We asked Dr Tsin Uin Foong, at IMC Katong and Uma Thambidurai, Director of Mother & Child and lactation expert everything you need to know about breastfeeding.
What are the most common issues you both see around breastfeeding?
Dr F: For mothers painful feeding usually caused by thrush and/or mastitis (blocked duct which occasionally causes an infection) where medication might be prescribed, difficulty latching on, anxiety about the amount of feed baby is obtaining, low milk supply (where medications might be considered to increase the supply). Treatment or active intervention is not always necessary, sometimes simply seeing a medical professional and talking through the issue, simple pointers and support is all that is necessary.
UT: We see mothers with sore nipples, low milk supply, thrush on the nipples and mastitis.
If a mother has difficulty breastfeeding with the first child, will they have difficulty with the second?
Dr F: Not always, unless there is a structural issue. She might be anxious having had a previous breastfeeding issue so it is useful to talk about this during the pregnancy with her obstetrician/ GP who can provide necessary support and advice before the baby arrives. The doctor may suggest seeing a lactation consultant.
UT: A mother may be more confident the second time around and may not be as overwhelmed but may still face some problems. I would recommend that she has a pre-lactation visit with the lactation consultant in late pregnancy to ensure that she gets off to a good start.
What factors contribute to breastfeeding problems?
Dr F: A common issue is lack of rest/sleep and nutritional intake. One does not necessarily have to have special confinement menus but regular meals and adequate and nutritional food intake, plus drinking plenty of water. This is the time to eat a balanced and full diet, and not to consider any diets for weight loss or cutting out any food groups. Getting family or friends to ensure you are fed well/ bring you food is one of the most practical forms of help they can offer.
UT: Early improper latching techniques that contribute to sore nipples; inadequate removal of milk from the breasts in the early weeks resulting in low supply; and a difficult or long labour and instrumental birth contributing to the inability of the baby to suck efficiently.
If breastfeeding is painful each time – does it indicate a problem with latching on?
Dr F: It quite often is although there could be other issues too. Referral for an assessment with a lactation consultant is highly recommended at this stage.
UT: Forcing the baby on the breast and interfering with the latch results in the baby clamping down and causing sore nipples. Allowing the baby to self-latch or baby led latching technique reduces the incidence of sore nipples. The baby should also be assessed for a tongue tie.
Does ‘nature’ generally make sure mothers create enough milk for baby?
Dr F: Absolutely! Some exceptions are premature births or complicated births but often these Mum’s are still able to have an enjoyable breast feeding journey.
UT: Yes, if there are no complications such as post-partum haemorrhage and retained placental products which could inhibit the production of the hormone prolactin which induces milk production. Frequent and adequate milk removal by the baby in the early weeks will ensure a good milk supply.
How can breastfeeding mothers avoid getting mastitis? What is the treatment for mastitis?
Dr F: Ensure regular emptying of both breasts either through feeding or expressing. Try to avoid frequent lengthening between feeds intervals (equally do not panic if you miss just one!). There is no fixed, minimum time frame between feeds to prevent this. The important step in treatment is to keep emptying the breasts during a bout of mastitis, and this early intervention can sometimes prevent the use of antibiotics. Mastitis causes painful breasts and a lump is often felt (blocked duct) and flu-like symptoms with a fever. If antibiotics are used, they are chosen to ensure that the woman is still able to breast feed safely. Seek medical help if you are ever unsure.
UT: Adequate removal of milk from the breast is recommended. Feed regularly and follow your baby’s feeding cues. Avoid fixed schedules. The mother should rest enough and ensure that she is not fatigued as this is a precursor for mastitis. She should seek medical advice if her symptoms of mastitis are not alleviated within 24 hours of the onset. Failure to treat might lead to an abscess.
What happens if a new mother struggles with breastfeeding…? Who should they go to for help?
Dr F: We are fortunate at IMC to work with experienced lactation consultants and can signpost patients readily to them. Do not hesitate to speak to your doctor. Certainly, listen to good meaning friends or family, but please remember if their personal experience is different from yours, it does not mean yours is not normal! Always clarify with experienced professionals.
UT: Mothers should seek the help of their doctor or a lactation consultant as soon as possible to avoid serious complications, attributing to slow weight gain for the infant, mastitis and low supply.
From all your wealth of experience, any last thoughts?
Dr F: Breast feeding should be an enjoyable journey and there is plenty of help out there to make it so.. Together with the lactation consultants, we will try our very best to support you to make it a success. Listen to your body and listen to your baby. However it sometimes does not work out for some Mums, and we are equally supportive of that journey too.
UT: Getting off to a good start is the key factor to successful breastfeeding. Three key points
- Initiate breastfeeding early, ideally within an hour of birth.
- Practice skin to skin contact in the first hour of birth and continue daily for the first six weeks.
- Remove milk from the breast frequently and adequately by feeding the baby to ensure a good milk supply.
Dr Tsin Uin Foong is Deputy Medical Director based in IMC Katong. Call 6342 4440 or visit www.imc-healthcare.com to make an appointment.
Uma Thambidurai, Director of Mother & Child is a IBCLC certified lactation consultant, a midwife and nurse. Uma has lactation support appointments available at IMC Katong on Tues and Thurs and at Mother and Child Tanglin Mall close to IMC Camden on other days. Call 6836 0063 or visit www.motherandchild.com.sg