Breastfeeding is an extremely effective method of ensuring a child's health and survival. However, over two-thirds of infants are not breastfed exclusively for the recommended six months—a percentage that has been constant for two decades. 

As you might know breastmilk is the optimum newborn nourishment. It is safe and hygienic, as well as containing antibodies that help defend against a variety of common pediatric infections.  

Breastmilk supplies all the energy and nutrients an infant requires during the first months of life and continues to supply up to half or more of a child's nutritional requirements throughout the second half of the first year, and up to one-third during the second year. 

Over several decades research has identified that breastfed children score higher on IQ tests, are less likely to be overweight or obese later in life, and are less likely to develop diabetes. Breastfeeding mothers also had a lower risk of breast and ovarian cancer.  

Exclusive breastfeeding of infants under six months has a hormonal effect on mother that frequently results in menstrual irregularity. This is a natural (albeit not completely effective) technique of birth control called the Lactation Amenorrhoea Method. 

Inappropriate marketing of breast-milk substitutes continues to jeopardize global efforts to increase the rate and duration of breastfeeding.  

As a new mother, you're probably wondering what to do and when to commence breastfeeding, as well as what to do if you're unable to breastfeed your child. Here, we're aggregating all of the recommendations made by several world health authoritative bodies to provide you with a research-based guideline. 

Importance of Breastfeeding 

Breastfeeding has the following benefits:  

• Breastfeeding helps you bond with your baby;  

• Breastfeeding reduces your baby's risk of developing a variety of health problems, including:  

1. Ear infections; 

2.  Gastrointestinal infections   

3. Urinary tract infections  

4. Respiratory infections and asthma  

5. Certain childhood cancers   

6. Diarrheal diseases   

7. Juvenile diabetes (increasing rapidly) 

8. Childhood obesity  

9. Allergies or eczema. 

10.  Sudden unexplained infant death (SUDI), which includes sudden unexpected baby death (SIDS). 

• Health benefits for you, including a decreased risk of breast cancer, ovarian cancer, and osteoporosis, as well as a more rapid restoration of your uterus to its pre-pregnancy size. 

• Breastfeeding is less expensive than formula feeding;  

• Breastfeeding is a highly convenient method of feeding. 

How Breastmilk is Produced 

Before you begin feeding your child, you should have a basic understanding of a few scientific principles in order to gain a holistic perspective. 

1. Role of Your Breasts 

The alveoli, which are grape-like clusters of cells within the breast, are where milk is produced. The milk is pumped out via the alveoli and into the milk ducts, which look like bridges. The milk is carried through the breast through the ducts. 

Interestingly, your ability to breastfeed is unaffected by the size of your breasts. Women with small breasts produce the same amount of milk and of the same quality as women with larger breasts. 

2. Role of Brain 

Your baby's suckling sends a signal to your brain. The hormones prolactin and oxytocin are then released as a result of the brain's signal. Prolactin triggers the production of milk in the alveoli. The hormone oxytocin causes the muscles around the alveoli to contract, forcing milk out through the milk ducts. 

The let-down response occurs when milk is discharged.  

• Tingling, fullness, dull discomfort, or tightening in the breasts are all signs of milk secretion (although some moms do not feel any of these sensations). 

• The breasts are overflowing with milk. 
• Uterine cramping after breast-feeding your baby for the first several days following birth. 

Try the following strategies to encourage your milk to come out: 

• Find strategies to unwind, such as traveling to a peaceful location or practicing deep breathing. 
• Before breastfeeding, apply a warm compress to your breasts. 

• Massage your breasts and express a small amount of milk with your hand. 

The let-down reaction can occur for a variety of reasons after you've been breastfeeding for a while, such as hearing your baby scream or seeing or thinking about your kid.  

3. Role of Baby 

By sucking and extracting milk from your breast, your baby assists you in producing milk. The more milk your infant consumes, the more milk your body produces.  

Frequent nursing or milk removal (8-12 times or more every 24 hours), particularly during the first few days and weeks of your baby's existence, assists you in developing a sufficient milk supply. 

Your milk will continue to change in response to your baby's nutritional requirements. Each time your baby feeds, your body is alerted to the need to produce additional milk for the following meal.  

The amount of milk you produce will fluctuate according to how frequently your baby eats. By breastfeeding as frequently and as long as your baby desires, you assist your body in producing more milk.  

At first, it may appear as though you are only breastfeeding. Soon, you and your infant will establish a routine that is beneficial to both of you. 

Guideline by WHO and UNICEF Regarding Breastfeeding: 

Annually, malnutrition is expected to cause 2.7 million child deaths, or 45 percent of all child mortality. Infant and young child nutrition is critical for promoting child survival and good growth and development.  

The first two years of a child's life are critical, as optimum nutrition during this time reduces morbidity and mortality, lowers the risk of chronic disease, and promotes overall growth.  

Breastfeeding optimally is crucial because it has the potential to save the lives of approximately 820 000 children under the age of five each year. 

Babies should be breastfed exclusively during the first six months of their lives, following which they should continue breastfeeding and eating other healthy and safe foods until they reach the age of two years or beyond.  

Breast milk literally saves children's lives by providing antibodies that enhance babies' immune systems and prevent them from a variety of childhood illnesses. 

To maximize the benefits of breastfeeding, WHO and UNICEF recommend the following: 

• Early initiation of breastfeeding within 1 hour of birth; 
• Exclusive breastfeeding for the first 6 months of life; and 
• Introduction of nutritionally-adequate and safe complementary (solid) foods at 6 months together with continued breastfeeding up to 2 years of age or beyond.  

The Importance of Initiating Breastfeeding within One Hour After Delivery 

Early initiation of breastfeeding refers to the practice of providing mother's breast milk to infants within one hour of birth. Breastfeeding rates in the first hour after birth are highest in Eastern and Southern Africa (65%) and lowest in East Asia and the Pacific (32%), according to the survey by UNICEF. https://www.unicef.org/timorleste/press-releases/3-5-babies-not-breastfed-first-hour-life 

• This practice guarantees that the infant receives the colostrum, or "first milk," which is rich in protective elements. Colostrum is a viscous yellow-white material produced shortly after delivery by the mother's breast. It is an excellent source of antibodies and critical nutrients.  

Nonetheless, many cultures, unaware of its health benefits, discard it. Giving neonates water or other liquids deprives them of a "healthy start in life," the WHO states, pointing to the WHO Child Growth Standards and how kids fed colostrum within the first hour of birth meet the standards. 

• Skin-to-skin contact between mother and newborn shortly after birth appears to aid in the initiation of early breastfeeding and enhances the likelihood of exclusive breastfeeding for the first one to four months of life, as well as the duration of breastfeeding overall.  
• Infants who are introduced to their mothers' skin-to-skin contact early on appear to engage more with their moms and scream less. 

• According to research, newborns who began nursing between two and 23 hours after birth faced a 33% greater risk of death than those who breastfed within an hour. And the risk was more than doubled in newborns who began within a day or two of birth. 
• According to a 2006 study published in the journal Pediatrics, 41% of neonates who die in the first month of life may be prevented if they were nursed within the first hour of birth. https://www.medicalnewstoday.com/articles/78485#1 
• Additionally, the WHO notes that administering colostrum during the first hour enhances the likelihood that infants will continue to breastfeed, giving them a leg up in the "battle against malnutrition." There are 170 million underweight children worldwide, and three million die each year. 
• Breastfeeding in the first hour or so after birth also benefits the mother, including increased lactation and less blood loss. 

Pre-lacteal Feeding: Reason Why You Shouldn’t introduce Pre-lacteal feeding to the newborn 

Pre-lacteal feeds are foods given to babies before the establishment of breastfeeding or before breast milk "comes in," which typically occurs on the first day of life. Honey, jaggery (brown sugar made from sugar cane), ghee (clarified butter), and ghutti (herbal paste) are all examples of pre-lacteals.  

World Health Organization, 2009. Infant and young child feeding: model chapter for textbooks for medical students and allied health professionals. World Health Organization. 

• It is a significant public health issue because it raises the risk of respiratory tract infections, diarrhea, and malnutrition among the newborn.  
• Additionally, pre-lacteal feeding deprives neonates of nutrient- and immunoglobulin-rich colostrum.  

• Additionally, it has been demonstrated that pre-lacteal meals delay breastfeeding beginning and obstruct exclusive breastfeeding. 

Guideline for Breastfeeding during COVID 19 by WHO 

Currently, COVID 19 has a high rate of spread. So, what can a new mother with COVID 19 can do in regard to breastfeeding? 

So here is the answer.  

https://www.who.int/news-room/commentaries/detail/breastfeeding-and-covid-19 

Breastfeeding is permitted for women who have COVID 19. 

According to the WHO, a COVID 19-infected mother should continue nursing while adhering to the following rules. 

• Wash their hands with soap and water or an alcohol-based hand massage on a regular basis. 
• Additionally, they should wear a surgical mask whenever they come into contact with the infant. They should sneeze or cough onto a tissue when sneezing or coughing. 

• Mothers who are having COVID-19 symptoms are recommended to use a medical mask, but breastfeeding should continue regardless of whether this is feasible. 
• Mother and infant should be able to share a room throughout the day and night and practice skin-to-skin contact, including kangaroo mother care, especially immediately after birth and during breastfeeding establishment, regardless of whether they or their infants have suspected or confirmed COVID-19. 

Guideline for Breastfeeding for HIV Affected Mothers by WHO

Breastfeeding, and especially early and exclusive breastfeeding, is one of the most significant ways to improve infant survival rates.  

While HIV can pass from a mother to her child during pregnancy, labor or delivery, and also through breast-milk, the evidence on HIV and infant feeding shows that giving antiretroviral treatment (ART) to mothers living with HIV significantly reduces the risk of transmission through breastfeeding and also improves her health. 

WHO now recommends that all people living with HIV, including pregnant women and lactating mothers living with HIV, take ART for life from when they first learn their infection status.  

WHO Recommends Breastfeeding in Exceptionally Difficult Circumstances 

Families and children facing adversity for example-  

• low-birth-weight or premature infants;  

• mothers living with settings where diarrhea, pneumonia, and malnutrition continue to be prevalent;  

• adolescent mothers;  

• malnourished infants and young children; and  

• families dealing with the aftermath of complex emergencies require extra attention and practical assistance.  

In all of the aforementioned situations, it is critical to initiate breastfeeding as soon as possible. 

Wherever possible, mothers and infants should remain together and receive the support necessary to use the most appropriate feeding method available.  

Recommendations by WHO: For Health Care Provider  

Immediate support to initiate and establish breastfeeding 

1. Early and uninterrupted skin-to-skin contact between mothers and infants should be facilitated and encouraged as soon as possible after birth (recommended, moderate-quality evidence).  

2. All mothers should be supported to initiate breastfeeding as soon as possible after birth, within the first hour after delivery (recommended, high-quality evidence).  

3. Mothers should receive practical support to enable them to initiate and establish breastfeeding and manage common breastfeeding difficulties (recommended, moderate-quality evidence).  

4. Mothers should be coached on how to express breast milk as a means of maintaining lactation in the event of their being separated temporarily from their infants (recommended, very low-quality evidence).  

5. Facilities providing maternity and newborn services should enable mothers and their infants to remain together and to practice rooming-in throughout the day and night. This may not apply in circumstances when infants need to be moved for specialized medical care (recommended, moderate-quality evidence).  

6. Mothers should be supported to practice responsive feeding as part of nurturing care (recommended, very low-quality evidence).  

Feeding practices and additional needs of infants  

7. Mothers should be discouraged from giving any food or fluids other than breast milk, unless medically indicated (recommended, moderate-quality evidence).  

8. Mothers should be supported to recognize their infants’ cues for feeding, closeness and comfort, and enabled to respond accordingly to these cues with a variety of options, during their stay at the facility providing maternity and newborn services (recommended, high-quality evidence).  

9. For preterm infants who are unable to breastfeed directly, non-nutritive sucking and oral stimulation may be beneficial until breastfeeding is established (recommended, low-quality evidence).  

10. If expressed breast milk or other feeds are medically indicated for term infants, feeding methods such as cups, spoons or feeding bottles and teats may be used during their stay at the facility (recommended, moderate-quality evidence).  

11. If expressed breast milk or other feeds are medically indicated for preterm infants, feeding methods such as cups or spoons are preferable to feeding bottles and teats (recommended, moderate-quality evidence). 

Creating an enabling environment  

12. Facilities providing maternity and newborn services should have a clearly written breastfeeding policy that is routinely communicated to staff and parents (recommended, very low-quality evidence).  

13. Health-facility staff who provide infant feeding services, including breastfeeding support, should have sufficient knowledge, competence and skills to support women to breastfeed (recommended, very low-quality evidence).  

14. Where facilities provide antenatal care, pregnant women and their families should be counselled about the benefits and management of breastfeeding (recommended, moderate-quality evidence).  

15. As part of protecting, promoting and supporting breastfeeding, discharge from facilities providing maternity and newborn services should be planned for and coordinated, so that parents and their infants have access to ongoing support and receive appropriate care (recommended, low-quality evidence). 

Reason Why Some Mother Can’t Breastfeed  

Undoubtedly, breastfeeding is beneficial for both parents and babies. But still there are several reasons why mother should not or may not be able to breastfeed their child.  

For instance, some mother may be unable to produce a sufficient supply of breast milk, while others may be on specific drugs or require medical care that is not nursing safe. Additionally, there are a few medical problems that preclude breastfeeding.  

In some cases, mother may be able to pump and bottle feed their baby, or they may be able to temporarily discontinue nursing and then resume depending on situation. 

Low Breast Milk Supply 

Many parents are concerned that they are not making enough milk for their baby, but in reality, only a small fraction of people who wish to breastfeed are unable to do so due to a serious shortage of breast milk.   

A true low milk supply is uncommon, and is usually the result of another underlying illness. Certain issues can be remedied by treatment, but others cannot be resolved. The following factors contribute to a true shortage of milk: 

• Insufficient glandular tissue (hypoplastic breasts) 
• Polycystic ovary syndrome (PCOS) 
• Hypothyroidism 

• Previous breast surgery, such as mastectomy or breast reduction surgery 
• Prior radiation treatment for breast cancer 

Contraindicated Medicines 

While many drugs, including those obtained through a prescription, are compatible with nursing, others are not. Certain medications can pose a risk to a breastfed babies when taken by the breastfeeding parent, such as:  

• Chemotherapy drugs 

• Antiretroviral medications 
• Radioactive iodine 
• Some sedatives 
• Seizure medication 
• Medicines that may cause drowsiness 

• Medications that suppress breathing 

Other drugs may result in a decrease in milk production, making them an unfavorable option for nursing mothers. These include pseudoephedrine-containing cold and sinus drugs, as well as certain hormonal birth control methods. 

Consult your doctor about any medications—not just new ones—prior to nursing. They can advise you on the safety of using certain products while breastfeeding. 

It is critical for new mothers to be certain that they are starting any new medication according to their doctor's advice. 

Infectious Diseases 

Numerous common diseases are easily treatable and have no adverse effect on nursing or the infant. However, a few infectious diseases can be transmitted to a newborn through breast milk, and the danger of transmission can outweigh the benefits of nursing in some situations.  

Before starting breastfeeding, mom should learn about her health status. 

HIV 

HIV is the virus that causes acquired immunodeficiency syndrome (AIDS) (AIDS). HIV-positive mothers can transmit the infection to their children through nursing and breast milk. 

Due to the fact that AIDS is incurable, mothers who are HIV positive should refrain from breastfeeding if they live in an area of the world where a safe alternative such as infant formula is available.  

In places where no safe substitute is available, however, exclusive nursing may be advocated.  

HTLV 

Human T-cell lymphotropic virus type 1 (HTLV-1) is a virus that has been associated with leukemia and lymphoma. Human T-cell lymphotropic virus type 2 (HTLV-2) can cause problems with the brain and lungs. While many viruses may not manifest symptoms at all, they are chronic illnesses for which there is now no cure.  

Because HTLV-1 and HTLV-2 can be transmitted to a newborn through breast milk, infants born to HTLV-positive parents should not nurse. 

Active Tuberculosis Infection 

Tuberculosis (TB) is a bacterial infection of the lungs caused by tuberculosis. It is transmitted via respiratory droplets, not breast milk or breastfeeding.  

However, a parent can infect a child with active tuberculosis by coughing, sneezing, or touching. When a parent has active tuberculosis but their child has not, the parent should avoid intimate contact with the child and hence avoid breastfeeding. 

Due to the fact that tuberculosis is not spread through breast milk, a newborn can receive pumped breast milk until approximately two weeks after treatment begins. When both the breastfeeding parent and the infant have tuberculosis, they can remain together during therapy and the infant can continue breastfeeding. 

Herpes on the Breast 

Herpes is not transmitted through breast milk; therefore, breastfeeding is safe as long as lesions are not on the breast, lesions on other body parts are covered, and rigorous hand washing is practiced. However, nursing is harmful when there are active sores on the breast, as the herpes virus can be fatal to a baby. 

Alternative Ways to Ensure Infant Feeding 

Breastfeeding is, in theory, the healthiest way to feed your kid. It provides them with nutrients and vital antibodies (proteins that support your immune system). Breastfed newborns are less likely to get certain ailments, ranging from ear infections to allergies to gastrointestinal troubles, according to research. 

For these reasons and more, you should feed your infant exclusively breastmilk for six months if possible. Following that, breast milk should be continued for another six months as solid foods are introduced. Breastfeeding is recommended until the baby reaches the age of two years, according to the World Health Organization. 

Now for a dose of reality: The majority of mothers do not strictly adhere to those standards. In 2015, four out of every five infants were breastfed at birth. By three months, little under half had been exclusively breastfed. Only a third of infants were still nursed at their first birthday. 

You may choose not to breastfeed because you:  

• Are unaware of the benefits of nursing; 
• Believe that bottle-feeding is more socially acceptable  
• Lack of family, social, and/or employer support  
• Experience difficulties latching, painful nipples, or inflammation 

If breastfeeding is not an option for you, be aware of your other options for feeding and caring for your baby. 

1. Pumped milk 

Simply because you are not able to breastfeed directly from breast does not mean you cannot provide breastmilk to your kid – ideally, you can express your breastmilk using an electronic or manual pump and then saved for future use.  

You can power pump milk while maintaining your regular schedule. Make contact with a lactation consultant to assist you in establishing suitable pumping sessions so that you can provide your newborn with breastmilk regularly enough to meet her nutritional requirements. 

There is a learning curve, though parents who are familiar with breastfeeding are also familiar with pumping. According to research, more than 85% of breastfeeding moms pump milk at some point. 

2. Formula feeding 

Formula feeding is recommended solely for those who are unable to breastfeed their child due to medical issues or for any other reason. 

With so many options and kinds, selecting the finest baby formula for your child may be as challenging as it is critical. Your choice of product will be influenced by a variety of factors, ranging from your baby's health requirements to the cost, and everything in between.  

However, it will largely rely on what your child will accept. 

For the first six months of life, breast milk or formula should be the sole source of nutrition for your infant, and then the primary source (supplemented with solid food) for the first year. 

If you formula feed your child, educate yourself on your alternatives so you can make informed purchasing decisions. 

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