Breast Feeding

By Marsha Walker et al – Unbekoming Book Summary

Nothing scares the system more than an unpoisoned baby.

It’s why it works so hard to make sure you “just do it.”

Once injected the next step is to make sure you don’t feed her properly.

The Baby Formula Cartel sweeps in.

I blame three factors for the failure of doctors to urge that mothers breast-feed their children. First, they learn nothing about nutrition in medical school and are actually taught that formula is just as good as mother's milk. Second, this belief is reinforced by the misleading medical journal advertising purchased by the formula manufacturers. It stops just short of citing women as defective because their breasts aren't calibrated and encased in tin. Finally, I believe doctors oppose breast-feeding for the same reason they oppose natural childbirth. It denies them too many lucrative opportunities to intervene. – Dr Robert Mendelsohn

I was put onto this book by Dr Jennifer Margulis, that I’ve decided to summarize and promote. It can be added to this Baby Series list.

Delayed Cord Clamping

Childhood Vaccination

Baby Formula and Breastfeeding

Diapers

Sleep

Babywatching

Breast Feeding

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Breast Feeding By Marsha Walker Et Al Unbekoming Book Summary

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Breast Feeding Your Baby (1981)

by Marsha Walker et al

Question 1: What are the two aspects of lactation?

Making milk and giving milk are the two aspects of lactation, both of which are controlled by hormones. The size of the breasts has no bearing on their ability to produce milk.

Question 2: How does the concept of supply and demand relate to milk production?

The amount of milk made is a direct result of the amount the baby removes. The more the baby nurses, the more milk will be made. This is the concept of supply and demand.

Question 3: What is the difference between foremilk and hindmilk?

Foremilk is the milk that collects in the lactiferous sinuses between feedings and is available to the baby first. It is high in protein and low in fat. Hindmilk is the deeper milk that becomes available after the let-down occurs, making up two-thirds of the available breast milk. It is higher in fat content than the foremilk.

Question 4: How does the let-down reflex work?

The let-down reflex occurs when the baby's suckling stimulates the nipples, sending a message to the brain to release prolactin and oxytocin. Prolactin signals the alveoli to make more milk, while oxytocin causes the cells around the alveoli and ducts to contract and squeeze milk out to the nipple.

Question 5: What are the benefits of breast feeding for the baby?

Breast feeding provides many benefits for the baby, including:

• Breast milk components are ideally suited to the baby's immature digestive and excretory systems

• Prevents constipation, lowers incidence of allergies, colic, and eczema

• Promotes proper tooth and jaw development

• Provides a readily available food supply that cannot be contaminated

• Always at the right temperature

• Provides oral gratification and a sense of security from closeness to mother

Question 6: What are the benefits of breast feeding for the mother?

Breast feeding offers several advantages for the mother:

• Reduces chance of hemorrhaging from the placental site

• Helps uterus return to pre-pregnant size quickly

• Consumes calories, allowing for weight loss while enjoying enhanced appetite

• Breast milk is cheap and convenient

• Breast fed babies have mild-smelling spit-up and sweet-smelling bowel movements

• Allows one arm free during feedings for other tasks

• Can be done modestly and discreetly when traveling

• Provides emotional gratification and sense of fulfillment

Question 7: What are the recommended methods for preparing nipples for breast feeding?

Recommended procedures for conditioning the nipples include:

• Performing the pinch test to determine if nipples protrude, flatten or retract

• Wearing milk cups starting at 3-7 months if nipples are retracting

• Using the Hoffman technique to draw out nipples by breaking adhesions at the base

• Doing nipple rolling exercises to encourage protrusion and suppleness

• Exposing breasts to air and sunlight daily

• Allowing nipples to rub against clothing

• Gently buffing nipples with a towel

Question 8: What questions should be asked when choosing a pediatrician who is supportive of breast feeding?

When interviewing potential pediatricians, ask:

1. What percentage of their patients nurse and for how long on average?

2. When do they recommend starting solid foods?

3. Under what circumstances would they suggest weaning?

4. Did the doctor's wife nurse their children and what was her experience?

5. What do they consider the advantages and disadvantages of breast feeding?

Pediatricians who are knowledgeable and supportive of breast feeding will have thoughtful, informed answers reflecting the benefits of nursing.

Question 9: What arrangements should be made with the hospital before giving birth to facilitate breast feeding?

Before delivery, the expectant mother should:

1. Learn about the routines and policies in the maternity unit

2. Find out if the hospital practices family-centered maternity care

3. Make a list specifying breast feeding preferences, such as:

• No test feeds of water/formula for baby

• No separation after birth unless medically necessary

• Rooming-in with baby whenever possible

• Baby to be brought for feeding on demand

• No formula/sugar water between nursings

• No nipple shields or alcohol on nipples

4. Ensure the pediatrician has communicated these preferences to hospital staff

Question 10: What are the recommended positions for breast feeding?

Three suggested nursing positions are:

1. Sitting: Prop up in bed with pillows, put baby on pillow on lap with knees bent slightly. Baby should be on his side with legs around mother's waist.

2. Lying: Lie on side with pillows behind back and head. Place folded towel under baby to align mouth with nipple.

3. Football hold: Sit supported by pillows, with baby's legs extending behind mother and head cupped in hand.

The key is for the mother to be comfortable and relaxed in any position.

Question 11: How should the baby be encouraged to latch on properly during breast feeding?

Proper latching on can be encouraged by:

1. Stimulating the baby's rooting reflex by compressing the nipple and areola and stroking the baby's cheek nearest the nipple

2. Guiding the nipple into baby's mouth as he turns and opens wide

3. Ensuring baby's tongue is flat on lower gum

4. Aiming to get as much areola into baby's mouth as possible

5. Pressing breast gently away from baby's nose for airflow

6. Supporting breast if needed to keep nipple in baby's mouth

Question 12: What is engorgement and how can it be prevented and treated?

Engorgement is temporary swelling and hardening of the breasts due to increased blood supply and pressure from newly produced milk, usually occurring 2-5 days after birth. Prevention:

• Nurse frequently and on demand from birth

• No formula/sugar water between feedings

• Don't skip feedings day or night

• Relax and encourage let-down

• Allow adequate sucking time and empty breasts well Treatment:

• Nurse frequently, every 1.5-2 hours

• Apply moist heat before feedings and massage toward nipple

• Soften areola and nipple before latching

• Massage breasts while nursing

• Express milk after feedings if needed

Question 13: What causes sore nipples and how can they be prevented and treated?

Sore nipples are often caused by incorrect positioning, poor latching, or nipple confusion from artificial nipples. They usually occur early on as the nipples adjust to nursing. Prevention:

• Prepare nipples during pregnancy

• Keep nipples dry between feedings

• Nurse frequently before breasts get overfull

• Use proper positioning and break suction carefully Treatment:

• Nurse on least sore side first, for shorter durations

• Soften areola and express milk until let-down before nursing

• Air dry and apply dry heat to nipples after nursing

• Get help from a nursing support group

Question 14: How should a sleepy baby be encouraged to nurse effectively?

Sleepy babies, often due to medication during labor, need extra stimulation to nurse. Tips:

• Nurse every 2-3 hours even if you must wake baby

• Unwrap, undress, change diaper, stroke, talk to baby

• Give baby a bath or do "baby sit-ups" to rouse them

• Draw out nipples before nursing

• Express milk into baby's mouth to encourage sucking

• Avoid pacifiers and nipple shields

• Provide lots of skin-to-skin contact

Question 15: What are the different types of jaundice in newborns and how do they relate to breast feeding?

The three main types of newborn jaundice are:

1. Physiologic: Occurs as baby's liver matures in handling red blood cell breakdown. Nursing helps by providing fluids and prompting frequent stooling.

2. Blood incompatibility: Due to differences between maternal and fetal blood types. Nursing continues as usual in most cases.

3. Breast milk jaundice: Rare condition where a substance in some mothers' milk inhibits liver enzyme activity. May require temporary supplementation but usually resolves with continued nursing.

In most jaundice cases, frequent nursing, adequate fluids and stool output are important to managing the condition. Interrupting breast feeding is rarely indicated.

Question 16: What are the recommended strategies for breast feeding after a Cesarean delivery?

Nursing after a C-section requires extra support and preparation:

• Nurse as soon as possible after surgery, ideally while pain medication is still effective

• Have assistance with positioning and supporting the baby at the breast

• Use extra pillows to support back, arms and incision

• Take pain medication as needed

• Practice deep breathing to manage discomfort

• Keep baby close and limit visitors to allow rest

• Feed baby on demand, at least every 2-3 hours

• Express milk if baby doesn't empty the breast well

• Ask for help with baby care and household tasks

Question 17: How can mothers of premature babies establish and maintain milk supply?

When babies are premature, establishing milk supply may require:

• Informing medical staff of desire to breast feed

• Frequent pumping (every 2-3 hrs) starting soon after birth to stimulate production

• Pumping for 10-15 min per side using a hospital grade pump if possible

• Using relaxation techniques and breast massage to encourage let-down

• Providing pumped colostrum/milk for baby even if by feeding tube at first

• Putting baby to breast when mature enough to suckle

• Frequent skin-to-skin contact as soon as possible

• Monitoring baby's weight gain as milk supply increases

Question 18: What are the recommended positions and strategies for breast feeding twins?

Twins can be nursed together or separately, in various positions:

• Football hold: Babies' bodies under mother's arms with heads supported in her hands.

• Criss-cross: Babies cradled in opposite arms in front of mother.

• Combination: One baby in cradle hold, one in football hold.

Other tips:

• Alternate breasts for each baby at feedings

• Use pillows for support and seek help getting positioned

• Nurse on demand and wake babies to feed every 2-3 hrs

• Burp and change babies between breasts

• Ensure adequate fluid and calorie intake for mother

• Seek support from other mothers of multiples

Question 19: What are the four cornerstones of a successful breast feeding experience?

The four cornerstones of successful breast feeding are:

1. Adequate rest

2. Frequent nursing, about 10 times per 24 hours in the first weeks

3. Increased fluid intake, 2-2.5 quarts per day

4. Proper nutrition based on recommended servings from each food group

Question 20: How can a good milk supply be maintained?

Maintaining a good milk supply involves:

• Nursing frequently, every 2-3 hours

• Offering both breasts at each feeding

• Staying hydrated with at least 8 glasses of fluid daily

• Eating a balanced diet with adequate calories

• Getting enough rest, napping when the baby sleeps

• Relaxing and minimizing stress to allow let-down

Question 21: What causes leaking breasts and how can it be managed?

Leaking, a normal response to the milk let-down reflex, is common in the early weeks. It may occur when breasts are full, during let-down on one side while nursing on the other, or when thinking about the baby. Tips:

• Apply pressure to stop the flow by pressing palms against nipples or folding arms tightly across chest

• Wear nursing pads and change them frequently

• Put a rubber sheet on the bed to protect the mattress

• Wear light-colored clothes to minimize visible wet spots

Question 22: What are plugged ducts and mastitis, and how can they be prevented and treated?

Plugged ducts are lumpy, painful areas caused by insufficient breast emptying or pressure on the breast. Mastitis is a breast infection marked by flu-like symptoms, breast pain and redness. Prevention:

• Nurse frequently and empty breasts thoroughly

• Avoid restrictive clothing or pressure on the breasts

• Alternate nursing positions to drain all ducts

• Get adequate rest and nutrition Treatment:

• Apply moist heat and massage affected area toward nipple

• Nurse often, starting on affected side, and in different positions

• Rest in bed and take in extra fluids

• Consult a doctor if fever is over 101°F, antibiotics may be needed

Question 23: What is thrush and how can it be managed?

Thrush is a fungal infection causing white patches in the baby's mouth and sometimes nipple soreness for the mother. Management:

• Swab baby's mouth with a solution of 1 tsp baking soda in 1 cup water after each nursing

• Wash nipples with the same baking soda solution

• Use a clean cotton swab each time and make a fresh solution for each feeding

• If thrush persists, consult a pediatrician for a prescription anti-fungal medication

Question 24: What are growth spurts and how do they affect breast feeding?

Growth spurts are times of rapid growth during which the baby will nurse very frequently, as often as every hour, for 1-2 days. They typically occur around 10 days, 3 weeks, 6 weeks and 3 months of age. Frequent nursing during growth spurts is the baby's way of increasing the milk supply to meet his growing needs. Tips for growth spurts:

• Follow the baby's lead and nurse on demand

• Offer both breasts at each feeding

• Drink extra fluids and eat well

• Rest as much as possible

Question 25: What are some common breast feeding personalities in babies?

There are several common nursing personality types in babies:

1. Barracuda: Latches on and sucks vigorously with no hesitation.

2. Procrastinator: Seems uninterested at first but nurses well once milk comes in.

3. Gourmet: Likes to savor the milk, may get frustrated if rushed.

4. Rester: Takes breaks between sucking bursts, prefers a calm pace.

5. Frantic feeder: Eager but disorganized, may need help staying latched.

Recognizing a baby's natural nursing style can help the mother relax and work with her baby's tendencies.

Question 26: How can breast milk be expressed and stored?

Expressing breast milk, by hand or with a pump, allows the baby to have breast milk when being fed by someone else. Hand expression:

1. Wash hands and massage breasts.

2. Place thumb and fingers around areola and press back against chest wall.

3. Compress thumb and fingers together in a rhythmic motion.

4. Rotate hand position to express from all ducts. Pump options include manual or electric pumps. Hospital-grade electric pumps are most efficient. Storage guidelines:

• Collect expressed milk in a clean container.

• Store in refrigerator for up to 8 days or at the back of a 0°F freezer for up to 6 months.

• Thaw frozen milk in the refrigerator or under warm running water.

Question 27: When and how should supplementary bottles be introduced?

If a nursing mother plans to be away from her baby, it's wise to introduce a bottle around 3-4 weeks of age. Tips:

• Offer a bottle once or twice a week, not right before or after nursing.

• Have someone else feed the baby to minimize nipple confusion.

• Use slow-flow bottle nipples to mimic the breast.

• For a breastfed baby, express breast milk to use in the supplemental bottle if possible.

Question 28: How do various drugs, alcohol, and smoking affect breast feeding?

Many substances pass into breast milk and can affect the baby or milk supply:

• Nicotine: Can decrease milk supply and cause nausea and vomiting in the baby.

• Alcohol: Passes into milk and can cause drowsiness, weak suck, and weight gain issues in the infant. Limit intake, especially in the first 3 months.

• Caffeine: May lead to irritability and sleep disturbances in the baby. Avoid large amounts (>3 cups per day).

• Marijuana: Passes to the baby and stays in the infant's system much longer than the mother's. May negatively impact brain development.

• Prescription/OTC drugs: Can pass into milk with various effects. Always inform doctor you are nursing before taking medication.

Question 29: What factors influence a baby's weight gain?

A breastfed baby's weight gain is influenced by:

• Frequency of nursing: Frequent milk removal is needed to maintain robust supply.

• Nursing duration: Feedings should be long enough to access high-fat hindmilk.

• Latch and positioning: A good latch and comfortable positioning promote effective milk transfer.

• Mother's diet: Adequate nutrition and fluid intake support a plentiful milk supply.

• Baby's health: Medical issues like tongue-tie, reflux or illness can hinder weight gain.

Monitoring the baby's weight, feedings, and wet/soiled diapers helps identify any growth issues early.

Question 30: What causes fussiness and colic in babies and how can they be managed?

Fussiness is common in young babies and has many potential causes, including hunger, discomfort, overstimulation or fatigue. Colic, which often peaks around 6 weeks, is marked by prolonged, inconsolable crying and may be related to digestive discomfort or an immature nervous system.

Soothing techniques for fussy or colicky babies:

• Check that baby's basic needs are met (feeding, diaper, temperature)

• Hold baby close and walk, rock or bounce gently

• Provide white noise or calming sounds

• Massage baby's tummy in a clockwise motion

• Burp frequently during and after feedings

• Offer a pacifier for extra sucking

• Wear baby in a sling or carrier

• Take baby for a car ride or stroller walk

Question 31: What is the role of fathers and siblings in the breast feeding family?

Fathers and siblings play an important supportive role in the breast feeding household: Fathers can:

• Provide emotional support and encouragement

• Help with positioning and bringing baby to mother

• Burp, change, bathe and comfort baby

• Take on household chores and child care to allow mother to rest

• Spend one-on-one time bonding with baby Siblings can:

• "Help" by bringing diapers, blankets or a drink for mother

• Entertain baby with songs or gentle play

• Hold and cuddle baby with supervision

• Assist with age-appropriate household tasks

Including the whole family promotes a positive adjustment to the new baby and breastfeeding.

Question 32: What are the recommended methods for weaning a baby gradually or abruptly?

Gradual weaning, the preferred approach, involves:

• Dropping one feeding at a time, starting with baby's least favorite

• Replacing dropped feedings with other foods or comfort measures

• Decreasing mother's fluid intake gradually to avoid engorgement

• Providing extra cuddles and attention to ease the transition

Abrupt weaning may be necessary due to illness, medication or sudden separation. Tips for abrupt weaning:

• Decrease fluid intake and express just enough to relieve discomfort

• Use cold compresses and pain medication for engorgement

• Pump and discard milk to avoid mastitis

• Seek support for emotional challenges of unexpected weaning

Question 33: Where can nursing mothers find support and help with breast feeding issues?

New mothers can find breast feeding information and support from multiple sources:

• La Leche League: International organization dedicated to breast feeding support, with local groups and leaders

• Lactation consultants: Trained professionals who provide clinical expertise and assistance

• Breast feeding support groups: Community organizations, often led by experienced nursing mothers

• Birthing hospitals: Many have lactation programs and resources for new mothers

• Doctors and nurses: Can offer guidance and referrals to specialists as needed

• Friends and family: Emotional support and practical help from loved ones is invaluable

• Online resources: Websites and forums provide education and virtual community

Building a strong support network is key to overcoming challenges and meeting breast feeding goals.

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