BREAST FEEDING: Queries & Problems

Breast feeding means bonding, care and love of a mother for her newborn. It’s also called the best gift of nature as it is the ONLY best nutrition for baby’s growth and development, providing all the required nutrients in right proportion also has immunity enhancing chemicals (antibodies) to fight against infections and illness like diarrhea, constipation and reduces risk of obesity. It is also beneficial for mothers for helping uterus to return to its original size, burning extra calories and  protecting against diabetes, breast and ovarian cancer.

It may not always be easy in the beginning; some new mothers do not want to breast feed as there are many myths and disturbing questions which need to be clarified. Sometimes, there are medical  problems resulting in discontinuation of breast feeding. All these issues need to be addressed timely with proper guidance of healthcare professionals and support, and encouragement of family. 

This blog would give answers to commonly asked questions and provide guidance for breast feeding problems:

How is Colostrum (breast milk of first few days after delivery) beneficial?
It is also called “Liquid gold”, it is thick, produced in small amounts and is full of disease fighting, immunity booster antibodies.

How often new baby should be breast fed?
A newborn breast feeds 10 to 12 times in 24 hours, it is better having early and frequent breast feeding for establishing proper let down reflex of milk.

What are the signs of enough breast milk for baby?
The baby is active and alert, wakes up easily, has a strong cry and is satisfied and content after many feeds.

Could I give baby soothers (pacifiers)?
No, try to avoid it till proper breast feeding establishes, which takes weeks. It is supply and demand mechanism, when baby is more breast fed, the milk production is increased. Therefore soothers would not only decrease milk production but also interferes with correct attachment of baby onto breast.

How to breast feed after a cesarean delivery?
Try to start breast feeding as early as possible as it helps to keep uterus well contracted reducing chances of heavy bleeding, it also helps body to get back in shape. If you are unable to feed or is separated from the baby, express milk, it will maintain milk production in breasts.

Is there a special diet during breast feeding?
Breast milk is 80% water, make sure that you are drinking plenty of water. Take a healthy balanced diet providing all the required nutrients, it means:

• Add 5 to 7 servings of fruits, vegetables and fresh salads
• Proteins such as egg, red meat, fish and poultry
• Wholegrain bread, pasta, rice or potatoes
• Plenty of fiber to prevent constipation, fruits, vegetables, whole grain, beans
• Dairy products such as milk, cheese and yoghurt

What are the healthy snacks for breast feeding mothers?
It is recommended that in addition to above diet, whenever you feel hungry try to grab a healthy snack like:

• Sandwiches
• Fresh fruits
• Dried fruits such as almonds, apricots and prune
• Boiled eggs
• Cereals
• Yoghurt
• Backed beans
• Potatoes

Which foods should be avoided?
Eat a balanced, healthy and nutritious diet. Fish have fats (omega fatty acids) that are really good for developing brain, BUT BE CAREFUL, some oily fish like marlin, sword fish, shark have high pollutant mercury level which can built up in body and is dangerous for baby. Do Not eat these fish more than once in a week. Similar is with Tuna fish, you can have only 12 ounces per week.

Could “Caffeine” intake give trouble while breast feeding?
Caffeinated drinks, tea or coffee can keep your baby awake or more active. You are allowed to intake only 200 mg per day same as in pregnancy.

Note the following:

• 1 mug of tea = 75 mg caffeine
• 1 mug of instant coffee = 100 mg caffeine
• 1 mug of filter coffee = 140 mg caffeine
• 1 cola drink = 40 mg caffeine
• 1 can energy drink = 40 mg caffeine

Which medicines are safe during breast feeding?
Do not take any medicine without a doctor’s prescription. Most medicines will be present in breast milk and can affect your baby and also milk production.

Are there any remedies to increase breast milk ?
There is always adequate milk production in the breasts  for the newborn baby. PLEASE do not press and check the nipples. Sometimes milk is not expressed as it is in the breast tissue, it will only cause pain and frustration. Baby should be offered breast right after delivery. If mother can’t breast feed (baby or mother medical problem) then pump or express milk after every 2 to 3 hours, it will give regular breast stimulation for milk, let down reflex and will prevent breast engorgement.

The following tips are really helpful:

• Take plenty of fluids about 3 to 4 liters.
• Take full meals, don’t starve yourself to lose weight. It will only suppress milk production.
• Foods like barley porridge, cottage cheese and milk help in producing and maintaining breast milk.
• Take Fenugreek seeds (METHI seeds). Grind them and take 2 table spoons thrice daily for a week. They can be taken with water, honey or yogurt. Noticeable increase occurs after 24 hours. Please note, herbal medicines and supplements would be more effective with physical stimulation by direct feeding or pumping.

Could breast feeding become painful?
Normally breast feeding is NOT painful. It can cause pain if baby is NOT positioned or attached correctly to breast. Also, look for cracked nipples, if it’s not the problem then check baby’s mouth for thrush or tongue tie.

What is treatment of cracked nipples?
ALWAYS wash hands before feeding. After each feed apply some milk onto nipple area and let it dry before covering. Apply and massage Lanolin Ointment on effected area, sometimes local antibiotics and anti-fungal creams are also used. If baby has oral thrush then oral anti-fungal drops should be given to the baby. Express milk with hand or with a breast pump for 1 to 2 days, to give time to heal.

How to deal with engorged breasts?
It can occur in early days of feeding or when weaning is started. The breasts get hard and painful due to engorgement. The useful tips are:

• Evacuate breast by manual compression or using breast pump.
• Put a warm flannel for few minutes or take warm shower before starting evacuation, it will help in relieving pain and let down milk reflex.
• Wear a well-fitting nursing bra, for breast support and preventing further engorgement.
• Keep cabbage leaves in fridge and put them on breasts after each feed. Take painkillers like paracetamol or ibuprofen for pain relief.

What if there is soreness of breasts with fever?
A breast duct is blocked when milk is not flowing out of it which can cause local soreness, hardness and a tender lump formation. It can occur due to incorrect positioning and attachment of baby onto breast, inadequate breast emptying and very tight compressing breast tissue. If this is not relieved timely, infection starts(Mastitis) which causes high grade fever, flu like symptoms, generalized body aches and pains. Breast examination shows tender red patch. It can be dealt by starting feed from affected breast frequently or expressing milk from that side. After feeding, do  frequent cold fomentation of breast with a cold cloth. Massage breast while baby is feeding. Take rest and painkillers. If symptoms get worse or do not settle within 12 to 24 hours then see your doctor.

Always remember, breast feeding requires patience and time. Proper guidance and information could really help you and your baby for comfortable breast feeding sessions.

Dr. Ayesha Azam Khan