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The miracle of a baby is a very special time for a new mother. Carriwell specialises in uniquely designed products suited to a woman’s changing shape and needs through pregnancy and beyond. Focusing on today’s mom, Carriwell products offer extreme comfort and convenience whilst still allowing her to feel femininely beautiful...
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Comfortable and convenient breast feeding.
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Contents
What’s inside
The Your Pregnancy Better Breastfeeding Guide is packed with everything you need to know 6 A MOTHER’S GIFT Why breastfeeding is so important for both moms and babies
10 MILK: A PERFECT FOOD The nutrients in breastmilk, how it’s made and the anatomy of the breast
14 PREPARING FOR BREASTFEEDING Steps you can take to prepare for breastfeeding
20 YOUR FIRST FEED What is skin to skin? Latching, breastfeeding positions and more
26 THE FIRST SIX WEEKS Newborn hunger signs, feeding patterns and burping your baby BREASTFEEDING GUIDE 3
Contents 30 GETTING ENOUGH MILK? Follow baby’s cues to learn if they are satisfied
34 TAKING CARE OF MOM Eating well to feed well
38 EXPRESSING Different ways of expressing and storing
44 SOLUTIONS Overcome common problems
48 SEX & BREASTFEEDING How the changes in your body affect your sex life
50 HIV+ BREASTFEEDING Safe feeding
56 MYTHS BUSTED Common myths tackles
58 MOM’S Q&A Your questions answered
62 FEEDING CHARTS Keep track of your progress 4 YOUR PREGNANCY
Your Pregnancy Better Breastfeeding Guide is produced Media24. Editor Tsholofelo Modise Associate Editor Kerryn Massyn Deputy editor Jessica Blase Art director Debbie Farrell Contributors Sr Linda Britz, Sr Burgie Ireland, Dr Louise Gilbert, Margot Bertelsmann, Camilla Rankin Sales Zoë Smith, Brigitte Kolver Copyright subsists in all work published in this magazine. The magazine or any part thereof may not be reproduced or adapted without written pemission of the publishers. Failure to obtain permission constitutes an infringement of copyright and may constitute a criminal offence. Your Pregnancy welcomes material submitted for publication but retain the unrestricted right to edit any received copy. Your Pregnancy assumes no responsibilty to return unsolicited material. The opinions expressed are not considered those of the publishers who accept no liabilty of any nature arising out of or in connection with the contents of this magazine. While reasonable care has been taken to ensure the accuracy of advice given in this magazine, the editor and publisher cannot accept responsibilty for any loss, damage or inconvenience that may arise therefrom.
Ed’s Note From the minute you find out you’re expecting, you do everything you can to equip and prepare yourself for this exciting journey. In your mind, if you can get as much information as possible, you’re well on your way to becoming an amazing mom. What we often fail to realise is that there’s so much about motherhood you can only really learn through experience. Breastfeeding is one of those things. Until you’ve actually done it, you can’t know for sure what it feels like, if it works for you, if your body will cooperate, or even if your baby will take well to it. For many, it’s not as natural as most would like us to think. As with any new experience, what matters most is that you give it a fair shot. It takes some practice and getting used to, so be kind to yourself. Get the help you need. Speak to other moms – new and old – who have experience breastfeeding and enlist the services of a
professional. Your clinic sister, a lactation specialist or a knowledgeable La Leche League member are all invaluable sources of support. Our trusted lactation consultant Sister Linda Britz has, once more, been an integral part of producing this guide for you. We’re also grateful to Baby City for partnering with us again this year to produce The Better Breastfeeding Guide. Read the guide now then pack it into your baby bag before you go to the hospital – it will come in handy. Remember, breastmilk’s nutritional and healing properties are the best thing for your newborn. Congratulations and good luck!
BREASTFEEDING GUIDE 5
Mother’s Gift
BREAST IS BEST Breastfeeding is nature’s way of ensuring your baby gets the best nutritional start in life
Breastfeeding is one of the most natural and intimate of all human interactions. But just because it’s natural doesn’t mean it’s easy to do – especially in those first few overwhelming weeks with your newborn. Breastfeeding takes knowledge, practice and confidence. The best time to begin is right now, even before your baby is born. Start by finding out all you need to know about breastfeeding and how you can ensure it is a positive experience for you, your baby and your partner. This booklet is your one-stop resource for everything you need to know about breastfeeding, from understanding how milk is 6 YOUR PREGNANCY
made and getting it right from that very first feed. You’ll find advice and information on how to get the proper latch, what to eat while breastfeeding and how to tell if your baby is getting enough milk. You will also find tips and help on dealing with common breastfeeding challenges and getting the right help should you need it.
WHY IS BREASTMILK SO IMPORTANT? Breastmilk is perfectly designed for your baby. It’s a power-packed elixir that will not only give your baby all the nutrients required for proper growth and development, provide optimal health benefits, but it also contributes to your baby’s emotional development through the deep bond created between you and your baby.
THE PERFECT FOOD Breastmilk has just the right amount of water, protein, essential fats and healthy
Breastfeeding takes knowledge, practice and confidence BREASTFEEDING GUIDE 7
Mother’s Gift sugar to meet your baby’s specific nutritional requirements at any particular moment. It is a living fluid that changes and adjusts, just as your baby’s nutritional needs change. Your baby’s first milk is called colostrum. This milk is very rich in nutrients and antibodies to protect your newborn and also stimulate his immature digestive system to excrete meconium from his bowel. Within three or four days of delivery, your milk starts to change into mature milk, making sure that your baby gets exactly what he needs. Breastmilk is also easy to digest so that each nutrient counts and none is wasted.
HEALTH BOOST Your breastmilk is specially designed to support your baby’s immature immune system. Scientists have discovered close to 200 compounds in breastmilk that fight infection, help your baby’s immune system mature, 8 YOUR PREGNANCY
aid in digestion and support brain growth. At any given time your breastmilk is tailored to your baby’s needs, creating protection for your baby based on whatever germs or viruses you and you baby are exposed to. Yes, your body’s that clever! Breastfeeding’s protection against illness lasts beyond your baby’s breastfeeding stage, too. Studies have shown that breastfeeding can reduce a child’s risk of developing certain childhood cancers, obesity, diabetes, high cholesterol and inflammatory bowel disease. Scientists don’t know exactly how breastmilk reduces the risk, but they think antibodies in breastmilk give a baby’s immune system a boost. Babies who are exclusively breastfed for more than three months have been found to have a higher IQ. Experts say that the emotional bonding that is likely established during breastfeeding
probably contributes to some of the brain power benefits, but that the fatty acids found in breastmilk play the biggest role in this.
YOU WILL BENEFIT TOO Once you settle into your routine, breastfeeding can make your life much easier. There is no need for measuring, mixing, sterilising or midnight bottle warming. Yet the health benefits of breastfeeding for you are even more impressive. The hormones that are released during breastfeeding help reduce post-delivery blood loss and help the uterus shrink back to size. And some breastfeeding moms find that they burn kilojoules faster, helping their bodies bounce back. This is because producing milk burns kilojoules. A breastfeeding mother has a lowered longterm risk for premenopausal breast cancer, the kind that strikes before age 50. The risk for ovarian and
BREASTFEEDING FOR ANY LENGTH OF TIME WILL BENEFIT BOTH YOU AND YOUR BABY. THE WORLD HEALTH ORGANISATION (WHO) RECOMMENDS: 1 BREASTFEEDING EXCLUSIVELY (NO FORMULA, WATER OR SOLIDS) FOR SIX MONTHS, THEN INTRODUCING NUTRITIOUS FOODS. 2 CONTINUE TO BREASTFEED FOR A FURTHER TWO YEARS OR FOR AS LONG AS YOU LIKE. 3 WHILE THERE IS NO DOUBT THAT BREAST IS BEST FOR YOU AND BABY, IT’S A PERSONAL JOURNEY THAT REQUIRES GUIDANCE AND CONSTANT SUPPORT. thyroid cancer, type 2 diabetes and postpartum depression are also reduced for women who breastfeed their babies. YP BREASTFEEDING GUIDE 9
Milk Facts
THE PERFECT FOOD What makes breastmilk special?
Human milk has been specially designed to meet all your baby’s nutritional needs at any specific age. It is a living fluid and its composition adapts as your baby’s needs change (milk will even become more diluted in hot weather to help quench your baby’s thirst). Breastmilk contains vital ingredients. Colostrum is the protein-rich first milk, which is produced in the first couple of days after birth. Colostrum soon changes, as your baby grows, into mature milk. Even though the composition of breastmilk changes, it always consists of the same basic nutrients.
BASIC NUTRIENTS FOUND IN BREASTMILK PROTEIN Protein is needed for growth . 10 YOUR PREGNANCY
Human babies’ bodies grow slowly and they feed often, so there is only a small portion of protein in breastmilk (one percent). CARBOHYDRATE Nearly all of the carbohydrate in breastmilk is lactose, which is important for brain growth. The human baby has a large brain that grows fairly rapidly. FAT Essential for providing energy, the fat in breastmilk is easily digested by babies, with almost no waste. WATER Breastmilk is 90 percent water and is all a baby needs. Even in extreme heat or when suffering from a fever, a breastfed baby needs no extra water. VITAMINS The best and most balanced
BREASTFEEDING GUIDE 11
Milk Facts THE BREAST IS A GLAND MADE UP OF SEVERAL PARTS:
LOBES There are about 20 lobes inside each breast, each with its own individual milk duct system. ALVEOLI These are clusters of milk-producing cells found at the end of smaller ducts. During pregnancy the ducts and milk-producing cells grow and multiply. MUSCLE CELLS These are found around the alveoli. LYMPH This is fluid that helps fight disease and infection. In the breast it helps remove any waste. NERVES Nerve tissue in the breast makes them sensitive to touch, allowing the baby’s sucking to stimulate the let-down reflex (movement of milk in the breast) as well as milk production. FATTY TISSUE This is connective tissue that protects the breast from injury and is mostly what affects the size of a woman’s breasts. Contrary to popular belief, breast size does not affect the amount or quality of milk that a woman makes. source of vitamins for babies’ needs is provided in breastmilk. MINERALS Levels of iron in breastmilk are low, but in a form that is easily absorbed and combined with the baby’s own iron store. 12 YOUR PREGNANCY
HOW IS MILK MADE? Special cells inside your breasts make milk – this process is called lactation. These cells are called alveoli. When your breasts become full and tender during pregnancy, this is a sign that the
Lobe
Areola Nipple Milk duct Alveoli cells
alveoli are getting ready to work. Don’t worry if you do not notice a change in your breasts while pregnant. Some women do not feel these changes, while others only feel them once baby has been born. If you start to leak milk during pregnancy, don’t be alarmed. It’s quite normal. Invest in some breast pads. After birth, once the placenta has been delivered, pregnancy hormones drop and the milkproducing hormone called prolactin rises. There are tiny sacs in the breast that start to produce milk. The milk collects in these sacs, causing the breasts to get bigger. Another hormone, oxytocin, causes small muscles
around the alveoli to contract and move the milk through a series of small tubes called milk ducts. This moving of milk is called the let-down reflex. Oxytocin also causes the muscles of the uterus to contract during and after birth. This helps the uterus get back to its natural size and lessens any bleeding a woman may have after giving birth. The release of both prolactin and oxytocin are in part responsible for a mother’s intense feeling of needing to be with her baby.
Breast size does not affect the amount or quality of milk For the milk production cycle to continue, milk needs to be removed from the breast. In other words, babies need to feed frequently in the early weeks to stimulate this cycle. Remember that a baby who feeds frequently is not a sign that they are not receiving enough milk. YP BREASTFEEDING GUIDE 13
Get Prepped
14 YOUR PREGNANCY
GETTING PREPPED How can you prepare for breastfeeding? Your pregnancy hormones are doing everything your body (and breasts) need to do to get you ready to produce the perfect milk for your child. Successful breastfeeding starts with the belief that you can do it. So, find out as much as you can about breastfeeding as this will help build your confidence that you can breastfeed.
PREPARE FOR BREASTFEEDING Take a breastfeeding class. Ask your healthcare provider to give you a list of lactation consultants in your area. Talk to your healthcare provider about any health issues you may have such as previous breast surgery or any injury. If you are on medication for a
Getting clued up is the first step towards successful breastfeeding
chronic condition, check that it is safe to take this medication while breastfeeding. If this medication passes into your breastmilk easily and is not recommended for lactation, find out if you are able to adjust it or take a different kind while you are breastfeeding. Get good prenatal care, which may help you avoid early delivery. Babies born too early often need special care, which can make breastfeeding harder. Tell your midwife or doctor that you would like to breastfeed as soon as possible after the birth. The best way to do this is to insist on skin to skin contact
Succesful breastfeeding starts with the belief that you can do it BREASTFEEDING GUIDE 15
Get Prepped immediately after birth (provided there are no complications with the baby). The suckling instinct is very strong in the first hour after birth and this alone can help you to get off to a good start. Talk to friends who have breastfed or join a breastfeeding support group.
CAN I PREPARE MY BREASTS? Midwives, nursing sisters, grandmothers and your motherin-law may differ in their opinions on preparing your nipples for breastfeeding. In the past, it was believed that you needed to “toughen” your poor nipples up by scrubbing them with hard brushes or rough towels. There is little or no evidence that “toughening” helps. In fact rubbing removes the nipple’s natural oils and damages the skin. Also, excessive nipple stimulation can cause the uterus to contract. 16 YOUR PREGNANCY
Is the fear of having pain putting you off breastfeed ing? If baby is latched co rrectly it w on’t hurt. Latch your baby , wait 30 second s, if you’re still very sore th en baby is n’t latched co rrectly
If you have or suspect you have flat or inverted nipples ask your doctor or a lactation consultant for advice. Avoid getting soap and drying agents on your nipples as this can cause cracking, which is painful. rather wash with water. Get yourself rigged out with a properly fitting, supportive nursing and maternity bra. If you are leaking colostrum, wear a disposable or washable breast pad and allow your breasts to air dry after showering for a few minutes each day to prevent soreness. Many women’s breasts do not leak during pregnancy. Either way, this will not affect your ability to breastfeed.
Get Prepped BREASTFEEDING: BE ON A TEAM While fathers, partners and family members can’t supply the milk, there are things they can do to make breastfeeding easier for you. The current advice is that mothers should try to breastfeed for at least a year. Studies have shown that the more supportive their partners are, the longer mothers breastfeed. Therefore partners have a key role to play. Here’s how: By being involved with the decision to breastfeed – reading books and attending classes on breastfeeding is a great start. By showing their support for your decision to breastfeed especially in the early weeks when hormones and sleep deprivation can leave you feeling discouraged. By making sure that you have enough to eat and drink, get enough rest, help around the house, and take care of other children at home. 18 YOUR PREGNANCY
DAD AND BABY THE BOND BETWEEN MOTHER AND BABY IS IMPORTANT AND STRONG, BUT SO IS THE BOND BETWEEN FATHER AND BABY. DADS CAN ENCOURAGE THIS BOND BY CUDDLING AND PLAYING WITH BABY AND BY GENTLY WINDING BABY AFTER A FEED. IN FACT, SKIN TO SKIN CONTACT HELPS DAD AND BABY BOND, MUCH LIKE IT DOES FOR MOTHER AND BABY.
Studies have shown that the more supportive their partners are, the longer mothers breastfeed By listening to your breastfeeding concerns. Help by bringing your baby to you at night, and by burping or winding the baby after a feed. YP
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The First Feed
BABY’S FIRST FEED Nothing beats the moment when you latch your baby for the first time 20 YOUR PREGNANCY
During labour and birth your body uses a powerful mix of hormones to birth your baby and also prepare the way for breastfeeding. As your placenta separates from the uterus, your body releases a mix of prolactin (to stimulate milk production) and oxytocin (to allow the milk to flow), so that you are ready
to feed as soon as you and baby would like to. Babies are born competent, capable, ready and eager to breastfeed. As long as there are no medical complications, your baby is ready for his first feed almost immediately after birth and most will latch onto the breast within the first hour of life. In fact, the best start for breastfeeding is when a baby is kept skin to skin with you immediately after birth, for at least an hour.
WHAT IS SKIN TO SKIN? Skin to skin contact is when your healthy newborn is placed on your chest between your breasts immediately after birth (whether vaginal or caesarean section). You are both naked, so that your baby has full skin to skin contact with you. You can continue doing skin to skin contact long after birth with your baby. Much research has been done showing the benefits of skin to skin
contact, such as the regulation of the baby’s temperature, heartbeat and blood sugar, as well as aiding emotional bonding with your baby. This special bonding time is also an excellent primer for breastfeeding. Skin to skin babies are much more alert and their senses will begin to react straight away. He instinctively roots and sucks. The baby’s well-developed sense of smell allows him to find the breast to begin the initial latch-on. The odour of a substance secreted by the nipple is similar to the smell of a substance in the amniotic fluid, which surrounds the baby in the womb. If your baby does not take the breast right away, do not panic. There is almost never any rush, especially with a full term healthy baby.
LATCHING Getting your baby to latch correctly is one of the most BREASTFEEDING GUIDE 21
The First Feed 1
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important steps for successful breastfeeding and for your comfort – an incorrect latch can cause nipple pain. Your baby’s mouth must open wide enough to get a good amount of areola (the pigmented skin around your nipple) into his mouth. If your baby latches only onto your nipple, you will get sore and he’ll get a limited supply of milk. It is the massaging of the areola tissue from your baby’s suckle and the movement of his tongue that draws the milk out of your breast. Some babies latch on right away, for others it takes more time and practice.
HOW TO LATCH: 1 Hold your baby close to your 22 YOUR PREGNANCY
3
body with his tummy facing yours and his nose across from your nipple. 2 Gently tickle his upper lip with your nipple until his mouth opens wide, which looks similar to a yawn. 3 Pull him in chin first, quick and close, so that he takes in as much of your breast as possible. SIGNS OF AN EFFECTIVE LATCH An effective latch is a deep latch which allows your baby to get more milk and is also more comfortable for you. Here’s how to tell if your baby is latched well: Your baby’s chest is lying against your body (tummy to
If your baby latches only onto your nipple, you will get sore and he’ll get a limited supply mummy). He does not need to turn his head while feeding. Your baby’s chin touches your breast. Your baby’s lips are flared, like fish lips. You see little or no areola above your baby’s top lip and the bottom lip is curled well over the areola. You can see his ear wiggle slightly and his jaw moves as he takes long, drawing sucks. You can feel a strong tug that is not painful. You can hear him swallow (a soft sound like “ca-ca”). He has several periods of active sucking and swallowing during the feed. Once your baby is latched well, he will suck rapidly until the
milk starts flowing. Then he will settle into a rhythm of sucking and swallowing and his sucking will become slower, deeper and stronger, until he stops swallowing (or falls asleep) at the end of a feed.
BREASTFEEDNG POSITIONS There are four conventional holds that can help you and your baby breastfeed comfortably. Over time you’ll find what works best for you both. Always hold your baby close to your body. If needed, use a pillow to support your arms as you hold your baby at the level of your breast so you are comfortable and relaxed. CRADLE OR MADONNA HOLD This position is the most commonly used once your baby gains head control and you no longer need to guide him to your breast. Hold your baby in your lap, level with your breast. Support BREASTFEEDING GUIDE 23
The First Feed
Cradle or Madonna hold
your baby’s head in the crook of your arm as you hold him close. This arm supports his neck, spine and bottom. You can put a pillow under this arm for support if that is comfortable for you. CROSS CRADLE HOLD This hold is useful while you and your baby are learning to breastfeed as you can easily see how well your baby has latched. It is also useful for premature babies or babies with a weak suck because it gives extra support. Hold your baby with the opposite 24 YOUR PREGNANCY
Cross cradle hold
arm to the breast you are feeding from (if you are feeding from your left breast, hold your baby with your right arm). Turn his body so that his chest and tummy are facing you. Support the base of his neck loosely with your fingers, using your palm to support his shoulder and upper back. FOOTBALL HOLD This position is useful if you have had a c-section, you have large breasts or flat or inverted nipples, as you are better able to see and control your baby’s head, and
Football hold
keeps the baby away from your caesarean section incision. Hold your baby at your side, lying tilted towards you, with his nose at the level of your nipple. Bend his legs upward, behind you. You may need to rest him on a firm pillow. Support baby’s head with your fingers at the base of his neck and shoulders – the baby’s body is tucked underneath your arm on the same side that you are breastfeeding.
SIDE-LYING HOLD This is great position for resting while breastfeeding, day or night or if you have had a caesarean section or episiotomy. In this position, you and your baby lie on your sides, tummy to tummy. You can place a pillow between your knees and or behind your back for comfort. YP
Side-lying hold
Always hold your baby close to your body. If needed, use a pillow to support your arms BREASTFEEDING GUIDE 25
First Six Weeks
FIRST SIX WEEKS
Letting your baby lead the way is the key to success The first few weeks can be a real rollercoaster ride as you get to know your new baby and he gets to know you. It can take up to six weeks for you and baby to get the hang of breastfeeding and for breastfeeding to become established. The best way to do this is to let your baby lead the way – called baby-led or demand feeding. A mother and her baby are a finely tuned team, and as feedings increase, your body responds to the clues that her baby is giving by producing exactly the right amount of milk. Using a dummy or delaying feedings at this time will slow the production of milk and may cause problems for you both. 26 YOUR PREGNANCY
Most babies need and naturally request eight to 12 feedings in a 24 hour period – that’s every two to three hours. In the early sleepy days, however, babies tend not to feed as often. Listen and watch for your baby’s hunger cues and feed him before he gets upset. Once he is upset, this will make it harder for your baby to latch and feed calmly.
HUNGER SIGNS Getting into a routine is not about watching the clock and waking your baby for a feed, it is about learning to recognise your baby’s feeding cues (this will soon become second nature). Your baby will make special movements and sounds when he is hungry, such as: Sucking on tongue or lips during sleep. Sucking on fingers. Moving fist, hand and arms towards mouth. Fussing or fidgeting while sleeping.
Turning his head from side to side. Turning head towards your breast and chest (this is called rooting). Crying – this is a late sign of hunger.
FEEDING PATTERNS Once breastfeeding is established, the best way to ensure a good milk supply is by allowing your baby to determine the frequency and duration of each feed. Some babies will feed between 20 to 40 minutes; others may be more efficient and need less time. Watch for any signs that he is full, such as self detaching from the breast, becoming sleepy, swallowing sounds that are less frequent, and your breasts feeling empty or softer. If your baby is still sucking without swallowing, then he is comfort sucking and can be taken off your breast. Let your baby finish at one breast and
then offer your baby the other at each feeding. This helps to stimulate milk production. If he chooses to take only one breast at a feeding, start the next feed with the fuller breast. If you follow these steps you will ensure proper milk removal from each breast, which will increase milk production, reduce the risk of breast engorgement and reduce nipple pain.
BURPING BABY Most breastfed babies do not always need to be burped or winded, especially if your baby has a tight seal during latch-on. But some babies will need to be burped occasionally, especially if they are fast feeders and/or you have a strong letdown reflex. Burping your baby will get rid of any excess air he may have swallowed and which may cause him discomfort. If you find that you are burping your baby for more than five minutes after a feed without anything BREASTFEEDING GUIDE 27
First Six Weeks happening, then he does not need to be winded.
HOW TO BURP YOUR BABY Until your baby can release trapped gas on his own, he has to rely on you to help him do it. There are many ways to burp a baby to do this. Besides the obligatory pat on the back, effective burping requires two actions: holding baby in an upright position and applying pressure on baby’s tummy. Put a cloth under his chin in case of any spit-ups or posseting. Hold him sitting up in your lap, slightly bent forward over your hand.
1 2
Keeping hydrated will help your milk supply
3
Support your baby’s chest and chin in one hand and gently rub his back with the other using upward motions. Gently rocking him back and forth in this position (use your other hand to support his head), will also release any trapped air. Once your baby has better head and neck control you can hold him against your chest with his chin on your shoulder while you rub or pat his back. You may also lay him over your upper legs with his tummy pressing gently onto your thigh, while gently rocking him. YP
AT BIRTH
WHAT WILL HAPPEN WITH YOU, YOUR BABY AND YOUR MILK IN THE FIRST SIX WEEKS: MILK Your breasts are stimulated to make colostrum in small amounts.
BABY Will probably be awake and alert in the first hour after birth.
This is a good time for that first breastfeed.
MOM You will be tired, emotional and exhilarated.
28 YOUR PREGNANCY
FIRST 12 TO 24 HOURS
MILK Your baby will drink about one teaspoon of colostrum at each
feeding – exactly what your baby needs in the right amounts.
BABY It is normal for baby to sleep heavily – labour and birth are
hard work for him too. Some babies like to nuzzle and may be too sleepy to latch properly at first. Feedings may be short and disorganised. As your baby wakes up, most will have a strong instinct to suck and feed every one to two hours. Many babies like to suckle, lick, pause, savour, doze, then suckle again.
MOM You will be tired too, so be sure to rest. MILK Your mature milk will start to fill your breasts. It is normal for it
NEXT 3 – 5 DAYS
to have a golden or yellow tint. Your breasts may become swollen and heavy – breastfeed frequently.
BABY Your baby will feed a lot, at least eight to 12 times or more
in 24 hours. Very young breastfed babies don’t eat on a schedule and will eat often as breastmilk is easily digested and their tiny tummies empty out quickly. The baby’s suckling rhythm will be slow and long and you might hear gulping. It is okay if your baby eats every two to three hours for several hours then sleeps for three to four. Follow your baby’s pattern as this helps your breasts to make plenty of milk.
MOM Your breasts may feel full and leak. Apply a warm cloth and
4 – 6 WEEKS
massage gently before feeds for comfort.
MILK Your mature milk will become established. BABY Your baby will get better at breastfeeding, as will you, and
have a larger stomach to hold more milk. Feedings may take less time and will be further apart.
MOM Your body gets used to breastfeeding so your breasts will be
softer and the leaking may slow down. Continue to massage breasts once a day in the shower. BREASTFEEDING GUIDE 29
Milk Quantity
30 YOUR PREGNANCY
IS YOUR BABY GETTING ENOUGH MILK? For most new moms their first concern is whether or not their new baby is getting enough breastmilk
At birth, your newborn’s stomach is the size of a small marble and can comfortably digest about 5ml (a teaspoon) per feed. In the first week, his stomach will grow to about the size of a golf ball and be able to hold about 50 to 60ml. By day 10 it is the size of a large chicken egg and can hold 60 to 81ml. If you are following a babyled feeding pattern, then the amount of milk produced by your breasts will exactly match the small amount that your baby’s tiny tummy can hold.
FOLLOW BABY’S CUES In time you will learn to recognise
the signs that your baby is full. Your baby will get enough milk if you feed him until he shows signs of being full. These are: He lets go of your breast or falls asleep after an active suckling cycle. He turns away from your breast and does not open his mouth wide. If he is awake, his arms and hands are relaxed and he is resting calmly. While you both get to know each other and until you get the hang of breastfeeding, there are some other tell-tale signs that will let you know that you are producing enough milk and that your baby is thriving. These include: Your baby switches between relatively short sleeping periods BREASTFEEDING GUIDE 31
Milk Quantity and periods of being awake. As he grows he’ll sleep for longer. Your baby is satisfied and content after feedings. Your breasts feel softer after you have fed. Your baby is putting on weight. Your baby is making enough wet and stool nappies (see the chart on opposite page).
LET THE SCALE TALK Checking your baby’s weight is a good way to tell if he is getting enough to eat. In the first few days after birth it is normal for your baby to lose a small amount of weight, but they should be back to their birth weight by 10 to 14 days old. After this, your baby should be gaining about 30 grams a day for the first three months of life.
NAPPY TALLY You can tell if your baby is getting enough milk by checking what is going into his nappy. Your baby’s urine should be pale 32 YOUR PREGNANCY
5ml = 50-60ml = 60-81ml = You can tell if your baby is getting enough milk by checking what is going into his nappy in colour and for the first week or two of his life a baby can have as many wet nappies as his age in days (so, four wet nappies on day four). Your baby’s first stool (poo) is called meconium and is black or very dark green, thick, sticky and looks like tar. As your colostrum changes to mature milk, your baby’s stools will become loose, yellow and seedy – these will continue to change as he gets older.
50-60ml
60-81ml
YOU CAN USE THIS CHART TO HELP YOU KEEP TRACK
Minimum number of wet nappies and bowel movements in a baby’s first six weeks. (It is fine if your baby has more.) 1 day = 24 hours. DAY 1 (FIRST 24 HOURS AFTER BIRTH) Number of wet nappies: 1 to 2 Number of poo nappies: The first one usually occurs within the first eight hours after birth Colour & texture of poo: thick, tarry and black (meconium) DAY 3 TO 4 Number of wet nappies: 3 to 5 nappies Number of poo nappies: 3 to 4 nappies Colour & texture of poo: looser, greenish to softer yellow 5 TO 6 WEEKS Number of wet nappies: 6 to 8 nappies Number of poo nappies: 3 to 6 nappies Colour & texture of poo: yellow, seedy soft and watery BREASTFEEDING GUIDE 33
For Mom The key to successful breastfeeding is looking after yourself as well as your baby. You are the supplier, which means you need to be healthy and relaxed enough to make the milk that will nourish your baby.
YOUR DIET Making sure you eat a healthy diet is especially important if you are breastfeeding. You need to get all the nutrients needed to produce breastmilk and to maintain your energy levels. This includes eating meals that contain enough protein, calcium, iron and vitamins.
TAKING CARE OF MOM It’s not just about baby’s needs: you also need to be in peak condition to breastfeed your baby
34 YOUR PREGNANCY
HANDY HIGH-ENERGY SNACKS TO KEEP HANDY Whole grain sandwiches and Pro-Vita crackers. Milk drinks. Fruit. Yoghurt. Nuts and seeds. Avocado. Cheese and biscuits.
YOUR DAILY REQUIREMENTS WATER Many women get very thirsty during and after breastfeeding. Drink to your thirst. Expect to drink two and a half litres a day. Water is the best source of fluid, so include a large share of your fluids as water. PROTEIN You will need to include extra protein in your diet, from foods such as: Lean meat, fish and chicken. Eggs. Cheese and yoghurt. Nuts and seeds. Legumes, such as lentils, baked beans and split peas. Quinoa, a grain with a high quality protein content. CALCIUM You need around four servings of calcium-rich foods daily. If your diet does not contain plenty of calcium, your body will
use calcium from your bones to meet your increased needs. This may weaken your bones and increase the risk of developing osteoporosis later in life. The best sources of calcium are dairy products (such as milk, cheese and yoghurt), and soya milk, fortified with calcium (look for a brand that includes around 120mg calcium per 100ml soya milk). Sesame seeds are also rich in calcium. IRON Pregnancy and breastfeeding uses up your iron stores so you need to increase your intake of iron-rich foods, such as: Red meat, chicken and fish. Legumes (like baked beans). Nuts and dried fruit. Whole grain bread and cereals. Green leafy vegetables. FOLATE AND VITAMINS While breastfeeding, you need to increase your intake of: Folate (leafy green vegetables BREASTFEEDING GUIDE 35
For Mom such as spinach, broccoli, cabbage and Brussels sprouts). Vitamin C (citrus fruits, berries, tropical fruit, tomatoes, red peppers and potatoes). Vitamin A (dark green and yellow vegetables such as broccoli and carrots).
VEGETARIAN MOTHERS A vegetarian diet can meet the nutritional needs of a breastfeeding mother, as long as it includes a variety of foods including good sources of protein, such as: Legumes and pulses. Eggs, milk and yoghurt. Wholegrain carbohydrates. Fruit and vegetables. Check with your dietician to make sure your diet has the right amount of kilojoules and nutrients.
However, there are still some foods you should avoid or limit while breastfeeding your baby. Caffeine can pass through into your breastmilk and can cause problems with irritability and sleeplessness in your baby. Therefore, try avoiding tea, coffee, soft drinks and limiting chocolate. You can also limit yourself to one cup of caffeine-containing drink per day or a few blocks of chocolate. If you must have these, rather have them straight after a breastfeeding session. Remember that often what you eat flavours your breastmilk and thus can affect your baby’s taste preferences later. For example, if you eat a lot of green veggies, this can give your baby a taste for these vegetables later.
WILL I LOSE WEIGHT? FOODS TO AVOID Some pregnancy no-nos are now back on the menu. Finally, sushi, raw eggs and cold meat are all fine to eat during breastfeeding. 36 YOUR PREGNANCY
Yes and no. It it is true that breastfeeding moms burn around an extra 2 000 kilojoules a day. But your body requires energy (read: kilojoules) to create
breastmilk. Breastfeeding doesn’t burn fat, but rather uses the extra kilojoules to cover the extra energy needed to produce breastmilk as well as to maintain the nutritional balance and kilojoule content of the breastmilk. The general recommendation is that you need an additional 2 100 kilojoules (equivalent to one cheese sandwich) when breastfeeding. But the way in which breastfeeding can use up kilojoules is the reason that some lucky women find they lose weight easily and quickly after giving birth. Unfortunately, not all women find breastfeeding helps them lose weight. Also, bear in mind
Focus on eating healthily and making the best food choices that your kilojoule needs during breastfeeding will depend on your baby’s age (older babies need less breastmilk) and whether you are breastfeeding exclusively (if you aren’t, then the amount of breastmilk your body needs to produce is decreased and thus your kilojoule demands are less). Breastfeeding should never be used as an excuse to overeat. Focus on eating healthily and making the best food choices for you and your baby. YP BREASTFEEDING GUIDE 37
Expressing
EXPRESSING MADE SIMPLE
With a little know-how pumping milk can be easy Whether you are a stay at home mom or you are going to go back to work after your maternity leave, a breast pump can help you in many ways throughout this journey. From the start, you may need a pump to stimulate milk production if your baby is not feeding effectively. You may also find yourself expressing excess milk and storing it for later so that dad can do a midnight feed and give you a longer sleep. At about six weeks into your breastfeeding journey, you and baby have more of an idea of how to do this intricate dance. Your milk supply has settled down and you have been given the go-ahead by your doctor to become more active. It’s time to start regaining a bit of your life 38 YOUR PREGNANCY
as your baby settles into more of a routine. In this case, pumping will become your best friend.
HAND EXPRESSION The bonus with hand pumping is that it’s free, although you could need some expert advice from a lactation consultant to learn how to do it effectively. This method requires practice and skill but also is only suitable if you are seldom away from your baby – hand expressing is hardly going to be the best option if you’re back at work.
MANUAL PUMP You use your hand and wrist to operate a hand-held device to pump milk. Many of the manual pumps on the market these days are as effective as electric ones
at a fraction of the cost. They are also not as noisy so perfect if you intend pumping from one breast while baby is latched on to the other.
AUTOMATIC OR ELECTRIC PUMPS These run on batteries or plugs into the electrical mains. Most moms opt for an electric pump. If you are having multiples, a good electric pump is a must as they are much easier and more convenient to use. You can choose one that pumps one breast at a time, or a double version that can pump both simultaneously (this collects more milk in less time).
HOSPITAL GRADE ELECTRIC PUMPS These can be rented from a lactation consultant or a breastfeeding organisation like the La Leche League. These pumps should be considered if your baby cannot feed from the
BREASTMILK CAN BE STORED FOR: SIX TO EIGHT HOURS AT ROOM TEMPERATURE (19 TO 26°C) 24 HOURS IN A COOLER WITH THREE ICE PACKS (15°C) FIVE DAYS IN THE FRIDGE (4°C) THREE TO SIX MONTHS IN FREEZER COMPARTMENT (-15°C ) SIX TO TWELVE MONTHS IN A DEEP FREEZER (-18 TO -20°C) THAWED BREASTMILK: USE WITHIN 24 HOURS. USE A BOWL OF WARM WATER TO WARM BREASTMILK UP IN. NEVER MICROWAVE IT AND NEVER REFREEZE THAWED MILK. breast (if he is premature and in NICU) or if you are having multiples, as they can be BREASTFEEDING GUIDE 39
Expressing invaluable in establishing and maintaining milk supply.
STORING Breastmilk can be stored in clean glass or BPA-free bottles with tight-fitting lids in the fridge. You can also use milk storage bags which have been specifically designed to be frozen.
THE LETDOWN REFLEX The key to any kind of milk expression is to get the milk to let down. Electric pumps stimulate the letdown reflex automatically by mimicking the baby’s sucking action, but when you are hand expressing or using a manual pump, you may need to stimulate the let down reflex yourself. Some women’s milk lets down easily, but many mothers have to work at it. Anything that helps you relax will help your milk let down. Try listen to music and have your partner rub your shoulders. 40 YOUR PREGNANCY
WHEN SHOULD YOU PUMP? FOR MOST WOMEN, GOING BACK TO WORK AND CONTINUING BREASTFEEDING IS THE CHALLENGE THEY FACE AT AROUND THREE MONTHS. IN THIS INSTANCE, YOU WILL HAVE TO PUMP AT WORK (AND STORE YOUR MILK THERE) TO KEEP YOUR SUPPLY UP. TALK TO YOUR EMPLOYER ABOUT IT. A PRIVATE, CLEAN ENVIRONMENT HAS TO BE PROVIDED FOR YOU TO PUMP IN PEACE. LEARN HOW TO BEST STORE YOUR MILK, SO BABY CAN CONTINUE BENEFITING FROM IT, AND TEACH YOUR CHILD-MINDER HOW TO DEFROST AND WARM IT PROPERLY BEFORE FEEDING BABY. To help your milk let down, try: Looking at a picture of your baby. Smelling and holding a blanket or piece of clothing that smells like him.
BREASTFEEDING GUIDE 41
Expressing Take a hot bath or shower before expressing, apply warm compresses and slowly massage your breasts.
times, providing the milk feeds for the next day. You express in place of missed feeds to maintain your supply.
INTRODUCE YOUR BABY TO EXPRESS FEEDING
STRESS-FREE WEANING
Around six weeks of age, once a good breastmilk supply has been established, a bottle can be introduced to your baby, allowing you to prepare baby to learn an alternative way of feeding. After eight weeks of age, it may be more difficult to get baby to accept a bottle. Offer your a bottle regularly at least once a day, from another caregiver or dad, to create familiarity and routine. Your baby will not easily accept this form of feeding from mom. Babies are clever and know mom has breasts! Make sure you choose a bottle that requires a good vacuum to remove milk, and requires the baby to make the same effort as breastfeeding does. At work you’ll need to pump at your usual feed 42 YOUR PREGNANCY
Most babies that are eating adequate nutritional food in the second year of life feed on average from the breast two to three times a day. Weaning your baby from breastfeeds should be done slowly over a couple of weeks. You can wean abruptly, but this usually results in sore, full, engorged breasts. If there is a good reason to do it quickly, then it is advised to take medication prescribed by a doctor to help decrease the prolactin levels in your body. That’s the hormone that produces milk. Your breasts will feel full at first. Do breast care regularly: gentle massage in the shower or bath to ensure a comfortable process. The dose of medication can be repeated if necessary. Within a few days your breasts will feel softer.
However, gentle weaning is really the easiest, less emotional way to go. If baby is feeding during the day, replace it with a healthy snack and offer water. After a few days, replace either the morning or evening breastfeed by offering milk (full cream cows’ milk or a follow-on growth milk) in a training cup before or around
the meal times. Your milk supply will decrease with less stimulation and baby should become disinterested at the breast. Once baby has settled after a couple of days, drop the last feed in the same way. Your breasts will settle within a couple of days, with gentle breast care, and can take up to 40 days to dry up completely. YP BREASTFEEDING GUIDE 43
Problems
PROBLEMS SOLVED
Stop stressing! There’s a solution for almost every breastfeeding issue that you’re experiencing 44 YOUR PREGNANCY
Breastfeeding is a natural practice, but many moms find a lot of challenges along the way.
BREASTFEEDING MULTIPLES Breastfeeding more than one child may sound daunting but it is entirely possible. It’s a case of supply and demand. The more the baby suckles, the more milk you will produce. Moms do face special challenges, mainly that twins and triplets are often born early and start their lives in the neonatal intensive care unit (NICU). In this case, a breast pump is a very good idea. Don’t delay starting to express if the babies aren’t with you. Don’t wait until the next day, even if you’ve had a caesarean section. Stick to the same feeding timetable the babies would have – express every two to three hours. As soon as possible, hold your babies skin to skin. Don’t be shy to ask the staff. This allows baby to get to know you and, crucially,
triggers the same hormones needed for breastfeeding. Your oxytocin levels definitely increase by doing skin to skin. So put baby to the breast – he doesn’t have to breastfeed, but just the fact that he is there is stimulating your milk supply. If you’re demand feeding, follow the hungrier twin’s cues. The second one must feed when the first one feeds. Save time by nursing both at once in the “rugby ball” position, with baby’s body tucked under your arm, feet towards your back.
BREASTFEEDING PREMATURE BABIES Like with multiples, try to have skin to skin with your premature baby as soon as possible. You’ll need to begin expressing by the day after your baby’s birth, and even earlier if possible. Some mothers prefer to begin with hand expressing their milk. A nurse or lactation counsellor should show you the proper way to express either by hand BREASTFEEDING GUIDE 45
Problems or with a breast pump. Once your milk has filled your breasts, you’ll need to begin using a good breast pump. The pump may feel uncomfortable at first, so try to use a low setting. In time, you will be able to increase the speed and the suction setting of the pump. To boost your confidence, ask a lactation consultant to do home visits after you leave the hospital with your baby.
BREASTFEEDING AFTER PLASTIC SURGERY Moms who have had their breasts augmented may not have too much trouble, but moms who have had breast reductions, while they can still breastfeed, may need some help and advice getting started.
POSTNATAL DEPRESSION Moms who suffer from postnatal depression are often advised to stop breastfeeding so they can be put on medication. But it’s important to keep in mind 46 YOUR PREGNANCY
that breastfeeding hormones like oxytocin are natural mood boosters, promoting feelings of wellbeing. Continuing breastfeeding can also boost moms’ self esteem; an effective aid against the baby blues.
MY BREASTS FEEL “EMPTY” The breasts are a continuous manufacturing site for the making of milk. When you breastfeed, you release a hormone called prolactin. This hormone makes the milk as your baby suckles at the breast. Once your breastmilk becomes established, and your breasts do not “fill up” between feeds, this does not mean that they are no longer supplying milk. As soon as your baby starts to feed (demand) your body will respond immediately (supply).
ENGORGEMENT Day three and your boobs feel like watermelons? Don’t worry. It won’t always feel like this. Right
now – like you – your boobs have no idea what they are doing, how much milk baby needs or how much is too much. As your baby latches and drains your breast, so your body learns to produce only enough milk for baby. After about two weeks, your breasts don’t feel engorged or sore every time your baby needs to feed. This is a sign that milk production is regulated. However, you can still feel engorgement if you skip a feed or feed slightly later than normal. Engorgement can be relieved by feeding baby or by pumping or by placing cold cabbage leaves on your breasts. The cabbage leaf has an enzyme which relieves inflammation. You can also take an anti-inflammatory medication (without codeine) to help reduce inflammation.
MASTITIS If nothing seems to be helping your engorgement and baby feeding still leaves your breast feeling full, you could be on
your way to developing mastitis. Mastitis is an infection of the breast caused by a blocked milk duct. It is very painful. The only cure is to continue feeding your baby while gently massaging your breast in an effort to clear the duct. Get plenty of rest and increase your fluids. You can also try a session of physiotherapy to clear the duct. Use safe painkillers. Warm compresses and massaging your breasts in the shower will also help. But if your breast is hard, red and you can feel swollen lumps then get to a doctor. You will soon develop aches, body chills and a fever and only antibiotics will clear it. But with the right treatment, your pain is reduced fairly quickly. Unfortunately if you have developed mastitis once, it is likely you will get it again so keep your eyes open for any signs. Feeding on demand (when baby wants to feed) and preventing engorgement goes a long way to preventing this painful condition. YP BREASTFEEDING GUIDE 47
For Mom
BREASTFEEDING AND SEX
There are numerous benefits to breastfeeding, but you may find that it also causes a number of unexpected physical changes in your body, which will affect your sexuality LOW LIBIDO
A slow-down in your sexual desire, or even no sexual desire at all is a completely normal part of the postpartum experience. As your hormones plummet after pregnancy, so does your interest in sex. Combined with the exhaustion that caring for a newborn brings, and the fact that your body is still healing from the birth, it is no wonder sex is the last thing you really feel like doing. You may even be scared to get pregnant again. All of this is completely normal, just remember 48 YOUR PREGNANCY
to keep communicating with your husband or partner.
VAGINAL DRYNESS Breastfeeding hormones are at work in your body and are responsible for decreasing the amount of vaginal lubrication. As a couple, remember that vaginal dryness does not reflect the woman’s level of arousal at all. You can use personal lubricants to make up for this time of drought.
MILK EJECTION Oxytocin, the hormone responsible for the milk ejection reflex, is also released during orgasm and is the hormone behind a woman’s need to cuddle. For these reasons, it’s often called the love hormone. Because you release oxytocin
during lovemaking or at the time of sexual climax, it is normal to notice milk let-down. Some women will only leak a few drops while others spray milk out. Some couples find this an added bonus of breastfeeding and enjoy the experience. Other women feel uncomfortable with it. If it bothers you, wear breastfeeding pads under your bra, apply pressure to your nipples, or have a towel nearby to help keep dry.
OVERSTIMULATED As a breastfeeding mother, a good part of your day is spent closely
feeding and holding your baby and you may feel over-touched. This doesn’t mean you don’t want to be cuddled or touched sexually, it will just take more time to ease into body contact. Remember explain this to your partner and indicate what you would like to happen. The good news is that most women report that the decrease in libido is temporary. As your baby grows and your body comes back into shape and you start having time for yourself once again, your desire, energy and responsiveness will return. YP BREASTFEEDING GUIDE 49
HIV Positive
HIV AND BREASTFEEDING With the right advice and information, breastfeeding is still an option for your baby 50 YOUR PREGNANCY
The World Health Organisation (WHO) promotes exclusive breastfeeding for all babies (including babies of HIV positive women) for the first six months of life. This is now possible thanks to early HIV intervention during pregnancy, and taking antiretroviral therapy (ART) medication regardless of the mother’s CD4 (white blood cell) count. HIV exposed babies receive drugs post-delivery to further prevent MTCT (mother to child transmission). A pregnant woman owes it to herself, her partner and unborn baby to get tested for HIV early in her pregnancy. The advantage of early intervention if her test is positive is that the mother can learn how to maintain, and even improve, her state of health while reducing the risk of HIV transmission to her unborn baby. ARTs are available, free of charge, to all pregnant women in government hospitals. Studies have shown
that a woman receiving ART who exclusively breastfeeds can have a less than two percent chance of transmitting HIV to her baby. If a woman does not receive treatment for HIV during her pregnancy, there is a 20 percent risk of HIV transmission to her baby, and if she does not receive treatment while breastfeeding, there is a further 20 percent risk of HIV transmission to the baby.
WINDOW PERIOD When a person is first infected by HIV (and may not realise it), they are in the window period. During this time the viral load quickly becomes very high because the immune system has not yet responded to an alien virus in the blood. The window period may last from six weeks to three months and during this time an HIV test result will show as negative. That is why it’s very important to be retested after six weeks. After the window period the immune system BREASTFEEDING GUIDE 51
HIV Positive will then produce antibodies to counterattack the virus.
VIRAL LOAD The viral load is the number of HI viruses. A high viral load means that there are lots of viruses in the blood. This happens when a person is in the window period, when an HIV positive person has an infection (sexually transmitted infection or pneumonia), when they do not adhere to antiretroviral medication or when he or she reaches the stage of AIDS (acquired immune deficiency syndrome). During pregnancy and breastfeeding, a high viral load puts the baby at risk for acquiring HIV.
HIV & BREASTFEEDING For many HIV infected women, deciding whether or not to breastfeed their child is a very difficult decision. The decision shouldn’t be made by anyone except yourself, as you are in the best position to decide what you 52 YOUR PREGNANCY
can and cannot cope with. When it comes to breastfeeding your baby, there are many benefits as well as many concerns that you should be aware of. Breastmilk contains all the best nutrients (in their correct, easily-digestible form), to help your baby grow well. Breastmilk also contains antibodies, which will help your baby to protect himself from many different infections. Breastmilk is very convenient as it is available on demand, free of charge and doesn’t require any special instruments for cleaning or feeding. Unfortunately, if you are HIV infected, your breastmilk may contain HIV and this may lead to your baby contracting HIV from the milk. If an HIV infected mom is not using any antiretroviral (ART) medication, the chance of her baby contracting HIV from breastmilk is about 20 percent (one in five babies will get HIV through breastmilk).
Fortunately, within South Africa, all HIV infected pregnant and breastfeeding mothers are eligible for triple antiretroviral therapy irrespective of their CD4 cell count. ART can reduce the chances of baby contracting HIV to around two percent (this means that only two out of 100 babies will get HIV). While it is ideal for ART to be initiated prior to pregnancy, the earlier in pregnancy this treatment is started, the more effective it will be in preventing mother to child transmission during pregnancy, birth and while breastfeeding. In order for ART to be most effective, it is also essential that the medication is taken every day at the same time. This will ensure that the breastmilk contains the least amount of HIV and is as safe as possible. As mentioned, your baby will receive drugs post-delivery to further prevent transmission. There are also a few tests that will be done on your newborn. All
HIV exposed babies should now receive an HIV PCR test at birth. These same babies who test negative at birth should receive a second PCR at 10 weeks of age. If the 10 week PCR is still negative, babies should receive a final PCR test six weeks after breastfeeding has ceased. In addition, all HIV exposed babies who have previously tested HIV negative should receive an HIV rapid/ELISA test at 18 months of age. Babies should also start using an antibiotic called cotrimoxazole from six weeks old until their second HIV PCR test comes back negative. This antibiotic will prevent your baby getting a chest infection (if she contracts HIV from the breastmilk). It is also essential that HIV positive moms who decide to use breastmilk use this milk exclusively. This will mean that your baby should receive only breastmilk for the first six months of her life (at six months old it is important to introduce your BREASTFEEDING GUIDE 53
HIV Positive baby to solid foods, in addition to continued breastfeeding). Mixed feeding (using other fluids or food in addition to breastmilk) can put your baby at greater risk of acquiring HIV. There are no specific rules when it comes to choosing a breast pump, however you should ensure that only you are allowed to use the breast pump (in order to prevent your baby getting HIV from another mom’s breastmilk and in order to prevent another baby getting HIV from your breastmilk).
PREPARE An HIV positive mother who plans to breastfeed her baby needs to prepare thoroughly for breastfeeding, ideally with the help of an antenatal teacher or breastfeeding support group such as the La Leche League. She needs to plan her life so that she can exclusively breastfeed her baby for the first six months. Ideally, this means 54 YOUR PREGNANCY
extended maternity leave, working from home or taking the baby to work. She can also learn to express milk for her baby while she is at work. Ideally, the expressed breastmilk should be fed to a baby using a cup. Some women choose to breastfeed only for as long as they are on maternity leave. Exclusive breastfeeding means using no water, herbal tea, juice, or solids for those first six months. Mixed feeding is when a mother feeds her baby anything together with breastmilk. This is discouraged because studies have shown that mixed feeding can increase the risk of HIV transmission. Correct latching is essential to help prevent nipple trauma and possible bleeding. HIV positive mothers who are actively breastfeeding need to take good care of their health, making sure they are eating a healthy diet. YP
BREASTFEEDING GUIDE 55
Myths & Facts
MYTH BUSTER
Clearing up the most common misperceptions about breastfeeding MYTH: After drinking alcohol, mom should “pump and dump” to remove the risk of baby getting alcohol from the milk. FACT: Mostly true. Experts disagree on how much alcohol is safe to drink when breastfeeding. One unit (a small glass of wine) should take about two hours to clear from your milk. Ultimately the safest option is to “pump and dump” after drinking alcohol, rather than risk the harmful effects that alcohol can have on your baby. If you would like to have a drink, express and dispose of the milk from your next feed. Use previously expressed milk to continue with your regular breastfeeding schedule thereafter. Just make sure you have expressed enough milk before you have a drink to cover the shortfall. 56 YOUR PREGNANCY
MYTH: Mom’s milk starts to become less nutritious after the first year. FACT: Mom’s milk is nutritious way beyond the first year. Yes, at some point your little one will need nutrition from other sources (after six months), but your milk remains a valuable contribution to his diet. MYTH: Many women don’t produce enough milk. FACT: Not true. Women producing an overabundance of milk are the norm. MYTH: After several months the immunities in mom’s milk decline. FACT: As long as nursing continues, immunity stays the same and even increases as baby approaches weaning.
Studies reveal that breastfed children have fewer illnesses than formula-fed babies.
MYTH: If you prolong breastfeeding it can make a child excessively dependent and cause psychological problems. FACT: Studies show that children who nurse past a year have remarkable social integration qualities. The American Academy of Paediatrics states: “There is no evidence of psychological or developmental harm from breastfeeding into the third year of life or longer.” MYTH: Moms who breastfeed should steer clear of “gassy” foods such as cabbage, to avoid giving the baby tummy troubles. FACT: True and false. There is a theory that gas forming vegetables (like cabbage and broccoli) can cause your baby
to become gassy. However there is no conclusive evidence to substantiate this. Eliminate these foods only if baby seems to be struggling with wind and then see if baby’s gas improves. But try not eliminate them unnecessarily as they are packed with antioxidants and vitamins.
MYTH: You have to wash your nipples each time before feeding. FACT: Washing your nipples before each feeding will wash away protective oils. MYTH: If you have small boobs you won’t be able to breastfeed. FACT: Whether you’re big or small, the size of your breasts has no real impact on your breastfeeding ability. The ability to produce milk depends entirely on the breast tissue, and small and large breasts usually have the same amount of milkproducing cells. YP BREASTFEEDING GUIDE 57
Questions
BREASTFEEDING QUESTIONS AND ANSWERS
Our breastfeeding experts answer your frequently asked questions
Q
WILL MY BREASTS SHRINK AFTER BREASTFEEDING? Pregnancy will alter the shape of your breasts, not breastfeeding. Make sure to wear supportive underwear throughout your pregnancy. Your breasts may or may not get smaller after breastfeeding.
to curb some of what you eat
Q
Q
IS IT TRUE THAT EATING FLAVOURED OR BRIGHTLY COLOURED FOODS CAN AFFECT THE MILK SUPPLY? Eating strongly flavoured foods may affect the taste of your milk once baby has been born and in some cases it is necessary
58 YOUR PREGNANCY
while breastfeeding. Eat a well balanced diet during your pregnancy and afterwards, especially when breastfeeding. Despite what you’ve heard, it is okay to eat oranges, chocolate and the occasional spicy curry. Your baby will let you know what he is not happy with. MY BABY HAS ORAL THRUSH. WHAT CAN I DO ABOUT IT? This appears as white spots in the mouth. You might have thrush that is passed on to baby. Continue breastfeeding but visit your doctor to get antifungal medication for both of you.
Q
DOES BREASTFEEDING USUALLY HURT? If your baby is positioned correctly and latched deeply onto the breast, breastfeeding shouldn’t hurt. Expect some discomfort in the first week or two, though, especially at the beginning of feeds. Try using the 30-second rule to determine if this is “normal”. If you need to grit your teeth when latching
baby, slowly count to thirty. If the pain improves considerably, or disappears completely, you’re probably experiencing normal sensitivity. If it is as bad or worse after half a minute, baby probably isn’t latched well. Break the suction with your little finger and try again. If your nipples remain sore or if they look pinched, squashed or damaged, get professional help. BREASTFEEDING GUIDE 59
Questions
Q
WHAT ARE HEALTHY SNACKS FOR BREASTFEEDING? Whole grain sandwiches, milk drinks, fruit, veggies, yoghurt, nuts, seeds, lean meat, cheese and crackers.
Q
DOES MY BREASTFED BABY NEED WATER? No, breastmilk contains everything your healthy baby needs for the first six months. At the beginning of a feed, your milk is low in fat and kilojoules and high in water. This quenches baby’s thirst. As he continues to nurse, the milk gradually becomes richer in fat and kilojoules to satisfy his hunger. In the first few months, water, tea and solids are actually harmful.
Q
DOES BREASTFEEDING AFFECT WHEN I WILL GET MY PERIOD AGAIN FOR THE FIRST TIME? If you are breastfeeding you may indeed not have your period for 60 YOUR PREGNANCY
a while. That is quite normal and has nothing to do with the way you have given birth to your baby. If you are not breastfeeding, I suggest that you contact your caregiver and have a check to see that all is well, and that you are not pregnant again.
Q
I’M GETTING SICK! SHOULD I WEAN? It’s not fair, but even moms of little ones get ill. The good news is that you can, and should, continue nursing. By the time you feel unwell, you’ve already exposed baby. The germs have been shared, now you may as well share the cure. When your body fights an illness, antibodies pass into your milk. This offers your baby partial or complete protection against the disease.
Q
WHAT IF I NEED TO TAKE MEDICATION? Contrary to popular belief, most medications are safe during
breastfeeding, as only a small percentage pass into your milk. If you do need a contraindicated medication, your doctor should be able to find a safe alternative. When in doubt, get more information. Always remind your healthcare provider that you are breastfeeding. Never take over the counter medications without medical advice.
Q
MY BABY WANTS TO NURSE EVERY TWO HOURS. DOES IT MEAN THAT MY MILK IS TOO WEAK OR NOT NUTRITIOUS ENOUGH? Your milk is always perfect. Breastmilk digests within 90 minutes, therefore most babies nurse ten to 12 times in 24 hours, or even more often when they are going through a growth spurt.
Q
WHAT IF I’M TOO TIRED TO BREASTFEED? Stay relaxed, rest often and remember that breastfeeding can
also become a mental issue, so try not to panic about it.
Q
I’D LOVE TO START EXERCISING AGAIN. HOW WILL THIS AFFECT BREASTFEEDING? Exercise is fantastic for you in this time. It relieves the stress of new motherhood and helps you shed any lingering postpregnancy kilos. Studies show that it makes the adjustment to motherhood easier and improves your relationship with your baby. Except for wearing a supportive bra, there are no special measures you need to take while exercising during breastfeeding. Even when you exercise to exhaustion, the taste and composition of your milk shouldn’t be affected. Neither should your milk supply. If you exercise in a chlorinated pool, it’s best to shower before nursing. Babies have sensitive noses and may be bothered by the smell. YP BREASTFEEDING GUIDE 61
Keep Track
YOUR FEEDING CHART
Record the time you start each feed and which breast you started on. Put a mark on the “wet” line for each wet nappy and a mark on the “stools” line for each poo. These daily charts are great to keep track and if you have any concerns. Make photocopies so you have a good supply and take them to your clinic to see how feeding is progressing. Contact your healthcare provider if you are worried.
Keep track of your feeding progress with these easy-touse charts
TIME BREAST AM PM AM PM AM PM AM PM AM PM AM PM AM PM AM PM AM PM AM PM AM PM AM PM WET: 62 YOUR PREGNANCY
STOOL:
L
R
L
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L
R
L
R
L
R
L
R
L
R
L
R
L
R
L
R
L
R
L
R
TIME BREAST AM PM AM PM AM PM AM PM AM PM AM PM AM PM AM PM AM PM AM PM AM PM AM PM WET:
STOOL:
L
R
L
R
L
R
L
R
L
R
L
R
L
R
L
R
L
R
L
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L
R
L
R
TIME BREAST AM PM AM PM AM PM AM PM AM PM AM PM AM PM AM PM AM PM AM PM AM PM AM PM WET:
L
R
L
R
L
R
L
R
L
R
L
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L
R
L
R
L
R
L
R
L
R
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STOOL:
WET:
STOOL:
AM PM AM PM AM PM AM PM AM PM AM PM AM PM AM PM AM PM AM PM AM PM AM PM WET:
TIME BREAST AM PM AM PM AM PM AM PM AM PM AM PM AM PM AM PM AM PM AM PM AM PM AM PM
TIME BREAST
L
R
L
R
L
R
L
R
L
R
L
R
L
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L
R
L
R
L
R
L
R
L
R
L
R
L
R
L
R
L
R
L
R
L
R
L
R
L
R
L
R
L
R
L
R
L
R
STOOL:
TIME BREAST AM PM AM PM AM PM AM PM AM PM AM PM AM PM AM PM AM PM AM PM AM PM AM PM WET:
L
R
L
R
L
R
L
R
L
R
L
R
L
R
L
R
L
R
L
R
L
R
L
R
STOOL: BREASTFEEDING GUIDE 63
Keep Track TIME BREAST AM PM AM PM AM PM AM PM AM PM AM PM AM PM AM PM AM PM AM PM AM PM AM PM WET:
L
R
L
R
L
R
L
R
L
R
L
R
L
R
L
R
L
R
L
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L
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L
R
STOOL:
WET: 64 YOUR PREGNANCY
STOOL:
AM PM AM PM AM PM AM PM AM PM AM PM AM PM AM PM AM PM AM PM AM PM AM PM WET:
TIME BREAST AM PM AM PM AM PM AM PM AM PM AM PM AM PM AM PM AM PM AM PM AM PM AM PM
TIME BREAST
L
R
L
R
L
R
L
R
L
R
L
R
L
R
L
R
L
R
L
R
L
R
L
R
L
R
L
R
L
R
L
R
L
R
L
R
L
R
L
R
L
R
L
R
L
R
L
R
STOOL:
TIME BREAST AM PM AM PM AM PM AM PM AM PM AM PM AM PM AM PM AM PM AM PM AM PM AM PM WET:
STOOL:
L
R
L
R
L
R
L
R
L
R
L
R
L
R
L
R
L
R
L
R
L
R
L
R
TIME BREAST AM PM AM PM AM PM AM PM AM PM AM PM AM PM AM PM AM PM AM PM AM PM AM PM WET:
L
R
L
R
L
R
L
R
L
R
L
R
L
R
L
R
L
R
L
R
L
R
L
R
STOOL:
WET:
STOOL:
AM PM AM PM AM PM AM PM AM PM AM PM AM PM AM PM AM PM AM PM AM PM AM PM WET:
TIME BREAST AM PM AM PM AM PM AM PM AM PM AM PM AM PM AM PM AM PM AM PM AM PM AM PM
TIME BREAST
L
R
L
R
L
R
L
R
L
R
L
R
L
R
L
R
L
R
L
R
L
R
L
R
L
R
L
R
L
R
L
R
L
R
L
R
L
R
L
R
L
R
L
R
L
R
L
R
STOOL:
TIME BREAST AM PM AM PM AM PM AM PM AM PM AM PM AM PM AM PM AM PM AM PM AM PM AM PM WET:
L
R
L
R
L
R
L
R
L
R
L
R
L
R
L
R
L
R
L
R
L
R
L
R
STOOL: BREASTFEEDING GUIDE 65
Contact details
WHO TO CONTACT Don’t be afraid to get help if and when you need it
LACTATION CONSULTANTS Most lactation consultants in South Africa are in private practice and consultation fees vary, averaging around R500. Depending on your medical aid plan and how you are invoiced, you may have the option to claim the consultation fee back through your medical aid. Find a consultant near you by browsing on the following websites: 66 YOUR PREGNANCY
La Leche League: www.llli.org/southafrica www.breastfeedingonline.com International Lactation Consultant Association (ILCA): www.ilca.org – provides referrals to board-certified lactation consultants. www.milkmatters.org www.breastfeeding.org.za – has links and resources to help you out.
Jolie Manual
NUK. The Orthodontists Choice.
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