Breastfeeding

Nursing

Natural nutrition is feeding exclusively with breast milk for the first 6 months after birth, without giving any additional food, including water. It is the most economical, beneficial, and environmentally friendly way of feeding. Many diseases seen in later life, Type 1 and Type 2 Diabetes, obesity, middle ear infection, asthma, leukemia, and sudden infant death syndrome are less common due to this type of nutrition. Our recommendation is to exclusively breastfeed for 6 months (180 days) and then continue breastfeeding along with complementary foods until 2 years of age. Breast milk is a miracle of nursing, but of course, there are situations where mothers cannot breastfeed or breast milk cannot be given. These babies also grow up healthy, and there are formula milk products available that are given when necessary and are designed to be close to breast milk. Not being able to breastfeed is not the end of the world, and it needs to be especially emphasized to mothers in this situation that a mother who cannot breastfeed is not an inadequate mother.

Factors that Increase Breast Milk Production:

• Mother’s willingness and confidence in breastfeeding
• Early breastfeeding after birth
• Frequent breastfeeding
• Regular emptying of breasts
• Effective breastfeeding
• Night breastfeeding
• Mother and baby being in the same room
• Environmental support for the mother regarding breastfeeding

Factors that Decrease Breast Milk Production:

• Mother’s unwillingness to breastfeed
• Insecurity, excessive fear, and anxiety
• Postpartum depression in the mother
• Irregular emptying of breasts, milk pooling in the breast
• Difficult and traumatic birth
• Certain medications
• Mother’s daily energy intake being below 1500 calories
• Mother’s previous negative breastfeeding experiences
• Use of pacifiers and bottles within the first 4 weeks after birth

Problems that may be Encountered During Breastfeeding and Their Solutions:

Insufficient Milk:

Insufficient milk: The most common cause is the inability to fully empty the breasts. Problems with breastfeeding technique, infrequent breastfeeding, and not breastfeeding for sufficient duration can be reasons. Breast milk insufficiency is a rare condition. Low weight gain and infrequent urination are indicators of insufficiency. Definite indicators are not reaching birth weight by the 2nd week after birth, weight gain less than 500 grams per month in the first months, less than 2-3 times urination per day in the first 2 days, less than 3 times on the 3rd day, less than 4 times on the 4th day, and less than 6 times on the 6th day.

Excessive Milk Production:

Excessive milk production: Uncontrolled milk production can occur if breastfeeding from the other breast before one breast is completely emptied. In this case, problems such as continuous milk flow from the mother’s breast, fullness in the breast, blocked milk ducts, and abscess may occur. The breast should be checked after each breastfeeding, and if necessary, it should be expressed to empty. Appropriate pads should be used for milk leakage, and if there are nipple cracks, appropriate treatment and airing should be provided.

Flat or Inverted Nipples:

Flat or inverted nipples: The effectiveness of massages done during pregnancy has not been demonstrated. In fact, inverted nipples are not a barrier to effective breastfeeding; taking the areola into the baby’s mouth is effective. Oxytocin and some secreted peptides cause the nipple to become erect. Long-term use of pumps and nipple molds is not recommended.

Nipple Cracks:

Nipple cracks: Painful nipples and nipple cracks are common problems usually encountered in the early stages of breastfeeding. The most important causes are errors in breastfeeding technique and ineffective breastfeeding. Pump usage errors can also cause this. Measures to be taken include breastfeeding by taking part of the areola, the brown part along with the nipple, into the baby’s mouth, properly removing the baby from the breast when breastfeeding is finished, and moistening the nipple with breast milk and air-drying it after breastfeeding. It’s not necessary to clean the nipples after each feeding. Showering once a day is sufficient. Breast pads that don’t allow air circulation should not be used. If the mother has great difficulty in latching the baby, she should express the milk and give it with a spoon or cup. Bottles should not be given.

Mastitis:

Mastitis: It is an inflammation of breast tissue due to microorganisms entering through nipple cracks. There may be fever, breast pain, redness, and hardness. Breasts should be regularly emptied. If the baby cannot suckle sufficiently, expressing is necessary. Plenty of fluids, antibiotics, and painkillers are used. Surgery may be required if there is an abscess.

Breast Engorgement, Milk Accumulation, Blocked Breast:

Breast engorgement, milk accumulation, blocked breast: Common in the first days of breastfeeding. The breast may be swollen and painful, fever may occur, and milk flow is slow. It is necessary to soften the breast by taking a warm shower and massaging, and to empty the breast. Frequent breastfeeding and expressing are used to empty the milk.

Expressing and Storing Breast Milk:

Expressing and storing breast milk: The most effective way to empty the breast is through suckling. Hand expression yields less milk, and pumping even less. Pain during expression reduces oxytocin secretion, leading to decreased milk production. When the mother is temporarily separated from the baby, to maintain milk supply, expression should be done every 3 hours during the day and every 4-5 hours at night. 5-20 minutes is sufficient. Expressed milk should be stored in a clean, covered container. The date and time of expression should be written on it. While opinions vary, breast milk can be stored at room temperature for 4-8 hours, in the refrigerator for 3-8 days, and in the freezer for 3-6 months. When feeding the baby, thaw the milk under warm water or in the refrigerator, then warm it in a water bath before giving it to the baby.

Breast Refusal:

Breast refusal: This is a common problem in babies. It can occur at any point during the breastfeeding process but is more common around the 4th month when the baby’s interest in the environment increases. It may involve the baby not taking the breast at all or starting to nurse and then crying or screaming, refusing to continue. Although this situation greatly worries mothers, it can be resolved quickly if the cause is found and supported; it’s important to remain calm and patient. Babies nurse frequently in the first months, and this decreases over time. Even if the amount of milk they drink remains the same, they suckle more strongly and get more milk in less time, and feeding intervals may increase. This might be mistaken for breast refusal, but it’s physiological and not a problem if growth is normal. Bottle use, pacifier use, illness, nasal congestion, teething, post-vaccination, oral thrush, and introduction of solid foods can cause this. Additionally, slow or too rapid milk flow, decreased milk supply, maternal illness, medications, eating foods with different tastes, perfume, hair dye, post-sea or pool exposure, pregnancy, or menstruation can be possible causes. So, what can be done?

• The mother should be patient and calm
• Frequent skin-to-skin contact and holding the baby
• Changing the breastfeeding position
• Distracting the baby to latch, trying to nurse outdoors, during bath time, or while the baby is sleepy. Increasing night feedings may help.
• It is recommended to have the baby examined by a pediatrician to determine if there are any health issues, and to conduct appropriate tests if necessary.