18/04/2024
🤱🏻The basics of breastfeeding🤱🏻
So many times, we hear of a mother that stopped breastfeeding for the reason that could quickly have been addressed if they were informed or if they consulted a lactation consultant in time. I decided to post a few breastfeeding basics and include the links to previous breastfeeding posts I have made to help new moms along the way. This is a LONG post; bear with me. Those that know me know I am a huge breastfeeding advocate, so I wanted to give you a comprehensive (although very long) guide with information to set you on the right track when starting your breastfeeding journey.
🤱🏻The anatomy of the breast🤱🏻
If you look at a breast from the outside, you will see the breast and the ni**le, and the ar**la. The ar**la is the round, dark area of the breast. On the ar**la, there are small glands, called Montgomery’s glands. These glands secrete an oily substance that protects the skin of the ar**la and ni**le during breastfeeding. This substance also has a characteristic smell that is unique to each woman. This is the smell your baby recognizes and knows where to search around for when looking to breastfeed.
The ni**le is the pointy thing in the middle of the ar**la that usually stands out. The ni**le has a few milk ducts that open to the outside. The amount of these varies from woman to woman.
Inside the breasts, there is mammary tissue. This tissue contains tiny sacs (called alveoli) that have cells that make milk. There are ducts that carry the milk from the alveoli to the outside of the breast. There are connective tissues around these ducts and alveoli, including specialized muscle cells, which contract to make the milk flow.
🤱🏻How do hormones play a role in breastfeeding?🤱🏻
The two main hormones that play a role in breastfeeding are Prolactin and Oxytocin. But even before then, Progesterone and Estrogen produced by the placenta in pregnancy already start their magic by increasing the size and number of milk ducts in your breasts.
When the baby attaches and sucks on the breast, a message is sent from the ni**le to the brain. In response to this message, a gland in the brain called the pituitary gland secretes Prolactin from the front part of this gland. The back part of this gland secretes the hormone Oxytocin.
Prolactin is responsible for the milk-producing cells in the alveoli of the breast, which start secreting breastmilk. During pregnancy, the levels of Prolactin rise, and it prepares the breasts for breastfeeding, but milk is not produced yet due to high levels of Estrogen and Progesterone. After pregnancy, these hormones decrease, and lactation starts to take place. When the baby begins to suck on the breast, the level of prolactin increases, and the alveoli begin producing milk. During the feed, this increased to ready the alveoli to produce milk for the next feed.
Oxytocin is the hormone that makes the cells around the alveoli contract. This allows the milk to flow from the alveoli through the ducts and be ejected to the outside of the breast. This is why the release of Oxytocin and then the milk is called the “let-down reflex.” The release of Oxytocin can start even before the feed. The reflex can become automatic when the mother touches the baby, smells sees, hears the baby cry, or even just thinks of her baby or looks at a photo or video. This is why some women may leak breastmilk more when around other babies or just thinking about their baby. If the mother is in pain, distressed, or even going through emotional turmoil, it may inhibit the oxytocin reflex.
🤱🏻What is in breastmilk?🤱🏻
Breastmilk contains all the nutrients that a baby will need in the first six months of their life. These nutrients include fat, carbohydrates, proteins, vitamins, minerals, and water.
Breastmilk also contains live substances (called bioactive substances) that affect the baby’s immune system. One of these bio-active factors is immunoglobulins, which are antibodies that protect the baby from infections. Epidermal Growth factor is another bioactive factor that allows the baby’s intestines to digest and absorb nutrients more effectively.
Breastmilk is composed in such a way that it is easily digested and used efficiently. Breastmilk contains long-chain polyunsaturated fatty acids that are important in the brain development of a baby.
The main carbohydrate in breastmilk is lactose, which is a milk sugar. It has a higher lactose content than other kinds of milk. The baby breaks down this lactose by an enzyme called Lactase.
Another essential carbohydrate in breastmilk is “Human Milk Oligosaccharides” (HMOs). These function as prebiotics and promote the growth of beneficial gut bacteria.
Breast milk contains much lower protein than other animal milk. Too much protein can damage a little baby’s kidneys.
To read up on all the benefits of breastfeeding, read here: https://m.facebook.com/story.php?story_fbid=666414538388402&id=100050595844490&mibextid=qC1gEa
Worried your breastmilk is not nutritious enough? Read here: https://www.facebook.com/share/p/S2Pa8X4CeZDUH6iW/?mibextid=WC7FNe
🤱🏻Do the size of my breasts matter?🤱🏻
Nope. The critical word here is storage capacity. It is the amount of milk the breasts can store between feeds. This is not determined by physical breast size at all.
The storage capacity also does not predict how much milk is MADE, just stored. Women with larger storage capacities may go longer between feeds as their breasts have a lot of milk at a particular stage. Women with smaller storage capacities often have to feed more often.
🤱🏻What are colostrum and mature milk?🤱🏻
Colostrum is special milk the mother’s breasts make in the first few days after birth. Some women may also secrete colostrum in pregnancy. Colostrum is made in small quantities but is loaded with white blood cells, vitamins, and minerals. The white blood cells are antibodies and play a vital role in giving important immune protection in those first few days after birth. The baby came from a sterile womb environment and is now exposed to many organisms outside. Colostrum is commonly referred to as the baby’s “first vaccine.” The amount needed is also minimal, as the baby’s stomach is also tiny. On the first day, the baby may only need 2-10ml of colostrum per feed.
After about two or so days, breastmilk starts to be produced in larger amounts. This is a natural process and cannot be hurried along. The breasts will begin to feel fuller and may even become engorged. This is commonly referred to as the milk “coming in.” After two weeks, the milk is considered mature milk.
🤱🏻What are hindmilk and foremilk?🤱🏻
The fats in breastmilk are secreted in droplet form. These droplets are tiny, and they become more and stick to each other as the feed progresses. At the beginning of the feed, this milk is called the foremilk. This milk contains less fat and may be more watery and blue-ish/grey. Later on, during the feed, the milk becomes Hindmilk rich in fat and looks creamy white.
There is no magic time that foremilk becomes hindmilk but instead happens gradually. There is no switch that is flipped to start secreting hindmilk.
🤱🏻Can the breastmilk change to tailor-fit your baby?🤱🏻
Yes, that is the unique part! Various studies are now ongoing on the “backwash” effect. During feeding, the sucking causes the baby’s saliva to go into the mother’s ni**le. This then communicates with the mother’s breast which pathogens the baby may be fighting or exposed to. The mother’s milk then becomes full of these antibodies and immune cells. A tailor-made immune boost!
Various studies have already proven that when a baby is sick, there are more white blood cells and antibodies in a mother’s milk.
Breastmilk produced at night is also designed to make your baby sleep better. Night-time milk contains more serotonin and other components. There is also more Melatonin, the hormone that regulates sleep and wake rhythms.
🤱🏻How to start a feed?🤱🏻
Choose a comfortable position because you might be there for a while. Hold your breast with one hand as if you were holding a burger. Rub your ni**le against the baby’s mouth. Wait for them to open their mouth and insert the ni**le deeply into their mouth. Check for a correct latch.
If the baby has had enough on the one breast (don’t time it, remember!), stop the feed, burp the baby, and then offer the same breast.
If they don’t want it, offer the other side. If they don’t want it as well, the feed is completed. The baby might need to burp a few times while still drinking from one breast. Keep a hair-tie around the arm on the side you fed on first, so you can remember which side to offer first at the next feed.
Your baby won’t always drink from both breasts; see the first breast as the main meal and the other breast as dessert. There’s isn’t always space for dessert.
🤱🏻How important is the correct latch?🤱🏻
Extremely! If the baby latches appropriately, the baby will feed effectively and also gain weight and be healthy. If the latch isn’t good, the baby won’t remove the right amount of milk effectively, and breast milk production might also decrease.
A good latch has the following signs:
☑️Most of the ar**la is visible above the baby’s top lip than below the lower lip.
☑️The baby’s mouth is wide open.
☑️The baby’s lower lip is curled outwards.
☑️The baby’s chin is touching or almost touching the breast.
If the latch does not have signs above or is painful or uncomfortable, the baby should be unlatched by putting your finger in the corner of their mouth and the breast to break the suction, then be relatched.
If you struggle to get a good latch, don’t struggle on by yourself and get a lactation consultant on board ASAP.
🤱🏻Which positions are best for breastfeeding?🤱🏻
There are so many different positions the baby and the mother can be in to breastfeed successfully, so no specific one is better than the other one.
The mother can be sitting, standing, lying down as long as she is relaxed and comfortable. Breastfeeding can be rough on a mother’s back, so she must make sure that her back is supported.
The baby can be in any position in relation to the mother. Typical positions include the cradle hold, cross-cradle hold, football hold, side-lying, laid-back, dangle feeding, koala, or even feeding in a baby carrier.
There are, however, a few checks you have to do to check the baby’s position to ensure the baby can comfortably latch:
✔️The baby’s body should be straight, and the whole body should be supported. You can use your arm, feeding pillow, regular pillow, the mother’s lap, bed, etc. The baby’s ear, shoulder, and hip should be in line.
✔️They should be facing the breast and preferably be able to see the mother’s face.
✔️The baby’s body should be close to the mother’s baby.
🤱🏻What might I experience when the baby starts feeding?🤱🏻
🚺Abdominal discomfort🚺
The hormone Oxytocin is responsible for the contraction of the uterus after delivery. This is important to reduce bleeding after delivery. When the baby feeding stimulates the let-down reflex and a release of Oxytocin, this also stimulates the contraction of the uterus. You might feel this abdominal discomfort when starting a feed in the early days after birth. It is therefore essential to breastfeed as soon as possible after delivery to help with the contraction of the uterus.
🚺Tingling/sharp feeling in the breast🚺
This is due to the release of Oxytocin, which allows the ejection of milk from the breast. The discomfort you might experience in the breasts is due to the milk being released from the alveoli. It usually only lasts a few seconds and is not painful. If it lasts long and is very painful, it may be an indication of thrush.
🚺Milk leaking from the other breast🚺
When feeding the baby on one breast, the other breast might leak as well. When Oxytocin is released, it stimulates the release of milk in both breasts, not just the one feeding on. A great way to not waste this leakage is to use a silicone pump on the other breast or wear a breast shell. My favourites are from MamaMoo Breastfeeding.
🚺Thirst🚺
This is also due to Oxytocin. Your body naturally reminds and encourages you to drink more fluids to keep hydrated to make adequate milk.
🚺Anxiety/Negative emotions🚺
On very rare occasions, some women may experience negative emotions just before their let-down reflex. This occurs with breastfeeding and expressing and usually becomes less distressing as the feed continues. This is known as Dysphoric Milk Ejection Reflex (D-MER). The cause for D-MER is still not clear and being researched, but it seems that the feel-good hormone Dopamine may be responsible. Usually, by 3-6 months, this improves. Speak to a lactation consultant to help you cope. If you experience this, it is very manageable with a few minor changes.
🤱🏻How long and often should I feed?🤱🏻
Throw away the clock. NOW. The most natural way to breastfeed a baby is baby-led. The baby needs to be able to feed as often and for as long as they want. This is what we call on-demand feeding. This is especially important within the first six weeks of life, as this is when the milk supply is established
Different babies drink different amounts at different times. It is unnatural to expect a baby to drink for a particular time or interval if they do not feel like it. You can’t let a fussy baby cry for another 20 minutes because it’s not feeding time yet. Maybe the baby is only thirsty and just wants a quick drink to get some foremilk, but when watching the clock, you force the baby to wait. Babies may drink up to 18 times a day, and that is still normal.
You should be wary of hunger cues and follow these and feed the baby if they feel like it. Crying is a late hunger cue. There are more subtle hunger cues like smacking the lips, opening the mouth, sticking out the tongue, turning their head looking for the breast, squirming, and fussing. If the baby is crying of hunger, it may be more challenging to get a good latch.
The breasts also never empty, so you don’t need to wait for the breasts to fill again after a feed. When babies feed, they also don’t drink all of the milk readily available at that specific time because they drink according to their appetite. Think of breastmilk production as a flowing river; the more you remove, the more it flows.
We need to remember that breastmilk is easily digested, which means babies will probably want to feed more regularly.
🤱🏻Should I wake my baby to feed?🤱🏻
Babies can be sleepy creatures, especially in the first few days. They may prefer to sleep rather than eat, especially in the first two weeks, so it may be necessary to wake them. Preferably feed them a minimum of 2-4 hourly during the day.
For night sleeps, this should be discussed with your baby’s healthcare professional. Preferably in the first six weeks, the baby should be fed 4-6 hourly (in the first two weeks, the American Academy of Paediatrics recommend feeding them no less than four hourly) during the night until the baby shows good weight gain (at least 113g per week) at their weekly weigh-in visits. Also, keep an eye on nappy output when deciding on waking for night feeds.
Certain babies have medical conditions and should be woken at night for feeds. These include premature babies, poor weight gain, and other medical issues.
🤱🏻What if my baby falls asleep on the breast the whole time?🤱🏻
Breastfeeding can be hard work, especially if they are latched incorrectly, and they have to work harder to get the milk out. But even correctly latched babies fall asleep while feeding because it’s just so warm and comfy.
If you think the baby hasn’t finished a feed yet and still sucks vigorously when awoken, there are a few things you can do to keep them more awake:
🔅You can use a wet wipe and wipe their face and hair.
🔅Undress your baby so that they are a tad cold.
🔅You can rub the baby’s back or legs.
🔅Unlatch them and burp them.
🔅Change the baby’s nappy.
🤱🏻Can I feed my baby to sleep?🤱🏻
During the first few weeks, the baby most likely will fall asleep on the breast anyway. They have a full stomach and are so comfy next to mom. When older, you might be scared that you are creating bad habits by allowing them to fall asleep on the breast. This is a personal decision for you. But in my personal opinion…it made life a whole lot easier for me popping in a b**b when they woke at night. And my kids started sleeping through the night early and settled by themselves when they were developmentally ready. Until then, b**b was always the answer.
Here is a post on safe sleeping: https://www.facebook.com/100050595844490/posts/687425106287345/?mibextid=cr9u03
If your baby is older and you want to get rid of night feeds, I did a post on it a while ago here: https://m.facebook.com/story.php?story_fbid=862143355482185&id=100050595844490&mibextid=cr9u03
🤱🏻What if my baby is feeding long and the whole time?🤱🏻
If the baby is feeding long and very often, make sure that they have a good latch. If their latch is ineffective, they will struggle to get enough milk and feed for long or often. If you are unsure if it is a good latch, rather have a lactation consultant have a look.
If the latch is fine and they are gaining weight well, then they just like your b**b. Some babies just like feeding more than others. They don’t only feed for hunger. They might be thirsty, bored, may miss you, or just want some TLC. Read my post on the 4th trimester here: https://m.facebook.com/story.php?story_fbid=676335624062960&id=100050595844490&mibextid=qC1gEa
🤱🏻Why is my baby so fussy and wanting to be breastfed in the early evening?🤱🏻
This is called cluster feeding. Babies feed more often in closer intervals. See this as your baby getting in the needed calories to maybe have a longer sleep in the early evening later. The baby may also be fussier at the breast at this time, as the baby might be a bit overstimulated from all the day’s happenings, and the mom might think her milk supply is diminishing. She might feel that the baby isn’t getting enough milk because he is trying to feed too much in the late evening, or she might think the baby is feeding fussily because they aren’t getting enough milk. All of these behaviours are normal, and you should cut yourself some slack and just let your baby feed as much and as long as they want. They might even spoil you with a night of longer sleep.
Do not supplement with formula thinking it will keep them fuller for longer. You will only diminish your milk supply if you skip a feed.
🤱🏻Why can skipping a feed cause a decrease in milk supply?🤱🏻
At the beginning of a feed, the hormone Prolactin increases and peaks around 30min after the start of the feed. This Prolactin stimulates the alveoli to produce milk for the following feed. If you skip a breastfeed, the Prolactin will be decreased.
Milk production is also controlled by a substance called Feedback Inhibitor of Lactation (FIL). This is a substance present in breastmilk. This is a local control mechanism in the breast to control the production in each breast. If milk is not removed from the breast, FIL increases and stops the cells from creating more breastmilk. This is a protective mechanism to protect the breasts from becoming too engorged. When the milk is removed, FIL is also removed, and the breast continues to make more milk. FIL is, therefore, the regulator of how MUCH milk is produced, where Prolactin is responsible for the secretion by the alveoli cells.
🤱🏻Why are the first six weeks of breastfeeding very important?🤱🏻
During the first six weeks of breastfeeding, the more the baby feeds, the more Prolactin is produced; therefore, more milk is produced. This is called establishing your milk supply; you are laying the basis of your milk production for the rest of your journey.
If you express milk on top of feeding on the breast, you might have very high prolactin levels, which may lead to increased milk production, which may lead to engorgement and other breast problems.
Read more about other breast problems during breastfeeding here: https://www.facebook.com/100050595844490/posts/373887037641155/?d=n
After six weeks, Prolactin does not play such a significant role in the amount of milk produced. While it is still a vital hormone in breastfeeding, the relationship between the two diminishes. After six weeks, FIL, as mentioned above, is an essential role-player in breastmilk production. FIL enables the amount of milk produced to be determined by how much the baby drinks and needs.
🤱🏻Is skin-to-skin important?🤱🏻
Absolutely, and this is especially important in the first six weeks while the milk supply is established. Skin-to-skin contact increases the release of Oxytocin, which allows the breastmilk to flow, and the baby will feed more regularly. This will, in turn, increase Prolactin, and that leads to producing more milk.
🤱🏻What about growth spurts?🤱🏻
You may notice that after about 7-10 days after birth, your baby suddenly wants to breastfeed more often or for longer. They may also be fussier. This is only temporary. They are trying to ramp up the calories to convert them to grow. They might also start to work on substantial developmental milestones, and these might coincide with growth spurts. Embrace this time to be kind to yourself. Camp out in front of the TV with your baby on the b**b the whole day if they want to.
These growth spurts usually only last about 2-3 days but may last a week. You might notice you are more thirsty or hungrier than usual. This is just your body’s way to tell you to keep hydrated and nourished to produce more milk.
🤱🏻How do I know my baby is getting enough milk?🤱🏻
See my post here: https://www.facebook.com/100050595844490/posts/725571522472703/?mibextid=cr9u03
If you are worried that you might have a low milk supply, read here: https://www.facebook.com/100050595844490/posts/698710008492188/?mibextid=cr9u03
🤱🏻What about using a dummy and bottles?🤱🏻
Preferably they shouldn’t be used before six weeks as they can cause ni**le confusion, and your baby may reject your breast. However, many women have used dummies for non-nutritive sucking before six weeks with great success. Babies naturally like sucking to calm themselves, so a dummy can be an excellent calming tool.
However, never use a dummy to replace the breast for comfort or to delay feeding.
Read more on the dummy here: https://www.facebook.com/share/p/mmeLQk68c5HXUaZS/?mibextid=WC7FNe
🤱🏻Last words🤱🏻
Sometimes breastfeeding is hard; you don’t have to always like it. Try to keep at it and use the resources around you. Phone a friend. Get a lactation consultant to help you. Join the La Leche League page. And if you’ve tried all the avenues and you still didn’t get it right, at least you tried, and you can be proud of what you gave your little one. Every tiny drop counts.
🤱🏻Other breastfeeding posts I’ve done in the past🤱🏻
🌀Biting during breastfeeding:
https://www.facebook.com/100050595844490/posts/721065289589993/?mibextid=cr9u03
🌀Getting your breastfed baby on the bottle:
https://m.facebook.com/story.php?story_fbid=853709756325545&id=100050595844490&mibextid=cr9u03
🌀Tips on expressing breastmilk:
https://www.facebook.com/100050595844490/posts/825466442483210/?mibextid=cr9u03
🌀Foods to avoid while breastfeeding:
https://www.facebook.com/share/p/d6DR1bhJBzziiT8K/?mibextid=WC7FNe
🌀Good foods to eat while breastfeeding:
https://www.facebook.com/1442008255941830/posts/1874444719364846/?d=n
🌀Galactagogues:
https://www.facebook.com/100050595844490/posts/829629682066886/?mibextid=cr9u03
🌀Medications during breastfeeding
https://www.facebook.com/100050595844490/posts/325457532484106/?d=n
🌀Nipple care:
https://www.facebook.com/100050595844490/posts/740156051014250/?mibextid=cr9u03
🌀Overfeeding milk:
https://www.facebook.com/100050595844490/posts/750137913349397/?mibextid=cr9u03 n
🌀Post-partum vaginal dryness:
https://m.facebook.com/story.php?story_fbid=668441404852382&id=100050595844490&mibextid=qC1gEa
🌀Storing breastmilk:
https://www.facebook.com/100050595844490/posts/825941329102388/?mibextid=cr9u03
🌀Transient lactase deficiency:
https://www.facebook.com/1442008255941830/posts/1479277632214892/?d=n
🌀Vaccines safe during breastfeeding:
https://m.facebook.com/story.php?story_fbid=653980106298512&id=100050595844490&mibextid=qC1gEa
Pic by Raychan on Unsplash.
Various sources were used for this post, including Kellymom, La Leche League, and my medical textbooks. Most were obviously from my experiential learning from being a passionate breastfeeding mother. I am not a certified lactation consultant.
