Breastfeeding 101: Benefits, Obstacles & Tips for Success

If you are a first time mom or expecting your first baby, you’ve likely read about the wonders of breastfeeding and how your newborn will come out of the womb and magically know where to go and what to do.

You may expect that your newborn will instinctually know how to latch on their own and direct their head towards your nipple. While in some cases, this may be so, for many new mothers, having this expectation can hinder their first experience with breastfeeding and be very discouraging. In this article, I will discuss the many benefits of breastfeeding for both baby and mom. I will also delve into some of the obstacles that new moms face around breastfeeding and provide strategies and tips for success.

The Benefits of Breastfeeding

A mother's breastmilk is continuously changing to provide individualized nutrients and antibodies based on the baby's needs. The baby's saliva contains essential information which signals to the mother's body to produce exactly what the baby requires. If the infant is exposed to an infection, the mother's adaptive immune system produces antibodies through breastmilk to help the baby's not yet developed immune system fight off the invader(2). If the baby is going through a growth spurt, the milk may have higher fat content for neurological development or higher protein for muscle growth(3). It is a specific nutrition plan perfectly designed for your child!

In addition to protecting against directly exposed infections, recent studies have shown that secretory antibodies (sIgA) and the mother's intestinal microbes found in breast milk help promote long-term immune effects by supporting the development of a healthy gut in the child. Simply speaking, breastmilk is helping to build the child's immune system and microbiome(4). This may be why breastfed children have lower incidences of allergies, eczema, asthma, and other atopic conditions.

The World Health Organization (WHO) recommends that women breastfeed exclusively for the first six months and then continue to breastfeed with solids from 6 months to 2+ years to ensure optimal nutrition, growth, and development. They recommend initiating breastfeeding within the first hour of your baby being born and encourage breastfeeding on-demand. For successful latching and feeding, they suggest new moms avoid the use of bottles and pacifiers initially (1).

Breastfeeding also has a positive effect on helping both mom and baby attain a healthy weight. Research has shown that children who were breastfed have lower incidences of obesity and are better able to determine when they are full, and therefore are less likely to overeat(5). Some psychologists believe that children whose parents stopped breastfeeding too soon may risk developing poor hunger regulation. This is based on the psychological strain of feeling deprived. In addition to the benefits for the child, women who breastfeed are able to lose the weight gained in pregnancy more quickly, as producing milk burns an extra 500 calories daily (6,7).

Another important benefit of breastfeeding for both mom and baby is the bonding produced by both the skin-to-skin contact and physical latching to the nipple. Breastfed babies tend to calm faster and are easier to soothe. During breastfeeding, oxytocin is released in both the brain of mom and baby. This chemical has a number of different effects in the body. It acts through many different pathways to stimulate the release of endogenous opioids, serotonin, dopamine, and noradrenaline. "Oxytocin stimulates well-being, it induces anti-stress effects, decreases sensitivity to pain, decreases inflammation and stimulates processes related to growth and healing (8)". Because of this, it has an important role in preventing postpartum depression.

In most cases, breastfeeding will delay the menstrual cycle from restarting by 20 to 30 weeks. Because of this, it helps reduce anemia in new moms and will, therefore, improve energy levels in a sleep-deprived new mom. This is particularly important for those who experienced significant blood loss during delivery or postpartum hemorrhaging (although incidences of postpartum hemorrhaging are also lower in women who breastfeed due to oxytocin stimulating uterine contractions) (9).

To summarize:

Benefits for Baby:

• provides the ideal nutrition for baby

• improves immune function – protection against infections

• improves digestive function and supports building a healthy microbiome

• decreases the prevalence of allergies, asthma, eczema and other atopic conditions

• decreases chances of becoming overweight/obese

• decreases chances of developing Type 2 Diabetes

• promotes optimal brain development

• Improves bonding, secure attachment, & social learning

Benefits for Mom:

• Prevents postpartum hemorrhage (decreases chances of being iron-deficient)

• Decreases risk of ovarian and breast cancer

• Promotes hormonal metabolic reset

• Lowers rates of obesity

• Stimulates the uterus to contract and return to normal size

• Decreases risk of postpartum depression and baby blues

• Improves bone density

Common Challenges

1. Sore Nipples

When initially starting to breastfeed, occasional tenderness is expected. However, when the pain persists and becomes unbearable, this can be a sign that the baby does not have a proper latch, or that the nipple may be infected. If the baby's latch is shallow it can aggravate the nipple. The baby's mouth should open wide and cover the areola, not latch to the nipple directly. The areola is the darker coloured skin circling around the nipple.

What you can do:

• Ensure nipple is elevated when your baby is done feeding, it should not be flat.

• If your baby does not have a proper latch, you can break the latch by placing your pinky finger in the corner of your baby's mouth and ensure your areola is covered

• Try different holding positions with each feed to ensure you find one that is comfortable for both you and baby

• Let nipple air dry or wear cotton/natural fibre shirts

• Avoid tight bras and shirts

• If using nipple pads, change frequently to avoid trapping moisture that may cause nipples to crack or promote candida growth

• Use breast milk or calendula oil on the nipple after feeding to help heal the sore/cracked tissue

• Avoid using any soap on the nipple and wash only with water

If latching difficulties persist your baby may have significant tongue-tie or it may be time to consider a lactation consultant. You do not want to delay feeding due to sore nipples as this can result in a decreased milk supply, another obstacle mothers face when trying to breastfeed.

2. Low Milk Supply

One of the reasons why new moms stop breastfeeding is due to low milk supply. You can determine whether your baby is getting enough milk by watching their weight and feeling their fontanelles to determine whether or not they are hydrated. If their fontanelles (the opening at the top of the skull where the bones have not yet fused) are concave, your baby may be dehydrated. This can be caused by mom not drinking enough fluid or not producing enough breast milk.

The production of breast milk occurs on a supply-demand basis. The more the baby feeds and the nipples are stimulated, the more milk mom will produce. There are many herbs known to both increase and inhibit breast milk production.

When the baby is first born, some moms may need supplement with formula while they wait for their milk to come in. If this is the case, you can give formula to the baby through a tube beside the nipple so that your newborn is still stimulating the nipple to produce breast milk, while also pumping to further support the milk coming in. It is important to avoid the use of bottles in this scenario, as this may cause the baby to become 'lazy' and alter their ability to properly latch and suck with sufficient force.

What you can do:

• Stay hydrated- Approximately 13 cups or 3L of water/day is recommended (This can come from herbal teas, soups and smoothies as well)

• Stimulate the nipple via breast pump or baby latching - breastfeeding occurs on a supply-demand basis

• Use galactagogue herbs (herbs that stimulate breast milk production) - there are many herbal tea formulations and tinctures pre-made with these herbs (see above)

3. Oversupply of milk/ Engorgement

Another common obstacle to breastfeeding for new moms is engorgement. It is normal that when the milk begins to come in, the breasts will feel larger and heavier. If this persists, the breast may become engorged. This occurs when the breast tissue produces an abundance of milk that is not being expelled fast enough and results in enlarged breasts that are tender to touch. If this is not treated, it may lead to plugged ducts.

What you can do:

• Apply cold cabbage leaves to your breasts between feedings - this may seem a bit strange, however topical cabbage can help decrease the milk supply and the cold compress from the leaves is very soothing

• Encourage your newborn to feed for as long as they desire and avoid trying to control feeding times. Research supports baby's feeding on demand rather than a specific feeding schedule.

• Massage the breasts and pump as needed to reduce engorgement. Excess milk can be used topically on your baby to help with any rashes or scratches. It is also nice to add to the baby's bathwater.

• Ensure your bra is not too tight, but supportive.

• If the breast is too engorged for baby to latch, you can begin pumping to ease flattening of the nipple or use your fingers and apply pressure to the areola to raise the nipple
  
  

4. Plugged Ducts

If you are experiencing tender hard lumps in your breast tissue, without fever or signs of infection, it is likely that you have plugged milk ducts. Plugged ducts are common in breastfeeding women. When this occurs, the milk cannot pass through to the nipple to get expelled and pressure increases within the ducts.

What you can do:

• First place a warm compress on your breast for 5-10 minutes. Then begin to massage the tender lumps in a circular motion with firm pressure, pushing towards the nipple. You are trying to support the flow of milk through the ducts.

• Encourage breastfeeding often on the breast with plugged ducts to support the flow of milk. If the baby is not hungry following a breast massage, you may want to consider pumping to help the milk flow through the canal.

• Avoid underwire bras, or tight constricting clothing. Because the plugged ducts result in pressure disabling the free-flow of milk, additional pressure on the breast tissue can interrupt milk flow.

• Some experts believe that over-exertion by the mother and lack of rest can aggravate plugged ducts, so don't be afraid to ask for support! This could be a sign from your body telling you that you are doing too much.

5. Strong let-down reflex

A strong let-down reflex can be the result of an excess of milk production or it may just be the natural flow of milk for some moms. This may pose a challenge for the baby to latch or may cause difficulty drinking due to excess milk resulting in the baby choking. In many cases, the baby adapts to the strong let-down, and feeds are only about 5 minutes compared to longer feeds with slow milk flow. In some cases, the baby may not handle the abundance of milk so gracefully. If you notice milk pouring from your baby's mouth or your baby starts to choke on the excess milk, release the latch and let the milk flow out of your nipple until it ceases. Then latch the baby again and continue to feed.

Some women also have had luck with beginning their feed with a breast pump and then having baby latch once some of the let-down has been released.

6. Infection (Mastitis)

Mastitis can resemble a plugged duct, however, it is accompanied by flu-like symptoms such as malaise, muscle tenderness, and fever. I have heard of many women who stopped breastfeeding when they developed mastitis. However, if treated properly, this should pass within 24-48 hours and often does not require pharmaceutical intervention. If the infection persists, a course of antibiotics may be required. Consult your medical doctor.

What you can do:

• Continue to breastfeed on the affected side. You may pump if you do not feel comfortable breastfeeding.

• For pain and swelling, apply cabbage leaves or a potato poultice continually. With the cabbage leaves, you want to switch them out when they become wilted and warm.

Safe Herbal and Nutritional Support during breastfeeding:

• Echinacea

• Garlic (raw or capsules)

• Zinc

• Vitamin C

• *Be sure to consult your naturopath for specifics around dosing

Common Homeopathic Remedies used for mastitis:

• Hepar sulph: when there is an extreme sensitivity to the least touch and you cannot handle the baby nursing.

• Phytolacca: breasts that are lumpy and hard with intense pain when the baby feeds. Pain often radiates.

• Belladonna: very sudden onset of fever and symptoms. Breast is hot to touch, swollen and engorged.

• *Be sure to consult your naturopath for specifics around dosing

7. Inverted or flat nipples

Not having a protruding nipple can be another common obstacle to breastfeeding, however, it doesn't mean that you'll be unable to breastfeed. It just might take a little extra work and utilization of certain techniques or devices. Many women's inverted nipples will become everted as they breastfeed due to the pressure of the baby's suction, so the challenge often becomes easier with each feed.

What you can do:

• Before attempting a feed, roll your nipple between your fingers by applying pressure around the areola. It may also help to apply a cold compress to stimulate the nipple's reflex to harden when cold. This may help the nipple protrude enough for baby to latch.

• Use a breast pump prior to feeding to help nipple evert and provide a shape to the nipple in order to facilitate latching.

• Shape your breasts in a desirable position for feeding by gripping the breast tissue in a 'C' or 'V' shape and guiding it towards your baby's mouth.

• Use a nipple shield. These devices are made to assist the baby's ability to latch and may only be required for a short period of time while your baby is learning how to latch.

8. Tongue-tie (Ankyloglossia)

Dealing with tongue-tie is definitely outside of the scope of Naturopathic Medicine. However, it is important to know that significant tongue-tie can be an important obstacle for breastfeeding. Ankyloglossia occurs when the tongue is fixed or anchored to the base of the oral cavity, limiting the range of motion of the baby's tongue. The consequences of tongue-tie likely persist beyond breastfeeding and may cause issues around speech, digestion, social skills, and even structurally within the pelvic floor. Luckily surgical interventions for tongue-tie exist and have a very rapid recovery with few risks using laser dentistry.

1 in 8 babies experiences some degree of tongue-tie. If you notice your baby's tongue does not extend out fully and forms a ruffle when their mouth is open wide, your baby likely has tongue-tie. To confirm, consult with your doctor. Upon confirmation, there are different options available for treatment. The most common being surgical intervention or myofascial tissue work. If you choose to go the surgical route, there are 2 procedures performed. You may have the tissue snipped with a blade or cut with a laser. Consult a dentist in your area that specializes in correcting ankyloglossia and that uses laser dentistry to perform a frenectomy. There are much greater risks with having the tissue snipped rather than using a laser.

Tips for Success

1. Start 'Lactation Tea' at 39 weeks gestation - use lactation promoting herbs mentioned above

2. Opt for skin-to-skin contact immediately after the baby is born

3. Attempt breastfeeding within the first hour of the baby being born

4. Avoid bottle feeding or using a soother while the baby is learning to latch

5. If you are struggling with breastfeeding, consult a lactation specialist right away or as soon as possible.

There are many circumstances in which a mother cannot or should not breastfeed. To be told you cannot breastfeed your baby can be truly devastating. If you are in a circumstance where you are taking certain drugs that inhibit you from breastfeeding, if you have adopted a child or used a surrogate mother, or have a chronic illness or past illness that make breastfeeding impossible, there are alternatives that your baby can take to ensure good nutrition, such as Goat's milk formula, or donated breast milk. Check within your community to see if this is a possibility for you!

For mothers with an abundance of breastmilk, consider donating your breastmilk to couples who are unable to breastfeed their babies. Here is a link you can access to find out if you meet the criteria to donate your breast milk: https://www.milkbankontario.ca/donate-milk/how-to-donate-breast-milk/

Breastfeeding has so many benefits and often just as many challenges. I hope that some of these tips will help you on your journey as you navigate the wonders of breastfeeding. Always remember to consult a lactation specialist if you are struggling, it is okay to seek help!