BREAST MILK:

MY FAVOURITE FOOD!

Authors Suzanne Dionne, MD CLSC de la Haute-Yamaska, CSSS H-Y Lise Bélanger, Nurse CH de Granby, CSSS H-Y Participation from the Direction de santé publique de la Montérégie Dany Gauthier, IBCLC, RLC Stéphane Groulx, MD Laura N. Haiek, MD Céline Lafrenière, MD Manon Lévesque, Secretary Ghislaine Reid, BA, IBCLC, RLC Lydia Rocheleau, P. Dt., M.Sc. Participation from the Direction du Secrétariat général—Direction des affaires administratives, des communications et de la qualité de la Monté-régie Anne-Marie Blain, Information Officer Yardly Kavanagh, Information Officer Illustrations Yves Steinmetz English Translation Original version: Peter Botteas Revised 2004 version: Ghislaine Reid

This booklet may be reproduced in full without further authorization from the authors, as long as the reference is cited. First edition 2001, Second edition 2004, Third edition 2008

Breast milk cannot be imitated or artificially reproduced. It is unique, full of essential living organisms and naturally adapted to your baby, your environment and the moment when you breastfeed. The “dispenser” - the mother’s breast - is also unique: it’s warm, soft and smells good. The taste of breast milk varies, depending on what the mother eats. It prepares the baby for the many flavours he/she will encounter in the future. Drinking amniotic fluid in the mother’s womb in the last few months of pregnancy prepares the baby for drinking breast milk. The quantity of breast milk produced increases day by day. The first two days after delivery, the breasts produce small quantities of colostrum: 10 to 100 mL (an average of 37 mL) per 24-hour period. Colostrum is a nourishing fluid that is ideally suited to the baby’s nutritional needs. A newborn generally drinks small quantities at a time, day and night (8 to 12 times per 24-hour period). The first day after delivery, however, the baby may sleep longer and therefore nurse less often. The colour of breast milk varies. Colostrum is of an orangey-yellow hue, whereas mature milk is bluish in colour. The texture also changes over time: colostrum is thick, whereas mature milk is watery at the start of each feeding but becomes creamy by the end of the feeding. Although certain formulas are nutritionally adequate, nothing can compare with breast milk.

Breastfeeding, no matter how long you continue,

is invaluable to both you and your baby.

BREAST MILK:

GIVING YOUR BABY THE VERY BEST!

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THE PROTECTIVE PROPERTIES OF BREASTMILK

Breast milk is much more than just a combination of nutrients that help the baby grow. Breast milk contains living organisms—white blood cells and antibodies—that help the baby fight off infection. A breastfed baby is much less likely to get ear, respiratory or urinary-tract infections, or gastroenteritis. The antibodies in breast milk vary depending on the germs to which the mother is exposed. Your baby will be better protected against infection:

if you breastfeed exclusively in the first few months (without feeding your baby any solids or other liquids for the first 6 months)

and the longer you breastfeed Breast milk will also protect your child from certain diseases that could occur later on. A child that has been breastfed is less likely to develop:

intestinal disorders certain allergies juvenile diabetes

BREASTMILK BENEFITS THE ENTIRE FAMILY

Breastfeeding saves you the cost of formula and bottles. It also saves on electricity and may reduce the amount you spend on medicine. Plus, a child in good health means fewer days off work and less worry. In Québec, mothers have the right to breastfeed wherever they wish.

What can the father do?

A baby needs lots of human contact and enjoys discovering his/her surroundings. There’s a lot the father can do—for instance, he can hold, talk to, walk, rock, bathe and massage the baby.

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WHAT BREASTFEEDING INVOLVES Since breast milk takes about 90 minutes for the baby to digest, your baby may breastfeed 8 to 12 times a day. A baby can be hungry anywhere, anytime. For some mothers, feeding time is restful, while for others it’s a chore. Many parents discover the joys of breastfeeding only a few weeks into the experience. Sometimes it takes just a bit of patience to come to fully enjoy breastfeeding. If you run into problems breastfeeding, don’t delay asking for help. It’s much easier to deal with a tiny problem before it grows into a major one!

Contact a nurse at your local CLSC or hospital or get in touch with a support group or with your doctor as soon as possible if you encounter the following:

your breasts are painful

your baby doesn’t seem to be swallowing when he/she feeds

you need support and encouragement

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BREASTFEEDING

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Three Keys to Breastfeeding: Get comfortable.

Make sure the baby is well positioned and properly supported.

If the baby’s hungry, it’s time to breastfeed!

Latching On

1° If you find it’s necessary to hold your breast, place your thumb on top and your four fingers on the bottom (as illustrated), away from the areola (the dark part around the nipple). The thumb and index finger should form a “C”.

2° Coax your baby to open his/her mouth wide by

drawing her or him close to your breast and tickling his/her upper lip with your nipple. Then move your breast away a bit and bring it close again, touching the baby’s upper lip. Repeat these movements until the baby’s mouth opens wide.

3° Once the baby’s mouth is wide open, draw the

baby quickly towards your breast, directing the nipple at the roof of the baby’s mouth. A large portion of the areola should enter the baby’s mouth, and his/her chin should rest on the breast.

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4° The breast should now be deep in the baby’s

mouth, where the nipple won’t be irritated by the baby’s gums or the suckling motion.

5° To remove the baby from the breast, gently

insert a finger in his/her mouth, between the gums, to break the suction.

6° The baby may successfully latch onto the breast

right away, or it may take a few tries. 7° If the baby has only the nipple in his/her mouth

or if suction is painful, remove the breast from the baby’s mouth and start again.

IMPORTANT TIPS

The baby takes a large portion of the areola in his mouth, more with the lower lip than the upper lip.

The baby’s chin should rest on the breast.

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Be patient! Keep your baby on your belly and try a little later.

Remember: You and your baby are both learning!

SOME WORDS OF ADVICE!

Don’t lean over the baby. Don’t move the breast towards the baby’s mouth; instead, draw the baby quickly towards you with your forearm.

Make sure the baby’s head and body are properly aligned when you start feeding. The baby’s head and his tummy must be facing the breast.

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WOULD YOU LIKE TO TRY?

This will help you know if the baby is taking enough of the breast into his/her mouth.

firmly squeeze the areola as far away as possible from the nipple, especially underneath;

close your eyes; be aware of the sensation; try the experiment again, but with your fingers

squeezing the areola close to the nipple; close your eyes; be aware of the sensation.

Which sensation best resembles what it feels like when your baby is nursing? If it’s the first one, FANTASTIC! The baby is taking the breast properly. If it’s the second one, GREAT! You’ve just identified a major problem that’s easy to fix. Take the baby away from your breast, remember what you need to do, and start over. Do this exercise as often as you need to. Now you know what it feels like when

the baby is latched on properly!

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CARE FOR YOUR BREASTS

AND NIPPLES

Normal hygiene is sufficient (i.e., daily shower, bath or sponge bath). If your nipple is cracked, wash it with an unscented soap, just as you would any wound.

No studies have demonstrated any benefits in using creams or oils for preventing sore nipples. The baby latching onto the breast incorrectly is often the cause of chapping and cracking. If this occurs, do not hesitate to consult a health-care professionnal.

It is up to you whether you wear a bra or not. If you use nursing pads, change them as soon as they become damp since it is prefereable to keep your nipples away from constant wetness.

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BREASTFEEDING

FROM A TO Z

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DECIDING TO BREASTFEED

∗ Get the help you

need to make an informed decision.

∗ Talk about it

with your partner, if needed.

∗ Try it out!

PREPARING FOR BREASTFEEDING

∗ Watch other

mothers breastfeed.

∗ Attend prenatal

classes on breastfeeding.

∗ Join a support

group.

PREPARING YOUR BREASTS

∗ You don’t need to do anything ahead of time—no need to rub, stretch out or use any sort of cream on your breasts.

STARTING OUT

∗ Let your baby latch onto your

breast as soon as he/she shows signs of hunger shortly after delivery.

POSITIONING YOURSELF

∗ Sit

comfortably! ∗ Do not lean

over your baby.

POSITIONING THE BABY (traditional feeding position)

∗ Rest the baby’s back on your

forearm.

∗ The baby’s body should be facing you.

∗ The baby’s

ear, shoulder and hip should be aligned.

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DURATION OF EACH

FEEDING

∗ Watch the baby, not the clock!

∗ Start off with one breast until the baby lets go of it by him/herself, falls asleep or starts suckling less vigorously.

∗ Present the other breast if need be.

ROOMING-IN

∗ Keep the baby in your room or in your bed day and night when you begin breastfeeding.

NO BOTTLES OR PACIFIERS

∗ Avoid giving the baby a pacifier until the baby is used to breastfeeding (4 to 6 weeks).

∗ Avoid giving bottles of artificial milk for the same reasons and to get the full benefit of breastfeeding. (see p. 4).

HOW TO PREVENT ENGORGEMENT

∗ Breastfeed frequently without limiting the length of each feeding and without skipping nighttime feedings. If your breasts become engorged:

1. Apply cold compresses after breastfeeding.

2. Apply warm compresses or take a warm shower before feeding.

3. Express some milk.

LATCHING ONTO THE BREAST

∗ Encourage the baby to open his/her mouth WIDE, as if yawning, by tickling his upper lip.

∗ Aim the nipple towards the roof of the mouth of the baby.

∗ Baby must take a large part of the areola, more with his lower lip.

FEEDING SCHEDULE

∗ Breastfeed whenever the baby is hungry.

∗ A baby breastfeeds 8 to 12 times per 24 h.

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NIPPLE PAIN

∗ Breastfeeding shouldn’t be painful! ∗ If you’re feeling soreness or pain: 1. Check how the baby

latches on to the breast.

2. Start feeding with the breast that is the least sore.

3. Vary the breastfeeding position.

4. Seek help if the pain persists.

BIRTH CONTROL

∗ Breastfeeding mothers are naturally infertile in the first few months after delivery, provided they meet certain conditions (ask for information on a natural birth-control method known as LAM).

∗ Other methods: - condoms - IUD - progestin-only contraceptives (on doctor’s recommandation).

RETURNING TO WORK ∗ You can

continue to breastfeed even once you go back to work by expressing your milk and having the baby fed your milk from a glass, cup or bottle. You can also use a mixed feeding method.

WEANING

∗ Wean your baby gradually over a two-or three-week period at least.

∗ No medication is necessary to help you stop producing milk.

IS THE BABY GETTING ENOUGH MILK?

∗ The more the baby drinks, the more milk you produce.

∗ In the first month of life, your baby will wet 6 to 8 diapers and have several bowel movements per day.

∗ Your baby gains between 105 and 220 grams a week.

BE PATIENT!

∗ Give yourself time to get used to breastfeeding.

∗ Get support or offer support to others, depending on what you’re going through on a given day.

BREASTFEEDING

FACTS AND MISCONCEPTIONS

The topic of breastfeeding often conjures pleasant images in peoples’ minds, yet it also raises questions and misconcep-tions. What are the facts?

Watching other mothers breastfeed and learning about breastfeeding from them will help you go through the

various stages of breastfeeding with realistic expectations. Learn to trust your instincts and get to know

your baby better.

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MISCONCEPTION: “Whether you breast-or bottle-feed, it doesn’t make any difference to the baby, as long as you have a good relationship with your baby.”

FACT: Since the beginning of time, breast milk has been the

means of survival for the young of our species. Formulas and cow’s milk should never be your first choice. In no way do they equal breast milk! The World Health Organization and the Canadian Pædiatric Society recommend breast milk as the food of choice for infants.

MISCONCEPTION: “Breastfeeding comes naturally. The mother and

baby automatically know what to do.” FACT: Breastfeeding is a combination of instinct, reflexes

and learning. A mother will instinctively want to draw her baby to her breast. When the baby cries, the mother’s immediate impulse is to feed him/her. Right from birth, babies have three reflexes they need in order to nurse: 1. turning their head towards anything that

touches their cheek; 2. sucking; 3. swallowing. The mother and baby both need to go through a learning process: the mother learns to find a comfortable position and position the baby properly at her breast, while the baby learns to latch onto the mother’s breast and nurse.

In societies where breastfeeding is the norm, young girls grow up seeing other women breastfeed their babies. They, in turn, learn to breastfeed more easily because of the models their culture provides. A great number of women did not have the opportunity of seeing their mothers breastfeed. Therefore, the support given by healthcare providers and breastfeeding support groups is very important to the success of breastfeeding.

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MISCONCEPTION: “It’s best to start a mixed feeding regimen as soon as the baby is born.”

FACT: Quite the contrary! The use of formula early in a

baby’s life can cause allergies in the short or long term. But that’s not all—drinking from a bottle is not at all the same as nursing at the mother’s breast. It is better to avoid bottles and pacifiers altogether.

MISCONCEPTION: “If you want to breastfeed, you have to

prepare your breasts, and specifically your nipples, during pregnancy.”

FACT: Scientific studies have shown that trying to prepare

your breasts ahead of time does not reduce pain, cracking or chapping, which can be prevented if the baby takes not only the nipple but also a large portion of the areola (the darker ring around the nipple) into his/her mouth.

MISCONCEPTION: “If you breastfeed, you have to eat a lot and

can’t eat whatever you want.” FACT: You don’t have to be “eating for two” when you

breastfeed. You simply have to drink enough to quench your thirst and eat a variety of foods to meet your baby’s nutritional needs as well as your own. Eating fast food once in a while won’t affect the quality of your milk.

Even if the taste of your milk will vary depending on what you eat, this will not affect your baby. Moreover, a baby’s excessive cries are rarely related to what his or her mother eats.

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MISCONCEPTION: “Your milk might not be rich enough.” FACT: The nutritional value of breast milk hardly varies

at all from one woman to another. Even in coun-tries hit by famine, the quality of milk produced by women suffering from malnutrition is similar to that of women who receive adequate nutrition.

MISCONCEPTION: “You have to limit the length of each feed-

ing, especially in the first few days, to keep your nipples from becoming painful.”

FACT: In most cases, nipple pain is not caused by the

length of feedings but by incorrect latch-on. It generally occurs when the baby takes only the nipple into his/her mouth. Remember that breast-feeding involves more than just the nipple!

MISCONCEPTION: “You’re supposed to give both breasts at

each feeding.” or “You’re supposed to give just one breast per feeding.”

FACT: Whether you offer one breast or both in a single

feeding depends on what satisfies both you and your baby. Start the baby off with one breast. The baby will let go on his/her own. If he/she is still hungry, give him/her the other breast. There aren’t any set rules!

MISCONCEPTION: “The baby must be fed every 4 hours, 6

times a day.” or “My baby feeds 12 times a day. Is this normal?”

FACT: The baby should nurse as often as he/she needs

to. Watch your baby, not the clock!

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MISCONCEPTION: “A breastfed baby needs to be given bottles of water, especially in hot weather.”

FACT: A healthy breastfed baby needs nothing other

than breast milk during the first 6 months of life. Breast milk contains all the water the baby needs.

MISCONCEPTION: “Your breasts will sag if you breast-

feed.” FACT: A woman’s breasts quickly increase in size

during pregnancy. When the breasts return to normal after delivery, they may sag in some women. Sagging breasts is simply part of having children and getting older.

MISCONCEPTION: “Trying to breastfeed twins is crazy!” FACT: Though breastfeeding twins takes a lot of

time and energy, many women do so suc-cessfully. A woman can have enough milk for twins, and even for triplets.

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WHO TO CALL FOR HELP OR SUPPORT

Important numbers:

Friend Relative Support group CLSC Doctor Hospital

Réalisée par la Direction de santé publique

Centre de santé et de servicede la Haute-Yamaska