Breastfeeding or lactation is a natural and normal way of providing newborns and infants with all the nutrients they need.
It is the purest, safest and most sustainable way to feed an infant.
Since it offers so many benefits to both the mother and the child, it is recommended that babies should be exclusively breastfed for the initial six months. Also, breastfeeding should be continued for at least two years This means that the child should not be given formula milk, juice or even water during the initial 6 months. Only after 6 months, additional food items and nutrients should be added to the diet.
In a bid to encourage breastfeeding, World Breastfeeding Week is celebrated every year from 1st to 7th August. It commemorates the Innocenti Declaration signed in August 1990 by government policymakers, WHO, UNICEF and other organizations to protect, promote and support breastfeeding.
Physiology of Breast Milk Production or Lactation
Read more about Breast Milk Production and Regulation
Read more about Anatomy of the Breast
Preparation of breasts (Mammogenesis)
Both the ducts and alveoli (glandular tissue) of breast start growing during pregnancy to prepare for breastfeeding.
Synthesis and secretion of milk (Lactogenesis)
Synthesis of milk begins during the late stages of pregnancy.
However, it is not secreted during pregnancy because the high levels of estrogen and progesterone present in the body prevent its secretion.
After delivery, when estrogen and progesterone levels fall, prolactin begins its milk secretory activity. The secretory activity is also influenced by other hormones like growth hormone, glucocorticoids, insulin, and thyroxine. Prolactin stimulates the breast tissue to synthesize milk protein.
Ejection of milk (Galactokinesis)
Suction exerted by the baby during suckling and the contractile mechanism of the breast tissue leads to the discharge of milk from the breast alveoli into the ducts.
Milk ejection or milk let out reflex: When a baby suckles, a reflex is set up. Impulses from the nipple and areola cause the release of oxytocin from the posterior pituitary gland. Oxytocin causes the milk present in the alveoli to move into the ducts from where it can be expressed by the mother or sucked by the baby.
Maintenance of lactation (Galactopoiesis)
Milk secretion is a continuous process. Regular suckling is important for moving the milk from glands into the ducts.
The two hormones prolactin and oxytocin and a positive feedback loop ensure continued milk production as long as the infant continues to breastfeed.
What is Golden Hour of Breastfeeding
The first hour after the baby is born when a mother has direct skin-to-skin contact with the baby is called the golden hour. This maximizes the bonding between the mother and the child and plays an important role in the child’s growth and development.
Earlier, after the birth of the baby, the baby was taken by the health professionals for physical assessment including weight, drawing of a blood sample or performing any medical procedure, if required. The recent view is that the newborn should be handed over to the mother immediately after birth and all the assessments or procedures should be carried out later on.
- Healthy newborns should be placed in direct “skin-to-skin” contact with the mother until the first round of breastfeeding is established.
- The health professionals can physically assess the child while it is on the mother’s chest.
- Procedures like weighing, measuring, bathing, withdrawing of a blood sample for blood tests should be carried out only after the first feeding.
- Baby and mother should remain together throughout the initial period.
- If a baby has any health problem, it should be given to the mother as soon as the baby is stabilized.
- Even in the case of cesarean section, the newborn should be moved to the mother’s chest soon after birth while the surgical procedure is still being performed.
Skin-to-skin contact and the suckling of the baby helps to release certain hormones within the mother’s body. This in turn
- Helps with the early establishment of breastfeeding
- Makes it more likely for a mother to continue breastfeeding for a long period.
- Increases infant survival rates
- Helps the mother to connect to her child creating a lifelong emotional bonding.
- Causes the uterus to contract
- Speeds up the delivery of the placenta and reduces the risk of postpartum hemorrhage
What is Colostrum
After birth, during the first few days, the breasts produce a thick and yellowish fluid called colostrum. Although it is produced in low quantity, this little amount is sufficient for newborn’s requirements. It is the ideal first food for the baby and helps the immature digestive tract of the newborn to develop. It is high in protein, low in sugar and contains essential nutrients. The protein present in colostrum is easily digested and absorbed by the newborn’s body, especially by the rapidly developing brain.
After the first few days, as the digestive tract of the baby starts maturing and the needs of the baby increase, the quantity of milk produced by the breasts also increases.
Does the Composition of Milk Remain Constant Throughout?
The number of calories and composition of breast milk is not constant. It keeps on changing throughout the lactation period as well as during each feed according to the baby’s needs. This is in contrast to formula milk whose composition remains constant.
As discussed earlier, initial breast milk or colostrum is less in quantity, high in protein and low in sugar content.
During each feed, the initial milk that comes is more watery and is meant to quench the baby’s thirst. After that, the milk that comes is thicker, has a higher fat content and is more nutritious.
This implies that to get the nutritious part of the milk, the baby should drink from one breast and empty it completely before switching to the other.
Advantages of Breastfeeding for The Baby
It provides the ideal nutrition for the baby
Breast milk is the ideal food for a baby and contains all the nutrients required by the infant. Its composition changes according to the needs of the baby.
Human milk contains all the nutrients – protein, carbohydrates, fats, vitamins, minerals, and water – in appropriate balance. Although formula milk tries to replicate the human milk composition, it remains a poor substitute for something that nature has provided.
- Breast milk contains both saturated and unsaturated fats, as well as cholesterol. , These form an important constituent of brain and nerve tissue and are essential for the infant’s rapidly developing brain. The fat present in breast milk is easier to digest than that in formula milk.
- The calories provided by breast milk are used more efficiently as compared to formula milk.
- A large number of vitamins and minerals that can be easily digested and absorbed by the infant are present in breast milk.
Breast milk contains important antibodies
Breast milk contains antibodies that help the newborn baby to fight against bacterial and viral infections. Some of the immunoprotective components present in milk include
- Lysozymes and milk leucocytes
- Secretory IgA
- Bifidus factor
Formula milk lacks these antibodies. Therefore babies fed on formula feed have a higher chance of getting diarrhea, pneumonia and other infections.
Lesser chances of diseases
Breastfed babies have reduced chances of developing several diseases in comparison to formula-fed babies. The low incidence is due to the immuno-protective factors present in breast milk and also because breast milk is sterile. These diseases include
- Respiratory tract infections including common cold
- Middle ear infections
- Nappy rash
- Intestinal tissue damage as in necrotizing enterocolitis
- Sudden infant death syndrome (SIDS)
- Allergic diseases like asthma, atopic dermatitis, and eczema
- Celiac disease
- Inflammatory bowel disease
- Childhood leukemia
Even if these diseases occur, their severity is much less in breastfed infants. This protection lasts not only throughout childhood but even adulthood.
Proper development of baby’s teeth
Breastfeeding promotes the proper development of the baby’s jaws and teeth. They also tend to have fewer dental cavities
Breastfeeding prevents obesity
Breastfed babies are less likely to develop childhood obesity.
This is because they have more number of good bacteria in their guts.
Also, they have higher levels of the hormone leptin in their bodies which regulates appetite and fat storage.
Breastfed babies have better self-regulatory control which means that they only eat till they have satisfied their hunger. They have a lesser tendency to overeat. This habit persists even in adulthood.
Breastfed babies have better-developed brains
These children have better learning ability, are more intelligent and tend to have lesser behavior abnormalities.
The difference in brain development is due to
- Right levels of saturated and unsaturated fats present in breast milk which is essential for brain development
- Physical contact and emotional attachment with the mother which happens during breastfeeding
Advantages of Breastfeeding for The Mother
It helps the mother to lose weight
Increased appetite and dietary requirements promote fat storage by the body of breastfeeding mothers in the initial few months. But after that, breastfeeding has been shown to help mothers to lose weight.
It helps the uterus to contract
Oxytocin is a hormone produced in increasing amounts during pregnancy which aids in labor. It is also produced during breastfeeding.
This hormone promotes uterine contractions and reduces bleeding. It thus helps the uterus to return to its original size thereby promoting early recovery.
It lowers the risk of maternal depression
Post-partum depression affects a significant number of mothers. It has been found that breastfeeding mothers have a lower incidence of depression as compared to mothers who wean early or don’t breastfeed at all. The increased amounts of oxytocin present in the breastfeeding mothers encourage mother-child bonding and has an anti-anxiety effect on the mother.
Lower incidence of several diseases in mothers
Breastfeeding protects the mother against ovarian and breast cancers. It also lowers the risk of several diseases like high blood pressure, heart disease arthritis, and type 2 diabetes.
Breastfeeding can act as a contraceptive
Breastfeeding over a long period causes temporary cessation of the menstrual cycle. This is beneficial as it provides a natural method of contraception.
However, it can’t be relied upon as an absolute preventive method and some additional contraceptive method must be adopted.
It saves time and is free of cost
Breastfeeding women don’t have to worry about buying milk bottles, cleaning and sterilizing them, warming and then bringing the milk to the right temperature before feeding, etc. Breast milk is always at the right temperature and ready to drink. It also saves a lot of money.
Nutrition During Breastfeeding
Breastfeeding mothers need proper nutrition which is balanced sufficiently to provide energy to mother and child both.
Healthy food that is available locally and part of the normal cuisine of that family should be eaten.
Even women who aren’t well fed are able to feed their babies well. If the mother does not consume sufficient calories or nutrients to produce milk, her body will utilize the nutrients stored in the body to maintain milk production.
Therefore, for own sake, a mother should eat well.
The mother’s diet should consist of plenty of fluids and sufficient calories and nutrients.
The diet should include milk and dairy products, bread, cereals, and whole grains, eggs, meats, nuts, fruits, legumes, pulses, and vegetables.
A breastfeeding mother should avoid alcohol, caffeine, spicy and gas-producing foods, etc.
Vitamin supplements, if desired should be taken after consultation with a physician.
Vegetarian diets are poor in vitamin B 12, vitamin D, and omega-3 fatty acids. So to compensate for these, additional food supplements may be taken by the mother.
Those on a vegan diet who don’t eat any animal products including milk or milk products, need to take adequate calcium supplements in addition to the above-mentioned supplements.
In general, mothers should avoid dieting during the breastfeeding period to avoid any nutrient deficit.
Read more about Diet for Breastfeeding Mothers- What to Eat and What to Avoid?
Common Problems During Breastfeeding and Their Solutions
Although breastfeeding is completely natural, a majority of women, especially first-time moms, experience difficulties during feeding. Fortunately, most of these problems can be solved by properly educating and counseling the mother.
Baby not latching properly
This is a very common problem especially with first-time-moms, flat or inverted nipples, premature babies and difficult deliveries.
Consult a lactation consultant who can guide the mother about proper technique. It must be remembered that the entire nipple and significant portion of the areola should be inside the baby’s mouth. This ensures that the nipple does not experience any friction or pressure and, thus, won’t get sore.
Flat or inverted nipples
This can cause problems in proper latching of the baby to the breast.
Gentle pressure applied around the nipples several times a day can help to draw out inverted or flat nipples.
Nipple formers made of soft and flexible material can be used to prepare flat or inverted nipples for feeding. They are to be worn under the bra during pregnancy as well as in between the feeds. They have vented holes that promote airflow.
These are very common in the early days of pregnancy once the production of milk increases. It may occur from one breast when the mother is feeding from the other breast. It may also occur upon unintentional stimulation of let down reflex such as on hearing some other baby crying. It usually resolves within 6 weeks. Nursing pads can be kept within the bra to prevent clothes from staining.
Pain due to sore and cracked nipples
Pain while breastfeeding is due to sore and cracked nipples. This again occurs in the initial days of pregnancy when both the milk supply and baby’s requirement increases. Some women may even develop blisters or bleeding.
The most common cause for this is improper latching of the baby. Treatment includes:
- Learning proper latching technique
- Cleaning of the nipple gently after every feed with a sterile moist cloth to remove any debris
- Drying of nipples with a clean cloth to prevent any infection
- Lanolin cream which is safe for the baby can be applied to the nipples which provide a soothing effect.
Pain due to injured nipples also settles after a few days once both the mother and the baby get used to the feeding routine.
Not producing enough milk
Milk production is low in the initial 2-4 days and starts increasing afterward. The biggest stimulus for increased milk production occurs by putting the baby to the breast which triggers hormone release thereby increasing the production. It is always better to feed the baby on demand and not on the schedule. This means the baby may have to be fed every 2-3 hours or even more frequently. Also, it is important for the mother to eat healthily and be free from any sort of stress.
Producing too much milk
Sometimes due to increased production, the milk may come out with excessive force. This will immediately lead to cough and splutter in the baby or the baby may have an upset stomach and frothy greenish stools. Expressing a little milk by hand before the feed can reduce the force of milk ejection. Trying a different position can also help as it may allow the baby to have better control over the flow of milk.
After 2-3 days when the breasts start producing a larger quantity of milk, the mother experiences a feeling of fullness and increased firmness of breasts. This is called engorgement of breasts. It occurs due to both increased production of milk and increased blood flow to the breasts.
This is usually a temporary problem. If the baby is taking adequate feeds at regular intervals, the condition resolves on its own within 1 or 2 days in most of the cases. But it remains a painful condition until it resolves.
In severe cases, there may be swelling and throbbing pain extending even up to the armpit. It can also cause soreness of nipples, blockage of breast ducts or mastitis.
The following precautions would help to reduce engorgement issues.
- Drain the breast at regular intervals by feeding the baby frequently [8-12 times per day] by latching the baby properly.
- Express a little milk before feeding. This makes the nipple softer.
- Gently messaging the breasts in a downward motion from the chest wall till the nipple during feeding helps the milk to come out easily.
- If the breast is still firm after the feed, use the manual expression or a breast pump.
- If the breast is leaking, applying warmth to the breast also helps to relieve pain and promotes the easy flow of milk.
- If the breast is not leaking, a cold compress can be applied to the breast to reduce pain and swelling.
- Do not miss feeds or abruptly stop feeding as it will worsen the engorgement.
If these remedies do not help, medication like paracetamol or ibuprofen can be taken to relieve pain and inflammation.
Read more about Breast Engorgement: Causes, Prevention, and Treatment
A breast pump is a mechanical device used by breastfeeding moms to extract milk from their breasts.
They can be of 2 types
Manual: operated by movements of hand or foot
Electrical: operated by batteries or electricity
Milk extracted with the help of breast pumps is directed into a container and stored there. It can be given to the baby with the help of a bottle. Excess milk can be stored in a refrigerator to be used later by the baby. It can also be donated to milk banks which provides human breast milk to babies whose mothers cannot provide them with their own feed due to any reason.
Indications and uses of a breast pump
- Help working mothers to exclusively breastfeed her baby. The mother can pump and store her milk and the caregiver can feed that milk to the baby while the mother is away for work.
- Premature or sick baby who is not able to suck properly can be offered pumped breast milk.
- Relieve pain from engorgement: Full and engorged breasts can be drained with the help of a breast pump. This provides relief to the mother. The milk thus stored can be fed to the baby later.
- Draw out flat or inverted nipples: flat or inverted nipples can make latching difficult for the baby. Pumping a few minutes before breastfeeding, can help a mother to draw out her nipples.
- Enables mothers to relax: Feeding every 2 or 3 hours including at night can be very exhausting for the mother. Pumping and storing breast milk can help the mother to relax for some time while the father or some other family person can feed the child. This can also help to create special bonding between the father and child.
Read more about Breast Pump – Types, Working, Uses and Selection Tips
Breastfeed is the best feed for the baby. It is also great for the mother’s health and creates a special bond between the mother and child.
But if for any reason, the mother is not able to feed, that’s okay too. Not being able to feed, does not make a woman a bad mother. It is wrong to judge a mother for not doing so.
- WHO 2003. World Health Organization. Global strategy for infant and young child feeding. WHO; Geneva: 2003. Global Strategy for Infant and Young Child Feeding.
- Giugliani ER. Common problems during lactation and their management. Jornal de Pediatria. 2004;80(5 Suppl): S147–S154.
- De Oliveira LD. Effect of intervention to improve breastfeeding technique on frequency of exclusive breastfeeding and lactation-related problems.
- Pang WW, Hartmann PE. Initiation of human lactation: secretory differentiation and secretory activation. J Mammary Gland Biol Neoplasia. 2007;12(4):211-221.
- Witt A, Bolman M, Kredit S, et al. Therapeutic breast massage in lactation for the management of engorgement, plugged ducts, and mastitis. J Hum Lact 2016;32:123–131.