Common Challenges

Most mothers can make enough milk for their babies. But many mothers are concerned about not having enough milk. Your breasts make milk in response to your baby’s needs.

The more often and effectively your baby breastfeeds, the more milk will be made. You may pump after feeding to boost your milk supply.

To help increase your supply, spend time bonding with your baby. Hold your baby in kangaroo or skin-to-skin contact and follow these steps:

• Nurse, nurse and nurse again
• Pump your milk to boost your supply
  
• Don’t worry and control your stress
  
• Try to rest and have short naps in between feeds
• Get support and drink plenty of water
  
• Feed yourself, feed baby
  
• Herbal Help?! Fenugreek, fennel seeds or blessed thistle can help

It is normal for your breasts to become larger, heavier and a little tender when they start producing more milk. It

usually happens during the third to fifth day after birth, but it can happen at any time. At this time you need to feed your baby more often and/or maybe pump your milk for relief. Milk building up and staying in the breasts can lead to engorgement and breasts get very hard and painful.

The best management of engorgement is to prevent it, by feeding your baby more often when your breasts start getting heavy. Be aware of your body and don’t let your breasts become overly full. If after breastfeeding, your breasts are still heavy, use a pump to express your milk until it is relieved. Remember, the key is to effectively

express the milk, but avoid over pumping as it may not be helpful.

Mastitis is infection on the breast and it can be accompanied by fever or flu like symptoms. You breasts may be warm, sensitive to touch and become red at one spot. You need to be seen by your doctor and you might need medicine. Remember, even if you are taking medicine, continue to breastfeeding even more than before, especially on the infected breast. This is the best for you and your baby.

Some women have nipples that appear flat or turn inward instead of protruding. Sometimes it makes breastfeeding difficult, but remember that baby has to attach to both nipple and the breast to breastfeed successfully. So, even inverted nipples can work. The attachment of baby with large nipples improves with time as baby grows. Mother may need to express her milk after feeding and give it to baby with a cup for the first couple of weeks. Ask for help from your doctor or a lactation consultant if you have questions or concerns about your nipple shape, especially if your baby has trouble attaching well.

Many twins may be born early and that means the benefits of breastfeeding is even greater. Sometimes the idea of breastfeeding twins may seem overwhelming, but many mothers find breastfeeding easier because it doesn’t

need preparation. Most mothers are able to make enough milk for twins. Many mothers finds it easier to breastfeed one baby at a time, one after another, to know each one individually and to develop their breastfeeding skills. Once you become confident breastfeeding one baby, learning how to breastfeed both babies at the same time may save a lot of time for you. Double pumping often helps mothers to increase their milk supply as well as saving time.

Many cultures have suggestions about foods to eat or to avoid while breastfeeding. Eating such foods may make you or other family members more comfortable. However, research shows that a mother’s milk is affected only slightly by the foods in her diet.

You can eat whatever you have been eating pre-pregnancy and don’t need to avoid certain foods. Babies love the flavour and the smell of foods that come through in your milk and make them ready for the foods they start to take at six months of age. Eat healthily with a variety of fresh foods. Just limit your drinks with caffeine, like coffee, to no more than two a day. If you are sensitive to any foods, avoid them as your baby may not like them as well. Remember, even if you don’t always eat healthily, the quality of your milk won’t change much. 

You may be thirstier and have a bigger appetite while you are breastfeeding. Drink enough water to keep from being thirsty and have small snacks in between your meals. You will need only about 500 extra calories more in a day when breastfeeding because making milk will use about 500 extra

calories a day. An active life style helps you to stay healthy, feel better, and have more energy.

Many mothers who breastfeed exclusively also go back to work or school. It might seem challenging, but planning ahead for your return to work or study can help to make the transition easier. Remember, your milk has everything your baby needs for the first six months. Breastfed babies are healthier and

get less infections which also help working mothers to be less absent from work. Let your employer know in advance that you wish to express your milk during the day. Here are some tips for you to make it work:

• Consider returning to work in the middle of the week to give you and your baby time to adjust to the routine

• Select a quality breast pump a few weeks before going back to work and start pumping in between feeds

• Store the pumped milk in the freezer, so that you will have stored milk before going back to work

• Nurse your baby right before you leave for work and right after you get home

• If possible, wear clothes that let you pump easily at work

• Find a private place at work and express your milk during the day. Try to pump as many times as your baby feeds while you are away. During a typical eight hour work period, you need to pump about two to three times. Pump for 10- 15 minutes on each breast with your hands-on the breast compressing

• Keep the milk in the fridge or cooler bag with an ice pack at work. Once you get home, transfer the milk to the fridge from cooler bag and your baby will use it the next day when you are at work

• The milk in the freezer is your back up milk that can be thawed and used whenever needed (see the storage of milk section)

• Breastfeed you baby more often when you are home especially during the weekends. This will help you to maintain your milk

You can express your milk by hand or by using a breast pump. A combination of using both pump and hand to express your milk is more efficient especially in the first few days due to the thickness of your first milk.

Expressing milk by hand is always available, easy to clean and it doesn’t need any preparation. It is gentler than the pump, particularly if the nipple is sore. Many mothers express some milk by their hand after they pumped their milk and report they get more milk than the pump could not remove.

Wash your hands, sit comfortably and lean forward

Have your baby or a photo of your baby in front of you, warm up your breast with small warm towel and gently massage your breasts

Hold your hand on a “C” shape with your thumb and forefinger about 3 centimeters behind the base of your nipple right in front of each other (for example at six and 12 o’clock)

Press back onto the chest wall Gently press your thumb and forefinger back towards your chest wall

Compress the breast by pressing the thumb and forefinger towards each other. Then relax.

Repeat rhythmically: Press - Compress – Relax - Press - Compress - Relax until milk flow stops. Alternate frequently and switch back and forth between breasts in different angles to increase the flow of the milk.

If you are expressing for a premature baby, you should have a hospital- grade electric breast pump for the first few weeks. It can be used with a double collection kit, which operates on both breasts at the same time. This will help you to establish and maintain a good milk supply. If you have twins or going back to work soon, you may benefit from a double pump to

save you some time. A standard electrical breast pump should be adequate for the mother of a full-term baby.

Read the manual instruction of how to use your pump and use the hands-on pumping technique:

Hands on pumping:

It is highly recommended to do hands on pumping. Using your hands to compress the breast gently while pumping can contribute to a 48% increase in the total amount of drained milk and double the fat content (hind milk) (Jane Morton, 2016).

Breast milk can be safely stored and used at a later date, as long as the following guidelines are followed:

• Make sure you wash your hands thoroughly and clean all the areas while handling expressed milk. Wash the bottles and pump spare parts after each use with warm soapy water and sterilise them once a day

• Store expressed breast milk in a clean, sealed container

• Store the milk in small amounts (90-120ml), leaving space at the top for expansion when frozen

• Label all storage containers with the date and time of expression

• Store the milk in the main part of fridge or freezer, not the door side and always transfer the milk in a cooler box with an ice pack outside home.

See the chart below your instruction of storage of milk at home:

• Gradual warming of the frozen milk is recommended. Transfer the milk from freezer to fridge, once thawed, you can keep for 24 hours in the fridge
  
• Only warm up the amount your baby needs not to waste any milk. Throw away the leftover milk after a feed
  
• Keep the cold milk in jug of warm water to reach body temperature
  
• Do not boil the milk or use microwaves
  
• If you want to use the milk directly from freezer, keep the frozen milk in a bowl of cold water and gradually warm up or hold under running warm water to thaw the milk. Don’t use hot water
  
• Use the oldest frozen milk first
  
• Always test the temperature of the milk by dropping a little onto your wrist before giving to your baby