Basics of Breastfeeding

Breast pump

Breastfeeding is a good habit for mothers. Breast milk is the best gift for the newborn baby. There are no substitutes for breast milk.  Formula feeding is discouraged throughout the world. Unless it is absolutely necessary, formula feeding should not be given. For the new mothers breastfeeding may be a new experience. Child below six months of ages must be given only breastfeeding. But many women in our country do not know this. Sometimes they ignore the importance of breastfeeding. Which is bad for the health and overall being of the children. Also, other foods must be given along with breastmilk after six months of age. Failure to do that properly may lead to acute malnutrition. There are many issues and complaints from the mother regarding breastfeeding. I will try to answer that in my post. If you have any questions regarding breastfeeding, feel free to ask in the comment section.

Hormonal Control of Breastfeeding

There are two hormones which directly affect breastfeeding namely prolactin and oxytocin. When a baby suckles at the breast, sensory impulses pass from the mother’s nipple to her brain. In response, the anterior lobe of the pituitary gland secretes prolactin and the posterior lobe secretes oxytocin.

Prolactin is necessary for the secretion of milk. The level of prolactin in the blood increases markedly during pregnancy. It prepares the breast for the upcoming child. It is responsible for the growth and development of the breast. After 2 hours of the birth of the baby, the prolactin level is high. If the mother stops breastfeeding prolactin level decreases gradually. More prolactin is produced at night, so breastfeeding at night is especially helpful for keeping up the milk supply. Prolactin makes a mother relax and feel sleepy.

Oxytocin is the hormone for milk ejection. It is sometimes called “letdown reflex”. It contracts the myoepithelial cells in breast and helps the flow of milk to the neonate. When the baby sucks at the breast oxytocin becomes activated. This reflex becomes conditioned to the mother’s sensations and feelings, such as touching, smelling or seeing her baby, hearing her baby cry, or thinking lovingly about him or her. If the mother is emotionally upset or feels uncomfortable, it hampers the activity of oxytocin and milk flowing may stop. That’s why the mother and baby should be kept together. Oxytocin also helps in uterine contractions and stopping the bleeding. This may sometimes cause pain which is helpful for the mother. No medication is necessary for this point.

breast feeding advice

Pre Lacteal food for the babies

Babies must not be given honey, water mixed with sugar, mustard oil, or any other liquid or food after birth. Only the breast milk and not even a drop of water.

When to start breastfeeding after birth?

If there are no complications after birth or the birth history is good, breastfeeding should be initiated within 1 hour after birth.

See here Benefits of Breast Feeding

What is Colostrum and why it is necessary?

Colostrum is the first milk produced by the breasts after delivery. It is different from later milk. Colostrum is high in carbohydrates, protein, antibodies and vitamin A. It is extremely easy to digest the perfect first food for a baby. It is low in volume. Colostrum has a laxative effect on the baby, helping the baby to pass early stools. Immunoglobulin A in colostrum protects the baby from infection. Colostrum has a high number of protective leucocyte. For premature and low birthweight newborns, colostrum is life-saving and should
be expressed and fed the baby if he or she can’t suckle.

What are foremilk and Hindmilk? Differences between them?

Foremilk is the milk that is produced early in a feed. It has a high content of water and its thinner. It is made in large amounts. When the baby starts sucking it gets foremilk first.

Hindmilk is the milk that is produced later in a feed. It is whiter, thicker and rich in fat. This fat provides the necessary energy for the baby.

So both the foremilk and hindmilk is essential for the baby. And that’s why the mother should feed the baby until the breast empties. The baby should be allowed to continue suckling until he or she is satisfied and leaves the breast by himself/herself.

Composition of Breastmilk


Mothers milk contains such essential fatty acid which is absent in other milk. It contains the appropriate amount of protein for the baby.

Mother must abstain from Alcohol and tobacco. It passes through breast milk and casues harm to babies.

When to Feed the Baby?

Usually baby shows some signs if it’s hungry. The early sign includes the opening of the mouth and late signs are cycling/limb movement or crying. These are the feeding cues. Always breastfeed when the baby wants. From my experience in NICU, Babies are awake in the night time and cries for feed. So mother needs to feed the baby during night time too. Baby is fed usually 2-3 hourly.

How to know if the baby is feeding well?

The following signs will assure a mother that her baby is getting adequate breastmilk.

  1. Baby is urinating six or more times in a day.
  2. Baby is playing (limb movement in a happy mood).
  3. Baby is sleeping well.
  4. Baby is gaining weight.

If the signs are reversed, this is a clue that the baby is not getting enough milk.

Bangladesh government has passed the Breast-Milk Substitute (Regulation of Marketing) Bill-2013.

Expression of breastmilk (EBM)

Sometimes it is necessary to express the breast milk and store it. When a mother goes out for a job or leaves home for a relatively long time, she can express the milk. The expressed milk can be fed with a cup and spoon. Bottle feeder is strongly discouraged for the babies. At normal room temperature, breastmilk remains safe for 6–8 hours. In a refrigerator (at 8° C) breastmilk remains safe for 2–3 days. During feeding, it should be warmed by putting the container in a bowl of hot water.

Breast pump

Breast milk is expressed with a manual breast pump machine. It is available at a low price in a local pharmacy.

My baby is crying excessively

Crying is a normal phenomenon for a child. If it is excessive, the baby should be evaluated clinically to determine the cause. Baby cries for attention. Usually, it’s not for hunger. If urine output is six or more times in 24 hours and the weight of the child is normal,
crying is not due to hunger-related to low milk supply.

The baby should be fed in an upright position and burped to promote the escape of swallowed wind.

Drugs for increasing Breast Milk supply

Sometimes drugs are prescribed for mothers to increase breast milk supply. For example,

Tab. Motigut (Domperidon) 1+1+1 or 2+2+2, 30mins before food for 7 days. OR

Cap. Lactogin 1+1+1 for 1 months.

Extended Breastfeeding

Extended breastfeeding means feeding the breastmilk to babies after 12 or 24 months. It depends upon the culture. You may have seen Lisa Tully, sister of Catelyn Stark feeding her son Robin arryn in Game of Thrones. You must remember to add complementary feeding after 6 months of age in addition to breast milk for proper growth and development. breastfeeding older children is not a common culture in Bangladesh.

Breastfeeding at Work

Bangladesh govt is helpful to create breastfeeding corner in every office and institutions.

About Dr. Alamgir Hossain Shemul 94 Articles
Passionate about Child Health and Well Being. MD Resident of Pediatric Hematology and Oncology in BSMMU. Passed MBBS from Rajshahi Medical College. Completed FCPS Part 1 in Paediatrics. Ex-Honorary Medical Officer at Dhaka Medical College Hospital and NICU Medical officer at Anwer Khan Modern Hospital, Dhaka.

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