Saturday, February 26, 2011

When Latching

Cross Cradle Position for Left Breast:
  • Align baby’s nose so that it does not go past your nipple, or go to the left of your nipple, in other words, your nipple should not be aligned with his chin
  • Place your right hand under baby’s face so your four fingers make a pillow for baby’s cheek (keep your four fingers tightly together as if the were stuck together with glue)
  • You are now supporting the weight of baby’s head with your hand
  • You may want to sit baby’s bottom on you arm as though it were a shelf (this will work in the beginning with a newborn)
  • Or you may want to let baby’s bottom fall diagonally a bit and squeeze it against your rib cage with your elbow
  • Baby’s body and legs should be wrapped around mother.
  • Pull baby’s bottom into your body with the inside/underside of your forearm as if serving baby to you on a platter
  • This will bring him toward your breast with the nipple pointing to the roof of his mouth
  • Head supported but NOT pushed in against your breast.
  • In fact, try to think of it not as bringing baby’s head into or near your breast at all—instead, bring baby’s body into your body and the head will follow, as if serving baby to you on a platter.
  • Head should be tilted back slightly so the nose is up and the baby’s chin is coming into the breast while the nose never touches the breast.
  • Use your whole arm to bring the baby onto the breast, when baby’s mouth is wide.
  • Baby’s chin should be far away from Baby’s chest.
WATCH LOWER LIP, aim it as far from base of nipple as possible, so tongue draws lots of breast into mouth. Move baby’s body and head together – keep baby uncurled. If you keep your wrist straight, with baby’s cheek resting on your fingers, then baby’s chin will not bend down toward his chest

Once latched, baby’s top lip will be close to nipple, areola shows above lip. Keep baby’s chin close against your breast.



Need mouth wide before baby moved onto breast. Teach baby to open wide/gape:
  • Avoid placing baby down in a feeding position until you are completely ready to latch baby. The longer baby waits while you get ready (undoing your breast, etc) the more frustrated baby gets and the less open baby’s mouth will go.
  • move baby toward breast, touch top lip against nipple
  • move mouth away SLIGHTLY
  • touch top lip against nipple again, move away again
  • repeat until baby opens wide and has tongue forward
  • Or, better yet, run nipple along the baby’s upper lip, from one corner to the other, lightly, until baby opens wide






Mother’s Posture
  • Sit with straight, well-supported back
  • Trunk facing forwards, lap flat
Baby’s Position Before Feed Begins
  • Nipple points to the baby’s upper lip or nostril
Baby’s Body
  • Placed not quite tummy to tummy, but so that baby comes up to breast from below and baby’s eyes make contact with mother’s Support Breast
  • Firm inner breast tissue by raising breast slightly with fingers placed flat on chest wall and thumb pointing up (if helpful, also use sling or tensor bandage around breast)
Move Baby Quickly On To Breast
  • Head tilted back slightly, pushing in across shoulders so chin and lower jaw make contact (not nose) while mouth still wide open, keep baby uncurled (means tongue nearer breast) lower lip is aimed as far from nipple as possible so baby’s tongue draws in maximum amount of breast tissue
Cautions
Mother needs to AVOID
  • pushing her breast across her body
  • chasing the baby with her breast
  • flapping the breast up and down
  • holding breast with scissor grip
  • not supporting breast
  • twisting her body towards the baby instead of slightly away
  • aiming nipple to centre of baby’s mouth
  • pulling baby’s chin down to open mouth
  • flexing baby’s head when bringing to breast
  • moving breast into baby’s mouth instead of bringing baby to breast
  • moving baby onto breast without a proper gape
  • not moving baby onto breast quickly enough at height of gape
  • having baby’s nose touch breast and not the chin
  • holding breast away from baby’s nose (not necessary if the baby is well latched on, as the nose will be away from the breast anyway)

Sore Nipples

Introduction

The best treatment of sore nipples is prevention. The best prevention is getting the baby to latch on properly from the first day. Mother and baby skin to skin contact immediately after birth for at least the first hour or two will frequently result in a baby latching on all by himself with a good latch. See the information sheets Breastfeeding—Starting Out Right and The Importance of Skin to Skin Contact.

Early onset nipple pain is usually due to one or both of two causes. Either the baby is not positioned and latched properly, or the baby is not suckling properly, or both. However, babies learn to suck properly by getting milk from the breast when they are latched on well. (They learn by doing). Thus, “suck” problems are often caused by poor latching on. Fungal infections of the nipple (due to Candida albicans) may also cause sore nipples. Vasospasm (which is due to irritation of the blood vessels in the nipple from poor latching and/or a fungal infection) may also cause sore nipples (see the information sheet Vasospasm and Raynaud’s Phenomenon). The soreness caused by poor latching and ineffective suckling hurts most as you latch the baby on and usually improves as the baby breastfeeds. However, if damage is severe, the soreness of a poor latch and/or ineffective suckling may go on throughout the feeding. The pain from the fungal infection often goes on throughout the feed and may continue even after the feed is over. Women describe knifelike pain from the a poor latch or ineffective sucking. The pain of the fungal infection is often described as burning but it does not have to be burning in nature. A new onset of nipple pain when feedings had previously been painless is a tip off that the pain may be due to a Candidal infection, but a Candidal infection may also be superimposed on other causes of nipple pain, so there was never a pain free period. Cracks may be due to a yeast infection. Dermatologic conditions may also cause late onset nipple pain. There are several other causes of sore nipples.

Proper Positioning and Latching
 
(See information sheet When Latching)

It is not uncommon for women to experience difficulty positioning and latching the baby on. If the mother positions the baby well, she facilitates the baby’s getting a good latch and a good latch not only decreases the risk of the mother becoming sore, but also reduces the baby’s chances of becoming “gassy” because a good latch allows the baby to control the flow of milk better. Thus, poor latching may also result in the baby not gaining adequately, or feeding frequently, or being colicky (see the information sheet Colic in the Breastfed Baby). See also nbci.ca for videos that show how to latch a baby on, how to know a baby is getting milk and how to use compression.

Positioning—For the Purposes of Explanation, Let Us Assume That You Are Feeding On the Left Breast (See information sheet When Latching and the videos at nbci.ca)

Good positioning facilitates a good latch. A lot of what follows under latching comes automatically if the baby is well positioned in the first place.

At first, it may be easiest for many mothers to use the cross cradle hold to position your baby for latching on. Hold the baby in your right arm, pushing in the baby’s bottom with the side of your forearm so that your hand turns palm upwards (towards the ceiling). This will help you support his body more easily as the baby’s weight is on your forearm rather than your wrist or hand. Holding the baby like this also will bring the baby in from the correct direction so that he gets a good latch. Your hand will be palm up under the baby’s face (not shoulder or under his neck). The web between your thumb and index finger should be behind the nape of his neck (not behind his head). The baby will be almost horizontal across your body, with his head slight tilted backward, and should be turned so that his chest, belly and thighs are against you with a slight tilt upwards so the baby can look at you. Hold the breast with your left hand, with the thumb on top and the other fingers underneath, fairly far back from the nipple and areola.

The baby should be approaching the breast with the head just slightly tilted backwards. The nipple then automatically points to the roof of the baby's mouth.

Latching

  1. Now, get the baby to open up his mouth wide. The way to do this is to run your nipple, still pointing to the roof of the baby’s mouth, along the baby’s upper lip (not lower), lightly, just a tickle, from one corner of the mouth to the other. Or you can run the baby along your nipple, something some mothers find easier. Wait for the baby to open up as if yawning. As you bring the baby toward the breast, only his chin should touch your breast. Do not scoop him around so that the nipple points to the middle of his mouth. Instead the nipple should still be pointing to the roof of the baby’s mouth.
  2. When the baby opens up his mouth, use the arm that is holding him to bring him straight (not scooped around) onto the breast. Don’t worry about the baby’s breathing. If he is properly positioned and latched on, he will breathe without any problem since his nose will be far away from the breast. If he cannot breathe, he will pull away from the breast. If he cannot breathe, he is not latched properly. Don’t be afraid to be quick.
  3. If the nipple still hurts, use your index finger to pull down on the baby’s chin; this will bring more of your breast into the baby’s mouth. You may have to do this for the duration of the feed, but not usually. The pain should usually subside. Do not take the baby on and off the breast several times to get the perfect latch. If the baby goes on and off the breast 5 times and it hurts, you will have 5 times more pain, and worse, 5 times more damage, and the baby and you will both be frustrated. Adjust the latch when putting him to the other breast, or at the next feeding.
  4. The same principles apply whether you are sitting or lying down with the baby or using the football or cradle hold. Get the baby to open wide; don’t let the baby latch onto the nipple, but get as much of the areola (brown part of breast) into the mouth as possible (not necessarily the whole areola).
  5. There is no “normal” length of feeding time. If you have questions, call the clinic.
  6. A baby properly latched on will be covering more of the areola with his lower lip than with the upper lip.
See the video clips at the website nbci.ca

Improving the Baby’s Suck

The baby learns to suckle properly by breastfeeding and by getting milk into his mouth. The baby’s suckle may be made ineffective or not appropriate for breastfeeding by the early use of artificial nipples or from poor latching on from the beginning. Some babies just seem to take their time developing an effective suckle. Suck training and/or finger feeding (See the information sheet Finger and Cup Feeding) may help, but note, taking the baby off the breast to finger feed instead is not a good idea and should be done as a last resort only.

Vasospasm: “My Nipple Turns White After the Baby Comes Off the Breast”

The pain associated with this blanching of the nipple is frequently described by mothers as “burning”, but generally begins only after the feeding is over. It may last several minutes or more, after which the nipple returns to its normal colour, but then a new pain develops which is usually described by mothers as “throbbing”. The throbbing part of the pain may last for seconds or minutes and then the nipple may turn white again and the process repeats itself. The cause would seem to be a spasm of the blood vessels (often called “vasospasm” or Raynaud’s Phenomenon) in the nipple (when the nipple is white), followed by relaxation of these blood vessels (when the nipple returns to its normal colour). Sometimes this pain continues even after the nipple pain during the feeding no longer is a problem, so that the mother has pain only after the feeding, but not during it. What can be done?
  1. Pay careful attention to getting the baby to latch onto the breast as best possible. This type of pain is almost always associated with and probably caused by whatever is causing your pain during the feeding. The best treatment for this vasospasm is the treatment of the other causes of nipple pain. If the main cause of the nipple pain is fixed, the vasospasm also usually disappears.
  2. Heat (hot washcloth, hot water bottle, hair dryer) applied to the nipple immediately after breastfeeding may prevent or decrease the reaction. Dry heat is usually better than wet heat, because wet heat may cause further damage to the nipples.
  3. Vitamin B6 multi complex can also be used, as can magnesium with calcium. On occasion, we have had to use an oral medication (nifedipine) to prevent this type of reaction. For more on these treatments see the information sheet Vasospasm and Raynaud’s Phenomenon)

General Measures for Nipple Soreness

  1. Nipples can be warmed for short periods of time after each feeding, using a hair dryer on low setting.
  2. Nipples should be exposed to air as much as possible, except when there is vasospasm.
  3. When it is not possible to expose nipples to air, plastic dome-shaped breast shells (not nipple shields which are not, in our opinion, a good treatment for sore nipples or any breastfeeding problem for that matter) can be worn to protect your nipples from rubbing by your clothing (use the largest hole available so your nipple is not rubbing against the plastic). Breastfeeding pads keep moisture against the nipple and may cause damage that way. They also tend to stick to damaged nipples. If you leak a lot you can wear the pad over the breast shell.
  4. Ointments can sometimes be helpful. If using our ointment, use just a very small amount after breastfeeding and do not wash it off. We use an “all purpose nipple ointment” (APNO) that we find very useful. See the information sheet Candida Protocol for the recipe. Note, once any ointment or cream is applied to the nipples they are no longer air drying.
  5. Do not wash your nipples frequently. Daily bathing is more than enough.
  6. If your baby is gaining weight well, there is no good reason the baby must be fed on both breasts at each feeding. It may save you pain, and speed healing if you feed your baby on only one breast each feed, but be careful, not all mothers can feed a baby on only one breast at every feeding or even at all. See the video clips at the website nbci.ca so that you know when the baby is drinking (or not). It will help to compress the breast (see the information sheet Breast Compression), once the baby is no longer swallowing on his own in order to continue his getting milk. You may be able to manage this some feedings, but not others. In very difficult situations, a lactation aid (see the information sheet Lactation Aid) can be used to supplement (preferably expressed milk), so that the baby will finish the feeding on the first side. Taking the baby off the breast is a last resort.
If you are unable to put the baby to the breast because of pain, in spite of trying all the above measures, it may still be possible to continue breastfeeding after a temporary (3-5 days) cessation to allow the nipples to heal. During this time, it would be better that the baby not be fed with a rubber nipple. Of course it is also best for you and the baby if the baby is fed your expressed milk. Feed the baby with a cup or use the technique called “finger feeding” (see the information sheet Finger an Cup Feeding). Once again, it should be emphasized that this is a last resort and taking a baby off the breast should not be taken lightly. Furthermore, it often doesn’t work.

We do not recommend nipple shields because, although they sometimes help temporarily, they often do not. In fact, they may often increase the degree of trauma to the nipples. They may also cut down the milk supply dramatically, and the baby may become fussy and/or not gain weight well. Once the baby is used to them, it may be impossible to get the baby back onto the breast. Use as a last resort only but get help first.

Breastfeeding and Nipple Soreness

GENERAL INFORMATION:

 

 

How do you get sore nipples?

It is not uncommon to have sore or tender nipples in the first few days of breastfeeding. The tenderness may be greatest when your baby first latches onto the breast but it should lessen as the feeding continues. The tenderness is usually at its worst between 3 to 5 days after your baby is born. And, it usually doesn't last longer than the 1st week. Nipple soreness lasting beyond the first week is not normal. Soreness that interferes with feedings or continues throughout a feeding is also not normal. And, it is not normal to have skin breakdown like cracks, blisters, bruises, or bleeding on the nipple or areola. The areola is the dark area around the nipple.
  • Nipple soreness is usually caused by holding the baby incorrectly or by how your baby latches-on. Your baby's suckling pattern could be incorrect. Then, you may also find yourself postponing feedings because of the soreness. And, this may limit the amount of milk your baby gets. So, your overall milk supply could also decrease.
    Infant Feeding Breast Feed Latch-on 2 Incorrect Positions
    Picture of incorrect infant latch-on positions
  • Nipple pain can prevent or slow your let-down reflex. This may cause excess milk to be left in your breasts so your breasts become engorged (overfull). Engorged breasts get so full and tight, your baby has trouble latching-on to your nipple. Incorrect latch-on or an incorrect sucking pattern may make sore nipples even worse. This may be caused by a tight, full areola with a flat nipple.
  • A bacterial or yeast infection of the nipples and areola can cause healing of cracked nipples to take longer.

What can I do to prevent sore nipples?

  • Use only warm water when washing your breasts. Avoid soap and lotions or creams that have alcohol. But, you can put a thin layer of lanolin-based ointment on your nipples and areola after feedings. And, do not use plastic-lined bras or bra pads. Also, change your bra and bra pads as soon as possible when they get wet in order to keep your nipples dry.
  • Relax and gently massage your breasts before a feeding to help your milk let-down.
  • Carefully watch your baby's suckling pattern at the breast. Position your baby correctly at the breast; chest to chest, nose to breast. Make sure your baby opens his mouth wide to properly attach to your breast. His mouth needs to be on the areola well behind the nipple (1/2 to 1 inch). Ask your caregiver for the CareNotes™ handout about how to position and attach your baby to the breast.
  • Release your baby's suction before you take him off the breast. And, you may want to leave your breasts open to the air for a few minutes after each feeding. Express a small amount of breastmilk and massage it onto the nipples and areola.
  • Breastfeed your baby often, like 8 to 12 times in 24 hours.
  • Express some breastmilk before feeding if your breasts become engorged and your baby is having trouble latching-on. This softens the nipple and areola so that he can correctly attach and suckle at your breast. Ask your caregiver for CareNotes™ handout about the difference between breast fullness and engorgement.

What do I do if I get sore nipples?

Talk with your caregiver, a Lactation Consultant, or an LLL (La Leche League) Leader to help find out what is causing your sore nipples.
  • Breastfeed on the least sore side first.
  • Wear breast shells inside your bra to keep clothing and wet breast pads off your nipple. This helps prevent further irritation and pain.
  • Pump with a hospital grade, double electric breast pump at least 8 times in 24 hours if the nipple soreness is severe. This helps your sore nipples heal faster. You may only need to pump for 1 to 2 days.
  • Call your caregiver for pain medicine that can be taken while breastfeeding.

When should I call my caregiver?

Call your caregiver if you have any of the following problems.
  • Shaking chills or a temperature over 101 degrees F (38.4C).
  • Headache or muscle aches.
  • Pain and redness in one or both breasts. This may mean that you have a breast infection, which needs treatment. Shooting pains in your breasts during or after feedings may be signs that you have a bacterial or yeast infection.
  • You feel a lump in your breast
  • Nipples and areola that are red, swollen, itchy, burning, or have cracks lasting longer than 1 week.
  • Unrelieved engorgement (overfull breasts) for greater than 48 hours.

Can my baby's caregiver help me if I have breastfeeding questions or problems?

Ask for information about breastfeeding and make sure caregivers know that breastfeeding is important to you. Ask your caregiver for the name of a Lactation Consultant. This person is specially trained to help women breastfeed their babies. Also, ask caregivers about a breastfeeding class before your baby is born. Or, call your hospital for more information. Breastfeeding support groups can also help you learn about breastfeeding your baby. Call or write one of the following organizations for more information.
1400 N. Meacham Rd Schaumburg IL 60173-4808
La Leche League International
847 519-7730
http://www.lalecheleague.org

Nipple Shields

It is surprising that the nipple shield, the use of which we had seen decline rapidly from the 1970’s and before, would once again be thought in the 2000’s as an appropriate treatment to cure many breastfeeding problems? It was generally thought to be a mistake to use nipple shields as their use resulted in babies seeming to be stuck on these gadgets. With time, the mother’s milk production would usually decrease if a mother used a nipple shield. Some studies will suggest that there is not a decrease; if one compares milk extraction on a nipple shield to a poorly latched baby, sure, there may be no decrease. The point is to get a baby well latched. We believe a nipple shield does not allow for this. Unfortunately, it is still true in our opinion that it is often not best practise to use a nipple shield and it is the considered opinion of our clinic and institute that nipple shields need hardly ever, if ever, be used.

What are nipple shields?
A nipple shield is different from a breast shield or shell. The breast shell is not used while feeding the baby, but rather in between feedings, and its purpose is to make the nipple more prominent, so that the baby will take the breast better, or, to protect the nipple from contact with the mother’s bra, particularly when the nipple has trauma. Whether the shell actually succeeds in this purpose is debatable, but a breast shell is probably harmless; a nipple shield is not harmless.

Nipple shields are flexible artificial nipples put over the mothers nipple and areola. They are made of silicone nowadays and come in various diameters and sizes. They are used generally for the following reasons:
  1. The baby will not take the breast.
  2. The mother has sore nipples.
  3. The baby is born prematurely.
  4. The baby needs to “learn how to suck”.
Nipple shields are not, in fact, the answer to these problems. They give the illusion that the problems have been dealt with, but in fact, the problems have not been dealt with at all. The illusion that things are now going well leads to mothers not getting help early and making fixing the problems more difficult as time goes by. Let’s look at these questions more closely.

1. The baby will not take the breast.
A nipple shield is not usually the answer. In fact, a baby who sucks at the breast through a nipple shield is not latched on to the breast; he is latched on to the nipple shield. Does this matter? Yes, because a poor latch is still a poor latch and baby on a nipple shield has, at best, a poor latch. This means the baby will depend on the mother’s having milk ejection reflexes (letdown reflexes) in order to get milk. If the mother’s milk production is abundant, then the baby actually may gain weight well. Even then, however, we believe that it is problematic to use the nipple shield (see below).

Many mothers have a good milk supply but not what one would call an abundant milk supply. In that case it is very possible that the baby will not gain weight adequately with a nipple shield. Furthermore, as mentioned above, when a baby feeds through a nipple shield, the milk supply can even decrease (see the information sheet Slow Weight Gain after Early Good Weight Gain). Even worse, if the milk supply decreases, it becomes more difficult to get the baby to take the breast without using a nipple shield.

Even if some justification can be found for using a nipple shield, starting one before the “milk comes” in is, in our opinion, not best practise. So many babies who do not latch on in the first few days, will latch on without trouble, even easily, when the mother’s milk “comes in”, especially if the mother gets good help. If the mother believes that the nipple shield has dealt with her problem, she may not get help until it is too late. Here is just one email (identifying information deleted) of hundreds we could have included:

“My baby was born on xxx weighing 2.5 kg (5lb 8oz). I started using a breast shield when the baby was a few days old because my baby would not latch on; everything seemed to go okay, but somewhere around 3 weeks I began to notice she didn’t seem to be sucking properly and by her one month check up she’d only gained an ounce.”

So what now? After a month feeding on the nipple shield, it may be extremely difficult to get the baby to take the breast directly especially if the slow weight gain was due to the milk supply decreasing rather than the baby not getting milk well because of the nipple shield (both are, in fact, possible). The mother may have been asked to supplement. The mother needed a lot of support.

We believe it is better that a mother express her milk and give it to the baby by cup (or, if absolutely necessary, by bottle) rather than use a nipple shield. At least expressing milk will usually maintain the milk supply. See the information sheets When the Baby Does Not Yet Latch, Finger & Cup Feeding and Expressing Milk.

2. The mother has sore nipples
Using a nipple shield for sore nipples has the same problems as using it for a baby who will not latch on. Milk supply may decrease and the baby may not want to take the breast directly again. Furthermore, a nipple shield is not a good way to treat sore nipples, oftentimes it will make the problem worse and cause more trauma. True, I have heard from some mothers that using the nipple shield helped them get past the pain and they were able to get the baby to take the breast again without pain; this is not always the case and there are better ways of dealing with sore nipples (prevention being the best of all). See the information sheets When Latching, Sore Nipples, The All Purpose Nipple Ointment, Candida Protocol as well as the video clips.

3. The baby is born prematurely.
If the baby is not restricted to starting breastfeeding at 34 weeks gestation (as in most of special care units or neonatal intensive care units in North America and Western Europe), if the mother is helped get the best latch possible and shown how to know a baby is getting milk, then nipple shields will hardly ever be necessary for the premature baby. See the information sheet Premature Baby.

4. The baby needs to learn how to suck
A baby learns to suck and suck well by breastfeeding. If a baby “sucks better” on a nipple shield it’s only because the baby is not latching on to the breast. A baby who latches on and gets milk will suck just fine. The problem is that the baby is not latching on well and using a nipple shield does not teach a baby now to do that.

Breastfeeding and Illness

Introduction
Over the years, far too many women have been wrongly told they had to stop breastfeeding. The decision about continuing breastfeeding when the mother takes a drug, for example, is far more involved than whether the baby will get any in the milk. It also involves taking into consideration the risks of not breastfeeding, for the mother, the baby and the family, as well as society. And there are plenty of risks in not breastfeeding, so the question essentially boils down to: Does the addition of a small amount of medication to the mother’s milk make breastfeeding more hazardous than formula feeding? The answer is almost never. Breastfeeding with a little drug in the milk is almost always safer. In other words, being careful means continuing breastfeeding, not stopping. The same consideration needs to be taken into account when the mother or the baby is sick.

Remember that stopping breastfeeding for a week or even days may result in permanent weaning as the baby may then not take the breast again. On the other hand, it should be taken into consideration that some babies may refuse to take the bottle completely, so that the advice to stop is not only wrong, but often impractical as well. On top of that it is easy to advise the mother to pump her milk while the baby is not breastfeeding, but this is not always easy in practice and the mother may end up painfully engorged.

Illness in the Mother
Very few maternal illnesses require the mother to stop breastfeeding. This is particularly true for infections the mother might have, and infections are the most common type of illness for which mothers are told they must stop. Viruses cause most infections, and most infections due to viruses are most infectious before the mother even has an idea she is sick. By the time the mother has fever (or runny nose, or diarrhoea, or cough, or rash, or vomiting etc), she has probably already passed on the infection to the baby. However, breastfeeding protects the baby against infection, and the mother should continue breastfeeding, in order to protect the baby. If the baby does get sick, which is possible, he is likely to get less sick than if breastfeeding had stopped. But often mothers are pleasantly surprised that their babies do not get sick at all. The baby was protected by the mother’s continuing breastfeeding. Bacterial infections (such as “strep throat”) are also not of concern for the very same reasons.

See previous Information Sheet, Breastfeeding and Medications with regard to continuing breastfeeding while taking medication.

The only exception to the above is HIV infection in the mother. Until we have further information, it is generally felt that the mother who is HIV positive not breastfeed, at least in the situation where the risks of artificial feeding are considered acceptable. There are, however, situations, even in Canada, where the risks of not breastfeeding are elevated enough that breastfeeding should not be automatically ruled out. The final word is not yet in. Indeed, recently information came out that exclusive breastfeeding protected the baby from acquiring HIV better than formula feeding and that the highest risk is associated with mixed feeding (breastfeeding + artificial feeding). This work needs to be confirmed.

Antibodies in the Milk
Some mothers have what are called “autoimmune diseases”, such as idiopathic thrombocytopenic purpura, autoimmune thyroid disease, autoimmune hemolytic anemia and many others. These illnesses are characterized by antibodies being produced by the mother against her own tissues. Some mothers have been told that because antibodies get into the milk, the mother should not breastfeed, as she will cause illness in her baby. This is incredible nonsense. The mother should breastfeed.

The antibodies that make up the vast majority of the antibodies in the milk are of the type called secretory IgA. Autoimmune diseases are not caused by secretory IgA. Even if they were, the baby does not absorb secretory IgA. There is no issue. Continue breastfeeding.

Breast Problems
  • Mastitis (breast infection) is not a reason to stop breastfeeding. In fact, the breast is likely to heal more rapidly if the mother continues breastfeeding on the affected side. (See Information Sheet Blocked Ducts and Mastitis)
  • Breast abscess is not a reason to stop breastfeeding, even on the affected side. Although surgery on a lactating breast is more difficult, the surgery and the postpartum course do not necessarily become easier if the mother stops breastfeeding, as milk continues to be formed for weeks after stopping breastfeeding. Indeed, engorgement after surgery only makes things worse. Make sure the surgeon does not do an incision that follows the line of the areola (the line between the dark part of the breast and the lighter part). Such an incision may decrease the milk supply considerably. An incision that resembles the spoke on a bicycle wheel (the nipple being the centre of the wheel) would be less damaging to milk-making tissue. These days breast abscess does not always require surgery. Repeated needle aspiration, or placement of a catheter to drain the abscess plus antibiotics often allows avoidance of surgery.
  • Any surgery does not require stopping breastfeeding. Is the surgery truly necessary now, while you are breastfeeding? Are you sure that other treatment approaches are not possible? Does that lump have to be taken out now, not a year from now? Could a needle biopsy be enough? If you do need the surgery now, make sure again the incision is not made around the areola. You can continue breastfeeding after the surgery is over, immediately, as soon as you are awake and up to it. If, for some reason, you do have to stop on the affected side, do not stop on the other. Some surgeons do not know that you can dry up on one side only. You do not have to stop breastfeeding because you are having general anaesthesia. You can breastfeed as soon as you are awake and up to it.
  • Mammograms are more difficult to read if the mother is breastfeeding, but can still be useful. Once again, how long must a mother wait for her breast no longer to be considered lactating? Evaluation of a lump that requires more than history and physical examination can be done by other means besides a mammogram (for example, ultrasound, needle biopsy). Discuss the options with your doctor. Let him/her know breastfeeding is important to you.
New Pregnancy
There is no reason that you cannot continue breastfeeding if you become pregnant. There is no evidence that breastfeeding while pregnant does any harm to you, or the baby in your womb or to the one who is nursing. If you wish to stop, do so slowly, though; because pregnancy is associated with a decreased milk supply and the baby may stop on his own.

Illness in the Baby
Breastfeeding rarely needs to be discontinued for infant illness. Through breastfeeding, the mother is able to comfort the sick child, and, by breastfeeding, the child is able to comfort the mother.
  • Diarrhoea and vomiting. Intestinal infections are rare in exclusively breastfed babies. (Though loose bowel movements are very common and normal in exclusively breastfed babies.) The best treatment for this condition is to continue breastfeeding. The baby will get better more quickly while breastfeeding. The baby will do well with breastfeeding alone in the vast majority of situations and will not require additional fluids such as so called oral electrolyte solutions except in extraordinary cases.
  • Respiratory illness. There is a medical myth that milk should not be given to children with respiratory infections. Whether or not this is true for milk, it is definitely not true for breastmilk.
  • Jaundice. Exclusively breastfed babies are commonly jaundiced, even to 3 months of age, though usually, the yellow colour of the skin is barely noticeable. Rather than being a problem, this is normal. (There are causes of jaundice that are not normal, but these do not, except in very rare cases, require stopping breastfeeding.) If breastfeeding is going well, jaundice does not require the mother to stop breastfeeding. If the breastfeeding is not going well, fixing the breastfeeding will fix the problem, whereas stopping breastfeeding even for a short time may completely undo the breastfeeding. Stopping breastfeeding is not an answer, not a solution, not a good idea. (See Information Sheet Breastfeeding and Jaundice)
A sick baby does not need breastfeeding less, he needs it more!!

If the question you have is not discussed above, do not assume that you must stop breastfeeding. Do not stop. Get more information. Mothers have been told they must stop breastfeeding for reasons too silly to discuss.

How to Know a Healthcare Practitioner is not Supportive of Breastfeeding

Most healthcare practitioners say they are supportive of breastfeeding. But many are supportive only when breastfeeding is going well, and some, not even then. As soon as breastfeeding, or anything in the life of the new mother is not perfect, too many advise weaning or supplementation. The following is a partial list of clues that help you judge whether the health professional is supportive of breastfeeding, at least supportive enough so that if there is trouble, s/he will make efforts to help you continue breastfeeding.

How To Know A Health Professional Is Not Supportive:

1. S/he gives you formula samples or formula company literature when you are pregnant, or after you have had the baby. These samples and literature are inducements to use the product, and their distribution is called marketing. There is no evidence that any particular formula is better or worse than any other for the normal baby. The literature, CD’s or videos accompanying samples are a means of subtly (and not so subtly) undermining breastfeeding and glorifying formula. If you do not believe this, ask yourself why the formula companies are using cutthroat tactics to make sure that your doctor or hospital gives out their literature and samples and not other companies’? Should you not also wonder why the health professional is not marketing breastfeeding?

2. S/he tells you that breastfeeding and bottle feeding are essentially the same. Most bottle-fed babies grow up healthy and secure and not all breastfed babies grow up healthy and secure. But this does not mean that breastfeeding and bottle feeding are essentially the same. Infant formula is a rough copy of what we knew several years ago about breastmilk which is in itself only a rough approximation of something we are only beginning to get an inkling of and are constantly being surprised by. For example, we have known for many years that DHA and ARA were important to the baby’s brain development, but it took years to get it into formulas. But it doesn’t follow that the addition of these to formulas is doing what they are supposed to, as their absorption from formula is different from breastmilk. The many differences have important health consequences. Many elements in breastmilk are not found in artificial baby milk (formula) even though we have known of their importance to the baby for several years—for example, antibodies and cells for protection of the baby against infection, growth factors that help the immune system, the brain and other organs to mature. And breastfeeding is not the same as bottle feeding; it is a whole different relationship. If you have been unable to breastfeed, that is unfortunate (though most times the problems could have been avoided), but to imply it is of no importance is patronizing and just plain wrong. A baby does not have to be breastfed to grow up happy, healthy and secure, but it does help.

3. S/he tells you that formula x is best. This usually means that s/he is listening too much to a particular formula representative. It may mean that her/his children tolerated this particular formula better than other formulas. It means that s/he has unsubstantiated prejudices.

4. S/he tells you that it is not necessary to feed the baby immediately after the birth since you are (will be) tired and the baby is often not interested anyhow. It isn’t necessary, but it is often very helpful (See handouts Breastfeeding—Starting Out Right and The Importance of Skin to Skin Contact). Babies can breastfeed while the mother is lying down or sleeping, though most mothers do not want to sleep at a moment such as this. Babies do not always show an interest in feeding immediately, but this is not a reason to prevent them from having the opportunity. Many babies latch on in the hour or two after delivery, and this is the time that is most conducive to getting started well, but they can’t do it if they are separated from their mothers. If you are getting the impression that the baby’s getting weighed, eye drops and vitamin K injection have priority over establishing breastfeeding, you might wonder about someone’s commitment to breastfeeding.

5. S/he tells you that there is no such thing as nipple confusion and you should start giving bottles early to your baby to make sure that the baby accepts a bottle nipple. Why do you have to start giving bottles early if there is no such thing as nipple confusion? Arguing that there is no evidence for the existence of nipple confusion is putting the cart before the horse. It is the artificial nipple, which no mammal until man had ever used, and even man, not commonly before the end of the nineteenth century, which needs to be shown to be harmless. But the artificial nipple has not been proved harmless to breastfeeding. The health professional who assumes the artificial nipple is harmless is looking at the world as if bottle feeding, not breastfeeding, were the normal physiologic method of infant feeding. By the way, just because not all, or perhaps even not most, babies who get artificial nipples have trouble with breastfeeding, it does not follow that the early use of these things cannot cause problems for some babies. It is often a combination of factors, one of which could be the using of an artificial nipple, which add up to trouble.

6. S/he tells you that you must stop breastfeeding because you or your baby is sick, or because you will be taking medicine or you will have a medical test done. There are occasional, rare, situations when breastfeeding cannot continue, but often health professionals only assume that the mother cannot continue and very often they are wrong. The health professional who is supportive of breastfeeding will make efforts to find out how to avoid interruption of breastfeeding (the information in white pages of the blue Compendium of Pharmaceutical Specialties and the PDR are not a good references—every drug is contraindicated according to them as the drug companies are more interested in their liability than in the interests of mothers and babies). When a mother must take medicine, the health professional will try to use medication that does not require the mother to stop breastfeeding. (In fact, very few medications require the mother to stop breastfeeding). It is extremely uncommon for there to be only one medication that can be used for a particular problem. If the first choice of the health professional is a medication that requires you to stop breastfeeding, you have a right to be concerned that s/he has not really thought about the importance of breastfeeding.

7. S/he is surprised to learn that your six month old is still breastfeeding. Many health professionals believe that babies should be continued on artificial baby milk for at least nine months and even 12 months (and now that the formula companies sell formulas for up to 18 months and even three years, soon some health professionals will be urging mothers to use formula for three years), but at the same time seem to believe that breastmilk and breastfeeding are unnecessary and even harmful if continued longer than six months. Why is the imitation better than the original? Shouldn’t you wonder what this line of reasoning implies? In most of the world, breastfeeding to two or three years of age is common and normal, though, thanks to good marketing of formula, less and less common.

8. S/he tells you that breastmilk has no nutritional value after the baby is 6 months or older. Even if it were true, there is still value in breastfeeding. Breastfeeding is a unique interaction between two people in love even without the milk. But it is not true. Breastmilk is still milk, with fat, protein, calories, vitamins and the rest, and the antibodies and other elements that protect the baby against infections are still there, some in greater quantities than when the baby was younger. Anyone who tells you this doesn’t know the first thing about breastfeeding.

9. S/he tells you that you must never allow your baby to fall asleep at the breast. Why not? It is fine if a baby can also fall asleep without breastfeeding, but one of the advantages of breastfeeding is that you have a handy way of putting your tired baby to sleep. Mothers around the world since the beginning of mammalian time have done just that. One of the great pleasures of parenthood is having a child fall asleep in your arms, feeling the warmth he gives off as sleep overcomes him. It is one of the pleasures of breastfeeding, both for the mother and probably also for the baby, when the baby falls asleep at the breast.

10. S/he tells you that you should not stay in hospital to breastfeed your sick child because it is important you rest at home. It is important you rest, and the hospital that is supportive of breastfeeding will arrange it so that you can rest while you stay in the hospital to breastfeed your baby. Sick babies do not need breastfeeding less than a healthy baby, they need it more.

11. S/he does not try to get you help if you are having trouble with breastfeeding. Most problems can be prevented or cured, and most of the time the answer to breastfeeding problems is not giving formula. Unfortunately, many health professionals, particularly physicians, and even more particularly pediatricians, do not know how to help. But there is help out there. Insist on getting it. “You don’t have to breastfeed to be a good mother”, is true, but not an answer to a breastfeeding problem.

Questions? First look at the website nbci.ca or drjacknewman.com. If the information you need is not there, go to Contact Us and give us the information listed there in your email. Information is also available in Dr. Jack Newman’s Guide to Breastfeeding (called The Ultimate Breastfeeding Book of Answers in the USA); and/or our DVD, Dr. Jack Newman’s Visual Guide to Breastfeeding (available in French or with subtitles in Spanish, Portuguese and Italian); and/or The Latch Book and Other Keys to Breastfeeding Success; and/or L-eat Latch and Transfer Tool; and/or the GamePlan for Protecting and Supporting Breastfeeding in the First 24 Hours of Life and Beyond.

Monday, February 21, 2011

Order Tote Bag

Hari ni ummi ada berita baik untuk diri sendiri dan anak dara ummi yang sulung tu c sofwa ;). Beritanya bag yang ummi order 2 minggu lepas kalau tak silap dah pun disiapkan. Dan sekarang dalam perjalanan kepada tuan punya beg c ummi dam c kakak @ sofwa. Ummi beli secara online kat Blog Tinicraft cantik2 lah hasil kreatif yg dihasilkan oleh tuan punya blog. Kalau berkenan jum ler ke blog beliau ya. ok ummi order 3 beg (2 beg besar dan satu beg kecik), yg bestnya kalau order dr tinicraft kita leh design sendiri beg yg kita mahu beli tu. Cuba tengok hasilnya, cantik kan? Heppynya hati ummi dan kakak hehe :).



Saturday, February 19, 2011

WHAT IS THE DEFINITION OF BREASTFEEDING?

 Hai semua, baru hari ni berkesempatan mem'paste' maklumat breastfeeding kat blog ni. So hari ni ummi nak berkongsi beberapa term atau pengertian penyusuan susu ibu, ni amik dari site momslittleones.com.

 Ya kita boleh menambah pengetahuan tentang apakah sebenarnya penyusuan ibu secara ekslusif tersebut. Jom kita baca! ;)  

MIRIAM LABBOK, MD, MPH, IBCLC
from BREASTFEEDING ABSTRACTS, February 2000, Volume 19,
Number 3, pp. 19-21.

International Definitions
Two newer sets of internationally recognized definitions of various
breastfeeding terms predominate today in research and program design.
One addresses the maternal/infant parameters that affect so many of the
health outcomes and management issues associated with breastfeeding,
while the second deals primarily with infant nutritional intake.
IGAB Consortium Definitions

The agreed-upon definitions are:

Exclusive breastfeeding: No other liquid or solid from any
other source enters the infant ’s mouth.(Penyusuan secara ekslusif ialah: Tiada cecair atau bahan pejal dari sumber selain susu ibu yang dimasukkan ke mulut bayi. Maksudnya hanya pemberian susu ibu ibu semata-mata tidak diberikan sama ada air masak, susu formula dan sebagainya)

Almost exclusive: Allows occasional tastes of other liquids,
traditional foods, vitamins, medicines, etc. (pemberian susu ibu dan bercampur juga dengan pemberian pelbagai cecair berperasa yg lain spt: makanan tradisional, vitamin, ubat-ubatan)

Full breastfeeding: Includes exclusive and almost
exclusive.

Full breast-milk feeding (or fully breast-milk fed): The
infant receives expressed breast milk in addition to
breastfeeding.(bayi diberi susu ibu perahan untuk meneruskan penyusuan)

Partial: Mixed feeding, designated at high, medium, or low.
Methods for classification suggested include percentage of
calories from breastfeeding, percentage of feeds that are
breastfeeds, etc. Any feeding of expressed breast milk would
fall under this category.

Token: Minimal, occasional breastfeeds (for comfort or with
less than 10 percent of the nutrition thereby provided.)



WHO Breastfeeding Definitions (pengertian penyusuan mengikut World  Health Organisation)

The WHO/UNICEF definitions are:

Breastfeeding: The child has received breast milk direct
from the breast or expressed.(Bayi disusukan dengan susu ibu sama ada secara terus dari payudara ibu atau secara pemberian susu perahan)

Exclusive breastfeeding: The infant has received only
breast milk from the mother or a wet nurse, or expressed
breast milk, and no other liquids or solids with the exception
of drops or syrups consisting of vitamins, mineral
supplements, or medicines. (Bayi hanya diberikan susu ibu sama ada dari ibu atau ibu susuan, atau diberi secara perahan (susu ibu yg diperah)  dan tidak sama sekali diberikan cecair lain atau makanan pejal lain tapi pengecualian kpd pemberian beberapa titis sirap vitamin, mineral suplemen atau ubat-ubatan )

Predominant breastfeeding :The infant ’s predominant
source of nourishment has been breast milk. However, the
infant may also have received water and water-based drinks
(sweetened and flavored water, teas, infusions, etc.), fruit
juice; oral rehydration salts solution (ORS), drop and syrup
forms of vitamins, minerals and medicines, and ritual fluids
(in limited quantities). With the exception of fruit juice and
sugar water, no food-based fluid is allowed under this
definition.

Full breastfeeding: Exclusive breastfeeding and
predominant breastfeeding together constitute full
breastfeeding.

Complementary feeding: The child has received both
breast milk and solid or semi-solid food.

Bottle-feeding: The child has received liquid or semi-solid
food from a bottle with a nipple/teat.


sumber dari: http://momslittleones.com/shop/download/THE_DEFINITIONS_OF_BREASTFEEDING.pdf

Friday, February 18, 2011

Exclusive breastfeeding

Exclusive breastfeeding

Exclusive breastfeeding means that an infant receives only breastmilk with no additional foods or liquids, not even water. The benefits of exclusive breastfeeding on child survival, growth, and development are well documented. Exclusive breastfeeding also provides health benefits for mothers.

Benefits

Impact on neonatal and infant survival and health
  • Saves lives. Exclusive breastfeeding is the single most effective intervention for preventing child deaths, yet less than 40 percent of infants under 6 months old receive the benefits of exclusive breastfeeding. Diarrhea and pneumonia are the leading causes of death among infants in developing countries. Infants under 2 months old who are not breastfed are six times more likely to die from diarrhea or acute respiratory infections than those who are breastfed. Approximately 1.3 million deaths could be prevented each year if exclusive breastfeeding rates increased to 90 percent. Read more on the impact of early and exclusive breastfeeding on neonatal mortality.
  • Protects against illness. Breastmilk, especially the first yellow thick milk called colostrum, contains anti-bacterial and anti-viral agents and high levels of vitamin A that protect infants against disease.
  • Promotes recovery of the sick child. Breastfeeding provides a nutritious, easily digestible food when a sick child loses his or her appetite for other foods. Continued breastfeeding during diarrhea reduces dehydration, the severity and duration of diarrhea, and the risk of malnutrition.
Impact on child nutrition
  • Provides total food security. Breastmilk is a hygienic source of food with the right amount of energy, protein, fat, vitamins, and other nutrients for infants in the first six months. It cannot be duplicated. Breastmilk is the only safe and reliable source of food for infants in an emergency.
  • Meets all water requirements. Breastmilk is 88 percent water. Studies show that healthy, exclusively breastfed infants under 6 months old do not need additional fluids, even in countries with extremely high temperatures and low humidity. Offering water before 6 months of age reduces breastmilk intake, interferes with full absorption of breastmilk nutrients, and increases the risk of illness from contaminated water and feeding bottles.
Impact on child development
  • Optimizes a child's physical and mental growth and development. Infants fed breastmilk show higher developmental scores as toddlers and higher IQs as children than those who are not fed breastmilk. Breastmilk supplies key nutrients that are critical for health, growth, and development
Benefits for women
  • Benefits maternal health. Breastfeeding reduces the mother's risk of fatal postpartum hemorrhage and premenopausal breast and ovarian cancer. Frequent and exclusive breastfeeding contributes to a delay in the return of fertility and helps protect women against anemia by conserving iron.
  • Bonds mother and child. Breastfeeding provides frequent interaction between mother and infant, fostering emotional bonds, a sense of security, and stimulus to the baby’s developing brain.
Economic and environmental benefits
  • Saves money. Families save money that would have been spent to treat illnesses due to contaminated and inadequate breastmilk substitutes. Exclusive breastfeeding eliminates dependence on costly breastmilk substitutes, feeding equipment, and fuel for preparation.
  • Protects the environment. Breastmilk is a naturally renewable, sustainable resource that requires no fuel for preparation, packaging, shipping, or disposal.

 

Promoting and supporting exclusive breastfeeding

Despite its many benefits, many women do not breastfeed exclusively. Obstacles to exclusive breastfeeding can be overcome in the following ways:
  • Prevent and treat early problems. Most breastfeeding problems occur in the first 2 weeks of life. These problems include cracked nipples, engorgement, and mastitis and all too often lead to very early infant supplementation and abandonment of exclusive breastfeeding. Proper positioning and attachment of the baby to the breast and frequent breastfeedings can prevent these problems. Support to the mother for early initiation is easy to provide via peer support networks and has been effective at prolonging exclusive breastfeeding.
  • Restrict commercial pressures. Aggressive marketing of infant formula often gives new mothers and families the impression that human milk is less modern and thus less healthy for infants than infant formula. Enforced restrictions on marketing of infant formula are part of efforts to support and prolong exclusive breastfeeding.
  • Provide timely and accurate information. Many women and family members are unaware of the benefits of colostrum and exclusive breastfeeding. Women must sort through myths, misinformation, and mixed messages about breastfeeding. Ensuring that women receive complete, accurate, timely, and consistent information is fundamental for any program promoting exclusive breastfeeding.
  • Address social barriers. Attitudes that undervalue breastfeeding discourage women from breastfeeding. These attitudes may be communicated in the media and reflected in the advice of relatives and friends. Successful efforts to promote good feeding practices focus not only on the mother but on those who influence her feeding decisions, such as her doctor, mother-in-law, and husband.
  • Create supportive work environments. Few mothers are provided with paid maternity leave or time and a private place to breastfeed or express their breastmilk. Legislation around maternity leave and policies that provide time, space, and support for breastfeeding in the workplace could reduce one of the barriers to exclusive breastfeeding.
  • Establish good practices in health facilities. Distribution of free samples of infant formula, the use of glucose water, and separation of mother from newborn are obstacles to the establishment of good feeding in health services. Adopting the Baby-friendly Hospital Initiative’s "Ten Steps to Successful Breastfeeding" and enhancing the skills of health care providers to support exclusive breastfeeding would help to ensure the best start for infants.
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