Got milk?

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Many women are able to breastfeed for a year or longer. Others give up after attempting it, finding it either too difficult or too painful. Some never plan to breastfeed at all, while others desperately want to but can’t. While there’s never any argument that all babies benefit from a diet of breast milk, there are many factors that influence whether mothers will be able to provide it. Breastfeeding is the most natural and normal way to feed a baby, and according to the World Health Organization (WHO), “Almost all mothers can breastfeed successfully”.

And breastfeeding doesn’t just benefit babies: the effects on a mother’s health are also well-documented. According to the WHO, “Breastfeeding delays the return of a woman’s fertility and reduces the risks of post-partum haemorrhage, pre-menopausal breast cancer and ovarian cancer.” Many women claim that breastfeeding helped them return to their pre-pregnancy weight a lot faster, and some claim that successful breastfeeding can prevent postnatal depression.

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Breastfeeding basics

It’s widely recommended that breastfeeding is initiated in the first hour after birth to allow both mother and baby time to bond and to give them the best chance of establishing breastfeeding. Hulda Thorey from maternity services provider Annerley, a midwife and mother of four, says, “If you have ever seen a baby be born naturally and put straight into its mum’s arms without any interference, it is obvious that this is what babies are meant to do. The sucking reflex and rooting instinct is strong and most babies want to breastfeed. Mother and baby connect in a way that is very special.”

The first milk, colostrum, is a yellowish substance that contains antibodies to help build a baby’s immune system. It’s easier to digest than breast milk and helps prevent babies from developing jaundice. Once a woman’s milk “comes in” a few days later, the benefits to both mother and baby continue. The local La Leche League (LLLHK) team says, “Breastfeeding isn’t just best, it is the normal way to feed our babies. It is what their bodies expect, and getting breast milk provides the protection nature intended,” – protection against acute illnesses such as influenza, meningitis, pneumonia, ear infections and gastroenteritis. In the long-term, breast-fed babies have lower incidences of chronic conditions like asthma, obesity, heart disease, high cholesterol, diabetes and high blood pressure.

Not always easy

Once the baby arrives and a mother is faced with the reality of putting all her knowledge into practice, many are surprised by how difficult breastfeeding can be. Most breastfeeding mothers have experienced difficulties at one time or another. Getting the baby to latch correctly takes a great deal of patience, and many new mums experience the agony of cracked nipples and engorgement before they figure it all out. Establishing your milk supply also takes work and, sometimes, hours of constant feeding in the early days.

It’s important that you know where to get help, and that you seek help early. Liz Purnell-Webb, a doula and childbirth educator with A Mother’s Touch, says, “Have a support person on standby so you can contact them as soon as you feel you need support. I personally believe misinformation and the lack of support is the fundamental downfall to successful breastfeeding. Many hiccups along the way – mastitis, blocked ducts, thrush and inverted nipples, for example – can all be addressed effectively if addressed early and correctly.”

Robin Barker, midwife, baby guru and author of Baby Love, says that the first six weeks after birth are the hardest. She also believes that if you can make it through those first six weeks, and all of the challenges they present, you will be able to breastfeed indefinitely. Yvonne Heavyside, a midwife and International Board Certified Lactation Consultant (IBCLC) from The Family Zone, gives similar advice to her clients, and recommends setting small goals. She says it’s important to “take one day at a time. It can be disheartening if you think you have a long way to go.” Mother-of-two Lara took this advice to heart with her second child: “I was so proud of myself when I made it to that six-week mark and it gave me the motivation to keep going. We patted ourselves on the back when we reached three months, and now as our second child is almost six months, I’m still happily breastfeeding and looking forward to doing so for a while yet.”

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Most breastfeeding advocates believe that the key to successful, less stressful breastfeeding lies in building a strong support team. Hulda says, “Research shows us that a partner’s support about breastfeeding is one of the strongest tools in helping mums to do so for longer, and to get through challenging times, if they occur. Any mum who goes through challenges in breastfeeding will be influenced by so many factors and when the attitudes around them are not very breastfeeding-friendly, this will have a bearing.” The LLLHK leaders agree, and offer this advice:

“Surround yourself with those supportive of your choices. Find family members, friends, groups who are supportive of breastfeeding.” Whether it’s the doctor who tells you to supplement with formula, or the mother-in-law who tells you that all her babies were formula-fed and “they turned out OK,” a lack of support can be as detrimental, and as painful, as untreated mastitis or a poor latch, and can be avoided by clearly stating your intentions and asking those around you to respect your choices.

Tough times

When we were expecting our first child, my husband and I – complete novices – went to childbirth classes. We listened intently as the lactation consultant touted the “breast is best” mantra, and came home feeling confident. Despite having friends who had struggled with breastfeeding, I simply assumed that I would breastfeed successfully. I really believed a positive attitude and some guidance was all it took. Then my son arrived and the reality was very different.

During his first few days of life, Joshua seemed to want to feed 24 hours a day. He fed every three hours, taking two hours each time, day and night – leaving me just an hour to eat and sleep. He was a big boy and we thought it was only natural that he was so hungry. Despite letting him feed as often and for as long as he wanted to, he cried constantly. After a few worryingly dry nappies and a failure to regain his birth weight, we took him to the doctor, who diagnosed dehydration. Five days after he was born, my milk had not appeared. As I cracked open that first tin of formula, under doctor’s orders, my heart broke – I had failed in my first, most basic task of motherhood.

Many new mothers describe similar experiences, with resounding feelings of shock and disappointment that the early days of breastfeeding were not at all as they had imagined. So where did it all go wrong? Hulda believes that there are many ways that successful breastfeeding can be hindered from the moment a baby is born, generally occurring “in the environment, rather than [because of] anatomy or physiology. [At the very beginning] the baby needs to go straight to the mum, without clothing ideally, and stay there, uninterrupted, until it has breastfed. Too much noise, smell, lights and handling can really interfere. Taking the baby away for check-ups after birth should never have to happen. Then, not having the right support from the start, both in terms of professionals and also the family, can make a dent in the self-esteem. Wrong information about breastfeeding will obviously not help. So things can go wrong if the mum does not know how to latch the baby, has not got a good position or positions to choose from, does not recognise the signs of the baby feeding right, swallowing, etc. Additionally, if the baby is very small, jaundiced or unusually big, there may be things to factor in to ensure that the baby gets enough milk from the start, but they are all quite manageable.”

For most mothers, minor issues such as poor latch, mastitis and low supply can all be overcome with the right advice and support. But, for a small minority, not only are the obstacles insurmountable, but there are times when breastfeeding is simply not possible. So what are the alternatives?

Express yourself

Expressing breast milk and feeding it to your baby in a bottle is an option many women try, and is considered the next best thing to breastfeeding. It gives you the advantage of being able to leave the baby or have someone else feed them, while still providing them with the benefits of breast milk. Australian mum-of-two Nicole expressed for her second child for 12 months after she was born. Nicole says, “My second daughter was born with a cleft lip and palate, and spent four months in a neonatal intensive care unit being fed via a feeding tube, so breastfeeding her was medically impossible. I was determined, however, that she would have the health benefits of breast milk, particularly since her health was of greater concern at birth. I began expressing colostrum shortly after birth and pumped until a week before her first birthday. I’m glad that I was able to provide my daughter with the benefits of breast milk, even though breastfeeding was impossible. I would do it all over again if I had to.”

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As maternity leave in Hong Kong can be as short as ten weeks, many women are forced to leave their babies for the day at a time when they have only just established breastfeeding, and pumping is the best way to maintain their milk supply and continue feeding breast milk to their little ones. Sometimes a physical issue such as cracked nipples or mastitis makes breastfeeding painful and women express temporarily while they heal. For mother-of-two Miranda, breastfeeding was so painful that she ended up expressing for her son for almost six months. She says, “I worked closely with a lactation consultant for six weeks straight and we tried every clinical and homeopathic remedy there is, but were never able to make the irritation and pain bearable for me. I also had issues with thrush as well as mastitis.”

While a number of mums say that there was far too much equipment involved in pumping, many felt that it was worth the effort. Yvonne from The Family Zone recommends hiring a hospital-strength pump, like the Medela Symphony, if you are serious about expressing on a regular basis. These are available in Hong Kong through Celki Medical Supplies.

Formula

Infant formula has received some pretty damning press recently, from the 2008 melamine scandal, to the more recent reports of certain brands being withdrawn from sale for lacking essential nutrients, to claims that formula contributes to childhood obesity. Despite the ubiquitous promotion here of formula, it is certainly not without its critics. In my research I came across many Hong Kong mothers and lactation experts who described it as “junk food,” and “force-feeding,” while one mother went so far as to liken formula feeding to “child neglect.”

It’s a subject that generates a great deal of controversy and debate. Whether you are for or against it, according to Liz of A Mother’s Touch, “Breast milk contains over 100 ingredients that the formula industry cannot replicate,” and most experts agree that there is simply no comparison between the two – formula is a substandard substitute. But it does exist for a reason, and as we live in a society where human milk banks and wet nurses are not readily available, without formula a number of babies simply would not survive.

When there’s no other choice

While a small number of mothers choose to give up breastfeeding despite having no medical reason to do so, there are a number of cases where breastfeeding simply isn’t an option. And when expressing isn’t possible, formula must be used. In a 2009 report, the WHO lists conditions such as galactosemia, a condition in which the body is unable to metabolise the simple sugar galactose, and phenylketonuria, a rare condition in which a baby is born without the ability to properly break down an amino acid called phenylalanine, as not conducive to feeding on breast milk.

The WHO report also suggests that babies born prematurely or those who are ill and who may be at risk of low blood sugar may be given formula temporarily. Lizzy, a mother of twin boys, was not able to breastfeed initially. She says, “I had a caesarean section at 35 weeks, which meant a delay of about ten days in the milk coming in, so my boys were on formula with all the colostrum that I could give them at first. Initially the boys were too small to latch on, so I had to express. I was able to feed one at three weeks, but the other took maybe six weeks till he could do it.”

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Reflux and allergies can also make breastfeeding extremely difficult. Jane, a mother of one from the US, expressed and fed her son breast milk in a bottle for the first six weeks, until it became apparent that an underlying condition was making further breastfeeding impossible. She says: “My son had severe GERD (gastroesophageal reflux disease), as well as colic, which contributed to the challenges I had with breastfeeding. He was also diagnosed with allergies to milk protein, eggs and soy. While I was breastfeeding, he screamed non-stop after every pumped bottle, projectile vomited every 20 minutes, and was not gaining weight. After battling with the hospital’s lactation consultants, he finally got an ounce of formula at four days old, when his little lips and tongue were like sandpaper from dehydration and the paediatrician grimly told me we had 24 hours until there was ‘permanent damage’.” In the end, Jane was forced to switch to a prescribed, hypoallergenic formula, but felt a distinct lack of support despite the fact that she had no choice.

Occasionally, illness or a condition affecting a new mother may also inhibit breastfeeding. Susan, a mother of one from Manila, learned just four weeks after her daughter was born that she had a meningioma – a brain tumour. Within days of being diagnosed, Susan was forced to make the decision to stop breastfeeding. She was immediately put on medication to reduce the size of the tumour and, just two weeks later, underwent the first of many painful and debilitating surgeries. Several months of radiotherapy followed, while her daughter thrived on formula, bottle-fed to her by family and friends.

Lactation consultant Yvonne Heavyside believes that it’s crucial to maintain perspective when trying to breastfeed. While she strongly encourages breastfeeding, she also teaches her clients that enjoying their babies and cherishing the time with them is also really important for their development and for a mother’s sanity.

Next month, Brooke will investigate Hong Kong’s cultural response to breastfeeding and what new mums can expect to find when breastfeeding in public.

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