Commonly Asked Questions About Lactation

To learn about the basics of breastfeeding, we asked Ms. Yasa Yong Nyuk Yin, Senior Lactation Consultant, Mount Elizabeth Novena Hospital to answer some commonly asked questions.

Breastfeeding commonly asked questions

Q: What are some of the essential breastfeeding products and accessories I should get before my baby is born?

Enjoy the first few days of your baby’s life before deciding on your breastfeeding journey. Usually, accessories are not needed if your baby is breastfeeding on demand. They are mostly needed when a mother is preparing and going back to work, where storage of breast milk is required.

A breast pump is needed if you plan to bottle feed your breast milk for as long as you wish to. Make sure the breast shield size fits well onto your nipples. If you are planning to pump frequently, consider getting an electrical pump that can express simultaneously on both breasts. This would save you time and have more rest.
Bags or milk bottle to collect and store your breast milk.
A sterilizer to ensure the bottles and bottle teats are properly sterile before use.
A small tube of nipple cream to apply on sensitive nipples during the early feeding days.
A few pieces of comfortable wireless bras. Do make sure there are no supporting wires as they may cause blocked ducts.
Reusable breast pad such as LilyPadz from Ardo, helps to stop milk from leaking on one breast while nursing the newborn on the other side.

Q: When should I start shopping for breastfeeding essentials and accessories?

Start scouting around during the early stage of your pregnancy so that you can choose the most suitable breast pump and accessories needed. In the event that you haven’t bought the items before your delivery, most of the items are easily available around the maternity hospitals. The nurses or Lactation Consultant would be able to advise on what is required and assist you during the process of breastfeeding.

Q: Is attending antenatal or breastfeeding classes necessary?

Such classes are usually run by accredited and recognised Lactation Consultants who have observed thousands of mothers with successful and unsuccessful breastfeeding outcome.

It covers information on avoiding potential breastfeeding pitfalls in the early weeks like sore nipples and engorgement. Other topics such as how to massage the mother’s breasts and how to hand express and collect breast milk will be included.

Through our observations, couples who have the opportunity to prepare and ask questions before the arrival of their newborn, are more likely to be successful at breastfeeding than those who do not. The knowledge gained also motivates mothers to be committed to breastfeeding.

Q: Do I need to inform my doctor or the hospital that I want to breastfeed exclusively? How does having a birth plan help in this instance?

Yes, do inform your obstetrician that you are committed to breastfeeding your new-born, so that he or she would be able to refer to a pediatrician who is supportive of the process. It is encouraged to indicate your decision in the birth plan so that the nursing team will do their best to assist you from the beginning of your hospital stay.

Q: How will my body prepare for breastfeeding?

A women’s breasts are prepared to produce milk as early as the 16^th to the 20^th week of gestation. The breasts increase in size due to an increase in lobules and alveoli. The nipples grow darker to help the newborn search for his or her milk after birth. Milk production is initiated in the breasts during the post-partum period, after delivery of the placenta.

Women you underwent an urgent caesarean section or had a long labour before their vaginal delivery, are more likely to have a delayed onset of breast fullness and lactogenesis (the production of breast milk) in the first days after delivery.

Q: What are the recommended websites or reading materials for breastfeeding information and tips?

The resources you turn to can either help you succeed or discourage and undermine your capability. Go to the experts and specialised websites such as the ones below:

American Association of Paediatrics – Breastfeeding Initiatives
Australian Breastfeeding Association
Jack Newman – Breastfeeding
International Lactation Consultant Association
Singapore Health Promotion Board – Baby Friendly Hospital Initiation
The Academy of Breastfeeding Medicine
World Health Organisation – Steps toward successful breastfeeding

What are the commonly asked questions about lactation in new mothers? Ms Loh Lee Lian, a Certified Lactation Consultant at Mount Elizabeth Hospital with 34 years of experience, addresses these questions.

Q: How often should I breastfeed? How will I know whether my baby is getting enough milk?

Breastfeeding should be by baby’s demand regardless of frequencies, but ideally, the baby should be fed every 2 – 3 hourly. Baby should get enough milk, if the baby latches and suckles well on each breast for about 15 – 20 minutes and about 8 – 12 times in 24 hours. 5 – 6 wet diapers and regular bowel movements a day indicate sufficient milk intake. Baby should be contented and alert after breastfeeding.

Q: How do I prevent sore nipples?

Mother’s correct positioning on holding baby very close to the body helps with latching. Ensure baby’s mouth is opened when moving baby to latch. Baby should be suckling on the areola instead of the nipple.

Remove baby and re-latch if baby is sucking on the nipple. Prolong sucking on one breast may cause soreness. Offer both breasts each time and frequent and short feeding if nipples are sore.

Q. Can I continue breastfeeding if my breasts hurt or if I have a cold or the flu?

Breasts tend to feel tender when milk comes in. Breast massage and warm compress before breastfeeding helps to stimulate flow and relief hardness. Continue frequent breastfeeding to avoid engorgement.

Breast discomfort will ease when the breastfeeding demands and supply are more regular. Cold compress may be used after breastfeeding to relief discomfort. If mother has cold or flu, breastfeeding should be continued, as breastmilk has high content of antibodies that protect babies against infection.

Q: Are there foods I should avoid eating while breastfeeding? What about alcohol or caffeine?

Breastfeeding mothers should eat well-balanced diet and allowed 500 calories extra daily. All food can be taken in moderation. As alcohol is not encouraged as it is also drying for the body and may be used in moderation for cooking. Basically, caffeine of about 200gms (100gm per cup) per day consumed is safe, but best to drink it soon after breastfeeding as generally caffeine takes about 1-2 hours to be absorbed and dissipated from the body.

Q: Are there any medications that I should stop taking?

Generally, less than 1 percent of medications are not suitable for breastfeeding babies. Breastfeeding should be avoided if the mother is on Chemotherapy drugs, sedations, antidepressant medication or radium therapy. Mothers who are breastfeeding should be highlighted to Doctors on prescribing baby-safe medications.

Q: What should I look out for when searching for a good lactation consultant?

Basically, the Lactation Consultant should be trained and experienced, a practicing LC and currently registered with IBCLC (International Board of Certified Lactation Consultant).

Q: I’ve heard that I can’t get pregnant while breastfeeding. Is this true?

Total breastfeeding, not missing any breastfeeds in some way prevents the onset of the menstrual period, thus acts as a natural contraceptive measure. It is not totally a safe measure and may need a second contraceptive method.

Q: How do I prevent my breasts from becoming engorged?

Engorged breasts are usually due to stagnant breastmilk, hence total and frequent breastfeeding day and night will maintain the flow. Breast massage and warm compress before breastfeeding may help to stimulate flow.

Q: What happens when I have engorged breasts?

Engorged breasts will cause discomfort and fever. Mother may take analgesia to lower fever and relieve pain. When breast is engorged, it will be hard and difficult for baby to latch on and the flow will also be impeded.

Breast pump may not be effective in milk removal when breasts are too engorged. Breast massage, warm compress, hand expression and with continue frequent breastfeeding will maintain smooth milk flow and supply. To be comfortable, cold packs may be used after feed.

Q: When should I introduce a bottle?

Bottle feeding is best introduced after the 4th week in order to avoid ‘nipple confusion’. Suckling from the breast and drinking from a bottle require different techniques. If bottles are introduced too early, some babies may refuse to latch onto the breast or latch well.

Q: What should I look for in a breast pump?

It is important to select the breast pump and accessories for individual situation. While manual breast pumps are great for stay-at-home mothers who are exclusively breastfeeding, electric breast pumps are the better choice for moms who are frequently separated from the babies because of work or health problems.

Depending on the different models of pumps available and the frequencies of use, the breast pump should effectively remove milk in order to sustain supply.

Q: How often should I pump when I go back to work?

To replace baby suckling on the breast, regular breast pumping every 3 hours should maintain the supply of breast milk and avoid breast engorgement.

Q: What does a midwife do?

As a midwife, job-scope in the maternity unit encompasses looking after mothers starting from when they are admitted for labour and delivery. Nursing care, on how to manage pain, support and advice are given continuously throughout for safe well-being of the mothers and babies in the process of labour and delivery.

After delivery, midwives are also responsible in the postnatal care, and that includes helping and teaching mothers the correct technique to breastfeed and to ensure that baby is feeding well.

Mothers are also shown and taught on how to take care of baby (e.g. holding baby, change diaper, bathing, burping and swaddling). Physical and psychological well-being of mothers during postnatal period is maintained during their hospital stay.

For more information about the maternity ward services at Mount Elizabeth Hospital visit mountematernity.sg. A virtual tour of the rooms is available at mountelizabeth.com.sg/virtualtour

This article is part of Breastfeeding with Love campaign, initiated by The New Age Parents and New Age Pregnancy.

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