When it comes to babies, “breast is best”. Granted, there are cases where mothers genuinely cannot breastfeed their babies, for example, due to health reasons. Jamilah Samian had the opportunity to seek the expert views of Dr Ning Desiyanti Soehartojo, a medical officer-turned-lactation consultant.
JS: Please tell us your personal and professional background, how you got into the lactation field.
ND: I’m a mother to 3 teenage boys and 1 tweenage girl. My breastfeeding journey with my children was a colourful one. Each with its own set of challenges influenced by the circumstances and situation I was in. I was blessed to have a supportive husband and fellow friends and colleagues to help me through those times.
My working experience as a Pediatric Medical Officer in Klang GH for several years was my stepping stone into the lactation field. I had the privilege to work with the Special Care Nursery & NICU team, helping moms initiate and establish breastfeeding and/or breastmilk for their precious little ones.
In 2009, I became an International Board Certified Lactation Consultant. Since then I have been actively involved in supporting breastfeeding families beyond the hospital setting.
Currently, I am practicing as a Lactation Consultant & Certified HUG teacher in private practice. The Hug Your Baby Program provides help, understanding & guidance for young families, focusing on understanding the baby’s body language and behaviour. I do one-to-one consultations, conduct breastfeeding classes and incorporate Hug Your Baby strategies into the care I provide.
I volunteer as a Peer Counselor Program Administrator @ Trainer with the Malaysian Breastfeeding Peer Counselor Association.
JS: “Breastfeeding is a natural process and should be easy.” Please comment.
ND: Breastfeeding is a natural process – it is a biological norm for moms and babies. It is important to note that, breastfeeding is not just about providing breastmilk. It’s also about nurturing, providing the baby warmth, comfort and a sense of security.
However, currently in most parts of the world, breastfeeding is no longer a norm. When breastfeeding is the norm, girls (and society at large) learned about breastfeeding as they were growing up by seeing women actually doing it. But if they haven’t seen women breastfeed, they may have no idea what to expect and what to do.
Many moms expect that breastfeeding will come “naturally” and that they would instinctively know what to do. Breastfeeding is a learned skill. It is like learning to ride a bike, which one learns by doing and not just reading about it. Breastfeeding may not be automatic at first but with support, patience, perseverance and practise, it will get easier. For some moms, it may take a couple of days or weeks, but that is normal.
There are also situations which may interfere with getting breastfeeding off to a good start. These include but are not limited to: prolonged and difficult labour, medicalized birth, mother’s and/or baby’s health issues, confinement and cultural practices / belief, unrealistic expectation of mom’s ability and/or baby ‘s behaviour, overthinking breastfeeding and also lack of breastfeeding support in general.
Breastfeeding isn’t always easy for some moms, but every single one of us (family, friends, health care provider, community, private and government agencies) who come into contact with a breastfeeding dyad (mom and baby) can do our part to make it easier for them to breastfeed.
Dr Ning Desiyanti: medical officer-turned-lactation consultant
JS: What are the issues pertaining to breastfeeding?
ND: Promoting, supporting and protecting breastfeeding. Yes, there is a growing awareness about breastfeeding, not only locally but worldwide. This is due to the collective effort by individuals and organizations around the globe in promoting the importance of breastfeeding. An increase in breastfeeding initiation worldwide indicates that most moms know that breastfeeding is best for their baby.
We also see an increasing number of breastfeeding support groups in communities, health centres and agencies. However, there is still much room for improvement. Even though many moms were able to initiate breastfeeding soon after birth, still the majority of those mothers do not yet meet their breastfeeding goals. The global breastfeeding rates remain well below acceptable levels.
What is equally important and lacking worldwide is the effort to protect breastfeeding. The unethical marketing of infant formula products and misleading advertising by commercial companies undoubtedly foster misperceptions and have been shown to undermine women’s confidence in their ability to successfully breastfeed.
In 1981, WHO passed its landmark International Code of Marketing of Breastmilk Substitute to help safeguard breastfeeding by protecting infant and young child health from the excessive marketing of commercial infant. The WHO Code, however is not legally binding in most countries including Malaysia.
Malaysia has “The Code of Ethics for the Marketing of Infant Foods and Related Products”, a voluntary guideline to govern the marketing practices of manufacturers and distributors in the country. Nevertheless, the commercial companies continue to break the Code and/or exploit loopholes in the Code. A concerted effort and much work is needed to strengthen and implement the Code. We hope that it can be achieved very soon as Malaysia is currently revising the Code.
JS: In general, we hear and see a growing awareness and emphasis about breastfeeding. Is it always possible to breastfeed? Why and why not?
ND: There are very few medical contraindications to breastfeeding:
- Galactosemia in infant. This is a rare inborn error of metabolism (genetic disorder), in which the infant is missing the necessary enzyme to digest lactose.
- Mothers infected with HIV (in developed countries) & HTLV (human T cell leukemia virus)
- Mothers who are taking illegal drugs.
- Mothers who are on anti-cancer drugs, antimetabolites & radioactive diagnostic isotopes.
- Mothers who have untreated tuberculosis and herpes simplex lesions on the breasts – they can resume breastfeeding once treated.
Breastfeeding may pose a challenge for mothers and babies with underlying medical problems, (eg : mothers with anatomical problem – underdeveloped breast, breast / nipple surgery, injury, mothers with hormonal problems, babies born with disability, oral / facial defect or babies who require immediate medical attention after birth). With timely and appropriate support, breastfeeding is possible for these mothers and babies.
JS: If a mother has tried for some time to breastfeed but couldn’t, how does she deal with it? Is it normal to feel like a failure?
ND: This is a tough question.
If she hasn’t reached out for help and support yet, it’s best for her to do so.
If mom finds that no matter what she does, she can’t breastfeed and she’s not able to enjoy the moment with her baby, perhaps it’s best she find what works for her and baby.
Talking to someone she trusts, may help her put things into perspective. Many a time, mom is so fixated on things she can’t achieve, that she overlooks her list of accomplishments.
Every mom will do everything she can to provide the best for her child. So, when things don’t go as planned, it is normal to feel like a failure. Mom probably feels she has let her child down. Before she goes down that road, it would be a good idea though, for mom to revisit her goals. She should reassess whether her expectations were realistic in the first place, based on the circumstances she was in.
Breastfeeding is not all or nothing. The more breastmilk, the greater the benefit – but as long as baby is getting mom’s milk, he will continue to receive many benefits from breastmilk and if possible, the act of breastfeeding.
JS: How and where can young parents who have issues in breastfeeding, find help?
ND: They can get help and support from :
- Experienced breastfeeding moms among family and friends
- Breastfeeding peer counselors in the community. There are now several breastfeeding support groups both offline and online. Moms can get in touch with these volunteers via the local NGO groups, public health clinics, private and public hospitals.
- Lactation counselors – individuals trained in basic breastfeeding management and/or breastfeeding counselling courses. There are lactation counselors in most public health clinics and hospitals, some private hospitals / maternity centres and NGO groups.
- Lactation Consultants (IBCLC – International board certified lactation consultants) – allied health care professionals who specialize in the clinical management of breastfeeding. The Find A Lactation Consultant directory helps moms to locate a practicing IBCLC near them: http://www.ilca.org/i4a/pages/index.cfm?pageid=3432
Ideally, expecting parents should begin identifying their support network before the baby arrives. It would be less stressful if they know who to call / contact in times of need.
JS: Any other comments which might help readers understand lactation better?
ND: Lactation is a medical term which means the process of milk production.
In human lactation, there are 3 stages involved.
The first stage begins around 16-22 weeks of pregnancy where the mom’s breasts begin to produce colostrum in the milk glands. The breasts continue to make milk until the later part of pregnancy.
The second stage takes place about 30-40 hours after birth. This is when more milk comes in and usually by the third day onwards mom begins to feel an increase in breast fullness.
These first two stages are hormonally driven. That means, as long as the proper hormones are in place, mom will start making milk as early as the second trimester and her milk will increase in volume around 30-40 hours after birth.
In other words:
(1) the first two stages of lactation will occur automatically, regardless of whether mom intends to breastfeed or not. A pregnant mom may not feel ready to breastfeed, but physiologically / naturally, her body is.
(2) since milk production begins about halfway through pregnancy, a mom who delivers prematurely, has milk in store for her baby. The preterm breastmilk contains more of the nutrients her premature baby needs. When a baby is carried to term, mom’s breastmilk will change accordingly.
(3) mom does have colostrum on the day the baby is born. It is important for mom to know this, even though there is no significant change in her breasts size and the breasts seem “soft” in the first two days after birth. Many moms mistakenly think that they don’t have any milk at this point. This leads to the decision to either delay breastfeeding until her breasts feel full and/or feed baby with formula milk. Allowing the baby to suckle as soon as possible after birth, and allowing baby to breastfeed on demand, will help mom establish her milk supply earlier. Besides, it is much easier for a newborn baby to practise and learn to suckle a “soft” breast compared to a full breast. In situations where early initiation of breastfeeding is not possible, mom is encouraged to initiate breast massage and use hand expression to get the milk supply going. Getting help and support in the early days is crucial in getting breastfeeding off to a good start.
Next, comes the third stage which is the maintenance stage of milk production. Unlike the first two stages, this stage is controlled locally at the breasts. How much milk breasts make depends on how often baby breastfeeds and how much milk she takes. It is the removal of the milk that causes more milk to be made. This principle of supply and demand, or demand equals supply is the key element to maintaining milk supply throughout a mom’s breastfeeding journey. In other words, supplements / milk boosters would not be effective if the supply and demand requirement is not met in the first place.
When we talk about breastfeeding, much emphasis is placed on the mother and her ability or inability to make milk. Newborns are seen as helpless infants. In actual fact, babies are born with reflexes and instincts that urge them on to find and suckle at their mother’s breasts. Mothers and babies have physiological responses that draw them to each other, encouraging them to look at each other, talk, touch and interact. This behaviour, as described by Allan Schore, a neuropsychoanalyst, is guided by the right side of the brain. It helps baby settle and stay calm. As baby gets older and his attachment to his mother grows, this right brain connection also helps him learn to regulate emotions. Mothers who have gotten off to a rough start, can use her baby’s built-in responses to get back on track.[NOTE: The reader may contact Dr Ning Desiyanti Soehartojo personally at [email protected] or 016.278.0552.]