Breastfeeding Impasse, Is It Her Fault?

Some women consider breastfeeding as a natural parenting duty that has to happen (no second thoughts). Whether they’ve given it a thought or not, women who decide to breast-feed could become highly disappointed if they cannot do so (for various reasons). Rashmi Ullas tries to understand the distress of this breastfeeding impasse and finds out means of overcoming them.

More than just a physical act

The journey of breastfeeding is not always easy. Every mother finds it hard in the beginning, especially when the child is not used to latching and sucking. There could be pain and some laceration too.

Even after these herculean two weeks are over, women may face other hurdles. It’s a lot of sacrifice of time and energy when it comes to breastfeeding your baby. Then there are the leaky breasts and the food restrictions you have to endure. As the months progress, your baby will start teething and may bite into your nipples with his little (but mighty and powerful) teeth. But most mothers who breast-feed can vouch that watching their baby blossom with nourishment is worth every agony.

Breastfeeding is indeed a very special act of love so the realisation that it’s not possible could become very upsetting, especially for women who deeply desire to breastfeed their babies.

Why some women can’t breastfeed?

We human beings are mammals, which means we have mammary glands that are meant to feed the little ones. So by nature’s law, every woman has the ability to breastfeed. Unfortunately, some women cannot do so because of some shortcomings.

Women with diseases like HIV, heart disease, severe anaemia or untreated tuberculosis are advised against breastfeeding, even if they produce enough milk. Even the cancer patients undergoing radiation or chemotherapy and patients who are under certain medications are advised against breastfeeding, as these medicines could be harmful to the infant. Of course women addicted to alcohol, drugs and thosewho smoke SHOULD NOT breastfeed.

Apart from these hurdles, some women just cannot breastfeed, because their milk supply is very low or they experience extreme pain during breastfeeding. There could be many reasons for this, like the presence of rare medical conditions such as insufficient glandular tissue, breast cancer, hypoplastic (underdeveloped) breast syndrome, breast reduction or other extensive breast surgery, galactosemia (rare genetic metabolic disorder), pituitary gland or thyroid imbalances.

Get a hold on it

For those women who are extremely down with the thought of not being able to breastfeed, it might comfort you a little to know that formula milk is a very good supplement to breast milk and can provide all the required nutrition for your baby so try not to beat up yourself too much.

If low milk supply is your issue, there are some grandma’s remedies that could prove effective. Breastfeeding is linked to stress; the more stressed you are, the less likely you are to produce milk. Stay calm and keep trying, because you will get the hang of breastfeeding in a couple of weeks.

It is also true that the more you feed, the more milk you produce (at least in most cases). So feed your baby as much as you can. If your nipples hurt, you could alternate with expressing your milk. You could also improve the blood circulation and stimulate the breasts with a warm compress before feeding.

Keep your body well hydrated, especially before feeding. You could also massage your breasts before feeding. This will improve the flow of milk to your nipples. Some people believe that cumin seeds, fennel seeds, fenugreek seeds, green leafy vegetables and tubers (such as beetroot and carrot) can improve milk supply. Check with your nutritionist before consuming any specific food.

Finally, don’t hesitate to get help. Talk about your problems with your doctor, mid-wife or nurse. They can give you professional help and advice.

When you’ve tried every possibility and can’t feed

Stop blaming yourself! It’s not your fault. Just because you can’t breastfeed, it doesn’t mean you have failed as a mother. Remember that good parenting goes beyond breastfeeding. You can express your disappointment by crying it out, but you should get over the lamenting as fast as you can, because you’ve done nothing wrong.

Be honest with your feelings and talk to your spouse, family and a lactation expert. The soothing and encouraging words could help you feel a lot better.

And if you still believe that you should only give your baby breast milk, then you could find out more about donated breast milk. Yes… people do donate breast milk. The ‘Human Milk 4 Human Babies’ (http://hm4hb.net/) is one such thriving global online community, which enables sharing of breast milk.1 Mothers who are blessed with surplus milk supply donate the excess milk, instead of discarding it. Breast milk can be stored for between 48 hours to up to a year depending on the mode and temperature of storage. However, some experts have suggested that the donated breast milk is not always screened and so the health risks of sharing unregulated milk outweighs its benefits.

To improve the chances of safe milk donation, it is more appropriate to share milk among relatives or good friends who are also nursing. By and large, the safest alternative to breast milk is formula milk (not donated breast milk).

The bonding is no less

There’s no doubt that breastfeeding is one of the most wonderful ways of bonding with your newborn, but it’s not the only way. You can bond with him while you bottle-feed by keeping your babe close to your bosom and looking into the pretty, sparkling eyes. Your bond with your baby will never reduce, just because you cannot breastfeed. So cheer up and enjoy the parenting experience

We know there are always questions about breastfeeding, so we spoke to Mrs Quah, Senior registered nurse and mother of 2 to find out more.

LW: Does breastfeeding hurts?

Ms Quah: Most mothers experience pain on the breasts in the first week after delivery, commonly due to engorgement. Engorgement is commonly due to blocked ducts. First-time mothers may commonly experience pain at the nipple because nipple is not soft enough for baby to latch on. If the latching-on technique is perfect, most first-time mothers will experience constriction of the uterus as baby latches on. It feels like menses cramp. However, it is a good sign when the uterus constricts so it can get back to shape sooner and the mother will also slim down gradually.

How can I prevent sore nipples?

Generally if baby latches on correctly, the mother should not have any sore nipples. Most hospitals will have a lactation nurse visiting the mother and baby to guide them on proper latching-on technique. Mothers are encouraged to learn how to help the baby latch on by themselves (return demo) before discharging.

Should you need a one-to-one breastfeeding private consultation, you may contact me at 8102 9174 for a phone consultation from 9am to 9pm, Mondays to Sundays. You can also drop me a text if I’m unable to pick up your call. A home visit can be arranged should further assistance is needed.

Will I need to give up eating my favourite food in order to breastfeed?

Yes and no, depending on what is your favourite food. There are mothers with gestational diabetes during the pregnancy. A significant number of this group of mothers may go on to develop Type 2 diabetes later in their life. Whether this group of mothers is breastfeeding or not, they should go on a diet that has moderate sugar and carbohydrate as well as monitor their blood sugar level for a period of time, as prescribed by their doctor.

Alcohol is also commonly used to cook confinement food, especially those in the Chinese confinement diet. Generally, alcohol evaporates out of the body. Should the breastfeeding mother needs to consume a moderate amount of alcohol amount due to health reasons, breastfeed or express the breast milk before consuming alcohol.

Mothers should only express the breast milk or do a direct latch-on two hours from the consumption of one standard glass alcohol. If you have consumed 2 standard glasses, the waiting period will be 4 hours before your baby latches on or you express the milk. There is no need to discard the breast milk just because mother consumes alcohol.

How do I tell if my baby is getting enough milk?

Newborns have 8-12 or more feeds in 24 hours. Night feeds are important in the early days. The number and length of feeds every 24 hours decreases as babies get older. Fully breastfed babies are never constipated. They poo frequently: about 3 times a day, once every week or once every 10 days, and the poo is usually regular, soft, and mustard yellow in colour.

Very hard and pebbly poo as well as very dark yellow strong smelling pee can be a sign that the baby is not getting enough breast milk. It’s also common for babies to vomit breast milk after feeds.

Some signs of baby not having enough milk intakes include:
• Low urine output (fewer than six wet nappies in 24 hours after Day 2)
• Abnormal stool pattern, i.e. no yellow stools by Day 5, fewer than 3 stools per day (for babies under 4-6 weeks), or no change in the colour and consistency of stool by Day 3.
• High suck:swallow ratio during feeding
• Persistent jaundice
• Excessive weight loss (first week) or slow/no weight gain (for older baby)

Is it true that I cannot get pregnant while I’m breastfeeding?

In non-lactating women, ovulation may occur as early as 5-6 weeks postpartum. In women who are fully breastfeeding and amenorrhoeic, the risk of pregnancy before 6 months is less than 2%. For some women, the fear of pregnancy may inhibit sexual expression so they would prefer to use contraception when resuming intercourse, but I would advise you to discuss future contraception during pregnancy with your doctor.

What should I look for in breast pump?

Let’s look into different type of breast pumps.

MANUAL PUMPS: Manual breast pumps are operated by hand. It’s usually a single pump. While it is a slower process, it is lightweight, suitable to carry around and inexpensive. One pump can cost as low as SGD50 so it might be wise to leave one at workplace “just in case”.

ELECTRIC PUMPS: Most electric pump can function via AC or batteries It will make a humming noise. Noise is usually not an issue since most mothers will pump milk outside the baby’s room so they do not wake the baby up with the humming sound by the breast pump. Most importantly, is that the breast pump has a suitable amount of suction. When using the electric breast pump, you have the option to choose the level of suction you prefer: Level 1 to 3.

You should not feel any pain when using the breast pump. If you do, you may have some clotted ducts or the suction may be too strong for you. As for double pumps, while they are heavier to transport, it also helps pump out the milk in a shorter time. Please remember not to share the breast pump but passing down the pump motor is acceptable.

OPEN SYSTEM VS. CLOSED SYSTEM: A closed system breast pump is designed to keep every drop of your expressed milk away from the pump’s motor and into your collection container. This decreases the possibility of mould growth and infectious particles.

REPLACEMENT OF PARTS: If your pump stops working effectively after a while e.g. the suction is not as strong, it might mean that some of the parts are worn. The parts that most commonly need replacement are the valves & membranes. Please note that choosing the right breast pump funnel size is very important.

1. Available at: http://www.sgh.com.sg/about-us/newsroom/News-Articles-Reports/Pages/risky-share-milk.aspx