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Fed is Best or Breast is Best?

May 19, 2017

     Do you remember your first night back at home with your newborn? I remember it vividly. That night, i was admiring the beautiful baby I was blessed with when I got so overwhelmed by emotions (or hormones) that I started tearing like a tap. Let’s just say my breastfeeding pillow was soaked with tears, mostly happy tears.  It feels so good to be a mother. No matter how tired or beaten I feel at times, whenever I see my kids’ happy faces - it’s all good.

 

     Recently, more stories of mothers struggling with breastfeeding have surfaced in social media. My heart aches for every story I’ve came across and especially for those where a precious life is lost. There is one story that is viral enough to catch my attention. The title alone was disturbing to me- https://fedisbest.org/2017/02/given-just-one-bottle-still-alive/

Picture source: https://fedisbest.org

 

     As I read the article, I noticed that mom Jillian has checked not only one but many red flags that are risk factors which can negatively impact the success of breastfeeding. In the hospital, her lactation consultant had identified risk factors for failed and delayed lactogenesis II (milk production) such as borderline diabetes, Polycystic ovarian syndrome (PCOS), issues with infertility, small, widely spaced nipples with minimal growth during pregnancy and emergency C-section due to fetal intolerance to labour. This is such a unique combination of risk factors and I will not be surprised if she experiences a delay in onset of lactation (milk ‘coming-in’) or fails to breastfeed successfully. I also noticed two other factors that may contribute to infant weight loss and unsuccessful breastfeeding: (i) mom mentioned that baby Landon cried. And cried. All the time. Such persistent crying can be a sign of colic and it can drain the baby of the nutrition (burn off the calories) he has received from colostrum/breastmilk, (ii) mom had undergone emergency C-section because baby was not getting enough oxygen during labour. This suggested that baby already in distress and mom may had a long labour process, given ample IV fluids or had assisted birth. Research has shown that these procedures will cause higher infant weight loss. Also, some of a newborn's initial weight loss may be due to the infant regulating its hydration and not related to a lack of breast milk. Hence, baby’s weight lost cannot be 100% attributed to insufficient nutrition from exclusive breastfeeding. In addition, normal and healthy newborns will have enough energy stores in their bodies to keep them going for the first few days of life. I am pointing out these points because I think that exclusive breastfeeding may be accused of being the main cause of this tragedy although it is actually a combination of all those risk factors and inadequate professional care. In my opinion, this tragedy could have been prevented if baby Landon’s healthcare team was informed of his persistent crying, assessed him for colic and teach mom how to better manage her baby, mom’s prenatal team should have educated her about how her diabetic condition may delay milk production and advise her to prepare a few syringes of colostrum before birth, and the postnatal team should have arranged for an extra night in the hospital to monitor baby due to his significant weight lost. Most importantly, I think mom Jillian shouldn’t be burdened with guilt as she did what she could to the best of her knowledge for baby Landon.

 

     The term ‘Fed is Best’ has been going around lately too. The Fed is Best Foundation has been actively promoting their belief- ‘babies should never go hungry and mothers should be supported in choosing clinically safe feeding options for their babies. Whether breast milk, formula, or a combination of both.’  The content in their site and social platform featured many cases of unsuccessful breastfeeding, points out underfeeding in exclusive breastfeeding as the culprit for complications like dehydration, hypoglycemia and excessive jaundice. They even started a petition to protect newborns from brain injury caused by insufficient breastmilk intake. I must say that I am concerned. Simply because they seem to focus on amplifying cases of insufficient or unsuccessful breastfeeding.  Let’s just say that I can only partially subscribe to their cause, and that is ‘babies should not go hungry and mothers should not be shamed for unsuccessful breastfeeding.’ Eventhough we must not be judgmental to mother's situation and choice, we should still encourage and applaud every mother’s desire and attempt to breastfeed.  Wouldn’t it be good to spread some positive encouragement and amplify more stories about successful breastfeeding? Mine’s captured in picture below- all happy, healthy and riding high on their growth curves.

 

     As a mom of 3, I know the challenges of breastfeeding very well. With my first born, before I became a breastfeeding specialist, I too struggled with delayed milk production, incorrect latching, painful cracked nipples, super sleepy baby (higher than norm jaundice level), exhaustion from frequent feeding and pumping every 2 hourly or less. I felt beaten every time my baby cried within an hour or so after a feed. I thought I didn’t have enough milk. Although I was determined to exclusively breastfeed my baby, I finally caved in on day 5 or 6 after my ever-patient confinement lady told me that baby had to be supplemented before he could sleep well. While my confinement lady was cup/spoon feeding, I spent the day tearing in bed and pumping 2 hourly. That very night, my breasts were engorged and I woke up with a soaked t-shirt and extreme pain. With my case, I now know what had gone wrong. I didn’t get the help from a specialist to correct my latch early enough, I was too stressed and I wasn’t getting enough rest at all. All these contributed to my failed attempts at satisfying my baby at this early stage. I improved my latch, geared up with confidence and went on a slow and steady journey with my infant practicing breastfeeding together until we both got really good at it!

 

     My message is simple. If you believe in the fantastic benefits of breastmilk, then try your very best. Most mothers will succeed unless you have special conditions like breast augmentation or a serious medical problem etc… With the right preparation, practice and professional help, you can surely succeed. Introducing a bottle too early will affect and delay breastmilk from ‘coming-in’ because baby's suckling will help trigger hormones to produce more breastmilk, the more practice sessions mom and baby have, the better they will be at breastfeeding. It is that simple!

 

     Fight the battle of doubt, fatigue but don’t fight alone! If you are struggling, do rope in the right experts early and get full family support. Be positive and don’t focus on the few negative cases. There are more than millions of success stories out there. A mother’s love is more powerful than anything, you can do it!

 

This post is dedicated to my first born, Nathan for helping me learn to breastfeed and motivating me with his loving grip (pic below). It seems to tell me:

“ Mommy, let’s do this together, hold me tight and feed me right.”

 My top 10 tips for breastfeeding success:

  1. Garner support, from hubby, family and caregiver for your decision to breastfeed. Your team’s moral support can do wonders!

  2. Attend a breastfeeding preparation class or better still, book an appointment with a lactation specialist to help you prepare, learn and examine your breast/nipples to ensure there are no physical obstacles (eg; inverted nipples).

  3. Inform your delivery suite nurses and your medical team that you would like to breastfeed and request for baby skin to skin and initiate breastfeeding within an hour of birth if possible (reasons why in previous post).

  4. Request for lactation consultant’s help to establish the correct latch as soon as possible.

  5. Learn breast massage from lactation specialist as this will help you produce more breastmilk.

  6. Eat well, stay hydrated and rest in between feeds. Avoid too many visitors in the first few days so that you can recover and establish breastfeeding.

  7. Feed regularly (every 2 hours) and wake your sleepy infant up for feeds. Regular feeding helps your body to produce more milk.

  8. Be patient. Give yourself and baby a few days to practice and learn to breastfeed well.

  9. Be realistic. In the first few days, don't expect your breast milk to flow/gush. Your colostrum will appear in small quantity (teaspoonfuls). It is designed to be thick so that it can line your baby’s intestines.

  10. Babies cry for many reasons, don’t blame or doubt yourself or your breastmilk immediately. Stay positive and learn to read baby’s cues well.

 

How do we know if baby has taken in my breastmilk?

  1. Observe baby’s swallowing, there should be pauses to signify swallowing. Ask your husband or caregiver to go close to baby and listen for the sounds of swallowing. Watch this useful video by Dr Jack Newman https://www.youtube.com/watch?v=NO5ZDKynaD0

  2. Observe baby’s stools. If the poo changes texture and colour from dark meconium to light brown or yellow then your baby has taken in your breastmilk.

  3. Diaper output can be considered a rough indicator of milk intake. According to the International Lactation Consultant Association: signs of effective breastfeeding are at least three stools per day after Day 1 and six wet diapers per day by Day 4.

  4. Your breasts should feel lighter and softer after a feed.

 

References:

  • Fed is Best Foundation. https://fedisbest.org/

  • BioMed Central. "Maternal IV fluids linked to newborns' weight loss." ScienceDaily.                                                www.sciencedaily.com/releases/2011/08/110814223805.htm

  • An observational study of associations among maternal fluids during parturition, neonatal output, and breastfed newborn weight loss Noel-Weiss et al. International Breastfeeding Journal 2011, 6:9                               http://www.internationalbreastfeedingjournal.com/content/6/1/9

  • Is onset of lactation delayed in women with diabetes in pregnancy? A systematic review. https://www.ncbi.nlm.nih.gov/pubmed/26113051

  • Systematic Review or Meta-analysis: Is onset of lactation delayed in women with diabetes in pregnancy? A systematic review                                                                             http://onlinelibrary.wiley.com/wol1/doi/10.1111/dme.12846/full

  • Feeding and Nutrition of Newborn Babies http://www.aboutkidshealth.ca/En/ResourceCentres/PregnancyBabies/NewbornBabies/FeedingNewbornBabies/Pages/default.aspx

  • Colostrum: Your Baby's First Meal                                                               https://www.healthychildren.org/English/ages-stages/baby/breastfeeding/pages/Colostrum-Your-Babys-First-Meal.aspx

  • Promoting proper feeding for infants and young children                       http://www.who.int/nutrition/topics/infantfeeding/en/

  • Diaper Output and Milk Intake in the Early Weeks                             https://breastfeedingusa.org/content/article/diaper-output-and-milk-intake-early-weeks

  • http://ibconline.ca

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