Breastfeeding: Basics and Tips for Nursing Your Baby

My phone started ringing at midnight, “Doctor, there is an emergency!! My baby is sleeping since evening and not taking breast feed”; I am trying for last two hours, but failed, what to do now? Is there something wrong? What will happen? Should I bring the baby to the emergency or nursery? What should I do now?” On the other side of the line, a new mom was crying.

It is a very common problem, and some new mom’s have a misconception that the baby will feed when its hungry or its sleepy, will cry for feed when needed. No! You should know that you have to find the trouble and overcome it. Remember, a baby who does not nurse, usually has some problem, you cannot just simply ignore it.

This blog is to help all those new mothers and it will guide and give you answers to most of your queries. 

 There could be various reasons when babies stop nursing. First of all it could be poor positioning or inappropriate way of breast feeding or as simple as that it could be a dirty diaper. All the newborns are examined for any birth defects of cleft lip, cleft palate or any birth defect and birth injuries, swallowing and sucking are also checked after first feed, so there are less likely chances of a serious problem. Sometimes sore throat, nasal blockage due to secretions, makes breathing difficult. Few babies have exaggerated gag reflex making feeding difficult, colic and gas in tummy also irritates a baby.

Occasionally there is no reason, baby is aggressive and hyper, becomes irritable on holding and nursing, always give some time to settle. You should aim on feeding the baby and maintaining a continuous feed.       

FEED THE BABY 

A baby will learn to nurse easily when he/she is getting the right amount of calories and nutrition. Obviously mothers milk is the first priority over infant formula milk, it should be given ONLY in case of non-availability of mothers milk. Some people try to give cows or buffalo milk but it is dangerous, if given without dilution.

  MAINTIAN MOTHER MILK SUPPLY  

It is common mistake that new moms stop breast feeding and start formula milk, once baby is giving trouble in nursing, as a result milk production is decreased, making it difficult to start nursing. It can be avoided by milk expression at regular intervals; meanwhile baby will have time to learn to nurse.   

HOW TO CALM DOWN AND FEED THE BABY

Check the nappy, change if dirty.

Baby should be held close to chest, mother and baby should be comfortable, cross cradle and modified football hold are convenient positions, never ever force the baby for breast-feeding, and it will only stress both and create aversion. If baby is not latching after more than 10 minutes, you feel that both are tired then take a break, try short intervals of breast-feeding.

Sometimes just offering baby a finger to suckle, relaxes the baby. Always wait, after a major nursing problem, baby will settle down gradually …give it TIME.

Nursing mothers should wear a comfortable, soft and easily manageable dress, so baby does not become impatient and uncomfortable. Mother and baby skin to skin contact is very important in bonding for successful nursing .The earlier the contact between mother and   baby, more easy the nursing becomes, it is therefore a common practice to start it right after delivery, in labor room, when baby is placed on mummies tummy.

Similarly holding, hugging, humming and talking to baby are also helpful, baby recognizes mother’s touch, and Kangaroo care is really affective in starting and maintaining nursing.

If baby is hungry, both of you are tired, then give it half of formula milk, once baby calms down, try again, if failed then you can give the rest of feed. But then you have to evacuate breast, this expressed milk can be used afterwards, and maintain nursing.

The instant reward techniques are also helpful for babies who stop sucking after sometime, manual or pump breast compression can help in let down reflex making nursing easy for baby. Sometimes nipple shields can be filled by expressed milk and are helpful in settling a baby who is refusing breast .You can also relax the baby by putting few of milk on the upper lip of baby, it will encourage latching.

HOW TO MAINTAIN NURSING?

Sometimes baby is sucking but milk stops, and in cases where baby is not nursing, or having problems results in incomplete evacuation, frequent breast emptying with a pump would be beneficial.

There are various breast pumps available; Medea and Aventis Company are the best options for it. These pumps are electrical and manual. They really help in initiation and maintenance of breast feed. Make sure that you select the right size for avoiding injury to breast.

Breast evacuation by manual compression or breast pump should be started, after 6 to 8 hours of delivery, at least 20 min for 8 to 10 times in a day till milk start coming, it is basically breast stimulation for milk let down reflex .If baby is not taking breast feed then, 20 to 30 ounces of milk should be removed, till nursing is started.

If milk supply is less, after a week or 10 days after delivery then first of all, try to increase fluid intake to 4 to 5 liters, frequent breast pumping for 15 to 20 min after every 2 to 3 hours, nursing while having food is helpful. Avoid hormonal oral contraceptive, alcohol, pseudoephedrine (cough syrups), and ergots.

If all these measures fail then herbs fenugreek  (Metra), drugs like metoclopramide (maxalon); domeperidone (motilium) can be used after consultation.

HOW TO TREAT ENGORGED BREASTS?

Sometimes incomplete breast evacuation leads to breast engorgement, third to fifth days after delivery, which is a very painful condition, causing breast tenderness, high grade fever and if left untreated then breast milk gets infected leading to pus filled abscess requiring drainage operation.

Therefore if you feel heaviness and pain in breast, empty the breast immediately either with hands or pump, make sure that you only extract milk till breast become soft, do not go for complete evacuation, otherwise milk formation will increase.

Breast support and cold fomentation are also soothing. Remember warm towel application before nursing, decreases pain and improves feed, but after nursing, ice packs or iced cabbage leave application for half an hour really works, cabbage leaves have chemical Sulfur, which reduces inflammation, swelling and reduces milk production, simple pain painkillers also help to subside it. In some severe cases, after doctor consultation, milk formation is suppressed with drugs.

Remember these problems of breast-feeding can easily be overcome with proper guidance and help. Every child should be breast-fed; it is only possible when we educate our mothers’. The key for a successful nursing is patience.

Dr. Ayesha Azam Khan