Concerns of breastfeeding mothers

By: Christine Langlois

Author: Canadian Living


Concerns of breastfeeding mothers

By: Christine Langlois

What to eat
Fatigue can take away your appetite. Or you may be hungrier than ever before. To feed the nursing mother is to feed the baby. Small amounts of everything you eat end up in your milk. As you munch your way through the lasagna your neighbour made, and the strawberry cheesecake your mom baked, your milk picks up the odours and flavours of the foods. This ever-changing taste spectrum of breastmilk will help your baby accept new foods when he's older.

There are no foods that you must eat while you're nursing, nor is it necessary to eat more while you're nursing. But it's important to eat well and nutritiously. To be sure you meet your nutritional requirements follow Canada's Food Guide to Healthy Eating. Every day, have 5 to 12 servings of grain products; 5 to 10 servings of vegetables and fruit; 3 to 4 servings of milk products; and 2 to 3 servings of meat or alternatives such as legumes. It is not necessary to avoid specific foods or spices while breastfeeding, unless your baby shows evidence of food sensitivities or allergies.

What to drink
You may also be thirstier than ever before. A nursing mother produces up to 1L (35 oz.) of breastmilk a day. To combat thirst, some nursing women follow the rule: Whenever you pass a tap, take a drink. Other mothers sip a tall glass of water every time they nurse. If your urine is dark or cloudy, it probably means you are not drinking enough. It means it's time for a glass of water, milk, juice, a hot bowl of soup, or a pot of a weak herbal tea (avoid teas with high-alkaloid herbs). Limit coffee, tea, and colas. Not only can they dehydrate you, the caffeine in them may make your baby irritable.

Alcohol can pass into breastmilk. Although the occasional drink is considered compatible with breastfeeding, heavy consumption of alcohol interferes with your milk supply and is harmful to your baby. To minimize the amount of alcohol your baby receives, avoid alcohol for two hours before breastfeeding.

Breastfeeding and your waistline
Breastfeeding naturally mobilizes fat stores, making it easier to shed the pounds you gained during pregnancy. But don't diet when you're nursing. Since we all store PCBs in our fat and crash diets mobilize the PCBs, a nursing mother may pass PCB toxins to her baby through her breastmilk. However, tiny amounts of pesticides and pollutants are found in all foods, including formula; so breastmilk is still considered the safest food for babies. Be aware that a diet with fewer than 1,500 calories a day will reduce your milk supply and contribute to your fatigue.

You may find that fatigue interferes with your let-down and contributes to an inadequate milk supply. Check your expectations. When you're nursing a baby around the clock, don't expect to be able to do everything you did before the baby arrived. There is no pat solution to new-mother fatigue, especially if you don't have family help close by. But if a friend offers to take your older kids to the zoo for the day, say yes. If there's a choice between vacuuming and taking a nap, crawl between the sheets.

If you smoke, you may feel more motivated to cut down, if not quit, since nicotine passes into breastmilk. Smoking more than ten cigarettes a day has been associated with decreased milk production and decreased ejection as well as with infant irritability and poor weight gain. heavy smoking may give your baby nausea or diarrhea or it may cause her to vomit. Breastmilk is still the best choice for your baby, so try to reduce the harmful effects on your baby by smoking only after Breastfeeding, not before. To reduce the risks of second-hand smoke, don't smoke or allow others to smoke near your baby, since it increases the risk of SIDS.

Breastfeeding may offer some protection against pregnancy if the mother is exclusively breastfeeding the baby day and night. However, it is not reliable as a method of birth control. New mothers start ovulating as early as eight weeks after the baby's birth, so if they don't wish to conceive, they should use a contraceptive method. An IUD, diaphragm, or condom with spermicidal foam are the preferred choices. The progesterone mini-pill, implants, and injections increase milk secretions. For some mothers, the estrogen-progesterone pill occasionally reduces their milk production.

Should breastfeeding feel this good?
Here's the best-kept secret about breastfeeding. Women's hormones for lactation and the sexual cycle are similar. Nursing can be sensually stimulating, if not sexually arousing. Health Canada has given its blessing on these feelings by stating that they are "normal."

If you have a cold
Absolutely continue to breastfeed. Although you are exposing your baby to your germs, you're also protecting him with your antibodies.

Vegetarians and vitamin supplements
If you are a lacto-ovo-vegetarian who enjoys both dairy and egg foods, breastfeeding will not pose dietary concerns beyond those of all nursing mothers. If you are a vegan who eats no animal products then vitamin B12 supplements for both you and your baby are crucial. Health Canada recommends that nursing women who are vegans take a 1.5 mcg vitamin B12 supplement daily. Some babies of vegan mothers who haven't taken a vitamin B12 supplement during pregnancy or while nursing, and who haven't given their baby a B12 supplement have suffered major neurological problems before their first birthday.

The Canadian Paediatric Society and Health Canada recommend that breastfed babies of vegan mothers receive a daily B12 supplement. For infants, the Canadian Pharmaceutical Association recommends 0.3 mcg daily, beginning in the second week of life and continuing until at least the second birthday. This B12 supplement is in addition to the vitamin supplements recommended for all breastfed babies.

Chances are, any drug you take will pass into your milk. Fortunately, the average residue in breastmilk is less than I per cent of the mother's dose. There are few medications that cause a mother to give up breastfeeding, but if you're unsure whether to take a drug while nursing, discuss your concerns with your doctor, your pharmacist or a drug information centre. One centre devoted to pregnant and breastfeeding mothers and health-care providers is the MotherRisk Clinic at The Hospital for Sick Children in Toronto (416) 813-6780.

Over-the-counter drugs
Most over-the-counter drugs are safe when used according to manufacturer's directions. However, it's best to check with your physician or pharmacist before self-medicating. For pain relief, acetaminophen rather than acetylsalicylic acid (aspirin) is recommended. For pain accompanied by inflammation, ibuprofen can be taken.

Prescription drugs
When you take prescription drugs, minimize your child's exposure to them by taking the medication after she has breastfed, or just before she's ready to sleep. You should not breast-feed if you are taking any of the following prescription drugs:

• bromocriptine
• cyclophosphamide
• cyclosporine
• doxorubicin
• ergotamine
• lithium
• methotrexate
• phencyclidine

Non-prescription drugs
Because there have been no studies on the effects of illegal drugs or so-called recreational drugs like marijuana on breastmilk, the MotherRisk program at The Hospital for Sick Children recommends that any women using drugs not breast-feed.

Herbal remedies
Many herbal remedies contain pharmacologically active ingredients. In fact, many prescription drugs come from herbs. If you're taking herbal remedies, stay within recommended dosages and monitor your baby for side-effects. Some herbal teas (those not containing alkaloid herbs) are considered safe while you're breastfeeding. But, as with any food or drink, avoid excessive intake. If the tea contains sage, for example, a large amount can reduce your supply of milk.

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."

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Concerns of breastfeeding mothers