New motherhood: What you need to know about breastfeeding

Breastfeeding not only helps the baby to withstand infections, it also enhances mother-baby bonding. In a conversation with Pavitra Jayaraman, lactation consultant Dr Shaibya Saldanha, stresses on the importance of breastfeeding for the mental wellbeing of the baby, and explains how new mothers can cope with the stress posed by difficulties in feeding. Edited excerpts:

How are breastfeeding and mental wellbeing related?

Breastfeeding is essential for the wellbeing of the baby. Unfortunately, it has become so fraught with  difficulties, worries and anxieties, that it very often seems to be failing. Breastfeeding is the next step after pregnancy and delivery and so if it doesn't work well or if there are too many worries and anxieties, the mother can get completely upset, traumatized and worried.

What are the challenges faced by urban women in breastfeeding?

Inherently, most of the actions that human beings do are learnt behavior. So whether it is about eating with your hand or eating with a knife and fork; or whether it is washing your bottom with water or with tissue paper, they are all learnt - you didn't know it instinctively. I'm glad you mentioned the urban woman, in contrast to either the rural woman or a girl who has grown up in slums. This is because of the middle class culture which has developed, making breastfeeding as an activity to be kept private and not something that is done within the family environment. The girl growing up in the urban situation hasn't seen anyone breastfeed, whereas a girl in a village or slums has seen her mother breastfeeding her siblings, has seen her sister and sister-in-law feeding their children. So inherently she has already learnt - though she hasn't realized it - how to hold the baby, how to burp and comfort a baby. So, they need a lactation consultant because of the lack of learnt knowledge.

A lactation consultant, in a way, helps women by explaining positions and the process of milk production, because a lot of women don't know that for the first 24 hours, you don't even get any milk. On the second day, there is about 20-30 ml. It is the third day that the milk starts producing and you get breast engorgement, and they don't know that. So they are really worried and instantly, all babies lose 10 per cent of their birth weight in the first 3-4 days, but this causes panic because they say, “Oh my god, the baby's weight came down. That's never meant to happen.” And so they start putting the baby onto formula and start disregarding breastfeeding.

When should preparation for breastfeeding begin?

After delivery, the woman's stitches are paining and her breasts are engorged and she has no sleep; this is not the time to start off explaining lactation to her. It should have happened in the antenatal period. So she should have sat with her family; breastfeeding is a family job. So the partner, her mother, mother-in-law and any of the people who will be involved in helping looking after the mother, must be involved in learning about what are the issues she would face while breastfeeding. Another thing is the myths. Sometimes it's very important to ask them, “What have you heard?.” Because they would say, “Oh, my friend had no milk” and somebody else will say “The baby never sucked” or “the baby cried all night” and things like that, which already cause a lot of stress and they already have these worries, which then become self-fulfilling prophesies.

Why does breastfeeding becomes stressful?

Stress and anxiety would be the riding emotion for pregnancy and after, for the simple reason that most women haven't even planned for the baby. They are persuaded to become pregnant by families, though they are not willing for it or ready for it. Then they have a baby, whom they haven't actually wanted. On top of that, if the gender is different, that is, if they wanted a girl, they got a boy and vice versa, or the color is different, it really upsets them.

I had a patient who had a baby girl. She, her husband and family were very happy. She had started off with her breastfeeding immediately after delivery. On the second day, I came for rounds and I found her sitting and crying, and the baby looking upset. She said the baby had cried all night and hadn't fed at all. So I tried to find out whether she had pain in the stitches and I found that something was not okay in the room. So, when I questioned her a little further, I found out from the mother that an aunt had commented, “Oh what a dark baby. What a pity she is a girl.” And that had set it off. So, until then, the woman was really happy, started off breastfeeding well. Now it just dropped to zero because of an extremely insensitive comment by a relative.   

How does breastfeeding help the mother bond with her baby?

The main hormone, which is secreted during breastfeeding is called oxytonin. It's also known as the cuddle hormone, a term used very often in Valentine’s Day celebrations. This hormone really helps in bringing attachment between the mother and baby. During breastfeeding, the mother relaxes and causes lot of comfort for the baby. Because the baby has been taken away from the natural environment where it was sitting for nine months, and is now settled on the mother's breast, it's actually hearing the mother's heartbeat, which was the running sound in the baby's life for the last nine months. So, breastfeeding inherently calms the mother and the child. The bonding definitely increases from there. But also beyond that is the ease of breastfeeding. A lot of women who wanted the baby, when they are happy about the baby, they can cope with all the initial hiccups. For human beings, babies need to be taught how to breastfeed. It doesn't happen with puppies and kittens but only with us. So how the baby's held, picked up, all of that makes a difference.

Is breastfeeding possible after the woman returns to work?

Industrialization is the main reason why breastfeeding has been harmed, because when there was a need for a greater workforce, the entire concept of formula feeding and bottle feeding came in. And it actually harms the growth of the child, who would be perfectly looked after if it was breastfed for a year. All the concepts of maternity leave not being given for more than 84 days, which is a standard in many governments and private firms that give even less, is terribly harmful for the child. In spite of that, mothers who are determined can breastfeed. Even if the woman breastfeeds through the night, she gives 500-600 ml of milk every night, and during the day, she can express milk, give the baby other weaned foods and totally avoid bottle and formula feeds.

Can mothers with psychiatric illnesses breastfeed?

The first question one would like to ask is if the woman is suffering from psychiatric illness, is she capable emotionally and physically to have pregnancy and take care of the child? That is the bigger question because unfortunately, specially in our Indian cultural system, it is presumed that if anyone has mental disease, you just get them married off and have a baby and everything is going to be fine, which is doubly harmful for both mother and the baby. So in psychiatric diseases, which are well controlled with the complete compliance of the mother and her partner, only then should the pregnancy be started. They need a lot more support, lot of care, especially understand about what medicines to take and even postnatally, if the woman has psychiatric disease, she can still be on medication and breastfeed without any problems.

What is the role of the family in supporting the new mother?

Breastfeeding will be successful when a woman who has delivered a baby has the full support of her family and doctor, and they are available to support her and the child, whether it's in feeding, taking care of the baby, or giving her the confidence that she can breastfeed. When a woman breastfeeds with confidence, she enjoys both the process of breastfeeding, she enjoys her baby, and she enjoys her post delivery period. It enriches her enormously, both in giving her an emotional experience which she may not have experienced otherwise, as well as giving the baby a fantastic start in life.

In fact, a lot of times we consider that breastfeeding is the first immunization for the baby. The emotional stability a child gets, the ability to withstand infections, the bonding and strength that babies have, which we now consider as the attachment to the primary caregiver, is hugely enhanced by breastfeeding. But, this will not be possible unless we realize that the mother breastfeeding the baby is a small part of the family dynamics. It means the mothers, the mothers-in-law, the grandmothers need to support the mother. It is very important for the husband to be part of the entire process, because for a woman, the husband's emotional support towards her baby makes a huge difference.