Breastfeeding - a community effort

 World Breastfeeding Week – 1 – 7 August

Why is breastfeeding so important?

Justus von Liebig, a chemist introduced formula in 1865. Back then, the marketing tactics persuaded women that formula-feeding was superior to breast milk. Today, bottle feeding is just easier. Now that we understand the benefits of breastfeeding, both for mom and baby, especially the development of the immune system, the tide is turning, and more women are opting to breastfeed, especially during the first six months.

Sharing this responsibility.

Successful breastfeeding begins before the birth when future parents learn as much as they can about breastfeeding. Hospitals have also adopted a breastfeeding policy, using ‘The Ten Steps to Successful Breastfeeding’ guidelines, and closing the milk kitchen where formula feeds were mixed.  Nurses and midwives working in these units attend regular breastfeeding updates so that they can advise new moms on how to prevent breastfeeding problems. Lactation Consultants specialise in breastfeeding difficulties and help moms with home visits or online consultations. They’re also registered with medical aid providers.

Immediately after the birth, the baby is put skin-to-skin on the mother’s chest for what is called the ‘first magic hour. This is when the baby is most alert, the sense of smell the strongest, and when bonding between mom and baby begins. Left undisturbed, the baby instinctively nuzzles looking for the nipple. When the baby suckles, s/he gets their first taste of sweet colostrum (baby’s first milk) and mom’s breastfeeding hormones kick in.

Dealing with Covid-19:

To minimise the risk of getting Covid-19 in the hospital, when there are no complications, mom and baby are sent home after the first 24 hours. Women who have had a c-section go home on their third day. All women are encouraged to get breastfeeding help and advice from organisations like La Leche League, the Gauteng Breastfeeding Forum, their ante-natal midwife or a Lactation Consultant.

According to Professor Priya Soma-Pillay, obstetrician gynaecologist who heads the research centre for maternal, foetal and new-born child health at Pretoria University, lactating women can safely be inoculated and continue breastfeeding.

Benefits of breastfeeding:

MOM or Mother’s Own Milk is unique and perfectly formulated according to the needs of each individual baby because her milk comes from what she eats and contains invaluable antibodies to protect her baby from infections

Colostrum – or baby’s first milk – has been called ‘liquid gold’ because contains everything a newborn needs. Just one teaspoonful at each feed for the first 12 hours is enough

Colostrum has a laxative effect that helps to prevent or minimise ‘baby jaundice’

Breastmilk has unique immunological benefits – in other words, it prepares the gut to absorb nutrients while minimising the risks of developing allergies and poor gut health

Babies benefit from amino acids (proteins) only found in breastmilk. These help to feed a baby’s fast-growing brain. 

Breastfeeding can help to reduce a woman’s risks of breast cancer

Breastfeeding helps mom to burn extra calories she may have gained during pregnancy

Breastfeeding means fresh milk at the right temperature is always ‘on tap’

Night-time feeds are easier to deal with

Research has shown that breastfed babies are less likely to get asthma, allergies and colic. Breastfeeding also helps to reduce the risks of obesity and type 11 diabetes in adulthood.

 Breastfeeding is economical and more hygienic.

For more breastfeeding information, type ‘breastfeeding’ in the subject line on the gadgets page.

 

Deciding what to pack for the hospital and feeding options

 

Four weeks to go - Breastfeeding dilemma – do I, don’t I?

Hannah says her baby girl is moving like crazy – day and especially at night. I’ve heard it said that the way a baby moves in the womb is a pretty good indication of their personality. With both her parents self-confessed ‘firecrackers of ‘get up and go’, it’s not surprising that Hannah’s little one will be a bundle of energy too. Time will tell.  

Hannah has been packing her bag for the hospital. Now that she knows she will be having a c-section, there’s no need to pack a ‘labour bag’. Only the essentials for her hospital stay which shouldn’t be for longer than three nights.  Hannah’s hospital will supply a bag of essential ‘goodies’ like pads, disposable panties and nappies. She only needs to bring toiletries and pj’s, her going-home clothes, sleep-suits and blankets for her baby. Her dilemma is: what does she pack for feeding?

If Hannah chooses to breastfeed, she will need feeding bra’s, disposable breast pads, possibly nipple cream and a cabbage in the fridge at home (in case her breasts are uncomfortably full on her third day when she comes home from the hospital).

Her paediatrician has recommended formula feeding (Hannah is HIV positive, taking ARV’s and has an undetectable viral load – which means that there’s a possibility she could breastfeed providing her viral load stays undetectable). If Hannah chooses to formula feed, she needs to bring formula, bottles, teats and all the necessary feeding and sterilising paraphernalia. This is because maternity hospitals no longer have a ‘milk kitchen’ for formula-fed babies. This is because all women are encouraged to breastfeed.

This is a toughie for women like Hannah. In the first place, not every woman WANTS to breastfeed and women should ENJOY their babies and not feel OBLIGED to breastfeed. An example of women who can’t breastfeed is those who have had a breast reduction – especially if the nipple was removed and reattached. Similarly, depending on the type of surgery, women who have had a breast enlargement or treatment for cancer such as a partial mastectomy or reconstructive surgery. There are also medical reasons, such as severe type 1 diabetes, certain auto-immune diseases or conditions requiring chronic medication like epilepsy.

Weighing up the pros and cons:

Hannah worries that if she doesn’t breastfeed, she will miss out on ‘bonding’, and the convenience of having milk ‘on tap’ – especially at night when she can simply lift her baby from the crib, and latch her. MOM (Mother’s Own Milk) is custom made for each individual baby which means not having to stress about which formula to use. Another bonus is that breastmilk changes according to the baby’s needs. (To learn more about breastfeeding, simply type the word breastfeeding into the subject line on the blog dashboard)

On the other hand, if Hannah chooses to formula feed, her partner, mom or sister can feed her baby – a satisfying and bonding experience for them. Formula feeding means that you don’t need to ‘wear your baby everywhere you go. Breastfeeding in public is still taboo – especially in restaurants where the strongest objectors are men. Formula-fed babies adapt more easily to a routine, and moms are spared discomforts like engorged breasts, cracked nipples or a hungry baby when the milk supply is low.

This is Hannah’s choice. My only advice for her (and all other women facing this dilemma) is: trust your instincts. This maternal instinct is a gift of motherhood. Learning to trust your instincts is the first and most important lesson you’ll learn. It comes naturally. Do you remember what happened 9 months ago? You realised that something was different – and instinctively asked ‘Am I be pregnant?’

Breastfeeding and Covid-19:

According to Professor Priya Sama-Pillay, head of obstetrics and Gynaecology and the Research Centre on Maternal, foetal and new-born and child health, Pretoria University, pregnant women should be vaccinated (preferably at or after 14 weeks), breastfeeding women can be safely vaccinated and shouldn’t stop breastfeeding.

Women who contract Covid-19 and are infectious can continue breastfeeding, but should be extra cautious – wearing a mask and sanitising. If she is unwell, she can express her milk, (this is safe to feed to her baby) taking all the necessary precautions to prevent contamination.

Photograph: Aloise Ireland

  

Physical and emotional changes in the third trimester

Five weeks to go. Hannah’s calling herself: ‘Fatty sitting on the sofa’

It’s been a week filled with fear and anxiety for all South Africans. Hannah* too. In fact, she’s been ‘down the rabbit hole’ of despair, calling it an ‘overwhelming week’.

Why has this happened?

Prolonged Covid isolation

Feeling hopeless and helpless in light of the country’s carnage

Feeling guilty that she is safe while others are in danger

Wondering what kind of world she is bringing their child into?

Asking herself: Will I be a good mom? And …

Will I ever be ‘me’ again?

I love Hannah’s honesty. She’s not covering up this stage of her pregnancy in a bubble of maternal bliss. Coming from a marketing background, Hannah knows all about unrealistic ‘window dressing’, social media platforms that make pregnancy look like a breeze, glossy magazines with gorgeous models and photoshopped pictures depicting pregnancy and motherhood as heavenly bliss.

What’s happening to Hannah – and all pregnant women at this stage:

Pregnancy brings about both physical and emotional changes. During the first trimester, a woman’s thoughts are self-centered: ‘I’m pregnant'. In the second trimester, especially once she feels her baby move, her thoughts are ‘I’m having a baby'. In the last trimester, she realises, ‘I’m going to be a mom’. It's scary!

Hannah, a self-confessed ‘fashion queen’, socialite and people’s person who loves giving spur-of-the-moment dinner parties, enjoying a glass of wine or two with her girlfriends, relishing freedom and independence, is already mourning the loss of her ‘old self’ and has begun the journey of rediscovering who she is.

The pressure of deadlines and putting out fires in the chaos of the marketing world kept Hannah on her toes. The adrenaline rush gave her energy, and the success of pulling off yet another project gave her a sense of achievement. Now she’s is struggling to come to terms with losing her job, the loss of income, and finding a new job in the New Year.  

Covid restrictions have put just about everybody under house arrest. This means no more browsing malls and spending time in a coffee shop or book store. All we can do is wear a mask, arm ourselves with a sanitizer, avoid other shoppers, buy what we need and hurry home.

And then there are the physical changes of pregnancy. Hannah says she’s feeling ‘fat’ but she is just full of her baby, placenta, and amniotic fluid. Now her belly is getting in the way of her mobility, and simple things like getting in and out of bed, or off the sofa, are getting more and more difficult.

Many women struggle with mood swings that Hannah has managed (so far) to avoid. Feeling happy one minute, then bursting into tears the next, is common and confusing during pregnancy.

How is Hannah coping?

“Being able to talk to my mom is a big help,” Hannah told me. Her sister, who has a young baby, is on ‘speed dial’. Hannah is also attending online prenatal classes and benefitting from good advice from her midwife.

We discussed what Hannah has achieved so far: the nursery is ready, Hannah’s health is good, the date of her c-section has been set and her paperwork is in order (search ‘paperwork’ on the gadgets column for this post).

Now Hannah needs to fill her days with something constructive and creative, with an activity that’s easy and practical to do (the link to ’44 life-giving hobbies for tired moms’ is also on the gadgets column). Hannah has done a few color-in pictures, and painting. This week she is going to try hand-crafts like knitting. It’s relaxing, constructive, enjoyable, and easy to do.       

* We’re sharing Hannah’s journey through the last few weeks of her pregnancy. If you missed the first blog, check out last week’s post.

 

 

Following Hannah's pregnancy

 This is happening – six weeks to go!

Welcome, Hannah* - 33 weeks pregnant with her first baby, age 36, HIV positive with a positive attitude in life. This special lady is going to share the last leg of her pregnancy with us.

When Hannah was diagnosed with the Human Immuno-Deficient Virus (HIV) 15 years ago, she thought that getting pregnant “would never happen to me”. She was overwhelmed with the stigma attached to this viral infection. At the time she thought HIV would rob her of a “normal life”. “This pregnancy has shown my partner and I that we’re as normal as any other couple,” Hannah said in an interview.

The road to this point hasn’t been easy. When Hannah tested positive, she started anti-retroviral treatment. By sticking to a rigorous medication regime and healthy habits, like eating healthy and exercising regularly, Hannah focused on her career and living positively. Her persistence, patience and perseverance over the last ten years has resulted in an undetectable viral load and a healthy CD4 count.

Cape Town based HIV clinician; Dr Laurence confirmed in a medical webinar that modern ARV’s have changed the lives of people living with HIV. “Having an undetectable viral load reduces the risk of transmission by up to 96%”, he said. Although neither a cure nor a vaccine has been found, ongoing research in the field of gene therapy and injectable ARV’s is promising. Research for an HIV vaccine helped to develop the Covid-19 vaccine.    

To date, Hanna’s pregnancy – apart from setbacks like Covid restrictions and retrenchment – has gone smoothly. “Now that I’m not working, I’ve been able to escape corporate stress, spend time at home with family and look after my health,” she said.

Understanding viruses like HIV and Covid-19:

A virus on its own is weak. It cannot move, jump, slip, slide, grow or multiply. It’s absolutely helpless and, unlike a bacteria or fungus, without a host, it simply dies. BUT, once it gets into a host (human or animal) through the nose and mouth (as with Covid) or body fluids (HIV), it’s super powerful. This sneaky virus latches onto immune white cells (CD4) where it changes DNA into its own RNA, enabling it to multiply. The result is an increased viral load that damages the immune system (low CD4 count). Taking ARV’s helps to stop the multiplication of the virus and keep it under control. Providing a person living with HIV is taking their medicines regularly and without a break, the viral load can be kept low, even ‘undetectable’.

‘Let’s be real’ decisions:

Now that Hannah has only six weeks to go, it’s time to face the reality of giving birth. Her gynaecologist said that, although it is possible to have a vaginal birth with HIV, in Hanna’s circumstances, it will be best if her baby girl, is delivered by c-section. Luckily, Hannah did not have her heart set on a ‘birth plan’, preferring to put her trust in the decisions made by her specialists. A booked c-section can help to eliminate risks like prolonged labour, haemorrhaging, exposure to Covid and interfering with Hanna’s healthy immune system.

Hannah’s paediatrician has also recommended formula feeding.

“I don’t want to have to feel guilty or explain to people why I have been booked for a c-section, or why we will be stocking up on formula,” Hannah said. “Everybody’s circumstances are different, and I trust my health-care providers who only want to the best for me and my baby girl.”

Right now, Hannah is enjoying good health, admittedly skipping yoga and spending more time on the couch than she intended, enjoying feeling her baby-girl move within her belly, and looking forward to the day when her carefully prepared nursery will be home to a very special little girl just waiting to make her grand entrance! 

*Not her real name.

Pregnancy niggles - constipation

 

Things we don’t talk about when we’re pregnant

Burping, breaking wind and constipation are just a few ‘unmentionables’ pregnant women don’t like talking about. Seemingly a minor issue, they’re never-the-less problematic, not to say embarrassing. Hormones, pressure, nausea and the lack of exercise usually trigger these problems.

Causes of constipation:

During pregnancy, progesterone tends to make the bowel sluggish. This delays the progress of food through the gut, maximising nutritional absorption. On the downside, this delay tends to reabsorb water and dry-out stools, making them hard and difficult to pass.  

Ongoing constipation often begins with bad bowel habits – like over-using laxatives, delaying the ‘call of nature’, not drinking enough water, a bland diet and not getting enough exercise.

Irritable bowel syndrome (IBS) with bloating, passing wind, constipation and diarrhoea is more common than we realise. This is mostly caused by today’s sedentary lifestyle, stress overloaded (no doubt exaggerated by Covid-19) and not eating enough raw fruit and vegetables.

Medical problems like diabetes or an underactive thyroid gland and depression tend to exaggerate constipation. More serious conditions like a damaged spinal cord, multiple sclerosis and Lupus Sjögren’s all cause chronic constipation. This means they won’t go away, and you’ll need to find ways to cope with this problem.

Chronic constipation is something you should talk to your doctor about because it could have more serious implications.

Supplementary Iron (folic acid) is prescribed during pregnancy. It should be taken with a glass of water to prevent constipation. Molasses is a good substitute because it’s rich in iron and doesn’t aggravate constipation problems. Other medications to avoid are codeine and calcium-based antacids. Some women have weird cravings. Called pica, nibbling on clay, chalk, laundry starch, toothpaste and even sand is not good for the gut.   

Fruit can help. Bananas, however, because they contain pectin, can either aggravate or relieve constipation.

Women confined to bedrest miss out on exercise. Fortunately, this is rare and most women can carry on with their regular exercise routine throughout pregnancy.  

What happens when you’re constipated?

Constipation can make you feel very uncomfortable – especially when your baby is taking up most of your tummy space. You could get haemorrhoids (piles) – best dealt with by using creams like Preparation-H. Passing big, bulky stools could split or tear the anus. This is evident when fresh blood is seen after wiping.  

What can you do about it?

Treatment depends on the cause. In mild cases, a change of diet, exercise and increasing fluid intake solves the problem. A mild laxative such as milk of magnesia can help. Glycerine suppositories help to soften hard-to-budge stools.

Bowel-training means getting into the habit of emptying your bowel regularly – not necessarily daily, but at least 3 – 4 times a week.

A prescribed laxative should contain natural ingredients. Ask your pharmacist or doctor. Don’t self-medicate.  Laxatives that contain fibre or softeners make stools easier to pass. Some laxatives draw water from the bowel or stimulates peristalsis. These are not recommended during pregnancy. It’s best to use herbal or natural laxatives – excluding Senna – during pregnancy.