Feeding Time

MADE UP YOUR MIND?

Research shows that most mothers have made up their minds about whether or not to breastfeed before becoming pregnant and some mothers also decide how long they wish to feed beforehand. This decision may be influenced by factors such as previous exposure to breastfeeding through family and friends, understanding of the benefits of breastfeeding and personal views on what is a manageable amount of breastfeeding to do or what you consider to be ‘enough’.

What may shape your decision is the recent change in guidelines for employers, employed parents and their co-workers on how to facilitate combining breastfeeding and work The best way to make a decision about how long to breastfeed and how to go about returning to work is to be well informed about the benefits of breastfeeding. Acquaint yourself with support networks, websites, IBCLC’s (Lactation Consultants) and the booklet, published by the Health Promotion Unit, Combining Breastfeeding and Work– all before your baby is born. ( www.healthpromotion.ie/breastfeeding/)

It is a global public health recommendation that infants should be exclusively breastfed for the first 12 months of life to achieve optimal growth, development and health and should receive nutritionally adequate and safe complementary foods while breastfeeding continues for up to two years of age or beyond.

In Ireland today the financial pressure many parents are under to have two wage earners, has led some parents to feel cornered into restricting breastfeeding due to work obligations. However, the following essential tips can help you to maximise your time and the resources available to you directly after birth. This will help to get feeding off to a great start and to continue over the following months and should help you avoid any restrictions put in place by returning to work.

GETTING STARTED

Key Words for Success: Early, Frequent and Effective Feeding.

Establishing breastfeeding effectively and having a clear view of your baby’s “normal” behaviour will ensure that your confidence remains buoyant as your family steps into the joys and demands of breastfeeding. Reading recommended sources can help you find out what ‘normal’ behaviour really means. Understanding how your baby drives the system in maintaining milk production can help you relax and mould your life in all good conscience around your new baby. Having a healthy lifestyle (getting enough rest and eating a healthy diet) is fundamental in order to get the most out of your time available for exclusive breastfeeding. For instance, blocked milk ducts and mastitis can be caused by exhaustion and stress alone.

In order to establish feeding well from birth there is a path along which your hospital can lead you. This path is ‘Baby Friendly’ and the hospital will support you along the way in its endeavor to follow the 10 steps of the ‘Baby Friendly Hospital Initiative.’ This path begins with breastfeeding education before your baby is born. Contacting your local health centre breastfeeding support group or groups like La Leche or Cuidiú (The Irish Childbirth Trust) before the birth is also helpful. What is most helpful is to attend a class given by a Lactation Consultant either privately in a class or in your own home or in the hospital where you will give birth. This makes it easier to continue the contact after the baby is born.

GET THE ‘KNOW HOW’ BEFORE YOUR BABY ARRIVES!

When a healthy term baby is born,/ allowing the baby to/ /drive the system/ as we have said, from the start, will ensure that exclusive breastfeeding continues well for as long as you decide, including when you return to work.

SKIN TO SKIN CONTACT

It all begins with skin-to-skin contact directly after birth if this is agreeable to you. Your baby rests naked, except for a nappy, on your chest for a minimum of 30 minutes. His/her heart rate will return to normal, the breathing will regulate and his/her body heat will rise one whole degree. There is a reduced production of stress hormones as the baby recovers from birth on your chest and the sense of well being and bonding enhances many important physiological changes that need to occur in the first few hours. Skin-to-skin is also very effective from fathers. ( See the work of Dr. Nils Bergman at his website:www.kangaroomothercare.com)

FROM DAY ONE

Breastfeeding within one hour after birth is highly recommended because baby has received hormones from you towards the end of the birth that make her alert and ready to feed at this time. Midwives are available to help with the initiation of breastfeeding. If you do not get the minimum 30-minute skin-to-skin contact or help with the initiation of breastfeeding in the labour ward, this can be done in the postnatal unit where baby stays in the room with you all the time. Doing skin-to-skin contact means that the dressing and bathing of your baby is delayed until she has had the “Kangaroo Mother Care” attention for a minimum of 30 minutes. After two hours baby may well sleep deeply for four to six hours and be difficult to rouse for feeding, so getting the first feed in is very important in order that her instinct to suckle, having already been stimulated, can continue as soon as she wakes. It is best to wake your baby after six hours and encourage her to feed so that you feed at least six times in the first 24 hours.

HOW MUCH SHOULD BABY FEED?

When your baby is first born, as an exclusively breastfed baby she/he has a requirement to feed – now confirmed by the American Association of Paediatrics 2004– at least six times in the first 24 hours of life and eight to 12 times in the following 24 hours. After an initial feed in the labout ward and perhaps a second feed with skin to skin on the postnatal ward your baby will be ready for a long sleep. Baby can sleep at this point up to 6 hours but should then be woken and then woken to feed so that the required amount of recommended feeds be given. This is ‘/demand feeding’/ which means that your baby feeds for as long as it wants to. This does *NOT *mean that your baby feeds /when /it wants to. It is better for the colostrum period that you keep the over view as recommended in the feeding times about this because some babies will sleep when they have a low blood sugar level or when they are unwell.*Waking your baby to feed in the first thirty six hours will ensure that you don’t have the /- /the* *second night /Feeding Frenzy -/ as Kittie Franz calls it*.A baby maintains its glucose and weight levels and stays hydrated enough to cope with any physiological jaundice that might arise due to natural conditions when it feeds early, frequently and effectively. Ask your midwife,public health nurse or lactation consultant to check the attachment of the baby on your breast. This will ensure that baby is adequately and accurately suckling by taking good amounts of the nipple and areola well into the back of his/her mouth. Rebecca Glover has good visual pictures of how to do this. Allowing the baby to feed this way ensures that your baby does not need supplementary feeds. Introducing bottles or pacifiers may cause nipple confusion, so if supplementary feeding is medically necessary due to excessive weight loss (more than 10% on the 3rd day) or low blood sugar levels, then cup or syringe feeding can safeguard the baby’s attachment and sucking behaviour at the breast. You can ask the hospital midwives to do this for you as most of the Dublin Maternity hospitals have a policy not to give bottles to breastfed babies. Unfortunately the insurance does not cover parents to do this themselves.

HOW TO ENSURE THAT BREASTFEEDING CONTINUES WHEN YOU RETURN TO WORK

Combining Breastfeeding and Work is a booklet available online at www.healthpromotion.ie/breastfeeding/ and at many HPH (Health Promoting Hospitals) units and health centres around the country. It provides guidelines for employers, employed parents, and co-workers on how to facilitate combining breastfeeding and working and includes a sample form for requesting breastfeeding breaks, a sample workplace breastfeeding policy, key points of the legislation, advantages of supporting breastfeeding, as well as information on how to express.
The advantages of supporting breastfeeding for employed parents are many. Mothers who breastfeed are at a reduced risk of developing health problems, such as cancers of the breast and ovaries and osteoporosis later in life. They also return to their pre-pregnancy weight faster. Breast milk is freely available, which is another positive economic advantage to breastfeeding for families. Breastfed children are healthier in the short, medium and long term, therefore parents of breastfed children are less likely to be absent from work to care for them when they are sick. 4Research shows that mothers are more likely to return to work and return to work much earlier when they are supported to continue breastfeeding.

If you decide to continue to breastfeed and return to work, usually a quiet time with baby at the breast is the last thing on the agenda before you go off to work and the first thing you do when you return home. You will need to express your milk once or twice whilst at work and you are now entitled as part of the Maternity Protection (Amendment) Act 2004 to take one hour in order to do this in an eight hour working day.

EXPRESSING YOUR MILK

Giving a baby your own expressed breast milk is the next best thing to breastfeeding. Expressed breast milk (EBM) keeps for five days in a fridge and in a freezer for three months. Even at room temperature it does not ‘go off’ as quickly as other liquid milks or formula. Look for advice from your LC on how to safely express your milk. For some mothers who have a great milk supply expressing can overstimulate the supply and lead to blocked milk ducts. It is not advised to express your milk until 6 weeks after the birth so that the baby and mother have properly synchronised the milk requirements of the individual baby. All babies are different.
Hand expressing or pumping milk helps maintain your milk supply. It prevents or relieves uncomfortable fullness, minimises leaking and helps prevent plugged ducts or breast infection, which may develop if the breasts remain overly full. This is a learned skill and it is worthwhile to remember that it takes time and practice to get it to work well. It is far simpler than pumping when you get good at it, although pumping may stimulate your supply better if you have long hours at work. You will also pump better amounts over time. At weekends and days off, the milk supply is re-stimulated with more frequent feeding.

DON’T RUSH THE BOTTLE

Delay introducing the bottle. Many mothers who are planning to return to work may be tempted to begin using bottles early ‘to get the baby used to them’. But there are several reasons why this can bring a quick end to breastfeeding. If the bottles contain formula, this can interfere with a new mother’s milk supply. The amount of milk a mother produces is determined by how often her baby nurses and how much her baby takes from the breast. Giving formula during the adjustment period sometimes short-circuits this ‘demand-and supply’ process, reducing the amount of milk produced. For the same reason, pumping so your partner or babysitter can feed the baby is best avoided. Partners can support you in many other ways. (See “The Womanly Art of Breastfeeding,” 2004) for examples.

Even if you pump your own milk, giving bottles too soon can cause nipple confusion. Feeding at the breast requires more active participation from a baby than taking liquid from a bottle. If both breast and bottle are given during the impressionable early weeks, a baby may try to suck the breast as he sucks the artificial nipple. Babies may learn to suck less efficiently at the breast and may not gain well or may refuse to nurse altogether. If baby refuses to take a bottle when you are separated, feedings can be given by a cup or spoon until baby gets used to the change. Check with the NMH’s alternative methods of feeding.

Breastfeeding mothers in the paid workforce are now entitled, under The Maternity Protection (Amendment) Act 2004, to:

Paid time off from work for the purposes of breastfeeding, or the expression of breast milk, where facilities are provided in the workplace by the employer (employers will be required to provide appropriate facilities where this does not give rise to more than a nominal cost); or

A reduction in working hours without loss of pay to facilitate breastfeeding where facilities are not provided.
Breastfeeding breaks or a reduction in working hours without loss of pay for the purpose of sustaining breastfeeding can be in the form of one 60-minute break, two 30-minute breaks or three 20-minute breaks or such number as agreed between with the employee and her employer.

IS IT ALL WORTH IT?

Would it be easier to give up breastfeeding if you plan to return to work?’ One working mother who had bottle-fed a previous baby and is now breastfeeding puts it this way: “Breastfeeding simplifies many things for me, plus it helps to ensure that when I am home, I am spending time with my children.” Coping with separation for many mothers can be the hardest part of returning to work. A mother who plans to combine working would do well to find the time to attend La Leche League/Cuidiú, or (health centre) support meetings. Breastfeeding mothers who are separated from their babies regularly need the important support that comes from being with other nursing mothers. – from The Womanly Art of Breastfeeding.

SUPPORT GROUPS

Breastfeeding peer support groups provide a relaxed environment where breastfeeding is the “norm” and mothers can share information. Cuidiú and LLL run local meetings that are co-ordinated by trained counsellors who can guide mothers through practical aspects of breastfeeding, like feeding positions and latching on.

Cuidiú-ICT
Carmichael House
North Brunswick Street
Dublin 7
Tel: (01) 872 4501
Email: info@cuidiu-ict.ie

La Leche League Ireland

The Community Mothers Programme
First Floor
Park House
North Circular Road
Dublin 7
Tel: (01) 838 7122

REFERENCES

1. Auerbach KG and Riordan J. Breastfeeding and Human Lactation 3:73
2. World Health Organization. Global Strategy on infant and young child feeding. 2002-4;13.10
3. Bachrach, V.R. G .et al. Breastfeeding and the risk of hospitalization for respiratory disease in infancy averages: A metaanalysis. ArchPediatr Adolesc Med 2003;157(3):237-43
4. Auerbach KG and Riordan J. Breastfeeding and Human Lactation.
5.The baby drives the System A unique Partnership. by Kittie Franz RN, CPNP-PC