Nourishing Bonds: Breastfeeding

Dr Neema Shrestha

Dr Neema Shrestha is currently working as a Consultant Pediatrician and Neonatologist at Grande International Hospital. She completed her MBBS from Kasturba Medical College, Diploma in Child Health from D.Y. Patil University and MD Pediatrics from Nepal Medical College. With a keen interest in Neonatology, she further pursued her Fellowship in Neonatology from Sir Ganga Ram Hospital (GRIPMER). She also previously served as a tutor for the Sydney Child Health Program (SCHP), helping medical graduates to become better child care advocates. Her field of passion is neonatology and immunization and she is dedicated to improving the well-being of premature neonates and working in tandem with the parents to give them the best possible care.

Pull Quotes:

World Breastfeeding Week is celebrated every year from 1^st to 7^th August. The theme for World Breastfeeding week 2024 is “Closing the gap, Breastfeeding support for all”.

“Breastfeeding is the best food for the child, providing total nutritional support and promoting emotional dependency.”

“Prolactin and oxytocin work together to ensure a steady milk supply and a happy, relaxed mother.”

“Breast milk contains all the nutrients needed for a baby’s optimal growth and development for the first six months of life.”

“Rooming in and skin-to-skin contact after birth are crucial for establishing breastfeeding and strengthening mother-baby bonds.”

Breastfeeding is the best food for the child. It is one of the most effective ways to ensure child health and survival. Breastfeeding alone provides total nutritional support for the baby and also helps to promote emotional dependency of the baby. Exclusive breastfeeding is recommended as the optimal and exclusive source of feeding for a baby from the newborn period up to six months of age. There are numerous myths in our society with regards to breastfeeding. Let us debunk those myths first.

Myths about breastfeeding in our society

1. Breastfeeding is easy: While some babies latch immediately after birth to start breastfeeding, some babies need help and support to get a good latch. This process may be delayed in mothers with inverted nipples, swollen breasts/mastitis, cracked nipples. Mothers need to be given practical support and emotional guidance to start their breastfeeding journey.
2. Sore breasts and nipples are normal while breastfeeding: There may be some discomfort during the early days of breastfeeding, however, if a mother continues to feel pain, she must be assessed for poor latching and attachment and given the proper guidance to continue breastfeeding.
3. Mother and baby should be separated to allow the rest: Mother and baby should be roomed-in after birth and skin – to – skin contact should be initiated as early as possible to help the mother- baby bond which in turn will make breastfeeding easier. This also helps in production of milk from the early days of newborn life.
4. Mother must restrict her food habits while breastfeeding: Babies are already exposed to the mothers’ food preferences from their time in the womb. A breastfeeding mother, in fact, requires a balanced diet and extra calories during her lactational period. If a mother perceives that her baby is reacting to certain food that she is consuming, she must visit a consultant.
5. Water must be supplemented to breastfeeding infants during summers: Breast milk is composed of 87% water. Even during the hottest summers, a breastfed baby need not be given water separately. The baby may themselves demand and increase the frequency of feeding during summers.
6. Breastfeeding mothers cannot take any medication: While most regular medications are safe during breastfeeding, it is always better to consult a specialist before taking any medication.
7. Babies need to be fed with infant formula for adequate weight gain: Mothers milk production is determined by how often the baby feeds, how well the baby latches and how efficiently the baby is able to empty the breast during feeds. While most mothers are able to produce adequate breast milk, proper guidance and adequate support goes a long way in ensuring that they continue to breastfeed for the recommended duration.

Breastfeeding Benefits

Now that we have debunked the myths, it is time to look into the importance of breastfeeding. When we think about the importance of breastfeeding, we think only in terms of infants, in that infant is the receiver here, but then it turns out that the mother also gets benefited by breastfeeding the infant. Let us look into the importance of breastfeeding both for the mother and infant.

Why is breastfeeding important for an infant?

Breastfeeding has been noted to confer short-term and long-term benefits to both the mother and the child.

The benefits of breastfeeding in the baby are:

1. Nutrition: Breast milk contains all the nutrients needed for a baby’s optimal growth and development for the first six months of life. The nutritive value of breast milk also varies depending on the gestation of the baby at birth. So, a mother who delivers prematurely will produce milk with higher calories, proteins and fats. In terms of infants too, the composition of breast milk changes according to the needs of the child. Iron present in breast milk is more easily bio-available and therefore better absorbed. Breast milk is also more easily digested.
2. Helps in brain development – presence of taurine and cysteine in breast milk are useful for brain development. Higher PUFA content also helps in retinal development.
3. Lowers the risk of infections such as otitis media, diarrhea, respiratory infections such as pneumonia, whooping cough due to the presence of anti-infective factors such as secretory IgA/IgM, live phagocytic macrophages and lymphoid cells. It also decreases incidence of necrotizing enterocolitis in preterm neonates
4. Protection against allergic diseases – asthma, eczema
5. Protection against chronic illnesses – hypertension, obesity, diabetes mellitus, inflammatory bowel diseases in later life
6. Reduces incidence of lymphomas
7. Decreased incidence of sudden infant death syndrome (SIDS)
8. Passive immunization from an adequately immunized mother

The benefits of breastfeeding to the mother are:

1. Emotional bonding: promotion of close physical and emotional bonding between the mother and the baby leads to improved parent-child adjustment and helps to prolong the duration of breastfeeding
2. Helps involution of the uterus following delivery and lowers the risk of post-partum hemorrhage
3. Lowers the risk of ovarian cancer and breast cancer
4. Helps to suppress ovulation and acts as a method of birth control

How can we assess if the baby is being properly breastfed?

The baby should be breastfed on demand i.e. feeding as and when the baby cries for a feed. They should not be made to follow a timely schedule. Feeding on one side of the breast should be continued until the milk flow stops spontaneously and the baby releases the nipple on their own. If the baby still demands milk, the next breast should be offered until the baby is satiated.

The baby should also be checked for proper positioning and proper attachment at the time of feeds.

The following should be assessed to ensure proper positioning:

1. The infants head, neck and body should be held in a straight line
2. The infant’s whole body should be supported
3. The face of the infant should be directly in front of the nipple
4. The infant’s body should be close to the mother’s body

The signs of good attachment are:

1. More of the areola should be visible above the infant’s top lip than below the lower lip
2. The mouth of the infant should be wide open
3. The lower lip is curled outwards
4. the chin of the infant is touching the breast

All four signs of attachment must be present to ensure that the baby is well attached at the breast for feeding.

When to start breastfeeding and how long to continue?

Breastfeeding should be started as soon as the baby is born. If a baby born via vaginal delivery, breast feeding should be started as early as half – hour after birth and in babies born via cesarean – section, within 2 hours of birth.

It is advised to continue breastfeeding exclusively (no water, cow milk/formula feeding, honey, etc.) until 6 months of age following which breastfeeding is continued in tandem with complementary feeding up to 2 years of age or beyond.

Physiology of breastfeeding

Milk production is dependent on two main hormones – prolactin and oxytocin. When a baby suckles at the breast, sensory impulses pass from the nipples to the brain regulating the release of these two hormones from the anterior and posterior lobe of the pituitary respectively.

Prolactin is necessary for the secretion of milk by the cells of the alveoli. Prolactin is produced since pregnancy but milk secretion does not start then due to the presence of progesterone and estrogen which blocks the secretion of milk. Following delivery, the levels of progesterone and oxytocin falls and since the action of prolactin is no longer suppressed, milk secretion ensues. Prolactin levels peak 30 minutes after feeding is initiated, therefore, the hormone is important to make the next feed. During the initial stages of breastfeeding, when lactation is being established, the effects of prolactin are dependent on the demand by the baby – so, more the baby sucks at the nipple, more the prolactin is produced and more will be the milk produced. Prolactin is also produced more during night time, therefore, in order to establish breastfeeding night- times feeds are essential to keep a steady milk supply. Prolactin also makes the mother feel relaxed and happy, helping the mother to be well rested.

Prolactin

Oxytocin

Oxytocin makes the myoepithelial cells around the alveoli contract, causing the milk to flow and fill the ducts. Oxytocin reflex is therefore also called as the “let-down reflex” or the “milk ejection reflex”. The reflex becomes conditioned to the mother’s feelings such as touching the baby, seeing or smelling the baby, hearing the baby cry, etc. If a mother is distressed or in pain, the oxytocin can be inhibited thereby hampering her milk flow. Oxytocin also helps the uterus contract following delivery and helps to reduce bleeding. Thus, rooming in of the baby and mother after delivery and allowing skin – to – skin contact following birth is essential to establish breastfeeding.

While we all know the benefits of breastfeeding to the mother-baby duo and its overall importance in the health of the baby and the mother, there are many factors that play a role in making breastfeeding a successful journey. Providing every mother support and encouragement from her family and friends, healthcare workers, communities, and the government will go a long way to ensure that she continues to breastfeed her child for longer and also help to mitigate problems she faces along her breastfeeding journey.