Sunday, March 7, 2010

Breastfeeding the Early Days

Moeder en kroost by Inferis

Anas, may Allah be pleased with him, narrated: Salamah, the wetnurse of Ibrahim, the son of the Prophet, peace of and blessings of Allah upon him, said, "O Messenger of Allah. You give tidings of all the good to the men and you don't give tidings to the women." He said, "Did your female companions induce you to [ask] this?" She said, "Yes." He said, "Will one of you not be pleased that when she is pregnant from her husband and he is pleased with her that she has a reward like the reward of the one who fasts and prays in the way of Allah? Then when she is in labor, none of the people of the heavens or the earth know what is hidden for her of [pleasures,] soothing to her eyes. And when she delivers, no mouthful of milk flows from her nor a [child's] suck except that she has a reward with every mouthful and with every suck. And if [her child] keeps her awake during the night, she has a reward similar to the reward of freeing seventy slaves for the sake of Allah."

-Related by Tabarani in his Mu'jam al-Awsat

Isn't that an amazing hadith?! The reality for most women is that breastfeeding does come easily and continues without much of a hitch. However, it is not true for everyone, and for some mothers, this can be particularly devastating. One of the wisdoms which I gathered from the conference on lactation* is that birth practices do affect and impact breastfeeding and its longevity. I wish most of us would have home births, where for the most part, optimal birth practices are in place to promote breast feeding, but alas, I know that is not the case. Although most hospital staff are in support of breast feeding, much of what happens in the first few hours is dictated by hospital policies and procedures, rather than a drive towards successful lactation. It's time we started looking at breastfeeding as a part of the birth experience, not a separate component. The following is a brief, brief summary of what I learned at this past week's conference, which can optimize lactation, breast milk production and bonding for mother and child in those most invaluable early days. All of these things can be included in a birth plan and discussed with your midwife and/or doctor.

Skin to skin contact has been proven scientifically to increase, among many other things, rates of exclusive breastfeeding in mothers and infants. As long as the baby is stable at birth, this is easily accomplished and accommodated in any birth setting. Request that the baby be placed on your abdomen or chest immediately after birth. Skin to skin contact is dose dependent, the more skin to skin in the early days, the better adjusted your baby is to this earth, and the more successful breastfeeding becomes. Anyone can do skin to skin contact, the father, grandmother, auntie. It is ideal if it's the mother, but the self regulating mechanisms of skin to skin can be accomplished with other adults. The other benefits of skin to skin are that it begins to colonize the normal flora of a baby's many developing systems, it regulates temperature and respirations of a baby (particularly important for a preemie), and amazingly reduces pain in the baby. Skin to skin contact also increases levels of oxytocin in the mother's blood stream, a hormone essential for a mother to let down her milk supply to the baby.

Infants are born with an instinct to find the breast and self attach. This video eloquently demonstrates this. The areola, the darkened skin around the nipples acts as a point of focus for the baby. The scent of amniotic fluid reminds baby of his intrauterine home and as he journeys to the breast, he is smearing this scent from his hands over the mother's body. This is both calming and a guidance to the infant. As you'll see one of the remarkable things about this instinct, is that it is influenced by pain medications used in labor, if used the instinct is dulled and disorganized. Epidurals are not without their place in the birth world. However, they are not without their side effects either. A recent study found that women who used an epidural with Fentanyl (a narcotic analgesic) had lower rates of exclusive breastfeeding at six weeks postpartum. Undisturbed, natural birth deserves more credit than it receives, it's benefits are subtle and vast, the self attachment of a newborn to its source of nourishment being but one.

Prolactin, the hormone required for breast milk production, rises with repeated stimulation of the breast. When babies are born, they are usually in a quiet, alert state. Priming the hormonal pump, by taking advantage of this state and initiating breastfeeding within an hour and half or so of birth, can help to increase and maintain milk supplies. The feeds should not be timed or scheduled in order for baby to continue stimulating the release of this important hormone in the first few days postpartum.This usually translates as: stay in bed with the baby and let the baby feed frequently!

Hand expression is another useful tool for a breastfeeding mom to learn. This is a video which beautifully explains how to do it. Hand expression after each feed in the early days, continues to stimulate your breast to make more milk, it also fully empties the breast when a newborn cannot, another important element in increasing milk supply. An empty breast signals the brain that it needs to make more milk. Hand expression accomplishes this beautifully and without a bulky pump. If done regularly after each feeding, it can also prevent engorgement of the breast. Save what you collect and feed to the baby with a spoon, small cup, or syringe.

This is just a small assortment of things to help you along in the first few days of your new child's life. Things like latch and positioning are immense and deserve much more time than a blog posting allots. As the above hadith states, with every mouthful and suck, a mother gets a reward. I hope that these tips increase your babies moutfuls and sucks and in turn your reward!

*I would like to thank the woman at Evergreen Perinatal for their dedication to breastfeeding and for an amazing conference. If any of you get the chance to attend on of their lectures, it is well worth it.

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