Mothers Aware: Breastfeed for Your OWN Health!

We often hear of the myriad of benefits a baby gets from breastfeeding and breastmilk. These range from the antibodies and immune enhancing properties provided by colostrum, the changing but tailored macronutrient composition of breastmilk as an infant grows, to the reduction of infant mortality and a quicker recovery during illness for infants exclusively breastfed.

But what about for mothers? The list of benefits is just as impressive. Although more studies are needed, current research is showing that mothers with gestational diabetes who breastfeed tend to have better blood glucose control, and likely longer term benefits such as a reduced risk of type 2 diabetes, a reduced risk of metabolic syndrome and more long-term continued function of the pancreas in insulin production. The improved glucose control seems to come via many routes such as better glucose utilization for milk production and increased insulin secretion and pancreatic beta cell mass caused by the hormone prolactin which increases through lactation. Other benefits of breastfeeding for mothers include better cardiometabolic profiles, improved blood pressure levels, quicker contraction of the uterus postpartum and reduced ovarian and breast cancer risks.

From personal experience, this seems to be true. For my first pregnancy I had more severe gestational diabetes, requiring blood glucose checks 4 times a day, and relatively strict diet control to maintain good blood glucose levels. However,  I subsequently breastfed my firstborn for 15 months. When it came time for my oral glucose tolerance test (OGTT) during my second pregnancy, I was pleasantly surprised to see the results showing I had only borderline gestational diabetes. The doctor advised me that I only needed to check my glucose level once every day or so! As a result I had a much more relaxing second pregnancy and did not need to monitor everything I ate so closely, as my blood glucose levels staying mostly within range.  So mothers, breastfeed for your own health!

(Sources:

  1. Kalra B, Gupta Y, Kalra S. Breast feeding: preventive therapy for type 2 diabetes. J Pak Med Assoc. 2015; 65(10):1134-6. http://jpma.org.pk/PdfDownload/7505.pdf. Accessed May 15, 2016.
  1. Breastfeeding. World Health Organization. http://www.who.int/maternal_child_adolescent/topics/child/nutrition/breastfeeding/en/ . Accessed May 15, 2016.
  1. Gunderson EP. Impact of breastfeeding on maternal metabolism: implications for women with gestational diabetes. Curr Diab Rep. 2014; 14(2):460. http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4146528/pdf/nihms558299.pdf. Accessed May 15, 2016.
  1. Rabin RC. Breast-Feeding Is Good for Mothers, Not Just Babies, Studies Suggest. The New York Times. http://well.blogs.nytimes.com/2015/11/23/breast-feeding-is-good-for-mothers-not-just-babies/. November 23, 2015. Accessed May 15, 2016.
  1. Much D, Beyerlein A, Roßbauer M, Hummel S, Ziegler AG. Beneficial effects of breastfeeding in women with gestational diabetes mellitus. Mol Metab. 2014; 3(3):284-292. http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3986583/pdf/main.pdf. Accessed February 18, 2016.
  1. Ziegler AG, Wallner M, Kaiser I, Rossbauer M, Harsunen MH, Lachmann L, et al. Long-term protective effect of lactation on the development of type 2 diabetes in women with recent gestational diabetes mellitus. Diabetes.2012; 61:3167 – 3171. http://diabetes.diabetesjournals.org/content/61/12/3167.long. Accessed May 15, 2016.)

Qn of the Month: How Can I Tell My Baby Is Hungry?

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You just came home a few weeks ago with a newborn infant. How can you gauge whether your baby is hungry or crying for another reason? What many parents don’t realize is that crying is actually a very late feeding signal. Here are 10 important cues that may point to a baby being hungry and needing feeding… before the crying starts!

Watch for these signs in your infant (arranged generally in order from subtle to more visible signs):

  • General alertness
  • Starting to bring hand(s) to the mouth
  • Making sucking movements and sounds
  • Turning to you (the caregiver)
  • Starting to stick his or her tongue out
  • Turning his or her face towards the breast (rooting)
  • Displaying Rapid Eye Movement (REM)
  • Flexing arms and legs
  • Clenching fingers and fists
  • Displaying fussiness/crying

If possible, try to identify these signs and not to wait until your baby is really fussing and crying before feeding, because the baby may end up not breastfeeding or bottle feeding as well. To encourage latching on, a breastfeeding mother can show the infant the nipple and gently brush the baby’s cheek. This will stimulate the rooting reflex, causing baby to turn to the breast and latch on.

Moms Aware! What You Should Know About Keeping Breast Milk in the Fridge

As you may have seen by now, recommended storage times for expressed breast milk (EBM) in the freezer and in the fridge can vary quite a bit, depending on which guidelines you look at and factors like the type of freezer used.  For freshly pumped breast milk, the UK and US government guidelines are generally the same, which is that EBM can be stored in the back of the fridge for up to 5 days at a temperature of 4o C (39o F) or lower.

There is a study, cited in the American Academy of Pediatrics (AAP) 2012 position statement on Breastfeeding and the Use of Human Milk, which looked at the changes in expressed breast milk stored in a refrigerator in a hospital setting. Many factors were measured over time, including the pH, bacterial count, protein level and white blood cell counts. It found that EBM could be kept in a fridge for up to 96 hours (4 days) with minimal changes to its integrity. That’s good news. But, should expressed breast milk really be kept this long in the fridge? What about its taste?

What I have found over the months, is that the length of time the fresh breast milk sits in the fridge also impacts its taste. Very fresh breast milk tastes really good! It has a mild sweet aftertaste but is essentially quite bland. Think of 1% or non-fat cow’s milk but with a lighter, more watery and slightly sweet taste. By day 2, the expressed breast milk is already starting to taste a little ‘off’; you can taste a tiny bit of the free fatty acids from the lipases working, and a whitish layer forming on the top of the milk. By day 3, the ‘off’ soapy bitter taste is even stronger, even after mixing in the fat layer to the rest of the milk. I think at this point the baby may not be as willing to accept the milk already. If this is the case, you could try warming the milk more before offering it to baby, or use it in baby’s solids instead. By day 4, the ‘off’ taste gets even stronger. Much stronger.

The take home message? I would recommend using your expressed breast milk within 24 hours if kept in the fridge to optimize its taste and acceptability to the baby. Otherwise, definitely use it up by 4 days (96 hours). And still keep it at the back of the fridge! If you don’t think you’ll use it within 24 hours, then it may be best to freeze it, and then when you need it thaw the expressed breast milk and use it as soon as you can after it is thawed!
 

Sources:
1. Centers for Disease Control (CDC). Proper handling and storage of human milk.  http://www.cdc.gov/breastfeeding/recommendations/handling_breastmilk.htm. Accessed 26 October 2013.
2. National Health Service (NHS). Expressing and storing breast milk. http://www.nhs.uk/conditions/pregnancy-and-baby/pages/expressing-storing-breast-milk.aspx#close. Accessed 26 October 2013.
3.Section on Breastfeeding. American Academy of Pediatrics. Breastfeeding and the use of human milk. J Pediatr 2012;129: 3: e827-e841. http://pediatrics.aappublications.org/content/129/3/e827.full.pdf+html. Accessed 26 October, 2013.
4. Slutzah M, Codipilly CN, Potak D, Clark RM, Schanler RJ. Refrigerator storage of expressed human milk in the neonatal intensive care unit. J Pediatr. 2010;156(1):26–28.

Fresh Versus Frozen: The Taste of Thawed Breast Milk

Frozen thawed milk tastes different from fresh. How do I know? Because I was basically dared by my mother-in-law (MIL) to try my own breast milk (yes…). At the time, my baby was about 3 months of age and wasn’t taking breast milk well from the bottle. My MIL suggested it was the taste of the thawed breast milk, as her friend said her grandchildren had the same issue because the thawed breast milk did not taste good. I knew breast milk usually tasted slightly sweet because of the lactose content, but I didn’t really believe my MIL that there could be such a vast difference in taste between fresh and frozen to affect baby’s intake. Especially since I had learned as a dietitian that a baby doesn’t usually develop a strong taste preference until after 6 months of age. Before then it was often possible to get a baby established onto a more bitter tasting hydrolyzed formula even if the baby had been used to the sweet taste of breast milk. And after all, if the expressed breast milk had been quickly frozen, wouldn’t that slow down the lipase enzymatic action on the fats within the breast milk and so prevent the breast milk from going ‘off’ in taste? Well, my MIL then implied that if I didn’t believe her I should taste the breast milk myself. So I did. In front of her.

And okay… there IS a difference. Fresh breast milk tastes…fresh…a bit like cow’s milk but lighter, more watery and with a slightly sweet taste. The thawed breast milk tasted more bitter and metallic. I found it had to be heated more in temperature to make it more palatable tasting.

My little one still took the thawed frozen breast milk (sometimes with a bit of cajoling and distraction with a toy) from a bottle until about 4-5 months of age, then after that she seemed to get wise to the fact that it really didn’t taste very good, and so refused more adamantly to take it (even when she was really hungry). She would always drink fresh pumped breast milk though!

What I have found I needed to do was this: Give the frozen breast milk as soon as it has thawed. This means really within the first hour or two after it has been thawed out in the fridge. Doing so will keep the thawed frozen breast milk tasting as close as possible to freshly pumped milk. Any more than that, and the bitter, metallic and soapy taste starts to appear, especially the longer it sits (mainly because of the active components within the breast milk like the lipases which start to break down the fat within the milk).

Note that even if there are some taste changes in the thawed breast milk, you can still use it in the baby’s food, assuming the baby is eating at least a few tablespoons’ worth of solids in a sitting. This gets easier to do as baby gets bigger and eats more at a time. So don’t toss all your hard work of pumping away!