This month I’ll discuss four health topics that are crucial for the optimal care of your newborn baby. These topics are successful breastfeeding, preventing Sudden Infant Death Syndrome (SIDS), how to identify signs of serious infection, and recognizing bowel obstruction in newborns.
Breastfeeding may not go smoothly as planned. The potential benefits of sustained breastfeeding are enormous. Breast milk contains factors that modulate the immune system, gastrointestinal tract and nervous system to prevent many illnesses and promote health. Although extremely important, breastfeeding isn’t always natural or easy. Sometimes it doesn’t work and many mothers feel guilty, ashamed or less competent as a mother. Breastfeeding is a skill babies must learn and some are innately better at it than others. When breastfeeding doesn’t go well it’s generally due to the newborn’s physical condition or lack of feeding ability rather than the mother’s competence.
To give breastfeeding the best possible chance at working there are some things you should know before you deliver.
- Be an advocate for your child’s success at breastfeeding
With so much evidence to support the necessity of breastfeeding it seems this shouldn’t be necessary, especially working with health care providers in the hospital, but it is crucial. The team that serves the delivering mom will be supporting the mom’s interests to help her be happy and comfortable. Breastfeeding may be stressful and uncomfortable. In addition, the initiation of breastfeeding occurs when moms are often exhausted from delivery, sleep deprived, emotional from fluctuating hormones, and stressed from the pressure to care for the newborn and please family members. You will need to be committed to work through the problems and advocate for your support team to do the right things to help you.
- Understand the normal baby’s adaptation to life outside the womb
After delivery infants are usually awake for an hour or two. For the next day they are often quite sleepy, resting from delivery. On the second day of life they start to awaken more but still sleep the majority of the time. Most newborns have more wakefulness at nighttime.
- Appreciate normal fluid and nutrition needs in the first few days
Initially breastfeeding is mostly for practice latching and for breast stimulation. Any breastfeeding in the first day is a bonus. Healthy, term infants who are observed in the hospital will be fine during the first day of life even if they don’t receive any fluids by mouth. On the second day of life babies should have some colostrum intake with more frequent feedings but the amount is still marginal. If your child is premature, or small for gestational age, or has low blood sugar or other health problems, or is not observed in the hospital, then your baby may have different needs.
Feeling pressure that your baby must have fluids to avoid dehydration can sabotage the successful initiation of breastfeeding. Full term, healthy infant babies store up 5-7% of their body weight in extra fluid to help them through the first few days of life. They will lose 3-4 ounces of weight each day and are prepared to make it until your breast milk comes in. You will have to be committed to the fact that your baby doesn’t need a drop of fluid in the first day because you will likely feel pressure to feed with formula if breastfeeding isn’t going well.
The early use of bottles has been shown to decrease the chances of successful breastfeeding. Hunger, especially after the first day of life, is a natural urge that drives breastfeeding, and you will want to pay attention to your infant’s hunger drives to cue you to breastfeed. The American Academy of Pediatrics supports the concept that babies should not have anything but breast milk to drink while in the hospital unless medically indicated (source). If your newborn is the active barracuda personality and doesn’t seem satisfied with what your breasts have to offer, have them suck on your finger and hold him after a good breast feeding. Put him back to the breast in an hour if he seems hungry. Frequent feedings of short duration with effective sucking provide better nutrition than infrequent feedings for extended time.
- Learn about breastfeeding before you deliver
Some babies placed with their mom will find the breast on their own and feed naturally. Other newborns struggle to learn to breastfeed with the greatest of support. Proper latch and sucking can be a complicated process that will require education. It’s worth studying this process before you get to the hospital. Here are some helpful resources:
- The New Mother’s Guide to Breastfeeding book by Meek.
- http://www.breastfeedinginc.ca/ is an excellent supportive web site. I would especially recommend the handouts When Latching and Breastfeeding – Starting Out Right. The following videos demonstrate good latch and feeding compared with poor feeding, Baby 28 hours old assisted latching, Really good drinking vs. nibbling.
- The American Academy of Pediatrics Policy Statement on Breastfeeding is a wealth of scientific information if you are interested. http://pediatrics.aappublications.org/content/129/3/e827.full
- The American Academy of Pediatrics Parent Information Website HealthyChildren.org has excellent information about a variety of breast feeding topics. https://www.healthychildren.org/English/ages-stages/baby/breastfeeding/Pages/default.aspx
- Make breastfeeding a priority for your infant’s health care after birth
Your health care team will be focused on many important things to care for your newborn. However, unless your infant has pressing health problems, nothing will be more urgent than helping your baby learn to breastfeed. Keep your newborn skin to skin on your chest after birth for the first hour or so and try to breastfeed a few times. The nursing staff will need to do routine care but try to have your baby in the room with you as soon and as much as possible. Most newborns don’t cry when they awaken to breastfeed and the clues that they are ready to breastfeed can be subtle. Any sign of arousal, rooting, stirring, etc. should prompt you to bring your infant back to the breast. After the first 24 hours you should try to feed your infant at least eight times a day or roughly every three hours. Babies don’t feed on a schedule so it’s crucial to notice subtle cues. Some babies will feed every hour for a while then take longer breaks but over 24 hours your baby should feed a minimum of eight times. If your baby is the mellow type and not showing many cues for breast feeding then begin to awaken her at least every three hours starting the second day of life. Provide gentle stimulation such as unwrapping, stroking lips and cheeks, etc to awaken her.
It is important to have your baby in the room with you as much as possible, especially [JB1] at night since she will likely arouse more at this time. You will certainly need to take lots of naps during the day, and it may take a vigilant significant other to be with you to help get the baby to breast. Don’t be timid about eliciting the help of your significant other and relatives to aid you with chores and routine needs so you can focus on breastfeeding.
- Get support early if things aren’t going well
Ask for help from nursing or lactation staff. No matter how much you know or how well things have gone in the past, you may need a lactation specialist. If baby isn’t latching well on the first day, don’t panic. You have time to practice. Do lots of skin to skin time, and start pumping for short periods. Practice latching if baby begins to arouse. Don’t overdo it, and get some rest, because things will be going better on the second day and you’ll need some reserve to feed at night. If you aren’t getting the help you need, let your doctor know so he or she can find other resources for you.
- Increase your chances of success by reducing things that interfere with breastfeeding
Sucking on pacifiers may suppress the appetite and clues that the baby is ready to feed. Early bottle feeding definitely reduces the chances for success. Avoid giving your baby formula unless medically necessary. If it becomes necessary make sure you know why it is necessary and use a syringe or small tube with finger feeding rather than a bottle. Don’t decide to stop trying to breastfeed too soon. Some women mistakenly feel their milk supply is inadequate. Breasts have yet to be made with volume measurement indicators. Other indicators for successful feeding need to be used to determine appropriate intake such as: adequate latch, swallowing, urine and stool output, and weight. Let your health care providers assist you in determining adequate breast milk intake.
- Don’t let the events of life discourage you too easily
Most medications a mother takes are safe to continue taking while breast feeding. If there is any question call the Pregnancy Risk Line 1-800-822-2229 and check the LACTMED website http://toxnet.nlm.nih.gov/newtoxnet/lactmed.htm. Most babies and mothers who have illnesses can still breastfeed even if there is a temporary disruption. Ask your doctor about breast feeding with illness. Start pumping early if you know you won’t be able to breastfeed for a while. Use your federally mandated insurance benefit to obtain a breast pump for home use. Federal law also mandates accommodations in many workplace environments for breastfeeding. http://www2.aap.org/breastfeeding/files/pdf/FederalSupportforBreastfeedingResource.pdf
The government women’s health website is a wonderful place to learn how to deal with many of the logistics of complicated life and breast feeding from troubleshooting problems to pumping and storing to travel and work, etc.
- Your newborn infant should be seen in the office within 2-3 days after discharge to assure a healthy and smooth adjustment to life. Remember that in parenting, children don’t always cooperate with our plans. If your baby won’t breastfeed or medical problems preclude it, he will do fine on formula. Infant formula technology in this country is fabulous and getting better all the time. Breast feeding decreases the risk of many illnesses but formula doesn’t cause them. Problems are part of life – we just do the best we can.
Happy breast feeding!
John Bennett M.D. FAAP