What new parents need to know about breastfeeding

Expert response to questions from parents about breastfeeding

Dr. Kalpana Upadhyay Subedi
Gauri Devi
04 August 2022

Your baby’s brain, body and immune system grow and develop significantly during the first 1000 days, starting from the moment he or she is conceived. This is the reason we call it the golden thousand days. Your baby’s nutrition during this period can have a lifelong impact on their health and wellbeing.

Breast milk contains optimum nutrition to meet your baby’s needs until six months of age. Thereafter, it is best to continue breastfeeding along with complementary feeding until 2 years of age and beyond. This will help in your baby’s overall physical, cognitive and emotional development and growth.

Breastfeeding helps mothers to reduce the weight she gained during pregnancy and lowers the risk of breast cancer, ovarian cancer, diabetes and postpartum depression.

Welcoming a newborn is a joyful, life-changing moment for parents. But it can also come with numerous questions and concerns, including how to best feed a new baby. We recently sat down with Dr. Kalpana Subedi, Paediatrician and Chief Consultant at the Government of Nepal’s Ministry of Health and Population to ask her some of the pertinent questions most new and expecting parents may have about breastfeeding.

“How long after birth should I start breastfeeding my child?”

It’s best to start breastfeeding your baby within an hour of birth. The sooner, the better. Early initiation of breastfeeding protects your baby from life-threatening infections such as diarrhoea, pneumonia and meningitis.

“How many times do I need to breastfeed my baby in a day?”

Depending upon your baby’s demand, you can feed your baby 8 to 12 times a day. Feed your baby when she/he gives you signs that she/he is hungry. These are called hunger cues and may include opening the mouth and turning the head from side to side, sticking the tongue in and out, suckling on fingers and fists or crying.

Payal is breastfeeding her 2-month-old son Yunik at Bijawada village, India.

“What is exclusive breastfeeding? Why is it important?”

Exclusive breastfeeding is feeding your baby only breast milk, without any other foods or drinks except vitamins, mineral supplements or prescribed medicines.

Health professionals everywhere recommend exclusively breastfeeding your baby for the first six months of life to achieve best growth, development and health. Exclusive breastfeeding significantly reduces ear infections, respiratory illnesses, and diarrhoea in babies and helps quicker recovery during illness. The mortality risk is also significantly lower in infants exclusively breastfed compared to those partially or not breastfed at all.

“Can I give water to my child during exclusive breastfeeding?”

Breast milk has enough water to meet your baby’s fluid intake. On the contrary, giving water before six months can cause your baby to drink less breast milk or stop breastfeeding early, putting her/him at risk of malnutrition.

“Is it ok to start feeding solid food to my 5-month-old daughter after her weaning ceremony?”

I suggest parents wait until their baby is six months of age before starting solid food. Breast milk has all the nutrients needed to promote normal healthy growth and development in babies during their first six months of life. Starting solid food early can reduce the protection from infection provided by breast milk. There is also the likelihood of developing chronic diseases like diabetes, obesity, eczema and celiac diseases.

Transitioning from exclusive breastfeeding to solid foods is a vulnerable period. This is when your baby can become malnourished. Therefore, infants must receive proper, adequate and safe complementary foods at the right time.

Pratima Naik
Pratima Naik, 32, is breastfeeding her newborn daughter with the help of nurse Abanisatpathy in the PNC ward.

“Why should I choose breastfeeding over formula milk?”

Breast milk contains an adequate amount of nutrients, including protein, carbohydrates, healthy fat, and calcium in comparison to formula milk. The nutrients are better absorbed and used by your baby to grow and develop.

Unlike formula milk, breast milk is rich in antibodies to help boost your baby’s immunity. This is the reason breastfed babies are less likely to suffer from severe respiratory and gastrointestinal infections which require hospital admission. Breastfeeding also helps to prevent allergy, eczema, obesity, and hypertension.

In addition, breastfeeding is convenient. You can breastfeed your baby anywhere when needed. With formula milk, you need sterilized feeding bottles, water, utensils and formula milk power to prepare the milk.

Lastly, from an economic point of view, breastfeeding costs nothing, but the returns are immense in terms of good health and the growth of your baby. Formula milk is not universally affordable and lacks many of the nutrients found in breast milk.

“What would you recommend to mothers like me who cannot produce enough breast milk? I have no choice other than to feed my 4-month-old child formula milk and food.”

For cases where breast milk is inadequate to support your baby's normal growth, your paediatrician may recommend formula milk one or two times a day. However, it’s important to continue breastfeeding. Regularly consult your paediatrician on your baby’s health, and stop using formula milk if recommended.

“How can I increase my breast milk supply?”

You can increase breast milk supply by:

  • Breastfeeding your baby more often, at least 8 times a day.
  • Ensuring that baby is latching well and able to drink breast milk efficiently.
  • Emptying your breast of milk during each feeding. Also, start feeding from the first breast and only switch when the flow slows or stops altogether.
  • Eating healthy, nutritious food and drinking plenty of water. You can also take herbal supplements such as fenugreek and fennel soup.
  • Taking rest as much as possible between feeds

Is storing expressed breast milk in the refrigerator safe? I am a working mother and cannot always afford to feed my child fresh breast milk.”

Yes, expressed breast milk is safe. Always wash your hands before expressing. Express in a clean container and cover it with a lid. The milk can be kept at room temperature for 4-6 hours and in a refrigerator for 24 hours. This expressed milk can be given to your baby using a cup or spoon, but do not use a feeding bottle.

breastfeeding mother
A mother breastfeeds her child at an Aanganwadi centre in Muttuck, Assam.

“What food should I eat during breastfeeding?”

While breastfeeding your baby, eat an extra around 500 calories per day. Depending on your dietary preferences, you can eat any home-prepared food that is rich in proteins. These include meat, poultry, fish, eggs, dairy, beans, nuts and seeds. It is also important to include seasonal vegetables and fruits and cereal like wheat, maize, and oat in your diet. Lastly, drink a lot of water.

“Is it okay for mothers on medication or with illness to breastfeed?”

It is essential to consult your doctor when taking any medication. The same is true when you are breastfeeding. Most prescribed medicines will not harm your baby even if it passes a small amount to the breast milk. Your doctor will make sure you are aware of any risks to you or your baby before prescribing you medicines.

Mothers can continue breastfeeding during minor illnesses such as fever or flu while maintaining safety precautions as needed. To learn more about breastfeeding after testing positive for COVID-19, read this article.

“When should I avoid breastfeeding?”

  • If you are taking certain drugs like cancer chemotherapy agents, certain antipsychotic drugs or radiation therapy, you need to stop breastfeeding.
  • If you have herpes infections around your breast, avoid breastfeeding till the lesion clears.
  • If your baby has health conditions such as galactosemia, where breastfeeding cannot be done, your baby may need special formula milk which does not have lactose.
  • If you have recently consumed alcohol, avoid breastfeeding for a few hours.

“How can others help in creating a positive environment for breastfeeding mothers?”

In the home:

  • Ensure spouses, other family members and older children are aware of the importance of exclusive breastfeeding and are available to support the breastfeeding mother

In the workplace:

  • Ensure policies which encourage and support continued breastfeeding are in place and fully supported by management.
  • Nurture a welcoming environment for breastfeeding colleagues by ensuring a dedicated and secure space for breastfeeding or expressing milk; and refrigerators to store expressed breast milk, and displaying and distributing materials supporting breastfeeding.

Dr. Kalpana Upadhyay Subedi is the Chief Consultant Paediatrician at the Government of Nepal’s Ministry of Health and Population. She also heads the Department of Neonatology at Paropkar Maternity and Women’s Hospital. Dr. Upadhyay is a certified trainer and facilitator on newborn health. She is a Nepali national and holds an MD in Paediatrics and Adolescent Medicine.