By Ms. Sayali Sathe

Overcoming Breastfeeding Challenges with a Newborn

September, 2020

World Breastfeeding Week started in 1992, with annual themes including healthcare systems, women and work, the international code of marketing breast milk substitutes, community support, ecology, economy, science, education and human rights. World breastfeeding week celebrated from 1st - 7th August. This year the theme is “SUPPORT BREASTFEEDING-FOR A HEALTHIER PLANET”. The World Health Organization (WHO) recommends exclusive breastfeeding for the first six months of a baby’s life for optimum growth and health of the baby. Babies who are given feeds other than breast milk are known to have a poorer immune response, more illnesses and require more hospitalizations. Surprisingly, despite various initiatives by our government, not even half the babies are exclusively breastfed. India has one of the highest rates of malnutrition and infant mortality rates. Why are mothers unable to breastfeed? Fewer than 5% are medical reasons which include failure of lactation or medical condition of mother, and in the vast majority cultural practices are responsible. Breastfeeding is one of the best ways of bonding with your baby, it not only provides nutrition but comfort, nurturing and is also a time for mother and baby to study one another’s faces. Breastfeeding also releases oxytocin which is a love hormone that promotes bonding.

Barriers / obstacles to breastfeeding for a new mother
  1. Separation of mother and child: In India most of the caesarean births are nearly three times more in private as compared to public sector health facilities. Initial cues, alertness for breastfeeding is lost due separation and immediate use of formula feeds as tiny tummy fills up.
  2. Pre lacteal feeds: In India people believe and follow tradition. Practicing pre lacteal feeds such as honey, water, gold which prevents dehydration are some of the beliefs which causes very high risk of infection as well as reduces baby’s hunger and interferes with breastfeeding. Giving water is also not safe because it can cause infection and also fills the baby's tummy limiting their feed.
  3. Pressure on the mother to give the top feeds: Mothers gradually start believing that their milk is insufficient as the baby looks very thin and are pressurized to start animal milk or formula. False belief that milk is inadequate as babies tend to take larger supplemental feeds, sleep longer
  4. Feeding in public: Feeding the baby even under dupatta or shawl feels uncomfortable to mothers. Lack of areas designated for breastfeeding in public - Most mothers opt for bottle feeds when going out in public or travelling. The feeling of embarrassment restricts their activities and is cited as a reason for choosing to feed supplementary formula or to give up breastfeeding altogether.
  5. Working Mothers: Indian law allows 6 months maternity leave to allow the mother to exclusively breastfeed their babies for the welfare of mother and child. Employed mothers typically find that returning to work is a significant barrier to breastfeeding. Most women often face inflexibility in their work hours and locations and a lack of privacy for breastfeeding or expressing milk.
  6. Lack of awareness: Lack of knowledge of the benefits of breastfeeding, especially the importance of first milk (colostrum) is the major barrier to timely start breastfeeding. In a few set-ups because of myths correct positioning and techniques are lacking as mothers are strictly told not to breastfeed in sleeping (lying down) position. The relatives put immense pressure not to feed immediately as there is a myth that in the initial few days mother can’t satisfy her child with breast-milk. Most women are aware about benefits but they seem to lack knowledge about its specific benefits and correct guidance. In most of the sectors information about breastfeeding and infant formula, bottle kits are provided as mothers and relatives are encouraged to give bottle feeding for a mother to feel relaxed. Lack of Antenatal counselling on breastfeeding and nipple examination is a major barrier.
  7. Obstetric complications: Episiotomy, caesarean section, manual removal of the placenta causes substantial delay, ranging from an hour (Episiotomy) to a day (caesarean section), to starting of breastfeeding. Prolonged, exhaustive painful labour that leads to post-delivery fatigue.
  8. Breast abnormalities: Many of the first-time mothers face problems in initiating breastfeeding because of the pre-existing breast abnormalities that are retracted and inverted nipples. Feeding delays till the correction of inverted or flat nipple and correct attachments. Frequent problems with breastfeeding include sore nipples, engorged breasts, mastitis, leaking milk, pain, and failure to latch on by the infant. Besides breast abnormality, other comorbidities that include HIV, Hepatitis B delay the early feeding and in many cases mother or relatives refuse to give mother’s feed. Families are not convinced even though the baby has been given prophylaxis.
  9. Insufficient milk supply: This is another common reason for early weaning of the infant. Having a poor milk supply can result from infrequent feeding or poor breastfeeding techniques, delayed breastfeeding. Lack of confidence in breastfeeding or not getting exact guidance and support from family members lead to the perception of an insufficient milk supply when in fact the quantity is enough to nurture the baby.
  10. Preterm delivery: Sudden preterm delivery due to severe complications, LBW, hypoglycaemia, congenital issues delays breastfeeding. And the sudden separation of the baby from the mother, loses her confidence to bear a child.
  11. Gender based discrimination: If the newborn happens to be a baby girl, then mother either refuse to feed baby immediately or react reluctantly especially during second delivery if they are expecting a baby boy is significant cause of delayed breastfeeding.
Following ways to successful breastfeeding:
  • Antenatal counselling and sensitisation about breastfeeding in last trimester
  • Involve gynaecologist, paediatricians, lactation consultant and family members for 1000 days of your motherhood journey.
  • Liquid gold (colostrum) to be given soon after delivery. Gives protection, immunity and first vaccination to your tiny baby.
  • Semi demand and frequent trials of breastfeeding for better hormonal stimulation.
  • Correct attachment to the breast and better positioning of the baby is a key to successful breastfeeding.
  • Believe in yourself and breast-milk changes its properties according to the baby's increased demands.
  • Life can be easier when you breastfeed, as it creates a very good bond and unconditional love to your baby.
  • Breastfeeding will reduce hospitalisation and keep your baby healthy and active
  • Breastfeeding will improve your baby’s IQ if you feed exclusively for 6 months and continue breastfeeding up to 2 years with introducing solid food at the correct age.
  • Involve husband and family members in the baby care, and yes you are always there to nourish your baby.
  • Always keep some time for yourself like yoga, meditation which will keep you happy, relaxed and motivated.
  • See your baby’s hunger signs, follow your baby’s lead, make sure the baby sleeps close to you.
  • Look for 6 minimum wet diapers, comfort sleeping, activity, on demand feeding to boost your confidence of motherhood.
  • Avoid nipple confusion by introducing bottles, pacifiers, fancy objects as the baby loses interest in breastfeeding, will invite unnecessary infections.
  • Do follow up with your paediatrician to see how your baby is achieving milestones.
  • In case of any need or help contact lactation counsellors.

Ms. Sayali Sathe

Certified Breastfeeding Specialist (CBS), Lactation Counsellor & Nectar Human Milk Bank In-charge