Adoptive Breastfeeding
You can get
domperidone (see attached
protocols), without a prescription, COD
from Mexico at the following
number.
011 526 654-1834
fax number 011 526 654-5522
Oscar and Gabriel speak
English. They send it C.O.D. As far as
I know they
have been very reliable.
Or, http://www.1drugstore-online.com/
You can get domperidone without
a prescription. Look for the generic brand
by Jassen-Cilag which is
domperidone maleate (Motilium) They sell 100 tabs
(10 mg) for $25. The minimum
order is US$50 but shipping is free worldwide
and takes 10-15 days. If you need
the medication fast, they'll ship it
express for US$30. They will
accept orders from everywhere EXCEPT Canada.
Or, any Canadian Pharmacy can
send you domperidone if you get a prescription
from your doctor. Following is
one pharmacy which has experience with this.
Phone for more information:
murray shore pharmacy
For the U.S. and Canada
1-800-201-8590
1-800-201-8591 (fax)
http://www.mshorepharmacy.com/index.shtml
www.canadameds.com Domperidone
is available there with a prescription for
$82.29 (about $54 US, depending
on exchange rate) for a bottle of 500, 10 mg
tablets.
For Canadians who can't find a
doctor to prescibe domperidone,
http://www.pharmagroup.com/
They can get domperidone without
a prescription. Look for Motilium 10 mg 30
tabs for US$12. This comes out
to US$120 for 300 tabs. They will ship
worldwide including Canada and
the US under regular shipping for 6% of their
order or a minumum of US$16. If
they want the order within 3 business days
they'll have to pay 10% of their
order or a minumum of US$40.
Attached are:
1. a diagram showing the
"ideal" latch. Note that the
baby covers more of
the areola with his lower lip
than upper lip. Note also that the
baby's
nose is *not* in the breast.
2. a protocol for "not
enough milk".
3. a first draft chapter on not
enough milk, from my book, The Ultimate
Breastfeeding Book of Answers
(published in the USA by Prima
Publishing,August 2000) or Dr.
Jack Newman's Guide to Breastfeeding
(published in Canada by
HarperCollins Publishing, February 2000).
The book is available at
www.amazon.com or www.chapters.ca or www.indigo.ca
4. a photo showing a lactation
aid in use.
5. a protocol for adoption by
one of my former patients.
http://users.erols.com/cindyrn/newman.htm
Jack Newman, MD, FRCPC
When latching
Anne
J Barnes – May 1995
Have nipple and baby’s nostrils in line before latching.
Mother’s hand under the baby’s face.
Head supported but NOT pushed in against breast.
Head tilted back slightly.
Baby’s body and legs wrapped in around mother.
Push with base of hand on baby’s back and shoulders when MOUTH WIDE
OPEN to move baby quickly onto breast, so chin and lower jaw touch breast
first.
WATCH LOWER LIP, aim it as far from base of nipple as possible, so tongue draws LOTS OF BREAST into mouth.
Move baby’s body and head together – keep baby uncurled.
Once latched, top lip will be close to nipple, areola shows above lip.
Keep chin close against breast.
WIDE MOUTH / GAPE
Need MOUTH WIDE BEFORE baby moved onto breast.
Teach baby to open wide/gape :
move baby toward breast,
touch top lip against nipple
move mouth away SLIGHTLY
touch top lip against nipple
again, move away again
REPEAT UNTIL BABY OPENS WIDE
and has tongue forward
MOTHER’S VIEW WHILE LATCHING
BABY
Move baby not breast
MOTHER’S VIEW OF NURSING
BABY
RECOMMENDATIONS FOR THE
MOTHER
Mother’s posture
sit with straight,
well-supported back
trunk facing forwards, lap
flat
Baby’s position before feed begins
on pillow, nostril (not
mouth) in line with nipple
Baby’s body
placed not quite tummy to tummy, but so that baby comes up to breast
from below and baby’s upper eye makes eye contact with mother’s
Support breast
and firm inner breast tissue
by raising breast slightly with fingers placed flat on chest wall and thumb
pointing up (if helpful, also use sling of tensor bandage around breast)
Entice baby to gape
baby’s head and shoulders
supported so head extends slightly as baby moved to breast
touch baby’s top lip to
nipple and move baby away slightly and repeat until baby opens wide with
tongue `````forward
Move baby quickly on to breast
head tilted back slightly,
pushing in across shoulders so chin and lower jaw make first contact (not nose)
while mouth still wide open, keep baby uncurled (means tongue nearer breast)
lower lip is aimed as far
from nipple as possible so baby’s tongue draws in maximum amount of breast
tissue
Cautions
Mother needs to AVOID
pushing her breast across
her body
chasing the baby with her
breast
flapping the breast up and
down
holding breast with scissor
grip
not supporting breast
twisting her body towards
the baby instead of slightly away
aiming nipple to centre
of baby’s mouth
pulling baby’s chin down to
open mouth
flexing baby’s head when
bringing to breast
moving breast into baby’s
mouth instead of bringing baby to breast
moving baby onto breast
without a proper gape
not moving baby onto breast
quickly enough at height of gape
having baby’s nose touch breast
first and not the chin
holding breast away from
baby’s nose
Anne J. Barnes May 1995
Not Enough Milk
Myth:
Many women are not
capable of producing enough milk to feed their babies.
Fact:
The vast majority of
women produce more than enough milk, most enough for twins and some enough even
for triplets. True, a small number of women truly do not produce enough milk
but the vast majority are perfectly capable of producing all the milk their
babies need for at least four to six months, and can continue producing plenty
of milk for months and years as their babies eat other foods as well. In fact,
some women have the problem of an overabundance
of milk. When babies do not do well on breastfeeding alone, the problem is
usually not an insufficiency of milk, but rather the baby’s not getting the
milk which is available.
Why
then do so many women living in affluent societies believe they were not able
to produce enough milk for their babies or worry they will not make enough
milk. How is it that women all over the world, women living in poor countries,
in difficult conditions, women suffering from chronic illnesses, including
nutritional deficiencies usually manage to breastfeed quite adequately and
produce enough milk, while well nourished, generally healthy women in affluent
societies have so much trouble?
Is
there really a Problem?
The
Baby’s Behaviour
Sometimes
mothers think they don’t have enough milk because of the way their babies
behave. If the baby feeds frequently, or stays on the breast for long periods
of time and does not seem content when not on the breast, many mothers, and
their families will conclude that the mother does not have enough milk, or that
her milk is “weak”. Interestingly, one of the problems of an “oversupply” of
milk is that the baby feeds frequently, stays on the breast for long periods of
time, and is often unhappy and fussy. Yet frequently, these babies not only
gain weight well, they gain weight at a faster than average rate. For more on
this, go to the section on the fussy baby.
On
the other hand, a baby who sleeps a lot, especially in the first week, may not
be doing well at all. More on this later.
Although
we are seeing less of the scheduled feeding than we used to, there is an
unfortunate comeback to scheduled feedings. Trying to stick to a schedule can
make many mothers worry that they don’t have enough milk. If the baby wants to
eat sooner than whatever the schedule says they should, and cries, as he will,
usually, then the may assume that the baby did not get enough at the previous
feeding. The problem is not the supply, though, it is the schedule.
Breastfeeding works best when babies are fed when they want to be fed, so that
the mother’s supply adjusts to the baby’s needs. And, incidentally, the baby
will also adjust. But it is better not to force the adjustment.
A
few words about weight gain and growth charts
Mothers also become concerned about their milk
supplies after they have had the baby’s weight checked and charted at the
baby’s doctor.
There is an awful lot of concern about weight gain
amongst physicians, especially paediatricians, as well as public health nurses
and, of course, new mothers and their families.
The
first question we should be asking is “Why are we concerned about weight gain”?
More particularly, why is it necessary for babies to gain a certain amount of
weight each day or each week or each month?
Most
physicians would say that it is normal for a baby to lose weight during the
first few days, and then regain that weight by 10 days of age. (Actually, in my
experience in Africa, where babies were with the mothers, in their beds during
the entire hospital stay of a couple of days, many babies did not seem to lose
weight at all. Midwives also report that babies born at home and breastfed
without restrictions, will often be back over their birthweights by 4 or 5 days
of age). After that, the baby gains about 30 grams (one ounce equals 28.8
grams, so about 1 ounce each day) each day for the first 2 months or so, and
then 15 grams (about 1/2 ounce) a day until about 6 months of age. Thus a baby
who is born at 3.3 kg (about 7 pounds 4 ounces) will lose some weight during
the first days, and then, by 10 days of age will be back at 3.3 kg. By 30 days
of age, he should weigh 3.9 kg (8 lb 9 oz). By 60 days of age, he should weigh
another 900 grams or 4.8 kg (10 lb 9 oz). But now his rate of weight gain often
will slow down. By 90 days of age (about 3 months), he will weigh about 5.25 kg
(11 lb 9 oz). And by 180 days (about 6 months) the baby will weigh 6.57 kg (14
lb 7oz). Some physicians mistakenly expect the baby to continue gaining at the
same rate in the 3rd to 6th month as he would normally gain in the first 2
months, in which case the baby would weigh an incredible 8.85 kg (19 lb 8 oz)
at 6 months of age.
But
all growth rates are guidelines. What
does it mean if a baby gains a little less or a little more quickly? What does
it mean if the baby gains a lot less or a lot more quickly?
The
fact is that many health professionals seem to have forgotten what growth
standards and growth charts are really for. When a baby or a child who gains
weight and grows in length (or height) at a rate which can be considered
“normal” or “average”, then this is a sign of good health and development. Just
as a baby smiling by a certain age is a sign of good health and development,
just as social interaction with other people is, and just as an absence of a
heart murmur is. None of these, and the myriad other signs which we use, alone
is a guarantee that a child actually is in good health. Thus a child who smiles
socially at 4 weeks of age is on track for development, but could easily have a
heart problem. A baby could gain weight just fine, yet have a kidney problem.
Growth
charts developed because they were an easy way of keeping track of large
numbers of babies, particularly in poor areas, where medical care was not as
available as in more affluent areas of the world. Weighing babies, measuring
their lengths and head circumferences, is an easy way of screening large
numbers of infants to see which of them needs extra care. The weight, which is
the first of the three measures to go off when something is wrong, allowed
health workers to separate those babies who needed interventions from those who
did not. The intervention may just have required information about feeding the
baby more frequently on the breast if that is what seemed to be the problem, or
may have required more serious intervention, for a baby with heart disease, for
example.
Growth
charts are designed so that the baby’s weight is charted against his age in
months, and the lines which are on the chart are called percentile lines. The
baby’s line, drawn over weeks or months is the baby’s percentile line. Many
parents, and some physicians, seem to believe that only babies at the 50th
percentile and above are normal. This is not true. Growth charts are made from
data on normal babies (though the
majority of them were formula fed or not breastfed more than a few weeks, and
they often had solids introduced fairly early). Thus if a baby is on the
fiftieth percentile for his age, it means that 50 percent of all normal babies his age weigh more than
he, and 50 percent weigh less. It does not mean this baby is normal just
because he is on the 50th percentile. If a baby is on the third percentile, it
means that 97% of normal babies his age weigh more than he does. But it does
not mean he is unhealthy, and it does not mean he should weigh more. Somebody has got to be there on the
third percentile. If all babies weighed 50% more, and so did the baby on the
3rd percentile, the baby would still be
on the third percentile.
Furthermore,
a single weight does not tell anyone anything. A baby who was on the 50th
percentile at 6 months of age, and is on the 10th percentile at 12 months, is a
baby to be concerned about. A baby who was on the 10th percentile at 2, 4, 6, 8
and 12 months of age is probably fine. And he is doing just what we expect him
to do.
In
other words, growth charts have to be interpreted. The person that is reading
the information has to take into account that the data might not be appropriate
to the child being weighed and put on that chart. Growth charts available in
North America were developed using data from mostly Caucasian babies and
children, fed formula from early on in their lives and who got solids
relatively early on as well. Thus, these growth charts may not represent normal
growth curves for Chinese babies, or Inuit babies, regardless of how they were
fed. (In fact they do not. Recently growth charts were developed in Hong Kong
for babies of Chinese origin. Their curves, in a population where malnutrition
in babies is almost unknown, are quite different from those developed in North
America or Britain). And they may not represent normal growth curves for
exclusively breastfed babies. As with all tools, mistakes can be made as well.
A child who is 4 months old, whose weight is at the 50th percentile at 4
months, will look as if he is not doing well, if his weight is plotted on the
line for a 6 month old. This is an easy mistake to make, by the way.
Incidentally,
the birth weight is not the standard which determines where the baby should be.
Some babies are born big and then settle into “their” percentile which might,
in fact make them seem to be growing too slowly. Trying to keep them on their
birth weight percentile is not only futile, but, may lead to early introduction
of supplements which will undermine the breastfeeding, to no avail.
But
does a baby really have to follow along “his line”? Remember our earlier
discussion of weight gain being only one sign amongst many that gives us
information about how the baby is doing. Is it okay for a baby to gain no
weight for a prolonged period of time (which would result in his dropping down
percentiles)? No, but as discussed below, there are ways of helping with the
breastfeeding so that this problem is overcome. Is it okay for a baby to gain
slowly, say 15 grams a day even during the first two months of age? Maybe. A
baby who gains 15 grams a day will fall down percentiles. But does this mean
something terrible will happen? No. A baby who gains 15 grams a day will be
thin, but will also be fine. My approach would be to make sure the baby does
not have any physical reasons for slower than average growth, to help the baby
get more (see below), but if the baby is content, developing normally, and
growing slowly but steadily, I would keep an eye on him, but not really be too
concerned. On the other hand, if the baby is a very fussy baby, I believe it
would be more important to improve the intake of milk (see below).
First
of all, and it may surprise many people, breastfed babies who are doing well,
actually gain weight faster than formula fed babies, at least for the first few
months. Not all do, and some gain at about the same rate and some even more
slowly. Between 4 and 6 months of age they actually gain more slowly than
formula fed babies. As mentioned above, on the growth chart made for
artificially fed babies, they may show weights that are passing from one
percentile, say 50th, down through, say 25th. If the growth chart were made
from breastfed babies, it might show the baby staying on the 50th percentile.
The
importance of a good latch
If most women can produce enough or even more than
enough milk, why is it that so many babies gain slowly or even not at all when
“breastfeeding”? The answer is that in order to get milk well from the breast,
the baby must latch on to the breast well. The word latch is used to describe
the way a baby takes the breast into his mouth. The greater the mother’s milk
supply, the less well the baby needs to latch on well, but the mother may pay a
price. For example, sore nipples are almost always due to a poor latch. Even in
the presence of an abundant milk supply, the baby who latches on poorly may be
on the breast for long periods of time or frequently or both, leading some
mothers to believe their milk supply is inadequate!
It
may be helpful to use a bottle feeding comparison, as, in our bottle feeding
culture, we understand bottle feeding much better than breastfeeding. When a
baby latches on poorly, it is similar to his being fed a bottle with a nipple
hole which is too small. The bottle is full of milk, but the baby will have
difficulties getting that milk. The baby may suck for a long time, he may fall
asleep while sucking, only to wake up soon after the bottle has been withdrawn
from his mouth. Why does he wake up?
Because he hasn’t taken much. The smaller the nipple hole, the less milk
he will get, and the longer it will take for him to get that milk. At the
extreme (no nipple hole at all), the baby will get no milk, and eventually
become sleepier and sleepier, as he becomes more and more dehydrated, despite
the fact that there was plenty of milk available, at least in theory.
It
could be argued that women all over the world, since the beginning of human
time on earth, have breastfed their babies, usually quite successfully, without
paying much attention to how exactly the baby was latched on. This is
undoubtedly true, but does not mean the latch is not important. Because most women have more than enough
milk, babies almost always grew reasonably well, despite less than ideal
latches, even before breastfeeding clinics and lactation specialists existed.
In traditional cultures, however, the fact that the baby was on the breast many
hours of the day, sometimes constantly, did not cause a great commotion. Babies
were expected to be on the breast much of the time and nobody gave the mothers
a hard time about their milk being too weak, or inadequate in quantity, or
accused the mothers of spoiling the baby by having him on the breast too much
or carrying him too much or sleeping with him at the breast. With a generous
milk supply available to them, with free access to the breast, most babies
gained weight just fine.
In
addition, in more traditional cultures, mothers have, from the time they were
toddlers, watched babies being breastfed. The notion of breastfeeding is as normal
in their minds as breathing. They have a subconscious image of the way
breastfeeding works, how babies are to be held and how they take the breast.
In
modern, affluent societies (as well as the affluent parts of modern, not so
affluent societies), however, an obsession with numbers and the clock, with
scientific medicine’s increasingly greater involvement with infant feeding,
this more relaxed and usually successful approach was largely discarded.
Furthermore, our society’s mental image of infant feeding is not breastfeeding
but bottle feeding. In our society, the bottle is the cliche image of babyhood.
Using the bottle fed baby as our model of infant feeding has led to great
problems of understanding of how breastfeeding works, for mothers, fathers, families
of the new mother, and health professionals.
By
the early years of the twentieth century, “scientific infant feeding” was
starting to take over. Paediatricians were advising mothers to feed by the
clock, so many minutes on each side every so many hours (each paediatrician had
a different number of minutes which represented the ideal feeding time and so
many hours the ideal feeding interval, though usually 3 or 4 hours).
“Scientific” infant feeding, the basis from which the speciality of modern paediatrics
grew, incidentally, often enough did not work,
so that more and more, supplemental milk was “required”. Surprisingly, though,
given the obstacles the scheduled feedings put in the way of successful
breastfeeding, breastfeeding sometimes did work nevertheless. When the mother’s
supply is abundant, sometimes even the most bizarre of rules will not derail
the process. Of course, some mothers simply ignored the advice they got because
the clock was not working, or because they couldn’t be bothered to try to feed
a baby by the clock, which, in a way, takes more work and energy. This is
lucky, since, otherwise, the art of breastfeeding might have been lost
completely in the industrialized world.
We
now know that there are more efficient and less efficient ways of having a baby
take the breast. Observations by experienced mothers and interested health
professionals have shown us that babies can do better or less well at the
breast depending on how the babies are latched on to the breast. When the
amount of time the baby spends at the breast or the frequency with which the
baby takes the breast are not considerations, how well the baby takes the
breast may not be that important. But when society, and the mother herself, and
the “experts” expect the baby to feed 20 minutes on each side every three
hours, a poor latch can result in the baby’s finding it very difficult to get
enough milk within the given time limits. Furthermore, the less milk a mother
has, even if the amount is sufficient to nourish her baby quite adequately, the
better the latch of the baby must be
in order for the baby to get enough milk.
1) good latch + abundant milk supply =
good weight gain, pain free nursing, “short” feedings, feedings which are not
frequent
2) adequate latch + abundant milk
supply = good weight gain, pain free nursing, more frequent and longer feedings
3) poor latch + abundant milk supply =
slower weight gain ± sore nipples. As the latch becomes poorer, there may be no
weight gain, weight loss, or, on occasion even severe weight loss and
dehydration even in the presence of an
abundant milk supply.
4) good latch + average milk supply =
good weight gain, pain free nursing, “short” feedings, feedings which are not
usually frequent.
5) poor latch + average milk supply =
slow weight gain, even weight loss ± sore nipples.
Another
reason many women worry about not having enough milk is that there has been
much media coverage recently of cases where babies who were breastfeeding
became dehydrated. Actually, the babies who became dehydrated were not breastfeeding. If they were
breastfeeding, they would not have become dehydrated. They had the breast in
their mouths, but they were not getting milk. Note that dehydration may occur
even in babies whose mothers have an abundant
milk supply. In my experience, most of the mothers whose babies have become
dehydrated have more than adequate milk supplies, and if they persist with
breastfeeding usually are able to go on to breastfeed exclusively.
The
principle always holds. The better the latch, the more easily the baby gets the
mother’s milk. Even in the unusual instances when a mother is truly incapable
of producing enough milk, the baby will still get more of her milk when he is
well latched on than when he is poorly latched on.
If
you are a nursing mother, you can try this test yourself. Pretend your thumb
and index finger are your baby’s gums. Put your thumb over the top of one of
your nipples and your index finger under the nipple. Now squeeze. You may feel
pain, and notice how much milk comes out. Now move your fingers back 2 or 3
centimetres and squeeze. You likely feel no pain, and quite possibly your milk
will spray out. What a big difference such a short distance can make. It is
exaggerating only a little put it this way, but that’s all there is to
breastfeeding—getting the baby to latch on properly.
What
is a good latch? (PHOTOS OR DRAWINGS HERE)
The
answer to this question has changed over the years, as more and more
observations of breastfeeding babies were made by knowledgeable observers. It
was often written that a baby was well latched on if he had most or all of the
areola in his mouth. The areola is the pigmented area surrounding the nipple.
As a general rule, it is probably good if the baby has most of the areola
covered by his mouth, but this does not guarantee that he has a good latch. A
baby may cover most of a small areola and still not be well latched on; a baby
may cover nowhere near most of a large areola and still be well latched on.
(Some women have areolas that cover well over a third of their entire breasts).
Later it was said that the baby should have both his nose and his chin just
touching the breast, and if his lips were flanged back, the baby was well
latched on. This refinement has led to more babies and their mothers having an
easier time of it. But more mothers and
babies still will have an easier time of it if the baby comes to the breast and
latches on asymmetrically, covering
more of the areola with his lower lip than the upper lip. If a baby latches on
this way, he can get his lower gums under the milk sinuses and extract milk
from the breast in a more efficient manner.
In
order to achieve this latch more easily, I encourage the mother to hold her
baby in the “cross cradle” hold. Most mothers find this the easiest way of
achieving the best latch. But it is not the only way. The best latch can also
be achieved using the cradle hold (Madonna hold), or the “football” hold or
while lying down with the baby side by side.
If
the mother is putting the baby to the left breast using the “cross cradle”
hold, she would hold the baby with her right arm. Her forearm holds the baby’s
bottom firmly against her body and supports the baby’s
weight. The baby’s legs would be under her right arm. The baby is “wrapped
around” the mother’s body. The mother supports the baby’s head with her right
hand, with her fingers on his face,
and the web between her thumb and index finger at the nape of the baby’s neck.
In this way, the mother’s forearm, not fingers, support the baby’s weight. The
baby’s body will now be in a straight line (even though he’s “wrapped around
the mother”), with the head slightly titled backwards. The baby will come
toward the breast at an angle, so
that the mother’s nipple points to the roof
of his mouth. The mother should then lightly brush the baby’s upper lip with her nipple, from one
corner of the baby’s mouth to the other, wait
for the baby to open his mouth widely, like a yawn, and when he does, use
her arm, not just her hand or wrist, to bring the baby onto the breast. If the
baby gets on well:
1. he will cover more of the areola
with his lower lip than his upper lip
2. his lips will be turned outwards
3. the baby’s chin, but not his nose, will be touching the
mother’s breast
The fact that the baby’s nose is away
from the breast is one sign that he is latched on well. The baby will usually
be able to breathe just fine even if his nose is buried in the mother’s breast.
It is not for the baby’s breathing
that the baby is held in this way, but so that the baby can latch on well and
get milk well, without causing the mother pain.
The
whole point of using what many women would consider an unnatural way of putting
the baby to the breast, is to get the baby onto the breast asymmetrically. So, do not
bring the baby around, or lift the baby’s body so that the nipple is centred on
the baby’s mouth just before you latch him on. That is what you are trying to
avoid. While this position may seem awkward at first, it will more likely make
breastfeeding easier for the mother, and the mother will naturally, over the
next days or weeks revert to the more usual cradle hold.
The
mother can achieve the above latch with any position of the baby; lying in bed
side by side with the baby, or using the “football” hold, or the regular
“cradle” hold. It is just easier to
manage with the “cross cradle” hold.
But it is best to do what works best for you.
The
Best Way to Assure a Good Milk Supply: A good Beginning
How did we get the poor beginning?
From
early in the twentieth century, hospital routines have made breastfeeding
difficult to get going properly. Yes, some mothers managed regardless, but this
should not be seen as an endorsement of these routines, which were based on
bottle feeding babies and how they were supposed to be fed. Bottle fed babies
could be given certain measured amounts of milk and the doctors and nurses
could be relatively certain that the babies would sleep or be satisfied for a
certain period of time. Hospital staff
began to feel that since it was possible to
make a baby drink 60 ml (about 2 ounces) of milk in 10 or 15 minutes, for
example, and as a result have the baby sleep for 3 or 4 hours, this was a good
thing. In fact, if the bottle fed baby
would take that amount of milk (obviously much more than a breastfed baby was
getting), and sleep 3 or 4 hours, this was not only a good thing, but probably
the normal thing for babies to
do. From there, it was only a short step
to deciding that if the breastfeeding baby was at the breast for longer than 10
or 15 minutes, and wanted to return to the breast before 3 or 4 hours had elapsed, this was a bad thing.
Routines
which seemed to work for the bottle fed babies were imposed on the
breastfeeding babies, as most health professionals were becoming convinced that
breastfeeding, though better, was essentially not different from bottle
feeding. Artificial feeding was the same not only in the food the baby was
getting (not true even today despite the many refinements which have improved
infant formulas), but also in the “mechanics” of the feeding. Actually, by the
1920’s many health professionals were beginning to believe that bottle feeding
was better, because it was more “scientific”.
It was possible to say how much the baby was getting, in ounces and even
quarter ounces. It was possible to make “special milks” for babies which would
contain “exactly the ingredients” babies needed to grow properly. It was
possible to keep a baby to a schedule. The fact that what you put into a
formula does not necessarily mean that that
is what the baby will absorb—the fact that knowledge of exactly what the baby needed to grow was
extremely limited—the fact that we didn’t even know what was in breastmilk (and
we are still quite ignorant of breastmilk’s ingredients, though we have learned
a lot)—none of this mattered or was even considered. Because the babies
thrived. Well, not always.
“In the late 19th century, as the
chemical composition of milks was determined, animal milk was modified to
approach human milk more closely in gross composition. Milk first was diluted
with water, so that protein and electrolyte concentrations were reduced. Babies fed this diluted formula failed to
grow. Experiments revealed that the caloric density of human and cow's milk
were similar. Subsequently, sugar was
added to the mixture. Some infants fed these formulas lived. Manipulating the
composition of formulas heralded the advent of Pediatrics as a specialty.” Lewis
Barness. Remarks to American Academy of Pediatrics, March 19, 1991 San Diego,
California. In Pediatrics 1991;88:1055
And
then there was money. Money? What has money got to do with it? Well, a lot.
With increasing artificial feeding, physicians got a whole new business. With
breastfeeding, in the days of yore before the art of it was lost, women would
get help and information from their mothers, sisters, friends, and neighbours,
most of whom had nursed several children. The idea of going to a physician,
almost all of whom were men, to ask about breastfeeding, would have seemed a
bizarre joke.
Once
artificial feeding became more common, by the 1920’s, mothers needed help from physicians. Artificial
feeding in bottles was complicated and risky. Babies were frequently ill, and
some died, but it was not artificial feeding that was considered at fault (true
even today, incidentally), it was that mothers made mistakes in not following
instructions. But even with proper mixing and sterilizing, babies did not always
do well. So changes in the formulas were made according to the baby’s age,
weight, bowel movements and how the baby reacted to the chemical soup.
Instructions were written down in great detail and meant to be followed to the
letter. Physicians got more business because of the mother’s need to get
instruction on the use of infant formulas, and got more business from the
increased illnesses the artificially fed babies developed. And they got control. Women were now dependent on
their advice in order to feed their babies. Who can reject such power easily? A
little power was also apportioned out by the physician to the nurses who worked
with new mothers and babies in hospital during the early days after birth. The
nurses now had power over how much the baby was fed, the power to override such
foolish old fashioned ideas such as “demand feeding”, and the power to push the
use of bottles and supplements “for the good of the baby”.
In
her novel The Group, Mary McCarthy
describes very tellingly in chapter 10 how a new mother, at first wanting to
breastfeed, is led by inaccurate information from physicians and nurses and
family to wondering, by the end of the chapter, whether breastfeeding was
really natural. Of course, the mother in the novel “failed” at breastfeeding.
And in real life, of course, her story was not unique. Not by a long shot.
“Scientific
infant feeding” was the driving force behind the scheduled feedings.
Observations on formula fed babies determined how babies were to be breastfed.
For example, nurses, from very early on, noticed that babies fed formula in the
first few hours after birth would frequently be fussy and spit up their
feedings. A policy was developed to deal with this “problem”. Babies were not to be fed for the first
twenty-four hours of life.
This
policy was virtually universal in North America for many years and continued
until the early 1970’s in some hospitals. My most poignant memory of my fourth
year medical school rotation in obstetrics was the babies’ screaming in the nursery,
with no one who would pick them up or feed them, because this policy was felt
to be right. It was a policy based on bottle feeding and artificial food, and
it was wrong even for those babies, but it was a disaster for breastfeeding.
Happily, this policy has been consigned to the dustbin of history.
Since
babies were not being fed for the first day anyway, it seemed unnecessary to
have them with their mothers. The babies could be kept separate in a nursery, a
bizarre name, since rarely did any nursing (breastfeeding) take place there.
Babies could be better observed, since mothers who were heavily sedated could
not be trusted to do it themselves. By the 1950’s, the nursery had become the
babies’ ward, and the mothers and babies were separated during the entire
hospital stay, which was often 7 days or longer. Eventually, the idea arose,
never stated openly, perhaps, that the baby actually “belonged” to the
hospital, not to the parents, at least until they left the hospital. The belief
that the mothers could not take care of their babies during the first 24 hours
led insinuously and sinisterly to the notion that mothers were not competent to
take care of their own babies at all. This attitude has not completely
disappeared.
Today,
as more women are breastfeeding again, other reasons are used to separate
mothers and babies and interfere with breastfeeding. Many of these “reasons”
are bogus, and once again have to do with health care professionals letting the
parents know who is in charge (not the parents). For example, some hospitals
have policies in which all babies are observed after birth by nurses for a few
to up to 24 hours. This is not only unnecessary, but interferes with mother and
baby bonding as well as the establishment of breastfeeding. This type of policy
may be based, perhaps, on a desire to “make sure the baby is okay”, but very
few nurses observe babies in the nursery as well as a mother observes her own
newborn. In the days of hospital funding cutbacks, a lot of “routine”
separation has more to do with justifying the staffing of the special care
nursery, than observation of the baby.
Today,
more than ever, many health professionals do not believe that new mothers
produce enough milk during the first few days after the birth. This, of course, is based on the amounts of
formula a bottle feeding baby will take, which is obviously much more than a
breastfeeding baby will get at the breast during these early days. Secondly, as
well, during the first few days, “breastfed” babies tend to want to stay on the
breast for long periods of time and will often fuss if taken off the breast.
These observations reinforce the notion that there is not enough milk in the
first few days. But there is enough
colostrum. The baby does not need much, but he needs some. The way to get the baby his colostrum is to make sure the
baby starts nursing early and making sure
the baby is latched on as well as possible. Because when the milk flow is
not rapid, as it is not during the first few days, a baby has to latch on well
to get milk well.
Thus,
if there is a medical reason that a baby must
start feeding early, there is a tendency to introduce supplements. The infant of a diabetic mother, for
example, is at risk of developing a low blood sugar, and a low blood sugar can
be quite serious. The way to deal with this risk is to get the baby feeding
early. The best feeding for the baby is colostrum, as formula tends to raise
the baby’s blood insulin, which then can decrease the blood sugar again. But
since most health professionals do not believe there is enough colostrum, they
will feed the baby formula, often without even trying the baby at the breast.
Furthermore,
the fear of low blood sugars, has resulted in many hospitals adopting routine
testing of newborns for sugar. This is completely inappropriate, and resulting
in unnecessary pokes to the baby to get blood, anxiety in the parents, and
unnecessary treatments and separations.
More on this elsewhere.
So,
despite many hospital policies which “encourage” early feeding at the breast
and rooming-in, the practice in many of these hospitals is that babies are
separated during the early hours and often fed inappropriately with bottles and
formula.
So
what is a good beginning?
It
has been known for many years now that breastfeeding works best when mothers
and babies get started as early as possible, if babies learn to latch on well,
and supplements, especially when given by bottle are avoided. Here are some of
the important first steps in preventing the problem of “not enough milk” and
almost all breastfeeding problems, for that matter. It is not always necessary
to fulfil all the steps below, as
many mothers know very well, but the better the start, the less the risk of
problems with milk supply developing. Many mothers develop an abundant milk
supply regardless of a delayed start to breastfeeding, despite early
introduction of bottles (almost always unnecessarily, incidentally), and
despite not being with their babies 24 hours a day during the first few days. But for some mothers and babies, a poor
start means an early end to breastfeeding. Since it is not possible to know
which mother and baby will have difficulties, every effort should be made to
ensure that all mothers and babies get the best start possible. Of course, sometimes
infant or mother illness require separation and a delayed start to
breastfeeding, though nowhere as frequently as is done in many hospitals. However, because a baby and mother are
separated, it is not necessary to throw everything else important to a good
beginning out the window. For example, just because, occasionally, babies do
need supplements (though nowhere as frequently as they are given), it is not
necessary to give them by bottle, as if the bottle were the only “natural”
alternative. There is nothing natural about a bottle.
A. Breastfeeding
should begin as soon as possible after birth.
An
early start is definitely important for getting breastfeeding started right.
UNICEF’s Baby Friendly Hospital Initiative, a programme to encourage hospital
routines which will improve breastfeeding success, encourages trying the baby
at the breast within 30 minutes of birth. This guideline, 30 minutes, is just a
guideline, but emphasizes how early a baby can
start breastfeeding. Indeed, work from Scandinavia has shown us that, not only
can babies start breastfeeding within minutes of birth, they can actually crawl
up to the breast and latch on all by themselves, without help.
Basically,
it works like this. The just born baby is dried off, but then immediately
placed on the mother’s abdomen. For about 20 minutes, on average, the baby will
just lie there. Then, after this time, the baby starts moving his head from
side to side, then starts to push with his feet (a reflex called the “stepping
reflex” in medical textbooks). Slowly, the baby will work his way to the breast
and take the breast and start suckling. On average this takes about an hour
from the moment the baby is placed on the mother’s abdomen to the moment the
baby latches on to the breast, all by himself,
with no help. Not all babies will do this right away, and some will latch
on immediately they placed anywhere near the breast. It is a fascinating thing
to watch, and videos of the process are available. It is even more fascinating
to observe first hand, and even more fascinating to experience first hand.
Very
few new mothers have ever had the opportunity to experience this “self
attachment”. One problem is that narcotics, and possibly other medications
during labour could easily interfere with the baby’s ability to accomplish his
crawl to the breast and self attachment. Of all the medications which
interfere, the one most commonly used during labour for pain relief, meperidine
(Demerol) is the worst. It gets to the baby very easily during labour and it
stays around in his blood, affecting his ability to nurse very significantly
for many days and even weeks.
There
is debate about whether the medications from epidural or spinal anaesthesia can
affect the baby in this way, but despite what is frequently said about these
methods, some medication will get into the mother’s blood stream, and some will
get to the baby. This does not mean that the baby will necessarily have
difficulty crawling to the breast or difficulty suckling, but the evidence is
difficult to interpret.
It
is fascinating what we are learning about the newborn’s behaviour. The fact
that a baby will crawl up to the breast and latch on all by himself should not
be surprising. Most baby mammals find their way to the mother’s breast without
help. The joey (baby kangaroo) accomplishes this by completing a voyage that is
nothing less than amazing, travelling, in a much more immature state than the
human baby, a distance which is many many times the length of his own tiny
body. Pigs also find the sow’s breast, even fighting with his siblings for
prime position. For many, this may seem threatening, a reminder of our
relationship to other animals, something many would like to forget. But it
should also remind us of how much we have forgotten, in our flight from nature.
Research
has shown that smell may have something to do with the baby’s ability to latch
on to the breast in the first hours. When researchers had mothers wash one
breast, while leaving the other unwashed, the babies, allowed to crawl up to
the breast and latch on on their own, almost always chose the unwashed nipple.
Again, a reminder than in our haste to “make things better, cleaner, safer”, we
may be interfering with things we are not even aware of, never mind understand.
Another
reason few babies self attach is that they are not given the opportunity. Even
in some of the more enlightened maternity departments, the opportunity for the
mother staying with the baby skin to skin for an hour or more is just not in
the cards. Hospital routines “must be followed”.
The baby must be examined
by the paediatrician and suctioned and given an Apgar score. (In fact, he
doesn’t. A baby who crawls up to the breast has an Apgar of 9 or 10. Suctioning
is not necessary for the vast majority of newborns, and may even interfere with
suckling. The baby can be examined later. In any case, giving an Apgar score
takes only a few seconds and can be done while the baby and mother are together
skin to skin.)
The baby and mother cannot
be skin to skin because it’s too cold in the delivery room. (If it’s too cold,
this is a problem for the mother’s comfort, though the baby stays as warm skin
to skin with the mother as he would in an incubator. Delivery rooms have
traditionally been kept cool because in the days when hospital staff wore
gowns, masks and caps for deliveries, the staff would become very uncomfortable
in a regularly warmed room. Also the work and “distraction” of labour was
supposed to keep the mother from not feeling cold; but she did, once the baby
was born.)
The baby has to get his
injection of vitamin K and needs his eye drops. (Well, these can wait a couple
of hours without any danger to the baby.)
The baby and mother have to
go to their rooms. (Yes, but surely that does not mean the mother and baby
cannot be together skin to skin. Furthermore, hospitals wishing to make labour
and birth as pleasant an experience as possible for the mother and baby have
developed rooms where the mother labours, gives birth and stays with the baby,
without needing to be transferred to another place.)
The baby needs to be
observed for abnormalities. (Really? And in what way does having the mother and
baby skin to skin interfere with this observation? The baby’s colour, breathing
and general activity can be observed while the baby and mother are together.)
Most
babies and mothers would profit greatly from being together without
interruption for the first couple of hours. It is one of the great mysteries,
at least to me, how so often the excuse for the mother and baby being separated
immediately after birth is that the mother is tired. Undoubtedly, the mother is
tired, especially if her labour has been long and difficult, but surely, after
that long and difficult labour, the mother has the right to have the fruit of
that labour with her as compensation. Surely having the mother and baby skin to
skin together, allowing the baby to learn to be with her, is not that tiring. Indeed, many mothers
express anxiety at having their babies taken away from them, just at the time
they wanted so much to see them.
Granted,
it is not always possible to allow
immediate contact between mother and baby, for a variety of legitimate reasons.
Unfortunately, too often, mothers and babies are separated for reasons which
are not legitimate. Here are a few:
1. The baby passed meconium before
he was born.
A
significant percentage of babies pass meconium before they are born. In some
studies this may be as high as 1 in 5. Having passed meconium before birth does
not mean a baby needs special observation. The vast majority of those who do,
do not run into any problems. The tiny percentage of those who do, are
obviously sick very soon after birth. Thus separation for observation of babies
who pass meconium, just because they have done so before birth, is not a
reasonable reason for separation of the mother and baby.
2. The baby was born by caesarean
section.
Once
again, if the baby was born by caesarean section, it may be that he is quite
sick, or that the mother is quite sick. Nevertheless, in the majority of cases,
caesarean sections are not done under those circumstances, especially in North
America. Even if the caesarean section is done with general anaesthesia, it
does not mean the mother and baby cannot be together as soon as the mother is awake.
Until then, the baby can be with the father, and once the mother is awake and
up to it (this does not necessarily take 4 hours or more), the mother and baby
can be side by side, and skin to skin together.
3. There was evidence of fetal
distress during the labour.
Well,
if the interventions which occurred during labour as a result of the fetal
distress resulted in a healthy baby at birth, why is it necessary to separate
the mother from her baby? Congratulations to those who made the wise decisions
and leave the mother and baby together.
“The benefits to the mother
of immediate breastfeeding are innumerable, not the least of which after the
weariness of labor and birth is the emotional gratification, the feeling of
strength, the composure, and the sense of fulfilment that comes with the
handling and suckling of the baby.” Ashley Montague.Touching. Harper & Row 1978
B. Babies
should go to the breast when they are ready to go to the breast. There should
be no restriction on the amount of time a baby breastfeeds.
Schedules
and breastfeeding do not go together. Babies do not breastfeed better if they
are forced to wait three or four hours so that they will be really hungry or so
that the mother’s breasts will “fill up”. Nor do they do better if they are kept
on the breast for only short periods of time. This is a throwback to the days
when we thought that limiting time on the breast would prevent sore nipples. It
doesn’t. It does prevent the smooth establishment of breastfeeding, however.
It
is important to understand that there is a difference between a baby who is on
the breast and actually getting milk, and a baby who is on the breast but not
getting milk, or only getting a very little. Any advice from anyone to let the
baby feed 20 minutes (10 minutes, 30 minutes, whatever) on each side indicates
that that person does not really understand breastfeeding. A baby who drinks
well from the breast for 20 minutes is unlikely to even be interested in the
second side. A baby who sucks on the breast without
drinking for 20 hours will still come off the breast hungry. It is because
so many babies are not drinking milk at the breast that so many babies in the
first few days seem unsatisfied, wanting always to return to the breast and
suck. Of course, if the baby did drink well, and wants to stay at the breast
for comfort, there is nothing wrong with this. Why shouldn’t a baby want to be
comfortable? But the emphasis should be, if there is a concern, that the baby
drink well, and if he has, then getting comfort from the breast is fine too.
What
about the baby who is feeding less frequently than the schedule demands? Is it
bad that a baby does not drink for 5 or 6 hours at a time during the first few
days? Many mothers have been told that a baby must feed every 3 hours for the
mother to establish a good milk supply. Modern management of obstetrics makes
the answer to this question more difficult. Because many babies have been
sedated by drugs given to the mother during labour, the baby may not wake up in
response to hunger. Furthermore, in some hospitals, babies are wrapped up so
warmly and tightly and the temperature of the room is so high, that the baby
just sleeps comfortably on.
For
this reason, it is best that mother and baby be close, skin to skin, in bed
together, during the first days. Babies often give clues that they are ready to
feed which can easily be missed if the baby is in the nursery, or even in a
bassinet next to the mother. One of the most dramatic, because others often
don’t notice, is the change in breathing that many babies demonstrate when they
are starting to wake in order to feed. From a regular deep respiration, the
baby may start panting, and this change of breathing will often awaken the
mother if she is asleep.
Another
cue is the baby’s lifting his hands to his face or mouth. He may even try to
suck his hands. But, if the baby is tightly wrapped in a blanket, he may not be
able to show this.
It
should be obvious from the above that the mother and baby should be rooming in
together 24 hours a day. Indeed, rooming in means 24 hours a day, and there is
no such thing as rooming in 12 or 18 hours a day. It means that the baby is not
separated from the mother for more than a few minutes at a time for the
accomplishment of hospital routines. The offer to take the baby to the nursery
for the night should be politely refused by the mother. This is not a favour
that is being offered you. It is usually unnecessary, and often a mistake. The
evidence suggests that mothers sleep better when the baby is with them than if
the baby is in the nursery. Besides, it is a good habit to get into to sleep
beside your baby, as you will get more rest once you are home if you can nurse
lying down, and even sleep while your baby nurses.
C. Artificial
teats or nipples should not be used for the breastfeeding baby.
Sometimes
supplements do need to be given to the baby. I would like to emphasize that
they are being given far too often, and often, quite unnecessarily, as infant
formula, rather than expressed milk or sugar water. Nevertheless, if
supplements are truly necessary, we now have methods of supplementing the baby
without using an artificial nipple.
Is
there such a thing as nipple confusion? This question and sometimes the strong feelings
and debate around this question are unnecessary since we don’t need to use
artificial nipples to feed breastfeeding babies supplements, if supplements are
considered necessary. But let us consider this question anyway.
Nipple
confusion, or nipple preference, if you prefer, is not an “all or nothing”
situation. As mentioned earlier, the key, the basis of successful breastfeeding
is a good latch. If the mother has a bountiful supply, the latch does not have
to be great for the baby to do well. If the mother’s supply is just abundant
enough, the baby really must have a good latch in order to do well.
Babies
are not complicated. The want milk and if they get it, they are content. If
they go to the breast and get lots to drink, and then get lots to drink from a
bottle, they usually will do both breast and bottle. If they go to the breast
and get little, and then get a bottle and get lots, it is also obvious that
sooner or later, the baby will catch on, and realize that he gets his milk from
the bottle. If he is not too hungry he may still take the breast, but if he is
ravenous, he may refuse the breast. Indeed, some babies refuse the breast
without ever having had an artificial nipple, if they do not get good flow from
the breast.
In
order for a baby to get milk from a bottle, he does not have to open
particularly wide, for example. Thus, if the baby has had some experience with
bottles, he may open his mouth only a little when going to the breast, but he
won’t get milk quite as well. If the baby latches less well than he could, he
depends more on the rapid flow of milk (caused by the “letdown” or milk
ejection reflex), than on actually extracting milk from the breast. When the
flow slows, he no longer drinks. Babies drink well when they get good flow, and
in the early days, when the flow slows, they tend to fall asleep, even if they
have not had enough. The less good the latch, the less well the baby will
suckle. Because the baby suckles less well, sooner or later, the milk supply
will decrease, and the baby will stop nursing earlier and earlier. Furthermore,
the early use of bottles can lead to sore nipples because the baby tends not to
open his mouth as well when he comes to the breast.
It
is interesting that some of the loudest mockers of “nipple confusion” are often
also the very same people who encourage the mother to start bottles early, or
“the baby will never take one”. And it is sometimes true that a baby who is
breastfeeding only, will refuse to take a bottle or pacifier. This may occur as
early as a few weeks of age, or only after three or four months of age. It may
also occur even if the baby is getting regular bottles from early on. Suddenly
a baby who is taking both, stops taking the bottle when he is 3 or 4 months of
age. Or, unfortunately, a baby who was taking both breast and bottle stops
taking the breast. It is also patently obvious that some babies who are doing
“both breast and bottle” are not. In fact they “pacify” on the breast, but
actually feed from the bottle. They get virtually no milk from the breast.
One
example. Lise is breastfeeding her five week old baby and is doing fine, as is
the baby who is gaining weight very well. The mother has no problems with
nipple soreness, no problems with milk supply. She is prescribed metronidazole
(Flagyl™) for a problem unrelated to breastfeeding and incorrectly told she must stop breastfeeding during the 10 days she
is on it. The mother takes the baby off the breast; she maintains her milk
supply very well with pumping. After a week, she finds out that she did not
have to take the baby off the breast. All efforts to put the baby back to the
breast fail. How do we explain this phenomenon? Is it low milk supply? Well,
it’s not a low milk supply, because the baby was able to grow subsequently on expressed
milk (with no formula) at a tremendous rate.
I
believe the conclusion is obvious. And this is only one example.
“Nipple
confusion” is not a black and white issue. The use of artificial nipples may
cause no problems for some babies, tremendous problems for others and
everything in between. Since it is rarely necessary to use bottles to feed
babies (more on this later) even if they need supplementation, and since it is
not always possible to know which baby will be affected, we should do everything
to avoid the use of bottles until breastfeeding is well established. And that
certainly means no bottles in the first few days. Each baby is different. Each
baby is an individual and so a mother who “fed her others both breast and
bottle and the baby did well” may not do as well with this new baby.
Methods of supplementing which do not
require a bottle
There
are several methods of supplementing which do not require the baby getting an
artificial nipple. The best is what I call a “lactation aid”, or others call a
“nursing supplementer”. This device is best because the baby is at the breast
and breastfeeding. Other methods include cup feeding, finger feeding, syringe
feeding and feeding the baby with a tube put through his nose or mouth into his
stomach. This last method should only be used with babies who are too premature
or too ill to suck. All these methods, as with all tools, can be, and have
been, misused. They are often used at inappropriate times; they are often used
wrong; they are often used when another method would be better.
1. The Lactation Aid
This
device can be made up from hospital materials: an ordinary feeding bottle with
the nipple hole enlarged with scissors so that a 5 French, 91 cm (36 inch)
feeding tube can pass through the hole. Or it can be bought ready made. In most
cases, especially in the first day or so, there is no need to buy the
manufactured device, as the supplement may be required for only a few feedings.
Generally a lactation aid is used as
follows:
a) The
baby must be latched on as well as possible. Of course, not all babies
latch on perfectly in the first few days, but using a lactation aid to
supplement before fixing the latch is a wrong use of the lactation aid. This is
key! In the first place, the better the baby latches on, the less likely will
the supplement actually be necessary. Secondly, the better the baby latches on,
the easier the lactation aid is to use. Thirdly, the better the baby latches
on, the shorter the time the device will be necessary.
b) The
mother must be able to tell whether the baby is getting milk. This is easy
to see once you’ve seen it, but difficult to describe. However, here goes. A
baby who is getting milk in substantial quantities demonstrates a very definite
pause in his chin as he opens his
mouth to the maximum while he is sucking. The baby opens his mouth and as the
“opening” phase of the suck comes to an end and he has opened wide (to the
maximum opening) there is a delay, or a pause, just before he closes again.
That pause tells you the baby just got a mouth full of milk. The longer the
pause, the more milk he got; the shorter the pause, the less, but if there is a
pause definitely there, the baby got a significant amount of milk. This pause
can be seen on the first day of life if
the baby is latched on well. You will see the pause when your milk supply
is more abundant than on the first day or so even without a good latch. But if
you see it on day one, the baby must be latched on well, or you have quite a
lot of colostrum. This pause when you see it, is your guarantee that the baby
just got milk. You don’t have to hear the baby swallow, unlikely in any case
during the first days. Also, I mistrust “hearing the baby swallow”, though like
the pause, once you hear it you know what it is. The trouble is that babies can
make all sorts of noises while on the breast which can be mistaken for
swallowing. The pause is more reliable.
c. The
lactation aid is introduced only after the baby has nursed on both sides. A
baby who is reasonably latched on should not have the tube introduced
immediately. The mother should feed the baby on the first side until the baby
does not appear to be drinking any more (no more pauses). Then she changes
sides and feeds the baby some more, until the baby no longer drinks. If she
wishes, she can offer the first side again, and, go back and forth several
times if she wishes, but she should feed at least both sides before offering
the supplement with the tube. The supplement is then given and the baby takes
what he wants. In this way, as things improve, the mother will be introducing
the tube later and later in the feeding, until, perhaps, the baby actually
refuses the supplement.
2. Cup Feeding
Cup
feeding has been around for thousands of years. Cups for feeding infants have been
found in Egyptian tombs. All around the world, women feed their babies water
(unnecessarily) using the oldest cup around, the human hand. It works just
fine. I have seen a mother give her one day old baby water with the cup of her
hand and the baby drinking it quite nicely. This giving of water to young
babies is, in fact, not a good idea, especially in those parts of the world
where the practice is most common, because the water supply is often unsafe,
and breastmilk if far superior even to slake a baby’s thirst. It has been well
shown in well designed studies that even in the hottest of climates, enough
breastmilk also means enough water, as breastmilk is 90% water, more or less.