April
van Oers
obstetric - specialisations - lactation consultant - preconception care
Choosing food for the baby
Breastfeeding
Breastfeeding is chosen by most mothers as their baby’s first food. Your body is already preparing for this during your pregnancy.
Why breastfeed?
Breastfeeding is the best nutrition for your baby because its composition is different every day, tailored exactly to what your child needs. It protects your baby from diseases and it helps you recover after giving birth. Breastfeeding can be difficult or get used to in the beginning. Good guidance is then very important, so that your breastfeeding quickly runs smoothly and this is nice for you and your baby.
How does breastfeeding work?
Immediately after birth, the baby is usually very alert and awake. In this hour the baby’s reflexes are strong and the baby will also fanatically search for food (sucking reflex). This manifests itself by moving its head adrift until its mouth encounters something it can suck on. These are often (coincidentally) the baby’s own fists or the finger of mom or dad. However, if the baby is placed near the breast during that search, he will also be able (sometimes with a little help) to find the mother’s nipple and areola and automatically start sucking on these. How you can help the baby with this, you can read further on.
This quick latching on ensures that the right hormones are immediately stimulated. While the baby is already sucking the first bits of colostrum (first milk) from the breast, new milk is being produced and oxytocin is already pushing the rest of the colostrum into the reservoirs. The baby automatically adapts to this process by first making quick, short sucking movements for a few minutes and only then making long deep strokes when sucking. The rapid movements stimulate the baby’s production of oxytocin, which triggers the letdown reflex. The milk shoots forward where it fills the reservoirs. The baby senses there is milk and sucks it out with slow deep breaths. The slow pulls increase prolactin production, which ultimately results in more milk being made.
- While drinking, the baby will drink for a while, but will also take a break each time. This is part of a normal drinking pattern and allows the empty milk reservoirs under the nipple to fill up again and again with a new amount of milk. Instinctively, the baby knows that this pattern is the most energy-efficient.
The baby drank well and long from the breasts immediately after birth. So we now know that the technique is familiar to the baby and that the production of milk is increased right away.
- Important to keep sending signals that production may go up.
- Some babies self-report regularly (sometimes every hour) that they are hungry and then “search” for food. If they don’t do this, it does make sense to wake the baby up every two hours during the day and try to get them to drink at the breast.
- If latching on does not work, handpump and give the colostrum on a spoon to the baby. The more prolactin will be produced and thus milk.
- In these days, the small bits of colostrum are more than enough for the baby to maintain his fluids and energy, if he gets them frequently enough.
After a few days (for a first child usually after about four days, for subsequent children it may be earlier) this system begins to bear fruit.
- The mother notices that milk production is well underway because her breasts get bigger and feel tense. This is called congestion and is therefore a good sign. Some women experience this for two days, but others don’t notice much because the baby can keep up with production by emptying the breast. Explanations and tips are also found further down.
- After weaning, a (calmer) schedule in breastfeeding often comes slowly. You just continue feeding on demand, but if your baby doesn’t report, it’s okay to leave him for four hours for a feeding.
- Before that, you were sometimes getting to 10 or 12 feedings per 24 hours, now your child is moving to a schedule of about 7 feedings.
Regulation Days
The principle of supply and demand will rebalance a few more times. About two weeks after delivery, but also after six weeks, three and six months, you may experience regulation days. These are days when you notice that milk production is not enough for the baby’s demand. The baby will want to eat often and for a long time and will be restless.
- Especially during these times, feeding on demand is so important. Even if your baby wants to eat after an hour, it is important to put him/her on. Production continues continuously, so after an hour there will already be some milk ready.
- However, what is even more important from this much docking is that lots of signals are passed on, so prolactin and milk production are going to be greatly increased.
These days take a lot of energy from you, especially since rest/eating/drinking are prerequisites for your milk production, but the balance in production and need of milk will be restored after two days. Take some rest. What you should keep in mind, however, is that although you may/should put the baby on often, after about 20- 25 minutes a breast has lost the largest amount of milk and you should then take the baby off the breast. It is then better to put him/her on the other breast again.
Breastfeeding roadmap
Docking your baby when breastfeeding
Docking starts with getting used to each other. You and baby lie against each other, recognize each other’s smell and touch each other. After being born, the baby will settle down in your arms and build a bond with you by using all the senses.
Put your baby on
Good hygiene
Good hygiene is very important when breastfeeding. Both the mother’s breasts and nipples and the baby itself are susceptible to bacteria or fungi.
- So wash your hands thoroughly before each breastfeeding, especially after changing your baby for the first time. (Bring along disinfectant hand gel for on the go).
- Wash your breasts only with water and also do not use cream with fragrances. For your baby, your own scent is very important.
A comfortable posture
First, it is important to lie/sit in a comfortable position. Especially if you are breastfeeding for the first time, overview is important. Moreover, a child drinks often and sometimes for a long 5/20 to 30 minutes and your muscles will get sore if you lie in an uncomfortable position all that time. After delivery, the side position is usually the most comfortable and relaxed position. Make sure you turn all the way over on your side, use a pillow in your back if necessary and definitely a pillow between your knees. Your head is supported by one or more pillows, but your shoulder and arms are “free.”
Baby's posture
Now put the baby in the right position against you.
- This position for the baby is the same as your own.
- The baby should always lie with its belly against your belly, so that it does not have to turn its head to reach the nipple.
- Your baby’s back and head form a straight line, so the baby also lies on its side when you lie on your side.
- Your arm that is underneath puts around the baby. This arm has the child’s head in the elbow crease and supports the baby’s back up to the buttocks.
Docking your baby
- The baby lies with its nose exactly at the level of the nipple.
- With the other hand, at the base of the chest, the breast is grasped. The thumb rests on top of the breast, the fingers support the breast from the bottom. Be careful not to grasp too close to the nipple, as that is where you are exactly pressing on the reservoirs and can close off the influx of milk.
- The hand supporting the breast directs it so that the nipple strokes the baby’s cheek and lips. With this touch, the search reflex is activated and the baby will turn and open the mouth to the touch.
It is important that the child opens the mouth far, because when sucking on the breast properly, the child has not only the nipple but also a large piece of areola in the mouth.
Well laid out?
- When you see your baby take a big bite, gently pull your whole baby, with the arm behind his back, toward the breast.
- It is not good to push the breast into the baby’s mouth, nor is it nice to force the baby’s head to the breast.
- You bring your baby close to the breast whole with a gentle movement so that the baby can latch on by himself.
- The baby feels the nipple against his palate and will start sucking.
You can see that the baby has a whole piece of the breast in its mouth. This pulls in a little bit at a time. When your baby has a good hold of the breast, both his lips curl outward. Check this every time you are in doubt. Especially the lower lip sometimes gets sucked in. Moreover, when a baby is latching on well, you can see the tongue slide over the bottom of the breast.
Is the nose clear?
If you have your child’s tummy against your own, there is no need to keep his/her nose clear. If your child does have trouble breathing through the nose, it is better to try to pull the tummy even more against you, so that the baby’s head is at a different angle to your chest. In fact, by denting the breast you can push the reservoirs closed again.
Vacuum
A child who grasps the breast properly will pull this vacuum. So you shouldn’t be able to hear any big smacking noises indicating that the baby is sucking air along. Because of this vacuum, breastfeeding children also tend to have fewer cramps and do not always need to burp after eating.
Taking your baby off the breast
If you want to take your child off the breast, you must first break the vacuum in the mouth, otherwise there will be a lot of pulling on your nipple. This in turn can cause cracking and/or pain. You break the vacuum by inserting a (clean) little finger into the corner of the baby’s mouth/cheek until you feel the baby let go.
Proper latching important for mother and child
Latching may be painful for the first 10 seconds. When a baby is positioned properly at the breast, this feeling will subside. Also, with good latching, you are less likely to get nipple fissures. Does it still hurt or do you think the baby only has the nipple in its mouth or does not have a good drinking position? Then take him/her off the breast and lay again. If you continue feeding when a child is latching on incorrectly, you will quickly have nipple fissures because the nipple will rub against the baby’s hard palate (when drinking properly, the nipple comes all the way up to the soft palate). Moreover, the baby has to suck much harder if he or she is not drinking properly and this force (on the vulnerable sides of the nipple) will also be able to cause fissures and he/she will also get less milk.
Breastfeeding education and/or counseling
Want to learn more about breastfeeding, need guidance, or want to rent a pump contact lactation consultant Ruth Adriaansensns or or April van Oers. Or come to our breastfeeding education session.
Anatomy and function of breasts
Breasts are made up of milk glands, fatty tissue and connective tissue. The amount of fat and connective tissue in a breast determine its shape and size. Thus, the appearance of a breast is not affected by the mammary glands and thus does not affect the amount and quality of breastfeeding. The mammary glands all eventually end up in the nipple where they have their exits. Surrounding the nipple is a dark ring: the areola. On the areola, you can find glands (sometimes clearly visible as bumps) that secrete fat, protecting your nipple from the outside environment. Surrounding the milk glands and their drainage tubes are small muscles that can propel milk to the nipple. Each mammary gland can expand to contain a certain amount of milk.
Breasts during pregnancy
- In pregnancy, more mammary glands appear and the existing glands become larger. Therefore, the breasts themselves also grow larger.
- The nipple becomes larger and more erect.
- The nipple and areola become darker in color.
- As early as pregnancy, yellowish, watery milk is made, sometimes already leaking from the breast. This milk is called colostrum and is the milk the baby ingests during the first few days.
Hormones in breastfeeding
Two hormones are important in breastfeeding:
- Prolactin: First of all, the hormone prolactin. This hormone is produced in greater quantities after childbirth as the pregnancy hormone estrogen decreases. Prolactin triggers milk production. The more prolactin, the more milk is made.
- Oxytocin: The second important hormone is oxytocin. This hormone is also found in men, but is produced in women when the nerves in the breast are stimulated, such as when sucking on the breast. Oxytocin causes the muscles around the mammary glands to contract, pushing milk into the milk reservoirs. This movement is called the letdown reflex and causes the milk to lie just below the nipple ready for the baby to suck from the breast.
- The production of oxytocin can be influenced psychologically. If the mother is tired, anxious or stressed, for example, less oxytocin is produced. This can stop the letdown reflex, causing milk to remain in the back of the breast.
- By the way, oxytocin is also the hormone produced during childbirth that also causes the muscles of the uterus to contract(contractions).
- After childbirth, it not only causes the muscles in the breast to contract, but also still causes the uterus to contract. This can be felt as “aftereffects.” These contractions cause the woman to lose less blood and the uterus to return to its original size and location more quickly, and thus recover faster.
- Oxytocin is also the hormone you produce when you are in love. You feel connected to the other person. It makes you feel relaxed, sometimes even a little sleepy, and it makes you produce fewer stress hormones, which makes you feel better about yourself.
Prolactin is also produced when the nerves in the breast are stimulated. The more stimulation, the more prolactin.
- Stimulation of these nerves is done by suckling at the breast, as well as by pumping by hand or with a pump.
- The greatest release of prolactin occurs about half an hour after the start of a feeding.
- If that breast is stimulated again within three hours, it will only produce more prolactin and thus more milk.
- However, if the breast has not been stimulated after four hours, an inhibitory substance (PIF) will inhibit the production and release of prolactin and milk production will be reduced. Together, these two substances eventually balance milk production.
If there is not enough milk for the baby (yet), the baby will want to drink often (hunger) and frequent stimulation increases prolactin and milk production. If there is a lot of milk, the baby will only report back for a feeding after about four hours and PIF will cause milk production to decrease a bit. However, achieving such a balance may take up to 2 or 3 weeks.
The person behind care
Ruth
Adriaansens
lactation consultant - healthcare partner of 040verloskunde
Collaborative partners breastfeeding 040verloskunde
Breastfeeding is the most natural nutrition. It is better adapted to a baby's specific needs. Moreover, it is always ready to use, free and environmentally friendly. Breastfeeding reduces your baby's risk of gastrointestinal infections, infectious diseases and allergic disorders. In the long run, breastfed children also have a lower risk of obesity and asthma, and they are sick less often. Breastfeeding is also healthy for mothers. The bond between you and your baby is closer and you recover more smoothly from childbirth. Breastfeeding lowers the risk of heart disease and type 2 diabetes for the rest of your life. Every extra month you breastfeed also lowers your risk of a number of cancers, including breast, ovarian and uterine cancers.
What food you feed your baby is an important choice. Not only for development, but also for the health of you and your baby. You can choose between breastfeeding or powdered milk (formula/bottle feeding). Our practice encourages breastfeeding, but your freedom of choice is very important. If (full) breastfeeding is not an option - for whatever reason - we will of course respect this. You will always get the information, guidance and support you need. If you would like to have a personal conversation with a breastfeeding consultant, please make an appointment at our breastfeeding consultation hour.