Breastfeeding Challenges and Best Practices

Breastfeeding is the process of exclusively feeding an infant a mother’s breast milk, either directly from the breast or indirectly via tools such as a bottle, spoon, or cup, for up to six months and then supplementing it until the child reaches the age of two or older for optimal growth and development. Additionally, breastfeeding has numerous health benefits for both mothers and infants. 

Despite its many benefits, many mothers face challenges when it comes to breastfeeding. In this article, you will explore the common problems that breastfeeding mothers face and the best practices that can help overcome these problems, promote successful breastfeeding, and make the breastfeeding journey easier for both mother and children.

Statistics on breastfeeding

Globally, breastfeeding rates are falling short of what is recommended to protect the health of women and children. Recent data shows that between 2013 and 2018, only 43% of newborns were breastfed within the first hour of birth, and just 41% of infants under six months were exclusively breastfed. 

Although 70% of women continue to breastfeed for at least one year, the rate drops to 45% by the time their child reaches two years old. These numbers underscore the need for increased efforts to promote breastfeeding and ensure that children worldwide have access to its many benefits.

According to the analysis of health monitoring data for 130 countries, not following the recommended practice of breastfeeding is linked to cases of diarrhea and pneumonia in children under two years old. The study estimates that annually, 166 million incidents of diarrhea and 9 million incidents of pneumonia could be prevented if the recommended practice of breastfeeding is followed. The research findings suggest that infants who do not receive exclusive breastfeeding are at a higher risk of developing these illnesses later in life.

Breastfeeding challenges

Breastfeeding can sometimes be challenging for new mothers, as it can take time to establish a good breastfeeding routine and some may experience difficulties such as breast pain, low milk supply, and maternal stress. 

These difficulties can contribute to early cessation of breastfeeding and decrease the likelihood of mothers continuing to breastfeed their infants. Common breastfeeding challenges include:

Nipple pain

New mothers often face common challenges such as nipple pain or latch-related nipple pain (LNRP) when initiating breastfeeding, which may cause them to discontinue breastfeeding earlier than intended. 

One possible explanation for this is that the infant’s sucking action creates a vacuum that causes physical friction on the nipple, leading to tissue damage and subsequent pain. Symptoms of LNRP include nipple tenderness, soreness, cracking, redness, scabbing, bleeding, and inversion or flattening.

To relieve nipple pain, try to use HPA lanolin or nipple creams that can be used to promote better healing and less pain. The use of HPA Lanolin was also linked to an increase in breastfeeding duration, which helps mother reach their personal breastfeeding objectives and boosts overall breastfeeding rates.

Breast engorgement

Breast engorgement is a condition characterized by breast swelling and distension that is commonly experienced by breastfeeding mothers and can lead to potentially serious issues such as painful blebs, plugged milk ducts, or mastitis. 

Risk factors for engorgement include failure to adequately drain the breasts due to infrequent feedings or inadequate milk removal. Severe engorgement may make it difficult for the baby to latch properly and feed effectively, and can also lead to an increase in body temperature, commonly referred to as milk fever.

To treat breast engorgement, there are several measures aim to relieve discomfort, aid breastfeeding, and prevent complications. These measures include applying moist heat to the breast before feeding, feeding frequently, softening the areola before attachment, correct positioning and attachment of the baby during breastfeeding, gentle massage before and during feeding, and applying cold compresses after feeding.

Skilled support to help mothers attach their baby to the breast as soon and as often as possible is crucial to relieving engorgement and maintaining breastfeeding. If breastfeeding is not feasible, it is recommended to frequently hand-express or pump milk for comfort.

Insufficient milk supply

The perception of insufficient milk supply refers to a mother’s belief that the amount of breast milk she produces is not enough to meet her infant’s needs. Typically, mothers rely on unreliable indicators such as infant satiety cues or crying instead of monitoring the number of wet diapers and stools to gauge their milk supply. 

This perception can cause mothers to delay breastfeeding initiation and introduce formula supplementation prematurely. However, maternal perception of milk supply can be changed, and identifying at-risk mothers early on can improve breastfeeding behavior. The perception of milk insufficiency is a widespread issue across the globe.

Practicing skin-to-skin contact with the baby can help a mother perceive her milk supply more positively. This contact stimulates breastfeeding by providing massage-like movements, including caressing the areola and breast skin, which encourages infant suckling and triggers the let-down reflex by increasing plasma oxytocin levels. 

When a mother experiences the let-down reflex while the baby is nursing, she gains confidence in her milk supply. It is advisable for mothers to have more physical contact with their babies to recognize feeding cues.

Maternal stress

The experience of psychosocial stress following delivery has a negative correlation with various breastfeeding aspects, including the start of lactation, milk production, feeding frequency, and the duration of the initial feeding. 

High levels of stress in mothers can increase the likelihood of delayed onset and establishment of breastfeeding, which can negatively impact the health of their infants. The negative effects of maternal stress on breastfeeding practices can diminish the beneficial and protective role that breastfeeding has on the health of offspring.

Engaging in self-care activities can help mothers avoid stress while breastfeeding. Maternal self-care refers to a mother’s capability and willingness to take care of herself both physically and emotionally. 

This can involve various practical applications such as ensuring proper nourishment, taking breaks when necessary, practicing good hygiene and maintaining a presentable physical appearance, getting enough sleep, being willing to delegate tasks, and having the ability to set boundaries.

Good practices for breastfeeding

Breastfeeding practices play a crucial role in the health and well-being of both mother and infant. Below are several breastfeeding practices that mothers can implement to make the experience more comfortable and beneficial for both mother and infant.

Breastfeeding routine

To facilitate sufficient milk production and flow during six months of exclusive breastfeeding, and continued breastfeeding thereafter, consider adopting or incorporating this routine:

1. To ensure optimal breastfeeding, the infant should be fed as frequently and for as long as desired, both day and night, allowing suckling until the infant voluntarily releases the nipple.
2. This is referred to as demand feeding, which is essential as limiting the nursing session duration can result in the infant receiving less energy-rich hindmilk. On average, during the first six months, the newborn consumes around 800ml of milk per day.
3. It is common for a mother to have concerns about her breast milk’s adequacy for her infant. To determine nursing sufficiency, several factors can be documented, including the newborn’s return to birth weight within two weeks, a cumulative weight gain of more than 500g in a month, and at least six instances of urine passage per day during exclusive breastfeeding.

Breast care routine

Taking care of breasts involves gentle activities such as cleansing, compressing, and massaging the breast area to promote and maintain breast health. Breast care can be done independently, with guidance from a midwife, or with the help of family members. 

Regular breast care, performed once a day, can enhance blood flow in the breast and stimulate sensory nerve endings around the nipple, which can promote milk production. Listed below are some strategies that can be incorporated into a breast care routine:

1. Maintain the cleanliness of your breasts and nipples by washing them regularly with warm water during your shower or bath. It is essential to wash your hands before touching your breasts to prevent infections.
2. Replace breast pads or cotton squares in your bra that become dirty, wet, or moist. Wearing clean and dry nursing pads can prevent nipple soreness, thrush, and mastitis.
3. Pick a well-fitted and supportive nursing bra or a regular bra that is not too tight to ensure comfort and proper support for your breasts.
4. If you experience pain and swelling, apply a cold compress on your breasts to alleviate the discomfort.

Healthy dietary

During lactation, both the mother and the infant require an increased dietary intake to meet their nutritional needs. The concentration of vitamins (such as A, D, B12, thiamin, riboflavin, and pyridoxine), iodine, selenium, and fatty acids in breast milk is influenced by maternal nutritional status and dietary intake.

However, the concentration of proteins, carbohydrates, and other minerals in breast milk remains consistent, unless the mother is severely malnourished or has depleted body stores. There is no specific food that should be avoided during breastfeeding, and there is no evidence that a maternal exclusion diet during lactation can reduce the risk of atopic illnesses in infants.

Moreover, there is no evidence linking colic symptoms to cow’s milk, dairy products, chocolate, cruciferous vegetables, or beans; thus, mothers should not be advised to avoid these foods as a preventive measure. 

However, consulting a doctor about dietary intake during breastfeeding is essential to ensure the mother maintains good health and offers optimal nutrition for her baby, since health professionals can provide other valuable information.

Expressing breast milk

Breast milk expression is crucial because it enables mothers to provide milk to their babies even when they are away from them. It is particularly useful for working mothers or those who travel frequently. 

Moreover, regular breast milk expression helps maintain milk supply, prevents discomforts like engorgement, and promotes lactation success. Breast milk expression may be required in various situations such as when:

1. The infant is too small or unwell to nurse effectively through breastfeeding;
2. The mother experiences engorged and uncomfortable breasts due to an overabundant milk supply;
3. The mother needs to be separated from her infant for extended periods due to work or other reasons, and wishes to continue providing breast milk; and
4. The mother chooses to feed her baby with expressed breast milk (EBM) using a bottle instead of nursing directly.

In addition to breast milk expression, here are some recommendations for storing and thawing expressed breast milk:

Refrigeration

It is important to store EBM in the back of the fridge where it can remain the coolest. Avoid storing it on the fridge door, where it may be exposed to more warmth.

If the temperature in the fridge is consistently at or below 4°C, EBM can be stored for up to five days. However, this may not be possible in a regularly opened residential refrigerator. Therefore, it may be advisable to freeze the EBM if it is not used within 48 hours.

Freezing

EBM can be safely stored for up to two weeks in the freezer compartment of a fridge or for up to six months in a household freezer that maintains a temperature of minus 18°C or below.

Thawing frozen breast milk

When thawing frozen EBM, it should only be defrosted in the fridge and consumed within 24 hours after being defrosted. Once the EBM has started to thaw, it should not be refrozen. 

It is important to avoid warming or defrosting EBM in a microwave oven, as this can destroy valuable nutrients and create hot spots that can burn the baby’s mouth. Instead, place the EBM in a bowl of warm water to slowly thaw it.

How to know when your infant is hungry

Infants have various ways of expressing their hunger or satiety through their behavior and vocalizations. Crying is one of the early indications of hunger, but as the baby grows, it will develop new cues for hunger and fullness. Recognizing these cues is crucial for successful breastfeeding:

Signs that the infant may be hungry

Keep an eye out for these signs and then feed the baby right away:

• Putting their hands to their mouth
• Turning their head towards the breast or bottle
• Puckering, smacking, or licking their lips
• Clasping their hands

Signs that the infant is full

Some signs that babies are done eating or that they are still full:

• Closing their mouth
• Turning away from the breast or bottle
• Relaxing their hands

In conclusion

Breastfeeding is recommended for up to two years or more for optimal growth and development of children, but globally, breastfeeding rates fall short of recommendations. However, breastfeeding can sometimes be challenging for new mothers, and they may experience difficulties such as nipple pain, breast engorgement, insufficient milk supply, and maternal stress.

To overcome these challenges and promote successful breastfeeding, there are good practices that mothers can follow, such as breastfeeding and breast care routines, a healthy dietary, and expressing breast milk. It is crucial to increase efforts to promote breastfeeding and ensure that mothers and infants worldwide have access to its many benefits.

If you would like to see more resources on breastfeeding, check out the Parenting Science Labs. The lab uses the research of the Institute for Life Management Science to produce courses, certifications, podcasts, videos, and other tools. Visit the Parenting Science Labs today.

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