BREASTFEEDING

Breastfeeding is the feeding of an infant or young child with breast milk directly from female human breasts (i.e., via lactation) rather than from a baby bottle or other container. Babies have a sucking reflex that enables them to suck and swallow milk. Many specialists recommend mothers exclusively breastfeed for six months or more, without the addition of infant formula or solid food. There are conflicting views about how long exclusive breastfeeding remains beneficial.

Breastfeeding was the rule in ancient times up to recent human history, and babies were carried with the mother and fed as required. With 18th and 19th century industrialization in the Western world, mother in many urban centers began despensing with breastfeeding due to work requirement in urban Europe. Breastfeeding declined significantly from 1900 to 1960, due to improved sanitation, nutritional technologies, and increasingly negative social attitudes towards the practice.^[4] By the 1950s, the predominant attitude to breastfeeding was that is was something practiced by the uneducated and those lacking temperment of lower classes. The practice was consider old-fashion and "a little disgusting", left for those who could not afford infant formula and discouraged by medical practioners and media of the time.^[5] In fact, letters and editorials to the women's magazine Chatelaine from 1945 to as late as 1995, regarded breastfeeding with a predominately negative attitude.^[5] However, since the middle 1960s there has been a steady resurgence in the practice of breastfeeding in Canada and the US, especially among more educated, affluent women.

                         IMPORTANT OF BREAST FEEDING.

The importance of breast feeding to human generation cannot be over enhanced but have to be looked into critically and appreciated for in the life of the infant, mother, the family and to the society in general.

        To The Child.

It  is considered the healthiest form of milk for all infant.

It prevent sicjness and diseases

Under modern heath care, human breast milk is considered the healthiest form of milk for babies. Breastfeeding promotes health and helps to prevent disease. Experts agree that breastfeeding is beneficial and have concerns about the effects of artificial formulas. Artificial feeding is associated with more deaths from diarrhea in infants in both developing and developed countries.  There are few exceptions, such as when the mother is taking certain drugs or is infected with human T-lymphotropic virus, or has active untreated tuberculosis. In developed countries with access to infant formula and clean drinking water, maternal HIV infection is an absolute contraindication to breastfeeding (regardless of maternal HIV viral load or antiretroviral treatment) due to the risk for mother-to-child HIV transmission.

…….note After the addition of solid food, mothers are advised to continue breastfeeding for at least a year. The World Health Organization recommends nursing for at least two years or more. The World Health Organization (WHO) and the American Academy of Pediatrics (AAP) emphasize the value of breastfeeding for mothers as well as children. Both recommend exclusive breastfeeding for the first six months of life. The AAP recommends that this be followed by supplemented breastfeeding for at least one year, while WHO recommends that supplemented breastfeeding continue two years or more. While recognizing the superiority of breastfeeding, regulating authorities also work to minimize the risks of artificial feeding.

Why breastfeeding is important

• Breastfeeding protects babies
• Mothers benefit from breastfeeding
• Breastfeeding benefits society
• Breastfeeding during an emergency
• More information on why breastfeeding is important

Breastfeeding protects babies

1.     Early breast milk is liquid gold – Known as liquid gold, colostrum (coh-LOSS-trum) is the thick yellow first breast milk that you make during pregnancy and just after birth. This milk is very rich in nutrients and antibodies to protect your baby. Although your baby only gets a small amount of colostrum at each feeding, it matches the amount his or her tiny stomach can hold. (Visit How to know your baby is getting enough milk to see just how small your newborn’s tummy is!)

2.     Related information

·        Pregnancy

·        The National Breastfeeding Campaign

Did you know?

While formula-feeding raises health risks in babies, it can also save lives. Very rarely, babies are born unable to tolerate milk of any kind. These babies must have soy formula. Formula may also be needed if the mother has certain health conditions and she does not have access to donor breast milk. To learn more about rare breastfeeding restrictions in the mother, visit the Breastfeeding a baby with health problems section. To learn more about donor milk banks, visit the Breastfeeding and special situations section.

For health professionals

·        Breastfeeding and the Risk of Postneonatal Death in the United States (American Academy of Pediatrics)

·        Breastfeeding and Health Outcomes (Agency for Healthcare Research and Quality)

·        A Summary of the Agency for Healthcare Research and Quality’s Evidence Report on Breastfeeding in Developed Countries.

3.     Your breast milk changes as your baby grows – Colostrum changes into what is called mature milk. By the third to fifth day after birth, this mature breast milk has just the right amount of fat, sugar, water, and protein to help your baby continue to grow. It is a thinner type of milk than colostrum, but it provides all of the nutrients and antibodies your baby needs.

4.     Breast milk is easier to digest – For most babies — especially premature babies — breast milk is easier to digest than formula. The proteins in formula are made from cow’s milk and it takes time for babies’ stomachs to adjust to digesting them.

5.     Breast milk fights disease – The cells, hormones, and antibodies in breast milk protect babies from illness. This protection is unique; formula cannot match the chemical makeup of human breast milk. In fact, among formula-fed babies, ear infections and diarrhea are more common. Formula-fed babies also have higher risks of:

·        Necrotizing (nek-roh-TEYE-zing) enterocolitis (en-TUR-oh-coh-lyt-iss), a disease that affects the gastrointestinal tract in preterm infants.

·        Lower respiratory infections

·        Asthma

·        Obesity

·        Type 2 diabetes

Some research shows that breastfeeding can also reduce the risk of Type 1 diabetes, childhood leukemia, and atopic dermatitis (a type of skin rash) in babies. Breastfeeding has also been shown to lower the risk of SIDS (sudden infant death syndrome).

Mothers benefit from breastfeeding

1.     Life can be easier when you breastfeed – Breastfeeding may take a little more effort than formula feeding at first. But it can make life easier once you and your baby settle into a good routine. Plus, when you breastfeed, there are no bottles and nipples to sterilize. You do not have to buy, measure, and mix formula. And there are no bottles to warm in the middle of the night! You can satisfy your baby’s hunger right away when breastfeeding.

2.     Breastfeeding can save money – Formula and feeding supplies can cost well over $1,500 each year, depending on how much your baby eats. Breastfed babies are also sick less often, which can lower health care costs.

3.     Breastfeeding can feel great – Physical contact is important to newborns. It can help them feel more secure, warm, and comforted. Mothers can benefit from this closeness, as well. Breastfeeding requires a mother to take some quiet relaxed time to bond. The skin-to-skin contact can boost the mother’s oxytocin (OKS-ee-TOH-suhn) levels. Oxytocin is a hormone that helps milk flow and can calm the mother.

4.     Breastfeeding can be good for the mother’s health, too – Breastfeeding is linked to a lower risk of these health problems in women:

1.     Type 2 diabetes

2.     Breast cancer

3.     Ovarian cancer

4.     Postpartum depression

Experts are still looking at the effects of breastfeeding on osteoporosis and weight loss after birth. Many studies have reported greater weight loss for breastfeeding mothers than for those who don’t. But more research is needed to understand if a strong link exists.

5.     Mothers miss less work – Breastfeeding mothers miss fewer days from work because their infants are sick less often.

Breastfeeding

Going back to work

·        During pregnancy

·        After the baby is born

·        During your maternity leave

·        Back at work

·        More information on going back to work

Planning ahead for your return to work can help ease the transition. Learn as much as you can ahead of time and talk with your employer about your options. This can help you continue to enjoy breastfeeding your baby long after your maternity leave is over.

During pregnancy

·        Join a breastfeeding support group to talk with other mothers about breastfeeding while working.

·        Talk with your supervisor about your plans to breastfeed. Discuss different types of schedules, such as starting back part-time at first or taking split shifts.

·        Find out if your company provides a lactation support program for employees. If not, ask about private areas where you can comfortably and safely express milk. The Affordable Care Act (health care reform) supports work-based efforts to assist nursing mothers.

·        Ask the lactation program director, your supervisor, wellness program director, employee human resources office, or other coworkers if they know of other women at your company who have breastfed after returning to work.

Your business can take easy steps to support breastfeeding!

The Office on Women's Health has a partnership with the U.S. Health Resources and Services Administration (HRSA) to encourage business owners to support breastfeeding.

The Business Case for Breastfeeding program points out the benefits of breastfeeding to businesses and gives them easy steps to make a breastfeeding-friendly work environment. The program includes tools you can use to help your workplace support breastfeeding. You can also share the program's information with your supervisor or your company's human resources department.

Did you know?

You can contact a lactation consultant or your local hospital, WIC program, or public health department to learn where to buy or rent a good breast pump.

After the baby is born

• Follow the steps in our Tips for making it work section to set up a breastfeeding routine that works for you and your baby.
• Ask for help from a lactation consultant or your doctor, if you need it.

During your maternity leave

·        Take as many weeks off as you can. At least six weeks of leave can help you recover from childbirth and settle into a good breastfeeding routine. Twelve weeks is even better.

·        Practice expressing your milk by hand or with a quality breast pump, which may be the best method for efficiently removing milk during the workday. Freeze 2–4 ounces at a time to save for your baby after you return to work. See our Pumping and milk storage section for more information about pumping and storage.

·        Help your baby adjust to taking breast milk from a bottle (or cup for infants 3-4 months old) shortly before you return to work. Babies are used to nursing with mom, so they usually drink from a bottle or cup when it’s given by somebody else.

·        See if there is a childcare option close to work, so that you can visit and breastfeed your baby, if possible. Ask if the facility has a place set aside for breastfeeding mothers. Ask if the facility will feed your baby with your pumped breast milk.

·        Talk with your family and your childcare provider about your desire to breastfeed. Let them know that you will need their support.

Back at work

·        Keep talking with your supervisor about your schedule and what is or isn’t working for you. Keep in mind that returning to work gradually gives you more time to adjust.

·        If your childcare is close by, find out if you can visit to breastfeed over lunch.

·        When you arrive to pick up your baby from childcare, take time to breastfeed first. This will give you both time to reconnect before traveling home and returning to other family responsibilities.

Find a private place to express milk

Work with your supervisor to find a private place to express your milk. The Affordable Care Act (health care reform) supports work-based efforts to assist nursing mothers. The Department of Labor is proposing a new regulation to allow nursing women reasonable break time in a private place (other than a bathroom) to express milk while at work. (Employers with fewer than 50 employees are not required to comply if it would cause the company financial strain.)

If your company does not provide a private lactation room, find another private area you can use. You may be able to use:

·        An office with a door

·        A conference room

·        A little-used closet or storage area

The room should be private and secure from intruders when in use. The room should also have an electrical outlet if you are using an electric breast pump. Explain to your supervisor that it is best not to express milk in a restroom. Restrooms are unsanitary and there are usually no electrical outlets. It can also be difficult to manage a pump in a toilet stall.

Pumping and milk storage tips

It may take time to adjust pumping breast milk in a work environment. For easier pumping, try these tips for getting your milk to let down from the milk ducts:

·        Relax as much as you can

·        Massage your breasts

·        Gently rub your nipples

·        Visualize the milk flowing down

·        Think about your baby — bring a photo of your baby, or a blanket or item of clothing that smells like your baby

When to express milk

At work, you will need to express and store milk during the times you would normally feed your baby. (In the first few months of life, babies need to breastfeed 8–12 times in 24 hours.) This turns out to be about two to three times during a typical 8-hour work period. Expressing milk can take about 10–15 minutes. Sometimes it may take longer. (Electric pumps that allow you to express milk from both breasts at the same time reduce pumping time.) This will help you make enough milk for your childcare provider to feed your baby while you are at work. The number of times you need to express milk at work should be equal to the number of feedings your baby will need while you are away. As the baby gets older, the number of feeding times may go down. Many women take their regular breaks and lunch breaks to pump. Some women come to work early or stay late to make up the time needed to express milk.

Storing your milk

Breast milk is food, so it is safe to keep it in an employee refrigerator or a cooler with ice packs. Talk to your supervisor about the best place to store your milk. If you work in a medical department, do not store milk in the same refrigerators where medical specimens are kept. Be sure to label the milk container with your name and the date you expressed the milk.

Return to top

More information on Going back to work

Explore other publications and websites

·        Break Time for Nursing Mothers under the FLSA - This fact sheet provides general information about the law that allows break time for breastfeeding mothers under the Patient Protection and Affordable Care Act.

·        Breastfeeding (Copyright © Association of Women's Health, Obstetric and Neonatal Nurses)  - AWHONN supports legislation and initiatives that promote and protect breastfeeding and lactation in the workplace. This statement describes elements of breastfeeding support legislation supported by AWHONN and provides background information.

·        Breastfeeding and Returning to Work (Copyright © American Academy of Family Physicians) - Going back to work and keeping up with breastfeeding can be a challenge for many new mothers. This publication answers some commonly asked questions about how to transition back to work after having a child and still maintain a breastfeeding schedule.

·        Breastfeeding and the Law (Copyright © La Leche League International)  - This site provides a list of publications that address different legal issues and breastfeeding.

·        Breastfeeding: How to Pump and Store Milk (Copyright © American Academy of Family Physicians)  - This fact sheet discusses ways in which learning how to pump and store breast milk can make returning to work easier and less stressful. It does require some work and careful planning, but it can be done.

·        Health Care Reform Boosts Support for Employed Breastfeeding Mothers (Copyright © United States Breastfeeding Committee)  - With the passage of the Patient Protection and Affordable Care Act, breastfeeding mothers now have protections guaranteed by law. This fact sheet describes the Reasonable Break Time for Nursing Mothers law and how it works.

·        Returning to Work While Breastfeeding (Copyright © American Academy of Family Physicians)  - This article discusses how to plan for pumping at work before you go on your maternity leave and after you have your baby. It gives information on talking to your employer and coworkers, practicing pumping at home, and it gives a checklist with everything you'll need before returning to work.

·        Working It Out: Breastfeeding at Work (Copyright © La Leche League International)  - This publication addresses the issue of returning to work and breastfeeding. It provides ways to be proactive about educating your supervisor and provides information on the latest legislation regarding your rights at work.

 

Common breastfeeding challenges

Breastfeeding can be challenging at times, especially in the early days. But it is important to remember that you are not alone. Lactation consultants are trained to help you find ways to make breastfeeding work for you. And while many women are faced with one or more of the challenges listed here, many women do not struggle at all! Also, many women may have certain problems with one baby that they don’t have with their second or third babies. Read on for ways to troubleshoot problems.

Sore nipples

Many moms report that nipples can be tender at first. Breastfeeding should be comfortable once you have found some positions that work and a good latch is established. Yet it is possible to still have pain from an abrasion you already have. You may also have pain if your baby is sucking on only the nipple.

Related information

• Breastfeeding fact sheet – Find answers to common questions about breastfeeding

Ask for help!

Ask a lactation consultant for help to improve your baby’s latch. Talk to your doctor if your pain does not go away or if you suddenly get sore nipples after several weeks of pain-free breastfeeding. Sore nipples may lead to a breast infection, which needs to be treated by a doctor.

What you can do

1.     A good latch is key, so visit the Bringing your baby to the breast to latch section for detailed instructions. If your baby is sucking only on the nipple, gently break your baby’s suction to your breast by placing a clean finger in the corner of your baby’s mouth and try again. (Your nipple should not look flat or compressed when it comes out of your baby’s mouth. It should look round and long, or the same shape as it was before the feeding.)

2.     If you find yourself wanting to delay feedings because of pain, get help from a lactation consultant. Delaying feedings can cause more pain and harm your supply.

3.     Try changing positions each time you breastfeed. This puts the pressure on a different part of the breast.

4.     After breastfeeding, express a few drops of milk and gently rub it on your nipples with clean hands. Human milk has natural healing properties and emollients that soothe. Also try letting your nipples air-dry after feeding, or wear a soft cotton shirt.

5.     If you are thinking about using creams, hydrogel pads, or a nipple shield, get help from a health care provider first.

6.     Avoid wearing bras or clothes that are too tight and put pressure on your nipples.

7.     Change nursing pads often to avoid trapping in moisture.

8.     Avoid using soap or ointments that contain astringents or other chemicals on your nipples. Make sure to avoid products that must be removed before breastfeeding. Washing with clean water is all that is needed to keep your nipples and breasts clean.

9.     If you have very sore nipples, you can ask your doctor about using non-aspirin pain relievers.

There may be times when you think your supply is low, but it is actually just fine:

• When your baby is around 6 weeks to 2 months old, your breasts may no longer feel full. This is normal. At the same time, your baby may nurse for only five minutes at a time. This can mean that you and baby are just adjusting to the breastfeeding process — and getting good at it!
• Growth spurts can cause your baby to want to nurse longer and more often. These growth spurts can happen around 2 to 3 weeks, 6 weeks, and 3 months of age. They can also happen at any time. Don’t be alarmed that your supply is too low to satisfy your baby. Follow your baby’s lead — nursing more and more often will help build up your milk supply. Once your supply increases, you will likely be back to your usual routine.

What you can do

1.     Make sure your baby is latched on and positioned well.

2.     Breastfeed often and let your baby decide when to end the feeding.

3.     Offer both breasts at each feeding. Have your baby stay at the first breast as long as he or she is still sucking and swallowing. Offer the second breast when the baby slows down or stops.

4.     Try to avoid giving your baby formula or cereal as it may lead to less interest in breast milk. This will decrease your milk supply. Your baby doesn’t need solid foods until he or she is at least 6 months old. If you need to supplement the baby’s feedings, try using a spoon, cup, or a dropper.

5.     Limit or stop pacifier use while trying the above tips at the same time.

What you can do

1.     Breastfeed on one side for each feeding. Continue to offer that same side for at least two hours until the next full feeding, gradually increasing the length of time per feeding.

2.     If the other breast feels unbearably full before you are ready to breastfeed on it, hand express for a few moments to relieve some of the pressure. You can also use a cold compress or washcloth to reduce discomfort and swelling.

3.     Feed your baby before he or she becomes overly hungry to prevent aggressive sucking. (Learn about hunger signs in the Tips for making it work section.)

4.     Try positions that don’t allow the force of gravity to help as much with milk ejection, such as the side-lying position or the football hold. (See the Breastfeeding holds section for illustrations of these positions.)

5.     Burp your baby frequently if he or she is gassy.

Some women have a strong milk ejection reflex or let-down. This can happen along with an oversupply of milk. If you have a rush of milk, try the following:

1.     Hold your nipple between your forefinger and middle finger or with the side of your hand to lightly compress milk ducts to reduce the force of the milk ejection.

2.     If baby chokes or sputters, unlatch him or her and let the excess milk spray into a towel or cloth.

3.     Allow your baby to come on and off the breast at will.

What you can do

1.     Breastfeed often after birth, allowing the baby to feed as long as he or she likes, as long as he or she is latched on well and sucking effectively. In the early weeks after birth, you should wake your baby to feed if four hours have passed since the beginning of the last feeding.

2.     Work with a lactation consultant to improve the baby’s latch.

3.     Breastfeed often on the affected side to remove the milk, keep it moving freely, and prevent the breast from becoming overly full.

4.     Avoid overusing pacifiers and using bottles to supplement feedings.

5.     Hand express or pump a little milk to first soften the breast, areola, and nipple before breastfeeding.

6.     Massage the breast.

7.     Use cold compresses in between feedings to help ease pain.

8.     If you are returning to work, try to pump your milk on the same schedule that the baby breastfed at home. Or, you can pump at least every four hours.

9.     Get enough rest, proper nutrition, and fluids.

10.                        Wear a well-fitting, supportive bra that is not too tight.