Challenges of Exclusive Breastfeeding
I planned to write about the challenges in breastfeeding while doing a breastfeeding series in April 2018. However, it was a pain to write about the pains of breastfeeding. Moreover, the challenges in breastfeeding varies quite a bit from mother to mother. So I procrastinated and forgot about it.
17+ months have passed since I started breastfeeding and things got significantly better when she got older. I tried to wean her off and it seemed to be working until our untimely Korea trip, coupled with her viral fever. My toddler regressed to nurse like a newborn.
The Different Paths Mothers Take
Mothers I know (with full term healthy babies) start with exclusive breastfeeding or nursing. But after a while, a few other scenarios can emerge:
- Exclusive Breastfeeding (nurse and pump): Latch the baby and later on interchange with bottle feeding of breastmilk.
- Exclusive Pumping:
- Because of bad latch, sore nipple, slow flow, etc, mothers give up on latching and do exclusive pumping.
- Some mothers want to have a routine, and it is easier to set and measure the feeds with bottle feeding. E.g. during sleep training.
- Mothers want to know with certainty that the baby is full, unlike nursing.
- Exclusive Nursing (without pumping): Because of baby’s bottle rejection or the chore to wash the pump parts and bottles, mothers simply latch on demand. I belong to this category!
- Mix feed (breastmilk and formula): Because of low supply, mothers give up on nursing and introduce formula milk along with breastmilk. Yet there are also mothers with good supply who will still give formula from birth because they don’t want the babies to reject formula.
- Exclusive Formula / Early Introduction of Solids: Some simply choose not to give breastmlk. Or maybe the baby has medical conditions that required measured feedings. And in rare cases where baby rejects breastmilk or milk in general. It happened to a friend of mine!
Common Challenges of Exclusive Breastfeeding
Before I gave birth, many parents shared a little about how hard breastfeeding is. They simply hinted by saying, “It’s okay if you feel like giving up,” without going into the gory details. Perhaps they didn’t want to dissuade me before I start. Good thing I did a little research to prepare myself and those around me about breastfeeding and its challenges.
Top Breastfeeding Challenges
I decided to re-visit the challenges of breastfeeding because recently I have two friends struggling with latching – one has given up and the other one is on the verge. Both have different circumstances but both led to similar struggles to give up nursing, and probably breastmilk soon. Their reasons resonated with the top three breastfeeding challenges of mothers in this study about exclusive breastfeeding in Ghana:
- Belief that breast milk alone was not sufficient in meeting their babies’ nutritional needs
- Short maternity leave period
- Socio-cultural pressure to introduce water and artificial feeds
Opposition or Cheerleaders?
After hearing so many stories, I think one of the major challenges or encouragement to your breastfeeding journey is the people around you. It’s important to surround yourself with the right people. But in the case of family members and confinement lady, they will still be there in your crucial first month.
Thus, you have to be careful of what you hear. To do so, research, read and be informed about breastfeeding before giving birth. You will then know what advice to take in. Otherwise as first time mothers, you will be overwhelmed by the myriad of advice and just take in whatever from experienced ladies who are not experts in breastfeeding.
Convince or inform your husband, parents, parents-in-law and other family members about your wish to breastfeed and choose a confinement lady who is pro-breastfeeding. However, when the baby cries, they might still dissuade you from breastfeeding and introduce formula early in the game to stop the cries.
Ultimately, it’s about your will and beliefs to stand against all odds. How to bolster your will? Brainwash yourself with the benefits of breastmilk and read testimonies of breastfeeding mummies. More on this in the section at the end, “Why Press on through the Challenges” .
Practical Challenges of Breastfeeding
If you realised, the top challenges of breastfeeding are not the breastfeeding act itself. It’s more of the external factors. But of course, there are the pains and frustrations of breastfeeding itself.
Sore, Cracked Nipples
Sore nipples is common. Our nipples are not used to being sucked that hard, so they need to be conditioned by the baby’s suckle. It will get better in time. Meanwhile use breastmilk as natural lubricant. In my case, I needed something more to alleviate my pain. Hence, I used Lansinoh HPA Lanolin Nipple Cream*. It’s good to get a tube of nipple cream on standby! It acts as a lubricant to prevent or heal sore or cracked nipples. Avoid petroleum based products on your nipples.
Also don’t use soap and alcohol to clean your nipple, it could dry or damage your skin, nipples or areolae. Just rinse your breasts with clean water during your daily bath or shower. There’s no need to worry about hygiene. The glands around the nipple will secrete natural oil that discourages bacteria growth, so your breastmilk is safe for baby to drink!
After nursing, it’s best to air your nipples, or blow warm air across the breasts for 2-3 mins. It provided a brief respite for my aching nipples! In dry climate, moisture will help more.
* You can set up an account with this Pupsik referral link or referral code: 4748898.
Sometimes, mothers get “bandung”, pinkish milk that is caused by tiny amount of blood in the milk. It usually happens during expressing or pumping. Common causes are sore, cracked nipples, poor breastfeeding latch or “Rusty Pipe Syndrome”. This syndrome occurs in first time mothers as a result of old blood left during pregnancy.
I had recurrent milk blister due to a supposed bad latch. Milk blister will block the milk ducts, which is not a good thing. With milk blister on sore nipples, I get abrasion pain even from wearing bras, and especially when the baby nursed.
I couldn’t take it anymore and so used alcohol wipes to wipe (sewing) needles and poked those blisters. But it’s actually quite a risk, some mothers got infection as a result. Best to get professional to do it. Otherwise, the best treatment for milk blister is to feed frequently. Ouch!
Plugged or Blocked ducts
Plugged or blocked duct is an area of the breast where milk flow is obstructed, leading to engorgement. This is a common problem too. It could be because the nipple pore is blocked, or the obstruction is further back in the ducts.
How do you know if you have blocked ducts? Feel your breast all around, and if you feel any hardness or pain, there’s a blocked duct. Bottom line, your breasts should feel soft.
How to unblock?
- Best treatment for engorgement is to nurse frequently. Then express milk after nursing to drain the breasts.
- Be familiar with different breastfeeding positions, e.g. cradle and football hold. Point the baby’s chin to the part of the breasts with blocked ducts.
- Before nursing, massage and hand express. Massage the areola to clear the blockage, then gently massage your breast in circular motions, stroke towards the nipple and hand express. This will clear your blocked ducts with lesser pain and make the milk flow faster. Find youtube videos on how to hand express.
- Before nursing, place a warm compress over your breast to promote let-down of milk and relieve plugged ducts. A warm shower or bath may also help.
- Avoid tight-fitting clothing, including underwire bras.
Mastitis and Breast Abscess
Mastitis is an inflammation of the breast that usually comes with fever above 38.5°C (101.3°), chills and flu-like aching. The pain and swelling in mastitis is usually more intense than plugged ducts. It is most common in the first 2 to 3 weeks and may come on abruptly, usually affecting only one breast.
It’s important to see a doctor for mastitis as soon as possible to reduce the risk of getting an breast abscess, a painful build-up of pus in the breast caused by an infection.
Mastitis can be caused by blocked ducts, infection and/or allergy. If it’s an infection, your GP will prescribe antibiotics. If not, your mastitis can improve through plenty of rest and fluids, over-the-counter painkillers such as paracetamol or ibuprofen to reduce pain or fever, and the same methods to clear blocked ducts.
My friend had mastitis and it sounded so bad with pain in the boobs and fever. I was so scared to have that when my vagina area was still in tearing pain from the episiotomy. So I was very diligent in massaging my breasts every time before I nurse and before I shower and sleep for the night.
Low Milk Supply
This is the reason why many mothers give up. They think the baby is not drinking enough.
According to a breastfeeding counsellor in the facebook group, “If baby is satisfied with this current feeding amount, there is no need to change. It is easy to overfeed with the bottle, and bottle feeding increases risk of obesity and diabetes later on in life. Diaper output and weight gain will tell you whether baby is getting enough milk. Not duration of feeds, frequency of feeds or volume per bottle feed.”
By stressing yourself out with the supply, it will actually cause the supply to dip, because stress is a major cause of supply dip. More about milk supply in my “Establish and Boost Milk Supply” post.
My friend with low supply said she can’t bear to let the baby cry and suffer from hunger and so supplement with formula. I didn’t know then why that didn’t sit well with me. I thought about it and realised why. By increasing frequency to latch doesn’t mean we are making the baby suffer, the baby is still getting food. It’s just tougher for the mother to keep nursing.
To put my point across, I’m making an extreme statement here: It might be even worse that in order to satisfy short term hunger with a quick formula fix, we give up the long term benefits of breastmilk.
(p.s. I want to add a caveat, I know there are many reasons for formula. I just want mothers not to give up on breastfeeding so easily at the first roadblock or in the first month or so. But ultimately the mother’s mental well-being is still the most important. If you are blaming yourself and feeling depressed, don’t force yourself to breastfeed.)
Low milk supply? A newborn having a hard time latching? Hear from this mother:
“During my first month, I wanted to give up at every feed because it was so hard! But I’m going on 4 months now and it is getting better each day. My first three months were hell, but I endured. Keep going, take one feed at a time. Stay in bed with baby for a few days to cuddle, have lots of skin to skin and latch.
If baby cries, get hubby to walk her, ideally outside of the house. Meanwhile, you take a nap. 30 minutes later, latch again and you will have milk. Babies can drink less but then they will drink more often. The newborns are still so young and thus their jaw muscles aren’t developed enough to suck properly, but it will get better. For me it suddenly got super easy at exactly 3 months. The baby latches on by himself, and feed only 5 minutes. You will get there too, don’t give up.”
Solution: Use of warm and cold compress
For warm compress, you can soak washcloth in warm water. I did that for a while and then got a gel pad for convenience’s sake. For cool and heat therapy, you can use Lansinoh TheraPearl 3-in-1 Breast Therapy* .
- Cool therapy helps to relieve pain and swelling due to engorgement.
- Heat therapy helps to relieve plugged ducts and mastitis.
- Heat therapy encourages let-down and milk flow.
* You can set up an account with this Pupsik referral link or referral code: 4748898.
Solution: Lactation consultant
If you are at your wits’ ends, and nothing on google or youtube can solve your problem, go to a lactation consultant (“LC”) for advice. Because of my milk blister, I went back to my lactation consultant in NUH. But there are good ones at Mount Alvernia like popular Ms Kang (Phaik Gaik).
Why press on through all challenges?
To have the determination to brave through the challenges, it’s important to know why you want to breastfeed in the first place. If you are not convince that breastmilk is the best for your baby, it’s hard to convince others too.
Breastfeeding Benefits Babies
- Breast milk changes to provide ideal nutrition for your baby
- Breast milk is easily digested by your baby: Thus less likely to give constipation or diarrhoea than infant formulas.
- Breastfeeding provides warmth and security to your baby: Close body contact during breastfeeding helps create a special bond between you and your baby.
- Breast milk helps boost your baby’s immune system and reduce his risk of infections: Baby inherits your antibodies through breast milk. Studies show that children who are breastfed may also have reduced risk of obesity and diabetes, as well as lower blood pressure and total cholesterol later in life
- Breast feeding may protect against allergies: Chances of developing an allergy may be reduced due to a delay in exposing the child to allergens until the child is older and the immune system more mature.
- Breast milk may promote better mental and visual development in your baby
- Breastfeeding improves jaw movement.
Breastfeeding Benefits Mothers
- Heals your body: Breastfeeding releases the hormone oxytocin which helps your uterus, which was stretched during pregnancy, to contract and return to its pre-pregnancy shape and may reduce uterine bleeding after birth. Also prevents painful breast engorgement.
- Lowers risk of certain types of illnesses: Breast cancer, ovarian cancer, type II diabetes, cardiovascular disease, hypertension and hyperlipidaemia.
- Helps you lose weight faster
- Saves time and money
Sources: www.healthxchange.sg/women/post-pregnancy/breastfeeding-health-benefits-baby; www.healthxchange.sg/women/post-pregnancy/breastfeeding-health-benefits-mother
Testimonies of Breastfeeding Mothers
There are many testimonies of breastfeeding mothers you can find at these facebook groups: Breastfeeding Mums and SG Breastfeeding Mums. I’ll share two I read here:
Mummy #1: It’s definitely not the same (formula and breastmilk). I breastfeed my five children for various lengths of time and the one who is breastfed the longest definitely has the best immunity. I’m still breastfeeding my #5 who is turning 20 months soon. I regretted not being persistent in breastfeeding my #1 and #2 and thus they grew up drinking formula milk. I can see the great difference in their immune systems. That’s why breastmilk is call the liquid of gold.
Mummy #2: My child is one of those you mentioned, poor immunity even when she was fully breastfed. I asked my pediatrician why and he told me “Without breastmilk, she could be worse.” Now she’s already three and she’s tough. Genetics plays a part, but breastmilk also plays a part for sure.’
You might also want to read this article which was widely shared at one point in time, a good read: www.calmfamily.org/blog/fed-is-best
How long should I press on?
6 months is the standard the Singapore government set, but 1 year is even more ideal from my research. From askdrsears.com,
“While weaning is a personal decision, nutritionists and physicians advise breastfeeding for at least one year because by that time most infants have outgrown most of their food allergies and will thrive on alternative nourishment. We urge mothers to think in terms of years, not months, when contemplating how long to nurse. Breastfeeding is a long-term investment in your child. You want to give your baby the best emotional, physical, and mental start.”
Emotionally Exhausting, But For The Best of Our Children
Before I end, I want to assure you that you are not alone. It’s really hard in the beginning and you will feel like giving up. Very confused and all. I cried many times! Although I am a big supporter of breastfeeding, I know it might not work for some mothers and babies. Looking back on my journey, I thank God for the grace to persevere on to breastfeed, amidst recurring thoughts of wanting to give up.
Do what you feel is right for you and your baby. Consider your emotional well-being too. Happy mother means happy child too. At the end of the day, we just want the best for our children.
p.s. This is part of JoogoStyle’s breastfeeding series.
Do you have other questions about breastfeeding? Or do you have encouraging testimonies to share with other mummies? Please leave your comments below. Love to hear from you!
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