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By Dr Geeta Baruah Nath, Consultant
Gynaecologist; Illustration by Shinod AP
With first time mothers, trouble may arise even after
they have begun lactating properly. A new mother always
has a lot of questions concerning her new experience.
Antenatal Preparation
The second trimester is considered the best time to
start breast feeding. Since the baby starts moving and
it becomes easier for the mother to connect with the
baby. It is also around this time that the mother starts
making preparations for the baby's arrival.
Many mothers ambivalent towards breast feeding will be
able to nurse successfully if their obstetrician
reassures them about their ability to feed. Pregnant
mothers' breasts are routinely examined from the second
trimester onwards. If the obstetrician discovers any
abnormality in the nipples, the patient is taught ways
to tackle it. For example a retracted nipple can be
pulled out to make it become normal.
The First Feed
The child can be breastfed right there in the delivery
room within one hour after delivery. It has been
observed that the sucking reflex of a new born is at its
height 20 to 30 minutes after birth. If the infant is
not fed, the reflex diminishes rapidly to reappear
adequately 40 hours later.
If the infant is put to the breast within half an hour
after birth, not only does he respond well, the process
also reduces early weight loss. Besides, the antibody
content - the colostrum is at its maximum during the
first 12 hours after delivery.
Early breast feeding also has a physiological effect on
the uterus. The suckling of the baby starts the
mechanism that helps the uterus to contract and come
back to its normal shape. Nursing soon after delivery
has a laxative effect on the meconium, or black stool,
that is released in the first two to three days.
Co-operation between mother and child
Each mother infant relationship is unique. There are
individual variations. The interaction between the
mother and the infant is not a mechanical one. Emotional
bonding plays a great role in co-operation between
mother and child. The compatibility of mother's
temperament with that of her infant will determine their
relationship, and in the first months this includes
breastfeeding.
Leaking
In some mothers lack of tone of the sphincter muscles
around the milk duct causes a steady leakage. Leaking is
strongest when the ejection reflex is active and because
the reflex affects both breasts at the same time, milk
flows from one breast while the baby is feeding at the
other breast. A cotton pad can be used under the bra to
avoid discomfort. Leaking usually becomes less of a
problem as time passes. While the baby is feeding from
one breast, milk begins to flow from the other breast.
This can be stopped by pressing the nipple with a
handkerchief. The leaking will reduce gradually.
Studies show that mothers who stay close to their babies
are twice as likely to have no problems with breast
feeding than mothers whose babies are kept away.
'Rooming-in' refers to the situation where the baby is
kept within easy reach of the mother in the same room.
Rooming-in facilities promotes breast feeding and
prevents many breast feeding problems. It is strongly
recommended by the International Federation of
Gynecology and Obstetrics, World Health Organization,
UNICEF and the Indian Academy of Pediatrics
Tips for correct positioning
many mothers breastfeed in odd positions, which they
claim to be comfortable in. In their anxiousness to
succeed, they are tense and sit in an uncomfortable
position. Not only are these positions exhausting,
mother could also develop sore nipples and backache in
these positions.
Hold the baby flat on his back with his head turned
sideways.
Keep your arm wide and do not pull it in tightly to the
side.
Bring him close so that his chin touches your breast.
Offer him the breast but do not put it into his mouth.
Make him find it. This will ensure that the breast is
not pulled in your enthusiasm to feed.
Hold the baby's head so that he is aligned with your
body. If the baby is not close enough to the breast, he
may have to suck too hard on the nipple in order to keep
it in the mouth. This can damage the sensitive nipple
skin and make it sore.
Be careful about your back. Make sure that your back is
straight and has a backrest. This way you can avoid
getting a backache after feeding.
You also have to make sure that the baby's breathing is
not obstructed in any way. Hold on to the breast with a
finger while the baby is feeding so that this part of
the breast does not suffocate him.
Positional errors
Baby is too far from breast.
Mother leans forward and her back and shoulders are
slouched as she strains to feed him.
Baby is held by the head, which strains the infant's
neck.
Baby is asleep and is not feeding.
Bad feeding positions could cause:
Sore nipples are a result of bad feeding positions. To
avoid such a situation, make sure that the baby has
enough of the areola in his mouth and not only the tip
of the nipple.
Also avoid using soap on the nipple and wash the nipple
once or twice a day only. Do not pull the nipple out of
the baby's mouth. Wait until the baby releases the
nipple or break the suction with your finger. You could
also use a protective cream or any edible oil, or milk
cream. Make sure that the nipple does not get infected.
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