BREASTFEEDING Q&A

From your breast size to milk sup­ply, regis­tered di­eti­cian Abi­gail Courte­nay an­swers your nig­gling ques­tions.

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Q| I have type 1 di­a­betes and plan to breast­feed when I give birth in a few weeks. Will it be pos­si­ble and will my med­i­ca­tion have any ef­fect on my baby?

AYes, you can def­i­nitely breast­feed if you have type 1 di­a­betes. This be­ing said, you may ex­pe­ri­ence lac­ta­tion hy­po­gly­caemia as your breastfeeding ses­sions progress. Your sugar lev­els will be lower, be­cause your stores will be used for milk pro­duc­tion. Your daily in­sulin re­quire­ments may de­crease and fre­quent glu­cose mon­i­tor­ing is es­sen­tial for the safety of you and your baby. It’s al­ways wise to con­sult reg­u­larly with your di­a­betes team dur­ing this time so they can tailor your med­i­ca­tion and pre­vent hy­po­gly­caemia, which could be un­safe for both of you. Keep healthy car­bo­hy­drate-con­tain­ing snacks, like fruit, crack­ers with a dip, peanuts and raisins or even a nu­tri­tional shake, on hand to preempt low blood sugar be­fore a feed. Q|Can I still breast­feed if I have thrush? My nip­ples are also bleed­ing, is this nor­mal? Thrush is not pleas­ant for you or your baby, so I sym­pa­thise with you, but breastfeeding should still con­tinue. Your breast milk is safe, and if you stop breastfeeding, your sup­ply will de­crease, which will jeop­ar­dise your breastfeeding suc­cess. Both you and your baby should re­ceive treat­ment for thrush to pre­vent cross­in­fec­tion or re­in­fec­tion. Wash your hands well, ster­ilise items in con­tact with your breasts, your baby’s mouth or nappy area, and keep your nip­ples dry. Med­i­cated nip­ple oint­ment or oral med­i­ca­tion like an an­ti­fun­gal may be pre­scribed by your doc­tor.

Bleed­ing nip­ples are not nor­mal and this may be due to a poor latch if it’s in­cred­i­bly painful. Ask your mid­wife or clinic sis­ter to help you cor­rect your latch as soon as pos­si­ble. Breastfeeding should not be painful. Q|my I stopped breastfeeding four-year-old two months ago, but she de­cided to feed re­cently and dis­cov­ered I still have a lot of milk. At what point will the milk dry out and is my milk still OK?

ABreast­milk works on a sup­ply and de­mand prin­ci­ple. This means if there is milk be­ing re­moved by feed­ing or ex­press­ing, more milk will be made. If she doesn’t feed for a long time, the milk will even­tu­ally “dry up” or de­crease. This may take days, weeks or even months, depend­ing on many fac­tors.

The milk is still good as it does not spoil or be­come “old”, so it’s com­pletely safe and even healthy for your child. Breastfeeding is rec­om­mended for two years and for as long as you and your baby feel com­fort­able. Q| I’ve read that if you have smaller breasts, it doesn’t nec­es­sar­ily mean you’ll pro­duce less milk, but why do some women pro­duce more milk than oth­ers?

AYou are 100% cor­rect. Breast size should not im­pact your abil­ity to breast­feed suc­cess­fully. Ge­net­i­cally, some women don’t have suf­fi­cient alve­o­lar tis­sue, which may af­fect sup­ply, but this is rare.

A va­ri­ety of fac­tors can af­fect your sup­ply and these are mod­i­fi­able, so let’s fo­cus on what we can change. Not feed­ing on de­mand, in my opin­ion, is one of the main de­ter­min­ing fac­tors of in­suf­fi­cient milk pro­duc­tion, but stress, fa­tigue and a poor diet can also af­fect your sup­ply. Take

time out, del­e­gate re­spon­si­bil­i­ties, and slow down where pos­si­ble. Also con­tinue tak­ing your preg­nancy mul­ti­vi­ta­mins or a nu­tri­tional shake to en­sure you mit­i­gate some of the risk. Q| I know this is ter­ri­ble, but I re­ally strug­gled to quit smok­ing dur­ing my preg­nancy. Now I’m breastfeeding and try­ing to cut down even more, but it’s just so hard. Can smok­ing harm my baby in any way if I’m breastfeeding?

ASmok­ing may have a neg­a­tive ef­fect on both your milk let-down and milk sup­ply.

From a health per­spec­tive, we know that smok­ing and in­hala­tion of sec­ond hand smoke can be harm­ful for both mom and baby. Prob­lems in­clude, but are not lim­ited to, more fre­quent and se­vere asthma at­tacks, res­pi­ra­tory in­fec­tions, ear in­fec­tions, and even sud­den in­fant death syn­drome (SIDS). Cut­ting down is a step in the right di­rec­tion, but take care not to smoke around your baby and change your clothes be­fore you feed or in­ter­act with your lit­tle one to de­crease ex­po­sure as much as pos­si­ble. Q| Are there any spe­cific foods I can eat to in­crease my breast milk sup­ply?

AFoods like oats, bar­ley, brown rice, beans, sesame seeds, al­monds, dark green leafy veg­eta­bles, apri­cots, dates, figs and cooked green pa­paya have tra­di­tion­ally been rec­om­mended to help “in­crease” breast milk sup­ply. While these are all per­fectly healthy foods, their ef­fec­tive­ness is un­proven and un­doc­u­mented. The best ad­vice I can give is to ini­ti­ate breastfeeding as soon as pos­si­ble af­ter birth and breast­feed on de­mand – es­pe­cially while you’re es­tab­lish­ing your breast milk sup­ply, which can take up to two months. You should be feed­ing eight to 12 times a day with a new­born, and a well-fed baby will typ­i­cally gain weight and length steadily, have at least six to eight wet nap­pies a day as well as fre­quent soft stools. Q| At times, my baby seems a lit­tle col­icky af­ter feeds. Could this have some­thing to do with what I ate that day?

ABe­fore you jump to the con­clu­sion that colic symp­toms are caused by food in­tol­er­ance, make sure your baby is latch­ing prop­erly and isn’t gulp­ing in air while feed­ing. Also burp her prop­erly af­ter a feed. If you still strug­gle, you should visit a regis­tered di­eti­cian with a spe­cial in­ter­est in ma­ter­nal health who will help you elim­i­nate the foods that are po­ten­tially caus­ing a prob­lem while main­tain­ing the in­tegrity of your nu­tri­ent and en­ergy in­take. You don’t want to try this on your own as you may fall short of some es­sen­tial nu­tri­ents and com­pro­mise your breastfeeding ef­forts. Q| When I’m breastfeeding my seven-week-old baby, my let down seems to be too strong for her and she al­most chokes. What can I do about this?

AYou can try less­en­ing the force by al­low­ing grav­ity to work with you and nurse with baby sit­ting in an up­right po­si­tion, or with you ly­ing down on your back. Al­ter­na­tively, if you lie in a side po­si­tion, any ex­tra over­flow milk can eas­ily be drib­bled from your baby’s mouth with­out caus­ing chok­ing or gag­ging.

Re­mem­ber to burp your baby of­ten as she may be gulp­ing air.

You can also let your baby start suck­ling and as your milk is “let down”, re­move her and catch the ex­tra milk with a towel or a cup. I am breastfeeding my lit­tle one ex­clu­sively, but would like to en­joy a drink with my hus­band on the week­end. Will this be OK, or will the al­co­hol af­fect my breast milk?

AQ| No amount of al­co­hol has been es­tab­lished as safe for a nurs­ing mother. If you are go­ing to drink, cur­rent rec­om­men­da­tions in­clude lim­it­ing your in­take to 0.5g al­co­hol per kilo­gramme of ma­ter­nal body weight. So, for a 60kg mother, this equals ap­prox­i­mately a 30ml tot of liquor, 240ml glass of wine, or two beers per day.

Peak al­co­hol lev­els oc­cur about 30 min­utes to an hour af­ter drink­ing, so there is no need to “pump and dump” af­ter hav­ing one or two drinks, un­less you are do­ing this as a safety pre­cau­tion. Many moth­ers in­cor­rectly think this will speed up the elim­i­na­tion of al­co­hol from their milk. As your blood al­co­hol de­creases, so does the al­co­hol con­cen­tra­tion in the milk.

I usu­ally rec­om­mend al­co­hol avoid­ance if you are breastfeeding a pre­ma­ture baby, if your baby is younger than three months, or if he is sick. Prac­ti­cally, you should breast­feed first, then have your glass of al­co­hol. By the next feed the al­co­hol in your breast milk should be min­i­mal.

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