What you need to know about breastfeeding

CEBU, Philippines – Hi, my name is Marini.  In my work as a Pediatrician and Certified Breastfeeding Specialist many mothers approach me with similar concerns.  These questions are also frequently asked in Support Group Forums (in Facebook:  Milk Making Mommies/ Cebu Breastfeeding Club, LATCH Moms, BF Pinays; small group discussion or face to face support group: Cebu Breastfeeding Club).

Here are the top questions new moms ask me:

1. My baby seems hungry all the time! Do I have enough milk?

Your baby will breastfeed a minimum of 8-10 times a day. Sometimes this feels like your baby is breastfeeding all the time! His stomach's capacity is around 5-7 ml. That's the size of a small Kalamansi. To know if you baby is taking enough milk here are some signs to note:

. After feeding your baby is sleepy and you will see him relax his tightly clenched little fist. He will be milk drunk!

. After the 4th day of life, your baby will urinate 'wiwi' six or more times, with 3-4 soft, seedy, yellow, curdy stools (looks like 'lata nga kamatis') per day.

. Breasts will feel less heavy and is softer after a feed.

. Because of Oxytocin (the hormone that make the muscles around the milk gland squeeze the milk out: milk ejection reflex) you also feel relaxed and sometimes even sleepy!

A mother's breast will make all the milk her baby needs as long as the baby is allowed to breastfeed ad libitum (unli-latch).  Your baby will also love to breastfeed at night time.  Prolactin, the hormone that directs milk production is highest at night, and baby knows it! Milk production is controlled by the amount of milk removed in the previous feeding. Therefore, the more milk is removed, the more milk produced! If a lot of milk remains in the breast after a feed less milk will be made for the next. It follows the law of Supply and Demand.

2. I just gave birth. Why don't I see the milk?

In the first 2-3 days of life, baby's tummy is quickly filled with the protective colostrum, the first milk that is rich with Immunoglobulins that serves as the baby's first immunization. It is designed to coat the baby's sterile gastrointestinal tract, from the mouth to the anus, as protection from pathogens.  Your baby's tummy is 'kalamansi-sized' in the first 2-3 days after birth that 5-7 ml of colostrum per feed is perfect to provide all of your baby's caloric and nutritional needs. In 24 hours your baby will consume about 30 ml of colostrum. There is no need to give water, vitamins, supplements, etc. because breast milk is complete.  Letting your baby breastfeed is the best way to get the protection of colostrum.  In around 4-5 days, your milk will transition and your breasts will be heavy with mature milk.

3. What is Skin to Skin (STS) Contact or Kangaroo Mother Care (KMC)?

From birth, a baby is kept in skin to skin contact with the mother (or father). This decreases your baby's stress levels because he knows he is safe in his parent's loving embrace.  Heart rate and temperature levels are more stable and the baby doesn't spend many calories crying and getting upset!  You may search for Dr. Nils Bergman's documentary of this online.

Because of proximity, you will be quick to notice your baby's hunger cues and the breast can be offered. Some examples of hunger cues are when baby turns his head from side to side, mouths his hands or makes sucking movements. Don't wait for the baby to cry before offering the breast!

4. It hurts when my baby breastfeeds. Is this normal?

Breastfeeding need not be painful! With proper positioning and a good latch-on to the breast, feeding is a relaxing and fulfilling activity.

At times the new parents feel lost when the new baby arrives. It is useful to arm yourself with knowledge of good positioning and attachment even before giving birth. In preparing to breastfeed, you should assume your most comfortable position. Imagine yourself preparing to read your favorite book or watch a movie. Some like to sit semi-reclined, some like to lie down (especially after CS), etc.

Bring the baby close, you may roll him to face you so that his body is chest to chest or tummy to tummy with yours, not twisted.  Allow the baby to latch to the whole nipple-areola complex, not just the nipple. This will allow painless breastfeeding and good milk transfer from breast to baby.

Elements of good attachment: 1) Wide open mouth. 2) Lips flanged out, like fish lips. 3) Chin close to the breast.

5. I am returning to work soon. How should I feed my baby?

Hand expression of breastmilk is a very important tool for working mothers! It allows you to store milk for your baby, and to relieve engorgement when you and baby are separated.  You'll only need your clean hands and a covered container. There is no need to buy equipment.

Republic Act 10028 States that mothers are entitled to an additional 40 minutes of compensable breastfeeding break for every 8 hour workday. You choose your preferred schedule to pump at your work area or at your Workplace Breastfeeding Room (all public places are mandated to have one). Here is an example of a hand expression or pumping at work schedule:

Arrive at office

Morning break 20 mins

Lunch break

Afternoon break 20 mins

Before going home

. This schedule allows you to express milk or pump 5 times in 1 day!  Store your milk in a covered container and refrigerate or you may use a Styrofoam ice box with gel ice to keep your milk in and transport it.  Breastmilk in the back of the refrigerator is perfect for healthy, term babies for 3 days.  If you put your breastmilk in the freezer of a single door refrigerator   you may use it for 2 weeks, and 3 months for a 2-door refrigerator with separate freezer! Once milk is thawed it should be used within 24 hours. To avoid wastage you may store your breast milk in 2-3 oz aliquots.

6.May I drink medication?

Many medications are compatible with breastfeeding.  Please discuss with your doctor your desire to continue breastfeeding, and the drug in question.  You may also check a drug database which is available online: http://toxnet.nlm.nih.gov/cgi-bin/sis/htmlgen?LACTMED

The Philippine Pediatric Society is committed to serve the Filipino family by caring for the their children. One of the best ways to accomplish this task is to ensure that that children are given a happy and  healthy childhood.  Last August 6, 2015 the Philippine Pediatric Society Inc, in Cooperation with the Central Visayas Chapter (PPSCV), hosted the "1st International Breastfeeding Conference and 3rd Annual Breastfeeding Congress - Cebu Leg" with the Theme:  "Breastfeeding and Work- Let's Make it Work!".  Dr. Jennifer Thomas, MD, MPH, IBCLC, FAAP, FABM and Dr. Julie Smith, B Ec, PhD shared their expertise on Breastfeeding Medicine and the Economics of Breastfeeding.  This was a consolidated effort of the PPS CV and the Department of Health Region 7, the National Nutrition Council Region 7, SM Cares Foundation, the local chapters of the Philippine Obstetric and Gynecological Society, Philippine Nurses Association, Philippine League of Government and Private Midwives Inc, Integrated Midwives Association of the Philippines and Glory Reborn.

It was attended by 600 health care providers (doctors, nurses, midwives, nutritionists, peer support groups) who are joined in the interest of caring for mothers and babies. The day before, on August 5, the speakers also shared their knowledge to more than 300  students at the SM City Cebu Event Center.

For questions about breastfeeding, you can reach Dr. Marini Esguerra at 0943-7251777.