Breastfeeding is best, but not always possible
SINGAPORE — Lauded as the ideal food for infants, the benefits of breast milk have been well-publicised. The World Health Organisation (WHO), as well as the local authorities including the Health Promotion Board, recommend that mothers breastfeed their babies exclusively in the first six months of life, and continue for up to two years of age or longer after solids are introduced when a child is six months old.
However, some women are unable to produce sufficient milk to meet their baby’s needs.
While some lactation experts believe most of the obstacles mothers face can be overcome and they should keep trying, at least one lactation expert said it is not the end of the world if mothers are still unable to generate a sufficient supply after trying for a period of time and having sought professional help.
Obstacles faced may range from postnatal complications and existing medical conditions to breast structural issues from previous breast trauma or surgery, all of which could affect breast milk supply, said Ms Wong Lai Ying, a lactation consultant at the National University Hospital (NUH) Women’s Centre, which typically sees fewer than 10 such cases each year.
Dr Wong Boh Boi, senior lactation and parentcraft consultant at Thomson Medical Centre (TMC), said she once encountered a mother who was unable to breastfeed because of her previous nipple piercings.
“While she was able to produce breast milk, the scarring of nipple tissue obstructed the opening of the milk ducts, and led to mastitis, or breast inflammation,” she said.
Rarely are mothers discouraged from breastfeeding, but women who are HIV-positive, undergoing chemotherapy or whose babies have metabolic conditions like galactosemia (which affects how the body processes a sugar called galactose), are not encouraged to do so, said NUH’s Ms Wong.
According to Dr Wong, TMC’s assistant director (clinical), women who have medical issues severe enough to affect their ability to produce milk make up about 5 per cent of all mothers. Yet, only slightly over a quarter (28 per cent) of Singapore women exclusively breastfeed after two months of giving birth, according to a National Breastfeeding Survey conducted in 2011. At six months of age, less than half of the infants were receiving any breast milk and only 1 per cent were exclusively breastfed.
Lactation consultant Ms Lim Peng Im from NUH Women’s Centre said common reasons mothers give for not breastfeeding beyond one month include insufficient supply, sore nipples and breasts engorgement. But these are often preventable issues that can be resolved with professional support and help, she said.
“If the medical issue is a short-term one, mothers should be able to breastfeed successfully once it is resolved,” added TMC’s Dr Wong.
The hectic modern Singaporean lifestyle is another obstacle preventing local mothers from breastfeeding their babies exclusively. Based on her recent study of 227 local mothers, Dr Wong said that the majority tend to stop exclusive breastfeeding after the four-month mark when they return to work, citing reasons such as lack of support from employers, the work environment and work stress.
Instead of giving up so soon, the lactation experts said getting professional support is important.
Dr Wong advised persisting for at least three months to see if the milk-boosting measures work. “For mothers who cannot breastfeed exclusively, they can still provide their babies with the goodness of breast milk through mixed feeding, which is a combination of formula and breast milk,” she said.
Besides professional help, support from the baby’s father in the immediate postnatal period is vital for successful breastfeeding, added Ms Lim. In a study published in the International Breastfeeding Journal in 2013, women said they felt more confident and capable about breastfeeding when they perceived their partners as supportive and actively involved.
While mothers are encouraged to “try their best” to breastfeed, Dr Wong cautioned mothers against being overly fixated on their cause.
“I’ve seen mums who end up physically bruised, exhausted and depressed because they spend all their time trying to increase their milk supply. They are so upset that they will come and cry on my shoulder,” she said.
“If nothing works after months of trying and professional help, perhaps it is time to let it go and spend more time bonding with your baby through other means such as infant massage, singing and playing.”