Before I start on this post, I have to say, YES!, I am an ardent supporter that all mummies should at least try to breastfeed their babies, and that all mummies have sufficient breastmilk for their kids (provided they latch fully or pump regularly day AND night, and drink 4-6litres of water a day). However, that being said, many do not realise that breastfeeding is NOT easy. We always highlight all the good things about breastfeeding like free milk, bonding with child, full of nutrients and antibodies, etc. But we always neglect the fact that it could be a difficult (but worthwhile) journey, especially to first time mummies. So, kudos to all mummies who have breastfed their babies, whether it is weeks or months or years! And kudos also to all their colleagues/bosses and friends/families for understanding our desire to provide for our babies.
Just some background information, I have breastfed all my 3 babies. (Currently feeding my #3 who is 1 month old.) For these 3, I have had countless times of engorgement, milk blisters, mastitis, sore nipples, stinging pain, just to name a few. I had to pay to see the LC and the Massage Aunty. (So actually Breastmilk is not free). I have struggled to pump during work. Woken up to latch every hour etc.
What I have learnt though, is that all these are problems that CAN be solved or even, prevented, and your supply can go back to normal again, your breast will feel normal again. So I will try my best to offer remedies to 10 (selected) difficulties that you might be facing for breastfeeding and hopefully it will make your journey an easier one than mine.
1. Sore Nipples
This is the first thing that you will have once you start to latch at the hospital. To help to lessen it, pack along in your hospital bag a tube of nipple cream, and apply after every single time the baby latches. My favourite brand is Medela Purelan. It is very thick and works well for me. If you already have sore nipples, after latch slab on the nipple cream and air the nipples. Yes, air meaning go completely topless to air. No bra no t-shirt. If there is a need to be modest because there are other people in the house, buy breast shields. (I use the avent breastshields). Breast shields and nipple cream are God-sent for sore nipples. Just for info, i had sore nipples for the first 3 weeks after birth and had to apply nipple cream after every latch. They only toughened up after that!
Most likely you will get this when your colostrum is converting into milk. And countless times later when you skip a latch/pump (please try not to do this), or when you wear wired bra (don’t do this too), or just have no idea how but it just happens. Tell tale signs are when part of your breast still feels hard even after pumping or latching, or it hurts when you press it. You can try to clear it by taking a warm shower. Whilst in the shower, soap the engorged area and use a large teeth comb to comb towards the nipple. You will have to apply some pressure. After bath, pump as much as possible to empty. Latch baby after that. If by doing this it doesn’t clear, it is time to call in the massage lady or LC to help you with it. Do not delay or it could end up being infected, leading to Mastitis, or even worse, having to have the blocked and solidified infected milk removed via surgery. Certain foods may also cause engorgement. For me, avocado and durian thickens my milk, which is not a good thing because apparently my milk ducts are very narrow. So if i eat those foods, I will get blocked ducts. If I want to eat, I will have to take Lecithin too, to thin the milk!
Mastitis starts off as an engorgement. But if the engorgement is either not noticed or not cleared fast, it will lead up to Mastitis. Mastitis comes like a viral fever, where you feel achy all over and weak. Fever can go up to 39+ degrees Celcius. Your breasts may or may not feel hard (because the blocked duct could be very deep inside) and there may or may not have red patches on them (maybe due to the same reason too). The question when I first got mastitis was, who do I see? LC or Gynae or GP? Well I decided to go to the Gynae as I was totally clueless. She did give me antibiotics for the mastitis, but was unable to clear it for me and so I had to visit the LC anyway. Gynae charged quite high for the consultation and LC was of course not cheap as well. (I like to go to the LC at Mount Alvernia. $80+ if you did not deliver there, and $60+ if you did). Subsequently when I got mastitis, I would go to the GP to get the anti-inflammatory pills and paracetamol (for the fever and pain), and call the Massage Aunty in to massage for me at $50-60 per session. Tip: take a dose of Panadol 1 hour before the breast massage.
4. Milk Blister
Once I got an engorgement that I was unable to clear using the methods I shared above. I then realised there was a white dot on my nipple and when I squeezed the engorged portion, the white spot seemed to grow bigger. On closer inspection, I realised then it was a piece of skin that grew over a milk “pore”, which was preventing all the milk from that duct to be expressed out. That was a milk blister. You can use a sterile needle (run hot water over a needle) to poke a little hole in the blister, and the problem is solved. Pump the milk out after that and then apply nipple cream. Some massage ladies told me that you can also use a cloth to rub the blister until it burst. But to me, that sounds more painful than the needle.
5. Falling Sick
If you fall sick, yes you can continue to breastfeed. Latch would be even better. When the baby sucks, and the saliva is in contact with the nipple, we will produce the appropriate antibodies in the milk for the babies to drink. So amazing right? If you do go to the GP for medication, do let the doctor know that you are breastfeeding so they will prescribe medication suitable for breastfeeding. The only illness when I think you should not latch is if you have contagious by contact illnesses eg HFMD, Chickenpox.
6. Baby doesn’t want to latch
I always advice my first time mum friends to make sure baby can latch before getting discharged from the hospital. Ask the LCs at the hospitals to help you with breastfeeding as much as possible. A good latch will kick start your journey in breastfeeding. A bad latch will make it more difficult. There is help for inverted nipples or short nipples. For inverted, there is a tool which you can use to correct the nipple. It can be worn everyday under your bra. Ask the LCs about it when you go to the hospital for your pre-natal lessons or gynae visits or scans. For some with short nipple, nipple shields can help also. My friends have used the nipple shields at the start and transited to direct latching later on. In any case, if there is a problem latching, go and visit a Lactation Consultant. I highly recommend Mount Alvernia’s LCs. You can call up their Parentcraft Centre to book appointments. If you gave birth there, the fees are about $60+. If not, it would be $80+. House visits will be about $150-160+.
7. Nipple confusion
Nipple confusion can happen if you give the bottle to the baby too early on. (before about 3-4 weeks old). Babies tend to prefer drinking from the bottle as they do not have to wait for the letdown for milk to come and also it takes less effort to suck from the bottle. Sometimes though, the baby needs to be supplemented with fm due to jaundice or breastmilk not coming in yet. The hospitals can do cup feeding. I had to supplement a feed during my stay at the hospital. And the nurse asked me if I wanted cup feed or bottle feed. I chose cup of course. There is a special cup (by Medela) that can be bought to feed babies before starting on bottle later on. So if you intend to feed at home, you can buy the cup. It costs less than $5.
8. Rejecting the bottle
This can be prevented by starting the fully breastfed baby on a bottle feed daily from about 3-4 weeks old. Remember to give frozen breastmilk once in a while too if not that could be another thing that the baby might reject. After all, fresh ebm taste much better than fbm! If baby has already rejected the bottle, read a full post on how to get the baby to drink the bottle HERE.
9. Weaning off the breast
Making the baby take the bottle is one thing. Stopping the baby from latching is another. Babies do not only latch for food. They latch for comfort as well, which is why it is so difficult to wean from the breast. You will have to decide when to do it. When baby is older, you can pre-warn the toddler that when he/she turns 2 years old, that he cannot drink from mummy anymore. If baby is younger, the cold turkey method works the best. However, replace the boob with lots of hugs and cuddles instead. When I weaned our #1 off the breast, we converted to co-sleeping so he could still feel the closeness then.
10. Low supply
I believe that all of us are able to sufficiently feed our babies, provided we are hardworking about it. If you have what you think is low supply, check on the following. Is baby only a few days old? Maybe you are still producing colostrum. Most PDs will tell you that there is no need to supplement baby with fm. However, if you really want to do so, latch first, then supplement with about 10ml of fm. Use cup feeding to prevent nipple confusion. Your gynae can also prescribe you with Motilium. This would help you start producing milk sooner. Also, are you drinking enough? A breastfeeding mummy should be drinking 4-6 litres of fluids a day as breastmilk is made up of mainly water. Fluids can be in the form of water, red date longan tea, soups, milo, juice, etc. Plenty of rest and as little stress as possible is important too. That’s why it is good to get a confinement nanny to take care of all your needs while you rest (and produce milk). Some milk boosters for foods are fish(eg. salmon, threadfin, cod), spinach, black fungus, jin zhen cai, oats, brewers yeast, flaxseed, avocado, durian. Some milk killers and foods that might cause baby to be gassy are caffeine, chocolates, brocolli, alcohol. So try to have as much of milk boosters in your foods every meal and as little of milk killers as possible. Supplements like fenugreek can also help with milk supply. That said, it is very important to latch and pump regularly to build up the supply. If you are fully pumping, then pump every 2-3 hours day and night. If latching, latch on demand day and night. Latch even if baby ask you for milk every hour, because that might be a growth spurt which helps you to increase your milk supply. You are advised to only latch one side per feed to ensure baby gets to the hind milk. To increase supply, you can also pump after every latch. Or pump in between latching if your baby latches at a very regular interval. Or use haakaa to pump one side while you latch the other.
Breastfeeding might not be the easiest thing to do, but it is definitely very fulfilling. Let’s all press on together to give the best to our babies! 🙂