Birth

Mothers whose pregnancy goes to full-term are likely to experience smoother labour and their babies fewer health problems than those who are early or late. According to the World Health Organization, a healthy birthweight is between 3000g (6.5lbs) and 3500g (7.75lbs). A baby weighing less than 2500g (5.5lbs) is considered to have a low birth weight. There are a number of factors that influence a baby’s birth weight including:

  • Mother and father’s height and weight.
  • Age of mother – teenage and mothers over 35 may have babies of lower birth weight.

  • First babies tend to have lower birth weight than those that come after.

  • Twins tend to be smaller than singular babies.

  • Being born prematurely.

  • Overweight women tend to give birth to larger than average babies.

  • Poor diet, smoking and drinking during pregnancy can all result in lower birth weight.

  • Boys are usually slightly heavier than girls.

  • Medical issues during pregnancy like anaemia and high blood pressure can result in lower birth weight.

  • Mothers with diabetes may have babies who are larger than average.

In the first week of life, new-borns are likely to lose weight, with formula fed babies losing around 5% and breast-fed babies 7-10%. Most will make good this loss during the second week.

Isilac recognises World Health Organisation recommendations and encourages mothers to breastfeed for the first 6 months of life, but also realises that when breastfeeding isn’t possible, for babies under one year, the only alternative is infant formula.Infant formulas are based on cows’ milk and have been developed, as far as possible, to mimic the content and benefits of breastmilk. Most formula milks will contain carbohydrates in the form of the milk sugar ‘lactose’, iron, protein, minerals such as calcium and zinc, and vitamins A, C, D, E and the B variants.The nutrients that are needed by babies include:
  • Calcium to help build strong bones and teeth.
  • Fat to create energy, help the brain develop, keep skin and hair healthy and protect against infection.
  • Folate to help cells divide.
  • Iron to build blood cells and help the brain develop. Breast-fed babies should receive iron supplements.
  • Protein & carbohydrates to provide energy and fuel growth.
  • Zinc to help grow and repair themselves.
  • Vitamins such as:

Vitamin A – To keep skin, hair, vision and the immune system healthy.
Vitamin B1 (thiamine) – To help the body turn food into energy.
Vitamin B2 (riboflavin) – To help the body turn food into energy and protect cells from damage.
Vitamin B3 (niacin) – To help the body turn food into energy and use fats and protein.
Vitamin B6 – To help keep the brain and immune system healthy.

Vitamin B12 – To keep the nerve and blood cells healthy and make DNA.
Vitamin C – To protect against infections, build bones and muscle and help wounds heal.
Vitamin D – To help the body absorb calcium and keep bones and teeth healthy. – Breast-fed babies may need a vitamin D supplement.
Vitamin E – To protect cells from damage and strengthen the immune system.
Vitamin K – To help the blood to clot.

It is recognised that breastmilk gives babies the best start in life as it contains pretty much everything that the new-born needs – in all the right proportions. Its composition even changes according to baby’s changing needs, especially during the first month of life – and even from the beginning to the end of an individual feed.

During the first days after birth, mothers produce a thick yellowish fluid called colostrum. It is high in protein, low in sugar and packed with antibodies that help baby fight off viruses and bacteria. Colostrum is the ideal first milk and helps the new-born’s immature digestive tract develop. After the first few days, mothers start producing larger amounts of milk as the baby’s stomach grows and its needs change.

Breastfeeding may reduce baby’s risk for many illnesses including respiratory tract and middle ear infections, colds, gut infections, sudden infant death syndrome, allergic conditions like asthma, dermatitis and eczema, bowel diseases, diabetes and childhood leukemia. It is also thought to help prevent childhood obesity and may even be beneficial for brain development.

Women who breastfeed have a lower risk for high blood pressure, arthritis, high blood fats, heart disease and type 2 diabetes. It is also thought to be linked to a lower risk of ovarian and breast cancer and helps avoid postpartum depression.

Continued breastfeeding helps the uterus return to its normal size and may pause ovulation and menstruation. This may be nature’s way of ensuring some time between pregnancies. Breastfeeding may also help mothers lose weight after pregnancy, but this is not guaranteed. Some women gain weight while others lose weight effortlessly.

Infant formula is usually made from cow’s milk that has been treated to make it suitable for babies. Some infant formulas like Isilac have been developed to more nearly mimic breastmilk with revised proportions of constituents like prebiotics, probiotics and long-chain polyunsaturated fatty acids. Most formula milks will contain carbohydrates in the form of the milk sugar ‘lactose’, iron, protein, minerals such as calcium and zinc, and vitamins A, C, D, E and the B variants.As babies grow, what they need from their formula milk changes. Consequently, formula milks are usually designed to suit the needs of babies who are:

From birth to 6 months
From 6-12 months
From 1 year

There are also other special formulas for babies who have particular requirements due to problems like colic or lactose intolerance.

Preparing a Feed

Instructions will vary between one formula and another, but the following points are a good guide:

  • 1
    Fill the kettle with at least 1 litre of fresh tap water. Do not use water that has been boiled before.
  • 2
    Boil the water. Then leave the water to cool for no more than 30 minutes, so that it remains at a temperature of at least 70ºC.
  • 3
    Clean and disinfect the surface you are going to use.
  • 4
    It is important that you wash your hands.
  • 5
    If you are using a cold-water steriliser, shake off any excess solution from the bottle and the teat, or rinse them with cooled boiled water from the kettle – not tap water.
  • 6
    Stand the bottle on the cleaned, disinfected surface.
  • 7
    Follow the manufacturer’s instructions and pour the amount of water you need into the bottle. Double check that the water level is correct. Always put the water in the bottle first, while it is still hot, before adding the powdered formula.
  • 8
    Loosely fill the scoop with formula powder, according to the manufacturer’s instructions, then level it either using the flat edge of a clean dry knife or the leveller provided.
  • 9
    Holding the edge of the teat, put it into the retaining ring, check it is secure, then screw the ring onto the bottle.
  • 10
    Cover the teat with the cap and shake the bottle until the powder is dissolved.
  • 11
    It is important to cool the formula, so it is not too hot to drink. Do this by holding the bottle (with the lid on) under cold running water.
  • 12
    Test the temperature of the formula on the inside of your wrist before giving it to baby. It should be body temperature which means it should feel warm or cool but not hot.
  • 13
    If there is any made-up feed left in the bottle after a feed, throw it away.

Dos & Don’ts of making up formula feeds

  • It is important to follow the manufacturer’s instructions carefully, as they vary as to how much water and powder to use.
  • Do not add extra formula powder when making up a feed. This can make baby constipated or dehydrated. Too little powder may not give baby enough nourishment.
  • Do not add sugar or cereals to baby’s formula.
  • Never warm up formula in a microwave, as it may heat the feed unevenly and burn baby’s mouth.

Sterilisation

It is important to sterilise babies’ feeding equipment, including bottles and teats until they are at least one year old. This will help protect baby against infections. Before sterilising it is necessary to:

  • Clean bottles, teats and other feeding equipment in hot, soapy water as soon as possible after feeds.
  • Use a clean bottle brush to clean bottles (only use this brush for cleaning bottles) and a small teat brush to clean the inside of teats. You can also turn teats inside out and wash them in hot soapy water.
  • Do not use salt to clean teats as this can be dangerous to baby.
  • If preferred, baby’s feeding equipment can be put in the dishwasher to clean it. Putting equipment through the dishwasher will clean it but does not sterilise it. Make sure bottles, lids and teats are facing downwards. You may prefer to wash teats separately by hand to make sure they are completely clean.
  • Rinse all equipment in clean, cold running water before sterilising.
There are several ways to sterilise baby’s feeding equipment:
  • Follow the manufacturer’s instructions.
  • Leave feeding equipment in the sterilising solution for at least 30 minutes.
  • Change the sterilising solution every 24 hours.
  • Make sure there are no air bubbles trapped in the bottles or teats when putting them in the sterilising solution.
  • The steriliser should have a floating cover or a plunger to keep all the equipment under the solution.
  • It is important to follow the manufacturer’s instructions as there are several types of steriliser.
  • Make sure the openings of the bottles and teats are facing downwards in the steriliser.
  • Manufacturers will give guidelines on how long you can leave equipment in the steriliser before it needs sterilising again.
  • Make sure the items you want to sterilise are safe to boil.
  • Boil the feeding equipment in a large pan of water for at least 10 minutes, making sure it all stays under the surface.
  • Set a timer so you do not forget to turn the heat off.
  • Be aware that teats tend to get damaged faster with this method. Regularly check that teats and bottles are not torn, cracked or damaged.
After you’ve finished sterilising, it is best to leave bottles and teats in the steriliser or pan until they are needed. If they are taken out, put the teats and lids on the bottles straight away. It is important to wash and dry hands before handling sterilised equipment and better still, use sterilised tongs. Bottles should be assembled on a clean disinfected surface or the upturned lid of the steriliser.

There are a number or reasons why mothers may want to combine breastfeeding with bottle feeding:
  • 1
    Mothers may be breastfeeding and want to use a bottle to offer baby some expressed breast milk.
  • 2
    Mothers may want to breastfeed for some of baby’s feeds but give bottles of formula for 1 or more feeds.
  • 3
    Mothers are bottle feeding baby and want to start breastfeeding.
  • 4
    Mothers who need to leave baby and to make sure baby has milk while they are away.
Introducing formula feeds can affect the amount of breast milk mothers produce and babies may not breastfeed well because the sucking action is different at the bottle than it is at the breast. Breastmilk supply will not usually be affected if bottle feeding is started when baby is a little older and mothers are breastfeeding every day.
If mothers are combining breastfeeding with formula feeds:
  • It is best to do it gradually in order to give the body time to reduce the amount of milk it makes. This should reduce the chance of getting uncomfortable swollen breasts or mastitis.
  • If mothers are going back to work, it is wise to start a few weeks beforehand so both mother and baby have time to readjust.
  • It usually helps to give babies their first bottle when they are happy and relaxed – not when they are very hungry.
  • It may help if someone else gives the first bottle feeds, so baby is away from mother and not smelling her breast milk.
  • It may be helpful to use a different position for bottle and breastfeeding.
It is a good idea to ask the midwife or health visitor for support, but the following may help:
  • Mothers should hold and cuddle baby as much as possible – ideally skin to skin. This will encourage mother’s body to make milk and baby to feed.
  • Express breast milk regularly – around 8 times a day including once at night is ideal. This releases the hormone prolactin which stimulates breasts to make milk.
  • Mothers should try bottle feeding while holding baby skin to skin – and near to the breasts.
  • If baby is latching on, feed little and often. Don’t worry if baby does not feed for long to begin with.
  • Choose times when baby is relaxed, alert and not too hungry.
  • Number of bottles should be reduced gradually as breastmilk supply increases.