Breastfeeding

• Lactation can be induced by adoptive or non-birth mothers using the same principle of frequent hormonal and breast stimulation
• Assessing infant feeding

  Assess urine output, stooling patterns, and weight trends to ensure the infant is getting enough. Weight loss is common in newborns, but weight loss of greater than seven percent in the first week of life can indicate a problem with feeding. Birth weight should be regained by about two weeks of life. An infant who is breastfeeding well should gain about 20 to 30 grams per day
• Encouraging successful latching

  Infant should be unswaddled and placed on mom's bare chest in a calm quiet environment. A preferred position for learning to breastfeed is with mom sitting back supported and baby in a prone position on the chest. A successful latch happens when the baby has her mouth over most of the areola and achieves an organized sucking pattern
• Physiology of breastfeeding

  Initially after birth, a new mother produces colostrum, a low volume yellow liquid concentrated with protein and antibodies. Milk comes in around 48 to 72 hours postpartum. Prolactin is the primary hormone involved with milk production, and oxytocin is the primary hormone with milk expression. Frequent suckling leads to increased production of these hormones, helping to establish milk supply
• Effective breastfeeding

  Milk removal with a breast pump is essential to ongoing breast milk production. Counseling should encourage skin-to-skin contact and frequent feeding at least 8 times in every 24 hours. New parents should be taught about infant feeding cues to recognize when their baby is hungry and ready to feed
• It is important to help new parents distinguish between non-nutritive comfort suckling and effective feeding with swallowing
• Mothers may note that her breasts feel firm and full prior to feeding and softer upon completion. Mothers may also feel a letdown reflex as their milk starts to flow. Swallowing is a sign of milk transfer, and milk should be visible in the baby's mouth if adequate breastfeeding is occurring
• If adequate breastfeeding cannot be established, first steps should be to provide additional breastfeeding counseling and support from a lactation consultant
• Some medications are not safe to take when breastfeeding, such as amphetamines, ergotamines, statins, and many chemotherapy drugs
• Contraindications to breastfeeding include classic galactosemia, maternal HIV infection, active tuberculosis, or active herpes simplex virus on the breast
• Challenges new families may experience with exclusive breastfeeding include lack of education and preparation from healthcare providers
• Exclusive breastfeeding should be maintained for about six months, after which foods containing iron and zinc should be introduced
• All breastfed infants should receive supplementation with vitamin D daily beginning at four months of life
• Pumping for five to ten minutes after each breastfeeding session may help provide additional stimulation
• Donor breast milk may be an option in certain scenarios, but it is not a long-term solution due to the financial cost of pasteurization and storage
• Breastfeeding process

  1. Breasts feel firm and full prior to feeding and softer upon completion

  2. Mothers may feel a letdown reflex as their milk starts to flow

  3. Listening for swallowing as a sign of milk transfer

  4. Seeing milk in the baby's mouth
• Steps if adequate breastfeeding cannot be established

  1. Provide additional breastfeeding counseling and support from a lactation consultant

  2. Examine the infant for possible oral motor abnormalities such as ankyloglossia

  3. Encourage pumping breast milk to feed the baby and improve milk production

  4. Consider supplementation with formula if necessary
• Breastfeeding is the preferred form of infant nutrition in the first six to twelve months of life and confers many health benefits for both infants and mothers
• Common reasons for giving up breastfeeding include sore breasts and nipples, often due to poor latch
• Supplementation with iron should be initiated and continued until iron-containing foods are introduced
• Under US federal law enacted in 2010, employers are required to provide nursing mothers with adequate break time and a private place to express breast milk that is not a bathroom
• Mothers enrolled in substance abuse treatment programs and receiving opiate prescription therapy can breastfeed, but certain substances like heroin, cocaine, and marijuana pass into breast milk