Is your baby getting enough breast milk?

A friend once shared a story of a woman who had spent a week without producing breast milk for her newborn baby. She went into a frenzy, running from one pharmacy to the next looking for alternative baby food while trying various baby formula.
However, her baby would immediately get an upset stomach making the suggested remedies ineffective.
In another case, a woman faced with a similar problem was aised by her grandmother to eat bitter berries commonly known as katunkuma to boost the production of breast milk or increase its amount. Nutritionists agree that these foods may help but little is known about how they work.

The case for exclusive breastfeeding
“Breast milk is a very important diet for babies and they should be initiated to it immediately after birth with a recommendation of six months of exclusive breast feeding and complimentary feeding up to two years,” says Dr Isaac Musoke, a nutritionist at Nsambya Homecare clinic.
Musoke aises that if a mother cannot produce breast milk, the baby should just be laid on her chest where it will start suckling immediately to provoke the production of milk. He says that this early initiation also helps in the bonding of mother and baby.
He adds that the baby should not be fed on anything, not even water before it has tasted breast milk. This is to guard against the possibility of the baby rejecting breast milk and yet their stomachs are not yet adapted to artificial foods at this stage.
Dr Musoke explains that exclusive breastfeeding means giving the baby only breast milk for the first six months of life and complimentary feeding means giving breast milk alongside other feeds as the baby grows.
Breast milk contains vitamins, proteins, fats and carbohydrates which are required for early childhood development. “It is the recommended food for babies because it is a balanced diet with all the required nutrients for the baby in the right amounts. Breast milk also has anti-bodies passed on from the mother which boost the baby’s immune system,” says Dr Lynnth Turyagyenda, a nutritionist with Mwanamugimu nutrition unit at Mulago National Referral Hospital.
She says the antibodies in the breast milk protect the baby against infections such as flu, cough, diarrhoea, pneumonia and malnutrition.
Studies show that children who are breastfed are more likely to be better performers as compared to those who did not breastfeed because breast milk contains nutrients that stimulate brain development. Dr Musoke, however, says that other baby feeds such as formula have the nutrients but not in proportional amounts.

Foods that boost milk production
“The breast is not just a store for milk but a factory that produces milk for the baby and this should happen normally for every mother, says Dr Godfrey Magumba, the country director of Malaria Consortium.
Changing the mother’s diet will enable her produce the required breast milk. He therefore recommends that the mother feed on carrots, sesame seeds, oatmeal, garlic, ginger, groundnuts to boost milk production.
“She must increase her intake of hot drinks as well such as porridge to enable free flow of the milk, including drinking more water and eating more food while breast feeding,” Dr Musoke recommends.
Dr Turyagyenda aises that breast feeding mothers should take at least five balanced meals a day with plenty of vegetables and fruits.
“A mother should also take one big flask of highly nutritious hot porridge such as bushera with milk or soya porridge at least an hour before breastfeeding. This hot porridge or soup stimulates faster flow of milk,” she adds.

Feed on demand
Dr Turyagyenda aises that mothers should follow the “breastfeed on demand principle” where the baby is fed whenever it shows signs of hunger. She says this is because breast milk is produced when the baby suckles. “The more it suckles, the more milk is produced as the brain signals to the glands that more milk is needed. If the baby does not breast feed then the brain will signal the milk flow to reduce,” she adds.
For mothers who work away from their babies, Dr Turyagyenda aises that they express the breast milk either using their hands or a breast pump. Before expressing the milk, the mother should wash her hands and use clean containers for storing the milk.
The extracted milk can be stored at room temperature for up to eight hours, and 24 hours under refrigeration without going bad or losing its nutrients. If it is frozen, it can stay for months.
Factors that limit the production of milk include stress, illness, fatigue, caffeinated drinks, some medications, spices, alcohol and smoking. Mothers with untreated TB, HIVAids, Hepatitis B, breast cancer, mental illness and breast sores may be exempted from breastfeeding.

HIV and breastfeeding
For HIV positive mothers, Dr Isaac- Musoke aises that they should be counselled beforehand so that they can decide whether to breast feed or not. “If she decides to breast feed, she must stay on antiretroviral drugs (ARVs) then begin with exclusive feeding for the first six months before introducing other food later on,” Dr Musoke says.
“However many mothers cannot afford baby formula so we encourage them to breast feed while on treatment,” she says.
Turyagenda argues that giving the baby mixed feeds doubles their chances of acquiring infections since their immunity has not been boosted with antibodies from breast milk.


Common mistakes
According to Dr Lynnth Turyagyenda, some of the common mistakes first time mothers make include
Failing to put the baby on the breasts immediately after delivery or within a period of 24 hours. This breaks the bonding to the breast which is supposed to stimulate milk flow.
Some mothers worsen this by discharging themselves from the hospital without initiating the baby to breast milk which makes the baby dislike breast milk upon reaching home yet the mother has no medical personnel to help her.
Poor positioning is another challenge to breastfeeding mothers who do not know the right way to hold the baby while feeding. Once the baby or mother is not in a comfortable position, effective breastfeeding cannot take place. To ensure that the baby is well-positioned, your baby’s tummy should be facing your tummy, head and body should be in line, its nose should be facing the nipple and the whole body should be supported.
Taking tea or coffee with meals interferes with iron absorption and contributes to anaemia. Mothers who cannot avoid tea should take it at least one hour before eating food for proper absorption to occur.
Mothers also ignorantly self-medicate themselves with pain killers without their doctor’s prescription which could be harmful to the baby.
There is a misconception that small breasts mean less milk or breast feeding may cause their breasts to sag. He says this is not yet proven scientifically. He suggests that counselling and massaging the mother’s back helps relax her and improves breast milk production especially for the working mothers.

Feeding positions
“Generally, there are four basic positions for breast feeding babies, cradle, cross cradle for small infants, under arm and lying down position,” says Fatuma Naigiro, a nutrition intern at Nsambya Home care clinic.
In all these, Naigiro says the baby’s mouth should be fully open with its lower lip below the nipple. The mother can then hold around the nipple with her thumb and the rest of the fingers should support the weight of the breast.

Dr Lynnth Turyagyenda, nutritionist with Mwanamugimu nutrition unit at Mulago national referral hospital
Dr Godfrey Magumba, the country director of Malaria Consortium.

To breastfeed in public or not?

I think breastfeeding should be done anywhere at any time as long as there is breast milk because milk plays such a pivotal role in child development and growth of a child.”
Christopher senyimba, customer relations and feedback officer

It’s okay to breastfeed anywhere as long as the person doing it is comfortable. However, they should bear in mind that contaminated breast milk can affect the baby.”
Sulaiman Onzima, marketer

While at home, one should breastfeed in the bedroom if there are other people around. Breastfeeding should never be done in public.”
Sam Ntesibe, circulation and sales supervisor

I think every woman should endeavour to breastfeed for not less than a year. However, it should be done privately. If it is inevitable while in a public place, they should cover themselves.”
Mary Atuheire, Brand Coordinator

As long as the breasts are clean, a mother can breastfeed anytime a child is hungry. I can’t let my baby cry because I have no privacy to breastfeed. I just pull it out and cover a bit in order not to expose the breasts to the public.”
Betina Kavuma, volunteer

Breasts are considered private to a woman. So in that case, breastfeeding should be done in private either at home or washrooms. Not everybody is interested in looking at a woman’s breasts.”
Liz Nasuna, self employed


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