Breastfeeding Room

Fenugreek (Trigonella foenum-graecum) is a plant. In Hausa it is known as Hulba is used both as an herb and as a spice . It is cultivated worldwide as a semi-arid crop. It is frequently used in to flavour maple syrup and in soups. In fact the sweat of  woman who takes an adequate amount should begin to smell like maple syrup.

It is a common galactologue (increases milk supply). It is widely available and can be purchased from the spice sections of some supermarkets as well as in the Market.

Dosage: In powder form one teaspoon should be taken three times daily.

Use with caution or avoid if you have a history of:

Peanut or chickpea allergy: Fenugreek is in the same family with peanuts and chickpeas, and may cause an allergic reaction in susceptible individuals. Two cases of fenugreek allergy have been reported in the literature. [

Diabetes or hypoglycemia: Fenugreek reduces blood glucose levels, and in the few studies using it as a hypoglycemic, also reduces blood cholesterol. Dosages higher than the recommended one (given above) may result in hypoglycemia in some mothers.If you’re diabetic, use fenugreek only if you have good control of your blood glucose levels. While taking this, closely monitor your fasting levels and post-prandial (after meals) levels. Mothers with hypoglycaemia should also use fenugreek with caution. For more on fenugreek and glucose levels, see the references below.

Asthma: Fenugreek is often cited as a natural remedy for asthma. However, inhalation of the powder can cause asthma and allergic symptoms. Some mothers have reported that it worsened their asthma symptoms. .

Abnormal menstrual cycles: Fenugreek is considered to be an emmenagogue (promotes menstrual flow). It may cause breakthrough menstrual bleeding; this source recommends using fenugreek with caution if you have a history of abnormal menstrual cycles.

Migraines: Fenugreek is often cited as a natural remedy for migraines. However it may trigger a migraine and/or contribute to the duration and severity of a migraine.

Blood pressure problems or heart disease: Fenugreek is commonly reported to lower blood pressure and LDL blood cholesterol levels.However, few sources suggest that it may cause or contribute to hypertension (high blood pressure) - this source recommends avoiding this herb if you have a history of hypertension, or if there is a strong family history of hypertension or heart disease.

1. Many women do not produce enough milk.

Not true! The vast majority of women produce more than enough milk. Indeed, an overabundance of milk is common. Most babies that gain too slowly, or lose weight, do so not because the mother does not have enough milk, but because the baby does not get the milk that the mother has. The usual reason that the baby does not get the milk that is available is that he is poorly latched onto the breast. This is why it is so important that the mother be shown, on the first day, how to latch a baby on properly, by someone who knows what they are doing.

2. It is normal for breastfeeding to hurt.

Not true! Though some tenderness during the first few days is relatively common, this should be a temporary situation that lasts only a few days and should never be so bad that the mother dreads nursing. Any pain that is more than mild is abnormal and is almost always due to the baby latching on poorly. Any nipple pain that is not getting better by day three or four or lasts beyond five or six days should not be ignored. A new onset of pain when things have been going well for a while may be due to a yeast infection of the nipples. Limiting feeding time does not prevent soreness. Taking the baby off the breast for the nipples to heal should be a last resort only. (See Handout 3a: Sore Nipples).

3. There is no (not enough) milk during the first three or four days after birth.

Not true! It often seems like that because the baby is not latched on properly and therefore is unable to get the milk that is available. When there is not a lot of milk (as there is not, normally, in the first few days), the baby must be well latched on in order to get the milk. This accounts for “but he’s been on the breast for 2 hours and is still hungry when I take him off”. By not latching on well, the baby is unable to get the mother’s first milk, called colostrum. Anyone who suggests you pump your milk to know how much colostrum there is, does not understand breastfeeding, and should be politely ignored. Once the mother’s milk is abundant, a baby can latch on poorly and still may get plenty of milk.

4. A baby should be on the breast 20 (10, 15, 7.6) minutes on each side.

Not true! However, a distinction needs to be made between “being on the breast” and “breastfeeding”. If a baby is actually drinking for most of 15-20 minutes on the first side, he may not want to take the second side at all. If he drinks only a minute on the first side, and then nibbles or sleeps, and does the same on the other, no amount of time will be enough. The baby will breastfeed better and longer if he is latched on properly. He can also be helped to breastfeed longer if the mother compresses the breast to keep the flow of milk going, once he no longer swallows on his own (Handout 15: Breast Compression). Thus it is obvious that the rule of thumb that “the baby gets 90% of the milk in the breast in the first 10 minutes” is equally hopelessly wrong. To see how to know a baby is getting milk see the videos at http://www.drjacknewman.com/

5. A breastfeeding baby needs extra water in hot weather.

Not true! Breastmilk contains all the water a baby needs.

6. Breastfeeding babies need extra vitamin D.

Not true! Everyone needs vitamin D. Formula has it added at the factory. But the baby is born with a liver full of vitamin D, and outside exposure allows the baby to get the vitamin D from ultraviolet light even in winter. The baby does not need a lot of outside exposure and does not need outside exposure every day. Vitamin D is a fat soluble vitamin and is stored in the body. In some circumstances (for example, if the mother herself was vitamin D deficient during the pregnancy) it may be prudent to supplement the baby with vitamin D. Exposing the baby to sunlight through a closed window does not work to get the baby more vitamin D.

7. A mother should wash her nipples each time before feeding the baby.

Not true! Formula feeding requires careful attention to cleanliness because formula not only does not protect the baby against infection, but also is actually a good breeding ground for bacteria and can also be easily contaminated. On the other hand, breastmilk protects the baby against infection. Washing nipples before each feeding makes breastfeeding unnecessarily complicated and washes away protective oils from the nipple.

8. Pumping is a good way of knowing how much milk the mother has.

Not true! How much milk can be pumped depends on many factors, including the mother’s stress level. The baby who nurses well can get much more milk than his mother can pump. Pumping only tells you have much you can pump.

9. Breastmilk does not contain enough iron for the baby’s needs.

Not true! Breastmilk contains just enough iron for the baby’s needs. If the baby is full term he will get enough iron from breastmilk to last him at least the first six months. Formulas contain too much iron, but this quantity may be necessary to ensure the baby absorbs enough to prevent iron deficiency. The iron in formula is poorly absorbed, and the baby poops out most of it. Generally, there is no need to add other foods to breastmilk before about 6 months of age.

10. It is easier to bottle feed than to breastfeed.

Not true! Or, this should not be true. However, breastfeeding is made difficult because women often do not receive the help they should to get started properly. A poor start can indeed make breastfeeding difficult. But a poor start can also be overcome. Breastfeeding is often more difficult at first, due to a poor start, but usually becomes easier later.

11. Breastfeeding ties the mother down.

Not true! But it depends how you look at it. A baby can be nursed anywhere, anytime, and thus breastfeeding is liberating for the mother. No need to drag around bottles or formula. No need to worry about where to warm up the milk. No need to worry about sterility. No need to worry about how your baby is, because he is with you.

12. There is no way to know how much breastmilk the baby is getting.

Not true! There is no easy way to measure how much the baby is getting, but this does not mean that you cannot know if the baby is getting enough. The best way to know is that the baby actually drinks at the breast for several minutes at each feeding (open mouth wide—pause—close mouth type of suck). Other ways also help show that the baby is getting plenty (Handout 4: Is My Baby Getting Enough Milk?). See the videos at http://www.drjacknewman.com/

13. Modern formulas are almost the same as breastmilk.

Not true! The same claim was made in 1900 and before. Modern formulas are only superficially similar to breastmilk. Every correction of a deficiency in formulas is advertised as an advance. Fundamentally, formulas are inexact copies based on outdated and incomplete knowledge of what breastmilk is. Formulas contain no antibodies, no living cells, no enzymes, no hormones. They contain much more aluminum, manganese, cadmium, lead and iron than breastmilk. They contain significantly more protein than breastmilk. The proteins and fats are fundamentally different from those in breastmilk. Formulas do not vary from the beginning of the feed to the end of the feed, or from day 1 to day 7 to day 30, or from woman to woman, or from baby to baby. Your breastmilk is made as required to suit your baby. Formulas are made to suit every baby, and thus no baby. Formulas succeed only at making babies grow well, usually, but there is more to breastfeeding than nutrients.

14. If the mother has an infection she should stop breastfeeding.

Not true! With very, very few exceptions, the mother’s continuing to breastfeed will actually protect the baby. By the time the mother has fever (or cough, vomiting, diarrhea, rash, etc) she has already given the baby the infection, since she has been infectious for several days before she even knew she was sick. The baby’s best protection against getting the infection is for the mother to continue breastfeeding. If the baby does get sick, he will be less sick if the mother continues breastfeeding. Besides, maybe it was the baby who gave the infection to the mother, but the baby did not show signs of illness because he was breastfeeding. Also, breast infections, including breast abscess, though painful, are not reasons to stop breastfeeding. Indeed, the infection is likely to settle more quickly if the mother continues breastfeeding on the affected side. (Handout 9a: You Should Continue Breastfeeding-1 (Drugs and Breastfeeding) and Handout 9b: You Should Continue Breastfeeding-2 (Illness in the mother or baby)).

15. If the baby has diarrhea or vomiting, the mother should stop breastfeeding.

Not true! The best medicine for a baby’s gut infection is breastfeeding. Stop other foods for a short time, but continue breastfeeding. Breastmilk is the only fluid your baby requires when he has diarrhea and/or vomiting, except under exceptional circumstances. The push to use “oral rehydrating solutions” is mainly a push by the formula manufacturers (who also make oral rehydrating solutions) to make even more money. The baby is comforted by the breastfeeding, and the mother is comforted by the baby’s breastfeeding. (Handout 9a: You Should Continue Breastfeeding-1 (Drugs and Breastfeeding) and Handout 9b: You Should Continue Breastfeeding-2 (Illness in the mother or baby)).

16. If the mother is taking medicine she should not breastfeed.

Not true! There are very very few medicines that a mother cannot take safely while breastfeeding. A very small amount of most medicines appears in the milk, but usually in such small quantities that there is no concern. If a medicine is truly of concern, there are usually equally effective, alternative medicines that are safe. The risks of artificial feeding for both the mother and the baby must be taken into account when weighing if breastfeeding should be continued (Handout 9a: You Should Continue Breastfeeding-1 (Drugs and Breastfeeding) and Handout 9b: You Should Continue Breastfeeding-2 (Illness in the mother or baby)).

Questions? (416) 813-5757 (option 3) or drjacknewman@sympatico.ca or my book Dr. Jack Newman’s Guide to Breastfeeding (called The Ultimate Breastfeeding Book Of Answers in the USA.)

Handout #11 Some Breastfeeding Myths. Revised January 2005

Written by Jack Newman, MD, FRCPC. © 2005

This handout may be copied and distributed without further permission, on the condition that it is not used in any context in which the WHO code on the marketing of breastmilk substitutes is violated

Whenever I ask new mothers why they are supplementing breast milk with formula the top reason I get is “I am not getting enough milk”. One of the major reasons for a low milk supply is supplementing breastfeeding with infant formula.

However the truth is that rarely is milk supply insufficient. Here are a few reasons mothers erroneously believe they have a supply problem.

·         The baby nurses often: This isn’t because you don’t have enough milk rather it because breast milk is easier to digest than formula thus the need for breastfed to eat more often than formula fed babies. As a rule exclusively breastfed babies should be fed on demand and not timed.

·         Your breasts are soft and seem to be empty: Note the word seem, the body learns to produce only what’s needed so that soft breasts are a sign that your body is producing the needed quantity of milk.

·         You don’t feel the sensation of your milk letting down: This sensation usually stops after a while and if you’re like me after the first couple of weeks you won’t feel the let-down sensation.

·         No leaky breasts: Again this is because the body knows how much milk to produce. While some mothers may leak milk for up to a year, many stop leaking milk after a couple of months.

·         Baby seems unusually hungry: The baby may be experiencing a growth spurt just continue nursing.

However in some cases milk supply may actually be compromised. The chief sign that milk supply is low is if the baby is loosing or not gaining weight in which case you should see a doctor immediately.

If milk supply is indeed low these are some ways it can be increased.

·         Increase frequency of nursing: The best way to increase milk supply is by emptying the breast more often. The most effective and efficient way of doing so is by feeding baby as often as possible.

·         Expressing: This is for the same reason as above.Even when baby is asleep one can express to increase milk supply

·         Avoid bottles and pacifiers as they may cause bottle confusion.  It takes more effort to suck a human nipple than a bottle nipple, so once a baby gets used to sucking from a bottle he or she may not want to bother with the effort needed to suck from the breast. Here are signs that milk supply is low.

·         Use fenugreek: Fenugreek is an herbal supplement that can help increase your milk supply. It however works better in the first few weeks of breastfeeding. This should be taken as last resort as herbs should be treated as medicines an only taken when necessary.

Dr Jack Newman is Paediatrician and top breastfeeding specialist. Over time I will be publishing some of his breastfeeding handouts.

Breastfeeding is the natural, physiologic way of feeding infants and young children, and human milk is the milk made specifically for human infants. Formulas made from cow’s milk or soybeans (most formulas, even “designer formulas”) are only superficially similar, and advertising which states otherwise is misleading. Breastfeeding should be easy and trouble free for most mothers. A good start helps to ensure breastfeeding is a happy experience for both mother and baby.

The vast majority of mothers are perfectly capable of breastfeeding their babies exclusively for about six months. In fact, most mothers produce more than enough milk. Unfortunately, outdated hospital routines based on bottle feeding still predominate in too many health care institutions and make breastfeeding difficult, even impossible, for too many mothers and babies. For breastfeeding to be well and properly established, a good start in the early few days can be crucial. Admittedly, even with a terrible start, many mothers and babies manage.

The trick to breastfeeding is getting the baby to latch on well. A baby who latches on well, gets milk well. A baby who latches on poorly has more difficulty getting milk, especially if the supply is low. A poor latch is similar to giving a baby a bottle with a nipple hole that is too small—the bottle is full of milk, but the baby will not get much. When a baby is latching on poorly, he may also cause the mother nipple pain. And if he does not get milk well, he will usually stay on the breast for long periods, thus aggravating the pain. Unfortunately anyone can say that the baby is latched on well, even if he isn’t. Too many people whoshould know better just don’t know what a good latch is. Here are a few ways breastfeeding can be made easy:

1. A proper latch is crucial to success. This is the key to successful breastfeeding . Unfortunately, too many mothers are being “helped” by people who don’t know what a proper latch is. If you are being told your two day old’s latch is good despite your having very sore nipples, be sceptical, and ask for help from someone else who knows. Before you leave the hospital, you should be shown that your baby is latched on properly, and that he is actually getting milk from the breast and that you know how to know he is getting milk from the breast (open mouth wide—pause—close mouth type of suck). See also the website http://www.drjacknewman.com/ for videos on how to latch a baby on (as well as other videos). If you and the baby are leaving hospital not knowing this, get experienced help quickly (see Handout A: When Latching). Some staff in the hospital will tell mothers that if the breastfeeding is painful, the latch is not good (usually true), so that the mother should take the baby off and latch him on again. This is not a good idea. The pain usually settles, and the latch should be fixed on the other side or at the next feeding. Taking the baby off the breast and latching him on again and again only multiplies the pain and the damage.

2. The baby should be at the breast immediately after birth. The vast majority of newborns can be at the breast within minutes of birth. Indeed, research has shown that, given the chance, many babies only minutes old will crawl up to the breast from the mother’s abdomen, latch on and start breastfeeding all by themselves. This process may take up to an hour or longer, but the mother and baby should be given this time together to start learning about each other. Babies who “self-attach” run into far fewer breastfeeding problems. This process does not take any effort on the mother’s part, and the excuse that it cannot be done because the mother is tired after labour is nonsense, pure and simple. Incidentally, studies have also shown that skin-to-skin contact between mothers and babies keeps the baby as warm as an incubator (see section on skin to skin contact). Incidentally, many babies do not latch on and breastfeed during this time. Generally, this is not a problem, and there is no harm in waiting for the baby to start breastfeeding. The skin to skin contact is good for the baby and the mother even if the baby does not latch on.

3. The mother and baby should room in together. There is absolutely no medical reason for healthy mothers and babies to be separated from each other, even for short periods.

Health facilities that have routine separations of mothers and babies after birth are years behind the times, and the reasons for the separation often have to do with letting parents know who is in control (the hospital) and who is not (the parents). Often, bogus reasons are given for separations. One example is that the baby passed meconium before birth. A baby who passes meconium and is fine a few minutes after birth will be fine and does not need to be in an incubator for several hours’ “observation”.

There is no evidence that mothers who are separated from their babies are better rested. On the contrary, they are more rested and less stressed when they are with their babies. Mothers and babies learn how to sleep in the same rhythm. Thus, when the baby starts waking for a feed, the mother is also starting to wake up naturally. This is not as tiring for the mother as being awakened from deep sleep, as she often is if the baby is elsewhere when he wakes up. If the mother is shown how to feed the baby while both are lying down side by side, the mother is better rested.

The baby shows long before he starts crying that he is ready to feed. His breathing may change, for example. Or he may start to stretch. The mother, being in light sleep, will awaken, her milk will start to flow and the calm baby will be content to nurse. A baby who has been crying for some time before being tried on the breast may refuse to take the breast even if he is ravenous. Mothers and babies should be encouraged to sleep side by side in hospital. This is a great way for mothers to rest while the baby nurses. Breastfeeding should be relaxing, not tiring.

4. Artificial nipples should not be given to the baby. There seems to be some controversy about whether “nipple confusion” exists. Babies will take whatever gives them a rapid flow of fluid and may refuse others that do not. Thus, in the first few days, when the mother is normally producing only a little milk (as nature intended), and the baby gets a bottle (as nature intended?) from which he gets rapid flow, the baby will tend to prefer the rapid flow method. You don’t have to be a rocket scientist to figure that one out, though many health professionals, who are supposed to be helping you, don’t seem to be able to manage it. Note, it is not the baby who is confused. Nipple confusion includes a range of problems, including the baby not taking the breast as well as he could and thus not getting milk well and/or the mother getting sore nipples. Just because a baby will “take both” does not mean that the bottle is not having a negative effect. Since there are now alternatives available if the baby needs to be supplemented, (see Handout 5: Using a Lactation Aid 2005 , and Handout 8: Finger Feeding 2005) why use an artificial nipple?

5. No restriction on length or frequency of breastfeedings. A baby who drinks well will not be on the breast for hours at a time. Thus, if he is, it is usually because he is not latching on well and not getting the milk that is available. Get help to fix the baby’s latch, and use compression to get the baby more milk (Handout 15: Breast Compression). Compression works very well in the first few days to get the colostrum flowing well. This, not a pacifier, not a bottle, not taking the baby to the nursery, will help.

6. Supplements of water, sugar water, or formula are rarely needed. Most supplements could be avoided by getting the baby to take the breast properly and thus get the milk that is available. If you are being told you need to supplement without someone having observed you breastfeeding, ask for someone to help who knows what they are doing. There are rare indications for supplementation, but often supplements are suggested for the convenience of the hospital staff. If supplements are required, they should be given by lactation aid at the breast (see Handout 5: Using a Lactation Aid), not cup, finger feeding, syringe or bottle. The best supplement is your own colostrum. It can be mixed with 5% sugar water if you are not able to express much at first. Formula is hardly ever necessary in the first few days.

7. Free formula samples and formula company literature are not gifts. There is only one purpose for these “gifts” and that is to get you to use formula. It is very effective, and it is unethical marketing. If you get any from any health professional, you should be wondering about his/her knowledge of breastfeeding and his/her commitment to breastfeeding. “But I need formula because the baby is not getting enough!” Maybe, but, more likely, you weren’t given good help and the baby is simply not getting the milk that is available. Even if you need formula, nobody should be suggesting a particular brand and giving you free samples. Get good help. Formula samples are not help.

Under some circumstances, it may be impossible to start breastfeeding early. However, most “medical reasons” (maternal medication, for example) are not true reasons for stopping or delaying breastfeeding, and you are getting misinformation. Get good help. Premature babies can start breastfeeding much, much earlier than they do in many health facilities. In fact, studies are now quite definite that it is less stressful for a premature baby to breastfeed than to bottle feed. Unfortunately, too many health professionals dealing with premature babies do not seem to be aware of this.

Written by Jack Newman, MD, FRCPC. © 2005

The decision whether or not one breastfeeds exclusively is made long before baby arrives. Once you have made that all important decision there are some necessary preparations that must be made.

· Prepare your nipples: Women with inverted nipples may have latching on problems. It is therefore important that such nipples are prepared by manually bring out the nipple daily before baby arrives.

· Nursing Bras: Good nursing bras are essential for comfortable breastfeeding. You should purchase bras of different sizes as the breasts are much fuller than normal during the first weeks of breastfeeding i.e. if you are normally a 36b , then buy nursing bras in 36c and maybe d.

· Nursing pads: Breasts will leak milk for the first few months, and if you’re like me for the first year! It is therefore essential to get good quality nursing pads. There are reusable cotton nursing pads which should be washed every day as well as disposable pads. If you choose to use disposable pads make sure you use the ones without plastic lining as this lining encourages moisture retention on the breast and could lead to fungal infections.

· Breast pump: If you work away from home a good breast pump is essential. However be sure to put baby to the breast whenever you can so that nipple confusion does not occur, for the same reason giving breast milk by bottle should be avoided for the first few weeks. There are manual and electric pumps, be sure to avoid pumps made by formula companies are they are designed to be as uncomfortable as possible. It is however possible to express milk by hand. Please contact me personally for advice on the best pumps to use.

· Bottles: This is especially important for mothers who want to continue exclusive breastfeeding once they return to work. Most pumps come with bottles that compliment them.If you are a stay at home mum you may not need any bottles, as by the time baby is 6months a cup can be introduced rather than a bottle.

· Breastfeeding friendly clothes: Be sure to invest in clothes with easy access for breastfeeding in public. You may also need little shawls for discreet breastfeeding. I personally discourage the draping of baby with heavy shawls all in the name of discreet nursing, instead you a small cloth or bib to cover the breast while nursing.

· Be prepared to handle critics. You must be prepared to handle criticism from people who wonder why you are still breastfeeding. Rememeber that most of them mean well and educate them instead of getting discouraged.

Breastfeeding for me is always painful as I have very inverted nipples but after a few days the pain stops and I enjoy giving my baby the best nourishment possible. Please feel free to email me with any breastfeeding difficulties you may encounter.