Episode 6 Lactation & Breastfeeding

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“Hello. My name is Dr Alyce Wilson. I'm a public health registrar and senior research fellow at the Burnet Institute. I also continue to work at the Royal Women’s Hospital and have an honorary role in the Department of Obstetrics and Gynaecology at the University of Melbourne.

So today, I'd like to talk to you a little bit about breastfeeding. And so, breastfeeding has many benefits for both mothers and babies. And in Australia our infant feeding guidelines align with the World Health Organization guidelines, which is that infants are exclusively breastfed until around six months of age when solid foods are introduced, and that breastfeeding is continued until 12 months and beyond as suits the mother and the baby.

There is now quite a lot of evidence to show the benefits of breastfeeding. And so breastfed babies are less likely to suffer from necrotizing enterocolitis, diarrhoea, respiratory illness, middle ear infection, type 1 diabetes, and childhood leukaemia. And there's also some evidence that shows that breastfed babies have enhanced cognitive development.

Breastfeeding also benefits mothers by promoting faster recovery from childbirth, reducing the risk of breast and ovarian cancers in later life and helps with increased birth spacing and reduced maternal depression. Breastfeeding can also help with mother and infant bonding. However, unfortunately, the Australian National Infant Feeding Survey, which was last conducted in 2010, showed that not enough babies in Australia are exclusively breastfed. And so, whilst 90 percent of women started exclusive breastfeeding, only 15.4 percent of babies were exclusively breastfed to five months, which is actually less than the recommendation of six months. In Australia, we do have an Australian National Breastfeeding Strategy, which is from 2019 to beyond. And this has a whole lot of different evidence-based strategies for trying to increase breastfeeding in the community.

So, there's been a lot of work which has been undertaken by the World Health Organization, by UNICEF, to try and encourage breastfeeding, and also and particularly around making breastfeeding something that is okay and should be promoted anywhere, anytime. And so, there's a lot of different advocacy work and initiatives to try and make our societies more breastfeeding friendly. The Lancet series on breastfeeding, which was conducted a few years ago, found that if all infants under six months of age were exclusively breastfed, we could prevent 823, 000 annual deaths in children under five years and save an estimated 302 billion dollars annually in economic losses from cognitive deficits.

However, there's a lot of the formula industry is quite powerful, and they have also had quite a role in influencing recommendations around breastfeeding which is really unfortunate. So, in Australia, as I mentioned, our recommendations align with the World Health Organization. There are a number of different initiatives such as breast baby friendly hospital initiatives, which really promote hospitals that are breastfeeding friendly.

So, this is where clinicians and midwives, obstetricians and gynaecologists will have skills and knowledge in breastfeeding to be able to support mothers and their families with breastfeeding as well as different issues around introduction of formula, so preventing introduction of formula and so forth to try and really encourage that exclusive breastfeeding early on.

And particularly you'll probably be aware that the colostrum, which is a breast milk produced in the first few days after birth, is particularly rich with lots of different immune components of breast milk. So, really important antibodies and so forth to protect baby from any infections.

So, whether or not women decide to breastfeed is really a personal decision and it's something that they will want to discuss in conjunction with their partner, with midwives as well with obstetricians and gynaecologists. And if women choose not to breastfeed, then it's really important that they're provided with the support to know how to properly prepare and safely prepare infant formula and to watch for any feeding cues from babies.

And even if women choose to not breastfeed and choose to use infant formula, skin to skin and that contact between mother and baby and partner and baby is really important still and has lots of different health benefits. Some women who may have planned to breastfeed and then for different reasons are not able to may be quite disappointed that they haven't been able to breastfeed.

And so, it's really important that there's support and help provided and that women are referred to the relevant different services to help with this. So, for women that are breastfeeding, there can be lots of different tips and ways to support women to breastfeed and to help. And so, this can be around that skin to skin and feeding the baby as soon after birth as possible.

The World Health Organization and our guidelines in Australia recommend that baby is fed within the first hour after birth. It can take a few days for the milk to come in, per se, and this will be helped by the baby suckling at the nipple. And so sometimes the milk can take up to 72 hours after birth to actually come in. And so, the baby's just having colostrum at the start, and then the milk will start to come in.

Newborn babies need to feed pretty frequently. They have a small stomach, and they do feed quite often, and this could be up to 8-12 times in 24 hours. Breastfeeding is not something that just necessarily comes naturally to people. It is a learned skill. And so really having that support early on to make sure there's good attachment between the baby and the nipple is really important. That will not only ensure the baby is fed and is able to get a good feed, but also that breastfeeding is less uncomfortable. So that's ensuring that there's a good attachment and sometimes reattaching the baby can be really important. Learning to breastfeed does take time and so it's really important that women are supported during this time. Midwives are excellent, lactation consultants, GPs, and obstetricians and gynaecologists. It's all really important that everyone is supportive of breastfeeding and helping the mothers in learning how to how to breastfeed.

In terms of knowing how many breastfeeds is normal or what's normal, it, it really is sort of babies will feed on demand. And so sometimes mothers won't know whether their baby's having enough breast milk. But some of the good markers can be if a baby has six to eight really wet cloth nappies or four to five really heavy disposal nappies in 24 hours, generally they're having enough milk; they've got soft bowel motions usually at least once a day in the first three months; that they settle after the feed; they're gaining weight appropriate to their age, and by visiting the maternal child health nurse, they'll have their weight and their height against the growth charts, and so if they're gaining weight and height appropriately, then they're having enough food, enough breastmilk.

So, as mentioned we recommend exclusive breastfeeding to six months, after this stage, breast milk doesn't have sufficient iron content to meet the needs of a baby at around six months, and babies will start to show interest in solid foods as well. And so, there's this gradual introduction of appropriate solids, but breast milk or formula is still important for the first year of life.

And then women may choose to breastfeed beyond 12 months as well. In terms of support for breastfeeding women, so there's a number of different organizations such as the Australian Breastfeeding Association which does have a hotline that women can call to get support. Most hospitals, particularly tertiary hospitals, will have lactation consultants which are available to provide extra support, as well as of course midwives.

And there are some recommendations that if women are wanting to breastfeed that they actually attend breastfeeding classes while they're pregnant and particularly with their partner, it is really important. The research shows that, you know, for breastfeeding to be more effective and successful, that there's a supportive partner and family wider environment that includes parents in laws and wider family that everybody is supportive of this.

And those breastfeeding classes can provide really helpful information around breastfeeding techniques and any myths or misconceptions, helping to build confidence and also setting appropriate expectations and discussing any questions that women may have.

So, there can be a number of different problems that can occur with breastfeeding that can be that can be common, including mastitis. So, mastitis is inflammation or infection of the breast and it's often caused by a blocked milk duct or some kind of damage to the nipple which prevents proper release of the milk and therefore there's some stasis of the milk leading to infection. Also, if there's poor attachment or if the breasts are too engorged, and this can be due to too long between feeds or the breast not being fully drained during a feed, if a bra is too tight, there can be lots of different causes.

Some of the symptoms of mastitis can be fever, women can feel really unwell, there can be a patch of red skin on the breasts or like a really sore and hard area. And so, to help manage mastitis, it's really important women actually continue breastfeeding as this helps the breasts to drain and to clear the infection.

Women can use warm packs or a warm shower. They can gently massage any breast lumps out or they can use a cool pack on the breast after feeding to reduce any discomfort and swelling. They can also take Paracetamol and Nurofen. You can use Nurofen after pregnancy, safely, and drinking plenty of water.

However, if mastitis is not treated or not managed early, it can become quite a serious infection. And so it can be appropriate for antibiotics to be prescribed. And so, it's really important that they see their GP if there is ongoing issues. Just like pregnancy, there's certain medicines that are that are safe or that are unsafe to take while breastfeeding.

And so, it's really important that you ask about whether women are breastfeeding or not so that you can ensure that any medications or medicines that are being prescribed are safe for them to take when they're breastfeeding and safe for baby. And that's all. Thank you."