Right from the Vedic times to the present day, literature is full of the bounties of breast . Whether it is a book on medicine, health, a poem or a story, breast-feeding is glorified and often associated with feelings of love, sacrifice and strength. Whenever the Rajput warriors went to battle, they used to swear by their mother's milk. If someone proved a coward in battle, he was said to have disgraced his mother's milk.

Stories apart, even medically, there is no doubt that breastmilk is the best of all. Nature intended human milk for humans. It enhances the emotional bond between the child and the mother and provides warmth, love and affection. It is more than just a food. The pleasure and satisfaction of breast feeding an best be described by the mother herself.

Human milk is the easiest to digest. The fats in it are better emulsified and because of a higher proportion of lactoalbumin (human milk protein) it is easier to digest than casein (protein in buffaloes or cow's milk). It is easily digestible even by premature babies. Iron in the human milk is better absorbed and utilized, preventing the occurrence of iron deficiency anemia. Human milk contains adequate quantities of Vitamin C, provided the mother takes sufficient quantities of Vitamin C in her diet (lemon, oranges, and mausami).

Breastfeeding enhances brain development. Breastfed babies have been shown to have a higher intelligence quotient (I.Q). Some studies have shown better mathematical abilities in breastfed babies as compared to those who were not breastfed. Since most of the brain develops during first two years it becomes essential that breastfeeding is used as a key feeding method.

Besides providing good nutrition, it gives protection to the child against many diseases. It contains various substances that have a protective value against disease. Infections like gastroenteritis, dysentery, vomiting is very common in developing countries like ours. Such infections are very low in breastfed infants as the milk passes directly from the mother to the infant and provides live immune cells. There are studies, which show a marked decrease in respiratory diseases and ear infections in breastfed babies. Infant formula in whatever form is of no use in these context.

There are similar studies which show an increase incidence of allergic disease like eczema and asthma in children who are fed on cow’s or buffalo’s milk. Don’t forget that most tinned are also prepared from cow’s or buffalo’s milk. Studies have even shown a reduced incidence of high blood pressure, heart disease and diabetes in breastfed babies.

There are many in our country that cannot afford to buy milk. For them breastfeeding is the most economical way to provide good nutrition to infants. Besides, one does not have to worry about cleaning the bottles and preparing the milk. The child gets the right type of milk at the right temperature. It also helps the mother's uterus or womb to return to its normal size. Some mothers feel that breastfeeding will keep them tied to the baby and home, which to some extent is quite true. On the other hand, traveling is much easier while breastfeeding; no bottles or tins of milk to carry. Even at night, it is the easiest way to feed the child. The traditional belief that breastfeeding prevents conception is well supported by medical research. However, it is not foolproof and some other method of contraception should be used in addition.

Many mothers feel that breastfeeding will spoil their figures. But the changes that occur in the body result from overeating, inactivity, or pregnancy itself. Whether or not one breastfeeds, the final changes in the breast tissue are the same. A good supporting brassier helps maintain the full contours of the breast. Breastfeding also helps the mother’s uterus or womb to return to its normal size.

Incidence of breast cancer is lower in mothers who breastfeed their babies. Women in a fishing village of Hong Kong used to feed their babies only from the right breast. There was a higher incidence of breast cancer on the left side amongst them.

Some mothers get upset every time the baby cries, and start the bottle in the belief that he is not getting enough. Some fear the child would reject the bottle later, and hinder their activities. Often, bottle-feeding is started in the hospital itself, when mother’s don't want to be disturbed at night or the nurses are too preoccupied. Some mothers are not willing to spend the time and effort for breastfeeding; so they turn to the bottle, which can be given by the maid or other members of the family. The commonest reason for starting a bottle and not giving exclusively is the advice by friends and family members. They are well meaning but they are the ones who did not give exclusive breastfeeding to their children. Ask a mother who has exclusively breastfed her child for “her opinion”. All these reasons for starting the bottle-feed are unfortunate, as they are not in the interest of the child.

Frequent colic, semi-liquid stools, vomiting, irritability, sleeplessness and many other trivial problems of the baby are wrongly attributed to breastfeeding. Next to lack of motivation; it is the introduction of a bottle in the early phases of breastfeeding, which is responsible for the failure of the . Bottle-feeding interferes with milk production in the breast, which is based on nature's principle of demand and supply.

There are very few reasons for not breastfeeding your child. Depression, emotional disorders, some serious illness and occasionally malnutrition are the reason. You must check with your pediatrician whether your illness or the drugs you are taking would harm your child if you continue to breastfeed him. If for some reason breast feeding has been stopped for a few days, with a little patience & perseverance it can be restarted as the milk supply will restart with sucking. When to start feeding? You can put him to the breast soon after the delivery within one hour, when you are still in the labour room. Baby is quite active for about 40-45 minutes soon after birth, later on he gets sleepy. Initial contact of ‘eye to eye’ and ‘skin to skin’ with the mother helps in binding and establishing successful breastfeeding. If you are embarrassed or exhausted then you can put him to breast in your room a little later. Don't feel discouraged if initially he is not interested in sucking. This is a good time to have a good look at your baby and enjoy your first meeting. If it is a Caesarian case, put the baby to the breast as soon as the mother recovers from the anesthetic condition.Ask for spinal anesthesia if possible. Since the wound makes the movements of the mother painful, she can be helped in changing the baby from one breast to the other. With encouragement from the family and the doctor most of the mothers succeed in breastfeeding their children. The initial flow of milk () lasts for about four or five days, after which the milk flows normally, looks slightly blue and is thinner than cow's milk. If the baby is not sucking at breast do not give honey, sugar, sweetened water, plain water , any other milk or herbal mixtures called 'ghutti'. Any food or liquid given before the first breastfeed is called pre lacteal feed. These prelactial feeds inhibit the process of lactation as the baby gets temporarily satisfied and his urge to breastfed is diminished. Moreover, there is a danger of infection due to the unhygienic way in which such mixtures are prepared and fed to the baby.

How to nurse your baby?

A hospital may not be a very congenial place to start breast-feeding, but you don’t have much choice. Visitors, nurses and doctors keep intruding into your privacy while you are trying hard to feed your child. Close the door from inside or put up a “Do not disturb” sign outside the door, when a mother is feeding her child. Keep the baby by your side and in constant touch. If you are lying down, roll to one side and lay the baby down by you so that he is on his side with his head facing your breast. Stroke the baby's cheek nearest to you. He will respond by turning inwards towards the breast. Later, the touch of your bare breast against his cheek would be enough to evoke this response. The suction by the baby's gum should be on the areola, the pigmented area around the nipple, and not on the nipple itself.This is called good attachment when the baby has a mouthful of breast inside. If the baby sucks at the nipple alone, it will make the nipple sore and cracked.

Later, when you return home, choose a quiet place or a room for breast-feeding, where you will not be disturbed. Ensure complete privacy. Sit in a comfortable position on the bed, sofa, or low chair, and if the seat is high, rest your feet on a stool. Hold the baby in your arm in such a way that his head is above the level of the stomach. If you hold the child flat, the air he takes with the milk will not be able to rise to the top of his stomach for easy burping. Don't hold the head forcibly against the breast, as he occasionally needs to turn the head away for a rest. Do not lean forward to put your nipple in the baby's mouth as this may give you a backache. While feeding in the reclining position, do not put the weight of your body on the elbow, as it will soon start hurting. Use pillows to support your arms and body. Keep the baby's outside hand free, as he will soon like to stroke breast as part of active feeding.

If you had a caesarian delivery, it is better to lie on one side with the elbow propped up and the baby beside you on the bed. You can use soft pillows to attain a comfortable position. If you prefer a sitting position, then the baby should be facing you with the legs tucked under your arm. This position can also be used for nursing twins simultaneously at the same time, one on each breast. However, you can feed them separately also. Frankly, it doesn't matter which position you choose, as long as it is comfortable for you and the baby. The first few days of breastfeeding are the most difficult. Not only do you have to train the child to suck properly, but also to persuade the breasts to yield enough milk with ease. Many mothers when they do not get support get di sheartened and give up breast-feeding in the first few weeks. If you are disheartened or for any other reason do not give up exclusive breastfeeding at this stage by introducing a bottle. Instead consult your pediatrician immediately and discuss your problem with him.

How often to feed your baby ?

Feed your baby whenever he cries or seems to want feeding; when your breasts are full; and more often if you feel like. Do not keep to any sort of schedule. This is called 'demand feeding'. However, some children may not demand early enough and your breasts may feel full or engorged. For the first few days it would be better not to wait for more than three hours before feeding the child. Longer gaps may reduce your milk supply, a there may not be enough stimulation by sucking. When the baby sucks at the breast two types of hormones are released. Prolactin, which makes the breast produce more milk. More the baby sucks more the milk is produced. If a mother has twins , breastmilk also increases due to increased sucking. Prolactin is produced more at night, hence night feeding is important. Many mothers mistakenly put the child on bottle at night so they can sleep well. This reduces the prolactin secretions and hence milk production. Prolactin also makes a mother feel relaxed. Please do breastfed your baby at night. The other hormone Oxytocin acts on muscles around the breast tissue causing ejection of milk. The oxytocin depends on your state of mind and confidence. Negative feeling like pain, anxiety and doubt about your ability to feed the child reduce the oxytocin release. The baby may have difficulty in “getting” the milk, though there is enough milk and the breasts feel full. Emotions of love & affection for the baby, and feeling of confidence about your ability to feed the baby helps oxytocin release.

Let your baby feed from one breast till he is satisfied or the breast has emptied, and then put him to the other breast. The latter part of breast milk has a higher fat content and hence more calories. Start the next feed with the breast you fed with last. The first is usually emptied better than the second and it is important for both breasts to take turns at being completely emptied.

Many babies show they have had enough simply by falling asleep or by unclenching their fists, a smile or obvious refusal to feed further. Do not force him to feed against his will. Accept your baby's judgment of what he wants. If your breasts feel soft, he probably has had all that there is.

• Breast milk is the best • You can breastfeed soon after the birth Is your baby getting enough• Never milk? offer a bottle. • Give demand feeds. Many mothers, who start a top feed with the bottle, do so in the mistaken belief that their child is not getting enough of milk. Since breast milk cannot be measured, one has to assess this indirectly. If your child does not cry for two to three hours after a feed and is gaining normal weight, there is nothing to worry about. Babies fed on demand have a more rapid weight gain than babies on a three or four hourly schedule. Most babies regain their birth weight in about ten days. Some may take much longer. Thereafter, a baby gains approximately 25 gms a day for the next ten to twelve weeks. If a baby who is exclusively breastfed passes urine more than 6 times a day, he is getting enough milk. A contented baby who sleeps a good deal during the day and night, has normal stools and appears to be growing, is obviously getting enough milk from the breast. If there is any doubt as to whether your baby is thriving, increase your milk supply by feeding him more often.

Problem of insufficient breast milk

In my practice I have seldom come across a mother from the poorer sections of society who could not breastfeed a child. It is usually the affluent mothers who find it difficult to breastfeed. A poor mother knows she cannot afford to buy milk and that the child would starve if it is not breastfed. She has no alternative so she almost always succeeds, whereas the well-to-do mother doesn't have an economic compulsion, and hence her motivation is not so strong.

A strong desire to breastfeed is absolutely necessary for its success. Don't get discouraged if you are not able to satisfy your child in the beginning. It may take from a few days to two or three weeks to ensure a regular and sufficient supply of breast milk. The mother may have had a caesarian section, or fever or some illness or just fatigue, which delays the supply of milk.

If you feel breastmilk is not enough

Do not start on top feed Consult you doctor first

Prevention is always better than cure. Perhaps the most common reason for the feeling of lactational failure or insufficient breast milk is the early introduction of the bottle. In many hospitals or homes, nurses or relatives may give bottle feeds at night so as not to disturb the mother. This should be discouraged.More the sucking ,more milk is produced. Complete emptying of the breast stimulates it to produce more milk. Feed the baby at least once or twice during the night, especially in the initial stages. Avoid separation of the baby and the mother even for short periods. Feed the baby frequently on demand, and do not stick to any predetermined schedules of 3-4 hourly feedings. Do not stop breastfeeding during minor ailments. If you have to discontinue breastfeeding for a few days due to unavoidable circumstances, do not suppress the milk with medication. Instead express the milk frequently, so as to prevent breast engorgement. Do not use oral contraceptives in the first few months, as they reduce the milk supply.Early start of breast feeding and good attachment ensures effective milk transfer from the breast to the baby and this prevent many breastfeeding problems like sore nipples,breast engorgement and infection.Retracted nipples require help during pregnancy from a trained healthworker. Taking nutritious diet consisting of milk, milk products, water, fruit, vegetables, cereals, meat and eggs ensures a good milk supply. Taking excessive amount of milk in your diet does not mean increased supply of your breast milk.

Statements like ‘child is looking very weak’ can instill doubts in your mind about your capacity to breastfeed the child. Ignore these statements. Have confidence in your ability. If you are worried, get your child weighed regularly and if he is growing well ,that should reassure you.

Trials on the use of drugs to increase the milk supply are limited. Consult your doctor about them. Simple, harmless dietary home remedies may be tried; they vary in different communities and may have some benefits.

If you have to supplement your feed, then give small amounts of cow’s, buffalo's or tinned milk with a spoon. Try to avoid the use of bottle. Do not satisfy him fully; otherwise he would not be willing to suck the breasts efficiently. Many mothers have a good start initially but get less and less milk after two or three months. They are the ones who are not completely convinced about the usefulness of breastfeeding. They may be working, ill, or have some family problems bothering them. They use the slightest pretext to convince themselves that they don't have enough milk and that the child's health will suffer if not given additional milk from the bottle. They need reassurance.

Can you give him one top feed? Many mothers like to give one top feed with the bottle, usually the night feed. The mother feels that the child should get used to one bottle-feed so that if she is away for a few hours the child can be fed from the bottle in her absence, otherwise it is binding for her to return home to feed the child or she has to take the child with her. Moreover, the top feed (cow's, buffalo's or tin milk) satiates the child's appetite for longer hours, so they can sleep through the night without disturbing the mother. The trouble is that the moment you start giving one top feed to the baby, pretty soon you have to start the second, then the third and so on. With the result that within a few weeks the child is totally on bottle-feeds, as the breasts have stopped producing enough milk for the baby.

A rubber nipple (teat) of the bottle is much easier to suck from. Once the baby gets used to it he may not be willing to put in the necessary effort to suck from the breast. It is the same story of not wanting to walk a short distance, when you have a car. As I have mentioned earlier, sucking stimulates the production of milk. If the baby does not suck often and enough, the breast milk starts decreasing. Insufficient breast milk leads to more top feeds to satisfy the baby. This vicious circle continues till there is no breastfeeding at all. Moreover, even one bottle a day is enough to cause allergy problems in a child with a strong family history of asthma or eczema.

Now you can judge for yourself, whether you still want to give one top feed to your baby. The fussy feeder Some babies are very fussy while feeding, while others tend doze off after a few minutes of feeding. The poor mother is not sure whether or not he has had his fill. But so sooner does she put him in the cot then he is up again crying for the feed.

It may be that while feeding he is not in a comfortable position, or his nose is blocked due to secretions or being pushed against the breast. In a bottle-feed baby, the hole in the nipple may be so small that the child tires easily. Often there may be no obvious reason. The child's nervous system may not have matured enough to realize when his stomach is full. Whatever the reason, it makes the mother tense which, in turn, makes feeding even more difficult. The mother gets frustrated having to feed every half an hour and the child remains unsatisfied and irritable. In such a situation, it is important for the mother to remain calm and comforting to the child. Shift him from one breast to the other. If he still goes to sleep, put him back in the cot very gently. If he cries soon after try to comfort him, may be you can give him few spoons of water to pacify him. If this doesn't work, then try to feed him again. Sometimes nothing works and you have just to Use your patience until the child grows a little older; after a few weeks most babies settle down to a routine.

What not to eat while breastfeeding?

In India, we are very fussy about the diet of a mother who is breast-feeding. It is true that there are some foods, which can upset your baby. Unless you know definitely which particular food is upsetting the baby, you should not start eliminating it from your diet, for mothers are unnecessarily prone to eliminating too many foods from their diet. If you are not sure, consult your doctor.

You can eat everything But in moderation

Make sure your diet is balanced. milk and eat plenty of fruits and vegetables. Fresh vegetables and fruits are a good source of Vitamin C. Non-vegetarians can eat eggs and meat. Take plenty of water and avoid eating excess spices, coffee, tea, chocolates and food cooked in excessive oil. Basically a mother can eat everything, but in moderation.

Remember that many medicines find their way into your milk and then to the baby, so check with your doctor about patent medicines. Many mothers take laxatives for their constipation. These laxative pass via the breast milk to the baby and cause loose stools. Nicotine from tobacco smoking or chewing pan masala with tobacco can reduce the milk supply of the mother as well as harm the child. Smoking can be passive also, that is when others in the room are smoking. Other drugs which are passed through breast milk are caffeine from coffee, tea and colas, alcohol, barbiturates, iodides, bromides, aspirin, sulfonamides, most antibiotics.

Caffeine is a stimulant and may keep the child awake and jittery. Oral pills used as contraceptives may interfere with milk secretion. It is better to use some other form of contraceptive for the first few months after delivery. If you have a minor ailment like a cold, cough, mild fever or gripes in the stomach you can still feed the child. If running high fever or taking drugs, consult your doctor regarding feeding.

Care of the nipple Wash your nipples with water but not soap during your bath. Leave them exposed to air for a while whenever you can. There is no need to put anything on your nipples. There are natural secretions to keep your nipple protected. Cold or medicated creams are generally unnecessary. However, you can use them on your doctor's advice.

Retracted nipples If your nipples are flat or retracted (drawn back into the breast tissue) the baby may have difficulty in sucking. If this happens, try to squeeze out some of the milk by hand, for this will soften the areola - the dark pigmented area around the nipples. Press the areola with the thumb and the index finger before putting the nipple into the baby's mouth. Sore nipples A mother's nipple may become sore at any time during lactation. It is usually due to a faulty sucking technique or letting the infant suck for too long in a bad position.This is a preventable problem. Nipples are well supplied with pain fibers. The pain is worst at the start of sucking but begins to get less as nursing proceeds. Pain can inhibit the production of milk. Use of “Nipple Shield” is not of much use and can be counter productive at times. The best thing to do is to prevent a sore nipple by taking proper care of the nipple and avoiding faulty techniques. The baby should feed on with good attachment which means wide open mouth,much of the areola should go completely inside his mouth and not sucking on the nipple only.Chin of the baby actually touches the breast.The mother needs support and guidance to attach well. Correction of position by a skilled worker is sometimes required to solve this problem. In between expressed breast milk can be given to the baby and this can be applied over damaged areas.No should be applied.Frequent, short nursings promote speedy healing. Withholding the feed may actually worsen the situation by causing breast engorgement. However, if she can't feed, express the milk as explained below to avoid engorgement of the breast. The baby can be feed from the other breast for a day or two.

Engorged breasts If there is too much milk in your breasts, causing engorgement and pain, express the milk manually in the following manner. Wash your hands well and place the thumb just above the areola and the forefinger just below it. Press the hand inwards until the ribs can be felt. At the same time raise the whole breast with the rest of the hand. Open and close the thumb and the forefinger in a scissor-like motion.

Breast abscess This is a complication of an untreated cracked nipple. A part of the inflamed breast will be red in colour and feel sore and warm. Consult your doctor at the first sign. He will give your antibiotics. If the infection is mild, the baby can continue to feed at the breast. But if that is not possible, continue feeding from the healthy breast only till the other one heals.

When to wean from the breast? There is no hard and fast rule of up to what age the child can be breastfed. As long as the baby is stimulating your breasts, they will produce milk. In a well-nourished mother, it can continue for a period of one to three years. In villages, it is a common practice, but mainly because of economic reasons. As long as the child is gaining in height and weight and both the mother and the child are happy, exclusive breastfeeding should continue till six months of age. Solids can be added to the diet after 6 months of age, but breastfeeding can continue for as long as you and your baby want it to.

You can wean the child from the breast to katori and spoon, cup, or a glass. A child can be ready to drink from the cup after six months. You can also use a sipper or a “paladai” used commonly in South of India. Paladai is also used in hospital nurseries to feed premature or very small children who cannot suck at the breast. Most breastfed babies can make a gradual change from the breast to a cup or glass without ever having a bottle. The katori, paladai , sipper is also hygienically better as it is much easier to keep them clean compared to bottles and nipples. When you first offer your baby a cup, don't expect instant success. Here also, patience is needed. It is not necessary to wean your child because of a minor illness. Try to wean gradually. Initially, stop one feed. Then after sometime you can omit the second. If your breasts feel full and painful let the baby nurse for thirty to sixty seconds to relieve the pressure within the breasts. If you have to wean suddenly (and there must be a good reason for that), consult your doctor. He might prescribe some medicine to reduce the production of milk. In the absence of medical help, limit your fluid intake, apply a tight binder and put ice packs on the breasts. Whenever the breasts become full, relieve the pressure as described earlier, by manual expression. You can find information on successful breastfeeding and expression on the website of Breastfeeding Promotion network of India (BPNI)

www.bpni.org

Which milk to give? We make a lot of fuss about the type of milk and its concentration, and many mothers keep changing the type of milk on the advice of their friends and neighbors as they attribute all the baby's ailments to the type of milk they are using. Most types of milk, except buffalo's contain approximately 20 calories per ounce (60- cal/100 ml). You should not add water to toned milk, cow's milk or buffalo's milk, as this will reduce the strength of the milk. If you mix one cup of cow's milk with one cup of water and give the baby two cups of the mixture, he has in fact had only one cup of milk. If the quantity of milk is substandard or diluted, the baby will not gain in weight and will be irritable and unhappy. As buffalo's milk has a lot of fat, remove the cream after the milk is boiled and cooled. You need not add only sugar to it. Can milk be stored? Can tore left-over milk from a feed in the refrigerator to be used in the next feed? If only a little milk is left, throw it away. If the baby has left most of the feed, you may store it in the refrigerator and re-warm it.

Burping the baby Most breastfed babies swallow very little air while feeding and do not need burping. Some babies who have a tendency to vomit may need burping. After the feed, put the baby on your shoulder and rub his back gently to burp him. Some babies are very obstinate and refuse to oblige. This should not worry you. You can turn the child on his right side after feeding so that air can come out easily. It is not necessary that all children should burp during feeding. Many do not do so and yet have no complaint. One young mother had a lot of difficulty during the feed. She insisted that the child should burp and he would not oblige. The tussle went on, leaving both the mother and the child frustrated and exhausted. It was explained to her that she should quit her insistence on burping. Thereafter, feeding the child ceased to be a problem. Almost all babies occasionally bring up some milk, with or without a burp. Usually, the quantity is small but it may look a lot to the young mother, as it is mixed with saliva and spreads all over her shoulder. If you are in doubt spill a tablespoon of milk on your baby's shoulders and compare it. If it really is a lot, there may be a reason for it. You may have fed him in too flat a position, preventing the air from rising above the milk in the stomach. Someone may have bounced and played with him during the feed, mixing air with milk. He may have cried a lot before or during the feed: children swallow a lot of air while crying.

Should you give water to the baby?

Exclusively breastfed babies do not need water. There is enough water in the milk. When the newborn infant is on top feeds or in hot weather; during the failure of electricity when fans and other cooling devices are not working, one may give boiled and cooled water with a spoon. Do not sweeten the water, as it would satiate the child's appetite and reduce his desire to suck at the breasts. This should be done only on the advice of your doctor. Exclusively breastfed babies do not need water