On your first visit to the antenatal clinic you will probably be asked if you wish to breast-feed your baby. If you have not yet decided or are in doubt you should discuss it with the midwife. You don’t have to decide immediately but the sooner the better because the preparation for breast-feeding should begin in early pregnancy.
You will be instructed in the advantages of breast-feeding and if you are going to feed your baby yourself your intention to do so will be encouraged. You must also realize, even at this stage, that if you do not wish to breast-feed, or some unforeseen circumstance leads to failure of breast-feeding, proper artificial feeding, despite its additional labour, is both safe and effective.
The routine examination of the mother’s breasts at the first antenatal clinic includes an assessment of the suitability of the nipples for breast-feeding. The breasts and nipples are re-examined at regular intervals. If by the sixth month of pregnancy the nipples are retracted (turned inwards) then shells should be worn daily until the nipples become everted.
An adequate diet during pregnancy is fundamental as it has a direct influence on normal healthy development of the unborn child and is an important factor in successful breast-feeding.
Cleanliness of the Breasts
Antenatal care aims at promoting and maintaining cleanliness of the breasts, particularly the nipples. The breasts and nipples should be carefully washed and dried each day, particular attention being paid to the undersurface of the breasts and to removing any crusted secretions on the nipples.
Expression of Colostrum
Expression of colostrum which is similar to milk should be started about the fifth month of pregnancy. The doctor or midwife will instruct on the daily massage and expression of colostrum to be done by the pregnant woman herself. The hands and breasts are lubricated with baby oil. The fingers and palms grasp the breast and stroke gently in a downward direction towards the nipple for a few moments. The finger and thumb are then placed on the outer margin of the pigmented area surrounding the nipple and with a squeezing movement the colostrum is expelled from the breast.
The weight of the enlarged breasts tends to pull them down so that the tissue attaching the breasts to the chest wall and the skin over the upper part of the breasts become stretched. Stretching of the supporting tissues causes the breasts to sag and must be prevented during pregnancy by wearing a good supporting brassiere. Enlargement of the breasts may increase the bust measurement by as much as 8 to 10 cm. Well supported breasts will not lose their shape but it is surprising how quickly breasts will sag if they are not adequately supported. This is, of course, particularly applicable to the few days immediately after delivery. It is true that, following pregnancy, delivery and breast-feeding the breasts will never regain the same consistency that they had before pregnancy commenced, but if they are properly supported and looked after there is no reason why they should change their shape or droop.
Different advice is frequently given about care of the breasts in pregnancy and this advice changes not only from year to year but also from town to town and country to country. It is often incorrectly stated that the nipples should be bathed in alcohol in order to ‘ harden the skin’ or scrubbed with a soft brush. Nipples of normal shape and size require no care other than the daily use of soap and water, and perhaps massage of the nipples and the surrounding skin with a bland cream such as lanoline once each day to make the skin soft and pliable, and gentle moulding and drawing out of the nipples between the thumb and index finger. Dry skin is thus avoided. This procedure can conveniently become part of the daily bath routine.
Inversion of the nipple is usually a congenital condition in which the nipple fails to protrude at all, or remains flat or inverted when stimulated. It is obvious that a child cannot feed from a breast unless the nipple protrudes so that it can be placed completely within the child’s mouth. Inversion can be corrected or cured by manipulation and by wearing Woolwich Breast Shells. These should be worn underneath a closely fitting brassiere with good supporting straps so that the nipple protrudes through the aperture on the flat surface of one side of the shell. The shell consists of two plastic halves screwed together and its particular shape together with the woman’s continual movement exert a gradual, constant, evenly distributed pressure on tissues and structures immediately around the nipple, which will eventually cause normal protrusion of the nipple. The time during pregnancy at which a woman should begin wearing breast shells varies with the severity of the inversion of the nipple. Most authorities recommend that they should be worn during the last six to eight weeks of pregnancy, initially for only one or two hours a day, preferably during the afternoon. After about one week the shells may be worn for progressively longer periods each day until after three or four weeks they are being worn throughout the day. There is no need to wear the shells at night.
In the last three or four weeks of pregnancy some secretion may occur from the nipple. This is completely normal and providing the shells are worn with the air-hole uppermost the secretion will be collected in the shell itself.
Care must be taken that the shells are not worn for an excessive length of time each day and this must be judged by the individual. If they are worn for too long the skin around the nipple becomes sore and tender. The shells should be washed and dried each day after taking them apart to empty the colostrum. The skin of the breast that is in contact with the plastic should be lightly powdered to avoid irritation due to perspiration.