<div><p><span style="font-family: helvetica;">Achieving exclusive breastfeeding has been elusive for long due to varied challenges that hinder support for women and families of breastfeeding mothers. </span></p><p><span style="font-family: helvetica;">Initially, when a baby was born in a homestead, the society and community at large including experienced mothers would visit that home from time to time to nurse, gift and counsel the new mother on proper ways to care for the newborn and how to breastfeed. However, in recent times, the practice has changed and often after delivery and discharge from hospital, the new mother is left alone with their spouse to continue the care at home.</span></p><p><span style="font-family: helvetica;">At the point of discharge, a significant number of women may not be knowledgeable enough on how to breastfeed which within a week sends them back to hospital with breastfeeding-related problems like dehydration and loss of weight which may require admission for management.</span></p><p><span style="font-family: helvetica;">This year's World Breastfeeding Week themed “support breastfeeding for a healthier planet' calls for governments and private sector partnerships to protect and promote women's access to skilled breastfeeding counselling to support promote exclusive breastfeeding. </span></p><p><span style="font-family: helvetica;">Mary Mathenge, a Lactation Manager at Aga Khan University Hospital, Nairobi highlights some of the common breastfeeding related questions that require counselling support to build confidence in breastfeeding mothers. Such include;</span></p><p><strong style="font-family: helvetica;">What should you do if a baby refuses the breast?</strong></p><p><span style="font-family: helvetica;">The common causes are sore mouth due to thrush, the baby being ill or upset, or milk flow being too fast for the baby. As the baby gets older, they spend less time feeding. Do not hold the baby's head too tightly or push the face towards the breast as the baby will turn towards your hand instead of the nipple. It helps to squeeze a little breast milk onto the nipple before latching the baby.
</span></p><p><strong style="font-family: helvetica;">What makes the baby to choke while breastfeeding?</strong></p><p><span style="font-family: helvetica;">Sometimes the mother may have too much milk and the milk flows too fast causing the baby to choke or gag when feeding. As a result, the baby may refuse to feed and become restless. The mother may have to express a bit to soften the areola before starting to feed. Only offer one breast per feed and only when the baby appears hungry and the milk supply will settle with time.</span></p><p><strong style="font-family: helvetica;">How should you manage swollen or painful breasts?</strong></p><p><span style="font-family: helvetica;">A normal full breast feels tense and heavy, hot or hard, milk is flowing and there is no fever. It is not painful and is relieved by feeding. Breasts that are painful, swollen, tight (especially nipple), shiny may look red, tender, hard, lumpy, milk not flowing and fever are caused by either engorgement or mastitis. Both engorgement and mastitis result from an obstruction in milk flow.</span></p><p><span style="font-family: helvetica;">Engorged breasts are usually swollen, hard and painful but the mother does not feel ill. The milk does not flow freely. Treatment consists of encouraging the baby to suckle frequently. The baby should be fed on the most painful breast first. Placing ice or frozen cabbage leaves onto the breasts between the feeds will help reduce the swelling and a warm shower relieves the discomfort. A mild analgesic like paracetamol can also be helpful.</span></p><p><span style="font-family: helvetica;">Engorgement may be prevented by letting babies feed as soon as possible after delivery. Make sure the baby is well positioned and attached to the breast and frequently breastfeeding. Milk then does not build up in the breast. If the baby is not able to suckle to remove the milk, then the mother should express either manually or using a breast pump. If milk is not removed, it will result in mastitis or milk breast abscess.</span></p><p><span style="font-family: helvetica;">Mastitis is the inflammation of the breast due to blocked milk ducts and seepage of milk into the surrounding tissues. It causes severe pain, fever and the woman feels ill. Part of the breast is swollen and hard with redness of the overlying skin.</span></p><p><span style="font-family: helvetica;">Treatment of mastitis is warm compress, rest and mild analgesic. It is most important that the baby continues to suckle frequently on the affected breast as this will help the milk to flow.</span></p><p><span style="font-family: helvetica;">Mastitis affects part of the breast and usually only one breast, unlike engorgement that affects the whole breast and often both breasts. If the mastitis becomes infective, the mother should seek medical help for treatment.</span></p><p><strong style="font-family: helvetica;">How do you prevent painful nipples?</strong></p><p><span style="font-family: helvetica;">It is most important that the baby is correctly latched at the breast so that the nipple is not chewed. Remember that babies breastfeed and do not nipple feed. Make sure that the baby has all of the nipple and most of areola in the mouth when feeding. This wa,y nipples should not be painful, even in the first few days, if the baby is correctly latched to the breast.</span></p><p><span style="font-family: helvetica;">When removing the baby from the breast, the mother should insert her little finger into the corner of the baby's mouth to break the suction.</span></p><p><span style="font-family: helvetica;">After each feed, the mother should express a little colostrum or hind milk and apply on the nipples. The milk has anti-infective properties and the fat protects the nipples. Avoid vigorous washing or soap on the nipples, as this causes the nipples to dry and increase the risk of cracking.</span></p><p><strong style="font-family: helvetica;">How should you treat painful nipples?</strong></p><p><span style="font-family: helvetica;">Cracked nipples are very painful and should be prevented by correctly latching the baby to the breast and avoiding engorged breasts. Treat cracked nipples with breast milk spread on the nipple between feeds. Usually with correct latching to the breast, the mother will feel no pain and the crack will heal within a day. However, should the cracked nipple be too sore to continue feeding, express the affected breast. Feed the baby on the other breast and after the feed, give the expressed breast milk by cup.</span></p><p><strong style="font-family: helvetica;">Do breastfed babies need complementary feeds?</strong></p><p><span style="font-family: helvetica;">A mother can continue to breastfeed exclusively for 6 months and beyond. Most breastfed babies do not need complementary feeds or formula. Complementary feeds decrease the time the baby spends on the breasts and thereby, reduce the production of breast milk. Both feeds may confuse the baby.</span></p><p><span style="font-family: helvetica;">Only if the baby continues to lose weight and the mother has inadequate lactation, should complementary feeds be used. The mother should express her breasts to increase milk production.</span></p><p><span style="font-family: helvetica;">This is a decision that should only be reached at after consultation with health provider and efforts to improve lactation deemed unsuccessful.</span></p><p><strong style="font-family: helvetica;">How long does expressed breast milk last?</strong></p><p><span style="font-family: helvetica;">For working mothers, breast milk can be expressed and stored while at work, then given to the baby after work. Expressed milk is safe for 8 hours in room temperature.</span></p><p><span style="font-family: helvetica;">Expressed milk can be stored safely in a deep- freezer for 3-6 months.</span></p><p><span style="font-family: helvetica;">Frozen milk should be liquefied slowly by placing the container in warm water. Direct heating (boiling) or using a microwave is not allowed as this may destroy all the antibodies and living cells in the milk.</span></p><p><span style="font-family: helvetica;"><strong>Do drugs cross into the breast milk?</strong> </span></p><p><span style="font-family: helvetica;">Almost all drugs that the mother takes by mouth will cross into the breast milk. Breastfeeding mothers should only take medication after consultation with their doctor who should be made aware she is breastfeeding.</span></p><p><span style="font-family: helvetica;"><strong><em>Responses by Mary Mathenge, a Lactation Manager at Aga Khan University Hospital, Nairobi</em></strong></span></p></div>
