Breastfeeding dos and don’ts: A mother’s perspective.

“Motherhood” is breastfeeding my first baby exclusively for the first 6 months, and still being apprehensive and clueless each day of my second term. I believe this is one of the most challenging aspects of being a new mom.

There is an enormous amount of literature on how to and how not to breastfeed, with an unending Dos and Don’ts involved. Some days, I wish that babies came with a perfect pre-written custom-made manual for breastfeeding. Problem solved!

Despite having a very intelligent and experienced paediatrician-cum-husband at my disposal, 24#7, I have scrolled thousands of internet pages, navigated my intellects through tens of pediatric textbooks, searching for ‘the perfect answer’. Trust me, I have experienced, reasoned, and researched each aspect personally as a mother, and scientifically as a doctor.

Babies grow super fast, jumping one milestone to another in the blink of an eye, and while we surround ourselves with the constant guilt of our presumed inadequacy, missing a lot of fun along the way.

From “one mother to another”.

Eat heartily, and healthily. Your diet preferences don’t alter your milk composition.

Don’t go burying yourself in guilt trips every time your baby just whines and whines. Tune your brain to mute the resonating voice of the advisors who keep questioning: what did u eat last?

It’s scientifically proven that breast milk has a very fixed composition that is not normally altered by your intake of Rajma or Bhature-chole.

Just go ahead and enjoy a healthy, balanced, and diverse diet with an occasional allowance for binges.

Some foods that need moderation while breastfeeding(please Don’t read NOT TO BE TAKEN)

• Alcohol
• Fish, owing to its high mercury content
• Caffeine. FDA recommends 300mg or 2 cups of coffee for nursing women. Energy drinks, soda, tea, and chocolate also contain caffeine
• Highly processed food laced with artificial chemicals.

The most common culprits, that actually cause trouble, are allergens. These are tiny chemicals that cross-over and cause food allergy in infants. Cow-milk, milk products, peanuts, and eggs are the most frequent offenders. Be assured, these are rare allergies but need specialist intervention.

Trust your gut

If you believe something is actually causing those cramps and discomfort in your baby, never ignore that feeling. Mothers have a very strong intuition or 6^th sense guarding the well being of their children. Give the suspected food a trial of omission, observe the change, and slowly introduce it again under strict supervision. Work scientifically, not emotionally.

If that does not help, please don’t delay seeing your physician/pediatrician., especially if your child displays signs of allergy (like hives, red patches, bloating, gassiness, diarrhea, wheezing) or is lagging behind the expected weight. Management may include diet modification for nursing mothers and/or specialized formulas for the infant.

Supplement your diet

• Add an extra 450-500 = kcal/ day to your diet, depending on your BMI.
• Take calcium supplements.
• Multivitamin can be added, only if needed.
• DHA supplements are known to augment improved brain development in the child.
• Vit. D supplement for the infant, 400IU/day for an year.

Note of caution for vegan moms

A vegetarian diet is deficient in vitamin B12, and this must be supplemented throughout pregnancy and breastfeeding. I will be writing about ‘multivitamins and pregnancy’, in the future.

Establishing lactation. Be patient, it takes time and effort.

Don’t beat yourself over the fear of inadequate milk production. Most of us do just fine on that front. Lactation experts tell-

• Put the baby to breast within 1 hour of birth
• It takes 1-2 weeks for lactation establishment. It’s normal to produce less milk at this time. Be assured the supply matches your child’s needs.
• Feed on cues: sucking movements and sounds, hand to mouth movements, rapid eye movements, soft cooing or sighing sounds, lip-smacking, restlessness, etc. Don’t wait for crying which is a late sign and signals distress.
• Feed 8-10 times in 24 hours a day until lactation sets in fully.
• A child is well-fed if s/he has frequent urination and stools, and is gaining weight as per standards.
• Indian Academy Of Pediatrics provides detailed guidelines to follow.

Having an occasional drink is ‘OKAY’.

Alcohol can freely cross to your infant through breast milk. The actual amount transferred depends on the quantity you take, whether you eat along or not, and the time passed since last drink. Mother’s milk is the best nutrition for the baby, and alcohol is BAD. Period! That doesn’t mean you can’t enjoy your drink, we just need working around this predicament.

Alcohol will completely clear off breastmilk in approximately 2 to 3 hours of your last sip. This is typically true for 355 ml of beer (5%), 148 ml of wine (11%), or 44 ml of liquor (40%), depending on your body weight.

Here are some suggestions that might help you enjoy your drink peacefully, while on a lovely date-night, or dealing with an exhausted day:

• Feed the child before the drink. Your milk would be clear for the next feed, this way.
• Express and feed later, if you plan to enjoy more than a few drinks.
• Switch to bottle feed, if you are already into this.
• Pump and discard, to avoid engorgement for longer intervals. Remember, it is not an effective way of cleaning alcohol from your milk.

CAUTION: No amount of alcohol is deemed safe for babies. Regular exposure can lead to health issues like impaired motor development and abnormal sleep patterns. It is also linked to a decrease in maternal milk production.

Expressing and storing breastmilk.

Breast milk is ‘THE ideal food‘ for the baby. Even when you can’t breastfeed the baby, feed her your breastmilk. This is especially important for the first 6 months when most health authorities, including the Indian Academy of Pediatrics and WHO, recommend exclusive breastfeeding.

Expressing the milk

You need to get accustomed to using a breast-pump for this one. There are a confusing plethora of choices available; manual vs electric, single vs double, wireless vs wired, and so-on. Choose as per your need, convenience, and budget.

The routine that does the trick for me:

• Be relaxed
• Put on some calming music
• Have clean towels/ wipes at hand
• Keep storing bottle nearby
• Be patient. Don’t jump buttons for suction intensity. It takes time and hurrying can cause failure and nipple trouble
• Ensure a good latch with the machine. A big portion of your areola should be inside the suction cup
• Follow nipple care
• Clean and store the components as per brand recommendation
• Don’t forget to read the manual

Good hygiene is of utmost importance, milk is a potent nutrient medium for germs. Maintain aseptic chain from collection, through, till feeding.

Storing the milk

Make sure you collect the precious liquid in clean containers specifically made for breastmilk, and not in disposable bags, or plastic bottles. Medela has some handy and very useful stuff for breastmilk storage like bags, bottles, and cooler sets. Clearly label the date and time of collection, when intended for later use. Remember to utilize the milk within the recommended time-frame

• Room temperature: up to 4 hours
• Refrigerator: up to 3 days
• Freezer: up to 6 months

I have kept bottles at room temperature for up to 4 hours, and in the refrigerator for about 8 hours, storing it in the collection-bottle only. My experience with freezing is limited, I hope some of you can help enrich my knowledge on this.

Feeding stored breast milk

Room temperature or refrigerator-stored milk does not need warming. you can feed just as it is. For thawed milk, use a warm water bath or commercial bottle warmers. Do not reheat the milk directly. Thawed milk can be kept in the refrigerator for 24 hours or at room temperature for up to 2 hours. Once frozen breast milk is thawed, do not refreeze it.

I use Philips Avent single electric comfort breast pump. It’s a reputed brand, the pump is easy to use and clean, all parts are easily available online for a replacement. Thanks to this little miracle machine, I joined work at 5 months post-partum yet breastfed my son exclusively for 6 months, and through his weaning. It gives you the freedom to move out, have your dinner-dates, or enjoy a peaceful drink without compromising your breastfeeding promise.

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Introduce the bottle early.

This one comes deep from my aching heart.

I am all pro for exclusive breastfeeding till 6 months and breast milk supplementation till the child is fully weaned. Trust me, a bottle introduced in the baby’s routine as early as 4 weeks, helps later smooth transition from ‘breast to bottle’. I prefer pumped breast milk, but a bottle of good brand formula-feed is not a bad option at all.

Our cute little monsters are undeniably clever and rigid with their preferences, and if you delay this introduction at a “catch-able” age, you may actually miss that bus.

With my elder son, I made sure to give him a bottle of pumped milk once or twice a day since he was 3 weeks, and it worked wonders. I was able to take a good nap, watch a movie, go on a dinner date with my husband, and so on. But as I was destined to, I failed to pounce on this opportunity this time with my daughter.

What a mistake I made.

She is 6 months now and in total refusal of any kind of nipple/bottle/milk combination. It’s so tough making any plan that does not include her. And, as I now approach the time when I would wish to rejoin work soon, this comes as a very significant and tough road-block on the map.

Maintain nipple health. A cracked, sore nipple impedes your breastfeeding success.

If there is one preventable blunder while breastfeeding, it’s not taking care of your nipples. An infant struggling on a sore nipple can send a chill down your spine. Then, starts the vicious cycle of an ever-increasing chance of lactation failure. Although the maternal instinct would push you to bear that pain, you will pull away physically and emotionally at a subconscious level. Having soft, supple, and pain-free nipples will help you sail through this breastfeeding journey joyfully.

Nipple cream

Its use is of utmost importance in making sure that you maintain your nipple-health. Based on my personal experience I recommend:

• A generous application after every feed, covering the entire nipple. Wipe off gently with moist cotton before the next feed (prefer boiled, RO water). I am using Mom’s Co Natural Nipple Butter from day 1. It is safe for the baby, has a pleasant smell, and a smooth creamy texture.
• For sore, dry, or cracked nipples, use a pure lanolin formulation like Purelan from Medela. I have experienced the relief myself, and recommend it for anyone nursing a sore nipple. Its healing power compensates for its price convincingly. But, for daily use, you may feel out-budgeted.

Giving a day or two for the cracked, and painful nipple to heal is the best strategy. An engorged breast should be expressed. Consult your gynecologist early, before the problem deteriorates, hindering your ‘exclusive breastfeeding’ plan. You may need a pain-killer and/or anti-inflammatory drug for the unsettling times.

Nipple shield

It shields the affected nipple from the trauma of direct suckling, hastening the recovery. Choose the correct size, and follow strict nipple-care regimen for good results.

I have tried my luck with this both times while breastfeeding (Pigeon nipple shield for the first baby and Farlin nipple shield this time), but somehow establishing the latch has been a tough job, and the process felt cumbersome.

Maintain hygiene, use breast pads.

Leaking breast milk not only stains and soils your clothes, its a source of bacterial growth and potential infection. The odor that emanates is a big-time downer as well.

Apart from the daily ritual, take a bath and change the gown as frequently as needed. You may not realize but someone up-close may faint (from that smell) on the spot.

Breast-pads

As a routine, use breast pads to collect and lock-in the spilled milk. That would save you a lot of hassle. It keeps you dry, odor-free, protects the tender nipples from friction against rough cloth, and prevents garment-soiling.

I recommend a change-over to a fresh pad, at least once every 8 hours. You should check brand recommendation, and customize it as per your personal need.

Choose a breast pad having a soft and smooth breast face, wide and good quality sticking back. It should have a good holding capacity and preferably not show itself through your garment. I had a good experience with Phillips Avent and Pigeon breast pads. Both suited my need, with Avent pads scoring at the top. The Luvlap pads, however, did not seem to perform very well.

Low supply. Boosting the milk production.

Infants, gaining good weight (400g/month), having frequent wet nappies, and soiled diapers, are mostly well-fed and don’t need any boost. The best person for your proper guidance would be a lactation expert, though I can suggest a few tips that may do the trick for you:

• Nurse on demand, do it more frequently.
• Use breast-pump after you feed the baby to empty the breast, and in-between feeds. It’s a potent signal for the body to kick in more production. Do it frequently for a few days to establish a boosted supply.
• Try foods known to enhance milk supply: fenugreek or alfalfa, flaxseed meal, oats, wheat gram, and brewer’s yeast.
• Lactation cookies, supplements, teas are available over the counter and may merit a trial as per your preferences

Milk-overproduction or Strong/Forceful let-down.

Making more milk than the baby can handle? Yes, it can happen to some-of-us. It’s annoyingly troublesome and difficult to handle. Having suffered badly, I couldn’t hold myself from a quick remark.

Oversupply vs Forceful Let-Down

“Too Much Milk and Oversupply” from La Leche League GB, deals with the issue in detail and may merit a visit if you are in immediate need of some good, and practical information.

Breast engorgement. Soft, and supple breast is half-the-battle won.

It is such a common menace that interferes with establishing a good lactation/breastfeeding routine. An engorged breast is not only painful and uncomfortable, but it also hinders proper latching and sucking by the infant. Use a warm towel to let excess milk flow while you doing a gentle massage, or use a breast pump for the purpose. Try cold compresses after a feed to soothe the swelling and pain.

Don’t squeeze the breasts, it is not only painful and useless but can also lead to duct trauma and infection. You may need to consult your doctor for pain, fever, or persistent swelling.

Nursing bra. Good support is the key.

This is vital if you don’t want sagging, ugly breasts dangling as a permanent memento for your breastfeeding days. More importantly, and in the present context, proper support will be invaluable in keeping you away from engorged, and sore breasts. Always wear a perfect size. A loose fit will not serve the purpose, while tight one may become the cause of engorgement and sore nipples.

Unsupported or improperly supported breasts can become a cause for your chronic relentless back-pain.

After hit and trial, I found peace in padded nursing bralettes with good support, especially at night time. The padding helps keep sensitive nipples shielded from friction, and small impacts.

Exercise while breastfeeding.

It is good to start an exercise routine as soon as you recover from the physical trauma of birth, stitches, and cesarian wound, all included. Always consult your gynecologist before you start.

Start with a simple walk followed by some low-impact exercises. I will advise against high-impact especially upper-body workouts, that may cause trauma, mastitis, or duct blockage. Always wear a good support bra, shower before feeding, and try to feed before you start to exercise ( exercise increases lactic acid temporarily, and you may want to avoid that). Eat a balanced diet and keep yourself well hydrated. For further details on the topic please read my blog on exercise after c.section.

Breastfeeding is vital to new-born development, and the establishment of a loving mother-child bond. I have squeezed in a lot of information and tried to talk about common concerns based on my personal experience. Please share your side of the story and any other aspect that you want to discuss, in the comments below.

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