Concerns of breastfeeding mothers

Special breastfeeding considerations cesarean birth
A cesarean birth does not affect milk supply or lactation, but a baby may be slower to latch on until the effects of anesthesia wear off. However, if breastfeeding at birth is important to you, you can nurse immediately after a cesarean, right on the delivery-table. If you feel too queasy to breastfeed right away, you can still cuddle your newborn and begin feeding a little later.

Following a cesarean, the most comfortable feeding position may be lying on your side, with a folded towel protecting the incision. Flex your knees, perhaps with a pillow between them, to prevent straining the incision. Later, a comfortable feeding position may be sitting with a pillow on your lap to protect the incision, and holding the baby in the "football hold."

Your premature baby
Breastfeeding is considered crucial to the premature baby -- some Canadian doctors say that breastmilk is like medicine to the preemie. As the mother of a premature baby, you face unique breastfeeding challenges. With the trauma of the early birth and the stress of seeing your tiny baby rigged to wires, you are understandably upset. If you are battling your own medical problems, your baby may have to be separated from you. Even if you can he with her, there may not be a private place in the NICU to pump your breastmilk or to feed her.

Initially, you may be asked to express your milk so it can be fed through a nasogastric tube that's inserted into the baby's nose and through to her stomach. As the baby gains strength, she will be encouraged to lick or nuzzle the breast. Before the baby can actually breast-feed, she must be able to coordinate sucking and swallowing.

Your twins and triplets
Mothers of twins, triplets, and even quadruplets have breastfed their babies. Mothers of multiples will have enough milk if they follow the basic rule: the more you nurse, the more milk you produce. In Canada, the mother of a single baby may feel she has to defend her decision to bottle-feed, while a mother of multiples may have to defend her decision to breast-feed.

Amid a frantic schedule of diapering, laundry, and perhaps caring for an older child, breastfeeding can offer a welcome chance to snuggle and rejoice in your double blessing. In the few weeks after birth, mothers of twins usually nurse one baby at a time. When the babies develop better head control and do not need as much positioning, it may be more convenient to nurse the babies together.

Parents of Multiple Births Association of Canada (POMBA) estimates that breastfeeding saves parents of twins three hundred hours a year in time that would have been spent sterilizing and preparing bottles, and over $1,200 a year in formula costs. For parent-to-parent support, contact POMBA.

Your allergic baby
Babies are rarely allergic to breastmilk, but infants can react to the allergens in their mother's diet that pass into her milk. It's likely that your baby has a food sensitivity if, 15 or 20 minutes after a feeding, he breaks out in hives, has acute diarrhea or projectile vomiting, has difficulty breathing or displays other allergic symptoms. If your baby experiences breathing difficulties or swelling of the lips or tongue, get immediate emergency medical help. For other allergic reactions, consult your doctor.

Commonly, an allergic baby is reacting to his mother's intake of cow's milk, other dairy products or eggs, and peanuts. Some doctors recommend that pregnant women and nursing mothers avoid or restrict peanut products. Other allergens that babies can be sensitive to include wheat, corn, citrus fruits, fish, seafood, and chocolate. Before eliminating foods, consult your doctor.

The Allergy/Asthma Information Association (AAIA) recommends breastfeeding a high-risk allergic baby (one whose parents have known food allergies) for a minimum of three months, and ideally for twelve months. The association maintains that if your baby is sensitive to the tiny amounts of food components in your milk, he will likely be unable to tolerate most formulas. Breastmilk may inoculate your baby against some allergens or bolster his immunity against others.

Your adopted baby
It is possible to breast-feed an adopted baby, whether or not you have ever been pregnant. It can be difficult and it is time-consuming; but for the family committed to sharing the intimacy of breastfeeding, at least a partial milk supply can be created. Adoptive mothers can begin establishing a milk supply by pumping for about four minutes on each breast, several times a day, for up to two months before the baby arrives. Once your baby is in your arms, encourage her to nurse as frequently as possible.

When it is necessary to supplement your baby's intake with formula, you may wish to use a nursing supplementer (a gadget taped to the breast) so the baby receives the extra nourishment while nursing. While you are reestablishing or inducing lactation, closely monitor your child's weight and growth with a supportive physician. To help guide your way, read Breastfeeding the Adopted Baby (Corona, 1994) by Debra Stewart Peterson, who breastfed all three of her adopted children.

Your baby with special needs
Babies with cleft lip/cleft palate, cystic fibrosis, celiac disease, neurological impairments, and other medical problems have successfully breastfed. In some situations, the added health benefits of breastmilk are especially significant. For example, the immune benefits of breastfeeding are considered important for a baby with Down syndrome because of his greater susceptibility to infections. La Leche League Canada, which offers parent-to-parent support, offers the following publications: "Breastfeeding the Chronically Ill Child" and "Nursing Your Baby with Cleft Lip or Cleft Palate."