Now for some thoughts on breastfeeding. I usually get into trouble when I express my views on this topic. When breastfeeding goes well, it is great – convenient, less hassle, readily available and most women (but not all) find it satisfying. However, I see so many women at their six week postnatal visit who have been traumatised physically and emotionally by their attempts to breastfeed. There is so much pressure to breastfeed from the media, peers and midwives. For most first time mothers, their experience of breastfeeding will have been seeing women feeding in public. Usually the women who breastfeed in public are those have older babies, not newborns, and for whom breastfeeding is going well. The biggest problem with breastfeeding is dealing with your own and other’s expectations. For many women their first six weeks when they come home is a mad whirl of breast feeding, cracked nipples, expressing, topping up, taking Motilium to increase supply and getting conflicting advice from everyone, including the plumber or woman at the checkout.
Women are told that breastfed babies are more intelligent, more settled and have fewer infections. While the scientific literature supports this, the quality of that literature is questionable. The big problem from a scientific viewpoint is that, to do a proper study comparing breastfed and bottle fed babies, you would need to randomly assign the babies to being either breast- or bottle fed. There is no way that anyone is ever going to do a study like that because mothers would (rightly) not agree to be part of this. So the literature on breastfeeding is compromised by what is called ‘selection bias’, i.e. there are going to be differences between the mothers who choose to breastfeed and those who don’t. If the two groups of mothers are not the same, then any differences in the outcomes of their babies could be due to differences between the mothers and not to differences between breast- and bottle fed babies. The effect of mixed feeding (breast and bottle as many mothers do) is a further complicating and unknown factor.
The natural course of events
Breast milk doesn’t usually ’come in’ (i.e. is not produced) for three full days after the birth. Sometimes it’s a bit sooner and may be longer, particularly if the mother has been unwell or had a difficult birth. For the first 24 hours the baby will clear its lungs of fluid, swallow it and then often bring it up as mucus. After 24 hours it will have nothing in its stomach and may get cranky. Mothers will usually have a few mLs of colostrum which satisfies some babies but most will be unsettled, want to feed often and not sleep. This means that the mother (and partner) will also not sleep. This is one of the most difficult parts of caring for a newborn baby. In many cases mothers will already be sleep-derived from labouring overnight or sometimes longer. Sleep deprivation is one of the ways they torture people and brains do not function properly. So it is difficult to concentrate, memory fails and problem solving becomes impossible – just when, with your first baby, you’re having to learn a whole lot of new skills. I believe the “three day blues” that are so common are not due to changes in hormones as most people say (”oh, it’s just your hormones”), but rather related to this sleep deprivation.
Mastitis is an infection in the breast, usually due to a bacterium called Staphylococcus aureus. It doesn’t occur unless there has been cracking of the nipple(s) which allows bacteria to get into the breast tissue. Normal breasts with intact nipples don’t get infected. The breast symptoms are pain with tenderness to touch and redness over the infected area. Other symptoms are more general and flu-like: fever, feeling unwell, aches and pains. These symptoms may appear before the pain in the breast becomes obvious. Qiara Pregnancy & Breastfeeding, a probiotic isolated from breast milk containing good bacteria, Lactobacillus fermentum, may help to relieve or reduce breast pain and the recurrence of mastitis. Antibiotics should be started as soon as possible and the antibiotic should be flucloxacillin or cephalexin (these drugs have different trade names depending on which drug company produces them so check for the drug name somewhere on the box) unless there is an allergy to these. Both of these drugs are safe to use for the baby. If the flu-like symptoms persist and/or temperature gets worse, then admission to hospital for intravenous antibiotics is needed. If it’s untreated or incompletely treated, an abscess (collection of pus) may develop in the breast which may need to be drained surgically.
I am certainly not opposed to breast feeding and both of my own children were breastfed: I think it is the perfect method when it works well. What I am opposed to is women feeling pressured to breastfeed, having difficulty breastfeeding and having a miserable time with their new baby. As with labour and birth, it is important to think about what you would like to happen, but keep an open mind so you can adapt to what does happen.