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