Breastfeeding | Glengarry Private Hospital | Perth

Breastmilk

Breastfeeding is the optimal method of nutrition for babies. Colostrum, the initial breastmilk for a baby, is full of carbohydrates, protein and antibodies. These protect against infection. The amount of breastmilk increases over the first weeks, and is balanced in nutrients for your baby. Your supply is influenced by the frequency of feeds. The amount of breastmilk will increase as your baby feeds more.

Sore nipples

Correctly positioning & attachment prevents sore nipples. However if soreness occurs, nipple shields and Lanolin can be used. Having a lactation consultant assess technique can be very helpful. See below for some more tips on latching. The use of laser is popular with sore nipples but is still somewhat unproven. Trials are ongoing, but we use it here at Attadale in Perth empirically, and it seems to help new mothers.

Is baby getting enough milk?

Signs of this are

• 6+ wet nappies + several poos daily
• Baby is alert
• Feeds 8+ times daily
• Good weight gain
• Skin is elastic

Do I need to feed my baby every three hours?

No. Cluster feeding then breastfeeding with longer gaps is fine. Aim for 8+ feeds daily rather than strict intervals. There is variation however between babies, mothers’ breast capacity, and if the baby is unwell.

What about drugs to increase breast milk supply?

These drugs are controversial.

Metoclopramide increases prolactin production and probably increases supply although this may be a placebo effect. Minor side effects like dizziness or headache can sometimes occur. Rarely a severe muscular spasm can occur which means you have to stop the medication. It is probably safe for mum & baby, but is unlicensed for breastfeeding.

Domperidone is the controversial drug. It’s more commonly prescribed in Perth & Australia then metoclopramide as there are possibly fewer minor side-effects. It probably increases milk supply to a moderate extent, albeit at higher doses. At standard doses it’s effects are modest. A proper trial is currently ongoing to see if it really works and how frequently major side effects occur. The drug is possibly associated with rare sudden deaths due to changes in the heart’s electrical supply, especially when high doses are used. It is banned in the US, restricted in Europe, and currently the subject of a government warning in Canada. In the meantime, we do not prescribe this medication.

When should I wean?

The best time to wean is between 5-6 months. Breastfeeding exclusively beyond 6 months may be less healthy according to research.

• Breastfeeding should not be decreased when starting on solids
• Food should be given with a spoon or cup, not in a bottle
• Food should be clean & safe
• Ample time is needed for children to learn to eat solids

Breastfeeding as contraception

Exclusive breastfeeding, as long as the periods haven’t started is good contraception. When the periods start, fertility is increased. A popular choice for contraception while breastfeeding is the mini-pill. The mini-pill is extremely safe, and too low a dose of hormone to interfere with breastfeeding.

What are the benefits of breastfeeding?

The main benefits are in the first 6 months. Breastfeeding protects against infection eg. gastroenteritis & chest infections, in early life; promotes bonding & closeness; is healthy, matched to your baby; and is free. Using expressed breast milk allows Dad to help with feeds on occasion.

Breastfeeding protects against breast & ovarian cancer, and can help weight loss when combined with a healthy diet.

Breastfeeding does not cause changes to the shape and support of the breasts – pregnancy & time do this. There is no difference in the breasts of women who breastfeed vs. those who formula feed.

The long-term benefits are much more controversial. The World Health Organisation has recently published a report confirming that there are no medical benefits to breastfeeding beyond 6 months. However, the benefits in terms of closeness, convenience & economy obviously continue if breastfeeding continues. Your baby should not be exclusively breast-fed beyond 6 months – introduce some food.

Preparation

• Drink lots of water, sleep & eat well, otherwise your supply may be affected.
• Try and find a quiet area if you can so you can relax with your baby and enjoy the special time together.
• Don't watch the clock to see how often or how long your baby is feeding - go with your instincts. If your baby is rooting around or crying, then feed — even if you just did.
• Go to the toilet before you start.
• Have a breastfeeding pack to hand: water bottle, energy bar, something to read, baby nail clippers, pen & paper, lanolin, burp cloths etc.
• Breastfeeding pillows are great for supporting baby and freeing up a hand – even more important for twins.
 

Latching

• Make sure your baby's mouth covers a large part of the underside of your nipple.
• Stay ahead of baby’s hunger. Check around the time of waking and watch for tongue-sucking and lip-smacking in light sleep. Then put the baby to the breast before proper hunger-crying starts. Baby won’t suck as hard.
• Drink cold water through a straw, as baby is latching, to distract from the discomfort.
• Nipple shields can be good if you have small nipples. Alternatively, use a syringe to pull the nipple bigger until the nipples conform.
• Tongue-tie is over-diagnosed and often persistence pays off in border-line case as the baby and you learn to feed. Squashing the nipples down so baby can take them in is helpful. However, the procedure for alleviating tongue-tie is straight forward – incision of the frenulum.
 

During breastfeeding

• Try and drain your breasts all the way down, one at a time, so baby can reach the hind milk which will quench hunger.
• A baby that's crying because it's hungry, with an exhausted mum with a supply that hasn't caught up, is common. A little bit of formula, combined with expressing to make sure demand sustains supply, together with the rest that's needed in milk production does work, when used occasionally.
 

After breastfeeding

• Use lanolin ointment on your nipples morning and night.
• After feeding, express some milk and spread on your nipples to prevent dryness & cracking.
• Blocked milk ducts – use a warming bag, take 400mg ibuprofen, hand-express from that area during the next feed.
 

Other stuff

• Leaking breasts despite breast pads? Use an ultra-thin sanitary pad folded in half.
• Persevere. Don't give up. Many women struggle but win in the end.
• And finally, do what's right for you, don't let anyone judge you!