Breastfeeding - The How, What and Why of Breastfeeding

Dr. Jahanavi Meena
MBBS, MS ( Obstetrics & Gynaecology)
Senior Consultant, Gynaecology and Obstetrics, 
East Delhi Medical Centre

Breastfeeding Journey

As a gynecologist with over 20 years of experience, I’ve had the privilege of guiding countless mothers through their breastfeeding journey. As we come to World Breastfeeding Week 2024, I want to answer the many questions I get asked by patients.

Breastfeeding is one of the most natural and beneficial ways to nourish your newborn. It’s a unique bond between mother and child that goes beyond mere nutrition. You must hear this everywhere, but this is an undisputed truth backed by years of data and research. There is nothing more beneficial than breast milk, during the first 6 months of a baby’s life.

Breastfeeding might seem straightforward, but being natural doesn’t mean it will come naturally too. it’s a skill that both mother and baby need to learn together. In my practice, I’ve seen mothers face various challenges, from latching issues to concerns about milk supply. However, with proper guidance and support, most women can successfully breastfeed their babies.

Let’s decode

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First Few Days of Breastfeeding - An overview

The Golden First Days: Colostrum and Transitional Milk

Your breastfeeding journey begins with a remarkable substance called colostrum. This thick, yellowish fluid is nature’s first vaccine for your newborn. We have talked about it here multiple times but that is how important it is! Rich in antibodies and essential nutrients, colostrum helps kickstart your baby’s immune system. Don’t worry if you see only small amounts – it’s perfectly normal and sufficient for your baby’s tiny tummy.

Around the third day postpartum, you’ll notice a significant change. Your breasts may feel fuller and warmer as your milk “comes in.” This transitional milk is thinner and whiter than colostrum. First-time mothers might experience this change a bit later, which is completely normal. If you have any concerns, don’t hesitate to reach out to me or a lactation consultant.

Breastfeeding Challenges: What to Expect

  1. Breast Fullness and Engorgement In the initial weeks, you might experience breast engorgement – a condition where your breasts feel uncomfortably full, firm, and warm. This is your body adjusting to milk production. Frequent feeding can help alleviate this discomfort and prevent severe engorgement.
  2. Nipple Sensitivity It’s common for new mothers to experience some nipple tenderness as they adjust to breastfeeding. However, if you notice cracked skin or persistent pain beyond the first couple of weeks, please consult me or a lactation expert.
  3. Breastfeeding Discomfort While some initial discomfort is normal, breastfeeding shouldn’t be painful once your baby is properly latched. Pain during feeding, especially accompanied by fever, could indicate issues like improper latch, plugged milk ducts, or mastitis. Don’t hesitate to seek help if you experience persistent pain.

Emotional Wellbeing and Breastfeeding

It’s crucial to understand the difference between the common “baby blues” and postpartum depression.

Baby Blues: Many new mothers experience mood swings, anxiety, and fatigue in the first few days after delivery. These feelings typically subside within a week or two.

Postpartum Depression: This is a more serious condition characterized by intense and prolonged feelings of sadness, anxiety, or hopelessness. If you’re experiencing these symptoms, please reach out to your doctor immediately. Remember, postpartum depression is common and treatable, and with proper guidance, you can usually continue breastfeeding while receiving treatment.

Your breastfeeding journey is unique, and as your gynecologist, I’m here to support you every step of the way. Don’t hesitate to ask questions or seek help – your health and your baby’s wellbeing are our top priorities.

What are the benefits of breastfeeding?

You may be surprised to know that breast feeding is beenficial not just for Babies but for mothers also! 

For Babies:

  1. Optimal nutrition: Breast milk is uniquely tailored to meet your baby’s nutritional needs. It contains the perfect balance of proteins, fats, carbohydrates, and vitamins for your infant’s growth and development.
  2. Enhanced immunity: The antibodies in breast milk help protect your baby from various infections and diseases. I’ve noticed that breastfed babies in my practice tend to have fewer ear infections, respiratory illnesses, and gastrointestinal problems.
  3. Reduced risk of SIDS: Studies have shown that breastfeeding is associated with a lower risk of Sudden Infant Death Syndrome (SIDS).
  4. Long-term health benefits: Breastfed babies have a lower risk of obesity, type 2 diabetes, and certain childhood cancers later in life.

For Mothers:

  1. Faster postpartum recovery: Breastfeeding releases oxytocin, which helps the uterus contract and return to its pre-pregnancy size more quickly. You will be able to get back to way you were before the pregnancy faster with breastfeeding.
  2. Lower risk of certain cancers: I always inform my patients that breastfeeding can reduce their risk of breast and ovarian cancers. This is one of the many wonders of human body, something so essential to your baby fortifies your own body too.
  3. Emotional bonding: The quintessential picture of a happy mother and child is accurate biologically too. The skin-to-skin contact during breastfeeding promotes a strong emotional bond between mother and child.
  4. Convenience and cost-effectiveness: Breast milk is always available at the right temperature, and it’s free – a significant advantage over formula feeding. This is a significant point in low income groups who can be at a loss to provide all the right nutrients for the baby.
  5. Potential for weight loss: Breastfeeding burns extra calories, which can help with postpartum weight loss.

how to increase breast milk / How to Increase Lactation?

This is one of the most common questions I get asked. Increasing milk supply is a very common concern, and let’s talk about some methods

  • Frequent Feeding: Breastfeed your baby often, this stimulates milk production.
  • Empty the Breasts: Ensure your breasts are emptied completely at each feeding. You can use a breast pump after feeding to ensure complete emptying
  • Stay Hydrated and Eat Well: Drink plenty of fluids and maintain a balanced diet rich in fruits, vegetables, and whole grains
  • Skin-to-Skin Contact: Spend time holding your baby skin-to-skin. This can help stimulate milk production
  • Avoid Supplementing: Avoid giving your baby formula or other supplements unless medically necessary.
Mother Breastfeeding baby

Timing of Breastfeeding - When to start, When to stop, How long should each session be

Here we have a crucial part of Breastfeeding. The first step I want you to take is not to listen to any relatives or information from Internet. There are too many myths about Breastfeeding and a lot of misinformation which you need to avoid.

When to start Breastfeeding: Ideally, breastfeeding should begin within the first hour after birth. This early initiation, known as the “golden hour,” has several benefits:

  1. Colostrum delivery: The first milk, colostrum, is rich in immunoglobulins and growth factors. Early breastfeeding ensures the infant receives this “liquid gold.” Colostrum is the amazing super food which will fortify your baby, amplify the baby’s immune system and give it everything it needs. A curious fact, there is a sad myth which used to be prevalent and said that the first part of breast milk should be thrown away!
  2. Improved lactogenesis : Early suckling stimulates prolactin receptors, promoting the onset of copious milk production, typically occurring 30-40 hours postpartum.

  3. Enhanced bonding: Skin-to-skin contact during early breastfeeding promotes mother-infant bonding and helps regulate the newborn’s temperature and blood glucose levels.

When to stop: The World Health Organization (WHO) recommends:

  1. Exclusive breastfeeding for the first 6 months of life. I would elaborate on it later, but did you know, you don’t even need to feed your baby water during first 6 months! Breast milk has everything the baby needs.
  2. Continued breastfeeding along with appropriate complementary foods up to 2 years of age or beyond.

Weaning is typically a gradual process. It doesn’t happen overnight. In my practice, I encourage mothers to follow their infant’s cues and their own comfort level when deciding when to stop breastfeeding.

Duration of each feeding session: The duration of each breastfeeding session can vary widely. I advise my patients to focus on effective milk transfer rather than strict timing. However, some general guidelines include:

  1. Newborns: The newborn babies may nurse for 20-45 minutes per breast. Frequent shorter sessions are common as the infant’s stomach capacity is limited (about 5-7 ml on day 1, increasing to 60-80 ml by day 7). Please note these numbers are based on average data. Often infants and mothers have unique needs and timing, but while that being said, if the difference is too much, please visit a gynecologist!
  2. Older infants: As feeding efficiency improves, sessions may shorten.
  3. Cluster feeding: Periods of frequent, shorter feeds are normal, especially during growth spurts.

 

How do I know if my baby is feeding properly?

A lot of patients come wondering if the baby is feeding properly. Often parents tend to overthink and worry, but many times they are right. So watch out for signs of effective feeding

  1. Audible swallowing
  2. Rhythmic suck-swallow-breathe pattern
  3. Softening of the breast during feeding
  4. Adequate diaper output (6-8 wet diapers per day by day 5-7 – This may vary also)

I must repeat again, these are general guidelines. I’ve found that every mother-infant pair is unique, and feeding patterns can vary widely while still being normal and healthy.

Mother and child breastfeeding

Am I producing enough Milk for my baby?

As a gynecologist, I understand that concerns about milk supply are common among new mothers. Sometimes the mothers are overtly harsh on themselves too.  But you consult your doctor and then decide!

Weight Gain: Your baby should gain weight steadily after the initial weight loss in the first few days. Typically, babies regain their birth weight by about two weeks and then gain about 150-200 grams per week.

Diaper Output: Expect at least six wet diapers and three to four stools per day by the time your baby is a week old.

Feeding Frequency: Your baby should be feeding 8-12 times in 24 hours.

Swallowing Sounds: (The point we covered above) you should hear your baby swallowing during feeding.

If you are concerned about your milk supply, consult a lactation consultant or your healthcare provider for personalized advice.

Are there any reasons why I should not breastfeed?

While breastfeeding is beneficial for most mother-infant dyads, there are specific situations where it’s not recommended. But before reading further, I suggest you must consult your gynecologist before making any decision.

  1. HIV infection: The Centers for Disease Control and Prevention (CDC) advise against breastfeeding for mothers with HIV due to the risk of vertical transmission. The virus can be present in breast milk, potentially infecting the infant.
    I urge you to read Indian Government’s guidelines, Prevention of Parent to Child Transmission (PPTCT), on the same here ( https://naco.gov.in/sites/default/files/National_Guidelines_for_PPTCT_0.pdf )

  2. Active untreated tuberculosis: Mothers with active, untreated tuberculosis should not breastfeed until they’ve received appropriate treatment and are no longer infectious. Another case is when the mother is non-compliant to the medicines themselves. In either of these scenarios, consult Gynecologist and Pulmonologist to get a complete diagnosis.

  3. Human T-cell lymphotropic virus type I or II: These retroviruses can be transmitted through breast milk, potentially leading to T-cell leukemia/lymphoma.

  4. Certain medications: Some medications are contraindicated during breastfeeding due to their potential to harm the infant. Examples include:
    • Chemotherapeutic agents
    • Radioactive isotopes (temporary contraindication)
    • Some anticonvulsants and psychotropic medications

You should consult with your doctor to identify the medicines and ensure there are no issues for the baby.

  1. Substance abuse: Active use of illicit drugs, especially stimulants like cocaine or methamphetamine, is a contraindication to breastfeeding due to their presence in breast milk and potential harm to the infant.
  2. Galactosemia in the infant: This rare genetic metabolic disorder prevents proper metabolism of galactose, a sugar present in breast milk. Infants with galactosemia require a specialized galactose-free formula.

It’s crucial to note that these contraindications are relatively rare. At East Deli Medical Centre, I always conduct a thorough assessment of each mother-infant pair to determine the safety and appropriateness of breastfeeding.

How do I properly latch my baby?

A proper latch is crucial for effective breastfeeding and to prevent nipple pain. Here are the steps to achieve a good latch:

Positioning: Hold your baby close with their nose level with your nipple. Their head, shoulders, and hips should be aligned

Tickle the Lips: Gently tickle your baby’s lips with your nipple to encourage them to open their mouth wide

Aim the Nipple: Aim your nipple towards the roof of your baby’s mouth. Their chin should touch your breast first

Wide Mouth: Ensure your baby takes a large portion of the areola into their mouth, not just the nipple

Check the Latch: Your baby’s lips should be flanged out like a fish, and you should see more of the areola above their top lip than below their bottom lip

If you experience pain or discomfort, gently break the suction with your finger and try again.

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Do I need extra calories while breastfeeding?

As a gynecologist, I often get this question from new mothers. The answer is yes, you do need some additional calories. The World Health Organization recommends about 330 to 400 extra calories a day for breastfeeding mothers. This extra energy supports your body in producing nutritious milk for your baby.

In the Indian context, this could mean adding a katori of dal, an extra roti, or a small bowl of yogurt to your daily diet. Remember, the key is to choose nutrient-dense foods. Opt for traditional Indian foods like whole grain rotis, dal, seasonal vegetables, and fruits. These not only provide calories but also essential nutrients for you and your baby.

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What foods should I eat while breastfeeding?

In my practice, I advise breastfeeding mothers to focus on a balanced diet rich in proteins, complex carbohydrates, and healthy fats. Here’s what I recommend:

a) Protein: Include dal, legumes, milk, curd, paneer, eggs (if you consume them), and lean meats. These help in milk production and your own muscle health.

b) Whole grains: Opt for whole wheat rotis, brown rice, and millets like ragi or jowar. These provide sustained energy.

c) Fruits and vegetables: Eat a variety of seasonal fruits and vegetables. They provide essential vitamins, minerals, and fiber.

d) Healthy fats: Include nuts, seeds, and oils like mustard or coconut oil in moderation.

e) Traditional Indian superfoods: Foods like methi (fenugreek), ajwain (carom seeds), and jeera (cumin) are not only nutritious but are also believed to support lactation.

Please note, Consult your dietician before making significant changes.

How much fluid do I need while breastfeeding?

Staying hydrated is crucial for milk production. Drink water whenever you feel thirsty and aim for clear or light yellow urine as a sign of good hydration. If you do not feel thirsty, make it a habit of drinking water.

In India, we have several healthy traditional drinks that can contribute to your fluid intake. Nimbu pani (lemon water), coconut water, and chaach (buttermilk) are excellent options. However, I caution against excessive consumption of sugary drinks or caffeine. Limit yourself to no more than 2-3 cups of caffeinated beverages like chai or coffee per day, as caffeine can pass into your breast milk and may affect your baby’s sleep.

What about a vegetarian diet and breastfeeding?

Many of my patients follow vegetarian diets, which can absolutely provide all the nutrients needed for breastfeeding. Here’s what I recommend:

a) Protein: Combine dals and legumes with whole grains for complete proteins. Include milk, curd, and paneer if you consume dairy.

b) Iron: Eat plenty of green leafy vegetables like spinach, amaranth, and fenugreek leaves. Combine these with vitamin C-rich foods like amla or lemon to enhance iron absorption.

c) Calcium: Apart from dairy, get calcium from ragi, sesame seeds, and leafy greens.

d) Vitamin B12: This can be challenging in a vegetarian diet. Consider fortified foods or talk to me about supplements.

e) Omega-3: Flaxseeds, chia seeds, and walnuts are good plant sources.

Remember, if you’re vegan or have a restricted diet, discuss this with your Doctor.

What foods and drinks should I limit or avoid while breastfeeding?

This list is rather obvious, but we don’t often live our lives according to perfect routines. So here are the things you need to take care of –

a) Alcohol: It’s best to avoid alcohol while breastfeeding. If you do drink occasionally, wait at least 2-3 hours per drink before nursing. I would suggest you to completely avoid dinking, if you insist on it, I suggest pumping the milk for the baby beforehand or waiting till the alcohol is out of your system.

b) Caffeine: Limit to 2-3 cups of tea or coffee per day.

c) Certain fish: While fish is nutritious, avoid high-mercury fish like king mackerel. Opt for smaller fish like Indian salmon (rawas) or pomfret

d) Strongly flavored foods: Some babies might be sensitive to foods like garlic, onions, or spicy dishes. If you notice your baby becoming fussy after you eat certain foods, you might want to avoid them temporarily.

Remember, every mother and baby pair is unique. If you have concerns about your diet affecting your baby, don’t hesitate to discuss them with me or your pediatrician. We’re here to support you on your breastfeeding journey.

How do I deal with breastfeeding pain or discomfort?

 

Ensure a Proper Latch: A poor latch is a common cause of nipple pain and it is much more common than we think. What you have to do is to make sure your baby’s mouth covers a large part of the areola, not just the nipple. It may take a few tires but you can do it effectively.

Breastfeeding Position: Try different breastfeeding positions to find one that is comfortable for both you and your baby. The cradle hold, football hold, and side-lying position are some options. I will answer this in detail below.

Nipple Care: Nipples are very sensitive. After feeding, express a few drops of breast milk and gently rub it into your nipples. Let them air dry. This can help soothe and heal sore nipples

Warm Compresses: A potent way is applying warm compresses to your breasts before feeding can help with milk flow and reduce discomfort during breastfeeding itself.

Consult your doctor for a more specific and detailed analysis of why you could be feeling pain

What should I do if my baby refuses to breastfeed?

If your baby refuses to breastfeed, it can be distressing, but there are steps you can take. I must repeat, don’t blindly listen to relatives

Check for Illness: Ensure your baby is not ill or experiencing discomfort, such as an ear infection or teething.

Skin-to-Skin Contact: Spend more time holding your baby skin-to-skin to encourage breastfeeding.

Try Different Positions: Experiment with different breastfeeding positions to find one that your baby prefers.

Offer the Breast When Sleepy: Try breastfeeding when your baby is sleepy, as they may be more willing to nurse.

Why is Skin to skin contact important?

Simple act of placing a newborn on the mother’s bare chest can work wonders. Here’s why I always encourage this practice:

A Calming Embrace: Both mother and baby experience a sense of peace and relaxation. It’s beautiful to watch the tension melt away as they bond.

Easing the Transition: The newborn’s heartbeat and breathing patterns stabilize, helping them adjust to the world outside the womb.

Kickstarting Digestion: It’s fascinating to see how this contact stimulates the baby’s digestive system and often triggers their first feeding instincts.

Natural Thermostat: The mother’s body acts as a perfect temperature regulator for the baby.

Nature’s Shield: The baby’s skin gets colonized with the mother’s beneficial bacteria, providing a natural defense against infections.

Hormonal Harmony: This contact releases hormones that support breastfeeding and nurture the mother-child bond.

Conclusion

The science is clear: breastfeeding offers unparalleled benefits for both mother and child. From providing tailored nutrition to boosting your baby’s immune system, from reducing your risk of certain cancers to fostering an unmatched emotional bond, the advantages are numerous and well-documented.

But beyond the clinical facts, there’s a profound emotional aspect to breastfeeding that shouldn’t be overlooked. It’s a unique connection, a silent conversation between you and your baby. In those quiet moments of nursing, you’re not just providing nourishment; you’re offering comfort, security, and unconditional love.

Remember, every drop of breast milk is a gift. Even if you’re able to breastfeed for only a short time, or if you’re combining breast and bottle feeding, you’re making a positive impact on your baby’s health and development.