Living your Breast Life!
Breastfeeding is a topic that is extremely close to my heart, and not just physically!
There was an report in the Irish Times recently (link) about how Ireland has one of the lowest rates of breastfeeding in the world. I found it a sobering read, and it inspired this blog. I breastfed Jack, now 3, until he was 14 months old and Nova just turned 1 and is still having night feeds. This blog a mix of my practical advice as a breastfeeding mum and some incredible advice from a registered Lactation Consultant, Midwife and mum of 4.
I am well aware that there are mums who can't breastfeed and other mums who choose not to for very valid reasons. However, if you have just begun your breastfeeding journey or are considering it and/or interested to know more about it, I hope this blog can help you. There are so many benefits to breastfeeding your baby, however here we will focus here on practical advice about the journey.
A few things I wish I knew then.
It doesn't always come naturally - it sounds simple right? Your baby will just drink from your breast. The reality can be quite different. I mean, have you ever really watched someone breastfeeding? Really watched, not just seen someone doing it while avoiding looking closely and focusing hard on maintaining eye contact with the Mom. Your baby wasn't watching how to videos in the womb either. So my advice, lower your expectations realise it is a learning curve for both of you, cut yourself some slack, accept that it may be a difficult journey, educate yourself, take a course, ask a feeding mom to show you, TALK about it and ask for support. It is out there.
Help is out there - The midwives and lactation consultants at the hospitals, preparation courses such as Bump Baby & Me's Preparing to Breastfeed and of course registered Lactation Consultants are there to help, you can find them on the ALCI Ireland website www.alcireland.ie. There is also alot of information on breastfeeding topics on the HSE website (link). You will be exhausted, you will probaby be a total mess, you most likely cry alot, but most of these women that are around to support you have been there. They know, they understand, so don't be afraid of reaching out, no one will judge you, they are here to help.
Lanolin Nipple cream doubles as the BEST lip balm. Of course it is also brilliant for sore cracked nipples...
You will get Boobie Trapped so keep snacks, water and your phone near you! Especially at the beginning, when babies tummies are so tiny and they cluster feed to encourage your milk supply, you may get boobie trapped for hours in the same place. The thirst and hunger are real! Don't worry - it doesn't last long.
It isn't all or nothing. Yes at the beginning of your journey you want to establish your milk supply, but after that, be realistic about what works for your situation. For sure you will have times in your journey when you can't feed your baby - relax about it, try not to stress too much. I was in a panic when I went to hospital when Jack was 6 weeks old suffering from pneumonia, I had medication which meant I couldn't feed him, and no back up supply. I remember being so upset at the time that he was having formula - I felt like a failure - which obviously was ridiculous. He was absolutely fine, I recovered and we got back to our regular feeding routine. The odd feed here and there when you need a break or life has thrown you a curve ball it all OK. If you decide you want to mix feed it's all OK. If you try breastfeeding and it isn't for you, it's all OK.
You can lie down and breastfeed. I spent so much time when Jack was born sitting up in the middle of the night feeding him, it is exhausting. When I realised I could lie down and do it...GAME CHANGER!
Get a good pump. If you are going to pump, get your hands on a good one, it makes life much easier. I love my Medela Freestyle (link).
You don't need to set a time limit. Everyone has always asked me how long I will breastfeed my kids for, why? I have no idea, but my answer has always been the same for as long as it is the best option for us.
Bra's and feeding clothes? Get measured after your milk comes in and get yourself some comfy feeding bra's, I loved the non underwired ones from Marks & Spencer (link). The first few weeks the H&M Mama Nursing Vest tops (link - which I am still using as PJ's!) and the Dunnes Stores nighties (link) were perfect for me. Feeding cover - I used one with Jack as I was living in Dubai and needed to cover when feeding, I liked the ones where you can still maintain eye contact so you can see what you're doing at the beginning (link). Here in Ireland though, I just cracked on without it, everyone was so diligently avoiding watching even if you have a nip slip, really no one notices - apart from the delivery guy when you forget to clip your top back up....OOOPSIE! Nursing pads? I found the disposable ones itchy, and actually the inserts of padded bra's that I normally took out anyway worked much better.
In my experience it has been amazing, I have loved my journey including the ups and downs. It was so worth stucking at it. Nova has started taking cows milk now she has turned 1, during the day she doesn't want to sit still and nurse, so I'm only feeding her in the night time. I treasure those moments, I know they will end soon, and I am getting very emotional about it!
So they are my top tips from a practical perspective based on my experience - but here is the good stuff, the expert, the REAL advice.
Q&A with lactation Consultant, Midwife, Mum of 4 and all round superwoman, my cousin (how lucky am I!), Suzanne Thornhill.
So Sue, tell me a bit about yourself and your experience.
I'm Suzanne, Mum to four daughters and they are the greatest of gifts, motherhood is an amazing journey, and aren’t we all ‘Super Woman’? In our modern world which demands so much of us, I believe that being a woman is a super power in itself. This may be the reason I was called to Midwifery (I may also have been a bit burnt out by the General Nursing system in which I had been working for 10 years). I studied and worked in all areas of the busy National Maternity Hospital and felt my expertise was most matched to the Postnatal Care setting. That time in a woman’s life when she becomes a Mother is so ground-breaking, a rite of passage to be nurtured and celebrated. Support and education is key to easing this transition into motherhood. After experiencing it first-hand and breastfeeding my own babies I felt a duty to share my experience and help others breastfeed, especially as Ireland continues to have the lowest rate of breastfeeding in Europe. Hence, I studied and qualified as a Lactation Consultant. The International Board of Certified Lactation Consultants (IBCLC) is the body that measures and promotes the continued competence of Lactation Consultants in Ireland. IBLC certification remains valid for five years, after which one can re-certify by examination or earned continuing education recognition points (CERPS). I loved most aspects of Midwifery but the long hours, night duty and shift work cause exhaustion when juggling with a busy family life. So three years ago I took a step back from the hospital setting. If motherhood has taught me anything it is that there is no other comparable loving experience. I try to embrace it all and to be ‘in the moment’ of every day. I endeavour to lean into the uncomfortable and sometimes challenging moments. These are fortunately fleeting, and although it is a cliché they grow up so fast. I currently work as a part-time Practice Nurse in a local doctors surgery and enjoy sea swimming, yoga and the odd cup of hot coffee to myself!
What are the most common issues you get asked about and what advice do you give?
It has to be said that breastfeeding is a learned skill and is not always without difficulty however many breastfeeding difficulties arise within the first two weeks and are simple to deal with providing there is support at hand.
Sore nipples: Sore nipples are a common reason many women give up breastfeeding in the early days. It is usually due to frequent feeding. Newborn babies will be feeding every 2 hours in order to stimulate the milk to ‘come in’. The problem can worsen if the nipples crack, become blistered or bleed. Soreness that continues throughout the breastfeed, or lasts for more than one week of breastfeeding is not normal and may indicate there is an underlying problem with baby’s latch or poor positioning.
Learn to recognise your baby’s early feeding cues so that you have time to get in a comfortable position before baby gets too hungry (crying is a late hunger cue) and so often I see Mum’s crouched over their babies, maintain good posture when possible, your shoulders will thank you.
Check your baby’s latch. A baby’s mouth needs to be wide and encompass both the nipple and the areola (the dark area surrounding the nipple) so that the nipple is on the soft palate in baby’s mouth. You will know baby is positioned correctly when their chin touches the breast, their lips are splayed out and you cannot see your nipple or part of the lower areola. Practice really makes perfect getting a good latch and more often than not, Mums and babies work it out together. Varying nursing positions can vary the position of baby’s mouth on your breast alleviating discomfort.
Lanolin can be applied to soothe sore nipples, it is natural and does not need to be removed before feedings. Compresses such as Multimam compresses can be soothing. I have seen the beneficial effects of Silver nipple shells though never used them myself; Silver is a natural antimicrobial metal that also contains anti-inflammatory agents, the shells are expensive but I have come across groups of friends lending them out to one another with good success. Express a little milk or colostrum on to your nipples. In many cultures breastmilk is used to treat skin irritations.
Engorgement: This is very common on Day 3 or 4 as your milk supply increases and the breasts become fuller and firmer. This can cause them to be tender, uncomfortable and even painful.
Advice: The good news is that engorgement only lasts 24 to 48hours as you and baby establish that all important feeding relationship. If it is difficult for baby to latch while the breasts are so engorged it may be helpful to hand express a small amount before the feed, this softens the flattened nipple and makes it easier for baby to latch. Using a warm compress before a feed can ease discomfort, massage your breasts while feeding, switching positions and wearing loose clothing. Like most things in breastfeeding (and motherhood) ‘this too shall pass’.
Milk supply: The most common reason for Mums to stop breastfeeding is that they think their baby is not getting enough milk. That is usually not the case. Newborn babies feed around 8 times in 24 hours to stimulate milk supply. If milk supplements have been used or baby has been sleepy and not been feeding regularly, this may affect milk supply. The best way to see your milk supply is adequate is to monitor baby’s wet and dirty nappies, observe how long and often baby feeds for and if they settle after a feed. Most of the time I believe that we need to be honest and education should include the realities of breastfeeding and that the early weeks of motherhood can be a far cry away from the glossy depictions in magazines and on social media. Frequent feeding, frequent waking, periods of crying and fussiness are all normal newborn behaviours that often lead women to stop breastfeeding before they intended to because they believed their body was inadequate to feed their baby. Support and encouragement is so important.
It takes a newborn 2 weeks to gain back their birthweight (it is common for them to lose up to 10% weight in the first few days of life). They should start to gain 140-200grams a week. I stress every baby is different and will gain weight differently, however it is known they generally have growth spurts around 2 weeks and 6 weeks. After that its 3 months, 6 months and 9 months. These growth spurts usually last a couple of days and a baby who was maybe feeding every 3 hours may want to feed every hour or 2 in order to stimulate your milk supply to fuel this growth spurt.
Women who have medical conditions that are not under control such as polycystic ovary syndrome (PCOS), a low or high thyroid, hypertension or hormonal problems that made it difficult to conceive can contribute to low milk supply because making milk relies on the hormonal signals being sent to the breasts.
Advice: Contact a Lactation Consultant who can observe a breastfeed and check baby’s latch. If latch is not the issue, you may try to feed more often to stimulate more milk production. Think putting baby to the breast is what tells the brain to signal milk production. Pumping between feeds will stimulate more milk production however I am always wary of women starting to pump without advise, especially within the first 2 weeks of breastfeeding as it can interrupt the natural feeding relationship being built between Mum and baby.
Blocked milk ducts/ Mastitis: Sometimes a milk duct can become blocked. This results in a red, tender lump. Although a blocked duct is not serious and usually resolves with continued breastfeeding, it can sometimes lead to an infection.
Advice: Don’t give up! Breastfeeding keeps the milk flowing and will clear the duct. Apply warm compress before feeding and massage the lump while you breastfeed. Try feeding baby on the affected side first at every feed until the duct is clear.
What is mastitis? Mastitis is an inflammation of the breast tissue that sometimes involves an infection causing redness, warmth and breast pain. It can cause fever and flu-like symptoms. It usually occurs when a milk duct becomes clogged causing the milk to back up and cause infection, engorgement, or bacteria from your skin or baby’s mouth can enter the milk ducts through a crack in the skin of the nipple. Stagnant milk in the breast that isn’t emptied provides a breeding ground for the bacteria.
Advice: Mastitis should always be treated with care. Although not all mastitis cases require antibiotic treatment, many do. It is important to seek support from a Lactation Consultant and/or GP who will prescribe antibiotics if they are needed. It is important to continue breastfeeding in the treatment of the infection. Warm compress (before a feed) and cold compress (after a feed) can help ease discomfort. Rest and drink fluids.
What are some other issues you get asked about and what advice would you give?
What support is out there for Mums and Mums to be?
During pregnancy it is a good idea to line up support with a voluntary group in your area such as La Leche League (link), Ciudiu (link), Friends of Breastfeeding (link). There is also a HSE website (link) which is interactive with online queries answered by professionals.
Mums worrying about not having enough milk what can you advice?
The numbers of women who cannot physically breastfeed are actually very low. Yes there are some women who will struggle to build a full supply but this does not mean they cannot breastfeed, they just need that extra professional support and encouragement. I would advise seeking support from a Lactation Consultant or a breastfeeding group to observe a breastfeed and baby’s latch. As I mentioned above, any issue of low supply can generally be improved with more frequent feeds and pumping.
Any advice for other family members on supporting a breastfeeding Mum?
Be kind, be patient and above all be supportive. Birth is not only about making babies it is about making mothers. There is societal pressure to be ‘up and about’ after going through childbirth, one of the massive changes in a woman’s life. In contrast, new mums should be encouraged to ‘chill out’ in their pyjamas. I recall when we visited the new mothers in my midwifery training, they would get a gentle ‘ticking off’ if they weren’t in their ‘jammies’.
That approach makes sense, and in other cultures the post-partum period is given far greater emphasis. Mexico has ‘cuarentena’ a 30 day rest period with family and China has a similar practice. In India women have a ‘lying in’ period of six weeks where the mum is mothered
herself, she is not allowed to do any housework and instead is pampered with love for the month. Within Ayurveda, a 5000 year old Indian healing tradition, Mums are given hot oil massages daily and are fed special foods and a number of herbal drinks to promote healing, boost their immunity and improve milk supply. We have it so wrong; If visiting a new Mum with a hot dinner or a healthy meal, although well intentioned, don’t stay too long!
She may be ‘high’ with all the lovely birth hormones but she needs time to recuperate, bond with her baby and establish breatfeeding. Don’t ask can you hold the baby unless she offers, instead ask if there is anything useful you can do for her. Irish women, unlike other cultures, are not accustomed to ask for help or accept offers of help. We tend to follow the societal norms and just ‘get on with it’.
When can you introduce a bottle there is a lot of chatter about nipple confusion?
It has to be said that supplementary feeds or ‘top up’ bottles have interrupted many a woman’s breastfeeding journey. There are of course some situations where a supplement feed is required but I would make sure that Mum is aware there can be consequences of giving a bottle, especially in the early days. I would not recommend giving a bottle unnecessarily until breastfeeding is established (4-6 weeks). The biggest risk when introducing a bottle is that it can disrupt your milk supply. When a baby has a bottle it means the baby is not suckling at the breast to stimulate milk production. If this happens regularly, your milk supply will not keep up with baby’s needs. When baby is having a growth spurt, it is natural to cluster feed or feed frequent to increase supply. This may be tiresome, even exhausting, but if you give a bottle at this time, your breasts will not adapt to increase supply to meet baby’s growth spurt demands. If you give a bottle then the simplest way to maintain your supply is to express milk as well.
Drinking from a bottle does not require much effort whereas baby has to suck, swallow and breathe at the breast. Thus, by baby taking the lazier option, nipple confusion can happen and a baby can refuse the breast if bottles are used regularly. In saying that, many babies will always prefer the breast. If you want to combine breastfeeding and bottle-feeding, the best way is to use paced bottle feeding where you use the bottle to imitate the let-down reflex of the breast. If Mum gets the right help from a professional and takes the appropriate precautions it means she can continue on her chosen breastfeeding journey.
Irish Mums commonly ask when can they have their first drink to celebrate. The HSE states it is best to avoid drinking alcohol until your baby is more than 1 month old and until breastfeeding is established. If you are going to have that celebration and give your baby a bottle remember the volume of breastmilk they require is far less than bottle fed babies. The reason for this is that breastmilk is so easily absorbed, it is digested more rapidly than formula milk. For this reason breastfed babies wake for feeds more regularly. Feed your baby before you plan on giving a bottle (before drinking alcohol), express and dump your milk if you plan on having more than 2 standard drinks, you may have to pump for breast comfort and to preserve milk supply.
Science is learning that the health of your gut is crucial to overall health. The gut contains more nerve cells than the brain and a significant portion of the immune system is situated in the gut walls. Exclusively breastfed babies have very different and healthier bacteria in their gut than non-breastfed babies. When you add formula this changes or dilutes the healthy bacteria.
In the current environment I would like to leave this quote here:
“Immunisation is preventative medicine par excellence. If a new vaccine became available that could prevent 1 million or more child deaths a year and that was moreover, cheap, safe, administered orally and required no cold chain, it would become an immediate public health imperative” “Breastfeeding could do all this and more, but it requires its own ‘warm chain’ of support that is skilled care for mothers to build their confidence and show them what to do, and protect them from harmful practices” (The Lancet, 1994)
As a Mum of 4 kids who have breastfed what advice would you give to breastfeeding Mums?