The Hidden Treasures of Breastfeeding by Penang Adventist Hospital

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THE HIDDEN TREASURES OF

Breastfeeding

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The World Health Organization (WHO) recommends all mothers to breastfeed their babies exclusively from birth to 6 months and to continue breastfeeding with complementary food up to 2 years or longer.

We are proud to announce that Penang Adventist Hospital is the ﬁrst private hospital in the northern region of Peninsular Malaysia to be accredited as Baby Friendly Hospital since December 2005.

BENEFITS OF BREASTFEEDING

Beneﬁts of breastfeeding to baby:-

• Breast milk is the perfect nutrition for baby.

• Colostrum, mother’s ﬁrst milk contains antibodies and is the baby’s ﬁrst immunisation against bacteria and viruses.

• It reduces the incidences of cough, colds, ear infection, bronchitis, pneumonia, and meningitis.

• Breastfeeding prevents colic and lowers the risk of gastrointestinal infection and diarrhea.

• It protects baby from asthma, eczema, colds and food allergies.

• Breastfeeding lowers the risk of baby developing juvenile diabetes and heart disease.

• It enhances IQ level.

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Beneﬁts of breastfeeding to mother:-

• Promotes mother and child bonding.

• It helps to contract uterus and prevent uterine bleeding in the mother after delivery.

• Reduces the risk of breast and ovarian cancer in mother.

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• Help mother to lose weight and get back to pre-pregnancy weight.

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Beneﬁts of breastfeeding to family:A natural form of family planning.* It’s convenient anywhere, at anytime. Save money.

*Conditions apply

BREASTFEEDING

Initiate breastfeeding as soon after birth within 1st hour of birth. At this stage, newborn is alert and instinct (rooting reﬂex) to search for breast is strong.

Importance of initiating early breastfeeding:-

• Stimulates breast milk production.

• Ensure that the infant receives the colostrum, or “ﬁrst milk”, which is rich in antibodies.

• Help in exclusive breastfeeding.

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SKIN TO SKIN CONTACT

Newborns are given to mothers as soon after birth for skin to skin contact for at least one hour.

During skin-to-skin contact, the baby is naked and is placed on the mother’s bare chest, between her breasts.

Mother is encouraged to identify “feeding cues” and initiate breastfeeding.

Importance of immediate skin to skin contact after birth:-

• Stabilise baby’s body temperature.

• Calms the mother and the baby.

• Facilitates bonding between the mother and her baby.

• Initiates early breastfeeding.

• Baby learns that mother’s chest and breasts are safe place.

• Enable colonisation of good bacteria from mother’s body to newborn.

• Stabilise the baby’s heartbeat and breathing.

• Reduces infant crying, thus reducing stress and energy use.

• Assists in blood glucose stabilisation in the baby.

• Skin to skin contact also creates good bonding for baby and father.

MOTHER AND BABY ROOMING-IN

After delivery, mother and baby will stay in the same room day and night.

Importance:-

• Baby learns to recognize his/ her mother.

• Enhance bonding between newborn and mother.

• Enable mother to breastfeed baby according to baby’s feeding cues.

• Soothing baby more quickly and sleeps better.

• Stimulate more breast milk production.

• Maternal closeness will keep baby warm and cozy.

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BREASTFEEDING ON DEMAND OR WITH FEEDING CUES

Importance:-

• Stimulate more breast milk production.

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• Reduce jaundice level.

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• Increase baby’s body weight.

• Avoid breast engorgement.

On Demand

• It is convenient! Mother can breastfeed her baby whenever baby show signs of hunger eg. More alert or active, mouthing (putting hand or ﬁsts to mouth and making suckling motion with mouth) or rooting (turning head in search of breast).

• No time limit on duration or frequency of feeds. Feed as long as the baby wants.

• No need to time the baby. Feed whenever the baby is hungry.

• If the baby sleeps too long, wake the baby up for breastfeeding.

• Do not miss the night feed. Sleep in the same bed with baby with safety measures.

• Allow suckling till baby sleeps and release the nipple voluntarily.

• Do not pull baby oﬀ the nipple. If baby cries, put baby back on the same breast.

• Allow the baby to complete one feed on one breast.

• Oﬀer the other breast the next feed.

• Colostrum is more than enough for baby until mature milk comes in.

• No need to give water, glucose or formula milk.

• Avoid bottles, paciﬁers or artiﬁcial nipples as this may cause nipple confusion.

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Feeding Cues

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Early Cues : These mean “I AM HUNGRY”

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Mid Cues : These mean “I AM REALLY HUNGRY”

Late Cues : These mean “I AM REALLY UPSET”

*Calm baby before feed: try cuddling, skin to skin contact on chest, talking and stroking.

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FUNCTIONS OF PROLACTIN & OXYTOCIN HORMONES

*more Prolactin at night.

WHAT DOES BREAST MIL K LOOK LIK E ?

Colostrum Foremilk Hindmilk

Important for newborns.

Colostrum is produced in the ﬁrst few days after birth.

Rich in water and nutrients to keep your baby healthy and hydrated.

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Rich in fat and calories which your baby needs to grow strong and healthy.

Mature milk (Foremilk & Hindmilk) usually produced 3-5 days after birth.

NEWBORN STOMACH SIZE

Day One Size

Day Three Size

One

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BREASTFEEDING POSITIONS

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Football Hold

Good for Twins delivery or Caesarean birth.

Sitting

Mother’s Position

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Side Lying

This allow mother to rest while breastfeeding. Good for Caesarean birth too.

Cradle Hold

Commonly used position that is comfortable for most mothers.

• Sit upright, and support yourself well with pillows. Do not hunch. Support. Hold your baby behind her back , shoulder and head, so her chest is touching your chest. Bring her nose in line with your nipple. Gently brush your nipple from your baby’s nose to his lips – this will encourage him to open his mouth wide.

When your baby’s mouth is wide open, quickly bring your baby to your breast, directing your nipple at the roof of her mouth. Her mouth will close over your breast and start suckling.

Baby’s Position

• In line - Baby’s head, neck and back should be aligned.

• Close - Baby is held close to the mother’s body, chest-to-chest.

• Facing - Baby’s tummy is facing the mother's body, not turned away.

• Supported - Baby’s head, shoulder and buttock should be supported.

IMPORTANCE OF PROPER POSITION AND ATTACHMENT

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• Enable baby to get enough milk eﬀectively.

• Avoid breast engorgement and sore nipple.

• Enhance breast milk ﬂow.

Good attachment

• Baby’s mouth wide open.

• More areola is visible above baby’s top lip than below the bottom lip.

• Chin touching the breast.

• Lips are curled out.

Poor attachment

• Chin far away from the breast.

• Not much of the areola in the baby’s mouth.

• Mother feels pain when baby suckles.

Notes: Signs of good suckling include baby’s cheeks are rounded and not drawn in during feeding, visible slow deep sucks, and gentle swallowing sounds like clicks or gulps.

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1. Nose on target with nipple.

2. Tickle lower lip with nipple.

3. Wait for wide mouth to latch.

4. Lips ﬂanged. Chin tucked

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SIGNS OF HAVING ENOUGH MILK

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• In the beginning of breastfeeding, babies’ body straightens and slowly relaxes once proper latching is achieved.

• Most babies release mother’s breast voluntarily when full or falls asleep while suckling slowly on mother’s breast.

• Breastfeed one side of breast until ﬁnish before oﬀering the other breast to ensure baby gets hind milk which is high in fat that helps in weight gain.

• To unlatch, insert little ﬁnger at the side of baby’s mouth with slight pressure to release the nipple.

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How To Ensure Baby Is Getting Enough Milk

• Baby will be contented after a feed.

• Baby passes clear diluted urine 6-8 times a day.

• Baby passes bright yellow watery stool 3-8 times a day.

• Baby puts on at least 18-20 grammes per day.

• Baby has good skin turgor and does not show any signs of dehydration.

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EXCLUSIVE BREASTFEEDING

FOR FIRST 6 MONTHS

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Exclusive breastfeeding from birth till the age of 6 months of life.

“Exclusive breastfeeding" is deﬁned as giving only breast milk. No food or drink.

Vitamin and supplements can be given if medically indicated and as advised by paediatrician.

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Importance:-

Breast milk contains the ideal nutrition content and water needed to achieve optimal growth, development and health for the infants’ ﬁrst 6 months of life.

Reduces indigestion such as diarrhea or abdominal bloating.

Reduces risks of respiratory infection.

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Breast milk contains antibodies that help your baby ﬁght against viruses and bacteria.

The importance of continuing breastfeeding after 6 months while giving complementary food:-

After 6 months of age, babies are given complementary feeding on top of breast milk.

It is important to continue breastfeeding as breast milk provides 1/3 to 1/2 of calories needed till the age of 12months.

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Breastfeeding should be continued till 2 years of age and above.

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RISKS OF FORMULA MILK

• Not breastfeeding is associated with health risks for both mother and baby.

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Sleep apnoea

Asthma

Allergies

Obesity

Diabetes

Digestive problems

Respiratory infections

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Childhood leukemia

High blood pressure & heart disease

Lower IQ & cognitive development

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Diabetes (gestational & Type 2)

Overweight & obesity

Osteoporosis

Breast cancer, ovarian cancer

Hypertensive & cardiovascular diseases

Reduced child spacing

Exposure to environmental contaminants

Dental problems and malocclusions

SIDS (Sudden Infant Death Syndrome)

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Iron-deﬁciency anaemia

Ear infections

HOW TO EXPRESS BREAST MILK

Breast Massage

Back and forth motion horizontally, repeat vertically Massage in circular motions Stroke the area surrounding the nipple

Reasons for expressing breast milk:-

Babies who are separated from mother.

To increase milk production.

To avoid breast engorgement.

Hand expression

Wash hands. Prepare a clean container. Find a clean and comfortable place.

Stimulate a letdown reﬂex, e.g gently massage the breast, rub on the mother’s back.

Place the thumb on the areola above the nipple and place index finger on lower areola opposite the thumb. Support breast with the remaining fingers. Press the thumb and finger towards the chest wall.

Compress all around the areola to ensure that milk is expressed from all segment of the breast.

Compress the milk into a clean container.

Use your thumb and the rest of your ﬁngers in the “C” shape, and then gently squeeze to produce.

STORAGE OF EXPRESS BREAST MILK

• Cover your breast milk in a clean and sterile container.

• Label the date and time. Store milk in a small amount to minimize wastage about 2-4 oz per container.

• Leave some space at the top of the container for milk to expand as it freezes.

Method of storage Storage

Room temperature (15°C to 37°C)

Refrigerator (2°C to 4°C)

Freezer

(1 door; -18°C to 0 °C)

Freezer

(2 doors; -18°C to 0 °C)

Deep Freezer (-20°C to -18°C)

Thawed in a refrigerator

Below 25°C: 4 to 8 hours

Above 25°C: 3 to 4 hours

THAWING OR WARMING BREAST MILK

• Use the oldest milk ﬁrst.

• Defrost the frozen milk in the refrigerator the night before use or under warm running water.

• Do not defrost milk in microwave or boil it on the stove.

• Defrosted milk stored in the refrigerator must be used within 24 hours.

• Defrosted milk kept at room temperature should be used within 1 hour.

• Do not refreeze defrosted milk.

• Feed baby by using spoon or cup. Avoid using bottles.

Giving Expressed Breast Milk

Cup Feeding Techniques:-

a) Placed baby in sitting position on lap.

b) Place a small cup on baby’s lower lip and tilt the cup towards the baby’s lips.

c) DON’T POUR. Allow the baby to sip the milk.

d) The baby will stop drinking once full.

BREASTFEEDING FOR WORKING MOTHERS

Breastfeed your baby exclusively for 6 months. Add solid food and to continue breastfeed up to 2 years and beyond. Most mothers may have to return to work before this. So how do you continue to breastfeed your baby?

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Guide for working mothers

• Train the mother or care giver to feed baby with expressed breast milk (EBM) 2 weeks before returning to work.

• After breastfeeding, any excess milk can be expressed and stored in a clean container. Write down the time and date and store in the freezer.

You can use your hand or electric pump to express your breast milk.

Baby’s feeding schedule before mother goes back to work Day Time Day 1 - 3 Day 4 - 6 Day 7 - 9 Day 11 - 14

7am - 9 am 9am - 11am

11am - 2pm 2pm - 5pm

You can express your breast milk while you are at your working place

• Bring along icebox container and few sterile containers to store EBM.

• Express your breast milk in work place and bring home to give your baby the next day.

• Looking at your baby’s photo while expressing also helps in breast milk ﬂow.

• Mothers who receive support from their husband and family members are most likely to breastfeed successfully.

• Seek support from health care givers who are experienced in breastfeeding.

Join breastfeeding support group to gain conﬁdence, motivation and knowledge e.g “Kangaroo Club” in Penang Adventist Hospital.

COMMON PROBLEMS DURING BREASTFEEDING

Some women breastfeed without problems, however there are many women who do encounter minor problems. This is especially so if it is their ﬁrst time breastfeeding. The good news is that most problems can be solved with a little help and support. A small percentage may require the assistance of your health care provider. In order to prevent problems from arising, please remember the three most important things about breastfeeding.

Breastfeed early and frequently

1. Breast Engorgements

Symptoms

Breastfeed using the correct technique

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• Breast(s) become bigger, swollen, hard and warm to touch.

• The skin overlying the breast is shiny looking.

• Nipple(s) appear ﬂat.

• Painful breast with heavy feeling.

• Sometimes associated with low grade fever.

2. Blocked Milk Ducts

Symptoms

• Tender, painful and reddened lump (s) in the breast.

• Sometimes associated with low grade fever.

• Pain in the breast.

• Slow breast milk ﬂow.

3. Mastitis

*Mastitis is an infection in the breast. Symptoms

• Painful and hard breast.

• Swollen breast, skin over the aﬀected breast usually turns red.

• Lump(s) in the breast.

• Fever or ﬂu-like symptoms.

• Breast warm to touch.

• Some may experience headache, nausea and vomiting.

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Management

Continue breastfeeding. Start with affected breast. Practice correct breastfeeding technique. Make sure your baby is attached correctly for effective sucking Breastfeed or express frequently. Apply hot compress to soften hard breast and to encourage the milk flow. DO breast massage. Apply a bit more pressure on the lumpy area and press toward the nipple.

Ensure adequate ﬂuids intake and a good balanced diet.

To reduce pain, apply cold compress before and after feeding or expressing.

If condition does not improve within 24 hours, please contact your doctor or health provider.

4. Sore or Cracked nipple Symptoms

• Painful, injured or bleeding nipple(s).

• Nipple(s) look very pink and red, compressed or blanched after feeding. Management

• Use correct breastfeeding technique.

• Apply breast milk to nipple and areola before and after feeding.

• Begin breastfeeding on the least aﬀected nipple .

• Do not delay breastfeeding. Try to relax so your let-down comes easily.

• Do not wear nipple shield because it will not relieve sore nipple. On the contrary it may cause prolong soreness.

• Avoid tight bras or clothes as it may press on your nipple.

• Avoid using soap or ointments that contain astringent.

• Keep nipples dry (air dry).

• Avoid breast engorgement.

• Get treatment for thrush infection.

• For pain relief, apply ice cubes on the aﬀected nipple.

• Gently remove baby from your breast, if baby has fallen asleep and is not sucking actively.

If condition gets worse, consult a doctor, health care provider or counselor who is trained or experienced in breastfeeding.

MOTHER-FRIENDLY CARE

Practices in Successful Breastfeeding

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Encouraging mothers to have companion of their choice for support during labour and birth.

During labour, a companion can help to:

• Provide emotional support to mother

• Reduces labour pain.

• Assist mother in ambulation.

• Reduce emotional stress.

• Speeds up labour process.

• Increase mother’s conﬁdence during labour.

Allow mothers to drink and eat light food during labour process (Low risk mothers).

Labour process requires energy. Research showed no evidence of beneﬁt to restrict low risk mothers from drinking during labour. 2

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Labour mothers are encouraged to use non-drug method of pain relief.

Non-Drug Pain Management:

• Support from companion during labour.

• Ambulation during labour pain.

• Massage.

• Drink warm water.

• Practice traditional methods or religion belief.

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Mothers are encouraged to move and walk about before labour unless medically indicated.

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Avoid invasive procedure and instrumental deliveries unless medically indicated. If it is needed, it should be explained to the mother.

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MOTHERS WITH SUSPECTED/

COVID 19 ARE ADVISED TO:

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Wear a face mask all the time, especially when breastfeeding.

Practice hand hygiene before and after contact with the baby, including during breastfeeding and after coughing or sneezing. Practice respiratory hygiene if there are symptoms:

- Cover the nose and mouth with a tissue during coughing or sneezing.

- Dispose of tissue in a closed container

- Wash hands immediately afterwards.

5 Reduce physical contact with baby during rooming-in. Hold the baby for breastfeeding only.

7 Ensure good room ventilation.

Routine cleaning and disinfect surface touched by the symptomatic mother.

Physical distancing with infants while not breastfeeding.

Avoid air -conditioned rooms.

WHERE TO GET HELP

Useful internet sources on breastfeeding

If you encounter any breastfeeding problems while breastfeeding, please do not be shy to get help. If you want to breastfeed successfully please seek advice from the professional

Here are some contacts that you can reach:

Kangaroo Club Breastfeeding Support Group

(Breastfeeding Support Group of Penang Adventist Hospital)

Penang Adventist Hospital, 465 Burma Road 10350 Penang.

24 hours helpline (+604) 222 7328

Clinic Hours (+604) 222 7709

Clinic Hours Mon - Thurs 8am - 5pm Fri & Sun 8am - 1pm

Sat & selected public holidays: Closed

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Email lactation@pah.com.my (Attn to: Lactation Nurse)

Website www.pah.com.my

Facebook Page & Kangaroo Club Breastfeeding Support Group

Messenger

World Alliance For Breastfeeding Action (WABA)

A Penang based global network of organization and individuals, which believe breastfeeding to be the right of all mothers and children.

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Email waba@waba.org.my

Website www.waba.org.my

Facebook Page WABA

La Leche League International

Email info@llli.org

Website www.llli.org

BREASTFEEDING LOG

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Baby’s Name:

DAY 1

Date:

Calm

Sleeping

Crying

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Babies are often awake, alert, and looking for the breast. S: Soft P: Pain E: Engorged

The ﬁrst hour is a magical time!

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A Tiny Amount of Colostrum is powerful! Every little drop is important!

Tips for Successfully Breastfeeding:

1. Room in with your baby day and night to feed at the ﬁrst signs of hunger and try not to wait until baby is crying.

2. Feed on demand by identifying baby’s early signs of hunger. Newborns need to breastfeed at least 8-12 (or more!) times every 24 hours.

3. Make sure your baby has a good latch. Breastfeeding shouldn’t be painful, poor latching = poor feeding.

Newborns usually become extremely sleepy and hard to rouse from about 2 to 24 hours after they’re born. You may need to wake baby up for breastfeeding to ensure they get at least 8-12 feeding every 24 hours!

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If baby is really sleepy, wake baby to breastfeed, 2 hourly during the day and 3-4 hourly at night.

Crying

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SCAN HERE

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Operated by Adventist Hospital & Clinic Services (M) (Reg. No. 199301000960) 465, Jalan Burma, 10350 Penang, Malaysia Tel: (+604) 222 7200 LoCall: 1-300-88-4325 Fax: (+604) 228 0443 E-mail: enquiry@pah.com.my Website: www.pah.com.my Facebook: fb.com/pahpg