A-Z of Breastfeeding Words - W-Z At last!

We’re on the home run and Z in in sight in the Breastfeeding Norfolk, slightly sideways look at breastmilk and breastfeeding A-Z. I hope I’m not being too boring, but I must complete this marathon. A marathon is 26 miles (plus a little), and the alphabet has 26 letters so that’s an apt description! Here are the last 4 of the big 26.

W for Whey. This is one of two proteins in breastmilk. The other protein in casein. The whey is the liquid part of the milk when separated from the curds or casein. I always think of Miss Muffet etc. Whey is much greater than casein in breastmilk, reckoned to be 90%/10%, when babies are very young, becoming around 50%/50% after 6 months. So clever. Whey provides the immunological, and bacterial defences, plus nice sloshy inoffensive poo. This helps the baby’s digestive system mature gradually.

X for prevention of Xeropthalmia. Sorry – I had to really search for the X factor. How about this. Xeropthalmia is an eye disease and is found particularly in parts of Africa. Its caused by a deficiency in Vitamin A, which is one of the fat-soluble vitamins in breastmilk. Human milk is a known preventative of this disease because of this vitamin.   

Y for “Yes, I want to breastfeed”. More mums than ever in recent times say this before they have their babies, yet, there is a big drop out rate by 6-8 weeks after their babies have been born. Breastfeeding is a whole body, mind, and emotional commitment. Mums don’t take it on unless they really want to keep going. The answer is to keep asking questions and get answers if breastfeeding is not going well. There is always a reason, and in most situations, an answer leading to a happier experience can be reached. Do get support. You deserve it.

Z for Zebras. What? Well; zebra milk is most similar to human milk. Interested? I found this lovely piece as I really struggled with a nice Z!        http://www.bbc.com/future/story/20160707-the-surprising-links-between-human-milk-and-the-wild

A-Z of Breastfeeding Words. Now S-V

S is for Suckle. I love this old word. It doesn’t get used much at all now. Traditionally; it is defined as what the mother does or gives. She suckles her infant at her breast. If it is used now, it is often described as the baby breastfeeding.

T for tingle. This follows on neatly from suckle. When the mum’s milk ejection/let-down reflex (see Oxytocin) happens, she may experience a tingle within her breast or in her other breast. I stress the word “may” here as not all mums feel this sensation, however, her baby is growing well so the reflex works well to release her milk perfectly. Some mums feel the tingle in one breast always, but not in the other, some mums feel it only sometimes, and some mums feel it at every feed. There are even some mums who feel it when they’re not feeding their babies. Making love can also induce the tingle – and the milk ejection that follows – how refreshing! 

U for Undersupply. This refers to low milk supply. There are very successful ways of rectifying a low milk supply in most mums. Breastmilk is made by frequent breastmilk removal. Getting knowledgeable help very quickly to understand why the supply is low, and then practical and skilled help, leading to the mum and baby to breastfeed comfortably and efficiently is fundamental to a happy conclusion.

V for Vasospasm. In this case of the nipple. The mum will probably feel pain on breastfeeding, and notice that after the feed her nipple is white, and then becomes more painful as it returns to its normal colour. Nipple vasospasm and nipple pain is caused by the nipple being compressed into the baby’s hard palate and slowing down or stopping the blood circulating to the end of it. The increased pain as the white nipple returns to normal a while after the feed is because of the blood returning. Support to help the mum adjust her baby’s angle to gain a deeper attachment for breastfeeding needed here.  

Only another 4 letters to go. I will try to make Z something to look forward to!

A-Z Continues with M-R

M for Macrophages (what?!) These account for most of the white cells within breastmilk. Its job is to swallow pathogens / harmful bacteria by releasing fabulous lactoferrin and lysozyme, plus Secretory Iga which is that huge mummy anti-body machine. Macrophages are great for babies, but they also have an anti-inflammatory job for the breast itself, and spring into action if the mum is starting to get mastitis. How clever.

N for Nipples. Yes of course for nipples! We don’t often look at other women’s nipples unless we have a professional need to. As someone with this professional requirement, I can say that there are many types of nipples, from inverted and tethered, to inverted but can be coaxed out, to flat, to, small to very large, to thin and to thick. The nipple is where the milk is released into the baby’s mouth, not where it is made. I have read that it is breastfeeding (emphasis on breast), and so the size and shape of the mum’s nipple makes no difference to the breastfeeding experience. Yes, it’s true that it is indeed breastfeeding. It’s also true to say that the baby only knows its mum’s own nipples and doesn’t know that there are other mums with different shaped nipples. However; for some babies their mums’ nipples can take time to get to know. When babies are born alert, they have an instinct to get to their mums’ breasts and feed. They make a “sweeping” action with their heads which brushes their lips and cheeks over the nipples to make them evert or protrude more before babies breastfeed. A mum may have a long or very thick nipple which may cause difficulty too at the new-born stage. If babies are having difficulty in breastfeeding because of a difficult attachment, then help should always be given speedily.

0 for Oxytocin. How could this essential for a peaceful life hormone not be here? Oxytocin is produced beautifully by part of the brain when a person is feeling content. This can be as simple as eating a favourite food or being with someone nice or having a gorgeous bath (either alone or with someone nice!) During breastfeeding this wonder hormone releases milk from the milk sacs, pushes it into the milk duct system and out through the nipple. This is what causes the “let-down” or “milk ejection” reflex. I prefer to call it the milk ejection reflex as I think it describes well the “whoosh” of the milk being released. Sometimes mums find that the reflex is delayed, particularly when using a breast pump. Taking a breath or 2. Thinking of milky waterfalls and other nice stuff can help. If mums are not too exposed to the public gaze, a breast massage and some hand expression helps here. Did you know that as well as mums having skin to skin contact with their babies, upper back massage has a direct link to oxytocin release too?

P for Prolactin. This has to follow oxytocin really. Prolactin is a hormone produced by part of the brain. Its responsible for stimulating breast development, and for making breastmilk. So; prolactin makes breastmilk and oxytocin releases it. One needs the other. Prolactin is at its highest in mums at delivery. It needs nurturing along, if the mum has had a difficult delivery or a Caesarean section. Again, in tandem with oxytocin; lots of skin to skin contact, and breastfeeding help and support in those early hours and days is so helpful. Expressing colostrum in addition to breastfeeding may be necessary to begin the milk-making process if things have been hard from the beginning. Breastfeeding will work if help is asked for and given. See R for Rest for more about prolactin.

Q for Questions. Knowing the questions to ask about breastfeeding is always helpful. That expression, “you don’t know what you don’t know” is true. If a baby is finding attaching to breastfeed difficult, or breastfeeding hurts the mum’s nipples and/or breast, then asking why this is happening gives mums a sense of control. Similarly; if a baby is not gaining weight very easily, by asking the question why, and getting a response will help her to be part of any plan to make things improve. Mums are mums for the rest of their lives and will have lots of decisions to make on their children’s behalf. Feeling enabled and empowered from the start is so important to growing in confidence to feel like a good enough mum.

R for Rest. Yes really! As hard as it may seem to believe; mums can rest when breastfeeding. Taking the time to “do it” as a task may be a funny way to think about it but it’s worth the investment. We’ve already had a quick look at Prolactin; the milk-making hormone and how it combines with oxytocin. Prolactin piggy-backs onto sleep and rest. This means that it’s so worthwhile in those first few weeks to try to get some decent rest. All breastfed babies get raggedy and challenging little humans in the evening when the prolactin hormone is at its lowest in the mum’s blood circulation, so try resting/feet up (for prolactin) with a cuppa and tasty snack (for your energy) late afternoon to see if this helps those testing evenings.  

Eight more letters to go! Nearly there!

G-L Great start and finish!

Hello there and welcome to the next part of the non-definitive with a bit of lateral thinking A-Z of breastfeeding human lactation. I thought I’d offer G-L this time. Here we go then:

G for Ghrelin. This is something to get excited about especially in these days of infant and child obesity. Ghrelin (my spell checker keeps wanting me to change it to gremlin!) is a hormone produced in everybody’s stomachs, plus it is a component of breastmilk. This incredible hormone has 2 functions as it regulates appetite by telling babies when they are hungry, plus research has found that it has a profound effect on long term body fat and weight gain. As with all things, more research needs to be done, but ghrelin being an active component in breastmilk, in addition to being produced in the stomach, may be the reason for breastfed babies to have less body fat than formula fed babies. Formula milk does not contain ghrelin.

H for Help. Yes – most breastfeeding mums need help, though not all. Knowing when to get help is the key. If breastfeeding hurts mums’ breasts and/or nipples; if babies are not putting on weight very easily; if babies are excessively windy and/or refluxy, if babies slip off mums’ breasts through the feeds, and if babies are breastfeeding more than 13 times per 24 hours consistently, these mums and babies need help quickly. Knowing where to get help is also important of course. Midwives and Health Visitors are there to support mums to breastfeed, and the Trusts have the Baby Friendly award now. This award is an indication that staff can offer mums help at a level to support her to breastfeed. Friends with breastfeeding experience can be a great support too. Nikki and I at Breastfeeding Norfolk are both International Board Certified Lactation Consultants. We are volunteers at West Pottergate Breastfeeding Support Centre on Thursday mornings, and we work in private practice in mums’ homes. Just get in touch or for more information check out this website.

I for Immunities. When breastfeeding mums become ill with chest infections or tummy bugs a great process to protect her baby from those pathogens or nasty bacteria happens. This is known as passive immunity. Her body recognises the bacteria, and quickly makes anti-bodies to fight them. The anti-bodies called Secretory IGA slip into the breastmilk via a pathway using breast cells and pass into the baby. It also works the other way. If a baby is “brewing” an infection, and then breastfeeds, the cells recognise the bug within the baby’s saliva, and then make the anti-bodies within the mum’s milk to fight the infection. What a cool system. I have been asked by mums if they should breastfeed their babies when they have tummy bugs particularly. Yes! Do carry on breastfeeding with obvious super hand hygiene of course. Just think of all those active anti-bodies building breastfed babies’ immunity. Magical stuff. 

J for Jaundice. New-born jaundice, or physiological jaundice is very common and normal as over 51% of all babies become jaundiced after a couple of days. The name indicates the colour of the baby’s skin and even the whites of the eyes – think of the French for yellow which is jaune! When babies are born they are carrying a high load of red blood cells that need to be broken down to a substance called bilirubin, which is pushed out of the body in the meconium/black poo and first breast milk poos. If breastfeeding or expressed breastmilk feeding is slow to get started it will also slow down the rate of the meconium passed. Bilirubin is then reabsorbed back into the body making the baby very sleepy as it takes energy to eliminate it from the body. Jaundice symptoms pass within a week or 2. If there is any doubt about a baby’s health then tests will be carried out and treatment will be started quickly. Breastmilk jaundice happens when despite great breastfeeding and therefore babies getting plenty of milk, the bilirubin levels stay elevated. This is not dangerous, and is thought to affect about 2% of breastfed babies. It goes away by about 3 months.

K for Kangaroo Mother Care. I have Dr Nils Bergman who is a specialist in peri-natal neuroscience to thank for introducing me to Kangaroo Mother Care. This is now more universally known as skin to skin care, and its practice is promoted widely for premature and full term babies and to be continued up to any age of baby. No need for me to bore you. If you’d like to see a lovely video that explains how needed and wonderful this care of babies is, go to:

  https://www.youtube.com/watch?v=2IYtFrgbDUo

L for Leptin. This hormone is in all of us and tells our brain when we’ve had enough to eat. So, if ghrelin is the start eating button, then leptin is the stop eating button. There’s a lot of interest in this hormone in these days of high obesity levels. Well, who’d have thought it, leptin is in breastmilk too. It is also known as the satiety hormone, and reduces in breastmilk as the baby grows. How sensible this is as it stops breastfed babies from taking too much milk for their stomach capacity. We talk about breastmilk being age specific. Well here’s a great example. 

A-Z of Breastfeeding Words continued - D-F

D for Diet. Thinking about maternal diet here. Unless a mum is living on the edge of hunger, then she is able to produce milk for her baby. Milk supply is not driven by particular foods, or how much a mum eats, but by her baby breastfeeding frequently enough to begin the process, and then to maintain it. It wasn’t that long ago that mums were told that they should drink cows’ milk to make good quality breastmilk. Not only that, but to eat lots of cake and mashed potatoes and gravy to make more milk. Now we know that this isn’t true, and that it is most important for babies to feed frequently and deeply attached – at least 8-12 times in a 24 hour period. Of course, every mum should eat enough to feel good, apart from anything else food gives energy to help get through the day and night. Extra calories are used in breastfeeding, but most mums feel hungrier, and so eat more during early breastfeeding anyway, so it isn’t a case of forcing food down, rather gobbling it up!

E for Expressing milk. This is a useful thing to know about. Expressing milk may not ever be needed or necessary, but if more colostrum or breastmilk is needed, or a baby or mum are not able to physically breastfeed at any time then it’s fantastic. Breast pumps (various) are there to buy or rent but how about by hand? Learning how to hand express is easy if mums remember that they need to reach their milk sacs (where milk is made ready), rather than sliding and rubbing their fingers over the breast skin which just makes it sore. First things; don’t be in a hurry. Spend time in some breast massage for the hormone oxytocin (more about oxytocin later) to get ready do its work of releasing milk from the milk sacs into the milk ducts. Then, mum placing her hand about 3-4cms back from nipple base where it meets her breast and where there are oodles of milk sacs. She’ll push back into her chest wall, then with some firmness but not too harshly, get a rhythm going to replicate the baby’s sucking by compressing and releasing her breast. An efficient way to express milk is for mums to use a combination of hand expressing, then pumping, then back to hand expressing to finish. This is because pumps “pull” milk out of the breast, but hand expression “presses” milk out of the milk sacs to really “capture” all the available milk for that expressing session. Most importantly; no pump or expert hands will release as much milk as a baby who attaches deeply to breastfeed efficiently.      

F for Fat. This can be a minefield. Essentially; all mums have times in the day and night when they have high fat feeds, and times when they have low fat feeds. We never now when these differences occur though. So, the key here is for all mums to check that their babies are breastfeeding efficiently. If there are any concerns regarding a baby’s weight gain for example, especially in combination with a mum’s very sore and damaged nipples, and extremely frequent feeds as in consistently above 14 per 24 hours, or constant feeding. I favour both breasts being offered per feed as this helps a mum avoid lumpy breasts/blocked milk ducts and gives her soft breasts. Softer breasts have a higher fat volume too. Of course, we cannot make babies actually feed from both breasts – see “B for Breastfeed”!  

I’ll post “G-K” next time. I hope you enjoyed the read.

A-Z of breastfeeding words

Happy New Year from Jan and Nikki and welcome to our new-look blog, and starting with this from Jan:

When women become pregnant, unless they have studied human biology recently, they are plunged into the mysterious world of other words, and with breastfeeding / human lactation, even more words are introduced.

I've been wondering if a little slightly alternative, though certainly not definitive A-Z of breastfeeding might be interesting, helpful, or even fun to put together and for you to read. This will be an A-Z, but not all at once. I think I'll go with A-C for starters. Here we go:

A for Attachment. This is also interchanged with Latch, and in the 70s, 80s and 90s with Fix. Now, "fixing the baby on" sounds pretty uncomfortable so I'm so glad that's not used any more. I don't really like any of the above as they sound so mechanical and something one should wear a boiler suit for, but a word must be used. How about Breastfeeding? (Tongue in cheek comment). Attachment to breastfeed is all about the efficient and comfortable milk transfer from mum to baby, usually resulting in a well growing baby. Shallow attachment will result in less milk transferred than a deep attachment over the same amount of time for example. Shallow attachment can also lead to difficulty in gaining weight, and the mum’s sore and damaged nipples, though not always funnily enough.

B for Breastfeed. This is what babies do to drink the milk their wonderful mummies provide. Obvious statement? Well we also say that mums breastfeed. I will quote Canadian paediatrician Dr Jack Newman here, "Babies breastfeed, mothers and others bottle feed". His point is that babies are the active partners in the breastfeeding relationship with the mother. Mums find out very quickly that they cannot make a baby breastfeed if they don't want to at the time. Stimulating the palate with a bottle teat will encourage a bottle fed baby to feed however. Food for thought there.

C for Colostrum. This fluid is made in mums' breasts from about weeks 16 - 19 of pregnancy. It is packed with precious immunoglobulins and anti-bodies to stave off infections. It is there to give babies a huge protective inoculation at the start of life, so available in tiny quantities to suit babies’ tiny stomachs, but there’s lots of it to suit the frequent feeds that newborn babies need. It is also great for its laxative effect on babies, helping them to pass those sticky black meconium poos and make prolonged jaundice (see “J” in later post) less likely. The release of colostrum is essential for effective milk production to begin, so especially if the baby has difficulty in attaching to breastfeed, it is so important get the colostrum moving through the mum’s breasts by hand expressing very frequently to really kick-start the process. When weaning off the mum’s breast happens naturally by feeds being reduced over time, her breastmilk returns to a colostrum-like state, and so the last feeds the baby/child has can be described as another huge inoculation against infection. I love that!   

More in a couple of days. Exciting stuff featuring D for diet, E for Expressing breastmilk, and F for Fat!