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All your questions on breastfeeding answered

07/03/2012

Q: Many mothers have difficulties to breastfeed their babies in the first few days and are concerned that they can't produce enough milk. How can we help them?

A: A mother's very first milk - colostrum - is extremely beneficial for new-born babies. Early contact, early suckling and early initiation of the flow of breast-milk can be aided by the support of midwives and health staff. Infants should be put to the mother's breast shortly after birth to keep skin-to-skin contact when they have the strongest instinct to suckle the mother's nipples. Babies should not be forced to suckle if they are not willing to. Early introduction of a milk bottle or powered milk can ruin the child's natural sucking reflex, and is one of the main reasons that infants can fail to breast-feed properly.

People usually worry that the baby will be hungry or dehydrated before sufficient colostrum is produced by their mothers. In fact, new-born babies have stored up adequate body fluids that completely meet their limited needs at this very early stage of life. No water, juice or formula milk is needed. Therefore, anything other than colostrum – mother's first milk – can have a negative impact on the baby's health. Lack of colostrum may cause diarrhea in the baby and mother's lactation can be interrupted because the baby loses it's instinct to breast feed.   

Q: Will Caesarean-section affect breastfeeding?

A: Research shows that Caesarean-section is another factor that affects breastfeeding, early initiation in particular. C-sections make delivery and neonatal care processes far more complicated, but have no impact on lactation. According to WHO guidelines, antibiotics commonly used after this surgery, such as amoxicillin and cephalosporin V will not cause any problems with breastfeeding. After regaining consciousness, mother can start skin contact with the baby and initiate breastfeeding right away. However, mothers who experienced C-sections will need more care when holding the babies and breastfeeding them with each nipple alternatively. They will feel constant pain during the first several days so breastfeeding in a lying position will be more suitable for new mothers who have just gone through a Caesarean section delivery.

Q: If in the first six months of its life, a baby is exclusively fed with breast milk without any intake of water, will it feel hungry, thirsty or suffer from excessive internal heat?

A: 88% of breast milk is water, and this is totally sufficient for babies less than 6 months old. There is no need to feed the baby water or other fluid. 

On the contrary, water can be hazardous for baby less than 6 months old. Water fills up the baby's stomach and prevents it from taking-in breast milk. It is also difficult to guarantee the safety of drinking water and the hygienic condition of utensils.

Even in a hot, dry environment, the baby can acquire adequate water through frequent breastfeeding. You can tell if the baby is provided with sufficient water by observing their urine. If the baby is passing yellowish urine six times a day it means they have adequate water supply.

Q: Is it true that after six months, the breast milk will contain no nutrients just like water?

A: Breast milk is perfectly designed to nourish human babies, and almost all women are able to produce breast milk with the expected nutrient composition. The quality of breast milk is affected in under-nourished women with very low Body Mass Index – below 18.

The composition of breast milk can vary at different stages, from colostrum at birth, to mature milk later on. And composition also changes within a feed from light fore-milk at the beginning of a feed to quench the baby's thirst, to richer hind milk to satisfy energy and nutrient needs. This is one of the miraculous qualities of human milk. The body adjusts the composition of milk to suit the babies changing needs.

The composition in terms of energy, protein, and iron is quite similar before and after 6 months. The percentage contribution varies from nutrient to nutrient. Immunity factors in breast milk also vary from time to time depending on exposure of the mother to various antigens. But it is untrue that breast milk has no nutrients after 6 months.

The fact is that after 6 months the energy and nutrient needs of the baby can no longer be met by breast milk alone. This is why UNICEF and WHO recommend continued breast feedingwith complementary foods after 6 months.

Q: How can breastfeeding affect the development of preterm, low birth weight and twin babies?

A: The mother's body is able to adjust the formulation and amount of breast milk produced, according to the needs of the baby. Almost all preterm, low birth-weight and twin babies can be fed with breast milk. There is more protein in the breast milk of a mother who gave birth to a premature baby, and this helps produce faster growth. Nutritional supplements can be provided to lactating women when necessary to improve their nutritional conditions. 

It is extremely critical for the baby to suck the mother's nipples as early as possible. For babies who have problems in sucking nipples, breast milk can be pumped out and fed via stomach tubes, suction tubes or cups. Babies with more than 1,800g of body weight can learn to suckle for breast milk normally.

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