BREASTFEEDING can be very stressful, especially if you’re doing it for the first time and not sure if you’re doing it correctly. Is your child latching on well? Is he getting any milk? Is it enough? These are some of the questions that typically go through the minds of new mothers.
Lactation consultant Nor Kamariah Mohamad Alwi has heard it all. While there are only about 30 lactation consultants in the country, there are many lactation counsellors and peer counsellors to assist new mothers.
What is the difference? A lactation consultant has had to sit for professional exams certified by an international board (International Board of Lactation Consultant Examiners). A counsellor has some training in breastfeeding. They are usually nurses who have gone through lactation management and counselling courses.
Peer counsellors are mothers who have experience breastfeeding and have gone for training by lactation consultants. Usually, they are trained in communication and how to apply their experiences to help other mothers.
“What worked for you may not work for others, so peer counsellors have to analyse the situation and choose which solutions would suit the mother,” explains Kamariah, who is also a board member of the International Lactation Consultant Association.
She recommends that pregnant women go for antenatal classes to get basic information about childbirth, breastfeeding and taking care of the baby. This is also where they can get contacts for lactation advice.
“The class should teach you what to do on the first day. If you know what to expect, you will know what to do by yourself in the first week. Help is also available as most women deliver in a hospital. Of course, if you give birth in a busy hospital, you can’t expect people to be there all the time, but at least you know that you should bring the baby to the breast and that you need to breastfeed frequently,” says Kamariah of Susuibu.com.
Usually, if mothers start nursing early, the mother and baby will get the opportunity to practise. Then if they have problems later on (usually when they go home), such as a delay of the mature milk coming in, the mother can contact a lactation consultant or counsellor for advice.
“When I visit clients, I ask them what is their main concern at that point. Observation is the most important thing to do during a visit. I observe how they nurse and from there I would tweak their method to improve on what they already know.
“If they have enough opportunity to practise, most of them will be able to do it naturally, by instinct. It’s just that sometimes the positioning is not ideal or the latching needs to be improved. They might not know what is the correct latching position, or how they can make it less painful. If a mother has an abundance of milk, which happens sometimes in the early days, it might not be manageable if they don’t know how to properly remove the milk. I help them to manage this situation when I visit.
“Sometimes it involves massaging the breast to express out the milk by hand because when the breast is engorged sometimes even the breast pump cannot work on it. So, we have to teach them how to do hand expression. If it’s already blocked and engorged, usually we have to help ease the mother first.
“In some rare cases, it might be difficult for the mother to adapt to the technique so sometimes it takes a few visits. But this is rare. Usually, only one visit is required and I will follow up with them on Whatsapp. Each visit usually lasts about two or two and a half hours, unless there is severe engorgement, in which case it will take longer,” explains Kamariah.
According to her, some clients are not really sure what a lactation consultant does. Those who know what to expect will be able to benefit more as they would be equipped with all the questions and concerns they have, which can be addressed by the consultant.
Nonetheless, Kamariah always arrives with her own checklist:
- Observation of the mother and baby overall;
- Condition of the breasts;
- Positioning and attachment of baby on the breast;
- Milk transfer to the baby; and
- Baby’s output (comparable to input).
While Kamariah would be able to help mums and babies on their breastfeeding journey, there are limits to what she can do. For example, if a baby has tongue-tie, a lactation consultant cannot do anything about it. However, a consultant would be able to observe, detect and refer the case to a paediatrician who would be able to assist, as the baby would need medical intervention.
“If I feel that the baby is too lethargic and I know there’s something wrong, I would refer the mother and baby to a paediatrician. Sometimes the mother just doesn’t know that the baby is not thriving so we need to let them know and refer them to a doctor,” says Kamariah.
While it is important to get assistance as soon as possible, it is equally important for mother and baby to be given ample time to practise.
“Breastfeeding is all about confidence. We don’t want to overwhelm the mother by telling her this is not right and that is wrong. So, I would first approach the mother to find out what she has done. If it’s correct, then it’s correct and I tell her what she has done is good. Usually, if we give praises like that, the mum will be more confident in her skills and she will continue nursing for a longer time.
“It’s a matter of giving a chance to the mother and baby to do it. In most cases where they stop early, it is because they are not even allowed to breastfeed. For instance, in some confinement homes, the baby and mother are separated and there’s no feeding at night. This doesn’t help. In such cases, it’s not because the mother and baby couldn’t do it, but because of the management in the early days. How can they become good at something, if they don’t practise a lot? By the time they leave the confinement home, it may be too late. It’s not necessarily that they can’t do it after that, but it just becomes that much harder,” explains Kamariah.
She reminds mothers that each case is unique. Although you have breastfed once doesn’t mean the second and third child will be a breeze. Sometimes mothers who breastfed the first two children still have problems with the third. She has even seen cases where there is a problem with the seventh child!
You might think that being surrounded by many women who have breastfed makes it easier because of the support system. However, for someone attempting it for the first time, this also means there is greater pressure and expectations are high.
While online groups are good for support, Kamariah recommends getting advice from professionals because even though the problems or challenges look the same, the solutions may not apply to all nursing mums.
“Even if they are doing it correctly, sometimes mothers just need reassurance from the lactation experts. At home sometimes they receive a lot of comments from others, so having a lactation consultant is helpful to guide them,” says Kamariah, noting that latching and low milk supply are the biggest problems she sees.
For mums and pregnant couples looking for video help, Kamariah recommends https://www.globalhealthmedia.org/videos/breastfeeding/.