Breast or Bottle ?
Successful nourishment of the newly born baby aids his healthy growth and development and provides contentment to both mother and baby. Breast-milk is the ideal food for the baby in the first few months and breast-feeding should be easy and pleasurable to the mother and her child.
If you have decided for one reason or another that you do not want to breast-feed, or if you cannot do so for medical reasons, there is no cause to reproach yourself. Your baby will not be deprived of anything vital and, providing you handle the bottle-feeding in the right way, a very warm and close relationship develops in just the same way as if he were breast-fed. Tests have shown no difference between the rates of progress or development of babies fed naturally or artificially.
Breast-feeding is a wonderful experience for both mother and baby, but it is not by any means the only wonderful experience, and just as good a relationship can be established with a bottle-fed baby. If a mother is worried about any of the difficulties in breast-feeding she will be tense and this will be communicated to the baby so that the difficulties are increased. If the mother’s milk supply is not adequate, feeding the baby may be more difficult than simply settling for the bottle. If there are any difficulties she should consult her doctor, or her health visitor who can be contacted through any maternity or child welfare clinic if she has not already called at the house.
A baby should be put to the breast very soon after his birth, unless there has been some complication in which case he may rest quietly in his cot or incubator for 24 to 48 hours, where he will be fed by bottle with glucose water. The first feed is supervised and the mother is helped and advised by the midwife. These notes are a general guide; you should follow your midwife’s instructions.
One most important aspect of breast-feeding is a relaxed and affectionate atmosphere. The baby can sense if this is lacking and may become fretful so that he will not feed satisfactorily. If a mother wants to breast-feed, she is for more likely to succeed than if she is reluctant. Indeed, a mother who is reluctant to breast-feed her baby rarely succeeds and both she and her baby benefit if artificial feeding is begun from birth. Breast-feeding is a technique which has to be learned; there are bound to be some difficulties at first and it is essential to persevere for a while rather than give up in despair at the first obstacle.
The incidence of complete breast-feeding is distressingly low for a variety of reasons. Some mothers do not want to breast-feed, whereas others give it up because of inadequate lactation, pain during feeding or difficulty in getting the baby to suck satisfactorily. For any but the most natural mother, the first 3 or 4 weeks may be a rather worrying and difficult time, but the mother who does feed her baby gets her own reward.
The advantages of breast-feeding are many:
1. It provides a happy relationship between the mother and child.
2. It provides the baby with milk of suitable composition and the correct temperature.
3. There is little risk of contamination of the milk or of infection during feeding.
4. It is easier than artificial feeding since there is no mixing of feed and sterilizing of equipment.
5. It is cheaper.
6. Infections, particularly gastro-enteritis, are less frequent in breast-fed babies.
7. It aids involution of the uterus.
Preparations for breast-feeding must begin in early pregnancy, and it is discussed either at the booking clinic or shortly afterwards. For the mother who is breast-feeding, cleanliness is the first essential. A daily warm bath is ideal; hot baths are exhausting and may cause fainting. The mother’s hands must be washed before each feed and the nails should be short and clean. The modern tendency is to wash the nipples as little as possible, washing the whole breast only before feeds, using a minimum of soap. Lanolin or other suitable ointment, such as Masse Cream, may be applied to the nipples at the end of each feed. A good supporting brassiere should be worn and washed each day. Nightdresses should have shoulder straps that slip off or untie, so that they need not be pulled up over the breasts from below.
The baby obtains milk from the breast on suckling and this experience ought to be a pleasure as well as a necessity for him and the mother. Both should be relaxed and comfortable. The baby must not be tightly wrapped in clothing; let his hands be free to touch the breast if he wants to. The baby may require a few moments to waken up before being put to the breast, and this is an ideal time for a little love and play. When feeding in bed the mother should be supported with pillows so that she leans slightly forward, holding the infant in the crook of one arm. The palm of her other hand supports the breast at which the baby is suckling and the index finger is above the nipple so that it can be guided into the baby’s mouth and the breast held back from his nostrils so that he can breathe properly. At first he may need a little help in finding the nipple and if you touch his cheek with the breast he will turn towards it. When he sucks be sure that he takes in his mouth not only the nipple itself, but most of the coloured area around it. Cradle the baby in the right arm while feeding at the right breast, and use the left hand to manipulate the breast. Use the opposite arm and hand for the left breast. If there is soreness from perineal sutures it is more comfortable to lie in bed, first on one side and then on the other. Comfort for the baby and mother is always essential when feeding and a low nursing chair is especially valuable when the mother is out of bed.
At first a baby usually does no more than nuzzle the nipple and lick it, and he should not be forced to suck; he will when he is ready to do so. It may take a few days before he masters the art of sucking and meanwhile he is given a small amount of boiled water between feeds. Since this does not satisfy his appetite he will be hungry when put to the breast, and this encourages him to learn to suck properly. A new-born baby does not require much food for the first 3 days because he is born with an excess of fluid in his body. Loss of this fluid as urine and sweat causes the loss of weight which all babies suffer during the first 2 or 3 days of life. This lack of appetite usually lasts until the time at which the milk begins to flow from the breast. There is a very little colostrum for the first 2 days and on the third day the breasts fill up and proper milk begins to flow in gradually increasing amounts.
Time and Length of Feeding
It is important to avoid getting sore nipples. For this reason, put the baby to each breast for only 1 minute on the first day, 2 or 3 minutes on the second and third days, and so on up to 10 minutes each side by the end of the first week. It is most important that these times should not be exceeded. Sore nipples are caused by the baby chewing the nipple. This can only happen if the whole nipple and the surrounding areola are not placed properly in the baby’s mouth. A baby will suck, chew or rest; a woman knows if her baby is actively sucking at the breast and he must not be allowed to chew or bite the nipple. Ten minutes at each breast is the maximum time allowed when full feeding is established. A hungry baby empties the breast in less time and, as he takes nearly two-thirds of his feed in the first 5 minutes, he should be put to alternate breasts at the start of each feed.
The majority of babies of 3-2 to 3-4 kg. and over will be contented on feeds at approximately 4-hourly intervals—five to six feeds daily. Smaller babies are often happier on 3-hourly feeds—six or seven feeds daily. Night feeds should not be forbidden. If a baby will not settle after being made comfortable and given a little water, he is probably hungry and should be fed. Water does not pacify a hungry baby and he will not learn to sleep at night by screaming for hours. There is no danger of the baby forming a habit of waking to be fed in the night. When he gets enough food during the day he will sleep for longer periods at night until eventually he sleeps from 10.30 p.m. until 5 a.m.
Some mothers may wish to demand feed their babies, and providing this is carried out in a sensible fashion there is nothing wrong with it and it gradually resolves into a regular feeding routine which is acceptable to mother, baby and the rest of the family. It is often more relaxing and successful than sticking to a rigid timetable.
Breaking the Wind
Most babies bring up wind once during the feed, usually when they are being changed from one breast to the other. To ‘wind’ the baby he is held upright against the left chest and his back gently patted or rubbed. This slight movement releases the air in his stomach. If the baby is held upright no milk will come up with the air. He should be ‘winded’ again at the end of the feed. If the baby is laid in his cot without first bringing up wind, he will bring it up later with part of his feed, or it will pass into his intestine and cause colicky pain.
Complete Emptying of the Breasts
The breasts should be completely empty after feeding and until breast-feeding is fully established they should be expressed after each feed, thus stimulating lactation and avoiding engorgement. A few minutes spent expressing milk after feeds can make the difference between successful and unsuccessful lactation, and the art is quickly learned.
Maintenance of Breast-feeding
Continual breast-feeding should present no difficulty providing that lactation has been properly established. Lactation usually falls off a little during the first few days at home when the mother has the baby on her own and is busy doing all the housework and shopping. For a few days, therefore, the baby may be fretful and less contented but with a little patience and understanding he will settle down. Good health, plenty of rest and nutritious food are essential for the mother if breast-feeding is to be continued successfully. Spicy foods and stoned fruit should not be eaten because they can affect breast-milk and upset the baby.
Test weighing should never be undertaken unless there is reason to suspect that the baby is underfeeding. A single test feed is of little value; the results of two or three feeds may be useful, but test weighing should ideally be continued over 24 hours. The baby should be weighed on accurate scales in his clothes before being fed and again in the same clothes after the feed without changing his napkin even if it is dirty. The difference between the two weights is the amount of milk he has taken from the breast.
Overfeeding. It is impossible to overfeed a baby on the breast; he will take what he needs and no more. But underfeeding is possible and if the baby is obviously hungry he can occasionally be given a bottle after his breast-feed. The holes in the bottle teat must not be too large or he will get milk more easily than from the breast which may make him prefer the bottle. Apart from this there is no truth in the old wives’ tale that once a baby has been on a bottle he will not return to the breast.
Complementary feeding is a temporary measure when the supply of breast-milk is not sufficient. The baby is given additional milk immediately after an inadequate breast-feed; this should be done when it is hoped to establish satisfactory breast-feeding in the near future. The last feed at night may be complemented to make sure the baby, and therefore the mother as well, have a good night’s rest.
Supplementary feeding consists of giving bottle-milk in place of a breast-feed and should not be done when the breasts do not contain enough milk since their production of milk is stimulated by suckling. Occasionally it may be used if breast-feeding is well established and the mother wishes to be absent at feeding time.
Will Breast-feeding affect your Figure
Having a baby has some effect on the breast outline. The breasts are inclined to lose some of their firmness, though this is usually not very marked after the first or even second baby, but is more common after breast-feeding and especially if the breasts are allowed to become engorged. Once the breasts have sagged nothing can be done to restore their shape except plastic surgery. Hot and cold sponging night and morning is often advised, but does not usually help. Simple windmill exercises are useless because the breasts do not contain muscle. Exercises to improve posture or strengthen the muscles of the arms may help the appearance of the breast outline. Creams are of no value. Wearing a good brassiere is more important than anything else.
Some women who breast-feed find that their breasts become smaller.
Difficulties in Breast-feeding
Engorged breasts. If the breasts are not prepared for feeding they commonly become heavy and hard on the third and fourth day of the puerperium. This is painful and should be treated by:
1. bathing the breasts in warm water before feeds and gently stroking the breasts firmly towards the nipple for a few moments;
2. expressing some milk, putting the baby to the breasts for a few minutes and then expressing the remaining milk;
3. applying lanolin to the nipples and wearing a firm supporting brassiere.
4. Panadol tablets can be taken to relieve discomfort.
Cracked nipples. If cracked nipples are treated promptly they will heal rapidly. The baby should be taken off the breast for 24 hours if the nipple is tender and 48 to 78 hours if cracked. The milk should be expressed from the breast manually or by breast pump. Ointments soothe the nipple but must be applied sparingly. Lanolin or Masse Cream may be used; hydrocortisone is the most efficient treatment but must be prescribed by your doctor.
Difficulties in breast-feeding due to the baby
1. Premature babies may be too weak to suckle at the breast and should not be taken out of the warm nursery.
2. Congenital abnormalities such as cleft lip or deft palate prevent the infant from sucking.
3. Thrush infection of the mouth may make the baby disinclined to feed.
4. Snuffles, usually due to nasal infection, interfere with breathing during suckling.
5. Mentally subnormal babies do not use their tongues effectively for successful breast-feeding.
6. Jaundice causes lethargy and disinclination to feed.
Reasons for not Breast-feeding
If there is a severe psychiatric disorder of the mother, breastfeeding may be inadvisable because of the possibility of the mother doing harm to her child.
Some of the drugs used to control epilepsy are excreted in the milk in which instance the mother must not breast-feed. Each woman however must be assessed individually and attention given to her condition and to the safety of her child.
A mother suffering from active pulmonary tuberculosis must not breast-feed, both for her benefit and the safety of her baby. Mothers whose chest infections have healed are usually allowed to breastfeed, but only on the advice of the chest physician.
Breast-feeding is seldom allowed in women who suffer from chronic nephritis or who have had malignant diseases of any kind.
A baby with Down’s syndrome (mongolism) is usually difficult to feed and he should then be artificially fed. If, however, breast-feeding can be established easily it should be encouraged.
There are diverse opinions about breast-feeding of babies who are to be adopted. Each of these mothers and babies are dealt with as an individual problem.
A baby is bottle-fed when breast-feeding is impossible or impracticable, or if the mother does not want to breast-feed.
New-born babies cannot easily digest plain fresh cows’ milk because it contains more protein, fat and mineral salts, but less sugar than human milk. Furthermore there is considerable variation in the chemical structure of these elements, especially the protein, so that cows’ milk must be slightly modified to make it suitable for human infants.
Dried or powdered milk is made by heating cows’ milk to a specific temperature and removing the fluid by evaporation. To reconstitute the milk, water is added by the mother as instructed on each individual packet. Dried milk suitable for baby feeding is prepared in two forms: half-cream and full-cream. Some brands of dried milk are already sweetened while others are not and sugar must be added to these.
The advantages of dried milk are:
1. It is already sterilized and does not easily become infected.
2. The method of preparation is simple, each packet giving full instructions.
3. It is convenient, easily transported and a constant supply can be easily stored.
Its main disadvantage is that it has to be reconstituted with sterilized water in sterilized utensils.
Arrangement of Feeds
Bottle-feeds are usually given approximately every 4 hours but some babies prefer a 3-hourly regime. Times should not be rigid but a scheme should be worked out which satisfies both the baby and the particular routine of the home and family. A baby does not always accept the same quantity of milk mixture at each feed. The breastfed baby, regulating his own feeds, seldom takes exactly the same amount at every feed and the artificially fed child must therefore be allowed to decide to a certain extent upon the volume of his feed. He may want an extra ounce or two at his last feed at night and he may want a larger early morning feed.
Choice of Bottles and Teats
Feeding bottles with a wide neck are easier to fill and clean. They are also better for travelling because the teat can be kept clean and protected by reversing it inside the bottle.
The teats should be carefully chosen and the same type used throughout bottle-feeding. The plain-ended teat is the most satisfactory though certain babies prefer the bulb-ended type. A teat with a flange at the base is easier to put on the bottle. The holes in the teat should be of such a size that the milk drips from the upturned bottle at the rate of 12 to 20 drips a minute. The rate of flow must be adjusted to meet the needs of the individual baby so that he can feed easily without choking.
The most important aspect of bottle-feeding is hygiene. A baby can get an upset tummy or even a severe infection from his bottle if it is not properly sterilized. One of the simplest and most reliable methods of sterilizing all bottle-feeding equipment is by using sodium hypochlorite (Milton).
The equipment required for feed preparation is several bottles, teats, measuring jug, spoon to mix the powdered milk, knife for levelling off, cleaning brush, large container for sterilizing, the powdered milk and boiled water.
To make up the feed make a smooth paste with a little of the previously boiled water and powder and then add the correct amount of water, the exact amount of which is clearly set out in the instructions on the milk packet. If you leave any lumps of powdered milk during the mixing which cannot pass through the holes in the teat, your baby won’t get his full ration of milk because the lumps will stick in the teat and block the flow of milk. This will cause the baby great frustration and also let him suck in air which will give him wind. To test the temperature of the feed shake a few drops on the back of your hand and feel the bottle with the inside of your arm to make sure the milk is not above body temperature.
The amount of the feed. It is important to know how much to offer your baby at each feed and as a rough guide, since babies vary so much in their needs, 90 ml. should be given for every pound of your baby’s weight every 24 hours. A complete table is usually printed on every tin or packet of dried or powdered milk. For example: a baby weighing 4.5 kg. will need 10 X 90 ml. = 900 ml. each 24 hours and if he is on six feeds a day each can be 140 gm. If he finishes the bottle, try making up an extra ounce each time. It is easy to underfeed a baby but contrary to general belief it is virtually impossible to overfeed a young baby as he simply brings it back if his stomach is full.
A baby can swallow a great deal of wind during bottle feeding so it is important to make sure that the holes in the teats are the correct size.
If you have a refrigerator you can make up all the feeds you need for the day provided they are cooled quickly and always kept refrigerated until needed. You should warm the bottle to the correct temperature either in water in a saucepan or in an automatic bottle warmer. Make sure the milk is the correct temperature. If you do not have a refrigerator then it is probably best to make up each feed separately.
Evaporated milk is made by removing about half the water. The treatment of the milk during evaporation leads to physical changes in the protein which result in better digestibility. It is unsweetened and sugar must be added. It is easy to make up a feed by pouring the milk directly from the punctured can and adding sugar and water as required. The usual basic formula for feeds is 1 part of milk and 2 parts of water, with half a teaspoonful of sugar to every 85 gm. of mixture. This mixture is well tolerated by all babies, including premature babies, although minor alterations may be necessary on special occasions.
Cleaning. After the feed the bottle and teat must be well washed in cold water. This cleans the bottle and does not coagulate the milk proteins which could otherwise adhere in a film to the bottle. A bottle brush can be used to complete the cleaning, and then hot water used to remove the fat.
Sterilization of Bottles and Teats
Bottles and teats may be heat-sterilized or treated in sodium hypochlorite solution. The latter method is preferable. It is simple, less dangerous, more efficient, easier; it preserves the teats well and the bottles do not get furred, cracked or damaged. It can be used for plastic bottles.
Heat sterilization. The bottle and teat are completely immersed in cold water in a saucepan, boiled for 10 minutes and left in a covered pan to cool until the feed is required. After preparing the feed and filling the bottle, the teat is placed on the bottle and covered with a beaker or egg-cup to keep it clean. If the bottle is sealed with a valve, the teat is left covered in the boiled water until the feed is ready to be given.
Cold sterilization. The bottle and teat are completely immersed in a solution of sodium hypochlorite in which they are left until the next feed is due. The solution is changed each day.
Opinions vary widely on the advisability of adding cereal to a baby’s diet. Each baby is an individual. Like all of us, he or she has different and individual tastes. There is no fixed time to introduce mixed feeding.
All babies must have a good supply of vitamins A, C, and D, whether in solid foods or in a concentrated form. Vitamin A helps prevent infections and helps normal growth. Vitamin C ensures healthy blood vessels and helps to prevent anaemia. There is not enough vitamin C in either bottle or breast-milk but it is present in orange juice which can be given after a few weeks. Vitamin D is found with vitamin A and is essential in the formation of good, strong bones.
Cod liver oil is rich in vitamins A and D and is most often prescribed for babies when they are a few weeks old. When your baby does start taking vitamins it is best to give them to him just before you bath him so that the oily preparations cannot stain his clothes.