Breastfeeding

A ll mothers should consider breastfeeding their infants exclusively at least for the first six months for optimal health and development of the baby. Breastfeeding can be continued thereafter with other foods until the baby is two years and beyond as desired.

Benefits of Breastfeeding

There are tremendous benefits for the infant. Breastfeeding decreases the incidence and the severity of infections, such as diarrhoea , respiratory tract infection and urinary tract infection. Infants with a family history of allergy, who were exclusively breastfed, also had significantly lower incidence of allergic disease.

Breastfeeding is beneficial to you as well! It is well known that breast and ovarian cancer is less common in women who had previously breastfed. This protective effect increases with longer duration of breastfeeding. You will also return to your pre-pregnancy weight quicker.

Mothers who should not breastfeed

We would strongly advise that mothers with human immunodeficiency virus (HIV) infection, active and untreated tuberculosis infection and those undergoing treatment for cancer , not to breastfeed. Also, mothers who are on recreational drug or an alcohol abuser should not breastfeed.

Prepare for Breastfeeding

Have a breast examination done by your doctor to check for inverted or non-protractile nipples. Seek advice from your doctor or a lactation specialist early if you have these problems.

Mothers with truly inverted nipples often encounter difficulties latching their babies to the breast. The use of niplette as a non-surgical correction of inverted nipples may be recommended during pregnancy from 12 weeks of pregnancy onwards.

Latching Technique

Encourage your newborn to take a large amount of your breast into his/ her mouth, with more of the areola and with the nipple pointing towards the soft palate. Hold your breast during the attachment initially and draw the baby to the breast to ensure a good latch (Figure 45.1).

Use different feeding positions such as the football hold or modified cradle hold to facilitate latching on to the breast, as these feeding positions provide better control of your baby’s head and achieve a good latch (Figures 45.2 and 45.3).

Increasing Your Milk Supply

Ensure a good latch so that there is effective milk flow to baby. Offer your breasts more frequently to your baby.

Use breast compression during feeding to help increase the intake of milk to your baby. Expressing of milk after a feed tends to increase the milk supply. For diet or supplements to increase milk flow, read the article on Eating Right f or Breastfeeding .

If necessary, medications such as metoclopramide or domperidone may be prescribed by y our doctor to improve your milk supply.

Maintaining Your Milk Supply

Regular breastfeeding usually is adequate to ensure milk supply. You must understand that the milk supply increases with your baby’s demand.

Avoid substituting or delaying breastfeeding, as this may reduce milk supply because of the reduced stimulation by your baby’s suckling.

How Often Should I Breastfeed?

Frequent regular feedings of eight to ten feeds a day is normal during the initial four to eight weeks after birth.

Separation of you and baby should be avoided if possible. During separation, regular pumping of the breasts (every three hours) should be sufficient to maintain the milk supply. The expressed milk can be stored and given to the baby.

Can Breast Milk Be Stored?

Yes. Expressed milk can be safely stored for up to:

• 4 hours at room temperature,

• 48 hours in a fridge (at 4°C),

• 3 to 6 months in a freezer (at –15° to –5°C),

• 6 to 12 months in a deep freezer (at –20°C).

Is Breast Milk Alone Sufficient to Meet My Baby’s Nutritional Needs?

The composition of breast milk changes as the baby grows to meet the baby’s nutritional needs. The World Health Organization recommends that babies be breastfed exclusively for the first six months, and up to two years of age and beyond as mutually agreeable by mother and child. This means there is no need for other liquids or foods in the first six months, and even after solid foods are introduced at the 6th month, breast milk can be given as the main milk drink.

Managing Breastfeeding Problems

Sore nipples

Sore nipples occurring during the initial few days of breastfeeding are usually due to poor positioning or incorrect latch-on technique. Correct positioning and attachment is the key to prevent sore nipples. Seek help as soon as possible to learn the proper technique of latching on.

Purified lanolin cream may be applied to the sore nipples to promote healing. Breast shell may be worn in between feeding to protect the sore nipples from rubbing against the clothing. This will also facilitate healing.

Candidiasis (fungal infection)

Candidiasis may present as persistent sore nipples or soreness that appears suddenly with no apparent problems with latching-on. The soreness can be severe with burning sensations or itching, with the nipple and areola presenting as a striking deep pink. You may also notice that your baby may have diaper rash with scalded-looking buttocks and the mouth may have oral thrush presenting as white patches on the tongue and gums.

Please see your doctor urgently, as treatment is required for both you and baby. The infant should be treated with oral nystatin (anti-fungal medication). Treatment of the mother includes topical anti-fungal cream (nystatin, miconazole or ketoconazole cream) applied on the nipple after each feeding.

For persistent candidiasis, oral Fluconazole (Diflucan) may be prescribed for the mother if the baby is at least six months of age.

In addition, pacifier, teats, teethers, breast pump parts, bras or reusable breast pads should be washed and boiled daily. Avoid storing and freezing breast milk during this period as freezing deactivates the fungus but does not kill it.

Breast engorgement

Engorgement occurs when there is a decrease in the frequency of feeding, causing excessive accumulation of milk in the breast. It often occurs during the first week after delivery with the onset of the copious milk and especially if there is delay in starting breastfeeding or feeding is infrequent. Apart from the infrequent removal of milk from the breast, incomplete milk removal due to poor attachment can also lead to engorgement.

Engorgement usually affects both breasts, involving the areola and the peripheral area of the breast, which becomes full, hard and tender. If engorgement is not relieved, milk production may be affected. Early initiation of breast-feeding, unrestricted feeding day and night and ensuring proper attachment for effective emptying will help to prevent or reduce the severity of engorgement.

Treatment of engorgement includes massaging the breast, nipple and areola area to clear any blockage and to enhance the milk flow. Allow the baby to breastfeed frequently round the clock as the infant suckling is the most effective mechanism for removal of milk.

You can apply a cold pack or cold cabbage leaves on the breast in between feeding to help reduce swelling, warmth and pain. Take analgesia medication such as Paracetamol to alleviate the pain.

Apply warm packs only if the breasts are leaking after the breast massage as the heat from the warm packs may aggravate the swelling if the ducts are blocked. Seek help from a lactation specialist if engorgement is not relieved with the above measures.

Plugged ducts

A plugged duct is a localized blockage of milk resulting from milk stasis. It usually presents as a painful palpable lump with well-defined margins. It may be caused by inadequately drainage in one area of the breast or by tight or restrictive clothing. Plugged ducts can develop into mastitis if not treated adequately.

Massaging the breast is an effective way to help dislodge the blocked milk. Continue to breastfeed and commence feeding on the affected breast to promote drainage. Massage the affected breast before and during feeding to stimulate the flow of the milk. Apply warm compress to the affected area before feeding once the milk starts to leak after the massage. Use different feeding positions to help drain the different parts of the breast. Seek medical advice if redness and fever are present as antibiotics may be needed.

Milk blister

Milk blister is a whitish, tender area, often found at the tip of the nipple. It seals a nipple pore preventing the duct system from draining and causing milk buildup behind the occlusion. This leads to a blocked milk duct.

Breast massage should be done to clear the buildup of milk. Continue breastfeeding to clear the blocked milk duct. Seek help from a doctor or a lactation specialist, as it may be necessary to break the skin using a sterile needle.

Mastitis

Mastitis refers to a unilateral bacterial infection of the breast. It may cause fatigue, localized breast tenderness and a flu-like, muscular aching with fever. The infection, which is usually unilateral, is located in one area of the breast. Stress, fatigue, cracked nipples, plugged ducts, a tight bra, engorgement and an abrupt change in the feeding frequency can predispose to mastitis.

Treatment of mastitis includes massaging the breast to clear the plugged ducts. Apply moist heat to promote drainage once milk is leaking after massage. You can continue to breastfeed. Increase your intake of fluids and take antipyretics to reduce fever. See your doctor early for antibiotic therapy.

Breast abscess

Mastitis may develop into abscess (collection of pus) if the treatment is delayed or inadequate. Breastfeeding can be continued on the unaffected breast. Continue to hand-express or pump the milk from the affected breast to prevent engorgement and to maintain milk supply.

Fine-needle aspiration under ultrasound guidance or incision and drainage could be done by your doctor to drain the pus.

Frequently Asked Questions

1. Can I continue to breastfeed my baby if I am pregnant again?

There are a few concerns about continuing breastfeeding during pregnancy. Firstly, there is the concern about deficiency of nutrients to the developing fetus and the impact on the mother’s health such as depleting her own store of calcium. Thus, continue to take prenatal vitamins and calcium supplements as well as continue a healthy diet. Secondly, the pregnancy hormones may also decrease the amount of milk as well as change the taste of the milk.

There are some studies which link breastfeeding to miscarriage and premature labour although the results were not conclusive. If you are experiencing these symptoms, do inform your doctor.

2. Is it normal if I start leaking milk at seven months of pregnancy?

The milk glands in your breasts may start to produce colostrum as early as seven months of pregnancy. Thus, it is not unusual if your breasts leak colostrum at this stage.

3. I notice an extra breast tissue in the armpit. Is this normal?

Some women may have an extra breast or pair of breasts in the lower armpit, known as accessory breasts. These extra breasts may also enlarge due to hormonal stimulation in pregnancy. So, do not be alarmed.

4. Can I breastfeed if I have had breast augmentation surgery with implants?

Many women who have had breast augmentation or implants ask if they can breastfeed. For most women, breastfeeding is no more difficult with implants than without.

For women who have silicone implants, there is the fear that breastfeeding would endanger the child. However, studies have shown no adverse effects as the silicone molecule is too large to pass into the milk ducts. Nowadays, silicone implants have been replaced by saline implants. Even if the saline leaks into the milk, there will not be any harmful effects on the baby as saline is an inert substance.

Acknowledgement

Source: Dr TAN Thiam Chye, Dr TAN Kim Teng, Dr TAN Heng Hao, Dr TEE Chee Seng John, The New Art and Science of Pregnancy and Childbirth, World Scientific 2008.

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