Breast is Best!
Breastfeeding Basics for doctors who love children
Jennifer E. Guss, MD
Breast Feeding Benefits
AAP recs exclusive breastfeeding for the first 6 months of life
and continuing for the second 6 months
breast milk is optimal nutrition ptn/fat/carb
anti-infective properties/decr infectious dz: diarrhea, pathogenic
bacterial flora, nec, OM, LRTI, UTI
prevent immune mediated dz-DM, Crohn, eczema, asthma,
allergic gastro
long term cognitive and psych benefits
Breastfeeding Benefits
mother-infant bonding enhanced-skin to
skin contact
improved scores on tests of cognitive
devel.
Breast fed babies have on average IQ
score 7 points higher than formula fed
babies
other factors assoc with breastfeeding
enhance infant development/IQ:
socioeconomic,mat ed, mat IQ
it is wonderful!
Breastfeeding Benefits-
what’s in it for mom
promotes uterine contractions to
accelerate uterus returning to
prepregnancy state
burns 400-500 calories per day so
promotes reversal of pregnancy weight
gain
very cheap!
convenient! No mixing, washing,
preparation needed!
Statistics-USA 2003
70% initially breastfed some or exclusively
at 4-5 months old only 33% are still
breastfeeding some or exclusively
at 12 months old only 15% are still
breastfeeding some or exclusively
exclusive breastfeeing rates are even
lower
Statistics-USA
In US women most likely to breastfeed are:
married, older, higher level of education
barriers to breastfeeding-many!
Breast Milk Nutrition
Protein Content: 70% whey 30% casein
Bovine milk is 18% whey 82% casein
whey ptns digested more easily, resist acid
ppt= promotes gastric emptying
lactoferrin, lysozyme, secetory IgA specific
whey ptns involved in host defense
Breast Milk Nutrition
also passive immunity enhanced by mom
excreting specific Ab’s when exposed to
foreign Ag
Lipid: 50% caloric content, Arachidonic
Acid and docosahexaenoic acid (DHA) are
in human but not bovine milk(both VLCFA)
deficiency of AA and DHA asoc with poorer
neural, devel, visual function
Breast Milk Nutrition
Carbohydrate=Lactose
minerals , vitamins, micronutrients
sufficient to achieve optimum growth for
term babies
at 4-6mo iron must be suppl, vit D at 2 mo
What do we give to supplement breast fed
babies the iron and Vitamin D they need?
Poly-Vi-Sol with Fe 1 cc po qday
At 4-6 months of age the infant may also
begin with iron fortified foods( ie cereal)
Clinical Scenario #1
Your are visiting with a first time mother a
few hours after the birth of her baby. She
wants to breastfeed and asks for your
guidance about how to proceed.
How to breastfeed
Mom must be relaxed, comfortable, well
hydrated, well nourished
begin by massaging the breast to stimulate
milk flow
manually express small amout of
milk/colostrum to tempt baby to begin
sucking
get baby in position to latch on
How to breastfeed
cradle hold
football hold
proper latch
nursing pillows: “Boppy”/ “Breast Friend”
How to feed
breastfeed AD LIB
offer breast whenever baby is awake
until baby is gaining weight well at the two
week visit, may not sleep longer than 3
hour intervals. May have one four hour
interval per day=ensure adequate weight
gain and hydration
How to breastfeed
most lactation consultants and
pediatricians recommend waiting two
weeks before introducing a pacifier or
bottle to avoid “nipple confusion.” The MD
should put an order in the breastfeeding
infant’s hospital chart stating “no pacifiers,
no bottles.”
Clinical Scenario #2
On DOL #2 you visit the same mother.
She is crying because she has blisters and
cracked, bleeding areas on her nipples.
She says she is in so much pain that she is
dreading each feed.
Trouble shooting
never breastfeed for more than 45 minutes
total each feed
never breastfeed for more than 30 minutes
on one breast
for ad lib feeders : don’t offer breast more
frequently than every 45 minutes
Trouble shooting
make sure that the baby is latched on
properly
apply lanolin cream to the nipples after
each feed-different brands “Medela”
“Lansin-Oh”, may be purchased at Target,
Walmart, grocery stores in baby section
with diapers and bottles
Clinical Scenario #3
A nursing mother calls you on postpartum
day number 5. She thinks her milk has
“come in” but isn’t sure. What signs can
she look for to know?
Signs of milk ingestion
audible swallowing/gulping
milk drips out side of mouth
good uo
breasts empty/soft after feed
baby appears “milk drunk”
Clinical Scenario #4
A new mother calls your office on post
partum day #10. She is crying because
she thinks her milk supply is drying up and
she wants desperately to continue
breastfeeding. She is appropriately
supplementing and the baby is well
hydrated. What do you recommend?
How to breastfeed
breastfeeding burns 400-500 calories/day
must eat and drink well to have adequate
milk supply-make sure she is eating and
drinking!
must continue taking PNV’s for mother’s
health especially her bones and teeth
How to breastfeed
Reglan: 10mg po TID x 7 days, then stop
for 7 days. Repeat if needed.
Reglan side effects: abdominal cramping,
diarrhea, increased infant stooling,
dystonic reaction-treat with benadryl
Reglan increases prolactin levels
fenugreek
How to breastfeed
nurse as much as possible to increase milk
supply.
The body produces breastmilk based on
infant demand
How to Breastfeed
set the mood! a quiet, comfortable place
prop up on pillows
have a large glass of water within reach
have the phone within reach
Dads/partners/friends can help with above
Clinical scenario #5
At the two month visit, the baby’s mother
tells you that she will soon be returning to
work but wants to continue to exclusively
breastfeed. What advice can you give
her?
Breastfeeding and
working
Pumping: hand held pumps, electric
pumps
Supplementing with formula
Any amount of breast milk is good and
some is better than none!
“Something’s better than nothing, but
nothing’s better than more.”
“Something’s better than nothing, but
nothing’s better than more!” “More” by
Steven Sondheim sung by Madonna as
Breathless Mahony in the 1990’s film Dick
Tracy
Pumping
Milk supply is greatest at about 6AM so
pump after first morning feed
have baby nurse off only one breast each
AM and pump the other. Both breasts will
produce adequate supply.
At work, try to pump as often as baby
nurses. Bring photo of baby to stimulate
milk supply.
Pumping
Expressed milk will stay fresh at room
temp for 30 minutes, in the fridge for 24
hours, in the freezer for at least 3 months.
As with formula, once a bottle has been
prepared and eaten from, it must be
discarded after one hour.
Breastfeeding Aids
breastfeeding trainers-good after breast
surgery(reductions, augmentations,
removal of masses)
Medela makes bras that hold pump horns
in place so a woman may pump “hands
free”
nursing clothes
Politics
self conscious nurser v. “La Leche Freaks”
The Right to Breastfeed Act, HR 1848-
signed into law 9/28/99- right to bf on
Federal property/public parks/museums
Texas Health and Safety Code-right to bf
in any place where the mother has a right
to be, since 1995