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Breastfeeding; A Feminist Issue Filled With Fraught

Breast feeding

Mothers who want to breast feed should make the right preparations, and know the best ways to achieve success, in order to give their babies this beneficial start in life.

l have just had a baby and have heard stories that it is impossible to get pregnant again while breast feeding. Is this true?
Has anyone ever tried this 'method? If so, you can see the result for yourself. It is a fact that during breast feeding your hormone balance is altered in such a way that you usually have no periods and the release of eggs from your ovaries tends to be suppressed. But this is by no means a reliable contraceptive and it is wise to take precautions against getting pregnant again while breast feeding—unless, of course, you want another baby in a year.

l thought that breast milk was the perfect food, but my health visitor has suggested that I give my baby vitamin supplements. Why?
Vitamin supplements are a good idea because both breast milk and cow's milk are, in fact, rather deficient in vitamin D, which is necessary for proper bone development. But always consult you r doctor or health visitor about the amount you give.

Will breast feeding make my breasts sag afterwards?

As long as you wear a good supporting bra during pregnancy and feeding, there is no reason why your breasts should sag. Many women maintain that breast feeding improves figures.

When I wanted to breast feed my baby recently, the nurses in the hospital where I had him were decidedly unhelpful. In fact, I was given an injection to stop the milk before I had a chance to talk it over with them properly. Why should this happen when breast feeding is such a good thing?

Breast feeding has always been subject to fashion and you may have been unlucky enough to go somewhere where those in charge held other views—or they may have simply been too short-staffed to be able to give you the extra help you needed to get feeding established properly. It is a point to clear up at the antenatal stage.

There are two basic positions for breast feeding, either from a sitting position (left) or lying down (above). But no matter which is used, the important thing is that mother and child are both comfortable.

A personal choice

While any woman who has successfully breast fed her baby would urge other mothers to do the same, there can be no hard and fast rule, for there is no advan­tage to either you or the baby if the experience is not an enjoyable one, or if the baby fails to thrive.

Breast feeding is undoubtedly the best start in life, both physically and psycho­logically, but these assets will quickly become tarnished if feeding the baby

becomes a painful chore, rather than a chance for mutual comfort and reas­surance. And even with the increasingly relaxed attitude of society towards bare breasts, even the most determined mother may find herself in many an embarrassing situation. So the choice must be a personal one which is more likely to come down in favour of breast feeding if you are well prepared for the experience, aware of some of the prob­lems that may arise and given the support of your doctor, midwife, health visitor, family and friends.

Preparation

Before your baby is born, it is a good idea to see a mother actually breast feeding— a close friend or relative perhaps. As far as physical preparation is concerned—if the nipples are not very prominent it may be a good idea to massage them every day between finger and thumb in the last month of pregnancy, to help them to 'stand out' more, and a nightly appli­cation of lanolin cream will help to keep them supple.

If you want to breast feed you will also need several well-supporting maternity bras which open at the front, so allowing each breast to be separately exposed. Cotton is the best fabric, as it is more comfortable and absorbent than syn­thetic fibres. Nightclothes and shirts or dresses that fasten down the front are also more convenient and will make it easier for both you and the baby.

Size is not important

During pregnancy the breasts become physically prepared for milk production, but no milk is actually made until after the baby is born. The milk-making poten­tial of the breasts depends not on their actual size but on the number of glands they contain, so if you have small breasts there is no need to worry that you will not be able to make enough milk.

Immediately after birth, the only fluid made by the breasts is colostrum, a clear liquid, rich in proteins and in antibodies, which gives the baby all it needs in the first few days and also provides inval­uable protection against disease. Milk only comes into the breasts between two and five days after birth and to begin with is mixed with colostrum, giving it a yellowish colour; this soon turns to a pale blue as the production of colostrum stops. Compared with colostrum, milk is much higher in fats and sugars and lower in proteins, but is still a complete food.

The release or 'let down' of milk in the first week of birth, also known as the 'draught reflex' depends on the sucking action of the baby. Milk is secreted into the sacs, or alveoli, in the breast glands before the baby is put on to the breast. As the baby suckles, nerve messages are carried from the nipples to the hypo­thalamus in the brain, which in turn tells the pituitary gland to release the hor­mone, oxytocin, which travels in the bloodstream to the alveoli. Stimulated by oxytocin, the alveoli squeeze milk into the ducts within the breast, from where it travels to reservoirs just behind the nipple to be sucked out by the baby.

Getting started

Mothers who are keen to breast feed usually want to put the baby to the breast as soon as they can and this may be possible immediately after the baby is delivered. If not, this will be the first thing to do after a good long sleep.

If you have just become a mother for the first time you are bound to be appre­hensive, but you can relax in the know­ledge that breast feeding is a most rewarding—if demanding—experience for which your body is perfectly adapted. The first few days before true milk comes in are valuable, not just because this is the time of mutual 'getting to know one another'. It is also when you find the most comfortable position for feeding which may be sitting or lying down. A mother of twins can experiment to discover the best way of putting two babies to the breast at the same time, but this need not be a worry, because both babies may not want feeding at the same time.

Although babies will automatically suck at a nipple, they need your guidance to become competent feeders. Babies are born with a 'rooting reflex': as soon as the nipple touches the baby's cheek it will instinctively turn to it and 'root around' with the mouth until it is found. Help the baby by holding the nipple between the base of the index and second fingers so that it gets the whole nipple, with its dark surround or areola, into its mouth. This will make sucking more efficient by helping to create a tight seal between the baby's lips and the breast and to prevent the nipple becoming sore. As the baby sucks, make sure its breathing is not blocked by pressing down with the index finger so that the soft breast tissue is drawn away from its nostrils.

Most mothers find breast feeding dif­ficult in the first few days after milk has come into their breasts. The initial let down of milk may make the breasts so full that the baby cannot grasp the nipple properly, or the milk may come out so fast that the baby chokes. It may seem all too easy to give up at this early stage—es­pecially if, as often happens, the baby wants to feed every two hours day and night—but these reactions are quite normal. Ask for advice from all around you and try not to feel too anxious.

Relaxation now, and throughout feed­ing, is very important, not just because breast feeding should be a pleasure, but because anxiety can inhibit the flow of oxytocin from the brain and slow down the supply of milk. The relaxation routine that you learnt to cope with labour can be a big help at this time too. Settle down for each feed in peace and quiet.

Problems with breast feeding

One of the chief worries of nursing mothers is whether the baby is getting enough milk. Unlike bottle-fed babies, breast-fed ones regulate their own intake. The more they suck, the more milk is produced. To begin with you should allow the baby to suck for two minutes on each side. Increase this time by a minute a day. The maximum length of time is deter­mined by the baby's needs and its speed and strength of sucking.

If the nipples are sore it may be better to give fewer smaller feeds because the baby gets most milk in the first minute of sucking. Remember to alternate sides so that the baby does not take the first draught from the same breast twice run­ning. Otherwise, one breast will become over-full, and possibly painful.

Most new born babies need to feed every three to four hours, but unless the baby is very sleepy (in which case you should seek medical advice) there is no need to wake a sleeping baby to feed it.

In the early days of breast feeding you can help to stimulate your milk supply by expressing the remaining milk from the breast after a feed with a special pump, or by squeezing milk out with your hand, starting from the edge of the breast and working towards the nipple. The milk can be collected in a bowl or cup and stored in the refrigerator and if not needed by your baby will be gladly received by any hos­pital with a premature baby unit. Later on, expressing milk can be very useful if you want to leave your baby for several hours but do not want it to have any other kind of milk. You should take good care of your breasts by keeping the nipples clean and dry and apply lanolin cream twice daily to keep them supple.

Outlook

All mothers find caring for a new baby exhausting, but there is no reason why breast feeding should be any more tiring than bottle feeding as long as you are generally fit and eat a good diet.

If all goes well, you can carry on breast feeding until the baby is ready to drink from a beaker with a spout, usually after the age of six months, and as the child gets used to this, successive feeds can be dropped. But you should never feel a failure if you give your baby an occa­sional bottle or if circumstances prevent you from breast feeding; nor should you worry that your baby will be psycho­logically damaged if you do not breast feed.

 

 Problems and solutions                                              Problem Solution/Treatment
Sore nipples Wash and dry nipples and apply lanolin cream after each feed. If possible expose nipples to the air for some time during the day. Make sure area surrounding nipple is in baby's mouth
Cracked nipple Stop feeding on that side and express the milk by hand. If problem persists more than 24 hours see your doctor
Breast inflamed and red due to an infection See your doctor as soon as possible and stop feeding on that side. It should be possible to continue feeding on one side
Lump in breast due to . blocked duct Have a hot bath, massage the breast gently towards nipple. If lump remains, see doctor as soon as possible
Nipples retracted Pull out nipple with fingers and massage it. Wear breast shield
Breasts overfull, making it hard for baby to grasp nipple Massage the breast towards the nipple then squeeze the base of the nipple between finger and thumb. Try applying hot towels or ice packs to the breasts
Pains in mother's abdomen Normal. As baby sucks, the uterus contracts. Pains will soon pass and the contractions help uterus return to normal size
Baby reluctant to feed in first few days after birth Stroke baby's cheek with nipple to trigger the 'rooting' reflex. Try to feed baby before screaming is at full pitch
Baby chokes on first flow of milk into breast Take baby off breast until flow subsides. Place a towel under breast to mop up excess milk
Baby   seems constantly hungry Very common as milk supply is becoming established. Try to relax to increase milk flow at each feed. Make sure baby is not crying for some other reason. Consult the doctor, midwife or clinic and arrange for a test weighing if necessary
Baby restless at breast, sucks in fits and starts Hold the baby firmly and try to anticipate its needs so it is not over-agitated when the feed is begun. Try not to hurry
Baby falls asleep during the feed Try tickling toes to keep the baby awake. Lengthen intervals between feeds so that baby is more keen to feed
Baby regurgitates milk Normal: doesn't mean milk unsuitable. Do not overfeed baby— he may not need food every time he cries
Older brothers and sisters jealous at feeding time Put baby and another child on your lap while feeding and tell or read a story to older child
Father feels neglected Involve father as much as possible in all aspects.
Embarrassment Do not get discouraged. If other people find breast feeding offensive, go into a room where you can be alone

You will also find the following articles helpful and up to date, if you have any problems, please consult your health care worker to discuss these issues in more detail. 

Baby Feeding, a Feminist Issue Filled With Fraught

Posted on by Ruth Kava

First of all, by “fraught” I mean some thing, situation or decision attended by worry or stress. And why should baby feeding be so considered? After all, as mammals we humans typically have the ability to breastfeed our offspring. And as inhabitants of a technologically advanced, developed country, we have the opportunity to choose one of a number of nutritionally complete formulas designed for the same purpose. So what’s the issue (or issues)? And what do feminists think about it?

The answer is — it depends.

The basic feminist stance is that women should be able, and society should support, whatever baby-feeding strategy mothers choose. But this has become complicated by the position of many that breastfeeding is the only means of infant nourishing a woman should choose.

And some go so far as to accuse women who don’t breastfeed as being irresponsible, selfish and callous about the welfare of their babies.

Still, there is also the position that while the culture supposedly supports women who breastfeed, in reality it can be difficult to do so. Few employers make allowances for mothers to interrupt work to pump milk, and overtly nursing a baby in a public place is discouraged — sometimes rudely (although in New York State she has the right to do so).

The zeitgeist is that breast milk confers health benefits on the baby and child, such as: fewer allergies; reduced chance of obesity; lower risk of developing Type 2 diabetes, gastrointestinal disorders and middle ear infections, as well as providing better overall immunity.

Also, benefits might accrue to mom since she’s putting out on the order of 500 calories pre day. Given these benefits, it seems obvious to many that “breast is best” under pretty much any circumstances.

However, the veracity of the data that support the above has been seriously questioned — because the studies reporting such benefits have been subject to confounding by economic and demographic characteristics. If indeed these supposed benefits are really not strongly supported by the data, then about the only argument that can be made is that breastfeeding is the most natural way to feed a baby.

So the most common position is that breastfeeding is the best and should be the only way to feed baby. Which position bangs up against the feminist ideal of freeing women’s choices — even to formula feed if that’s what they want to do.

Anti-formula voices claim variously that big companies (e.g. Nestle, Gerber and the like) push their clearly second- or third-rate feeding options on weary moms. Some hook in anti-GMO and anti-genetically engineered growth hormone (for cows, not kids) in their anti-formula screeds.

But there are other voices being raised — those that participate in a backlash against the “only breast is best” scenario. And perhaps this is a much-needed rebalancing of the feminist position, now that breastfeeding is much more widely accepted. Next, we have to agree that neither breastfeeding advocates, nor those who opt to feed formulas, should be excoriated for their choices. After all, both feeding methods can result in healthy, well-nourished offspring.
New baby feeding guidelines clear confusion on when to start solids

Professor Katie Allen: Tuesday 17 May 2016

Working out what to feed your child—when to begin feeding solids, and what allergenic foods to avoid—can seem overwhelming.

Katie Allen, from the Murdoch Children's Research Institute in Melbourne, acknowledges that it's difficult.

There is now absolutely no evidence that hydrolysed formula [has] any role in preventing allergic disease.

'It's awfully confusing. Parents have, over the last few decades, been given a whole raft of different guidelines from different specialists all around the world and here in Australia.'

 The new guidelines, she says, are aimed squarely at halving the rate of peanut allergies in Australian children.

'The jury is out until we actually see what happens,' Allen says, 'but that is the hope.'

When your infant is ready, at around six months, but not before four months, start to introduce a variety of solid foods, starting with iron-rich foods, while continuing breastfeeding.

Happily, this is a recommendation that most Australian parents are already following.

Currently, around 90 per cent of Australian parents introduce solids between four and six months—with the remaining 10 per cent introducing solid foods either before or after that time.

While previously it was thought that introducing solids might affect rates of breastfeeding, Allen is confident this isn't the case.

'Introducing solids around the age of six months isn't going to affect the rate of breastfeeding.

'We do believe breastfeeding is best for a baby's healthy start to life, not just for bonding with the mother but IQ and infectious disease rates, so breast is definitely the best way to go.'

All infants should be given allergenic solid foods including peanut butter, cooked egg, dairy and wheat products in the first year of life. This includes infants at high risk of allergy.

Allergenic solids include peanut paste, egg and cows' milk, wheat—the sort of foods that previously parents would have shied away from feeding their infants in the first year of life due to concerns over allergic reactions.

In the past, the recommendation in Australia, Europe and the US has been to delay these forms of solids.

'Luckily,' Allen says, 'a lot of people ignored that advice.'

The summit's guidelines recommend that all children, regardless of whether they are high or low allergy risk, benefit from the addition of cooked egg and peanut butter soon after starting solids.

Allen acknowledges that this recommendation can seem counterintuitive. But, she says, the costs of not introducing allergenic foods early on can be high.

'People are not introducing the allergenic solids in a timely manner... and that may be increasing and driving the rates of allergy in our community.'

Hydrolysed (partially and extensively) infant formulas are not recommended for prevention of allergic disease.

There are claims hydrolysed baby formulas are less likely to cause an allergic reaction because they contain milk proteins that have been extensively broken down.

Allen dismisses these claims. 'There is now absolutely no evidence that hydrolysed formula [has] any role in preventing allergic disease,' she says.

Foetal Alcohol syndrome (FAS)

Foetal (Fetal: Alternative spelling) alcohol syndrome (FAS) is a birth defect that is the result of maternal drinking of alcoholic beverages during the pregnancy.

It is a preventable birth defect in that pregnant women who avoid consuming alcohol can prevent this particular birth defect from occurring.

All foetuses of pregnant women who drink alcohol while pregnant are at risk for foetal alcohol syndrome (FAS).

The effects of FAS are irreversible and can include mental and behavioural problems.

There are as many as 40,000 (1/750) babies born each year in the United States who are diagnosed with FAS.

Symptoms of FAS:

fasThis birth defect manifests itself in a cluster of different but related problems due to the exposure to alcohol during foetal development. The cluster of problems may be referred to as foetal alcohol spectrum disorders (FASD).

Foetal alcohol syndrome is a leading cause of mental retardation and yet it is preventable and to this day is still ranking the most prevalent cause of mental retardation - a truly dismaying statement.

Symptoms:

Small eyes, very thin upper lip and a short turned up nose

Heart defects

Deformity of joints, limbs and fingers

Delayed physical growth before birth and after birth

Vision difficulties

Hearing difficulties

Small head circumference

Small brain size (microcephaly)

Mental retardation

Delayed development

Short attention span

Hyperactivity

Poor impulse control

Extreme nervousness and anxiety

Physicians may use other terms to describe the symptoms of FAS such as: Alcohol-related neuro-developmental disorder (ARND) which refers to the mental and behavioural impairments experienced as a result of exposure to alcohol during foetal development and alcohol-related birth defects (ARBDs) which refer to the physical defects that occur as a result of FAS.

What causes FAS?

When a pregnant woman drinks alcohol, it enters her bloodstream, crosses over through the placenta into the baby's bloodstream.

The unborn baby has a much slower metabolism than its mother and thus the alcohol concentrations are higher.

The alcohol will impair the optimal nutrition for the baby's developing tissues and organs and can even damage brain cells. The risk increases the more alcohol the mother consumes.

Impairment to the developing baby includes facial features, organs including the heart, bones, the central nervous system and the brain.

The most damage can be done during the first trimester when some women may not even know that they are pregnant. Brain damage can be done at any stage of pregnancy.

Drinking alcohol during pregnancy can lead to birth defects and it can cause miscarriage. Women who can conceive, suspect they may be pregnant or are pregnant should not consume any alcohol.

The more alcohol consumed the higher the risk for birth defects.
FAS Factsheet

pregnancy

1

Phenylketonuria (PKU)

Birth Defect: Phenylketonuria (PKU)

This is a rare birth defect that can be detected by a heel prick blood test at birth. Left undetected PKU can cause mental retardation.

PKU is a genetic birth defect inherited from both parents. Babies who have PKU need a special formula (low-phenylalanine) to meet its nutritional needs that will compensate for the deficient or missing enzyme that is needed to process the essential amino acid called phenylalanine. The child will need to continue to a special diet as a child and as an adult.

Phenylketonuria is rare, but it still needs to be tested for because left untreated, serious health problems can result.

Symptoms:

Mental retardation

Behavioural or social problems

Jerking, tremors or seizures in the arms or legs

Rocking motions

Hyperactivity

Stunted growth

Skin rashes

Small head size (microcephaly)

Vomiting

Musty breath, skin or urine, which is caused by too much phenylalanine in the body.

Fair skin and blue eyes

Those children with "classic PKU", which is the severest form, usually develop obvious and permanent mental retardation and behavioural problems before their first birthday.

There is also mild and moderate forms of PKU. These children have a smaller risk for brain damage. The special diet will prevent the mental retardation.

A woman who herself had PKU and becomes pregnant is at risk for another form of the condition called "maternal PKU". She will need to follow the PKU diet during pregnancy, otherwise the phenylalanine levels can become dangerously high for her foetus. Individuals are recommended to follow the PKU diet for life.

Babies born to mothers with PKU may not inherit the defect, they may however have complications at birth. They may not need to follow the PKU diet if they test normal at the PKU screening. They are however at risk for being born with microcephaly (small head) and mental retardation, low birth weight, heart defects and behavioural problems due to the high levels of phenylalanine levels in the bloodstream due to the mother's PKU.

The Cause:

A single mutated gene causes PKU. This mutated gene is suppose to carry instructions for making the enzyme needed to process amino acid (phenylalanine). Those who have PKU are missing this gene or have a defective gene. Without this gene to process phenylalanine, a dangerous level of phenylalanine can build up in the body when the person with PKU eats foods that are high in protein such as milk, cheese, nuts or meats. Serious health problems can result when a person with PKU consumes these foods high in protein. A person can have the defective gene but not have the disorder, this is called being a carrier. In order for a baby to have PKU, both parents must have the defective or missing gene.

Risks:

Phenylketonuria (PKU)An unborn baby is at risk if both parents have the missing or defective PKU gene. If only one parent has the missing or defective PKU gene than there is no risk for passing along the defect to the unborn baby.

Babies of mothers who have PKU and who did not follow the PKU diet during pregnancy are at risk for the consequences of high levels of phenylalanine in the mother's blood.

Seek Medical Attention:

Newborn - if routine PKU tests show the baby has PKU; the baby will need to be started on a special formula and may be referred to a specialist in genetics and a dietician or nutritionist who will help with the diet guidelines.

Adults - doctors now recommend that all individuals with PKU continue the diet for life as it may improve mental functioning and behaviour and slow any damage to the central nervous system.

Women - It is important that all women especially who are of child producing age follow the diet as having high levels of phenylalanine can be dangerous to a developing foetus and not all women realize when they are pregnant until after the foetus has developed most of the major organs.