Postpartum and beyond

August 1, 2011

In the first few days of breast-feeding, immediately after delivery and before the mature milk comes in, a thick, yellowish liquid known as colostrum is produced in small quantities and secreted from the nipples. Yet this “premilk” is sufficient to nourish the baby, satisfy the baby, and protect the baby from jaundice and many infectious diseases during the first few days of life. Colostrum that can even be present early in the second trimester of pregnancy contains complex immunological proteins, white blood cells, and factors that activate bowel function, a necessary stimulus to excrete the yellow pigment bilirubin (a by-product of red blood cell damage) into the stool. “Foremilk,” which is the first portion of expressed milk, is similar to skim milk in both appearance and fat content. It is also larger in volume than “hindmilk,” the creamier milk with a higher fat content that comes toward the end of the feeding. The volume of milk production will only diminish if the hormonal pathway regulated by frequent suckling is inhibited, if there is severe malnutrition, or if the mother is more than 10% dehydrated.

Nursing frequency and its influence on both infant and maternal nutrition can be categorized into one of three breast-feeding patterns. Exclusive breast-feeding (also known as unrestricted breast-feeding) is the term applied when infants are fed only by this method, on demand, and for unrestricted periods. Typically this entails an average of 10-12 feedings per day and occurs during the first 6 months of life. Partial breast-feeding is the term coined when breast-feeding is supplemented with limited amounts of formula, juice, water, or solid foods. Minimal breast-feeding, sometimes referred to as “token” feeding, usually means that the infant receives nearly all sustenance from formula and other foods. Research has found that the benefits of breast milk increase with increased exclusiveness of breast-feeding, and in fact, “token” breast-feeding has little or no nutritional value.

The chemical makeup of breast milk changes with every feed, making it tailored for the infants’ needs. Its nutritional content is primarily fat, protein, lactose, water, vitamins, and minerals, including calcium and iron. Nutritional requirements of the lactating mother should begin with a balanced diet and supplements based on maternal dietary deficiencies. Health care providers should give particular attention to vegetarians and malnourished women, as calcium and B vitamins, among other things, may need to be supplemented. Also, living in an industrialized, developed country is not a guarantee against malnourishment and thus every woman should have a nutritional assessment. Other supplements like vitamin D, iron, and fluoride may be recommended for the infant beyond 6 months of age depending on other environmental and lifestyle factors. Assessment of the infant’s nutritional status begins with monitoring the number of wet and soiled diapers, weight gain, and signs of jaundice. A health provider should observe suckling techniques and evaluate feeding frequency if any concerns arise.

SEE ALSO: Lactation, Pregnancy

Category: Breast-Feeding