It is recommended to breastfeed for two years and beyond with the addition of complementary foods. This standard is endorsed by the general medical community. However, as mentioned earlier, any breastfeeding is beneficial to the infant, and the baby doesn’t need any other additional food for the first 4-6 months of life. The medical community does recommend a Vitamin D supplement to be given to breastfeeding babies. There is no need to give additional water, and solids should not be introduced until 4-6 months, preferably six months. This is because the newborn gut will be able to handle the introduction of solids at this point. Any earlier can increase the risk of an allergic response in the infant.
Even if you have had difficulty in the past, breastfeeding can be successful with the next infant. The first week of postpartum is a critical period for establishing a good supply and a good latch. Maximum support from nursing staff, lactation consultants, and well-informed peers/family can be crucial in getting mom and baby off to a good start. Bottle feeding breastmilk can be introduced at any time, but it is recommended to wait until breastfeeding is well established which is usually around six weeks. Any sooner and the baby may have difficulty with latching as the baby suckles differently on the bottle than the breast. Some infants have no problem with both breast and bottle, but mom should be well informed of the risks of introducing bottles too early as well as soothers. Using the formula is a risk with the main concern that it can predispose the infant to allergic reactions as it is a foreign protein.
The healthy, full-term normal infant doesn’t require supplementation and can learn to breastfeed in the early days without intervention. The mom needs to know the required output (pees and bowel movements) expected to evaluate how the baby is doing. The baby should be attempting the breast 8-14 times in 24 hours, and skin to skin contact is one of the best ways to promote breastfeeding. It is a common misconception that moms who have small breasts cannot breastfeed. The mom may need to feed more often as the “storage container” may not be that large but it doesn’t have an impact on supply itself. Only if the mom has marked abnormal breast growth, then she should consult a specialist to see if this may impact on her ability to produce milk. Mom should have noticed tenderness in her breasts early in pregnancy and should have increased in size over the course of her pregnancy.
Another concern is the shape or eversion of the nipples. Nipples come in all sizes and, can be flat, inverted or protracted. One nipple can be completely different from the other on the same woman. Most nipples will evert over the course of the pregnancy, and with the addition of latching or pumping, will be fine for breastfeeding. A truly inverted nipple can cause a more difficult time with latching but by no means, is it impossible. Seek assistance from an LC if this is your case. It is important to remember that the baby doesn’t latch on the nipple but instead, should have the nipple to the posterior of its mouth and should be latched on to the areola. If latching correctly mom may feel initial latch-on pain, but it should not continue through the feed. Simple positioning techniques can aid a mom to get a better latch which will ensure an adequate supply and a well-nourished infant. Sometimes lactation consultants institute aids such as nipple shields to assist with the latch, especially with a premature infant who may be at the breast. These are specialized tools that should only be used with qualified assistance.
Sometimes a mom may have a difficult birth, a baby may have complications, or other untoward events may lead to separation of mom and baby. It is absolutely critical for mom to start pumping her breasts (or do manual expression). As soon as it’s possible to establish the mother’s supply, we generally suggest double pumping with a hospital grade electric pump for 15-20 minutes every three hours. Mom may not even get any milk at first but it is the stimulation to the breasts that will encourage a good milk supply. Anything mom gets, even droplets can be fed to the infant, the sooner the better. If mom has a cesarean section, she should be able to breastfeed in the recovery room if all is well. The standard is to allow the baby to go skin to skin until the first feed occurs and many hospitals are trying to provide the opportunity for moms to have these first moments with their newborn. Mom’s need to be given correct information on pumping, directions to places she can rent or purchase a pump, and proper pumping and storage guidelines. Any milk should be given to the infant as soon as possible.