Overcoming breastfeeding challenges

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By BEATRICE NAKIBUUKA

“When I was pregnant with my first child, I did not get any preparation classes for breastfeeding even when I attended my antenatal care regularly. I did not know what to do. When I gave birth, I developed cracks and sores on my nipples but did not get help from the medics I consulted,” Doreen Mazakpwe SSemujju is the founder of Naturally Nourish Ltd recalls.
Many mothers run to the internet and other social media platforms like Mama Tendo when they have breastfeeding challenges. This is because failure to breastfeed is a motherhood nightmare that brings guilt and despair. The lactation consultant has on several occasions held breastfeeding lessons for pregnant and lactating mothers at TMR International Hospital. From her experience of not finding help, she wants to bridge the gap of frustrated mothers that never get help after failing to breast feed.
According to her, lactation consultancy is not a field so many doctors have adventured into probably because they think breastfeeding in Africa is automatic and therefore mothers do not experience any problems.
“During pregnancy and after delivery, mothers often interact with gynaecologists, obstetricians, midwives, paediatric nurses and general practitioners only because they or the baby are sick but when they have breastfeeding issues, these specialists often do not have enough information to address these issues,” she says.

The medical school curriculum in Uganda does not offer extra training to help the medics handle the issues around breastfeeding.
The body starts making the first milk (colostrum) as early as 16 to 20 weeks into pregnancy. This is the reason some women have leaking breasts during pregnancy and it is normal. After giving birth, breastfeeding begins the flow of milk starting with colostrum, usually thick, viscous and creamy. This milk is very important for a child because it contains a lot of antibodies and it continues to flow for 3 to 5 days of breastfeeding.
Dr Mazakpwe remarks that, “Some mothers complain they do not have breast milk but sometimes it is because they do not know how to express it and have not put enough time to it. They keep on pressing the nipple while neglecting the whole breast where the milk is supposed to come from.
If the baby is not latching well at the breast, then it will be difficult for the milk to come.”
The mother should make sure that the whole dark area of the breast (areola) is inside the baby’s mouth. If the baby latches on the nipple alone, the breast will develop cracks and sores which causes breaking of the skin around the nipple.
She says, “Owing to the organisms that live on the body, the nipple will eventually develop infections making it impossible for the mother to breastfeed due to the infection induced pain. Thereafter, because milk is left in the breast, it attracts all kinds of infections including inflammation, blocked ducts, mastitis that can lead to an abscess, stasis and engorgement where the breasts swell and become hard because they are filled with milk.”
Sometimes because the baby is unable to finish all the milk, the breast does not drain properly and when the milk stays, it is likely to cause blocked ducts and other breast problems.

Management
Nonetheless, there is a technique known as the therapeutic breast massage of lactation that can relieve the engorgement, mastitis, blocked ducts and inflammation with a few or no antibiotics at all. Lymphatic drainage that is aimed at directing the excess extra milk fluid to the opposite direction from the normal flow of the milk can be done by a lactation clinician to help relieve a mother of the pain from breastfeeding challenges.
The clinician can also teach the mother how to do the massage and will continue doing this while at home. The mother can also apply a cold compress with ice to suppress the congestion that may be in the breast.
It is however important to note that mothers should only apply a warm compress only if they want to increase the supply of milk.
She explains that, “In cases where mothers develop flat nipples, it becomes very hard for the child to latch properly because they are hard. The lactation clinician will then apply the reverse pressure softening technique to make the nipple more prominent for the child to be able to latch well.”
She advises that, “Whenever the mother has breastfeeding problems with no other complications, they should never put their child to bottle feeding but rather continue breastfeeding them while the problem is solved. If the problem is handled well, the baby can latch properly without the mother feeling pain.”

Positioning
The other issue that most mothers grapple with is positioning. There are different breastfeeding positions although many mothers are more familiar with the cradle hold position. When breastfeeding, comfort is very important coupled with ensuring that the baby is latching well.
For mothers with flat or inverted or large nipples, the under arm and laid back positions are usually comfortable because they have to lean back and it enables the baby to latch on the breast very well.
“Health workers should help mothers to explore different positions such as cross cradle, under arm hold, side laying. This will also enable the mother to drain different areas of the breast which is usually difficult in the early stages since the baby is unable to drain them.”

Signs that they need to feed
However, despite knowing how to position the baby, mothers need to learn when to feed their children.
After birth, a baby feeds between eight to 12 times daily with an interval of two to three hours. It is important however that a mother feeds a baby on demand after seeing the signs of the hand to mouth movements, pulling on something to the mouth, rapid eye movement under the lid, waking up from sleep, smacking of the lips and routing when you move something close to their eyes.
Dr Mazakpwe says, “Many mothers only wait for their babies to first cry before they feed them. This is not recommendable because crying is a late sign of hunger. When the baby cries, it swallows a lot of air, and becomes frustrated.

The mother will first have to soothe the child to stop crying then feed them because while crying, the baby’s tongue moves up yet it must be down in order for the baby to feed well.”
Babies are not like adults who may feed during day and sleep throughout the night. Mothers should be able to wake up in the night and feed the baby like they feed during day.
While feeding your baby, it is important to note the changes in the colour of the stool right from the first day as well as weight gain changes. In the first 14 days of life, it is normal for the baby to lose a little weight but it must be progressive thereafter.
She remarks that, “At 6 to 8 weeks, babies that are breastfed usually pass out stool once in several days which scares mothers for fear that their babies are constipated. If the baby is not sick or does not cry, let them be because it is normal. That said, a baby is supposed to gain 30g every day. Monitor the different milestones achieved in a period.”

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