22/09/2016
Dr.Jack Newman
The first few days after birth. Why so many problems?
Watch the attached video. This baby is 24 hours old and is drinking very well from the breast. Better than most babies of his age. How do I know? Because of the pause in this baby’s chin as he lowers his chin to the maximum. That pause in the chin says to an observer “I just got a mouthful of milk”, and the longer the pause, the more milk the baby got. The opposite of this is a baby who nibbles, who sucks but shows no pause in the chin. The baby in this video https://goo.gl/k93aAj is nibbling only and getting very little if any milk. So, the bottom line is that if one knows about the pause in the chin, one knows when a baby is getting milk and one knows when the baby is not getting milk. A baby is not getting milk simply because he is latched on and sucking. Unfortunately, too many of our health professionals don’t have this simple knowledge. And neither do most mothers. And so we get the following problems arising in the first few days, not because breastfeeding cannot work or because breastfeeding is hazardous, but because most mothers don’t get good help and most health professionals don’t how to help. And we end up with:
1.The mother having sore ni***es: Breastfeeding should not hurt. If it does, then something is wrong. Here’s an anecdote. A few months ago, I was called to see the daughter of a friend. She had just given birth and when I saw her 36 hours after the birth, the mother had started to get sore ni***es and the baby never settled after a feeding. It took me a couple of minutes at most, to help the mother latch the baby on better. This resulted in the mother having no pain. And I then taught her how to know the baby was getting milk or not and if not, to use breast compression to increase the flow of milk to the baby. For a video showing breast compression being used in a 2 days old baby, see https://goo.gl/dy3m0c. For the first time, the baby was satisfied. And now, at 5 months of age, the baby is still exclusively breastfed and gaining weight beautifully.
2.Dehydration: Dehydration during the first few days is due to the baby not getting milk. Why does it happen? Because too many health professionals think that if the baby is latched on and sucking the baby must be getting milk. So the mothers are reassured. But if the baby is nibbling only, the baby is getting very little milk. In many cases, luckily, the situation turns around when the mother’s milk comes in. But not always, because some babies get sleepier and sleepier, since at this young age many babies fall asleep at the breast when the flow of milk is slow and soon many do not wake up on their own. This is not a problem with breastfeeding, that somehow breastfeeding cannot work; it is a problem with how mothers are helped immediately after birth. And too often they get poor help.
Incidentally, % weight loss is not a good measure of how well a baby is breastfeeding. To begin with, in many Western countries, women often get large amounts of intravenous fluids during the labour and birth. Some of that fluid goes to the baby who starts to pass urine and loses weight, which is a reason that a lot of wet diapers does not help you know if the baby is getting enough from the breast. Secondly, mistakes are often made while weighing or the answer put incorrectly into the chart. But there is an issue with the intravenous fluids. And that is that many women get significant swelling with fluid including swelling of their ni***es and areolas, which makes it different for the baby to latch on and thus get milk well. This problem is not recognized as often as it should be because treatment is not difficult and if initiated early, the baby will then be able to latch on well and get milk from the breast. Watch this video https://goo.gl/uFVQTl. This 3 day old baby is drinking lots of milk (in spite of a less than perfect latch), but the mother is under pressure from the nursing staff to give formula because the baby is 10% below birth weight. Luckily, the mother received good help from a lactation consultant and did not supplement and mother and baby both breastfed exclusively with no problems. On the other hand, this baby, see https://goo.gl/k93aAj, is hardly drinking at all.
3.Jaundice: Higher levels of jaundice in the first few days after birth are usually due to the baby not getting milk and thus is often combined with dehydration, but not always. The prevention and treatment is the same as with dehydration; in other words, let’s make the breastfeeding work well and make sure the baby is drinking milk well.
4.The baby does not latch on: There are several reasons for this occurring, including medications the mother got during the labour and birth and affected the baby. Yes, drugs given in the epidural/spinal do get to the baby and may result in the baby being too sleepy or having his ability to latch on interfered with. Again, fluid swelling of the ni***es and areolas may also play a role.
After all is said and done, the problems are not due to breastfeeding, but how mothers’ breastfeeding is interfered with and how those who are supposed to help the mother do not know how to know a baby is breastfeeding well or not and/or do not know how to help. I am not saying this is true of every health professional, but it is very common.
And finally, millions of babies have not died in the world because of the implementation of the Baby Friendly Hospital Initiative, but rather millions of babies have died in the world because they were not breastfed. I have worked in Africa and I know this to be true.
