Nursing or breastfeeding is the feeding of babies and young children with milk from a woman’s breast. Breasts begin producing mature milk around the third or fourth day after birth. Early in a nursing session, the breasts produce foremilk, a thinner milk containing many proteins and vitamins. If the baby keeps nursing, then hindmilk is produced. Hindmilk has a creamier color and texture. There is increasing evidence that suggests that early skin-to-skin contact (also called kangaroo care) between mother and baby stimulates breastfeeding behavior in the baby. Newborns who are immediately placed on their mother’s skin have a natural instinct to latch on to the breast and start nursing, typically within one hour of birth. Immediate skin-to-skin contact may provide a form of imprinting that makes subsequent feeding significantly easier. In addition to more successful breastfeeding and bonding, immediate skin-to-skin contact reduces crying and warms the baby. Children who are born preterm have difficulty in initiating breast feeds immediately after birth. By convention, such children are often fed on expressed breast milk or other supplementary feeds through tubes or bottles until they develop satisfactory ability to suck breast milk. Health organizations recommend breastfeeding exclusively for six months following birth, unless medically contraindicated. According to studies cited by UNICEF, babies naturally follow a process which leads to a first breastfeed. Initially after birth the baby cries with its first breaths. Shortly after, it relaxes and makes small movements of the arms, shoulders and head. If placed on the mother’s abdomen the baby then crawls towards the breast, called the breast crawl and begins to feed.When the baby suckles its mother’s breast, a hormone called oxytocin compels the milk to flow from the alveoli (lobules), through the ducts (milk canals), into the sacs (milk pools) behind the areola, and then into the baby’s mouth. After feeding, it is normal for a baby to remain latched to the breast while resting. This is sometimes mistaken for lack of appetite. Absent interruptions, all babies follow this process. Rushing or interrupting the process, such as removing the baby to weigh him/her, may complicate subsequent feeding. Activities such as weighing; measuring, bathing, needle-sticks, and eye prophylaxis wait until after the first feeding. It is recommended by Health professionals for mothers to initiate breastfeeding within the first hour of a baby’s life and continue as often and as much as the baby wants. The baby is placed on the mother and feeding starts as soon as the baby shows interest.Newborn babies typically express demand for feeding every one to three hours (8–12 times in 24 hours) for the first two to four weeks. Newborn babies typically express demand for feeding every one to three hours (8–12 times in 24 hours) for the first two to four weeks. A newborn has a very small stomach capacity. At one-day old it is 5–7 ml, about the size of a large marble; at day three it is 22–30 ml, about the size of a ping-pong ball; and at day seven it is 45–60 ml, or about the size of a golf ball. Many newborns will feed for 10 to 15 minutes on each breast. If the infant wants to nurse for a much longer period—say 30 minutes or longer on each breast—they may not be getting enough milk. According to some authorities the majority of infants do not immediately begin to suckle if placed between the mother’s breasts but rather enter a period of rest and quiet alertness. During this time they seem to be more interested in the mother’s face, especially her eyes, than beginning to suckle. It has been speculated that this period of infant-mother interaction assists in the mother-child bonding for both mother and baby. Hormones released during breastfeeding help to strengthen the mother baby bond. During the first few weeks of life babies may nurse roughly every two to three hours, and the duration of a feeding is usually ten to fifteen minutes on each breast. The Health organizations, including the World Health Organization (WHO), recommend breastfeeding exclusively for six months. This means that no other foods or drinks, other than possibly vitamin D, are typically given. After the introduction of foods at six months of age, recommendations include continued breastfeeding until one to two years of age or more. Globally, about 38% of infants are only breastfed during their first six months of life. Medical conditions that do not allow breastfeeding are rare. Mothers who take certain recreational drugs and medications should not breastfeed. Smoking tobacco and consuming limited amounts of alcohol and/or coffee are not reasons to avoid breastfeeding. Support for breastfeeding is universal among major health and children’s organizations. WHO states, “Breast milk is the ideal food for the healthy growth and development of infants; breastfeeding is also an integral part of the reproductive process with important implications for the health of mothers .Breastfeeding has a number of benefits to both mother and baby, which infant formula lacks Breastfeeding is also less expensive than infant formula Breastfeeding decreases the risk of a number of diseases in both mothers and babies..Researchers report that babies who receive no breast milk are almost six times more likely to die by the age of one month than those who are partially or fully breastfed. The Deaths of an estimated 820,000 children under the age of five could be prevented globally every year with increased breastfeeding. Breastfeeding decreases the risk of respiratory tract infections and diarrhea for the baby, both in developing and developed countries. Approximately 60% of full-term infants develop jaundice within several days of birth. Jaundice, or yellowing of the skin and eyes, occurs when a normal substance, bilirubin, builds up in the newborn’s bloodstream faster than the liver can break it down and excrete it through the baby’s stool. By breastfeeding more frequently or for longer periods of time, the infant’s body can usually rid itself of the bilirubin excess. Other benefits include lower risks of asthma, food allergies, and type 1 diabetes. Breastfeeding may also improve cognitive development and decrease the risk of obesity in adulthood. Mothers may feel pressure to breastfeed, but in the developed world children generally grow up normally when bottle fed with formula. Benefits for the mother include less blood loss following delivery, better uterus shrinkage, and decreased postpartum depression. Breastfeeding delays the return of menstruation and fertility, a phenomenon known as lactational amenorrhea. Long-term benefits for the mother include decreased risk of breast cancer, cardiovascular disease, and rheumatoid arthritis. Before pregnancy the breast is largely composed of adipose (fat) tissue but under the influence of the hormones estrogen, progesterone, prolactin, and other hormones, the breasts prepare for production of milk for the baby. There is an increase in blood flow to the breasts. Pigmentation of the nipples and areola also increases. Size increases as well, but breast size is not related to the amount of milk that the mother will be able to produce after the baby is born. Correct positioning and technique for latching on are necessary to prevent nipple soreness and allow the baby to obtain enough milk. By the second trimester of pregnancy colostrum, a thick yellowish fluid, begins to be produced in the alveoli and continues to be produced for the first few days after birth until the milk “comes in”, around 30 to 40 hours after delivery.Oxytocin contracts the smooth muscle of the uterus during birth and following delivery, called the postpartum period, while breastfeeding. Oxytocin also contracts the smooth muscle layer of band-like cells surrounding the alveoli to squeeze the newly produced milk into the duct system. Oxytocin is necessary for the milk ejection reflex, or let-down, in response to suckling, to occur. If breastfeeding is suddenly stopped a woman’s breasts are likely to become engorged with milk. Pumping small amounts to relieve discomfort helps to gradually train the breasts to produce less milk. Not all of breast milk’s properties are understood, but its nutrient content is relatively consistent. Breast milk is made from nutrients in the mother’s bloodstream and bodily stores. It has an optimal balance of fat, sugar, water, and protein that is needed for a baby’s growth and development. Breastfeeding triggers biochemical reactions which allows for the enzymes, hormones, growth factors and immunologic substances to effectively defend against infectious diseases for the infant. The breast milk also has long-chain polyunsaturated fatty acids which help with normal retinal and neuraldevelopment.The composition of breast milk changes depending on how long the baby nurses at each session, as well as on the child’s age. The first type, produced during the first days after childbirth, is called colostrum which is easy to digest although it is more concentrated than mature milk. It has a laxative effect that helps the infant to pass early stools, aiding in the excretion of excess bilirubin, which helps to prevent jaundice. Colostrum also contains a substance which is new to the newborn, secretory immunoglobulin A (IgA) that works to attack germs in the mucous membranes of the throat, lungs, and intestines, which are most likely to come under attack from germs. It is important to mention that all medicines pass into breast milk in small amounts so mother must be careful while taking any drug during breast feeding. Colostrum also helps to seal the infants gastrointestional tract from foreign substances, which may sensitize the baby to foods that the mother has eaten.
World Breastfeeding Week is marked every year between 1 to 7 August to raise awareness on the importance of breastfeeding for mothers and infants. There is a direct influence of the nutritional status of the mother on the quality of breast milk she produces which further has an impact on the health of the baby. Breastfed babies have stronger immune systems, fewer risk of infections, less overall illness, and fewer gastrointestinal problems. At the same time, breastfeeding is a healthy practice for new mothers as it aids post-partum recovery, reduces the risk of cancer, helps burn calories, stimulates the uterus to return to its normal size, and creates an emotional bonding with the new-born. Successful breastfeeding requires a constant dose of healthy nutrients that boost milk supply and help enhance the health status of the mother and the baby. There is an additional requirement of 500 extra calories per day for women who breastfeed and there are certain nutrients that are quintessential. Blow are given some healthy food choices lactating mothers can adapt to (a) Folic Acid: Folic acid is also known as vitamin B9 and it is essential to nourish the new-born when it passes from the breast milk. It helps in the production of new and healthy cells and at the same time, it also boosts the brain health of the baby. Folic acid can be obtained from dark green leafy vegetables like spinach, kale, and arugula. It is also found in beans, lentils, peas, walnuts, flaxseeds, peanuts, whole grains, and sunflower seeds.(b) Protein-rich Foods: Optimum protein intake helps to nourish and support the growth of the baby while it also helps in stimulating breast milk. Lactating mothers often require an additional 25 grams of protein in their daily diet. As a rule, breastfeeding women should include protein-rich foods in breakfast, lunch, and dinner, every single day. Good protein-rich sources include- lean meat, poultry, dairy products, legumes, pulses, whole grains, nuts, seeds, and some vegetables. (c)Iron-rich foods: Iron is required for the formation of red blood cells in mothers and the baby. Iron helps to carry oxygen in the blood and a lack of it can lead to fatigue, tiredness, and diminished energy levels. The infant’s brain and body need iron and oxygen to grow. The best sources of iron are lean meats, especially liver and kidney. Green leafy vegetables, cooked beans, and peas are also good sources of iron. Other food sources include- cashews, baked potatoes, pumpkin seeds, whole grains, and flaxseeds. To absorb more iron from vegetables, eat foods rich in vitamin C at the same time like citrus fruits, tomatoes, or broccoli. Tea and coffee reduce iron absorption, so the intake should be limited. (d) Calcium-rich foods: Calcium is a mineral essential throughout life but while nursing, a woman can lose 3-5% of bone mass and this mineral becomes all the more important. About 1000 milligrams of calcium per day is the ideal recommendation for a breastfeeding mother. Calcium is crucial for the bone, teeth, and muscle development of the baby and it prevents the future risk of bone-related disorders like osteoporosis for the mothers. Dietary sources of calcium include- dairy products like milk, ghee, buttermilk, yogurt, and cottage cheese. It is also found in dark green leafy vegetables, soy products, sesame seeds, sunflower seeds, quinoa, ragi, chickpeas, and some pulses. (e) Galactagogues: Any herb, food, or medicine used to boost the supply of breast milk is known as a galactagogue. Certain types of natural herbs are being used since ancient times helping women to boost their milk supply. Natural galactagogues include- whole grains like oats and barley, caraway (ajwain) seeds, milk thistle, dill herb, dark green leafy vegetables, fennel seeds, garlic, fenugreek seeds, chickpeas, ginger, papaya, nuts, and seeds. Breast feeding as per researchers is beneficial for both baby as well for mother. The science-based benefits of breastfeeding for mother and baby are as Breast Milk Provides Ideal Nutrition for Babies, Breast Milk Contains Important Antibodies, Breastfeeding May Reduce Disease Risk, Breast Milk Promotes a Healthy Weight, Breastfeeding May Make Children Smarter, Breastfeeding May Help You Lose Weight, Breastfeeding Helps the Uterus Contract, Mothers Who Breastfeed Have a Lower Risk of Depression, Breastfeeding Reduces Your Disease Risk, Breastfeeding May Prevent Menstruation and It Also Saves Time and Money. It is concluded that breastfeeding is an ancient practice which protects mothers and babies from infection. In mothers, breastfeeding significantly reduces physiological and subjective stress, facilitates positive affect, and improves maternal sensitivity and care. Researchers have found that women who breastfeed benefit from decreased risk of breast, ovarian and uterine cancers. Breast milk contains antibodies that help baby to fight off viruses and bacteria. Breastfeeding lowers baby’s risk of having asthma or allergies. Babies who are breastfed exclusively for the first 6 months, without any formula, have fewer ear infections, respiratory illnesses, and bouts of diarrhea. The theme of world breast feeding week 2021 is “Protect Breastfeeding: A Shared Responsibility”. It is a global campaign to raise awareness and galvanise action on themes related to breastfeeding. In current circumstances, it is important women’s confirmed or suspected COVID-19 infection, mothers with any symptoms who are breastfeeding or practicing skin-to-skin contact should take precautions.
(Bilkees Nazir is a research Scholar at the Department of Zoology, University of Kashmir and Dr Bilal A Bhat is an Associate Professor Statistics at S K University of Agriculture Sciences & Technology-SKUAST Shalimar Srinagar. Views are their own)
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