Achieving exclusive breastfeeding has been elusive for long due to many challenges that hinder support for breastfeeding mothers and their families.
In the when a baby was born in a homestead, the community at large, including experienced mothers, would visit time to time to nurse, gift and counsel the new mother on proper ways to care for the newborn and how to breastfeed.
However, in recent times, the practice has changed and often after delivery and discharge from hospital, the new mother is left alone with their spouse to continue the care at home.
At the point of discharge, a significant number of women may not be knowledgeable enough on how to breastfeed. Within a week, they may be back to hospital with breastfeeding-related problems like dehydration and loss of weight which may require admission for management.
This year’s World Breastfeeding Week themed “support breastfeeding for a healthier planet’ calls for government and private sector partnerships to protect and promote women’s access to skilled breastfeeding counselling to promote exclusive breastfeeding.
WHAT SHOULD YOU DO IF A BABY REFUSES THE BREAST?
The common causes are sore mouth due to thrush, the baby being ill or upset, or milk flow being too fast for the baby. As the baby gets older, they spend less time feeding. Do not hold the baby’s head too tightly or push the face towards the breast as the baby will turn towards your hand instead of the nipple. It helps to squeeze a little breast milk onto the nipple before latching the baby.
WHAT MAKES THE BABY TO CHOKE WHILE BREASTFEEDING?
Sometimes the mother may have too much milk and the milk flows too fast causing the baby to choke or gag when feeding. As a result, the baby may refuse to feed and become restless. The mother may have to express a bit to soften the areola before starting to feed. Only offer one breast per feed and only when the baby appears hungry and the milk supply will settle with time.
HOW SHOULD YOU MANAGE SWOLLEN OR PAINFUL BREASTS?
Breasts that are painful, swollen, tight (especially nipple), shiny may look red, tender, hard, lumpy, milk not flowing and fever are caused by either engorgement or mastitis. Both engorgement and mastitis result from an obstruction in milk flow.
Engorged breasts are usually swollen, hard and painful but the mother does not feel ill. The milk does not flow freely. Treatment consists of encouraging the baby to suckle frequently. The baby should be fed on the most painful breast first. Placing ice or frozen cabbage leaves onto the breasts between the feeds will help reduce the swelling and a warm shower relieves the discomfort. A mild analgesic like paracetamol can also be helpful.
Engorgement may be prevented by letting babies feed as soon as possible after delivery. Make sure the baby is well positioned and attached to the breast and frequently breastfeeding. Milk then does not build up in the breast. If the baby is not able to suckle to remove the milk, then the mother should express either manually or using a breast pump.
Mastitis is the inflammation of the breast due to blocked milk ducts and seepage of milk into the surrounding tissues. It causes severe pain, fever and the woman feels ill. Part of the breast is swollen and hard with redness of the overlying skin.
Treatment of mastitis is warm compress, rest and mild analgesic. It is most important that the baby continues to suckle frequently on the affected breast as this will help the milk to flow.
Mastitis affects part of the breast and usually only one breast, unlike engorgement that affects the whole breast and often both breasts.
HOW DO YOU PREVENT PAINFUL NIPPLES?
It is most important that the baby is correctly latched at the breast so that the nipple is not chewed. Remember that babies breastfeed and do not nipple feed. Make sure that the baby has all of the nipple and most of areola in the mouth when feeding. This way nipples should not be painful, even in the first few days, if the baby is correctly latched to the breast.
When removing the baby from the breast, the mother should insert her little finger into the corner of the baby’s mouth to break the suction.
After each feed, the mother should express a little colostrum or hind milk and apply on the nipples. The milk has anti-infective properties and the fat protects the nipples. Avoid vigorous washing or soap on the nipples, as this causes the nipples to dry and increase the risk of cracking.
HOW SHOULD YOU TREAT PAINFUL NIPPLES?
Cracked nipples are very painful and should be prevented by correctly latching the baby to the breast and avoiding engorged breasts. Treat cracked nipples with breast milk spread on the nipple between feeds. Usually with correct latching to the breast, the mother will feel no pain and the crack will heal within a day. However, should the cracked nipple be too sore to continue feeding, express the affected breast. Feed the baby on the other breast and after the feed, give the expressed breast milk by cup.
DO BREASTFED BABIES NEED COMPLEMENTARY FEEDS?
A mother can continue to breastfeed exclusively for 6 months and beyond. Most breastfed babies do not need complementary feeds or formula. Complementary feeds decrease the time the baby spends on the breasts and thereby, reduce the production of breast milk. Both feeds may confuse the baby.
Only if the baby continues to lose weight and the mother has inadequate lactation, should complementary feeds be used. The mother should express her breasts to increase milk production. This is a decision that should only be reached at after consultation with health provider and efforts to improve lactation deemed unsuccessful.
Mathenge is a Lactation Manager at Aga Khan University Hospital, Nairobi
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