Crack Nipple

Healing Tips for Nipple Cracks or Abrasions

By Kelly Bonyata, BS, IBCLC

The following measures can be very helpful if the skin on the nipple is broken for any reason (cracked nipple due to improper latch or thrush, a bite, milk blister, etc.).

Keep in mind that one of the most important factors in healing is to correct the source of the problem.

Continue to work on correct latch and positioning, thrush treatment, etc. as you treat the symptoms, and talk to a La Leche League Leader and/or board certified lactation consultant (IBCLC) if what you’re doing is not working.

During the nursing session

• Breastfeed from the uninjured (or less injured) side first. Baby will tend to nurse more gently on the second side offered.
• The initial latch-on tends to hurt the worst – a brief application of ice right before latching can help to numb the area.
• Experiment with different breastfeeding positions to determine which is most comfortable.
• If breastfeeding is too painful, it is very important to express milk from the injured side to reduce the risk of mastitis and to maintain supply. If pumping is too painful, try hand expression.

After nursing

Salt water rinse
This special type of salt water, called normal saline, has the same salt concentration as tears and should not be painful to use.

To make your own normal saline solution:

Mix 1/2 teaspoon of salt in one cup (8 oz) of warm water. Make a fresh supply each day to avoid bacterial contamination. You may also buy individual-use packets of sterile saline solution.

• After breastfeeding, soak nipple(s) in a small bowl of warm saline solution for a minute or so–long enough for the saline to get onto all areas of the nipple. Alternately, put the saline solution into a squeeze bottle and squirt it on gently; use plenty of saline, making sure to get it on all areas of broken skin.
• Avoid prolonged soaking (more than 5-10 minutes) that “super” hydrates the skin, as this can promote cracking and delay healing.
• Pat dry very gently with a soft paper towel.
• If baby objects to the taste of the residual salt from the saline rinse, rinse directly before nursing by dipping nipple(s) into a bowl of plain water. Pat dry gently.

After the salt water rinse

• Apply expressed breastmilk to the nipples to promote healing–this can be done in addition to other treatments.
• To promote “moist wound healing” (this refers to maintaining the internal moisture of the skin, not keeping the exterior of the skin wet) apply a medical grade lanolin ointment (e.g., Lansinoh, Purelan), soft paraffin/vaseline or a hydrogel dressing (e.g., ComfortGel, Soothies).
• If you have thrush, follow the saline soak with an antifungal ointment or other thrush treatment.
• If needed, apply an antibiotic ointment (e.g. Bactroban/mupirocin, Polysporin) or Dr. Jack Newman’s All Purpose Nipple Ointment (APNO; an antibiotic/anti-inflammatory/anti-yeast combo) sparingly after each feeding.
• Per Hale, Bactroban ointment (mupirocin; lactation risk category L1/safest), available only by prescription, may be the best choice for nursing mothers.
• Of the over-the-counter treatments, Polysporin (Polymyxin B Sulfate and Bacitracin Zinc) may be preferred for topical use in the nipple area of nursing moms over antibiotic ointments containing neomycin (such as Neosporin or triple antibiotic ointment). Neomycin carries a small risk (1-2% of the general population) of contact dermatitis (see The Role of Topical Antibiotics in Dermatologic Practice by J.J. Leyden, MD).
• It is not necessary to wash small amounts of antibiotic or APNO ointment from the nipple prior to nursing, even if baby nurses again within minutes (see Dr. Jack Newman’s Sore Nipples handout). If too much ointment was used and there is an obvious amount remaining when baby is ready to nurse again, gently wipe the excess off with a damp cloth.

Between nursings

• Keep nipples exposed to air when possible. When wearing a bra, use fresh disposable pads (change when damp). Some mothers use breast shells to protect the nipple from the dampness and friction of the bra.
• If there is a specific injury–like a bite–cold compresses (ice packs over a layer of cloth) may help: 20 minutes on, 20 minutes off; repeat as needed.
• Ibuprofen (Advil, Motrin) or acetaminophen (Tylenol) is compatible with breastfeeding.
• Once a day, use a non-antibacterial, non-perfumed soap to gently clean the wounded area, then rinse well under running water. Using soap on the nipple area is not recommended unless the skin is broken.

Contact your health care provider if you notice: Fever, inflammation/redness, swelling, oozing, pus, or other signs of infection. It is possible to have multiple infections (both fungal and bacterial). If the nipple is obviously infected, then talk to your health care provider about the possibility of using an oral (systemic) antibiotic. One study indicated that topical antibiotics and good breastfeeding techniques might not be sufficient if infection is present. (See Livingstone V, Stringer LJ. The treatment of Staphyloccocus aureus infected sore nipples: a randomized comparative study. J Hum Lact. 1999 Sep;15(3):241-6.) See also Oral antibiotic use for sore, cracked nipples.)

Breastfeeding Problem

Common Problems When You Begin Breastfeeding

The following problems are not uncommon during the get-acquainted phase of breastfeeding. Fortunately, such problems are usually worked out successfully before you leave the hospital or by the time your milk comes in abundantly. Don’t be discouraged if things aren’t picture-perfect; it’s all part of the learning process. With patience and practice, both you and your baby will become more proficient in your roles. If you continue to have difficulty after you go home, you should seek expert help without delay. The sooner you detect a breastfeeding problem and get help, the easier it is to remedy.

Baby Won’t Awaken to Nurse
Some newborns sleep longer than desired in the early days of life, perhaps as a result of a long labor, medications used during childbirth, birth trauma, or other events. You might be anxious to begin breastfeeding, only to realize it takes two cooperative partners to make the process work. If more than about three and a half hours have passed without a feeding attempt, ask your baby’s nurse to help you awaken your infant. Don’t wait for your baby to cry to try to feed her. Instead, keep her with you in your room and try to arouse her from light sleep-look for eyelid movement, facial twitches, movements of her arms or legs, or mouthing motions. Unswaddle her from her blankets, change her diaper, remove some clothing, wipe her bottom with a wet washcloth, stroke her head, or massage her feet. Babies naturally open their eyes when placed upright. You can put her in a sitting position on your lap, with your hand supporting her chin, or hold her over your shoulder. Try dimming the lights if bright lights make her close her eyes.

Infant Has Difficulty Latching on to the Breast
Even when the infant is awake, alert, and demanding, he may not latch on to your breast right away. Often the baby cries, acts distressed, and doesn’t seem to know what to do. This can be enormously frustrating, especially when a mother has the misperception that breastfeeding should be as easy as falling off a log. It also can feel like outright rejection, and often a distraught mother will announce, “My baby doesn’t want my breast.” Nothing could be further from the truth. Of course your baby wants to breastfeed, but he doesn’t yet know how to grasp your nipple/areola and obtain milk. If your baby is having trouble latching on, try the following measures:

• Stop your efforts that have made you and the baby upset. Take a deep breath and calm down. Soothe your baby with your voice and by swaddling him. Try settling him down by letting him suck on your clean little finger inserted with the palm side (fleshy part) upward against the roof of his mouth. Tell yourself that latch-on difficulties are common and that many women have felt as you do right now. Keep your baby with you so you can try again as soon as he shows interest.
• Help your baby enjoy being close to your breast. Keep him cradled at your breast even when you are not attempting to breastfeed. Remove your top and provide as much skin-to-skin contact as possible. These “breast-friendly” measures will help offset any frustration that either of you might experience from unsuccessful breastfeeding attempts.
• Review the basics of breastfeeding technique: position-ing yourself, positioning your baby, and supporting your breast. Correct anything in your technique that could be improved.
• Squeeze a few drops of colostrum onto your nipple to entice your baby or drip a little sugar water onto your nipple from a bottle.
• Enlist a skilled nurse or hospital lactation consultant to help your baby attach correctly to your breast. Then you can apply the effective techniques she demonstrates when you are on your own.
• Use a breast pump to express some milk. Offer this milk, or a small quantity of formula, preferably by cup or spoon, to calm your baby sufficiently to work with him at the breast again.
• If your nipple is flat, use a pump for a few minutes to draw your nipple out and start some milk flowing before trying to attach your baby.
• If your baby is using a pacifier, this could be reinforcing the expectation of a long, rigid nipple. Discontinue the pacifier until breastfeeding is going well.
• As a last resort, start pumping your breasts approximately every three hours with a rental-grade electric pump to keep up your milk supply. Offer your expressed milk by bottle or other method to keep your baby well nourished. Continue to try to attach your baby at every available opportunity. As long as your baby remains well fed and your supply is maintained, your baby can eventually learn to breastfeed. Don’t give up! You will need to arrange close follow-up with your baby’s physician and a lacta-tion specialist after discharge.

Baby Won’t Suck
Some babies will initially attach to the nipple/areola, but then take only a few sucks before coming off the breast and crying. Usually these babies are frustrated at not receiving an immediate reward. Perhaps they have had one or more bottle-feedings and expect a rapid flow of milk as soon as a nipple enters their mouth. If an SNS device is available, it can be used to provide supplemental milk while the baby nurses, and thus keep the baby interested in breastfeeding. Usually, once the baby starts sucking rhythmically while using the SNS, the mother’s own breast milk begins to flow. The device might be needed for only a feeding or two until the baby starts nursing effectively.

Another reason babies may not suck is that they may “shut down” when put to the breast. If previous attempts at feeding have been negative experiences, perhaps due to rough handling of the baby or aggressive efforts to push the nipple into his mouth, the baby may react to such distress by shutting down and refusing to feed. Other possible signals that your baby may be experienc-ing sensory overload and needs you to back off include hiccups, yawning, and the “stop sign,” raising his hand with palm facing outward. Don’t let any feeding session turn into a power struggle. Hold your baby tenderly, speak reassuringly, and let him rest securely against your breast. It might become necessary to pump and feed your expressed milk until feedings, in general, become a pleasant experience before resuming attempts at the breast. Since poor feeding can be a sign of infant illness, I must also caution that it’s always essential for the hospital staff to evaluate a baby who isn’t feeding well.

Baby Takes One Side Only
Often, the baby latches on more readily to one breast than the other. Perhaps one nipple is easier to grasp, or the milk on that side flows more freely. It is important to keep working with the baby to take the less-preferred side as quickly as possible, to assure that both breasts receive adequate stimulation and emptying. You can start feedings on the “difficult” side and see if the baby cooperates more when he is hungry. If he starts to fuss too much, switch to the preferred breast and let him settle and nurse. Then, building on this success, resume your attempts on the other side. If your baby isn’t taking both breasts well by the time your milk comes in abundantly you should start using a hospital-grade rental electric breast pump to regularly remove milk from the breast that isn’t being suckled. (I actually recommend pumping both breasts simultaneously since it takes no longer than pumping one side and will help keep the overall milk production generous.) Breast preferences very quickly can cause a lopsided milk supply, which only aggravates the problem. The baby’s preference for using one breast results in greater milk production on that side, which in turn makes the baby prefer the better-producing breast even more. Many mothers attest to the effectiveness of a simple maneuver to entice the baby to take the less-preferred breast. Start nursing on the favored side (a cross-cradle hold works well) and then slide the baby over to the second breast without changing his position. As one woman explained, “My baby just thinks I have two left breasts.”

Nipple Pain
During the first couple of days of breastfeeding, women often will complain of slight nipple discomfort for the first minute after latch-on. Severe nipple pain that lasts throughout the feeding, or nipple discomfort that doesn’t improve once your milk comes in, suggests that the baby is either attached incorrectly or is sucking improperly. You shouldn’t need a high pain threshold in order to breastfeed. Severe pain means something is wrong, so don’t ignore this important clue. Get help right away with your nursing technique. The most common problem is that the baby is not opening wide enough and is latching on to the tip of the nipple instead of taking a large mouthful of breast. Other strategies to improve sore nipples include patting the nipples dry after feeds and applying USP Modified Lanolin (medical grade); nursing for shorter periods at more frequent intervals; and starting feedings on the least-sore side, then moving the baby to the more pain-ful side once let-down has been triggered.

Baby Isn’t Satisfied After Nursing. Some new mothers become frustrated because their baby nurses for prolonged periods but doesn’t seem satisfied. Often these are larger babies, over eight or nine pounds, who act persistently hungry until the mother’s milk increases around the third day. Sometimes the baby will settle when swaddled snugly, held by his mother or father, or allowed to sleep on a parent’s chest. Despite what I said earlier about not using a pacifier, such a baby might need one for a day or so. As long as the baby nurses well and often, short-term use of a pacifier is not likely to interfere with subsequent breastfeeding. If supplemental milk is temporarily required until your milk increases in volume, it can be offered by SNS, cup, or bottle. (Ask about using a hypoallergenic formula if you have a family history of allergies, asthma, or other allergic disease.) If the baby is already a proficient nurser, he probably will continue to breastfeed just fine. Be sure to nurse as often as possible and try to discontinue any supplements as soon as your milk starts to increase. If the baby still isn’t being satisfied by the fourth day, notify your baby’s doctor and seek additional help with breastfeeding. It’s possible the infant isn’t nursing correctly and may not be obtaining the milk he needs.

Uncomfortable Breast Engorgement
Few mothers these days are still in the hospital when their milk starts coming in abundantly. More typically, postpartum breast engorgement occurs once a mother has gone home. Exceptions to this include some mothers with C-section deliveries and those with longer stays due to medical complications. Milk coming in abundantly typically causes noticeable breast swelling, tenderness, and firmness. Latch-on may become more difficult due to flattening of the nipple and firmness of the areola. The result can be improper attachment and nipple pain. For some women, engorgement can be a source of discomfort and frustration, especially when excessive pressure interferes with milk flow. When engorgement is unrelieved, the residual milk and pressure can cause the mother’s milk supply to decline rapidly.

Early and frequent nursing (at least every two to three hours) is the best way to prevent excessive breast engorgement. Applying warm compresses before nursing often helps start milk flowing, while cool compresses between feedings help relieve pressure and discomfort. Express some milk before nursing, preferably using a hospital-grade electric breast pump, to soften your breasts and draw out your nipples. Pay careful attention to proper nursing technique to assure your baby latches on correctly and obtains the maximum amount of milk.

Common Problems Encountered by Breastfeeding Women

Routine Treatment of Sore Nipples
Assure that your infant is properly positioned to nurse and grasps your breast correctly. Carefully review the detailed guidelines for correct positioning and latch-on. Cup your breast in a C-hold, with four fingers below and thumb above. Make sure your fingers are placed well behind the areola. With your baby well supported, aligned with your breast, and turned completely to face you, gently tickle her lips with your nipple. When she opens her mouth wide, quickly pull her toward you so that she grasps a large mouthful of breast, with the nipple centered in her mouth. Do not let your baby munch onto your nipple or just grasp the tip without any surrounding areola. That is a sure setup for discomfort and ineffective milk extraction. It’s always better to remove your baby and let her reattach to your breast than to continue to let her nurse with an improper grasp. The football hold makes it easier for a baby to attach correctly since this position affords the mother a good view of the baby’s mouth on her nipple.

Begin feeding on the least sore nipple to trigger your milk ejection reflex. Once milk flow has begun and your baby has taken part of her feeding, she will be less hungry when brought to the second, more painful side. Your baby will nurse less vigorously after the let-down reflex has been triggered, making breastfeeding more comfortable. As soon as possible, resume alternating the breast on which you begin feedings to prevent a lopsided milk supply.

Frequent, shorter feedings are preferable to lengthy nursings spaced at wider intervals. Temporarily, limit feedings to ten minutes per side if your nipples are very sore. Many women with sore nipples postpone feedings because they dread the pain associated with nursing. However, this can result in a ravenously hungry baby who nurses more frantically and produces more trauma. Also, the longer feedings are postponed, the more engorged the breasts become, and the harder it is for the baby to correctly grasp the breast. Finally, less frequent feedings can diminish a mother’s milk supply, which already has a tendency to be low in women with sore nipples.

Gently pat your nipples dry with a clean cloth after nursing to remove surface wetness. Excessive moisture on the skin surface can delay healing and cause chapping. If you wear breast pads, change them as soon as they become wet, and remove surface moisture after each feeding. However, don’t go to extremes and excessively dry your nipples, as this can worsen the condition of your skin. In the past, many breastfeeding experts gave erroneous advice that led to excessive drying and cracking of nipples. Women were advised to use a hair dryer on a low setting or to expose their nipples to prolonged air drying in low-humidity environments. We now recognize that, just as excessive drying can crack and split chapped lips, it can contribute to breakdown and delayed healing of damaged nipple skin.

If you have cracks or other breaks in the skin, keep your nipples covered with a soothing emollient to maintain internal moisture. Applying a soothing ointment to sore, cracked nipples will protect them from excessive moisture loss and will speed healing. A coating of USP Modified Lanolin (medical grade) is the superior emollient to use on your nipples. This ultrapure grade of lanolin is sold as Lansinoh for Breastfeeding Mothers and PureLan. Apply the lanolin to your nipples after each feeding just as you would keep chapped lips covered with lip balm to maintain the normal moisture present in the skin and promote healing. Emollients like medical-grade lanolin are particularly effective in climates with low humidity to protect nipples from excess drying.

Many breastfeeding experts tout the well-known healing properties of milk itself. They recommend expressing a few drops of milk after each nursing, and gently coating the nipple with it, then allowing the milk to dry on the nipples. Although I have little firsthand experience with this practice, the many proponents of the technique claim it promotes healing of sore nipples. However, the nipples of nursing mothers inevitably are bathed in milk much of each day, affording them the benefit of milk’s anti-infective properties. The reason I don’t routinely recommend coating damaged nipples with milk after nursing is my belief that cracked nipples are similar to chapped lips. The constant wet-to-dry effect that results from frequent licking of chapped lips only provokes more drying and cracking. Rather than allowing milk to dry on nipples, it would seem prudent to remove surface wetness and then keep nipples protected with lanolin to avoid the wet-to-dry cycles that further damage skin.

Health professionals who specialize in wound healing have found that the use of moisture-retaining occlusive dressings are effective in promoting healing of wounds in other body sites. Recently some physicians and lactation specialists have tried this treatment with sore nipples. They are reporting good results using hydrogel dressings applied to the nipples between feedings to maintain a moist environment for nipple healing.

Wear wide-based breast shells over your nipples between nursings. These devices minimize discomfort from a crack or open wound and accelerate healing by preventing direct contact with nursing pads or your bra. Without these devices protecting your nipples, your bra or nursing pad might stick to a cracked or irritated area of nipple skin, causing the wound to reopen every time you remove the covering.

If your nipple pain is so severe that you are unable to tolerate nursing your baby, a hospital-grade rental electric breast pump can be used to express your milk comfortably. Pumping provides a convenient means of emptying your breasts and maintaining or even increasing your milk supply, while allowing your nipples to heal. Previously, I had been taught to believe that “no pump is as gentle or as effective as your nursing baby.” We now appreciate that not every baby necessarily nurses correctly or effectively. Persistent pain during feedings is a sign that healing is not occurring. Trying to be tough and enduring the pain just subjects your nipples to continued trauma. In this case, the best electric pumps probably will be more gentle and more efficient than your baby’s improper, uncomfortable sucking. We are fortunate to have highly effective hospital-grade electric pumps to break the devastating pain cycle, preserve milk production, promote healing, and provide the option of returning to breastfeeding after calm has been restored to a family. I recall one woman whose nipple pain was so excruciating that she admitted in private: “I expected breastfeeding to make me feel more connected to my baby. Instead, I look at her and dread the thought of having to feed again. The discomfort of breastfeeding is straining my relationship with my baby.” This distraught woman was elated when pumping proved to be pain-free. Her whole attitude improved and she began to enjoy her baby more when she stopped associating her infant with pain. While her nipples healed, she fed her expressed milk to her infant, then cautiously resumed breastfeeding with expert guidance to assure proper technique. For this woman, breaking the pain cycle was the key to her ultimate breastfeeding success.

Blood in breast milk
I also recommend pumping instead of nursing when the breast milk contains blood from a cracked nipple (or other causes). Although many babies ingest blood-tinged milk without parents or health professionals ever knowing about it, drinking bloody breast milk is not entirely benign. For one thing, blood is irritating to the gut and can have a purgative effect. I recall a newborn who was admitted to the hospital for “bloody diarrhea” and was subjected to numerous diagnostic tests to determine the cause before it was found that the blood being passed was the mother’s and not the infant’s. The mother had been unaware that her painful, cracked nipple was bleeding, nor that her baby was obtaining bloody milk with breastfeeding. Ingested blood also can increase a newborn baby’s bilirubin level, worsening infant jaundice. Furthermore, blood in breast milk can increase a baby’s risk of acquiring certain infectious diseases while breastfeeding (if the mother is infected herself).

In general, hand pumps, battery pumps, and small electric pump models are not as comfortable or effective as the hospital-grade rental electric pumps.

If you decide to use a pump to interrupt breastfeeding and allow your nipples to heal, plan to pump your breasts every time your baby needs to be fed. This will be a minimum of eight times in twenty-four hours. You will want to express at least as much milk as your baby requires to be satisfied. A more generous milk supply is even better, and the excess milk can be frozen. When a mother’s milk supply is abundant, her baby obtains milk more easily and is less likely to damage her nipples. Beginning about two to three weeks postpartum, the amount of milk you should expect to get from both breasts combined is about an ounce for every hour that has elapsed since you last pumped or fed your baby. Thus, if you pumped after a three-hour interval, you should get about three ounces. If you slept for a five-hour stretch at night, you would expect to pump about five ounces when you awoke. You can feed the expressed milk by bottle, cup, or other method approved by your baby’s doctor. Keep in mind that a healthy baby shouldn’t require more than thirty minutes to complete a feeding.

If you use an electric pump to heal sore nipples, I must emphasize the importance of obtaining expert help with your breastfeeding technique when you are ready to return to nursing. I recall one woman who spent nearly a week pumping and healing her severely cracked nipples, only to have the wounds reopen when she resumed nursing her baby using the same inappropriate technique that had damaged her nipples in the first place. Synthetic oxytocin nasal spray can be used to help facilitate the let-down reflex in women with sore nipples. As mentioned earlier, the pain of sore nipples can cause a woman to tense up at feeding times, resulting in inhibition of the milk ejection reflex. This only compounds the problem of sore nipples because a baby sucks more vigorously before milk lets-down. You can try simple strategies to help trigger your milk ejection reflex, such as breast stroking and massage, drinking a beverage, or using relaxation breathing. Synthetic oxytocin nasal spray is an additional aid that might prove helpful to some women with sore nipples by triggering their milk let-down.

First Do No Harm
One of the most important principles in medicine is “first do no harm.” The sad truth is that inappropriate treatments often prove worse than no treatment at all. Over the years, some nipple creams have been marketed that were useless at best or that actually aggravated sore nipples. Many women are sensitive to the additives in various nipple creams. Some that were used in the past contained alcohol and other drying agents. One reason I recommend USP Modified Lanolin (medical grade) is that it is free of any other ingredients to which a woman might react. Although a popular belief exists that women who are allergic to wool will react adversely to lanolin, dermatologists insist that true lanolin allergies are very rare. Most women “allergic to wool” are sensitive to the fibers. If you suspect you may be allergic to lanolin, apply a small amount to your inner arm to see if you react before trying it on your nipples.

Most breastfeeding experts agree that medical-grade lanolin is the most effective and safest substance that can be applied to sore nipples to promote healing. PureLan and Lansinoh for Breastfeeding Mothers are the purest and safest brands of USP Modified Lanolin and do not need to be removed before feedings. I cannot recommend other creams, ointments, or topical applications because they are not as effective and some are not safe for infants.

Some breastfeeding counselors recommend applying ice to sore nipples. They claim that ice treatments temporarily desensi-tize sore nipples sufficiently to allow some women to tolerate nursing. While I advocate ice in the treatment of engorgement, mastitis, sports injuries, and other conditions, I do not recommend it for sore nipples. First, I don’t believe in numbing the pain to make nursing tolerable. Discomfort while nursing is a warning sign that the baby is latched on incorrectly or that mechanical trauma is continuing and is preventing healing. I also think there is some risk of ice causing cold injury to the sensitive skin of the nipples.

Postpartum Breast Engorgement

The amount of postpartum breast engorgement women experience is highly variable. Some women can scarcely tell that their milk has come in, while others have extraordinary breast swelling, firmness, and discomfort. The amount of engorgement probably is influenced by the frequency of milk removal, the number of milk glands present, the rate at which hormones fall after delivery, and other individual differences.

Breastfeeding Problems Related to Engorgement
Over fifty years ago, a noted British physician, Dr. Harold Waller, published an insightful article in the medical literature describing the contribution of severe breast engorgement to various breastfeeding problems. He estimated that about 20 percent of first-time mothers experienced very dramatic breast engorgement and had difficulty establishing milk flow. It was his belief that this excessive engorgement, if not relieved promptly, soon led to the problems outlined below and was the chief explanation for early failure of breastfeeding. My own observations match Dr. Waller’s conclusions, and I wholeheartedly concur with his hypothesis. In my opinion, severe or unrelieved engorgement in the first postpartum week represents the greatest single physical cause of unsuccessful breastfeeding. Severe engorgement, if not promptly relieved, can contribute to each of the following difficulties:

Breast swelling and firmness can make the nipple and surrounding areola more difficult (certainly not easier!) to grasp. As a result, an infant may latch on incorrectly, taking only the tip of the nipple, thereby obtaining little milk and causing nipple discomfort. Babies who have learned to attach correctly in the first day or two when the nipple and areola are soft and pliable will be better prepared to nurse effectively should excessive engorgement occur later. In the past, when new mothers routinely remained hospitalized for several days after delivery, abundant milk production began prior to discharge, and nurses were available to help women position their babies correctly if engorgement was present. Today, however, most women find themselves at home when their milk comes in, and are left to muddle through the experience without benefit of guidance from health professionals. An early follow-up visit within two days of hospital discharge can help identify infants having latching troubles due to severe engorgement.

Swelling of the skin of the nipple and areola during engorgement makes the nipple more susceptible to trauma during attempts to breastfeed and contributes to soreness. The resulting damage-often with cracking, bruising, or abrasions on the nipple-leads to nipple soreness, ranging from mild to severe, that can interfere with nursing. Thus, uncomfortable breast engorgement and painful nipples often go hand in hand, creating what one mother referred to as the “double whammy” blow to breastfeeding.

Excessive engorgement leads to residual milk and elevated pressure in the milk ducts that causes diminished milk produc-tion. When the pressure of severe engorgement interferes with milk flow, residual milk in the breasts can decrease further milk production. Thus, a woman can go very quickly from too much to too little milk. Bottle-feeding mothers represent a commonplace ex-ample of how quickly unrelieved engorgement can cause decreased milk supply. Bottle-feeding mothers attest that extreme breast firmness and fullness subside substantially within about forty-eight hours, as the milk-producing glands cease to function. Thus, the period of engorgement is a critical time in the initiation of breastfeeding, often the make-it-or-break-it period. If milk flow is easily established and the breasts are drained regularly, then full milk production continues. However, if the pressure in tense, tight breasts cannot be relieved and little milk is removed, a woman’s body will react as if she is bottle-feeding. Within a few short days, a woman with unrelieved breast engorgement can suffer diminished milk supply. It can take days, or even weeks, of dedicated effort to restore milk production to its full capacity after only a few days of early difficulties. Sometimes the effect can be permanent. Unrelieved breast engorgement is more than a temporary nuisance or an uncomfortable inconvenience. It is a very real threat to the success of breastfeeding because it is so harmful to milk supply.

Severe and unrelieved breast engorgement can make it difficult for the baby to obtain sufficient milk with nursing. Several factors can limit a baby’s milk intake during excessive engorgement. Not only is correct latch-on made more difficult when the breasts are swollen and firm, but excessive pressure can impair milk flow. A mother may struggle at feeding times to get her baby to latch on and suckle well, while the hungry baby cries in frustration at not being able to properly position her mouth on the tense areola. Or, a baby seemingly may nurse often enough, yet remain underfed because she is unable to effectively extract milk during nursing attempts. As the days go by, a baby may lose an excessive amount of weight, becoming less able to nurse effectively, at the same time that milk production rapidly is declining. This is a dangerous combination that all too often follows severe, unrelieved breast engorgement.

Treatment of Engorgement
Feeding Schedule
Whether or not engorgement can be prevented by frequent feedings, I definitely agree that it is improved by frequent, effective nursing. By the time milk comes in around the third day, a baby should be nursing every two to three hours, at least eight to ten times in twenty-four hours. It’s not uncommon for a baby to have one longer sleep interval (hopefully at night!). Ordinarily, I would allow a newborn one five-hour stretch without feeding in a twenty-four-hour period, but if your breasts are engorged, I wouldn’t let this single longer interval exceed about 31/2 hours. I recommend you not allow your baby to use a pacifier in the early weeks of breastfeeding, and this is especially true during engorgement. It does no good for your baby to suck non-nutritively on a pacifier when your full breasts need to be drained. Even if your baby just nursed forty minutes ago, if she exhibits any feeding cues, put her back to your breast. It’s entirely possible that her last feeding was not very effective and that she obtained little milk. Now she wants to try again-and she should! Going by the clock (“Gee, she shouldn’t be due to feed yet”) is likely to prevent your breasts from getting the stimulation and emptying they need and your baby from getting all the milk she requires.

Correct Positioning at the Breast
Going through the motions of frequent feedings does little good if the baby is positioned incorrectly to nurse. In fact, it can make things worse by causing sore nipples that interfere with subsequent feedings. You may have to use a breast pump (see below) or hand expression to take off some milk before latching your baby on. Expressing some milk first will soften the nipple-areola area and make it easier for your baby to grasp. Also, starting some milk dripping from your nipple will help entice your baby to latch on. Cupping your breast in the C-hold, with your fingers well behind the areola, you may need to gently compress your thumb and forefinger to make the nipple and surrounding areola easier to grasp. Make sure your baby takes a large mouthful of breast. Her lips should be flanged out, not curled in.

Cold and Heat
Simple measures like cold and heat application can help relieve breast discomfort and improve milk flow. Cold therapy increasingly is being recognized for its value in reducing inflammation and pain. Traditional ice packs, cool compresses, or commercial cold packs-even bags of frozen vegetables!-can be applied to the engorged breasts for fifteen to twenty minutes at a time to reduce blood congestion and tissue swelling. This will diminish internal pressure in the breast and help milk move through the ducts to the nipple openings.

Many women attest that their breasts start dripping milk when they stand under a warm shower. This observation has led to the widespread recommendation to apply moist heat to engorged breasts, particularly before feedings to increase circulation to the breast and bring the hormone oxytocin to help trigger milk let-down. Wrapping the breasts in warm, wet washcloths or towels for ten to twenty minutes not only feels good but also can start milk dripping. Commercial hot packs are available from a breast pump manufacturer. These packs can be reused by warming them in the microwave. Be careful not to burn the already stretched, damaged breast tissues, especially in the sensitive nipple area. Try both heat and cold applications to find which brings you most relief from discomfort and which helps best to improve your milk flow and decrease breast congestion. You can alternate these therapies in a way that is most effective for you.

Cabbage Leaves
For centuries, cabbage has been used in many countries as a folk remedy for a wide variety of ailments. All kinds of medicinal applications have been suggested for cabbage, including eating it raw or lightly cooked, drinking fresh cabbage juice, or applying a raw cabbage leaf poultice. In recent years, a number of lactation experts have suggested that wrapping engorged breasts in cabbage leaves brings rapid, effective relief of discomfort and facilitates milk flow. Many women attest to the benefits of this treatment, but scientific proof is still lacking to confirm whether such therapy truly is effective for breast engorgement. The home remedy is used as follows:

1. Thoroughly rinsed and dried, refrigerated or room-temperature, crisp, green cabbage leaves are prepared by stripping out the large vein before applying the leaves over the engorged breast or breasts. The leaves can either be worn inside the bra or as compresses covered by a cool towel. Holes can be cut in the leaves, if necessary, to allow the nipples to be kept dry. The cabbage leaf compresses are left in place for about twenty minutes, or until they have wilted, at which time they can be replaced by fresh leaves. Most women report significant relief within eight hours. Continued application up to eighteen hours has been recommended for mothers who needed to wean abruptly or for severely engorged bottle-feeding mothers who wanted to dry up completely.
2. The applications should be discontinued as soon as the desired result is obtained; overtreatment is claimed to reduce milk supply. Practitioners who use cabbage leaves report that women usually require only one or two applications to establish good milk flow.

Breast Pump
Many women are reluctant to pump or express milk during engorgement for fear that they might stimulate too much milk and exacerbate the condition. But engorgement is more a problem of poor milk flow than excessive milk production. Removing milk is essential to reducing the pressure in the breasts and the backup of milk that eventually can decrease milk supply. Improving the ease of milk flow from the breasts makes it easier for the baby to obtain milk when nursing. Because the situation so often is compounded by infant difficulties in breastfeeding, a breast pump can be enormously helpful in managing engorgement. A wide array of pumps is available, ranging from inexpensive hand pumps to hospital-grade electric pumps. I strongly recommend that you obtain a hospital-grade rental electric pump with a dual collection kit that can empty both breasts simultaneously if your breasts become severely engorged. Because unrelieved engorgement can be so distressing and its prompt resolution is so critical to continued success, you will want to have the most comfortable, convenient, and effective means of emptying your breasts. If your baby is not nursing well or if your breasts remain uncomfortably full after breastfeeding, pump after feedings to express any remaining milk and reduce breast firmness. Ten to fifteen minutes of pumping with an electric pump is usually sufficient at one session. Longer pump-ing times can damage nipples and swollen breast tissues. For severe engorgement, some women obtain better results by pumping one breast at a time, instead of both breasts. Use your free hand to gently massage your breast while pumping. Steady pressure applied to areas of firmness often starts milk flowing, at least briefly. When milk flow stops, switch to the opposite breast. Massage and pump on the second side as long as you are getting results. Then switch again when milk flow stops. After fifteen to twenty minutes of total effort, wait an hour or two before trying again.

Relaxation
Do your best to relax and visualize your milk flowing. Being anxious and uptight is only likely to inhibit your milk ejection reflex. Play calming music or practice relaxation techniques such as Lamaze breathing. Ask your partner to give you a neck massage or back rub. Extend your arms above your head and slowly bring them down to your sides. Repeat this “flying angel” exercise several times. Many women find it helps their milk to let-down.

Synthetic Oxytocin Nasal Spray
The hormone your body makes to trigger your milk ejection reflex and start your milk flowing is known as oxytocin. A synthetic form of this hormone was formerly marketed as a nasal spray known as Syntocinon (Sandoz Laboratories). The drug was prescribed for breastfeeding women to help trigger their let-down reflex and promote milk flow when the milk ejection reflex was thought to be inhibited. Synthetic oxytocin was sometimes prescribed for mothers of premature infants and employed mothers who needed help conditioning their milk ejection reflex when using a breast pump. The medication was also recommended to help relieve severe breast engorgement by triggering the milk ejection reflex and stimulating milk flow. Unfortunately, Syntocinon is no longer being marketed. However, a compounding pharmacist can prepare an equivalent drug with a physician’s prescription. A compounding pharmacist is a pharmacist who makes custom-tailored medications from scratch. The International Academy of Compounding Pharmacists offers a referral service for patients to help them locate a compounding pharmacist within a fifty-mile radius of their zip code (see Resource List, page 451). If other measures to relieve engorgement haven’t helped, ask your doctor whether synthetic oxytocin nasal spray might be worth trying in your case.

Lopsided! What can I do?
…When baby prefers one side, or when supply or breast size is greater on one side

By Kelly Bonyata, BS, IBCLC

• Is this a problem?
• Why does it happen?
• Evening things up
• Persuading baby to nurse better on the less preferred side
• Will baby get enough milk?

Is this a problem?

Most women notice differences in milk supply, pumping output, milk flow and/or size between breasts. As with many other things (foot size, ring size, eyesight, etc.) asymmetry is normal in humans. In some women the difference between breasts is hardly noticeable; in others it is very noticeable. There is every variation in between. This is not usually a problem in terms of the breastfeeding relationship, so you certainly don’t need to do anything about it if the asymmetry does not bother you or baby; however some mothers prefer to even things out, particularly if there is a very noticable difference in breast size.

Sometimes babies will refuse or fuss at a breast when the let-down is slower or too forceful, or the supply a bit lower. They in turn will prefer the side which lets down more/less quickly and in which the supply is more bountiful.

Why does it happen?

Possible reasons for variations in supply/milk flow between breasts:

• Normal anatomical differences. All women have one breast that has more working ducts and alveoli than the other (usually the left side, though either is normal). Some women also have differences between the two areola/nipples (inverted, flat, different shape/size) which make it easier for baby to latch on to one side than the other.
• Baby’s preference for one side. Most babies have a side preference to some extent. From the start, your baby may feel more comfortable being held on one side and therefore nurse it more efficiently and/or more frequently.
• Mother’s preference for one side. Mom (consciously or subconsciously) may offer one side more than the other because she feels more comfortable nursing on that side.
• Breast surgery or injury. If one breast was ever operated on or injured in any way, supply and/or milk flow can be affected.

If your newborn is refusing one side, have her doctor do a good physical exam to check for birth injuries. Some babies will have an injury that goes unnoticed at birth, but causes baby discomfort when in certain nursing positions.

If baby suddenly begins to refuse one side, it could be caused by an ear infection or other illness in baby (making nursing painful or uncomfortable on that side), an injury to baby (or something else, such as a sore immunization site) that makes nursing painful in that position, or a breast infection in that breast (which can make the milk taste salty). Many babies who refuse one side do so because mom has a much faster or slower letdown on one side (baby might prefer either the faster or slower flow). If all other possible causes are ruled out and baby continues to refuse one side, then consider seeing your doctor just to rule out any breast problems.

Evening things up

It is fine to just do nothing, but if the lopsidedness is bothering you, you can try to increase milk supply on the smaller side to increase the supply/breast size/milk flow on that side. Be careful, though, not to neglect the larger producing breast too much and allow too much backup of milk in that breast, because that may make you vulnerable to plugged ducts and mastitis.

Here are some things that can help to even things up (you don’t need to do them all; start off with the one thing that looks most workable for you):

• Start baby on the smaller side for each feeding for a few days (baby usually nurses more vigorously on the first breast offered).
• Nurse on the smaller side twice as often. For instance if you nurse on one side per feeding, you might nurse on the small side for two feedings, the larger side for one, then back to the smaller side for the next two feedings, etc.
• Pump the smaller side for 5-10 minutes after some feedings.
• Add an extra pumping session (for 10-20 minutes – smaller side only) in between feedings.

If the larger side becomes overfull, express just enough milk to relieve the pressure. Most mothers notice an “evening out” of some proportion within 3-5 days of doing these things. Most moms use these measures for a short time only, until they get the desired results, but others continue long-term.

There may always be a small degree of difference in breast size – at least to your own eyes. If there is an obvious difference in appearance through your clothing, you may want want to use nursing pads to give a more even appearance. Usually a difference in size is much more noticeable to you than to anyone else.

Persuading baby to nurse better on the less preferred side

• Try starting your baby on the preferred breast and then once let-down occurs, slide her over to the other side without changing the position of her body. For example, start her in the cradle position and then slide her over into the football position.
• Continue to try different nursing positions.
• Offer this breast to your baby when she is just waking up but not fully awake or already a little sleepy. She is more likely to instinctively nurse at this time.
• Nurse in a darkened and quiet room.
• Offer this side with motion; i.e. walk, sway, bounce, rock, etc. until your baby starts
  nursing well.
• If let-down on the less preferred side is too fast or slow, follow the suggestions in Let-down Reflex: Too slow? or Forceful Let-down Reflex
• If supply on the less preferred side is low, follow the suggestions above and in Increasing low milk supply.
• If baby seems to want a faster flow from the less preferred side, then try doing breast compressions to speed the flow.
• See the suggestions in Help — My Baby Won’t Nurse!
• Patience and persistence are key. Keep trying, and praise baby when she nurses well. Most of the time a baby will take the less-preferred breast with time. If baby is refusing or nursing rarely on one side, you may need to pump this side as often as the baby is nursing the other side in order to better maintain your milk supply.

Will baby get enough milk?

Yes – your baby can get all that she needs as long as she is allowed to nurse unlimitedly and unrestrictedly – even if you nurse exclusively on only one side. If there is simply a difference in supply between breasts, baby will adjust her nursing to compensate. Overall milk production is generally not a concern unless other factors are involved.

If baby is completely refusing one side, you’ll want to pump that side as often as she nurses to maintain supply until you get her back nursing on that side.

If all else fails, one-sided nursing is very possible as long as your baby is allowed to
nurse without restriction. The side that you are not nursing on, once allowed to “dry up,” will be smaller than the other side. This will result in some degree of lopsidedness (though it may not be obvious), but this will remedy itself once weaning occurs.

Overcoming breastfeeding problems

Breastfeeding (nursing) your baby can be a comfortable and relaxing experience, though nipple soreness should be expected, especially during the first weeks of breastfeeding. Some breastfeeding mothers describe nipple soreness as a pinching, itching, or burning sensation.

Nipple soreness may be caused by:

• Improper position of baby
• Improper feeding techniques
• Improper nipple care

For many women, there is no identified cause. A simple change in your baby’s position while feeding may relieve nipple soreness. Some breastfeeding mothers report nipple soreness only during the initial adjustment period.

Comfortable breastfeeding takes time and experience. To encourage a comfortable and successful breastfeeding experience, get an early start in the hospital. Request the help of a lactation consultant or nurse to get you started with proper positioning and breast care. A list of lactation consultants is available at www.breast-feeding.com.

Nipple soreness may be caused by incomplete suction release at the end of your baby’s feeding. You can help your baby learn to release (and reduce your discomfort) by gently inserting a finger into the side of the mouth to break the suction.

Excessively dry or excessively moist skin can also cause nipple soreness. Moisture may be due to wearing bras made of synthetic fabrics which increase sweating and hinder evaporation.

Using soaps or solutions that remove natural skin oils can cause excessively dry skin. Ointments containing lanolin may be helpful for the care of dry or cracking nipples. Olive oil and expressed milk are also effective for soothing uncomfortable nipples. Using different feeding positions also may help reduce soreness.

Nipple soreness can also be caused by your baby chewing or biting on the nipples. When your baby begins teething, the gums will swell, itch, and hurt. Biting and chewing seems to help relieve this discomfort.

To comfort your baby and reduce the desire to chew on or bite your breast, provide something cold and wet to chew on for a few minutes before breastfeeding. A clean, wet washcloth from the refrigerator will work well for this purpose. The cold will help numb painful gums and may give relief throughout the feeding.

You may want to allow the infant to chew on another cold, wet washcloth before feeding on the other breast begins.

BREAST ENGORGEMENT OR BREAST FULLNESS

Breast engorgement is caused by congestion of the blood vessels in the breast. The breasts are swollen, hard, and painful. The nipples cannot protrude to allow the baby to latch on correctly, and nursing is difficult.

Engorgement is different from breast fullness. Breast fullness is the gradual accumulation of blood and milk in the breast a few days after birth and is a sign that your milk is coming in. Breast fullness doesn’t impair efficient breastfeeding because the breast tissues can be easily compressed by the baby’s mouth.

Nurse often (8 times or more in 24 hours) and for at least 15 minutes for each feeding to prevent engorgement. To relieve breast engorgement, express milk manually or with a pump. Electric breast pumps work best. Alternate taking warm showers and using cold compresses to help relieve the discomfort.

LET-DOWN REFLEX

The let-down reflex is a normal and necessary part of breastfeeding. Hormones (prolactin and oxytocin) control the reflex and allow milk produced in the milk glands to be released into the milk ducts.

Pain, stress, and anxiety can interfere with the reflex. This will cause the retention of milk within the milk glands which can cause additional pain and anxiety. Treatment includes relaxation and a comfortable nursing position.

Reducing distractions during nursing, performing a gentle massage, and applying heat to the breast will also help. You should discuss prolonged problems with your health care provider.

INADEQUATE MILK SUPPLY

The baby’s milk demand determines the mother’s supply. Frequent feedings, adequate rest, good nutrition, and adequate fluid intake can help maintain a good milk supply.

Checking weight and growth frequently is the best way to make sure your baby is taking enough milk. If you have concerns about how much breast milk your baby is consuming, consult your physician.

PLUGGED MILK DUCT

A milk duct can become plugged if the baby does not feed well, if the mother skips feedings (common when the child is weaning), or if she wears a constricting bra. Symptoms of a plugged milk duct include tenderness, heat and redness in
one area of the breast, or a palpable lump close to the skin.

Sometimes, a tiny white dot can be seen at the opening of the duct on the nipple. Massaging the area and gentle pressure can help to remove the plug.

BREAST INFECTION

A breast infection (mastitis) causes flu-like symptoms such as aching muscles, fever, and a red, hot, tender area on one breast. Consult your doctor if you develop these symptoms, as medication is needed to treat this infection.

Breast infections most commonly occur in mothers who are stressed and exhausted, have cracked nipples, plugged milk ducts or breast engorgement, have skipped feedings, or wear a tight bra.

Treatment frequently includes

• Antibiotics for the infection
• Moist, warm compresses to the infected area
• Wearing a comfortable bra between feedings
• Rest

Breast milk is safe for the baby and continues to be the best source of nutrition — even when you have a breast infection.

Frequent nursing from the affected breast will promote healing. Although only one breast is usually infected, it is important to continue breastfeeding from both breasts to prevent the infection from getting worse.

If nursing is too uncomfortable, pumping or manual expression is recommended. You can try offering the unaffected breast first until let-down occurs, to prevent discomfort. Consult your physician for help.

THRUSH

Thrush is a common yeast infection that can be passed between the mother and the baby during breastfeeding. The yeast (called Candida albicans) thrives in warm, moist areas.

The baby’s mouth and the mother’s nipples are perfect places for this yeast to grow. A yeast infection can be difficult to cure, but fortunately this is uncommon. Yeast infections frequently occur during or after antibiotic treatments.

Symptoms of yeast infection in the mother are deep-pink nipples that are tender or uncomfortable during and immediately after nursing. Symptoms of thrush (an oral yeast infection) in the baby include white patches and increased redness in the baby’s mouth.

The baby may also have a diaper rash, a change in mood, and will want to
suckle more frequently. Contact your physician to get a prescription for an anti-fungal medication for affected members of your family.

ILLNESS

If you develop a fever or illness, contact your health care provider. Breastfeeding can be safely continued during most illnesses, and the baby is likely to benefit from the mother’s antibodies.

Breast Problems During Pregnancy and Lactation: Frequently Asked Questions

Carol Scott-Conner, M.D.
Department of Surgery
University of Iowa Hospitals and Clinics

Creation Date: April 2000
Last Revision Date: April 2000
Peer Review Status: Internally Peer Reviewed

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Most of the common problems that occur during pregnancy, or lactation, can be managed without interrupting either the pregnancy or the breast-feeding. A woman who develops a lump in her breasts should see her physician because occasionally it is a sign of something more serious.

What are the most common problems a woman faces with her first child and breast-feeding? How can an expecting mom prepare herself for these issues?

The most common problem is nipple irritation and associated with that is mastitis, or inflammation and infection in the breast. The best way to prepare for this is by seeking the guidance of someone who is experienced in breast-feeding. There are now lactation consultants in many communities, and they are excellent sources of information. The nipples are a very sensitive area, and when the new baby starts to nurse, irritation may occur. Careful hygiene and cleanliness are important.

How can a woman prevent “cracking nipples” during lactation?

The best way to prevent cracking nipples is to use an approved lubricant of some kind. Check with your physician or health care provider for something to put on the nipples to keep them from drying out.

What advice would you give someone who developed a significant galactocele during her first lactation? Do I need surgery to correct it?

It may or may not re-accumulate during the 2nd pregnancy and lactation. I would not advise prophylactic surgery. Galactocele’s are generally treated by aspiration and if this one recurs, then you should see your physician.

I am not sure if I am in right room, my son is almost 2. I never breastfed him, but I continued to leak until he was 8 mo. Now 2 years later I am leaking again, any ideas?

You should see your physician. That could be something serious.

What is galactocele, and is it preventable?

Galactoceles are single or multiple nodules that contain milk. Anything that obstructs the duct of the breast during lactation may cause a galactocele. Most often, galactoceles occur at the end of breast-feeding when the milk is allowed to stagnate in the breast. Sometimes the mass isn’t found until months later. There really aren’t any preventive measures, and galactoceles are simply dealt with by aspirating the milk with a needle.

Unfortunately, my OBs had trouble diagnosing the galactocele and it achieved about 8 centimeters in diameter. Would you consider surgery prophylactic at that point?

Again, we don’t generally advise prophylactic surgery for galactoceles. If a large galactocele has been a problem in the past, then early detection and aspiration, if it recurs, should solve the problem.

Is there any reason a mother should consider not breastfeeding?

That is an individual decision that a woman should take up with her obstetrician but I am not aware of any specific conditions, with the exception of some very rare illnesses, that would make it wrong for a woman to breast feed. Some medications that a woman might have to take for life-threatening illnesses are excreted in the breast milk and that could be a problem. A woman should talk this over with her obstetrician. Remember, there are numerous benefits to mother and child from breast-feeding. Also, studies show that breast feeding reduces the risk of getting breast cancer later in life.

Can women continue to nurse, even when experiencing problems such as galactoceles?

Yes, a woman can continue to nurse and sometimes keeping the breasts empty by nursing helps the problem go away. Occasional repeated aspiration is needed. If the galactocele keeps coming back, surgery may be required.

Are lactation consultants a good idea?

I think that if it is your first baby, getting advice from someone who knows how to teach you the ins and outs of breast feeding is very important. For many women, a lactation consultant is the best option. Depending upon your circumstances, you may find that a nurse, a nurse midwife, or your obstetrician may be able to offer similar advice. Of course, some women get the support from other women in their family. The La Leche League is a nationwide organization that helps women with breastfeeding.

During lactation, one of my breasts grew quite larger than the other (obviously my son preferred that one because it seemed to produced more milk!) Is there any way to prevent this from happening with my next child?

I don’t know of any way to prevent this. It is normal for the breast to increase during size and weight during pregnancy. Usually the increase is symmetric but occasionally one breast enlarges more than the other. It is likely that if this has happened once, it may happen again.

How do you manage breast infections? Do you have to stop breast-feeding?

Breast infections don’t have to interrupt breast-feeding. Antibiotics can treat most of the common breast infections, and the woman can continue to breast-feed. Keeping the breasts empty by the baby nursing actually helps by avoiding the accumulation of milk in the breast because milk is a culture medium and the bacteria can grow in the milk. It does not have to interrupt breast-feeding.

What happens if a woman is diagnosed with breast cancer during pregnancy?

We can treat breast cancer during pregnancy without interrupting the pregnancy. Fortunately breast cancer is rare during pregnancy, but it occasionally occurs. Women that have breast cancer have had children come to term and do well. There isn’t any danger of transmitting the cancer to the unborn child. We have enough alternatives in treatment now that we can treat the cancer adequately.

I’ve heard that bloody nipple discharge can be a sign of cancer. What about bloody nipple discharge during pregnancy?

During the last part of pregnancy, that is the last trimester, the nipple undergoes changes preparing for breast-feeding. With these changes, it is fairly common for women to have nipple discharge that may even be bloody. It usually gets better once a woman starts breast-feeding. It is not necessarily a sign of cancer. We don’t do anything other than watch and carefully examine the woman.

What are the most common reasons women give up on breast-feeding?

Sometimes women think they don’t produce enough milk, and they become discouraged and give up. I think it would be better to supplement with formula if necessary and continue breast-feeding as long as possible. That has probably been the most common reason I have seen women give up.

What should a pregnant woman do if she finds a lump on her breast?

A pregnant woman who finds a lump in her breast should see her physician for a careful examination, an ultrasound of the breast, and possibly an aspiration. Most breast lumps that occur during pregnancy are benign but occasionally women do develop breast cancer during pregnancy. Any lump that develops should be taken seriously whether the woman is pregnant or not. We don’t do mammograms in pregnant women because the breasts are so dense from the pregnancy that mammograms are not very effective. Ultrasound is an excellent way to study various masses and is very useful. A woman who develops a lump in her breast during pregnancy should have it evaluated.

When should you stop breast-feeding?

That is something that ought be worked out with your own physician.

Do you need to do anything after you stop breastfeeding to stop the milk production?

Generally, just stopping breast-feeding suppress lactation. In addition, there are medications that a physician can prescribe.

What are some of the more common breast problems experienced during pregnancy? Are they hereditary? What types of breast problems occur in women who are NOT pregnant?

Breast lumps are very common in women who are pregnant and women who are not pregnant. Most of the time, these are caused by benign problems that are not cancerous. Once in a while, a lump is a sign of something serious. For that reason, any women, pregnant or not, who finds a lump in her breast should see her physician and have it checked out. Nipple discharge, as discussed earlier, is also a fairly common sign and in pregnant woman is also less worrisome but again should be evaluated by a physician. Breast pain is a very common and nonspecific problem in both pregnant and non-pregnant women. During pregnancy, the breasts enlarge; they get heavier and the blood supply increases. This makes it harder to feel lumps and makes it very important that a woman have a good breast exam early in pregnancy as a baseline for later comparison. Most of the common problems are not hereditary.

How do you fix an inverted nipple?

We usually leave inverted nipples alone and most women with inverted nipples are able to breast feed. If the nipple inversion is new, that is if the woman has not had it all of her adult life, it may be a sign of a problem and she should see her physician.

Do fibrocystic breast become more “lumpy” after pregnancy?

After pregnancy and after breast feeding, once you are finished breast feeding and they have shrunk down again, or involuted, lumps may be more prominent which creates the appearance of being more lumpy.

Breast Health

Breast Health in Lactating Women

Anne M. Montgomery, MD, IBCLC

Lactating women may develop breast conditions related to lactation, but they also remain susceptible to conditions found in non-lactating women. With delayed childbearing and reproductive technology, more women in their forties—and even fifties—may be lactating, increasing the likelihood that screening for breast cancer will need to occur before a woman finishes breastfeeding.

Infectious conditions

Superficial infections of the breast may include staphylococcus, streptococcus, candida, and herpes viruses. S. aureus infection should be suspected when there are significant cracks or fissures of the nipple; systemic antibacterial treatment should be considered to avoid progression to mastitis.¹ Topical treatment frequently suffices for treatment of minor superficial infections. Recurrent bacterial infections may indicate that mother or baby is a carrier; topical treatment of the nares with muciprocin ointment may eradicate the carrier state.^{2, 3} With candida, both mother and baby should be treated simultaneously to avoid reinfection. Yeast infection of ducts has been suspected in cases of deep, shooting breast pain, and may respond to systemic antifungals such as fluconazole.

Herpetic lesions on the breast may have been transmitted from the baby’s mouth or from contact with another source of infection. If the baby is beyond the newborn period, breastfeeding may continue unless the lesions are on the nipple or areola. If so, the baby should feed only on the contralateral side until the lesions have dried.³ The lesions should be covered if possible. Good attention to hand-washing and avoiding kissing when oral lesions are present can help prevent spread.

Bacterial mastitis occurs in about 2.5 percent of nursing mothers, most commonly occurring between 2 and 5 weeks post-delivery. It can be prevented by good breast hygiene and hand-washing, and by regular emptying of the breast. If a specific area of the breast does not drain well, manual expression of the milk from that duct may help avoid milk stasis. Treatment for bacterial mastitis includes adequate breast emptying, rest, hydration, and antibiotic therapy directed at the most common organisms (S. aureus, coagulase-negative staphylococcus, streptococci, E. coli). Adequate treatment is essential in order to avoid development of breast abscess. Breastfeeding should continue, as the baby is the most efficient remover of milk; there is no significant risk to the baby from the infection or from the common antibacterial therapies.^{2, 3, 4}

Breast abscesses may be simple or complex. They require surgical drainage. Breastfeeding may continue as long as the incision is away from the nipple and does not interfere with latch-on.^{2, 4}

Chronic inflammation of the breast may lead to plasma cell mastitis. This condition, most commonly seen in multiparous women or women with long nursing histories, results from chronic inspissation of secretions into connective tissue, with development of sterile, granulomatous inflammation. The resulting fibrosis and nipple retraction may mimic malignancy.⁴

Dermatoses

Eczema, psoriasis, seborrheic dermatitis, contact dermatitis, and neurodermatitis may occur on the skin of the breast or areola.

Breastfeeding may cause irritation of the nipple and areolar skin leading to outbreaks of these dermatoses in susceptible women. Topical agents can lead to contact dermatitis. Maternal allergy to foods or cow’s milk or soy formula consumed by the nursling and still in the mouth during breastfeeding can also contribute.

Treatment with careful hygiene, gentle washing after feeding, adequate drying, and topical corticosteroids may relieve the symptoms. Steroid creams should be gently wiped from the nipple to avoid excessive exposure for the baby. Persistent inflammatory lesions may be superinfected with bacteria or yeast, or may represent inflammatory cancer.²

Other benign conditions of the breast

Nipple bleeding and blood in the milk are very common, especially among primiparas during pregnancy and early breastfeeding. This is likely due to the increased vascularity of the breast. If the bloody discharge resolves spontaneously, it is most likely benign. If there is persistent bleeding from a single duct, a ductogram may reveal a papilloma. Bleeding associated with a mass needs to be evaluated for the possibility of malignancy. In general, there is no contraindication to continuing to breastfeed despite the presence of blood in the milk.^{1, 2, 3}

Vasospasm of the nipple (Raynaud’s phenomenon) has been reported. This may manifest as blanching and pain of the nipple, either spontaneously or after nursing. This may or may not be associated with other manifestations of Raynaud’s phenomenon or rheumatologic disease. Avoiding nipple trauma and keeping the nipple warm can prevent some of the occurrences. Calcium channel blockers may be used in severe cases.²

Cyclic nipple and/or breast pain may occur when women resume ovulating. Nipple tenderness around the time of ovulation and breast pain during the luteal phase occur commonly. If nipple and breast pain occur without other explanation and the woman is not menstruating, the possibility of pregnancy should be considered.

Breast cancer screening

Breast cancer has been thought to have a poor prognosis when found in pregnant or lactating women, but most likely this is because of delay in diagnosis of aggressive disease. Many breast cancers diagnosed in pregnant and breastfeeding women have been found as a result of self breast exam. A baseline exam at the first prenatal visit and subsequent periodic exams, ideally by the same examiner, can allow early detection of suspicious masses.⁷ Pregnant and lactating women should follow guidelines for breast cancer screening for their age and risk status.

Mammography in lactating women, as in younger women, may be less sensitive due to increased breast density. One recent report, however, indicates that an individual woman’s breast density may not change significantly with pregnancy or lactation.⁷ There is no clear evidence that mammography in premenopausal women decreases the risk of death from breast cancer. If a mammogram is indicated for breast cancer screening, the woman should empty her breasts as completely as possible just prior to the mammogram. Women may develop new micro-calcifications after weaning. These have a benign, diffuse pattern and may be followed for stability. However, for high-risk women, a stereotactic biopsy should be considered. The radiologist should be told of the woman’s lactation history.⁷

Mammography, combined with self-exam and periodic clinical breast exam, should continue during pregnancy and lactation as per published guidelines. While breastfeeding may provide some protection against the development of breast cancer, most breast cancers found during pregnancy and lactation actually had their beginnings years earlier. Even though breasts may be denser, women and health practitioners do find new, persistent masses that require close observation and further evaluation.

Evaluation of breast masses in lactating women

All breast masses in all women need to be evaluated and explained. In lactating women, a breast mass has an approximately 10 percent likelihood of being malignant, although this figure may be higher in older lactating women. Fortunately, most breast masses can be evaluated without excisional biopsy. Ultrasound examination may identify cystic masses. These may represent fibrocystic fluid or galactoceles. Aspiration may allow diagnosis and resolution of the cyst.⁴

Solid masses require further evaluation. Benign masses include lipomas, fibroadenomas, lobular hyperplasia, and inflammatory lesions. In most cases, a benign diagnosis can be established by fine-needle aspiration (FNA) performed by an experienced practitioner. The pathologist should be informed that the sample comes from a lactating breast. If the FNA results are unequivocally benign, excisional biopsy is not required. The mass should be closely followed and re-evaluated after weaning. If the FNA results are equivocal or suspicious, the woman should undergo an excisional biopsy.⁷ There is an increased risk of milk fistula and post-biopsy infection in lactating women, so many surgeons recommend weaning prior to biopsy. If the mother accepts these risks she may continue to breastfeed, although she should nurse the baby and/or express as much milk as possible just prior to the surgery.⁷

Breast cancer treatment in lactating women usually requires weaning. Because premenopausal breast cancer is an aggressive disease, most women are treated with radiation and chemotherapy. Antimetabolite and anti-estrogen therapy are contraindications to breastfeeding.² Emotional support should be provided for the mother and family as they face the cancer and also grieve premature weaning.

Pregnancy and lactation after treatment for breast cancer remain somewhat controversial, and recommendations may depend on the estrogen- and progesterone-receptor status of the original tumor. In most cases, women who do become pregnant after breast cancer treatment may be encouraged to breastfeed. They should be monitored for adequate milk production from post-surgical or post-radiation breasts.^{2, 3}

Anne Montgomery, MD, IBCLC, is a board-certified family physician who practices at Group Health Cooperative of Puget Sound in Olympia, Washington. She also has a private lactation practice, Olympia Breastfeeding Medicine. She is Clinical Associate Professor of Family Medicine at the University of Washington, a member of the Board of Directors of the Academy of Breastfeeding Medicine, an LLL Medical Associate, and an accredited LLL Leader.

REFERENCES

1. Livingstone, V. and L. J. Stringer. The treatment of Staphylococcus aureus infected sore nipples: A randomized comparative study. J Hum Lact 1999; 15(3):241-46.

2. Lawrence, R. A. and R. M. Lawrence. Medical complications of the mother. Chapter 15 in Breastfeeding: A Guide for the Medical Profession, 5th ed. St. Louis: Mosby, 1999.

3. Riordan, J. and K. G. Auerbach. Breast-related problems. Chapter 15 in Breastfeeding and Human Lactation, 2nd ed. Sudbury, MA: Jones and Bartlett, 1999.

4. Olsen, C. A. and R. E. Gordon. Breast disorders in nursing mothers. Am Fam Physician 1990; 41(5):1509-16.

5. Sorosky, J. I. and C. E. H. Scott-Conner. Breast disease complicating pregnancy. Obstet Gynecol Clinics North Am 1998; 25(2):353-63.

6. Lawlor-Smith, L. and C. Lawlor-Smith. Vasospasm of the nipple—a manifestation of Raynaud’s phenomenon: Case reports. Br Med J 1997; 314:644-45.

7. Scott-Conner, C. E. H. and S. J. Schorr. The diagnosis and management of breast problems during pregnancy and lactation. Am J Surgery 1995; 170:401-5.

8. Swinford, A. E., D. D. Adler, and K. A. Garver. Mammography appearance the breasts during pregnancy and lactation: False assumptions. Acad Radiol 1998; 5(7):467-72.

9. Stucker, D. T., D. M. Ikeda, A. R. Hartman et.al. New bilateral microcalcifica-tions at mammography in a postlactational woman: Case report. Radiology 2000; 217(1):247-50.

10. Gupta, R. K., A. G. R. McHutchinson, C. S. Dowle, and J. S. Simpson. Fine-needle aspiration cytodiagnosis of breast masses in pregnant and lactating women and its impact on management. Diagnostic Cytopathology 1993; 9(2):156-59.

Problem Menyusui

Si Kecil Hanya Suka 1 Sisi
Oleh: Tuti Asrianti, Konselor Laktasi

Bingung bayi hanya suka menyusu pada satu sisi saja? Apakah rasa ASI kanan dan kiri bisa berbeda? Jangan-jangan posisi menyusui Anda yang kurang benar.

Pengalaman terindah bagi ibu baru adalah dapat menyusui buah hatinya. ASI eksklusif adalah hadiah terbaik buat bayi Anda. Selain kandungan gizinya paling baik, dengan memberikan ASI akan terjalin ikatan kasih sayang yang mesra antara ibu dan bayi (bonding). Ny. Dilla yang baru saja melahirkan putri pertamanya sudah bertekad memberi ASI eksklusif. Namun sebulan belakangan ini Ny. Dilla dilanda kebingungan. Pasalnya setiap kali menyusui, si bayi hanya senang pada payudara kanan saja. Dilla merasa khawatir ada apa-apa dengan payudara sebelah kirinya, sehingga putrinya tak suka.

Beberapa kemungkinan penyebab
Seringkali ibu lebih percaya mitos. Misalnya percaya bahwa sisi yang satu terasa manis, sementara sisi yang lain tawar. Padahal anggapan ini tidak benar.

Masalah yang dialami Ny. Dilla sepertinya banyak dialami oleh para ibu baru lainnya. Bayi jadi sering menangis dan rewel karena lapar, ia hanya mau minum pada satu sisi payudara saja. Andai Anda mengalami hal itu, tak perlu resah dan cepat-cepat memutuskan untuk memberi susu formula atau makanan tambahan, karena takut kualitas ASI tak menyukupi. Memang tak ada efek kekurangan nutrisi bila bayi hanya senang menyusu pada satu sisi saja, namun sebaiknya bayi bisa menyusu pada ASI kiri dan kanan. Selain itu menyusu kedua sisi payudara menciptakan keseimbangan agar bentuk payudara ibu tak kendur sebelah.

Coba cari tahu mengapa si kecil hanya senang menyusu pada satu sisi saja. Mungkin si kecil baru pandai mengisap salah satu puting saja, karena puting tersebut lebih lembut. Payudara yang sudah terbiasa diisap memiliki tekstur yang lebih lembut dan kenyal dan si kecil sudah merasa familiar dengan kondisi ini. Sehingga ketika ia diberi payudara sisi yang lain, ia merasa asing dan sulit mengisapnya.

Yang sering tak terpikirkan adalah posisi ibu saat menggendong bayi, karena faktor kebiasaan. Misalnya ibu sudah merasa lebih nyaman memberi sisi kiri ketimbang kanan, sehingga saat memberi sisi kanan Anda merasa tegang. Akibatnya, bayi pun menyesuaikannya, dan menjadi kebiasaan. Selain itu pada kasus tertentu yang relatif jarang terjadi cedera kepala akibat tindakan persalinan bisa membuat bayi hanya nyaman menyusu pada posisi tertentu saja.

Bagaimana mengatasinya

Suasana rileks
Saat memberikan ASI, posisi menyusui harus benar dan ibu harus santai, tidak boleh tegang ataupun ragu, sehingga bayi enjoy saat menyusu. Bawa pikiran dan perasaan yang positif, misalnya senang dan puas terhadap bayi, limpahkan kasih sayang Anda dan percaya bahwa ASI adalah yang terbaik untuk bayi, yang akan membantu refleks oksitoksin (hormon penghasil ASI) bekerja, dan ASI mengalir dengan lancar.

Faktor kebiasaan
Hal lain yang paling penting adalah perasaan nyaman bayi dan ibunya. Nyaman tidaknya bayi dipengaruhi oleh posisi areola di mulut. Yang baik adalah seluruh areola berada di dalam mulut bayi. Posisi yang pas membuat produksi ASI melimpah.

Coba pindah-pindahkan posisi menggendong bayi, sehingga semua posisi terasa nyaman bagi Anda berdua.

Susui saat mengantuk
Solusi lain bila ingin bayi kembali menyusu pada kedua payudara, susuilah bayi dengan payudara yang ’tidak disukai’ pada saat bayi mengantuk (dalam keadaan tidak sadar penuh), dengan demikian si kecil mau menyusu pada payudara ’bukan favoritnya’.

Panduan Praktis lainnya

· Niatkan bahwa Anda ingin memberi yang terbaik buat bayi. Ciptakan suasana santai dan rileks. Biarkan kepala bayi terjatuh pada pertengahan lengan bawah atau pergelangan tangan ibu

· Pegang bagian belakang dan bahu bayi. Hadapkan wajah si kecil dengan wajah Anda, agar ia dapat leluasamemandang wajah ibunya.

· Dekap erat si kecil, sesekali belai kepalanya dengan lembut.

· Pastikan seluruh areola masuk ke dalam mulut bayi, dan hidung tidak tertutup oleh payudara.

Stres Mengganggu Menyusui?

Saya (26 tahun) ingin sekali memberikan ASI eksklusif pada anak saya yang berumur satu bulan. Perlu Dokter ketahui, akhir-akhir ini saya stres berat karena suatu masalah. Apakah ini akan berpengaruh pada kualitas ASI saya? Lalu, apakah pemberian ASI eksklusif ini perlu dilanjutkan?

Setelah melahirkan, ASI saya belum lancar sehingga perawat memberikan susu formula pada bayi saya. Apakah hal ini menjadikan program ASI eksklusif gagal? Manakah yang terbaik diberikan: air tawar atau susu formula ketika bayi sulit menyusui pada jam pertama kehidupannya?

Khoirul Umah

Malang

Memang, stres akan mengganggu produksi ASI, maka sebisa mungkin hindari stres. Perlu Anda ketahui, memberikan ASI akan memberikan kenikmatan tersendiri sehingga dapat mengurangi stres.

ASI seringkali baru keluar pada hari kedua atau ketiga setelah melahirkan. Hal ini biasanya tergantung pada kesiapan mental ibu, serta sering dan benarnya isapan bayi pada payudara ibu. Setelah lahir, bayi yang sehat tidak perlu diberikan minuman apa pun. Bayi mempunyai persediaan enerji dan cairan, sehingga dapat mempertahankan hidupnya selama beberapa hari tanpa diberi minuman. Kalau diberikan minuman, ia akan malas menyusu. Akibatnya, perangsangan pada payudara berkurang. Ini dapat menyebabkan pengeluaran ASI tertunda, dan program ASI eksklusif gagal. Yang penting, Ibu harus percaya diri. Susukan bayi sesering mungkin dengan posisi dan perlekatan yang baik dan benar.

Perlu Ditambah Susu Formula?

Putri saya, Naya (berat badan lahir 3,2 kg dan panjang 47 cm) kini sudah berusia 11 bulan (berat badan 9,5 kg dan tinggi badan 76 cm). Ia masih saya beri ASI. Berhubung saya bekerja, maka dia saya beri susu formula pada pagi dan siang hari. Masalahnya, putri saya tersebut susah sekali minum susu formula. Terpaksa, susu formula tersebut diberikan padanya dengan cara disendoki (itu pun hanya 90 cc sekali minum).

Jadwal makan putri saya 3 kali sehari, yaitu pagi: 3-4 sendok makan bubur susu; siang dan sore: nasi tim; buah satu kali sehari; dan biskuit sekali-sekali. Putri saya tidak sulit makan, malah bisa dibilang sangat lahap. Kalau hari libur, putri saya tidak pernah mau minum susu formula, sehingga selalu saya beri ASI.
Bagaimana caranya supaya putri saya mau minum susu layaknya anak-anak sebayanya dengan mempergunakan dot? Apakah konsumsi susu formula 1 x 90 cc dalam sehari ditambah ASI di malam hari cukup untuk proses tumbuh- kembangnya? Kapan sebaiknya saya berhenti memberinya ASI? Terima kasih atas bantuan Prof. untuk menjawab pertanyaan saya.

Hanna Lilis

Duri-Riau

Bayi Anda yang berusia 11 bulan dengan berat badan 9,5 kg dan panjang 76 cm adalah baik sekali. Selain itu, dia pintar karena tidak mau diberikan susu formula dengan botol. Pemberian dengan botol sudah tidak dianjurkan lagi. Sebaiknya bayi Anda diajarkan minum dari gelas. Pemberian ASI dianjurkan sampai ia berusia dua tahun.

Jadi, selama ini pemberian makan Anda sudah benar, hanya barangkali bubur susunya diganti saja dengan nasi tim. Jadwal makannya menjadi tiga kali nasi tim, satu kali buah dan ASI setiap bayi mau. Selama Anda bekerja, perah ASI dan bawa pulang (disimpan di lemari es) untuk dapat diberikan keesokan harinya kepada bayi dengan sendok/cangkir. Pada malam hari atau hari libur, langsung teteki dia. Bayi Anda belum perlu diberi tambahan susu formula.

Berbagai masalah menyusui

Payudara
Proses menyusui memang tidak selamanya berjalan mulus. Akibatnya, payudara Anda pun membengkak atau meradang. Menyebalkan memang. Tapi, bisa kok disiasati. Bagaimana caranya?

Payudara membengkak
Terjadi sekitar 2-3 hari setelah melahirkan. Biasanya nih, payudara membengkak gara-gara meningkatnya aliran darah ke payudara dan mulainya produksi ASI. Masalahnya, bengkak bisa bikin puting susu jadi rata, sehingga bayi sulit menyusu. Gangguan akan berkurang dalam waktu 24-48 jam, namun bisa makin menjadi-jadi bila Anda jarang menyusuinya. Untuk mengatasinya, sering-sering menyusui sampai payudara betul-betul kosong, jangan pakai BH yang ketat, kompres payudara dengan air dingin, pijat-pijat payudara sebelum menyusui, dan lainnya.

Payudara meradang
Gangguan ini dikenal juga sebagai mastitis. Umumnya sih, terjadi 2-6 minggu setelah melahirkan akibat adanya infeksi bakteri serta pemakaian BH yang terlalu ketat. Gejalanya? Payudara membengkak, agak kemerahan, demam, dan merasa sangat lelah. Untuk itu, kompres payudara dengan air hangat dan susui si kecil sesering mungkin. Segera ke dokter bila radang cukup parah dan timbul abses (nanah) pada payudara. Bisa jadi, Anda perlu operasi untuk mengeluarkan nanah tersebut.

Puting susu
Selain payudara, puting susu juga sering jadi sasaran masalah. Dan ternyata, cukup mengganggu juga bila dibiarkan berlarut-larut. Apa sih yang perlu jadi perhatian?

Puting susu datar
Kelainan bawaan ini terjadi karena pelekatan mengakibatkan saluran susu lebih pendek dan menarik puting susu ke dalam. Mudah kok menyiasatinya. Tarik puting susu keluar dengan jari tangan, tahan selama beberapa waktu. Lakukan ini sebanyak 2 kali sehari. Atau, gunakan alat bantu, seperti nipple shields dan breast shields. Bisa juga, puting susu “direndam” dulu ke dalam air hangat sebelum menyusui, lalu tarik-tarik puting susu keluar.

Puting susu nyeri
Ini karena tidak pasnya posisi mulut bayi saat menyusu. Umumnya sih, terjadi pada hari-hari pertama menyusui. Bila tidak nyeri-nyeri amat, terus saja menyusui si kecil. Agar nyeri berkurang, oleskan sedikit ASI pada puting susu dan sekitarnya atau kompres payudara dengan air hangat sebelum menyusu. Kelar menyusui, oleskan lagi ASI pada payudara, lalu biarkan kering. Biar puting susu tetap kering, pilih-pilih BH (bahan menyerap keringat, seperti katun) dan juga sering-sering mengganti BH.

Puting Lecet

Saya (27 tahun) ingin sekali memberikan ASI eksklusif pada anak kedua saya yang berumur 2 minggu (BB 3,1 kg, TB 49 cm). Sayang sekali puting payudara saya pecah-pecah, sehingga jika sedang menyusui terasa perih sekali. Beruntung ada salep Kamilosan yang agak membantu mengurangi perih..

Sampai berapa lamakah sakit/perih pada puting ini? Berpengaruhkan rasa sakit saya terhadap produksi ASI? Bagaimana dan berapa lamakah ASI dapat disimpan di botol karena cuti saya hanya 2 bulan?

Ajeng WS
Pamulang, Tangerang

Puting yang lecet itu biasanya akibat salah posisi bayi dan perlekatan mulut bayi pada payudara. Penyebab lain adalah cara yang salah saat melepaskan mulut bayi dari isapan, atau karena infeksi. Jadi, mencegah terjadinya puting lecet adalah dengan memperbaiki posisi bayi, memperbaiki perlekatan bayi, melepaskan isapan bayi secara benar dan membersihkan payudara dengan ASI yang diperah saat akan menyusui.

Rasa sakit tentu akan mempengaruhi produksi ASI karena rangsangan isapan bayi ke otak akan terganggu oleh rangsangan yang lebih kuat, yaitu rasa sakit. Jadi, untuk keberhasilan menyusui memang Anda harus berada dalam keadaan nyaman.

ASI perah dapat disimpan di suhu ruangan selama 6-8 jam, di lemari pendingin selama 2 x 24 jam, dan di freezer sampai berbulan-bulan.

Masalah-Masalah ASI

9 PROBLEMA MENYUSUI
Tahukah Ibu, kapan menyusui harus dilakukan pertama kali?

“Saya bahagia punya bayi. Saya ingin sekali menyusuinya sampai usia
setahun, bahkan dua tahun.” Tapi apa yang terjadi? Baru sebulan saja,
produksi ASI berhenti. Ibu mana yang tak sedih, bahkan mungkin merasa
kurang berharga karena tidak dapat memberikan manfaat ASI kepada
bayinya. Sementara banyak ibu lain dengan persiapan biasa-biasa saja
dapat lancar menyusui. Kadang, sampai tumpah ruah produksi ASI-nya.
Mengapa bisa demikian?

Sebenarnya, baik menyusui dan menyusu merupakan aktivitas yang
kompleks bagi ibu dan bayi. Di tengah jalan, prosesnya bisa saja
mengalami hambatan. Persoalan ini dialami banyak ibu. Kadang faktor
penyebabnya terlalu samar dan coba dinafikan oleh yang bersangkutan.
Apa saja persoalan itu, kami merangkumkan 9 yang paling banyak
ditemui pada pengunjung Klinik Laktasi, RS St. Carolus, Jakarta
Pusat, tahun 2006. Semoga tulisan ini membantu Ibu mencari jalan
keluar dari masalahnya.

1. Merasa ASI kurang
Para ibu yang merasa ASI-nya kurang menduduki peringkat utama atau
yang terbanyak. Tercatat sekitar 464 ibu yang mengeluhkan masalah ini
ke Klinik Laktasi RS St. Carolus. Faktor penyebabnya ternyata lebih
bersifat psikologis (emotional factor). Yakni, ibu merasa produksi
ASI kurang, padahal sebenarnya bisa mencukupi kebutuhan bayi.
Ketidakpedean ibu sebenarnya bisa diatasi dengan diberi motivasi agar
ibu lebih yakin bahwa ia bisa memproduksi ASI sesuai kebutuhan bayi.
Termasuk ibu yang ingin menyusui bayi kembar, sebenarnya kebutuhan
ASI akan tercukupi.

Ada beberapa langkah untuk meningkatkan produksi ASI, di antaranya:
* Pastikan ibu menyusui dengan posisi yang benar dan perlekatan yang
baik.
* Memberikan kesempatan pada bayi untuk menyusu sesering mungkin dan
sesuai keinginan bayi (on demand). Kalau dihitung secara umum, dalam
sehari bisa 10-12 kali menyusu.

* Bayi tidak diberikan dot/empeng.
* Pastikan ibu mendapatkan asupan makanan bergizi dan minum yang
cukup.
* Usahakan untuk selalu relaks dan cukup istirahat.
* Jangan lupa skin to skin contact, misalnya saat tidur bersama bayi
atau saat mengganti popoknya bila buang air kecil/besar.

2. Kurang memahami penatalaksanaan laktasi
Tercatat 307 ibu yang kurang paham soal ini. Padahal penjelasan
informasi tentang manfaat menyusui dan penatalaksanaannya seharusnya
dimulai sejak masa kehamilan (usia kandungan 32 minggu/antenatal
preparation), lalu pada masa bayi lahir sampai berusia 2 tahun.
Termasuk cara mengatasi kesulitan menyusui.

Menyusui bayi dalam 30 menit setelah melahirkan, yang dilakukan di
ruang bersalin juga menentukan kelancaran proses berikutnya. Apabila
ibu menjalani operasi sesar pun bayi tetap disusui segera setelah
lahir, kecuali ada kendala medis. Tujuannya untuk memberikan
perangsangan sesegera mungkin pada payudara agar kegiatan produksi
dan pengaliran ASI berjalan mulus. Bayi pun dilatih menggunakan
refleks mengisapnya sesegera mungkin agar dapat menyusu dengan
lancar. Biasanya pada proses menyusu pertama kali, bayi memang tidak
langsung mendapat ASI. Ada yang baru pada hari ke-3 ASI mengalir ke
luar. Nutrisi yang dibawa bayi dari kandungan membuatnya mampu
bertahan hidup selama menunggu ASI keluar.

Manajemen laktasi juga mencakup bagaimana cara menyusui yang benar
dan cara mempertahankan menyusui meski ibu dipisah dari bayi atas
indikasi medis. Diharapkan ibu tak memberikan makanan atau minuman
apa pun selain ASI kepada bayi baru lahir. Ini juga termasuk tidak
memberikan dot atau empeng kepada bayi yang diberi ASI perah.

Sayang, banyak ibu baru mengetahui manajemen laktasi setelah
melahirkan. Alhasil, mereka kerap mengalami berbagai kendala
menyusui. Misal, kesulitan mencari posisi menyusui yang tepat,
kendala payudara bengkak dan sebagainya. Bila ibu sudah paham
manajemen laktasi sejak hamil, tentu persoalan menyusui diharapkan
takkan ditemui. Kalaupun ada kendala, masalahnya tak sampai berat dan
dapat diatasi segera. Dengan begitu, ibu pun bisa lancar memberikan
ASI eksklusif pada si kecil.

3. Relaktasi
Relaktasi adalah suatu keadaan dimana ibu yang telah berhenti
menyusui ingin memulainya kembali. Ada beberapa situasi yang
mendorong dilakukannya relaktasi, di antaranya:

* Bayi sakit dan sudah lama tak menyusu pada ibu.
* Bayi sudah diberikan makanan pendamping, tapi ibu ingin kembali
menyusui.
* Ibu menderita sakit sehingga berhenti menyusui.
* Ibu merasa bersalah lantaran memberikan susu botol, padahal ASI
adalah yang terbaik bagi bayi.
Sepanjang 2006, terjadi peningkatan jumlah ibu yang melakukan
relaktasi di RS St Carolus, yakni sekitar 198 ibu. Akan tetapi,
proses relaktasi tidaklah selalu mudah. Perlu ketekunan dan kesabaran
ibu. Apalagi bayi yang sudah lama tak menyusu, tentu akan mengalami
bingung puting. Proses relaktasi kadang harus menggunakan alat
suplementer berupa pipa plastik atau slang yang diletakkan dekat
puting payudara sehingga lama-kelamaan bayi akan beralih menyusu
lagi. Dengan usaha yang terus-menerus, motivasi yang kuat, konsisten
serta relaktasi lebih dini, kemungkinan untuk berhasil akan lebih
tinggi.

4. Sudah mendapat prelacteal feeding
Maksudnya ibu memberikan makanan atau minuman lain selain ASI terlalu
dini (di bawah 6 bulan). Contoh, bayi diberi air putih, air gula,
bahkan susu formula. Tercatat sekitar 186 ibu yang berkonsultasi ke
klinik laktasi mengaku melakukan hal ini. Mereka umumnya kurang
memahami penatalaksanaan laktasi yang benar sehingga memberikan
makanan/minuman lain selain ASI.

Kekurangpahaman ibu akan manajemen laktasi juga berkaitan dengan
banyak tempat bersalin/rumah sakit yang kurang peduli akan manfaat
ASI. Para ibu yang melahirkan di sana dan ASI-nya tidak/belum keluar
tidak didukung oleh petugas kesehatan yang malah memberikan air putih
atau susu formula. Selain kehilangan manfaat ASI sejak fase
kolostrum, bayi pun akan menghadapi masalah seperti bingung puting.
Ibu sendiri mengalami payudara bengkak karena tidak menyusui. Umumnya
ibu yang menyadari bahwa pemberian prelakteal tak ada gunanya karena
malah akan mengganggu proses menyusui, berusaha untuk melakukan
relaktasi.

5. Ibu bekerja
Para ibu bekerja umumnya paling sering mengalami persoalan manajemen
laktasi. Terutama ketika sudah harus kembali bekerja. Tentu saja ASI
perah adalah jawabannya. Memerah di mana? Rancanglah pojok yang
nyaman dan memenuhi privasi di ruangan kantor. Lakukan setelah makan
siang, sebelum jam istirahan habis. Gunakan jari atau alat perah.
Jangan lupa, bawa wadah ASI (bisa berupa beberapa botol susu bayi).
Tanpa pendinginan atau di suhu ruangan, ASI bisa bertahan selama 6
jam. Hitunglah lamanya waktu kerja setelah memerah dan perjalanan
pulang ke rumah, apakah masih kurang dari 6 jam? Kalau lebih, bawalah
termos es atau sediakan kulkas portabel di bawah meja kerja supaya
ASI dapat bertahan lebih lama.

6. Kelainan ibu
Yang dimaksud adalah persoalan fisik seputar menyusui, misal puting
lecet karena digigit, payudara bengkak, mastitis, dan abses. Yang
cukup sering terjadi, kasus puting lecet karena posisi bayi menyusu
kurang tepat, atau bayi menggigit puting, yang tentunya membuat ibu
merasa sakit. Akhirnya, banyak ibu memutuskan berhenti menyusui.

Sebenarnya ibu tak usah berhenti menyusui, karena berikutnya akan
muncul masalah baru lagi yaitu payudara bengkak. Yang perlu
diperbaiki adalah posisi menyusui. Lecet pada puting dapat sembuh
dengan sendirinya bila masih ringan. Akan lebih membantu jika luka
tersebut diolesi ASI sedikit. Jika parah sampai timbul
mastitis/abses, mintalah saran dan obat dari dokter.

Nah ada beberapa cara agar masalah ini bisa teratasi, di antaranya:

* Berikan perhatian pada bayi terutama saat ia menyusu agar terjalin
perlekatan yang baik.
* Bila bayi tampak mengubah posisi mulutnya dan bersiap menggigit,
segera lepaskan payudara dengan memasukkan jari kelingking ke sudut
mulutnya sehingga pengisapan terhenti.
* Pindahkan bayi dari payudara sehingga bayi tak berada pada posisi
menyusu lagi.
* Dorong bayi lebih mendekat ke payudara hingga hidungnya terhalang
dan ia melepas puting untuk bernapas dengan mulutnya. Sedikit
trik “jahil” ini tidak mengapa dilakukan pada bayi demi melindungi
puting dan kelancaran proses menyusui berikutnya.

7. Kelainan bayi
Keluhan bayi sakit di klinik Latasi RS St Carolus cukup banyak
terjadi. Akibatnya, bayi sulit mendapat ASI eksklusif karena harus
mengonsumsi obat. Memang demikian kondisinya, namun ibu dianjurkan
untuk terus memberikan ASI selama si kecil sakit, bahkan jika ia
harus dirawat di rumah sakit. Jika ibu tak dapat mendampingi bayinya
setiap saat, titipkan susu perahan sebanyak yang diperlukan sampai
ibu datang menjenguk kembali kepada perawat yang menjaga dan mengurus
bayi. Mintalah padanya untuk memberikan ASI dengan sendok.

8. Kurang motivasi ibu/keluarga
Kurangnya motivasi baik dari ibu sendiri ataupun keluarga juga
menyebabkan proses menyusui terganggu. Misalnya, ketika si bayi rewel
terus, ia langsung diberi susu formula atau pakai dot supaya anteng.
Keluarga kurang mendukung untuk proses pemberian ASI sehingga ibu pun
tidak memiliki motivasi yang kuat untuk memberi ASI secara eksklusif
kepada bayinya. Untuk itu, keluarga pun setidaknya perlu mendapatkan
informasi atau manajemen ASI sehingga program ASI ekslusif bisa
dilakukan.

9. Berat badan turun
Beberapa ibu mengeluhkan berat badan bayinya turun atau tidak naik
secara cepat. Hal ini membuat ASI sering dipojokkan sebagai biang
keladi bayi tak tampak gemuk. Sebenarnya, tak masalah BB bayi turun
sedikit atau naik secara perlahan selama angkanya masih dalam batas
kurva BB normal. Jika masih sesuai dengan grafik pertumbuhan, bayi
masih dikatakan sehat. Perlu diketahui, umumnya berat badan lahir
bayi akan turun pada minggu-minggu pertama. Jadi ibu tak perlu
khawatir.

Hilman Hilmansyah. Foto: Iman/NAKITA

Mengatasi 7 Masalah dalam Menyusui

“KEDUA buah dada ibu lebih pandai merangkai suatu campuran makanan yang sesuai bagi bayi apabila dibandingkan kedua belah tangan dan otak seorang profesor yang ahli dalam bidang ini.”

BAHWA memberi ASI itu penting, nyaris semua mengetahuinya meski dalam prakteknya tidak semua wanita mampu melaksanakannya. Kasus-kasus gagal menyusui masih sering ditemui. Ibu-ibu muda –yang baru pertama kali punya anak– kerap mengalaminya.

Akan tetapi, bisa menyusui pun bukan berarti tanpa masalah. Timbulnya lecet pada puting misalnya atau juga ketakutan buah dadanya cepat kendur. Lagi-lagi hal ini pun paling banyak dikeluhkan para ibu muda. Beberapa alternatif berikut insya Allah dapat menolong para ibu dari 7 masalah berkaitan dengan menyusui.

1. Ogah keluar
Tidak perlu tergesa-gesa memberi formula bayi jika air susu ogah keluar. Usahakan untuk tetap tenang sambil terus berupaya untuk menyusui bayi pada waktu-waktu tertentu. Perasaan cemas bisa menghambat produksi ASI sedangkan sikap tenang dan isapan bayi akan menstimulasi buah dada mengeluarkan ASI. Selain itu, sejak hamil ibu pun perlu melatih buah dadanya agar memiliki otot yang kuat dan sehat serta makan makanan bergizi. Pada saat demikian peran suami sangat penting artinya.

Beberapa bahan makanan yang diketahui juga memiliki efek positif dalam memperlancar ASI adalah daun katuk dan lobak segar. Makanlah bahan makanan tersebut sebagai sayur atau lalapan serta biji jagung tua yang disangrai dengan ketumbar.

2. Bengkak
Bengkak terjadi biasanya akibat air susu yang melimpah tidak keluar. Langkah yang sebaiknya dilakukan adalah hindari mengonsumsi obat-obatan yang memiliki efek mengurangi pengeluaran air susu atau melakukan pengikatan buah dada dengan kain sebab dapat menyebabkan air susu cepat mengering hingga tersumbatnya kelenjar. Latihlah bayi agar kuat menetek dengan cara meneteskan air susu ke dalam mulutnya. Jika bengkaknya keras, panas, sakit bila disentuh serta warnanya kemeraha, kompreslah buah dada dengan air hangat sambil dipijit dengan gerakan berputar.

Cara lain yaitu dengan menempelkan remasan daun kacang panjang yang telah dicampur sedikit air kapur sirih pada bagian yang bengkak –kecuali bagian puting. Bisa juga dengan menggunakan daun dadap serep atau daun tembelekan yang diremas atau ditumbuk halus,kemudian dilumurkan pada bagian buah dada yang sakit.

3. Puting lecet seperti terbelah
Cara menyusui yang salah dapat menyebabkan puting lecet, demikian pula bila sang anak terlalu hot menetek. Obati puting yang lecet dengan gentian violet 1%. Bisa juga dengan mengoleskan daun wortel yang telah dipanggang hingga kering, ditumbuk halus, lalu ditambahkan minyak zaitun secukupnya pada puting susu. Bagian luka yang mengeras dapat diolesi minyak kelapa hangat.

4. Terbelit kesibukan
Sebaiknya meneteki jangan diputus, sesibuk apa pun kegiatan ibu. Jika tidak mungkin membawa anak ke tempat kerja, memompa ASI yang telanjur diproduksi lalu membuangnya merupakan tindakan yang benar, meski akan lebih benar lagi seandainya ASI tersebut dimasukkan ke dalam botol steril dan dikirim segera ke rumah untuk diberikan pada sang bayi.

5. Bau amis dan berair
Menjaga kebersihan buah dada dan bra merupakan hal penting lainnya yang juga perlu diperhatikan. Untuk mengurangi efek bau amis, makanlah kunyit. Di samping itu, pijatlah buah dada secara memutar setelah meneteki agar air susu tidak menetes terus.

6. Air susu menetesi kuping dan pipi bayi
Air susu yang menetes ke kuping atau pipi bayi menyebabkan congekan dan koreng. Guna menghindarinya usahakan senantiasa menyusui dalam keadaan terjaga dan duduk sehingga tercecernya air susu dapat dihindari. Kulit yang koreng bisa ditanggulangi dengan lanolin. Meski demikian, supaya lebih aman segera konsultasikan hal ini ke dokter.

7. Takut kendur
Terkadang masih dijumpai juga anggapan negatif ihwal menyusui yang berpengaruh terhadap keindahan buah dada membuat kendur misalnya. Padahal tanpa menysui pun buah dada itu lama-lama bakal kendur juga. Akan tetapi, agar proses tersebut dapat diperlambat, usahakan tidak melepas buah dada begitu saja waktu meneteki, tahanlah dengan tangan, lakukan olah raga sehari 2 kali, terutama olah raga yang melatih otot dada, perut, dan punggung. Selain itu, memperbanyak konsumsi sayuran segar. Bisa juga dengan rajin meminum 60-100 gr jalar/sulur ketimun yang direbus dengan air secukupnya.

Resep tradisional lain yang disebut-sebut mampu mempertahankan kekencangan buah dada adalah mengurutnya dengan menggunakan minyak bulus; mengolesi dengan ramuan tumbuk halus 3 helai daun jarak, 2 buah pinang, 1 ibu jari jahe ditambah sedikit garam dan air. Mendiamkannya hingga kering, lalu dibilas air hangat, atau dengan mengoleskan sari kacang panjang hasil dari 10 batang kacang panjang yang telah bersih dan ditumbuk ke buah dada, didiamkan hingga kering lalu dibilas air hangat. (Yuga Pramita)***

Bayi ASI Overweight ?

Selama ini, putra saya (6 bulan, berat badan 10,1 kg) mendapat ASI eksklusif. Dia lahir dengan berat 3,7 kg dan panjang 51 cm. Apakah anak saya overweight ?

Saya berencana memberinya MP-ASI (Makanan Pendamping ASI), tetapi saya takut ia akan bertambah gemuk. Sebaliknya, kalau tidak saya beri MP-ASI, saya takut dia lemas. Bagaimana sebaiknya, Prof.? Patokan apa yang dapat saya pegang dalam mengambil keputusan untuk memberi MP-ASI? Perlu Prof. ketahui, ASI saya sampai sekarang masih banyak. Terima kasih.

Artin Wuriyani

Yogya

Bayi enam bulan dengan berat badan 10 kg memang besar. Tetapi, bila panjang badan sesuai dengan berat, dan aktifitasnya tidak terhambat (paling kurang dia sudah bisa tengkurap bolak balik), maka dia belum disebut overweight . Jadi, tidak perlu dikuatirkan dan tetap berikan ASI.

Rencana pemberian MP-ASI baik sekali, karena anak Anda memang sudah saatnya mendapatkan MP-ASI. Penggantian dua porsi ASI menjadi satu porsi nasi tim dan satu porsi jus buah justru akan mengurangi intake kalorinya, dan menambah jumlah seratnya. Untuk jus, pilih buah yang banyak airnya dan jangan ditambahkan gula.

Selain itu, kalau tengah malam dia terbangun, tidak usah disusukan. Dengan demikian, dia tidak akan bangun lagi malam hari (toh tidak diberi minum), dan untuk selanjutnya dia dapat terus tidur sampai pagi.

9 MITOS MENYUSUI DAN FAKTANYA

sumber: http://www.tabloid-nakita.com/

Katanya ASI bisa kurang kalau si bayi rakus.
Bagaimana faktanya? Dr. Rudy Firmansjah B. Rivai, Sp.A dari Rumah Sakit Anak dan Bersalin (RSAB) HarapanKita Jakarta menjelaskannya kepada kita.

1. ASI BELUM KELUAR PADA HARI PERTAMA SEHINGGA PERLU DITAMBAH CAIRAN LAIN
Salah. Memang, banyak ibu yang mengalami kesulitan menyusui di hari pertama dan mengeluhkan ASI-nya tidak bisa keluar. Namun tak perlu cemas karena dihari pertama, selain bayi belum memerlukan cairan tambahan, di dalamtubuhnya pun masih ada cadangan cairan yang cukup.ASI sendiri terdiri atas 88% air. Jadi, kebiasaan memberi cairan seperti susu formula, air putih, teh manis kepada bayi baru lahir tentu kurangtepat. Di banyak negara tindakan ini sudah menjadi kebiasaan dengan alasanagar bayi tidak rewel atau sekadar menghilangkan hausnya. Ditambah lagi, bila cairan itu diberikan dengan dot, selain refleks mengisap bayi jaditidak terasah, ia juga berisiko bingung puting.

2. ASI TIDAK BISA MEMUASKAN BAYI “RAKUS”
Salah. ASI bisa mencukupi semua kebutuhan asupan makanan dan minuman bayi hingga bayi berusia 6 bulan. Rata-rata kebutuhan cairan bayi pada minggupertama sekitar 80-100 ml/kg per hari, dan meningkat menjadi 140-160 ml/kgpada usia 3-6 bulan. Semua itu cukup dipenuhi hanya dengan ASI. Bahkan bagi bayi superrakus sekalipun.Sebuah penelitian menyebutkan, 98 ribu dari 100 ribu ibu yang mengatakanproduksi ASI-nya kurang, ternyata memiliki cukup ASI. ASI tidak bisaberproduksi secara optimal karena manajemen laktasi yang kurang baik.

Misalnya, tidak tahu posisi menyusui yang tepat, stres, terpengaruhmitos-mitos menyusui, kurang istirahat, dan lain-lain.ASI yang dikeluarkan, baik dari payudara kanan maupun kiri, sama-samamengandung foremilk dan hindmilk atau dengan kata lain memiliki komposisi yang sama. Jadi, salah kalau ada yang menganggap payudara kanan mengandungmakanan dan yang kiri minuman. Puaskan bayi pada satu payudara selamakira-kira 15 menit. Bila masih belum puas, barulah pindahkan lagi ke payudara pertama.

3. PAYUDARA KENDUR GARA-GARA MENYUSUI
Tidak ada hubungannya. Kendur tidaknya payudara tidak ada hubungannyadengan pemberian ASI. Biang keladi perubahan payudara adalah kehamilan itu sendiri. Saat hamil hormon-hormon membuat payudara penuh berisi ASI. Ukuranpayudara pun terlihat lebih besar dari biasanya. Nah, pascamenyusui, ukuranpayudara kembali normal. Akibatnya, otot-ototnya pun mengendur dan membuat payudara sedikit kendur.Hal ini tidak perlu dikhawatirkan. Lewat pijat atau senam payudarakeindahan bentuk payudara bisa dipertahankan. Pilih juga bra yang tepatagar bisa membuat bentuk payudara tidak kendur. Selain itu, menyusui juga bisa memproteksi payudara dari serangan kanker payudara. Penelitianmembuktikan, risiko terkena kanker mengecil jika ibu menyusui anaknya.

4. SULIT TURUNKAN BB JIKA MENYUSUI
Salah. Konon, menyusui membuat nafsu makan ibu bertambah lahap, sehingga sulit mengatur berat badan. Ini tidaklah tepat. Sebuah penelitianmenyebutkan, menyusui dapat membantu ibu menurunkan berat badan lebihcepat. Kala menyusui timbunan lemak yang terjadi pada waktu hamil diubahmenjadi energi. Sebaliknya, timbunan lemak ini sulit disingkirkan jika ibutidak menyusui.

5. UKURAN PAYUDARA TENTUKAN BANYAKNYA ASI
Salah. Banyak tidaknya ASI tidak ditentukan oleh besar kecilnya payudara, tapi tergantung seberapa banyak kelenjar pembentuk air susu. Payudaraberukuran besar kanan bergizi yang cukup dan seimbang.Bahkan menyusui bisa memberi perlindungan terhadap zat kimia beracuntertentu. Pada kecelakaan kebocoran reaktor di Chernobyl, didapat fakta bahwa kadar zat radio aktif dalam ASI jauh lebih sedikit daripada dalamtubuh ibu. Para ahli pun berkesimpulan, ada mekanisme tubuh tertentu yangmenyaring racun sehingga konsentrasinya dalam ASI sangat rendah.

7. BANYAK BERISTIRAHAT BISA MENAMBAH PRODUKSI ASI
Kurang tepat. Mitosnya saat istirahat produksi ASI akan berjalan lancar.Ini tidak sepenuhnya benar. Yang betul makin sering ASI diberikan, makinbanyak pula ASI dihasilkan. Produksi ASI meningkat seiring dengan gerakan mengisap. Sebaliknya, jika dihentikan maka lambat laun produksi ASI punberkurang. Itulah mengapa, berikan ASI atau pompalah secara teratur. Janganlupa untuk merawat dan memijat payudara agar produksi ASI tetap lancar.

8. TIDUR BAYI LEBIH LELAP JIKA MINUM SUSU FORMULA
Tidak tepat. Memang, bayi-bayi yang diberikan susu formula cenderung tidurlama. Penyebabnya, susu formula umumnya tidak dapat dicerna dengan cepat,sehingga efek rasa kenyangnya lebih lama dan tidurnya pun terkesan lebih lama. Tapi kuantitas tidak menjamin kualitas. Jadi, tidak ada perbedaankualitas tidur antara bayi peminum ASI dan susu formula.

9. MENYUSUI TANGKAL KEHAMILAN
Tidak sepenuhnya salah. Sebuah riset mengemukakan, menyusui bisa menurunkan kesuburan. Pada ibu yang tidak menyusui, kesuburan biasanya muncul kembalidalam 4-6 minggu pascapersalinan. Pada ibu menyusui, rentangnya bisa lebihlama, karena proses ovulasi terhambat.Saat menyusui produksi hormon prolaktin meningkat. Hormon ini cukup efektif menghambat ovulasi, menstruasi pun menjadi tertunda. Itulah mengapa, kalamenyusui, tubuh tak mampu menghasilkan sel telur matang. Walhasil, spermayang masuk tidak akan menemukan “pasangan”nya. Kehamilan pun tidak akan terjadi atau disebut KB alami, yang sering diistilahkan LAM (LactationAmenorrhoe Methode).Meskipun efektivitasnya mencapai 98%, menyusui tidak menjamin ibu tidakhamil. Karena persyaratan menyusui sebagai KB alami sangat ketat, di antaranya ASI harus diberikan secara eksklusif. Frekuensi pemberiannyaharus diatur, 10 kali dalam satu hari, disamping banyak syarat lain yangharus dipenuhi. Risiko kehamilan tetap besar jika ibu tidak bisa mematuhi syarat-syarat tersebut.

Peta Nursery Room

Jakarta Selatan
CITOS ada, di deket Resto AW, lantai 1 depan MatahariPIM 1 di lantai 2. Fasilitas dispenser aqua, baby tafel, tidak ada ruang tertutup khusus menyusui.
PIM 2 di beberapa lantai ada. Fasilitas baby tafel, dua ruang khusus untuk menyusui dengan kursi yang sangat nyaman dan toilet untuk kids.
Carrefour Lebakbulus di lantai dasar. Tapi untuk penggunaan harus hubungi customer service dulu (?!)
Plaza Semanggi di lt. 3 AFasilitas ada peminjaman stroller dengan menunjukkan KTP.
Plaza Senayan
Senayan City

Jakarta Utara :
Megamall Pluit di Lt. 1Carrefour Lt. dasar
Mall Kelapa Gading 3 di lt. 3 food court
Mall Kelapa Gading 3 di lt. 1 (Mothercare) dan lt. 2
Mall Kelapa Gading 1 deket Diamond
Mal Artha Gading, setiap toilet wanita disediakan kursi panjang disudutruangan, dan bahkan di lantai 3 dekat Kid Station (satu lantai dengan TimeZone) juga disediakan sofa dengan tirai yang bisa ditutup. Jadi nyaman kalongajak baby jalan2 ke MAG.

Jakarta Barat :
Citraland Lt. dasar (masuk gang antara AW dan Hollanda Bakery)
Di Puri Mal, di dalam Keris Gallery ada counter Le Monde, ada ruangan kecil di sudut bisa untuk ganti diapers maupun menyusui, cuma pintunya gak full dan gak ada kuncinya.

Jakarta Pusat :
Carrefour Cempaka Putih Lt. dasar foodcourtnya, deket tempat cuci tangan

Jakarta Timur :
Carrefour MT Haryono, letaknya sebelum escalator Lt. 1BSD :BSD Plaza Lt. 2 finco

BANDUNG:
- Bandung Super Mall (BSM) Lt. 1 dan 2 (dekat Cafe Excelso & Metro)Ruangannya cukup untuk 3 orang dan 1 stroller. Hanya tersedia wastafeldan bangku yang bisa untuk duduk menyusui atau jadi baby tafel.-
Plaza IBCC lt. 1 (Area komputer)

PANTURA:
Pom Bensin jalur Tegal – Pemalang atau Pom Bensin MURI dengan WCterbanyak. Kalau tidak salah Pom Bensin 44.52104 Jl. Mayjen Soetoyo,Tegal.Buat yang mau mudik, mungkin satu-satunya Pom Bensin terlengkap denganruang menyusui, Baby tafel dan WC Bersih..

Penyimpanan ASI

Penyimpanan ASI

Dari Asuh Indonesia

ASI perah adalah ASI yang diambil dengan cara diperah dari payudara untuk kemudian disimpan dan nantinya diberikan pada bayi. Apa tidak basi? Sampai waktu tertentu dan dengan penyimpanan yang benar, ASI tidak akan basi

Misalnya, ASI tahan disimpan di dalam suhu ruangan sampai 6 jam. Jika disimpan di thermos yang diberi es batu, bisa tahan hingga 24 jam. Bahkan, kalau disimpan di kulkas ketahanannya meningkat hingga 2 minggu dengan suhu kulkas yang bervariasi. Jika disimpan di frezeer yang tidak terpisah dari kulkas, dan sering dibuka, ASI tahan 3-4 bulan. Sedangkan pada freezer dengan pintu terpisah dari kulkas dan suhu bisa dijaga dengan konstan, maka ketahanan ASI mencapai 6 bulan.

• Taruh ASI dalam kantung plastik polietilen (misl plastik gula); atau wadah plastik untuk makanan atau yang bisa dimasukkan dalam microwave, wadah melamin, gelas, cangkir keramik. Jangan masukkan dalam gelas plastik minuman kemasan maupun plastik styrofoam.
• Beri tanggal dan jam pada masing-masing wadah.
• Dinginkan dalam refrigerator (kulkas). Simpan sampai batas waktu yang diijinkan (+ 2 minggu).

Jika hendak dibekukan, masukkan dulu dalam refrigerator selama semalam, baru masukkan ke freezer (bagian kulkas untuk membekukan makanan), gunakan sebelum batas maksimal yang diijinkan. (+3-6 bulan)

Mencairkan ASI

Jika ASI beku akan dicairkan, pindahkan ASI ke refrigerator semalam sebelumnya, esoknya baru cairkan dan hangatkan. Jangan membekukan kembali ASI yang sudah dipindah ke refrigerator.

Wadah Penyimpanan ASI

Aneka Wadah
a. wadah yang terbuat dari stainlees steel
b. wadah yang terbuat dari kaca (beling) dengan tutup yang rapat
c. wadah yang terbuat dari semi kaca atau plastik dengan permukaan yang keras (jenis yang tembus pandang dan tidak buram) dan tutup yang rapat
d. Kantong plastik khusus untuk menyimpan ASI
e. Kantong plastik makanan bening

Kondisi Wadah
- bening tanpa gambar
- tidak mudah bocor
- bisa dibersihkan atau disterilkan
- untuk botol kaca, simpan dalam jumlah 1/2 atau 3/4 saja untuk menghindari pemuaian yang beresiko menyebabkan botol retak atau pecah

Volume Penyimpanan ASIP
Simpan ASIP dalam jumlah sedikit atau cukup utk sekali minum, +/- 60 ml, tujuannya agar tidak ada ASI yg tersisa dan terbuang. berikan label untuk penamaan, penanggalan dan jam memerah atau memompa di tiap wadah penyimpanan ASI, bila tidak ada label dapat menggunakan penulisan langsung dengan tinta yang non toxic ASI yg lebih awal disimpan, tujuan pemberian label agar lebih mudah bagi para ibu untuk menjalankan prinsip first come first out

Tatacara Penyimpanan ASI
Waktu Penyimpanan ASI berdasarkan suhu ruang:
1. Suhu ruang (19-27C) sekitar 4-10 jam
2. Refrigerator (kulkas bawah) dg suhu 0-4C sekitar 2-3 hari
3. Freezer pd kulkas berpintu satu (suhu variatif

Meski dapat disimpan lebih lama, disarankan agar tidak terlalu lama menyimpan ASIP. Karena ASI diproduksi sesuai dg kebutuhan pertumbuhan & perkembangan anak.

Segera simpan ASI peras tidak lebih dari 1 jam dari waktu mulai memerah ke lemari pendingin, apabila direncanakan ASI perah tersebut untuk tabungan jangka waktu lama maka setelah 30 – 60 menit dilemari pendingin dapat dipindahkanke freezer/lemari pembeku.

Untuk Ibu yang memerah asi di kantor, cukup masukkan ke lemari pendingin, untuk memudahkan penstabilan suhu ketika asi dibawa pulang dalam perjalanan, sesampainya dirumah bisa langsung diletakkan di freezer, sehingga tidak terjadi turun naik suhu yang beresiko menyebabkan hilangnya beberap zat penting dalam ASI. bawa ASIP dengan wadah tertutup bisa coolbox atau tas biasa dengan didampingin blue ice atau es batu, untuk mempertahankan suhu ASIP

Jika tidak ada lemari pendingin
Ada atau tidaknya lemari pendingin/kulkas bukan hambatan bagi ibu utk menyimpan ASI. Artinya jika ditempat ibu bekerja ataupun saat ibu bepergian jauh dr bayi utk waktu lama tidak ditemukan kulkas, maka ibu dapat menyimpan botol (wadah) berisi ASI peras/pompa dalam termos es yg telah diisi es batu tentunya. Jika es batu mencair, ibu bisa menggantinya lagi. Atau ada juga cooler khusus utk mendinginkan lebih lama dg blue ice.

Tata Cara Pemberian ASI peras/pompa ke bayi
1. Bagi ibu yang memiliki banyak asi beku, berikan secara variasi antara asi beku dengan asi yang diperas 1 hari sebelum waktu pemberian

contoh
ASI akan diberikan tanggal 12 september, maka berikan asi yang diperas tanggal 11 september dan ebrikan juga asi beku yang ada di freezer dengan tanggal lebih tua, simpan juga asi yang tanggal 11 lainnya untuk mengganti persediaan asi beku yang digunakan

Hal ini mengingat salah satu prinsip asi yang dihasilkan sesuai kebutuhan Bayi dan berubah setiap harinya

2. Cairkan ASI beku terlebih dahulu di kulkas bawah/lemari pendingin, baru kemudian setelah mencari didiamkan di suhu ruang, atau bisa direndam dalam wadah berisi air dingin, kemudian bertahap ke wadah berisi air hangat

3.JANGAN menghangatkan ASI dalam suhu tinggi, merebus atau memanaskan dengan microwave

4. Kocok wadah ASIP secara perlahan sebelum diberikan ke bayi.

5. Alat Pemberian ASIP
- sendok yang tidak tajam
- pipet
- sendok khusus
- gelas atau cangkir kecil
dsb. Untuk bayi

Petunjuk penyimpanan ASI Perah (ASIP) ini berlaku bagi para ibu yang:

· Memiliki bayi yang sehat dan tidak lahir secara prematur; dan

· Menyimpan ASIP untuk kebutuhan di rumah dan bukan untuk keperluan selama berada di Rumah Sakit

Yang perlu diingat sebelum mulai menyimpan ASIP:

· Mencuci tangan sebelum memerah atau memompa ASI

· Mencuci wadah penyimpanan ASIP serta peralatan pompa ASI dengan air panas dan sabun (pastikan apabila menggunakan pompa ASI anda mengikuti instruksi pencucian yang tertera pada kemasan produk), dan disiram sekali lagi dengan air matang – tidak perlu untuk disterilkan

· Jangan lupa untuk memberikan label hari dan tanggal ASIP diperah atau dipompa pada wadahnya

Tatacara menyimpan ASIP:

· Sebelum dimasukkan ke dalam freezer, ASIP didinginkan terlebih dahulu di dalam lemari es/kulkas

· Sebaiknya menyimpan ASIP sebanyak 60 – 120ml per botol/wadah untuk mengurangi sisa ASIP yang terbuang

· Apabila memungkinan, gunakan ASIP yang masih disimpan di dalam lemari es/kulkas daripada ASIP yang sudah dibekukan didalam freezer – kandungan nutrisi dan zat-zat anti infeksinya lebih banyak

· Gabungan ASIP dari hasil beberapa kali perah/pompa dapat dilakukan dalam 1 botol/wadah sesuai dengan metode penyimpanan ASIP dibawah ini — contoh: ASI segar dapat digabungkan dalam 1 wadah dengan ASIP lainnya yang masih disimpan dalam suhu ruangan, namun apabila ingin digabungkan dalam 1 wadah dengan ASIP yang disimpan di dalam lemari es/kulkas harus didinginkan terlebih dahulu, dan apabila ingin digabungkan dalam 1 wadah dengan ASIP beku dalam freezer, maka selain harus didinginkan terlebih dahulu jumlahnya juga harus lebih sedikit dibandingkan dengan ASIP beku yang sudah tersimpan dalam wadah tersebut

Metode Penyimpanan ASIP

	ASI	Suhu Ruangan	Lemari Es / Kulkas	Freezer
	ASI yang baru saja diperah (ASI segar)	Kolostrum – hari ke-5 (12-24 jam dalam suhu ASI matang:24 jam dalam suhu 15ºC10 jam dalam suhu 19-22ºC4-6 jam dalam suhu 25ºC	3–8 hari dengan suhu 0-4ºC. Jangan simpan di bagian pintu, tetapi simpan di bagian paling belakang lemari es/kulkas – paling dingin dan tidak terlalu terpengaruh perubahan suhu	2 minggu dalam freezer yang terdapat di dalam lemari es/kulkas (1 pintu). 3-4 bulan dalam freezer yang terpisah dari lemari es/kulkas (2 pintu). 6–12 bulan dalam freezer khusus yang sangat dingin(<18ºc)
	ASIP beku— dicairkan dalam lemari es/kulkas tapi belum dihangatkan	Tidak lebih dari 4 jam(yaitu jadwal minum ASIP berikutnya)	Simpan di dalam lemari es/kulkas sampai dengan 24 jam	JANGAN masukkan kembali dalam freezer
	ASIP yang sudah dicairkan dengan air hangat	Untuk diminum sekaligus	Dapat disimpan selama 4 jam atau sampai jadwal minum ASIP berikutnya	JANGAN masukkan kembali dalam freezer
	ASIP yang sudah mulai diminum oleh bayi dari botol yang sama	Sisa yang tidak dihabiskan harus dibuang	Dibuang	Dibuang

Wadah penyimpanan ASIP:

· Botol atau jenis wadah lainnya yang terbuat dari kaca (beling) dengan tutup yang rapat

· Botol atau wadah plastik dengan permukaan yang keras (jenis yang tembus pandang dan tidak buram) dan mempunyai tutup yang rapat

· Kantong plastik khusus untuk menyimpan ASIP

· Kantong plastik makanan dengan label ”food grade”

Cara menghangatkan ASIP:

· Gunakan ASIP dengan hari dan tanggal yang paling lama terlebih dahulu

· Apabila bau dan rasanya basi, untuk amannya berarti ASIP tersebut memang sudah basi

· Cairkan ASIP beku selama 12 jam dalam lemari es/kulkas sebelum diberikan kepada bayi

· Hangatkan ASIP dingin dengan cara meletakkan botol/wadah ASIP di dalam mangkuk berisi air hangat, atau pegang botol/wadah ASIP dibawah aliran air hangat

· JANGAN panaskan ASIP diatas kompor – JANGAN direbus

· JANGAN panaskan ASIP dalam microwave

· Karena ASI tidak bersifat homogen, maka apabila disimpan cenderung untuk terjadi proses pemisahan, dimana lemaknya akan naik keatas dan membentuk lapisan krim – cukup kocok secara perlahan-lahan sebelum diberikan kepada bayi

· Jangan lupa untuk memeriksa suhu ASIP yang sudah dihangatkan sebelum diberikan kepada bayi

· Apabila perlu, cicipi ASIP terlebih dahulu sebelum diberikan kepada bayi

CATATAN KHUSUS – KADAR ENZIM LIPASE YANG TINGGI

Para ibu yang memiliki ASI dengan kadar enzim lipase yang tinggi seringkali menemukan bahwa ASIP mereka sangat berminyak dan berbau seperti sabun. Enzim lipase berfungsi untuk menguraikan kandungan lemak dalam ASI – semakin tinggi kadar enzim ini, maka akan semakin cepat sel-sel lemaknya terurai sehingga menghasilkan ASI dengan bau yang sangat khas tersebut. Akibatnya, banyak bayi yang menolak untuk minum ASIP dengan ”bau sabun” padahal ASIP tersebut masih sangat layak untuk diminum.

Bagaimana cara mengatasinya? Apabila bayi memang menolak untuk minum ASIP tersebut, maka ASI segar yang baru saja diperah dan belum dimasukkan ke dalam lemari es/kulkas, dipanaskan terlebih dahulu diatas kompor sampai hampir mendidih (70-80ºC saja) setelah itu langsung diangkat/didinginkan sebelum dimasukkan ke dalam lemari es/kulkas. Dengan memanaskan terlebih dahulu seperti ini, maka proses kerja penguraian sel-sel lemak oleh enzim lipase akan dihentikan.

Bagaimana cara mengetahui ASI anda mempunyai kadar enzim lipase yang tinggi?

· Perah ASI anda seperti biasa, lalu biarkan ASI tersebut pada suhu ruangan selama 30 menit. Perah lagi ASI baru, lalu bandingkan rasanya antara ASI yang baru saja diperah dengan yang sudah dibiarkan dalam waktu 30 menit tadi.

· Bisa juga bandingkan ASI yang baru diperah (ASI segar) dengan ASIP yang sudah disimpan di kulkas (yang sudah didinginkan).

· Coba juga bandingkan lagi ASI segar dengan ASIP yang sudah dibekukan di dalam freezer.

· Bandingkan lagi ASI segar dengan ASIP dingin atau beku yang sudah dicairkan dan dihangatkan.

Kalau diantara percobaan-percobaan tersebut tidak ada perbedaan rasa (mungkin sedikit berbeda, tetapi tidak terlalu tajam/mencolok perbedaan rasa dan baunya), maka kadar enzim lipase anda tergolong normal.

Sumber:

1. The Breastfeeding Book: Everything You Need to Know About Nursing Your Child From Birth Through Weaning, Sears, R.N., Martha dan William Sears, M.D., Parenting Libary, 2000.

2. Breastfeeding Made Simple: Seven Natural Laws for Nursing Mothers, Mohrbacher, IBCLC, Nancy dan Kathleen Kendall-Tackett, Ph.D, IBCLC, New Harbinger Publications, Inc., 2005.

3. La Leche League International: The Womanly Art of Breastfeeding 7th ed., Plume, 2004.

4. http://www.kellymom.com/bf/pumping/lipase-expressedmilk.html

http://www.drjaygordon.com/development/bf/worknursetips.asp

FAQ Seputar Penyimpanan ASI

BERAPA LAMA ASI HASIL POMPA/PERAS BISA DISIMPAN PADA SUHU RUANG?
Jika ruangan tidak ber-AC, disarankan tidak lebih dari 4 jam
Jika ruangan ber-AC, bisa sampai 6 jam
-catatan: suhu di atas harus stabil, misalnya ruangan ber-AC, tidak mati
sama sekali selama botol ASI ada di dalamnya.

BERAPA LAMA ASI HASIL POMPA/PERAS BISA DISIMPAN PADA SUHU LEMARI ES?
Jika Ibu mengetahui bahwa dalam 4 jam ke depan ASI hasil pompa/peras tidak akan diberikan pada bayi, maka segeralah simpan di lemari es. ASI ini bias bertahan sampai 8 (delapan) hari dalam suhu lemari es, jika ditempatkan dalam compartment yang terpisah dari bahan makanan lain yg ada di lemari es tsb.
Jika lemari es Ibu kebetulan tidak memiliki compartment terpisah untuk
menyimpan botol ASI hasil pompa/perasan, maka sebaiknya ASI tersebut jangan disimpan lebih dari 3 x 24 jam.
Ibu juga dapat “membuat” compartment terpisah dengan cara menempatkan botol ASI dalam container plastik yang tentunya dibersihkan terlebih dahulu dengan baik.

BERAPA LAMA ASI HASIL POMPA/PERAS BISA DISIMPAN PADA SUHU FREEZER?
ASI hasil pompa/perasan dapat disimpan dalam freezer biasa sampai 3 (bulan) lamanya. Namun Ibu jangan menyimpan ASI ini di bagian pintu freezer, karena bagian ini yang mengalami perubahan dan variasi suhu udara terbesar.

Jika Ibu kebetulan memiliki freezer penyimpan daging yang terpisah (biasanya disebut deep freezer) yang umumnya memiliki suhu lebih rendah dari freezer biasa, maka ASI hasil pompa/perasan bahkan dapat disimpan sampai dengan 6 (enam) bulan di dalamnya.

BAGAIMANA CARA MENYIMPAN ASI HASIL POMPA/PERASAN YANG BAIK?
- Simpan ASI dalam botol yang telah disterilkan terlebih dahulu
- Botol yang paling baik sebetulnya adalah yang terbuat dari gelas/beling,namun jika terpaksa menggunakan botol plastik, pastikanlah bahwa plastiknya cukup kuat (tidak meleleh jika direndam dalam air panas)
- Jangan pakai botol susu yang berwarna / bergambar, karena ada kemungkinan catnya meleleh jika terkena panas
- Jangan lupa bubuhkan label setiap kali Ibu akan menyimpan botol ASI,
dengan mencantumkan tanggal dan jam ASI dipompa/peras
- Simpan ASI di dalam botol yang tertutup rapat (jangan ditutup dengan dot,karena masih ada peluang untuk berinteraksi dengan udara)
- Jika dalam satu hari Ibu memompa/memeras ASI beberapa kali, bisa saja Ibu menggabungkan hasil pompa/perasan tsb dalam botol yang sama, dengan catatan bahwa suhu tempat botol disimpan stabil, antara 0 s/d 15 derajat Celcius).
Penggabungan hasil simpanan ini bisa dilakukan asalkan jangka waktu
pemompaan/pemerasan pertama s/d terakhir tidak lebih dari 24 jam

BAGAIMANA CARA PEMBERIAN ASI YANG SUDAH DIDINGINKAN KEPADA BAYI?
- Panaskan ASI dengan cara:
(a) membiarkan botol dialiri air panas (bukan mendidih) yang keluar dari
keran
ATAU
(b) merendam botol di dalam baskom / mangkuk yang berisi air panas (bukan mendidih)

- Jangan sekali-sekali memanaskan botol dengan cara mendidihkannya dalam
panci, menggunakan microwave atau alat pemanas lainnya (kecuali yang memang di-design untuk memanaskan botol berisi simpanan ASI)

- Ibu tentunya mengetahui berapa banyak bayi Ibu biasanya sekali meminum
ASI. Sesuaikanlah jumlah susu yang dipanaskan dengan kebiasaan tsb. Misalnya dalam satu botol Ibu menyimpan sebanyak 180 cc ASI tetapi bayi Ibu biasanya hanya meminum 80, jangan langsung dipanaskan semua. INGAT bahwa susu yang sudah dipanaskan tidak bisa disimpan lagi!

BAGAIMANA SAYA MENGETAHUI APAKAH ASI YANG DISIMPAN SUDAH BASI?
Sebenarnya jika Ibu mengikuti pedoman pemompaan/pemerasan ASI dan penyimpanan yang baik, ASI tidak akan mungkin basi. Kadang memang setelah disimpan / didinginkan akan terjadi perubahan warna dan rasa, tapi itu tidak menandakan bahwa ASI sudah basi. Asalkan Ibu berada dalam keadaan bersih ketika memompa/memeras, menyimpan ASI dalam botol yang steril & tertutup rapat, dalam jangka waktu yang dijabarkan seperti di atas dan saat memanaskan juga mengikuti petunjuk, mudah-mudahan ASI Ibu terjaga dalam kondisi yang baik.

Dibandingkan susu formula, ASI lebih tahan lama. Pada saat berinteraksi dengan udara luar, biasanya yang terjadi bukan pembusukan ASI tetapi lebih merupakan berkurangnya khasiat ASI, terutama zat yang membantu pembentukan daya imun bayi.

SELAMAT ! Bayi Ibu sungguh beruntung memiliki Ibu yang menyadari betul arti dan manfaat pemberian ASI dalam awal kehidupannya. Semoga ia tumbuh sehat dan selalu berada dalam lindungan Tuhan. Amiin.
————————————————————————
Nara Sumber:

Barger, J. and Bull, P.A., Comparison of the bacterial composition of breast milk stored at room temperature and stored in the refrigerator. Intl Journal of Childbirth Ed 2: pages 29 and 30 1987.
Hamosh, M. et al., Breastfeeding and the working mother effect of time and temperature of short term storage on proteolysis, lipolysis, and bacterial growth in milk. Pediatrics 97 (4) 492 to 498, 1996
Mohrbacher, N. and Stock, J., The Breastfeeding Answer Book, La Leche League International, 1997, pp 30 to 31.
Pardou, A. et al., Human milk banking: influence of storage processes and of bacterial contamination on some milk constituents. Biol Neonate 65:302 to 309, 1994

ASI perah :

di ruangan biasa dengan suhu biasa : 6 – 8 jam
di dalam termos es : 1x 24 jam
di dalam lemari es (tempat sayur) : 2x 24 jam
di dalam freezer 1 pintu : 2 minggu
di dalam freezer 2 pintu 3 bulan

ASI adalah cairan hidup yang mengandung makanan dan anti infeksi, jadi
cara penyimpanannya menentukan kualitas anti infeksi dan zat gizi ASI
yang dikandungnnya, nah anti infeksi dalam asi ini yang membantu asi
segar lebih lama, anti bakteri mengurangi pertumbuhan bakteri dalam
asi perah yang disimpan.

tempat penyimpanan disarankan di dalam botol gelas atau botol plastik
keras, volumennya bisa 80 – 100 CC.

selalu untuk menulis label jam dan tanggal dibuat, dan sebaiknya
sebelum di simpan ke freezer dinginkan dulu kurang lebih 30 menit di
lemari es.

terimakasih semoga bermamfaat..

SENRA LAKTASI INDONESIA
http://selasi.org
kami membuka konsultasi lewat telp ke nomor :
021-83795168

Panduan Menyimpan ASI

ASI yang diperah atau dipompa haruslah disimpan secara benar untuk memaksimalkan kandungan nutrisi dan kualitas yang terkandung di dalamnya. ASI sebenarnya memiliki kandungan anti-bakteri untuk mempertahankan kesegarannya. ASI yang baru diperah atau dipompa pasti akan lebih segar dan memiliki kualitas yang baik/

Informasi dibawah ini dihasilkan dari riset terkini dan berlaku bagi para ibu yang:

§ Memiliki anak yang sehat dan lahir tidak premature (full-term babies)

§ Menyimpan ASI untuk keperluan di dalam rumah (bukan untuk keperluan di RS)

§ Mencuci tangannya sebelum memerah atau memompa

§ Menggunakan wadah atau tempat penyimpanan ASI yang telah dibersihkan dengan air panas, sabun dan telah disiram dengan air bersih.

§ Semua ASI yang disimpan harus diberi tanggal sesuai hari di saat ASI itu diperah atau dipompa.

Panduan Menyimpan ASI

Menyimpan sekitar 60 – 120 ml per botol sangat disarankan untuk mengurangi sisa ASI. ASI yang disimpan di kulkas lebih besar kandungan anti-infeksinya disbanding ASI yang beku dari freezer. Masukkan ASI kedalam kulkas biasa dulu untuk merendahkan suhunya baru pindahkan ke dalam freezer.

ASI bisa disimpan:

Dalam suhu ruangan (19-22°C) sampai 10 jam lamanya

Di dalam kulkas (0-4°C) sampai 8 hari (usahakan di bagian paling belakang dari kulkas) sampai 8 hari lamanya

Di dalam freezer (dengan suhu bervariasi tergantung berapa sering pintu freezer dibuka dan ditutup) sampai 2 mingg

Di dalam freezer dengan bagian khusus yang memiliki tutup terpisah dari pintu freezer (dengan suhu bervariasi tergantung berapa sering pintu freezer dibuka dan ditutup) sampai 3-4 bulan.

Di dalam freezer yang sangat dingin (-17 sampai -8°C) sampai 6 bulan lamanya

Tempat untuk menyimpan ASI

ASI yang disimpan di kulkas atau ASI beku dapat ditempatkan pada:

• Plastik dengan permukaan keras (seperti botol bayi) atau wadah yang terbuat dari gelas dengan tutup yang rapat.
• Kantong ASI yang didesain khusus untuk penyimpanan dalam freezer.

Catatan: botol susu sekali pakai tidak direkomendasikan untuk dipakai.

Bagiamana cara menghangatkan ASI?

Rendam atau aliri botol dengan air panas.

ASI jangan dipanaskan sampai mendidih

Perlahan kocok-kocok ASI sebelum mengukur suhunya. Mengocok secara perlahan juga akan membantu mencampur bagian yang mengental dengan yang cair.

Dilarang menggunakan microwave dalam menghangatkan ASI.

ASI beku yang telah dicairkan

Jika ASI beku telah dicairkan, masih bisa disimpan dalam kulkas biasa sampai 24 jam ke depan. Tetapi ASI tidak boleh dibekukan lagi. Tidak diketahui dengan pasti apakah ASI yang tersisa di botol aman dan masih baik kondisinya untuk diminumkan lagi kepada bayi pada saat minum berikutnya. Untuk mencegah hal ini, sebaiknya ASI disimpan dalam botol yang tidak terlalu besar, jadi mengurangi sisa ASI yang tidak terminum.

Menurut buku THE BREASTFEEDING ANSWER BOOK, halaman 228, beberapa penelitian menunjukkan bahwa terdapat kandungan zat dalam ASI yang tak dikenal untuk melindungi ASI dari bakteri dan kontaminasi. Sebuah studi, Barger & Bull 1987, mnemukan secara statistik bahwa tidak ada perbedaan kadar bakteri dalam ASI yang telah disimpan 10 jam dalam suhu ruangan dengan ASI yang telah disimpan selama 10 jam. Bahkan sebuah penelitian lain, Pardou 1994, menemukan bahwa setelah 8 hari disimpan di kulkas ada kecenderungan ASI memiliki kadar bakteri yang lebih rendah dibanding saat setelah diperah atau dipompa.

Sumber: diterjemahkan dari situs La Leche League ( http://www.lalecheleague.org )

ASI di freezer & Cara Penyimpanan Asi

Sumber: ibu ibu DI

Tanya
Selama ini aku tidak pernah menyimpan asi di freezer (menyimpannya di kulkas biasa), jadi perasan asi hari ini selalu dipakai keesokan harinya (tidak lebih dari 24 jam). Waktu kemarin bahas asi eksklusif ada beberapa ibu yang menyimpan asinya di freezer untuk beberapa hari. Sudah 1-2 bulan ini aku mulai ikut menyimpan asi di freezer, perasan asi hari jumat dipakainya hari senin. Pertanyaanku, apakah asi yang disimpan di freezer itu hasil ‘pemanasan’nya (setelah dikeluarin dan direndam di air panas) sama dengan asi yang disimpan di kulkas biasa? masalahnya, asiku yang kusimpan di freezer setelah dikeluarin dan dipanasin’ warnanya agak kekuningan dan berminyak. Sudah begitu anakku agak ogah-ogahan kalau hari senin minum asi yang dari frezzer ini. Memang kalau kuperhatikan lebih fresh yang disimpan di kulkas biasa (hasil perasan sehari sebelumnya). Apa memang seperti itu? atau asiku sudah ‘rusak’? atau kebetulan saja anakku pas malas minum asi? (Llk)

Jawab
Kalau aku simpan ASI di Freezer, ASI sebelum dipakai, mesti ditaruh dulu didalam refrigator, minimal 5 jam sampai dia tidak beku lagi, baru deh habis itu bisa diproses seperti ASI yang disimpan di Refrigator. Nah kalau ASI beku langsung dipanaskan, memang nantinya suka pecah, jadi agak berminyak, dan pasti tidak enak [It]

Asi beku dari freezer jangan langsung dipanasin, bisa rusak, kalau aku dulu, misalnya mau diminum siang, pagi keluarin dari freezer, taruh di kulkas bagian bawah, ntar pas mau diminum baru dipanasin. Tapi dulu itu aku sering mbandel juga, asi perasan jumat yang untuk diminum senin siang sering tidak aku simpan di freezer, cuma aku taruh persis dibawahnya freezer. Alhamdulillah anakku tidak apa-apa & tetap doyan. Kalau untuk cadangan/bakal disimpan lama, baru aku taruh di freezer. [Rat]

Aku juga pakai sistem diturunin dulu ke kulkas bagian bawah, tapi entah kenapa jadinya tetap agak berminyak begitu ya ? karena semalam asisten laporan kalau anakku susah minum asi kalau yang dari freezer itu, jadinya kepikiran apa memang asinya yang sudah ‘rusak’ atau kebetulan saja ya? Mudah-mudahan cuma kebetulan saja dia pas males minum. (Llk)

Kalau mau pakai asi dari freezer, direndam air biasa dulu (jangan air panas). Nanti kalau sudah netral suhunya, baru direndam di air hangat [Has]

Aku dulu sering juga menyimpan ASI di freezer. Berdasar literatur yang aku baca. ASI yang disimpan di freezer memang akan rusak emulsinya, ini yang menyebabkan jadi terpisahnya lemak susu dari ikatannya, karena proses pendinginan dan pembekuan. Jadi terlihat berminyak/ terpisah minyaknya saat pencairan. Dijelaskan juga bahwa itu tidak berarti ASI tersebut rusak, kandungan gizinya akan tetap lengkap yang berkurang adalah zat kekebalan tubuh yang terkandung di ASI secara alami. Aku untuk Senin biasanya stok dari Sabtu, tidak perlu di freezer tidak papa. Cuma untuk jaga-jaga waktu lama memang ku masukan ke freezer dalam kantong plastik yang sudah kuberi tanggal dan jam perah. [al]

Kalau aku habis diturunin ke kulkas bawah; mis. untuk senin pagi, minggu malem dituruninnya; senin paginya kan belum tentu sudah cair semua. Dicairkan dulu di air biasa. Baru masukkan kembali ke kulkas bawah. Kalau mau dipakai, baru dituang seperlunya untuk dihangatkan di air panas. [Ri]

Harusnya sih warna kekuning-kuningan itu tidak muncul kalau proses pencairannya perlahan. Jadi jauh-jauh sebelum jadwal minum susu, min. satu jam, keluarkan botol ASI beku dan rendam di dalam mangkuk berisi air keran. Biasanya setiap kali air rendaman terasa makin dingin, aku ganti terus beberapa kali. Kalau bisa sampai sebagian besar atau malah seluruh ASI mencair. Setelah itu campur air rendaman dengan air termos – biar tidak terlalu panas – sehingga asi nantinya tidak berwarna kekuning-kuningan. Kalau punya waktu lebih lama lagi sih, turunin saja dulu dari freezer ke refrigerator, lalu ikuti proses di atas. [Jud]

Dulu anakku juga tidak mau minum asi yang sudah masuk freezer, terus, aku diberi tahu saudaraku, mungkin juga pengaruh bahan-bahan lain yang disimpan di freezer misalnya daging dll, walaupun zat di dalam asi-nya mungkin tetep sama tapi baunya mungkin sudah beda, jadi mungkin beli kulkas musti 2 ya kalau punya baby. [ver]

Kan ada yang untuk penetral bau di kulkas harganya sekitar Rp. 5000,00 yang kecil aku beli di supermarket Bagus merknya, ada juga merk Gajah (maaf sebutin brand), cari saja sekitar kapur barus, pemakaian buat jangka waktu 6 bulan. [Nik]

Panduan Menyimpan ASI

ASI yang diperah atau dipompa haruslah disimpan secara benar untuk memaksimalkan kandungan nutrisi dan kualitas yang terkandung di dalamnya. ASI sebenarnya memiliki kandungan anti-bakteri untuk mempertahankan kesegarannya. ASI yang baru diperah atau dipompa pasti akan lebih segar dan memiliki kualitas yang baik/

Informasi dibawah ini dihasilkan dari riset terkini dan berlaku bagi para ibu yang:

· Memiliki anak yang sehat dan lahir tidak premature (full-term babies)

· Menyimpan ASI untuk keperluan di dalam rumah (bukan untuk keperluan di RS)

· Mencuci tangannya sebelum memerah atau memompa

· Menggunakan wadah atau tempat penyimpanan ASI yang telah dibersihkan dengan air panas, sabun dan telah disiram dengan air bersih.

· Semua ASI yang disimpan harus diberi tanggal sesuai hari di saat ASI itu diperah atau dipompa.

Panduan Menyimpan ASI

Menyimpan sekitar 60 – 120 ml per botol sangat disarankan untuk mengurangi sisa ASI. ASI yang disimpan di kulkas lebih besar kandungan anti-infeksinya disbanding ASI yang beku dari freezer. Masukkan ASI kedalam kulkas biasa dulu untuk merendahkan suhunya baru pindahkan ke dalam freezer.

ASI bisa disimpan:

· Dalam suhu ruangan (19-22°C) sampai 10 jam lamanya

· Di dalam kulkas (0-4°C) sampai 8 hari (usahakan di bagian paling belakang dari kulkas) sampai 8 hari lamanya

· Di dalam freezer (dengan suhu bervariasi tergantung berapa sering pintu freezer dibuka dan ditutup) sampai 2 minggu

· Di dalam freezer dengan bagian khusus yang memiliki tutup terpisah dari pintu freezer (dengan suhu bervariasi tergantung berapa sering pintu freezer dibuka dan ditutup) sampai 3-4 bulan.

· Di dalam freezer yang sangat dingin (-17 sampai -8°C) sampai 6 bulan lamanya

Tempat untuk menyimpan ASI

ASI yang disimpan di kulkas atau ASI beku dapat ditempatkan pada:

• Plastik dengan permukaan keras (seperti botol bayi) atau wadah yang terbuat dari gelas dengan tutup yang rapat.
• Kantong ASI yang didesain khusus untuk penyimpanan dalam freezer.

Catatan: botol susu sekali pakai tidak direkomendasikan untuk dipakai.

Bagiamana cara menghangatkan ASI?

§ Rendam atau aliri botol dengan air panas.

§ ASI jangan dipanaskan sampai mendidih

§ Perlahan kocok-kocok ASI sebelum mengukur suhunya. Mengocok secara perlahan juga akan membantu mencampur bagian yang mengental dengan yang cair.

§ Dilarang menggunakan microwave dalam menghangatkan ASI.

ASI beku yang telah dicairkan

Jika ASI beku telah dicairkan, masih bisa disimpan dalam kulkas biasa sampai 24 jam ke depan. Tetapi ASI tidak boleh dibekukan lagi. Tidak diketahui dengan pasti apakah ASI yang tersisa di botol aman dan masih baik kondisinya untuk diminumkan lagi kepada bayi pada saat minum berikutnya. Untuk mencegah hal ini, sebaiknya ASI disimpan dalam botol yang tidak terlalu besar, jadi mengurangi sisa ASI yang tidak terminum.

Menurut buku THE BREASTFEEDING ANSWER BOOK, halaman 228, beberapa penelitian menunjukkan bahwa terdapat kandungan zat dalam ASI yang tak dikenal untuk melindungi ASI dari bakteri dan kontaminasi. Sebuah studi, Barger & Bull 1987, mnemukan secara statistik bahwa tidak ada perbedaan kadar bakteri dalam ASI yang telah disimpan 10 jam dalam suhu ruangan dengan ASI yang telah disimpan selama 10 jam. Bahkan sebuah penelitian lain, Pardou 1994, menemukan bahwa setelah 8 hari disimpan di kulkas ada kecenderungan ASI memiliki kadar bakteri yang lebih rendah dibanding saat setelah diperah atau dipompa.

Sumber: diterjemahkan dari situs La Leche League ( http://www.lalecheleague.org )

Pacifier

Pacifiers: The basics
Approved by the Medical Advisory Board
Reviewed by Nancy Showen, M.D.

Should I give my baby a pacifier?
There’s nothing wrong with offering your baby a pacifier if you use
it intelligently — for the baby’s benefit, not yours, and never as a
substitute for nurturing.

Like so many parenting decisions, whether to use a pacifier is
something you’ll need to decide for yourself after examining the
pros and cons. Your little one will have a lot to say about this
decision — many babies are content to suck during feedings and find
activities like rocking and cuddling to be more soothing, while
others just can’t seem to get enough of sucking even when they’re
not hungry.

Pacifier pros and cons
The pros
• A pacifier can help meet your baby’s need to suck and help her
soothe herself. It’s perfectly natural for your baby to want to suck
even after she’s had her fill of formula or breast milk. A pacifier
isn’t a substitute for nurturing or feeding, of course, but if
you’ve fed, burped, cuddled, rocked, and played with your baby and
she’s still fussy, you might want to see if a pacifier will satisfy
her.

• Pacifiers may reduce the risk of sudden infant death syndrome
(SIDS). Studies have shown that babies who use pacifiers at bedtime
and naptime have a reduced risk of SIDS. These studies don’t show
that the pacifier itself prevents SIDS, just that there is a strong
association between pacifiers and a reduced risk of SIDS.

• A pacifier habit is easier to break than a thumb-sucking habit.
After all, you can dispose of a pacifier.

The cons
• If you introduce a pacifier too early, it may interfere with
breastfeeding. Sucking on a pacifier and sucking on a breast are
different, and babies who are offered a pacifier before they become
adept at nursing sometimes experience nipple confusion.

For this reason, the American Academy of Pediatrics (AAP) suggests
that you wait until your baby has learned to latch on and suck well
and your milk supply is well established. Her 1-month birthday
should be about right.

• Sucking on a pacifier is likely to become a habit. Some parents
don’t want to introduce a pacifier because they don’t want to deal
with having to take it away down the road.
• Studies show that using a pacifier may increase the risk of middle
ear infections in babies and children.
• Some parents can’t bear the thought of having a 3-year-old walking
around with a binky in her mouth. If used judiciously, however, and
only when your baby really needs it, your child is unlikely to
become overly dependent on a pacifier.
• If your baby lulls herself to sleep while sucking on a pacifier,
she’s likely to awaken as soon as it falls out of her mouth. Until
she’s old enough to put it back in (around 6 months), that’ll be
your job.

Pacifier guidelines
If you decide to introduce a pacifier, keep these guidelines in mind:
• Let your baby guide your decision. If she seems to love the binky
right off the bat, fine. But if she resists, don’t force it. You can
try again another time if you like, or just respect her decision and
let it go.
• Don’t use a pacifier to delay your baby’s feedings or as a
substitute for your attention. Offer the pacifier between feedings,
when you know she’s not hungry. And always try to comfort your baby
in other ways first, such as cuddling, rocking, or singing.
• Never tie a pacifier around your baby’s neck or to her crib. She
could strangle in the cord or ribbon. It’s safe to attach the
pacifier to her clothes with a diaper pin or a clip made especially
for the job, though.
• Take care of the pacifier. Choose a pacifier that’s safe and
appropriate for your baby and keep it clean. Replace it as soon as
it shows any signs of wear.

Are there times when a baby definitely should not be given a
pacifier?
A baby who is having problems gaining weight shouldn’t be given a
pacifier. If your baby is breastfeeding and having any difficulty
nursing — or if you’re having trouble maintaining your milk supply —
you’ll want to do without the pacifier, at least for now. You’ll
also want to consider having your baby go without a pacifier if
she’s had repeated ear infections.

If you don’t want your newborn to have a pacifier at the hospital,
alert the staff in advance — particularly if you intend to
breastfeed. Although a day or two of pacifier use in the hospital
won’t hook your baby on binkies, it simply makes sense not to
introduce something you aren’t going to use at home.

Will a pacifier interfere with the development of my child’s teeth?
Sucking on a pacifier well into the childhood years might threaten
proper dental development, but it’s unlikely that your child will be
at it for that long.

During the years when your child is likely to be using a pacifier,
she only has her baby teeth. (Permanent teeth generally start
appearing by age 4 to 6.) If you’re concerned, ask your baby’s
doctor or dentist to check that her jaw and teeth are doing fine

ASI Berlimpah Repot

ASI Berlimpah, Repot Juga!

Ternyata, produksi ASI yang berlimpah bisa merepotkan juga. Namun, jangan khawatir, ada kiat-kiat mengatasinya.

Kebanyakan ibu khawatir bayinya kurang gizi akibat produksi ASI-nya sedikit. Tapi ada juga yang sebaliknya. Mereka malah bingung karena produksi ASI-nya berlimpah. Bahkan dengan refleks pengaliran air susu yang ringan saja, ASI sudah memancar dengan deras. Tentu saja ibu sulit mengontrolnya, sehingga sang bayi kerap tersedak atau muntah.

Bila bayi menolak menyusu dan menangis, payudara ibu menjadi “penuh” dan membengkak. Bahkan, ASI akan menetes dan mengotori baju. Repot dan tidak nyaman, bukan?

Ada beberapa penyebab

Masalah ASI berlimpah (hiperlaktasi) ini diduga disebabkan oleh beberapa hal, yaitu:

• Bila dialami pada minggu-minggu pertama masa menyusui, maka hiperlaktasi ini sebenarnya mencerminkan antusiasme tubuh ibu untuk menghasilkan susu sebanyak mungkin. Bila tubuh ibu dan bayi telah menemukan “rumusan” yang tepat untuk menyeimbangkan penawaran dan permintaan ASI yang saling menguntungkan, masalah ini akan hilang dengan sendirinya (dalam waktu kurang lebih 6-10 minggu).

• Bila hiperlaktasi ini terus dialami oleh seorang ibu, maka penyebabnya mungkin karena ibu yang bersangkutan memiliki banyak alveoli (kelenjar yang memproduksi ASI) dalam payudaranya. Perlu diketahui, jumlah rata-rata alveoli adalah 100.000 sampai 300.000 per payudara. Ibu dengan hiperlaktasi sering mencapai batas atas dari jumlah rata-rata tersebut.

• Masalah hiperlaktasi juga dapat disebabkan oleh adanya ketidakseimbangan hormon atau adanya tumor pada kelenjar pituitari (kelenjar yang terletak di bawah otak dan menghasilkan banyak hormon).

Sehubungan dengan hal itu, ibu dengan hiperlaktasi sebaiknya menemui dokter atau konsultan laktasi. Dengan demikian, bisa dicari apa penyebab dari masalah yang sedang dihadapinya.

Cari jalan keluarnya

Beberapa kiat berikut dapat membantu Anda untuk mencegah bayi tersedak.

• Sebelum mulai menyusui bayi, perahlah sedikit ASI. Tindakan ini akan memperlambat aliran ASI yang keluar saat disusukan pada bayi. Jumlah ASI yang diperah sebaiknya tidak terlalu banyak, dan jangan melakukannya diantara dua waktu menyusui. Karena, semakin banyak ASI yang Anda perah dan semakin sering Anda merangsang payudara, maka semakin banyak tubuh Anda memproduksi ASI.

• Cobalah menyusui lebih sering dalam berbagai posisi. Posisi yang biasanya sesuai untuk mengatasi masalah hiperlaktasi ini adalah posisi ibu setengah tidur dan bayi ditengkurapkan di dada ibunya. Dalam posisi ini, aliran ASI mengarah ke atas, sehingga keluarnya ASI tidak terlalu deras.

Sedangkan untuk mengurangi produksi ASI, Anda dapat melakukannya dengan menyisakan ASI di dalam payudara. Caranya, upayakanlah agar bayi tidak terlalu lama menyusu. Seiring dengan berkurangnya jumlah ASI yang keluar dari payudara pada satu waktu menyusui, tubuh ibu pun akan mengurangi produksi ASI-nya.

Satu hal yang perlu Anda ingat, upaya untuk mengurangi produksi ASI tersebut perlu waktu. Jadi, Anda sebaiknya tidak putus asa, atau menduga bayi akan menolak Anda selamanya. Perlu diketahui, dia hanya belum mampu mengatasi derasnya aliran ASI saat ini, dan akan terus berupaya mengatasinya bersama-sama Anda. Sementara itu, untuk mencegah baju Anda kotor karena ASI, gunakanlah breast pads dan baju atasan yang bermotif. Atau, tidak ada salahnya pula bila Anda mendonorkan kelebihan ASI Anda tersebut ke rumah sakit. Kelebihan ASI Anda akan sangat bermanfaat bagi banyak bayi lain.

Bila tidak ada satu cara pun yang berhasil pada Anda, segeralah temui dokter atau konsultan laktasi. Hiperlaktasi mungkin membuat bayi sulit menyusu, namun hal ini tidak akan membahayakannya. Selain itu, kabar baiknya adalah tubuh Anda memproduksi makanan dalam jumlah berlimpah, sehingga bayi dapat tumbuh kembang optimal.

Dewi Handajani

Konsultasi ilmiah: Prof. dr. Rulina Suradi, Sp.A(K), IBCLC, Bagian Ilmu Kesehatan Anak, FKUI, RSUPN Cipto Mangunkusumo, Jakarta.

Overabundant milk supply; refusal to nurse

Overabundant Milk Supply
I have made so many references in this book to low milk supply that you might wonder whether anyone really produces excessive quantities of milk. While many more women seek help for too little milk than for too much milk, an overabundant supply is a frustrating problem for some women. Obviously Mother Nature prefers to closely match a woman’s supply to her infant’s need. The process of lactation is not efficient when a woman’s body makes surplus milk that isn’t needed by her infant. I don’t know why some women produce extra, unwanted milk, while others fail to produce enough. Although low-milk problems often result from improper breastfeeding management, overabundant milk production is usually unrelated to a mother’s breastfeeding practices.

I am convinced that women vary widely in their capacity to produce milk. In earlier times, some mothers with overabundant supplies sought employment as wet nurses. I suspect that an overabundant supply results from a triple combination: exceptional production capacity, a brisk and well-conditioned milk ejection reflex, and a superefficient nursing baby. While generally preferable to low milk, the problem can still be a source of frustration and discomfort for both mother and baby. Women with an overabundant milk supply often voice the following complaints:

• Breasts that easily become uncomfortably engorged
• Dramatic (sometimes painful) sensations of the milk ejection reflex
• Chronic leaking milk
• Repeated clogged ducts
• One or more breast infections
• Rapid weight loss due to the high metabolic demands of producing so much milk

As if the problems that an overabundant supply cause a mother aren’t troubling enough, having superabundant milk can also be frustrating for babies. Many women are more upset by the distress their overproduction seems to cause their infant, including the following:

• Choking and sputtering when milk lets down
• Excessive gas and abdominal discomfort from overeating
• Rapid weight gain
• Inability to enjoy “comfort nursing” since the baby obtains unwanted milk even when trying to nurse to sleep
• Frustration with breastfeeding that leads to early weaning or a nursing strike

Fortunately, the problem of overabundant milk usually im-proves with time. The baby may “grow into” his milk supply as he gets a little older. Furthermore, the supply tends to gradually diminish since the mother’s breasts don’t get well drained. Ordinary life stresses like returning to work, becoming ill, skipping meals, or suffering a breast infection all can cause milk production to decrease.

Meanwhile, you can try some of the following strategies to help your baby enjoy nursings better, to prevent the risk of clogged ducts and mastitis, and to gradually reduce your milk production:

Position your baby so that his head and throat are higher than your nipple. By nursing “uphill,” he will be better able to control your overly fast flow of milk. Use the football hold and lean back to elevate your baby’s head. Or, try the cradle hold, with your baby elevated higher than usual, while you lean back in a recliner.

If your let-down is causing your baby to choke and/or cry, temporarily interrupt the feeding until your milk stops spraying. Then allow your baby to resume feeding after the milk flow has slowed.

The two key ways to reduce milk production are to remove less milk at each nursing and to remove milk at less-frequent intervals. To prolong the interval at which milk is removed, you can try nursing on only one breast at each feeding, alternating the breast you use. Using one breast at each nursing might also make feedings go more smoothly for your baby. After the initial rapid flow tapers, your baby may be able to comfortably handle the milk volume from a single breast. However, the unsuckled breast may be left uncomfortably full and place you at risk for mastitis. If you decide to use one breast, you probably will need to express sufficient milk from the opposite breast to relieve some of the pressure and keep you comfortable. Eventually, the milk supply should decrease.

Another way to modify feedings is to allow your baby to nurse from both breasts at each feeding, but to avoid emptying either side well. The first breast will be left softer than the second, but neither will be thoroughly drained. You’ll want to nurse at the first breast for at least five to seven minutes after your milk lets-down to assure that your baby gets ample hindmilk. Once he switches to the second breast, some mixing of foremilk and hindmilk already will have occurred. What isn’t desired is to have your baby take only the watery foremilk from each breast.

Some women with overabundant milk choose to obtain a hospital-grade electric breast pump so they can soften their breasts whenever the need arises. They simply freeze their excess milk for later use-perhaps after they return to work.

Where feasible, supermilk producers can collect and donate their surplus milk to a Donor Milk Bank. This is an option available in Denver since we have a large distributing Mothers’ Milk Bank. Being able to provide extra milk for infants in need serves to reframe a woman’s “problem” and turn it into a positive.

Note: As unlikely as it seems right now, you actually can go from too much to too little milk in only a few days. I have seen this happen a number of times when women started skipping nursings and leaving their breasts engorged. Remember, extra milk is preferable to insufficient milk!

Nursing Strike
Occasionally, a breastfed infant starts refusing to nurse without apparent explanation. Nursing strike is an apt term used to describe this sudden breastfeeding refusal. It occurs most commonly between four and seven months of age. In a typical case of nursing strike, a mother will report that when she offers her breast, her baby cries, arches his back, pulls away, and essentially rejects the breast. He may latch on for a few seconds, but does not suckle for any appreciable time. The baby usually accepts a bottle well and is content to bottle-feed. Faced with this frustrating behavior in her infant, it is not uncommon for a woman to give up nursing and explain that her baby “weaned himself.” Other women are distressed at the prospect of not being able to continue breastfeeding and seek advice from their doctor or a breastfeeding counselor. With prompt intervention, nursing strikes can often be remedied, thus preserving the opportunity for a woman to continue to breastfeed.

At first consideration, a nursing strike appears to occur suddenly and without obvious reason. Upon more careful examination, however, I find that one or more contributing factors are usually present. Some infants begin their distressing behavior during the course of an upper-respiratory infection. A stuffy nose can create distress when a baby tries to breath while nursing. Or an ear infection can be more painful when a baby reclines to nurse. The refusal behavior sometimes coincides with teething and may be the result of discomfort while sucking. I’m also aware of a few instances of nursing strike that started after a teething infant bit his unsuspecting mother and caused her to shriek in surprise and pain-which, in turn, startled and upset the baby. A busy mother may find she has been hurrying feedings to get to other activities instead of permitting her infant leisurely nursings. Another baby may go on strike because he has been frustrated by an overabundant milk supply or an overactive milk ejection reflex. The common theme in these examples is some type of unpleasantness associated with breastfeeding.

While any number of reasons-recognized or overlooked-may contribute to a nursing strike, I have come to conclude that many cases also involve a gradually dwindling milk supply. After the early months of frequent, round-the-clock nursing, many mothers begin giving supplemental bottles and spending increased periods of time separated from their babies. A mother’s milk supply may decline after her baby starts sleeping through the night, causing her breasts to go eight, ten, or twelve hours without emptying. At first a mother may not even be aware that her supply is less abundant or that her baby is becoming frustrated with the increased effort to obtain milk. Without consciously planning it, she actually may have started weaning, and her baby may decide to escalate the process abruptly through a nursing strike. Thus, I believe the common denominator of nursing strikes all too often is low milk supply. When diminished milk flow is coupled with a baby who has been exposed to the ease of bottle-feeding, abrupt refusal to nurse can result. Low milk volume and bottle use aren’t always to blame, however. Other cases have been described in which the mother had an abundant milk supply and the baby was being fully breastfed.

If your baby is manifesting a nursing strike, seek consultation with a lactation consultant or other breastfeeding specialist. You also should let your baby’s doctor know that your infant is experiencing this feeding problem. The physician will want to make sure that no illness is present to explain your baby’s behavior and that the infant continues to receive sufficient nourishment during the period of breast refusal. Effective treatment of a nursing strike involves three key strategies:

1. First, try to get your baby to return to breastfeeding by attempting to nurse him in his sleep. Fortunately, most infants will cooperate, although some may cry upon awakening and finding themselves at the breast. Eventually, your baby may awaken and continue to nurse without protest. Some mothers have found that they could keep their child nursing by walking with the infant. Bottle-feeding should be avoided if at all possible. If your baby requires supplemental milk, several options are available for providing it without using bottles. If regular bottle-feeding is inevitable, try to have another caretaker give the bottle. If breastfeeding frustrates your baby because it does not satisfy his hunger, you may be able to woo him back to the breast beginning with “comfort nursing” after he has been given supplemental formula to curb his appetite.

2. Eliminate any unpleasantness associated with nursings and remedy any exacerbating factors. If your baby has a cold, nurse your infant after clearing the nasal passages with a bulb syringe. If you think an ear infection could be present, have your child checked and treated. Attempt to nurse in subdued, quiet surroundings to minimize distractions, and let your baby take all the time he wants. If discomfort from teething seems to be contributing to difficulty nursing, soothe your baby’s gums with a cold teething ring.

3. Evaluate your milk supply and, if low, attempt to increase your milk production. Even if your supply was normal prior to the nursing strike, your milk can rapidly decrease if your baby refuses to nurse. Once the original problem is compounded by low milk, it will be even harder to get your baby back to breastfeeding. So, unless your infant immediately can be enticed to resume breastfeeding at the normal frequency and for a suitable duration, you will need to obtain an effective breast pump to maintain (and increase) your milk supply. While hand expression and manual pumps prove highly effective for some women, in general, I recommend an efficient hospital-grade electric pump to regularly empty your breasts and keep your milk production up until your baby is nursing well once again.

Pumping can create a potential dilemma since you can’t predict when your baby might be willing to cooperate and nurse. It’s possible you will finish emptying your breasts with the pump just when your baby acts like he might be willing to breastfeed. On the other hand, if you leave your breasts unemptied while waiting expectantly for your baby to suckle, your milk supply may dwindle. I would advise putting your baby to breast every couple of hours (preferably with the infant asleep or drowsy at first). Then, you should pump both breasts immediately after your nurs-ing attempt to assure they are well drained.

With sufficient reassurance, a strong commitment to nursing, and the temporary discontinuation of bottle-feeding, a nursing strike often can be overcome. Increasing your milk if it is low and nursing your baby in his sleep are your best strategies.

Olahraga Vs ASI

Secara umum, ibu-ibu yang habis melahirkan dan sehat bisa melakukan olahraga dengan intensitas sedang (kalau Anda kurang bugar, intensitasnya ringan saja). Hal ini sudah diteliti dan sama sekali tidak mengganggu kegiatan laktasi.

Kathryn G. Dewey, Ph.D, seorang guru besar di bidang gizi pada University of California, sekitar tahun 1994 membandingkan 18 wanita yang habis melahirkan dan melakukan latihan (sekitar 4 kali seminggu, 45 menit, dan 60-70% dari denyut nadi maksimal) dengan 15 wanita yang sama sekali tidak melakukan latihan apa pun. Setelah diamati selama 12 minggu, kuantitas dan kualitas ASI ibu-ibu yang melakukan latihan ternyata tidak terganggu. Pertambahan berat badan bayinya pun baik. Selain itu, mereka juga tidak mengalami pusing atau capai setelah berolahraga.

Boks 7:

Indy Barends (31 tahun),

presenter, ibu seorang putra

“ Menyusui Membuat Berat Badan Cepat Turun”

Berat badan saya sebelum hamil 47 kg. Namun, selama hamil, berat saya naik sampai 24 kg! Kebayang, ‘kan? Untungnya, beberapa hari usai persalinan, berat saya langsung susut sekitar 15 kg. Sekarang Rafa, panggilan Rafael Benaya Sarmanella, sudah berusia 5 bulan. Nah, selama itulah proses pelangsingan tubuh saya berjalan. Sekarang, berat badan saya sudah 52 kg. Tapi, target saya, sih , bisa mencapai 47 kg lagi.

Untuk menurunkan berat badan, saya tidak ikut program apa pun. Saya hanya bertekat menyusui Rafa secara eksklusif selama 6 bulan. Bukankah menyusui secara otomatis akan mengurangi lemak? Nah, untuk melancarkan ASI, saya banyak makan buah-buahan, susu, dan sayuran, terutama daun katuk.

Faktor lain yang membuat berat badan saya cepat menyusut adalah mengurus Rafa sendiri. Mulai pagi sampai malam hari. Dijamin, deh , berat badan berkurang, walau tidak secara instan!

Saya tidak anti program pelangsingan yang banyak bertebaran di mana-mana. Tentu saja, sepanjang pengobatannya tidak memakai zat-zat yang dimasukkan ke dalam tubuh. Kalau tidak perlu, saya memang tidak mau ada zat kimia yang masuk ke dalam tubuh.

Dari banyak penelitian laktasi menunjukkan bahwa tidak ada pengaruh antara
aktivitas berolahraga dg produksi ASI.
Saya kutip disini ya hasil riset yg dilakukan byk ahli laktasi ;

“Aerobic exercise performed four or five times per week beginning six to
eight weeks postpartum had no adverse effect on lactation and
significantly improved the cardiovascular fitness of the mothers.” (N Engl
J Med 1994 Feb 17;330(7):449-453)

“Exercise sufficient to improve cardiovascular fitness without
substantially altering energy balance does not adversely affect lactation
performance.” (Nutr Rev 1994 Oct;52(10):358-360)

“Aerobic exercise improves cardiovascular fitness and does not affect milk
energy transfer to the infant.” (J Nutr 1998 Feb;128(2 Suppl):386S-389S)

“Exercising subjects tended to have higher milk volume (839 vs 776 g/d)
and energy output in milk (538 vs 494 kcal/d). Thus, there was no apparent
adverse effect of vigorous exercise on lactation performance.” (Am J Clin
Nutr 1990 Jul;52(1):103-109)

Saya yakin banyak sekali ibu disini yg rajin berolahraga dan tidak
bermasalah dg ASInya. Jadi gak usah khawatir ya mbak. Nanti kalo khawatir
malah hormon oksitosinnya jadi malas memproduksi ASI kan ?! Spt yg
disampaikan mbak sisil, jika ragu asi menurun, coba persering
memerah/mompa/menyusui. Dan relax tentu saja. Moloco dan suplemen ASI
lainnya hanya sbg tim horenya aja kok

Luluk Lely Soraya

Nipple Confusion

There are some basic mechanical differences between how a baby gets milk from a bottle and how a baby gets milk out of the breast. Giving bottles or pacifiers to young, breastfeeding babies often leads to nipple confusion. Baby tries to use the bottle-feeding technique on the breast and has difficulty latching-on and sucking. Baby gets very frustrated, and so does mother. Nipple confusion can even lead to baby refusing the breast. Here’s an explanation.

To get milk from the breast, baby must coordinate tongue and jaw movements in a sucking motion that’s unique to breastfeeding.

When baby latches onto the breast, he opens his mouth wide and draws the very stretchable nipple and areola tissue far back into his mouth. The tongue holds the breast tissue against the roof of baby’s mouth while forming a trough beneath the nipple and areola. The gums compress the milk sinuses underneath the areola (the pigmented area around the nipple) while the tongue rhythmically “milks” the breast
with a wave-like motion from front to back, drawing the milk from the areola and the nipple. Since the nipple is far back in baby’s mouth, it’s not compressed by the
gums, so it’s less likely to get sore. Babies suck from a bottle entirely differently. Thanks to gravity, milk flows from a bottle so easily that baby does not have to suck “correctly” to get milk.

He doesn’t have to open his mouth as wide or correctly turn out the lips to form a tight seal. The bottle nipple does not need to be far back into the mouth, nor is the
milking action of the tongue necessary. Baby can lazily gum the nubbin of the rubber and suck with only his lips. When the milk comes out too fast, baby may thrust his tongue forward and upward, to stop the flow from the nipple. Milk keeps on coming during feedings from bottles–whether or not baby sucks–so there are no pauses to rest during bottle-feedings. Problems occur when babies apply the lessons learned from bottle-feeding to nursing at the breast. When you compare the illustration of sucking at an artificial nipple with the illustration of sucking at the breast, you
will see that if baby sucks from the breast the same way he does the bottle, the tongue and the gums will traumatize mother’s nipple.

Babies who get bottles soon after birth may thrust their tongue upward during sucking and push the breast nipple out of their mouth. They don’t open their mouths wide enough when latching-on, so they suck only the tip of the nipple. They don’t get enough milk, and mother’s nipples get sore. Baby becomes accustomed to the immediate flow of milk that comes from the bottle; at the breast, babies have to suck for a minute or two to stimulate mother’s milk ejection reflex and get the milk flowing. Does this mean that bottle-feeding is easier than breastfeeding? Yes, and
no. Bottles require less sucking finesse and less effort. However, studies comparing premature infants during bottle-feedings and during breastfeedings have shown that breastfeeding is actually less stressful.

Babies’ breathing and heart rate are more stable during feedings at the breast.
Babies have more control over the milk flow and can establish a more regular rhythm of sucking, swallowing, and pausing. Feeding at the breast also requires less energy.

PREVENTING NIPPLE CONFUSION

It is easier to prevent nipple confusion than to fix it–though it is a problem that can be solved, should it occur (see below). Breastfed babies should not be given artificial nipples during the first three to four weeks when they are learning and perfecting their breastfeeding skills. Avoiding artificial nipples means avoiding pacifiers as well as bottles. Supplements, if medically necessary, can be given in ways that don’t
involve artificial nipples. (See Alternatives to Bottles.)

Will it be more difficult to introduce the bottle later? Many mothers, because they are going back to work or because they eventually plan to get out for a few hours by themselves, want their breastfed babies to accept feedings from bottles. They have heard stories of babies who adamantly refused anything but the breast. Getting baby to accept a bottle at age two or three months may take some patience, but most babies will catch on after a few tries. (Babies can also be fed with alternatives to bottles when mother is gone.) While introducing the bottle at one or two weeks of
age may insure that baby accepts the bottle later, you’re taking a risk. Some babies easily go back and forth between breast and bottle, but many others do not. Don’t jeopardize your breastfeeding relationship when it has barely begun.

UN-CONFUSING THE NIPPLE-CONFUSED BABY

When a baby who is getting bottles begins to balk at taking the breast, nipple confusion is probably at the heart of the problem. Here’s how to re-teach a baby what to do at the breast:

Banish bottles and pacifiers. Even if your baby will eventually have to learn to use the bottle because you are returning to work, don’t ask him to learn both skills at the same time.

If supplements are needed, they can be given in ways that don’t use artificial nipples. (See Alternatives to bottles.)

Reacquaint baby with the pleasures of breastfeeding. Give her lots of skin-to-skin contact. Carry her in a sling near the breast between feedings.

Breastfeed when baby is calm, usually in the morning or upon awakening from a nap. Don’t wait until baby is ravenously hungry–she’ll be in no mood to try something new.

Review the latch-on basics. Be sure that baby is positioned properly in your arms. Wait until her mouth is wide open and her tongue is down before latching her on to the breast.

Show and tell. Open your mouth as you say “open” to baby during latch-on. Even newborns can imitate adult facial expressions.

Provide baby with instant gratification at the breast. Use a breast pump or manual expression to stimulate your milk ejection reflex and get the milk flowing before latching baby on. She’ll be rewarded with a hearty flow of milk after the first few sucks.

Use an eyedropper or feeding syringe to drip milk into baby’s mouth as she latches on to the breast. (Get some help with this one.) This may encourage baby to stay latched-on and to continue sucking.

For more suggestions and support, get help from a La Leche League Leader or a lactation consultant. Babies often act puzzled or uncertain when they are re-introduced to the breast. Be patient. Praise your baby for every tiny step she takes back to breastfeeding. It may take a few days to woo baby back to the breast, but
you can do it.

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