To breast or not to breast?

If you ask any healthcare practitioner these days whether babies should be breastfed or not, the answer will be an unequivocal “yes!” The idea that “breast is best” is pounded into medical students’ heads throughout their training, and popular media has also taken a firm stance on pushing breastfeeding. What has NOT been taken into account is that every situation is unique, and what works for one mommy doesn’t work for another. The result? An increase in stigmatisation against women who can’t, or choose not to, breastfeed.

In the interests of full disclosure, I breastfed both my boys for three years altogether. There were highs and there were lows, but I am so glad I did it. I am therefore in the pro-breastfeeding camp, both as a doctor and as a mommy.

Scanning the literature, you’ll find all the medical advantages of breastfeeding. According to the WHO:

• Breast milk is the ideal food for newborns and infants. It gives infants all the nutrients they need for healthy development. It is safe and contains antibodies that help protect infants from common childhood illnesses such as diarrhoea and pneumonia, the two primary causes of child mortality worldwide. Breast milk is readily available and affordable, which helps to ensure that infants get adequate nutrition.

• Exclusive breastfeeding is associated with a natural (though not fail-safe) method of birth control. It reduces risks of maternal breast and ovarian cancer, type 2 diabetes and postpartum depression. It also helps the uterus return to its normal size a lot sooner and helps to burn mom’s excess fat stores.

• The long-term benefits of breastfeeding for mothers and children cannot be replicated with infant formula. When infant formula is not properly prepared, there are risks arising from the use of unsafe water and unsterilised equipment or the potential presence of bacteria in powdered formula. Malnutrition can result from over-diluting formula to “stretch” supplies. While frequent feeding maintains breast milk supply, if formula is used but becomes unavailable, a return to breastfeeding may not be an option due to diminished breastmilk production.

• Then there are practical considerations. A breastfed baby is very easy to move around with. No pre-packing of sterile water and premeasured formula, no bottles to sterilise, no having to plan feeds – just leave the house and when baby gets hungry, offer a breast!

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• Night feeds are also a pleasure since there is no prepping of bottles. It is a lot easier for a sleep-deprived mommy to plonk into her feeding chair and doze while baby has a drink.

• The sensory aspect of breastfeeding is very important for mommy-baby bonding. Skin-on-skin contact, the smell of mom, hearing mom’s voice and heartbeat and the varying flavours of mom’s breastmilk all contribute to the experience for baby. Oxytocin is released as part of the let-down reflex. There’s a reason why oxytocin is called the “love hormone” and it plays a role in relationship building. One review of research into oxytocin states that the hormone’s impact on “pro-social behaviours” and emotional responses contributes to relaxation, trust and psychological stability.

With all these advantages, what could possibly go wrong?

Unfortunately, the road to breastfeeding is littered with an abundance of potholes. Some medical, some socio-economic, some emotional; some are short-term and some are insurmountable.

“Fed is best” (whatever the source) and insisting on sticking to breastfeeding when there is clear evidence that it is not working could land up harming the baby.”

Right from the beginning, low milk supply is a huge worry. In some moms, low supply is only perceived and in others, it is genuinely low. Nonetheless, the anxiety over not being able to nourish and hydrate one’s baby is tremendous.

Your baby is getting enough milk if they:

• are active, alert and responsive;
• are producing six to eight wet nappies a day and the urine is pale in colour;
• are gaining weight according to the curve on their growth chart;
• have bright eyes, a moist mouth and good skin tone.

If your baby is not getting enough milk, it is important to ascertain the cause since some are reversible. Your milk supply may be low due to previous breast surgery, poor positioning and sucking techniques, medication such as the combined oral contraceptive or antihistamines, poor nutrition in mom, mood disorders and having long periods of not feeding.

“Fed is best” (whatever the source) and insisting on sticking to breastfeeding when there is clear evidence that it is not working could land up harming the baby. There are some mothers who cannot breastfeed because they need to go back onto essential medication which would harm the baby if transferred via the breast milk. Examples of such medications include those for psychiatric conditions and epilepsy. In these instances, mom’s medical needs outweigh the benefits of breastfeeding.

Most moms also need to consider returning to work. While the labour law in this country makes provision for protected maternity leave, it does not oblige the employer to provide any remuneration during this period. For some moms, the financial pressure to return to work means leaving baby sooner than they would like.

Expressing milk for feeds is indeed an option but the reality is that pumping is time-consuming, disruptive and often yields much less milk than baby could extract naturally – and let’s not forget that not all breastfed babies are happy to take a bottle.

Other complications with breastfeeding can be quite painful. Cracked, painful nipples (especially initially) can discourage many moms from persevering and should be addressed by a lactation consultant. Mastitis is an infection of the tissue of the breast that occurs most frequently in breastfeeding moms. It can occur when bacteria, often from the baby’s mouth, enter a milk duct through a crack in the nipple. This would warrant a trip to your doctor and advice on how to safely continue feeding while combatting the infection.

Issues with infant digestion and absorption fall beyond the spectrum of this article but may also necessitate special formulas. Such cases would be diagnosed and managed by a paediatrician.

With breastfeeding being such an emotive and controversial topic, there is no right or wrong answer. As such, it is important not to judge mothers but rather empower them to make the decision they feel will best serve them and their babies.