BREASTFEEDING; HOW? January 14 HELEN BORG, INFANT FEEDING MIDWIFE MATER DEI HOSPITAL

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1 BREASTFEEDING; HOW? January 14 HELEN BORG, INFANT FEEDING MIDWIFE MATER DEI HOSPITAL 1

2 THE IMMIGRANT MOTHER- BABY DYAD Challenges to Breastfeeding and Bonding Lack of Information How to enhance milk supply Hunger/Satiety cues Comforting skills CUTURAL PRESSURES Baby is too skinny Breastmilk is never enough Fat babies are healthy babies BREAST PROBLEMS Painful nipples engorgement FAMILY DEMANDS Protected time for breastfeeding Night feeds to quiet baby Siblings LIFE EXPERIENCE Refugee camps, Disease, malnutrition Bottlefed previous baby Lack of family support 2

3 STRONG CUTURAL AND RELIGIOUS SUPPORT FOR BREASTFEEDING BUT INSECURITY ABOUT BREASTMILK ADEQUACY Many mothers breastfeed for over one year Colostrum is inadequate as has been in breast over 3 months Early supplementation common in Somalia

4 OVERFEEDING Chubby children are viewed as healthy Tendency to fear insufficient milk supply Cannot visualise quantity of breastmilk LEADS TO Frequent formula supplementation Waking the baby to feed OVERFEEDING often results in OVERWEIGHT or FAILURE TO THRIVE 4

5 PRENATAL EDUCATION Teach how breastmilk is produced The concept of supply and demand Foods that encourage milk supply carbohydrates, and fluid intake Stress the importance of colostrum (1 st milk) If available provide written information in native language 5

6 MILK SUPPLY Prolactin responsible for breastmilk production Oxytocin responsible for breastmilk release Feedback Inhibitor of Lactation (FIL) small protein in milk to stimulate production Effective, frequent emptying of the breasts necessary for good production 6

7 ESTABLISHING BREASTFEEDING Newborns should be fed approx 8-12 times in 24 hours Normal patterns Feed continuously for several hours then sleep for long period, very short, frequent breastfeeds, demanding during evening then a longer sleep 7

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9 INFANT FEEDING CUES Rooting Sucking movements or sounds Hand to mouth Restlessness 9

10 PROVIDER ROLE IN ESTABLISHING BREASTFEEDING Discourage separation in early days Help with good positioning and attachment Encourage demand feeding Discourage supplements Provide follow-up weighing 10

11 SIGNS OF GOOD FEEDING Baby is content Audible swallowing during feeds Opens bowels at least 3 times daily and stools change appropriately Stops losing weight after 3 rd day Breasts feel less full after feeding 11

12 WASTE PRODUCTS Output is a good way of assessing input. Urine is a sign of good hydration. There should be 6-8 wet nappies in 24 hours. Disposable nappies detecting urine difficult in a newborn. The nappy should be checked from the outside for a jelly-like consistency or a tissue can be applied. Urates (Pink crystals) on day 2-4 can be considered as normal but may be a sign of dehydration is an older baby. 12

13 The first stools are a black/dark green and tar like, called meconium. 13

14 Around 3-4 days after birth stools change to a lighter green to brown, transitional stools. 14

15 Over the next day or so stools become more yellowish raging from mustard yellow to lime green, a breastmilk stool. The stool is very watery resembling diarrhea. The main difference is that the smell is not offensive. Stools may be very small or large in quantity. A young baby will pass stools very frequently, even 10 times a day. 15

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17 The older baby changes and may go anything up to a week with no bowel movements but produces a full nappy when he does eventually go. 17

18 WARNING SIGNS OF POOR FEEDING Baby seems to sleep most of the time. Baby is irritable most of the time. There are less than six wet nappies within 24 hours. Baby is passing small, dark stools five days after birth. 18

19 Baby s skin is very wrinkled especially on the arms and legs. Baby seems to look more yellow in co lour after the first weeks. Baby does not develop a round face by three weeks. 19

20 WEIGHT GAIN Normal to lose weight in the first 3 days Regain birth weight by days Weight gain approx grams per week for 1 st 3-4 months Until 6 months grams per week After 6 months grams per week Genes and metabolic rate are also relevant 20

21 PERCEIVED BREASTMILK INSUFFICIENCY Many women have this concern at times Common cause of weaning Approx 2% of women have insufficient glandular breast tissue 21

22 REASONS WHY MOTHER DOUBT MILK PRODUCTION Lack of knowledge of normal breastfeeding patterns and behaviour Soft breasts Growth spurts Vigorous sucking action on a bottle Inability to express breastmilk Fussy infant that is gaining weight well 22

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24 CALMING A CRYING BABY Crying does not necessarily indicate hunger Nappy change Cuddle Burp Overfeeding Reflux 24

25 CAUSES OF DECREASED MILK SUPPLY Separation of mother and baby Scheduled timing of feeds Stopping a breastfeed Poor latch Use of pacifiers Prematurity 25

26 MOST COMMON CAUSE INFANT FORMULA 26

27 INDICATORS OF POOR GROWTH More than 10% weight loss Failure to regain birth weight by 14 days Slow or lack of weight gain 27

28 POOR HYGIENE Oral thrush common due to lack of sterilisation of feeding equipment 28

29 UNSAFE BOTTLE FEEDING Over concentration of feeds Watering down of feeds Use of unboiled water 29

30 BABIES ARE BORN TO BREASTFEED 30