7 Pressing breastfeeding questions answered


*Originally published in January 2014

My breasts are very small. Will I still be able to produce enough milk?

Breast size doesn’t influence your ability to breastfeed, says Judy Kirkwood, international board-certified lactation consultant based at Sandton Clinic. “It’s not your breast size that counts, but the breast milk storage capacity, which is related to the glandular tissue. We look at the space between the breasts – if there’s a wide space, it might indicate that there’s less glandular tissue, so the mom might need more help with breastfeeding,” says Kirkwood.
She says that 97% of women can breastfeed – at least partially. “Even moms who adopt.” She adds that women who’ve had breast augmentation surgery usually manage to breastfeed; those who’ve had reductions might need to supplement with top-up feeds.
“If you have flat or inverted nipples, it doesn’t mean you can’t breastfeed, but you should seek help from a lactation consultant,” she notes.

How can I get off to a good start?

Let your newborn latch in the first hour after birth. Aim for skin-on-skin contact between you and your baby. Kirkwood calls this the “miracle hour” when the baby is alert and her sense of smell is strong.
“Hospitals don’t always promote this early mother-baby time, but it’s worth pushing for,” says Kirkwood. Skin-on-skin contact has real benefits in terms of breastfeeding, bonding and temperature control. The baby hears mom’s heartbeat and this lowers stress levels,” she notes.

What is breast milk made of?

Breast milk contains over 260 known macro- and micro-elements and more are being discovered all the time. It consists of water, fat, carbohydrates, protein, fat- and water-soluble vitamins and minerals, as well as amino acids, enzymes and white blood cells (leucocytes). Long-chain fatty acids (also called omega acids) are important components and are essential for the healthy development of the brain, eyes and nervous system. The body can’t produce omega acids – they have to be taken in with food. The level of omega-3 in your breast milk depends on your diet, so make sure you eat your oily fish or take a supplement.
Breast milk fulfils your baby’s nutritional needs, while white blood cells strengthen her immune system to fight many bacteria, viruses and infections. Amazingly, human milk changes to meet your baby’s needs as she grows. The breast milk a mother produces for her newborn baby differs from the milk she produces for her six-month-old baby.

How long should I breastfeed?

The SA Department of Health (DoH) recommends breastfeeding exclusively for six months. Hereafter you can start with solids, while continuing to breastfeed. The American Academy of Pediatrics (AAP) recommends breastfeeding for at least 12 months, while The World Health Organisation (WHO) recommends that moms continue to breastfeed up to two years or beyond.
“Breastfeeding gives a cumulative benefit, so the longer the better. Stats show that from an allergy point of view, continue as long as you can, as breastfeeding lines the gut and prevents the absorption of foreign proteins,” says Kirkwood.

Can I still breastfeed when I’m sick?

“Yes. Carry on. The baby will have the antibodies for your illness,” says Kirkwood. In fact, the DoH advises moms to breastfeed even if they’re HIV positive. It’s recommended that both mom and baby receive anti-retroviral treatment and breastfeed for up to a year, starting solids at six months,” says Kirkwood.

What should I eat while I’m breastfeeding?

Follow a normal, nutrient-rich diet with enough fluids. Avoid any foods that irritate your system.
Sometimes, moms suspect that their babies are gassy or uncomfortable after a particular food. If you think that a food is affecting your baby adversely, try cutting it out for a few days. Don’t cut out key food groups like dairy without consulting your doctor.
Like everything you eat or drink, alcohol is absorbed into your breast milk. If you want to have a drink, Kirkwood says you should feed your baby first and then have a white wine spritzer.
Limit caffeine to one drink per day, as it may cause colic symptoms. Some types of medication should be avoided, as they pass into your breast milk. Check with your doctor if you’re breastfeeding and you need medication.
You’ll need an extra 500 kilojoules per day while you’re breastfeeding, so you can enjoy lots of small meals and snacks. Continue with your prenatal vitamins and consider omega-3 supplements. Also, follow your doctor or caregiver’s advice.

How do I know that my baby’s getting enough milk?

This is something that often troubles new moms. Golden rule: if your baby seems content and is gaining weight steadily at her regular well-baby-check-ups, that’s a good sign that she’s getting enough milk. Regular wet and poo nappies are also a good sign. The poo should be a decent size (not just a smudge) and should have a yellowy colour.
Dark poo might indicate your baby’s digesting the milk slowly. If your baby’s always crying and doesn’t settle well after a feed, that might be cause for concern. “Go with your gut. If you’re worried, talk to your clinic sister or doctor. I often advise moms to go to the clinic once a week for the first six weeks to weigh the baby. It gives moms a confidence boost; they get out and about; and they get some support,” says Kirkwood.
Remember that a newborn’s tummy’s tiny – about the size of a hazelnut. It might seem that she’s getting next to nothing, but a feed of 5ml to 7ml is sufficient on day one. “Your baby’s learning how to suck, swallow and breathe. The colostrum she is getting is perfect – low volume and high calories. Once the milk comes in, somewhere between day three and six, you will have learnt how to breastfeed your baby.”


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