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The Star/ANN
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Baby’s best food

IT is a question that perplexes many mothers when it comes to breastfeeding. “If it is natural, why can’t I seem to get it right?”

It may be that all these years, women have been told, even as young girls, that nursing is a natural, maternal instinct all mothers have. And it may be that all along we have assumed that once our baby arrives, we will naturally know what to do.

But these assumptions – as experts agree and studies show – are not exactly accurate. Even the WHO, in its web page on exclusive breastfeeding, spells it out: “While breastfeeding is a natural act, it is also a learned behaviour. An extensive body of research has demonstrated that mothers and other caregivers require active support for establishing and sustaining appropriate breastfeeding practices.”

The instinct to care and provide for the baby is natural, but when it comes to nursing, many mothers need to learn how.

Actress Erra Fazira believes that nursing is a natural process for a mother, but she also believes in being prepared. When she was pregnant with her first daughter Aleesya, who celebrated her first birthday four months ago, she knew that breastfeeding is a process she didn’t want to miss.

Without going into details – we were in mixed company – her excitement still shows as she candidly described the way she prepared for it. “I’m the type who likes to prepare myself mentally. So, I read a lot of books, especially those for new mothers. Malay, English, I read everything.”

The preparation had helped her prepare herself mentally, but nursing for the first time was still a challenge. The soreness she felt all over and adjustments she had to make to her sleep patterns when she was in confinement was the toughest to bear. “After that, everything went smoothly,” she gushes in relief.

Although she only breastfed for three months due to work commitments, there is little doubt that she would do it again. “As a new mother, I get very excited and tried to do everything myself. Next time, I’ll do it with more help.”

Nursing starters

With the increasing amount of books, websites, and support groups dedicated to help women learn how to breastfeed, one does wonder, just how did our ancestors do it?

Paediatrician Dr Koe Swee Lee explains, “Young girls (those days) grew up seeing their mothers, aunties, and neighbours breastfeed, but nowadays, a lot of young women grow up without seeing their mothers breastfeed.”

Dr Koe Swee Lee tries to make it as simple and natural as possible when she teaches new mothers how to breastfeed. In this picture, she demonstrates the correct way to hold a baby while breastfeeding.

Today, the difference is if women don’t learn from their mothers the skills to nurse, they can now learn them from their own reading, lactation consultants, or even some nurses.

Dr Koe tries to make it as simple and natural as possible when she teaches new mothers how to breastfeed. “If a mother wants to breastfeed, she needs to remember only three things: feed early, feed frequently, and feed properly,” she says.

Feeding early means mothers should be encouraged to feed their babies within the first half or one hour after they are born, or as soon as possible if the baby has medical conditions that require immediate treatment.

All a nurse has to do is clean the baby and place him on his mother’s abdomen or chest. “Experiments have shown that when the baby is born, if you put the baby on top of the mother’s abdomen, the baby will actually crawl and look for the breast,” says Dr Koe. This reflex is called the ‘breast crawl’.”

When the baby gets there, the mother needs to learn the proper way to breastfeed so the child can feed easily and she could do so with minimal discomfort. “Though the mother’s breasts may be more sensitive during the first week (of the child’s life), breastfeeding should not be painful,” Dr Koe notes.

It sounds simple. At least, when you read the guide Dr Koe hands out to new mothers.

“Hold the baby at breast level, lying on his side, chest to chest. Stimulate the rooting reflex with nipple touching baby’s lips. (The rooting reflex is a behaviour seen in newborn babies, who automatically turn their face toward the stimulus and make sucking motions when the cheek or lip is touched.)

“Quickly bring baby to breast when his mouth opens wide. Baby latches on properly and prevents sore nipples, when the nipple and much of the areola (the coloured skin around the nipple) are in the baby’s mouth.”

Even when help is available, breastfeeding is challenging (see Common problems in breastfeeding), and it takes much practice to get it right.

Practise, practise, practise

While babies suck naturally, they need to be taught how to suck correctly. This involves mothers learning how to sit properly and holding the baby properly.

“If the baby sucks only on the nipple, the mother will get sore nipples,” says Dr Koe. So if the baby does not suck correctly, the mother needs to pull him away and let him latch on again.

How long do you let the baby suckle? It is up to the baby. “Let the baby suckle until he is asleep. It may take 20 to 30 minutes, and once the baby has finished, don’t pull him off the nipple, wait for the baby to let go,” Dr Koe explains.

Mothers can gauge whether their child is getting enough milk by observing their sleeping habits and bowel movements. If a child is able to sleep for at least an hour, is passing urine five to six times a day and starts to produce stools that are yellow instead of the initial, dark green and almost-black hue, then he is getting enough milk.

After that is done, the next step would be to feed the baby frequently, whenever he feels like it. This is because the sensations a mother feels while her baby suckles will send signals to her brain to release prolactin and oxytocin (hormones that stimulate milk production and promote milk flow respectively) so mothers can produce sufficient milk for their babies.

As a mother’s milk contains all the nutrients and water a baby needs, there is no need to give the baby water, glucose, or formula milk, at least for the first six months of his life.

According to the WHO model chapter for medical textbooks on infant and young child feeding, artificial teats, milk bottles and pacifiers are not encouraged as it may make it more difficult for the baby to learn to attach at the breast and breastfeed satisfactorily. If a baby cannot feed from the breast, the safest alternative is to feed him from a cup.

“If the baby has not been introduced to a bottle, the baby will suck naturally and latch on well,” says Dr Koe. “It is only when mothers start giving the bottle – the teat of the bottle is very different from the nipples – the baby gets used to the rubber teat, and he will forget how to suck on the breast. It can cause a lot of damage to a mother’s nipples,” she adds.

While the time between feeds varies from baby to baby, a general estimate is about one and a half hours to two hours because breast milk is very easily digested.

This can be a problem for working mothers when they return to work. However, they can learn how to express their milk with their hands or breast pumps and store them (up to three months in the freezer and five days in the refrigerator shelves) one month before they return to work so their baby so can still feed while they are away at work.

Making choices

Despite its challenges, breastfeeding offers many benefits to both mother and child. Breast milk is the best nutrition a mother can give to her baby, and with the nutrients and antibodies, her baby can grow up healthier, with less infections and reduced risk of long-term, immune related diseases.

As for the mother, she can reduce her risk of excessive bleeding after delivery if she breastfeeds immediately, and exclusive breastfeeding (feeding with breast milk only) can also delay fertility and help mothers return to their pre-pregnancy weight faster.

But for Erra, it is the mother-daughter bond she feels the most. “I feel more attached to Aleesya and she to me,” she says.

The question is, can all women breastfeed?

While women with certain medical conditions, like HIV infections, are generally not encouraged to breastfeed in countries where clean water is readily accessible and formula milk is a safe alternative, Dr Koe says almost every woman can breastfeed.

“I’d say that 98% mothers have enough milk. There are only one to two percent that have problems: they don’t have enough breast tissue or their breasts do not develop during pregnancy,” she explains.

However, despite all the good breastfeeding can give to mothers and their children, some may find its demands overwhelming (it is not easy) and some may not be able to do it due to health reasons.

In the end, it is still the mother’s choice whether they want to breastfeed or not, but Dr Koe says it should be an informed one.

“If a mother comes to me, I always encourage her to breastfeed, and if the mother still says no, that it is fine too. It’s your choice. But you need to get information first,” says Dr Koe.

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