Health Notes

It is best to avoid all unnecessary medications, herbs, and nutritional supplements when breast-feeding. Most prescribed and over-the-counter medications, when taken by a breast-feeding mother, are considered safe for the baby. However, a doctor should always be consulted before any medication is taken. There are a few medications that mothers may need to take that may make it necessary to interrupt breast-feeding temporarily.

Caffeine

Caffeine, which is considered a drug, is excreted into breast milk. It is estimated that a baby receives 1.5 to 3.1 mg of caffeine after the mother drinks a cup of coffee (a cup of coffee typically contains 60 to 50 mg of caffeine). Because this amount is fairly low, a morning cup of coffee is not likely to cause any problems. However, if the mother is a heavy caffeine user, caffeine can accumulate in the baby.¹ Infants have immature livers that are unable to adequately process caffeine. A baby who is irritable and sleeping poorly may be reacting to caffeine in the mother’s diet. A woman can switch to decaffeinated coffees and teas to effectively reduce the amount of caffeine her baby receives through her milk.

Alcohol

Alcohol reaches maternal milk in concentrations similar to those in the mother’s blood.² It is therefore best for breast-feeding mothers to minimise or eliminate alcohol consumption. It is commonly believed that drinking beer can increase a woman’s milk supply. In fact, drinking beer intake does increase secretion of prolactin (the hormone that stimulates production of breast milk) in both men and women.³ However, research has shown that infants breast-fed after their mothers drank alcoholic beer consumed less milk than when their mothers drank non-alcoholic beer.⁴

Smoking

Breast-feeding mothers should not smoke. Nicotine passes to the baby through the breast milk and can cause feeding problems and illness, especially in newborns. Babies should also be protected from the dangers of second-hand smoke. Second-hand smoke has been shown to increase the risk of SIDS (sudden baby death syndrome)^{5, 6, 7, 8, 9} and colic in newborns.¹⁰

Initiating the breast-feeding relationship

There are many reasons why women decide not to breast-feed or discontinue breast-feeding earlier than the recommended six months. These include a lack of family, societal, or medical support;¹¹ misinformation or lack of education about breast-feeding;¹² marketing of commercial formulas to new mothers;¹³ and the difficulties often encountered in returning to work or school.¹⁴ In addition, there are some common difficulties that could interfere with a healthy breast-feeding relationship. These include fear of not having enough milk to nourish the baby, sore nipples, engorgement, and mastitis (inflammation of the breast, frequently caused by infection).

A new mother should try to breast-feed her baby as soon as possible after delivery, ideally within the first hour of life.¹⁵ a baby should be fed on demand. A hungry baby will first get fussy, with increased activity and rooting (a reflex wherein the baby appears to be searching for the breast with his or her mouth) or mouthing behaviour. Crying is a late sign of hunger. To get into the habit of feeding their babies, new mothers are often instructed to follow a schedule of breast-feeding Q4H around the clock. However, these imposed schedules, if followed beyond the first few weeks of life, often lead to frustration and confusion. The only baby who needs to be breast-fed on such a schedule is the baby who does not demand to be fed. Feeding on demand is the best way to increase milk supply. Most infants will empty the breast in 10 to 15 minutes. Some doctors advise gradually increasing the duration of breast-feeding over the first week of life. If this regimen is followed, it is important to breast-feed for at least five minutes on each side to get the benefit of the let-down reflex (which promotes the release of milk from the storage ducts in the breasts).¹⁶

Infants need no additional foods or liquids, if exclusively breast-feeding. Early introduction of these items may make successful breast-feeding difficult. Most breast-fed infants will not require any supplemental vitamins or minerals to meet daily requirements until at least six months of age.¹⁷Vitamin D may be required for infants whose mothers are vitamin D-deficient or those infants not exposed to adequate sunlight. Iron may be required for infants with low iron stores or anaemia.¹⁸

Anxiety over milk supply

Breast milk is made on demand. The more often a baby feeds, the more milk will be produced. If breast-feeding sessions are frequent and long enough, the milk supply will rarely be inadequate. Parents can be reassured that their infants are receiving enough milk if they have six or more wet diapers a day while exclusively breast-feeding. If a parent still feels anxious about the adequacy of the nourishment provided by breast-feeding alone, weekly weighing may allay fears. A weight gain of 0.38 pound (190 grams) per week is evidence of sufficient nourishment and growth.

Some low-birth-weight infants will require intensive care and ventilation in the hospital. Mothers of these infants often have difficulty continuing to produce breast milk. These mothers must rely on expressing breast milk manually because their babies cannot effectively breast-feed. Pumping milk is much less efficient than breast-feeding. Due to the inadequacy of pumping milk, milk production can decline. In low-birth-weight infants in an intensive care setting, skin-to-skin holding over a four-week period postpartum has increased a mother’s milk supply.¹⁹ In contrast, women who did not participate in skin-to-skin holding of their low-birth-weight infants did not experience an increase in milk production. These findings may have implications for all mothers experiencing a diminishing milk supply. In addition, some doctors will prescribe a day of rest to busy mothers whose milk supply seems to be lessening.²⁰ Spending a day in close and relaxed contact with one’s newborn, with its associated increase in frequency of feedings, can effectively increasing milk supply.

Stress and fatigue can greatly inhibit the let-down reflex, lessening the production of milk. In a clinical trial involving mothers of premature infants, mothers who listened to an audiocassette tape based on relaxation and imagery techniques increased milk production by more than 60%, compared with mothers not listening to the tape.²¹ Whether relaxation techniques would increase milk supply in the mothers of full-term infants is not known.