight, the baby usually gains between 100 and 150 grams every week during the first month.
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5. Many nursing failures are due to a bad posture during breastfeeding.
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6. The mother should pay special care to her breasts during the pregnancy and after the childbirth.
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7. The maternal milk can be collected with disks or a manual or electric pump.
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8. While the baby is being breastfed, the mother should avoid smoking and drinking coffee, alcohol and other liquids.
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9. It is necessary that the mother eats well during the whole nursing period.
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10. After a Cesarean, nursing should start when the tissue has healed because the baby's weight can open the wound.
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11. If the parents want to wean the baby before the third month, it is best to give him adapted milk since he is born.
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