Breastfeeding Education Module

Types of Breast Milk


Colostrum is the first type of breast milk that develops during pregnancy. Colostrum is yellow in color and has a thick consistency. This type of milk is present for a few days after the baby is born. Colostrum is a good source of protein, antibodies, vitamins and minerals. Between two to four days after childbirth, colostrum is replaced by transitional milk. This type of milk is white and thin in consistency. It has high amounts of calories, protein, fat, vitamins, and lactose. About 10 to 15 days after childbirth, mature milk begins to be produced. The foremilk, which is present in the beginning of the feeding and is mostly composed of water, may appear to have a blue tint to it. The hindmilk is white in color, and has an increased fat content. Hindmilk is what provides the majority of the baby’s nutrition at this time.

When to Breast Feed
A baby typically breastfeeds between eight to twelve times each day, at about two hour intervals. However, each baby is different. ("Breastfeeding Guidelines". Rady Children's Hospital San Diego. Retrieved 2007-03-04.) Babies should not be forced to feed.

How Much is Enough?
If your baby is producing six wet diapers a day, he or she is receiving enough milk. Most mothers are able to provide sufficient milk for their babies. The newborn’s tummy is only about the size of a large marble—it doesn’t take much to fill it up!

Proper Latching

 * Latching is a term that refers to your baby's attachment to your breast during feeding. [[Image:Breastfeeding of a child.JPG|thumb|right|Proper Latching from an Infant]]
 * The first step is to get your baby's mouth to open by stroking his or her lips with your nipple.
 * Once open, quickly pull his or her mouth onto your nipple.
 * The baby's gums should be wrapped around a large part of the areola.
 * The baby's lips should be protruding out rather than sucking in. You should feel no pain.
 * Alternate which breast is offered to the infant initially each feeding.



Common Supporting Techniques

 * The “C” hold involves supporting the breast with the thumb placed on top, and the fingers placed underneath. The “U” hold involves placing the fingers flat on the ribcage under the mother’s breast, with the index finger in the crease underneath the breast. The elbow should be lowered so that the breast can be supported between the mother’s index finger and thumb. (V Livingstone. The Art of Successful Breastfeeding. [VHS]. Vancouver, BC, Canada: New Vision Media Ltd..) Make sure you are in a comfortable position with your back supported. Pillows can be used to support your arms. The baby should be positioned close to you, with his or her hips in a flexed position. This will ensure that he or she doesn’t need to turn his or her head in order to reach the breast. The baby’s mouth and nose should be facing the nipple. The breast should be supported, with the weight of the breast removed from the baby’s chin. You can rub the breast on the baby’s bottom lip to encourage him or her to open the mouth wide. The nipple should be slightly pointed toward the roof of the infant’s mouth. The baby’s back should be supported, and his or her nose should be touching the breast.




 * The cradle position is when the mother holds the baby in her lap, with the baby resting on his shoulder and hip. The mouth is at the level of the nipple. The breast should be supported with either a “U” or “C” hold. The baby’s head can rest on the mother’s forearm, with his back along the inner arm and palm.
 * In the cross-cradle position, a pillow is placed across the mother’s lap is used to support the baby. Pillows can also be used to support the mother’s elbows. In this position, the baby’s neck can rest between the mother’s thumb and index finger, and the palm of the mother’s hand supports the baby between the shoulder blades.
 * The clutch, or football position is good for the mother who has had a Cesarean birth, because it places the baby away from the incision site. The baby’s head is supported in the mother’s hand, with his back along the mother’s arm beside her. The breast is supported with a “C”. The legs and feet of the infant are tucked under the mother’s arm, with the hips flexed and legs resting along the mother’s back rest, with the bottom of the feet pointed up.
 * In the side-lying position, the mom and baby lie down on their sides to face each other. Many mothers find this position to be most comfortable to breastfeed. ("Proper positioning and latch-on skills". AskDrSears.com. 2006. Retrieved 2008-09-24.)

Skin-to-skin Contact
Early skin-to-skin contact begins ideally at birth and involves placing the naked baby, covered across the back with a warm blanket, prone on the mother's bare chest (Moore ER, Anderson GC, Bergman N. "Early skin-to-skin contact for mothers and their healthy newborn infants”. Cochrane Database of Systematic Reviews 2007, Issue 4. Art. No.: CD003519. DOI: 10.1002/14651858.CD003519.pub2.) As much skin-to-skin contact is important in the first few weeks of life to help establish a good breastfeeding routine. It tends to keep the infant more alert than if it was swaddled in blankets; this will enable the infant to get a sufficient amount of breastmilk during each feeding. Benefits of early skin-to-skin contact include the following: (The Importance of Skin to Skin Contact. 2009. Jack Newman MD, FRCPC and Edith Kernerman, IBCLC)
 * It stabilizes the infant’s body temperature, heart rate, respiratory rate, and blood pressure
 * The baby has a higher blood sugar
 * The baby is more likely to latch and latch well
 * The baby is happier and less likely to cry
 * The baby is more likely to breastfeed exclusively and longer

Signs of Improper Latching
Signs of improper latching include a nipple that appears pinched when the infant finishes feeding, having the nose of the baby too close to the breast when feeding, having the baby’s mouth on the breast, or being unable to see a portion of the areola of the nipple above the upper lip of the infant. Another sign of improper latching is when the infant’s mouth on the breast appears pursed, instead of being relaxed and wide open. ("Infant feeding–Breast or bottle and how to breast feed". Retrieved 2007-05-26.)

Infant Nutrition
Breast milk contains an ideal combination of fat, protein, water, and sugar that is required for the growth and development of the infant. One hundred ml of breast milk produced after 21 days of lactation contains approximately 70 calories (7.4 g carbohydrates, 4.2 g fat, and 1.3 g protein). However, the fat content varies greatly from mother to mother. (Auestad et al 2003. Visual, Cognitive, and Language Assessments at 39 Months: A Follow-up Study of Children Fed Formulas Containing Long-Chain Polyunsaturated Fatty Acids to 1 Year of Age. Pediatrics 112 (3): e177-e183) Fat is necessary for infant growth, and is required to metabolize many vitamins. Thus, a dietary deficiency in fat can lead to vitamin deficiencies. Some fatty acids in breast milk also contribute to brain development in the infant. (Greer FR, Sicherer SH, Burks AW (2008). "Effects of early nutritional interventions on the development of atopic disease in infants and children: the role of maternal dietary restriction, breastfeeding, timing of introduction of complementary foods, and hydrolyzed formulas". Pediatrics (journal) 121 (1): 183–91.) Antibodies, including IgA, are passed to the baby during breastfeeding, which helps to protect the baby’s lungs, throat and intestines. Breastfed infants have also been shown to have lower risk of infection than formula-fed infants. (Horta BL, Bahl R, Martines JC, Victora CG (2007). Evidence on the long-term effects of breastfeeding: systematic reviews and meta-analyses. Geneva, Switzerland: World Health Organization.) Moreover, breastfed infants have a reduced risk of ear infection, upper respiratory tract infection, and urinary tract infection. Studies have also shown that breastfed infants have a lower chance of developing Types I and II Diabetes, a lower risk of childhood obesity, and are less likely to develop allergies and asthma. (Arenz S, Rückerl R, Koletzko B, von Kries R (2004). "Breast-feeding and childhood obesity--a systematic review". Int. J. Obes. Relat. Metab. Disord. 28 (10): 1247–56.)

Psychosocial Advantages
Breastfeeding in infancy is correlated with higher intelligence later in life, and may have benefits on child cognitive development (Horwood LJ, Darlow BA, Mogridge N (2001). "Breast milk feeding and cognitive ability at 7-8 years". Arch. Dis. Child. Fetal Neonatal Ed. 84 (1): F23–7). Further, a mother’s emotional health may benefit from the relationship that is developed with the infant during breastfeeding. Breastfeeding mothers often experience lower levels of anxiety, as well as a stronger connection with their babies. This may be due to the hormones released during breastfeeding, which help to strengthen the bond between mother and child. (The perils of intimacy: Closeness and distance in feeding and weaning. Daws, Dilys Source:Journal of Child Psychotherapy, Vol 23(2), Aug, 1997. pp. 179-199)

Breastmilk Versus Formula
Breastfeeding’s benefits have been well-established with considerable research throughout the years. Formula is often derived from cow’s milk, which is considerably more difficult for human babies to digest than human breast milk. ("Infant feeding–Breast or bottle and how to breast feed". Retrieved 2007-05-26.) Formula also lacks the benefits of colostrum and antibodies (see ‘Infant Nutrition’). Breast milk has large amounts of lactose, which has been shown to lead to larger brain development in infants. (Kramer MS, Aboud F, Mironova E, et al. (2008). "Breastfeeding and child cognitive development: new evidence from a large randomized trial". Arch Gen Psychiatry 65 (5): 578–84.) Lactose is found in significantly lower levels in cow’s milk. Moreover, the minerals found in breast milk are more readily absorbed by the baby. Formula simply can’t replicate the many ingredients found in human breast milk. (Greer FR, Sicherer SH, Burks AW (2008). "Effects of early nutritional interventions on the development of atopic disease in infants and children: the role of maternal dietary restriction, breastfeeding, timing of introduction of complementary foods, and hydrolyzed formulas". Pediatrics (journal) 121 (1): 183–91.)

Advantages for the Mother
Mothers experience many benefits from breastfeeding, including bonding. During breastfeeding, hormones are released (including oxytocin) that can strengthen the bond between mother and child. Oxytocin can also make the increase the mother’s rate of uterine contractions after childbirth, which can help reduce bleeding. (Flower H (2003). Adventures in Tandem Nursing: Breastfeeding During Pregnancy and Beyond. La Leche League International. ISBN 978-0912500973.) Mothers can enjoy the added benefit of weight loss that accompanies breastfeeding, as the fat gained during the pregnancy period is used to produce milk. Breastfeeding can also delay the return of fertility, as a breastfeeding woman might not ovulate while she is breastfeeding. (Feldman S (July-August 2000). "Nursing Through Pregnancy". New Beginnings (La Leche League International) 17 (4): 116–118, 145.)

Societal Advantages
Breastfeeding has effects on our society as a whole. The nutrition that babies today receive will affect their cognitive development, thus affecting the quality of our society’s leaders tomorrow. Further, the production of formula, bottles, nipples, packaging, etc. creates an incredible amount of waste materials. Human breast milk, on the other hand, generates no industrial waste. (''Breastfeeding Myths Perpetuated by Culture, Society and the Health Care System, Jack Newman, MD Reported by Kathy Kerr Arlington, Virginia, USA From: LEAVEN, Vol. 35 No. 5, October-November 1999, p. 107'') The U.S. government spends millions of dollars annually on formula for programs like the Special Supplemental Nutrition Program for Women, Infants, and Children (WIC). Breastfeeding could save our country millions of dollars, which would otherwise be spent on formula. Perhaps most significant, breastfeeding can reduce the cost of infant health care, as breastfed infants have fewer infections and hospitalizations. (Bartick M, Reinhold A (2010-04-05). "The burden of suboptimal breastfeeding in the United States: a pediatric cost analysis". Pediatrics 125 (5): e1048–56.)

Importance of Continued Breastfeeding
Continued breastfeeding during the first year of life provides countless benefits for the infant and mother. These advantages include increased child survival rates, as well as benefits to the health, nutrition, and cognitive development of the child. Continued breastfeeding helps to lower the rates and severity of infections during the first few years of life, by providing the child with immunoprotective effects. Moreover, mothers who continue to breastfeed during the first year of life reduce their risk of breast and other types of cancers. 

What Age to Introduce Solid Foods
Infants can be introduced to solid foods beginning at about six months of age. These foods can supplement breastfeeding. Other indicators that an infant is ready to have solid foods include the infant being able to hold his or her head in an upright position, and can sit with support. Initially, the infant should be introduced to baby cereal. Then, pureed meat, fruits, and vegetables can be added to his or her diet, followed by finely chopped finger foods at around ages 8-10 months. 

Nutrition During Breastfeeding
A breastfeeding woman should consume a balanced diet, with a variety of healthy foods. She should eat fresh fruits and vegetables, a variety of whole grains, protein foods from animal and/or plant sources, and small amounts of fats. She should eat natural foods, meaning foods that are fresh, contain no additives, are minimally processed, and use little to no contaminants. Also important to note, breastfeeding women should consume an additional 500 extra calories each day. 

Which Medications Are Safe?
There are many medications that are safe to use during breastfeeding. However, most drugs will end up in the breastmilk, and can potentially affect the supply of milk. Drugs including acetaminophen (Tylenol), caffeine, corticosteroids, and cephalosporins are generally safe to take in usual doses. However, antineoplastics, clozapine, cocaine, or large doses of salicyclates (Aspirin), amongst other drugs, are not safe for breastfeeding mothers. If a mother must take these drugs for health reasons, she should stop breastfeeding. Please talk to your healthcare provider about any medication you begin to take if you are breastfeeding. 

Discuss your experiences!
To discuss any information or breastfeeding tips you wish to share with the community, please follow these instructions. Please register with wikieducator.org in the upper right-hand corner of the screen. Then, come back to the Breastfeeding Education Module. Above and to the left of this wiki's information, you will see a tab marked "Discussion". Please click on this tab and share your experiences!

Other Resources
Why Breastfeeding is Important (CDC)

Breastfeeding Recommendations (CDC)

La Leche League

Dr. Jack Newman

Kelly Mom