Foreword: The below information is not intended to shame mothers who cannot or do not want to breastfeed. This article has been prepared by a group of mamas who have, at different times, exclusively breastfed, mix-fed, express-fed, and formula-fed our babies. There is no judgement here. We believe that inability to breastfeed or disinterest in breastfeeding does not reflect on the failure of mothers, but rather the failure of society and modern healthcare to adequately support and prepare mothers. The best remedy for this is to hold the mamas in our community and arm them with education as best we can. Our hope is that you take something from this article, whether you breastfed, plan to breastfeed, had to give up before you were ready or bottle-fed from day dot.
As expectant first-time mums, we don’t often give much thought to breastfeeding before baby arrives. The extent of our breastfeeding knowledge is usually an intersection of war stories about mastitis and painful latch, and triumphant tales of bubs who take to the boob like champs and never look back. The reality of breastfeeding, however, is that it is at different times painful, beautiful, laborious, and rewarding – and sometimes all of these at once.
Nothing compares to the magic of feeding your precious child from your chest. Ah, the sweet oxytocin rush of that unshakeable bond, somehow making multiple nightly wake-up calls and the bitty teething stage so worthwhile. And while it’s true that many babes will take to breastfeeding with no issue, it’s important to be aware of problems that can pop up and spoil the milky party and know that there are solutions.
As with all things mama-hood, we draw upon the best of ancient and contemporary practice, to provide the best care and advice to our Golden Mamas. This month, we’ve teamed up with veteran Adelaide midwife and lactation consultant, Megan Goodeve, of Adelaide Lactation Consultants, Midwifery & Hypno-birthing, to bring you evidence-based breastfeeding advice that will help you prepare for your role as milk maker and give you the confidence to move through challenges with more ease and less worry.
Women were born to breastfeed
Formula has existed for the tiniest blip in time, in the context of human history. For hundreds of thousands of years, human mothers have breastfed their children. Yes, even amid the rigours of cave life, involving periods of famine and ducking predators, we’ve whipped out the ladies and fed our young. Our survival as a species is a testament to that fact. If you’re worried about your ability to breastfeed, or to overcome breastfeeding challenges, know this: grandmothers have re-lactated in order to feed their grandchildren. Yep, women’s bodies are bleepin’ amazing! If you want to breastfeed your baby, you absolutely can in all but the rarest of circumstances.
But with the rise of food intolerance and allergies, oral defects, and medicalised birth, and the breakdown of maternal support systems, we modern mamas face perhaps the most challenging route to breastfeeding success. The problem begins during pregnancy, with conventional antenatal care devoid of breastfeeding education; continues throughout labour and delivery, when mothers receive drugs and anaesthesia that can inhibit baby’s ability to feed at birth; and intensifies during early motherhood, when women receive inadequate support and nutrition, and are told that any and all feeding pain is normal.
We’ve heard accounts of early feeds feeling like baby was gnawing mum’s nipples from her chest, and the hospital midwives chiming that baby’s latch looked fine; hospital paediatricians failing to diagnose and correct lip and tongue ties; and midwives seemingly unaware that oral defects can be externally untraceable when watching a baby feed. If we, and our primary healthcare providers, have limited knowledge of breastfeeding impediments, we are already on the back foot should they arise. We have to go digging for answers at a time when we’re already exhausted and overwhelmed, and by the time we find them (or run ourselves ragged trying), breastfeeding has become an insurmountable slope.
Around ninety-six percent of expectant mothers start out breastfeeding their babies, but at three months post-birth, only thirty-nine percent are exclusively breastfeeding. Many mums feel great sadness and shame when they cannot master breastfeeding. But often, it isn’t that they can’t breastfeed, it’s that they didn’t know how to overcome difficulties that arose and, deep in the thick of sleep deprivation and spinning around a 24/7 newborn schedule, they grasped for the formula tin. And voila! Baby seemed contented and didn’t want to feed every five minutes, and mum’s chapped nipples healed, and she could stop stressing about supply. But that first bottle of formula can sound the death knell for breastfeeding success unless we know where to turn for personalised and expert advice.
Enter: The Lactation Consultant
Breastfeeding is a skill, and as with any other skill, you will benefit from acing the theory first and having an excellent teacher. Engaging an International Board-Certified Lactation Consultant (IBCLC) is essential if you’re planning to breastfeed exclusively – caring and empathetic fountains of wisdom who will visit you in your home, listen to your story and arm you with an action plan for breastfeeding success. Many IBCLCs are registered midwives, and all have completed extensive training and practical experience to register with the International Board of Lactation Consultant Examiners. Whatever challenges you might experience, an IBCLC has addressed it.
Please note that not all midwives are qualified lactation consultants and may not have experience with specialised breastfeeding challenges. And to be blunt, many paediatricians and physicians are all too happy to lob you a formula tin and send you on your way, so please always seek the advice of an IBCLC for all things breastfeeding, particularly if you have concerns. You can find a registry of practicing IBCLCs in your area by visiting lcanz.org.
To set yourself up for success, we recommend a breastfeeding education session before baby arrives and an early lactation assessment to identify and remedy any hiccups at the outset. Some IBCLCs, like Megan, are Medicare-endorsed, which will entitle you to a rebate on lactation consults before baby is six weeks. Some private health insurers also provide cover, so it’s a good idea to inquire with your health fund as to what you might be entitled to.
Breastfeeding success starts before bub is earth-side
Some women begin producing colostrum late in pregnancy and, even if it’s not outwardly noticeable, best believe your breasts are ready to do their thing. Don’t let a drop of that energy-packed, immune-boosting gold go to waste! At around 36 weeks, begin hand-expressing your colostrum, which you can store in covered ice cube trays or 1ml syringes in the freezer, until baby makes an entrance.
Many women experience stress while waiting for their milk to come in and feel pressure from hospital staff to supplement with formula if things aren’t happening according to their rigid schedule. Stress and top-up feeding are extremely counterproductive to the establishment of breastfeeding. Breastmilk production relies on regular demand. Where formula is extremely filling, colostrum is low-fat and energy-rich, prompting your newbie to feed often. These frequent feeds, known as cluster feeding, trigger all the right hormones to get your mummy milk bar up and running. Having a stash of colostrum to rely on, should early feeding hiccups arise, gives you time to address the issue and establish supply without having to top-up feed.
Nourish yourself, divine queen
Growing and birthing a baby and being their sole source of nutrients for six months requires mammoth amounts of energy and strength. According to eastern tradition, nourishing foods, liquids and herbs, mother care, and energy rebuilding are the pillars of breastfeeding success. Staying hydrated, eating plenty of healthy fats – avocado, coconut, tahini, nuts and seeds, and their oils – and proteins – chickpeas, miso, tempeh, organic tofu, and brown rice – and taking a high-quality, bioavailable prenatal supplement from early on in pregnancy will build your energy and nutrition stores for the momentous task ahead.
Unfortunately, many chemist-brand pregnancy supplements contain vitamins and minerals in synthetic form (read: difficult for the body to break down and use). NaturoBest is an excellent, naturopath-formulated supplement brand containing nutrients in highly-useable form. Their Prenatal Trimester 2 & 3 plus Breastfeeding will top you up on all the essentials your body needs to make milk and grow a baby.
Ayurveda and Traditional Chinese Medicine advocate certain herbs and spices to warm the mother, restore energy and promote the healthy flow of milk. Garlic and ginger are especially important and should be consumed daily; fennel seeds and fenugreek seeds increase milk production by boosting estrogen; and cinnamon, cumin, basil, anise, and almonds should be fixtures in a breastfeeding mama’s diet and are stalwarts of our Golden Month menu.
To ensure you’ll receive plenty of nutrition, post-birth, ask for healthy meal delivery vouchers, in lieu of pointless baby things that you’ll end up with doubles and triples of. Make and freeze heat-n-eat meals and bake lactation cookies in the weeks before bub arrives and, when family and friends ask if they can do anything to support you, tell them: ‘hells yes sister, help me build my freezer stash!’ So often, women feel shame about accepting offers of support, but this is one occasion in your life when you should banish those feelings! You and your baby’s wellbeing, and your ability to breastfeed, depends on you being well-nourished and cared for. Let people take care of you!
Don’t expect anything of yourself during those early weeks and months. That you and your babe are well-rested and fed is the only priority at this time. Forget the housework, avoid strenuous exercise, and set boundaries with visitors. Cuddle up to your little one, enjoy copious skin-to-skin contact, which will trigger your milk-making hormones, and soak up the precious newborn stage that’ll pass you by in a blink.
Don't ignore persistent pain
With hormones surging in your body after birth, breasts brimming with milk, and a little booby monster hoovering the days away, a little tenderness is absolutely normal as your body adjusts to breastfeeding. What isn’t normal, though, is stinging pain, chafing, cracking, or bleeding, or feeling as though bub is clamping down on your nipples with his or her gums.
These issues indicate poor latch and can be the result of small oral defects in baby’s mouth, most commonly a lip and/or tongue tie. Sometimes, simple changes in positioning and attachment can be all that’s needed to remedy painful feeds. An IBCLC will gently assess your bub’s mouth for these formations and refer you to a paediatric dentist for diagnosis and correction. Quick revision of oral ties can be necessary to prevent ongoing damage to your nipples and a drop in milk supply, due to baby’s inability to drain your breasts at each feed. Take care to complete follow-up exercises recommended by your healthcare provider, post-revision, to prevent reattachment of ties.
If you’re suffering nipple damage, nipple shields can be a godsend. They are soft nipple covers, with small holes on the end, modelled on real nipples. Made of thin, malleable silicone, they allow baby to breastfeed as usual, without impacting skin-to-skin contact. It’s important to note that nipple shields are not a long-term solution to poor and painful latch. While they will reduce pain, to a degree, and give your nipples time to heal, you will almost certainly notice a drop in milk supply if the root cause of the pain is not addressed quickly. Be sure to chat to an IBCLC at the first sign of pain or damage, to address the underlying cause and see if nipple shields are suitable for your short-term use.
The TCM approach
TCM is highly effective at remedying breastfeeding issues, such as mastitis and low supply, using a combination of herbs, nutrition counselling and acupuncture. TCM views insufficient breastmilk through the lens of poor milk supply or energy stagnation resulting in poor milk flow. Sometimes, a combination of these factors can impact breastfeeding success.
Low milk supply is the result of blood and chi (lifeforce energy) deficiency and is common following the mammoth amounts of energy and nutrients expended to grow and birth a baby, coupled with blood lost during birth. According to TCM, a woman’s menstrual blood is converted to breastmilk when her baby is born, the same blood that was diverted to the placenta during pregnancy. An abundance of chi is required to transform blood to breastmilk and adequate blood stores are necessary for a woman to produce enough milk for her babe.
A history of anaemia and blood loss during birth, coupled with exhaustion from the task of labouring and birthing, and now revolving around a newbie’s 24-hour schedule, can mean that mama simply doesn’t have the energy, blood, or nutrients to nurture a whole other human. You can’t pour from an empty boob, my friend! Nutrition is vital in addressing low milk supply and this is why our Golden Menu is full of what are known as ‘blood-building’ ingredients. Proteins and collagens are particularly important at this time – subsisting on toast and coffee simply isn’t going to cut it.
Chi stagnation in the breast area impedes let-down and breastmilk flow. Stagnation can result in sensations of fullness, pain, and engorgement and, unremedied, can be key in the development of mastitis. Like any food or drink that sits there for too long, the milk in your breasts will attract opportunistic germs. TCM views unbalanced emotions as the root of stagnation. Whether it’s sadness from a birth that didn’t meet your expectations or stress from tension with the in-laws, negative emotions stagnate the liver energy channel, which influences nipple function and can impede energy flow to the surrounding milk ducts.
Acupuncture is *amazing* at opening energy channels and stimulating energy flow within the body. Don’t be surprised if you can actually feel the flow of blood and energy increasing during your treatment. Dr Carla, our resident Doctor of Chinese Medicine, has had great success treating stagnation and mastitis with acupuncture, massage therapy, medicinal compresses, and herbs, where conventional methods have failed to address the root cause, resulting in recurrent mastitis.
Avoiding emotional stress and moving through negative emotions, using counselling, journaling, or meditation, can be helpful in alleviating stagnation. In the case of mastitis, cabbage compresses at room temperature (never cold) and expressing often with a good-quality pump, are especially useful. Warming herbs and spices will fortify your body’s immune response and help stamp out the infection with heat.
Many mums who are new to breastfeeding are astounded at just how often babies feed during those early weeks and months. It is common to stress that you aren’t making enough milk or feel bloody exhausted feeding around the clock but as long as bub is peeing and pooing and continuing to gain weight, try not to stress. Cluster feeding is necessary in those first few weeks to establish healthy breastmilk supply, and later, you’ll find that bub may feed frequently during developmental leaps, illness, and teething – all completely natural!
Our advice? Abandon any semblance of a schedule and trust your body. Invest in a co-sleeper bassinet, allowing you to easily roll over in bed and feed your baby. Co-sleeping is inevitable on your breastfeeding journey, so read up on safe co-sleeping practices from an authority on the subject, James McKenna of Notre Dame University.
And finally, if in doubt, whip it out! Breastfeeding has an abundance of benefits for babes, over and above filling their little bellies – temperature regulation, immune protection, pain-relief, and comfort. There is almost nothing that a boob can’t fix for a crying baby, and it is so reassuring to know that you can calm your little one at the same time as providing them with the ultimate in bioavailable nutrition. You’ve got this mama, and we’ve got you!