13 Jul The Raw Reality of Breastfeeding… and some Tips to help you Persevere
By Anchen Verster – Registered nurse and midwife, SACPE, SA certified lactation consultant student
I recently searched the web looking for breastfeeding pictures for a workshop. I was particularly looking for a picture of a mother crying while breastfeeding. I found ONE!
All the other pictures were serene beautiful pictures of mothers smiling while cradling their calm baby. Most mothers were dressed, had make up on and some had beautifully manicured hair and hands. I’m afraid this is a bit of a fallacy. When it comes to social media platforms we tend to put our best foot forward. I’d even go as far as to say we show a side of ourselves that doesn’t necessarily exist. This creates a mistaken perception that mothers who struggle with breastfeeding are in the minority- the one sad picture out of thousands of beautiful stories. For new mothers who are struggling with breastfeeding this can be very very discouraging and isolating. Added to this, teaching tools like YouTube clips only include the section where the baby latched well but don’t usually include the 25 minutes of fussiness, difficult latching or on-off latching before that baby took the breast and started the feed. When we hear friends stories it’s usually either end-of-the-spectrum – horrific stories that ended in breastfeeding cessation or beautiful breastfeeding journeys that don’t include the trials the mother went through to get to the ‘beautiful’. From my own breastfeeding challenges and being able to see hundreds of mothers each with individual stories I’m including here a few of the hurdles you may have to climb.
The intention is not to discourage you but to help you persevere when the road is a bit rocky and give you a few tips to overcoming your challenge or minimising the consequences. Know that breastfeeding can be very challenging.
- Babies do not always latch within the first 1-2 hours after birth. Ideally we’d like babies to be in skin-to-skin contact with mom immediately after birth or as soon as possible after. Once they have had some skin-to-skin contact they usually show signs of being ready to breastfeed and this is then the ideal time to allow your baby to self-latch. However, some babies need some time on oxygen and possibly taken to ICU – separated from mom. As soon as you are with your baby, do some skin-to-skin and this will help you both “catch up” on the time lost. Start hand-expressing colostrum and store it in a sterile syringe – ideally within an hour after birth and thereafter every 2-3 hours during the day and 4 hourly at night. This will give your body the cues it needs to continue producing colostrum and then milk. Make sure you’ve learned to hand express before giving birth.
- Some mothers milk takes longer to “come in” than others. While you are still pregnant your breasts will start producing colostrum which is the first nutrition you will give your baby until roughly day 3-4 after birth. This sticky yellowish milk is jam-packed with immune cells to protect your baby for life outside of the womb and to help maintain blood sugar. However, the removal or birthing of your placenta is your body’s cue to start producing breastmilk. This then begins to fill your breasts around day 3 just at the time when your baby is wanting bigger feed volumes. However, multiple factors such as caesarean birth, diabetes in mother, excessive bleeding after birth may delay this process. The term for this is “Delayed Lactogenesis II”. This usually increases the chance of your baby getting a formula top-up although the World Health Organization recommends donor milk before opting for formula. If you find yourself in this situation, continue hand-expressing. However you may want to shift over to using a breastpump on day two or three. Allow your little one to spend some time at the breast – until he or she show’s they are not happy to continue suckling and then pump or hand-express. In these early days it is ideal to use a strong hospital grade breastpump (most hospitals have one available), some pumps do not do an effective job at removing milk especially when there are feeding difficulties. Aim for 8 to 10 pumping sessions – keep the breasts as empty as frequently as possible.
- When your milk comes in, latching can become very difficult. On day three or four your milk begins to fill your breasts, they will also become fuller with lymph and serous fluid. This sometimes is made worse when mothers have had lots of extra intravenous fluid during the birth. Because of the increased pressure in the breast, the nipple can flatten some-what making latching more difficult for your baby. Given the extra fluid in the breast and the difficult latching, your baby may become frustrated at the breast. This can be a very difficult day and hard not to feel discouraged with the breastfeeding. However, it usually does not last longer than twenty-four hours and there are multiple things that can ease the frustration. You may need to ask a lactation consultant to come and do a session with you to help put together a plan and encourage you through. “Reverse pressure softening” is a technique that she can help you with to make the nipple more “latch-able”. Some mothers find it useful standing under the shower and hand expressing some milk out just until the breast feels more comfortable and the nipple is easier to latch onto. In general, we only use WARM water, WARM cloths or WARM compresses on the breast to aid the flow of the milk (during feeding or expressing). At any other time during this engorgement phase, COLD compresses or COLD cloths or COLD ice-packs should be used on the breast to help decrease the inflammation. A simple tool is wetting a clean disposable nappy and cooling it in the freezer and then placing it into your bra. There are also custom-designed ice packs available on the market for breast engorgement. Some mothers find it helpful to place clean, cold, uncooked cabbage leaves inside their bra to decrease the swelling. A good latch is important to help your baby effectively drain the milk. Again, a lactation consultant can help you with latching and possibly choosing tissue salts or homeopathic remedies that may speed up relief.
- Newborns feed 8-12 times in 24 hours. This may come as a shock. Feeding frequency is counted from the beginning of one feed (one feed may include 2-4 helpings) to the beginning of the next feed. In other words if your little one is waking roughly 3 hourly for the next meal. This frequent wake-feed-sleep is protective against sudden infant death and usually as your little one gets older their feeding frequency might get less giving you a little more space in-between feeds. However, for now- frequent night wakings for feeds are normal and healthy.
- Not all health professionals give up-to-date information. This is one of the factors that I think make a mother’s hospital breastfeeding experience more difficult. The Healthcare team (nurses, doctors, physio etc) all have diffiering opinions and advice and new mothers are bombarded with different voices. Night staff says to hold the baby in a certain way and limit time at the breast and day staff says to change position and not to limit the time at the breast. Of course each mom and baby dyad differs and has their own unique challenges so advice may need to vary, however when you are hearing different voices it can be very confusing. Pick one or two people that you listen to and ignore the rest. Ideally get a professional in to help put a plan together that suits your circumstances. Many mothers find it helpful attending a pre-birth lactation workshop or private consultation. Either of these can help get you off to an easier start.
- Babies hands can be very busy at the breast making latching difficult. Because we don’t see enough women in our communities breastfeeding, it often comes as a surprise when a newborn is very “busy” at the breast and their hands are prodding and poking and getting in the way as you are trying to latch. These little hands are designed to frantically grab and poke at your breast because each poke is felt by the nerve supply to your skin, breast and nipple in-turn sending a message to your brain to signal the fact that the milk needs to start flowing and thereby stimulating the release of Oxytocin into the bloodstream. So to put it simply, the little prodding hands are telling the milk-flow to start. Of course this doesn’t help you to get a good position and latch. It may be helpful to allow baby to lie at the breast for a few seconds before starting the latch so that he has opportunity to “fiddle”. Once you are both comfortable you can tuck one hand under your bra strap or allow your little one to grasp onto your thumb while latching. Once the milk starts to flow the hands should settle.
- Some babies have tight frenulums under their tongue or at their upper lip impairing a good latch. There is much controversy about oral restrictions (tongue and lip ties) but growing evidence shows the impact on feeding. You may need a specialist to do a further assessment and if necessary release the tie.
- Some babies need a nipple shield to latch and feed: this is a silicone cap that fits over your nipple providing more nipple for your baby to latch onto. Pre-term babies are more likely to need the help of a nipple shield. If a nipple shield keeps you breastfeeding then it’s a win. Usually in time you will be able to get rid of it.
- Many mothers were never breastfed as babies so they don’t necessarily get the support they need from their own mothers. Breastfeeding is a team effort and a crowd of supporters can really be the difference between success or giving up early. I regularly hear mothers say, “my mother never breastfed me, so she doesn’t know how to help me” and indeed these grannies feel like their hands are tied and it’s terrible watching their daughters struggle. We just need to change the experience for this generation of breastfeeders so that the grannies of the future can give their daughters first-hand-experience-support. However, this doesn’t help you now. Make sure you are well prepared to breastfeed, attend a pre-birth lactation workshop and fill your mind with very specific benefits of breastfeeding. See if your mother and partner can join you at this workshop so that you’re all on the same page. This knowledge will help you persevere. Find help from a lactation consultant when your family is rooting for you to switch to formula.
- Some mothers are prone to frequent breast infections. This can be very discouraging especially when you are well motivated to breastfeed and things are otherwise going well. Breast infections can begin with breast pain but progress to fever and flu-like symptoms. Some mothers feel very unwell during this infection and it makes it difficult for them to care for their baby. Sometimes it’s not possible to find the reason for the recurrent infection but other times something simple like a poorly designed breastpump or incorrect flange size may be the culprit. Poorly drained breasts or milk stasis may also be the cause. Antibiotics at birth may have impacted on your flora. The breast and breastmilk is usually filled with an abundance of flora but mastitis may occur when there is an imbalance in these colonies. A suitably chosen probiotic for a few weeks may minimise recurrence. A comfortable, effective latch will minimise skin abrasion which potentially introduces pathogens into the breast. Sometimes basic remedies can treat the mastitis but other times antibiotic therapy is necessary to prevent an abscess from forming.
- Nipple ducts can become blocked causing painful feeding. These are called nipple blebs and often look like small white spots on the nipple but cause extreme pain especially during feeding. Some mothers describe how they feel a pressure build-up in the breast that cannot escape via a certain route because of the bleb. Again professional lactation help will enable you to find treatment that brings relief. Some mothers find that soaking the nipple in “Epsom salts” water softens the blockage. Other mothers need more intervention than this like topical cortisone, but it is possible to find a solution so that the pain disappears and breastfeeding can continue.
- Feeding, burping, nappy changing and settling baby can take more than an hour in the first weeks making your sleep time minimal or frequently interrupted. I have twin daughters. In the first two weeks after their birth it took me an hour and a half or more to feed, burp and change them. This meant that when they were feeding three hourly the whole ‘drill’ would start again 1.5 hours after i finished the previous ‘drill’. Exhausting is an understatement. I never conceived that I would be getting 90 minutes of sleep at a time. A few things helped me get through this. Firstly I knew that they would soon start feeding faster and possibly taking longer gaps between feeds at night, so I kept my sights on this. I aimed for at least one nap time for myself during the day. Additionally, and this was hard for me, I accepted help from almost all who offered. Some mothers find it useful to completely feed their baby at the 8 or 9pm feed (however many helpings baby wants) and then give baby to partner to burp and change and settle while mom climbs into bed. This may work out to an hour of extra sleep before the next feeding session. Once your baby is around 6 weeks, you could also try expressing a little after a few feeds in the day until you make up a full feed and then get your partner to do the 8 or 9pm feed and you go to bed at 8 or 9pm. This means you may be able to have one sleep gap of 5-6 hours which for some mothers makes the world of difference in coping.
- Some mothers don’t make enough breastmilk to meet baby’s full demand. There are certain health issues that make complete breastfeeding difficult or impossible. Childbirth courses are very helpful in giving you a good idea of what to expect and how to prepare for birth and breastfeeding but there isn’t always time to discuss what to do when the plan deviates (and there are so many possible deviations). Your childbirth educator should run through a list of “risk factors” for breastfeeding. If you have one of the health issues on the list it is not a guarantee that you will have breastfeeding problems, but you would benefit from a pre-birth lactation plan in order to minimise the issues. Each mother and baby’s situation is unique. Some mothers are only able to produce half the amount of breastmilk their baby needs and for that mother and baby they have reached breastfeeding success.
- Bottle refusal. After a few bumpy weeks breastfeeding usually gets much easier. Close to four months when many moms have to go back to work some babies decide that they do not want the milk from a bottle but will only drink if they are at the breast. Take this as a huge compliment, mom! He knows where and from whom the milk comes and any other means is just not good enough! Of course this may mean a few stressful weeks while you find ways to feed your little once back at work. You may need to get in touch with your lactation consultant again to overcome this hurdle.
So, without being unduly pessimistic, it may be useful knowing in advance that the breastfeeding road may have some bumps. However, there are many many mothers who have gone before you and overcome significant obstacles and they are cheering you from the side-lines as you take up your breastfeeding journey.