It's World Breastfeeding Week (WBW) once again. This year's theme is "Breastfeeding: A Vital Emergency Response. Are You Ready?" More information can be found on the World Breastfeeding Week website. I don't really want to talk about event, and themes...I just thought it would be an opportunity to share some brief thoughts on breastfeeding. Earlier this year, I trained as a breastfeeding counsellor and currently I am a volunteer counsellor with a breastfeeding counselling hotline. Even though I have 4.5yrs of breastfeeding experience and have read widely on the subject, it's been a wonderful learning experience for me. And hopefully, I've helped a few mums along the way...
I receive many different types of calls. One of the most common (and painful) stories I hear from new mums is that they don't have enough milk for their babies. Many are exhausted, and suffering from post-natal blues. The apparent lack of milk affects their confidence terribly and makes them question if they are good mothers.
The lack of milk may or may not be real. If it's real, it frequently is due to poor breastfeeding management in the early post-partum period. The best way to ensure a good supply of milk is to drain the breast frequently and effectively, i.e. newborns need to nurse at least 8 - 12 times in a 24 hour period, or every 2 - 3 hours on average. A breast that is suckled sends signals to the brain to release hormones that are involved in milk production. So that when the baby is put to the breast more frequently, the breast starts to increase its production of milk and the baby gets more milk.
Unfortunately, this natural feedback mechanism is often not allowed to work. In hospitals, even those that claim to be breastfeeding friendly, a well-meaning but misguided nurse may encourage the mother to rest and leave the care of the baby to the nursing staff. As the baby is not allowed to nurse on the breast, the body does not receive critical information to jumpstart milk production. For mothers who are genetically blessed with an ample supply anyway, this may not be a problem. But for many mothers, this is the start of a series of problems that can make breastfeeding a very painful journey. A journey that many mothers decide not to complete.
The mother who thinks she doesn't have enough milk, may be tempted to give her baby formula, which then encourages the baby to drink less from the breast, which will in turn produce less milk. It is a vicious cycle.
If the young infant is fed through a bottle and artificial nipples, problems are compounded, as some babies develop a preference for artificial nipples. The mechanism for feeding from a breast is very different from the mechanism for feeding from an artificial nipple (which is generally why breastfed babies have better jaw development). And, even if the mother expresses her milk to feed to her baby through a bottle, a breast pump is not as good as a baby in emptying the breast. Expressing milk on a permanent basis is also very tiring for the mother, and she may be tempted to skip pumping sessions (especially at night). All these factors lead to dwindling milk supplies.
Fortunately, it is often possible to help these mothers achieve a full milk supply. However, it can be a very tiring process, depending on how far down the cycle the mother is. Strategies include getting the mother to nurse her baby more frequently, to ensure that her baby is actively drinking and not just mouthing at the nipple (i.e. milk is being removed from the breast), to pump after nursing sessions to ensure the breast is fully drained, getting the mother to rest, relax, eat and drink well. Often, a mother may have a lot of milk, but because she is stressed, the breast is not able to eject the milk. Finally, we may recommend herbal remedies, such as fenugreek, or medication, such as domperidone. Herbal remedies will not work if the mother is not able to drain her breasts frequently and effectively. Medication can be very effective. But it should only be used as a last resort, if other strategies have not worked very well.
The mothers I speak to are usually very encouraged by the fact that they can do something to make things right again. Often, I can hear their spirits lifted. But because it can involve quite hard work, I know that not all will last the course. Some are angry that they had been ill-advised. And, often, I am angry too.
There's a lot of advice on breastfeeding going out to new mums and mums to be. At the top of my list is always this: Supply = Demand. As long as you abide by this principle, you will always have enough milk for you baby.
Happy Breastfeeding!
Posts
