Calling All Babies – Expressing the Need for Colostrum

As some of you know, I am a strong advocate of the veterinary model of healthcare management when it comes to birth and early infant feeding, regardless of one’s species! Anyone who breeds cows, horses or other mammals will tell you how important it is for a newborn to receive colostrum, a mother’s very first milk. Loaded with antibodies, colostrum protects an infant from harmful environmental bacteria and viruses. To this end, farmers who raise cattle will immediately coax a newborn calf to its mother, skin-to-skin with her udder. Knowing the serious health consequences of not receiving species-specific colostrum as soon as possible after birth, veterinarians and zoologists will take extraordinary measures (like milk expression and alternative feeding methods) to ensure that a newborn receives its mother’s first milk. In the animal world, it is well-recognized that health, and even survival, is greatly influenced by receipt of this amazing liquid. Although artificial baby milks may be formulated for some species, illness and healthcare costs are significantly higher for those that must be “hand raised” (formula fed).

Human infants are no different. Infants not having received colostrum are four times more likely to become ill and require hospitalization during the first year of life than their human-milk-fed counterparts. Often called baby’s “first immunization,” colostrum provides passive immunity to a newborn because it is so rich in antibodies. In addition to immune factors, colostrum has an amazing ability to stabilize blood sugar levels, far better than formula. This is extremely important to a newborn infant, especially those who may have had a stressful birth, been born prematurely or delivered by a diabetic mother.

Like farmers and veterinarians, We too can ensure that our babies receive colostrum as soon as possible after birth. In cases where baby can be placed directly at the breast, skin-to-skin after birth, we certainly should do so. If not, let’s hand express and spoon- or syringe-feed this liquid gold to our newborns (see blog on hand expression). Our babies deserve the very best, so let’s let advocate for them by behaving like a bunch of animals!

Skin-to-Skin Kangaroo Care – Yet Another Amazing Story!

You all HAVE to see this video clip featured on the TODAY show this morning. An amazing story you cannot miss! Here’s the link
Parenting on Today Show - Premature infant stirs to life after two hours of kangaroo care
It is yet another testament to the value of skin to skin contact for all babies!

Hand Expression of Milk

Over the course of my career I have been privileged to observe hundreds of mothers happily breastfeeding their infants AFTER having had early and/or significant challenges with breastfeeding. In other words, breastfeeding doesn’t always get off to an easy start. However, with expert clinical assistance, time, patience and determination, most breastfeeding issues can be resolved. In the interim, expression of mother’s milk may be necessary to ensure a baby’s receipt of breast milk. When a baby is unable to or has trouble with attachment (or latching), it’s highly recommended that the mother begin pumping with a hospital-grade electric pump as soon as possible after birth. Pumping technology has advanced to the point that mothers can maintain a milk supply for months and even years. However, manual (hand) expression is still considered to be the most effective means of expressing colostrum, mother’s very important first milk. Hand expression of milk may also be helpful later when managing breast engorgement (another discussion for another day). Using the thumb and index finger in a systematic method of breast compression, we are often able to collect significant amounts of this thick, rich colostral milk for our babies. Spoons, syringes, feeding tubes or even tiny cups may be used for feeding this liquid gold to our little ones. I have included this link for step-by-step instruction of hand expression of colostrum, which you may find extremely helpful:

Hand Expression Video - Stanford University

Whether or not hand expression becomes necessary in the early days of breastfeeding, I recommend that all breastfeeding mothers develop the propensity to perform this handy maneuver. You never know when your breasts will express their need for some relief! Happy expressing!

“Cah, Cah”…Evaluating for Transfer of Mother’s Milk

One of the best ways to evaluate an infant’s feeding at the breast is to observe for swallowing. During the first few minutes at breast (after your transitional milk has come in), your baby should exhibit a suck/swallow ratio of about one-to-two sucks per swallow. This means that you should see one or two jaw excursions (sucks) followed by a deep draw (chin drops and mouth pauses in an open position) then the sound of a swallow may be heard (a quick, gentle “cah” sound). Swallowing may also be felt by resting a finger gently on baby’s throat while he is feeding. Remember, a good attachment to the breast is important. There should be a wide gape of baby’s mouth around your breast. His lips should be flanged outward with a good seal between your breast tissue and his lips. No air spaces should be seen and milk should not run out from the corners of his mouth. So listen and count those “cah’s.” They eventually turn into coo’s! Relax and enjoy your baby’s feeding!

Tick, Toc, Tick, Toc: Must we always watch the clock?

We talk about how human infants should feed every two to three hours in the early weeks and months, and certainly that is true. However, once effective breastfeeding is well-established and baby is gaining weight nicely without intervention, it may be time to kick back and relax. What’s wrong with letting baby dictate how often he wants to eat as long as he is thriving? A baby who begins to get hungry will exhibit early hunger “cues.” Examples of early hunger cues include upper body movement, hand-to-mouth behaviors, rapid eye movement during sleep, etc. Late signs of hunger include fussing and crying. So, sit back, put your feet up and let your baby do the talking. Tick, Toc, Tick, Toc…perhaps we shouldn’t watch the clock!

The Value of Skin-to-Skin Contact

Did you know that placing your baby skin-to-skin on your chest, especially while you are resting, is more than just a sweet snuggle time? Skin-to-skin positioning (also known as kangaroo care) not only facilitates milk production and the release of the maternal hormone oxytocin (the mothering hormone), but also has an effect on your baby’s physiology. Holding your baby skin-to-skin (no fabric between you) actually regulates his body temperature, respirations and heart rate. Research in this area is absolutely fascinating! For example, a mother’s breast temperature actually rises in order to warm and lowers in order to cool her baby when he has direct skin-to-skin contact with his mother. His breathing becomes relaxed, and his heart rate becomes regular. Talk about a mother’s ability to provide for her baby! Here’s another fascinating example: in two separate case studies, pre-term twins were placed simultaneously skin-to-skin with their mother, each against one of her breasts. Remarkably, each breast (in all four cases) responded individually to the thermal needs of the infant on that particular breast by raising and lowering its temperature independently of the other. So, let’s not underestimate the power of our breasts. Food, warmth and security… all in a soft, beautiful package! What more could our babies want?

Night Time Feedings

New mothers usually want to know if they should wake their baby for night time feedings. The answer is dependent upon several things. First of all, if your baby is under two weeks of age, you will want to remove milk from your breasts every two to three hours. This will assist in establishing a good milk supply and keep you comfortable. Most full-term babies wake to feed at this frequency anyway, so it works out well for both. Babies who were born a little earlier than expected, may need to be aroused for their feedings in order to gain weight. A two- to three-hour interval works well. Once your baby is nursing effectively, stooling and voiding within normal limits, and gaining weight, it’s acceptable to allow for longer intervals between feedings, especially at night. So, if your breasts can tolerate a wee bit of fullness, I say go for it, and let baby sleep. Enjoy your ZZZ’s.