When is my breastfeeding baby finished feeding?

Recently I visited a colleague who had her first baby. The baby was 8 weeks old and sported a gorgeous shock of dark hair. Mum was typically tired. As we devoured my other friend’s amazing raspberry scrolls there were lots of questions. At one point it dawned on me that my colleague was still doing things she was told do in hospital 8 weeks later. This resonated with my clinical Post-Doctoral Fellow who was lamenting similar scenarios she had seen in practice.

One limiting and tiring practice in the early days is long feeds of more than 20 to 30 minutes. Watching my friend’s baby at the breast, she started feeding and gulping milk (mum has a great supply) then she happily slipped into a dozy, cuddly, sucking style consisting of long pauses and very short bursts of sucking. When the baby started to detatch from the breast this stimulated her to start sucking again. The mum assumed that the baby was still hungry and was still receiving milk from the breast.

It seems my friend was told to let the baby detach from the breast herself which, on more probing, was understandable as the babe had lost 10% of her weight after birth and there was some angst around her consuming adequate volumes of milk in the early days. However, at 8 weeks of age baby was consuming plenty of milk but happily spending lots (and lots) of time at the breast without actively feeding. Exhausting to say the least.

So intuitively, or not so, watching the baby and detaching her after the initial nutritive sucking (fast and furious, or slow and steady) and some non-nutritive sucking (those gentle sucks and long pauses) is a strategy to help mum cope with frequent breastfeeds without jeopardizing breastfeeding. Often it is expected that the baby will spontaneously detach from the breast but that isn’t always the case. Other signs that the baby has finished feeding include both non-nutritive sucking (those gentle sucks and long pauses) and disinterest when the second breast is offered. Of course, if it is convenient and enjoyable to both mum and baby for the baby to stay at the breast, intermittently sleeping and feeding over an extended period, this is fine – but it is not necessary for every feed.

What does the research say? One study ‘Does breastfeeding method influence infant weight gain’ showed babies put on less weight when they we left to detach from the breast on their own. The same study also showed that long feeds was linked to lower weight gain. Our study ‘Ultrasound Imaging of Infant Sucking Dynamics during the Establishment of Lactation’ shows that babies feed for around 16 to 20 minutes on average in the first 4 weeks. By 10 weeks we found the length of the feed reduced to around 10 minutes (‘Longitudinal Changes in Suck-Swallow-Breathe, Oxygen Saturation, and Heart Rate Patterns in Term Breastfeeding Infants’). So, what does this mean? It means when babies appear to be finished with active nutritive sucking at the first breast you can switch them to the second breast. This increases the chance of the baby taking more milk in less time. It also ensures the baby receives the volume of milk he/she needs, and that milk supply is maintained. Further, getting the balance will improve the breastfeeding relationship and the mum’s wellbeing.

[1-3]

1.             Walshaw, C.A.; Owens, J.M.; Scally, A.J.; Walshaw, M.J. Does breastfeeding method influence infant weight gain? Arch Dis Child 2008, 93, 292-296, doi:10.1136/adc.2006.107102.

2.             Sakalidis, V.S.; Williams, T.M.; Garbin, C.P.; Hepworth, A.R.; Hartmann, P.E.; Paech, M.J.; Geddes, D.T. Ultrasound imaging of infant sucking dynamics during the establishment of lactation. J Hum Lact 2013, 29, 205-213, doi:10.1177/0890334412452933.

3.             Sakalidis, V.S.; Kent, J.C.; Garbin, C.P.; Hepworth, A.R.; Hartmann, P.E.; Geddes, D.T. Longitudinal changes in suck-swallow-breathe, oxygen saturation, and heart rate patterns in term breastfeeding infants. J Hum Lact 2013, 29, 236-245, doi:10.1177/0890334412474864.

My milk doesn’t look creamy! Is it rich enough

Breast milk is different to cow’s milk in many ways, with one difference being the colour of the milk. We are used to seeing milk as a consistent white colour, but breast milk varies in colour.  “Breast milk can range from somewhat translucent to a bluish colour to pale white to a creamy white or even yellow and it all usually depends on the amount of fat in the milk” says UWA’s Professor of Human Lactation Donna Geddes.

Indeed, the fat in breast milk varies depending on how much milk is in the breast and well as how much milk the baby takes from the breast at a feed. The fuller the breast the less ‘cream’ in the milk. Not to worry though because as the baby feeds the milk gets ‘creamier’ and the fat content increases. “Mums often worry about whether their baby receives enough fat from their breast milk, but they need not. Over the course of the day, it all evens out and the baby receives what they need. There is a normal range for the amount of fat consumed in breast milk, so it varies between babies. In fact, it is the volume of milk that a baby consumes rather than the fat content that drives infant weight gain.

Prof Geddes groups publication “Volume and Frequency of Breastfeedings and Fat Content of Breast Milk Throughout the Day” has shown that the fat content received in breast milk is similar for boy and girl babies. Further the amount of fat received does not depend on how many feeds the baby has throughout the day. This means that it doesn’t matter if the baby has few feeds of large volumes compared to a baby that has small frequent feeds.

 “Breastfed babies receive a lot of calories from the fat in breast milk to help them grow rapidly. The type of fats in breast milk are also very special. They help with brain development and appear to respond to the mums and baby’s health” says Prof Geddes.

“Since we want our babies to receive as much milk as they need and all of the beneficial nutrients it’s best to allow the baby to finish their feeds at each breast without being too concerned about how long they are feeding”.

“We think that the increase in fat at the end of a breastfeed may also help the baby feel full. This is a good reason for not timing feeds but rather allowing the baby to finish suckling before stopping the feed or changing to the other breast” she adds.  

How many times should I feed my baby?

New mothers often wonder whether their baby should feed from one or both breasts, and whether it’s okay for them to switch between sides a few times at a feed. “Babies take different volumes at each breastfeed, so our advice is to feed until the baby is happily full. That means the baby may feed from one or two breasts and even go back to the first breast for a top up” says The University of Western Australia’s Professor of Human Lactation Donna Geddes.

Indeed, the group’s publication “Volume and Frequency of Breastfeeding and Fat Content of Breast Milk Throughout the Day” shows that for many babies, 44% of breastfeeds happen from one breast and 53% from both breasts. It is not unusual for babies to mix it up during the day and night. “When babies go back to the first breast for more milk, we call it cluster feeding.”

Professor Geddes, director of the Geddes Hartmann Human Lactation Research Group based at UWA, urges mothers to feed their babies when they show signs of wanting a feed without worrying how long it has been since the last feed. “We have found that the time between feeds ranges from as little as 4 to 40 minutes with an average of 2 to 3 hours. In essence babies do not feed to a schedule but feed when they are hungry or thirsty.”

“Babies can take as little as 27 mL to as much as 147 mL milk from one breast. Restricting the timing of feeds or limiting all feeds to one side only will potentially decrease the amount of milk taken by the baby, and this will slow weight gain which is not ideal” said Professor Geddes. “Restricting feeds can also set up a vicious cycle; feeding less slows milk secretion and can reduce milk supply, which may lead to giving complementary feeds and eventually to stopping breastfeeding sooner than the mum had planned.”

“The first few months after birth are a hectic time, making mums question whether they should be setting a routine for their baby. In all honesty a pattern begins to emerge naturally as babies establish their circadian or daily rhythms. Breast milk contains components that help this process, but it takes some time.”

Mums benefit from breastfeeding: reduced risk of endometrial cancer →

I find when I am at a conference much emphasis is put on the benefits of breastfeeding for the baby and admittedly the list is long. However, mum reaps multiple benefits as well, such as decreased risk of breast and ovarian cancer. More recent findings also show a decreased risk of cardiovascular disease and diabetes but oh my gosh, women do not breastfeed have been found to have on average 7.5 cm of extra fat around their waist. To boot they also have more fat around their internal organs. Now that’s not good for the looks or health.

Breastfeeding reduces endometrial cancer

A recent meta-analysis, which is the highest quality analysis of multiple studies that can be done found that breastfeeding women had less risk of cancer of the lining of the uterus (endometrial cancer). The difference with this one is that they can adjust for things that might predispose you to endometrial cancer in the first place like BMI (fatness), time since you were last pregnant and how long you breastfed for.  
Adjusting for all of these things means the answer or result is less likely to be wrong or should I say more likely to be right.

What is endometrial cancer?

Endometrial cancer is the most common gynaecological cancer and is on the rise globally. More than 57,000 women in the US, Canada and Australia are diagnosed with endometrial cancer annually. The most common symptom is heavy bleeding however; luckily most cases can be cured. There are a number of things that put you at higher risk of endometrial cancer such as high BMI and increased levels of the hormone oestrogen.

Why does breastfeeding protect against endometrial cancer?  

According to the research women that breastfed up to 6 or 9 months had the lowest risk of endometrial cancer. It is not known exactly why breastfeeding protects women but scientists suspect that it is because women that breastfeed have lower oestrogen levels. Lower oestrogen results in less cell division of the lining of the uterus hence less chance for things to go awry. Women that breastfeed a lot (especially exclusively in the first 6 months) had the lowest levels of oestrogen. Some breastfeeding women have levels as low as postmenopausal women! With such low levels it is also less likely that you will produce an egg, from your ovaries, to be fertilised. Its no wonder it can be hard to get pregnant when breastfeeding. Increased birth spacing is yet another benefit of breastfeeding for mothers to add to the list.

More is better

Mostly the benefits of breastfeeding increase the long the mother breastfeeds. This goes for both the mother and infant. So with data like this we should all be working to help mothers feed their babies for as long as they can. Indeed accommodating breastfeeding women in the workplace is fundamental and with a role model like Senator Larissa Waters we may well have a chance to make it happen

Breastfeeding in Parliament: the norm →

Senator Larissa Waters has hit the news by breastfeeding her daughter while moving a Senate motion Down Under in Auz. It is refreshing to see a Senator make history by breastfeeding while fulfilling her parliamentary duties.  However it prompts one to reflect why a woman breastfeeding her baby in the public eye makes the news. Why do we feel the need to legislate to protect breastfeeding women who feed in public? Yet there are no consequences for those who harass women that are simply attending to their babies needs. Breastfeeding is a normal behaviour for both the mother and the baby..it is the norm. Our norms unfortunately have been becoming less family friendly which is highlighted in Larissa’s tweet “….We need more #women & parents in Parli.' Clearly its time to rethink our norms.

pixabay.com

How do we support breastfeeding?

So after reflecting why it is such a big deal to see women breastfeeding in public the next elephant in the room is how can clinicians and researchers assist women to breastfeed successfully? Currently the situation is dire with many women giving up breastfeeding in the first 3 months. This dilemma requires a rethinking of the support provided to mothers and babies, education, as well as targeting research to the major causes of early weaning. Why do we need research if mothers know breastfeeding is good for them and their babies? Well because currently mothers are having a tough time and they are giving up because we don’t have all of the answers or solutions. Bringing all of the players to the table will undoubtedly ensure we have a greater chance of solving the puzzle. Indeed some of Scotland's leading experts in maternal and infant health believe new mothers need to be offered better support with breastfeeding and this requires a cross discipline approach.