Breastfeeding: Getting it right

“I wanted to breastfeed my baby because I knew how important it was. But when my daughter was born, my breasts were simply empty. I ate everything recommended; egg plants, katunkuma, katogo, porridge, but still had to feed my baby on Nan for some days,” recounts Julian about her first breastfeeding experience, adding, “I never suffered what I have seen with some mothers that even need breast pads. My baby’s feeding officially included Nan and breast milk whenever it was available.”

Julian continues to narrate her ordeal, “On some days though, the breasts get really heavy in the evening and very painful, which still happens today, nine months after I gave birth. I have meanwhile failed to master the right way to hold the breast and how to breastfeed while lying down so I have to sit upright throughout the night to breastfeed.”

This is one mother’s breastfeeding challenge including, of course, the inevitable act of having to expose her chest as she pulls out her breast, regardless of who is watching, to feed the baby, the lack of time to sit and feed her baby who doesn’t like the breastmilk among others. “My breasts hurt so much after I gave birth, I failed to breastfeed the baby,” recounts another mother, Sylvia Kagoya.

Every mother that has been through it will tell you that breastfeeding is not as easy as it sounds. But then, today, most mothers also appreciate that the value of breast milk surpasses all these challenges. Dr Victoria Nakibuuka Kirabira, a paediatrician at Nsambya Hospital, explains, “Mothers go through all that trouble because breast milk is very precious and is a mother’s way of showing love to her child. It is also cheap, always at the right temperature, has all the nutrients that the baby needs for its growth and most times (unless when pumped) is given by the mother so the child and mother bond. The baby looks at the mother while breastfeeding, gets used to her face and gets attached to her. Also, antibodies are passed on to the baby through breastfeeding which helps prevent some illnesses, mainly diahorrea and pneumonia.”

Edith Nassuna, the Senior Principal Nursing Officer at Mulago Hospital, adds, “Breast milk is so precious that it should be initiated immediately after birth.” That is, within the first hour after birth, according to the World Health Organisation recommendations.

With the undisputable value established, what remains is the challenge of doing the task right, in a way that surpasses the challenges involved.

Making breast feeding fruitful

Don’t waste the colostrum: Dr Catherine Nyangabyaki Twesigye, a paediatrician at Nsambya Hospital, advises that breastfeeding should start right away by feeding the baby what comes out of the breast first. “A number of breastfeeding mothers think that the first milk (colostrum), which is yellowish in colour is bad and not enough for the baby. Colostrum is however the most concentrated in terms of nutrients and therefore the best milk. It comes only for the first one or two days,” explains Twesigye. Though it seems little, it is enough for the baby because it is of the best quality and is important for the baby’s growth.

Get the posture right: The paediatricians say the right comfortable posture addresses problems like sore nipples, backache and choking the baby.

Dr Kirabira explains, “The mother has to sit upright and hold the baby as close to her chest as possible. The baby should be carried in a way that his or her body from head to toes is straight. Don’t place a finger on baby’s chin because that interferes with the feeding and feed lying on your side if you were operated on.”

Dr Twesigye adds, “Attach baby properly to the breast to ensure the whole black part of the breast (areola) and not just the nipple is in the mouth.” She explains that this is because the milk buds are in the secondary layer of the areola. So, most of it should be in the child’s mouth. Sucking the nipple alone causes sore nipples. “It is good to start with a prayer for the baby before breast feeding just like you would when going to have any other meal,” Nassuna says.

Breast feeding frequency: Regarding the number of times the baby should be breastfed, Dr Twesigye says the mother should feed the baby on demand. Dr Kirabira agrees, “The minimum number of times should be eight times a day [for up] to six months when the baby should be feeding exclusively on breast milk.”

Nassuna says mothers should continue feeding the child as often as they can until it is two years old. “If you can’t move with the baby, pump the breast milk, keep it in bottles and teach the babysitter how to feed the baby and how to warm it to a required temperature.”

Feed consistently for more milk production: However, a number of mothers like Kagoya complain about not having enough milk to feed the baby. How can they keep the milk coming?

According to Dr Kirabira, mothers like Kagoya should just continue breastfeeding the baby. “The more you breastfeed, the more the milk comes. The mother’s state of mind is also very important. If she is stressed, it will affect the milk production. You need to be calm and relaxed.” She adds that no wonder in the African tradition, women go and stay at their mother’s homes for the first few months after giving birth just so they concentrate on breastfeeding the baby and not have to worry about housework and other responsibilities.

Nassuuna says the mother’s state of mind is a responsibility of those around her especially the husband who has to make the environment peaceful. They also recommend that breastfeeding mothers feed on only nutritious foods so that they can get milk for the baby.

Dangers to watch out for

Flatulence: If the child is not properly attached to the breast, it will end up sucking a lot of air. The baby will then have so much gas in the stomach and keep on crying because of the discomfort it causes. She says that is why mothers are encouraged to put the baby on the shoulder and repeatedly pat the back so it belches which helps to release the gas in the stomach.

Suffocation and choking: She insists that mothers should concentrate on the baby when breastfeeding to avoid suffocation or choking. “Some women’s breasts are so big and if not lifted a little can cover the babies’ nose. And, at times, the milk comes out so fast that it becomes hard for the child to suck. When that happens, a mother should press the breast slowly to control the flow. But if pressed so hard, the flow will increase. For the mother to tell how high to lift the breast or how hard she should press, she needs to look at the baby, she says.

Twesigye emphasises that breast milk will always be the best milk for the baby so mothers should do all they can to have it and to feed the babies on it for as long as possible.