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Supporting Mothers to Start and Continue Breastfeeding 83
Over the subsequent few days infants begin to vitamin D from skin synthesis for all women and
take larger volumes at each feed and settle into a infants.
routine of feeding less frequently. Some feed about
every 3–4 hours, however, other babies prefer more Most term infants are born with adequate
frequent feeds until they are older. vitamin D stores for the first 6 months of life.
However, those infants whose mothers were
More skin-to-skin contact between a mother vitamin D deficient during pregnancy are born
and her infant is recommended for newborn with inadequate stores and are at risk of tetanic fits
infants who do not feed well. or rickets due to vitamin D deficiency.
Mature milk Groups of women at high risk of vitamin D
deficiency are listed on page 65.
Mature milk production is controlled by hormones
and feedback mechanisms. Removal of milk from The Department of Health (1994) recommends
the breast is essential for continued production. that:
Throughout each feed the composition of the ●● all breastfeeding mothers should take vitamin D
milk changes: supplements during breastfeeding
●● At the beginning of the feed the milk has a high ●● breastfed infants whose mothers did not take
water content and low fat content satisfying the vitamin D supplements during pregnancy
infant’s thirst. It is often called foremilk. should be given vitamin D supplements from
about 1 month of age
●● As the feed progresses the fat content increases,
increasing the calorie content of the milk and ●● all other breastfed infants should begin vitamin
satisfying the infant’s hunger. This high-fat milk D supplements from 6 months.
produced at the end of the feed is often called
hindmilk. Supporting Mothers to Start and
Continue Breastfeeding
Allowing infants to finish feeding from one breast
before being offered the other breast ensures that When infants are delivered onto the mother’s bare
both foremilk and hindmilk are taken, providing skin the period of skin-to-skin contact triggers the
the correct balance of energy and nutrients. onset of lactation, stimulates instinctive feeding
behaviour and facilitates bonding. Infants should
No other food or fluids need to be offered, be offered a breastfeed soon after birth – ideally
unless medically indicated, until weaning onto within the first hour (Jones and Spencer 2007).
solid foods. Even in hot weather additional water is
unnecessary as breastfeeding on demand will Breastfeeding is a skill that mothers and their
satisfy the infant’s fluid requirements. Shorter, babies learn together. Reassurance and consistent
more frequent feeds may be demanded to satisfy advice on correct positioning and attachment for
any increased thirst. breastfeeding will help mothers to breastfeed
successfully and overcome problems.
Mature milk will provide all the nutrients an
infant needs until weaning except for vitamin D in A mother needs to learn the cues her infant gives
infants whose mothers were vitamin D deficient her to show he or she is hungry. Most newborn
during pregnancy. infants show the rooting reflex when hungry,
turning the head from side to side and making
Vitamin D Supplementation sucking movements. Infants who remain close to
Recommendations their mother can be fed on demand throughout the
day and night.
The main source of vitamin D is skin synthesis,
not food, but the immigration patterns and When mothers develop a routine for each
lifestyles today do not necessarily ensure adequate feeding session, the baby learns what to expect at
each feed.
