Introduction

Breast feeding is beneficial to the mother in that it reduces the chance of hemorrhaging from the placental site, gives the mother an opportunity to rest, and encourages the uterus to contract, returning it to its pre-pregnant size. In addition many investigations have now shown that breast-feeding delays the return of menstruation and provides some degree of protection against a subsequent pregnancy. Less than 5-10% of women conceive during this period. However once menstruation returns, lactation no longer provides protection against conception.

It's supposed to be the most natural thing in the world. But many people -- new mothers, meddling mothers-in-laws, and even many doctors -- have misconceptions about breast-feeding. A decade ago, 60 percent of new mothers breast-fed. Today, that number is down to 50 percent, with fewer than one in five mothers breast-feeding after the infant is five months old.

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Between the third and sixth day after birth, colostrum changes to a "transitional" form of breast milk. During this time, the amount of protein and immune factors in the milk gradually decrease while fat, lactose, and calories in the milk increase. By the tenth day after birth, the mother produces mature breast milk.

While breast milk from most women has the same nutrients, there are small differences, based on what a woman eats and how her body produces breast milk. If the mother eats a poor diet, this can decrease both the amount of milk produced and the nutrients found in the milk. Milk content can also change from one time of the day to another, and from the beginning of a breast feeding session to the end of a breast feeding session. The nutrients in breast milk also change from the early months of infancy to the later months of infancy. These changes match the changing nutritional needs of the growing infant. For instance, it contains more zinc in the first few weeks of life than later on, since newborns have higher zinc needs than older infants.

The fat in human breast milk is also easily absorbed by an infant's digestive system. An enzyme called lipoprotein lipase helps an infant absorb the fat in breast milk. A mother's breast milk contains essential fats and cholesterol that a growing infant needs to make tissues of the nervous system. The amount of fat in breast milk rises significantly at the end of a breast-feeding session. This may be nature's way of making an infant feel full and stop feeding.

Breast milk contains large amounts of lactose, which is a carbohydrate. Lactose is used in tissues of the brain and spinal cord, and it provides the infant with energy. Bacteria in the infant's intestines feed on lactose and produce B vitamins. Lactose may also help the infant absorb essential nutrients such as calcium, phosphorus and magnesium.

Human breast milk contains small amount of iron, but the iron in breast milk is easily absorbed. Fifty percent of the iron in human breast milk is absorbed compared with only 4 to 10 percent of the iron in cow's milk or commercial infant formulas. Breast milk contains all the vitamins an infant needs for good health. The actual amount of each vitamin can vary, depending on a woman's diet and genetic makeup.

Breast-fed babies are less likely than bottle-fed infants to suffer from gastrointestinal problems and ear infections. Infants nourished by breast also appear better protected against wheezing during the first few months of life. In addition, evidence suggests that babies given breast milk have a lower chance of developing several chronic diseases of childhood. Breast-fed babies may also have enhanced intellectual, visual, and oral development.

It's not that commercial infant formula isn't reliable for adequate growth and development. But, says Dr. Ronald Kleinman, M.D., former head of the Committee on Nutrition at the American Academy of Pediatrics, "as much as technology has been able to approximate the benefits of breast milk in formula, there remain differences between the two whose significance is not fully understood."

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• Drink adequate amounts of fluids and get as much rest as possible. Both are essential for successful lactation.
• When feeding, make sure the baby takes the entire nipple and most of the areola (the dark circle around the nipple) into his mouth. That allows good pumping action and stimulates the release of a sufficient supply of milk during feeding.
• Generally, use both breasts during a feeding and let the baby suckle as much -- or as little -- as he wants. An infant can suck 80 to 90 percent of the milk from a breast within four minutes. But there's nothing wrong with his sucking longer; it may help to stimulate lactation.
• If your nipples become cracked or bleed a little, continue breast-feeding if you wish. The amount of blood that gets into the milk is insignificant. Pain can be kept to a minimum by feeding from the not-as-sore breast first. The baby will tend to suckle harder on the first nipple offered. Contact your health care provider, however, if the cracking or bleeding continues or worsens
• You can breast-feed even if you have a cold. You're always in close proximity to your baby, so if the cold is contagious it will be transmitted whether you breast-feed or not. ·
• Don't fuss and fidget too much while nursing. Excess movement can cause a still-hungry baby to stop feeding.
• Forget about sticking to feeding schedules. Unlike adults, infants may not always take in the exact amount at the scheduled time. Furthermore, don't worry that you will spoil your baby by feeding him when he cries for nourishment -- even if he has just fed a short while ago. Unlike toddlers, infants don't know about power struggles. They just know they're hungry, so feed on demand.

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Successful breast-feeding depends in large part on the mother's confidence in her ability to breast-feed. This involves having the proper environment to nurse and being prepared emotionally and physically for the experience. If the mother is pain free, relaxed and supported by family and others, success is more likely. Proper nipple care, positioning and nursing frequency may help to prevent some common breast-feeding problems.

Symptoms of problems can include

• breast engorgement
• inadequate milk supply
• plugged milk duct
• nipple soreness
• breast infection
• thrush and painful let-down reflex
• noninfectious inflammation ENG

• Give your baby short, frequent feedings. A feeding schedule of every one and a half, to two hours day and night should be maintained while engorgement lasts.
• Express milk between feedings to relieve pressure.
• Apply moist heat for thirty minutes proceeding each feeding, and massage the breast during feedings to help get the milk flowing.
  
• Do not use nipple shields, as they can confuse the baby's sucking pattern, damage nipples, reduce stimulation of the breast, and decrease the milk supply.
• To prevent engorgement, feed your baby on demand and without delay, and allowing unrestricted suckling time.
• Do not skip or delay feedings during the day or night.
• Do not give your baby any formula or sugar water, and allow the baby to empty each breast completely at each feeding. This should take about seven minutes on each side.

• Drink plenty of fluids.
• Get plenty of rest.
• Apply heat with a hot water bottle or heating pad.
• Do not stop nursing your baby if you do, the ducts will remain full, and overfilled ducts can worsen the problem.

• Check the nipple very carefully for any tiny dots of dried milk, and remove them by gentle cleansing. Together with frequent nursing on the affected breast, this should allow the duct to clear itself within twenty-four hours.
• Massage the breast with firm pressure, from the chest wall toward the nipple, to stimulate milk flow.
• Alter the position of the baby on the nipple so all the ducts are drained. Make sure you offer the affected breast first, when the baby's sucking is strongest.

• Nurse on the least sore side first. However if both breast are sore, hand express (massage the breast) until letdown occurs and milk is readily available to the baby.
• Make sure that the baby's jaws exert pressure on the least tender spots. Do not pull away when the baby is about to begin feeding. Learn to relax.
• Use dry heat such as a low-wattage electric bulb placed twelve to eighteen inches from the breast for ten to fifteen minutes following each feeding.
• To prevent sore nipples feed your baby frequently. This helps avoid a baby who is overly hungry bite down roughly upon the nipple. Change nursing positions often to rotate the pressure of the baby's mouth on the breast, and learn to break suction correctly. Between feeding, keep the nipples dry. Expose them to sunlight and air. Do not wash them with soap, alcohol or petroleum-based products, which can wash away their natural protection.
• If the pain is severe and persists despite these measures, it may be a sign of a fungal infection. Contact your doctor.