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One
of the commonest reasons for introducing supplementary
milk early or even terminating breastfeeding
is that mothers believe that they are not producing
enough breastmilk. Mothers often worry about
the amount of breastmilk they produce as early
as the first days after delivery. Sometimes
relatives, friends or health workers suggest
to the mother that she may not have enough milk.
The mother's confidence in her ability to meet
the baby's needs is easily undermined.
Almost all mothers can produce enough breastmilk
for one or even two babies, provided the baby
suckles effectively and breastfeeds as often
as needed.
Even when a mother perceives her milk to be
insufficient, the baby usually gets all the
milk it needs. The amount of milk the breasts
produce is determined by the amount that the
baby needs; it increases when the baby takes
more. Even in societies where the diet is poor,
most women produce breastmilk in amounts that
are adequate for good infant growth.
Sometimes,
however, a baby does not get enough breastmilk.
Usually this is because the baby is either not
suckling enough, or is not suckling effectively.
If
you believe that you do not have enough breastmilk.
How
to tackle the problem
1. First, decide whether the baby is getting
enough milk or not.
2. If the baby is not getting enough breastmilk,
decide why.
3. Decide how to help the mother and baby.
1. Is the baby getting enough breastmilk?
Reliable signs
There
are two signs that show reliably that a baby
is getting enough milk:
If the baby is below
its birth weight after two weeks or gains less
than 500 grams a month during the first six
months of life, the baby is probably not getting
enough milk.
Possible signs
That, indicate that the baby
is not getting enough milk:
-
not
satisfied after a breastfeed,
-
cries
often,
-
wants
frequent breastfeeds,
-
takes
very long breastfeeds,
-
refuses
to breastfeed,
-
has
hard, dry or green stools,
-
has
infrequent small stools.
Some
maternal complaints should also lead one to
suspect inadequate milk production:
-
Breasts
did not enlarge during pregnancy
-
Breastmilk
did not "come in" after delivery
-
No
milk comes out on expression
In
all such cases there is a need to check for
reliable signs to be certain whether or not
the baby is getting enough breastmilk.
2. If the Baby is not getting enough breastmilk,
decide why?
If a baby is not getting all the breastmilk
that it needs, try to decide why. Look for reasons.
Table
1 summarizes the reasons why a baby may not
get enough breastmilk. The reasons listed under
'Breastfeeding factors' and 'Mother's psychological
factors' are commoner. Psychological factors
and breastfeeding factors often go together;
for example, lack of confidence causes a mother
to give bottle-feeds, and giving bottle-feeds
further reduces her confidence.
Table 1
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REASONS
WHY A BABY MAY NOT GET ENOUGH BREASTMILK
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Breastfeeding
factors
- Delayed
start
- Infrequent
feeds
- No
right feeds
- Short
feeds
- Poor
attachment
- Bottles,
pacifiers
- Complementary
feeds
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Mother:
Psychological factors
- Lack
of confidence
- Worry,
stress
- Dislike
of breastfeeding
- Rejection
of baby
- Tiredness
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Mother:Physical
condition
- Contraceptive
pill, diuretics
- Pregnancy
- Severe
malnutrition
- Alcohol
- Smoking
- Retained
piece placenta (rare)
- Poor
breast development (very rare
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Baby's
condition
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These
are COMMON
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These
are NOT COMMON
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Breastfeeding
factors, how these affect breastmilk production
and flow.
-
A
delay in starting to breastfeed, it is difficult
to establish a good milk flow;
-
Infrequent
breastfeeding will produce less prolactin
and hence reduced milk production;
-
No
night feeding leads to less prolactin;
-
Less
suckling stimulus during shorter feedings
again leads to less prolactin release;
-
When
the baby is poorly attached, breastmilk
is not effectively transferred; it may SEEM
that milk is not enough.
-
Use
of bottles may lead to nipple confusion
and
-
Addition
of any other fluids/foods before six months
would actually lead to less prolactin and
hence reduced milk supply.
Psychological Factors
in the mother
Lack
of confidence in the mother that she is able
to produce enough or not, sets out a cycle of
poor confidence, less secretion of oxytocin,
apparent poor supply, worried mother, crying
baby and introduction of bottle/artificial feeding.
Stress, anxiety and worries also lead to poor
oxytocin reflex. Other problems lead to keeping
the baby away and poor attachment as well.
3. How to help the mother and the baby.
If the Baby is not getting enough breastmilk
Restore
your confidence. Improve baby's attachment at
the breast. The baby should be allowed to suckle
more frequently (at least eight times in 24
hours) and for as long as it wishes. The baby
should be allowed to suckle at both the breasts.
If
the baby is less than four months old and you
gives supplementary milk feeds, reduce them.
Use a cup (not a bottle) and this should be
offered after the baby has breastfed for as
long as it wants - not instead of a breastfeed.
The supplementary milk feeds should be reduced
daily by about 30-60 ml (about one-quarter of
a cup) each day. You reduce more if the baby
is satisfied with breastmilk and is gaining
weight adequately, or less if weight gain is
slow. Make sure that the supplementary milk
feed is hygienically prepared and not overdiluted.
Take to a supporting health worker and follow
weight gain.
If the baby is getting enough breastmilk
The
reason for the signs that make you doubt her
your supply should be through of important for
you to remain confident. You should be helped
to improve baby's attachment at the breast.
She should you know how to comfort a baby who
cries a lot - a commonly used method is to hold
the baby with firm pressure on the abdomen with
a gentle rhythmic movement. You should know
how breastfeeding works and role of oxytocin
reflex in getting milk down for the baby and
how confidence can help to come out of the problem.
The
advantages of exclusive breastfeeding and the
dangers of unnecessary supplements should also
be clearly be known to you.
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