MEDICAL COLUMN
Dr. Olivia Wyatt was born in South Africa and raised
in Botswana, where she worked with HIV patients
with Harvard Medical School and the Clinton
Foundation. Now a mother of three—daughters Aggi
Rose and Evie and son Louis—Dr. Olivia regularly
convenes FMP’s Saigon International Mother and
Baby Association, a group supporting new and
expecting mothers with parenting guidance and
information, where she leads discussions on topics
such as feeding, sleeping, development milestones,
colds & coughs, and vaccinations over coffee, tea
and cakes.OI VIETNAM 95
experience at least one breastfeeding
problem in the first two weeks after
delivery, and many of those will consult
their doctor. The most common reasons
for stopping breastfeeding in those
early weeks is the baby not suckling or
rejecting the breast, as well as painful
breasts/nipples. After the first few weeks,
the most common reason for stopping
breastfeeding is reported as insufficient
milk—which can include the perception
of insufficient milk. Appropriate
management and support for these
problems is therefore key to achieving
ongoing breastfeeding.
Low milk supply is the most
commonly reported cause of mothers
choosing to stop breastfeeding.
However not all mothers who worry
about low milk supply have an
actual issue. Perception of low milk
supply is a common problem, when
parents misinterpret normal newborn
behaviors—such as cluster feeding
(prolonged periods of frequent brief
feeds), growth spurts, and frequent
feeding—or misunderstand how
breastfeeding works, not appreciating
that breasts may come to feel softer as
the weeks go by; a baby’s swallowing
pattern may change; or that response
to a breast pump is not a measurement
of milk supply. Milk production is
a feedback mechanism—the more
you feed, the more milk is produced,
and the less you feed, the less milk
is produced—so if the mother starts
supplementing breast milk with bottle
feeding, this may lead to an actual
decrease in her milk production.
Sometimes there really is an issue
with milk transfer, in that the milk
isn't being effectively withdrawn
from the breast by the baby. The most
common cause of this isn't an illness—
it's more to do with positioning and
attachment of the baby at the breast. If
the mother is not positioned correctly
while breastfeeding or the baby is not
attached to the breast well, feeding will
become more painful and this will lead
to ineffective milk transfer. The best
indicators of low milk supply are the
frequency of wet nappies and weight
gain (after five weeks of age).
Rarely, in perhaps 2–5% of cases,
there is an underlying medical problem.
Issues such as retained placenta,
hyperthyroidism, and heavy bleeding
during delivery can affect the pituitary
gland, which affects milk supply. One
third of women who have polycystic
ovarian syndrome will have problems
with their milk supply—breast surgery
can also be responsible for this
situation, as can the effect of hormonal
contraception.
Pain in breastfeeding can have a
significant impact on the relationship
and whether the mother chooses to
continue breastfeeding her child.
POSITIONING AND ATTACHMENT TIPS
- Sit comfortably with your back well-supported and your lap flat.
- Keep baby’s body in a straight line facing the breast.
- Support baby’s neck, shoulders and back so he/she can easily tilt back the
head. - Ensure baby’s lower lip and chin makes contact with the breast first.
SIGNS OF EFFECTIVE ATTACHMENT
- Baby has a large mouthful of breast.
- Baby’s chin is firmly touching the breast.
- Baby’s mouth is wide open.
- Feeding doesn’t hurt.
- No change in shape or color of the nipple after feeds.
- Baby’s cheeks stay rounded while sucking.
- Baby takes long, rhythmic sucks and swallows with occasional pauses.
- Baby finishes feeding independently.
Baby should produce regular soaked/heavy nappies. Bowel motions should be
soft and yellow from day 4/5 with two or more dirty nappies a day and poos at
least the size of a large coin.Usually, if the nipple is brushed
against a baby's top lip and nose, it
will fully open its mouth. This is called
rooting, and every suckling animal has
the same instinctive response. It will latch
on naturally when the nipple touches the
top of the mouth, which draws in quite a
large part of the breast rather than just
the nipple. If the mother and baby are
properly guided, the baby will get used
to the correct rooting response, and the
more frequently it will occur.
Trained healthcare professionals
can support mothers and educate them
about the best positions for the strongest
attachments. A lactation consultant—or a
midwife, or a nurse—can help to educate
new mothers on how breastfeeding
works, what to expect, what's normal,
and what's not often talked about,
especially in the early stages. Cracked or sore nipples are common
and are usually due to positioning and
attachment issues. This is common in
the early days of breastfeeding, and
usually with practice and patience the
issue resolves itself and the woman
can carry on without needing to see a
doctor. However, breastfeeding isn’t
supposed to be painful, and if the
problem continues for a long period it
is advised for the mother to seek help
from a medical or health professional.
If it does continue, it can cause fissures
and acute pain—which will then affect
breastfeeding. Applying a small amount
of breast milk on the nipple can be very
protective and restorative, as well as
using purified lanolin (which is found
in a lot of commercial nipple creams).
Sometimes an antibacterial ointment is
also necessary.
Cracked nipples are caused by
attachment problems, when the baby
is not attaching to the breast properly.
Usually, when a baby attaches to the
breast, it will make a wide open mouth
so the top lip is way above the nipple,
and make strong sucking motions. But if
the baby is latching onto the nipple only,
this will eventually cause nipple pain.
Sometimes when milk is not effectively
removed from the breast, a painful
condition called mastitis may arise, which
presents as a wedge-shaped area of the
breast that becomes painful, red, hard or
firm, and hot. It may be accompanied by
symptoms such as fever and chills, body
aches, tiredness, nausea, and vomiting.
It occurs when milk is held too long in
the duct, causing distension—a blocked
duct that then gives rise to mastitis.
Blocked ducts are normally caused by
poor positioning and attachment. When
mastitis does occur, it is important to
present to your doctor early to assess
whether treatment is needed and to get
advice on positioning and attachment to
prevent the problem in the future.