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The Wonders of Breastfeeding (original: pp16-23, 7 pages)- !Human Milk for Human Babies

This has been translated from Oketanisiki no Bonyu de Sodateru hon (Breastfeeding- !The Changes in FatYour Baby by The Oketani Method), published in 2002

- !Lactose, Which Makes Breast Milk Sweet(Syufunotomosya, Tokyo, Japan, translated in English by Ms. Amy Willison).

- !Special Proteins- !Breast milk: A Living Organism

The Oketani Method for breastfeeding, started through Ms. Sotomi Oketani, is a very
useful method for lactating mothers. It is neither easy nor simple to accumulate!Any Breast Can Produce Milk (original: pp25-34, 9pages)

scientific proof of the method's efficacy.

-

Humans are Made to Hold their Babies to Nurse

However, we are currently undertaking a process of verification using empirical-

Everyone’s Breasts are Different

methods.

-

The Structure of the Breast

We wish to extend our sincere gratitude to Ms. Amy Wilson for her excellent translation-

How Breast milk Comes Out

work of The Oketani Method. We also wish to thankfully acknowledge her extensive-

The Function of Hormones

encouragement and effort with our work.

- Feel Your Body’s Rhythms(Masayo Awano: Oketani International Project Team)-The Soft, Pliable Breast!The Correct Form for Holding and Nursing your Baby (original: pp58-70, 12 pages)- Preparing to Nurse-

Expressing milk-

Various Ways to Hold Your Baby while Nursing-

How to Nurse Successfully!Breastfeeding: The First Crucial Month (original: pp74 – 79, 5 pages)-

Babies are Made to Cry-

The Correlation Between Crying and Breast Milk-

Changes in the Mother’s Body-

The Role of the Family!Your Baby Is Born! The Time for Breastfeeding Has Come!
5-1 Breastfeeding – The First Time
5-2 Changes in the Breast
5-3 The Flavor of Colostrum12

5-4 The Physiology of the Newborn

  5-5 Problems During the First Week

(original: pp16-23, 7 pages)- !Human Milk for Human Babies

5-6 When Problems with Your Nipples Make Nursing Difficult

As is indicated by the word ‘mammal’, mammals are unique in that they raise their children on thebreast milk of their mothers. In nature, the elephant’s baby receives the breast milk of its elephant

6 A Monthly Guide for your Baby‘s Growth and Starting on Solid Foods (original: pp136-147, 11

mother, the lion baby that of its lion mother. This is necessary in order for the baby to receive thepages)

necessary nutrients to become an elephant or lion, respectively. In the same manner, human babies

6-1 The First Two Months

should be fed with the breast milk of their mothers, but in recent Japan, roughly two-thirds of

6-2 The Third Monthnewborn babies are fed with formula made from cow’s milk. Could it be that there is something with

6-3 Three to Six Months

the human mothers’ breasts that make milk production difficult? No, that is not possible; until very

6-4 Six Months to One Yearrecently, the human species developed without any problems into what it is today by feeding human

6-5 One Year to Two Yearsbabies breast milk, all without any problems.
Human breast milk is made to be the optimal nutritional sources for human babies, but even more,

7 For Those Who Feel They Are Not Producing Enough Milk

(original:

for each individual child, the breast milk of its mother is best. For example, mothers of premature

pp83-93, 10 pages)

babies produce milk that will enable their babies to grow and become healthy more quickly, and

7-1 A Seeming Lack of Breast Milkmothers who have been infected with a virus will secrete antibodies in their breast milk, which will

7-2 Amounts of Breast Milk

serve to protect the baby. In reverse, the same thing happens if the baby becomes ill. By nursing the

7-3 Evidence Indication You are Producing Sufficient Breast Milkbaby frequently, the germs will be transferred to the mother, where antibodies will be produced and7-4 How to Produce Large Quantities of Delicious Breast Milk

be once again transferred to the child. Thus, even though the mother is not aware of it, she is

7-5 For Those With a True Lack of Breast Milkchanging her milk everyday in order to meet the needs of her child. The formula of each maker is all

7-6 Returning to Nursing

the same, both in flavor and in nutritional content, but breast milk, just like people, is different from

7-7 For Babies with ‘Tongue-Tied Syndrome’person to person, and is the most perfect substance for the baby it is being produced for and there isnothing else exactly like it.

8 When to Wean Your Baby (original: pp164-166, 2 pages)

One can see the day to day changes in the breast milk by noticing the change from the colostrum, tothe transitional milk to the mature milk. In the beginning, the yellowish creamy milk slowly turns
white, and then almost blue as it turns into the very watery MATURE MILK. Just as the color
changes, the nutritional content also changes. In the colostrum, there is a great deal of antibodies toprotect newborn babies from the vast number of viruses. The amount calories in this milk is also
very high, so that is will provide enough nutrition for newborns even though they can drink very
little, as well as being a bit salty in order to purge the meconium as quickly as possible to prevent
jaundice.
If you pump the breast, the milk that is produced arrears weaker that formula. This is because breast
milk is approximately 90% water. Of the remaining 10%, one can find fat, protein, lactose and othernutrients. In other mammals, for instance, the seal, milk is over 50% fat, and has the consistency of34

butter. This is in order for these newborns to develop layers of fat as quickly as possible in order tonecessary amounts for the rapidly growing baby’s bones and teeth.

stay alive in their cold habitat. In addition, the difference in the makeup of the milk also leads to a

Besides lactose, breast milk also contains Oligo saccharin, which along with lactose promote thedifference in the way it is fed. Seals and whales are fed breast milk very high in fat, and even thoughdevelopment of Bacillus Bifidus in the intestines, which reduce the breeding rates of harmful

they are only nursed 2 to 3 times a day, they grow very quickly. Monkeys and humans, on the otherbacteria which cause diarrhea. This is the cause of the unique smell of bowel movements ofhand, whose breast milk is comparatively low in fat, babies must be fed more often and for a longer

babies who are breastfed. Finally, lactose has the unique property of breaking down at a steadyperiod of time. Thus, each animal produces the kind of breast milk necessary for its species torate, thus preventing a sudden increase in the amounts of sugar in the baby’s bloodstream, thus

survive... But what is it that is most necessary for humans?

even if a baby were to drink large amounts of breast milk, no harm could be caused.

The human brain is a very uniquely developed organ. Thus, human breast milk has evolved toprovide the necessary nutrients to allow the brain to develop most effectively.

- !Special Proteins
The lactation from both breast milk and cows milk is made up of two types of protein – casein- !The Changes in Fat

and whey protein. In the baby’s stomach, the casein mixes with the stomach acids to form ‘curd’,The most actively changing ingredient in human breast milk is fat. Both the amount and the make-up

a semi-solid substance similar to tofu. In comparison with the curd produced by breast milk,of the fat changes in relation to the development of the baby drinking, and it even changes during thewhich is soft and easily digested, curd produced from milk is larger and harder and thus is moreday, with the highest levels of fat found in morning milk and lower levels during the evening. It evendifficult to digest. Thus babies who drink milk requires more time to fully digest it.

changes during a single nursing session - the amount of fat increases towards the end of the nursing.

The other protein, whey protein, is made up of amino acids and various other substances,

Finally, the factor that most greatly affects the levels of fat in the mother’s milk is the mother’s dietwhich help to protect the baby from disease. One of these amino acids is taurine, which is crucial

itself (see p101, ‘Mother’s Diet during Nursing’).

for the formation of the brain cells and retina. Another, lactoferrin, protects infants from various

The essential fatty acids found which make up part of the fat in breast milk are necessary for the

diseases. For example, the colitis germs which cause diarrhea in infants try to use the protein inproper development of the nervous system. In addition, breast milk contains high level of cholesterol.

breast milk for nourishment to increase, but lactoferrin latches on to these proteins more quickly,

While this is considered to be a problem for adults, it is said to be necessary for babies who arethus decreasing the rate of reproduction of the germs.

maturing extremely rapidly. These things provide the necessary ingredients for the development of

In addition, breast milk is similar in make-up to blood. There are white blood cells and lymph

the brain and nervous system, as well as providing energy, but they are also hard to digest. Thus,

cells in breast milk just as in blood, both of which also serve to protect the baby against disease.

breast milk also contains ‘lipase’, an enzyme that promotes the digestion of fat, thus making theSecretory immunoglobulin IgA (SIgA) works directly on the mucous membranes of the infant’s

breakdown of fat in the intestines of the baby easier. These essential fatty acids, cholesterol, andintestines, bronchial tubes, mouth, nose and ears to prevent invasion of various viruses, allergens,lpase are all abundant in the human mother’s breast milk, but are almost nonexistent in cow’s milk.

and bacteria, thus babies who are raised on breast milk show fewer incidents of bronchitis,
tympanites (ear infection), and intestinal catarrh. SIgA is particularly abundant in the colostrum,- !Lactose, Which Makes Breast Milk Sweet

at levels equal to twenty times that found in adult blood serum, thus breastfeeding a newborn isLet’s compare the taste of breast milk and cow’s milk...Breast milk tastes just slightly sweet andlike giving your child pain-free immunization shots. These substances are not only present in thedelicious. Human breast milk contains 1.5 times the amount of lactose as cow’s milk, which iscolostrum, but continue to be secreted in breast milk throughout the time the child is nursing,more than of animals other than cows. Lactose can only be produced naturally be the mammary

though in less concentrated amounts, so it is said that children who nurse are strong and healthy.

glands, and is the ‘sugar of the breast’, which provides the baby not only energy, but is also

These substances are either nonexistent or are present only at very small levels in cow’s milk, andanother essential nutrient for the proper development of the brain and nervous systems. In

thus are produced and added artificially, but cannot reproduce exactly the naturally produced

addition, lactose facilitates the absorption of calcium contained in breast milk, thus providing thehuman mother’s milk.

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- ! Breast milk: A Living Organism

who breastfeed for long periods of time have fewer chances of contracting these forms of cancer.

Finally, vitamins and minerals are found in breast milk, and always at levels that are necessary andSome people worry that breastfeeding too long can result in weakening of the bones, but researchdigestible for the child, so there is never an insufficiency or overabundance of these nutrients. If one

results show that it actually leads to lower percentages of broken bones and osteoperosis. Thus, it

compares the levels of vitamins and iron in breast milk and formula, one may feel unsure that thecan be said that breastfeeding is a very important factor in women’s health.

small levels in breast milk will be sufficient for one’s child. But it is not a case of the levels being

There are also social advantages to breastfeeding. The fact that both mothers and their babies are

too low – it is just the amount that can be absorbed effectively by the infant. It is not a case of ‘thehealthier when breastfeeding is not only advantageous to individual household budgets, but also to

more, the better’, in fact, if overabundant, these nutrients can be a burden on the baby’s intestines

the national health budget as well. While the production of formula requires precious resources andand kidneys.

energy, there are no wasteful by-products to breastfeeding and no pollution of the environment, thus

It is obvious that breast milk is not only the best food for an infant, but that it also protects thebreastfeeding is good for the planet as well. Even though it is said that the research into formula hasbaby from disease. In addition, when compared to the formula-fed infant, we now know that breast

resulted in it becoming much more similar to breast milk, there are limits to man-made substances.

milk enables a sick child to recover more quickly, it is less likely to cause Sudden Infant Death

Only a mother’s breast can make such a wonderful substance as breast milk.

Syndrome (SIDS) (the number of formula fed infants dying from SIDS is 4 times that of breastfed
infants), it is more difficult to become overweight, the development of the jaw and teeth is better,!Any Breast Can Produce Milk (original: pp25-34, 9pages)

there are fewer incidences of heart conditions and cancer as adults, etc. But not only from a standpoint of physical health, but also from a standpoint of mental health, there are various merits such as
emotionally stability, that can be pointed out in children who are breastfed .

- !Humans are Made to Hold their Babies to Nurse
One woman once said, ‘It’s so hard to believe that my tiny breasts created this big and strong

For the brain and emotional development which is so crucial for the human infant, the use of the

body my son has!’ Another mother said, ‘After breastfeeding, I finally understand why I have twocleverly designed breastfeeding system provides the base for the child to live as a human being. The

breasts!’ Raising child in the uterus through the placenta, then enabling it to grow even further

mother’s milk is greatly effected by the mother herself. Climate, physical well-being, diet, sleeping

after birth through the production of milk by the breasts... women’s bodies are very cleverly

patterns, daily life, and other numerous factors all effect one another and finally the nutrients andmade!

flavor of the breast milk change on a minute-to-minute basis. Breast milk is a living substance. It
stimulates the baby as it makes the mind and body of the child.

Compared to other animals, most of which have nipples on their stomach, the human breast isboth comparatively large and located high on the chest. It is said that this is because humans

The advantages of breast milk are not only for the baby, but for the mother as well. The hormone

stand and face each other in order to communicate, or that this is so that the baby is at just theused in the production and expulsion of milk from the breast promotes the rapid recovery of theright height to focus on the mother’s face. One thing is sure, though - compared to other animals

uterus, and at the same time, relaxes the mother and creates the mothering instinct which causes

who can move themselves to their mother’s breast to feed right after birth, babies cannot walk at

women to feel affection towards their child. This helps the mother gain confidence and feelbirth, and thus must be held in order to feed. Until the human baby is ready to walk at about one

satisfaction in her child-raising methods. In addition, the increased production of these hormones

year or more, the mother has held the baby upwards of 3000-4000 times. Holding one’s baby toalso raises the immunity levels of the mother, and helps her to feel healthy and happy. Furthermore,breastfeed it is one of the most fundamental building blocks of the ‘Basic Trust Relationship’ thatbreastfeeding serves as a sort of natural diet, and the condition of their skin will improves, thus thea human needs to live. In being held, a baby feels ‘I am being protected and loved’, ‘the world isreason that so many people say that breastfeeding mothers look beautiful.

a place that I can trust’ in his whole body. The breast is a very important organ, attaching theIn addition, one should not overlook the fact that breastfeeding for a long period of time can help
protect the mother from various diseases. Breast cancer, cancer of the uterus and ovaries are effectedhearts of the mother and her child.
But just what exactly are the breasts made up of?

by genetics, environment, nutritional habits, and number of pregnancies, but it is said that women7

8

- !Everyone’s Breasts are Different

there are about fifteen to twenty of these stalks in each breast. Each of the ducts leading from

Both the size and shape of everyone’s breasts is different. Even the size and shape between

each gland and carrying the milk is called the mammary duct, and looks much like the stalk of

one person’s two breast can vary dramatically. The size of the breast is determined by the amountthe cauliflower. The mammary ducts become larger at one point near the nipple, an area calledof fat stored up in the breast . This fat acts as a cushion around the mammary glands and ductsthe ‘lactiferous sinus’, which controls the flow of the milk to the tip of the nipple, where it iswhich produce milk in the breast. As breast milk is produced in the mammary glands, there is nosecreted. Some people may see small spots on their nipples, but generally, as the milk ducts are

relationship between the size of the breast and the amount of milk produced. Thus, there is novery small, they are impossible to see with the naked eye. Most people have about ten ducts onneed to worry that having small breasts will result in a lack of breast milk, or that large breasts

each nipple, although some have as many as twenty.

are ‘all show and no power.’

Most baby bottle nipples have just one hole, easily visible to the naked eye, a quite simple

Besides the two breast that all women have on their chests, some women also have small

structure, which is quite different from the mother’s breast. The mother’s breast is quite

breast on their chest close to the armpit or in the armpit area, called ‘accessory or supernumerary

structurally complex and delicate. The baby adapts to these differences when it drinks, therefore

breasts. After birth, when the breast become engorged, it has been known for these accessory

the way a baby nurses is quite different from the way it feeds from a bottle. When both nursed

breasts to leak breast milk, but if they are iced, they will dry up naturally and shrink in size.

and fed with a bottle, some babies become confused and try to drink from the breast in the same

Also, the size, shape and color of the nipple and areola is, like the human face, different fromperson to person. Whether the nipple is large or small, flat or ‘pushed in’, whether the areola iswide or narrow, pink or black, whatever the size or shape, a mother can produce breast milk andnurse her child.

way as a bottle, which can lead to misshapen or crushed nipples, or nursing too high on the
nipple, which can injure it
In this manner, breast milk which is produced in the mammary glands flows through many
tiny ducts to join together, eventually pouring like a shower into the baby’s mouth.

We at Oketani call the half-sphere of the breast the ‘mammary body’. In roughly the middle ofthis body, we can find the areola and nipple. On the areola are small, white bumps, called- !How Breast milk Comes Out‘Montgomery Glands’, which are secretory glands producing a substance to lubricate the breast

A female’s breast are preparing for their future in nursing from a time a girl enters puberty (seeand prevent it from drying out and hardening after frequent feedings. Also, between the nipple

figure above). Upon entering puberty, the secretion of hormones rises, the mammary glands

and areola is what we call the nipple neck and areola around, which extends in length when the

begin to develop, and the breasts begin to swell in size. During pregnancy, the secretion of

baby feed, enabling the nipple to reach deep into the baby’s mouth. If this doesn’t lengthen

hormones increases again, causing further development of the mammary glands and swelling ofproperly, the nipples can become chapped and cracked. Both the nipple and areola are darker thanthe breasts. During this time, both hormones to promote the development of the breast and those

the rest of the breast. It is said that this is to enable the newborn to find the breast more easily,

to promote the production of milk are being secreted from the brain, but at the same time, theand the color gradually fades back to its original pinkish color approximately two months after

placenta is secreting a hormone to tell the body ‘I don’t need milk yet,’ so milk is not secreted

childbirth.

from the breasts. When the placenta leaves the body at birth, the hormone preventing thesecretion of milk leaves with it, and milk production begins in earnest.

- !The Structure of the Breast

In this way, from the time a woman becomes pregnant, her breasts are preparing for nursing,The breasts are on top of the greater pectoral muscle which covers the rib cage. The structure

and it is just a matter of ‘flipping the switch’ after birth. The newborn baby’s latching onto andof the inside of the breast is much like that of a cauliflower, Imagine the heads of each stalk assucking the nipples as what acts as this switch. The lips and tongue of the baby stimulate thethe mammary glands Each gland is like a tiny balloon, with a net-like mesh of blood capillaries

nipple, and when this stimulation goes through the spinal cord and reached the brain, theand myoepithelial cells, which expand and contract, covering the surface of each balloon.

hormone prolactin is secreted from the anterior pituitary gland in the brain. Due to the secretion

Between ten and a hundred of these balloons-like glands are gathered together on one stalk, andof prolactin, the capillaries surrounding the mammary glands become engorged with blood, and910

the mammary gland cells produce milk, which is then secreted into the balloon-like parts of the

In this way, the process of raising one’s child naturally and easily on breast milk is aided by the

mammary glands. It is said that for each 10 milliliters of milk, 500 milliliters of blood must passeffects of various hormones. Besides prolactin and oxytocin, corticoid and throxyn (thyroid

through the breasts. At the same time, the hormone oxytocin is also secreted from the post

hormone) are produced more actively during breastfeeding, which helps build energy and power

pituitary gland in the brain. This oxytocin induces the myoepithelial cells around the mammaryin the mother. By breastfeeding your baby, you are able to increase the production of hormones

glands to contract, thus forcing the milk produced in the ‘ balloon’ out into the milk duct, where

which enable her to approach child rearing in a positive way and treat your child with deep

it reaches the sinuses, is pulled into the nipple and out into the baby’s mouth and down its throat.

affection naturally and easily.

This process is repeated continuously (see picture at left). The hormone prolactin is secreted
when the baby stimulates the nipple by sucking on it. By nursing the baby frequently just after- !Feel Your Body’s Rhythms

birth, a great deal of this hormone is produced. Having the baby latch on to suckle and stimulate

Most women feel a sort of aching feeling in their breasts just about the time of nursing. This is

the nipple is the most important think for initiating milk production. Thus, after birth, you should

easier to feel when the baby is not latched on, rather than when it is nursing. This feeling isnurse your child as quickly and as frequently as possible. This is the best way to facilitate yourproduced by oxytocin, and is the feeling of the milk produced in the mammary glands being

milk production.

pumped out towards the nipples, with a feeling of ‘welling up’ or ‘springing forth’. In the
Oketani Method, this feeling is called the ‘lactogenic sensation’. and is felt differently in each

- ! The Function of Hormones

person.

The hormone prolactin, which promotes the production of milk, and the hormone oxytocin,

When you feel this ‘lactogenic sensation’ when the baby is latched on, look at the way the baby iswhich directs the milk towards the baby’s mouth, are both very important hormones for thenursing. You will see the baby go from a relaxed sucking to a dynamic, deep drink movement. A

nursing process. However, it has recently been discovered that they serve functions other thanbaby who nurses well can drink from 50 to 100 milliliters a minute during this time. The period,

just milk production.

however, does not last forever, but usually only about thirty seconds to a minute, after which

Prolactin is said to be the hormone which produces the ‘mothering instinct’, making the newsome babies go back to their relaxed sucking. After both the breast and the baby relax for a few

mother feel as such and develop the desire to care for and protect her child. It also relaxes her

minute, the feeling comes once again, and the baby drinks deeply once more. This cycle isduring nursing and makes her feel drowsy. Prolactin is secreted in greater amounts at night, thus

repeated about three times at a single nursing, thus allowing natural adjustment for the baby’s

nursing at night is very important for encouraging milk production. Therefore, while one muststomach, rather than causing it to expand too rapidly by pumping out continually. When thewake up several times to nurse at night, prolactin has the unique and delicate function that it

lactogenic sensation in the mother becomes synchronized with the desire to nurse in the baby, themakes it easy to both wake up and fall back to sleep after each nursing.

two feel as one, and nursing gradually settles into a two to three hour pattern. At this point, theOxytocin, at the same time it is pushing the milk out into the mammary ducts, is also contracting

mother and child both will develop a feeling of wellness in mind and body. In reverse, when thisthe muscles and uterus after birth, which leads to a faster recovery. In addition, oxytocin is

feeling becomes too sharp, or disappears, the milk-producing function in the breast diminishes,

known as ‘the love hormone’, because it makes the mother feel that her child is the cutest in thethe mother’s health declines, and she can feel great stress. In this way, one can say that theworld without bounds, and naturally brings out feelings of affection.

lactogenic sensation is a barometer of the mother’s body and breast condition.

In contrast with prolactin, which is secreted when the baby latches on to nurse, oxytocin is
produced when the mother thinks of the child or hears it crying. In reverse, if the mother is upset- !The Soft, Pliable Breastor in pain, or feels nervous or stress, oxytocin production ceases. However, there is already milk

You most likely understand by now that the most important thing for producing milk is to haveproduced in the breast, and when the mother feels relieved, the milk will once again be pumped

the baby nurse correctly and frequently, and for the mother to relax when nursing her child. Also,out.

you should keep your breasts soft in order to be able to produce a large quantity of milk. Ms.
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Sotomi Oketani, the originator of the Oketani Technique, discovered that in order to produce

Wash your hands thoroughly. There is no need to wipe or disinfect the nipple before nursing, aslarge quantities of milk, it is important that there be a proper amount of looseness at the base of

wiping the Montgomery Ducts can lead to dryness and cuts or splits in the nipple or areola.

the breast and the pectoral muscles, and termed this area the ‘base’ of the breast. People who

Wear clothes easy to nurse in. Wear clothes in which it is easy to expose both breasts.

cannot produce milk at all, or have other troubles when nursing, often find this area hard and stiff,

Breastfeeding is the most important form of skin-ship, so enjoy the feeling of the baby’s skinwithout the normal looseness of nursing mothers. In addition, with the recent dramatic change inagainst your own. It is not necessary to wear button-up clothing. A long elastic hair band can bemodern Japanese dietary habits and lack of exercise, many work using the shoulder and chest

used to hold up clothes for easy nursing (see picture).

areas, and the ‘base’ can become stiff easily. By using the Oketani Technique, this area softened,

Nurse in a place where you can relax and get comfortable. One of the best things about nursing iswhich in turn makes the whole breast area feel like a freshly-pounded rice cake (orthat you can do it anytime and anywhere. The production of breast milk increases when themarshmallow ), and enables the neck of the nipple to stretch more fully, all of which make itmother is relaxed, so find a place where you can get in a comfortable position and nurse at youreasier for the baby to nurse effectively. In addition, it increases the flow of blood to the whole

own pace. Using a cushion or pillow can also help you to nurse more comfortably (see picture).

breast area, relaxes the shoulder and back muscles of the mother, and generally refreshes the

Express some milk before nursing. In order to make it easier for the baby to nurse, soften up thewhole body. Of course, these all make for the production of delicious breast milk. Other forms ofnipple by squeezing some milk out. The goal is not to get a great deal of milk to come out.

breast massage focus on pressing, kneading or massaging the mammary gland system, but this is

Observe your nipples closely to see where the milk is expressed. When your nipples are soft, youmade up of tiny glands, capillaries and nerves crowded together in a netlike fashion. No matterare ready to nurse. For mothers with hard nipples or areolas, or mothers who produce so much

how much fat surrounds these, it is a very delicate area. The Oketani Technique protects this area

milk that their baby gags on it, the pre-nursing expression of milk is particularly important.

while focusing on the base of the breast in order to increase the flow of blood and the function ofMothers with a heavy flow of milk should pre-nurse until the flow lessens a little, making it

the lymph nodes.

easier for the baby to nurse.

The condition of the base often reflects the mother’s constitution and condition, her eating habits,
her overall lifestyle, and the baby’s manner of nursing. For example, if the mother is not nursing- ! Expressing milk

at night, the stored up milk will put pressure on the base of the breast, causing it to harden up and1) Wash your hands.

making it more difficult for milk to be pumped out. In this case, one would use the Oketani

2) Place your thumb and index finger approximately 2-3 centimeters (1 inch) from either side of theTechnique to improve the condition of the foundation, thus improving the flow of milk again, but

nipple at the edge of the areola (on the border of the areola)

if left with milk stored there, the breast’s condition will deteriorate again. For this reason, it is3) With your fingers, press on the areola so that it opens lightly (Figure 1), then bring the pads ofvery important to have a baby nurse frequently in order to keep the breasts as soft as fresh rice

your fingers together in a rhythmical manner (Figure 2)

cakes (marshmallows).

4) Do this at various angles. Do not twist, pull, stretch, or pinch the nipple, as it can lead to damage
and make it difficult for the baby to nurse. Express your milk gently, so as not to cause discomfort.

!The Correct Form for Holding and Nursing your Baby (original: pp58-70, 12 pages)
It is very important to master holding and feeding techniques in order to continue to nurse you

When special pumping is necessary:child smoothly. Understanding the basic techniques for both, and practicing them correctly, is the

If a child is born prematurely or if for some other reason the mother cannot be with it, if the mothereasiest route to success.

has concave nipples and the child cannot latch on well at first, or if the mother cannot nurse the childdue to her work schedule, pumping becomes necessary. There are several important points- !Preparing to Nurse

concerning this:Cut your fingernails to a short length

Disinfect an easy to use container with boiling water. It is not necessary to disinfect the nipples.
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Try to pump by hand if at all possible, as mechanical pumps can pull too hard at the nipple and(REVERSE HOLD) (Football Hold)

areola, causing damage to the mammary system behind.

When a child cannot nurse well in the regular hold, or the nipple is misshapen or crushed, try

Pump alternatively on the right and left breast. When the amount of milk coming out of one breast

nursing with the baby in the Reverse Hold (see picture, next page). Also, when breast milk builds

lessens, switch to the other.

up on the outside half of the breast, making it hard or stiff, this a good position for enabling the

It is better to pump several times in a short period than to pump once for a long time.

baby to nurse the milk out of that area more effectively and relieve your discomfort. In holding

Refer to ‘Breastfeeding for Working Mothers’ (page 182) for ways to freeze your milk.

the baby in the reverse hold, if the nipple and the areola don’t stretch enough, the nipple canbecome misshapen, and for some breasts, the breasts can become pulled back, causing the breast- !Various Ways to Hold Your Baby while Nursing

to be pulled to the outside and making it difficult for the baby to nurse, so one should pay careful

With a newborn baby, it is not unusual to nurse more than ten times a day/ If the mother is tense

attention when nursing in this position.

or holds herself too stiffly, it can result in sore shoulders or tendonitis, etc., so you should try to

When nursing from the right breast:

get in as comfortable a position as possible to prevent this.

19 Put the baby’s body on the right side of the mother with the mouth at the same height as theAlso, it is said that too frequent nursing can lead to cracked nipples, but it is actually the way anipple by placing cushions or pillows under the mother’s right armpit. Keep the right hand underchild is held or nursed that is what causes this. For a mother and her child, nursing is the firstthe back of the baby’s head to support it. Make sure that the baby’s back and head are aligned.

joint effort that they undertake together. The mother should try to act as ‘leader’, and be careful

2) Cup the right breast with the left hand to support it, and have the baby latch onto the nipple.

to hold the baby in a manner in which will not put a burden on the child.

3) When nursing from the left breast, reverse the position of each arm.

Here are two basic methods for holding your child. When the child becomes larger, you canarrange your holding position to suit him or her.
- !How to Nurse Successfully(REGULAR HOLD)

Watch carefully how the baby’s mouth moves as it nurses. Is the baby opening it’s mouth widely

When nursing from the right breast:

enough and taking the nipple in deeply enough that it’s mouth almost completely covers the1) Hold the baby so that the mother’s and the child’s stomachs press against each other. Rest the

areola? Is the baby’s tongue coming out beyond the lower gums to grasp the nipple firmly, andchild’s head in the crook of the right elbow, and hold it there by wrapping the arm lightly aroundmoving in a wave-like motion while the baby drinks? If the baby is holding the nipple lightly in

it. The same are should then run down the baby’s back, and the hand should support the bottom.

it’s mouth as if sipping from a bottle, it is not nursing efficiently. If the baby makes a clicking

Make sure that it is not only the neck facing inward or face down by keeping both the head andsound while nursing, it might be holding the nipple to lightly (or shallowly) in its mouth. This isbaby facing the mother.

often the cause of cracking, so you should remove the nipple and have the baby latch on again.

2) Bring the baby’s mouth to the height of the nipple. When the child is small, place a pillow or

Also, when newborns shake their heads back and forth before nursing, it is not because they arecushion on your lap to adjust the baby’s height.

refusing to nurse, but because they are searching for the breast. The mother should help them to3) Make sure that you are not leaning in too far forward, and release the tension in your shoulder

find and latch on to the nipple correctly.

muscles.
4) With the left hand, cup the breast to support it. When nursing, be sure to bring the baby to the

How to Insert the Nipple Correctly (Latching on)breast, not the breast to the baby.

When the baby latches on, make it open its mouth widely, after which you should direct your nipple

5) For the left breast, repeat the same process with the opposite arm.

straight into the back of the mouth, or along the roof of the mouth. When doing this, if you arecareful to NOT bring the breast to the baby, but bring the baby to the breast and lay the nipple on top

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of the tongue, it will be easier for the child to latch on and drink correctly.

begin to feel the ‘lactogenic sensation’. The mother can begin to nurse in synchronization with thisOnce the baby is latched on, observe carefully how the baby opens its mouth. Are the baby’s lips

feeling (see p. 32, ‘Feel Your Body’s Rhythm’). The baby will start nursing by sucking on the nipple

pouting outward, in the shape of a morning glory?

for a few seconds, and then stop and be still for a short period. It is waiting for the prolactin and

It is necessary for the baby to have the lactiferous sinus part below the areola in its mouth. If theoxytocin to be secreted and the breast milk to begin pumping forth after the stimulation of the nipple.

baby’s lips are folded inward towards the gums, the mother should use her finger to release theAfter this short period, the baby will begin to move their mouth vigorously, as well as their head andbaby’s hold on the nipple and have them latch on to the breast again so that the lips are pouting

body, as they drink down the milk that has sprung forth. At that time, you may feel a sort of achingoutward.

sensation from the lactogenic sensation in the breast that is not being nursed from. There are some

Also, while you can’t see the lower lip well when the baby is nursing, by putting your finger on thepeople who also find that this breast leaks milk while the baby is gulping down the milk from thebaby’s chin and pulling gently downward, the baby’s mouth will open wide and its lips will naturally

other breast. After a period generally lasting thirty seconds to a minute, your baby will stop gulping

pout outwards. Try to do this in rhythm with the baby’s nursing, but if it doesn’t work the first time,

down the milk and start drinking at a more moderate pace. Some babies even stop drinking andyou can always start again at the beginning.

drowse off during this period. After a few minutes, the lactogenic sensation will return, and you
should nurse from the opposite breast this time. Some babies fall asleep after drinking from only one

Nurse Back and Forth on Both Breasts

breast. If this occurs, you should change breasts at an earlier interval so that the baby drinks fromIn order to keep both breasts in the same condition and enable an equal amount of milk to beboth before falling asleep. During one nursing period, most women feel the lactogenic sensation

produced by both breasts, you should alternately. However, if nursing from one of your breasts is

between two and three times, but no matter how many times, it is important to nurse your child frompainful, one of your breasts is engorged, or the baby disfavors one of your breasts, you should start

both breasts.

on that side. But no matter how many problems you have with one or the other breast, you should
not always start on the same side, but sometimes start from the breast that is in better condition. This

Releasing Your Child’s Hold on the Nipple

is because the baby can nurse most strongly at the beginning of the nursing period, so that if you

If you release your baby’s hold on the nipple by simply pulling it off, it could cause damage to thealways start from the same side, the amount of milk produced on that side will increase. In order tonipple. Do not pull forcefully, but place you hand next to the baby’s mouth and stick your index

keep the breasts producing at equal levels, try to start nursing equally from both.

finger into the corner of the baby’s mouth between the gums and the tongue, and the baby will
naturally release the nipple (see picture).

Observe Your Nipples
When your baby has finished nursing and releases its hold on the nipple, look immediately at its

Burping & Spitting Up

shape. If the baby is nursing correctly, the nipple will be round in shape. Look carefully to see if it is

Baby’s who are nursing correctly do not have a great deal of problems with burping. However,crushed, or the top of the nipple is pointed. If the nipple is misshapen, it can lead to chapping or

babies who nurse with a sound of air being swallowed along with the milk, or babies who arecracking or even mastitis, so one should try again to change the baby’s way of nursing by making it

holding the nipple too shallowly in their mouths can swallow air and must be burped.

take the nipple in more deeply, holding the baby in a regular or reverse hold or a combination of thetwo, changing the direction of the baby’s mouth, and making sure that the baby nurses all the milk

Breastfeeding Frequency

out of the breast by having it nurse from various directions.

If your child seems to want to nurse more even though you have just finished nursing it, you should
allow it to do so for as long as it likes. For women who are not producing enough milk yet, nursing

Nursing in Sync with the ‘Lactogenic Sensation’frequently provides the stimulation necessary to promote the secretion of prolactin and increase theOnce the baby is nursing correctly and the mother’s breast are producing to capacity, the mother willamount of milk being produced. Once the milk production is in full swing, the mothers lactogenic

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sensation and the baby’s desire to nurse will come into sync, and the nursing cycle will begin to taketheir sleep time in REM sleep, but babies spend up to 50% of their sleep time in this level. Thus,

on a rhythm.

even though it seems as if babies do nothing but sleep all day, they are actually moving in and out

For babies whose sole nourishment is breast milk, other forms of nutrition or liquids are notof these cycles at 30 minute intervals or so. Adults can fall off into a deep sleep almost

necessary. There is no need to give your baby boiled water after taking a bath; nursing it is fine. It is

immediately, but babies can only reach the level of deep sleep after going through this REM levelalso not necessary to have your baby drink fruit juices or tea before one starts on solid foods. Shouldof sleep. Often, just after a baby has nursed, it seems to have dropped off to sleep, so the motheryour baby develop a fever, or have diarrhea or constipation, simply increase the frequency of nursing.

puts it down gently, only to have it wake up crying immediately with its eyes wide open. It is

Should it be necessary to give your baby formula, or if you have flat or convex nipples so it cannot

necessary to hold and rock your baby to sleep for twenty to thirty minutes before putting it down,

latch on to the nipple directly, the mother must feed her baby. In this case, it is best to feed yourso it will fall into the deep level of sleep. Why is it that babies enter this light stage of sleep every

child with a spoon or small cup rather than using a bottle. While your baby may not be able to nursehour? This is because the baby itself is stimulating its brain in order to promote its development.

well at first, and may spill alot, it will eventually learn how to use its tongue to wrap around the

It used to be said that a child that was restless right up until falling into sleep is intellegent, and it

nipple and take it in deeply in order to nurse correctly.

could be said that this stimulation is the reason.
As for the four levels of awareness when awake, the first level is that half-asleep time when the

Using a Spoonchild lies very still as if hypnotized, and doesn’t even respond much when spoken to. The next

Fill a teaspoon or baby spoon with breast milk or formula up to one third full, and place it on yourlevel is when the child is completely awake, and focuses on its mother with bright eyes and ababy’s lower lip (see picture). When it opens its mouth widely and sticks it tongue out beyond thelook upon its face that seems to say ‘I understand everything!’, ‘I can do anything!’. It is true thatgums, tilt the spoon and have the baby drink from the spoon by licking it. This will help you teachat this time, your baby is taking in many things. In particular, babies can see best in the 20 to 25

your baby how to use its tongue, so keep practicing little by little.

centimeter range (8 – 10 inches), which is just the distance of the mother’s face when nursing. It
can also hear very well, and is very sensitive to both smell and taste. It is the most sensitive to!Breastfeeding: The First Crucial Month (original: pp74 – 79, 5 pages)

touch, though, and loves to be touched and stroked.
If the child is held during this period of awakening, the time it spends in this level will increase,- !Babies are Made to Cry

however, if it is not paid enough attention to, it will enter the next level and begin fuss, waving its

The sound of a newborn crying can be quite effective in making all the adults around feelarms back and forth, moving more violently, and preparing to cry. Which is the final of the four

flustered, and wonder what it could be that is causing it to cry. Particularly in the first month, it islevels, when the baby stiffens all the muscles in its body and opens its mouth and lets out a cry

impossible to understand the meaning of their cries, whether they want to nurse, they want theirthat seems inconceivable for such a small body. The baby has no idea why it started to cry by thediapers change, etc., no matter how hard one listens.

time it reaches this level. Even in order to nurse, it is necessary to hold and rock the baby until its

Is it true that newborns do nothing but cry or sleep? It is said that newborns have two levels of

crying lessens. If the mother cares for the baby by nursing and changing the baby’s diapers before

sleeping, and four levels of conscious awareness when they are awake. The sleeping levels

the child reaches this level, she will not have to hear her child crying heavily too often. However,consist of deep sleep and light sleep. When they are sleeping deeply, their arms and leg muscles

if the baby does reach this level, what should the mother do? First, hold your child, then nurse it,

are completely relaxed and you can poke their cheeks, make a loud noise, or do virtuallyand finally change its diapers. In general, these three things fulfill most babies’ needs. As you cananything else and they won’t wake up. The other level of sleep is light sleep, in which they willsee, babies are in many more states than just sleeping and crying.

move their mouth as if nursing, smile, and sometimes move their arms and legs. If you lookclosely, you will also notice that their eyes are moving as well. This is an indication that they are- ! The Correlation Between Crying and Breast Milkin the REM level of sleep, in which it is possible to see dreams. Adults only spend 15 to 20% of

When a child cries, many new mothers worry that they might not be producing enough milk.

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However, most babies these days will drink energetically from a bottle even if they are perfectly

first month after childbirth, the newborn child and its mother are working furiously to try to getsatisfied with the amount of breast milk they just drank. This is because the primal instinct toto know each other and develop a rhythm together, so the people around them should justsuck on anything that touches their tongue lasts until approximately one month after birth, so aenvelop them with warmth and care.

baby will continue to drink from a bottle even if it has already nursed sufficiently. It is not

At the same time, it is also important to see to the environment of the mother and her changing

because the amount of breast milk being produced is insufficient.

body after childbirth. During the ‘lying-in’, or puerperal period, new mother’s bodies and minds

There are also other babies who sleep a great deal. They can sometimes sleep for three hours,

are both dramatically different than normal due to sudden changes in hormones. For years, thenurse, and then go right back to sleep, which may be a blessing for the first month for thosesaying of ‘three weeks in the sickbed’ was used for women who just gave childbirth, which ismothers. However, for children who continue to sleep for up to five or six hours at a stretch, it isbecause not only have there been incredible changes in the mother’s bodies, but also in theirnecessary to awaken and feed them at regular intervals, or the baby’s weight will not increase andpsychological makeup, and they are very sensitive during this period. It is very easy to fall into

the mother’s breast milk production will lessen. Even the child will not wake up no matter what‘maternity blues’ during this period, start crying at the slightest thing, or feel unfit as a mother

you try, you should express the milk yourself.

and become depressed. No one is a perfect mother from the very beginning. Raising a child isalso ‘raising’ yourself – you mature along with it. Right now, you probably have your hands full

- !Changes in the Mother’s Body

with just nursing your baby, but your baby is maturing even so, and the days when taking care of

It takes about four to eight weeks for the uterus to return to its original size after childbirth. While

your child becomes fun will come for sure. People around telling the new mother that she must

it is true that for mothers who breastfeed their children, this return to normal is faster and better‘grow up and take on this new responsibility’ create the risk of sending her into even greaterthan those who don’t, it is important to take it easy during this time. The first three weeks after

depression, so again, it is important to take all other work away from the mother and let her justchildbirth should be spent in pajamas, and the mother should lay down every time the baby goes

focus on nursing her child during this period.

down to sleep. Some people feel pain in the pelvic area or from the cuts of cesarean section,
which make it difficult to sit down, hold their child or move around freely, but this pain willrecede gradually.

5 Your Baby Is Born! The Time for Breastfeeding Has Come!

Also, mothers should be careful not to watch television or read small print for long periods oftime after childbirth, as this tires not only the eyes but the whole body as well. While it is true

Congratulations of the birth of your child. You must feel joyous to finally meet yourthat childbirth is not an illness, new mothers should try to leave as much of the housework as

beautiful baby face to face. This chapter explains when you should start nursing, howpossible to other family members, and rely on the help of family members while they concentrate

your breasts and the baby will change in the first few days, and how to settle into aon nursing their child.

nursing routine.

- !The Role of the Family

5-1 Breastfeeding – The First Time

In order for a new mother to nurse her child successfully, the cooperation of the whole family is

The first thing a baby puts into its mouth after birth should be its mothers breast.

essential. For first time mothers, the worry about whether they are producing enough milk is aThis is becoming more and more common in hospitals these days. Try to have your childbig one, and careless comments about such things at this time by members of the family canplace the nipple in its mouth as soon as possible after childbirth, even just to hold it

make these worries expand rapidly. Fathers and grandmothers who see the newborn child crying

there without sucking. This is just to help it learn, ‘This is my mother’, so sucking is nottend to say such things as ‘Is it getting enough milk?’, ‘Shall I feed it some formula?’. While they

important.

are only doing their best to help, these comments just discourage the nursing mother. During the21

Once the first hour of the newborn’s alert period is over, it will go to sleep, and the22mother should also rest then as well, to start recovering from childbirth. Then, once it

only a small amount of breast milk is secreted. Even expressing it oneself only produces

opens its eyes again, nurse the child once more.

a tiny amount of clear, yellowish colostrums. You may worry that your child is hungry,

If both the mother and child are healthy, you should try to keep them together

but babies at this age physiologically do not need to nurse yet. Some babies at this time

during their stay in the hospital. On the night of childbirth, even though the mother iscannot latch on or nurse correctly, or sleep or nurse constantly, or are continuously

tired, quite often she is also excited and thus cannot sleep, so it is helpful to have thecrying to be held and it is difficult to set a nursing rhythm yet. Just approach thisbaby by her side, where they can relax and get some rest together. Having the motherperiod as a time for both you and your child to practice nursing, and let your child nurse

and child together in the same room is a very natural style.

whenever it seems to want it.

When the baby moves its mouth in a drinking motion or cries out, try to nurse. This

After about the third day, the mother’s breast will start to feel engorged. The

stimulation of the nipples will send signals to the brain to initiate breast milk

mammary glands have become active and have begun to produce the yellowish

production. The more the baby tries to nurse the better, so don’t worry about how muchcolostrums in earnest now, but it is still only in small amounts.

time has passed – just feed the child whenever it seems to want to nurse. However, if it

By now, the baby as well has probably started to nurse more strongly, and sometimes

is nursing improperly, the nipples can become painful, so be sure to hold the baby in the

may fall asleep contentedly after nursing. During this period, the excretion of fluids

proper position.

from the body is greater than the amount taken in, and it is quite normal for mostIf it is impossible for the mother and child to be in the same room, ask that they callyou or bring the baby to you whenever it cries out.

babies to temporarily lose weight. Jaundice can also be seen in many newborns by thistime (see p.50, ‘The Physiology of Newborns’).

However, it the mother is very tired and is worried about the infant being with her,

You still may not have settled into a routine yet, and should continue to let youror she feels emotionally or physically incapable of caring for it, she should call for thechild nurse as often as it wants to. If it sleeps for more than three hours, wake it bymidwife or nurse to take the baby away and get some rest.

changing its diapers and nurse it then. If it still won’t wake up then, expel your breast
milk by hand, so as not to leave it in the breast, which could slow production.

5-2 Changes in the Breast

By the fourth or fifth day, some mothers will start to feel the lactation sensation

Just as everyone has a different face, they also have different breasts – large, small,periodically. Breast milk production has further increased, and the breasts may

long nipples, short nipples, etc. In addition, some mothers start producing milk very

continue to feel hard and engorged even after nursing. At this time, the colostrum

quickly while others take more time, and some produce a lot while others produce only abegins to change into a slightly whiter substance. The baby should slowly becoming

small amount. When nursing in the hospital with other new mothers, one cannot help

better at nursing, nut this is the period in which they lose the most weight and their

but compare, but remember that everyone is eventually able to produce breast milk, so

jaundice can become stronger.

just keep working at it.

By the sixth and seventh days, breast milk production in usually in full swing andEach newborn also has its own special characteristics – those who nurse well andmany new mothers can feel the lactation sensation, but their breasts are still usuallythose who don’t, those who suckle strongly or weakly, those who drink a lot and thoseengorged. The breast milk changes from colostrums to transitional milk to mature milk

who are satisfied with a small amount. Some babies are large, some small, some haveduring this time, getting more and more white. The baby is nursing more strongly and

impetuous personalities while others are more easy-going, some cry a great deal andit may have begun regaining weight, but it still may be jaundiced. While you still may

others not at all – from the time they are born, everyone is different. But they too will be

not have a nursing rhythm yet, be sure to nurse your baby no less than every two and aable to nurse eventually, so just relax and enjoy their progress.

half to three hours.

For the first couple of days after childbirth, there is little change in the breast, and23This is a rough explanation of the first week after childbirth, but it is important to24remember that everyone is different, so don’t get worried or upset if things are different
for you. Just be sure to nurse your child whenever it wants it, and you will eventually
discover your own pace.

the baby’s diet with formula during this time because they are losing weight.
The average weight loss for a baby is approximately 10% of its total body weight, butthere are some babies who lose even more. If the baby seems healthy and its weight

Many mothers say that their breasts feel ‘engorged’, but this is not necessary for

returns to the birth weight within two weeks of birth, there is no need to worry.

nursing. In fact, when the breasts are engorged, the nipples become hard and don’t
lengthen as easily, making it more difficult for the baby to nurse correctly. Try to nurse
before your breasts become engorged.

[Neonatal Jaundice]
Red blood cells in the blood are broken down by the liver into bilirubin and excreted

Also, some mothers aren’t able to produce much milk in the first week, but theirproduction will pick up eventually, so they shouldn’t give up.

as bile through the digestive tract. In a newborn, because there are a great deal of red
blood cells and because they have a short life span of only 60-90 days (as compared to an
adults 120 days), bilirubin is produced in large amounts. However, because the liver is

5-3 The Flavor of Colostrum

not fully functioning yet, this bilirubin can be excreted into the bloodstream, causing

Colostrum is full of immunity components. Try tasting it – you will find that it either

jaundice. This condition can be found in most newborns, and is usually temporary.

has no flavor at all, or that it is slightly salty, but that there is no sweetness to it. The

Usually by the fourth day or so, the liver’s functions improve and the bilirubin issalt is an important element, necessary to speed the expulsion of the meconium from

actively expelled, and thus the jaundice will go away. If it persists longer than normal,

the baby’s body.

or is more severe, the baby may need treatment by a physician, but the mother can still

After about three or four days, when the mother’s milk production increases, there

nurse. There is also something called ‘Breast milk jaundice’, in which the jaundice

will be a slightly sweet flavor to the breast milk. This milk will slowly change to thepersists longer than usual because the mother is breastfeeding, but there is no need tolight sweetness of mature milk.

stop nursing. However, there are a few cases in which a newborn’s condition may lead toa situation in which the mother is advised to stop breast feeding temporarily. Once the

5-4 The Physiology of the Newborn

child’s condition improves, you can go back to nursing, so be sure to continue to express

For an infant who has just spent ten months in the womb surrounded by amniotic

milk during this time.

fluid, birth brings about a dramatic environmental change. The first week for a
newborn is the period in which it must adjust itself to life outside the womb. Let’s take alook at the changes that occur in the baby during this time:[Meconium]
The first stools of the newborn are called ‘meconium’. They are very dark green andsticky, but by nursing the baby often, you are feeding it the colostrums, and the[Loss of Weight]

meconium will be expelled more quickly, also improving the baby’s jaundice.

A baby’s weight is 75 to 80% water, however, just after birth, they lose a great deal of

Next the baby should have yellowish-green ‘transitional stools’, after which they will

fluids through urine, bowel movements, tears and sweat. Because the mother’s breast

turn to the yellowish watery stools associated with breast milk. A baby can havemilk does not reach full production levels until three or four days after childbirth,anywhere from 1 or 2 stools all the way up to 10 stools a day.

babies will naturally lose weight during this time.
If the child was delivered normally, it should have approximately three days worth of
fluids and nutrition ‘saved up’ when it is born, and can thus wait until the mother’sbreast milk reaches normal levels of production. Thus there is no need to supplement25

5-5 Problems During the First Week
[Sudden Swelling of the Breasts]
Some women find that their breasts become very hot and painful with the sudden26

swelling after childbirth. When this happens, express milk by hand or through nursing.

Should the baby put painful pressure on the incisions on your stomach, hold it in an

If the breasts become hot, put a cool compress lightly on the affected area. Considering

inverted position or put a cushion between the mother and child, or continue to nurse it

the direction of blood flow into the breast, cooling the area from the upper breast to thelying down. Children born through caesarean sections have not had to go through aarea close to the armpits is most effective. In using cold compresses, it is important togreat deal of stress at the time of birth, and thus sometimes are not adequately aware

not cool the breast constantly, and to nurse or express milk every three hours or less.

that they have exited the womb. This may result in the child not trying to nurse very

Also, using ice or ice packs directly on the breast is too cold and will make the mammary

often, but don’t give up – just continue to practice as much as possible.

glands become even harder, so wrap the pack in a towel and cool the breast down
gradually. When using a glue pack, wrap it in a handkerchief to prevent the affectedarea from becoming cooled too rapidly.

[Problems After the First Week]
Most hospitals in Japan discharge mothers and their children after four to six days.

By avoiding high calorie foods and nursing frequently, this sudden swelling should

At this time, a mother’s patterns are still not very regular, and often the mother is still

slowly go down. It can also be prevented by keeping the mother and child in the same

not producing much breast milk yet. Many women are not used to their new

hospital room so that they can nurse every three hours or less to keep the mammary

motherhood and can become very anxious at this time.

ducts open and promote the flow of breast milk, and by avoiding high calorie foods.

But don’t worry. You will slowly become accustomed to your new life with your child,so the important thing is to try to relax and approach child rearing with an unstrained[Lack of Sufficient Breast Milk]

attitude.

It is difficult to tell whether the mother has a lack of breast milk in the first few days

The most important thing about raising your child on breast milk is to continue toafter birth. If the baby is being nursed regularly, the mother’s milk production should

nurse it often. Believe that childbirth makes the production of breast milk possible forstart by the third or fourth day, but there are some women who take even longer to start

everyone and continue to practice.

producing. Even after a week, it is still too soon to tell whether a woman is having

And finally, should you feel worried or anxious, do not try to struggle through is

problems producing breast milk. The most important thing during this time is toalone. Go to a lactician specialist or see a midwife at an Oketani Workshop and feel freecontinue nursing your child directly from the breast, and try to avoid giving it formula

to discuss any problems you might have!

as much as possible.
5-6 When Problems with Your Nipples Make Nursing Difficult[For Women Who Have Had A Caesarean Section]
There is no reason why women who have had a caesarean section cannot nurse their

Convex and Flat Nipples

children, so you should have the baby brought to you to nurse as soon as possible after‘My nipples are flat, and I’m not sure whether or not my baby will be able to latch

its birth. You should be able to move from left to right, so have someone help you to lie

on,’ ‘My nipples are convex, and I don’t know how to nurse my child.’ These are some of

the child down next to you and have it practice taking the nipple into its mouth, even if

the worries that many new mothers have. Just as every person has a different face, each

only to lick at it. Again, it is only necessary that the child begin to understand thatmother has different nipples. Large, small, flat, convex – often the left and right nipples‘these are its mother’s breasts’ at this time.

on the same woman are different. But none of these things should prevent you from

Each hospital has its own policies, but having your child in the same room as soon as

nursing your child. Look at a child who is nursing well. They always open their mouth

possible and nursing it as often as it wants is the fastest way to promote the production

very wide and not only take in the nipple, but the whole areola, When they do this, theirof one’s breast milk and becoming able to nurse one’s child smoothly.

upper and lower lips are puckered out like a morning glory (see picture). Thus, even if

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your nipples are small or convex, if a baby opens its mouth widely this way, they cantake in a large amount of the tip of the breast and are this able to nurse properly.

It is more important to try to correct a problem with convex nipples after childbirththan to try to do something about them during pregnancy. The first thing to do is to

In order to make this possible, you should try to nurse your infant as soon as possible

make sure your child does not use a pacifier or bottle with a small nipple. Because theafter birth, when the nipple and areola are still soft and supple. If you wait until thechild can hold onto and drink from either nipple without having to open its mouthbreasts have become engorged, the nipples will become too firm and be difficult to latch

widely or move its tongue, it becomes used to them very easily. If it is absolutely

onto, so you should consult with the hospital and arrange with the staff to nurse

impossible to have the child nurse directly from the breast, feed it with a spoon or a

immediately after delivery.

small cup. Even a newborn can drink from these skillfully.

At first, it may be difficult to nurse successfully and the newborn may do little more

The second thing necessary to enable the child to nurse successfully is to express

than lick at the nipples, but that is fine. The most important thing is for the baby tomilk every 3 hours or less and keep the breast in good condition for the baby. Using

become accustomed to the mother’s breasts, so be sure to do this as soon as possible.

improper massage techniques or an electric breast pump in order to try to increase theIn the case of flat or convex nipples, it is helpful to express some milk manually

production of breast milk can damage the nipple and areola, so you should only express

before nursing in order to soften up the nipples. To start nursing, cup the breast loosely

milk gently by hand. Using a nipple shield continuously can also cause the nipple toand guide the tip towards the baby’s mouth. Tap the mouth gently with the nipple andbecome hard and cause a disruption in the production of breast milk, and should only bewhen the baby opens its mouth widely, insert the nipple deep into the back of the mouth

used following proper instruction. With Oketani Massage, the convex nipple feels as if it

until the areola has disappeared. The breast may slip out, or the areola may not be fully

is resulting from the ligament supporting the breast being strongly pulled by theinserted. In this case, repeat the procedure as many times as necessary until the nipple

foundation of the breast. Through massage, this ligament becomes lengthens and theis correctly inserted.

nipple comes out, thus making it easier for the child to nurse.

For children who don’t open their mouths wide sufficiently, use the Pigeon ‘Nursing

When a child is unable to latch on and nurse correctly, many mothers becomeWorkshop’ Bottle to make the baby practice opening its mouth widely. Once the baby

depressed. Both time and perseverance are necessary at this time in order to enable thehas become accustomed to this position, gently try to switch it back to the breast (see p.

baby to nurse successfully from the breast. The family should try to be as cooperative as58, ‘Correct Ways to Hold and Nurse’).

possible, and enable the mother to spend her time and energy focusing on her child.

There are times when the baby is crying to hard that its tongue rises up from thefloor of the mouth and the baby is unable to latch on to the breast correctly. If thishappens, use previously expelled breast milk or formula and feed a little to the baby
with a spoon to calm it down, after which you can return the baby to the breast.
It is not necessary for women with convex nipples to massage their breast or use asuction sup to try to bring them out during pregnancy. In addition, some suggest that

When Nipples Become Cracked and Painful
For some women, the nipples may develop blood or water blisters, which then break
open and form scabs, or the areola has cracks that are extremely painful when nursing.
In some cases, these cracks may actually start bleeding, taking the joy out of nursing
and making it an extremely trying experience.

these women should wear breast shields to protect their nipples, but not only is their noThese problems can be caused by a baby who latches onto the tip of the nipple or a

proof that they are helpful, they can actually put pressure on the developing mammary

mother who holds her child incorrectly, which can cause the nipple to be crushed as theducts, which will result in the hardening of the breasts, and thus are not recommended.

baby nurses from an incorrect angle. If this happens, change the way you are nursing

During pregnancy, it is enough to simply clean the nipples when bathing every nightthe child in order to enable it to take in the nipple deeply, In addition, if the breast isand to go without a brassiere occasionally to allow the breasts a chance to come into

engorged and the nipple has hardened, it will be difficult for the child to latch on deeply,

direct contact with the air.

so express a nit of milk before nursing to soften the nipples. You could also continue to29

30

express milk long enough to get the lactation sensation and then quickly have the baby

the pain and speeding the healing process, so please don’t suffer alone.

latch on, which will also help to lessen the pain. Furthermore, you can change theposition of the child so that the portion of the nipple that is injured is inserted into theside of the child’s mouth.

6

A Monthly Guide to Nursing

If it is just too painful to nurse at all, you may have to stop for a short time, but you
must be sure to express milk at least every 3 hours or less. Without this stimulation,

6-1 One to Two Months

your milk production will drop.

After the first month after birth, your baby’s face will have become more expressive,

One of the common causes of injury to the breast found in new mothers is caused byand you will feel it is even cuter than it was when it was born. Some first-time mothers

wiping down or disinfection of the nipple. When the breast is wiped for disinfection, themay still not quite be used to caring for their children yet, and may not have developed

natural oils protecting it are also wiped away, leaving chafed skin that is more easily

their feelings of affection fully yet. Also, some mothers may become worried when, at

injured. The nipple and areola have naturally existing bacteria which keep them clean,

their baby’s one-month check-up, they find out that their baby’s weight is below average.

and the mother also has white blood cells and lymph cells in her breast milk which kill

However, this is not necessarily due to an insufficiency in breast milk. Not all babies ofbacteria, so there is no need to sterilize the nipple before nursing.

mothers who produce a great deal of milk gain a lot of weight.

In very rare cases, the nipple can be injured and become inflamed. The whole nipple

The Oketani Method conducted a survey of mothers who had raised their children

and areola area develops a burning sensation and a stinging pain, and becomes red as if

solely on breast milk, and discovered that the height and weight of these babies were

the skin had peeled off. This is most likely caused by candida bacteria. If the baby has

slightly lower than the average of that of the Ministry of Health and Welfare’s data,oral candidiasis (white mouth) or a severe diaper rash caused by candida, it is necessary

which measured babies raised on breast milk alone, breast milk and formula, andto treat the condition using medicine in both mother and child simultaneously. One

formula alone. In addition, they found that babies raised on breast milk had slightly

should see a pediatrician or a gynecologist in this case.

larger head and chest measurements, and to have more solidly- built body types (seeWhen a baby is very young, they sometimes object to the flavor of the mother’s milk
by pulling on the nipple, twisting their bodies around, or biting, all of which can also be

p.138, Changes in the Weight of Nursing Babies). Nursing requires the use of muscles
throughout the body, thus improving the circulation and the health of the baby.

the cause of injury to the nipple. Also, some babies bite when they begin teething. When

Looking at each child individually, we find that one child may start small but begin

this happens, do not think it is a sign to stop nursing altogether. If you are bitten,

to grow suddenly at about 12 months, while another may grow rapidly until threerelease the child’s hold on the nipple immediately saying, ‘Don’t bite, or you won’t bemonths and then taper off, each child growing in a manner which is best for them. This

able to nurse anymore.’ Also, be sure to be careful of what you eat in order to ensure

is the most healthy method, thus you need not be concerned about the differences inthat the flavor of your milk is good.

sizes of yours and other babies.

There are also some babies who bite to signal the end of each nursing session. These

Sometimes you may find that even though you have nursed and changed your baby,

children always look at their mother before they finish, so observe them carefully and

it is still very fussy. This often happens in the early evening, just as you are beginninguse your finger to release their hold on the nipple before they bite.

preparations for dinner, which can cause you a great deal of stress. This fussiness is due

In any case, an injury caused by a bite will always heal, so don’t give up nursing

to the development of the nervous system, and is common to most babies during their

altogether. However, should you find it difficult to nurse your child correctly and havesudden growth spurts. They may cry unless they are held, and some may even continue

an injury that doesn’t heal, getting an Oketani Massage can soften the foundation of theto cry when they are held, making the mother fret about what could be wrong. Whenbreast, areola and nipple, and enable the tip of the breast to stretch more, thus easing

this happens, try taking the baby outside for some fresh air. Both the mother and the3132

baby will enjoy the change in scenery and feel more refreshed.

night, you can try to wake the baby to nurse when you get the baby up to change its

There are also cases in which, even though it has nursed sufficiently, the baby will

diapers during the night. If even that doesn’t work and the baby continues to sleep, you

not release the nipple, sucking furiously when the mother tries to release the baby’s grip,

should pump yourself. Even a small amount of pumping is sufficient. The mostor crying when the nipple is taken away. Although it may be difficult at times, try to let

important thing is to not let more than three hours pass between each nursing or

the baby nurse until it is fully content. A baby feels most content when being held by its

expression of milk.

mother and nursing. There is no need to worry that it will become dependant on being

At this stage, many babies will bring their hands to their mouths often. Many startheld at all times. Holding and nursing your baby until it is fully content during thisby sucking their fists or knuckles, but will often change to sucking their fingers. This isperiod is the fastest way of developing the basic relationship of trust between mothera normal part of an infant’s development, and is not an indication of hunger. Do not feeland child and encouraging the development of the baby’s emotions.

that you must nurse your baby every time they suck their fingers.

6-2

Two – Three Months

As they grow, the baby’s bowel movements will also change. The watery bowel

In the past, people called the first 100 days after birth the ‘seedling period’, andmovements which occurred several times a day until they were about a month old willconsidered it a period in which all one’s efforts must be put into the care of the newborn.

lessen in frequency to about one or two times a day, and some babies may start to go“The 100-Day Cry” or ” the “100-Day Holding of Happiness”, the hundredth day was

three to four days without one, sometimes even up to a week. Mothers should also be

considered to be a turning point for the newborn. It does indeed seem that after theaware of their bowel movements, and care for their bodies so that it does continue.

100th day, the baby is able to play by itself a bit during the day, and caring for your childShould your baby become constipated, one way to solve this is to breastfeed more

becomes noticeably easier. Even though it still needs to be held most of the time, thefrequently. When fed infrequently, the baby is drinking breast milk that has been

baby begins to answer the mother with gurgles of its own. Try to talk to your baby assitting in the breast for long periods of time, which makes it easier for them to becomemuch as possible now.

constipated and have to really push to get their bowel movements out. When this

It is about this time that the mother’s lactogenic feeling and the baby’s desire tohappens, massaging their stomachs or giving them stimulate with cotton swab can benurse become synchronized, and nursing falls into a schedule of about every 2-2.5 hours.

effective. If that doesn’t work, a regular enema should be given. Eventually, as the baby

In particular, once the baby’s weight exceeds about 4.8 kilograms, it begins to be able tolearns to turn over and begins to eat solid foods, this constipation should end.

drink more effectively, and your breasts will thus become softer. Though you may feelthat your breasts should feel full for them to produce adequate amounts of milk, it isfrom this time on that the breasts actually change to produce only at scheduled nursing
times or when the baby is actually nursing.

6-3 Three – Six Months
As the baby’s neck gets stronger and stronger and it learns to turn over, its horizons
begin to expand dramatically. Once it can hold its head up, it can be carried in a carrieron the back. Try to use this and take your baby out more often.

There are also babies who begin to sleep long hours during the night by now. It is

After about three months, your baby will become even better at nursing, and will beoften said that babies that sleep well grow strong more quickly, but if one does not nurse

able to nurse large amounts of milk in a short period of time. It has also probably

at night for a continuous period, the mother’s milk production will go down, and in some

stopped crying and needing to nurse as frequently. You may also find that there re times

cases, menstruation may resume. If this happens, the flavor of the breast milk may

when the baby won’t nurse as often as other times. On one day, the baby may nurse

become bad, and the baby may give up nursing altogether. Try to retain a regularlightly and then play cheerfully, while another day, it might nurse for over an hour at apattern of nursing, and return to it as quickly as possible if some change in it occurs. At

time. In particular, some babies may want to nurse for long periods of time before bed at

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night. Mothers should try to accommodate their children during this period, nursing

immunities they received from the mother while in the uterus, but after about six

them as long and as often as they feel the need to. There is no need to feel that you

months, this natural immunity weakens. There is still some present in breast milk,

should reduce the number of times or amount of breastfeeding you have done until now

however, so you should make an effort to not allow excessive time to pass between

because they have reached this age.

feedings. Breast milk is especially important when the baby is sick. By breastfeeding toDuring this period, the mother’s breast will again become smaller and softer, but

overcome illness, the baby slowly builds up its resistance to further disease.

there is still no reduction in the amount of breast milk being produced.

At about six months, mothers should begin feeding your baby solid foods, while still

A child’s development is also progressing quite rapidly during this period, but eachcontinuing to breastfeed. Some may feel they should stop breastfeeding because theirchild progresses at different speeds. The steps or levels written in child-raising books

child doesn’t eat much, but actually the baby will not eat more if you stop, and will

provide a certain measure, but please don’t try to compare your baby to everythingactually be losing all the nutrients they were getting from nursing, so please do not stop

written in them. There is a certain order to development, and each child must progressnursing your child.

through that order at their own pace. There is no need to make them practice things.
Please just help them to progress naturally.

Some mothers experience problems with crying during the night, due to the baby’s
bad dreams or for other reasons. When this happens, you should first try nursing yourchild. This usually calms them down and stops their fussing. Holding your child is the

6-4 Six Months to 1 Year

best way to relax and reassure them.

With the development of their ability to move, your baby will progress from turningover to crawling to standing and walking during this period. In addition, its face will
become continually more expressive. Watching a mother and her child exchanging gazes
during this period is one of the most beautiful things in the world.

6-5

One to Two Years
A mother will never forget the first time her child stands and takes those first few

steps with a surprised look on their face. Learning to walk is the first step towards

Mothers usually begin to feel the fun of child raising as well during this period. It isindependence. Though most other mammals are able to walk shortly after born, because

generally thought that all women have the ‘mothering instinct’, and with the onset ofhuman babies are not fully developed at birth, it takes roughly a year for them to takepregnancy and childbirth, this instinct kicks in and they are able to adjust to being atheir first steps. Thus, in order for a child to become fully human, it is necessary formother easily, but this is not true. Bringing up a child is also bringing up oneself, andthem to continue to receive breast milk, which serves as a sort of ‘second placenta’ afterwith the nursing of your child, you will slowly become closer to feeling like a mother, asbirth.

the hormones released during nursing bring you naturally into the will to care for andraise your child

The Oketani Method says that once a baby can stand on two legs and walk, it has
become a human being and can thus be weaned. Roughly half of all babies can walk at

Breastfeeding is not something which one person instigates themselves. As the

12 months, but there are variations of anywhere between 8 and 16 months. This ismother feel her milk flow and the baby stimulates the breast during nursing, theinfluenced by the child’s muscle development, sense of balance and personality, among

mother and child’s rhythm become synchronized. They begin to feel as one, and childother things. One should take into account these differences and use the guideline of ’raising begins to become enjoyable during this period.

walking steadily’ as a guideline for weaning your child. However, regardless of walking

It is also during this time that most babies begin to show teeth. Babies who areability, weaning before the age of 12 months is not recommended. Conversely,

teething often have bad moods or a fever or other physical maladies. When nursing apremature babies and nannies who have had an illness may not walk until later, andbaby, it is very easy to tell whether or not the `baby has a fever. The first time the childnursing is important for building their strength.

has a fever, the mother may panic. Until this time, your child has been protected by the35

There are also some babies who, even though they are over 12 months old and eat
36solids well, continue to nurse vigorously, sometimes even nursing more than previously.

Even though they have breasts which are fully capable of producing enough milk to

Wanting to nurse often, or to touch their mother’s breasts are developmental steps showraise their baby on that alone, many women worry that they are not producing, and addthat the child is close to ‘graduating’ from nursing. During this period, the child uses

formula to their feeding schedule, which actually results in a loss of production which

their mother as a sort of ‘base camp’, separating for short times to explore their world.

they themselves have created.

In the course of a lifetime, the period during which a person nurses is very short,

In order to distinguish this type of lack of breast milk with the actual condition of

however, this very short one to two years holds great importance, something whichbeing unable to produce sufficient amounts of breast milk, we have termed this seemingbreastfeeding mothers understand well.

lack as ‘Perceived Lack of Breast Milk’. Most mothers worrying about their milk

To all mothers who have been nursing your baby for over a year, just how many liters

production fall into this category.

of breast milk might your child have drunk during this time? And how many times haveyou nursed them to create those strong, healthy bodies? It is certain that along with all
the breast milk, a mother’s love has also flowed to your child. For just a short time
longer until they are ready for weaning, continue to nurse your child freely.

7-2 Amounts of Breast Milk
How can one measure the amount of breast milk they are producing? With a bottle,
it is quite simple to see how much milk or formula has been consumed, but it is moredifficult when nursing. Some babies fall asleep during nursing, or want to nurse more
often after only a short period of time, making it harder to measure.

7 For Those Who Feel They Are Not Producing Enough Milk

In research done on the amount of breast milk drunk by babies raised on breast milkalone, the amount drunk at one sitting ranged from as little as 5 gram to as much as

7-1 A Seeming Lack of Breast Milk

200 gram. This is a great deal of variation in what amount of breast milk a child drinks

Many mothers ask, “Can I really raise my child on breast milk alone?”, and worry

each time it nurses. This variation is quite natural, particularly in newborns, as they dothat it won’t be possible. Even after telling oneself that human beings are mammals andnot nurse correctly every time. Those people who measure how much breast milk their

have raised their offspring on breast milk along since the beginning of their existence onchild drank (by measuring the difference in the baby’s weight both before and after

earth millions of years ago, when it comes to actually nursing your own child, many

nursing), often continue to do so at home to prevent becoming anxious or worried.

can’t help but worry.

Although the amount of breast milk a baby drinks may vary, the total amount of breast

People lose confidence in breast feeding for a variety of reasons: they feel theirmilk consumed per day is fairly consistent, thus one should not supplement eachbreasts are too small, their breasts don’t become engorged with milk, their breasts don’t

nursing with formula, or the child will not nurse sufficiently at later sittings, thus

leak, their baby cries very soon after nursing as if hungry once again, their childleading to an overall lack of milk production later and require further additions ofremains latched onto the breast for long periods of time, their baby doesn’t gain muchformula, thus continuing the vicious cycle. Weighing your baby after each nursing

weight, etc, etc. Approximately half of all mothers who come to Oketani Breastfeeding

simply adds to a mother’s worries, and causes her to feel stress, which in turnWorkshops have these kinds of anxieties. While there are a few women who actually do

suppresses hormones which promote milk production. Remember, no other animal

produce an insufficient amount of breast milk, the large majority of these women haveweighs their child after nursing!

breasts which would be fully capable of producing enough milk to raise their children on.

There are also some women who say, ‘I tried expressing my milk every 30 minutes,

Quite often, it would simply be a matter of educating them a little more about

but was only able to get a very small amount, so I must not be producing enough milk,”

breastfeeding, and they wouldn’t have to fell anxious, mix nursing with formula, or

but this is another misconception, as the amount of milk that can be expressed by handswitch to formula altogether.

is different than that which is drawn out by a nursing baby. Because breast milk is37

38

actually produced when a child nurses, even a person who is extremely skillful finds it

milk, they are probably producing a sufficient amount. However, by waiting until theydifficult to express an equal amount of milk as when an infant nurses. In addition,

become engorged before nursing every time, the mother’s body interprets this as, ‘Therebecause breast milk is digested more easily than formula, a small amount is sufficient.

is probably enough breast milk, so there is no need to produce any more,’ and will cease

So, just how can you check to see whether your child is getting a sufficient amount ofto produce hormones. Or, if you continually miss or are unable to nurse during the night,

breast milk?

the milk remaining in the breast will put weight on the ‘foundation’ of the breast andmake it more difficult for the breast to pump the breast milk out. Particularly at about 2

7-3 Evidence Indication You are Producing Sufficient Breast Milkand a half months, many mothers stop becoming engorged and they begin to worry that

The best ways to be sure your child is getting a sufficient amount of breast milk aretheir production has gone down, but this is a misconception. Mothers who nurse

to study the child’s appearance and observe how it is nursing. Check to see that thefrequently have very soft breasts, but they are actually producing sufficient amounts ofbaby is overall in a good mood, with healthy skin color, moving its arm and legs

breast milk. The best breast milk is not that which is stored up, but that which isfrequently and cries vigorously, and that it is nursing at least 8 times a day. Also if a

produced as a child nurses, so rather than storing up one’s milk, it is better to havebaby is not nursing properly, it may not be receiving enough breast milk, so refer tobreasts which can produce fresh milk each time you nurse.

“Correct Holding and Nursing Positions” (p. 58) to be sure that it is nursing correctly.

In particular, women with small breasts cannot store large amounts of breast milk in

The next indication is the amount of urine the baby produces. While the amount of

their breasts, so they are always producing milk as they nurse. In this way, they areurine excreted does not equal the amount of breast milk consumed, one can get a feel for

providing their children with fresh breast milk, and as the children nurse frequently,

the amount of breast milk being consumed this way. If the baby is fully wetting 6 orthey become able to produce even more milk. In Japan, small breasts have long been

more diapers a day, it is getting enough breast milk. Also, for the first month, the baby

considered to be optimal for the production of milk, so even those women with small

should have between 2 and 5 bowel movements a day of watery, yellowish stools, after

breasts should approach nursing with confidence.

which it should start to come out less frequently and in more quantity.

Just after childbirth, a woman’s breasts become engorged and enlarge easily, but

Another indication is the baby’s weight. At the one month checkup, mothers whose

after about two months, they usually cease to do so. It is at this point that the breasts

babies weight had not increased by a kilogram, or 30 grams a day, are often told thatbegin to produce milk due to the stimulation of the baby’s mouth latching onto thetheir child’s weight gain is insufficient, but according to world averages released by thenipple. Thus, the mother’s breasts become soft and supple, and though smaller, are still

World Health Organization, babies raised on only breast milk usually gain only 500

able to produce the same amount of breast milk as always. Even if your breasts do notgrams or so in the first month.

become engorged, if you feel a sort of Morse code-like series of twinges or pangs in the

To say that a baby’s lack of weight gain is due to an insufficient amount of breast
milk is untrue. There are many babies who are small regardless of the amount of breast
milk they consume. The most important thing is for each child to grow at a rate whichsuits him or her. Besides weight, it is equally important to track the changes in bodybreast opposite that which the baby is latched onto, you can be sure that you areproducing breast milk.
Also, pay attention to the sounds of your baby nursing. If you can hear it gulping or
swallowing quickly, you will know that it is nursing sufficiently.

length and head circumference as well. If a child’s body length is rapidly increasing, thechild weight may not increase notably, but if both body length and head circumference
are increasing regularly, there is no cause for concern.
In what ways can the mother’s breasts signify a sufficiency of breast milk, or lack7-4 How to Produce Large Quantities of Delicious Breast Milk
In order to prevent a lack of breast milk and enable yourself to raise your children on
breast milk alone, please be careful about the following things;

thereof? For example, most people feel that if their breasts become engorged with breast

1) Nurse your child frequently (at least 8 or more times a day). The number of times a

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child is nursed and the manner in which it nurses are the two factors which most effect9) Get Oketani Breast Massages. They not only help to increase milk production andbreast milk production. Because the breasts produce milk due to the stimulation

prevent mastitis, but also improve the mother’s blood circulation in the whole body, thus

provided by the baby’s nursing, having the baby nurse correctly and often is the best

helping her to stay in good health.

way to ensure an increase in milk production. If you are using a pacifier, the amount oftime the baby uses it is just that much time that it could be nursing instead, so you
should stop using it.

7-5 For Those With a True Lack of Breast Milk
If one follows all the above guidelines, is it still possible to have a slight, or even total

2) A baby wants to nurse even at night. In addition, the hormone which promotes the
production of breast milk is secreted in greater amounts at night, so you shouldlack of breast milk?
At the ‘Baby Friendly Hospitals’ designated be WHO and UNICEF, nearly 100% of

definitely nurse your child then.

all new mothers are able to nurse their children at the time of release from the hospital.

3) If there is some reason shy you must feed your child formula right now, be careful not

Thus, it would seem that nearly all women are capable of raising their children on

to feed it too much. If a child sleeps too long and there is too much time between nursing,breast milk alone.

a mother’s milk production will go down. Be sure to use only the amount of formula that

However, there are differences in the amount of breast milk each is able to produce.

will enable you to nurse your child every two and a half hours or less.

Also, there are some children who suck strongly and others who can only suck weakly,

4) Do not worry about time when you nurse. There is no rule that you must be finishedso depending on the combination of mother and baby, there are some women who mustwithin a certain number of minutes. Both the flavor and the nutritional content of thenurse up to twice as often as normal. Should you find that your child has not started

milk change dramatically between the beginning and the end of one nursing, so it isgaining 125 grams a week or 500 grams a month by the third month, or that its weight

important to give your child enough time to enjoy all the flavors and receive all theis not increasing even after increasing the number of times you nurse, and it isnutritional benefits of breast milk.

constantly sleeping and nursing less often or in lesser amounts, it is not active or it has5) A mother’s nutrition and rest are also very important. Be sure to eat nutritious meals

little urine and few bowel movements, there may be something wrong with the child,at regular intervals, take care of one’s overall health, and be sure to get enough rest andand it should be see by a pediatrician.

sleep.

On the mother’s side, women who were heavy smokers, used oral contraceptives, of6) Nurse your child in a relaxed atmosphere. If a mother is feeling frustrated, her whole

have problems with their thyroids often have problems with their milk production. In

body will become tense, and her blood circulation will worsen. This feeling of frustration

addition, mothers who have lost a life-threatening amount of blood during childbirthwill then be transmitted to the baby. The best thing to do is to relax and enjoy watching

and have received blood transfusions often can produce only small amounts of breast

your child’s development at each nursing.

milk until their overall condition improves, but if a mother only has a slight anemia,7) Having the support of one’s family is extremely important. A new mother is putting

there is generally no difference in the amount of the content of breast milk compared toevery effort into raising her child on breast milk alone, and having someone ask, “Don’tother women.

you think it hasn’t nursed enough?” or “Let me feed it some formula for you”, even said

There are some cases however, in which the placenta has not been fully flushed fromwith good intentions, can cause the mother great stress. Please be cooperative with thethe body and some remains in the uterus, which has led to a lowered breast production.

new mother, and put her feelings first.

In addition, some mothers who have had plastic surgery on their breasts may have8) Get enough exercise. With the convenience of modern day living, it is becoming moredone damage to the nerves or mammary ducts. In some cases, no matter how hard theand more difficult to get enough exercise. It is recommended that you do some lightbaby suckles on the breast, the signal is not transferred and the breast milk is notcalisthenics and do enough walking to refresh you every day.

produced. However, it is impossible to tell whether or not this damage has occurred

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until one nurses one’s child, so you should try nursing as much as possible in the
beginning.

One cause of a mother’s lack of breast milk production is the inability of the child tolatch on correctly. Should you have chapped or cracked nipples that don’t heal, if you

What about the case in which a mother has a special disease or condition? There arehave continual recurrences of mastitis or the baby never seems to gain any weight nosome cases in which a mother is on medication, or the sickness itself causes the breast

matter how often you nurse, look carefully inside the mouth. You will notice that there

milk to be released more slowly, but nearly all mothers can still nurse their babies.

is a tendon or flap of skin which connects the underside of the tongue to the lower jaw.

Please discuss these issues with your physician. There are even many women who haveThis is called the ‘lingual frenulum’.

had mastectomies that have raised their children on breast milk.

If the baby’s tongue protrudes beyond the lower lips, they are capable of nursing
correctly. But if their tongue is held back into a heart-like shape or cannot protrude

7-6 Returning to Nursing

beyond the gums, the baby often cannot nurse correctly. This condition is called

For those of you who want to nurse your children but have found yourself giving‘tongue-tied syndrome’. In this case the lingual frenulum connects the tongue all thethem mostly formula, or mixing nursing with giving formula more often than you

way to the tip, or it is too short and the tongue cannot reach out to wrap around theintended and want to return to nursing, don’t give up. Try to get back to nursing again.

nipple well enough to nurse.

For those mothers whose babies are able to latch onto their breasts, it is simply a

Nearly all cases of ‘Tongue-Tied Syndrome’ clear up as the child grows. Receiving

matter of nursing them frequently. By doing this, you will begin to produce more andOketani Style massages, and following the directions in “Correct Ways to Hold andmore delicious breast milk, and your baby will begin to prefer this over formula. If you

Nurse Your Child” (p.??) are also helpful. Should neither of these prove helpful and it

still must feed them formula, be sure to nurse them first, and only give them a small

seems too difficult to nurse your child, seek the professional help of an otologist, an oralamount of formula that they will be able to nurse again in two and a half hours or less.

surgeon or a pediatrician.

Be sure to nurse your child at least 8 to 10 times a day. Once you are able to nurse yourchild a sufficient amount, slowly reduce the amount and number of times you give it

8When to Wean

formula, keeping track of the amount of urine excreted all the while.
For mothers whose babies who have become too accustomed to the bottle and are noSince birth, your baby has enjoyed spending time close to it’s mother, being held in

longer able to latch onto the nipple, it is important to both express milk and have theyour arms and nursing frequently. During this time, the baby has grown larger andbaby practice latching on and nursing at least 8 times a day in order to keep up thedeveloped a sense of complete trust and a feeling of safety in its mother, who takes careproduction of fresh breast milk. At the same time, mothers should have these babiesof all its needs and wants. In addition, while receiving love from its mother through herpractice drinking formula from a cup rather than the bottle to which they have become

touch and voice, it has learned the basic human traits of loving and trusting others andtoo accustomed in order to get them to change their way of latching on. Once they have

has begun controlling its movements. The relationship of trust between a mother andaccomplished this, you can gradually reduce the amount of formula the baby drinks andher child becomes the basis for the child’s ability to trust others and its ability to feel

nurse more frequently.

close to others

During this time, going to Oketani Workshops can be very beneficial, not only

One mother said the following about deciding to wean her child, ‘I absolutely loved

because you can receive expert advice, but also because there are many other mothers

nursing my child. I felt true happiness when I nursed. But at about 18 months, my child

who have experienced similar problems and can help you work through them.

was able to speak quite well and suddenly became much stronger and more
independent. I felt like it might be time to wean it, but I didn’t do it at that time. When

7-7 For Babies with ‘Tongue-Tied Syndrome’43

my baby fell or something happened to upset it or it felt cranky, it would try to tell me
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what happened or what it needed with words or body language, but I always just pulled

and may even attempt to try to nurse once more. That feeling of loneliness is important,it close and nursed it. Every problem seemed to be easily and quickly solved by nursing.

because not only does the child begin to gain independence from the mother throughBut by the time my child reached the age of two, I began to wonder if my nursing theweaning, but the mother is also learning to ‘let go’ of the child as well. It is just as

baby was delaying its independence, and thus I finally weaned it. Had I stopped nursing

important that the mother recognize her child’s newly found independence as it is thatearlier, I would probably have listened to my child much more. I should have weaned

the child actually gain it. This is an important step in development for the mother as

my child at 18 months, when I first felt my child might be ready for it.’well.

This comment suggests several things. First, it indicates that the weaning method
prescribed by the Oketani Method is not one in which you are unilaterally denying thechild the ability to nurse, but a process in which, at the appropriate time, you arechanging the child’s perception of the breast from that of being a single tool there for
their purpose into two separate objects. Once the child can stand upright and walk, it
has become a complete human being, and after being weaned, will be able to make theeffort to understand and make itself understood to other human beings through thecommunication tool unique to humans – words.
Through nursing, a mother and child develop a deep bond. This bond remains in thechild as a feeling of complete trust. It is because this bond was developed throughnursing one’s child that one can wean it completely and suddenly, and enable the childto go on to the next step in its development.
Weaning one’s child is similar to giving its back a push out of the nest. It is a naturalprocess, like a piece of fully ripened fruit falling from the tree. Thus, it is not somethingwhich is done at a predetermined age. It is important that both mother and child should
nurse to their full satisfaction, and both should be fully ready to “graduate” when thetime comes.
One mother weaned her child on its first birthday. Her milk production was low andshe had to nurse the baby every hour during the night. She said, “I don’t feel it’s too
early to wean my child. I have been nursing my child twenty, sometimes thirty times aday, so this child has had the same amount of nursing that an average child has had inthree or four years. I think it has nursed enough by now.” After drawing faces on her
breasts and showing them to her child, it stopped nursing immediately and completely.
One would never have thought that it had been nursing twenty times a day up until the
day before.
After weaning one’s baby, a mother will probably feel lonely and left out for awhile.
They will begin to miss that period of becoming exhausted at her child’s crying every day,45

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