Breastfeeding

breast-feading

What are the advantages of breastfeeding?

Breastfeeding has benefits for both mom and baby. For you, as long as you have adequate privacy or are able to breastfeed comfortably with others around, it is very convenient (“Fast food—two convenient locations!”). It can help you return to your pre-pregnant weight more quickly, it reduces your risk of ovarian cancer, premenopausal breast cancer, obesity in later life, and perhaps, counter to what you’d suppose, it even reduces your risk of osteoporosis. It also tends to make you a more confident mother who trusts her understanding of her baby.

For your baby, there are well known immune benefits. Your breastfed baby is likely to need fewer sick visits. Specifically, a breastfed baby’s immune system matures faster than a formula fed baby’s, and due to this as well as specific immune factors your breast milk contains, s/he tends to have fewer diarrheal or respiratory illnesses or ear infections. Your baby’s stools will not seem smelly compared to formula stools, and s/he is very unlikely to get constipated.

In addition, your baby has a lower risk of obesity, and tends to gain a few IQ points when compared to a formula fed baby.

What if my baby is premature?

The advantages of breastmilk vs. formula may be even greater for a preterm baby. Your baby has a lower risk of serious infections, including a bowel disorder called necrotising enterocolitis. There are also advantages for the baby’s neurological development.

Your baby may not be able to be fed initially, or if s/he gets sick. But when the baby is stable enough, s/he will be allowed to nurse, or be fed breastmilk through a narrow tube from the nose or mouth into the stomach.

For a baby below about 35 weeks, the neonatologist (preterm baby specialist) may recommend “fortification” of your breastmilk with a powder that provides some added nutrients.

It may be harder for you to lactate (produce breastmilk) when your baby is in the preterm nursery, especially if it is your first time breastfeeding. This is partly due to lack of your breasts’ full readiness before 37 weeks, but perhaps more due to stress, separation from your baby, inadequate stimulation of your breasts (insufficient nursing or pumping), and also inadequate support by your and the baby’s health care providers.

If you want to provide breastmilk for your baby, make sure the baby’s doctors and nurses know, and get help building up and maintaining your milk supply.

Are there certain foods I should avoid when nursing?

In general, no. But if you, the baby’s father, or a previous baby has an allergic history—bad eczema, allergies or wheezing—then avoidance of peanuts and “tree nuts” (walnuts, almonds, brazil nuts, etc.) during pregnancy and lactation may be indicated.

If your diet is unrestricted and your baby develops extensive eczema, recurrent wheezing, or blood-stained stools, elimination of common allergens from your diet may help you avoid the need to medicate your baby. Common foods to cause allergy in a breastfeeding baby include dairy products, eggs, fish, peanuts and tree nuts. But, please don’t embark on a prolonged “elimination diet” without seeking nutritional advice for yourself. Supplemental minerals, especially calcium, and vitamins may be beneficial to you if you restrict your diet.

Nursing women often avoid broccoli, cucumbers, caffeine and other foods which have a reputation for causing “gas” or “colic” in breastfeeding babies. But, I think you should be able to consume these things as long as you try to monitor your baby for any pattern of symptoms. If you consistently notice distress after a certain food, you will probably want to avoid it.

Can I breastfeed if I’m taking medication, or smoke?

There are few medications that are absolutely contraindicated when breastfeeding. This needs to be reviewed on a case-by-case basis. Most drugs taken by a mom which appear in her bloodstream will be detectable in breastmilk. Sometimes the drug is not really indicated (i.e., over the counter cold medicines), sometimes it can be dosed at times that minimize its concentration in breastmilk. Some should be replaced with another one safer during breastfeeding, and occasionally breastmilk needs to be pumped and discarded until the milk is likely to be cleared of a drug used once-only or for a short course.

La Leche League has published a blurb on this general topic as an introduction to the issues involved. In another short read, a pediatrician, Dr Jack Newman, offers some more specific information.

Breastfeeding when smoking is controversial. The American Academy of Pediatrics used to categorize tobacco use as a contraindication to breastfeeding. However they rescinded that position in 2001, in part because a study showed that breastfeeding infants whose mothers smoke have some protection from respiratory illnesses. In addition, a respected expert in the field, University of Rochester (NY) professor and textbook author Ruth Lawrence, MD, believes the benefits of breastfeeding in general are so overwhelming that even additional exposure to tobacco byproducts in the breastmilk is not a reason to formula feed.

Tell anyone who prescribes for you that you want to breastfeed, and ask me whether your medication is safe for the baby.

What if I’ve had breast surgery?

If you’ve had breast surgery, some of your milk ducts may have been cut. If that has happened, you may not be able to give the baby enough milk for him/her to be solely breastfed.

Routine advice for support of lactation applies even more in this situation. Put the baby to your breast in the first half hour after birth, and have him/her “room in” with you. Consider seeing a lactation consultant.

If your baby loses too much weight, or doesn’t gain adequately, I will recommend you give some formula, too. After a week or two, it will be more clear whether breastfeeding will work for you.

How can I tell if my breastfed baby is getting enough?

You don’t need to know how many ounces your baby is getting when s/he nurses to know if s/he is getting enough. In the first week or so, you will be able to tell by how quickly the “brickdust urine” goes away—it shouldn’t be seen after about three to four days—and when your baby has a moderate or larger stool after most nursings. Also, s/he should stop losing weight by the third or fourth day, and get back to birthweight by seven to ten days of age.

By two to three weeks of age, your baby is usually mature enough to know whether s/he is still hungry after a feed. If s/he is fussy or cries a lot after feeds, consider getting a weight check to make sure your baby is getting enough.

Please also see 10 Signs of a Well-nourished Breastfed Infant by Marianne Neifert, MD.

What if I want to breast and formula feed?

There are several issues: whether, when and how a breastfeeding mom can give formula, or give breastmilk in a bottle. Experts in the field disagree.

Dr. Marianne Neifert, who runs a breastfeeding clinic in Denver and who also lectures widely, believes use of a bottle in a baby who already nurses well won’t compromise breastfeeding.

I recommend trying to avoid a bottle before about three weeks. On the other hand, offer one by about two to three months if you want the flexibility of bottle feeding (pumped breastmilk or formula). If you wait too long, your breastfeeding baby may refuse a bottle.

If there is no medical reason to give formula early, wait until your baby is at least three weeks old. That allows time for you and the baby to learn to breastfeed. Then if you do decide to give pumped breastmilk in a bottle, or to give formula in a bottle, there is more chance you’ll still be able to nurse.

If your baby has a high risk of allergies (based on yours, the father’s or an older sibling’s history), consider use of a hypoallergenic formula if non-breastmilk supplement is needed, or if you stop nursing before one year.

However if you allow your baby to bottle feed in the first two to three weeks, especially in the first week, you may never develop an adequate milk supply. If you give a bottle early, I will recommend you pump in addition to nursing to reduce the risk of inadequate supply.

If you give your baby some bottles after breastfeeding is well established, make sure you nurse or pump at least every 4–5 hours to maintain your supply. If your supply falls too much, nurse or pump more often again. Talk to me, a knowledgeable family member, or a lactation consultant if you have questions.

Are there any other dietary precautions I should consider if my baby has a high risk of developing allergies?

Exclusive breastfeeding, or exclusively breastmilk and a low-allergy risk formula (an extensively hydrolyzed or free amino acid-based formula) till age six months will protect your baby. As you introduce solids, continue with breastmilk or hypoallergenic formula until your baby is at least one. In this situation, the American Academy of Pediatrics recommends you don’t give your baby any dairy products before one year, withhold eggs till age two, and nuts and fish till age three.

My baby is one now, and we both enjoy breastfeeding still. Is that ok?

Within a family, it is common for an older relative, or an aunt or uncle, to express unhappiness with breastfeeding, especially after age one year, if this relative is not familiar with it from their own childrearing days.

However, the American Academy of Pediatrics states that sole breastfeeding is preferred for infant nutrition until about six months, and that breastfeeding will ideally continue with the addition of solid foods from that time until at least one year (“as long as is mutually desirable”)!

A consideration in nursing past one year, if you are still nursing overnight, is the effect on your baby’s dental health. Childhood dental decay has been called the most common chronic disease of childhood—and from my experience, I believe it.

Whether you are breastmilk or formula feeding, I recommend stopping nighttime feeds after about six to nine months, if your baby has teeth by then, to reduce the risk of cavities in your baby’s primary teeth.

If you practice the “family bed” style of childrearing, and you continue to nurse overnight well after your baby’s first teeth erupt, please let me help you minimize the chance of cavities by talking to me to learn every other habit that promotes dental health.