AskDoctorKT

Mothers are highly encouraged to breastfeed their babies because adequate breastfeeding is the birthright of every child and a highly fulfilling and rewarding adventure for the parents. However, we can’t rule out the fact that there are challenges associated with breastfeeding. Let’s discuss some of these challenges and practical solutions…

*DIFFICULT INITIATION
The process of lactation (lactogenesis and galactogenesis) starts during pregnancy. In the last few days of pregnancy, the breasts begin to produce a yellowish nutrient-filled liquid, known as COLOSTRUM. This means that all expectant mothers have been prepped to produce breastmilk even before the baby arrives! The success of breastfeeding depends on so many factors including the mother’s determination and keenness to breastfeed. A sick mother or baby may delay the onset of breastfeeding. Flat or retracted nipples can also discourage the baby from suckling. These should be corrected early, through manual traction or use of breast pumps.

*LACK OF ORIENTATION AND SUPPORT
It is the duty of the midwives and obstetrician to educate new mothers on how to breastfeed properly and effectively. Failure to understand the process of breastfeeding will result in frustration and early weaning. Family and friends often contribute to failed breastfeeding by encouraging the use of formula feed or added water which is not necessary at all. Mothers can also employ the services of ‘breastfeeding consultants’ where available.

*BREAST ENGORGEMENT
Some babies suckle fast while others are slow and unwilling to suck. If the breasts fill up faster than the baby sucks, engorgement results. It could also be a problem when the baby dies or falls ill, or due to lactose intolerance. This can cause moderate to severe pain, fever, insomnia, headache and psychological unrest for the mother. Early treatment with painkillers, tight bra and cold compress is necessary, to prevent secondary infection. Signs of infection should be taken seriously and reported to the hospital as soon as possible.

*CRACKED NIPPLES AND MASTITIS
This is often a direct effect of improper latching and prolonged engorgement. Cracked nipples gives way for infection with bacteria, which then gives rise to severe pain, fever, generalised body weakness and inability to continue breastfeeding. Natural oils or emollient creams can be applied to the nipples in between feedings. Mastitis is a serious problem which requires antibiotic therapy, strong analgesics and temporarily withholding breastfeeding.

*MATERNAL INFECTIONS
There are certain maternal infections that need special considerations before breastfeeding. Chief among them are HIV and Hepatitis viruses. HIV positive mothers are encouraged to breastfeed exclusively and wean ABRUPTLY at 6 months. The baby must receive antiretroviral drugs for 1 year. These measures will reduce the risk of mother-to-child transmission to the barest minimum. Babies exposed to Hepatitis positive mothers should receive immunoglobulin injection at birth, in addition to the routine immunisation against Hepatitis B. Again, breastfeeding is not discouraged, but it must be STRICTLY EXCLUSIVE.

*PSYCHOSOCIAL PROBLEMS
Breastfeeding requires a mentally stable mother. One of the effects of postpartum blues or depression, as well as other psychiatric problems, is inability to breastfeed effectively, as the safety of the baby might be jeopardised. In such cases, partners, family and friends have a great role to play. While the mother receives adequate care, she should also be encouraged to breastfeed, even if it’s through expression of breastmilk into bottles. Caregivers should take the baby and allow the mother to get enough rest so that she can recover quickly.

*BREASTFEEDING AND WORKING MOTHERS
Women are increasingly combining motherhood with active careers. Many have to resume for duty as soon as a few days after childbirth. This makes breastfeeding somewhat challenging. Many workplaces are yet to adopt the “baby-friendly” protocols, as recommended by WHO. A lot of women have to leave their babies at home or in daycare facilities. However, this still doesn’t preclude a successful breastfeeing. They can express breastmilk and store in a refrigerator, which can be reheated and given to the baby by spoon or bottles. They can also arrange with their employer to allow them bring the baby to work and continue breastfeeding. Women do not have to miss career opportunities or quit their jobs because they are nursing. There is a need to advocate for longer maternity leave (paid or unpaid) to encourage these women.

KT
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