Breast milk is the basic food for every baby. Besides being easily digestible, it boosts their immune system, therefore enhancing wellbeing and development.
Since these toddlers feed through the nipples that are located on the tip of the breasts, it is advisable that every breastfeeding mother observes high levels of personal hygiene.
When babies suckle dirty breasts
Joan Mukiibi Namakula, a midwife at International Hospital Kampala-Kololo branch says when mothers do not wash their breasts and nipples properly, they expose their babies to various diseases and infections.
“A dirty breast harbours germs and when an infant suckles it, there are high chances that they will get sick,” Namakula explains.
Some of the common conditions that can result from a child suckling dirty breasts include fever, diarrhoea, vomiting, developing a gaseous abdomen and loss of appetite by the baby.
Dr Alex Kakoraki, a general practitioner at Murchison Bay Hospital in Luzira says mothers who do not observe proper hygiene while breastfeeding are likely to emit an awful smell especially if they do not change clothes that have been stained by milk from the breasts.
“Once any kind of breast milk spills on either the bra or blouse, and the breastfeeding mother does not change the clothes, she will immediately start smelling,” he explains.
There is also a tendency for the breasts to become engorged or soggy when the mother does not wear any absorbent material.
“If one does not put on any kind of spongy material to absorb the milk coming from the breasts, it will spill on the bra eventually making it wet. The nipples will even become mushy and sore for the baby to suckle,” Kakoraki explains.
Also, a mother may develop wounds and cracks on the nipples as a result of the continuous poor placement of the breasts on the baby’s mouth.
Namakula says observing proper breast hygiene is the best way to prevent breastfeeding-related infections. Before any mother goes ahead to breastfeed their baby, Namakula says they should ensure they first wash their hands with clean water and soap. The baby should also be kept clean at all times, including during breastfeeding.
“The aim of bathing a child before breastfeeding is to ensure that they are comfortable as they suckle. This also ensures that they feed well,” she explains. If the mother does not have enough time, she can only wash the baby’s hands using a clean piece of cloth. This is crucial since babies keep touching the breasts during the process of suckling.
After cleaning the baby, a mother can then put water in a basin and use it for cleaning both her breasts. She could use either a sponge or any piece of cloth for cleaning.
“Make sure you concentrate on the areas beneath the breasts, nipples and areolas while cleaning,” says Namakula. The cleaning can last for about five to 10 minutes. Afterwards, the mother must wipe her breasts using a dry towel and then go ahead to feed the baby.
Mothers should however avoid using any kind of medicated soap or liquid during the cleaning process. This is because one may fail to rinse the nipples properly and when the baby suckles, they could easily get an infection.
During breast feeding
Namakula says that as the child is suckling one breast, the other should be covered so as to avoid milk spilling on the mother’s clothing.
In order to make the breast feeding moment lively, the mother could either talk to the baby or sing. Alternatively, the mother could play with the baby’s feet or hands.
What breastfeeding mothers can wear
“They should wear breast pads all the time since this can help absorb milk coming from the breasts, and therefore keep a mother’s clothes stain-free,” Namakula explains.
She says the pads can be changed every three hours, depending on how much milk is coming out of the mother’s breasts.
For mothers who cannot afford breast pads, Namakula says they could use small pieces of clothing made out of cotton material, as this can help to absorb the milk.
Namakula further advises mothers to desist from using cotton balls as they can easily peel off. Regarding what sort of clothing is suitable for mothers during breasfeeding, Namakula recommends front-buttoned, zips and V-necks, since they make it easy for the mother to access the breasts. But most importantly, she says nursing mothers should always ensure that they put on the right sizes of bras so that the breasts are kept in a firm position.
Best foods for breastfeeding mothers
Jennifer Mugisha, the national nutritional advisor at Strides for Family Health, says mothers mostly require foods that boost milk levels.
“Milk and porridge is good because it contains a lot of water, therefore, increasing the amount of milk a mother produces,” Mugisha explains.
She advises mothers to avoid fast foods and instead stick to organic foods such as sweet and Irish potatoes, bananas (matooke) and posho as these are considered energy-giving foods.
According to Mugisha, breastfeeding mums should also avoid taking alcohol or smoking since these will reduce the amount of breast milk and thereafter make it difficult for the baby to suckle.
Why some mothers may not be allowed to breastfeed their babies
Every expectant mother has been told about the benefits of breastfeeding their new born babies. Rarely though, have they been told circumstances under which they cannot breastfeed. And so for a mother like Rose Niwagaba, it was shocking when, after giving birth to her second child, doctors told her she could not breastfeed.
It all started after experiencing complications while in labour. The doctors realised that the foetal heartbeat was low and Niwagaba was advised to undergo a C-section.
After coming out of the theatre, she was not allowed to be with the baby as it was taken to the intensive care unit and put on oxygen. The reason? The baby had been born with three holes in the heart, and needed help breathing.
In the meantime, the mother could not access her baby and when she requested to do so, Niwagaba was told the baby had been moved to another hospital.
She was eager to breastfeed her baby but was informed by doctors that she could not do so because her breast milk was not good for the baby. Doctors had tested breast milk and found it to contain toxins.
Testing the breast milk
“When I gave birth, I had complications. The milk delayed to come. When it came, the doctors stopped me from breastfeeding. Instead, I was asked to pump the breast milk but they could not give it to the baby before testing,” Niwagaba explains.
She adds that even after testing, the milk was not given to the baby as the doctors said it was toxic. They said this had occurred as a result of accumulation of stress.
“I felt denied the right to breastfeed my baby. I did not know breast milk could go bad,” she says. Niwagaba wondered what had gone wrong since she had not been on any medication and did not have any illness. However, she admits to have been under stress.
“After one week, they were able to give the baby the milk through the tube. By then I was weak and stressed,” Niwagaba explains of her 2010 experience while living in Belgium.
Health experts say breastfeeding is influenced by the mother’s psychological and emotional wellbeing. Namusoke Samali, a senior nutritionist with ministry of health says it is difficult to produce breast milk if a mother is stressed.
She advises breastfeeding mothers to eat a balanced diet, take a lot of fluids and be encouraged to put their babies on the nipples because the baby’s suckling stimulates the glands that produce breast milk.
She says that loss of a loved one or lack of money in a family to meet basic needs contribute to stress and as a result, breast milk can easily disappear.
“Ideally, breastfeeding mothers should not be stressed. That is why you will hear many complaining that they do not have breast milk. Many times, mothers do not know they are stressed,” Namusoke says.
Other physicians say most women who give birth with the help of caesarean section have breastfeeding problems. This is because in some cases, a mother is separated from the baby in the initial stages.
The World Health Organisation recommends that a mother breastfeeds exclusively for six months before introducing the baby to other foods.
Dr Sabrina Kitaka, a paediatrician at Mulago hospital believes Niwagaba’s doctors were being conscious of what she had gone through, and were trying to avoid a scenario that would lead to other problems including high blood pressure.
“It can be difficult for a baby with a heart defect to suckle. In this case, the child was going for surgery. The doctors did not want to make a mistake that could affect the child,” says Dr Dr Kitaka.
She explains that when a mother is on medication, it increases the chances of the medicine leaking in the breast milk, thereby becoming toxic.
Dr Anita Tumwebaze, from Mulago hospital says Niwagaba’s experience is rare in Uganda, although she does not rule out that it can happen.
“That is a rare scenario in our setting. The main reasons a mother can be stopped from breastfeeding usually relate to infections. Even HIV positive mothers are advised to breastfeed,” Tumwebaze says.
She adds: “Of course we give both the mother and baby antiretroviral drugs. This is because some parents cannot afford buying milk or formula.”