Read on for the answers to some frequently-asked-questions about breastfeeding.
With the sheer amount of breastfeeding information and literature available, it is only natural for new mothers to feel overwhelmed. Regardless of whether mothers face challenges or have a smooth-sailing journey as they experience lactation for the first time, some common questions are bound to surface surrounding breastfeeding. Here, we address several, which will hopefully clear any doubts and bolster your confidence as you nurse and nourish your baby.
Q: How soon should I begin breastfeeding?
A: It is advised that attempts should be made to get your baby to latch on within an hour of giving birth. Even if you have delivered via caesarean section, you should be receptive to nursing your newborn as soon as possible, even if it’s in the operation room as you’re being stitched up. While this might seem too soon, the timing is to take advantage of the baby’s wakeful state immediately after birth. After this initial window period, your newborn will spend much of the next 24 hours asleep, which might make feeding more challenging.
Offering baby the breast sooner rather than later also establishes faster bonding with skin-to-skin contact. Your baby will also benefit from consuming colostrum, which is the thick, yellowish pre-milk your body will produce for about three to four days before breast milk appears. Colostrum is rich in immunity-boosting nutrients to protect your baby against infections.
Q: How frequently should I nurse my baby?
A: Breastfeeding is encouraged to be done on-demand, but the more you nurse, the more milk you can expect to produce. This is especially crucial in the early weeks to ensure a steady stream of milk. On average, you should breastfeed your baby an average of every two hours around the clock for the first month to six weeks. A very young infant is also unable to consume excessive amounts at one go, hence the need to feed more frequently. A baby will usually stop nursing once it is full, but ensure that one breast is emptied before offering the other, so that your baby can reach the nutritious hind-milk, which is produced in larger quantities during the later stages of feeding.
While on-demand nursing can feel gruelling at times, rest assured that your baby will be able to take in more amounts as his stomach grows in capacity, which will increase the lapse of time between feedings. Just remind yourself of the golden rule to nurse your baby as frequently as you can in the early days and weeks to regulate your milk production supply until it reaches the right level.
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Q: Is there such a thing as being unable to breastfeed?
A: As long as a woman has given birth, she will have the ability to nurse, even if her baby was breech, she has multiples, or has had a C-section. The let-down reflex, where a mother’s milk is released, may take longer to occur or feel slower in certain women depending on individual circumstances, but despite this, almost every woman should eventually be able to nurse her baby as long as the breast is offered and the baby latches on to suckle. This applies even to women with inverted nipples or who are small-breasted. Women with small breasts simply have less fatty tissue which has no effect on the ability to produce milk; this relies instead on the presence of mammary glands which are found in breasts of all shapes and sizes. Also, mothers need not worry whether any of their breastfeeding woes are hereditary as this condition is never genetic. Rather, the issue of insufficient milk (note: milk is never completely absent) can usually be traced back to mismanagement of the problem such as incorrect feeding techniques, giving up too early, infrequent nursing, poor diet and lack of support.
Q: Now that I know milk production is usually not an issue, how can I tell if I am producing enough to feed my baby?
A: As earlier mentioned, the more frequently your baby nurses during the first weeks of life, the more your breasts will be stimulated to produce milk. This fact alone ensures that most nursing mothers will produce sufficient milk to meet the nutritional needs of their babies. However, if your milk output remains a cause of concern, you can use a breast pump several times a day for 30-45 minutes before nursing your baby. The suction of the pump mimics the suckling of your baby, which will encourage the let-down reflex (triggering of milk flow).
You can also monitor the number of times your baby is wetting or soiling his diaper. Approximately seven to eight wet diapers daily is a good sign of sufficient hydration, along with between three to five bowel movements. Your baby will also gain weight, but you can check with your paediatrician if he is putting on enough. On average, infants will gain 500g a month, or about 125g a week. Some babies will also fill out more noticeably than others.
Mothers can also find reassurance by observing baby while he is nursing: there will be suckling and swallowing actions; some milk may dribble out of his mouth as he swallows; he appears satisfied after each feed; and your breasts will also feel noticeably softer after being drained of milk. Initially, some women’s breasts may leak between feedings, another sign of sufficient milk production. However, this will usually subside after a few months and is not a cause of concern if the other signs are taken into consideration. It just means your milk production has stabilised and is now established at a comfortable level.
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Q: Why do my nipples hurt when my baby is nursing?
A: Experiencing pain during breastfeeding usually means your baby has latched on incorrectly. Over time, the vigorous suckling that is repeatedly applied on the nipples can lead to the skin becoming raw and cracked, so it’s best to get baby in the right position from the start. Your baby’s mouth should not only cover your entire nipple, but most of the areola as well. Ensure that your infant’s head and body are properly supported, and that both your stomachs are touching during the feeding session, with baby lying on his side. Your comfort is important too during extended periods of nursing, so make sure you’re relaxed and use pillows to prop yourself up or to support your position.
If your nipples still feel tender, try rubbing in breast milk onto them and allow them to air dry after nursing. You can also invest in soothing gel pads to insert into your nursing bra in-between feeds to reduce chaffing. If the problem persists, you may schedule an appointment with the hospital at any time for a follow-up consultation with a lactation specialist who will further advise you on correct breastfeeding techniques.
Q: Why have my breasts grown hard, swollen and even painful?
A: Besides cracked nipples, another physical discomfort that adds to breastfeeding woes is the problem of engorgement. In her book, Breastfeeding: A Guide for the Medical Profession, Dr. Ruth Lawrence identifies three main reasons for engorgement: “congestion and increased vascularity (the physiologic response that follows removal of the placenta and does not depend on suckling); accumulation of milk, also a physiologic response to placental removal; and edema (swelling and fluid retention).”
Breasts may become full to the extent that they feel rock-hard and painful, with some women even reporting a sensation of heat and swelling extending to their underarms. Unfortunately, engorgement will not resolve by itself without intervention; in order for it to subside, the breasts must be emptied of this excess fluid.
Days after delivery, your breasts will steadily build up milk and baby should be draining their volume at around the same rate as the milk is produced. This is why the first week is so crucial as your milk flow is still being established. As milk production kicks in, it is normal to feel a growing sense of fullness, and this is also when it is critical to continue nursing frequently and ensure that baby properly latches on with the correct breastfeeding techniques. Some fullness is common as your milk increases during the first week, but it should subside with proper positioning and latching on, frequent feeding, and lots of rest.
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Q: I am experiencing engorgement. What can I do to relieve this?
A: While some mothers may faithfully adhere to a frequent nursing schedule to prevent engorgement from occurring, the problem may still arise (for example, you may experience a sudden spurt in milk production on the third or fourth day). When this happens, don’t worry. Instead, avoid engorgement from advancing with some simple measures, and above all else, don’t let up on breastfeeding. If your baby has still not established a regular feeding routine (which is common in the first few days), resort to using an electric breast pump every two to three hours to release enough milk. Don’t worry that pumping will trigger over-production of milk as you are only doing this to ease the pressure and fullness.
Besides giving yourself some relief from any growing discomfort, your aim is also to soften your breasts adequately. This is to help your baby latch on correctly as it becomes more difficult for him to grasp and suck in your areola with his mouth if your breasts are too full and hard. Engorgement will then be exacerbated when baby is able to suck only on your nipple because this will actually encourage more milk to be produced, but without stimulation of the surrounding areola tissue, the milk cannot flow as freely, hence leading to build-up in the ducts. Ironically, clogged milk ducts may eventually lead to decreased supply as the blockage prevents them from functioning normally.
Alternatively, gently hand expressing, massaging your breasts in a circular motion and applying a warm compress before a feeding session are other techniques that will be helpful in softening swollen breasts. To ease the pain and tenderness in between nursing, it is advised to use a cold compress instead. The cold will alleviate the feeling of heat and pain in your breasts and most helpful of all, reduce tissue swelling (which heat can actually aggravate). You can even try refrigerating a head of cabbage, stripping it of its leaves then fitting a cold leaf around each breast until it wilts (this remedy is entirely anecdotal and not based on research but generations of women claim that it works).
If you really must use heat for relief, aim intermittent jets of warm (not hot) water to the sore areas whilst in the shower.
In severe cases, milk ducts that have not been drained will experience inflammation. This may manifest as a sore, tender and painful lump in your breast. Usually, plugged ducts will not be accompanied by a fever, but if the problem persists, it could eventually lead to a breast infection called mastitis, which presents with flu-like symptoms such as body aches, chills, nausea, fatigue, and indeed, fever. Your doctor will prescribe antibiotics that are safe for breastfeeding, while paracetamol will help bring down your temperature. Lactation mastitis usually affects one breast at a time.
Engorgement should be viewed seriously and at first signs, steps must be taken to minimise it before it progresses. If you have enjoyed smooth nursing and this suddenly happens, take it in your stride. It is likely your body’s way of telling you to make adjustments to your feeding techniques, frequency or even your lifestyle. Unless otherwise advised, continue to breastfeed your baby as mother’s milk—even with engorged boobs—is still best!
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