Growing great babies breastmilk–wise: ensuring a good milk supply

Dr Cheryl BennPresented at the Breastfeeding Hui, CBS, 26 October 2011

Breastfeeding is the biological norm

• Evidence of benefits for babies is conclusive – breastfeeding is crucial for child health and survival (World Nutrition, 2(9), Oct 2011)

• Must have top priority• Know benefits for mum and baby• Know risks of formula feedingEVEN IN A DEVELOPED COUNTRY!

Breastmilk is more than a food

• Colostrum is baby’s first immunization. • Important for neurodevelopment (Paediatrics,

2011)• Compare newborn calves with newborn babies.• Immune factors bind microbes and prevent them

entering baby’s delicate tissues• Breastmilk is vital for vulnerable babies (e.g.

preterms, babies with cardiac problems and with cystic fibrosis)

Babies and mothers are hardwired to breastfeed

• Inbuilt reflexes and instincts- stepping and rooting

• Knows mum’s voice, scent and face

• Displays hunger cues

• Responds at the breast

• PROVIDED ….

Breastfeeding is done the right- brained way

• Skin-to-skin: body close, light touch, head back, chin forward

• Calm, alert baby• Responsive mother, who follows

baby’s lead• Breast is in the comfort zone (junction

of hard and soft palate) that triggers active suckling

Skin-to skin

• The new-born's natural habitat (kangaroo mother care has saved many babies lives)

• Prevents protest-despair; cry up to 10 times less

• Promotes self-latching and breastfeeding• Stable body temperature and higher blood

sugar levels• Less reaction to painful procedures

The key is OXYTOCIN, THE CALMING AND CONNECTING

HORMONE

The milk supply equation (West &

Marasco, 2009)

• Sufficient glandular tissue

• + intact nerve pathways and ducts

• + adequate hormones and hormone receptors

• +adequately frequent, effective milk removal and stimulation

______________________________

= GOOD MILK PRODUCTION

NORMAL BABY BEHAVIOURS AFTER MILK COMES IN

• Breastfeeds 6-8 x/24 hours, approximately 2-3 hours apart or clustered at times

• Grows appropriately (25-30g/day on average)• Sleeps no more than 1 x 4-5 hour stretch/day• Quick suckles followed by long drawing suckles, pause,

swallow• Swallows heard in first 5-10 minutes, “kuh” sound• Active feeding for 15-40 minutes/feed or less if milk flows

fast• Drains breast before taking other side or not at all

Misinterpreted baby behaviours

• Frequent feeds,• Frequency days and growth spurts• Less frequent feeds• Short feedings• Cries and takes a bottle after feeding• Chokes, sputters and arches at the breast• Fussiness in late afternoon/early evening• Not sleeping through the night (normal to take 1-

2 feeds between 10pm and 4am)• Baby’s body language

Breast compression

Compress as baby sucks but does not drink

How do we know baby is getting enough breastmilk

• Stools• Wet nappies • Weight gain (test weighs)• Calm restful baby

• But what if all ok but baby unhappy, not calm and restful?

Kay Hoover’s 3 rules:

1. Feed the baby – a well fed baby feeds better at the breast

Christine Smillie’s maxum “Finish at the breast”

2. Protect the milk supply3. Find and fix the problem

Supplementation• What is best?

– Mother’s milk from breast– Mother’s expressed breastmilk– Pasteurised human donor milk– Formula

• How much is milk per day is needed?– Baby over 1 month 750mls/24 hours– Baby under 1 month: 75 mls per 450g (e.g. 3.8kg baby will need

3800/450 x 75mls = 633mls in 24 hours div by 6 or 8 depending on number of feeds/24hrs)

• Then how much supplement per feed in addition to breast (test weigh or multiply deficit from previous week x 2)

• Give the volume and note how much baby takes esp a seriously underfed baby.

Devices

Identify and fix the problem

• The 3 Bs• Breasts• Baby• Both

Take timeGet help – a second opinion if necessary

Breasts

• Growth

• Breast surgery• Receptor development – the more and earlier baby

feeds the more receptors develop, • Higher levels of prolactin and oxytocin• Antenatal colostrum expression helps

Assessment• Take a history or review the history

– of breastfeeding (feeds, nos., visitor syndrome, night time feeds and sleep; milk volume)

– of family breastfeeding; of health issues such as thyroid problems, PCOS, pituitary tumours, retained products, blood loss

– Drugs– Hormone changes (periods, pregnancy)

• Look at the breasts- – Fullness, oedema– Nipples:

Assessment

• Check baby for – tongue tie, suck-swallow-breathe issues,

clefts or palate dimples,– head and neck problems– Latch issues (Spend time and watch a feed)

Plan• Frequency of feeds• Night feeds: Address the issue of sleep (

http://www.naturalchild.org/james_mckenna/) and partner involvement

• Diet – use of galactogues (Fennel, Fenugreek, Domperidone)

• Get further help for – identified medical problems– Muscloskeletal problems, such as sore head/neck,

favouring one side

Build confidence and

MAKE IT WORK FOR THE FAMILY

Evaluate plan

• Plan visits not too far apart

• Be available but don’t promote dependence

• Think of other health professionals who might be able to help

• Read to find the answers; use reputable websites (Jack Newman; lowmilksupply.org; breastfeedingmadesimple.com)