allaitement

Breastfeeding is fashionable again. But of course is not a fashion. Breast milk is better than available formulas. They are trying to emulate it, and succeed only partially. If the mother and her family environment are favourable, breast milk is definitely the best infant diet.

In Sweden, thanks to long maternity paid leaves, 70 percent of mothers continue to breastfeed when their baby is 7 months old. It is commonly assumed that this longer breastfeeding is the main reason why swedish children, up to the age of 7 years, enjoy a significantly better health than those in surrounding countries.

Breast feeding shields almost completely the infant against gut infections and reduces the allergic risk, a lasting personal advantage since the favourable influence on allergic diseases (less frequent and serious) remains measurable for up to 20 years. Respiratory infections heal faster. Otites (ear infections) are less common and sudden deaths more exceptional. Jaws grow better, limiting the need for orthodontic treatments. Children who were breastfed develop appendicitis less often.

An intelligence gain has also been observed : in average an IQ difference of 8 points to the advantage of children breastfed as little as 3-4 months.

Well managed breast feeding accurately meets the infants nutrition needs and reinforces the emotional link between mother and child.

Breast feeding also benefits mothers. The breastfeeding mother's bone density increases, preventing osteoporosis, provided calcium and vitamin D intakes are sufficient. Women who have breast fed develop fewer breast cancers.

On demand

The commonest mistake leading to breastfeeding failure is an effort to implement a schedule too early. Milk production depends on how often the baby is fed. Through sucking on the nipple, and emptying the breast, infants stimulate milk secretion and adjust rapidly their mother supply to their appetite, in general closely related to their true needs and in any case never excessive.

If shortly after birth, breasts are swollen and full of milk, this swelling recedes during the first few weeks of breastfeeding. Breasts store less milk and most mothers can go back to a smaller bra size. This does not mean they have less milk, but that a larger fraction (approximately one half) is produced during the feeding.

This notion is especially important to remember when the baby reaches the age of 3 weeks. At that age most, if not all normal babies experience a sudden appetite increase. The infant wakes up more often, becomes more active, asks to be fed earlier. Unfortunately it is also more or less at the same time that many mothers lose much of the help they could rely on, shortly after birth. The resulting fatigue tends to decrease milk production, at a time when an increase is required, and particularly towards the end of the day. This is a true crisis and to solve it, it must first be understood.

The mother must rest, forego non essential tasks and chores for a few days, and feed her baby as often as needed.

As a rule, if the baby cries and seems hungry, even half an hour after the preceding meal, he must be fed again and as often as he requires. Usually mothers quickly learn to tell hunger from other causes of crying, such as the need to be held or rocked. If the baby is not content after feeding on both breasts, each for about 10 minutes, he can be offered the first breast again, and the second, each for 5 to 10 minutes. This is called the "4 breasts meal". However the total duration of a feeding should never exceed half an hour.

This is the only way to obtain a happy, relaxed and satisfied baby and a mother who enjoys breast feeding, a very important contribution to its success.

In some maternities, the - rather wrong - advice is sometimes given to offer only one breast at each meal. But a breast which has not been emptied produces less. This technique puts a brake on milk secretion. This may be useful when the mother has too much milk. But most busy mothers would on the contrary spare no effort to increase their production, especially towards the end of the day, when fatigue limits milk secretion.

It is OK to set up a schedule, but not too early. It is certainly unreasonable to oppose a rigid schedule to babies needs or demands and their mothers pleasure to feed. If mothers choose to listen to their baby first, ignoring - if necessary - the advice of well-wishing but poorly informed relatives, they quickly realize that the infant gradually takes more milk during the feeding, wants to be fed less often and wakes up less during the night.

Every regularity should be encouraged but it is only after the age of about 2 months that attempts to stabilize the schedule can start. Eventually a regular, well structured day becomes psychologically more important to babies well-being than immediate responses to their demands. Events taking place at predictable times are reassuring, structure the baby's world and provide a feeling of safety.

How do we know if a breastfed infant drinks enough ? Growth and comfort are the main criteria. Feeding on demand will usually ensure that the child's hunger is satisfied, but some breast-fed babies are surprisingly tolerant and don't feed often enough to grow well. It is cautious not to space feedings by more than two hours in the morning and to expect that this interval will decrease during the day, often to less than an hour in late afternoon. A well-fed baby during the day is less likely to need and require night feedings.

In average, babies who appear satisfied and cry little take the breast between 8 and 12 times a day (24 hours). These infants, fed more often than bottle-fed babies suck less voraciously, swallow less air, their stomach is less full and digestive comfort is better. Colic and spitting up are less common, and burping can be completely absent.

Some health professionals warn against frequent feedings, suspected of contributing to colic. There is no doubt that some babies, mostly bottle-fed but breast-fed infants too, are satisfied and happy with 5 to 6 feedings a day. But in general, this advice is not appropriate for breast-fed babies. It is commonly associated with incessant crying, sometimes described as "colic" but more likely due to hunger. In this respect an observation which has long puzzled ethnologists challenges the idea that frequent feedings is responsible for digestive discomfort. In the African Kalahari desert, mothers of the Bushmen tribes breastfeed their babies during the day about every fifteen minutes. These babies do well, thrive normally, don't suffer from colic or spitting up. Actually, such a frequent nipple stimulation results in complete ovulation suppression. It is an effective technique of birth spacing, precious in an environment where food is scarce, to protect the group from starving. Of course this birth control method is not adapted to our life styles, but does provides evidence that even very frequent breast feedings are not a problem for infants.

Stools tend to be very frequent during the first few weeks, but gradually in some babies, they become quite rare. It is common to observe only 2 or 3 bowel movements a week or even less. If stools are soft, if the abdomen is not distended and the child remains comfortable, the situation is normal and there is no constipation .

Before feeding : prepare the nipple

Occasionnally the nipple does not protrude enough and the baby has difficulties seizing it. To overcome this problem, the following advice is given :

If despite all these measures, the nipple is still not protruding enough, it is often possible to extract it by pinching its base, pulling it upwards at the same time.

Keep the nipple in good condition

Breast secretion is a steady process and nipples are constantly wet with milk. It is best to allow them to dry, exposing them to air than to cover them with a piece of clothing rapidly soaked and prone to cause maceration or fissures. Bras compressing the nipple must be avoided, it is preferable to use special ones with a "window" The night gown must be ample, floating to leave nipples free. A good nipple hygiene is simple : wash it with water or normal saline, use ice or lemon in case of irritation. Creams and ointments are best avoided since they may interfere with skin breathing and drying.

And in case of nipple fissures ?

Nipple fissures hurt, bleed and may convince mothers to discontinue breastfeeding. This is unfortunate since an adequate treatment commonly takes care of them within a short time, about 24 hours. The above detailed advice is a good prevention, but what can be done for established fissures ?

Some mothers extract their milk, but are often disappointed by the amount they obtain. Actually, a normal baby is more efficient than the breast pump. The latter underestimates production and fails to stimulate it as much as the baby does.

During the feeding, a "tétrelle", a silicone nipple posed on the breast can significantly alleviate fissure-associated discomfort. After the feeding, the nipple must be cleansed with saline and dried without rubbing. Thereafter a small amount (approximately one dessertspoonful) of finely ground green clay ("argile verte moulue fine") available in pharmacies can be applied directly on nipples and fissures, covered with dry gauze, and held in place by a "window" bra until the next feeding. Other useful product are the Lansinoh cream or Démeter oil.