Problems in breast-feeding among first-time mothers

By Donya Betancourt

SANUR, Bali (JP): Today's issue is about problems in breast- feeding. Some of the problems are lack of milk, failure in suckling and improper feeding techniques.

Many first time mothers find the first few days after delivery full of worry and confusion besides feeling strange and uncomfortable when nursing their new born. However, don't give up if nursing becomes a struggle because when the "teething problems" are over, you will experience the happiest moments of motherhood.

Question: I am a 20-year-old mother and I have just delivered a healthy baby boy. I started nursing him 12 hours after birth. He sucks but then stops. I have no milk and my breasts do not fill up. I can't sleep. I am so worried and afraid that he is not receiving enough nutrition. What are the causes of these problems?

Answer: The possible causes are:

1. Anxiety. It can inhibit milk ejection reflex. Sucking of the breasts stimulates the hormones and hormones stimulate milk production and milk ejection. Milk is produced when the breasts are sucked. So, if he doesn't do that then breasts will not eject milk.

2. The proper position. Latching on is the key to success in breast-feeding.

3. Delayed nursing. Possibly the baby was started with a bottle which is a different technique and the baby finds bottle feeding "easier" because he doesn't have to suck to get milk.

4. Even when the breasts are stimulated they will not have large amounts of milk in the first few days but this little milk (colostrum) is the most valuable and nothing can substitute it.

My recommendation is don't give up. Find a comfortable position to feed your baby and relax. You may try to stimulate his sucking reflex by touching the side of his mouth. When he opens his mouth wider, put your nipple as far back into his mouth as possible until his lower jaw is on the areola. Continue nursing him as often as possible, at least every two hours.

I have a 10-day-old baby girl. She cries almost every one to two hours. I assume she is hungry so I breast-feed her. She then stops crying and I put her to sleep. I pump milk out but it looks very diluted compared to the formula. Do you think I am producing enough milk for her? Why is it that when the baby sucks one breast the other one has milk dripping out too?

Why does the baby cry and do you have enough milk? Babies cry for many reasons: hunger, discomfort from a wet diaper, feeling too hot or too cold or may be reacting to insect bites. If you assume that she cries because of hunger without checking the other causes and feed her, she will always stop crying because she can't cry with a mouthful of breast. You said that after feeding she stops crying and you put her to sleep. You should feed her 10 to 15 minutes for each breast and I think you are producing enough milk for your baby.

Why do you have milk coming out from both breasts at the same time? To answer your question, I would like to explain the process of milk production and milk ejection. They are two different mechanisms. When the baby is sucking the breast, the sucking stimulates two hormones, one is "prolactin", which acts on milk production. This hormone decreases when there is no sucking and increases when there is sucking. This is why you should feed your baby early after birth and as frequently as possible so that "prolactin" will be at a high level all the time and milk will be produced.

The other hormone is "oxytocin", which effects two organs. One is the muscles around the milk glands, they will contract and eject milk into the baby's mouth. Both breasts are effected by oxytocin so that's why you have milk dripping from the other breast when your baby is sucking one breast. The other organ is the uterus. Oxytocin stimulates uterus contraction which gives you your figure back faster. Prolactin and oxytocin are working while your baby is sucking. For success in breast-feeding you need these two hormones.

Why does breast milk look like diluted liquid?

Formula milk has more of a protein called "casein" than breast milk which is difficult for the body to digest and when it is exposed to heat from preparation some of this protein doesn't dissolve so it looks cloudy.

My mother-in-law told me that I should wear a support bra all day long if I breast-feed my baby. Why?

I agree with your mother-in-law because the average breast weight before pregnancy is 200 grams and while you are breast- feeding, your breast will be three to five times bigger and heavier. Breast have elasticity but if they are overstretched they will not return to their original shape. So wear a support bra to maintain the contour of your breast and you will thank your mother-in-law when you stop feeding your baby and still have the same beautiful breasts.

I have two children. I did not breast-feed my first child. My second child is four days old and I want to breast-feed her. I am following the two-hourly recommended feeding schedule. There is pain in my nipples when she is sucking. I thought this was normal but today when I examined my breasts because of the terrible pain, there were scratches and blood oozing from around both my nipples. What should I do?

When she is sucking, the baby's jaw should be placed around the areola, not the nipple, and when you pull your breast out of her mouth put your finger between her mouth and your breast otherwise you will get the scratched nipples you have now. So what you should do is stop breast-feeding for one to two days and open the ulcer area to let it air-dry. You should pump your breast milk and feed the baby with a spoon, do not use an artificial nipple because the baby will have "nipple confusion". If your milk is not enough, you can use formula and feed her with a spoon instead of from a bottle. Put lanolin oil or edible vitamin E around your nipples. Return to breast feeding your baby when the ulcers are dry.

I am a working mother and I want to breast-feed my baby as long as possible. How should I preserve my breast milk for her while I am away? Can I warm breast milk in a microwave oven?

You prepare the sterile bottles by boiling them for 10 minutes and pump your milk in them then put the bottles in the refrigerator (not freezer). Mark each bottle with a number and time ( which is first, second, third). The milk can be kept for 24 hours. The best time for you to pump your milk is after feeding your baby in the evening, before you go to bed and in the morning. The caregiver can feed your baby at 10 a.m., 1 p.m. and 4 p.m. When you return home, you can feed your baby from your breast. At work, use a breast shield because the edge of the shield will press on your areola. It will stimulate milk production and it is the same as your baby's suckling. When on holiday, breast-feed her. I don't recommend heating breast milk in a microwave.

The writer, a pediatrician based in Sanur, Bali, welcomes questions, comments and concerns through drdonya@hotmail.com.