Susan Schulman MD FAAP Breastfeeding Expert DrMDK.com
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Host: On the breastfeed, how often would you attempt to breastfeed the baby in the beginning? Susan Schulman: When the baby is first born, it should be breastfed in the delivery room. If you could possibly get the baby to lash on your nipples, immediately at birth, the babies nurses better from then on. That first nipple that he experiences, it's your breast rather than a bottle, he will be a better breastfeeder. Most babies are hungry right after they're born and it's easy to put onto the breast. As they get a little older in hours, to one hour, two hours, ten hours of age, they tend be get sleepy and they don't nurse very well the first day. So we would like to tell you to catch that first feeding as early as possible. After that we'll try to nurse them every two- and-half to three hours, and it depends on how well that they'll be sucking, whether or not that feeding is going to go a long time or a short time. Now a days, rather than the old advice, we tell mothers to try to do a whole feeding on one breast, to let them nourish on one side until they finish, burp them. If they want more, try to nourish again on that side to try to empty the breast, and then the next feeding, two-and-a-half to three hours later, we'll give him the other side. This is new advice, it just came around in the last five or six years, which shows that the last milk, it comes out of the breast, when it's almost empty, it has the most cream in it. It's the richest milk and the baby actually gains better from one side and it goes from taking part of both sides. We found that most mothers' breast will accommodate to filling up alternately like that. However, in the very beginning, sometimes you have to nurse on both sides, just to release the pressure, or sometimes you have to pump out one side, if the baby has finished from the other side. That brings into a whole different issue, which is how to avoid the pain and difficulties of soring up those engorgement right after the baby is born. Babies nurse for the first couple of days, and if the nipples are flexible and they can latch on, the mothers feel fine, but the two things happen, one is, the nipple gets sored from the baby's sucking on it, and the other is, the breast get too full. The first milk that comes out is called colostrum, which is clear, and then the breasts are not really full of it. Then suddenly in a young mother, age 18, 19, 20, within 48 hours, it will change from colostrum to milk. As the woman gets older, especially as she gets into her late 30s and early to mid 40s, that transition can take a lot longer. The younger the mother, the quicker they switch over to milk. When it happens suddenly, the breasts become extremely full, and it's something called engorgement happen. When that happens, it's critical that the mother keep nursing, and nursing, and nursing, and pumping her breast, and emptying her breast at the end of the feeding with a pump, and you can store the milk in a freezer if you want to, but not to let the breast stay too full. In the later weeks of nursing, the more you nurse, the more milk you get, but in the beginning, the engorgement is going to happen, no matter how much you nourish, and if you don't empty those breast, they just get more, and more, and more engorged. You produce the breast milk for triples, the first few days. You just have more milk than you need. So pumping it out isn't going to -- it's on overdrive. It's not going to make any difference. So you empty it, it will soften the breast, the pain will go away, you'll feel much better. We also advice mothers to wrap their breasts in a green cabbage leaves, because that also helps to relieve the pressure on the breasts. That only lasts for a day or two, and when the engorgement is over, then she can settle down and just nurse the baby for what he is hungry for, finish that breast and then go to the next breast on the next feeding. As far as how to avoid the soreness of the nipples, the most critical thin

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