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The archetypal image of breastfeeding often involves a woman smiling serenely at a baby suckling one of her breasts. Such a clichéd scene doesn’t quite capture the fair share of problems that can arise during this crucial period in the baby’s life.
Just because breastfeeding is a natural process doesn’t mean that it starts off easy.
Apart from physiological problems, women may be filled with doubt about their breastfeeding abilities. “Almost all mothers go through a period of questioning whether their milk supply is adequate, especially when they’re just beginning breastfeeding,” observes Dr Fong Kah Leng, Consultant Obstetrician and Gynaecologist at the Sincere Medical Specialist Center for Women in Singapore. “For most women, though, the real problem is delivery, not production. They produce plenty of milk, but for some reason—such as an incorrect latchon technique—the baby isn’t getting enough,” she explains.
“Learn as much as one can during the antenatal and postnatal classes,” advises Dr Arthur Tseng, an obstetrician and gynaecologist at Singapore’s Gleneagles Hospital. “Ask any and every question that comes to mind, no matter how small or silly it may sound. Do breastfeed on demand, and pump in between so as to establish milk flow. And never, never delay or neglect breastfeeding. Otherwise, clogged nipples, engorgement and mastitis occur.” Furthermore, hospitals may hold breastfeeding classes and offer a host of services—such as lactation consultants to guide new mums.
Thankfully, many issues can be addressed by the collective wisdom presented by modern medicine, traditional Chinese medicine (TCM) and time-and-tested home remedies from generations of breastfeeding mothers.
Here are some common problems and the relevant treatment options:
It’s normal for breasts to feel heavier and larger as milk is being produced and extra blood is flowing through the tissues. However, not relieving the milk supply can lead to painful engorgement of the breasts. The noticeable swelling may also come with an uncomfortable feeling of fullness in the breasts, tautness, and increased tenderness.
“There are two types of engorgement—physiological and pathological,” explains Wong Boh Boi, Senior Lactation Consultant and Assistant Director (Clinical) at Thomson ParentCraft Centre, located within Thomson Medical Centre in Singapore. “Pathological engorgement occurs when the amount of tissue retention is extreme.” Initiation of breastfeeding in the early stages and frequent feeding helps to prevent pathological engorgement.
On the other hand, physiological engorgement is known as the ‘coming in’ of milk supply, and congestion and vascularity increases. “With proper guidance on breastfeeding, the feeling of extreme fullness should be cleared up after 24 hours,” advises Wong. “In other words, feed, feed, and feed your baby. The baby provides the best relief.”
A popular home remedy recommends tucking clean cabbage leaves in the bra in between feedings to reduce the swelling. And it’s not just another piece of Granny’s outdated advice. “In 1999, cabbage leaf treatment for breast engorgement and length of breastfeeding was actually reviewed by the Cochrane Pregnancy and Childbirth Group,” reveals Dr Tseng. “It concluded that the use of cabbage leaves may help women to keep breastfeeding after birth.” He can’t be sure why cabbage leaves work, but Dr Tseng suggests that the high sulphur content in the vegetable could bring down swelling and inflammation.
Cabbage also appears to help reduce milk supply and decrease the discomfort of breast engorgement when applied. But be cautious with prolonged use, because it may decrease milk supply. The best way to reduce engorgement is breastfeeding itself,” explains Dr Tseng. He recommends that the leaves be changed as soon as they start wilting, which takes about two to three hours.
This problem is primarily due to the baby not latching well. Changing your breastfeeding technique can resolve this problem.
Improper use of a breast pump can also damage the nipples. Suction levels set too high, pumps that have flanges, or breast shields that are too small are some of the things that may be wrong. It may be painful, but breastfeeding should continue.
Wong recommends dabbing or smearing some breast milk on the sore nipple, which can actually help them to heal. “Breastfeeding cream may also be used to aid healing, but remember to use edible cream to avoid too much cleaning of the breasts, which can lead to more soreness. In addition, breast shells are useful in preventing your clothing from causing friction against your sore nipples,” she recommends.
This condition refers to the inflammation of breast tissue, which can be caused by milk stasis, engorgement, and bacteria entering via cracked nipples. Breasts may have a harder texture, feel unusually warm, and have red and painful patches of skin. The infection may present itself with a fever of 38.5°C or higher, or flu-like symptoms, such as chills, body-aches, and fatigue.
A case of mastitis should also be distinguished early on as either non-infective or infective. The latter case often requires a course of antibiotics. “If mastitis is not treated well with the right antibiotics, it may lead to a breast abscess, which needs to be removed by a breast surgeon via a needle aspiration or incision to drain the pus,” warns Kang Phaik Gaik, Senior Nurse Manager and Senior Lactation Consultant at the Alvernia Parentcraft Centre of Mount Alvernia Hospital in Singapore.
The risks of mastitis can be lowered by nursing or expressing milk frequently to avoid letting the breasts become engorged. “Gently but firmly massage the lump towards your nipple before and during each feed. Change feeding positions to let gravity help empty the breast. For example, if the blockage is on the armpit area of the left breast, lie on the right side, and lean over to feed the baby from the left breast,” instructs Wong. Complement the continued breastfeeding by getting plenty of rest, sufficient fluid intake, and wearing bras that fit appropriately and provide sufficient support.
According to Physician Qi Xiao Yan from the Eu Yan Sang TCM Clinic at Tiong Bahru, TCM encourages mothers to breastfeed because it believes that breast milk contains nutrients babies need.
Physician Qi believes that when mothers breastfeed, the only thing they have to take note of is to properly clean the nipples. “Breast milk is already at the perfect temperature, and it is not tainted,” she assures. “On top of that, breast milk can boost the immunity of the baby, encourage brain development, and lower the risk of allergic reactions in the baby.”
Although there are many advantages in breastfeeding, many new mothers don’t know how to go about it. That is understandable, as new mothers have a lot to cope with. However, not knowing how to breastfeed and not being able to breastfeed due to physiological issues are two completely different things.
According to Physician Qi, when new mothers are unable to breastfeed, it is due to one of three reasons: weakness caused by childbirth, plugged milk ducts, or underdeveloped milk ducts.
It’s normal for new mothers to experience a weakening of the body after childbirth. That’s why TCM health supplements are so important, especially the ones meant to replenish your qi-blood. “Confinement / Postpartum / Postnatal food—such as Eight Treasures Soup (Ba Zhen), All Nourishing Decoction (Shi Quan), and Mutton Soup with Angelica Roots—are all good for replenishing qi-blood,” she advises.
If the problem is caused by plugged milk ducts, it can be treated via medication. However, how much medication one should consume is based on one’s health condition. “Massages have also shown great results when it comes to plugged milk ducts,” she helpfully adds.
Won’t taking all the herbs affect the quality of the breast milk? Physician Qi emphasises that most TCM medications are plantbased and will not cause adverse side effects. “It is absolutely safe for breastfeeding mothers to consume,” she insists.
Physician Qi would like to clear up the misconception that women with large breasts produce more milk. “Whether or not enough breast milk can be expressed depends on the number of milk ducts. More milk ducts means more milk can be produced,” she discloses. “Women with small breasts can still produce a lot of milk if they have enough milk ducts.”
Photo courtesy of Thinkstock. This article first appeared in NATURA magazine issue No.4.
While most of us recognise that breast milk is better than formula milk, do we really know all the facts?