Breastfeeding

It may take several months for your breasts to return to their former size. They'll most likely be less firm than they were before you became pregnant, but this is the result of childbearing, not breastfeeding. They'll probably seem to be the same size they were before your pregnancy, although some women feel that their breasts become larger or smaller after nursing. This may have something to do with the amount of weight gained or lost or with their having become accustomed to having larger breasts.

 

Breastfeeding can help a mom return more quickly to her pre-pregnancy size. There's some evidence that nursing helps women to regain their figures, since the fat stores developed during pregnancy are laid down specifically for lactation. Women who don't nurse may have a harder time working off this fat. Just think of it—you're burning about 500 calories a day through lactation, as many calories as you'd burn on a five-mile run. Some women do retain a few pounds of extra weight while they're nursing, which they often lose after weaning without doing anything special. Other women find that after weaning they need to cut back on calories and embark on an exercise program to lose this weight.

 

My daughter is starting to eat more at night and less during the day (reverse cycling), how do I get her to stop? I'm a stay-at-home-mom, so I would prefer she eats during the day when I'm awake rather than 2-3 times at night. Any hints?

 

She needs to learn the difference between night and day! You can help her by keeping lights on and noise present (maybe from a TV or radio) during the day. You can also wake her at intervals that correspond to her present night-schedule. Also, taking her out in the fresh air and sunlight should help.

 

Are there official recommendations for mothers who have cesareans or who have premature babies, including micro premies? I know the idea is that breast milk is best, but many moms are separated from their babies and/or they are told that formula is better for their babies. What suggestions do you have for these mothers, especially about feeding at the time of birth and during the hospital stay.

 

Mothers who have cesarean deliveries can start to nurse as soon as those who have vaginal deliveries. You'll have to make special efforts not to put pressure on your incision, but otherwise the process is about the same. For moms who deliver prematurely the situation is different, depending on the size and health of the baby. If the baby cannot nurse right away, you can pump your milk and either supply it to the hospital or freeze it for later use. Prematurity is temporary, but breastfeeding can continue for many months.

 

Procedures for feeding a baby born before term vary, depending on the infant's size, gestational age, strength, and special needs. Your baby may be technically classified as preterm, but be well formed and strong and lack only a few ounces to be considered of normal weight. In this case, you can probably start to nurse immediately.

 

Very tiny infants, however, are often not able to suck; they may have to be fed by gavage (via a tube that goes from the nose into the stomach) for several weeks until they become strong enough to nurse. Ideally, the doctor in your hospital's preterm unit will graduate your baby directly from gavage to breast. In the United States this often happens when an infant reaches a weight between three and four pounds. Some hospitals, however, still require preterm babies to suck first from a bottle to demonstrate their ability to feed; only when they're taking a bottle at every feeding are they permitted to nurse at the breast.

 

Because of the protective factors in breast milk, it is best for preterm babies too – if the mother can produce enough milk, either to nurse her baby directly or to pump milk that will be fed by bottle or gavage. Very small preterm infants, however, who are receiving pumped breast milk may need more nutrients than the mother's milk can provide. These babies often receive a supplement added to breast milk called human milk fortifier (HMF), which is rich in calcium and protein. Your doctor may want your baby to continue to receive extra calcium and protein along with your breast milk for some months after discharge from the hospital. Since HMF is not available outside of hospitals, these nutrients may come from specially fortified formula given in addition to breast milk.

 

The milk of women who bear preterm babies differs from the milk produced by women who deliver at term. Mothers of preterm babies produce milk specifically designed for their own babies at the infants' stage of development.

 

Compared to the milk of a mother of a full-term baby, the milk of a mother of a preterm baby is easier to digest and better constituted for developing the preterm baby's brain and nervous system. Milk from mothers of preemies has higher levels of nitrogen, protein, sodium, and chloride than full-term milk, and lower lactose content than full-term milk. It provides more energy for the preterm infant's growth needs than mature milk. It also has a high level of lipase, an enzyme that aids in fat digestion.

 

Can a mother switch to exclusive breastfeeding (if she wants to) if a premie was given formula or bottles in the early days?

 

Yes. If she has kept up her milk supply by pumping, she should be able to provide whatever her baby needs once the baby is strong enough to nurse.

 

I heard recently that formula is now as good as breast milk, is this true? Can it ever really be done?

 

Formula will never be as good as breast milk for human babies. The milk of every species of mammal is different in composition from every other milk, and formula is typically based on milk from cows. Furthermore, each mother's milk is custom-designed for her own baby: Women develop specific antibodies against bacteria and viruses in their own lungs and intestines, which also appear in their milk. Breast milk changes in composition from feeding to feeding, from day to day, and from month to month, whereas formula remains the same at every feeding.

Human milk contains at least one hundred ingredients that are not in cow's milk, and while artificial formulas try to imitate mother's milk, they can never duplicate it exactly. No manufacturer has ever officially claimed that a formula product is just as good as or better than breast milk, and none is likely to make such an audacious claim. In fact, the Food Standards Agency in Great Britain plans to bar infant formula makers from making claims that their products are close to breast milk. As one team of researchers wrote, "Formula milk is just a food, whereas breast milk is a complex living nutritional fluid that contains antibodies, enzymes, and hormones, all of which have health benefits."

 

We're constantly discovering new ingredients in mother's milk. With breast milk, the whole is greater than the sum of its parts. We don't know all the constituents in breast milk and how they work together.

 

My first baby refused to take a bottle. I was a stay at home mom and was happy to breastfeed, but felt completely confined because I could not leave my husband home with a bottle of breast milk. Do you have any tips on how to get a baby to drink from a bottle when they are primarily breast fed?

 

The solution is to start offering a bottle early – after the course of breastfeeding is well established, but before the baby makes up her mind that the bottle is not for her. This window of opportunity generally comes up between 6 and 8 weeks of age. If a baby is older than this when you want to introduce the bottle, there are a few ways to overcome the baby's refusal of the bottle: warm the nipple and milk to body temperature, ask someone else to pick up the baby when he's sleeping but almost ready to wake so that his instinctual urge to suck takes hold, and experiment with different feeding positions.

 

If I drink a glass of wine, how long before it gets into the breast milk? Is it best to "pump and dump" when I plan on having a drink? What about four drinks?

 

What the mom takes in usually reaches the breast milk in a few hours. The best scheduling involves having your glass of wine soon after a feeding. Having four drinks within a short period of time can be considered "binge drinking," and not only would it be dangerous for a baby to nurse after the mother's having drunk that amount, it's not healthy for the mom either. As with so much in life, moderation is the key. While you're nursing it's best to be extra-moderate.

 

Is there a best age for weaning?

The American Academy of Pediatrics recommends nursing for at least a year and as long thereafter as mother and child want to continue. Both the World Health Organization and UNICEF recommend breastfeeding for at least two years. However, even if you cannot or do not want to nurse for many months, whatever breastfeeding you do offer your baby will go far to provide a good start in life.

 

During the first couple of days after birth, infants get the immunological advantages of colostrum, and they continue to receive immunological benefits from breast milk at least through the toddler years. During about the first six months, babies can usually satisfy all their nutritional needs from breast milk; at some time after this the combination of breast milk and various other foods will provide their essential nutrients. By nine months they usually have enough teeth and the intestinal maturity to handle a wide variety of foods. They are still, of course, dependent on their parents for many of the essentials of life, but from a nutritional aspect, they need no longer be dependent solely on their mothers' milk.

 

The emotional benefits that a mother and child derive from breastfeeding are just as valid, however, at two months, six months, nine months, one year, or later. If you want to continue nursing for emotional reasons rather than nutritional ones, there's no need to stop at any specified time.

 

But what if you decide, for one reason or another, to stop nursing before six months? Even if you have nursed only a few weeks and you have to, or want to, stop breastfeeding, you are still a successful nursing mother. You have given your baby a good start in life and you yourself have known the special joy of the nursing relationship. Any breastfeeding is better than none at all.