BREASTFEEDING ABC

A

ANATOMY

1. During pregnancy, the mammary gland tissue increases, and the breasts become fuller
2. Milk is made in the mammary glands
3. Around the mammary glands, muscle cells contract so that the milk comes out
4. The milk channels transport the milk.
5. The nipple has an average of nine tiny holes through which the milk can escape.
6. The areola is the dark-coloured skin around the nipple.
7. The Montgomery glands secrete sebum to keep the nipple and areola supple.

B

BENEFITS OF BREASTFEEDING

The main advantage of breastfeeding is that it is the most advanced nutrition available for your child.

• Breast milk contains antibodies against diseases. As a result, breastfed babies are better protected against diarrhoea, inflammation of the respiratory tract, ears, urinary tract and meninges, among other things.
• Breast milk contains the body’s own fatty acids DHA, which contribute to the development of the baby’s brain.
• For a child with an allergic disposition, breast milk is certainly preferable. The symptoms will be milder and often manifest later.
• Breast milk is a body’s own food, fresh and easily digestible and is fully absorbed by the intestines. Therefore babies rarely suffer from constipation and spit less.
• Drinking at the breast stimulates a good jaw development and determines the development of the face and the position of the teeth.
• Breast milk is readily available, always at the right temperature and of the right composition.
• Breastfeeding not only gives the baby food but also direct body contact and attention from the mother.
• Breastfed children are hospitalised five times less during the first year of life.
• Breast milk has a protective effect against cot death, diabetes mellitus, chronic intestinal diseases, allergies, metabolic diseases, etc.
• Reduced risk of obesity.
• Prevention of food allergy (at least six months excluding breastfeeding).

BOTH BREASTS

When breastfeeding, try to give both breasts in the beginning. This stimulates the milk production. Make sure the first breast is drunk smoothly before offering the second breast. Keep in mind that the breast is never “empty” but observe whether your baby is still feeding effectively and change breasts if this is no longer the case. If you find that you have too much milk, switch to one breast per feed. Your will baby indicate whether it has drunk enough. If this is the case, he will stop sucking, fall asleep, or turn his head away. Once it has normalized, you can go back to giving both breasts again

C

CESAREAN SECTION

Even after a caesarean section you can breastfeed your baby, but it sometimes takes a little more time to get the hang of feeding. It is different from a natural delivery. A caesarean section is major abdominal surgery. As a result, you are usually less mobile and need more help with latching your baby on.Therefore, it may be the case that your milk production starts a little later. If latching on is difficult because you cannot sit properly yet, you can pump milk temporarily. Another problem after a caesarean section is that babies can often lose a lot of weight in a day, which makes them feel a bit weak and not drink well. If you start breastfeeding late, the baby will often need a longer supplement before recovering. To initiate or maintain milk production, you can express the supplementary feed until production is sufficient. Ask for extra help if you are unsure whether things are going well. Ask if there is a lactation consultant in the hospital.

CLUSTER

In the morning or evening hours, your child may want to breastfeed four or five times in quick succession. This does not mean that you do not have enough milk and certainly does not mean that you have to supplement. By “clustering” the baby arranges a nice fatty meal for itself. It works as follows: if you haven’t fed for a while, your breasts are full of less fat “storage milk”. If there are hardly any reserves left in the breast, you can produce fat milk on the spot. In this case the baby uses up your reserves and then sleeps through for a few hours.

COLOSTRUM

In the first phase, the breast milk that is fed to the baby is called colostrum, this lasts a few days. Colostrum contains important antibodies that the baby needs after passing through the birth canal, where he has come into contact with pathogenic bacteria. Colostrum provides a protective layer over the intestinal wall (coating), and has a laxative effect, so the baby produces stool faster.

Colour of breast milk

Breastmilk can take on many different colours and forms; pink, yellow, green and blueish milk, or watery as opposed to creamy, it all occurs. Sometimes this is caused by what you have eaten. Nevertheless, breastfeeding is the best source of nutrition for your child because it always contains exactly what they need. Crying A child who is hungry will make smacking sounds or chew on their hands, these are the first feeding signals. Crying is actually a baby’s last feeding signal. Crying does not always mean that your baby is hungry. Many visitors, too many stimuli or just tiredness are other reasons for crying. Breastfeeding has a comforting effect on many babies.

F

FIRST HOUR AFTER BIRTH

After the baby is born, it won’t be long before the baby will start looking for the breast. During the first two hours after birth, the baby is very alert, and their reflexes are optimal. Latching on the baby during these hours ensures that the sucking behavior in the baby is “imprinted” in their system, which makes latching on during the sleepy hours easier.

H

HUNGER SIGNALS

The first days after birth you will mainly see that your baby makes “bite movements”, your baby starts making smacking sounds or will start looking for their hands. Newborns still have their eyes closed and are not likely to cry. These signals are hunger signals that are less obvious and can go unnoticed. Therefore, it is important to keep your baby in your room in the beginning, or else you might miss their signals. The faster you latch your baby on, the better the reflexes will work and the easier it will be. After about four days, your baby will increasingly wake up on their own before each feeding. Some babies will start sucking on their hands, but there are also those who immediately start crying. Babies differ in their nature: some babies roar at the first hunger signal, others take their time to wake up.

HINDMILK (AND fOREMILK)

The first milk to come out of the breast is called foremilk. This milk has a somewhat lower fat content and mainly helps against thirst. When the weather is warm, your baby will probably want to drink more frequently to quench his thirst. The milk poured after the foremilk, has a slightly higher fat content and more calories. This is referred to as hindmilk. Due to the higher fat content, hindmilk saturates more. That is why it is good to let your baby drink one breast until it loosens itself or is no longer feeding effectively. That way you know that he has also consumed enough of the fattier calorie-rich hindmilk. Thereafter you can also give the second breast for as long as it wants.

I

INTESTINAL cramps (colic)

Intestinal cramps (colic) occur in children who are breastfed as well as in children who are not. The cause is not entirely clear, but it is likely that this is due to the immaturity of the intestines. There is a tendency to attribute colic in breastfed babies to what the mother eats; cabbage, onions, garlic, orange juice, chocolate and spicy herbs are said to be the worst culprits. Until now, this relationship has never been scientifically proven. If you still feel that your child is responding to your diet, it is a matter of trying out different diets and seeing how your baby responds. After about three months, most children no longer suffer from colic, because the intestines have developed further.

L

LACTATION CONSULTANT

The lactation consultant is an expert in the field of breastfeeding, especially in special situations. If you want to know whether your insurance reimburses a consultation with the lactation consultant, please visit the NVL website www.nvl.borstvoeding.nl. This website tells you where you can find a lactation consultant is in your area, and how a consultation works. Some health insurers reimburse (part of) the consultation, depending on your insurance policy.

LATCHING ON

• Make sure you are sitting or lying comfortably so that the baby is at the correct height in front of you with the nipple just below the baby’s nose at rest. If necessary, use extra sturdy pillows in which you and your baby do not sink into. • When your baby is in front of you and he feels the breast, he will respond by looking for the breast (search reflex). • When the nipple touches your baby’s top lip, it opens its mouth wide. His lips curl out and sometimes you can see him sticking his tongue out. Then you pull your baby towards you. His chin lies against the chest and the nostrils are free. The tip of their nose often touches your chest, but because the nostrils are more to the side, your baby can still breathe. If the nose is not really free, you can pull your baby towards you with his buttocks so that his head is slightly tilted back, giving their nostrils more space. You can offer the breast by supporting the breast with your fingers and putting your thumb on top. Make sure your fingers are not too close to the areola so that your child has plenty of room to take a big bite (like taking a bite from a hamburger). Let-down REFLEX The let-down reflex starts when the baby sucks into the nipple at nerve endings and the areola is stimulated. A signal is sent via the nerves to the hypothalamus in the brain. The hypothalamus sends a signal to the pituitary gland, releasing two hormones, prolactin and oxytocin. Prolactin takes care of the milk production and oxytocin causes muscle cells in the breast to contract, making the milk flow better. The milk is now ready in the breast, under the areola, and the baby can drink. Some mothers already get a reflex when the baby starts crying because it is hungry. It can also happen that a feeding reflex occurs when a baby other than their own baby cries. A mother may become restless from this crying because she instinctively feels the urge to latch-on her baby. Heat (for example in the shower) can also cause a spectral reflex. Finally, the let-down reflex can occur after an orgasm because oxytocin is also released during an orgasm. Some women, however, have difficulty in getting an let-down reflex during pumping. In order to get an let-down reflex during pumping, certain remedies can be used, such as: massage and warmth. If these remedies do not help, a nasal spray with oxytocin can be a useful tool.

M

MILK PRODUCTION

Breastfeeding is initiated by stimulating the breasts. You do this by latching your baby on, or by pumping regulary. The more often you breastfeed, the more milk you produce. Since this requires a lot of effort, it is important that it works for you, and not the other way around. Sufficient rest is the best way to keep your milk flowing. Your partner, family and maternity nurse have – especially in the beginning – an important task to pamper you. Sleep where you can and keep your baby with you. That is also allowed skin-to-skin. That stimulates your baby’s reflexes. Research even shows that babies with a lot of body contact grow faster. Your partner can of course also hold your baby against themselves. If your baby cannot breastfeed on the first day, it is recommended to start pumping early. In this case, rent a professional electric pump. The sooner you start, the faster you will produce enough milk. The milk you produce in the first days after giving birth – colostrum – is very rich in antibodies and nutrients. Pumping just a little bit a day is enough. The most important thing is that your baby drinks your milk as soon as possible, feeding directly from the breast is something your baby can learn later.

N

NIGHT FEED

Feeding at night is normal,irrespective whether bottle or breast, it’s just part of it. When babies grow well, there will be a longer time period between feeds. Try to have an afternoon nap during the day. Breastfeeding is teamwork, so if you find it very tiring, you can also pump small amounts during the day and have your partner give a bottle of expressed milk at night. If you want to start pumping milk, it is recommended you consult an expert on doing so.

Nipple Confusion

In the Western world, the concept of nipple confusion has been around for a long time. The idea is that the technique of sucking on the nipple is so different that once the baby has had a bottle, the baby no longer knows how to suck on the breast. The baby grabs the breast in his mouth but doesn’t start drinking or pushes the nipple out of his mouth with his tongue and gets frustrated. The idea of nipple confusion is not based on scientific research. Such research is too difficult to carry out. However, many other ways of supplementary feeding have been introduced over the last ten years, such as the cup and syringe. The advice is not to start with the bottle or dummy until the baby is drinking the breast without any problems.

NUTRITIONAL SYRINGE

Another way to supplement is through the feeding syringe. Before offering the syringe, let the baby suck on the index finger so baby has to suck before the milk comes, just like with the breast. Most babies empty the syringe themselves without you having to press the syringe. In principle, supplementation is not necessary for a healthy baby with sufficient weight. Together with the midwife, the maternity nurse keeps a close eye on the fluid balance of the baby and if necessary, advice is given to supplement. “Old wives’ tales” Brown beer, fennel, cashews and caraway are said to stimulate breastfeeding. Aniseed is also said to be good for breastfeeding, hence the tradition of eating rusk with mice: the mice are aniseed with a layer of glaze. These are all supposedly true home remedies, of which the effects have never been scientifically proven. Incidentally, fennel has not been shown to be harmless, so be careful with it. The same goes for beer, of course. Latching on well, often and long enough is still the best basis for good milk production.

O

OXYTOCIN

The pituitary gland produces two hormones that are essential for breastfeeding: oxytocin and prolactin. The hormone oxytocin causes the muscles around the milk-producing cells to contract with force. This allows the milk to flow through the milk ducts to the nipple and into the baby’s mouth. Oxytocin also contracts the uterus. In addition, oxytocin gives a somewhat lethargic feeling, which relaxes the mother.

P

PACIFIER

Wait with a giving your child a pacifier until they are well above birth weight and you can recognize their hunger signals. By doing so, you don’t run the risk of “tricking” a hungry baby, resulting in your child getting too little nutrition.

PAIN DURING breastFEEDING

In the beginning, the nipples can be sensitive when first latching on, but breastfeeding should not hurt. If this is the case, take the baby off the breast and try again. Ask for help from a lactation consultant if breastfeeding continues to hurt.

PARTNER

Fathers play a decisive role in choosing to breastfeed your baby. Both emotional support and practical help contribute to a longer and more successful breastfeeding period. Much research has been done into the role of the father. It turns out that if the father is positive about breastfeeding, 98 percent of women start breastfeeding. If the father shows no interest, only 27 percent of mothers choose it. It is surprising that many women are actually not quite sure what their partner thinks about breastfeeding. Research shows that fathers are generally more positive about breastfeeding than expectant mothers. This is why it is important to discuss the choice of breastfeeding together. Other research shows that prenatal information about breastfeeding in groups has a positive effect. If the father is better informed, he will be able to support his wife more.

PROLACTIN

The hormone prolactin is especially important for milk production in the first period after childbirth. After the first period, the prolactin level decreases, while milk production increases. The more often the child drinks well at the breast, the greater the milk production. It’s a simple matter of supply and demand. The hormone prolactin is produced at night, which is why newborn babies want to drink often at night. Prolactin actually stimulates the initiation of breastfeeding. Once mothers know that latching at night has a purpose in the beginning, and that it has nothing to do with insufficient milk, it turns out to be no problem for them.

Pumping Milk

• A manual breast pump is suitable for occasional pumping and can be a useful tool for flat or inverted nipples. • A single-sided electric pump is especially useful if you are going to work for one or two days, or if you want to stock up on reserves. • A double electric pump is most suitable if you are going back to working your regular hours. • A double electric rental pump is recommended if breastfeeding problems arise during childbirth, for example to start your milk production. Especially in those first days, it is important that your milk production gets going and a good pump proves its worth. A pump must make sufficient suction movements per minute and have sufficient suction power. The rental pump is increasingly reimbursed by health insurers in an additional insurance policy. • A hospital pump is a double-sided electric pump. If premature babies are not yet able to breastfeed on their own, the mother will start pumping soon after delivery. The hospital pump is usually the same as a rental double electric pump. You only have to buy your personal pump set in the hospital. They are available in every hospital. Always choose the pump that you feel most comfortable with, because those work best. There are several pump-manufacturers who offer different shell sizes, so you can find a good “match” (fit).

R

REFLEXES

In order to be able to drink at the breast, the baby uses three innate reflexes: searching, sucking and swallowing. The baby must have room to move his head and look for the breast. When he feels the nipple against his lips, he will open his mouth. The mother waits for the baby to open its mouth wide and then pulls it closer. By touching the nipple, in the mouth and against the baby’s palate, the release of the hormone oxytocin is stimulated, causing the milk to run. The muscles around the mammary glands contract and the milk flows through the milk ducts to the nipple in the baby’s mouth: the let-down reflex When milk enters the baby’s mouth, it starts to swallow by itself. Not only the sucking of the baby, but also the mother’s state of mind can influence the feeding reflex. When she thinks of the baby, for example, the milk may start to flow spontaneously. On the other hand, pain, stress or cold can temporarily make the supply reflex less effective.

REGULAR DAYS

It can happen that your baby suddenly wants to drink very often: the so-called regulation days. If you just keep feeding on demand, your breasts will automatically produce more milk: the principle of supply and demand. The amount of milk automatically adjusts to your baby’s needs. After these so-called regulation days, your baby will return to a rhythm. You shouldn’t be surprised if this rhythm isn’t the same as it was before the regulation days. If you feed your baby on request, you may not even notice the regulation days.

S

SECOND-HAND Pumps

Although a second-hand pump seems more attractive in price, purchasing it is not recommended by many lactation consultants. This is because you do not know exactly how many hours the pump was used by the previous owner, there is a chance that the pump you just purchased will suffer from “engine fatigue”. As a result, although you pump often and for a long time, your production will decline. Also, from a hygienic point of view, buying a second-hand pump is often discouraged.

SKIN TO SKIN CONTACT

Skin-to-skin contact is important to start breastfeeding. In the first hour after delivery, your child is very awake and alert, which is precisely when you have to use their innate reflexes. Touch and smell play a major role. There are glands in the areola that emit a certain odor, which the baby relies on. During your pregnancy, the areola has also darkened, so your baby can see where to go. A child needs about an hour to reach the breast themselves, sometimes a little more. Other benefits of skin-to-skin contact are: • Skin-to-skin contact helps your baby with keeping its body at the right temperature. • When your baby is lying on your breast, you release the hormone oxytocin, which gives you a relaxed feeling. • The baby will feel more relaxed and cry less when there is skin-to-skin contant compared to when they are lying in bed separately.

Storing breast MILK

Breast milk can be kept for a maximum of 5 days in the refrigerator (in the back). In the freezer for a maximum of 2 weeks and in a three-star freezer at – 18 ° C for a maximum of 6 months. Breast milk is heated in a bottle warmer or “au bain-marie”. Heating the milk in the microwave is also a possibility, but is not preferred, because when heated in the microwave, living cells and protective antibodies in the breast milk are lost. The milk does not need to be heated, because the milk that comes directly from the breasts is lukewarm.

Sufficient Milk

When breastfeeding, it is not possible to exactly see how much milk your baby is receiving. Some parents become insecure about this. Especially when they don’t know that it is normal for a baby to lose weight in the first few days. Weighing your baby before and after feeding is not recommended as it causes too much anxiety. Sometimes a child drinks less than usual, but that doesn’t mean anything at all. The most important thing is that you latch your baby on often and well and let him drink long enough. Also pay attention to your baby’s stool and urine in their diapers. During the first few days after birth, the baby’s stool is black (meconium), after which you will see a yellowish, mustard-like substance. At the end of the maternity week, the baby should require about four diapers a day. After about six weeks, the number of diapers used is often much lower. It is possible that a baby who is only breastfed only poops their diaper once every ten days. The first few days the baby hardly pees, but this too will increase from the third day to about six to seven wet diapers a day.

SUPPLY AND DEMAND

Supply is determined by demand, so it is important to build often in the beginning. Milk production then gets off to a good start due to the hormone prolactin, and you will benefit greatly from this in the long term. It is a good investment for the future. Nature has arranged it well: the first week after your baby is born you usually have more milk than your baby needs. In the beginning ‘supply and demand’ is not yet in balance. The first few days are unpredictable. Some children can signal that they want to breastfeed as often as 10 to 12 times per day. It also depends on your baby. If you’ve just had a ten-pounder, you’ll understand that it naturally wants to eat a little more. Try to feed as needed. Don’t pin yourself on feeding at regular intervals or every few hours. Few babies stick to that.

SUPPLY CUP

If supplementary feeding is required in the first week, it is safer to avoid the risk of nipple confusion by feeding with a cup. When the baby sits upright on mother’s lap, it is useful to briefly put the baby’s mowing hands in a wrap. A cup; a plastic medicine cup or special cup is placed against the baby’s bottom lip, with the cup touching the corners of the mouth. The cup should be half full and tilted so that the food touches the lower lip. The baby will respond to this by licking or sucking the food from the cup. The baby sets the pace.

SURROUNDINGS

Your environment may come up with well-intended advice and tips, which you will not always be happy to receive as a young parent. And usually everyone says something different. Keep in mind that every woman who has had a child feels like an expert in this field. Since the advice is given with nothing but good and sincere intentions, it is sometimes difficult to ignore such advice. Remember that every delivery is different, which also goes for breastfeeding. There are many different ways in which you can do the right thing for your baby. Take the time to find out which is also right for you.

T

TASTE OF BREAST MILK

Babies have their first taste experience in the womb. The amniotic fluid tastes like what the mother has eaten. Somewhere between the third and fifth month, the foetus begins to swallow amniotic fluid. After birth, a baby who is only breastfed will learn many different flavours. The taste of breast milk depends on what the mother has eaten, so it changes every time. This is why breastfed children switch more easily to other food after six months than artificially fed children. They are also more likely to accept new flavours when introducing solid food. Varied food is therefore not only healthy for pregnant women and breastfeeding women, but also has an extra benefit for the child.

TWINS

You can feed twins very well by yourself. Because the more often the breast is stimulated, the more milk is produced. So in principle it works in the same way as with a single child. For the mother it is only the art of applying structure. Otherwise breastfeeding can quickly become too much for the mother. In the beginning let the babies drink one after the other and not at the same time. Latching on takes time and attention. You have to get the hang of it. Make sure that your children don’t get the same breast all the time, because that way they develop a preferred posture and that’s not good for their motor development. It is also important to change your baby’s breast after every feeding because one baby may suck a little harder than the other. Milk production can also vary from breast to breast. When you’ve got the hang of it, you can, of course, also let the babies drink at the same time, each on a breast.