1

a M o t h e r ’ s g u i d e t o b r e a s t f e e d i n g .

3

Nature’s most valuable gift to a new-born child is its mother’s milk.

It is vastly superior to any other nutrients available to a baby.

With this book, our endeavour is to help expectant mothers prepare for

breastfeeding, and introduce them to the importance of initiating it within an hour.

One of the most important preventive strategies to reduce infant mortality rate,

exclusive breastfeeding for 6 months can protect the baby from infection. But it’s not

only the baby who benefits from it. Continuous breastfeeding for 2 years reduces

the risk of breast and uterus cancer in the mother as well.

Two decades ago WHO and UNICEF jointly launched two breastfeeding promotion

programs, WABA (World Alliance For Breast Feeding Action) and BPNI (Breast

Feeding Promotion Network Of India). The aim is to protect, promote and support

breastfeeding. At present, the global strategy is IYCF (Infant and Young Child

Feeding).

Fortis Hospital, B.G. Road, Lactation Clinic with the help of BPNI guidance / training

conducts antenatal education program for to-be- and new mothers. They are trained

and counselled during the antenatal period. Also, after the delivery, during their

hospitalisation and post discharge, they are counselled as required. The Obstetrics

and Paediatrician team, including Lactation Consultants, jointly work to protect,

promote and support breastfeeding.

Team Nest

(Fortis Bannerghatta)

The contents of the book have been contributed by Ms Joyce, with guidance from Dr. Prakash Vemgal, Consultant Neonatologist and Paediatrician, and Dr. Aruna Divakar, Consultant Paediatrician, Fortis Hospitals.

4 5

According to studies conducted by WHO and UNICEF,

mother’s milk is vastly superior to any other nutrition

for a baby. No wonder that they have come up with the

programmes - Baby Friendly Hospital Initiative (BFHI) and

Infant and Young child Feeding Program (IYCF) - which

emphasise on the need for exclusive breastfeeding

for 6 months, and up to 2 years, along with other

complementary food.

Mother’s milk enhances the child’s development,

and also protects it against respiratory and allergic

infections, and diarrhoea. At the same time, it

prevents breast, uterine, and ovarian cancer in the

mother, contributing to her general good health.

Leaving aside the scientific and nutritional aspects,

there is also another benefit of breastfeeding: it

contributes to the uniquely beautiful way in which

the mother and child bond with each other.

W h Ybre a s t f eedingis i M Porta n t

6 7

• Reduces post-delivery bleeding and anaemia

• Delays next pregnancy

• Protects against breast and ovarian cancer

• Prevents obesity and shapes the body

b r e a s t f e e d i n gh e l P s t h e M o t h e r t o o !

Q u a l i t i e s o f b r e a s tM i l k

• Contains perfect nutrients

• Easily digestible

• Ready-to-serve

• Protects against infection

• Helps in adequate growth and development

• Enhances brain and visual development

• Enhances intelligence quotient

• Protects against allergic illness

• Protects against adult onset diseases (diabetes, blood pressure)

8 9

• Contains the right amount of carbohydrates, fats and proteins needed for the baby’s growth

• The protein is just right for the baby and has specific amino acids that promote brain growth

• Higher sugar level promotes brain development

• Contains essential fatty acids - DHA - which also promotes brain growth

• Has just the required amount of vitamins, calcium, phosphorus and salt

• Though the iron content is less, it is well absorbed and therefore adequate

b r e a s t M i l k – t h e P e r f e c t n u t r i t i o n f o r Y o u r n e W b o r n b a b Y

Breast milk is ideal for preterm babies as it contains more proteins, minerals and anti-infective proper-

ties, that suit the babies’ needs.

10 11

The body of a mother-to-be prepares itself for

breastfeeding. It is during this time that the ducts present

in the mammary glands develop, thus attracting more

blood towards it. A mother-to-be might notice a marked

growth in the breast size at this point.

t h i n g s t o k noW b e f o r e d e l i V e rY

However, this has nothing to do with the ability to nurse

successfully. It is important, at this stage, to learn the

best position in which to breastfeed the baby. Mothers-

to-be can also get a few front open dresses to make

breastfeeding easier.

12 13

a f e W Q u i c k

fa c t s f o r M o t h e r s -

t o - b e a n d n e W

M o t h e r s

• Breast milk is the BEST

• Bottle and artificial feeding is dangerous

• Breastfeeding helps mothers lose weight after delivery

• Size and shape of the breasts do not matter: they produce perfect milk

in sufficient quantity

• Mother’s nutrition is very important: include green leafy vegetables,

seasonal fruits, and protein rich foods such as milk, pulses and beans in your diet

• Breastfeeding should start within ½ hour of delivery, skin-to-skin

• New mothers feel more emotional and sensitive - these feelings

are normal and will pass off with time

• Building the confidence of the mother and the whole family is vital

14 15

PRODUCTION OF BREAST MILkThe breast consists of glands supported by tissue and fat. These

glandular tissues (known as alveoli) are small sacs, made up of

millions of milk secreting cells which form small tubes that open

into the nipple. Before reaching the nipple, these tubes become

wider, and form lactiferous sinuses in which milk collects. The nipple

contains many sensory nerves making it highly sensitive. Around the

nipple there is a circle of dark skin called areola beneath

which the lactiferous sinuses are located. Thus, the areola must go

inside the baby’s mouth in order for the baby to draw milk.

h o W b r e a s t f e e d i n g W o r k s

MILk REACHING YOUR BABY Every time your baby suckles at the

breast, the nerves ending in the nipple

are stimulated. These nerves prompt the

brain to release a hormone called prolactin

which in turn goes into the blood and into

the breast, secreting milk. This entire series

of events from stimulation to secretion

is called the milk secretion response, or

prolactin reflex. It is very important to

understand the effect of suckling on milk

production. If your baby suckles more,

your breast will make more milk. If the

baby stops suckling or never starts, the

breast stops making milk. If you have

twins and they both suckle, then your

breasts will make extra milk for two babies.

This is called the law of demand and

supply. Feeding during night increases the

supply of milk as more prolactin is secreted

at night. Muscle cells

Oxytocin makes them contract{

{

{

Prolactin makes them secrete milkMilk secreting cells

Ducts

Milk collects here

Lactiferous sinuses

Nipple

Areola

Alveoli

Supporting tissue and fat

16 17

PROLACTIN REFLEx INCREASES MOTHER’S MILk SUPPLYEjection and flow of milk to your baby is due to production of another

hormone called oxytocin. Stimulation of sensory nerves in the nipple

by suckling also induces the production of oxytocin, which acts on the

muscle cells around the alveoli, causing the ejection and flow of breast

milk to your baby’s mouth. These events are known as the ‘milk flow

response’ or oxytocin reflex.

OxYTOCIN REFLEx WORkS BEFORE / DURING THE FEED TO MAkE MILk FLOW

Oxytocin is produced quickly with the start of the suckling

and is responsible for milk transfer from breast to the baby.

If oxytocin is not produced adequately, the baby may not get

enough milk. The oxytocin reflex may either be helped or

hindered by the mother’s thoughts, feelings and sensations.

Sensory impulses from nipple

More prolactin secreted at night

Suppresses ovulation

Prolactin in blood

Baby suckling

Thinks lovingly of babySound of babySight of babyCONFIDENCE

Worry StressPainDoubt

These help reflex These hinder reflex

18 19

Property Importance

Antibody rich Protects against infection and allergy

Many white cells Protects against infection

Laxative Clears meconium, helps prevent jaundice

Growth factors Helps intestine mature

Vitamin A rich Reduces severity of infection

COLOSTRUM

THIS IS IMPORTANT FOR SEVERAL REASONS:• Allbabiesaremostalertandactiveassoonastheyarebornand

this is the best time to feed them, as they will sleep off soon, tired by their long journey!

• Feedingthebabywillhelpmaintainnormalbloodsugarlevelsin

the baby and prevent low sugar levels which can have long-term problems.

• Thefirstmilkyouwillhaveisveryrichinaparticularsubstancecalled

immunoglobulins, which shields the baby from infections.

• Holdingthebaby,whilebreastfeeding,willalsokeepthebabyniceandcozy.

• Thebondbetweenyouandyourlittleonewillbeformedearlierandstronger!

Oxytocin (the hormone mentioned in the earlier chapter) helps in contracting your

uterus, which decreases bleeding after delivery and helps it return to its original size quicker.

e a r lY i n i t i at i o nIt is of utmost importance to initiate breastfeeding as early as possible after delivery.

In case of a normal delivery, the baby should be put to the breast within half an

hour and in case of a caesarean section, within up to four hours.

• Prolactin(mentionedintheearlierchapter)helpsreducepainpost-delivery.

Also, the earlier the production of milk starts, the better, as this will ensure that

you have more than adequate amounts of milk.

During the latter half of pregnancy and for the first few days after delivery, a

thick yellow viscous fluid is produced called colostrum. Although produced

in very small amounts, it is extremely rich in nutrition and anti-infective

substances which protects the baby against infections. Highly concentrated,

the baby requires only a little of it to be satisfied and full. After the first 3-5

days, ‘mature milk’ is produced in larger quantities.

20 21

STEPS TO REMEMBER:

POSITIONING AND ATTACHMENT

The position of the baby in relation to the mother is known as

positioning. Attachment is a term used to describe how the

baby has latched onto the breast.

As mentioned in the previous chapters, for the milk to be

expressed, the baby needs to suckle not just on the nipple,

but also on the areola, since the milk secreting alveoli are

located under the areola. If the baby sucks only on

the nipple it does not get enough milk and in the

process, hurts the mother as well. Hence positioning

and attaching the baby correctly will enable the baby to

suck on the entire areola and not only on the nipple -

resulting in good flow of milk and a satisfied baby and a

happy mother!

s k i n - t o - s k i n c a r e at b i rt hThe practice of keeping the baby on the mother’s abdomen

soon after birth is known as skin-to-skin care. If left

undisturbed long enough, the baby can actually move

towards the breast and start suckling. While helping

the mother and child bond, this also increases exclusive

breastfeeding rates and decreases pain in the mother.

This care can be continued in the postnatal ward,

particularly in low birth weight babies. In case this is

not practiced, then rooming in is highly recommended,

where the baby and mother are kept in the same

room, preferably on the same bed.

• Touchthebabyatregularintervalsandseeifthebaby

is warm enough.

• Wrapthebabyinseverallayersofcottonclothduring

cold and rainy weather.

• Practiceskin-to-skincareevenwhencarryingthebaby.

22 23

SIGNS OF GOOD POSITIONS:

• Paralleltothemother;baby’shead,neckandbodyareinastraightline

• Baby’stummyshouldtouchthemother’stummy

• Babyshouldbeturnedtowardsthemother,facingthebreast

• Bothmotherandbabyshouldbecomfortable

• Ifbabyisnewborn,mothershouldsupporthisbottomandnotjusthisheadandshoulder

SIGNS OF GOOD ATTACHMENT:

• Themouthiswideopen

• Lowerlipisturnedoutward

• Thebaby’schintouchingthebreast

• Partofupperareolavisible

• Baby’scheeksarefull

• Babyiscalmandrelaxed

• MotherdoesnotfeelpainProper breastfeeding position and latch-on

Hold your baby with itswhole body facing your body

Your baby should draw both your nipple and areola into her mouth

Hold your baby with its whole body facing your body

Support your baby’s head, neck and back

Milk duct

Areola

Nipple

MilkTongue

Rooting reflexWhen something touches lips, baby opens mouth and puts tongue down and forward

Sucking reflexWhen something touches palate, baby sucks

Swallowing reflex

Good attachment Good attachmentPoor attachment

When mouth fills withmilk, baby swallows

SkillMother learns toposition baby,baby learns to take breast

Poor attachment

24 25

c u e s f o r f e e d i n g Here are a few indicators

which will help the mother

understand when the baby

needs to be fed.

Early cues – “I’m hungry”

• Stirring

• Mouthopening

• Turninghead

• Seeking/rooting

Mid cues – “I’m really hungry”

• Stretching

• Increasingphysicalmovement

• Handtomouth

Late cues – “Calm me, then feed me”

• Crying

• Agitatedbodymovements

• Colourturningred

Time to calm crying baby

• Cuddling

• Skin-to-skinonchest

• Talking

• Stroking

Mother and child eXPerience in the first feW Weeks

Time Milk The Baby The Mother

Birth Colostrum (a rich, thick, yellowish milk) will be secreted in small amounts. It gives the baby a healthy dose of early protection against diseases.

Will probably be awake in the first hour after birth. This is a good time to breastfeed the baby.

Will be tired and excited.

First 12-24 hours

The baby will drink about 1 teaspoon of colostrum at each feeding.

It is normal for the baby to sleep heavily. As the baby wakes up, feed every 1-2 hours. Many babies like to eat or lick, pause, savour, doze, then eat again.

Will be tired and needs to rest.

Next 3-5 days White milk comes in. It is normal for it to have a yellow or golden tint first. If the milk is not in yet, it is best to talk to a doctor and lactation consultant.

Will feed a lot (this helps in making plenty of milk), at least 8-12 times or more in 24 hours. Very young breastfed babies don’t eat on a schedule. Because breast milk is more easily digested than formula, breastfed babies eat more often than formula-fed babies. It is okay if the baby eats every 2-3 hours for several hours, then sleeps for 3-4 hours. Feedings may take about 15-20 minutes on each side. The baby’s sucking rhythm will be slow and long. They may also gulp.

The breasts may feel full and leak. (Disposable or cloth pads can be used in the bra to help with leaking.)

The first 4-6 weeks

White breast milk continues. Will likely be better at breastfeeding and have a larger stomach to hold more milk. Feedings may take less time and will be farther apart.

Body gets used to breastfeeding. Breasts will be softer and the leaking may slow down.

26 27

P h Y s i o l o g Y

TYPES OF NIPPLE:

PROTRACTILE NIPPLES:

Nipples vary in shape and size. Here’s a list of the different types.

Flat nipples are common in mothers who are having their first baby. Most nipples despite being flat are PROTRACTILE i.e., on

pulling the nipple, it protrudes. Protractility is more important than the length of the nipple. Nipples will improve when the

baby starts to suckle.

For effective breastfeeding, it is important to be familiar with the physiology of the breast. Here are a few pointers

which will help you understand your body better and thus, also feed your baby more comfortably.

INVERTED OR RETRACTED NIPPLE:

Inverted nipples i.e., a nipple that goes deeper into the breast when the areola is squeezed,

needs more support and confidence for breastfeeding. Inverted nipples improve and the syringe

technique can be used for treating the inverted nipples after the birth of the baby.

Inverted Protracts poorly Protracts easily

28 29

i n h i b i t o r o f b r e a s t M i l k P r o d u c t i o nFor a breast to continue producing milk, the milk must be removed frequently, ensuring that the

breast is emptied. The following maybe a few reasons why production of milk may be inhibited:

• If a baby is suckling from one breast only, the other

breast stops producing milk.

• If a baby suckles more from one breast, that breast

makes more milk and becomes larger than the other.

• If a baby cannot suckle from one or both breasts or

mother is not able to breastfeed, the breast milk must

be removed by expression to enable milk production to

continue.

e X P r e s s i n g b r e a s t M i l k Various situations may arise which would require mothers to express milk.

• Feedingalowbirthweightorsickbaby

• Torelieveengorgement

• Keepupthemilksupplywhenmotherisill

• Relieveleakingbreasts

• Leavemilkforthebabywhenthemothergoesouttowork

HOW TO ExPRESS THE MILk• Washyourhandsthoroughly

• Sitorstandcomfortablyandholdthecupnearthebreast

• Putyourthumbontheareolaabovethenippleandyourfirstfingerontheareolabelowthenipple

(opposite to thumb)

• Pressbackwardstowardsthechestandthensqueezetheareolabetweenthefingerandthumb

• Thisprocesshastobedonetillmilkstopsflowingfromthatsegment

• Thisprocessshouldberepeatedinallsegments

If breast remains full of milk, secretion stops

Inhibitor

30 31

HOW TO PREPARE THE CONTAINER

• Chooseacup,glass,jugorjarwithawidemouthwithlid

• Washthecupwithsoapandwaterandleaveitinthesuntodryorboilthecupbeforeyouexpress

• Afterexpressing,keepthemilkinaclosedcontainer

Breast pump can be used if expression is needed for long period. However, correct cleaning and sterilising is required.

Place the finger and thumb on the areolaand press inwards towards to chest wall

Press from the sides to take milk from the other segments

Press the areola behind the nipple,between the finger and thumb

INCREASING SUPPLY

STORING OF ExPRESSED BREAST MILk

Signs that your baby is not getting adequate milk:

• Babywillsuckvigorouslyforafewminutesandthendropofftosleep.

• Onceputdown,itwillwakeupinaveryshorttimeandrepeatthewholecycle.

• Itwillhavefewerwetnappies.

• Urinewillbeconcentrated.

• Bowelactionswillbescant.

This situation can be improved by transferring the baby to alternate sides. Offering both breasts twice during any one feed

will ensure a better feed for the baby and more stimulation for the mother. This will not only keep the baby awake and

enthusiastic during the feed and ensure better sleep, but production of milk will also increase dramatically over the next 48

hours. If this doesn’t happen, please contact your lactation consultant.

• Ensurehandsarecleanandthatallcontainers

have been thoroughly cleaned and sterilised.

• Useplasticcontainersorpre-sterilisedplastic

storage bags. When your baby is small you may

wish to store your expressed breast milk in small

quantities to avoidwastage. If freezing, a plastic

sterilised ice cube tray is useful for this. Seal in

a freezer bag once the cubes are frozen.

• Labelwiththedateandtimeandrefrigerate

or freeze.

• Expressedbreastmilkcanbestoredinthe

refrigerator at the back or the coldest area

(not the door) for up to 5 days.

32 33

Giving complementary food too early or too late could lead

to malnutrition and other problems. If given too early, the

infant may not be ready to digest the food properly and it

may also reduce intake of breast milk, thereby, losing out

on appropriate energy intake for its growth. This would

eventually result in increased risk of illnesses in the baby, and

increase the mother’s risk of pregnancy.

i n t r o d u c i n g s o l i d f o o d t o t h e b a b Y

When your baby completes 6 months, it is the time to

gradually introduce solids to its diet apart from breast milk.

The 6-11 month period is an especially vulnerable time

because infants are just learning to eat and must be fed soft

food frequently and patiently. Care must be taken to ensure

that these foods complement rather than replace breast

milk as it continues to be an important source of energy,

protein, vitamin A and vitamin C. Breastfeeding should

ideally continue up to the age of 2 years with appropriate

complementary feeding after 6 months.

IDEAL TIME TO INTRODUCE SOLID / COMPLEMENTARY FOOD

Every baby must be exclusively breastfed for at least 6 months. This means

that any liquid - honey, glucose water, gripe water, juices, vitamins, animal

powdered milk - or even plain water, should not be given to babies. There is

adequate water in breast milk to keep the baby hydrated even in hot climate.

Moreover, the baby may also get infections from water.

Even pre-lacteal feeds are a no-no, since they too can cause infections, and

most importantly, they may prevent the baby from sucking at the breast.

Pacifiers can give a false sense of satisfaction to the baby who may therefore

not suck at the breast. They are also a source of infection.

e X c l u s i V e b r e a s t f e e d i n g

i s i M P o rta n t

34 35

Introduction of complementary foods too late, on the other hand, results in an inadequate intake of energy

and protein leading to poor growth, and stunting, as well as iron and other nutrient deficiencies. This

results in increased risk of ill health, deficiencies and malnutrition.

Taste, consistency, texture and types of complementary food are important in order to ensure that the child

accepts solid food. A child’s first food should be based on cereals like suji or fruits like banana, thicker than

breast milk, and should be bland in taste and mashed or strained to homogenise. Consistency of food

gradually needs to be changed from liquid to semisolid and then to solid with advancing age of the child.

Initially, a baby might spit out the food. That does not mean he does not like it.

THE CHARACTERISTICS OF A GOOD COMPLEMENTARY FOOD

• Shouldberichinenergyandadequateingoodqualityprotein,vitaminsandminerals

• Shouldhavesoftconsistencytoenablethechildtoswalloweasily

• Shouldhavelowdietarybulk

• Shouldneedminimalpreparationpriortofeedingandshouldbeeasilydigestedbythechild

• Shouldbefreefromanti-nutritionalfactorsandlowinindigestiblefibre

• Shouldbefreefromartificialcoloursandflavours

• Shouldbelocallyavailable

TIPS FOR SMOOTH INTRODUCTION OF SOLID FOODS

• Relaxwhilefeedingyourbaby.

• Introduceonlyonefoodatatime.

• Offerhomemade/local/familyfood.

• Avoidspicesandchillies.

• Servethefoodtoyourchildonaseparateplateorinabowl.Thiswillgiveyouafairlygoodideaofthe

quantity of food your child has eaten. It also encourages your child to learn to feed himself.

• Introducevarietytothediettomakeitmoreappealing.

• Neverforcefeedthechild.Ifthechilddislikesaparticularfood,re-introduceitatalaterstageormixitwith

another food that the baby likes. If the child shows a persistent dislike for that food, substitute it with

something else.

• Ifacertainfoodmakesyourbabysickorpale,itmaybeallergictoit.Stopitrightaway.

• Encouragethechildtoeat,bytalking,playing,payingattentionandshowinginterest,loveandaffection.

36 37

Cereals: Cereals like rice, wheat, jawar and millets

are an important source of energy, iron, protein and

also a certain amount of fat. A thick creamy porridge

made from cereals in water / milk / milk-water mixture

can be used to feed your child. The porridge should

be thick (too thick to be given through a bottle) and

concentrated but soft. Some oil or fat (or sugar) can

be added to help swallow and digest. Care should

be taken to ensure that the porridge is not watered

down or made unduly thin which will further reduce

the energy content.

Legumes: Lentils, bengal gram, red gram, horse

gram, moong dal, arhar rajma, lubia etc. are also a

good source of vitamins and minerals in addition to

proteins. When eaten with cereal staples, they are just

as nutritious as animal foods (meat, fish, milk) but are

much cheaper.

Non-veg food: Can be started after the baby is 8

months old (avoid egg white till 12 months). Eggs,

TYPES OF COMPLEMENTARY FOODS

meat, and fish are all nutritious and rich sources

of energy. They provide high quality protein,

vitamin B12 and iron and are easily digestible. Eggs

should be initiated in a half boiled or full boiled

and mashed form. Meat of all origins needs to be

properly cooked, chopped very finely, pounded or

mashed before it can be given to your child.

Milk and milk products: All types of milk provide

high quality protein. While it is a rich source of

vitamins and calcium, it is a poor source of iron.

However, if you have a family history of allergy and

asthma, it may be avoided in the first year of your

child’s life. Also, at this point, breast milk is enough

for the baby.

Oil or fat: This helps in increasing the energy

density of the food and helps in absorption and

metabolism of vitamin A. It can be used during

initial cooking of the food or after it is ready. It aids

easy swallowing and digestion.

Sugar or jaggery: This may be added to the infant’s food

to improve taste and to provide additional energy and

minerals.

Vegetables and fruits: Vegetables increase the vitamin

(especially A, B and C) and minerals (especially iron)

contents of complementary foods. Dark green or yellow

coloured vegetables are particularly good sources of vitamin

A. Tubers and starchy roots like potato, sweet potato and

colocasia (arbi) are rich in carbohydrates. These should be

well cooked and properly mashed and are best given along

with the cereals.

Fruits add to variety and taste. They can be given mashed

either alone or with cereals. Fruits like banana, mango,

papaya, pear, plum, peaches are good sources of vitamin

A and citrus fruits provide vitamin C besides minerals.

Because fruits contain no proteins, they are not a good

source of energy.

Just right Too thin

38 39

By 6 months an infant can voluntarily control suckling and swallowing.

Biting movements also begin at this time. The tendency to push solids

out of the mouth decreases. This indicates that the child can eat soft and

starchy foods such as cereals.

By the age of 9 months a child can use the lips to clear a spoon and use

the tongue to move food between the teeth. At this age solids can be

chewed. Thus, mashed and chopped foods can now be introduced.

h o W Y o u r b a b Y ’ s f e e d i n g a b i l i t i e s d e V e l o P Development Chart

Exclusive breast feeding for initial 6 months

Eggs Animal Protein

Dhal / Pulses

Vegetables / Fruit

Ragi / Rice / Wheat

- 8-9 Months

- 10-12 Months

- 7 Months

- 6 Months

f o o d d e V e l o P M e n t c h a rt f o r Y o u r b a b Y

40 41

f i V e k e Y s t o s a f e r f o o d • keep clean: Wash your hands before handling food and also during preparation, after going to the toilet,

changing the baby or touching animals. Wash and clean all surfaces and equipment used for food preparation

or serving. Protect kitchen areas and food from insects, pests and other animals.

• Separate raw and cooked foods: Separate raw meat, poultry and seafood from other foods by storing them in

covered containers. Using separate equipment and utensils is also advised.

• Cook thoroughly: Cook food thoroughly, especially meat, poultry, eggs and seafood. Soups and stews should

be boiled properly. For meat and poultry, make sure juices are not pink. Reheat cooked food thoroughly,

bringing it to the boil or until it is too hot to touch. Stir while re-heating.

• keep food at safe temperatures: Do not leave cooked food at room temperature for more than 2 hours. Do not

store food too long, even in a refrigerator. Do not thaw frozen food at room temperature. Food for infants and

young children should ideally be freshly prepared and not stored at all after cooking.

• Use safe water and raw materials: Use safe water or treat it to make it safe. Choose fresh foods. Use

pasteurised milk. Wash fruits and vegetables in safe water, especially if eaten raw. Do not use packed food

beyond its expiry date.

b r e a s t f e e d i n g i n s P e c i a l c a s e sTWINS OR MULTIPLESThe benefits of breast milk to mothers of multiples and their babies are the same as for all mothers and babies –

possibly greater, because many multiples are born early. Here’s how you can overcome challenges to successfully

breastfeed twins and more even after going back to work.

BEING PREPAREDIt will help to learn as much as you can about breastfeeding during your pregnancy. You can:

• Takebreastfeedingclasses.

• FindInternetandprintresourceforparentsofmultiples.

• Joinasupportgroupforparentsofmultiplesthroughyourhealthcareprovider,hospitalorlocal

breastfeeding center.

• Letyourhealthcareproviderandfamilymembersknowthatyouplantobreastfeed.

• Findalactationconsultantwithmultiplesexperiencebeforethebabiesarebornsothatyouknowwhereto

turn for help. Ask her where you can rent a breast pump if the babies are born early.

42 43

Breastfeeding twins and more may take practice. keep trying different positions until you find ones that

work for you. For some mothers and babies, breastfeeding twins at the same time works well. Others find

individual feedings to work better. Still others find that it depends on the time - you may feed one baby at

a time at night and feed two babies at the same time during the day. Finally, as your babies grow, you may

find that you need to change your feeding routine.

Below are some positions that may work for you:

• Double clutch (“football”) – Place both babies in the clutch hold. You will need pillows

at your side (and maybe one on your lap) and you will place the babies on the pillows

with their legs going toward the back of the chair or couch. If you are placing the

babies in front of you, try to keep their whole bodies turned toward you, their chests

against your chest. Their bodies must not be facing up. This is very important to help

prevent nipple pain and to make sure that the babies are getting enough milk.

• Cradle-clutch combination – Place one baby (usually the easiest to latch or stay latched)

in the cradle position and then position the second baby in the clutch position.

• Double cradle – Place the babies in front of you with their legs overlapping, making an

x across your lap.

BREASTFEEDING POSITIONS

MAkING ENOUGH MILk

keep these tips in mind:

• Breastfeedingsoonafterbirth,andoften,ishelpfulformultiplesthesamewayitisforonebaby.Themoremilk

that is effectively removed, the more milk a mother’s body will make.

• Ifthebabiesarebornearly,doublepumpingoftenwillhelpthemothermakemoremilk.

• Thedoctor’sweightcheckscantellyouifyourbabiesaregettingenoughbreastmilk.Youcanalsotrackwet

diapers and bowel movements to tell if your babies are getting enough as mentioned in the previous chapters.

• Ithelpstohaveeachbabyfeedfrombothbreasts.Youcan“assign”abreasttoeachbabyforafeedingand

switch at the next feeding. Or, you can assign a breast to each baby for a day and switch the next day. Switching

breasts helps keep milk production up if one baby isn’t eating as well for a bit. It also gives babies a different view

to stimulate their eyes

44 45

Jaundice

Jaundice is caused by an excess of bilirubin, a substance that should be present in blood in very small amounts. In

newborns, the bilirubin build up is sometimes faster than natural. This causes yellowing of the skin and eyes. It affects most

newborns to some degree, appearing between the second and third day of life and usually clears up by two weeks of age.

It is not harmful.

Two types of jaundice can affect breastfed infants:

• Breastfeedingjaundice–Thiscanoccurwhenabreastfeedingbabyisnotgettingenoughbreastmilk.Thiscan

happen either because of breastfeeding challenges or because the mother’s milk hasn’t yet come in. This is not

caused by a problem with the breast milk itself.

• Breastmilkjaundice–Thismaybecausedbysubstancesinthemother’smilkthatpreventsbilirubinfrombeing

excreted from the body. Such jaundice appears in some healthy, breastfed babies after about one week of age. It

may last for a month or more and it is usually not harmful.

Jaundice is best treated by breastfeeding more frequently or for longer periods of time. It is crucial to ensure that the baby is

latching on and removing milk well. This is usually all that is needed for the infant’s body to rid itself of excess bilirubin.

Some babies will also need phototherapy treatment with a special light. This light helps break down bilirubin into a form

that can be removed from the body easily. If you are having trouble latching your baby to the breast, it is important to

pump or hand express to ensure a good milk supply. The same is true if the baby needs formula for a short time. It will

ensure that the baby has enough milk when you return to breastfeeding.

It is important to keep in mind that breastfeeding is best for your baby.

Reflux disease

Gastroesophageal reflux disease (GERD) occurs when the muscle at the opening of the stomach opens at the wrong times.

This allows milk and food to come back up into the esophagus. Some symptoms of GERD can include:

• Severespittingup,orspittingupaftereveryfeedingorhoursaftereating

• Projectilevomiting,wherethemilkshootsoutofthemouth

• Inconsolablecryingasifindiscomfort

• Archingofthebackasifinseverepain

• Refusaltoeatorpullingawayfromthebreastduringfeeding

• Wakingupoftenatnight

• Slowweightgain

• Gaggingorchoking,orproblemsswallowing

BABIES WITH HEALTH PROBLEMSListed below are some common health problems in babies, along with tips on how to they can be

breastfed.

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Premature and / or low birth weight

When a baby is born before 37 weeks’ gestation, it is said to be premature. This means that that the baby is born at a

low birth weight of less than 5½ pounds. Many babies born prematurely are often not able to breastfeed at first, but like

all newborns, they benefit from breast milk. Thus, they can be given expressed milk as often as they need to be breastfed

- about 8 times in 24 hours. Once the baby is ready to breastfeed directly, skin-to-skin contact is advisable. Many mothers

of premature babies find the cross cradle hold helpful. It may take some time for the mother and the baby to get into a

good routine.

Please keep in mind that many healthy babies might have some of these symptoms and not have GERD. But there are

babies who might only have a few of these symptoms and have a severe case of GERD. Consult your doctor if your baby

spits up after every feeding and has any of the other symptoms mentioned here. If your baby has GERD, it is important to

continue breastfeeding. Breast milk is more easily digested than infant formula.

Most babies with low birth weight, but born after 37 weeks (full term) can begin breastfeeding right away. They will need

more skin-to-skin contact with mom and dad to help keep them warm. These smaller babies may also need more frequent

feedings, and they may get sleepier during these feedings.

To ensure that the baby is well nourished, it is important for the mother to drink adequate amount of fluids and eat a

balanced normal diet. Most mothers feel thirsty when they are feeding and should be encouraged to take enough water.

There should be absolutely no restrictions in the mother’s diet.

Nutritional plan

An energy intake of approximately 1,800 kcal/day usually meets the nutritional requirements for lactation. At least 3 litres

of water per day should be taken, as low consumption of water can lead to lowered milk production.

M o t h e r s n u t r i t i o n

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Types of food recommended for lactating mothers:

• Lactogenic foods (help in the secretion of milk): Barley, dark leafy

vegetables, carrot, beetroot, yam, turmeric, nuts, green papaya, ginger

and garlic, sesame seeds, and garden cress seeds.

• Iron rich foods: Greens, ragi, jowar, watermelon, papaya, dry fruits,

rice flakes and cauliflower.

• Vitamin C rich foods: Citrus fruits, amla, guava and sprouts.

• Calcium rich foods: Milk and milk products, greens, sesame seeds,

curry leaves, ragi and jowar.

b r e a s t f e e d i n g i n P u b l i cMany women feel uncomfortable breastfeeding in public. But it is important to remember that feeding your baby is nothing

inappropriate. And even though it may seem taboo in some places, awareness of the need to support new breastfeeding

mothers is building.

Tips to make breastfeeding in public easier:

• Wearclothesthatalloweasyaccesstoyourbreasts,suchastopsthatpullupfromthewaistorbuttondown.

• Useaspecialbreastfeedingblanketaroundyourshoulders.Somebabiesdonotlikethis,though,soyou’llhaveto

see what works for your baby.

• Breastfeedyourbabyinasling.Slingsorothersoftinfantcarriersareespeciallyhelpfulfortravelling-itmakesit

easier to keep your baby comforted and close to you.

• Slipintoawomen’sloungeordressingroomtobreastfeed.

• Ifyouareworriedaboutbeingtoorevealinginpublic,practiceathomeuntilyouarecomfortable.

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g o i n g b a c k t o W o r kPlanning ahead is the key to ensure that everything goes smoothly after you return from your maternity leave. Talk with

your employer beforehand, to ensure that you continue to enjoy breastfeeding your baby, long after your maternity

leave is over.

During pregnancy

• Talkwithothermothersaboutbreastfeedingwhileworking.

• Talkwithyoursupervisoraboutyourplanstobreastfeed.Discussdifferenttypesofschedules,suchas,starting

part time at first or taking split shifts.

• Findoutifyourcompanyprovidesalactationsupportprogrammeforemployees.Ifnot,askaboutprivate

areas where you can comfortably and safely express milk.

• Askyoursupervisororothercoworkers,iftheyknowofotherwomenatyourcompanywhohavebreastfed

after returning to work.

It helps to breastfeed your baby before he or she becomes fussy, so

that you have the time to get into a comfortable place or position to

feed. It is important to remember that you are meeting your baby’s

needs. So feel free and be proud of your commitment!

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During your maternity leave

• Takeatleast6weeksto12weeksofleave,asitwillhelpyourecoverfromchildbirthandsettleintoagood

breastfeeding routine.

• Practiceexpressingyourmilkbyhandorwithaqualitybreastpump.Freeze60to120mlatatimetosavefor

your baby after you return to work.

• Helpyourbabyadjusttotakingbreastmilkfromabottle(orcupforinfants3to4monthsold)beforeyoureturn

to work.

• Seeifthereisachildcareoptionclosetowork.Askifthefacilitywilluseyourpumpedbreastmilk.

• Talkwithyourfamilyandyourchildcareprovideraboutyourdesiretobreastfeed.Letthemknowthatyouwill

need their support.

Back at work

• Keeptalkingwithyoursupervisoraboutwhatisorisn’tworkingforyou.Returningtoworkgraduallygivesyou

more time to adjust.

• Ifyourchildcareiscloseby,findoutifyoucanvisittobreastfeedoverlunch.

• Whenyouarrivetopickupyourbabyfromchildcare,taketimetobreastfeedfirst.Thiswillgiveyoubothtimeto

reconnect before travelling home and returning to other family responsibilities.

• Ifyouarehavingahardtimegettingsupport,talktoyourhumanresourcesdepartment.Youcanalsoaska

lactation consultant for tips.

Get a quality breast pump

A good quality electric breast pump can help you to remove milk during the workday. Contact a lactation consultant or your

local hospital to learn where to buy or rent a good pump.

Find a private place to express milk

If your company does not provide a private lactation room, find another private area you can use. The room should be

private and secure from intruders when in use. Explain to your supervisor that it is best not to express milk in a restroom.

Restrooms are unsanitary. It can also be difficult to manage a pump in a toilet stall.

Pumping tips

It may take time to adjust to pumping breast milk in a work environment. For easier pumping, try these tips for getting your

milk to let-down from the milk ducts:

• Relaxasmuchasyoucan

• Massageyourbreasts

• Gentlyrubyournipples

• Visualisethemilkflowingdown

• Thinkaboutyourbaby–bringaphotoofyourbaby,orablanketoritemofclothingthatsmellslikeyourbaby

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When to express milk

At work, you will need to express and store milk during the times you

would normally feed your baby. This will be about 2 to 3 times during a

typical 8-hour work period.

Expressing milk can take about 10 to 15 minutes or longer. The number

of times you need to express milk at work should be equal to the

number of feedings your baby will need while you are away. As the baby

gets older, the number of feeding times may go down.

Storing your milk

Breast milk is food, so it is safe to keep it in an employee refrigerator or

a cooler with ice packs. Talk to your supervisor about the best place to

store your milk. If you work in a medical department, do not store milk

in the same refrigerators where medical specimens are kept. Be sure

to label the milk container with your name and the date on which you

expressed the milk.

h a n d l i n g s t r e s sStress not just makes you fall sick, but it can also make problems you already have worse. It can induce trouble in sleeping,

stomach problems, headaches, and mental health conditions.

While having a new baby, learning how to breastfeed can be very stressful. With a little care and support, everything can

be managed. It is important for mothers to take care of themselves. Here are a few steps that can be taken to make new

mothers feel better.

• Gethelpfromaprofessional,ifyouneedit.

• Relax.Tryabubblebath,deepbreathing,yoga,meditation,andmassagetherapyorjusttakeafewminutestosit,

listen to soothing music, or read a book.

• Trytogetseventoninehoursofsleepeverynight.Ifyoucan’t,trytosleepwhenthebabysleeps.

• Eatrightandfuelupwithfruits,vegetables,proteins,andwholegrains.

• Physicalactivitynotonlyhelpsrelieveyourtensemusclesbuthelpsyourmoodtoo!Ifyouareanewmother,ask

your doctor when it is okay to start exercising.

• Talktofriends.Theywillremindyouthatyou’renotalone.

• Sometimes,it’snotalwaysworththestresstoargue.Giveinonceinawhile.

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• Keepajournal.Itcanbeagreatwaytogetthingsoffyourchestand

work through issues.

• Helpingsomeoneelsecanhelpyou.Helpyourneighbor,orvolunteerin

your community.

• Findsomethingyouenjoy.Makesuretogiveyourselftimetoexplore

your interests.

• Setlimits.Figureoutwhatyoucanreallydo.Don’tbeafraidtosayno

to requests for your time and energy.

• Planyourtime.Writeato-dolistandfigureoutwhichtasksarethe

most important to do.

• Don’tdealwithstressinunhealthyways.Thisincludesdrinkingtoo

much alcohol, using drugs, or smoking, all of which can harm the baby.

It is also unhealthy to over-eat in response to stress.

fa Q s1. When should I start breastfeeding?

Breastfeeding should be started immediately after the baby is born. The naked baby (after baby is mopped gently and

made dry) should be held by the mother, close to her breast with skin-to-skin contact. It stimulates smooth flow of milk

and keeps the baby warm, and helps emotional bonding between mother and baby.

2. How do I know my baby is getting enough milk?

A baby who is sucking well, passing urine at least 6 times in 24 hours and not losing too much weight is getting

adequate milk.

3. When I try to express milk, there is no milk. What should I do?

When a baby sucks, the milk is drawn out in a different way than expressing with the hands. Moreover, the baby sucking

at the breast itself will make you produce more milk. In case there is less production of milk, please get in touch with

your doctor or lactation consultant.

4. My baby is always crying. I think he is too hungry. What should I do?

Babies may cry for a variety of reasons: they are wet and need to be changed, they are cold or hot, want to be carried.

Hunger is just one of the reasons – so just because a baby is crying doesn’t mean that the baby is hungry.

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5. Will the baby suffocate if the nose gets pressed while feeding?

The nose has a cartilage and a bone which do not allow it to get so compressed as to obscure breathing. Most mothers

are scared of this but normal babies will not get suffocated. If you are still apprehensive about it, then keep one finger

near your baby’s nose to ensure it stays open – take care not to pull the areola out in the process.

6. Why should I only breastfeed?

It is the ONLY food your baby needs till 6 months of age. It is a COMPLETE food. Addition of any other milk or food in the

first 6 months is not only NOT required but may be harmful. After 6 months, your baby needs other food too in addition

to your breast milk. Breast milk should be continued along with other food till at least 2 years of age.

• Moreoveritisabsolutelysafe,andhygienic,protectsthebabyfromvariousinfections.

• Itiseasilydigestibleandwellabsorbed.

• Itnotonlyprovidesthenecessarynutrients,butalsohasvariousenzymestohelpdigestthenutrients.

7. How does my milk protect my baby from infections?

Breast milk is totally free from bacterial contamination. Formula or cow’s milk always has the danger of being

contaminated by bacteria which could be very harmful to the baby. This danger is present even if you take utmost care

while preparing the feed.

An exclusively breastfed baby is 14 times less likely to die from diarrhea, 4 times less likely to die from respiratory diseases

and 3 times less likely to die from other infections as compared to a bottle-fed baby.

In addition, it is enriched with many anti-infective substances such as:

• Antibodies(immunoglobulins).Yourbabyisprotectedfromcommoninfectionstillyourbabycanproducehis/her

own antibodies.

• Leukocytes–livingprotectivecells

• Lysozyme–activelykillsbacteria

• Lactoferrin–bindsironandmakesitunavailableforbacteriathatneediron.

8. When it is very hot, doesn’t my baby need water?

Breast milk has 88% water. This will satisfy the baby’s needs even in the hottest summer. Water supplementation can lead to

increased risk of diarrhea and also may reduce the intake of mother’s milk, leading to early stoppage of breastfeeding.

9. How does breastfeeding make my baby more intelligent?

Breast milk has numerous substances like lactose, DHA, various specific amnio acids that specifically promote brain growth in

the infant. These are not found in any other milk. In addition, breastfeeding creates a close bond between the mother and

the baby and helps in the social and emotional development of the baby.

10. Does breastfeeding have any long term benefit?

The benefits of breast milk extend far beyond the two years of breastfeeding. As compared to formula / cow’s milk-fed

babies, breast-fed babies have lower risk of diabetes, heart attack (cardiovascular problems), obesity, cancer, tooth decay, ear

infection, allergy and asthma

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11. How does breastfeeding protect from obesity?

Cow’s milk is designed to meet the demands of the calf that is growing much more rapidly than the human baby. Moreover many babies continue to suckle for comfort. With breastfeeding, prolonged suckling provides only a small amount of milk, whereas bottle feeding babies drink much more milk than required.

12. Is it true that babies who are only on mother’s milk cling only to their mothers? Will my baby be extremely dependent on

me when I feed only my milk?

No. Your baby and you will develop a close loving bond and will become very attached to each other. However, your baby will not be dependent on you. Breasts fed babies become more emotionally secure and develop good relationships with other people.

13. Will the mother become “weak” by breastfeeding?

Not at all. In fact, breastfeeding has many benefits for the mother’s health.

• Ithelpstostopbleedingafterdeliveryasthehormone“oxytocin”producedbythebabysucking,isthesamehormone that helps the uterus to contract.

• Itdelaysmenstruationandreducestheriskofanemia.

• Itdecreasestheriskofbreastandovariancancer

• Ithelpsthemotherloseweight.

• Itprotectsagainstanotherpregnancytoosoon

14. Does it mean that a mother who is breastfeeding does not need to practice family planning measures?

Breastfeeding provides 98% protection against another pregnancy, provided all the following three conditions are met:

• Themotherisexclusivelybreastfeeding

• Thebabyisunder6monthsold

• Menstrualperiodshavenotreturned

15. How can a mother who herself is undernourished feed her baby?

Even an undernourished mother can successfully feed her baby. Undernourished mothers may have less fat in their milk, but the total volume of the milk will be higher and the baby gets the required amount of nutrients.

16. How does breastfeeding save money?

In addition to direct saving of money spent on other milk and formula, breastfeeding also does not need water, fuel, and sterilization of utensils. Moreover, the breastfed baby has fewer infections and less expenditure on health care.

17. What are the dangers of artificial feeding?

Artificial feeding is inferior to breast milk in all respects:

• Hasinappropriateamountsofproteins,fats,vitaminsandmineralsneededforthebaby.

• Causesmorediarrhoeaandrespiratoryinfections.

• Itcausesmalnutritionandbabiesonartificialfeedshavehigherriskofdeath.

• Hashighersaltandcalciumandthismayleadtoseizures.

• Hasnoanti-infectiveproperties.

• Artificiallyfedbabieshavemoreriskofallergy,milkintolerance,chronicdiseases,obesity,andhavelower IQ scores.

• Causesnippleconfusionandleadstofailureofbreastfeeding.

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18. I have not breastfed my previous baby. My mother and sisters also had less milk. I feel that this time too, I will have less

milk. What can I do?

Every mother will be able to successfully breastfeed her baby with a little support from health personnel and family. Even

if the mother had poor lactation earlier, she will produce more than enough milk this time for her baby. Continuing to

breastfeed frequently, on demand and NOT introducing any other milk, baby suckling is enough to maintain the production

of milk.

Lack of milk is definitely not “genetic”. If the grandmother and sisters also had less milk, it implies that the entire family

needs information and counseling about breastfeeding. A new mother always looks to experienced and close female

relatives for support. They may give her wrong advice or encourage her to give artificial feeds, especially if they themselves

bottle fed their babies. Even a single suggestion to the mother that “she may have less milk” may make her stop

breastfeeding altogether.

It is therefore very important to counsel the family so that they can be supportive and encourage the mother on her ability

to successfully breastfeed.

19. My baby is low birth weight and preterm. Is my milk enough for him?

Yes! Mother’s milk is enough even for the smallest baby. When a baby is born with low birth weight, or preterm, he needs

extra protein and nutrients. He is also at greater risk of getting infections. Preterm milk is richer in protein, Vitamin A,

minerals and iron, and is adequate for the baby provided the baby also receives multivitamin, calcium and phosphorus

and iron. This is known as fortification of milk. Moreover, the anti-infective property of breast milk is often life-saving. In

addition, the baby should be kept warm by kangaroo care (skin-to-skin contact) and should have regular health check-ups

to ensure normal weight gain.

20. He does not suck well. How do I feed him?

If your baby does not suck well, you could feed him expressed breast milk either with a spoon or a small bowl. Do not use a

bottle as they are harder to clean and more prone to infections.

21. Is breast milk safe to give to a baby who has early jaundice?

Many newborns have jaundice after birth for a few days. This is due to slight immaturity of the liver. This usually disappears

on its own or with treatment using phototherapy. Jaundice is NOT a reason to stop breastfeeding. In fact, jaundice is partly

caused by the baby not getting enough breast milk. So babies with jaundice need more frequent feeds. Colostrum helps

clear the meconium and helps prevent jaundice.

22. Do I have to feed twins separately?

Twins can and should be fed at the same time. The position may be modified slightly to form the football position.

23. I have twin babies. I feel my milk will not be enough for both of them.

Breast milk production follows the rule of “DEMAND and SUPPLY” i.e. the more the requirement, greater is the production.

A mother with twins or triplets can produce up to even 2 litres of milk per day! In fact, both the twins can be fed together.

Feeding the twins together has the following benefits:

• Whenboththebabiessuckwellthestimulustoproducethemilkproducinghormone“prolactin”isdouble.This

ensures adequate milk production!

• Ifonebabyissuckingwellandtheotherisweak,thenbecauseofthestrongertwin,milkisproducedwelland

flows out of both breasts. This helps the weaker twin also to get enough milk without much effort.

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• Feedingboththetwinstogetherpromotesbondingbetweenthetwinsandthemother.

• Ofcourse,feedingtogethersavestimeforthemother.

• Familysupportisextremelyimportantforthemother.

24. My baby is not well. Do I need to give something else to the baby?

Some mothers stop breastfeeding when the baby is ill. On the contrary, illness is the time that the baby needs breast milk the most.

• Breastmilkisthemostnutritious,easilydigestiblefoodespeciallyforthesickbaby.

• Whenthebabyissick,hemaynotwanttofeedanythingelse,buthewillstillhaveanappetiteforbreastmilk.

• Breastmilkhelpsthebabytorecoverquickly.

• Duringillness,breastfeedingwillbeasourceofcomforttothebaby.

25. My nipples are flat. How do I feed my baby?

Whether the nipples are flat, small or big, baby suckles the breast (areola) and not the nipples. The areola and breast tissue are pulled out or protracted to form the “teat”. When the baby suckles, it stretches. Therefore, the size of the nipples is not a problem.

26. My nipples are cracked and painful. How do I feed my baby?

Usually the cause for sore or cracked nipples is poor position and incorrect attachment. Holding the baby in the correct position and ensuring proper attachment will prevent cracked nipples and will reduce pain while feeding. For correct positioning and attachment, refer to chapter 7.

27. My breasts are too full and hurt me. What should I do?

Feeding the baby more frequently or removing the milk by hand expressing can prevent breast engorgement. If it is

engorgement, the areola will be tight. Express the breast milk and then allow the baby to suckle, sometime you may get

“milk fever” for 24 hours. If the fever doesn’t come down in 48 hours, it’s best to meet a doctor.

28. I have painful swelling on one side of the breast. What should I do?

The ducts may be blocked due to lack of milk flow. It could also be because of holding the breast too tightly, tight clothes,

or improper suckling. The best way to relieve the pain and swelling is to gently massage the lumps towards the nipple and

empty the swollen part of the breast. It is best to wear loose clothes and change the baby’s position.

29. I have painful swelling in my breast. My doctor said it is an abscess and drained the pus. Can I feed my baby? And is it

normal to feel tired at this time?

• Itisbesttorestforafewdaysandtakeofffromwork

• Youcanfeedthebabyfromtheotherbreast

• Keepexpressingmilkfromtheinfectedbreast

• Continueantibioticsasadvisedbyyourdoctor

• Whenpusisdrainedandwoundishealed,restartfeedingfromthatbreast

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30. How frequently should I breastfeed the baby?

A healthy newborn baby can be breastfeed ON DEMAND i.e. whenever the baby cries.

31. What should be the time interval for feeding the baby?

Usual time interval between each feed is about 2 to 3 hours. But do not feed by the clock. Feed on demand. Make sure you

feed your baby at least 8-10 times in 24 hours and do not skip night feeds.

32. How do I find out if the baby is getting enough breast milk?

• Thebabypassesurine6-8timesin24hours

• Thebabysleepsfor2-3hoursafterthefeeds

• Thebabygainsweight10-15gmsperday

• Crossesbirthweightby2weeks

33. Do small breasts produce the required amount of milk for the baby?

Size does not matter. Milk production is dependent on how frequently the feeds happen.

34. My baby refuses to breastfeed. What should I do?

• Mostofthetimebabiesmovetheirheadfromsidetosidewhentheyarerootingforthenipple.Thisisknownas

‘homing’ behavior. This does not mean that the baby does not want to feed.

• Checkifthebaby’snoseisblockedasthismightcauseinconveniencetothebaby,leadingittorefusetofeed.

• Ifbabyhasfeverorissick,consultthedoctor.

• Thebabymayalsorefusetofeedifithearssomenoiseorhearsthemothertalkingtosomeone.Lookforaquiet,

private place to feed and ensure that there are no interruptions while feeding the baby.

35. My breast milk leaks, is it normal?

Yes! It means you have good milk production, and that your ejection reflex is active. Use breast pads to avoid staining on

clothes. You could also express some milk and keep it for your baby.

36. I do not have enough milk what can I do?

As the baby suckles the breast, more milk is produced. If your baby urinates 6 times in 24 hours, it means that your baby

has taken enough milk. Adequate weight gain also means that the baby is getting enough milk.

37. I have to go back to work. What can I do?

Refer to section “Going back to work”.

38. There is blood in my milk, what to do?

Please consult your doctor.

39. Sometimes my baby cries more than usual. Why?

The most common reason why babies cry is due to abdominal pain caused by swallowing air while feeding. This is known

as colic. In case of colic, the baby will pull up its knees while crying. If this happens, do not panic. Put the baby more often

to the breast. It may help to carry the baby face down over your arm, with a slight rhythmic movement, so that there is

pressure on the stomach. If the baby is ill, the crying pattern will change. In such cases, please consult a doctor.

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40. I am taking medicine. Can I continue breastfeeding my baby?

Yes. Most commonly used drugs do not cause any harm to babies. For further advise, please consult your doctor.

41. How should I massage my baby?

A baby’s message should always be a gentle touch of the hands. Safe massage techniques create a loving environment for

the baby, helping to gently smooth out their movements. It also increases the bond between the mother and the child.

How to prepare for the massage

• Chooseatimewhenbothyouandyourbabyarerelaxed,preferablyduringfeedingwhenthebabyisnottoo

hungry or full.

• Maintainawarmroomtemperature.

• Itisbesttomassageanewbornbabybyholdingitinyourarmsandlapforthewarmthandcloseness.

• Avoidalldistractions.

• Makesureyouareinacomfortablepositionwhilemassaging.

• Havethemassageoilreadyandwithinreach.Rubtheoiltobothyourhandstowarmitbeforeusingitonyour

baby. Never pour oil directly on the baby.

• Makesureyourfingernailsareshortandclean.

• Talkorsingtoyourbabywhilemassagingorhavesomesoftmusicplayinginthebackground.

• Letyourmassageprogressgentlyfromalighttofirmtouchandslowlyreturntolighttouch.Beforefinishingmakeall movements connected and flowing.

• Letthenumberoftimeyourepeatanymovementbedeterminedbyyourbabiesreaction,howevertrythestrokeat least 3-5 times before going to another stroke. Encourage your baby to move freely.

• Aboveall,ENJOYTHISTIMEwithyourbaby.Bestoiltouseisacarrieroillikeavegetableoilornutoil.

Benefits of massage for the baby and the mother

• Promotesmother-childbondingandcommunication

• Promotesbraingrowthofthebaby

• Increasesphysicalgrowthanddevelopment

• Improvesimmunesystemanddecreasesproductionofstresshormones

• Promotesconfidenceandcompetenceincarryingthechild

• Afunandrelaxingtimeforthemotherandchild

What to avoid while massaging

• Donotmassagewhilefeeding

• Donotblowintoears,nose,ormouthduringthemassage

• Donotuse“sambrani”barsorturmericsmoketodrythebaby

• Donotmassagevigorously

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Like every mom, I too wanted to breastfeed my baby from day one, but that is not an easy task. I received a lot of help

from the lactation experts at Fortis who highly encourage breastfeeding and very patiently explained the techniques,

not just once but several times, till I was doing it correctly. I could ask them just about anything. I thank the entire NEST

team for adding more joy and sweet memories to the feeling of ‘being mom’.

SUJATA MUkHERJEE

After delivering my baby boy, Joyce and her lactation experts at Fortis personally trained me on how to breastfeed

him. They showed me the various hold positions, how to get him to latch on and also how to express milk. Every time

I spoke to Joyce, I was left feeling comforted and encouraged. My child had troubles latching on and hence even after

discharge I came back regularly for lactation counselling. These sessions not only taught me how to feed my child

independently but also boosted my confidence and helped me tide over my postpartum blues.

SUPRIYA DIxIT

e X P e r i e n c e o f n e W M o t h e r s

c o n c l u s i o n We hope that the information carried in this book has been useful to you and will help you have a more fulfilling journey

on the path of motherhood. In case you have any other questions, or you wish to share your experience with us, please feel

free to write to us at the following email id:

care.bng@fortishealthcare.com

We request you to share this information with your friends and relatives.

REFERENCE:www.bpni.org/training.htmlwww.sjmj.in (Breastfeeding for women empowerment) issue no. 3 vol.1, 2012

154/9 Bannerghatta Road, Opp. IIM-B, Bangalore - 560 076.Ph: 080 6621 4444 / 95 38 99 55 36 Emergency No.: 105010.

Email: care.bng@fortishealthcare.com