By Rokiah Don From the lofty portals of the World Health Organisation to the most remote health centre, you will find doctors, nutritionists and dietitians unanimously agreeing that breast milk and breastfeeding are best for babies. Breast milk is a complete food, providing babies with all the energy and nutrients to fuel their growth and development from the time they are born. It also strengthens their immune system and helps protect them from many common childhood infections. Some studies have even suggested a positive link between breastfed babies and their improved intelligence and emotional health. Breastfeeding is one of the greatest gifts of love that Nature has enabled us to provide. Unfortunately, working mothers are finding it increasingly more difficult to do. The stress of adjusting to motherhood, poor breastfeeding technique, the need to return to one’s career responsibilities . . . all these have been known to affect their ability to breastfeed effectively. In many cases, they have led mothers to give up trying to breastfeed altogether. From one mother to another, here are some tips that may help you give your best to baby. Prepare yourself Decide to breastfeed. Then, start preparing yourself physically, mentally and emotionally way before baby arrives. Read extensively on the subject, learn the techniques, find out the possible obstacles and start planning how to overcome them. It also helps to discuss the matter with other mothers who have breastfed, or with your doctor or nurse. Suckling properly Try the following steps to get baby to suckle properly (with her mouth covering your nipple and areola): Make yourself comfortable. Your body needs to be in a posture where you can hold your baby’s body tucked in close to you, and in which your breast does not pull away her mouth as she feeds. This means that if you are sitting, you need to be upright, not leaning backward. On one arm, hold your baby close to and facing your breast. With the other hand, hold your breast with four fingers under it and your thumb on top (hand in C position), away from the areola. Bring baby to your breast. Brush your baby’s lips lightly against your nipple, to give her a sense of what to take in her mouth. Once she opens her mouth widely, quickly bring her to your breast, allowing her to take as much of the areola as possible into her mouth. Breast conditioning and care. If breastfeeding is a little painful at first, don’t give up. It’s mainly because your nipples are not conditioned for the task. This discomfort only lasts from a few days to a week. Having said this, you may also experience some other common problems. Here’s what you can do: Engorgement: Having painfully swollen breasts is usually a sign that milk is not flowing out effectively. It frequently happens two to four days after birth. This is usually resolved by frequent feedings, hot or warm compresses and expressing frequently. Flat/inverted nipples: Remember that babies do not nipple feed: they breastfeed! So right from the very first feed, encourage your baby to take a large mouthful of breast. If necessary, draw the nipple out before feeding by stimulating it or using a breast pump. Sore or cracked nipples: Consult your doctor or nurse to determine the cause, whether it is due to poor position, thrush, incorrect use of breast pumps and so on. Adopt a good position and ensure that baby is latching on correctly. Apply expressed breast milk to your nipple after each feed and air dry. Change breast pads frequently and use breast caps to avoid chaffing from your blouse or top. Expose the breasts to air and sun to aid in healing. Begin each breastfeed on the least sore or cracked nipple. Blocked ducts: These can cause pain, swelling and lumps in the breast, often with the skin turning red. Massage the lump down towards the nipple gently before and during the feed. Apply a moist, warm cloth to the area before a breastfeed. Avoid wearing tight brassieres. Mastitis (breast infection):Blocked ducts, coupled with fever, could indicate a bacterial infection of the breasts. DO NOT DISCONTINUE NURSING. Consult your doctor or nurse and get plenty of bed rest. Drink fluids in response to thirst. Nurse more frequently, ensuring proper positioning, attachment and removal technique. Keeping up supply Breastfeeding on demand or expressing your milk regularly, in case of separation, helps ensure a steady milk supply. If you have stopped breastfeeding and wish to start again, you will need to stimulate your breasts by encouraging your baby to suckle or expressing your milk frequently. It may take as long as the time you have stopped breastfeeding in order to build up your milk supply. You should consult your doctor or nurse for growth assessment. Also, check on your baby’s weight gain, number of wet nappies daily, and frequency of bowel movements to make sure she is getting enough milk. In early postpartum weeks, baby would normally have six or more wet nappies and four to eight bowel movements throughout the day, with an average weight gain of 18g to 30g per day. Keeping baby on breastmilk The Ministry of Health recommends that all mothers give only breast milk to their babies for the first four to six months and to continue to breastfeed for up to two years of age, unless recommended otherwise due to medical reasons. Complementary foods (solids or semi-solids) should be introduced at about four to six months of age. A word about your diet While you are breastfeeding, what you eat is important. In pregnancy, your baby was growing inside you, and you were aware that you needed to eat well to help him grow and develop healthily. During breastfeeding, your baby is growing fast and depends entirely on the milk you are feeding him, unless he is already on solids after the age of six months. You need to eat well to ensure you have enough protein, vitamins, calories and minerals for both your needs and your baby’s growth. Regular meals are necessary; either two large meals each day or frequent smaller portion meals throughout the day, containing plenty of fresh fruits and vegetables. You can breastfeed successfully if you are a vegetarian, but do ask your nutritionist, doctor or nurse for advice. Avoid dieting during this time. Your baby will essentially be taking in whatever substances you take in. Think carefully about your intake of nicotine from cigarettes. Be especially cautious about your intake of alcohol and caffeine (found in chocolate, many teas, soft drinks and coffee). They pass quickly into the breast milk and affect the baby in the same way they affect you. This article is part of an educational series disseminated for Nutrition Month Malaysia, jointly organised by the Nutrition Society of Malaysia, Malaysian Dietitians Association and the Malaysian Association for the Study of Obesity, and supported by the Ministry of Health.Rokiah Don is principal assistant director of the Nutrition Section of the Family Health Development Division, Ministry of Health.