Composition of mother’s milk

The composition of mother´s milk adapts to the child´s needs and varies during the lactation period, during the day and even during each feed.

Colostrum is the first milk, it is more of a yellowish colour and protein concentration is very high. It also contains immunoglobulins (anti-bodies) and provides a large amount of calories in a reduced volume. It is the ideal nourishment for the first days because the newborn´s stomach is small and needs to be fed frequently yet in very small amounts.

The composition of the milk also changes during each feed. At the beginning it contains more water and lactose and towards the end the milk contains much more fat.

The superiority of mother’s milk

Breast milk is uniquely superior and the best nutrition you can offer your newborn. It covers all the nutritional requirements for appropriate growth both physical and emotional. There is an increased resistance to infections and illness and breastfeeding promotes mother-baby bonding. Breastfeeding also provides benefits for mothers: mothers are less likely to develop breast or ovarian cancer, it lessens osteoporosis and reduces the risk of other pathologies. It also protects our environment.

Breastfeeding contraindications

In practice there are very few situations in which breastfeeding is contraindicated. These include (HIV) – when the mother is infected-, in the case of human T cell leukemia or when the infant suffers from galactosemia or congenital lactase deficiency. Heroin, cocaine, amfetamine or marihuana consumption is not compatible with breastfeeding. Some other exceptional situations may be: during treatment with antineoplastics and in certain cases of prolatinoma where treatment with bromocriptina or cabergolina is required. Breastfeeding should be temporarily stopped if the mother has to receive treatment with radioactive isotopes. Any doubts regarding compatibility of medication with breastfeeding may be consulted at www.e-lactancia.org.

If mother and child are both healthy the infant should be placed on top of the mother skin-to-skin, without interruptions, until the child feeds for the first time.

Skin and body contact shortly after birth helps to initiate early breastfeeding, the adaptation to extra-uterus life, as well as mother and child bonding.

It is advisable to carry out the identification process, the Apgar test, while the baby is on top of the mother. In order to alleviate pain and suffering any upsetting procedures like heel lance, should be carried out while the baby is nursing.

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Comité de Lactancia Materna
José Manuel Martín Morales

Spending the first twenty four hours together: facilitates breatfeeding on demand and promotes mother-child wellbeing.

Most babies are awake during the first two hours after birth. During this period most of them are able to find the mothers nipple. After this phase, there is a sleep or rest period of between 8 to 12 hours and then they feed quite frequently (8-12 times, or more per day). Breastfeeding will not follow a fixed pattern and will be more predominant during nights. Some babies will be sleepy and eat very little; in which case it will be necessary to wake them up.

The principal stimulus for milk production is sucking and emptying the breast completely: the more feeds the more milk will be produced.

It is recommended that you breastfeed when the baby shows signs of hunger ( sucking, head movement, sticking out of the tongue or sucking on his or her hands..) do not wait for crying as it is a late sign of hunger.

A healthy child breastfeeding correctly and on demand, requires nothing but mother´s milk. Consult your paediatrician before you begin with supplementary feeding.

Once mother and child return home it is necessary to feed on demand and contact the health centre for a check-up within 48 hours.

A baby that feeds frequently will urinate five or more times a day, have bowel movement and be satisfied after each feed. This means that he or she is getting all the milk required.

It is necessary to consult an expert in breastfeeding if the mother suffers any pain or has the feeling she does not have any milk, if the bay cries too much or too little as well as any other doubt. Support groups count on experienced mothers to help and guide you during this first period or throughout breastfeeding.

Bottle feeding will not solve the problem and may put breastfeeding at risk. This step should only be taken following the doctor´s advice.

Characteristics of the newborns stools

The child´s bowel movements depend on feeding and age. After passing the meconium, the baby´s stools will be yellowish, loose and seedy in texture. Colour may vary. The frequency should be one bowel movement after every feed during the first month. From 1 to 6 months: movement varies from one per day to once every twenty days, consistency will be buttery and variable in colour. Babies who breastfeed exclusively do not have bowel movement every day, but this is not a sign of constipation. The reason for this is that mother´s milk adapts perfectly to the infants needs, uses all the nutrients and therefore there is little to excrete.

Going back to work.

There are several possibilities in order to continue breastfeeding after maternal leave:

• Accumulate breastfeeding time during maternal leave.
• Ask for a reduction in working hours or temporary un-paid leave.
• Take the baby to work or leave work during breastfeeding hours.
• Feed the child just before leaving for work and once you return home allow the child to feed more frequently.
• Extract milk in order to feed the child while the mother is at work.
• In the case of children over six months of age supplementary feeding may be given during work hours.
• Rest as much as possible and make sure you have help from others at home in order to lower stress levels and maintain milk production.

It can be helpful to follow advice of other mothers and trade union experts.

Anticonception and Breastfeeding

The choice of anti-conception methods should be made considering the method which does not harm or affect mother, child or breastfeeding in any way.

When it comes to natural methods, MELA is the most efficient (98%) when used correctly. Conditions: Exclusive breastfeeding, frequent feeding during day and night, not having recommenced menstruation and while the child is still under six months of age.

When it comes to barrier methods; the preservative is ideal for post-delivery and during breastfeeding. Spermicides should be used together with other barrier methods.

Hormonal anticonceptives: These are not encouraged during breastfeeding if they contain estrogenes and prostgesterones. Anti-conceptives with only progesterone are the best choice.

Post-coital contraception with progestarone may be used as an emergency anti-conceptive method.

The DIU is compatible with breastfeeding.

Consult your gynecologist or midwife.

Introduction to complementary feeding

From 6 months onward the child is ready to start eating other kinds of food in order to cover all the nutritional requirements. Up to one year of age, the child should breastfeed first and then eat the other food products. This is because during this time of life mother´s milk is still fundamental for the child´s nutrition. The introduction of one new type of food every 2 to 5 days is recommended. These should be mashed or triturated and eaten using a spoon or cup in very small quantities.

Gluten should be introduced during the breastfeeding period and after 6 months of age. Do not add sugar or salt to the child´s food.

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Comité de Lactancia Materna
Paula Lalaguna Mallada

How much milk should the child receive after beginning complementary feeding

As a general rule, children who have started complementary feeding should drink approximately half a litre of milk every day.

If the child feeds between 4 and five times a day on mother´s milk, there is no need for any other milk or dairy products. During the first year it is best to breastfeed on demand and just before the purée o porridge; after one year of age it is better to breastfeed after eating or between meals.

Cow´s milk and other derivatives like yoghurt or cheese should not be introduced until after one year of age especially in the case of children with a high allergy risks (direct family members with a medical history including allergies.)

Weaning

The World Health Organization (WHO) recommends exclusive breastfeeding up to six months of age, with continued breastfeeding along with appropriate complementary foods up to two years of age or beyond. Nevertheless, breastfeeding is a very personal decision and only concerns mother and child. So the duration of breastfeeding will depend and what they decide.

When the moment for weaning arrives, it should be done gentling and gradually, reducing the feeds little by little, postponing feeds or offering the breast in certain conditions but always offering some sort of solace or consolation. It is important that the child receives lots of affection during the weaning period.

Breastfeeding during pregnancy

It is not unusual that a women fall pregnant while still breastfeeding her child. If the mother wants to there is no reason to stop breastfeeding. However, it is important to remember that nipple stimulation releases oxytocin and this hormone tells the uterine tissue to contract. As a result , breastfeeding should be avoided in certain circumstances like: multiple pregnancies, a history of miscarriages or premature deliveries.

Breastfeeding during pregnancy may increase nipple sensitivity or soreness and change the taste and amount of milk produced. Some babies refuse to nurse because of this change while others refuse to nurse at first but later on start to feed again.

Tandem nursing

It is possible to breastfeed throughout pregnancy and then breastfeed two children at the same time after delivery. This is known as tandem nursing or tandem breastfeeding.

During the first few days the babies should nurse first to ensure they get a full share of colostrum. The production of colostrum is limited so they baby should always go first.

Tandem nursing requires the normal measures as far as hygiene goes. If the older child has an outbreak of herpes (lips or elsewhere) he or she should stop nursing to prevent transmission and infection.