Breastfeeding is one of the first maternal duties for many mothers after childbirth. It is an intimate and important activity for both parent and child. But for some, it may be an experience fraught with failure and mistakes.
Many new mums are not given the necessary pre-natal knowledge they need to properly and efficiently nurse their newborns. This results in many cases where babies are given formula instead of breastmilk. While it’s not wrong to do so, it is sometimes an unfortunate situation that could otherwise have been avoided.
This article is for all the expectant mums who need to prepare for breastfeeding before their baby comes. To answer some of the most important questions nursing mums have about breastfeeding, Motherhood chats with Dr Nik Nor Aniza, Medical Deputy Director of Hospital Selayang and Vice President of the Malaysian Lactation Advisors & Consultants Association.
Here are some of the pearls of wisdom that she has shared with us.
Q1: What’s the number one misconception about breastfeeding?
There are many myths about breastfeeding. But I think the most common one is many women believe that breast size matters when it comes to breastfeeding. To be clear, it does not. Breast size does not matter when it comes to how much milk you can produce. A woman with small breasts can produce just as much breast milk as one with large breasts.
That said, there are many factors that can either increase or decrease your milk supply. Even if you have large breasts, you may still find it difficult to lactate if you’re experiencing certain medical or anatomical issues. The reverse can also be true. Even if you have small breasts, you may still be able to lactate sufficiently or even in surplus.
Q2: What are the most common breastfeeding mistakes parents make?
There are a few that I’ve encountered in my day. The first is that many new mothers seem to think they won’t get pregnant while they’re breastfeeding—which leads to a surprise pregnancy they didn’t plan for. And if the new parents are having financial difficulties, this can cause further stress. So, be careful, especially after the first 6 months.
While breastfeeding does delay ovulation, you need to fulfil these 3 criteria in order to enjoy the contraceptive powers of breastfeeding:
- The mother is not menstruating
- The mother is exclusively breastfeeding (day and night) with no long intervals between feeds
- The baby is less than 6 months old
The second mistake I see is when mothers stop breastfeeding their babies when they’re sick. If the illness is not transmissible through breastmilk, I encourage mums to continue breastfeeding even when they’re under the weather. It’s important for mother and child to remain together during the first few months after delivery.
If the mother is hospitalised, nurses will usually help the mother express breastmilk to help feed their babies for them, either through syringe or cup (hospitals avoid bottle feeding to prevent nipple confusion).
However, babies with conditions where it’s unsafe for mothers to breastfeed include HIV, respiratory untreated tuberculosis, radiotherapy, chemotherapy, recreational drugs, and early untreated chicken pox infection.
Conditions where it’s safe for mothers to breastfeed include Hepatitis B and C, fever, cytomegalovirus infection and yes, even COVID-19. Mothers should be counselled that the benefits of breastfeeding substantially outweigh the potential risks for transmission.
Q3: How can the husband and family members help a mother during her breastfeeding journey?
Spouses can provide help by being present and showing support. They should encourage the mother when she chooses to breastfeed, helping out with chores and looking after the baby. This is to ensure that the mother gets plenty of rest in between feedings.
Other family members can support by providing nutritious food during postpartum recovery, and encouraging and reminding the mother the importance of breastfeeding. It’s also important to recognise when the mother is feeling upset, worried or depressed. These can all be warning signs of postpartum depression, which needs immediate attention.
Q4: What’s the number one breastfeeding issue mothers struggle with and how can they address it?
New mums will almost always tend to worry about not producing enough milk for their babies. Breastfeeding pain and discomfort, as well as sore nipples are also another common complaint I hear about.
The second issue is a lot more serious because some new mothers will stop breastfeeding when it becomes too uncomfortable for them. But this is one thing you shouldn’t do. Stopping breastfeeding will actually cause the breast to swell even more, causing further pain.
Your baby may also cry if they don’t get breast milk, which impacts the mother’s oxytocin level. It’s all a vicious cycle. But all of these problems are interrelated. Poor milk supply, breastfeeding pain, and mother’s stress. It all goes back to poor latching.
So, it’s important to relearn and adjust both you and baby. Get comfortable. Look at educational pictures on how proper attachment should be. Visual is better than words sometimes.
Good attachment is where the baby’s mouth is wide open, the lower lip is turned out, the chin is touching the breast (or nearly so) and more of the areola is visible above the baby’s mouth than below. When the baby suckles you can hear a deep gulping sound in the throat. The correct rhythm would be your baby will suck, swallow, breath, suck, swallow, and breathe in a rhythmic gulp.
Poor attachment is the opposite. The mouth is not wide open, the lower lip is pointing forward, the chin is away from the breast and more of the areola is visible below the baby’s mouth (or equal amount above and below).
For proper positioning, ensure these 4 key points to help ensure baby is comfortable:
- the baby is in line (head, shoulder and body straight)
- close to mother’s body
- baby brought to breast, not breast to baby
- well supported at head and shoulders.
Q5: When do pregnant women begin to lactate and what should they do if they’re not lactating during this window of time?
Usually, women start to lactate in the second trimester of pregnancy from 15 to 18 weeks onwards. But this is not same for all women. Pregnancy lactation is just the body preparing itself to start producing more breast milk upon delivery.
Sometimes, some colostrum may leak out as a result. You should not worry if you’re not lactating during this time as it does not indicate your ability to breastfeed when the baby comes.
Q6: Why do some mothers have trouble lactating?
Many different things can be blamed for lactation issues. This can be due to maternal, baby and family factors, related closely to physiological, anatomical, mental and environmental factors.
Also, the method of delivery influences her success in breastfeeding after that. Caesarean delivery, for instance, often results in less breast milk production compared to natural births.
It’s important to check with your doctor what this cause may be. But sometimes, it is as simple as being worried about not being able to breastfeed, not being a good mother or not making enough breastmilk. All the negative thinking and worrying will actually trigger a negative hormone that will reduce or stop lactation from occurring.
Q7: How does a new mother know if she’s receiving good breast-feeding support from the hospital staff or clinic?
An expectant mum should already be sufficiently knowledgeable about breastfeeding prior to delivery. She should also be aware of the hospital is offering in terms of breastfeeding assistance. In this case, it’s important for mums to do their research and find a venue that has BFHI (Baby Friendly Hospital Initiative).
In other words, the hospital and clinic has been accredited as BFHI (Baby Friendly Hospital Initiative) Hospital/ Clinic by the Ministry of Health. BFHI hospitals must follow the 10steps+4 additional criteria. Not just during labour, but also during pregnancy and postpartum care.
With the help of competent and adequate instruction from hospital staff, post-delivery, the new mum should be able to:
- feed her baby on her own
- recognise good feeding
- recognise her baby’s feeding signs
- position her baby for good attachment
- know the signs of effective breastfeeding
- address poor milk yield
With these criteria successfully implemented, the mother will return home happy and fully equipped to breastfeed her baby on her own.
Q8: How does a new mother know if her baby is getting enough breast milk?
It’s easy to check if your baby is getting enough milk. The best way is to check their stool and urine output. If these are present on your baby’s diaper in adequate amounts, it will usually indicate that they are getting enough breast milk.
To see if this is the case, make sure your baby has 6 or more wet diapers within a period of 24 hours. The urine should be pale and diluted. As for bowel movement, there should ideally be 3 to 8 (diaper changes) within 24 hours. As babies grow older than one month, stooling may be less frequent.
Another way to check if they’re getting enough milk is to look at their weight. Babies should be gaining approximately 150g per week and they should also quickly be outgrowing their clothes. Healthy skin and good muscle tone also indicates sufficient nutrition.
Q9: What are your thoughts on pharmaceutical and natural galactagogues (breast milk boosters)?
Personally, I believe both are useful in certain situations. If for milk boosters in an already breastfed baby, natural galactagogues are better used as compared to pharmaceutical base.
Pharmaceutical medications may need to be used in certain cases like for re-lactation or induced lactation. Relactations are for those babies that were separated from their mothers for medical reasons.
Induced lactation is for non-pregnant ladies adopting a child.
Q10: In honour of Breastfeeding Awareness Month, do you have any other words of wisdom you would like to share with all the expectant and new mums out there who may be reading this?
Remember that God created reasons for breastfeeding. Nature celebrates it, science confirms it.
If you’re a new nursing mum, take one step at a time to recognise and overcome those challenges mentioned above like issues on low milk production, milk transfer and improving milk intake and concerns about ‘not enough milk’, incorrect positioning and attachment. Don’t worry about what people think about your choice to exclusively breastfeed, just concentrate on what your child needs. It’s once in a life time experience and one you should enjoy.
The theme for this year’s breastfeeding by WABA is most appropriate which is: Step Up for Breastfeeding: Educate and Support, which summarises it all in terms of empowering parents, protecting breastfeeding, a shared responsibility, sustaining the foundation of life for a healthier planet.
With that, I would like to thank my mother for her decision, dedication and perseverance to fully breastfeed me for more than 2 years despite having a difficult caesarean section those days in 1970s.
Disclaimer: The information provided in this article is for informational purposes only and should not be considered as medical advice from Motherhood. For any health-related concerns, it is advisable to consult with a qualified healthcare professional or medical practitioner.
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