Breastfeeding

An Assistive Guide

Objectives • Benefits of Breastfeeding

• Basic Nutritional Counseling

• Colostrum

• How to assess a newborn’s feeding habits

• Positioning and Latching

• Milk Storage

• Assistive agents to increase milk supply

• Mastitis

• Weaning

Benefits for Baby

Strong evidence decrease in LRI, diarrhea, otitis media,

bacteremia, bacterial meningitis, botulism, UTI, NEC

Protective effects: SIDS, IDDM, Crohn’s. Ulcerative

Colitis, lymphoma, allergies

Enhancement in visual and cognitive function,

NOT just nutrition-provides

information/protection and nuturing cues to baby

HEALTHY BABY!!

Benefits for Mother

• Decreased postpartum bleeding

• No periods while breastfeeding!

• Lose weight faster-burn up to 500 cal/day

• Stronger bones so less postmenopausal hip fractures Decreases lifetime risk of ovarian cancer and pre-menopausal breast cancer

• Reduced health care cost for families and fewer sick days needed to care for ill children

Maternal Nutrition is Key!!!

• Maintain 1800-2000 calorie diet

• Drink to thirst: forcing fluids does NOT increase milk supply

• Continue to take prenatal vitamin

• Calcium supplements: 1200-1500 mg/day – Make sure Vitamin D levels are appropriate too

• Vitamin C 120mg/day

• Special Considerations – Vegetarian/Vegan: may need supplemental Vitamins

B12, B6, A

– Low carbohydrate diet- may change the taste and smell of breast milk

Other Nutritional Considerations

• Caffeine- limit to 200mg day

– Two cups of home-brewed coffee, tea, or soda

– One regular-sized barista brewed coffee/tea

• Alcohol

– Best is to abstain

– Peak levels noted after 30-60 minutes on empty

stomach, 60-90 minutes if eating

• Best is to have occasional drink right after nursing to allow

metabolism to get rid of levels by the next feed

Other Nutritional Considerations

• What you eat may affect the baby

– A small percentage of babies react to foods in

mother’s diet

– Signs may include eczema, congestion, crying, and

sleeping issues

– Trial and error is the best way to reduce these irritants

to baby

• Common foods to avoid

– Sage, parsley, oregano, thyme, peppermint

(gum/mints/tea)

– Cabbage, Jasmine

Colostrum

• Production starts at 20 weeks

• May be thick in consistency and yellow in color

• Lasts for about 3 days

• Seals the lining of the infant’s intestinal system to decrease the adherence of bacteria

• Helps baby to excrete meconium, which decreases the risk of jaundice.

• High in protein and minerals

• Low in fat and lactose

• Contains IgA immunoglobins which boost the immune system

From Colostrum to Breast milk • Colostrum transitions to breast milk within the first

week

• Composition 88% water

• More balanced composition of protein, minerals, fats, carbohydrates

• Continues to promote immunoglobulin A to stimulate the immune system

• Increases Lactobacillus bifidus in the infant’s GI system

• Contains CCK (Cholecystokinin), a hormone that makes mom and baby sleepy and more relaxed – Proposed to be the hormone that helps prevents

postpartum blues/depression

First Week of Breastfeeding

• Babies are born with brown fat layers

– An energy source baby can use for first 96 hours of

life

– They EXPECT it to take time for the milk to come in!

• Baby’s stomach at birth is the size of a marble.

By day 10 size of an egg.

• Milk supply grows from 30cc on day one and up

to 900cc on day 40.

• Normal for Baby’s weight to drop up to 10% in

first week

– Will then increase 6oz day or 1.5lb/mo for the first four

months

First Week of Breastfeeding

• Breast should be offered within first hour of life.

• First 24 hours: Baby may only suck 2-3x at the breast

• First 24-48hr: Baby cluster feeds

– In a block of 4-5 hrs the baby will feed 15-20min on each breast then sleep 20-60min and repeat the cycle

• After 48 hours: Offer the breast every 3 hours during the day and on demand at night

• Supplement? General rule is to wait until the breast milk is well established ~ 2wks

First Week of Breastfeeding

• During days 1-3 after birth, if baby is left

unrestricted at the breast, they can obtain about

30ml/day of colostrum (1 ounce)

• By day 5, milk volume can rapidly rise to

600ml/24hr (20 ounces for whole day)

• Do not pump to try to determine how much milk

you are making

– Learn to understand the habits of your infant

– If not rooting after a feeding, has received enough

Assessing Adequate Intake of

Milk

• Inspect the urine – 24-48hrs of life: first urine may be orange-red in color

– Day 3-4: breastfed babies should make 3-4 wet

diapers per day with urine that looks like clear water

• Inspect the stool – First 72-96 hours: Meconium will pass first and

appear greenish black

– After 96 hours, should start turning golden brown

• Stool may appear loose and “seedy”—this is ok

– Expect 3-4 passages of stool per day

• This is the number one sign that the baby is gaining

weight

Baby Weight Gain Chart

Baby’s Age Average weight gain

per week

Average weight gain

per Month

Birth to Day 4

Up to 10% loss of birth

weight

n/a

Day 4 to 4 months

6oz 1.5 lbs

4-6 months

4-5oz 1 lb

6-12 months 2-4oz 0.5 lb

Helping Baby to Latch

• First, make sure the nipple reaches the soft

palate of the baby

Helping Baby to Latch

• Make sure baby’s entire upper and lower lip are wide open and covering as much of areola as possible—this creates the seal

Positioning Baby for

Breastfeeding

• Use positions that are comfortable for the baby

AND FOR YOU!

• Try different positions and alternate between

them if possible

• Position: Football

Breastfeeding Positions

Cradle Cross Cradle

Using same side of hand as head to

cradle

Use opposite hand of head to

cradle

Breastfeeding Positions

Side Lying Dancer

Storing Breast Milk: Guidelines LOCATION TEMP DURATION COMMENTS

COUNTERTOP ROOM TEMP UP TO

77*F OR 25*c

6-8HRS KEEP CONTAINERS

COVERED

INSULATED

COOLER/BAG

5-39*F OR -15-4*c 24HRS KEEP ICE PACKS IN

CONTACT WITH MILK, LIMIT

OPENING

REFRIGERATOR 39*F or 4*C 5 DAYS STORE MILK IN THE BACK

OF THE MAIN BODY OF THE

REFRIGERATOR

FREEZER

COMPARTMENT

5*F or -15*c 2 weeks STORE MILK IN THE BACK

OF THE FREEZER

FREEZER

COMPARTMENT-

SEPARATE DOORS

0*F OR -18* 3-6 MTHS MILK STORED FOR

LONGER PERIODS ARE

SAFE BUT SOME OF THE

LIPIDS UNDERGO

DEGRADATION RESULTING

IN LOWER QUALITY.

DEEP FREEZER -4*F OR -20*C 6-12 MTHS

How to Increase Milk Supply

• Fenugreek- helps increase the milk making hormone prolactin – Available over the counter

– 3 tablets 3 times per day

– Side effects to mom: increased gas, may increase maternal blood sugar

• Reglan/Metoclopramide- prescription needed – Usually used for nausea

– Does pass through breast milk– may affect GI tract of infant

• Notifiy pediatrician prior to use

– Possible side effects to mom: muscle spasms, depression, anxiety and glucose changes

How to Increase Milk Supply

• Domperidone/Motilium – Not FDA approved in USA

– Can be obtained on internet from Canada and Mexico

– Some pharmacies in USA do compound it

• Check with your pediatrician

• Other Herbs (not FDA approved) – Blessed thistle: may cause nausea or diarrhea – Alfalfa and Lactuca Virosa

• Not to be used by women with lupus or on blood thinner meds

– Goats Rue or French Lilac

• May notice increased sweating

– Shantavari

• Used in Australia for GI issues. Popular in China to help develop mammary glands

Medications that can Decrease Milk

Supply

• Pseudoephedrine or ephedrine

– Found in cold medicines like sudafed or weight loss

products

• Birth control pills that contain high doses of

estrogen

– Estrogen counteracts the effects of prolactin

– Progesterone only pills, Mirena IUD, and Paragard

IUD have no issues

Common Breast Issues

• Sore nipples

• Plugged Ducts

• Bacterial Mastitis

• Thrush

Sore Nipples • Usually due to poor baby positioning

– May be a high palate or tongue-tied

• May occur if pressing on breast too hard to see

the baby’s nose when latching

• Occurs more in women with fair skin

• Higher occurrence in women with inverted

nipples

• Nipple appears scabbed and red

• Treatment – Okay to continue to breastfeed

– Make sure to let breast milk air dry on nipple—the antimicrobial

components of the milk help them heal

– Lanolin cream available over the counter

– Jack Newman’s cream—available by prescription

Plugged Ducts • May occur anywhere in breast due to poor drainage

• No fever and onset of pain is gradual

• Causes: inadequate latch, tight bra, prior breast

surgery/implants, thick breast creams, diet high in

saturated fats

• Treatment

– Massage milk towards nipple when feeding baby

– Warm compresses on breast or soak in hot shower

– NSAIDs (i.e Motrin)

– Increase frequency of feeds

• Lecithin supplement : contain 1600mg phosphatide

(granulated better than liquid)

Bacterial Mastitis • Infection of the breast caused by bacteria

• Risk factors: ineffective latch, tight bra,

engorgement, and nipple trauma

• Signs: flu like symptoms, fever >101F, chills, red

and tender breast in one area of breast

– It’s rarely on both sides

• Treatment

– 7-14 days of antibiotic (needs prescription)

– Fluids/Motrin or Tylenol

– Safe to continue to breastfeed and drain the breast.

• Healthy full term baby GI can kill bacteria

Breast Candidiasis (Thrush) • Breast infection due to yeast

• Differences from bacterial mastitis

– Red/white rash with a flaky appearance on skin

– “Shooting pains” through nipple into breast

• Risk factors: infant with oral thrush, diaper rash,

diet high in sugar, recent antibiotic use

• Treatment

– Diflucan (by prescription)

– Treat infant of thrush/diaper rash (see the pediatrician)

– Re-sterilize bottles/pacifiers

– Jack Newman’s Cream or gentian violet

– Clean diaper area

WEANING- BIOLOGICAL AND

CULTURAL PROCESS

• World Health Organization recommends at least

6 months in industrial countries

• Gradual weaning is recommended to prevent

pain, plugged ducts or mastitis

– Stop the feeds with the lowest yields of milk

– Pump to relieve pressure if needed

– Ice packs, cabbage leaves

– Ibuprofen 400mg-600 mg every 6 hours for discomfort

– Minimize stimulation of breast

– Takes TIME & PATIENCE

WEB SITE RESOURCES

• lowmilksupply.org

• kellymom.com

• cdc.gov

• bfar.org

• www.aap.org (parents corner)

• www.acnm.org (gotmom.org)

• www. acog.org

• www.illi.org (La Leche League)

• National breastfeeding hotline (800) 994-9662

When to Call Your OBGYN or Pediatricain

• Mom

– Fever >101

– Painful, red breast lump that does not go away with

massage over 24 hours

– Shooting pains through nipple that do not go away

with massage over 24 hours

• Baby

– If baby is not making at least 4 wet diapers and 4

stool-filled diapers per day

– Baby’s mouth seems like it has thrush

– Diaper rash that doesn’t go away with normal

treatments