Breastfeeding Basics

Cite this article as:
Annabel Smith. Breastfeeding Basics, Don't Forget the Bubbles, 2019. Available at:
https://doi.org/10.31440/DFTB.21681

“If breastfeeding did not already exist, someone who invented it today would deserve a dual Nobel Prize in medicine and economics… Breastfeeding is a child’s first inoculation against death, disease, and poverty, but also their most enduring investment in physical, cognitive, and social capacity.”

The benefits to children, mothers, society, and our environment that breastfeeding brings are not to be underestimated. It is the most effective, and cost-effective, public health strategy known to man, and yet we are still constantly failing mothers, with insufficient education and lactation support, allowing the formula industry to have excessive influence over parents’ feeding choices, and providing inadequate societal and financial structures to support families. The World Health Organisation has set a global target for all mothers to, where medically possible, breastfeed exclusively for the first six months of life, and to continue feeding (with the addition of complementary foods) thereafter until at least two years of age. All nations, not least Australia, are falling drastically short of these minimum targets. It’s a complex area, often needing specialist input, but knowing some basics, including how women can access help, goes a long way to supporting mothers and infants in their breastfeeding journeys. The following covers a few basic points about breastfeeding to get those less familiar with this incredible process a bit more comfortable with the topic.

 

Creativity in breastfeeding

Jenny is a new mum, struggling with breastfeeding her 3-week-old baby, Lily. She has painful, cracked nipples, and finances are tight, so it looks like she’ll have to go back to work much sooner than expected. She wants to continue breastfeeding but it’s all quite overwhelming now, and she doesn’t know what to do next.

Whilst direct breastfeeding (infant mouth directly onto nipple) is ideal for several reasons, there are plenty of other ways to deliver breastmilk, which can provide some much-needed flexibility (and relief!) for mums, and alternatives for babies who struggle with direct feeding for any reason.

  • Nipple shields – these are flexible plastic covers which can be placed over the nipple to reduce discomfort and improve milk transfer for babies otherwise struggling. An experienced midwife or lactation consultant is usually needed to support mums in using these effectively. They can be purchased from pharmacies or supplied by hospitals.
  • Expressed breastmilk bottle feeds – The Australian Breastfeeding Association website has clear guidelines on how to pump, store and administer expressed milk, which is a time-consuming but often popular choice to improve maternal flexibility, especially when returning to the workplace. Frozen and reheated milk may lose some nutritional value, but it’s still a great choice.
  • Supply lines – This is another great choice, particularly for women with supply issues. A couple of commercial setups are available, consisting of a container, which mum fills with milk and wears around her neck, and a thin tube, which is placed in bub’s mouth during a direct breastfeed. As baby sucks on the nipple, additional milk is drawn into the mouth through the tube. This method works well as it rewards sucking, and encourages the baby to stay on the breast longer, which helps with building up supply. Babies with poor suck due to prematurity or other issues will also get more bang for their buck.
  • Mixed feeding – Although exclusive breastfeeding is the gold standard, adding formula bottles into the feeding regime is perfectly reasonable (and sometimes medically necessary). However, mixed feeding can affect maternal supply and can sometimes affect an infant’s willingness to suckle at a breast, so a relevant health professional should be involved to monitor things. It’s ideal to wait until breastfeeding is well established (e.g. around 6 weeks of age) before introducing formula feeds if possible.

 

Support crew

If you’re not a lactation expert yourself, you’ll need to find some immediate and ongoing support for Jenny. The options for getting help generally depend on location, although quality telehealth services may be available in many remote and regional areas.

  • Lactation Consultant (LC): A lactation consultant is a health professional, typically a midwife or General Practitioner, with extensive additional training in lactation medicine, holding an expert qualification as an International Board Certified Lactation Consultant (IBCLC). Private lactation consultants are often available for home visits, and community health centres and hospitals frequently have at least one on staff which families may be able to access.
  • Midwife: Midwives can be accessed in maternity units and through some community programs, with varying (but usually high!) levels of experience and skill in breastfeeding support.
  • Child Health Nurse: Nurses with specialist training in early childhood and/or midwifery are available through local community health centres, although again there will be variability in each individual’s skill and experience in breastfeeding support. Many community health centres offer free breastfeeding drop-in clinics, supported by midwives, child health nurses, and/or lactation consultants.
  • Australian Breastfeeding Association (ABA): The ABA offers a 24/7 hotline to provide breastfeeding advice and support. The website is also excellent.
  • General Practitioner (GP): GPs will again have varying skill in breastfeeding support, but many are brilliant at this and are an ideal resource for troubleshooting many breastfeeding issues. They also play a vital role in managing the various medical issues which may arise during the breastfeeding journey, such as mastitis, thrush, and assorted infant pathologies.
  • Paediatrician: Paediatricians can be utilised when GPs require additional support to manage problems in infants, such as poor growth, excessive vomiting, suspected allergies, and so forth, which may be associated with breastfeeding.

General Troubleshooting

Below is a very basic guide for approaching some of the more common issues arising during a breastfeeding journey.

 

Problem

Approach

Uncertainty about supply

If baby is alert, pink, warm, and moist, with clear urine and a soft stool here and there, intake is likely to be ok for the moment. Monitor growth over time (frequency depends on the situation) to ensure caloric intake is sufficient for baby to progress steadily along growth centiles. Please note, pumped volumes have no correlation with actual supply. Weighing baby before and after a feed can be helpful in some cases but is usually unnecessary. Most maternal/infant health professionals can assess this situation and refer as needed.

Painful feeding and nipple trauma

Support from a lactation consultant is ideal in this situation, as the causes are myriad. In the acute setting (such as ED), with limited specialist lactation support on hand, the mother could try nipple shields (if already trained to use these) or pumping and bottle feeding temporarily to allow the nipple(s) to heal. Lots of products are available to help soothe and support healing. Babies can drink milk which is contaminated with maternal blood due to nipple trauma (except where the mother has an infectious blood-borne illness, such as hepatitis C), although sometimes it causes a few pink-stained vomits.

Tongue Ties

See Tessa’s fantastic article on this controversial topic. As a general rule, a lactation consultant should be involved before considering intervention.

Blocked ducts and mastitis

The general rule is to keep feeding when possible. Massage, heat, adjusting positions, and antibiotics may all be needed. GPs, midwives and LCs may all need to be involved.

Maternal medical issues

Some medications may not be suitable for lactating mothers. There’s rarely a problem with mums feeding straight after anaesthetic, but check with the anaesthetist.

Suspected infant allergies

This should be managed under an experienced GP, paediatrician or allergy specialist, usually with dietician support. Mothers should never be starting elimination diets or stopping breastfeeding altogether without specialist advice and monitoring.

Suspected GORD/colic/other infant concerns

As above, these issues should always be managed by experts, often requiring paediatrician or specialist GP involvement. Stopping breastfeeding is rarely required, and should only be done on specialist advice.

Suspected lactose overload

Frothy, explosive stools, and a gassy, unhappy, seemingly hungry baby, might suggest lactose overload. Try block feeding – feeding on one breast only over a 4-hour period, then swapping to the other side. See the ABA website for more detail and suggestions.

Nipple and mouth thrush

This can be very painful for mums, and often tricky to detect, as there’s often no surface signs on the breasts. A more obvious clue is seeing a thick white coating in the baby’s mouth, and/or a refractory, nasty nappy rash. A GP is usually best placed to diagnose and manage mum and baby. Both will need treating if detected.

Additional nutritional needs

Breast milk contains very little vitamin D or iron, so some babies, such as those born prematurely, may need supplementation. Mothers with certain dietary restrictions may also lack specific components in their breastmilk (such as B12 in vegan mums). A GP, paediatrician, or dietician should usually advise individual families. All pregnant and breastfeeding women should take iodine supplementation.

 

Overall, the most important thing for us as health professionals working with infants and breastfeeding mums is to be educated enough on the topic to provide good general advice (just knowing your local resources is a brilliant start), and to celebrate every mother’s efforts to care for her child in the best way she can.

 

Selected references

Hansen K. Breastfeeding: a smart investment in people and in economies. The Lancet. 2016;387(10017):416.

WHO | Exclusive breastfeeding for six months best for babies everywhere [Internet]. Who.int. 2011. Available from: https://www.who.int/mediacentre/news/statements/2011/breastfeeding_20110115/en/

Australian Government. Department of Health | Breastfeeding [Internet]. Www1.health.gov.au. 2019. Available from: https://www1.health.gov.au/internet/main/publishing.nsf/Content/health-pubhlth-strateg-brfeed-index.htm

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About Annabel Smith

AvatarDr Annabel Smith is a General Paediatrician based on the Central Coast of New South Wales, with interests in public health, the environment, and doctor's wellbeing. She is passionate about breastfeeding, good sleep practices, physical exercise, excellent nutrition, and building family resilience and cohesion to promote long term health and wellbeing for all children.

Avatar
Author: Annabel Smith Dr Annabel Smith is a General Paediatrician based on the Central Coast of New South Wales, with interests in public health, the environment, and doctor's wellbeing. She is passionate about breastfeeding, good sleep practices, physical exercise, excellent nutrition, and building family resilience and cohesion to promote long term health and wellbeing for all children.

2 Responses to "Breastfeeding Basics"

  1. Avatar
    Shilpa Shah 12 months ago .Reply

    Excellent enjoyed reading it

    • Avatar
      Annabel Smith 12 months ago .Reply

      Thank you, I’m so glad it was helpful!

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