Do you have any breastfeeding questions but are too shy to ask them? Well this week Mombabbles has interviewed Simone Ebelthite a breastfeeding specialist and founder of Milk Mothers to find out more.
- What are the recommended guidelines for exclusive breastfeeding?
Exclusive breastfeeding for the first six months is a guide by the WHO (World Health Organisation) because of the proven benefits. Nothing else but breast milk gives a baby the best start to life. It is the perfect nutrition for them for building immunities from respiratory infections, diarrheal diseases, and even protection against obesity, asthma and diabetes. There are also major benefits for their brain development. This number is recommended because beyond six months parents are introducing solid food. The WHO have set this standard because introducing other nutrition before this mark contributes to a global issue of infant diseases and even death. Only 38% of infants are exclusively breastfed. Their goal is to increase the rate to 50% by 2025. For some mothers they have reported that introducing solids before six months has also impacted their supply negatively.
- WHO recommends exclusive breastfeeding for six months then continued breastfeeding combined with solids for two years or as long as the mother and baby desire. What’s your opinion on moms who breastfeed for longer than two years? Are there any benefits to it?
Moms who breastfeed beyond two years need an award! I think a few of those mums are met with a range of reactions because of the widely accepted myths around extended breastfeeding. Some of them are “there aren’t really any benefits – this is milk made for babies” “the child is manipulating the mother and using them as a dummy” “weaning should happen when babies get teeth” “this negatively impacts the child’s development” “the mother is just doing it for her own satisfaction”. Mothers can feel a pressure to wean and turn to ‘closet breastfeeding’. Those examples are external factors; mothers have internal factors – wanting the freedom of no longer feeding and all that goes with it. Benefits to feeding beyond a year means the child still gets all the benefits ranging from anti-infective to nutritional.
You asked for my opinion and I would say that mothers should do what they want to do when they are comfortable to do it. Every mother and baby is different and mothers should be empowered to make their own informed decisions.
- If women are having difficulties with breastfeeding what are the typical reasons why they are finding it problematic?
Mothers struggle with everything from latch and positioning to their routines or the demands of breastfeeding. After pregnancy breastfeeding will be a natural progression… and then they realise once the hormones and emotions kick in this isn’t easy! Mothers often hit a bump in the road with sore or cracked (even bleeding) nipples, they have expectations that baby will settle after a feed and often don’t. Mothers have terrible engorgement or get blocked ducts and mastitis. They worry about their supply. They struggle with how long a breastfeeding session should be, do I feed on both breasts, is it normal for my baby to cry and vomit up lots of the feed? Any of these questions are quite typical in the first few weeks.
- Can you expand on why babies sometimes find it difficult to latch?
I think there are some barriers to breastfeeding that occur in the first 24 and 48 hours that snowball. Babies need an uninterrupted first hour after birth with the mother. It is known as the golden hour and the babies are the ones to initiate breastfeeding. It is a natural process but unfortunately allowing this to play out for 80 minutes this isn’t always an option. Because of these factors suboptimal breastfeeding begins on day 0. Perhaps the mother has a Cesarean section delivery after a failed induction and epidural. Mothers are exhausted and doctors are monitoring both mother and baby. Some babies are only returned to the recovering mothers after two or three hours. If you gave birth during visiting hours some mothers have waited for up to six hours! At this stage the mother and her baby are playing catch up. Blood sugars drop, jaundice levels increase, temperature drops, maybe the baby has been supplemented, etc. Barriers to breastfeeding have occurred. We cannot MAKE a baby latch on. We want to set the situation up so that the baby WANTS to latch on. This is why some babies find it difficult.
- How can you tell if your baby is getting enough breastmilk?
There are a few indicators that we look at. Firstly, output. Is the baby making eight or so wet nappies and at least three poo nappies in 24 hours? Is the baby swallowing during feeds? Do you breasts feel “fuller” before a feed and a little “emptier” afterwards? And the most accurate would be weight gain. How much is your baby gaining? Feeding should be regular through 24 hours. Is your baby feeding every 2-3 hours? And if your baby is showing all those signs and is generally alert, happy and healthy your baby will be getting enough.
- What’s (generally) the best position to breastfeed?
If you’ve had a cesarean perhaps The Football Hold hold puts less pressure on your incision site. The most popular is The Cross Cradle and The Cradle. My favourite position for new mothers is the Laid Back Breastfeeding position also known as the Biological breastfeeding position. There is also the Side Lying position. I love the illustrations from MamaNatural.
The best positions during the day can be the Football and Cradle holds but perhaps through the night you are feeding lying down. The positions are there to be changed depending on what you’re doing.
- What are some of the pros and cons of nipple shields?
Nipple shields are wonderful tools for an effective latch on in a few cases. They are helpful for very small preterm babies, or mothers with flat or inverted nipples. They can assist with nipple confusion; when a baby won’t latch but is happy with a dummy or a bottle teat. If the baby has a tongue-tie and has an ineffective suck it can save a mothers nipples and help the baby achieve effective milk removal. They supply oral stimulation and can result in wonderful sucking bursts. Preterm infants have been shown to have a higher milk intake with them on. The cons would be weaning from the shield by the due date. They also need to be sterilized, carried around everywhere for feeds and most practitioners like to have weekly weight checks for a baby using a shield.
- What tips do you have for moms that have sore nipples?
I would say talk to a lactation consultant! Get some help and don’t suffer. It could be for a simple reason like a latch or something more complicated like thrush and then treat it. Get proper help on how to latch. Make sure you use lanolin, hind milk after a feed or hydrogel pads. You can use a breast shield (different to a nipple shield) to help protect your nipples from scratchy bras or T-shirts. A consultant can also help you with trying to change the baby’s latch on position from feed to feed to try and heal the painful areas.
- What’s your tips to moms on how to cope with night time feeds?
My favourite way to keep awake was to be on Whatsapp with my antenatal group or support group! Nothing like a little banter at 3am knowing you’re not alone. I even looked out of my window and spotted a light in the dark and would tell myself that was another Mother feeding her baby (clearly I am extraverted!) I am also a fan of the biological breastfeeding position and the side lying position. Latch that baby and then go back to sleep mama!
- What’s your opinion on moms that give up breastfeeding in favour of the bottle and formula?
My opinion is that every single mother needs to make a well educated and well supported decision that works for her and her baby. Until society is doing everything it can to provide education for woman and show proper, non-judgmental support for each and every mother, then I will work in breastfeeding to provide those two things. I wouldn’t want any mother to give up because she was lacking in either of those two areas.
- Why do you think there’s still a stigma attached to breastfeeding in public?
I think there are enough news articles around woman breastfeeding in Parliament or restaurants that proves there is still a stigma. I think we still live in a conservative society. To our advantage these days we are finding, more commonly, our considered norms are being questioned. The politics of the body for some aren’t a concern and they would happily feed wherever and deal with whatever happened. For others, they would be horrified at the thought of ever having that confrontation. I think the former group are still in the minority but that group is growing and I have faith that as we begin to have healthier conversations around breastfeeding in public we can begin to drop the stigma and choose to support mothers making healthy decisions for themselves and their babies.
- What do you think restaurants, shops and malls should do to make women feel more comfortable? Are they currently doing enough? If not, what would you like to see change?
There is not enough being done as a whole… I went to a baby store with my daughter in 2013 and they made me breastfeed in a store room. It was a baby store! I have seen more public places including breastfeeding families now, compared to when I had my daughter over four years ago. Don’t make a fuss, offer space if they need it, and if you’re able to, please include infrastructure for them.
- What do you think of what workplaces currently offer in terms of helping breastfeeding moms? Are they doing enough? If not, what should change?
I am doing more research into this. I have been approached by a corporate recently to possibly be part of their incentives in their employee programme. They have a few young women who have children while on staff and would like to provide pregnancy education, breastfeeding info and help with going back to the work environment after maternity leave. I think it’s brilliant and I would like to see more being done along those lines. If a wellness programme isn’t something your workplace could fund then advocate for flexible working hours and let’s keep mothers in our workforce. They are powerful multi-taskers and have two full time jobs. I think if you are the first women on your staff to be pumping at work then change the narrative so that you give permission to the next breastfeeding mother on staff.
- Do you have any advice or tips about choosing the right breast pump?
Yes! Pumps come in various shapes and forms and once you’ve decided on what kind of pumping you want to do – exclusive or just while at work or even once a week so you can make a Pilates class – then you can decide on what make and model would suit your needs. Your budget is a very important consideration and once you’ve found a model that suits your requirements then make sure you have the correct flange size and get some tips on learning to pump. For many mums they have found an art to pumping that yields much more. Finding the right breast pump means you might have to do a little research and chat to someone who can help you.
15. How can dads/partners help to support moms that are currently breastfeeding?
Mothers need encouragement. Studies show that supportive fathers have healthier babies. Fathers need encouragement too – breastfeeding is very much a mother-baby relationship so lets not be remiss to separate fathers and cause feelings of inadequacy. Let dad do some skin-to-skin and engage with burping. Let them be part of your breastfeeding strategy conversations. Education needs to be for both the mother and the father and so concerns for both are valid. Approve each other’s decisions and provide emotional support. Talk about expectations around sex and intimacy. It can be hard for a mother to breastfeed her baby at 7pm and then be physically intimate with her husband at 7:30pm. It can be hard for a father to be ignored every evening for weeks. Just because fathers aren’t the ones feeding doesn’t mean they can’t be educated in the same way so that they can be effective partners and cheerleaders for mothers.