Informed Breastfeeding – Part 1: Pregnancy and Birth

Accurate information and adequate support for pregnant mothers appears to be hard to come by in the general population, and is often mentioned as one of the key reasons for premature weaning or not breastfeeding at all.1

This can be seen as a result of sociocultural norms (for example, many grandmothers of today did not breastfeed their children or only breastfed for short lengths of time), misinformation and/or a lack of understanding of the biology of breastmilk and its digestion (the introduction of timed feeds), and the successful marketing carried out by artificial milk manufacturers, which left a lasting impression.2

The longevity of old wives’ tales and the lack of support and information translates into some inaccurate expectations of breastfeeding and breastmilk production, many of which we see when mothers are nearing the end of their pregnancies or during the first few days of their babies’ lives. We will now explore some of these myths and provide some accurate information on breastmilk and breastfeeding during pregnancy and the first few hours after a healthy, full-term baby is born to a healthy mother.

Pregnancy

The first thing we need to understand is how and when breastmilk production starts.

A pregnant mother’s body begins producing colostrum during pregnancy, from about 16–22 weeks gestation.3 Colostrum is the early form of breastmilk and is generally quite thick and varies in colour from clear to yellow (that’s why it is also known as “liquid gold”)! It is made in tiny quantities at first, but is extremely rich in both nutrients and antibodies: it contains high levels of carbohydrates, protein, and IgA antibodies.4 Hormones drive milk supply during this time, and the volume of colostrum being produced is usually kept quite low by the presence of high progesterone levels.5

Many mothers become concerned during pregnancy, either because they are leaking colostrum, or because they are not. The reality is that both scenarios are normal, and whether or not a mother leaks colostrum during pregnancy has no influence on how much milk she will produce once her baby is born.

At this point, mothers may begin to hear tales about “preparing” their breasts or nipples for breastfeeding: being instructed to “toughen up” by brushing them with a toothbrush or rolling/tugging at them – or any other strange and uncomfortable activities.

Rest assured that there is no need to physically prepare your nipples or breasts for feeding your baby: your incredible body is already hard at work behind the scenes!

The best preparation is simply to rest well and look after yourself, while taking in evidence-based information and garnering support from your loved ones for your breastfeeding journey.

You may have also heard that it is not safe to express colostrum prenatally or breastfeed when you are pregnant, either because “your colostrum will be finished before your baby comes” or it will kick-start labour.

Let us begin with the first statement.

You needn’t worry about your colostrum running out before your baby is born. Your breasts are not storage containers with a limited amount of stock – rather think of them as rivers that constantly flow.

As mentioned earlier, milk production during pregnancy is controlled by hormones. This means that your body will continuously produce colostrum, and only with the separation of your placenta during birth will the new message be sent to your body to start transitioning your milk from colostrum to mature milk.5

With regards to labour, no amount of breast or nipple stimulation will kick-start labour if your body is not already on the brink.

If you are at risk for pre-term labour, you will need to discuss breastfeeding or expressing colostrum during pregnancy with your healthcare provider. However, if you have a healthy pregnancy, you should be able to safely continue breastfeeding your older child and you can express colostrum without the risk of starting labour. If you feel any uterine cramps during feeding or expression, though, you should stop and contact your healthcare provider for further advice.

Antenatal expression of colostrum can be helpful if you expect that your child may require special care after birth (e.g. if you have gestational diabetes or if you foresee possible issues with latching or feeding, such as a baby with a cleft lip or palate, separation from your baby after birth, or breast abnormalities). It is usually done from about 36–37 weeks gestation via hand expression, using small syringes to store the milk in the freezer.6

Birth

Once you baby is born and they begin breastfeeding, a combination of oxytocin and your baby’s kicks on your abdomen result in the placenta detaching from your uterus and being birthed. Once this has happened, the levels of progesterone and a few other hormones drop, and the “breastfeeding” hormone, prolactin, increases and works with oxytocin (“the love hormone”) to begin stimulating your milk production.

When a baby is immediately placed skin to skin with their mother after birth and is left undisturbed, with routine checks being delayed until later, they go through nine instinctive phases during the first one to two hours as they find their way to the breast to suckle for the first time.  If this takes place, a mother’s likelihood of successful breastfeeding is greatly increased.7

Within each stage, a newborn may be observed doing all or some of the actions. The stages are as follows:

Stage 1: The Birth Cry – That first cry after a baby is born, when their lungs expand to take in air for the first time.

Stage 2: Relaxation – Once the baby has stopped crying and is warmly covered with a blanket or towel – skin to skin with their mother – he/she will appear relaxed, with relaxed hands and no mouth movements.

Stage 3: Awakening – Usually occurring about three minutes after birth, the baby will begin to move its head. It may open its eyes and move its mouth and shoulders.

Stage 4: Activity – About eight minutes after birth, the baby’s movements start to increase, with them beginning to make mouthing/sucking movements. The rooting reflex becomes noticeable at this point. The baby may keep their eyes open, look between their mother and her breasts, drool, move their head from side to side as though searching for a nipple, stick out their tongue, move their hands between their mouth and their mother’s breast (almost massaging at times), and lifting their torso from the mother’s body.

Stage 5: Rest – The baby may rest at any time between these movements, especially during the first hour after birth. This does not mean that the baby is uninterested in the breast or needs help with latching; they simply need to rest.

Stage 6: Crawling – About 35 minutes after birth, the baby will display small crawling movements – managed through leaping, sliding, and pushing – as they make their way to their mother’s breast.

Stage 7: Familiarisation – Beginning about 45 minutes after birth and continuing for up to 20 minutes, the baby will start to “get to know” their mother and her breasts. They do this by touching their mother’s breasts and licking her breast and nipple, as well as their own hands (amniotic fluid smells like colostrum, so you shouldn’t wash or wipe their hands!), looking at their mother and making sounds to get her attention, sticking out their tongue, and possibly observing any other people in the room.

Stage 8: Suckling – Around an hour after the baby is born, they will take the nipple into their mouth, self-attaching and suckling for their first feed. If the mother was medicated during the birth process, the baby may need a little longer in this skin-to-skin positioning to complete the previous stages and begin suckling.

Stage 9: Sleep – Around one and a half to two hours after they are born and have breastfed, the baby (and often mother, too) will fall into a restful sleep. Birth is a tiring process!

Your baby needs to feed frequently in the early days, around 10–12 times in 24 hours, as their stomachs are very small (just the right size for the small amounts of colostrum you will be producing).

Stay tuned for Part Two of this series, when we will discuss the early days of breastfeeding.

 

References

  1. https://internationalbreastfeedingjournal.biomedcentral.com/articles/10.1186/s13006-018-0166-9#ref-CR13
  2. https://www.ncbi.nlm.nih.gov/books/NBK52688/
  3. https://kellymom.com/ages/newborn/when-will-my-milk-come-in/
  4. https://www.sciencedaily.com/terms/colostrum.htm#:~:text=2-,Colostrum,it%20is%20small%20in%20quantity
  5. https://kellymom.com/hot-topics/milkproduction/
  6. https://www.laleche.org.uk/antenatal-expression-of-colostrum/
  7. https://onlinelibrary.wiley.com/doi/pdf/10.1111/apa.14754
  8. https://www.lllc.ca/thursday-tip-newborns-have-small-stomachs#:~:text=Baby’s%20stomach%20can%20now%20hold,%2D25%20ounces)%20per%20day

 

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