Breastfeeding
Expert file
Breastfeeding
Nowadays many mothers are choosing to breastfeed their child. This is a growing trend, but nonetheless is not without hesitations and questions.
In this file you will discover opinions from experts to help you to gain a better understanding of the different aspects of breastfeeding.
All of these interviews are taken from “Pragmacie” No. 3, a Laboratoires Expanscience publication.
Contents
1.Breastfeeding: a decision not to be taken lightly
By Bernard Maria, gynaecologist obstetrician
2. The signs of good lactation
By Béatrice Pipers, midwife
3. What good habits should be adopted?
By Marie-Claude Marchand, paediatrician
4. What are the main difficulties that may arise?
By Gisèle Gremmo-Féger, paediatrician
5. How should you approach weaning your infant?
By Elisa Guises, paediatric nurse
6. Putting an end to false ideas
Breastfeeding: a decision not to be taken lightly
By Bernard Maria, gynaecologist obstetrician
When should the question of breastfeeding be raised?
“Talking about maternal breastfeeding should not suddenly be brought up at the moment of giving birth. We therefore take advantage of the time available to us during pregnancy – among other things – to ask the mother-to-be very clearly how she views the birth of the baby and whether she wants to breastfeed her child.”
And what answers are given?
“The vast majority of women unhesitatingly want to breastfeed, proof that irrespective of their culture, background or social status, most women today view breastfeeding as a natural extension of
pregnancy. Which does not prevent a minority (10 to 15%) from categorically refusing this option.”
What are their reasons?
“Numerous sociological studies have considered this question. They reveal that in general these women have an extremely negative view of breastfeeding. They feel that it’s bestial, that the use of the breast should be considered in terms of sexuality rather than maternity, that breastfeeding implies a relationship of dependency with regard to the baby and, finally, that it deprives the father of something, unlike bottle-feeding.”
Why are certain women hesitant?
“Some women, for example, are lacking in confidence because of negative role models, such as a mother who had problems during their breastfeeding.
Women who smoke are also often reticent, because they think that breastfeeding is incompatible with smoking. However, maternal breastfeeding is possible in many situations, including if the mother smokes, providing that she takes a number of precautions, such as smoking after feeds and not before.
Whatever the reason for their hesitation, you must always be empathetic and reassure them, explaining to them that there is no reason for breastfeeding not to go well.”
Does the father have an influence on this decision?
“The father-to-be has an influence when he has ideas about breastfeeding. Some have extremely negative preconceived ideas due to poor information, but when they benefit from arguments in the right direction, most of them believe that it would be a shame to forgo an experience that could be a great one and then regret it afterwards.”
Professional experience
• Head of department at the maternity clinic in Villeneuve-Saint-Georges hospital centre (Val-de-Marne) since 1984
• Presided over the French National Health Evaluation and Accreditation Agency (ANAES*) working group, which in May 2002 published French recommendations on maternal breastfeeding
*www.anaes.fr
Bibliographical reference
• L’allaitement maternel : mise en oeuvre et poursuite dans les six premiers mois de vie de l’enfant. Recommandations pour la pratique clinique (RPC) de l’Agence nationale d’accréditation et d’évaluation en santé (ANAES, May 2002).
The signs of good lactation
By Béatrice Pipers, midwife
What do we mean by lactation?
“By definition, it is the production of milk. This depends a great deal on the needs of the newborn: the more and the better he suckles at the breast, the more the mother will produce milk. Rather than focusing on the amount produced, we will be more interested in the quality of breastfeeding and feeds, which determine successful lactation.”
What are the signs of good lactation?
“During the feed, the mother should have a feeling of discharge. This is confirmed by certain signs of flow (smarting in the breast, uterine contractions, etc.).
In terms of the baby, the sucking and deglutition rhythm is one of the most obvious signs for judging the quality of the feed. In addition, a breastfed newborn should produce at least six damp nappies a day and have yellow, lumpy and very frequent faeces at the beginning. Not to forget regular weight gain.”
Is there an ideal sucking and deglutition rhythm?
“No, it differs depending on the baby. But if you want to ensure that a feed is effective, first of all there must be rapid alternating between sucking and deglutition, with a rhythm that will slow down as the child’s hunger is satisfied. Once they have had their fill, they will release their mother’s breast or remain pressed against her but without moving their mouth.”
What are the other factors for an effective feed?
“The mother must be relaxed and comfortably positioned, seated or lying down. Regardless of her position, the baby must be turned to face her with their face “in the breast”, their mouth wide open
and their lips curled up in order to take the nipple as deeply as possible and optimally stimulate it.
While there is no hard and fast rule, feeds should nonetheless be relatively long (10 to 15 minutes) and frequent (6 to 8 times a day in the first month).”
And what if the baby does not position their mouth correctly?
“You can stimulate a few sensitive points around their mouth so that they open it wide.
You can also encourage them by letting a drop of milk run over the breast.”
Why is good lactation important?
“First of all, for the good growth of babies, in terms of weight and their general state of health (good sleep quality, calm behaviour, etc.). It also allows a reduction in morbidity.
Finally, it also strengthens the bond between mother and child and the mother’s satisfaction in having been able to breastfeed successfully. Lastly, in the medium and long term, the child will be better protected against a certain number of disorders.”
Professional experience
• Midwife for 18 years
• Practises as an independent midwife in the maternity hospital of Annecy General Clinic
• Holds a university diploma in maternal breastfeeding from Grenoble faculty of medicine (Isère)
• Cofounder of “Allaiter en Haute-Savoie”, an association that supports and assists mothers wishing to breastfeed
Bibliographical reference :
• L’allaitement maternel : mise en oeuvre et poursuite dans les six premiers mois de vie de l’enfant.
Recommandations pour la pratique clinique (RPC) de l’Agence nationale d’accréditation et d’évaluation en santé (ANAES, www.anaes.fr, May 2002).
• Guide de la puériculture, Gassier Jacqueline, published by Masson, 2002
The stress of weighing baby
For a long time, in order to find out the amount of milk that babies had drunk, they were weighed naked before and after feeding. This method has been virtually abandoned as it is a great source of anxiety for mothers, who may feel disheartened and guilty if the result does not meet their expectations.
Nonetheless, it is recommended to weigh newborns at least once or twice during the first month after leaving the maternity hospital to confirm that breastfeeding is going well. This precaution gives you the opportunity to “make up” in time for a difficult start, something that is much trickier to do once the first five weeks have passed.
What good habits should be adopted?
By Marie-Claude Marchand, paediatrician
What should mothers-to-be do beforehand in order to start breastfeeding under the best possible circumstances?
“During pregnancy, a woman’s body naturally gets itself ready, so there is no specific preparation for the breasts.
However, this is the opportunity for the mother-to-be to think about her breastfeeding plan, about what she wants to do, to become informed and possibly to meet women who are breastfeeding…It is also a good time to try to eat a balanced diet.”
Are there foodstuffs that are recommended during breastfeeding?
“Not particularly. Nothing has ever been scientifically proven with regard to food that is supposed to increase the amount of milk produced. However, if eating a particular type of food reassures the mother, this can have an influence: the more relaxed she is, the better breastfeeding will go.”
What should be eliminated?
“It is best to limit drinks containing caffeine and avoid alcohol, which is not good for babies’ cerebral growth.”
Is it true that mothers should drink more fluids when they are breastfeeding?
“This is conventional received wisdom. However, milk production does not depend on the amount of water ingested but on the quality of the feeds and their effectiveness in transferring milk to the baby. The mother will simply adjust how much she drinks according to her thirst or her
urine: if it is very concentrated, she is not drinking enough.”
Are there rules of hygiene to be respected?
“Above all, you must always wash your hands thoroughly! As for the breasts, there is no need to cleanse them before and after feeds, because this will remove the sebum produced by the subcutaneous glands of the nipple to protect it.”
Should a mother sleep with her baby to make feeding easier at night in the beginning?
“Closeness between mother and baby encourages breastfeeding. It is important that parents are properly informed of the safety conditions with regard to letting their child sleep in their bed.
In other words – to name just a few – a bedroom that is not too warm, a firm mattress, no duvet, etc. Another possible option is to place the baby’s cot alongside the parents’ bed.”
Can breastfeeding mothers be prescribed medication?
“Of course, you must seek advice, but it is possible to treat breastfeeding mothers for all common diseases.”
Professional experience
• Paediatrician, since January 2003 in a mother and child protection centre (Essonne)
• Trainer in neonatal adaptation and maternal breastfeeding at the IPSN Co-naître training institute
• IBCLC (International Board Certified Lactation Consultant) lactation consultant
Bibliographical references
• L’allaitement maternel : mise en oeuvre et poursuite dans les six premiers mois de vie de l’enfant. Recommandations pour la pratique clinique (RPC) de l’Agence nationale d’accréditation et d’évaluation en santé (ANAES, www.anaes.fr, May 2002).
• Medications and Mothers' Milk: A Manual of Lactional Pharmacology, Thomas Hale, 11th ed 2004; Pharmasoft Publishing
Which breast pump should you choose?
A breast pump, like other equipment associated with breastfeeding (nipple protectors, for example), is used especially in the event of separation from the baby (hospitalisation, relactation, resuming work, etc.).
Modern double pump electric breast pumps are now available based on a physiological understanding of lactation. For occasional use, manual breast pumps are often appreciated by mums because they are relatively gentle, easy to use and effective. A breast pump that is not used properly can give rise to painful lesions around the nipples. The majority of electric breast pumps can be hired from a pharmacist.
What are the main difficulties that may arise?
By Gisèle Gremmo-Féger, paediatrician
What is the primary reason for consultation?
“Insufficient milk, which is also the main reason for stopping breastfeeding. In the majority of cases, it is not a question of actual insufficiency, but a belief on the part of the mother who doubts her own ability to produce enough. This mistaken perception is the result of the newborn being unable to recognise their needs, but also of unrealistic expectations on the part of both parents and caregivers, especially in terms of the number of feeds and sleep at night.
However, when it comes to breastfeeding, it is impossible and futile to set standards regarding the number of feeds and all of the studies show that breastfeeding very rarely continues in the event of a low number of feeds.”
And if this insufficiency is proven to be genuine?
“It is seen in the newborn failing to put on sufficient weight, which should be interpreted bearing in mind that in comparison with children fed on industrial milk, the growth of breastfed infants tends to dip from the third/fourth month. It is essential to distinguish between primary milk insufficiency – in other words, the mother’s physiological inability to produce enough milk because of anatomical or hormonal factors – which should be spotted at an early stage, and secondary insufficiency, which is more frequent.
This is the result of an inadequate demand on the part of the baby and, above all, of breastfeeding not being carried out properly. In this respect, insufficient or ineffective feeds have a detrimental influence on the regulation of milk production, which is based on the law of supply and demand.
If the child does not suckle well and often enough, milk production will adjust itself to an inappropriate level.”
Can breastfeeding be painful?
“Yes, and it is usually because of traumatic lesions in the nipple area. They are generally inherent to friction associated with poor taking of the breast and the baby being incorrectly positioned during feeds.”
One woman in five is said to suffer from mammary inflammation during breastfeeding. What is the reason for this?
Professional experience
• Paediatrician, head of paediatrics in the maternity clinic in Brest teaching hospital (Finistère)
• IBCLC (International Board Certified Lactation Consultant) lactation consultant
Bibliographical references
• Allaitement maternel : mise en oeuvre et poursuite dans les six premiers mois de vie de l’enfant, Recommandations pour la pratique clinique (RPC) de l’Agence nationale d’accréditation et d’évaluation en santé (ANAES, www.anaes.fr, May 2002).
• Allaitement maternel et médicaments, by G. Gremmo- Féger, M. Dobrzyniski and M. Collet. J Gynecol Ostet Bio Reprod, 2003 / Volume 32, no. 5, 466-475.
• Allaitement maternel : l’insuffisance de lait est un mythe culturellement construit, by Gisèle Gremmo-Féger. Spirale, October 2003, published by Erès
How should you approach weaning your infant?
By Elisa Guises, paediatric nurse
When does weaning take place?
“Each case is unique, but currently weaning mostly not only takes place at an early stage (2 to 3 months after giving birth) but also lasts a short time (2 to 3 weeks approximately).
The cause? When a mother returns to work she cannot be constantly near her child. In principle, the law authorises women to breastfeed during their working hours: a provision that is, on the one hand, little known and, on the other, difficult to do on a daily basis. However, continuing breastfeeding, even after returning to work, is possible with the use of a breast pump.”
How does weaning take place in concrete terms? At what pace?
“Generally, weaning is gradually introduced one month before the return to work, replacing one feed by a bottle and increasing this approximately every week. For successful weaning, the mother must feel that she is ready. This is a key factor. In addition, you must take the baby into consideration and observe how they react and be prepared to go back a little if the mother considers weaning to be too destabilising for the child.”
Are there any particular precautions to be taken?
“It is important not to expose the child to a twofold deprivation: that of their mother’s arms and their mother’s milk. A break may unsettle the infant, resulting in a refusal of food or the bottle. A good way of gradually instigating the separation between the baby and their mother, and thus encouraging weaning, is to express milk so that dad can give the baby their bottle.”
Is weaning spread over several months the best solution?
“For those who can, it is indeed extremely advantageous because in this scenario weaning will happen more at the request of the infant, who – spontaneously and at their own pace – will express their desire for another way of feeding than their mother’s breast.”
Can you continue with a feed?
“Yes. For many mums, weaning must be total because they cannot imagine the possibility of maintaining a daily feed. Yet, it is completely possible for several months: given in the evening, it calms the baby before they go to sleep.”
What is weaning like for mums?
“Breastfeeding is often considered to be the very expression of maternity, a period of total well-being. Hence the difficulty for certain women in seeing their child become independent. But most women view it as a natural step in a child’s life.”
Professional experience
• Paediatric nurse for 20 years
• Lecturer at the Assistance Publique-Hôpitaux de Paris paediatric school, established in the Trousseau hospital in Paris’ 12th arrondissement
• Member of the Association nationale des puéricultrices diplômées et des étudiantes (ANPDE) (French National association of qualified paediatric nurses and students)
Bibliographical reference
• L’allaitement maternel : mise en oeuvre et poursuite dans les six premiers mois de vie de l’enfant. Recommandations pour la pratique clinique (RPC) de l’Agence nationale d’accréditation et d’évaluation en santé (ANAES, www.anaes.fr, May 2002)
• Guide de la puériculture, Gassier Jacqueline, published by Masson, 2002
What type of milk should be used in the bottle?
In the case of early weaning, hypoallergenic milk is often chosen because of its proteins, which are more similar to those in mother’s milk.
And cow’s milk? While it may be given to infants over 10 months old, industrial milk is, however, more suitable in terms of quality, especially with regard to mineral salts and essential fatty acids.
Putting an end to false ideas
Mother’s milk is not nutritional enough for certain babies.
FALSE
There is no such thing as mother’s milk that is not nutritional enough because infants regulate their nutritional needs according to the milk’s calorific value.
Night-time feeds make starting and maintaining lactation easier.
TRUE
In order to be able to regulate their nutritional needs, most infants need to suckle at night; moreover, night-time feeds encourage lactation, by preventing too long intervals between feeds.
If a breastfeeding mother has a fever, she should not breastfeed her baby.
FALSE
On the contrary, in so far as for most common infectious diseases, the maximum risk of contamination occurs before the appearance of the first symptoms in the mother, continuing maternal breastfeeding provides the baby with elements that help them to defend themselves against infection.
FALSE
In order to prevent lesions of the nipples and to optimise the transfer of milk from mother to child, it is very important that the baby take a large mouthful of breast into their mouth and not just the nipple.
Even if the nipple does not protrude, a baby that opens their mouth wide will be able to suckle.
Milk flows between feeds are not normal.
FALSE
It can be enough for a mother merely to think of her baby for milk to begin to flow!
Breastfed babies should receive vitamin K supplements.
TRUE
This supplementation is recommended from birth.
A previous breast abscess contraindicates breastfeeding.
FALSE
This does not change the ability of the mammary gland to produce milk during a new pregnancy.
Babies breastfed on demand present a lower risk
of obesity.
TRUE
In fact, babies naturally adapt their milk rations to their real needs.
In the event of congestion of the breasts during breastfeeding, the only recourse is the use of a breast pump.
FALSE
Manual massage of the nipple before expression of milk is the simplest way to ease congestion.
You must not breastfeed more than eight times a day at the risk of seeing cracks rapidly appear.
FALSE
“Lymphangitis, or rather mastitis, affects approximately 10% of women during breastfeeding. It is symptomised in the breasts by the existence of a red, hot and painful area and, more generally, by flu-like symptoms.
This inflammation is above all due to an accumulation of milk in the mammary glands, particularly because of too long intervals between feeds. Its treatment is not well known: in fact, when it occurs, mothers are still too often advised to stop breastfeeding. Yet, on the contrary, continuing breastfeeding in order to allow milk to flow effectively is the most important aspect of the treatment and does not pose any risk to a healthy infant.”
The primary cause of cracks is the baby being poorly positioned at the breast: the number and length of feeds is of little importance when the baby takes the breast correctly.
Bibliographical reference
A woman with flat nipples cannot breastfeed.
• www.santeallaitementmaternel.com site
• Dr Gremmo-Féger, L’allaitement maternel en 36 questions, April 2000