7 Academy of Breastfeeding Medicine Protocol Committee. ABM clinical protocol # 20: Engorgement. Breastfeed Med . 2009;4(2):111-113. - Protocol Committee of the Academy of Breastfeeding Medicine, "AVM Clinical Protocol No. 20: Engorgement, Revision 2016". Brestfeed Med (Breastfeeding Medicine). 2009;4(2):111-113.

Read instructions before use. Consult a specialist about possible contraindications.

*RU No. FSZ 2010/07352 dated 07/19/10

** RA No. FCZ 2010/06525 dated 17/03/2021

breastfeeding GBUZ GBUZ VFD Kopeisk

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Breastal fed

2 it is natural, useful, convenient and cheap. Nobody has come up with anything better than breast milk for a baby. And no formula, even the most expensive and enriched with vitamins, will replace mother's milk, because laboratories cannot synthesize or isolate most of the important components that are contained in breast milk from cow's milk. For example, protective cells of maternal immunity.

Breastfeeding is also good for the mother herself. Long-term breastfeeding is a proven prevention of breast cancer, ovarian cancer, and the development of diabetes.

And one more thing. Any woman can breastfeed, regardless of breast size, the baby was born on time or not, and other factors. True milk deficiency occurs in less than 2-3 percent of cases.

Advice for breastfeeding mothers

There are many difficulties that a breastfeeding mother may face. Here are some important tips for breastfeeding moms from a lactation consultant Anastasia Kulikova .

• It is important to ensure that the baby is properly attached to the breast. Otherwise, he will not completely empty the breast, this may lead to a decrease in milk production, and may also injure the nipples. Please note that the newborn should capture not only the nipple, but also the areola, and its main part is from below, that is, the attachment should not be symmetrical. Mom's posture should be comfortable and relaxed.
• Night feedings are very important for successful breastfeeding, namely between 3 and 6 am. It is at this time that the brain releases large amounts of prolactin, the hormone responsible for milk production.

• Drink plenty of fluids - 2-3 liters per day. It is also very important for a sufficient amount of milk. At night, put a bottle of water near you so as not to run to the kitchen.
• Do not be nervous, try to get enough sleep and be sure that you will be able to feed your baby for a long time. The calmness of the mother, her good emotional state is the key to successful breastfeeding of the newborn.
• If you have problems that you cannot solve yourself: you cannot establish proper attachment, you feel that there is not enough milk and nothing helps to increase lactation, or vice versa, you are experiencing milk stagnation, seek the help of a breastfeeding consultant . There are such specialists in some antenatal clinics, there are also special services that work on a paid basis.

How to start breastfeeding

It is important that the newborn is put to the breast immediately after birth, in the delivery room. In most maternity hospitals, the joint stay of mother and child is practiced today, which is also very important for the successful establishment of breastfeeding. In the first 1-3 days, colostrum is produced - it is very small, just a few drops, but enough for a newborn. Then comes the milk.

While in the hospital, breastfeed your baby more often to stimulate milk production. Remember, you need to feed the baby on demand, and not by the hour, as was customary in the past. This is the key to successful and long-term breastfeeding.

In the first month when lactation is established, discard bottles and nipples. Sucking from a bottle is much easier for a newborn, so there is a risk of rejection of the breast.

According to WHO recommendations, newborns should also not be supplemented with water. It is enough in mother's milk. And supplementation can lead to a decrease in milk production, as the baby will eat less of it.

Until what age can a child be fed

The World Health Organization recommends breastfeeding up to two years of age.

- In fact, there is no unequivocally correct answer to this question, - says Anna Levadnaya , pediatrician, PhD, author of the blog about pediatrics on Instagram @doctor_annamama. - I am convinced that you need to feed as long as both the baby and the mother enjoy it. If there are no objective reasons for stopping breastfeeding, up to a year, mother's milk must be present in the baby's diet. It is optimal to keep it up to a year and a half.

There is an opinion that after a year milk no longer brings much benefit to the child, but this is not so.

- Studies show that even after the first year of life in breast milk there is a high amount of protein, the concentration of immunoglobulins, lysozyme and lactoferrin, which help to form immunity, Anna Levadnaya notes. - Long-term breastfeeding reduces the risk of atherosclerosis in adulthood, diabetes and obesity, and many other diseases. Long-term breastfeeding helps the correct formation of the maxillofacial skeleton, the likelihood that the child will not have the correct bite is much lower. And some studies suggest that babies who breastfeed for a long time have higher IQs.

The benefits of breastfeeding

The benefits of breastfeeding cannot be overestimated. It is not only a source of valuable nutrients. During feeding, a strong emotional bond is formed between the newborn and mother. Scientists have conducted many studies on the benefits of breast milk. Here's what they say.

• Breast milk contributes to the maturation of the child's immune system, reduces the risk of cancer.
• Children on breastfeeding have a lower risk of atopic dermatitis, they are less likely to get otitis media, they need to remove the pharyngeal tonsils less often, they have better vision.
• Breastfed babies are less likely to experience constipation, diarrhea and intestinal infections, as well as food allergies (when breastfed for 6 months or more). Adults who were breastfed as children are less likely to develop Crohn's disease (severe inflammation of the intestines), ulcerative colitis (inflammation of the colon), and appendicitis.
• Breast milk contains less protein and salts, so there is less stress on the baby's immature kidneys. Less common are urinary tract infections.
• Improves the growth of nervous tissue - this is facilitated by cholesterol and other fats of breast milk.
• Breast sucking improves jaw muscle development. And if you feed your baby for more than a year, this reduces the risk of malocclusion. In addition, the gradual changes in the taste of breast milk with age prepare the baby for a variety of solid foods.
• Breastfed babies develop less respiratory tract infections and are much milder, less likely to develop bronchial asthma, pneumonia, and influenza.

What breast milk should look like

Don't look online for a picture of the "correct" color of breast milk. This is such a unique product that adapts to the needs of the child depending on his age and condition, which can change its composition, fat content and color even during the day. For example, in summer, when a child has a great need to drink, the milk becomes more liquid, the color is more transparent.

But usually with established lactation, the foremilk - the one that the baby receives at the beginning of feeding, is more liquid, it is rich in carbohydrates, its color is less saturated, white-bluish. Back milk, which the baby receives at the end of feeding, is rich in fats, the color is more saturated, yellowish.

If you express milk using a breast pump, you will first see a homogeneous liquid in the bottle. But after standing for quite a bit, it will separate just into these two layers: the top one - the “cream” layer - will be fatter, but smaller in volume.

How to know if a child is hungry

In fact, a child can ask for a breast not only because he is hungry. It helps the newborn to calm down, feel safe, sucking reduces the pain that the baby may experience due to colic. However, there are signs by which you can understand that the child really wants to eat.

• The child is anxious.
• He turns his head from side to side, opens his mouth, as if looking for a nipple, starts doing this especially actively if you pass his hand over his cheek.
• Starts fiddling, groaning, sticking out his tongue.
• Looks for breasts when you pick him up.
• Cries, does not calm down with motion sickness and other actions.

Remember, it is recommended to breastfeed on demand, but at least once every 3 hours during the day and 5 hours at night. Within 1-2 months, lactation gradually improves, milk is released during feeding, and the breast gets used to working in a certain rhythm of feeding.

Why breast milk is expressed

It is important to remember that when lactation is established, pumping is not necessary. Advice to a nursing mother: do not listen to grandmothers who are convinced that if you do not express milk after each feeding, then it will disappear. This is wrong.

- The arrival of milk is carried out according to the so-called "principle of direct feedback": the more milk left, the more it will come, - says Anna Levadnaya. - The child himself regulates the amount he needs. If a woman expresses milk after each feeding, she will be trapped: more milk will come, but the child does not need such an amount, it will stagnate in the chest, which threatens the development of lactostasis and mastitis.

However, there are times when it is necessary to express milk. If your baby was born prematurely and is in intensive care, then the mother should start expressing milk as soon as possible after birth. This will help preserve the milk until the newborn can suckle on his own. In the meantime, the expressed milk will be valuable food for him. Premature babies, as a rule, are fed through a tube, as they are still very weak, they do not have a sucking reflex.

Another occasion when it is necessary to express milk is when you feel that there is less or not enough milk. You need to pump after each feeding, including at night. In this case, breastfeeding specialists can help you.

If you have to be separated from your baby, you also need to express milk so that dad or someone else in the family can feed the baby. Also, pumping is necessary for lactostasis and mastitis in order to cope with milk stagnation.

What can be done while breastfeeding

How many unreasonable prohibitions today for a nursing mother. In fact, the list of what not to do while breastfeeding is very small. We will dispel myths and tell you what a woman can do while breastfeeding.

• No hypoallergenic diet required. We have long been of the opinion that a nursing mother should follow a special diet so that the child does not have diathesis. Meanwhile, in other countries, women eat what they want and how much they want, and the concept of “nursing mother’s diet” simply does not exist. But, despite the widespread practice of diets in pregnant and lactating women, the incidence of allergies continues to grow, and studies have shown that restrictions do not affect its manifestation in any way. Therefore, a nursing mother should eat varied, eat her favorite vegetables, fruits. It is necessary to exclude this or that product from the diet only with a proven food allergy to it.
• You can drink coffee, many women love it. But the amount should be limited to 2 cups per day.
• You can play sports. This does not affect the production and quality of milk. But consider important nuances. It is worth returning to full-fledged training not earlier than the child is 6 months old. It is better to give preference to moderate physical activity. During too intense activities, lactic acid accumulates in milk, the child may not like its taste. When playing sports, a lot of fluid is lost, so you need to drink more water to avoid dehydration.
• Can be dyed and curled.
• You can visit the sauna, observing all hygiene measures.
• You can do, if necessary, x-rays, fluorography, treat teeth using anesthesia (it is selected by the doctor, taking into account the fact that you are breastfeeding).
• You can visit beauty salons and get simple facial and body treatments, including massages that do not affect the chest area.
• You can drink alcohol in moderation. Yes, don't be surprised. Sometimes you can afford to have a glass of wine and relax a bit. But remember a few important points. Alcohol penetrates into breast milk, and its maximum concentration in it is reached after 60-90 minutes if you eat, and after 30-60 minutes if you drink on an empty stomach. And the rate of elimination of alcohol from the body depends on the weight of the woman (in full it will happen faster), the amount of alcohol consumed, its strength. A glass of wine or a glass of beer is excreted on average in 2-3 hours, strong alcohol - in 13 hours. Therefore, if you want to drink a glass of dry white wine, do it immediately after feeding your baby so that the next alcohol will be out of the body. Or express milk 1-2 feedings ahead if you plan to drink more. But in any case, cut out alcohol until your baby is 3 months old.

What not to do while breastfeeding

• A breastfeeding mother should not smoke. Continuous smoking reduces the level of prolactin, the hormone responsible for the production of sufficient milk. In a child, it can cause nausea, vomiting, colic, problems with stools, and irritability.
• You can not drink alcohol in large quantities, in a state of intoxication to feed a child.
• You can not do complex cosmetic procedures involving injections, the introduction of various drugs. For example, mesotherapy of the face and scalp, apparatus treatment, photo and laser hair removal, and others, their impact on the body of the mother and child during this period has not been studied.

What to do if the mother falls ill

Unfortunately, mothers get sick during breastfeeding. And often women unreasonably stop breastfeeding because of this. In fact, it is possible and necessary to feed a baby with SARS (perhaps, mothers get sick most often with them). Together with milk, the child will receive the necessary antibodies. And a woman can bring down a high temperature with drugs based on paracetamol or ibuprofen, they are allowed when breastfeeding.

But even more serious illnesses that require medication, including antibiotics, are no reason to stop breastfeeding. First, there are many drugs allowed during this period. And secondly, despite the fact that the instructions for the medicine often say that it can be taken only if the benefit to the woman outweighs the risks to the child, this does not mean at all that the remedy is dangerous and should not be taken.

- The fact is that studies on the safety of drugs during breastfeeding are very expensive, and manufacturers usually do not conduct them, - says Anna Levadnaya. - It is easier for them to write that the drug is not recommended for breastfeeding, for fear of liability. But such studies were carried out by other independent organizations, for example, the World Health Organization, the American Academy of Pediatrics. And in most cases, the drug is allowed during feeding. Or you can choose a safe analogue.

Moreover, this information is publicly available and you can check the compatibility of the drug and breastfeeding yourself.

- There are several sites for this, the simplest is the Spanish site. All data here is based on scientific publications and medical research.

Despite the fact that there is no Russian version of the site, it is not difficult to use it. Here are some tips for breastfeeding moms on how to do this. First determine the Latin name of the drug or active substance. On the site, select English, enter the name of the desired medicine in the search bar. A rectangle of green, yellow, orange or red color with a description will be highlighted. Green means very low risk, which means the drug is safe for the baby. Red - the risk is very high, which means that the drug cannot be used, you need to choose an analogue. But the final decision whether to take this or the drug during breastfeeding or the abolition of breastfeeding, you still need to work with your doctor.

Feeding after caesarean section

Women whose babies are born by caesarean section often worry that they will not be able to breastfeed their baby. Of course it isn't. There are some difficulties that a mother may face, but they are all surmountable. Milk after a cesarean may come a little later than after a natural birth. To speed up this process, take the baby to you from the nursery as soon as you can take care of him yourself, breastfeed more often.

If for some reason it is not possible to stay together with the baby in the maternity hospital after the operation, then the mother needs to express milk in order to maintain lactation, start doing this as soon as possible after the birth. True, in this case, the baby, who will receive the mixture at the maternity hospital, may refuse the breast at home: sucking from it requires much more effort than from a bottle. Do not despair! Try not to use nipples and bottles, offer breasts more often, and you can feed with expressed milk from a spoon or pipette.

Feeding premature babies

Breast milk is very important for premature babies. The baby receives the necessary nutrients, protection from infections. Breast milk is easier to digest, which is very important for the still immature digestive system of the baby.

Unfortunately, often children born prematurely can be in intensive care, sometimes for quite a long time. They cannot suckle on their own, they are fed through a tube. In this case, in order to save breast milk, the mother needs to start expressing as soon as possible after childbirth and continue to do this until the baby gets stronger and can not eat on her own. “If a premature baby is discharged from the hospital with a normal weight for his age, then the mother can only feed the baby with breast milk,” says Anna Levadnaya.

- If the baby is underweight, breast milk fortifiers should be used. These are special supplements that give a premature baby extra calories, vitamins, macro- and microelements. They are available in the form of a powder or a ready-made mixture. Add to expressed milk just before feeding.

There are two points of view, in many ways different.

The first is followed by many pediatricians and, in particular, the famous Dr. Komarovsky: the baby should be weaned when he is one year old, and do it quickly, decisively and irrevocably . Doctors assure: by this age the child has already received everything that is needed from mother's milk, and is able to eat coarser food, since teeth are already growing. Not delaying feeding is also good for the mother, in terms of social needs: for example, going to work.

Radical completion methods are proposed. For example, for a few days to leave the baby with his grandmother. Of course, the child will cry and look for his mother, but he will have to be firm. Mom, meanwhile, takes lactation suppressant pills and pumps. If you do everything right, the stress will be minimal and quickly forgotten. Weaning should be postponed if the baby is sick, teething, or there is a change of scenery (moving, going on vacation, etc.). But the time of year doesn't matter here. Previously, pediatricians really dissuaded from completing breastfeeding in the summer to protect the baby from intestinal infections and disorders. Now this is not relevant: it is enough to follow the usual rules of hygiene.

Lactation consultants and perinatal psychologists (yes, there are some) are strongly opposed to such an early termination, and especially disagree with doctoral methods, considering them ruthless. Like, for a child, separation from his mother is a catastrophe and betrayal, such injuries do not go away without a trace.

Breastfeeding should be completed by 2-3 years of age, gradually and gently, the authors of the popular BF blog advise. The breast is not only food for the baby, but also contact with the mother, calm falling asleep, confidence that everything is fine.

The scheme is as follows: from the age of 6 months, small restrictions on feeding are introduced, for example, on the street, at a party - only at home. Then the number of applications during the day is gradually reduced. How? Minimize everything that reminds of mother's milk: do not change clothes in front of the child, choose clothes that make it difficult to access the breast. Distract with something interesting or tasty. Next, we teach the baby to calm down and fall asleep without a breast. First during the day and then at night. Rituals will help here: before going to bed, read a fairy tale, sing a song, stroke ... Night feedings are removed the very last and also gradually, until the attachments become symbolic. This completion of the GW may take several weeks or even months, but it is worth it. And you can “round off” in a day or two, if the child himself is ready and simply outgrew the need for sucking.

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