Pigeon India

Wonders Of Breastmilk

Continuing To Breastfeed

Q&A (Mother's Edition)

Q&A (Baby's Edition)

First-Time Fathers

Medical Personnel

Change in the breasts

Summary and treatment for each disorder

Classification of Sucking and swallowing disorders

Sucking and swallowing disorders

How to hold your baby

How to care for your baby

Massaging your baby

How to give expressed breastmilk

How can you bond with your baby

How can you support your wife

When jaundice appears

Vomiting breastmilk

The breastfeeding period is too short or too long

The baby refuses to drink expressed breastmilk in a bottle

Your baby refuses to drink breastmilk

Biting the nipple

Your baby can't latch on to the breast well

Your baby doesn't gain weight at a good rate

Child-rearing consultation and information exchange

Where to breastfeed in the public places

Tandem nursing

Weaning timing

Pregnancy during the breastfeeding period

Freezing and frozen storage of breastmilk

Returning to work

Breastfeeding fatigue

Drug ingestion and breastmilk

Breast problems

Nipple problems

Not producing sufficient breastmilk

When you feel that your breastmilk is insufficient

Diet during the breastfeeding period

How to help your baby latch on

How to hold your baby

Components of breastmilk

Mechanism of breastmilk secretion

Advantages for both mother and baby

Wonders Of Breastmilk


Nursing your baby on breastmilk is not just good for the baby, it’s also great for the mother.

How is breastmilk produced? What components in breastmilk are good for the baby, and why?
  • Change in the breasts
  • Components of breastmilk
  • Mechanism of breastmilk secretion
  • Advantages for both mother and baby

Continuing To Breastfeed


For better breastfeeding, here are some helpful hints.
  • Diet during the breastfeeding period
  • How to help your baby latch on
  • How to hold your baby

Q&A (Mother's Edition)


I don’t think I have enough breastmilk…”
“I’d like to go back to work.”

We’ll answer these and others questions about the mother’s body and lifestyle.
  • Child-rearing consultation and information exchange.
  • Where to breastfeed in the public places.
  • Tandem nursing.
  • Weaning timing.

Q&A (Baby's Edition)


For better breastfeeding, here are some helpful hints.
  • The breastfeeding period is too short or too long
  • The baby refuses to drink expressed breastmilk in a bottle
  • Your baby refuses to drink breastmilk
  • Your baby doesn't gain weight at a good rate

First-Time Fathers


When your first child is born, your wife will be filled with anxiety about herself and about your baby.
  • How to hold your baby
  • How to care for your baby
  • How to give expressed breastmilk
  • How can you bond with your baby

Medical Personnel


This information is about the various conditions that prevent babies from nursing directly from the breast.

We introduce various products for low-birth-weight babies, babies with cleft palates, and babies with other nursing difficulties.
  • Summary and treatment for each disorder
  • Classification of Sucking and swallowing disorders
  • Sucking and swallowing disorders

Change in the breasts


The breasts are preparing for lactation after pregnancy

Your breasts grow larger when you are pregnant. First, there is a change in the nipples. They grow darker and become more sensitive, and the areola also increase in size.
This is because the acinus, which produces breastmilk and is located at the tip of the breast duct that is the path of breastmilk, grows and develops during pregnancy in preparation for lactation after the baby is born.
The average non-pregnant breasts (left and right) weigh about 200 g in total. This increases to 400-600 g in late pregnancy and 600-800 g during the lactation period, or 3-4 times heavier than normal.
The breasts grow smaller 6-9 months after the start of breastfeeding, but it has been reported that the ability to produce breastmilk does not change even after that.

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    First period

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    Middle period

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    Last period

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    Lactation period

Breast structure (Mammary gland)

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Summary and treatment for each disorder


1) Sucking and swallowing for low birth weight and preterm babies: Summary of symptoms

  • Low sucking pressure and unstable sucking and swallowing
  • Intermittent sucking
  • High risk of aspiration because of immature coordination between swallowing and breathing movements.

Ways of treatment:

  • Because the coordination of sucking, swallowing and breathing movements would be matured around 35 weeks of gestational age, it is important to nurse the babies carefully.
  • Practice the babies to latch on their own mothers' nipples with kangaroo care
  • Give the babies gentle massages outside and inside of their mouths to become habituated to the stimulus of sucking and swallowing.
  • Press gently the babies cheeks on the both sides to practice them to generate negative pressure in their oral cavity.

2) Sucking and swallowing for babies with a cleft lip/cleft palate: Summary of symptoms

  • Difficulties of sucking because of disfunctions of generating negative pressure and compressing nipple in the oral cavity
  • Risk of backward flow of breastmilk or formula through the nasal cavity of babies
  • Risk of aerophagia
  • Shortage of milk intake with taking excessive time of sucking

Ways of treatment:

  • Breastfeed or bottle-feed with much care of aspiration and backward flow of milk through nasal cavity
  • Take appropriate position during breastfeeding or bottle-feeding
  • For babies with cleft lips, make sure of shielding lips firmly while sucking
  • For babies with cleft palate, it would be effective to use an artificial palate (such as Hotz-type Orthopedic Plate)

3) Sucking and swallowing for babies with micrognathia: Summary of symptoms

  • A smaller jaw, receding mandible, or depression of the root of the tongue would block the respiratory path, causing sucking and swallowing disorders.
  • Robin Sequence is characterized by a small or receding mandible, depression of the root of the tongue, cleft palate, and obstruction of airway. Airway obstruction or cleft palate could affect sucking ability of babies because of the difficulty in generating negative pressure within the oral cavity.
  • Also the babies with Robin Sequencde usually have an U-shaped cleft palate. As a result, backward flow of breastmilk and formula enters the nasal cavity of the babies.

Ways of treatment:

  • Because the babies with micrognathia have respiratory disorders frequently, it is essential to check if the airway is blocked while nursing.
  • For more effective nursing, it could be recommendable to hold the baby on the vertical position, or pronely if needed, so that the airway could not be obstructed or the tongue of the baby could not recede.
  • In the case that the baby with micrognathia would also have a cleft palate, it is necessary to take care of the cleft palate itself.

Classification of Sucking and swallowing disorders


The table combined with etiology and dysfunction, is shown below.

1.ImmaturityLow birth weight infant Preterm infantThese conditions are not real "problems" but to be considered. Because of the prematurity of coordination between sucking, swallowing and respiration, they would have some risk of aspiration.
2.Anatomical and structural problemsCleft lip
Cleft palate
Micrognathia
Structural defect of lips, pharynx, larynx and esophagus could cause Sucking and swallowing disorders. That include congenital conditions (cleft lips/palate, micrognathia) and acquired illness such as tumors.
3.Problems of the central and peripheral nervous system, and musclesCerebral Palsy, Hypoxic-ischemic encephalopathy, Myotonic dystrophy, Werdnig-Hoffmann diseaseDysfunctions of the cerebrum, brainstem, cerebellum, spinal cord, peripheral nervous and muscles could cause the impairment of the coordination between sucking, swallowing and breathing. Also those dysfunctions could involve excessive increase and decrease in involuntary and voluntary muscle movement. All of these problems could lead Sucking and swallowing disorders.
4.Dysfunction of pharynx and esophagusLaryngomalacia Esophageal achalasiaDysfunctions in the pharyngeal and esophageal motor abilities could cause the difficulties of the coordinated movements.
5.Deterioration of general conditionCongenital heart disease
Respiratory disease
Systemic infection
Deterioration of the general health status, caused by various diseases leads to Sucking and swallowing disorders.
Even nasal obstruction could cause respiratory disturbance and sucking and swallowing disorders.
6.Psychological problemsTubal feeding dependenceProblems of appetite and mental issues such as anorexia, dependence of gavage feeding with refusal of oral feeding, and refusal of infant formula would cause sucking and swallowing difficulties.
7.OthersStomatitis
Dry mouth
Painful lesion such as stomatitis could cause Sucking and swallowing disorders.
Dryness of mouth due to fever or the side effects of medications could cause Sucking and swallowing disorders.

Sucking and swallowing disorders


Ingestion disorders and dysphagia during the neonatal period can be regarded as 1. Sucking and swallowing disorders. Patients need to be assessed with the following perspectives: 1) Nutrition intake and growth, 2) Development of sucking and swallowing functions, and 3) Underlying disorders.
Ingestion disorders and dysphagia are frequently observed in neonates with congenital disorders. If underlying disorders are treatable, the medical intervention would be prior to them. Because babies are undergoing development of ingestion and swallowing function, age factor should be considered. It is important to understand which process is disturbed.
Since babies are on the way of development, the symptoms would change drastically along with the neurorogical development. Moreover, the prognosis varies with the underlying disorders. This should be considered together with health condition.

Chart 1 Development of Ingestive Abilities in Infants

Age0-5 months5-6 months7-8 months9-11 months
Tongue movementPeristaltic-likeFront to backUp and downLeft and right
Lips and MouthHalf-open/Tongue protrudingLips closedLeft/right flex at the same timeLeft/right flex alternately
FoodLiquid→Mashed→Soft solids/Shredded→Bite-size/Solid

How to hold your baby


Pick up your baby slowly and hold him gently-and most of all,don’t be scared!

Everyone is nervous about picking up a newborn at first.
But this is the first step in taking care of him. Relax and pick him up slowly.

Holding your baby


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    Place your hand underneath your baby's head to support it.

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    Place your other hand between his legs to support his back.

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    Lift him to your body.

Note


Cradle your baby with his head resting on your arm. When you do this, bring him close to your heart.
It doesn't matter if you hold him facing left or right-choose whichever is most comfortable for you.

How to care for your baby


Frequent care is necessary.

The metabolism of a newborn is incomparably better than that of an adult.
This means that frequent care is necessary.
Try to perform some of this care when it is easier, such as when the baby is asleep or just after a bath.

All about washing your baby
Wash him as if you're stroking him-but be careful!

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    Head


    The so-called soft spot on your baby's head will be much smaller when he is about 18 months old, after his skull has come together. Until then, don't push on it-just wash his head by gently stroking it. Lather the baby shampoo well and make sure to clean your baby's head every day.

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    Face


    Wash your baby's face well with baby soap when you give him a bath, making sure to clean his cheeks, which can be come dirty with drool and milk, and his forehead, where there are many secretions from his skin. Be sure to wipe the soap from his face with a warm, damp cloth.

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    Body


    With all his baby fat, your baby has lots of crevices and wrinkles. Sweat and dirt can become trapped in these areas, and can even cause your baby to smell bad! Whenever giving him a bath, make sure to use your fingers to spread open these areas and wash them well.

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    Bottom


    Your baby's bottom is subject to urine and stool all day long in his diapers. This is particularly true in the deep wrinkles around his crotch, which is the dirtiest part of his body-so be sure to wash this area once a day.

    Day-to-day care of your baby
    Your baby's beautiful-in every single nook and cranny.

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    Bellybutton


    Many mothers are nervous about changing diapers while the umbilical cord is still attached. But your baby's umbilical cord will fall off naturally, so please just wait.
    Once it has fallen off, it is important that you continue cleaning the bellybutton with alcohol for a while and expose it to air as often as possible. You should also make sure it does not rub against his diapers. You may want to consider disposable diapers that have the area around the bellybutton cut out, especially for newborns.

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    Ears and nose


    Cleaning your baby's ears
    Use cotton swabs to remove the dirt. A tiny bit of baby oil will help make the cleaning process even easier. The best time to clean his ears is when his skin is still damp just after a bath.

    Cleaning your baby's nose
    There is a lot of mucous trapped inside of that tiny little nose. But if you try to clean too deeply, you could damage his delicate membranes, so exercise caution. Use a narrow cotton swab for babies or tweezers with rounded tips to remove only the mucous you can see. If your baby doesn't like having his nose cleaned, clean it when he is sleeping.

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    Nail


    Baby's nail grow quickly and should be trimmed once a week. If not trimmed properly, a baby's long nail may scratches his face. Hold a baby's finger securely, and round the baby's nail as you trim them. Cutting nail while sleeping is best.

Massaging your baby


Good for your baby's body and his heart as he feels your love

Baby massage makes your baby feel good while mom and dad gently touch him.
Cradling your baby makes him feel safe-after all, this is the first time he's been out in the world and he's full of uncertainty.

Preparations
Set the room temperature to one comfortable for your baby.
Adjust the lights in moderate brightness. You may also want to play some of your baby's favorite music.
Lay a mat or other cushion on the floor and cover it with a large bath towel. Also prepare a diaper and wipes so you can calmly change them when your baby wets himself when he feels good from the massage.

Prepare some plant-derived oil
Use plenty of oil, using your palms to gently and slowly rub it all over your baby's body.
While you're doing this, relax, make eye contact with your baby and talk to him, creating a pleasant atmosphere.

Massaging him face-up


Perform each of the massages 2-3 times.

Massaging both sides of your baby's body

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    Use your palm to gently massage his body, counting to 3 with each stroke. Make sure to massage all the way to his fingertips.

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    Stroke the sides of his face, then move down his arms to his fingers. Next, slide both hands from his underarms down the sides of his body, all the way down to his feet and toes.


Chest massage

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    Gently place both of your hands in the middle of your baby's chest and gently massage, drawing the shape of a heart.

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    Gently place your hands on both sides of your baby. Use your thumbs to lightly massage from the middle of his chest outward.


Belly massage

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    Place one of your hands on one of your baby's hands.
    With the other hand, massage his belly in little circles.
    Try to avoid his bellybutton.

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    Lightly place your hands on either side of his belly and gently rock it right and left.


Back massage

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    Use both hands to gently massage your baby's shoulders, back, bottom and legs, down to his toes.

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    Use both hands to gently massage from his shoulders down his arms and to his fingers.

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    Place one of your hands gently on your baby's back, and gently draw tiny circles as you massage his shoulders, back and bottom.

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    Using your fingertips, gently tap on your baby's back.


Hand massage

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    Take your baby's hands in your own and use your thumb to gently rub his hands, starting at the palm and working your way up his fingers. Follow with a light massage.

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    Use your thumbs to gently rub from the heel of your baby's hands outward to his fingertips.


Leg and foot massage

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    Place a hand on your baby's leg and use your palm to gently massage from his groin to his ankles.

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    Using both of your hands, lightly hold his thighs and then massage to his ankles using your palm.

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    Use your thumbs to press on the bottom of his feet, from his heel to his toes, gently massaging as you go.

How to give expressed breastmilk


Giving your baby expressed breastmilk is a great chance to bond.

Breastmilk is the best source of the baby's nutrition. Nursing creates bonds of love through the skin-to-skin contact. But, when the mother has difficulties with her nipples or breasts to nurse her baby directly, when she isn't in good physical condition, or when she's separated from her baby, it's necessary to give the baby expressed breastmilk.
This is where Dad comes in! Giving your baby expressed breastmilk is a great chance to bond.

Heating up expressed breastmilk


Expressed breastmilk can only be stored for a limited time.
The nutrients a baby needs change as he grows, and the composition of the breastmilk changes to meet these needs. For this reason, use stored expressed breastmilk as soon as possible, regardless of the storage life.
First, place frozen or chilled breastmilk under running water or in warm water until it thaws. After that, heat it in hot water until it is skin temperature.

Recommended storage period for expressed breastmilk


Freezer (Approx.-18℃)Refrigerator
Fresh breast milk3 weeks24 hours
Thawed breast milk but not warmedDo not refreeze24 hours
 

*Breastmilk that has been warmed once should not be refrigerated or frozen.
*Breastmilk should not be microwaved, as much of the nutritive value will be lost.
*Breastmilk should not be preserved at room temperature
*Use stored breastmilk as soon as possible, regardless of the storage life.

Freezing and frozen storage of breastmilk

Hold your baby the same way your wife does when she breastfeeds.


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Sit in a chair or on the floor, and cradle your baby. When you do this, make sure that your baby’s body is in a straight line, as it is when your wife holds him for breastfeeding.

 

Feed your baby so that he’s drinking from the bottle in the same way as he would breastfeed.


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When feeding your baby from a bottle, make sure that his lips are turned to the outside, as they are when breastfeeding, and that he opens his mouth wide and latches onto the nipple firmly. When your baby seizes the nipple shallowly, remove it and try again. Check that your baby can latch on deeply.

  • Before giving your baby a bottle, make sure that the temperature is suitable. Squeeze a few drops of heated milk onto the inside of your elbow or wrist to check the temperature. It should feel a little warm. When it feels too hot, cool it in cold water until it’s the appropriate temperature.
  • When giving your baby a bottle, there’s a chance the nipple will collapse; don’t tighten the cap too much.
  • Always feed your baby under adult supervision.

After feeding your baby, burp him.


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After feeding your baby a bottle, as with breastfeeding, you need to burp him. Hold your baby upright on your shoulder until he burps. When your baby just can’t produce a burp at this time, don’t force it, but put him down to sleep.
When there is any leftover breastmilk in the bottle, be sure to discard it.

How can you bond with your baby


The first step to taking in caring for your baby is to develop a bond with your baby.

Newborn babies are so cute that you just want to look at yours all the time. After your baby was born, you'll think "I'm a father!" more than before. But, you'll probably feel uncertain about how to raise or care for your baby.

During her pregnancy, your wife will get to know a lot about baby care. Naturally you may not be able to do the same, but there are things you can do for your baby because you are the father. Do your best and enjoy raising your child with your wife. The first step to taking in caring for your baby is to develop a bond with your baby.

Understanding primitive reflexes


Primitive reflexes are unconscious movements seen in babies. All human babies are born with these characteristic reflexes. As the baby grows, most of these primitive reflexes will gradually disappear, at different stages for different babies.

  • Rooting reflex


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    When something touches a baby’s mouth, she will reflexively close her lips over it and begin latching on. This reflex is known as the rooting reflex. Also, when you put your finger in your baby’s mouth, she will suck heartily on it. This is another primitive reflex called the sucking reflex. (They last until the baby is about 4 or 5 months old.)

    Try it! Touch your baby’s lips.

  • Exploratory reflex


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    When you touch a baby on the cheek, she will turn her head in the direction of the stimulus.

    Try it! Touch your baby’s mouth or cheek.

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  • Palmar grasp reflex


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    When you place your finger on the palm of your baby’s hand, she will grasp it. You may think that the grip is quite strong. (This reflex lasts until the age of about 6 months.)

    Try it! Place your finger on your baby’s palm.

How can you support your wife


Why not help with taking care of your baby and with housework as much as you can?

Newborn babies are so cute that you just want to look at yours all the time. After your baby is born, you'll think "I'm a father!" more than before.

But, you'll probably feel uncertain about how to raise or care for your baby. During her pregnancy, your wife will get to know a lot about baby care. Naturally you may not be able to do the same, but there are things you can do for your baby because you are the father. Do your best and enjoy raising your child with your wife.

Also remember that when this is your first child, your wife will also be anxious about many things. The baby has to be fed and his diapers changed every two or three hours - she won’t be able to get enough sleep, and will always be exhausted. Of course you’re busy too, but why not help with taking care of your baby and with housework as much as you can?

What the father can do to help the mother


  • Helping with housework and child-rearing With a newborn baby, the mother is constantly feeding the baby, changing diapers, bathing the baby and performing innumerable other tasks. Try to help out by doing the cleaning and the laundry and by tidying things up a little. Just taking over some of the night-time feedings and diaper changes will lighten your wife’s load considerably. When you’re not sure what you can do to help, just asking your wife directly “Is there anything I can do?” will surely lighten her mood.

  • Communicate with your wife frequentlyYour wife no doubt has many things to tell you about your baby, whose expressions and abilities change daily. But she’s not used to taking care of a baby either, and may be feeling tired or irritated. Although you can’t be with her during work days, ask her about her day, and reassure her that your heart is always with her. Of course, when you also explain to her your own feelings, and tell her about the growth and changes you observe in your baby, the two of you will be true partners in raising your child.

  • Together, enjoy watching your baby grow up You see primitive reflexes of your baby day by day. He’ll grow larger as you watch, and will begin to be able to hold his head up. His arms and legs will develop, and so will his range of facial expressions. And not just that - he’ll start to be able to express his own wishes using sounds, movements and even words. From the day he’s born and over the next few years, your baby will change in many and astonishing ways. Connect with your baby, and enjoy his growing years together with his mother!

Column

Understand how your wife’s body changes from conception to the time after birth.

A woman’s body changes drastically during pregnancy, childbirth, and in the postpartum period. She may be bewildered by all of these changes in her own body and feelings. After giving birth, she has to begin caring for her baby before her own body even has time to recover. Learn what’s going on in her body, and as a husband, work to get and stay close to her.

The most important thing is to understand and accept the physical changes that your wife's body undergoes during this period, and enjoy the pregnancy with a light heart

When jaundice appears


Breastfeeding soon after birth is the key!

It’s common for babies to have yellowish skin during the first week after birth. The baby’s liver is still undeveloped, and this can lead to jaundice. It usually appears 2 or 3 days after birth, and disappears at around 10 days after birth. Medical treatment is necessary only if the jaundice continues for a long time, or if the degree of jaundice is particularly strong. In these cases, be sure to have a doctor examine your baby and prescribe treatment.
Jaundice does not grow worse because of a problem with the breastmilk, and if treatment is necessary, it’s usually possible to do it and to continue breastfeeding. Just be sure to follow your doctor’s instructions.

About jaundice


Jaundice is caused by the increase of bilirubin, which is a metabolic product of hemoglobin, a component of erythrocytes. Newborn babies are susceptible to bilirubinemia (jaundice) in the early stages of life because their liver function for bilirubin metabolism is still immature.
Bilirubin has an antioxidative effect that protects the cells of a newborn baby, emerging from a hypoxic uterus, from oxygen toxicity.
Bilirubin is eliminated in the bowel movements, and immediate breastfeeding after delivery stimulates meconium elimination. Begin breastfeeding your baby soon after delivery.

Vomiting breastmilk


It's not uncommon for babies to vomit

It's not rare uncommon for babies to vomit after breastfeeding. In most cases, it's not a sign of illness. Your baby's immature stomach differs in form from that of an adult. Also, because the sphincter at the stomach entrance is still undeveloped, your baby often vomits when he burps. Your baby may stop vomiting automatically within 12-18 months after birth.
To prevent your baby from vomiting, straddle hold the baby when you breastfeed or let him burp a few times during breastfeeding. When you lay the baby down, the upper body should be above the level of the lower body or the face should be turned sideways, so that the breastmilk that the baby vomits does not clog the airways.
However, if vomiting becomes more forceful, or your baby loses weight even though he seems to be drinking enough, consult doctors, midwives or consultants.

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The breastfeeding period is too short or too long


Make enough time to enjoy the breastfeeding period.

You may give your baby milk 8-10 times a day when you breastfeed her. Newborn babies may drink breastmilk as often as 12 times a day. Each breastfeeding period ranges from 10 to 30 minutes. Sometimes there are 10-minute breastfeeding sessions 3-4 times close together and sometimes your baby drinks milk for 20-30 minutes and then sleeps for 5-6 hours. It may be hard for the mother when the breastfeeding periods and the intervals between are not stable shortly after the baby's birth, but the most important thing is to give the baby sufficient breastmilk and to allow both you and your baby to enjoy the precious breastfeeding period.

When the breastfeeding period is too short


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When the breastfeeding period is excessively short (it lasts only for a few minutes), or the interval is too short (your baby begins to cry after 30 minutes), the following reasons may be responsible.

  • Your baby can't latch on well
    >>How to hold your baby and help your baby latch on
    >>Your baby can't latch on to the breast well
  • Your baby refuses to drink breastmilk
  • Poor health of baby, vomiting
    >>Deconditioning / Vomiting / Medical section
  • There are problems with the mother’s breast
    >>Your baby refuses to drink breastmilk (Reasons on the mother’s side and methods of coping)

When the breastfeeding period is too long


When the breastfeeding period is excessively long, lasting for as long as 40-60 minutes (including when the baby drinks intermittently), the following reasons may be responsible.

  • Your baby can't latch on well
    >>How to hold your baby and help your baby latch on
    >>Your baby can't latch on well (Exploratory suckling, etc.)
  • Your baby refuses to drink breastmilk
  • Your baby is drinking breastmilk not for the nutritional intake, but for the feeling of security (formation of bond between you and your baby).

It may be a sign of weaning


If your baby is around 1 year old, has started to eat baby food (supplemental food), and has a very short breastfeeding period or only drinks intermittently and doesn't seem to want to drink milk, it may be a sign of weaning.

Although WHO recommends that you continue to breastfeed until the baby is 2 years old or older, even after he starts eating baby food (supplemental food), some babies stop drinking milk naturally. Consider weaning in consultation with a professional, and be sure not to force weaning.

The baby refuses to drink expressed breastmilk in a bottle


Let your baby drink bottled milk the same way he drinks breastmilk

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Reasons and methods of coping

  • Feeling sleepy

    Your baby may not be used to using a bottle especially when he is sleepy or shortly after he wakes up.

    Method of coping: Give your baby milk after he is fully awake.
    Give your baby milk after he has woken up and is ready to drink. Your baby may not latch on well shortly after he wakes up or when he is sleepy.

  • Not hungry

    Your baby may still be satisfied with the amount of breastmilk he had at the last feeding, and may just not be ready for the next feeding session.

    Method of coping: Don’t rush and don't force your baby to take the milk.
    Breastmilk is more easily digested than infant formula, so your baby may feel hungry after a short time. Also, breastfed babies regulate the amount of breastmilk they need when feeding at the breast though when she is offered milk in a bottle, she may drink all contents from a bottle. If you are not exclusively breastfeeding and are supplementing with formula, your baby may prefer the breastmilk. Moms are often concerned that their baby isn’t drinking enough milk or that he isn’t gaining weight smoothly, but try to relax and keep an eye out for the indications and signs that show that your baby is getting enough breastmilk, then trust in the signs.
    If you feel that either breastmilk or infant formula is insufficient, consult doctors, midwives or consultants.

  • Discomfort in the feeding position
    It is natural to use a breastfeeding position even when you are bottle-feeding.

    Method of coping: Give your baby milk in a position that relaxes him.
    Your can help your baby feel relaxed during a feeding.

  • Discomfort in the feeding position
    Method of coping:Try to relax your baby.
    Your baby is sensitive to slight changes in the environment. If your baby feels anxious because the environment is different from usual or the weather is bad, try to make him feel relaxed by taking a walk or carrying him.

    Method of coping: Give your baby milk in a position that relaxes him.
    Your can help your baby feel relaxed during a feeding.

  • Health problems/Birth defects such as cleft lip and palate

  • Using inappropriate size of the nipple for nursing bottle
    Your baby finds drinking milk stressful when too much or too little milk comes out.

    Method of coping:Select the appropriate nipple size.
    When your baby refuses the baby bottle, there is a possibility that the nipple for the nursing bottle is not the right size. Your baby finds drinking milk stressful when too much or too little milk comes out. Check the nipple size again and select the appropriate nipple size.

Your baby refuses to drink breastmilk


Relax and establish a breastfeeding style that suits both you and your baby.

Reasons on the baby’s side and methods of coping


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  • Inappropriate timing

    ・Feeling sleepy (Your baby won’t drink breastmilk appropriately when she is sleepy or shortly after she wakes up.)

    ・Not hungry (Your baby may still be satisfied with the breastmilk that she had the last time, and may just not be ready for the next breastfeeding session.)

    Method of coping: Breastfeed your baby after she is fully awake and is ready for breastfeeding. Your baby may not be able to latch on well shortly after she wakes up, or when she is sleepy. Adapt to the baby's breastfeeding rhythm.

  • Methods of how your baby drinks

    ・Inability to latch on (There is a possibility that your baby isn’t positioned properly or she isn’t latching on appropriately.)

    ・Not used to drinking breastmilk (Your baby won’t always be able to drink well shortly after birth.)

    More used to bottle-feeding
    Method of coping: Check the appropriate positioning and latch on. If your baby can't latch on even when she is positioned correctly, check if she is taking hold of the breast tightly with her mouth wide open. 

  • Poor physical condition
    ・Constipation, insufficient burping, stuffy nose, fever, temporary bad health, inability to relax

    ・Diseases (cleft lip and palate, cerebral palsy, internal disease, allergies, etc.)

    Method of coping: Let your baby burp sufficiently before the next breastfeeding. Don't forget to check if your baby has a stuffy nose or constipation. Consult a doctor if the case of poor health if the cause is unknown.
    If your baby has disabilities, don't act on your own judgment; consult doctors, midwives or consultants.

Reasons on the mother’s side and methods of coping


  • Excessive breastmilk production: Your baby chokes on the excess breastmilk.
    Method of coping:This is common shortly after the baby's birth.
    Once breastmilk production has stabilized, milk doesn’t spurt out as often when your baby latches on.
    This problem also decreases as your baby becomes used to breastfeeding.
    When your baby releases the nipple because of spurting breastmilk, stop the flow using a towel, and once things are calm, try again.

  • Inappropriate positioning: The breastfeeding position is making your baby uncomfortable

    Method of coping: It’s possible that your baby isn’t positioned appropriately, and doesn’t have good latch on. Check the appropriate breastfeeding positioning and latch on. If your baby can't latch on even when she is in the right position, check whether she is catching the nipple tightly with the mouth wide open.

  • Problems with breasts and nipples
    (a) The nipple is inverted or flattened
    ・If the mother’s nipple is inverted or flattened

    Method of coping: There are several methods that can be used. Moms can use a method called “reverse pressure softening”--a technique in which a mom can use her fingers to gently soften the circle around her nipple and areola. This technique briefly moves some of the swelling back and up into her breast to soften her areola. Pushing back the swelling also makes it easy to remove milk with her fingertips or with short periods of slow gentle pumping, combined with gentle forward massage of the upper breast, if you need to remove milk for your baby (Source: K. Jean Cotterman RNC, IBCLC.) Alternatively, a mom can use a nipple puller to evert the nipple using gentle suction.

    ・If the nipple is flattened because of breast engorgement, a little milk expression makes the breast softer and makes it easier for your baby to latch on. Be sure that production of breastmilk from both breasts is stable.

    (b) Engorgement(engorgement of one breast makes it difficult for your baby to latch on)
    When one breast is so engorged that it's hard for your baby to latch on

    Method of coping:If the nipple is flattened because of breast engorgement, a little milk expression makes the breast softer and makes it easier for your baby to latch on. Be sure that production of breastmilk from both breasts is stable.

    If you’re still having problems even after trying these coping strategies, don’t act on your own, but consult doctors, midwives or consultants.

  • Inability to relax
    Caused by impatience due to insufficiency (pressure to product breastmilk), mental fatigue caused by stress, etc.

    Method of coping: Both you and your baby need to be relaxed. The mother’s ability to relax is the most important factor in the baby being able to latch on comfortably. If your baby is agitated, relax her by taking a walk in a park or by holding her tightly in your arms.

Biting the nipple


One form of communications between you and your baby

The baby's appearance, how the baby drinks breastmilk, the amount and frequency of urine and feces output and the baby's body weight are indicators of whether enough breast milk is being produced.
Baby's frequent crying and slight engorgement of the breast do not indicate that insufficient breastmilk is being produced.
Breastmilk production increases and the amount of breastmilk stabilizes as you continue to breastfeed.

Reason why babies bite nipples


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Your baby may sometimes bite your nipple when he gets used to breastfeeding.

This is nothing to worry about; it’s not a sign that you’re not producing enough breastmilk or that your breastmilk doesn't taste good.

'Exploring sucking or exploratory sucking' can be seen 3 months after the birth. Even though he should be hungry and ready to nurse, your baby will roll your nipple with his tongue, smile with the nipple in his mouth, and may seem to play without concentrating on breastfeeding. At that time, your baby may bite your nipple, but it doesn't mean that he hasn’t had enough breastmilk or doesn't like breastmilk any more.
It's a phase in which the tongue and lips start moving in various ways, and your baby explores and enjoys moving his tongue and lips.

Although this varies among individuals, your baby will cut his first tooth about 7-8 months after birth, and will sometimes bites your nipple during breastfeeding at this time as his gums feel itchy.
This is tough on you, as it certainly hurts, but your baby isn’t refusing to drink breastmilk. Don’t scold your baby, but treat him well.

Breastfeeding becomes painful when the nipple is bitten and injured, either when your baby is exploring and cutting his first tooth. When that happens, take care of the nipple appropriately, following guides for care.

Your baby can't latch on to the breast well


Relax, and establish a breastfeeding style that suits you and your baby.

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Signs and reasons that your baby can’t latch on well

It takes some time to learn to breastfeed a newborn baby appropriately because both you and your baby are not used to it.
Sometimes the baby can't latch on to the breast well, or can’t keep sucking.
If the following signs are present, then there is a possibility that your baby is not latching on well.

  • Nipple is flat or has streaks
  • Nipple hurts
  • Breasts engorge
  • Suckling callus on baby's lips

If your baby can't latch on well, your nipples may hurt after breastfeeding or your breasts may feel engorged because enough breastmilk wasn't taken. It may be hard until you get used to it, but be patient and continue breastfeeding until you find the breastfeeding style that suits you and your baby.< br /> We would also explain how to let baby latch on to mother's breast well.

The most important thing to make it easier for your baby to latch on is for both of you to relax. Breastfeeding is a time for the two of you to have physical contact with each other and nurture bonding in a relaxed state. Take it easy and create an environment in which both of you can have physical contact while breastfeeding and in which your baby can latch on at her own initiative.

Reasons for not being able to latch on, and methods of coping


  • Your baby twists her neck when breastfeeding.
    Method of coping: Hold your baby close to your breast and keep her face at the same level as the breast, facing it.

  • Your baby's mouth isn't open wide.
    Method of coping: Tickle your baby's lips with tip of your nipple and wait until your baby opens her mouth wide.

  • The breast is so engorged that the nipple is flat.
    Method of coping: If your breast is too engorged, express your milk to help the nipple stick out.

  • The nipple is inverted.
    Method of coping: Use a nipple puller or breast shell to pull the inverted nipple out before breastfeeding.

Reasons for not being able to continue latching on and methods of coping


  • The baby has to stretch, twist or move her neck to continue sucking on the breast.
    Method of coping: Hold your baby close to your breast and keep her face at the same level as your breast, facing it.

  • Your baby can't breathe while latching on.
    Method of coping: Don't bend your baby's head forward.

  • Your baby's mouth releases the breast because her head isn't held tightly enough.
    Method of coping: Hold your baby with a side hold and hold her head with your hand.

  • The breastmilk is released too strongly
    Method of coping: If the breast is too engorged, express your milk to help the nipple stick out.

Your baby doesn't gain weight at a good rate


Babies grow at different rates

You may sometimes worry that your baby isn’t gaining weight, and wonder if your baby is drinking breastmilk appropriately, or if breastmilk alone is not enough.

Each baby grows at his own pace. One baby may seem to be growing at a fast pace, while another seems to be growing at a slow pace. Babies sometimes don’t gain much weight even if they drink enough breastmilk, so there’s really no need to be concerned.

Also, it is said that newborn babies lose 10% of their body weight during the first few days after birth.
This is a physiological phenomenon that is caused by the elimination of excess body fluid, which babies retain inside the uterus.
Babies usually return to their birth weight 2-3 weeks after birth when breastfeeding is going normally.

How to determine if your baby is gaining weight adequately


Determine if your baby is gaining weight appropriately not only by whether he is drinking enough breastmilk, but also by whether your baby is energetic, how much urine is released, how your baby drinks breastmilk, the characteristics of the breastfeeding rhythm. Develop an eye for determining if your baby is getting enough breastmilk.

If you observe signs such as the baby being unenergetic and not responding well, the diapers not being wet often, infrequent bowel movements, an inconsistent breastfeeding rhythm (breastfeeding sessions are too long, intervals are too short, your baby can't drink appropriately), consult doctors, midwives or consultants.

If your baby doesn't gain weight steadily, the possible causes include lack of breastmilk intake, which means that breastmilk is insufficient in quantity, and hyposecretion of breastmilk. Don't try to judge the production quantity by yourself; seek advice from a specialist.

Signs that a newborn is receiving sufficient breastmilk


  • He breastfeeds at least eight times in 24 hours.
  • During a feed, his suckling rhythm will slow down as milk is released, and swallowing or gulping may be heard.
  • He is alert, and has good muscle tone and healthy skin.
  • He is contented between feeds (though well-fed babies may be fussy for other reasons, leading mothers to believe they don’t have enough milk).
  • He has six or more wet diapers in 24 hours; with pale, diluted urine.
  • He will have three to eight bowel movements in 24 hours.
    As babies grow older, stooling may be less frequent.
  • He shows a consistent weight gain, with an average of 18-30 grammes/day.
  • The mother's breasts may feel full before a breastfeed and softer afterward, though not all women experience a dramatic change.

(Source: UNICEF WHO, "UNICEF/WHO Breastfeeding Management and Promotion in a Baby-Friendly Hospital, an 18-hour course for maternity staff”, 1993, p. 68)

Signs that a baby is not gaining weight adequately


  • He grows less than 18 grammes/day.
  • He has not recovered his birth weight by three weeks.
  • His growth line is not rising appropriately on the growth curve.
  • He sleeps for long periods of time to conserve energy.
  • He seems lethargic and has a weak or high pitched cry.
  • His urine output may be low with concentrated urine; or urinary output may be normal. Urinary output alone is not a reliable measure of weight gain.
  • He has very few stools, or none at all.
  • He may stay at the breast consistently.
  • He may have a worried look on his face, with hanging folds of skin on his body.
 

(Source: UNICEF WHO, "UNICEF/WHO Breastfeeding Management and Promotion in a Baby-Friendly Hospital, an 18-hour course for maternity staff”, 1993, p. 69)

refers to the average body weight of infants fed only on breastmilk
Fig. 10-A-1 Standard body growth percentile curve of infants fed only on breastmilk (compared to NCHS growth curve)
(Reference; Dewey KG, et al; Pediatr Clin North Am, 48:92-93, 2001)

Child-rearing consultation and information exchange


Breastfeeding can cause many struggles, but there are various places where you can solve them.

Breastfeeding is always accompanied by struggles. It is natural for you to be worried and unsure of what to do. You don't have to be ashamed of this. Don’t try to shoulder all of the problems yourself; get your husband, family, friends and people with experience in child-rearing to listen to you. It is also effective to rely on experts such as lactation consultants, midwives and healthcare nurses in your area.

Places where you can consult and exchange information about child-rearing

  • Experienced mothers

    You can surely find other mothers who have the same struggles and worries as you do.
    You can talk, exchange information and share it with them while you let your children play.

  • Bulletin boards on the Internet

    You will find more child-rearing support sites than you might expect.
    Mothers who don’t go out that much refer to these websites. Experienced mothers who have solved the same questions or worries as yours will answer your questions.

  • Regional facilities and events

    Try to participate in regional child-rearing support or child-rearing events.
    You will gain not only specialist advice from nursery staff, but also advice from other mothers like you.

  • Where to get counseling

    Hospitals and child-rearing support organizations provide counseling to relieve anxiety about breastfeeding.
    Breastfeeding consultants and health nurses will listen to you and give you precise advice there.

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Where to breastfeed in the public places


There are many places where you can breastfeed.

Breastfeeding when you are away from home

A lot of mothers think that it is hard to find places to breastfeed outside.
Some of them do research beforehand, go out by car and breastfeed in the car, or ask employees to let them use a private room or staff room. Others always bottle-feed the baby when they are outside.
Nowadays more and more public facilities, such as department stores, are equipped with nursing rooms, which you should try.

Breastfeeding in a public place

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Breastfeeding in a public place is controversial. Unfortunately, what's happening now is that breastfeeding in public tends not to be accepted in some areas of the world.
Opinions differ from region to region, so please check the situation where you are.
In some communities, mothers demand their right to breastfeed in public places.
The sign above indicates that you can breastfeed in that area.

Recommendation for nursing clothes

It's not easy to pull up your clothes or stretch the neckline down to expose your breast. Doing so chills your neck and stomach, and doesn’t shield the mother's privacy.
If you wish to meet the needs of your baby and care about yourself at the same time, breastfeeding clothes can be one solution. You can breastfeed without pulling your clothes up, and it also protects your privacy as it isn’t too revealing.
You can also find nursing underwear, such as bras that allow you to breastfeed without taking them off.

Tandem nursing


Breastfeeding methods vary among individuals.

There are many ways to tandem nurse. You can choose how to do it according to your preferences or the age of each child.
We will introduce 2 common breastfeeding methods in this section.

Breastfeeding 2 children at the same time

The mother lets each child suck on a breast at the same time. You may think that it would be difficult to breastfeed 2 children at the same time, but it really isn't, as the older child adjusts her positioning so that she can latch on.
You can fix which breast each child sucks on when you breastfeed them, but the older child will drink breastmilk less frequently than the younger one, so you can let the younger child drink from the opposite breast when the older one is away or asleep. In consideration of eyesight development, it is better to let your baby drink from both breasts.
When you fix which breast each child sucks on, the size of each breast changes according to each child's requirements. This isn’t really a problem, but if you wish to avoid it, it's better to switch the two babies from side to side.

Breastfeeding one child at a time

The mother breastfeeds one child at a time. One child has to wait while the other is being breastfed, but the advantage is that the mother can deal with each child one by one. The older child tends to be interested in other things while he is waiting to be breastfed. However, considering the establishment of a relationship of trust, it is important to breastfeed him even if she has forgotten.

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If the older child can speak

The older child sometimes feels jealous when you breastfeed two children at the same time. If the older child can speak, telling him about the baby before it’s born and showing him other babies being breastfed can help him accept the younger baby.

Weaning timing


There are no rules for the timing of weaning. It varies among individuals.

Weaning means the overall situation in which the baby stops drinking breastmilk. The timing for this varies, depending on the mother's situation, the advice of those around her, and the baby's feelings.

You sometimes have to give up breastfeeding because of nipple problems, breast problems, breastmilk insufficiency or breastfeeding fatigue, but in most cases it is possible to keep on breastfeeding if you can get appropriate information and support. Additionally, when your baby is over one and a half years old, he begins to learn to speak and to make his wishes clear, which may help you decide to stop breastfeeding.

The World Health Organization (WHO) encourages mothers to keep breastfeeding until the baby is 2 years old or older, as breastmilk is effective in promoting the physical and mental development of the baby.

Pregnancy during the breastfeeding period


It’s important to understand about pregnancy and breastfeeding while you are nursing

The possibility of pregnancy during the breastfeeding period

Breastfeeding decreases the possibility of getting pregnant, but you can get pregnant during the breastfeeding period.

The ability to get pregnant is greatly influenced by breastfeeding frequency. Infrequent breastfeeding increases the chance of ovulation, while even after your periods have started again, they may stop in the case of frequent breastfeeding. On average, periods start again one year and 3 months post partum.

Whether to keep breastfeeding or not

Decide whether to keep breastfeeding or not after considering carefully the baby's appearance and your own wishes. If you want to keep on breastfeeding, consult a medical expert. However, it is said that approximately 60-70% babies are weaned naturally.

Some reasons for this is that
  • The baby stops drinking because of changes in the amount and composition of breastmilk during pregnancy.
  • The mother decreases breastfeeding because of nipple pain and discomfort caused by hormones during pregnancy.
  • It is time for weaning regardless of pregnancy.

Additionally, the baby may start drinking breastmilk again after the new baby is born, even if he stopped drinking during pregnancy.

Freezing and frozen storage of breastmilk


Preserve nutrient-rich breastmilk in an appropriate way

There are times when a mother can't breastfeed her baby for many reasons. Sometimes you just want to preserve excess breastmilk. In such cases, you can express breastmilk in an appropriate way and freeze or refrigerate to give it to your baby later.
Breastmilk can generally be preserved in a freezer (about -18oC) for about 3 weeks. It can be preserved in a refrigerator (5oC and below) for up to 24 hours. The antibodies and other components of breastmilk show little change during these periods. However, breastmilk produced by the mother's body changes in composition according to the baby's growth. It's better to use frozen or refrigerated breastmilk as soon as possible.
Other precautions for handling breastmilk are below;

Freezer (Approx.-18℃)Refrigerator
Fresh breast milk3 weeks24 hours
Thawed breast milk but not warmedDo not refreeze24 hours
 
  • Breastmilk that has been warmed once should not be refrigerated or frozen.
  • Breastmilk should not be microwaved, as much of the nutritive value will be lost.
  • Breastmilk should not be preserved at room temperature.
  • Use stored breastmilk as soon as possible,regardless of the storage life.

Returning to work


It's a good idea to continue breastfeeding after returning to work

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Continue breastfeeding after you return to work.
Breastmilk will keep the relationship between you and your baby close when you can't be with your baby.
Seek the understanding of your family, employer and child-care worker so that you can balance a career and raising your child.

Advantages of breastfeeding while working

  • Helps relieve the anxiety of mother and baby when they have to spend a long time away from each other, and makes child-rearing easier.
  • Provides happy feelings and bonding, which makes up for the long time apart.
  • Prolactin functions to relax a breastfeeding mother. The mother can relieve the fatigue of work by taking care of the baby.
  • Babies who spend time in nursery centers are more likely to develop infections, and it is said that the immune factors and infection prevention effects of breastmilk help prevent this.

Management after returning to work

You'll need a breast pump so that you can express breastmilk at the office.
It is best to freeze the breastmilk that you express during the day, and have it thawed and given to baby at the nursery center.
You can express breastmilk a little at a time during breaks. It helps relieve breast engorgement, and as you can easily breastfeed at night and on holidays, it helps to prevent decreases in the amount of breastmilk produced.
Make use of facilities such as nursing rooms, which enable mothers to express breastmilk.

Tips for returning to work during the breastfeeding period

  • Breastfeed directly before and after work.
  • Tell the child-care worker not to feed the baby very much just before the time you pick the baby up.
  • Express breastmilk at the office as necessary, even a little bit at a time.
  • It's a good idea to bring something that will relax you (such as your baby's photo) to look at while expressing breastmilk at the workplace.
  • Dress in clothes that enable you to breastfeed or express milk easily.
  • Breastfeed frequently at night and on weekends.

Breastfeeding fatigue


For mothers who feel tired of breastfeeding

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It's hard to stay positive when you feel tired. Babies are very sensitive to their mothers’ moods.
It's good for both the mother and the baby if the mother’s fatigue is relieved, so seek support from your family or get some time for yourself in a positive way.

Physical fatigue

  • Awakened for breastfeeding while asleep

    Newborns can't drink breastmilk well. Sometimes they can drink a lot, another time only a little, and the frequency with which they want to breastmilk differs at different times.
    However, rest assured that you will both settle into a rhythm as your baby gets used to breastfeeding. It is also possible for you to arrange your lifestyle around the baby's demands.
  • Feeling tired from breastfeeding itself

    Strength and energy are needed for the mother to hold her heavy baby and breastfeed many times a day. If you feel tired from breastfeeding itself, seek support from the father, your grandmother and a nursing bottle. This also creates a bond between other family members and the baby.

Mental fatigue

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  • Make time to rest

    Prolactin makes a breastfeeding mother relaxed and sleepy. It is natural that as the baby feels sleepy after breastfeeding, the mother does too. It is important to make time for rest sometimes, like taking a nap with your baby, and relieve your fatigue rather than doing housework while your baby is asleep.
  • Make time for yourself

    It’s important to make time for yourself once in a while. If it is hard to seek the support of your family, one option is to use a day nursery or babysitter service. Such services abound these days.
    It is a good chance to take a look at what is important to you, and you will be a better mother when you see your baby the next time.
    Don't forget to express breastmilk beforehand and have them give it to your baby when you leave the baby at a day nursery or with a babysitter.
  • Exercise and refresh yourself with your baby

    Taking a walk with your baby can refresh both of you. In addition, these days there are more gyms where you can exercise with your baby.
    Exercising with your baby lets you to feel refreshed and reshapes your body post partum, and it can also be a happy time for your baby to bond with you.

Drug ingestion and breastmilk


Be sure to choose the appropriate drugs during the breastfeeding period

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When a mother takes drugs, most of them are transferred to the breastmilk and then more or less to the baby.
However, only a few drugs harm breastmilk, and most drugs are safe for mothers during the breastfeeding period.
Considering the baby's healthy growth, the advantages of breastfeeding are said to outweigh the risks of drugs, but you need to obtain the advice of a medical specialist and evaluate appropriately the detriments and danger of stopping breastfeeding with the amount of drugs that are transferred to the breastmilk, as the risks depend on the kind and amount of the drug.

Breast problems


Take appropriate measures depending on the symptoms

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symptoms of breast trouble are lumps or swelling that hurt, and mastitis.
Please follow the instructions of an expert, such as doctors, midwives, and lactation consultants, as breast problems can lead to breastmilk insufficiency and poor weight gain in your baby.

Lumps and swelling

If you find lumps or swelling, try to breastfeed using the appropriate positioning and latch on, and breastfeed frequently. Another way to take care of lumps and swelling is to express breastmilk after and between breastfeedings. Expressing breastmilk often helps, even when the lump causes a burning pain. There is a possibility that a lump in the mammary gland will become mastitis if it is left untreated. Additionally, if your baby suddenly stops wanting breastmilk, it may be a warning of mastitis.

Mastitis

Mastitis is a breast disease accompanied by pain, fever (38.5 degrees C and above) and engorgement, chills, flu-like body pain and systemic symptoms.
Mastitis is said to be most common 2-3 weeks postpartum, but it can develop at any time during the breastfeeding period.
Mastitis is divided into 2 types, one with a bacterial infection and the other without.

  • Congestive mastitis

    Stagnation mastitis (noninfectious mastitis) causes breast inflammation without bacterial infection. It is usually accompanied by redness, engorgement, lumps, a burning sensation in one breast, and sometimes a mild systemic fever. If you have these symptoms, try to breastfeed using the appropriate positioning and latch on to cope with the disruption of breastmilk.
  • Acute purulent mastitis

    If symptoms don’t improve within 24 hours of the start of the symptoms in (1) and you have flu-like symptoms such as fever, chills and body pain, you may be infected by this bacterial form of mastitis. If the symptoms are severe, a course of antibiotics may be recommended, but in any case, see a specialist and obtain advice.

Nipple problems


Take appropriate measures depending on the symptoms

For breastfeeding mothers, the most common nipple problem is sore nipple. This often occurs in the early postpartum period.
It is said that most sore nipple occurs because the mother isn't used to the appropriate way to hold the baby and let the baby suck on the nipple. In any case, it can be a challenge to continued breastfeeding. In this section, we’ll show you how to prevent sore nipple and coping strategies.

How can you prevent and cope with your symptoms?


SymptomsCausePreventionCoping strategies
Temporary nipple soreness that happens in the early postpartum periodApplication of breastmilk
Inappropriate way to hold baby and let baby latch onAppropriate way to hold baby and let baby latch on
Baby's inappropriate sucking styleApplication of medicine
Use of nipple protector
Enforced removal of breast from baby's mouthDo not force baby away from the breast
Breastfeed or express milk before the breast engorges
Breast engorgement
  • Abraded wound
Candida (thrush infection)Treatment of baby's oral Candida, mother's colitis
Preventing wounds and cracks from getting worse
Consulting a specialized agency (doctors, midwives, and lactation consultantts)
Other nipple infections
Use creams or ointmentsDo not use inappropriate creams or ointments
Baby bites the nipplePaying attention to baby's suckingConsulting a specialized agency (doctors, midwives, and lactation consultantts)
 

Symptoms


Nipple irritation

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  • The nipple is unusually sensitive because it isn't used to external stimuli.
  • There is nipple soreness with no visible damage, etc.
  • The pain can be an initial symptom of internal bleeding, blisters and cracking (rhagades).

Reddened skin

  • The surface skin of the nipple is thin.
  • The surface skin is partly peeling off, and the sub-epidermal layer is visibly inflamed.

Bleeding, internal bleeding

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It is believed that there is edema or pooled blood in the nipple, and the negative pressure produced by the baby's sucking promotes anoxia in the papillary tissues, which increases capillary permeability and leads to burst capillaries and internal bleeding.

Crack

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Created on the tip, sides and neck of the nipple; it resembles chapped skin and hurts when pressed or sucked.

Blisters

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Often caused by shallow sucking and deficient milk discharge.

Leucoderma

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  • White blobs of about 1mm in diameter found on the tip of the breast duct; these cause intense pain during breastfeeding.
  • It is believed to be related to breast duct closure.

Bite wound

  • Occurs when the baby bites the nipple.
  • Found mainly in the neck region of nipple.

Cause


Transient nipple soreness in the early postpartum period

What kind of nipple soreness?

  • Temporary pain in the nipple occurs in the early postpartum period even when the baby sucks appropriately.
  • The pain goes away in 20-30 seconds.
  • The pain achieves its peak 3-6 days postpartum.
  • After reaching its peak, the pain goes away as breastmilk secretion increases.

Why?

  • The nipple is too sensitive in the early postpartum period.
  • The breastmilk secretion mechanism hasn't started to function completely.

Nipple soreness caused by holding the baby inappropriately and by the baby sucking inappropriately.


What kind of nipple soreness?

  • Many kinds of early postpartum nipple soreness are said to be caused by holding the baby inappropriately or by the baby sucking inappropriately.
  • Occurs rapidly when baby starts sucking.
  • Pain slowly goes away, but it continues during breastfeeding. The skin from the tip of the nipple to the whole areola hurts.

Why?

  • The baby doesn't latch firmly onto the areola, but shallowly.
  • The baby sucks on with pursed lips.
  • The baby's whole body isn’t turned to face the mother.
  • The baby isn't held tightly to the mother, etc.
  • Example01

    Example of baby not held to mother tightly.

  • Example02

    Example of baby held appropriately while breastfeeding.

Nipple soreness caused by the baby sucks inappropriately


Why?

  • The baby is pressing nipple while sucking.
  • The baby sucks on with pursed lips.
  • The baby is sucking with her tongue pulled back behind the gum, etc.

Nipple soreness caused by enforced removal of breast from baby's mouth

Why?

  • Removing the baby from the breast before the baby is satisfied.

Nipple soreness caused by thrush infection


What kind of nipple soreness?

  • Stringing feeling with itching and a stabbing, burning pain in the whole breast or deep inside the breast, whether breastfeeding or not.
  • The breast and nipples shine pink or red, become swollen and the skin becomes so thin that it almost peels off.
  • The pain doesn't go away even when baby latches on appropriately.

Why?

  • Candida can occur anytime.
  • It is especially possible when the baby has an oral Candida infection or diaper rash or when the mother has colpitis.

Nipple soreness caused by other nipple infections


Why?

  • Caused by Staphylococcus aurous and hemolytic Streptococcus.

Nipple soreness caused by the use of creams and ointments

Why?

  • Pain can get worse by using the wrong ointment or cream.

Baby bites the nipple


Why?

  • The baby won’t bite when latched on appropriately, but will sometimes bite not sucking.

Coping strategies


  • Application of breastmilk
    Nipple tissues are hydrated and healed by applying expressed breastmilk after breastfeeding.
  • Application of medical treatment
    Promotes the recovery of wounds by hydrating the affected area.
  • Use of nipple shield.

Not producing sufficient breastmilk


There may also be physiological reasons for breastmilk insufficiency

Signs that a baby is not gaining weight adequately


  • He grows less than 18 grammes/day.
  • He has not recovered his birth weight by three weeks.
  • His growth line is not rising appropriately on the growth curve.
  • He sleeps for long periods of time to conserve energy.
  • He seems lethargic and has a weak or high pitched cry.
  • His urine output may be low with concentrated urine; or urinary output may be normal. Urinary output alone is not a reliable measure of weight gain.
  • He has very few stools, or none at all.
  • He may stay at the breast consistently.
  • He may have a worried look on his face, with hanging folds of skin on his body.

(Source: UNICEF WHO, "UNICEF/WHO Breastfeeding Management and Promotion in a Baby-Friendly Hospital, an 18-hour course for maternity staff”, 1993, p. 69)

(Caution) Poor weight gain is not just caused by breastmilk insufficiency. Don't try to judge by yourself; consult an expert.

Lack of breastmilk intake and hyposecretion of breastmilk


There are two types of breastmilk insufficiency:
Lack of breastmilk intake and hyposecretion of breastmilk. Refer to the following coping strategies and consult an expert such as doctors, midwives, and lactation consultants.

  • Lack of breastmilk intake

    Insufficiency of breastmilk intake because of inappropriate breastfeeding style and poor sucking of baby

    Coping strategy
    • Check how to hold your baby (positioning) and how to help your baby suck on (latch on), and modify if necessary.
    • Don't limit the frequency or duration of breastfeeding; allow your baby to nurse as often and as much as he wants.
  • Hyposecretion of breastmilk
    • Actual insufficiency of the breastmilk produced by the mother
    • Sometimes caused by breastmilk intake insufficiency
    • Divided into 2 types:
      Primary breastmilk hyposecretion, which occurs for medical reasons such as mammary gland hypoplasia, and secondary breastmilk hyposecretion, in which even though the ability to produce breastmilk is present, appropriate support is not provided and the amount of breastmilk secreted doesn’t increase, and may decrease.
  • Coping strategy

    If you have breastmilk hyposecretion caused by medical reasons, breastmilk production can often be insufficient and appropriate supplements are needed.
    If one breast has secretion insufficiency, you still can get sufficient breastmilk secretion from the other breast only. Milk expression is also effective in increasing breastmilk secretion.

Supplementing breastfeeding when the amount lactated is insufficient, in order of priority


  • Freshly expressed mother’s own milk
  • Chilled breastmilk
  • Frozen and thawed breastmilk
  • Infant formula

When you feel that your breastmilk is insufficient


Learn the signs that your baby is drinking breastmilk

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The baby's appearance, how the baby drinks breastmilk, the amount and frequency of urine and stool output and the baby's body weight are indicators of whether enough breastmilk is being produced.
Baby's frequent crying and slight engorgement of the breast do not indicate that insufficient breastmilk is being produced. Breastmilk secretion increases and the amount of breastmilk produced stabilizes as you continue to breastfeed.

Baby's appearance and causes


There can be other causes of the symptoms that are making you think that your breastmilk is insufficient.

For example,
  • Your baby cries frequently, wakes up and cries while asleep Even when your baby has consumed enough breastmilk, he can be in a bad mood or sleep only lightly for other reasons.

  • Your baby wants to nurse frequently Because breastmilk is easily digested and doesn't produce a long-lasting feeling of satiety, breastfeeding intervals are often short.
    Additionally, your baby's rate of growth will not always be the same. During periods when your baby is growing more quickly, your baby will want breastmilk frequently.

  • Your breasts don’t become engorged The mother's breasts often stop being engorged a few weeks after the baby's birth, but this doesn't mean that breastmilk production has decreased.

  • Your breasts grow smaller It is said that breast size has nothing to do with breastmilk production.

  • The amount of breastmilk your baby takes in is small The amount of intake differs from baby to baby. A more accurate indicator is whether your baby is gaining weight appropriately.

  • Only a little breastmilk is expressed It is said that the amount of milk secreted and the amount the baby takes in are not the same.

Signs that a newborn is receiving sufficient breastmilk


  • He breastfeeds at least eight times in 24 hours.

  • During a feed, his suckling rhythm will slow down as milk is released, and swallowing or gulping may be heard.

  • He is alert, and has good muscle tone and healthy skin.

  • He is contented between feeds (though well-fed babies may be fussy for other reasons, leading mothers to believe they don’t have enough milk).

  • He has six or more wet diapers in 24 hours; with pale, diluted urine.

  • He will have three to eight bowel movements in 24 hours. As babies grow older, stooling may be less frequent.

  • He shows a consistent weight gain, with an average of 18-30 grammes/day.

  • The mother's breasts may feel full before a breastfeed and softer afterward, though not all women experience a dramatic change.

(Source: UNICEF WHO, "UNICEF/WHO Breastfeeding Management and Promotion in a Baby-Friendly Hospital, an 18-hour course for maternity staff”, 1993, p. 68)

Diet during the breastfeeding period


Be careful about your diet for the sake of your baby.

Well-balanced diet

Post-partum mothers need more energy and nutrition than during pregnancy in order to produce breastmilk. During this period, the mother may suffer from poor sleep because she is taking care of her baby and may keep irregular hours.
Under these conditions, mothers tend to neglect their diets. Be sure to maintain a balanced diet for your sake and that of your baby.
Give yourself 6 months to lose the weight you gained during pregnancy and return to a standard weight. Don’t try to restrict your diet excessively so that you can lose weight faster, as this may affect not just your health, but also the health of the baby drinking your breastmilk.

Chance to increase the mother's bone mass

A mother's bone mass decreases substantially during pregnancy and breast-feeding. But women have a chance to increase bone mass during the 6 months to one year after their periods restart following pregnancy. During this time, it’s almost as if there is a skilled carpenter inside their bodies building stronger bones.
If you supply the building blocks of bones - calcium and vitamin D - then stronger bones will be produced. Take this opportunity to build stronger bones. Dairy products, small fish, beans, seaweed and wheat are all rich in calcium. Dairy products, eggs and mushrooms (cloud ear and dried shiitake) are rich in vitamin D.

The effects of drinking and smoking

Frequent drinking during pregnancy increases the possibility of fetal alcohol syndrome, which can mean congenital abnormalities, mental handicaps, and development disorders. You will probably also be offered celebratory drinks after your baby is born. Maybe you’re tempted because you’ve abstained for so long. But please wait a little longer, for the sake of your baby. As much as 2% of any alcohol you drink will find its way into your breastmilk. Drinking and smoking can also decrease the amount of milk secretion and inhibit the growth of your baby. Your baby's ability to rid the body of alcohol is poorly formed, and a very little can have an incomparably greater effect than on adults.
Mothers who smoke produce less breastmilk than who don’t smoke. It has also been reported that nicotine has direct effect on babies, including causing vomiting, diarrhea, an increased pulse rate and restlessness. The whole family should take the opportunity afforded by pregnancy to give up smoking.

The effects of caffeine

It is said that when mothers drink beverages, such as green tea and coffee, that contain caffeine, the caffeine is excreted in the breastmilk *1. Limit as much as possible your intake of products that contain caffeine, since breastmilk that contains caffeine can cause sleeping disorders in your baby. *2.

*1 Source:Berlin, C., et al.: Disposition of dietary caffeine in milk, saliva, and plasma of lactating women, Pediatrics, p. 73, p. 59-63, 1984
*2 Source:Supplements & Health Support Food Data Base Ver. 1, National Institute of Health Sciences, p. 144, 2007

How to help your baby latch on


Help your baby latch on appropriately and breastfeed comfortably.

Mothers generally breastfeed their babies 8-12 times a day, for 10-30 minutes each time. This means that it is important for the mother to be able to feel relaxed in a stress-free environment so that she can continue to breastfeed.

Holding your baby appropriately (positioning) and helping your baby suck on the nipple (latch on) are very important for smooth breastfeeding. Appropriate positioning and latching on will help prevent various problems and reduce risks, will help the baby drink breastmilk effectively and will reduce stress on the mother's breasts. Here we will introduce specific tips for breastfeeding.

How to help your baby latch on to your nipple

“Latch-on” means the way the baby attaches to the nipple and breast for the purpose of breastfeeding. Proper positioning is key for effective latch on so that the baby can get enough breastmilk.

First take a look at how the baby latches on to mother's breast and how the baby is breastfed.

When being breastfed, a baby moves mouth and tongue in a different way from that of an adult when drinking something through a straw. It is called “peristaltic movement”, and derives from innate sucking reflex movements.
A newborn baby also has a round dent in the center of the upper jaw, called the “sucking fossa.” This dent appears during the specific period of time when the baby is breastfeeding; the nipple is held between the dent and the thick fat layer inside the cheek. The sucking fossa disappears by itself when the baby is done with breastfeeding. In other words, the mouth and tongue of a human baby is innately and elaborately developed for the purpose of breastfeeding.

The peristaltic movement causes negative pressure, which pulls the breastmilk out through the nipple.
The tongue moves in a wave-like motion (peristaltic movement) that passes from the tip of the tongue to the root of the tongue in about 0.7 seconds.

latch

*Pigeon was the first in the world to explain the mechanics of this special muscle contraction in infants, using an intra-oral camera.
Help your baby latch on properly to take full advantage of this peristaltic movement that the baby is born with.

  • Position1
    Position the baby so that the baby's nose faces the nipple. The baby’s lower jaw should be touching the bottom of the areola.
  • Position2
    Touch the baby's lips with a nipple or areola to stimulate the searching reflex. Wait until the baby opens the mouth, and move the baby closer to the nipple.
  • Position3
    The part of the areola next to the baby's lower jaw enters the baby's mouth first. Check to see if the baby has firmly latched on to the nipple.
  • Position4
    Your baby will usually leave the nipple when he or she has had enough milk, but sometimes not. If that happens, slide your finger into the side of the baby's mouth to break the seal and stop the baby from sucking.

Column

Signs that a baby is attached for effective suckling

  • The baby's mouth is open wide.
  • The baby's chin is touching the breast.
  • The baby's lower lip is curled outward.
  • The baby suckles, pauses, and then suckles again 窶? in slow, deep sucks.
  • The mother may hear the baby swallowing.

Latch on timing

The waking states that are best for latching on are said to be phases 3-5 of Brazelton’s newborn awareness levels.

  • Phase 1: Deep sleep
  • Phase 2: Shallow sleep
  • Phase 3: Slumber
  • Phase 4: Calmly awake
  • Phase 5: Actively awake
  • Phase 6: Crying

It is also said that babies give the following signals when they are ready to breastfeed:

  • Wiggling the body
  • Bringing the hands to mouth and face
  • Moving the mouth in a sucking motion, etc.

(Source:Brazelton, T. B. (Tomitaro Akiyama, supv., Chisato Kawasaki, trans.), "Brazelton Neonatal Behavioral Assessment Scale, Ver. 3," Ishiyaku Pub, Inc., 1998)

img_1_8

Some mothers also take the following action when breastfeeding.

Because the mother’s clothes can cover the baby’s face and prevent the baby from latching on, the mothers use rubber bands or hair clips to fasten their clothing back.
We hope that both mother and baby will find positions for breastfeeding that are comfortable for them.

How to hold your baby


Hold your baby appropriately so that you can breastfeed comfortably

Mothers generally breastfeed their babies 8-12 times a day, for 10-30 minutes each time. This means that it is important for the mothers to be able to feel relaxed in a stress-free environment so that they can continue to breastfeed.

Holding your baby appropriately (positioning) and helping your baby suck on the nipple (latch on) are very important for smooth breastfeeding. Appropriate positioning and latching on will help prevent various problems and reduce risks, will help the baby drink breastmilk effectively and will reduce stress on the mother's breasts. Here we will introduce specific tips for breastfeeding.

Basic positioning

  • Side hold/cradle hold
  • Cross cradle hold/transitional hold
  • Clutch hold/football hold
  • Straddle hold

How to hold your baby (positioning)

Positioning involves holding the baby appropriately while breastfeeding, and also maintaining the appropriate posture while breastfeeding. There are 3 main ways to position your baby, and for all of them, the following items are important.


How to hold your baby (positioning)

positioning01

The mother feels relaxed and comfortable while reclining against cushions or a wall. The baby is awake and calm, and is not crying.


How to hold your baby (positioning)

positioning02

The mother and baby are in close contact with each other, and the baby's head is aligned with the baby's body; the ears, shoulders and lower back form a straight line, facing the breast.


How to hold your baby (positioning)

positioning03

When supporting the breast in one hand, the fingers should be far enough away from the areola. Support the entire breast with your hand; don't just squeeze the nipple with two fingers to push it out. (You won’t always need to support your breast with your hand).

Find the posture that is most comfortable for you based on the above criteria.

Basic positioning

1. Side hold/cradle hold

Hold the baby at breast level; your stomach and that of your baby should be close together, with the baby facing you. Support your baby’s head on the arm that is on the same side as the breast you are nursing with. This is one of the most common breastfeeding positions.

cradle-hold


2. Cross cradle hold/transitional hold

In this position, you support the baby’s head (base of the neck) using the arm on the opposite side of the breast you are nursing with. Support that breast with the opposite hand with which you are holding your baby.Babies sometimes don’t like it if you press too strongly on their heads, and this position is good for such babies. It is a better position for babies who have difficulty latching on and for babies with low birth weight, and you can control the movement of your baby’s head better. You can shift to the more common cradle hold after the baby has latched on tightly and started to drink.

transitional-hold


3. Clutch hold/football hold

Support the breast with the hand on the opposite side of the breast your baby is nursing from, and support the baby's head and body with the other hand. Your baby’s legs will pass under the arm supporting the baby, and point toward the rear. Hold your baby close to your side.This positioning is good for babies who have difficulty latching on, for babies with delicate health, and if you have to breastfeed from different directions because of nipple or breast problems. It is also good for mothers with Caesarean scars, since the baby won’t be pressing directly against the abdominal area.

football-hold


4. Straddle hold

Sit the baby on your knee and support the baby's head and shoulders. This position is better for babies who have difficulty latching on firmly, and for smaller babies.

Straddle-hold

breastfeeding

Some mothers also take the following action when breastfeeding.
Because the mother’s clothes can cover the baby’s face and prevent the baby from latching on, the mothers use rubber bands or hair clips to fasten their clothing back.

We hope that both mother and baby will find positions for breastfeeding that are comfortable for them.

Components of breastmilk


Take a look at the contents of breastmilk, which change over time.

Breastmilk has various advantages, one of which is that it contains well-balanced nutrients, including fat, lactose and protein, which are the main ingredients. The proportions of these ingredients are automatically adjusted at different times to match the growth of baby. This makes breastmilk the best food for your baby.

Breastmilk components and their functions

Fat, lactose and protein, the main components of breastmilk, have the characteristics below. Lactose is a source of energy and is contained the largest proportion (among fat, lactose and protein) in breastmilk.
Fat is an important ingredient in the development of your baby's brain and in the maintenance of the body structure.
Protein is broken down into amino acids when it is absorbed into your baby's body, and becomes a source for building muscles. It also contains important immunoproteins such as lactoferrin and IgA.

Other components have the functions explained below.

  • They reduce the risk of allergies developing
    Breastmilk has a substance that forms a protective coating on the intestinal wall, and promotes the development of the intestinal epidermis. Thus it prevents allergens from invading through the baby's intestines, which have numerous openings.
  • They help breastmilk be easily digested and absorbed
    Breastmilk contains enzymes such as lipase and amylase that help with digestion, so it is easily digested and absorbed by babies with fragile intestinal systems.

Change in breastmilk components

The components of breastmilk change according to different factors, including the number of days postpartum, the season and the mother’s diet. The composition of breastmilk changes each time your baby nurses, and even changes as your baby is nursing. Here is how the components change according to the number of days postpartum and with each breastfeeding.

  • Change of components in one breastfeeding
    The breastmilk released each time your baby begins breastfeeding is called fore milk, and this is followed by hind milk. As breastfeeding continues, the fat content, which is a source of energy and is important for the development of the brain and the maintenance of the body structure, increases.

    breast-feeding-advisor-graph1

    Conditions: Express breastmilk using a Pigeon Electric breast pump 5 times, 10 ml each. 5 ml of each sample was dispensed into test tubes, and centrifuged (3,000 rpm × 5 min.)

  • Change in breastmilk components according to postpartum date.
    Breastmilk is separated into two main groups, colostrum and mature milk.
    Colostrum is the breastmilk secreted until the fifth postpartum day. It is characterized by the large content of immunoproteins, such as lactoferrin and IgA. This breastmilk looks yellow because it contains β-carotene, which is also found in carrots and other vegetables.
    Mature milk is the breastmilk that is secreted 10 days postpartum. It is characterized by a lower protein content and higher content of lactose and fat as compared to the colostrum, making it higher in calories. Breastmilk at this time looks milky white.

    As stated above, breastmilk is a nourishing food that only mother can produce.
    Breastfeeding in infancy helps babies grow healthy in all the best ways.

    breast-feeding-advisor-graph

    Postpartum date
    Time course of breast milk contents Indicated by relatove values, contents of 3rd-5th postpartum date as 100%.

    Refferense:Itoda et al., 1991, Japanese Journal of Pediatric Gastroenterology, Nutrition 5(1), P145-158

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Human breastmilk has the highest content of lactose and the lowest content of protein.
Seals and whales that live under rough conditions in the ocean, in polar regions or in the desert, are generally said to produce breastmilk with a very high fat content, much higher in fat than that of dogs, pigs and humans, which have longer breastfeeding periods.

Chart 3.2 Breast milk compositions of each mammal (%)

AlassificationAnimalSolid ContentFatProteinLactoseMineral
Animals which have longer
breastfeeding priods
rabbit36.918.213.92.11.8
mouse29.313.1931.3
dog23.512.993.11.2
pig18.86.655.50.6
Animals which feeds according to
baby's demand
human12.43.81.570.2
horse11.21.92.56.20.5
cow12.73.73.14.80.7
monkey15.441.670.2
Animals under rough conditionsmole3520100.10.8
seal65.453.38.90.50.6
whale57.142.31111.4
polar bear47.633.110.90.31.4

Mechanism of breastmilk secretion


img_3

Action of hormones

When a baby sucks on the nipple, the stimulation is transmitted to the pituitary gland and hormones called prolactin and oxytocin are produced. Prolactin conveys commands to change blood into breastmilk, and oxytocin operates to push out the breastmilk that accumulates in the breast ducts.
Breastmilk is released when the baby sucks on the nipple. It may not work at first, as both baby and mother are beginners, but with repetition, both will grow more adept at it.


img_4

Mechanism of breastmilk secretion

The acinar is composed of a large number of acinar cells.
Breastmilk is produced in acinar cells, and secreted inside the acinar. It is released from the body through breast ducts. Myoepithelial cells around the acinar contract like a pump to discharge the breastmilk.

Advantages for both mother and baby


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Breastmilk is best for mother and baby

Breastfeeding is an ideal way for mother and baby to bond. In addition to that, there are other advantages to both, as below.

Baby

  • Provides balanced nutrition
  • Reduces immunity and infection risks
  • Is easily digested and absorbed

Mother

  • Helps with uterine contractions and with restoring the body to its prenatal condition
  • Doesn’t need the amount of work required to prepare baby formula
  • Is economical

Additionally, it is said that breastfeeding is effective in helping mothers lose weight. It also helps reduce the risk of breast cancer, ovarian cancer, infant diabetes, pediatric cancer, obesity, and allergies, and promotes mental abilities and cognitive faculty.