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82 4.1 Milk Feeding
●● less likely to succumb to sudden infant death
syndrome (SIDS)
●● less likely to visit the doctor in the first 2 years of ●● rich in antibodies and immunoglobulins which
life.
Evidence is controversial around whether
breastfeeding reduces:
●● risk of obesity (Li et al. 2003, Michels et al. 2007)
●● severity of the allergic conditions asthma and
eczema.
Benefits for the mother
Benefits for the mother (Ip et al. 2007) include:
●● delayed return to menstruation, allowing
maternal iron stores to replenish following
pregnancy and childbirth
●● reduced risk of breast and ovarian cancer
(World Cancer Research Fund 2007)
●● helps the return to their pre-pregnant weight
●● lower risk of postnatal depression.
In addition, women over the age of 65 who have
breastfed show a lower incidence of osteoporosis
and hip fractures.
Stages of Breast Milk
The composition of breast milk changes at
different stages of infant development. The
identifiable stages are colostrum, transitional
milk and mature milk.
Colostrum
During pregnancy the glandular tissue of the
breast proliferates and can produce colostrum
from mid-pregnancy. It is ready in the breasts
when the baby is born and has the following
properties:
●● a high-density, low-volume milk, which is ideal
for the newborn infant
●● less fat, lactose and water-soluble vitamins than
mature milk, but more protein, zinc and
fat-soluble vitamins A and K
●● a laxative effect to aid the passage of an infant’s
first stool (meconium)
provide protection against bacteria and viruses.
Over the first 2 days, infants may be quite sleepy
and feed infrequently. Very small volumes of
colostrum (10–13 mL/kg per day) are taken and are
adequate (Dollberg et al. 2001). A net body weight
loss occurs, which is mainly fluid as infant’s blood
volume decreases by about 25 per cent at this time.
A weight loss of up to 10 per cent of birthweight is
considered normal.
However, blood glucose testing at 2–4 hours
after birth should be carried out routinely in
infants of women with diabetes. They should also
feed as soon as possible after birth (within
30 minutes) and then at frequent intervals (every
2–3 hours) until feeding maintains pre-feed blood
glucose levels at a minimum of 2.0 mmol/L
(NICE 2008a).
Transitional milk
Transitional milk is colostrum diluted with mature
milk and is produced from around the third day
after delivery. It has a higher water content, making
it a less concentrated feed than colostrum and
infants begin to demand increased volumes of this
milk. Transitional milk gradually changes into
mature milk by about the 14th day as colostrum
production gradually diminishes.
Mothers may experience breast discomfort on
day 2 or 3 as the blood and lymph flow increases in
the breast in preparation for the higher volumes of
transitional milk (Jones and Spencer 2007). Breasts
may feel full and heavy. At the same time the infant
will begin to demand feeds more frequently.
Company and support from another adult will be
beneficial as a mother may need to feed very
frequently throughout that 24 hours. Mothers can
be reassured that although they may have an
uncomfortable 24 hours, over that time the volume
of milk produced will eventually equal the amount
that their infant is demanding and their breasts
will subsequently become more comfortable again.