Breastfeeding is the act of feeding a baby from the breast of a woman, specifically it’s mother.

Human milk is species-specific. In 2003, the Global Strategy for Infant and Young Child Feeding called for all mothers to have access to skilled support to initiate and sustain exclusive breastfeeding for 6 months and ensure the timely introduction of adequate and safe complementary foods with continued breastfeeding up to 2 years or beyond (World Health Organization [WHO]/UNICEF 2003).

Breastfeeding for the first 6 months of life is the ideal start for babies. This is termed as exclusive breastfeeding. Breastfeeding improves infant and maternal health and cognitive development in both developed and developing countries, and it is the single most important preventive approach for saving children’s lives (Renfrew and Hall 2008). It has been known for some time that exclusively breastfed babies who consume enough breastmilk to satisfy their energy needs will easily meet their fluid requirements, even in hot dry climates (Sachdev et al 1991; Ashrafet al 1993).

PROPERTIES OF THE BREAST MILK

Human milk varies in its composition:
• with the time of day (e.g. fat content is lowest in the morning and highest in the afternoon)
• with the stage of lactation (e.g. the fat and protein content of colostrum is higher than in mature milk)
• in response to maternal nutrition (e.g. although the total amount of fat is not influenced by diet, the type of fat that appears in the milk will be influenced by what the mother eats)
• because of individual variations.

However there are two basic types of breast milk that passes out during breastfeeding:

1. The fore milk: this is the breast milk that comes out at the very beginning of suckling. It is thin and watery and is largely composed of water.
2. Hind milk: this is the milk that comes out later on during proper suckling. It is highly nutritious, heavy and satisfying.

However improper suckling from the baby may not stimulate the production and ejection of the hind milk resulting in the baby suckling watery, less nutrient densed breast milk and as such leaving the baby with a non nutritious diet, hungrier in short intervals and gradual weight loss. This is the most common reason for which most mothers argue the breast milk is not enough for the baby and as such introduce complementary feeds before the 6 months expected time.

COMPONENTS OF THE BREAST MILK

The breast milk is composed of all the necessary nutrients needed for the effective growth and development of the newborn child in its correct proportions. These nutrients are:

1. Fats and fatty acids
This is the highest quantity found in breast milk since for the human baby, with its unique and rapidly growing brain, fat, not protein, in human milk has particular significance to its efficient development.

2. Carbohydrates: The carbohydrate component of human milk is provided chiefly by lactose, providing the baby with about 40% of calorific requirements.

3. Proteins: Human milk contains less protein than any other mammalian milk (Akre 1989a).

4. Vitamins: All the vitamins required for good nutrition and health are supplied in breastmilk, and although the actual amounts vary from mother to mother, none of the normal variations poses any risk to the infant (Hopkinson 2007).

5. Minerals and trace elements: these include a combination of so many mineral elements including; iron, zinc, calcium and so many other minerals.

6. Anti-infective factors: these include white blood cell components that build the earliest immunity for the baby. They include; leukocytes, immunoglobulins, lysozymes, lactoferrin, bifidus factor, hormones and growth factors.

POSITIONS USED IN BREASTFEEDING

• Sitting up/Upright hold: in this position, the mother sits at an angle of a 90 degrees in an upright chair or supported by pillows this is complemented with the baby sitting straddling on her thigh, or on her hip, with his spine and head upright as he feeds.
• Laidback nursing: the mother breastfeeds the child lying on her back between an angle of 30 to 60 degrees to increase comfort as the baby lies on top of her. It is the most common position and the very first practiced as right after delivery, the initiation of the skin to skin contact is done with the baby being placed on the chest of the mother.
• Football hold: in the football hold, the mother sits with the baby resting on her forearm and his body tucked alongside the mother’s side with his feet toward the back of the chair. A double football hold means a use of both arms to give maximum support.
• Cradle: in this position the mother sits or stands upright with the baby lying on his head. The baby is placed with his head and neck lying along the forearm of the mother and his body against the mother’s stomach termed tummy-to-mummy.
• Cross cradle: this is just like the cradle but with opposite arms interchanged and both arms involved. This is best for newborns as it allows the mother to have maximum support for the baby’s head and neck.
• Side lying: in side lying, the mother lies on her side sharing the bed with the baby. This position is ideal for night time feeds or when the mother feels sleepy as tired or sleepy as it allows her to have ample rest whilst feeding the baby.

Feeding behaviour
When a baby is introduced to the breast to feed, the baby typically performs one of three activities (Monaci and Woolridge 2011), these activities are:

1. Doing nothing.
2. Stimulating the mother’s nipple, without swallowing milk (non-nutritive
   sucking/simply sucking).
3. Sucking and swallowing milk (nutritive sucking/swallowing).

This is a very worrisome situation for most primip mothers especially with the point one where their baby just ignores the nipple and goes unmoved.

For others, they may pride themselves about how much their baby sucks the milk and yet continually witness a weight loss anytime at every visit to the Child welfare clinic for weighing.

For this we encourage mothers and pregnant women to make it a point to visit the ante natal care during the period of their pregnancy as all these and many more are taught. Also, we encourage our midwives to make it a point to educate these mothers after delivery and ensure the right measures are put in place.

In the proceeding articles, we’d delve deeper into circumstances and abnormalities that can hinder or impede effective breastfeeding.

#worldbreastfeedingweek

References

1. Akre J. Infant feeding: the physiological basis. Bulletin of the World Health Organization. 1989;67(Suppl 1)

2. Ashraf RN, Jalil F, Aperia A, et al. Additional water is not needed for healthy babies in a hot climate. Acta Paediatrica. 1993;82

3. Hopkinson J. Nutrition in lactation. Hale TV, Harmann PF. Textbook of human
lactation. Hale Publishing: Amarillo, TX; 2007

4. Monaci G, Woolridge M. Ultrasound video analysis for understanding infant
breastfeeding. [Proceedings of the 18th Institut d’Economia Ecològica i Ecologia Política International (IEEEP) Conference on Image Processing (ICIP), 1765–8. doi: 10.1109/ICIP.2011.6115802] 2011.

5. Renfrew MJ, Hall D. Enabling women to breast feed. Editorial. British Medical
Journal. 2008;337:

6. Sachdev H P S, Krishna J, Puri RK. Water supplementation in exclusively breast- fed infants during the summer in the tropics. Lancet. 1991

7. WHO (World Health Organization)/UNICEF. Global strategy on infant and young child feeding. [Available at] http://www.who.int/nutrition/topics/global_strategy/en/ and http://www.who.int/nutrition/publications/infantfeeding/9241562218/en/index.html; 2003 [(accessed 5 August 2013)].

8. Jayne Marshall, Maureen Raynor, 2014, Myles Textbook for Midwives, sixteenth edition, Churchill Livingston, Edinburg.