Brestfeeding

These are some of the questions that women ask themselves before or during breastfeeding:

“I am breastfeeding and I don't know if I can take a medication, what do I do?”

“How long should I breastfeed?”

“What is the correct position for breastfeeding? How do I know I'm doing it right?”

“How long should a feeding last? How often should I breastfeed my son/daughter?”

“Should I have any dietary restrictions during breastfeeding?”

“Can I get pregnant while breastfeeding? What contraceptive method is safe to use while breastfeeding?”

Breastfeeding is one of the issues that can cause the most stress for mothers in the first weeks after giving birth. All options are valid and respectable, as doctors we are available to advise and support you as best as possible, whatever option you choose.

If the option chosen is breastfeeding, this post aims to provide some information that will be helpful to you at this stage. If the chosen option is to opt for bottle-feeding, we are here to support you in this decision as well.

The production of milk to feed your babies is the main objective of the mammary gland:

Milk production occurs when the baby's sucking stimulates the production of prolactin and oxytocin by the pituitary gland. This causes the milk-producing cells in the alveoli to produce milk and in turn the muscles of these alveoli to contract, directing the milk towards the nipple through the ducts.

Nipple stimulation by the newborn begins after birth.

We are going to try to answer some of the most frequently asked questions:

How long should I breastfeed?

The WHO recommends exclusive breastfeeding for the first 6 months of a newborn's life and then combined breastfeeding for 2 years. However, this is adaptable to each woman, each baby and the unique circumstances of each one.

It is perfect to breastfeed for 3 years, and it is perfect to breastfeed for 4 months. We all do the best we can.

What is the composition of milk?

Colostrum is produced in the first few days, which is a milk very rich in fat and cholesterol. The composition is then modified to meet all the nutritional needs of the baby during the first 6 months of life.

In addition, milk contains antibodies that help protect the newborn from many childhood diseases.

What is the correct position?

The latch on to the breast is important. The most commonly used standard position is that of the head and body aligned perpendicular to the axis of the breast and with a slight deflection of the head, with the mouth open, the lips everted, the chin and cheek touching the breast. There must be a good sucking rhythm with the hearing of swallowing without clicking.

This latch is independent of the baby's orientation with respect to the mother. There are multiple ways of placing the baby on the breast (in front of the mother, in a rugby ball position, stretched out...), although the ideal latch is one.

How often and how long should breastfeeding last?

Breastfeeding is generally not scheduled, it depends on milk production, the length of the feeding, the time the baby is latched on without sucking…

It is a very difficult question to answer and there is no single answer. If the feedings last more than half an hour, we could check with a lactation consultant if the latch and suction are the most optimal.

The first few days or weeks, the frequency of feedings is usually more frequent, later the milk production is regulated to the needs of the baby and they are more spaced out. That said, there are no universal rules and each breastfeeding experience is different, even the same mother with different children.

What happens if I should take any medication during breastfeeding?

In general, both for breastfeeding and non-breastfeeding women, the unnecessary use of medication should be avoided, especially during pregnancy and breastfeeding. That said, there are very few medications that are incompatible with breastfeeding.

It is true that the drug leaflets are often not clear enough, and this causes many doubts and uncertainty.

A good resource is the portal: www.e-lactancia.org, which offers an updated review on the use of drugs during breastfeeding

Should I adapt my diet during breastfeeding?

A healthy and balanced diet is recommended, with a correct intake of proteins, carbohydrates and fats. Breastfeeding is a great strain on the mother, so it is recommended to pay attention to the diet and even consider taking supplements aimed at breastfeeding. It is advisable to increase the intake of calcium and omega 3 fatty acids, present in fish and nuts.

On the other hand, some babies develop intolerance to cow's milk, egg protein or nuts, which would manifest itself in the form of colic, gas, irritability in the newborn. If you suspect that your baby could be sensitive to dairy products, consult your pediatrician. It would be advisable to stop consuming dairy products and derivatives for a while, and observe if there is any change in the symptoms.

It is also true that some foods modify the taste of milk, such as spicy foods, citrus fruits... In this sense, the most appropriate thing is to observe your baby, and if you think that after eating some food he/she has colic-like symptoms, you can limit his/her consumption. But if the newborn does not show any problems, there is no need to give it any more thought and you can enjoy your meals normally.

Can I get pregnant while breastfeeding? What contraceptive method can be used?

During breastfeeding, due to the increase in prolactin, the pituitary gland inhibits the pulse of hormones that induce ovulation. As long as there is no ovulation, there is no possibility of pregnancy.

Many women, especially during the first months of breastfeeding, experience this lack of ovulation and do not have their period. This means that during those months, there has been no possibility of pregnancy.

The danger occurs because when ovulation starts again, the woman will not know until 14 days later, more or less, when she would have her period again. It is at this time that the possibility of becoming pregnant again arises, and that is why there are some cases of unexpected pregnancy during this period.

To avoid becoming pregnant during breastfeeding, barrier methods such as condoms can be used. Another option would be to insert an intrauterine device (IUD) or use contraceptives that contain only progesterone. Combined contraceptives, which contain estrogen and progesterone, cannot be used during breastfeeding, since estrogen crosses the placental barrier and reaches the infant.

In summary, methods that could be used:

1. Condom
2. IUD
3. Progesterone-based oral contraceptives

Bibliography:

1. Manual de la Práctica Clínica en Senología 2019. 4a edición. Capítulo 20, pag 164-170
2. Anatomía del pecho. UNICEF y OMS. Consejería en lactancia materna: curso capacitación. OMS. WHO/CDR/93,3-5. Ginebra; 1993 (Marzo2019). http://www.who.int/maternal_child_adolescent/documents/who_cdr_93_3/es/
3. Vinther T, Helsing E. Breastfeeding: How to support success. A practical guide to health workers: World Health Organization. Regional Office for Europe. Copenhagen; 1997 (Marzo 2019) http.//www.who.int/iris/handle/10655/108051
4. https://www.who.int/es/health-topics/breastfeeding#tab=tab_1