Lactation management session dwells on the intricacies of breastfeeding

“The one question I dread to ask any pregnant woman today is ‘How are you?,” were South India’s first certified breastfeeding counsellor Rekha Sudarsan’s opening remarks at the ‘lactation management session at Annal Gandhi Memorial Government Hospital. “They have so many fears that they forget to enjoy pregnancy and motherhood,” she said emphasising pregnancy is not a disease.

Addressing an audience comprising primarily of nurses, Ms.Rekha said, “It is the responsibility of nurses to ensure when a mother is discharged from hospital, she is happy about breastfeeding.” Though breastfeeding must be initiated within the first hour of birth, the initial hours should not be spent in teaching techniques but in allowing the mother and baby get used to each other first.

While exclusive breastfeeding for six months is reiterated, water, jaggery syrup and formula food, a strict no-no, is still slipped in by parents and grandmothers, she noted.

Dubbing it as a ‘miracle liquid’, she noted analysis of breast milk of various mothers has revealed that each mother’s milk adapts to the infant’s needs.

The milk has immunological, development and nutritional powers, a reason why it in necessary to give expressed breast milk for preterm babies that are too weak to feed directly. Breastfeeding is a supply-demand phenomenon. If a woman does not feed for the initial few days, the milk may revert back, she warned. Production is induced by stimulus, which is created by suckling of the infant.

Too much or too less?

Most mothers are worried that the quantity of milk is too much or too less for the baby. An infant has a stomach that is 1.5 cm in size on the day of birth requiring hardly 25-30 ml in the first few days. But eight to 12 feeds are mandatory as the infant passes urine frequently, which should ideally be seven to 10 times day. “Some mothers are happy in the case of 20 wet nappies a day, interpreting it as a sign of good feeding and are befuddled when there is no weight gain,” she stated. This is attributed to imbalance between foremilk, (the initial milk secreted while feeding) and hind milk (the latter part). The former is watery while the latter contains fats and proteins. A child that suckles only for 10 minutes on each breast contrary to required 20-25 minutes will get only the foremilk. Such children may get hungry every 45 minutes and urinate frequently.

‘Go by baby, not by clock’

“Never wake a sleeping baby for feeding. In the first 10 days, go by the baby and not by the clock,” recommended Ms. Rekha. Possible indications for feeding are when a baby cries, sucks knuckles, gapes the mouth, or displays signs of discomfort. But if a baby falls asleep while feeding, the mother can take a couple of deep breaths to restart feeding. Baby’s ear, shoulder and hip should be aligned in a straight line while feeding; one hand should hold the baby and the other hand support the breast.

D.Saminathan, head, department of paediatrics, Muthukumar, president, Indian Academy of Paediatrics, Tamil Nadu chapter, Hemalatha David, president, Tiruchi branch spoke.