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The Nest the Lactation Clinic in Bangalore is just the right place to seek guidance and counseling for would-be mothers and new mothers on topics ranging from breastfeeding and related issues, to prolonged breastfeeding.
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1
a M o t h e r ’ s g u i d e t o b r e a s t f e e d i n g .
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Nature’s most valuable gift to a new-born child is its mother’s milk.
It is vastly superior to any other nutrients available to a baby.
With this book, our endeavour is to help expectant mothers prepare for
breastfeeding, and introduce them to the importance of initiating it within an hour.
One of the most important preventive strategies to reduce infant mortality rate,
exclusive breastfeeding for 6 months can protect the baby from infection. But it’s not
only the baby who benefits from it. Continuous breastfeeding for 2 years reduces
the risk of breast and uterus cancer in the mother as well.
Two decades ago WHO and UNICEF jointly launched two breastfeeding promotion
programs, WABA (World Alliance For Breast Feeding Action) and BPNI (Breast
Feeding Promotion Network Of India). The aim is to protect, promote and support
breastfeeding. At present, the global strategy is IYCF (Infant and Young Child
Feeding).
Fortis Hospital, B.G. Road, Lactation Clinic with the help of BPNI guidance / training
conducts antenatal education program for to-be- and new mothers. They are trained
and counselled during the antenatal period. Also, after the delivery, during their
hospitalisation and post discharge, they are counselled as required. The Obstetrics
and Paediatrician team, including Lactation Consultants, jointly work to protect,
promote and support breastfeeding.
Team Nest
(Fortis Bannerghatta)
The contents of the book have been contributed by Ms Joyce, with guidance from Dr. Prakash Vemgal, Consultant Neonatologist and Paediatrician, and Dr. Aruna Divakar, Consultant Paediatrician, Fortis Hospitals.
4 5
According to studies conducted by WHO and UNICEF,
mother’s milk is vastly superior to any other nutrition
for a baby. No wonder that they have come up with the
programmes - Baby Friendly Hospital Initiative (BFHI) and
Infant and Young child Feeding Program (IYCF) - which
emphasise on the need for exclusive breastfeeding
for 6 months, and up to 2 years, along with other
complementary food.
Mother’s milk enhances the child’s development,
and also protects it against respiratory and allergic
infections, and diarrhoea. At the same time, it
prevents breast, uterine, and ovarian cancer in the
mother, contributing to her general good health.
Leaving aside the scientific and nutritional aspects,
there is also another benefit of breastfeeding: it
contributes to the uniquely beautiful way in which
the mother and child bond with each other.
W h Ybre a s t f eedingis i M Porta n t
6 7
• Reduces post-delivery bleeding and anaemia
• Delays next pregnancy
• Protects against breast and ovarian cancer
• Prevents obesity and shapes the body
b r e a s t f e e d i n gh e l P s t h e M o t h e r t o o !
Q u a l i t i e s o f b r e a s tM i l k
• Contains perfect nutrients
• Easily digestible
• Ready-to-serve
• Protects against infection
• Helps in adequate growth and development
• Enhances brain and visual development
• Enhances intelligence quotient
• Protects against allergic illness
• Protects against adult onset diseases (diabetes, blood pressure)
8 9
• Contains the right amount of carbohydrates, fats and proteins needed for the baby’s growth
• The protein is just right for the baby and has specific amino acids that promote brain growth
• Higher sugar level promotes brain development
• Contains essential fatty acids - DHA - which also promotes brain growth
• Has just the required amount of vitamins, calcium, phosphorus and salt
• Though the iron content is less, it is well absorbed and therefore adequate
b r e a s t M i l k – t h e P e r f e c t n u t r i t i o n f o r Y o u r n e W b o r n b a b Y
Breast milk is ideal for preterm babies as it contains more proteins, minerals and anti-infective proper-
ties, that suit the babies’ needs.
10 11
The body of a mother-to-be prepares itself for
breastfeeding. It is during this time that the ducts present
in the mammary glands develop, thus attracting more
blood towards it. A mother-to-be might notice a marked
growth in the breast size at this point.
t h i n g s t o k noW b e f o r e d e l i V e rY
However, this has nothing to do with the ability to nurse
successfully. It is important, at this stage, to learn the
best position in which to breastfeed the baby. Mothers-
to-be can also get a few front open dresses to make
breastfeeding easier.
12 13
a f e W Q u i c k
fa c t s f o r M o t h e r s -
t o - b e a n d n e W
M o t h e r s
• Breast milk is the BEST
• Bottle and artificial feeding is dangerous
• Breastfeeding helps mothers lose weight after delivery
• Size and shape of the breasts do not matter: they produce perfect milk
in sufficient quantity
• Mother’s nutrition is very important: include green leafy vegetables,
seasonal fruits, and protein rich foods such as milk, pulses and beans in your diet
• Breastfeeding should start within ½ hour of delivery, skin-to-skin
• New mothers feel more emotional and sensitive - these feelings
are normal and will pass off with time
• Building the confidence of the mother and the whole family is vital
14 15
PRODUCTION OF BREAST MILkThe breast consists of glands supported by tissue and fat. These
glandular tissues (known as alveoli) are small sacs, made up of
millions of milk secreting cells which form small tubes that open
into the nipple. Before reaching the nipple, these tubes become
wider, and form lactiferous sinuses in which milk collects. The nipple
contains many sensory nerves making it highly sensitive. Around the
nipple there is a circle of dark skin called areola beneath
which the lactiferous sinuses are located. Thus, the areola must go
inside the baby’s mouth in order for the baby to draw milk.
h o W b r e a s t f e e d i n g W o r k s
MILk REACHING YOUR BABY Every time your baby suckles at the
breast, the nerves ending in the nipple
are stimulated. These nerves prompt the
brain to release a hormone called prolactin
which in turn goes into the blood and into
the breast, secreting milk. This entire series
of events from stimulation to secretion
is called the milk secretion response, or
prolactin reflex. It is very important to
understand the effect of suckling on milk
production. If your baby suckles more,
your breast will make more milk. If the
baby stops suckling or never starts, the
breast stops making milk. If you have
twins and they both suckle, then your
breasts will make extra milk for two babies.
This is called the law of demand and
supply. Feeding during night increases the
supply of milk as more prolactin is secreted
at night. Muscle cells
Oxytocin makes them contract{
{
{
Prolactin makes them secrete milkMilk secreting cells
Ducts
Milk collects here
Lactiferous sinuses
Nipple
Areola
Alveoli
Supporting tissue and fat
16 17
PROLACTIN REFLEx INCREASES MOTHER’S MILk SUPPLYEjection and flow of milk to your baby is due to production of another
hormone called oxytocin. Stimulation of sensory nerves in the nipple
by suckling also induces the production of oxytocin, which acts on the
muscle cells around the alveoli, causing the ejection and flow of breast
milk to your baby’s mouth. These events are known as the ‘milk flow
response’ or oxytocin reflex.
OxYTOCIN REFLEx WORkS BEFORE / DURING THE FEED TO MAkE MILk FLOW
Oxytocin is produced quickly with the start of the suckling
and is responsible for milk transfer from breast to the baby.
If oxytocin is not produced adequately, the baby may not get
enough milk. The oxytocin reflex may either be helped or
hindered by the mother’s thoughts, feelings and sensations.
Sensory impulses from nipple
More prolactin secreted at night
Suppresses ovulation
Prolactin in blood
Baby suckling
Thinks lovingly of babySound of babySight of babyCONFIDENCE
Worry StressPainDoubt
These help reflex These hinder reflex
18 19
Property Importance
Antibody rich Protects against infection and allergy
Many white cells Protects against infection
Laxative Clears meconium, helps prevent jaundice
Growth factors Helps intestine mature
Vitamin A rich Reduces severity of infection
COLOSTRUM
THIS IS IMPORTANT FOR SEVERAL REASONS:• Allbabiesaremostalertandactiveassoonastheyarebornand
this is the best time to feed them, as they will sleep off soon, tired by their long journey!
• Feedingthebabywillhelpmaintainnormalbloodsugarlevelsin
the baby and prevent low sugar levels which can have long-term problems.
• Thefirstmilkyouwillhaveisveryrichinaparticularsubstancecalled
immunoglobulins, which shields the baby from infections.
• Holdingthebaby,whilebreastfeeding,willalsokeepthebabyniceandcozy.
• Thebondbetweenyouandyourlittleonewillbeformedearlierandstronger!
Oxytocin (the hormone mentioned in the earlier chapter) helps in contracting your
uterus, which decreases bleeding after delivery and helps it return to its original size quicker.
e a r lY i n i t i at i o nIt is of utmost importance to initiate breastfeeding as early as possible after delivery.
In case of a normal delivery, the baby should be put to the breast within half an
hour and in case of a caesarean section, within up to four hours.
• Prolactin(mentionedintheearlierchapter)helpsreducepainpost-delivery.
Also, the earlier the production of milk starts, the better, as this will ensure that
you have more than adequate amounts of milk.
During the latter half of pregnancy and for the first few days after delivery, a
thick yellow viscous fluid is produced called colostrum. Although produced
in very small amounts, it is extremely rich in nutrition and anti-infective
substances which protects the baby against infections. Highly concentrated,
the baby requires only a little of it to be satisfied and full. After the first 3-5
days, ‘mature milk’ is produced in larger quantities.
20 21
STEPS TO REMEMBER:
POSITIONING AND ATTACHMENT
The position of the baby in relation to the mother is known as
positioning. Attachment is a term used to describe how the
baby has latched onto the breast.
As mentioned in the previous chapters, for the milk to be
expressed, the baby needs to suckle not just on the nipple,
but also on the areola, since the milk secreting alveoli are
located under the areola. If the baby sucks only on
the nipple it does not get enough milk and in the
process, hurts the mother as well. Hence positioning
and attaching the baby correctly will enable the baby to
suck on the entire areola and not only on the nipple -
resulting in good flow of milk and a satisfied baby and a
happy mother!
s k i n - t o - s k i n c a r e at b i rt hThe practice of keeping the baby on the mother’s abdomen
soon after birth is known as skin-to-skin care. If left
undisturbed long enough, the baby can actually move
towards the breast and start suckling. While helping
the mother and child bond, this also increases exclusive
breastfeeding rates and decreases pain in the mother.
This care can be continued in the postnatal ward,
particularly in low birth weight babies. In case this is
not practiced, then rooming in is highly recommended,
where the baby and mother are kept in the same
room, preferably on the same bed.
• Touchthebabyatregularintervalsandseeifthebaby
is warm enough.
• Wrapthebabyinseverallayersofcottonclothduring
cold and rainy weather.
• Practiceskin-to-skincareevenwhencarryingthebaby.
22 23
SIGNS OF GOOD POSITIONS:
• Paralleltothemother;baby’shead,neckandbodyareinastraightline
• Baby’stummyshouldtouchthemother’stummy
• Babyshouldbeturnedtowardsthemother,facingthebreast
• Bothmotherandbabyshouldbecomfortable
• Ifbabyisnewborn,mothershouldsupporthisbottomandnotjusthisheadandshoulder
SIGNS OF GOOD ATTACHMENT:
• Themouthiswideopen
• Lowerlipisturnedoutward
• Thebaby’schintouchingthebreast
• Partofupperareolavisible
• Baby’scheeksarefull
• Babyiscalmandrelaxed
• MotherdoesnotfeelpainProper breastfeeding position and latch-on
Hold your baby with itswhole body facing your body
Your baby should draw both your nipple and areola into her mouth
Hold your baby with its whole body facing your body
Support your baby’s head, neck and back
Milk duct
Areola
Nipple
MilkTongue
Rooting reflexWhen something touches lips, baby opens mouth and puts tongue down and forward
Sucking reflexWhen something touches palate, baby sucks
Swallowing reflex
Good attachment Good attachmentPoor attachment
When mouth fills withmilk, baby swallows
SkillMother learns toposition baby,baby learns to take breast
Poor attachment
24 25
c u e s f o r f e e d i n g Here are a few indicators
which will help the mother
understand when the baby
needs to be fed.
Early cues – “I’m hungry”
• Stirring
• Mouthopening
• Turninghead
• Seeking/rooting
Mid cues – “I’m really hungry”
• Stretching
• Increasingphysicalmovement
• Handtomouth
Late cues – “Calm me, then feed me”
• Crying
• Agitatedbodymovements
• Colourturningred
Time to calm crying baby
• Cuddling
• Skin-to-skinonchest
• Talking
• Stroking
Mother and child eXPerience in the first feW Weeks
Time Milk The Baby The Mother
Birth Colostrum (a rich, thick, yellowish milk) will be secreted in small amounts. It gives the baby a healthy dose of early protection against diseases.
Will probably be awake in the first hour after birth. This is a good time to breastfeed the baby.
Will be tired and excited.
First 12-24 hours
The baby will drink about 1 teaspoon of colostrum at each feeding.
It is normal for the baby to sleep heavily. As the baby wakes up, feed every 1-2 hours. Many babies like to eat or lick, pause, savour, doze, then eat again.
Will be tired and needs to rest.
Next 3-5 days White milk comes in. It is normal for it to have a yellow or golden tint first. If the milk is not in yet, it is best to talk to a doctor and lactation consultant.
Will feed a lot (this helps in making plenty of milk), at least 8-12 times or more in 24 hours. Very young breastfed babies don’t eat on a schedule. Because breast milk is more easily digested than formula, breastfed babies eat more often than formula-fed babies. It is okay if the baby eats every 2-3 hours for several hours, then sleeps for 3-4 hours. Feedings may take about 15-20 minutes on each side. The baby’s sucking rhythm will be slow and long. They may also gulp.
The breasts may feel full and leak. (Disposable or cloth pads can be used in the bra to help with leaking.)
The first 4-6 weeks
White breast milk continues. Will likely be better at breastfeeding and have a larger stomach to hold more milk. Feedings may take less time and will be farther apart.
Body gets used to breastfeeding. Breasts will be softer and the leaking may slow down.
26 27
P h Y s i o l o g Y
TYPES OF NIPPLE:
PROTRACTILE NIPPLES:
Nipples vary in shape and size. Here’s a list of the different types.
Flat nipples are common in mothers who are having their first baby. Most nipples despite being flat are PROTRACTILE i.e., on
pulling the nipple, it protrudes. Protractility is more important than the length of the nipple. Nipples will improve when the
baby starts to suckle.
For effective breastfeeding, it is important to be familiar with the physiology of the breast. Here are a few pointers
which will help you understand your body better and thus, also feed your baby more comfortably.
INVERTED OR RETRACTED NIPPLE:
Inverted nipples i.e., a nipple that goes deeper into the breast when the areola is squeezed,
needs more support and confidence for breastfeeding. Inverted nipples improve and the syringe
technique can be used for treating the inverted nipples after the birth of the baby.
Inverted Protracts poorly Protracts easily
28 29
i n h i b i t o r o f b r e a s t M i l k P r o d u c t i o nFor a breast to continue producing milk, the milk must be removed frequently, ensuring that the
breast is emptied. The following maybe a few reasons why production of milk may be inhibited:
• If a baby is suckling from one breast only, the other
breast stops producing milk.
• If a baby suckles more from one breast, that breast
makes more milk and becomes larger than the other.
• If a baby cannot suckle from one or both breasts or
mother is not able to breastfeed, the breast milk must
be removed by expression to enable milk production to
continue.
e X P r e s s i n g b r e a s t M i l k Various situations may arise which would require mothers to express milk.
• Feedingalowbirthweightorsickbaby
• Torelieveengorgement
• Keepupthemilksupplywhenmotherisill
• Relieveleakingbreasts
• Leavemilkforthebabywhenthemothergoesouttowork
HOW TO ExPRESS THE MILk• Washyourhandsthoroughly
• Sitorstandcomfortablyandholdthecupnearthebreast
• Putyourthumbontheareolaabovethenippleandyourfirstfingerontheareolabelowthenipple
(opposite to thumb)
• Pressbackwardstowardsthechestandthensqueezetheareolabetweenthefingerandthumb
• Thisprocesshastobedonetillmilkstopsflowingfromthatsegment
• Thisprocessshouldberepeatedinallsegments
If breast remains full of milk, secretion stops
Inhibitor
30 31
HOW TO PREPARE THE CONTAINER
• Chooseacup,glass,jugorjarwithawidemouthwithlid
• Washthecupwithsoapandwaterandleaveitinthesuntodryorboilthecupbeforeyouexpress
• Afterexpressing,keepthemilkinaclosedcontainer
Breast pump can be used if expression is needed for long period. However, correct cleaning and sterilising is required.
Place the finger and thumb on the areolaand press inwards towards to chest wall
Press from the sides to take milk from the other segments
Press the areola behind the nipple,between the finger and thumb
INCREASING SUPPLY
STORING OF ExPRESSED BREAST MILk
Signs that your baby is not getting adequate milk:
• Babywillsuckvigorouslyforafewminutesandthendropofftosleep.
• Onceputdown,itwillwakeupinaveryshorttimeandrepeatthewholecycle.
• Itwillhavefewerwetnappies.
• Urinewillbeconcentrated.
• Bowelactionswillbescant.
This situation can be improved by transferring the baby to alternate sides. Offering both breasts twice during any one feed
will ensure a better feed for the baby and more stimulation for the mother. This will not only keep the baby awake and
enthusiastic during the feed and ensure better sleep, but production of milk will also increase dramatically over the next 48
hours. If this doesn’t happen, please contact your lactation consultant.
• Ensurehandsarecleanandthatallcontainers
have been thoroughly cleaned and sterilised.
• Useplasticcontainersorpre-sterilisedplastic
storage bags. When your baby is small you may
wish to store your expressed breast milk in small
quantities to avoidwastage. If freezing, a plastic
sterilised ice cube tray is useful for this. Seal in
a freezer bag once the cubes are frozen.
• Labelwiththedateandtimeandrefrigerate
or freeze.
• Expressedbreastmilkcanbestoredinthe
refrigerator at the back or the coldest area
(not the door) for up to 5 days.
32 33
Giving complementary food too early or too late could lead
to malnutrition and other problems. If given too early, the
infant may not be ready to digest the food properly and it
may also reduce intake of breast milk, thereby, losing out
on appropriate energy intake for its growth. This would
eventually result in increased risk of illnesses in the baby, and
increase the mother’s risk of pregnancy.
i n t r o d u c i n g s o l i d f o o d t o t h e b a b Y
When your baby completes 6 months, it is the time to
gradually introduce solids to its diet apart from breast milk.
The 6-11 month period is an especially vulnerable time
because infants are just learning to eat and must be fed soft
food frequently and patiently. Care must be taken to ensure
that these foods complement rather than replace breast
milk as it continues to be an important source of energy,
protein, vitamin A and vitamin C. Breastfeeding should
ideally continue up to the age of 2 years with appropriate
complementary feeding after 6 months.
IDEAL TIME TO INTRODUCE SOLID / COMPLEMENTARY FOOD
Every baby must be exclusively breastfed for at least 6 months. This means
that any liquid - honey, glucose water, gripe water, juices, vitamins, animal
powdered milk - or even plain water, should not be given to babies. There is
adequate water in breast milk to keep the baby hydrated even in hot climate.
Moreover, the baby may also get infections from water.
Even pre-lacteal feeds are a no-no, since they too can cause infections, and
most importantly, they may prevent the baby from sucking at the breast.
Pacifiers can give a false sense of satisfaction to the baby who may therefore
not suck at the breast. They are also a source of infection.
e X c l u s i V e b r e a s t f e e d i n g
i s i M P o rta n t
34 35
Introduction of complementary foods too late, on the other hand, results in an inadequate intake of energy
and protein leading to poor growth, and stunting, as well as iron and other nutrient deficiencies. This
results in increased risk of ill health, deficiencies and malnutrition.
Taste, consistency, texture and types of complementary food are important in order to ensure that the child
accepts solid food. A child’s first food should be based on cereals like suji or fruits like banana, thicker than
breast milk, and should be bland in taste and mashed or strained to homogenise. Consistency of food
gradually needs to be changed from liquid to semisolid and then to solid with advancing age of the child.
Initially, a baby might spit out the food. That does not mean he does not like it.
THE CHARACTERISTICS OF A GOOD COMPLEMENTARY FOOD
• Shouldberichinenergyandadequateingoodqualityprotein,vitaminsandminerals
• Shouldhavesoftconsistencytoenablethechildtoswalloweasily
• Shouldhavelowdietarybulk
• Shouldneedminimalpreparationpriortofeedingandshouldbeeasilydigestedbythechild
• Shouldbefreefromanti-nutritionalfactorsandlowinindigestiblefibre
• Shouldbefreefromartificialcoloursandflavours
• Shouldbelocallyavailable
TIPS FOR SMOOTH INTRODUCTION OF SOLID FOODS
• Relaxwhilefeedingyourbaby.
• Introduceonlyonefoodatatime.
• Offerhomemade/local/familyfood.
• Avoidspicesandchillies.
• Servethefoodtoyourchildonaseparateplateorinabowl.Thiswillgiveyouafairlygoodideaofthe
quantity of food your child has eaten. It also encourages your child to learn to feed himself.
• Introducevarietytothediettomakeitmoreappealing.
• Neverforcefeedthechild.Ifthechilddislikesaparticularfood,re-introduceitatalaterstageormixitwith
another food that the baby likes. If the child shows a persistent dislike for that food, substitute it with
something else.
• Ifacertainfoodmakesyourbabysickorpale,itmaybeallergictoit.Stopitrightaway.
• Encouragethechildtoeat,bytalking,playing,payingattentionandshowinginterest,loveandaffection.
36 37
Cereals: Cereals like rice, wheat, jawar and millets
are an important source of energy, iron, protein and
also a certain amount of fat. A thick creamy porridge
made from cereals in water / milk / milk-water mixture
can be used to feed your child. The porridge should
be thick (too thick to be given through a bottle) and
concentrated but soft. Some oil or fat (or sugar) can
be added to help swallow and digest. Care should
be taken to ensure that the porridge is not watered
down or made unduly thin which will further reduce
the energy content.
Legumes: Lentils, bengal gram, red gram, horse
gram, moong dal, arhar rajma, lubia etc. are also a
good source of vitamins and minerals in addition to
proteins. When eaten with cereal staples, they are just
as nutritious as animal foods (meat, fish, milk) but are
much cheaper.
Non-veg food: Can be started after the baby is 8
months old (avoid egg white till 12 months). Eggs,
TYPES OF COMPLEMENTARY FOODS
meat, and fish are all nutritious and rich sources
of energy. They provide high quality protein,
vitamin B12 and iron and are easily digestible. Eggs
should be initiated in a half boiled or full boiled
and mashed form. Meat of all origins needs to be
properly cooked, chopped very finely, pounded or
mashed before it can be given to your child.
Milk and milk products: All types of milk provide
high quality protein. While it is a rich source of
vitamins and calcium, it is a poor source of iron.
However, if you have a family history of allergy and
asthma, it may be avoided in the first year of your
child’s life. Also, at this point, breast milk is enough
for the baby.
Oil or fat: This helps in increasing the energy
density of the food and helps in absorption and
metabolism of vitamin A. It can be used during
initial cooking of the food or after it is ready. It aids
easy swallowing and digestion.
Sugar or jaggery: This may be added to the infant’s food
to improve taste and to provide additional energy and
minerals.
Vegetables and fruits: Vegetables increase the vitamin
(especially A, B and C) and minerals (especially iron)
contents of complementary foods. Dark green or yellow
coloured vegetables are particularly good sources of vitamin
A. Tubers and starchy roots like potato, sweet potato and
colocasia (arbi) are rich in carbohydrates. These should be
well cooked and properly mashed and are best given along
with the cereals.
Fruits add to variety and taste. They can be given mashed
either alone or with cereals. Fruits like banana, mango,
papaya, pear, plum, peaches are good sources of vitamin
A and citrus fruits provide vitamin C besides minerals.
Because fruits contain no proteins, they are not a good
source of energy.
Just right Too thin
38 39
By 6 months an infant can voluntarily control suckling and swallowing.
Biting movements also begin at this time. The tendency to push solids
out of the mouth decreases. This indicates that the child can eat soft and
starchy foods such as cereals.
By the age of 9 months a child can use the lips to clear a spoon and use
the tongue to move food between the teeth. At this age solids can be
chewed. Thus, mashed and chopped foods can now be introduced.
h o W Y o u r b a b Y ’ s f e e d i n g a b i l i t i e s d e V e l o P Development Chart
Exclusive breast feeding for initial 6 months
Eggs Animal Protein
Dhal / Pulses
Vegetables / Fruit
Ragi / Rice / Wheat
- 8-9 Months
- 10-12 Months
- 7 Months
- 6 Months
f o o d d e V e l o P M e n t c h a rt f o r Y o u r b a b Y
40 41
f i V e k e Y s t o s a f e r f o o d • keep clean: Wash your hands before handling food and also during preparation, after going to the toilet,
changing the baby or touching animals. Wash and clean all surfaces and equipment used for food preparation
or serving. Protect kitchen areas and food from insects, pests and other animals.
• Separate raw and cooked foods: Separate raw meat, poultry and seafood from other foods by storing them in
covered containers. Using separate equipment and utensils is also advised.
• Cook thoroughly: Cook food thoroughly, especially meat, poultry, eggs and seafood. Soups and stews should
be boiled properly. For meat and poultry, make sure juices are not pink. Reheat cooked food thoroughly,
bringing it to the boil or until it is too hot to touch. Stir while re-heating.
• keep food at safe temperatures: Do not leave cooked food at room temperature for more than 2 hours. Do not
store food too long, even in a refrigerator. Do not thaw frozen food at room temperature. Food for infants and
young children should ideally be freshly prepared and not stored at all after cooking.
• Use safe water and raw materials: Use safe water or treat it to make it safe. Choose fresh foods. Use
pasteurised milk. Wash fruits and vegetables in safe water, especially if eaten raw. Do not use packed food
beyond its expiry date.
b r e a s t f e e d i n g i n s P e c i a l c a s e sTWINS OR MULTIPLESThe benefits of breast milk to mothers of multiples and their babies are the same as for all mothers and babies –
possibly greater, because many multiples are born early. Here’s how you can overcome challenges to successfully
breastfeed twins and more even after going back to work.
BEING PREPAREDIt will help to learn as much as you can about breastfeeding during your pregnancy. You can:
• Takebreastfeedingclasses.
• FindInternetandprintresourceforparentsofmultiples.
• Joinasupportgroupforparentsofmultiplesthroughyourhealthcareprovider,hospitalorlocal
breastfeeding center.
• Letyourhealthcareproviderandfamilymembersknowthatyouplantobreastfeed.
• Findalactationconsultantwithmultiplesexperiencebeforethebabiesarebornsothatyouknowwhereto
turn for help. Ask her where you can rent a breast pump if the babies are born early.
42 43
Breastfeeding twins and more may take practice. keep trying different positions until you find ones that
work for you. For some mothers and babies, breastfeeding twins at the same time works well. Others find
individual feedings to work better. Still others find that it depends on the time - you may feed one baby at
a time at night and feed two babies at the same time during the day. Finally, as your babies grow, you may
find that you need to change your feeding routine.
Below are some positions that may work for you:
• Double clutch (“football”) – Place both babies in the clutch hold. You will need pillows
at your side (and maybe one on your lap) and you will place the babies on the pillows
with their legs going toward the back of the chair or couch. If you are placing the
babies in front of you, try to keep their whole bodies turned toward you, their chests
against your chest. Their bodies must not be facing up. This is very important to help
prevent nipple pain and to make sure that the babies are getting enough milk.
• Cradle-clutch combination – Place one baby (usually the easiest to latch or stay latched)
in the cradle position and then position the second baby in the clutch position.
• Double cradle – Place the babies in front of you with their legs overlapping, making an
x across your lap.
BREASTFEEDING POSITIONS
MAkING ENOUGH MILk
keep these tips in mind:
• Breastfeedingsoonafterbirth,andoften,ishelpfulformultiplesthesamewayitisforonebaby.Themoremilk
that is effectively removed, the more milk a mother’s body will make.
• Ifthebabiesarebornearly,doublepumpingoftenwillhelpthemothermakemoremilk.
• Thedoctor’sweightcheckscantellyouifyourbabiesaregettingenoughbreastmilk.Youcanalsotrackwet
diapers and bowel movements to tell if your babies are getting enough as mentioned in the previous chapters.
• Ithelpstohaveeachbabyfeedfrombothbreasts.Youcan“assign”abreasttoeachbabyforafeedingand
switch at the next feeding. Or, you can assign a breast to each baby for a day and switch the next day. Switching
breasts helps keep milk production up if one baby isn’t eating as well for a bit. It also gives babies a different view
to stimulate their eyes
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Jaundice
Jaundice is caused by an excess of bilirubin, a substance that should be present in blood in very small amounts. In
newborns, the bilirubin build up is sometimes faster than natural. This causes yellowing of the skin and eyes. It affects most
newborns to some degree, appearing between the second and third day of life and usually clears up by two weeks of age.
It is not harmful.
Two types of jaundice can affect breastfed infants:
• Breastfeedingjaundice–Thiscanoccurwhenabreastfeedingbabyisnotgettingenoughbreastmilk.Thiscan
happen either because of breastfeeding challenges or because the mother’s milk hasn’t yet come in. This is not
caused by a problem with the breast milk itself.
• Breastmilkjaundice–Thismaybecausedbysubstancesinthemother’smilkthatpreventsbilirubinfrombeing
excreted from the body. Such jaundice appears in some healthy, breastfed babies after about one week of age. It
may last for a month or more and it is usually not harmful.
Jaundice is best treated by breastfeeding more frequently or for longer periods of time. It is crucial to ensure that the baby is
latching on and removing milk well. This is usually all that is needed for the infant’s body to rid itself of excess bilirubin.
Some babies will also need phototherapy treatment with a special light. This light helps break down bilirubin into a form
that can be removed from the body easily. If you are having trouble latching your baby to the breast, it is important to
pump or hand express to ensure a good milk supply. The same is true if the baby needs formula for a short time. It will
ensure that the baby has enough milk when you return to breastfeeding.
It is important to keep in mind that breastfeeding is best for your baby.
Reflux disease
Gastroesophageal reflux disease (GERD) occurs when the muscle at the opening of the stomach opens at the wrong times.
This allows milk and food to come back up into the esophagus. Some symptoms of GERD can include:
• Severespittingup,orspittingupaftereveryfeedingorhoursaftereating
• Projectilevomiting,wherethemilkshootsoutofthemouth
• Inconsolablecryingasifindiscomfort
• Archingofthebackasifinseverepain
• Refusaltoeatorpullingawayfromthebreastduringfeeding
• Wakingupoftenatnight
• Slowweightgain
• Gaggingorchoking,orproblemsswallowing
BABIES WITH HEALTH PROBLEMSListed below are some common health problems in babies, along with tips on how to they can be
breastfed.
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Premature and / or low birth weight
When a baby is born before 37 weeks’ gestation, it is said to be premature. This means that that the baby is born at a
low birth weight of less than 5½ pounds. Many babies born prematurely are often not able to breastfeed at first, but like
all newborns, they benefit from breast milk. Thus, they can be given expressed milk as often as they need to be breastfed
- about 8 times in 24 hours. Once the baby is ready to breastfeed directly, skin-to-skin contact is advisable. Many mothers
of premature babies find the cross cradle hold helpful. It may take some time for the mother and the baby to get into a
good routine.
Please keep in mind that many healthy babies might have some of these symptoms and not have GERD. But there are
babies who might only have a few of these symptoms and have a severe case of GERD. Consult your doctor if your baby
spits up after every feeding and has any of the other symptoms mentioned here. If your baby has GERD, it is important to
continue breastfeeding. Breast milk is more easily digested than infant formula.
Most babies with low birth weight, but born after 37 weeks (full term) can begin breastfeeding right away. They will need
more skin-to-skin contact with mom and dad to help keep them warm. These smaller babies may also need more frequent
feedings, and they may get sleepier during these feedings.
To ensure that the baby is well nourished, it is important for the mother to drink adequate amount of fluids and eat a
balanced normal diet. Most mothers feel thirsty when they are feeding and should be encouraged to take enough water.
There should be absolutely no restrictions in the mother’s diet.
Nutritional plan
An energy intake of approximately 1,800 kcal/day usually meets the nutritional requirements for lactation. At least 3 litres
of water per day should be taken, as low consumption of water can lead to lowered milk production.
M o t h e r s n u t r i t i o n
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Types of food recommended for lactating mothers:
• Lactogenic foods (help in the secretion of milk): Barley, dark leafy
vegetables, carrot, beetroot, yam, turmeric, nuts, green papaya, ginger
and garlic, sesame seeds, and garden cress seeds.
• Iron rich foods: Greens, ragi, jowar, watermelon, papaya, dry fruits,
rice flakes and cauliflower.
• Vitamin C rich foods: Citrus fruits, amla, guava and sprouts.
• Calcium rich foods: Milk and milk products, greens, sesame seeds,
curry leaves, ragi and jowar.
b r e a s t f e e d i n g i n P u b l i cMany women feel uncomfortable breastfeeding in public. But it is important to remember that feeding your baby is nothing
inappropriate. And even though it may seem taboo in some places, awareness of the need to support new breastfeeding
mothers is building.
Tips to make breastfeeding in public easier:
• Wearclothesthatalloweasyaccesstoyourbreasts,suchastopsthatpullupfromthewaistorbuttondown.
• Useaspecialbreastfeedingblanketaroundyourshoulders.Somebabiesdonotlikethis,though,soyou’llhaveto
see what works for your baby.
• Breastfeedyourbabyinasling.Slingsorothersoftinfantcarriersareespeciallyhelpfulfortravelling-itmakesit
easier to keep your baby comforted and close to you.
• Slipintoawomen’sloungeordressingroomtobreastfeed.
• Ifyouareworriedaboutbeingtoorevealinginpublic,practiceathomeuntilyouarecomfortable.
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g o i n g b a c k t o W o r kPlanning ahead is the key to ensure that everything goes smoothly after you return from your maternity leave. Talk with
your employer beforehand, to ensure that you continue to enjoy breastfeeding your baby, long after your maternity
leave is over.
During pregnancy
• Talkwithothermothersaboutbreastfeedingwhileworking.
• Talkwithyoursupervisoraboutyourplanstobreastfeed.Discussdifferenttypesofschedules,suchas,starting
part time at first or taking split shifts.
• Findoutifyourcompanyprovidesalactationsupportprogrammeforemployees.Ifnot,askaboutprivate
areas where you can comfortably and safely express milk.
• Askyoursupervisororothercoworkers,iftheyknowofotherwomenatyourcompanywhohavebreastfed
after returning to work.
It helps to breastfeed your baby before he or she becomes fussy, so
that you have the time to get into a comfortable place or position to
feed. It is important to remember that you are meeting your baby’s
needs. So feel free and be proud of your commitment!
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During your maternity leave
• Takeatleast6weeksto12weeksofleave,asitwillhelpyourecoverfromchildbirthandsettleintoagood
breastfeeding routine.
• Practiceexpressingyourmilkbyhandorwithaqualitybreastpump.Freeze60to120mlatatimetosavefor
your baby after you return to work.
• Helpyourbabyadjusttotakingbreastmilkfromabottle(orcupforinfants3to4monthsold)beforeyoureturn
to work.
• Seeifthereisachildcareoptionclosetowork.Askifthefacilitywilluseyourpumpedbreastmilk.
• Talkwithyourfamilyandyourchildcareprovideraboutyourdesiretobreastfeed.Letthemknowthatyouwill
need their support.
Back at work
• Keeptalkingwithyoursupervisoraboutwhatisorisn’tworkingforyou.Returningtoworkgraduallygivesyou
more time to adjust.
• Ifyourchildcareiscloseby,findoutifyoucanvisittobreastfeedoverlunch.
• Whenyouarrivetopickupyourbabyfromchildcare,taketimetobreastfeedfirst.Thiswillgiveyoubothtimeto
reconnect before travelling home and returning to other family responsibilities.
• Ifyouarehavingahardtimegettingsupport,talktoyourhumanresourcesdepartment.Youcanalsoaska
lactation consultant for tips.
Get a quality breast pump
A good quality electric breast pump can help you to remove milk during the workday. Contact a lactation consultant or your
local hospital to learn where to buy or rent a good pump.
Find a private place to express milk
If your company does not provide a private lactation room, find another private area you can use. The room should be
private and secure from intruders when in use. Explain to your supervisor that it is best not to express milk in a restroom.
Restrooms are unsanitary. It can also be difficult to manage a pump in a toilet stall.
Pumping tips
It may take time to adjust to pumping breast milk in a work environment. For easier pumping, try these tips for getting your
milk to let-down from the milk ducts:
• Relaxasmuchasyoucan
• Massageyourbreasts
• Gentlyrubyournipples
• Visualisethemilkflowingdown
• Thinkaboutyourbaby–bringaphotoofyourbaby,orablanketoritemofclothingthatsmellslikeyourbaby
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When to express milk
At work, you will need to express and store milk during the times you
would normally feed your baby. This will be about 2 to 3 times during a
typical 8-hour work period.
Expressing milk can take about 10 to 15 minutes or longer. The number
of times you need to express milk at work should be equal to the
number of feedings your baby will need while you are away. As the baby
gets older, the number of feeding times may go down.
Storing your milk
Breast milk is food, so it is safe to keep it in an employee refrigerator or
a cooler with ice packs. Talk to your supervisor about the best place to
store your milk. If you work in a medical department, do not store milk
in the same refrigerators where medical specimens are kept. Be sure
to label the milk container with your name and the date on which you
expressed the milk.
h a n d l i n g s t r e s sStress not just makes you fall sick, but it can also make problems you already have worse. It can induce trouble in sleeping,
stomach problems, headaches, and mental health conditions.
While having a new baby, learning how to breastfeed can be very stressful. With a little care and support, everything can
be managed. It is important for mothers to take care of themselves. Here are a few steps that can be taken to make new
mothers feel better.
• Gethelpfromaprofessional,ifyouneedit.
• Relax.Tryabubblebath,deepbreathing,yoga,meditation,andmassagetherapyorjusttakeafewminutestosit,
listen to soothing music, or read a book.
• Trytogetseventoninehoursofsleepeverynight.Ifyoucan’t,trytosleepwhenthebabysleeps.
• Eatrightandfuelupwithfruits,vegetables,proteins,andwholegrains.
• Physicalactivitynotonlyhelpsrelieveyourtensemusclesbuthelpsyourmoodtoo!Ifyouareanewmother,ask
your doctor when it is okay to start exercising.
• Talktofriends.Theywillremindyouthatyou’renotalone.
• Sometimes,it’snotalwaysworththestresstoargue.Giveinonceinawhile.
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• Keepajournal.Itcanbeagreatwaytogetthingsoffyourchestand
work through issues.
• Helpingsomeoneelsecanhelpyou.Helpyourneighbor,orvolunteerin
your community.
• Findsomethingyouenjoy.Makesuretogiveyourselftimetoexplore
your interests.
• Setlimits.Figureoutwhatyoucanreallydo.Don’tbeafraidtosayno
to requests for your time and energy.
• Planyourtime.Writeato-dolistandfigureoutwhichtasksarethe
most important to do.
• Don’tdealwithstressinunhealthyways.Thisincludesdrinkingtoo
much alcohol, using drugs, or smoking, all of which can harm the baby.
It is also unhealthy to over-eat in response to stress.
fa Q s1. When should I start breastfeeding?
Breastfeeding should be started immediately after the baby is born. The naked baby (after baby is mopped gently and
made dry) should be held by the mother, close to her breast with skin-to-skin contact. It stimulates smooth flow of milk
and keeps the baby warm, and helps emotional bonding between mother and baby.
2. How do I know my baby is getting enough milk?
A baby who is sucking well, passing urine at least 6 times in 24 hours and not losing too much weight is getting
adequate milk.
3. When I try to express milk, there is no milk. What should I do?
When a baby sucks, the milk is drawn out in a different way than expressing with the hands. Moreover, the baby sucking
at the breast itself will make you produce more milk. In case there is less production of milk, please get in touch with
your doctor or lactation consultant.
4. My baby is always crying. I think he is too hungry. What should I do?
Babies may cry for a variety of reasons: they are wet and need to be changed, they are cold or hot, want to be carried.
Hunger is just one of the reasons – so just because a baby is crying doesn’t mean that the baby is hungry.
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5. Will the baby suffocate if the nose gets pressed while feeding?
The nose has a cartilage and a bone which do not allow it to get so compressed as to obscure breathing. Most mothers
are scared of this but normal babies will not get suffocated. If you are still apprehensive about it, then keep one finger
near your baby’s nose to ensure it stays open – take care not to pull the areola out in the process.
6. Why should I only breastfeed?
It is the ONLY food your baby needs till 6 months of age. It is a COMPLETE food. Addition of any other milk or food in the
first 6 months is not only NOT required but may be harmful. After 6 months, your baby needs other food too in addition
to your breast milk. Breast milk should be continued along with other food till at least 2 years of age.
• Moreoveritisabsolutelysafe,andhygienic,protectsthebabyfromvariousinfections.
• Itiseasilydigestibleandwellabsorbed.
• Itnotonlyprovidesthenecessarynutrients,butalsohasvariousenzymestohelpdigestthenutrients.
7. How does my milk protect my baby from infections?
Breast milk is totally free from bacterial contamination. Formula or cow’s milk always has the danger of being
contaminated by bacteria which could be very harmful to the baby. This danger is present even if you take utmost care
while preparing the feed.
An exclusively breastfed baby is 14 times less likely to die from diarrhea, 4 times less likely to die from respiratory diseases
and 3 times less likely to die from other infections as compared to a bottle-fed baby.
In addition, it is enriched with many anti-infective substances such as:
• Antibodies(immunoglobulins).Yourbabyisprotectedfromcommoninfectionstillyourbabycanproducehis/her
own antibodies.
• Leukocytes–livingprotectivecells
• Lysozyme–activelykillsbacteria
• Lactoferrin–bindsironandmakesitunavailableforbacteriathatneediron.
8. When it is very hot, doesn’t my baby need water?
Breast milk has 88% water. This will satisfy the baby’s needs even in the hottest summer. Water supplementation can lead to
increased risk of diarrhea and also may reduce the intake of mother’s milk, leading to early stoppage of breastfeeding.
9. How does breastfeeding make my baby more intelligent?
Breast milk has numerous substances like lactose, DHA, various specific amnio acids that specifically promote brain growth in
the infant. These are not found in any other milk. In addition, breastfeeding creates a close bond between the mother and
the baby and helps in the social and emotional development of the baby.
10. Does breastfeeding have any long term benefit?
The benefits of breast milk extend far beyond the two years of breastfeeding. As compared to formula / cow’s milk-fed
babies, breast-fed babies have lower risk of diabetes, heart attack (cardiovascular problems), obesity, cancer, tooth decay, ear
infection, allergy and asthma
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11. How does breastfeeding protect from obesity?
Cow’s milk is designed to meet the demands of the calf that is growing much more rapidly than the human baby. Moreover many babies continue to suckle for comfort. With breastfeeding, prolonged suckling provides only a small amount of milk, whereas bottle feeding babies drink much more milk than required.
12. Is it true that babies who are only on mother’s milk cling only to their mothers? Will my baby be extremely dependent on
me when I feed only my milk?
No. Your baby and you will develop a close loving bond and will become very attached to each other. However, your baby will not be dependent on you. Breasts fed babies become more emotionally secure and develop good relationships with other people.
13. Will the mother become “weak” by breastfeeding?
Not at all. In fact, breastfeeding has many benefits for the mother’s health.
• Ithelpstostopbleedingafterdeliveryasthehormone“oxytocin”producedbythebabysucking,isthesamehormone that helps the uterus to contract.
• Itdelaysmenstruationandreducestheriskofanemia.
• Itdecreasestheriskofbreastandovariancancer
• Ithelpsthemotherloseweight.
• Itprotectsagainstanotherpregnancytoosoon
14. Does it mean that a mother who is breastfeeding does not need to practice family planning measures?
Breastfeeding provides 98% protection against another pregnancy, provided all the following three conditions are met:
• Themotherisexclusivelybreastfeeding
• Thebabyisunder6monthsold
• Menstrualperiodshavenotreturned
15. How can a mother who herself is undernourished feed her baby?
Even an undernourished mother can successfully feed her baby. Undernourished mothers may have less fat in their milk, but the total volume of the milk will be higher and the baby gets the required amount of nutrients.
16. How does breastfeeding save money?
In addition to direct saving of money spent on other milk and formula, breastfeeding also does not need water, fuel, and sterilization of utensils. Moreover, the breastfed baby has fewer infections and less expenditure on health care.
17. What are the dangers of artificial feeding?
Artificial feeding is inferior to breast milk in all respects:
• Hasinappropriateamountsofproteins,fats,vitaminsandmineralsneededforthebaby.
• Causesmorediarrhoeaandrespiratoryinfections.
• Itcausesmalnutritionandbabiesonartificialfeedshavehigherriskofdeath.
• Hashighersaltandcalciumandthismayleadtoseizures.
• Hasnoanti-infectiveproperties.
• Artificiallyfedbabieshavemoreriskofallergy,milkintolerance,chronicdiseases,obesity,andhavelower IQ scores.
• Causesnippleconfusionandleadstofailureofbreastfeeding.
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18. I have not breastfed my previous baby. My mother and sisters also had less milk. I feel that this time too, I will have less
milk. What can I do?
Every mother will be able to successfully breastfeed her baby with a little support from health personnel and family. Even
if the mother had poor lactation earlier, she will produce more than enough milk this time for her baby. Continuing to
breastfeed frequently, on demand and NOT introducing any other milk, baby suckling is enough to maintain the production
of milk.
Lack of milk is definitely not “genetic”. If the grandmother and sisters also had less milk, it implies that the entire family
needs information and counseling about breastfeeding. A new mother always looks to experienced and close female
relatives for support. They may give her wrong advice or encourage her to give artificial feeds, especially if they themselves
bottle fed their babies. Even a single suggestion to the mother that “she may have less milk” may make her stop
breastfeeding altogether.
It is therefore very important to counsel the family so that they can be supportive and encourage the mother on her ability
to successfully breastfeed.
19. My baby is low birth weight and preterm. Is my milk enough for him?
Yes! Mother’s milk is enough even for the smallest baby. When a baby is born with low birth weight, or preterm, he needs
extra protein and nutrients. He is also at greater risk of getting infections. Preterm milk is richer in protein, Vitamin A,
minerals and iron, and is adequate for the baby provided the baby also receives multivitamin, calcium and phosphorus
and iron. This is known as fortification of milk. Moreover, the anti-infective property of breast milk is often life-saving. In
addition, the baby should be kept warm by kangaroo care (skin-to-skin contact) and should have regular health check-ups
to ensure normal weight gain.
20. He does not suck well. How do I feed him?
If your baby does not suck well, you could feed him expressed breast milk either with a spoon or a small bowl. Do not use a
bottle as they are harder to clean and more prone to infections.
21. Is breast milk safe to give to a baby who has early jaundice?
Many newborns have jaundice after birth for a few days. This is due to slight immaturity of the liver. This usually disappears
on its own or with treatment using phototherapy. Jaundice is NOT a reason to stop breastfeeding. In fact, jaundice is partly
caused by the baby not getting enough breast milk. So babies with jaundice need more frequent feeds. Colostrum helps
clear the meconium and helps prevent jaundice.
22. Do I have to feed twins separately?
Twins can and should be fed at the same time. The position may be modified slightly to form the football position.
23. I have twin babies. I feel my milk will not be enough for both of them.
Breast milk production follows the rule of “DEMAND and SUPPLY” i.e. the more the requirement, greater is the production.
A mother with twins or triplets can produce up to even 2 litres of milk per day! In fact, both the twins can be fed together.
Feeding the twins together has the following benefits:
• Whenboththebabiessuckwellthestimulustoproducethemilkproducinghormone“prolactin”isdouble.This
ensures adequate milk production!
• Ifonebabyissuckingwellandtheotherisweak,thenbecauseofthestrongertwin,milkisproducedwelland
flows out of both breasts. This helps the weaker twin also to get enough milk without much effort.
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• Feedingboththetwinstogetherpromotesbondingbetweenthetwinsandthemother.
• Ofcourse,feedingtogethersavestimeforthemother.
• Familysupportisextremelyimportantforthemother.
24. My baby is not well. Do I need to give something else to the baby?
Some mothers stop breastfeeding when the baby is ill. On the contrary, illness is the time that the baby needs breast milk the most.
• Breastmilkisthemostnutritious,easilydigestiblefoodespeciallyforthesickbaby.
• Whenthebabyissick,hemaynotwanttofeedanythingelse,buthewillstillhaveanappetiteforbreastmilk.
• Breastmilkhelpsthebabytorecoverquickly.
• Duringillness,breastfeedingwillbeasourceofcomforttothebaby.
25. My nipples are flat. How do I feed my baby?
Whether the nipples are flat, small or big, baby suckles the breast (areola) and not the nipples. The areola and breast tissue are pulled out or protracted to form the “teat”. When the baby suckles, it stretches. Therefore, the size of the nipples is not a problem.
26. My nipples are cracked and painful. How do I feed my baby?
Usually the cause for sore or cracked nipples is poor position and incorrect attachment. Holding the baby in the correct position and ensuring proper attachment will prevent cracked nipples and will reduce pain while feeding. For correct positioning and attachment, refer to chapter 7.
27. My breasts are too full and hurt me. What should I do?
Feeding the baby more frequently or removing the milk by hand expressing can prevent breast engorgement. If it is
engorgement, the areola will be tight. Express the breast milk and then allow the baby to suckle, sometime you may get
“milk fever” for 24 hours. If the fever doesn’t come down in 48 hours, it’s best to meet a doctor.
28. I have painful swelling on one side of the breast. What should I do?
The ducts may be blocked due to lack of milk flow. It could also be because of holding the breast too tightly, tight clothes,
or improper suckling. The best way to relieve the pain and swelling is to gently massage the lumps towards the nipple and
empty the swollen part of the breast. It is best to wear loose clothes and change the baby’s position.
29. I have painful swelling in my breast. My doctor said it is an abscess and drained the pus. Can I feed my baby? And is it
normal to feel tired at this time?
• Itisbesttorestforafewdaysandtakeofffromwork
• Youcanfeedthebabyfromtheotherbreast
• Keepexpressingmilkfromtheinfectedbreast
• Continueantibioticsasadvisedbyyourdoctor
• Whenpusisdrainedandwoundishealed,restartfeedingfromthatbreast
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30. How frequently should I breastfeed the baby?
A healthy newborn baby can be breastfeed ON DEMAND i.e. whenever the baby cries.
31. What should be the time interval for feeding the baby?
Usual time interval between each feed is about 2 to 3 hours. But do not feed by the clock. Feed on demand. Make sure you
feed your baby at least 8-10 times in 24 hours and do not skip night feeds.
32. How do I find out if the baby is getting enough breast milk?
• Thebabypassesurine6-8timesin24hours
• Thebabysleepsfor2-3hoursafterthefeeds
• Thebabygainsweight10-15gmsperday
• Crossesbirthweightby2weeks
33. Do small breasts produce the required amount of milk for the baby?
Size does not matter. Milk production is dependent on how frequently the feeds happen.
34. My baby refuses to breastfeed. What should I do?
• Mostofthetimebabiesmovetheirheadfromsidetosidewhentheyarerootingforthenipple.Thisisknownas
‘homing’ behavior. This does not mean that the baby does not want to feed.
• Checkifthebaby’snoseisblockedasthismightcauseinconveniencetothebaby,leadingittorefusetofeed.
• Ifbabyhasfeverorissick,consultthedoctor.
• Thebabymayalsorefusetofeedifithearssomenoiseorhearsthemothertalkingtosomeone.Lookforaquiet,
private place to feed and ensure that there are no interruptions while feeding the baby.
35. My breast milk leaks, is it normal?
Yes! It means you have good milk production, and that your ejection reflex is active. Use breast pads to avoid staining on
clothes. You could also express some milk and keep it for your baby.
36. I do not have enough milk what can I do?
As the baby suckles the breast, more milk is produced. If your baby urinates 6 times in 24 hours, it means that your baby
has taken enough milk. Adequate weight gain also means that the baby is getting enough milk.
37. I have to go back to work. What can I do?
Refer to section “Going back to work”.
38. There is blood in my milk, what to do?
Please consult your doctor.
39. Sometimes my baby cries more than usual. Why?
The most common reason why babies cry is due to abdominal pain caused by swallowing air while feeding. This is known
as colic. In case of colic, the baby will pull up its knees while crying. If this happens, do not panic. Put the baby more often
to the breast. It may help to carry the baby face down over your arm, with a slight rhythmic movement, so that there is
pressure on the stomach. If the baby is ill, the crying pattern will change. In such cases, please consult a doctor.
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40. I am taking medicine. Can I continue breastfeeding my baby?
Yes. Most commonly used drugs do not cause any harm to babies. For further advise, please consult your doctor.
41. How should I massage my baby?
A baby’s message should always be a gentle touch of the hands. Safe massage techniques create a loving environment for
the baby, helping to gently smooth out their movements. It also increases the bond between the mother and the child.
How to prepare for the massage
• Chooseatimewhenbothyouandyourbabyarerelaxed,preferablyduringfeedingwhenthebabyisnottoo
hungry or full.
• Maintainawarmroomtemperature.
• Itisbesttomassageanewbornbabybyholdingitinyourarmsandlapforthewarmthandcloseness.
• Avoidalldistractions.
• Makesureyouareinacomfortablepositionwhilemassaging.
• Havethemassageoilreadyandwithinreach.Rubtheoiltobothyourhandstowarmitbeforeusingitonyour
baby. Never pour oil directly on the baby.
• Makesureyourfingernailsareshortandclean.
• Talkorsingtoyourbabywhilemassagingorhavesomesoftmusicplayinginthebackground.
• Letyourmassageprogressgentlyfromalighttofirmtouchandslowlyreturntolighttouch.Beforefinishingmakeall movements connected and flowing.
• Letthenumberoftimeyourepeatanymovementbedeterminedbyyourbabiesreaction,howevertrythestrokeat least 3-5 times before going to another stroke. Encourage your baby to move freely.
• Aboveall,ENJOYTHISTIMEwithyourbaby.Bestoiltouseisacarrieroillikeavegetableoilornutoil.
Benefits of massage for the baby and the mother
• Promotesmother-childbondingandcommunication
• Promotesbraingrowthofthebaby
• Increasesphysicalgrowthanddevelopment
• Improvesimmunesystemanddecreasesproductionofstresshormones
• Promotesconfidenceandcompetenceincarryingthechild
• Afunandrelaxingtimeforthemotherandchild
What to avoid while massaging
• Donotmassagewhilefeeding
• Donotblowintoears,nose,ormouthduringthemassage
• Donotuse“sambrani”barsorturmericsmoketodrythebaby
• Donotmassagevigorously
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Like every mom, I too wanted to breastfeed my baby from day one, but that is not an easy task. I received a lot of help
from the lactation experts at Fortis who highly encourage breastfeeding and very patiently explained the techniques,
not just once but several times, till I was doing it correctly. I could ask them just about anything. I thank the entire NEST
team for adding more joy and sweet memories to the feeling of ‘being mom’.
SUJATA MUkHERJEE
After delivering my baby boy, Joyce and her lactation experts at Fortis personally trained me on how to breastfeed
him. They showed me the various hold positions, how to get him to latch on and also how to express milk. Every time
I spoke to Joyce, I was left feeling comforted and encouraged. My child had troubles latching on and hence even after
discharge I came back regularly for lactation counselling. These sessions not only taught me how to feed my child
independently but also boosted my confidence and helped me tide over my postpartum blues.
SUPRIYA DIxIT
e X P e r i e n c e o f n e W M o t h e r s
c o n c l u s i o n We hope that the information carried in this book has been useful to you and will help you have a more fulfilling journey
on the path of motherhood. In case you have any other questions, or you wish to share your experience with us, please feel
free to write to us at the following email id:
We request you to share this information with your friends and relatives.
REFERENCE:www.bpni.org/training.htmlwww.sjmj.in (Breastfeeding for women empowerment) issue no. 3 vol.1, 2012
154/9 Bannerghatta Road, Opp. IIM-B, Bangalore - 560 076.Ph: 080 6621 4444 / 95 38 99 55 36 Emergency No.: 105010.
Email: [email protected]