Articles about Breastfeeding
Melkbekkies Breastfeeding and Baby Clinic
Francoise van der Westhuizen
SACLC – SA certified lactation consultant, BCur, AUDHS health service management
Breastfeeding assistance and support. Information and advice about baby care. Home visits on the East Rand
082 940 5008
Proud Parent Centre
SACLC – SA certified lactation consultant, RN, RM, paediatrics, BACur community health, nursing administration, Immunisations, breastfeeding, childbirth education, breast pump hire
082 487 4533
SACLC – SA certified lactation consultant course developer, SACPE – SA certified perinatal educator, RN, RM, IBCLC
Lactation consultancy and training of lactation consultants
082 771 8526
Dr Christa Rocher
SACLC – SA certified lactation consultant, MBChB, DCH,
General practitioner with a special interest in women and child health
Home visits for breastfeeding information and support, antenatal breastfeeding classes
083 301 2826
Mother and Baby Clinic
SACLC – SA certified lactation consultant, BCur, registered nurse, community nurse, psychiatry nurse and midwife
Breastfeeding counsellor – hospital and home visits, home phototherapy
082 819 2226
The Baby Lady
SACLC – SA certified lactation consultant, BNurs midwifery, community, psychiatry, general
Prenatal lactation consultation, hospital support and postnatal home lactation visits. Postnatal mom and baby support group
082 494 2903
SACLC – SA certified lactation consultant, Physiotherapist,
Antenatal breastfeeding workshops and post birth breastfeeding support
082 642 0054
SACLC – SA certified lactation consultant, BCurI et A,
Antenatal classes, breastfeeding preparation workshop, postnatal support, breastfeeding consultations and home visits
072 490 7386
Deidre Smith Registered Dietician
SACLC – SA certified lactation consultant, BSC Dietetics, Post grad diploma Dietetics
General dietetic services (special interest in infant feeding, paediatrics and maternal health), Vitality nutrition assessments, lactation consults
083 453 4106
Latch 22 Consulting
SACLC – SA certified lactation consultant, Registered nurse, registered midwife, diploma in baby massage
Breastfeeding support. Hospital and home visits
076 893 9793
Roodepoort and northern suburbs
Pam Vorster Breastfeeding Support
Registered nurse, midwife, IBCLC
Hospital or Home visits to assist with breastfeeding
082 576 3749
Sr Hettie Grove
SACLC – SA certified lactation consultant course developer, RN, RM, RCN, RNA, RNT, Bcur ed/admin, specialist midwife, SA certified perinatal educator, IBCLC, Author of Born to Breastfeed, Born to be Breastfed
(011) 812-4234 / 083 492 5861
Annatjie van Zyl
SACLC – SA certified lactation consultant, RN, midwife
Lactation consultant, breastfeeding advice, breastfeeding education
083 663 6192 / (011) 812-4234w
SACLC – SA certified lactation consultant, RN, midwife, psychiatry and community health,
Mother and baby wellness centre and breastfeeding consultant
082 337 9911
Catherine Day Dietetics and Lactation Services
SACLC – SA certified lactation consultant, BSc Human Life Sciences, BSc Medical Honours in Medical Physiology, BSc Medical Honours in Nutrition and Dietetics
a Dietitian and lactation consultant focusing on pregnancy nutrition, breastfeeding and infant feeding
(021) 794 5789
All About Babies
SACLC – SA certified lactation consultant, RN, RM, ICCE – internationally certified childbirth educator
Well baby clinic specialising in vaccinations and breastfeeding / feeding
083 335 4653
Sr Lyn’s Baby Clinic
SACLC – SA certified lactation consultant, RN, midwife
Breastfeeding / lactation support and assistance, vaccinations, family planning, papsmears , nutrition interest
(021) 552-8126 / (021) 529-9195
Mouille Point + Southern suburbs
Thula Baby Centre
SACLC – SA certified lactation consultant, Registered nurse
Home visits in the Atlantic seaboard and southern suburbs
074 126 8645
Panorama Breastfeeding Clinic
SACLC – SA certified lactation consultant, RN
Breastfeeding consultant, well baby clinic, home visits
(021) 939-9720 / 083 225 4997
SACLC – SA certified lactation consultant, Registered nurse and midwife, community, general, BA psychology and communication science, BScHons psychology, IBCLC,
Breastfeeding clinic, antenatal classes, postnatal home visits, lactation consultations, mums teas
083 455 8338
www.meamama.co.za / www.breastfeedingmatters.co.za
Southern suburbs & CBD
SACLC – SA certified lactation consultant, BSc Med(Hons)Dietetics, PG dipl Diabetes
Infant feeding from birth through childhood, including lactation consulting, introduction to solids, management of allergies, GIT disorders etc
082 562 8376 / 0861 477 776
Caryn de Chazal – Registered Dietitian and Lactation Consultant
Caryn de Chazal
SACLC – SA certified lactation consultant, B Dietetics
Breastfeeding assessments, education and support
078 621 0600
Marilize Stander Consultations
SACLC – SA certified lactation consultant, BCur
Breastfeeding consultations, antenatal in hospital and after discharge
084 422 2994
Secunda area – home visits also including Evander, Trichardt, Kinross and by arrangement Bethal and Leandra
SACLC – SA certified lactation consultant, Registered dietitian
Lactation consultant – I offer help with all breastfeeding-related issues
076 734 1273
Standerton /Secunda / Newcastle / Vrede
SACLC – SA certified lactation consultant, BSc dietetics
Baby and mother assistance with nutrition – breastfeeding and growth upwards
082 442 6787
Lizelle Payne – Registered Dietitian & Lactation Consultant
SACLC – SA certified lactation consultant, BSc Dietetics
Special interest in antenatal nutrition as well as infant and young child feeding up to 5 years
083 748 0757
Life La Femme Clinic
Elna van Straten
SACLC – SA certified lactation consultant, RN and midwifery, SACPE – SA certified perinatal educator
Breastfeeding education and support, childbirth education, 4D scans, immunisations, postnatal support group
(014) 594-9500 / 072 124 7355
Rustenburg – Zinniaville
SACLC – SA certified lactation consultant, Registered counsellor, BA hons Psychology,
Breastfeeding support and motivation. Postpartum trauma and other counselling services
082 308 5188
By Sanja Nel – Dietitian, SACLC (SA certified lactation consultant)
Breastfeeding is truly the time of “eating for two” – your body is feeding a whole other person! A healthy diet is very important while you are breastfeeding: it will make sure that you remain strong and healthy while nourishing your little one. If your diet is deficient in important nutrients, you are more likely to suffer from tiredness and even illness.
Diet and milk quality
This is the question on every breastfeeding mother’s lips: what should I eat to make the best quality milk? The answer, ironically, is that it doesn’t matter that much. Your body will always make sure that your milk contains enough nutrients, even if it means depleting all your own body stores so that you develop a deficiency yourself. So unless you already have a nutrient deficiency and you are not eating well at the same time, your milk will always contain enough nutrients.
The most significant effect that your diet has on your milk is in the composition of the fats and, to a lesser extent, the proteins. For example, if you eat a lot of saturated fat, your milk fat will contain a higher percentage of saturated fat; similarly, if you take an omega-3 supplement, your milk will contain a larger percentage omega-3’s – but the total amount of fat will be similar.
Interestingly, the flavours of the foods you eat also pass into your breast milk. This is a good thing: it teaches your baby the flavours of your family and culture’s foods. Studies have also shown that breastfed babies accept a variety of different foods more easily, because they’re used to milk that tastes a bit different from day to day. So if you want your baby to eat his veggies someday, make sure you’re eating yours while you breastfeed!
The basics of a balanced diet
You don’t need to eat anything strange or special while breastfeeding. In fact, if you managed to sustain a healthy pregnancy, you can probably just continue eating what you were eating then. One bonus is that you no longer need to avoid raw animal foods, so you can have that sushi you’ve been craving.
In short, a balanced diet contains a variety of foods that are as minimally processed as possible. You want to include food from all the major food groups every day:
- Starches: choose mostly whole grains (whole-wheat breads and pasta, brown rice, oats, quinoa etc.) and starchy veggies (baby potatoes, sweet potato and mielies). Refined, white starches and sugars can cause low blood sugar, which can lead to tiredness and mood swings.
- Proteins: you can get your daily protein from animal foods (meat, milk, eggs, poultry and fish) or plant sources (legumes, nuts). You need more protein than a non-lactating woman, so try to include a protein-rich food at each meal.
- Fruits and veggies: aim for five a day. These are probably the best foods to binge on, now or at any other time.
- Fats: be sure to include healthy fats at every meal; you need the extra energy!
You may notice that your appetite increases dramatically while you are breastfeeding. It makes sense, since you’re burning a lot of calories to make breast milk. As long as you stick to healthy, unprocessed foods, you can eat until you’re no longer hungry.
Breastfeeding women are often advised to “drink a lot of water” to increase milk production. Now, while it is true that being dehydrated can decrease your milk production, you won’t see any further increase in milk production if you’re already well hydrated. The best guideline is to drink until you’re no longer thirsty. You will find you get thirsty a lot more while you are breastfeeding, so most women find they need to drink about 2-3 litres a day.
Foods to avoid while breastfeeding
On the internet you will find lists of hundreds of foods that you must avoid while breastfeeding. The irony is that the foods one culture says you should avoid are often recommended by another culture! The long and short of it is that you don’t need to avoid anything unless you are certain that your baby has a reaction to it every time you eat it.
Your milk is made from your blood, not from your stomach contents – so only things that end up in your blood can get into your milk. This means that gas-forming foods won’t give your baby gas, because the gas bubbles don’t travel through your blood (sadly, your baby will have gas regardless – you may just notice the smell more if you’ve had some cabbage or eggs, because those smelly sulphur compounds do get into your milk).
Caffeine and alcohol are two food components that do end up in your milk. Fortunately, most babies can tolerate caffeine quite well once they’re a few weeks old.
Losing the baby weight
A lot of women are very concerned with getting back to their pre-pregnancy weight as soon as possible. Be patient! It took you nine months to pick up all that weight, it will probably take you at least as long to lose it again. In fact, you don’t want to lose weight too quickly: a lot of toxins are stored in fat tissue, and if you burn a lot of fat very quickly, those toxins get released all at once and end up in your milk.
The best way to lose weight while breastfeeding is to eat a diet of healthy, minimally processed foods, concentrating on fruits and vegetables. Avoid anything not found in nature (such as soft drinks, sweets, polony…) and you’ll be safe. And although it’s popular right now, do not go on a low-carb diet; it can have a detrimental effect on your milk production.
You can also get some moderate exercise. As long as you don’t suddenly do a lot more exercise that your body is used to, it won’t have any negative effect on your milk production.
By Hettie Grove – Author of Born to Breastfeed, Born to be Breastfed, SA certified lactation consultant (SACLC)
You have heard it all, the benefits of breastfeeding, the risks of not breastfeeding….! Your breastfeeding plan has been written. Breastfeeding started when you were still in your mother’s womb. Your body is now ready and prepared. Your mind is set and you have birth plan A and B. Your first visit to a Certified Lactation Consultant went well and you have attended her breastfeeding class. You even have her number on speed dial. You are so, so ready to hold your baby and start skin to skin contact.
Your baby is born…. It is skin to skin and pure bliss. Watching the nine instinctive stages…. you are absolutely in awe to see how your baby performs the breast crawl. While sniffing your baby’s odour and baby smelling his mom starts the whole process. You fall in love with each other. The moment you hold him, keep smelling your precious baby! Sniffing your baby will help your body to start the lactation process. Keeping the baby in the breastaurant, will help him to adjust after the process of being born. Baby has left his Jacuzzi, which was his home the last 40 weeks. Birth is not the easiest thing in life, not for mother nor baby. Skin to skin and breastfeeding helps your baby to adjust in the transition to the extra uterine life.
Remember after birth everything is on baby’s time. Don’t feel rushed during the babymoon, let your baby set the pace. Try slow down a bit and enjoy the baby days. You will never experience these times ever again.
Lactation starts early and your body is primed to breastfeed. The moment the placenta detaches from the uterine wall the hormones cascade and these changes will help you to breastfeed well. You have trusted your body to grow your baby and nourish him well, start trusting your body to nourish him after the birth. Your body will provide enough milk for your baby. You need to partake in this process. It’s a two-way process. The breast takes over from the umbilical cord and starts to nourish your baby immediately after birth.
Birth plays a part in breastfeeding but it’s not the alpha and the omega. Keeping your baby skin to skin will help and play a tremendous role in the process of lactation. This will help both of you if the birth was not what you planned.
GETTING OFF TO A GOOD START
The first two weeks will help with the amount of milk you produce later on. Have a zero tolerance for separation, keep your baby with you all the time. This sets you up for the best journey ever. During these two weeks babies want to feed often, they are hardwired to feed often. Mothers are hardwired to respond to their cues and demands. This will really help to build receptors in your brain and breast for a good supply later.
Babies often have a good feed after birth and fall asleep. Most mommies and healthcare workers worry about this – with pretty good reason as the blood sugar level may drop. Keeping your baby skin to skin will prevent the blood sugar dropping. Keeping him in the breastaurant will help him to smell the breast, which will wake him to feed. If he does not want to feed hand express after two hours, in a spoon and decant in a syringe. You don’t want to waste liquid gold. I suggest hand expression in a spoon because colostrum (the first milk produced from about 16 to 22 weeks of pregnancy) is very dense almost like syrup which was in a refrigerator. Colostrum is produced in small amounts at a time. The amount is also very small due to the baby’s stomach capacity that is small. Hand expressing is more effective than a pump. Expressing in a spoon you easily get the small amount of colostrum that your baby needs. Five millilitres is more than enough. Expressing this, if the baby is in a deep sleep, will stimulate your breast for later supply.
Hand expressing is easy, its cheap and always available. Research has shown that when a mother hand expresses first before using a pump she will have a better supply.
Your first lesson in breastfeeding happened in nursery school when you started to use glue and paste pieces of paper. Remember the glue bottle you squeezed at the top and your hands were full of glue and it was a disaster. Breastfeeding is the same it is breastfeeding not nipple feeding. You need to have a good, deep, comfortable latch and this should not hurt. If it is hurting the latch is not right. Your baby needs to be tummy to mommy, very close with no spaces between the two of you. His mouth need to be completely open with lips curled out almost like a little fish mouth. If it hurts unlatch the baby by inserting your small finger into the corner of his mouth to break the suction. Do not pull the baby off as it will hurt your nipple. If it hurts call your certified lactation consultant. Don’t wait till everything starts going south – the sooner your latch can be fixed the easier the road ahead for breastfeeding.
Remember babies are hardwired to breastfeed and mommies learn to breastfeed. Both baby and mommy need to build muscle memory. Babies learn during pregnancy, they learn about familiar sounds, smells and some may even start to build motor memory for sucking their tongue, lips or hands. When born, babies are very primitive with a few survival reflexes and motor memory for milk feeding.
One of these reflexes is the crawl reflex, which is the reason for the breast crawl. The rooting reflex is also described as the search reflex and enables the baby to locate his food source. The oral grasp reflex supports the learning of finding the nipple and taking the nipple in their mouth. When your nipple touches your baby’s palate at the comfort zone where the sucking reflex occurs. The comfort zone is the area where the hard and soft palates join.
Babies have this amazing ability where they learn to coordinate a suck and swallow with breathing. While babies learn to feed, the sequence coordination is a lot of motor learning and produces muscle memory. Unfortunately, this is not a given because of intervention. These reflexes may be viewed as the small wheels of a bicycle and helps a baby to build this memory to feed well. Motivation is a big factor in learning and babes are born with this motivation to eat.
The greater the difficulty of the task, the greater the need for specific practice of the task. This in the end builds the motor and the muscle memory. Giving the baby a bottle or an artificial teat may lead to difficulty with breastfeeding because the flow is different and baby needs to go back and forth from the breast and bottle. It’s almost like starting to drive, it’s much easier driving an automatic car than a manual one. When you learn with an automatic car (the bottle) it’s hard to go and drive a manual (breast). However, if you start on a manual it’s easy to drive the automatic car. Rather feed your baby with a cup or a syringe if you need to feed the baby.
Let us revisit the anatomy of your breast. Your breast size doesn’t have an impact on your breastfeeding ability. Breast contains fatty tissue and breast tissue. Every pregnancy causes more breast tissue to be formed. Thus with every pregnancy more milk making cells are produced. Your breasts continues to grow till you are thirty-five.
Think of your breasts as a broccoli tree. The small little flowerets of the broccoli are a milk making cell or an alveolus. Around this little cell is a structure that resembles an elastic band. As the milk cells fill up with milk, this elastic band structure stretches and ejects the milk into the ductules where it flows towards the nipple. These ductules branches like the broccoli into bigger ducts that open on the nipple. Each nipple pore has a few openings and milk starts to spray out into the baby’s mouth.
It sounds so easy but it is hard work, here is the difference: the baby compresses and sucks on the breast. If you do hand expression you compress the breast whereas the breast pump will suck on the breast. Milk ejection does not happen randomly. The physiology of breastfeeding is like a new shampoo bottle with a spray top. You need to pump a few times before the shampoo appears. The same with the breast. The baby needs to suck a few times sending messages via the spinal cord to the brain. The brain in response to this message sends hormones to the alveoli to produce milk. The alveolus fills up and expands and the milk ejection reflex (when the little elastic bands ejects the milk) or let down occurs and milk starts to flow.
Think about the fact that if you needed to go to a funeral tomorrow you don’t doubt that your body will make enough tears. It’s a natural process when you are sad you can cry and tears will be produced. When you get to the funeral you will cry tears. If the baby starts to suck you will produce milk, which is the way your body works. So if you can trust your tears, you can then trust your breasts.
Day two is quite an intense day because all of a sudden the baby realises he’s not in the Jacuzzi anymore. Hunger pains, different voices and noises, uncomfortable clothing, a dry atmosphere and no food on tap. He wants to be on the boob all the time, and as soon as you put him down he wants to feed again. Couple this with healthcare workers saying “your baby is hungry, your milk is not in” and “his blood sugar is really low let’s give him a top up of formula”. Mothers start doubting their ability because they think that healthcare workers know better. One bottle won’t make a difference, they think. Unfortunately, it does. It delays the producing of copious amounts of milk, it interferes with the latch as there is no such thing as a slow flow bottle, it sensitizes your baby with different proteins than what we find in breast milk. And it paves the way for cessation of breast milk.
Babies learn to latch on a soft breast. When your breasts start to produce copious amounts of milk they may struggle to latch on your breasts. Imagine your breast is a balloon. As your breast fills up it’s like the balloon filling up with air. The nipple of the balloon will be easy to latch on but as it fills up the nipple flattens. The same happens with your breast. You may want to use reverse pressure softening to soften the areola or express a bit with your hand. This will help the baby to latch easier. They might also struggle with the fast flow, they are used to working hard for food versus a milk fountain. This will also be relieved by expressing a little before feeding.
If your baby can’t be with you after birth for various reasons and may be in the NNICU, the best thing you can do for your breast milk production and your baby is to start doing hand expression into a spoon and store the milk in a syringe. Start with a nice breast massage. (If you are still pregnant and reading this, start with breast massages during your last trimester). This will help later because you are already used to doing it. After massaging your breasts, you can start with hand expressing for at least a good few minutes on the one side. Move over to the other side. After this you may even try a pump. Research has proven hand expression is more efficient in the first few days than a pump. Take care with a pump because of the viscosity of the colostrum and the small amount available. You are wasting more precious gold with a pump. If your baby is not with you, express every two hours during the day and after the last expressing session of the day set your alarm for five hours and start the process. This is the best you can do for your baby.
Pumping breast milk only assures you of one thing and that is how much you have pumped. It is artificial. Your baby provides you with a lot of stimulation that you can’t get with a pump. Although some people are exclusive pumpers, mothers need to remember a few things that help you to produce more breast milk when the baby sucks from the breast. Skin to skin helps to increase the milk supply. Lovingly looking at your baby also increases your milk making hormones which will fill your baby’s stomach. A pump, even the Rolls Royce of pumps is still artificial. Smell your baby’s blanket, look at a video clip, talk to someone you love (this absorbs your attention), cover the pump with a blanket, drink something hot or something you really like. All of these will actually help you to have a better yield of breast milk.
If baby is healthy and with you, please don’t express if there is no medical reason. Rather feed your baby from the breast. Doing both is like having a roller skate on one foot and an ice skate on the other. You won’t get very far. For mother and baby, it’s better to learn one way at a time before learning another.
Although breast milk production still works on supply and demand we now know that there is much more to that phrase. Research shows that breast storage capacity has an important role in establishing and maintaining milk supply. What does this imply? Simply, the emptier the breast, the more and faster the milk will be produced.
Think about an automatic icemaker in a refrigerator generating ice blocks which drop into a basket. A mechanical arm is positioned over the basket, so that as the amount of ice in the basket increases, the arm raises up and slows the flow of water to reduce the rate at which the ice is produced. When the basket is full the arm is at its highest point and completely shuts off the flow of water. No more ice is made till the ice blocks are removed.
Breasts are exactly the same. Breastmilk contains a specific protein, the feedback inhibiting lactation (FIL) protein. If the breasts are full there are lots of this FIL and this slows down the production of milk. If the breasts are empty, there are less of this FIL and the breast milk production is increased. Emptier breasts produce more breast milk faster and full breasts decrease milk production.
A word of warning: do not assume that a baby is actually removing milk when he is at the breast. A baby with a poor suck or a problem will leave most of the milk in the breast and this will decrease the milk supply.
You know your baby is getting enough milk when
- Baby is drinking often – 8 to 12 times in a 24-hour period
- Baby is content after a feed looking “milk drunk”
- There are audible swallowing sounds
- Rhythmic jaw movement from the chin to the ear
- Baby is gaining weight
- Baby is passing at least 6 wet nappies in a 24-hour period after day 6
- Your breasts feel softer after a feed than before a feed.
The only rules in breastfeeding
- Feed the baby often
- Keep your baby with you, don’t allow any separation
- Move the milk
- Protect the supply, if the mom is not with the baby, express
- It’s your baby
- You know your baby best, if in doubt check it out
- Nobody knows everything
- Do not schedule feeds
- Do not wait for the baby to cry before you feed him. Feed the baby as soon as he displays feeding cues
- One position at the breast is success. More is just variety, there are 360 different positions.
If the latch hurts or you are unsure, call a Certified Lactation Consultant. Do not wait. The sooner you fix the problem, the better the journey. It’s your journey. Do not let anybody try to convince you otherwise. You can do it. Enjoy the journey!
By Jane Pitt – nursing sister and midwife, breastfeeding advisor
Breast milk has antibodies that pass from mother to baby, protecting baby from infection and this could mean having fewer medical bills and less days off work caring for sick children. Babies in crèches can pick up more infections than babies at home. Even if you breastfeed or give baby expressed milk only once a day, your baby still benefits from these antibodies. Recent studies show that breast milk has multipotent stem cells. These living cells have immense differentiation potential, vital for neonatal development and a target for stem cell therapy and breast cancer research.
Many mothers are employed outside the home. While you are on maternity leave, enjoy these precious first few months breastfeeding your baby even if you have no intention of feeding longer.
When back at work, the first option is to take your baby with you. If this is not possible, ask if you can have a private place to express. This needs to be negotiated before you return to work as you will have more bargaining power than if you wait until you are back at work. Some mothers even arrange for crèches to be opened in the workplace and then they feed baby at lunchtime and tea breaks, a wonderful solution.
Expressing at the office
The Minister of Labour enacted “The Code of Good Practice on the Protection of Employees during Pregnancy and after the Birth of a Child”. This code specifically states that employers must grant a breastfeeding employee a 30 minute break twice a day for breastfeeding or expressing milk, and this must be done on each working day until the child reaches 6 months of age. There is a chance that Government will extend this time for mothers with babies up to one year of age and those with multiples will hopefully get more time.
If you have your own office, you can close the door or book the boardroom if there is no other private place to pump. Wherever you are make yourself as comfortable as possible. If you are lucky enough to have a baby room or specific area, you will use this space. If not, some mothers who work in an open plan office can pump discreetly in a corner, reps pump in their cars, others choose to go to the ladies room as their best option. Some look forward to a break at lunchtime, put their feet up, read a book, eat their lunch and pump, all at the same time. However, Government regulations also say that your employer should give you time off to pump that is not your lunch time.
Working mothers continue to breastfeed in the following ways
- Expressing breast milk for the feeds you miss is the key factor. This helps maintain breast milk supply;
- Expressing must be quick, hygienic, comfortable and cost effective;
- Some mothers breastfeed just before leaving their baby with a caregiver, before going to work. On returning home, they feed the baby first and pump afterwards, keeping the extra milk for the next day. These mothers, especially if they only work half day, do not pump at work at all.
- Not expressing when you miss a feed, especially in the beginning, could cause inflammation leading to mastitis and will reduce your milk supply. To reduce/prevent overfilling of your breasts, express at least to comfort level.
Choosing a breast pump
Some mothers manage very well with hand expressing. Learning to express or use any breast pump sometimes takes time and practice. Once you are back at work it could be easier, as your breasts will be full and you will be pumping an entire missed feed. Just keep practicing and talk to your lactation consultant.
Some manual pumps only require one hand to operate – best if the handle is able to rotate / swivel to any position for ergonomic pumping which is the most comfortable action on hands and wrist. These are very popular with some moms.
Other manual pumps are still the original piston type. It is best to choose one with vacuum regulation.
Many working moms prefer electric breast pumps, as they are easier, quicker and more effective, especially with 2-phase suction. 2-phase pumps are designed to mimic the way the baby sucks; the stimulation phase, which has a fast and light sucking action, is followed by the expression phase, which is a slower and stronger rhythmic suction, like baby drinking/suckling. Really good pumps are gentle and effective, easy and comfortable to use.
Multi-user electric pumps (example: Medela Symphony and Lactina) can be hired and it is suggested you investigate and experiment to determine what is best for your needs. For hygiene reasons every mother needs to have her own kit.
Before purchasing your own pump, you can test hospital grade pumps using a disposable sterile kit. This will allow you an opportunity to feel the difference between single phase and 2-phase technology and you will be able to choose which feels best for you. When costing for pumps, remember to calculate the saving on regular monthly formula bills (R600 to R900 per month).
Working mothers would be advised to use a double electric pump with good 2-phase action for fast efficient expressing. Mothers also get more let-downs and more milk with double, 2-phase pumps. In addition, when used with a bustier (pumping bra), mothers have both hands free and can do something else at the same time (all mothers do seem to multitask). This also helps with more spontaneous let down and more milk as they are not holding up bottles of milk whilst pumping. They are more relaxed and get a better let down.
There are also good 2-phase, single electric pumps but research shows mothers get more milk with 2-phase double pumping and in addition a higher fat-content in their milk..
The size and portability of the pump is also a factor. An electric pump with battery option is preferable. Depending on your situation these factors might influence your decision: some are handheld, others can clip onto your waistband, while still others are bigger and need to be used on a desk or table top. Another deciding factor could be the noise a motor makes. Although all electric pumps have a motor, some are quieter than others.
Whatever pump you choose, make sure all replacement parts are readily available locally.
Comfort & Breastshield Fitting
If the pump you are using is not comfortable, check you are not using a vacuum setting that is too high for your body. Also check the fit of the breastshield. A breastshield which fits correctly keeps milk ducts open and gives you maximum comfort when expressing and also optimal emptying of the breast– this will help maintain your milk supply. Some companies have various size personal fit breastshields ranging in sizes from 21mm to 36mm. Try different sizes when necessary.
Before you pump and to increase comfort, always wet the whole areola around the nipple and/or the breastshield with milk or clean water to facilitate a smoother movement of the nipple and areola inside the breastshield. It should not be tight. Ensure your nipple is pulling centrally to the vacuum action.
Times to Express?
Early, before or while you feed baby in the morning (you have extra then), once or twice when you are at work and perhaps again before you go to bed, especially if baby misses a feed at night. Some mothers need to express less often than other mothers, to maintain their milk supply.
Milk supply fluctuates – working mothers have most milk on Mondays – least on Fridays and it builds up again over the weekend, when she breastfeeds more often. Moms will often feel most full in the mornings. This milk is high volume but lower calorie-value whereas in the evenings you might find you have less volume but remember this milk is very high in calories.
On the whole, use the milk you express today to give the baby’s caregiver tomorrow.
To increase milk supply, pump after feeds until milk stops flowing. Then pump for an extra 3-5 minutes on each side, 3-5 times a day and in a few days’ time, your supply should increase. For best results, use a gentle effective 2-phase, double breastpump.
Eat well! A good, well-balanced diet with regular meals. Drink enough fluids, lots of water (2 – 3 litres a day), especially just before pumping or feeding. This is essential to maintain your supply. Make sure you drink before arriving home. Also drink with night-feeds.
It is essential, after use, to separate and rinse all parts that come into contact with the milk with cold water. Then wash all working parts of the pump with hot water and liquid soap and clean off fat gently with a bottlebrush. Rinse again with clear water. (Please also ensure that your hands are clean whenever handling your breast pump or breast milk – especially when at work). Re-sterilise before pumping. Re-usable steam sterilising bags used in a microwave are very useful for mothers who are not at home. Dry all parts with clean paper towel before assembling the pump again.
Managing your breast milk
Breast milk should preferably not be stored at room temperature in hot climates. Best kept in a cooler bag with a good size frozen cooler brick nearby to store and transport expressed milk while at the office or out and about, then refrigerate immediately when you return home. Expressed milk can be refrigerated for 3-5 days at approximately 4°C before being used. Breast milk can be frozen for up to 6 months at approximately -16 to -18°C. It is best to store breastmilk at the back of the fridge or freezer, where it is coldest. Date your milk, so that you can use the oldest first. There are disposable freezer bags and breast milk storage containers available especially for storing breast milk. Make sure they are all BPA free. Some freezer bags are double lined to prevent freezer burn and to maintain the optimum nutritive value of your breast milk. Only refreeze thawed milk if there is still some frozen milk present and try to use milk within 10 hours of thawing.
How much and how often?
Working mothers always ask how much milk they should leave for the baby for a feed when they are at work. You take the baby’s weight in kilograms and multiply by 120ml – 150ml breast milk and divide by the number of feeds baby has in 24 hours.
For example for a breastfed baby –
A 4kg baby x 120 = 480ml in 24 hours,
Feeding four hourly = 6 feeds in 24 hours
480ml divided by 6 = 80ml per feed
Recent studies show that from 3 to 5 months of age breastfed babies gradually require less breast milk per kg of body weight because their growth rate is slower. This is good news for the mum who is expressing. Offer a maximum of 90-120ml per feed. Also, of course, once solids are introduced at 6 months all babies require less milk. Experiment and see what your baby needs, but don’t let him drink too much while with the caregiver.
How long does it take to express?
This is the question on everyone’s lips. This varies from mother to mother and breast pump to breast pump. Some mothers can pump even faster than they can breastfeed; others pump twice to get enough milk for one feed. Some mothers express easily. Other mothers need the very best and most effective breast pumps available. These breast pumps comfortably mimic the sucking action of the baby. The really sad thing is that if a mother uses a breast pump and it doesn’t work for her or it is not comfortable, she sometimes does not try another pump, thinking that all pumps are the same. They are different. Try another type of pump.
Most breast pump surveys state that pumping with a good electric pump is quicker than a manual pump. Double pumping is definitely fastest, (this means both breasts at the same time). A recent study shows that double pumping also increases the fat content as well as the quantity of mother’s milk especially for mothers of premature babies.
Try these tips:
- If you are struggling, pump on one side while you feed on the other;
- massaging the breast for a minute or two before, during or after expressing can also help increase milk flow if you need this extra assistance;
- to assist with increasing milk supply and decreasing the time it takes you to get it try alternating between the stimulation and expression phases of 2-phase pumps; and/or
- Keep a picture of your baby nearby. Thinking about your baby while pumping can assist with your let down. (Some moms scroll through all the pictures on their mobile phone while pumping and others even record their baby crying).
- Pump at regular times, especially while you are at work. Set your alarm on your cell to remind you. Your body gets used to regular pumping.
Feeding expressed breast milk to your baby – what to look out for
Remember never to heat your breast milk in the microwave as this will destroy many of the nutrients and living organisms which make human milk so precious e.g. antibodies.
If you introduce any alternative feeding device while at work it is important to note how your baby’s suckling action on the breast is affected. The suckling action on the breast should not change and your milk supply should remain stable.
More useful tips for expressing
Nipple problems are best prevented by good management including frequent feeding using correct latching techniques and variable feeding positions.
Expressing a little prior to latching, if breasts are very full or hard, will improve latching and aid comfort. Some moms find their pump to be a useful tool right in the very beginning when both mom and baby are learning the art of breastfeeding, especially after the milk first comes in (when baby is around 3 – 5 days old).
Pumping after a hot shower or hand expressing in the shower is very helpful for engorgement.
Do remember these are only suggestions and mothers cope in so many different ways. It is amazing what solutions mothers will find if they really want to work and still enjoy the pleasure and benefits of breastfeeding their baby. Anytime that you find that your milk supply dips, pump or feed a little more often and drink well and usually your supply will increase in a few days.
Enjoy your breastfeeding and the special relationship with your baby. We would love to hear your stories and experiences. Please write to us so we can also share your good information with other new moms.
For more information phone Jane Pitt. See our contact details below.
Breast Pump Hire
Tel: (011) 788-9102 / 083 300 4302
Hospital grade breast pumps available for hire nationwide. Phone for your nearest agent or for expressing advice.
“Wetness is opportunity. It represents the openness of nature to what falls from heaven.”
(From the book “Dirt: The Ecstatic Skin of the Earth” by William Bryant Logan)
The wetness of a kiss brings two people closer. The vagina moistens and lets in the penis to accept the heavy wet sperm. The sperm enters her waiting egg which is then enveloped by a warm watery sac. A laboring woman’s bag of waters breaks open moistening her birth canal. Even the wetness of her blood helps her baby to slip outside of her. Her wet baby lies on her chest and slides over towards her nipple. The mere smell and touch of his mother excites the babe and soon he drools his wet saliva onto her skin. He licks his lips in anticipation of what he does not know – something is coming, something wet and good that will make the move from his pickled womb to this dry, arid world easier to swallow. The first yellowy drop of colostrum appears enticing the baby to come closer. Come closer. “Wetness is opportunity.” Wetness is the beginning of life.
We tell mothers that her breast milk is important. It contains calories and vitamins, fats and protein. It has antibodies and immune factors; it has “pre” and “pro” biotics. Scientists have spent millions of dollars analyzing tiny drops of milk constantly updating the ever growing list of important things they have found within. We have come to attach a certain scientific aloofness to the value of human milk. It can be measured and scrutinized, it can be bottled and contained, it can be put on a shelf and held till needed. It can be produced at will. But we forget that inherent in its wetness is opportunity, the chance to connect mother and baby together again. Like the wet kiss that spurred the conception of this little one’s life, the moment a baby suckles on its mother’s breast the two are reminded that for this moment ’you are mine and I am yours, yours alone.’
Wetness is opportunity. It provides the chance to grow. The mother holds her baby close and lets him suckle at will. Immediately her other breast begins to let down and her milk leaks out attracting the baby to that breast as well. “Come here. It is wet here. Can you smell it? You see? There is more to come.” And because of her wetness the mother is prompted to offer the baby more and the baby is happy to accommodate her. Her wetness encourages him to eat, and yet without her help he knows when he has had enough. And in this way the two begin a rhythm. They begin to get in sync.
Wetness is an opportunity to be assured that all is well. The baby’s tiny belly fills and releases, fills and releases, again and again. The wetness of his diaper tells his mother that everything is okay. Her milk has reached his belly. He has taken what he needs from it and has let go of what was left. The pee is not too yellow; the wet poops are no longer green or black. And with each wet diaper that she changes she is reassured. “He is getting enough. We’re doing okay my baby and I, we’re going to be just fine.”
Each drop of wetness is an opportunity. The life source that surrounds us moves from drop towards precious drop. We are all connected by the wetness within. Our blood, our saliva, and the rest of our body’s many fluids, these are the things that make us alive, that make us human. It is our wetness, our milk, which we pass on to our babies to keep them alive as well. Each drop of wetness is an opportunity; an opportunity for connection, an opportunity for growth, an opportunity for reassurance. Each drop of wetness is an opportunity for life to be sustained.
By Hettie Grove – Registered nurse and advanced midwife, SACPE, ICCE, SACLC, SACLC course developer, IBCLC
The process of lactation actually starts in the foetal period of the mother as a baby.
Let’s look at normal breast development and the timeline of breast development.
Not only is breast development part of reproduction but unlike any other mammal the only mammal female who develops full breasts before they need to feed their young. Throughout a woman’s life breast development happens in a distinct rhythm from before birth right through to menopause. Changes occur during each menstrual cycle and also when she reaches her menopause. Breast development is all but static.
It all begins in the foetus when a thickening in the chest area is developed which we call the mammary ridge or milk line. At birth nipples and beginning of milk ducts are already formed. During the lifespan changes occur, and lobes or small subdivisions of breast tissue develop first. Thereafter mammary glands develop and consist of 15 to 24 lobes. From puberty these mammary glands are influenced by hormones. Involution or shrinkage of milk ducts is the final major change and around the age of 35 the mammary glands start shrinking again.
When ovulation and menstruation start, the maturing of the breasts begin with the formation of secretory glands and the end of milk ducts. The rate at which the breasts grow is different for each person.
|Breast developmental stages|
|Stage 1||After birth till puberty we find that the tip of the nipple is raised|
|Stage 2||Buds appear, breast and nipples raised, and the areola, that is the darker are around the nipple, enlarges|
|Stage 3||Breasts become slightly larger with glandular breast tissue present|
|Stage 4||The areola and nipple become bigger and form a second mound above the rest of the breast|
|Stage 5||In adulthood the breast becomes rounded and only the nipple is raised|
What happens in the menstrual cycle?
Menstrual cycles are usually cyclic. Each month during these cycles women experience fluctuations in hormones. The first half of the cycle is predominantly oestrogen which stimulates the growth of milk ducts and this gives the chance for the hormone progesterone to take over the second half of the cycle which stimulates the formation of milk glands. We believe this is responsible for cyclical changes like swelling, pain and tenderness that women experience just before menstruation. Menstruation heralded changes in breast texture therefore they have more lumpiness. The milk glands are therefore preparing for a pregnancy. The moment when pregnancy doesn’t occur the breasts return to normal.
If pregnancy occurs the breasts continue to mature and rapid growth of milk and alveolar buds take place. Breast changes is one of the very first signs or changes that heralds a pregnancy. Women start saying their breasts feel tender because the internal mammary artery runs down the side of each breast and this supplies blood to the breasts.
Due to this increased blood supply women might experience a tingling or even pricking sensation around their nipples. A bra with seams as well as lacy cups might increase the sensitivity of breasts. Breasts might also tingle with temperature changes and milk producing cells are reproducing quickly. In subsequent pregnancies some of the previous cells will still be there but a new batch will also form. The ones there from the previous pregnancy are the reason why some women might have more milk second time around (the so called muscle memory phenomenon).
Pregnancy rebuilds your breasts and actually armours them through changing the cells and proteins around them. The placental lactogens which are special hormones talk to the breasts and informs them about the sex of your baby (awesome hey!).
As the pregnancy progresses the nipples become more distinct and the areola, the area of skin around the nipple, starts to darken due to the increase in natural pigmentation, but is believed to become the bull’s eye for the baby to find the nipple more easily after birth. The combined and continued action of the hormones now oestrogen, progesterone and human placental lactogens are responsible for the growth of the glandular tissue and the milk ducts which start to swell in preparation for lactation.
In early pregnancy, breast growth is the most obvious sign of pregnancy, and some women can gain up to 680 grams in each breast (other much less). The pregnancy hormones and growing placenta encourages fat and breast ducts to grow. Breast tissue can also be found in the armpit and women with accessory breast tissue might also find that this gets larger. The alveoli which are small little sacs, almost like a grapelike form, which is where milk is secreted and stored, starts to expand and starts forming lobules which look like a bunch of grapes.
From around as early as eight weeks lots of blood vessels may be more visible just under the skin which is distinctive and known as “marbling”, all due to the increased blood supply. This network of blue veins are more obvious in fair skinned women and might not be noticeable in darker skin or in women with a higher body mass index.
The Montgomery tubercles start to appear, the little bump like formations, which are hypertrophic sebaceous glands, secrete an oil that helps to keep the skin supple and discourages bacteria forming. Each breast may have between 4 and 28 of these tubercles, which is a tell-tale and most reliable sign of a first pregnancy, but since they don’t shrink completely after birth might not be used as a diagnostic sign in subsequent pregnancies.
Soon after the ninth week of pregnancy the areola darkens more, may enlarge in diameter and become more erectile. Here the darker skin women might see more noticeable changes.
Girls who have so called inverted nipples might start to worry about how this might influence their ability to breastfeed. The largest percentage of inverted nipples will correct themselves but even if they stay inverted you will still be able to successfully breastfeed with correct positioning and help.
In first pregnancies it’s quite common for the nipple not to protrude fully. In about a third of women they will experience a degree of inversion. This improves as the skin changes and becomes more elastic, leaving about a tenth of them with some inversion at birth. Women who have breast implants might experience extreme tenderness at about 12 weeks. The skin might also feel very taut and uncomfortable.
Glandular tissue changes happens around 16 weeks. The alveoli sacs are lined with special milk producing cells which are called acinar cells. Colostrum may also be expressed from now. This is a concentrated sticky nutrition dense fluid that will feed your baby for a few days initially after birth before the production of copious amounts of mature milk. This colostrum contains sugar, protein as well as lots of antibodies and also boosts your baby’s immunity.
Due to sudden growth and increased number of blood vessels, some women might start to experience occasional leakage of a little bit of blood from the nipples. It might also be a little blood mixed with the colostrum that sticks the nipple to the bra. Although this probably is totally normal, speak to your health care worker to make sure.
Between week 20 and 22 stretch marks might become visible particularly on the underside of the breasts. Most women will develop stretch marks due to the collagen beneath the skin that stretches to accommodate the enlargement of breast tissue. The number of stretchmarks vary and is determined by genes and age – older women would have less elasticity and so experience more stretch marks. Receptors for oestrogen and progesterone start closing down which have a protective effect against cancer.
A second period of major breast growth occurs around 22 weeks and women might notice a sudden change in size. It might be worthwhile to get new bras, bearing in mind that underwiring of bras may restrict blood supply and have a crushing effect on the developing milk ducts.
As the breasts become fuller they might become more pendulous and a little sagging might take place, again elasticity plays a large role in the sagging process. Currently there is no scientific evidence that breastfeeding causes breasts to sag. Researchers have noted that there are several factors eg. Higher BMI, higher pregnancy number, smoking and greater age as well as the larger pre-pregnancy weight that can cause the breasts to sag.
Colostrum might now leak at random times more so during sex or a bath. Don’t worry if you don’t see or experience colostrum, it is there and you are more fortunate as there is no leaking. From about 27 to 28 weeks, your breasts are sufficiently developed to be able to feed a baby and to function as milk producing glands which is called lactogenesis, but the elevated progesterone levels of the pregnancy prevents the breasts from secreting milk until a few days after the birth once the placenta is delivered. The milk ducts will also start to dilate (what an awesome process).
A lot of women might experience what is called a sweat rash. The reason for this is a higher than normal proportion of blood flowing to the skin and the mucous membranes and the blood vessels dilate to accommodate it from about 30 weeks. The nipples might also be more prominent…..You are going to feed a baby! Check with your healthcare provider as this might be a fungal or bacterial infection. Try to keep the area as dry as possible.
A creamy fluid oozes from the Montgomery’s tubercles – which you might notice. Avoid using soap as this may dry them and cause them to itch. You might also remove the sebum that is there to keep your skin supple.
When you are in the homerun in the last few weeks of pregnancy, the colostrum changes from thick and yellow to pale, nearly colourless. The breasts are now fully mature and their stem cells change or differentiate into “cancer resistant high performance dairy equipment”. This protection will remain after weaning.
Labour and birth signals a physiological chain reaction and the mode of birth plays an important role in the whole breastfeeding story. Directly after the birth of the placenta the circulating oestrogen and progesterone fall and prolactin increases. At this time nerve impulses from the uterus travel to the brain via the spinal cord and the brain signals the pituitary gland to release the hormones prolactin and oxytocin. Thinking about these two hormones we can easily say that prolactin is the menu and oxytocin is the waiter that brings the food. This stimulates your breasts to start doing what they are supposed to do – lactate.
Some women might notice no changes at all till they start to produce copious amounts of milk after day 3. Some might experience these changes more gradually or not perceptibly. Remember each women is different and it may be normal for you. You may worry about insufficient glandular tissue but studies have shown no association with breast growth and subsequent milk production. If you are worried talk to your midwife or lactation consultant.
By Louise Goosen – Internationally Certified Lactation Consultant
So much has been written about breastfeeding but do we really appreciate what this wonder food does for our babies? Did you know for instance, that the unique first milk (colostrum) is referred to as a baby’s first immunization? It is most effective when your baby gets no other milk or water – only his mother’s colostrum.
Most healthy newborns are awake for the first 2 hours after birth. Should your baby be very sleepy, some of your colostrum can still give him the best start possible. You can achieve this by expressing a few drops of colostrum on a teaspoon and giving it to your baby. Continue doing this every hour or two until he is ready to breastfeed.
- Practice expressing once you are over 37 weeks pregnant. You may see nothing, a drop or two or more – it is all normal.
- Pack a clean teaspoon into your hospital bag – it need not be sterile for a healthy full term baby.
Should your newborn be too sick, premature or of low birth weight there is even more reason to provide him with the best nutrition possible. Your baby might not be ready to take anything for a day or two but don’t delay expressing. To ensure a good milk supply express 8 to 10 times in 24 hours.
- Express by hand for the first day or two even if you own a breast pump. The first few precious drops or teaspoons-full of colostrum will otherwise be lost in your pump. By hand expressing you could collect this colostrum in a sterile teaspoon or small syringe, ready to feed to you baby.
- Once your milk supply has increased, you could purchase a pump. The type may depend on how long it will be before your baby is able to breastfeed.
- For short term expressing a hand pump may be all you need. It is however essential that you purchase your own new pump and not borrow or buy a second hand one. Plenty are available priced at less than the cost of 6 weeks supply of formula.
- For longer term use you may want to consider a portable electric breast pump. As these pump motors are not sealed, it is possible for milk to enter the motor. These pumps are also strictly for individual use and should not be shared, hired or bought second-hand.
Many hospitals have multi-user electric pumps (Medela Lactina and Symphony). It is essential however that you purchase your own kit (consisting of connections, tubing and containers) to use with it. This kit can also be used on it’s own as a hand pump. It is worth buying your own even if you are offered the option of a kit that has been autoclaved.
(In the ‘Breastmilk Protocol for Premature and Sick Babies in Hospitals and Clinics of April 2002’ Prof G. Kirsten Head of Neonatology, Neonatal Intensive Care Unit, Tygerberg Hospital and Prof M. Cotton, Paediatric Infection Specialist Tygerberg Hospital, insist, that individual user breast pumps or their attachments cannot be shared under any circumstances.)
By Christine Klynhans – BCurI et A, SACLC – SA certified lactation consultant
Most new mothers plan to breastfeed their babies and, according to the South African Demographic and Health Survey of 1998, approximately 88% of mothers initiated breastfeeding at birth. However, only 10% of babies were breastfed exclusively in the first three months of life, with less than 8% reaching the 6 month mark. This makes South Africa one of the countries with the lowest breastfeeding rates in the world.
Increasingly research is showing that the birth option a woman chooses and the way births are conducted influence breastfeeding. Many women don’t realise this; in fact, many do not prepare for breastfeeding at all, assuming that it is something that will come naturally. Let’s take a closer look at what this means in practice.
Before examining the role of all the various interventions, it’s important to recognise the important positive contribution that a good, natural birth makes to breastfeeding.
Birth is a complex process that is extremely sensitive to outside influences, of which the fundamentals are still poorly understood. In her book ‘Gentle Birth, Gentle Mothering’, Dr Sarah J. Buckley describes the hormonal orchestra accompanying undisturbed birth, and how these hormones not only support the birth process, but also suffuse the brains of a new mother and her baby, catalysing profound neurological changes. These changes give the new mother the personal empowerment, physical strength and an intuitive sense of what her baby needs. It also kick-starts breastfeeding and breast milk production.
Two of the labour hormones that may specifically influence breastfeeding are Oxytocin and Beta-Endorphin.
Oxytocin – the hormone of love
In labour oxytocin is released in pulses by the posterior pituitary gland in the brain, and it is reckoned to be the prime mediator of rhythmic contractions. Oxytocin is also produced by the baby’s pituitary gland, as well as by the placenta and membranes. After birth skin-to-skin contact and the baby’s movements at the breast also stimulates oxytocin release.
Maternal blood oxytocin levels peak at one hour after birth, and then subside. Brain levels stay high for much longer, where it is involved in switching on maternal instinctive behaviour. Newborn babies have elevated oxytocin levels for at least four days after birth. Oxytocin is then also excreted while breastfeeding and causes the milk ducts to contract and excrete breast milk.
Another role that oxytocin plays in the olfactory system, which plays an important role in the establishment of mothering behaviour. One study found that monkeys who delivered by Caesarean section rejected their babies unless these babies were swabbed by secretions from the mother’s vagina. Newborn babies use their sense of smell to find and latch to the breast.
An elective Caesarean section (where the mother does not go through labour at all) or even an induction of labour where synthetic oxytocin is administered at a steady dose (instead of pulses), will have some influence on maternal and newborn oxytocin levels after birth. The true effect of this on bonding and breastfeeding is not known. However, one can speculate that it may play at least some role in why so many mothers seem to lack the confidence and persistence needed to persevere until breastfeeding is established.
Beta-endorphin – the hormone of pleasure and transcendence
This naturally occurring opiate is excreted by the posterior pituitary gland under conditions of stress and pain. During labour this hormone provides pain relief for women. In the hours after birth, beta-endorphin rewards and reinforces mother-baby interactions, including physical contact and breastfeeding, and contributes to feelings of pleasure and ecstasy for both.
One study found higher levels of Beta-endorphin four days postpartum in the breastmilk of mothers who gave normal birth compared to caesarean birth. This may help the newborn baby to adapt to the stressful environment outside the womb. Higher stress levels in babies may contribute to breastfeeding and latching difficulties.
The influence of birth interventions on breastfeeding
There is a difference between ‘normal vaginal deliveries’ as they are routinely done in most hospital set-ups, and ‘natural undisturbed birth’. Routine practices like brightly lit birthing rooms, the display of medical equipment, hospital noises in the back-ground, inserting IV lines and care by strangers are often the first spanners in the works, inhibiting a woman’s normal hormonal workings and leading to a cascade of interventions that could have been prevented. Simple changes like dimming lights or drawing curtains and playing soft music to drown out background noises can go a long way towards positively influencing birth and, indirectly, breastfeeding.
Induction of labour
First-time mothers have twice the likelihood of ending up with a caesarean section after an induction of labour compared to natural onset of labour. This increase is linked to the induction processes, not to the conditions for which the procedure was performed in the first place. All induction agents can cause uterine hyper stimulation, which in turn can lead to foetal distress. Inductions increase the need for other interventions like the insertion of IV-lines, continuous foetal monitoring and confinement to bed. Induced labours are more painful, and more women will require pharmacological pain relief and epidural anaesthesia. All of the above factors can negatively influence breastfeeding.
Especially concerning is the use of synthetic oxytocin during an induction, a drug linked to uterine hyper stimulation and postpartum haemorrhage. Postpartum haemorrhage may delay the initiation of breastfeeding. It is a common cause of delayed ‘coming in’ of milk. Maternal fatigue may also necessitate formula supplementation.
Pethidine for pain relief
In South African hospitals the opioid Pethidine is offered to labouring women for pain relief almost routinely. Pethidine during labour has been linked to delayed and depressed sucking and rooting behaviour in infants. Another study found that Pethidine also increases infants’ body temperatures and crying after birth. Through these effects Pethidine affects the baby’s ability to latch at the breast at a time when it is best programmed to learn how to do this.
Another well-known effect of Pethidine is the suppressing effect on the newborn infants’ respiratory system. This may cause low Apgar scores, may necessitate a traumatic and painful Narcan injection and can even lead to baby’s admission to NICU.
A literature review done in 2012 on the efectiveness of pain relief options for labour women found insufficient evidence that opioids are more effective than placebo for pain management in labour. It does, however lead to side-effects like nausea and drowsiness in the labouring women, disturbing the birth process and the precious first hours between mom and baby. Another concerning matter identified is that, despite concerns for more than 30 years about the effects of maternal opioid administration on subsequent baby behaviour and breastfeeding, only two out of the 57 studies reviewed reported on breastfeeding as an outcome. The fact is that the effects are probably far more severe than we currently know.
Epidural anaesthesia is currently the most effective method of pain relief in labouring women. However, epidurals disrupt birth processes in major ways, and are linked to very serious side-effects, many which are still poorly studied. Most women who receive epidurals are not informed of these possible effects on them and their babies.
Many of the maternal side-effects of epidural anaesthesia impact on breastfeeding. Epidurals drastically reduce oxytocin and beta-endorphin release, interfering with the normal hormonal symphony in labour and beyond. It is linked to longer labours, and a higher incidence of instrument deliveries.
The effects of epidural anaesthesia on breastfeeding are not well studied. It’s also difficult to study. Many mothers with epidurals have also been exposed to opioid drugs like Pethidine, with its well-known effects on breastfeeding, or underwent an induction. Different drugs and different dosages are used for epidurals, which may have different effects. How the fourth stage is managed will also still affect breastfeeding.
Lastly there are concerns over the neuro-behavioural, hormonal and autonomic effects of epidural anaesthesia during mom’s labour on babies. There seems to be a link between epidural anaesthesia and disorganized pre-feeding behaviour (finding the breast, licking, nipple massage and hand sucking), to more feeding difficulties in the early days and to shorter duration of breastfeeding.
Instrument deliveries usually follow complicated labours, and many of these women have already been exposed to opioid drugs, synthetic oxytocin and epidural anaesthesia. Another indication is foetal distress in the second stage of labour. All of the above already impacts negatively on breastfeeding, making it difficult to determine the exact role that the instrument delivery plays.
Instrument deliveries have been linked to short term risks for baby like bruising, facial injuries, displacement of the skull bones and cephalohaematoma.
In more serious cases, facial nerve and muscle damage, and intracranial haemorrhage will most certainly seriously affect breastfeeding. However, even babies with much milder injuries will still experience pain and discomfort, especially as the head may be touched or may press against bedding or mom’s body during breastfeeding. And of course there is the increased risk of jaundice with cephalohematoma, linked to separation between mom and baby and to sleepy babies, further impacting on breastfeeding. These little ones will need extra care and attention.
The majority of mothers delivering their babies in private sector hospitals in South Africa will do so via Caesarean section. While a proportion of these Caesars are medically justifiable, the majority are not.
Various breastfeeding difficulties are linked to birth by caesarean section. Even when a supposedly accurate due date has been estimated by sonography, an elective caesar holds the risk of medically caused prematurity, with all the implications of a premature birth for a baby. Various studies link caesarean birth to breathing difficulties after birth, often leading to separation between mom and baby and to admission in NICU. Babies born via caesarean section also miss out on the hormonal support that natural birth offers both mom and baby in the hours after birth, with physical and emotional consequences.
Due to all of the above, successful breastfeeding is less likely after a caesarean section. It has also been shown that abnormalities in the release of prolactin in the early days after caesarean section, negatively influence milk supply.
There is hope
It’s important to know that, no matter how bad the start, from the very first moment after birth we have the power to make a difference. Most babies hampered by difficult birth experiences will still be able to successfully breastfeed, with perseverance from the mother, continuous skin-to-skin contact and good breastfeeding support.
In celebrating Breastfeeding Week 1st to the 8th August, we bring you some advice from Dr Sarah Rayne from the Breast Care Centre in Johannesburg. This info will help you whether you are breast feeding or not so everyone can celebrate Breastfeeding week! Have a wonderful week!
Does it fit? Getting some good bra support…
It is estimated that 80% of women are wearing the wrong bra. Are you one of them?
“Good underwear! Wearing a good bra makes me feel confident and elegant. Make sure you know your correct bra size and invest in a well-fitting bra. Most women’s breasts change up to 6 times during their life so if you haven’t had a new bra for a while, chances are you are wearing the wrong size. Not only does a good bra do wonderful things for your assets, helping reduce breast pain and some back problems, but it will lift your boobs and lengthen your tummy – making it seem flatter, longer and sexier.
Whether lacy or plain, choose a bra with wide straps and make sure the cup fits all of your breast, sitting in the crease below the breast and separating the breast from the tummy and lifting it up. Most women wear too big a bandsize and too small a cup so suddenly a 38C woman will become a 34DD bombshell overnight!”
Wearing the wrong size bra can lead to increased pain in the neck and shoulders as the breasts are inadequately supported. One of the most common causes for breast pain is poor support and women are often shy to look for the correct size of bra. As a result their bust is unsupported from below and all the support comes from the shoulder straps which causes welts and indentations in the shoulders.
This lack of support can also lead to large breasts hanging down on the skin below the breast causing an area of warm moisture through the day. This results in a fantastic breeding ground for bacteria and fungi to grow-often seen as a white or red discolouration under the breasts and eventually leading to a darker discolouration in dark skins. An inappropriately tight bra can also cause problems. There is constriction of the respiratory muscles (the muscles that helps us breathe well) causing breathing problems, and back and shoulder aches too.
So what is the wrong bra and how do you find the right one for you? Look in the mirror with your bra on and see if it fits
It doesn’t fit properly if…
- The underband is riding up at the back: if the underband bows up at the back or lifts up when you raise your arms it is too loose.
- The shoulder straps are digging in: A vast majority of support for your breasts should come from the underband, support from below not suspension from above. If you have too loose a band you will feel the straps dig into your shoulders and be left with red marks there
- The centre between the cups lifts away from the body: The centres should lie flat against your body supporting and separating your breasts. If it does not, your cup size is probably too small
- The straps do not lie in parallel to each other but stretch outwards: This normally means that your underband is too tight and is overstretching at the fastening
- Some of your breast spills out over the top of your bra: The classic “four breast” look! The cup is dividing your breast tissue because your cup size is too small. Often women are alarmed to find they are actually a DD, E or F rather than a C cup
It will fit properly if ….
… you follow this easy plan to correct bra size
- Get some help: Most lingerie shops and departments offer a bra-sizing service and you should take them up on it. There should be no obligation to buy
- Budget for a good bra: If you are worried about the cost of a bra, take some time to see how much you have spent on clothes in the last 6 months, and how many times a week you wear the items. Your bras are the most often worn items in most women’s wardrobes, but the item they are most reluctant to spend money on. Spoil yourself and your bosom!
If you want to have an idea of your bra size before your shop: you will need to know your underband size and cup size. Even though South Africa follows metric measurements, bra sizes are still measured in inches. To convert centimetres to inches, divide by 2,5.
First, take a soft measuring tape and put it around your body just underneath your breasts. Take a deep breath in and pull it snug to your skin. Record this measurement (eg 31 inches) and then add 5 to it, rounding up to the next even number (31 + 5 = 36 inches). This is your band size.
Next measure round over the fullest part of your breasts (normally at the nipples) when you are wearing a bra. Record this measurement (eg 38 inches) and subtract this measurement from your band size (38 – 36 = 2). This will correspond to the cup size you should try first.
If the number is:
0 = AA cup
1 = A cup
2 = B cup
3 = C cup
4 = D cup
5 = DD cup
6 = E cup
Remember that his is only a rough guide of your size. You should then shop and try on sizes one above and below. As you adjust the band size up (eg 36 to 38) come down by one on the cup size (eg 36D to 38C).
Not all styles will suit all breast shapes, so it may take some time to find a bra that suits and fits you. When you find the right bra, it should not be uncomfortable or dig into your skin. It should hold your breasts well and give you a good shape. A good bra can give you as much shape and lift as expensive plastic surgery.
At the Helen Joseph Breast Care Centre, Helen Joseph Hospital, they have a new patient clinic every Wednesday morning for patients without medical aid. No appointment required: patients can just turn up between 7 – 10am for consultation, screening and investigations.
By Jane Pitt – Breastfeeding Advisor
Breast milk has antibodies that pass from mother to baby, protecting baby from infection and this could mean having fewer medical bills and less days off work caring for sick children. Babies in crèches can pick up more infections than babies at home.
Even if you breastfeed or give baby expressed milk only once a day, your baby still benefits from these antibodies. Recent studies show that breast milk has stem cells and we have yet to discover all the benefits of these stem cells.
Most mothers are employed outside the home. While you are on maternity leave enjoy these precious first few months breastfeeding your baby even if you have no intention of feeding longer.
How do working mothers continue to breastfeed?
The first option is to take your baby with you to work and this needs to be negotiated before you return to work. Some mothers even arrange for crèches to be opened in the workplace and then they feed baby at lunchtime and tea breaks, a wonderful solution.
- Expressing breast milk for the feeds you miss is the key factor. This helps maintain breast milk supply.
- Not expressing when you miss a feed especially in the beginning could cause inflammation leading to mastitis. To reduce overfilling at least express to comfort level.
- Expressing must be painless, quick, hygienic and cost effective.
Some mothers manage well with hand expressing. Most find breast pumps quicker and more hygienic, especially in the workplace. The really good pumps are gentle and effective, easy and comfortable to use. Good pumps should not give you aching hands or a sore neck or be painful in any way.
Multi-user electric pumps (Medela Lactina) can be hired and it is suggested you investigate and experiment. For hygiene reasons every mother should have her own kit. Ask to use a pump with a disposable sterile kit while in hospital before you decide to buy. When costing for pumps, remember to calculate the saving on regular monthly formula bills about R500 to R700.
Most hand pumps require two hands to operate. Some pumps only require one hand, leaving the other hand available to support the breast. To operate them with only one hand can be tiring. One manual model also enables someone else to pump for you, if you so wish. Only one make is convertible to a mini-electric model.
Many manuals are the piston type. The cheapest ones do not have any vacuum regulation. Those with precise vacuum settings, cost more and are recommended for comfort reasons especially for mothers with sensitive nipples.
Expressing a little prior to latching, if breasts are very full or hard, can improve latching and aid comfort. Nipple problems are best prevented by good management including variable feeding positions and correct latching techniques.
Some breast pumps have various funnel (breast shield) sizes available for best nipple comfort. You might need a bigger or smaller size nipple fitting than the standard size supplied with the pump. Before you pump, wet the nipple and whole areola with milk or clean water so the skin moves freely inside the pump. Ensure your nipple is pulling centrally to the vacuum action.
Some piston type hand pumps function better when the rubber seal is wet with sterile water. Those with vacuum adjustments are far easier to operate and are much more comfortable. Make sure all replacement parts are available locally.
Pumping after a hot shower is recommended or even in the shower with a hand pump – although this milk cannot be saved and used. Try a quick, gentle, suck and release action to stimulate a let-down, then a slower, stronger action to express your breast milk. Be patient and practise a little each day. Some electric pumps do this 2-phase pumping action automatically.
To most working mothers, time is of the essence and these mothers often prefer an electric model. True one-handed electric models are the most versatile, allowing you to pump and feed or read or write and now there are even double pumps.
It has been noticed that mothers get a much better letdown reflex with an automated action breast pump. This means the pump automatically releases at the end of each pumping phase.
When to Express?
Early, before or while you feed baby in the morning, once or twice when you are at work and perhaps again before you go to bed, especially if baby misses a feed. Some mothers need to express less often than other mothers, to maintain their milk supply.
To increase milk supply, pump after feeds until milk stops flowing. Then pump for an extra 3-5 minutes on each side, 3-5 times a day and in a few days time, your supply should increase. For best results, use a gentle effective automated breastpump.
On the whole, use the milk you express today to give the baby’s caregiver tomorrow.
Milk supply fluctuates – working mothers have most milk on Mondays – least on Fridays and it builds up again over the weekend, when she breastfeeds more often.
It is essential, after use, to wash all working parts of the pump with liquid soap and to clean off fat with a bottlebrush. Dry with a paper towel. Re-sterilise before pumping. Re-usable steam sterilising bags used in a microwave are very useful for mothers who are not at home.
Breast milk can be stored at room temperature for 6 hours in a clean, closed container and then should be used. Expressed milk can be refrigerated for 48 hours before being used or frozen in a freezer for 3 months. Normally, the milk you express today, you give to your baby tomorrow. Date your milk, so that you can use the oldest first. There are disposable freezer bags and breast milk storage bottles available especially for storing breast milk. Make sure they are all BPA free. Some freezer bags are double lined to prevent freezer burn and to maintain the optimum nutritive value of your breast milk.
How much and how often?
Working mothers always ask how much milk should they leave for the baby for a feed when they are at work? You take the baby’s weight in kilograms and multiply by 120ml breast milk or 150ml breast milk substitute and divide by the number of feeds baby has in 24 hours.
For example for a breastfed baby –
a 4kg baby x 120 = 480ml in 24 hours,
feeding four hourly = 6 feeds in 24 hours
480ml divided by 6 = 80ml per feed
Recent studies show that from 3 months to 5 months of age breastfed babies gradually require less breast milk per kg of body weight. This is good news for the mum who is expressing. Also, of course, once solids are introduced at 6 months all babies require less milk. Experiment and see what your baby needs.
How long does it take to pump?
This is the question on everyone’s lips. This varies from mother to mother and pump to pump. Some mothers can pump even faster than they can breastfeed, others pump twice to get enough milk for one feed. Some mothers express easily. Other mothers need the very best and most effective breast pumps available, which mimic the sucking action of the baby, exactly and comfortably. The really sad thing is that if a mother uses a breast pump and it doesn’t work for her or it is painful she sometimes does not try another pump, thinking that all pumps are the same.
Most breast pump surveys state that pumping with a good electric pump is quicker than manual pumps. Double pumping is definitely fastest, (this means both breasts at the same time). A recent study shows that double pumping also increases the fat content as well as the quantity of mother’s milk especially for mothers of premature babies.
Expressing at the office
Before you return to work, ask if you can have a private place to express. You will have more bargaining power than if you wait until you are back on the job. If you have your own office, you can close the door and pump whilst still working, holding the pump in one hand. These small electric pumps suck and let go automatically like a baby sucks and you do not need to do anything, the pump does all the work. You don’t get tired, hot or sweaty, as you can with manual pumps. Mothers who work in an open plan office pump discreetly in a corner, others choose to go to the ladies room. Some look forward to this break at lunchtime, put their feet up, read a book, eat their lunch and pump, all at the same time.
Some mothers do not pump at work at all. They feed their baby just before leaving them with the caregiver, or pump and feed, just before going to work and then on returning home, feeding the baby first and pumping afterwards, keeping the extra milk for the next day.
Mixing the fore milk and the hind milk
When breastfeeding a baby, the first milk the baby receives is very watery to quench baby’s thirst. The middle milk looks like ordinary milk and the hind milk or the last milk to be drawn off the breast is rich and creamy. When leaving a baby a feed, it is good to have the hind milk and the fore milk mixed together. In other words, expressing an entire feed is easiest. If you express before a feed, ensure you also express towards the end of a feed to give baby a mixture of fore and hind milk.
Breastfeeding and working – what to look out for
Feeding expressed breast milk to your baby
How can my caregiver feed my expressed breast milk to my baby without running the risk that my baby might prefer the bottle and become reluctant to breastfeed.
There is an innovative and unique feeding device designed for breast milk called Calma. Calma is not intended to replace breastfeeding but to enhance and assist continued breastfeeding for mothers going back to work or having to be apart from their babies for whatever reason.
In a study conducted at the University of Western Australia (Geddes, DT, Kent JC, Mitoulis LR, and Hartman, PE (2008). Tongue movement and intra-oral vacuum in breastfeeding infants. Early Human development 84:471-477) it was shown that babies at the breast produce a vacuum to stimulate milk flow. Babies learn that a combination of specific tongue and jaw movements is necessary for breastfeeding. Most mothers have been taught that a good “latch” is also essential for good milk flow and to avoid sore or cracked nipples. Unlike conventional teats, with Calma babies have to create a vacuum to get the breast milk to flow, just as they do with breastfeeding. Babies can thus maintain their natural sucking rhythm and can drink, pause and breathe regularly, without having to remove Calma from their mouth. This enables an easy transition between the breast and Calma and back to the breast. Note how your baby feeds on the breast after having introduced a bottle. Suckling action on the breast should not change. If the suckling action does change it could cause your milk supply to drop. Watch out for this. It is best to introduce Calma as the first feeding device, as baby has to work to get the milk out, like breastfeeding. Dip the Calma teat into some expressed breast milk for the first few times that you use Calma, to encourage your baby to start sucking because no milk flows from Calma (even if you turn the bottle upside down),until your baby starts sucking. You need to “latch” your baby onto Calma just as you would when breastfeeding.
It is suggested that you breastfeed exclusively for the first 6 – 8 weeks, without any bottles, allowing breastfeeding to become well established.
Do remember that these are only suggestions and mothers cope in many different ways. It is amazing what solutions mothers will find if they really want to work and still enjoy the pleasure and benefits of breastfeeding their baby.
Breast Pump Hire
(011) 788-9172/02 083 300 4302
Hospital grade breast pumps available for hire nationwide in many centres. Phone for your nearest agent or expressing advice.