Fay­ola Fras­er

For many new moth­ers, breast­feed­ing is por­trayed as some­thing that should come nat­u­ral­ly, an in­stinc­tive act that moth­er and ba­by sim­ply know how to do. Na­tion­al Breast­feed­ing Week is an an­nu­al ob­ser­vance from Au­gust 1-7 that high­lights the im­por­tance of breast­feed­ing and the wide-rang­ing ben­e­fits it pro­vides for ba­bies, moth­ers and fam­i­lies. It is al­so an op­por­tu­ni­ty to pro­mote greater aware­ness, ed­u­ca­tion and sup­port for moth­ers, while ad­dress­ing the chal­lenges and mis­con­cep­tions that can sur­round breast­feed­ing. In Trinidad and To­ba­go, the week pro­vides an im­por­tant plat­form to en­cour­age in­formed con­ver­sa­tions about breast­feed­ing, strength­en ac­cess to lac­ta­tion sup­port and re­mind moth­ers that they do not have to nav­i­gate their feed­ing jour­ney alone.

Dr Ash­ley-Anne Fred­er­ick, a med­ical doc­tor, mem­ber of the Roy­al Col­lege of Pae­di­atrics and Child Health, and board-cer­ti­fied lac­ta­tion con­sul­tant, is one re­source, among many, to help moth­ers and ba­bies nav­i­gate the breast­feed­ing jour­ney. Ac­cord­ing to Dr Fred­er­ick, one of the most im­por­tant fac­tors in­flu­enc­ing breast­feed­ing suc­cess is sur­pris­ing­ly sim­ple: en­sur­ing moth­ers have the in­for­ma­tion and sup­port they need.

There is a par­tic­u­lar kind of sure­ty peo­ple seem to ex­pect from a new moth­er. New moth­ers are ex­pect­ed to know how to hold the ba­by, when the ba­by is hun­gry, whether the ba­by is get­ting enough milk, and, some­how, how to breast­feed with­out be­ing taught. If it hurts, she is told to “tough­en up.” And if she strug­gles, she may qui­et­ly won­der whether she is fail­ing at some­thing that every­one in­sists should come nat­u­ral­ly. Dr Fred­er­ick says that “par­ents have lit­tle to no in­for­ma­tion, and be­ing aware de­creas­es like­li­hood of the par­ents seek­ing to re­ly on for­mu­la.”

That gap in in­for­ma­tion can have a pro­found ef­fect. With­out ad­e­quate knowl­edge, nor­mal as­pects of breast­feed­ing can eas­i­ly be­come sources of pan­ic. A moth­er may be­lieve her ba­by is not get­ting enough milk, for ex­am­ple, or in­ter­pret a par­tic­u­lar feed­ing pat­tern as a sign that some­thing is wrong. Ed­u­ca­tion, there­fore, is not about pres­sur­ing moth­ers to breast­feed, but em­pow­er­ing them to make in­formed de­ci­sions and help­ing them un­der­stand what their bod­ies and ba­bies are do­ing.

Part of that ed­u­ca­tion in­volves dis­pelling the old wives’ tales that con­tin­ue to sur­round breast­feed­ing. One com­mon be­lief is that breast­feed­ing is sup­posed to hurt. Dr Fred­er­ick is clear that this is not the case. “While some ini­tial sen­si­tiv­i­ty may oc­cur,” she says, “breast­feed­ing should not be per­sis­tent­ly painful, and cracked or in­jured nip­ples should not be dis­missed as some­thing a moth­er sim­ply has to en­dure.” An­oth­er mis­con­cep­tion is that women with small­er breasts will have dif­fi­cul­ty pro­duc­ing milk. Breast size does not de­ter­mine breast­feed­ing abil­i­ty. There is al­so the wide­spread ex­pec­ta­tion that moth­ers must wait for their milk to “come in.” In re­al­i­ty, moth­ers pro­duce colostrum in the ear­ly days af­ter birth, a “fan­tas­tic”, nu­tri­ent-rich sub­stance packed with an­ti­bod­ies that is ide­al­ly suit­ed to a new­born’s needs.

In Dr Fred­er­ick’s ex­pe­ri­ence, some­times new par­ents ne­glect them­selves dur­ing the new­born phase. She high­lights that the moth­er’s well­be­ing is equal­ly im­por­tant to breast­feed­ing suc­cess as any oth­er fac­tor. Ad­e­quate nu­tri­tion, hy­dra­tion and rest can all play a role in a moth­er’s abil­i­ty to main­tain her milk sup­ply and nav­i­gate the de­mands of car­ing for a new­born. This is where sup­port from part­ners, rel­a­tives and friends be­comes par­tic­u­lar­ly im­por­tant. Rather than fo­cus­ing ex­clu­sive­ly on the ba­by, fam­i­lies must al­so re­mem­ber to care for the moth­er, mak­ing sure she eats, drinks enough wa­ter, rests when she can and has some­one to turn to when she en­coun­ters dif­fi­cul­ties. Pro­fes­sion­al sup­port is al­so avail­able through or­gan­i­sa­tions such as the Breast­feed­ing As­so­ci­a­tion of T&T, doc­tors and lac­ta­tion con­sul­tants, who can pro­vide as­sis­tance be­fore and af­ter birth, whether in hos­pi­tal, at home or through of­fice vis­its. Guid­ance can range from help­ing moth­ers achieve an ap­pro­pri­ate latch to teach­ing them how to recog­nise whether their ba­by is re­ceiv­ing enough milk.

The im­por­tance and ben­e­fits of breast­feed­ing ex­tend well be­yond nour­ish­ment. For ba­bies, breast milk pro­vides op­ti­mal nu­tri­tion and an­ti­bod­ies that help pro­tect against child­hood ill­ness­es, in­clud­ing ear in­fec­tions and gas­troin­testi­nal ill­ness­es. Breast­feed­ing is al­so as­so­ci­at­ed with re­duced risks of some longer-term health con­di­tions in chil­dren, in­clud­ing asth­ma and obe­si­ty, while of­fer­ing oth­er ben­e­fits such as sup­port­ing a ba­by’s heart rate and breath­ing and help­ing to keep new­borns warm. For moth­ers, breast­feed­ing caus­es the uterus to con­tract af­ter birth, help­ing it re­turn to its pre-preg­nan­cy size, which, ac­cord­ing to Dr Fred­er­ick, can re­sult in un­ex­pect­ed cramps for moth­ers, but is com­plete­ly nor­mal. Over the longer term, breast­feed­ing is as­so­ci­at­ed with re­duced risks of breast and ovar­i­an can­cers and di­a­betes. And be­yond the phys­i­cal ben­e­fits, breast­feed­ing can en­cour­age close­ness and bond­ing be­tween moth­er and ba­by.

Yet, de­spite the ben­e­fits, Dr Fred­er­ick stress­es that moth­ers should not be made to feel guilty if breast­feed­ing does not un­fold ex­act­ly as planned. The idea that a woman should au­to­mat­i­cal­ly be able to breast­feed can cre­ate tremen­dous pres­sure, par­tic­u­lar­ly for moth­ers ex­pe­ri­enc­ing post­par­tum de­pres­sion, anx­i­ety or oth­er chal­lenges. While “be­ing un­able to breast­feed at all is rare, as 99.9% of moth­ers can pro­duce milk and breast­feed”, cer­tain cir­cum­stances, such as some forms of breast surgery, aug­men­ta­tion, com­plete mas­tec­to­my or breast re­duc­tion, can af­fect a woman’s abil­i­ty to pro­duce milk. In­suf­fi­cient glan­du­lar tis­sue, in which there is not enough milk-pro­duc­ing breast tis­sue to sup­port breast­feed­ing, is an­oth­er rare pos­si­bil­i­ty. For most moth­ers, how­ev­er, Dr Fred­er­ick be­lieves the chal­lenges are more of­ten re­lat­ed to a lack of in­for­ma­tion, guid­ance or sup­port than a nat­ur­al in­abil­i­ty to breast­feed.

Per­haps most im­por­tant­ly, breast­feed­ing should be un­der­stood as a learned skill rather than an au­to­mat­ic one. “Both moth­er and ba­by are learn­ing a new skill,” she says, “which takes time, pa­tience, prac­tice and re­set­ting.” That is why Na­tion­al Breast­feed­ing Week is not sim­ply about en­cour­ag­ing breast­feed­ing; it is al­so about cre­at­ing an en­vi­ron­ment where moth­ers have the knowl­edge, re­sources and sup­port to make the choic­es that are right for them. In Trinidad and To­ba­go, strength­en­ing ac­cess to breast­feed­ing ed­u­ca­tion and lac­ta­tion sup­port can help re­place fear and mis­in­for­ma­tion with con­fi­dence. While women are nav­i­gat­ing one of the most sig­nif­i­cant tran­si­tions of their lives, Dr Fred­er­ick wants them to re­mem­ber to give them­selves grace and reach out for help when need­ed. “Breast­feed­ing is a jour­ney,” she says “You shouldn’t walk alone.”