Why families need help breastfeeding
In her book Why Milk Matters, Maureen Minchin has this to say about Breastfeeding: “Making normal humans, creating familial bonds, optimizing women’s and children’s physical and mental health, immunizing, controlling disease and resistant pathogens, saving taxpayers’ money, promoting social mobility and equity and preventing needless environmental harms.”
Breastfeeding is a perfectly natural function and women have been doing it for all of human history. In theory breastfeeding is an art and a science. It requires some patience, some know-how and eventually it is going to be easy and natural, right?! So why would anyone need help with such a natural biological function? Surely it should just happen as nature intend?
The two main reasons why we need to learn about breastfeeding are: Because breastfeeding is invisible (we do not know what it looks like anymore – we don’t know what is normal) and because we interfere with nature (more about that later).
Before we continue and you become totally discouraged, a following post will tackle: "how to get breastfeeding off to a good start".
Western life has not been very conducive to breastfeeding. Due to the loss of extended family, most women do not learn much about breastfeeding while growing up (in most societies breastfeeding has become invisible). Nowadays most women initiate breastfeeding because they understand its importance to their babies and themselves. Sadly, many give up earlier than they planned due to problems such as sore nipples, inadequate milk production, and infant difficulties with breastfeeding. Most of these are either avoidable or manageable when mothers receive the necessary support.
When women receive incorrect or conflicting information, or are discouraged by un-supportive health professionals, relatives or friends, it undermines their confidence in their ability to breastfeed successfully.
We also interfere with nature, the birth process, etc. with inductions, augmentation of labour, vacuum & forceps deliveries, C/births, pain relief meds, mom & baby separation after birth and after that not rooming-in, baby oral insult which is suctioning of airways, dummies, supplements, the list goes on and we then end up with consequences like:
- Delayed onset of breastfeeding – taking longer for breastfeeding to establish
- Baby developing a disorganized suck or having a diminished early suckling response (and THIS could have an influence on the exclusivity and duration of breastfeeding)
- Delayed Lactogenesis 2 – milk talking longer to come in, mom not making enough milk, etc.
SUCCESSFUL BREASTFEEDING = Lots of milk + confident mother + good latch from baby + all in a basket of support.
A GOOD MILK PRODUCTION (lots of milk) = Sufficient glandular tissue + intact nerve pathways & ducts (anatomy) + adequate hormones & hormone receptors (physiology) + adequate frequent, effective milk removal & stimulation (mom & babe are role-players here).
Let's break this down and look at how each of these contributes to reasons why a mother might not make enough milk:
We need sufficient glandular tissue + intact nerve pathways & ducts (anatomy): Insufficient mammary glandular tissue, breast surgery, biopsy, radiation or trauma, surgical trauma to branches of 4th intercostal nerve, etc. can all contribute to issues.
We need adequate hormones & hormone receptors (glandular tissue responsiveness to hormonal influences) (physiology): Thus Diabetes, polycystic ovarian syndrome, history of infertility, cystic fibrosis, hypothyroidism, hypopituitarism, hypertension, maternal obesity BMI > 29, any hormonal contraceptives before breastfeeding is well established, postpartum hemorrhage with Sheehan's syndrome, effect of meds/drugs on milk supply (pseudoephedrine, high VitB6, alcohol, smoking), psychosocial stress (e.g. Oxytocin is inhibited by fear, pain, embarrassment, anxiety), etc. All of these factors could possible contribute to mom not making enough milk.
Adequate frequent, effective milk removal & stimulation. Mom & babe are role-players:
Mom: Anything that interferes with effective removal of milk (all of these are avoidable or manageable!)
- Mom and baby separation, reduced breast stimulation in early days - prolactin theory
- Timed feed - how long baby feeds
- Scheduled feeds - long intervals between feedings
- Unnecessary use of powdered infant formula (PIF), or other supplements
- Overuse of dummies
- Ineffective latch-on - how babe takes the breast
Babe: Any condition in infant that results in an ineffective or weak suck thus decreasing baby’s ability to remove milk effectively (all avoidable or manageable)
- Premature baby, less than 38 weeks gestation
- Anything which prevent baby’s innate reflexes to latch & suck from being stimulated (e.g. swaddling with arms between mom & baby, minimal Skin-to-Skin, etc.)
- Birth interventions and/or trauma to facial nerves
- Mom and baby separation - delayed first breastfeed
- Hyperbilirubinemia (exaggerated jaundice)
- Suck confusion (artificial teats / dummies)
- Abnormalities of face, mouth, pharynx (cleft, macroglossia, micrognathia, ankyloglossia or tongue tie, high palatal arch or bubble palate)
- Congenital heart defects, muscular dystrophy, cerebral palsy, Down syndrome, Central Nerves System infection (e.g. toxoplasmosis, Cytomegalovirus), thrush, etc.
Reading this you may think everyone will have issues breastfeeding? NO! most people have no issues at all!! and for those who do have some obstacles to overcome: SOME BREASTMILK IS ALWAYS BETTER THAN NONE!!
When and where to get help
If breastfeeding is difficult, especially during the 1st week, prompt and reliable assessment is vital! Breastfeeding families can get reliable help from a La Leche League Leader (LLLL) or an IBCLC. Great online resources: www.kellymom.com, www.nbci.ca (previously www.drjacknewman.com).
IBCLCs (International Board Certified Lactation Consultants®) have passed a rigorous examination that demonstrates their ability to provide competent, comprehensive lactation and breastfeeding care. IBCLCs may have different areas of expertise, so the mom might have to seek further help if her needs are not met. On Facebook: Lactation Consultants of South Africa or The Breastfeeding Clinic.
A La Leche League Leader (LLLL) is a mother who has successfully breastfed her own child for at least a year, and has been trained by La Leche League International in helping other mothers breastfeed. La Leche League Leaders are excellent in answering breastfeeding questions over the phone, and they are a perfect resource for older-baby breastfeeding question. Find a LLLL here: http://www.llli.org/southafrica.html or on Facebook: groups/lalecheleaguesouthafrica.
The real “learning” will only start once baby is finally in your arms. If things don't start off smoothly, or hiccups happen along the way, GET HELP!! Remember raising a baby should be a community effort ;-).