The Breastfeeding Challenges of a Mum of 3, and Tips on better latching/attaching and flow!
As a Mum of three boys, I have loved the ease and convenience of breastfeeding, the opportunity to bond with my boys right from the beginning, and the knowledge they are getting everything their bodies need – without having to worry about bottles, formulas, heating, quantities, etc.
It has however, not always been easy. Who would have thought it would be my third bub who would be the challenging one? I thought “I should have had it all down pat by now.” With my older two boys, they were both textbook feeders, and no real training or assistance was required. I had never experienced pain with breastfeeding or had a bub with a difficulty latching & attaching on one breast; that was until our baby Hugo came along.
As a chiropractor, I often hear Mums struggles with breastfeeding who then in turn, switch to formulas (and if this is you, which one to choose will be a blog to come).
Whilst WHO’s (World Health Organisations), UNICEF & the National Health and Medical Research Council’s (NHMR)recommendations for breastfeeding are exclusive breastfeeding for the first six months of life, followed by breastfeeding with the introduction of nutritious complementary foods, until at least one to two years or beyond,1-2 that’s not the reality for most Mums. The statistics show that whilst 92% of Mums start breastfeeding at birth, by six months, only 25% are still breastfeeding exclusively. 3
So, do any of these describe you?
· Are you pregnant and want to know more about breastfeeding?
· Are you a Mum that is struggling with breastfeeding?
· Is breastfeeding painful for you?
· Are you only still breastfeeding because you think it is the right thing to do? Or out of obligation - because you have fed your other children?
· Are you thinking why is it not as easy as it appears to be for others?
· Are you thinking I am not sure I can produce enough milk, or my bub is struggling?
· Does bub pop on and off the breast, is fussy, has problems with latching or attaching, or will only feed on one side?
If you said yes to any of the above, listen up for some of the great benefits of breastfeeding for both of you, some of the reasons why it can be difficult and some suggestions that may help.
The biggest undisputed benefit of breastfeeding is the nutrition from breastmilk, that has been shown to have all the nutrition a baby needs in that first year of life. It contains proteins, carbohydrates, fats, vitamins & minerals; and the macronutrient composition is consistent across different populations of women. All those nutrients have been found to be absorbed more readily in breastmilk than from other artificial sources.4
The benefits of breastfeeding also include improved immune protection for bub, thereby reducing infections,both due to the development of the bub’s intestinal microbiome and the transfer of antibodies from Mum. 4-6 There are many associations with reduced asthma, allergies, obesity, diabetes, cardiovascular disease, and numerous childhood cancers. 5-7 Not to mention the suggestion of improved brain function, language, and motor development in breastfed babies (of longer than six months duration). 8-10 So, the research is suggesting that breastfeeding can be a contributing factor to smarter kids!
Then for Mum it is not simply the convenience of having milk on tap for bub, but there are numerous health benefits for Mum too. There is evidence of decreased risk of osteoporosis, Type II Diabetes Mellitus, rheumatoid arthritis, cardiovascular disease 1 & ovarian & breast cancers. It also often delays the return of menstruation, which helps with Mum’s physical recovery and increases child spacing. It has also been shown to reduce the incidence of postnatal depression and can also help with weight loss. 5,9
What can go wrong? Whilst breastfeeding is a new skill and takes your body a little time to get used to it (and does take practice), it should be comfortable. Any pain that persists beyond the first week or so, should be evaluated. Problems that may occur in breastfeeding and may indicate that something is not quite right include pain, mastitis, attachment issues, fussiness at the breast, dribbling milk, low milk supply or low weight gain (or failure to thrive). Just remember feeding is supply and demand. Low milk supply is usually indicative of an issue with bub – ineffective & inefficient attachment, latching or sucking.
Why are these problems occurring? Why is it not easy?
Well it has been shown that problems (dysfunction) in biomechanics of the head, neck and shoulders can contribute to difficulty in attaching and latching. 12-17 It can simply be uncomfortable for bub. Have you experienced or heard of bubs feeding much easier on one breast than the other? They may simply have a sore neck or shoulder that prevents them attaching on one side. These spinal or shoulder misalignments are common (research is quoting between 70 and 85% of babies) 12-15 because of the birth process or even positioning in the womb. A survey of 2457 International Board-Certified Lactation Consultants (IBCLCs) reported referring 73% of infants with breastfeeding difficulties for musculoskeletal treatment. 91% of those who received treatment noticed improvements.16
Nerve function may also be a factor. There are nerves in the skull that are responsible for suck and swallow reflexes. Abnormal movement of the skull may create nerve dysfunction e.g. abnormal movement of the occiput can affect the nerves that control the tongue movement and function, which may then affect bubs suck reflex. 12-15 If bub has a problem with sucking, that then affects Mum’s milk supply and the problems may escalate.14,15,17
Tongue & lip ties may also be a factor affecting feeding. A tongue-tie is a band of tissue (frenulum) under the baby’s tongue, that is tight & shortened, reducing the movement and affecting function of the tongue. Lip-ties affect the movement of the lip which may affect the bubs seal around the breast. These are quite controversial topics currently with many different views. Whilst there are many professionals that believe and have seen that the tongue & lip ties can contribute to difficulty for bub being able to attach to the breast, at this stage there is inadequate data in research to prove it. 18-19 From personal and professional experience however, identifying and addressing it has frequently had beneficial results.
Back to our third baby Hugo. He was in a hurry to meet us (one hour of labour, my husband nearly caught him in the carpark!). He came out with his right arm up above his head like Superman. This affected his shoulder movement and he had difficulty feeding on my right breast (as I was pushing on that sore shoulder on that side in that position). A few gentle corrections improved his feeding and comfort significantly. He was also then a much happier baby. So, whilst he was feeding on both sides, and happier to do so, we also recognised very early that Hugo had a tongue and lip tie. Both my older boys had no difficulties with feeding. Hugo however created pain, clicking, falling asleep at the breast constantly. We had his tongue and lip tie lasered at nine days old. It truly did make the world of difference to his feeding. No longer was it painful. He was more efficient & it was easier & more comfortable for both of us.
My 6 Tips for better latching, attaching and flow:
· Ensure there are no biomechanical issues with bub – head, neck & shoulders.
· Sit supported – I see lots of Mums with neck and back pain as a result of not being supported. Look after your body. Use feeding pillows to bring bub up to you, rather than slouching down to them.
· Sitting comfortably, bring bub chest to chest, and your nipple to their nose. By gently touching bubs lip and cheek, they will open their mouth and reach for it. This helps with several reflexes and assists with better attaching and latch.
· Drink at least a glass of water each time you feed (to improve flow of milk). Mother’s milk teas (fennel, nettle leaf & aniseed) & lactation cookies worked a treat with increasing supply & flow (once we corrected the cause).
· Mums try to do a million things whilst they are feeding: from emails, online shopping, cooking, chatting on the phone etc. Focus on your bub. Put your phone away. I know it’s a big chunk of time you are sitting & feeing, but use this time to look at your bub, talk, read & sing to your bub & bond with them. Remember, the cuddling, chatting, singing etc. is also firing bubs neurons and connections – they are learning & you are helping improve their brain function! This season will be over in the blink of an eye, cherish it now.
· Reduce stress! – I know easier said than done, but it will truly help with letdown and milk flow. Drop your shoulders down away from your ears and breathe (& thinking of sitting on an island somewhere may also help.)
Here at Your Body Works, we assess your baby’s neck and shoulder movement, TMJ or jaw function, their cranial movement, suck, and swallow reflexes, presence of any tongue or lip ties, along with assessing their growth and development. If we detect any issues with bub’s function, we very gently correct it (using pressure of testing a ripe tomato). We refer when appropriate, or work collaboratively with lactation consultants, dentists, and paediatricians.
Current research along with personal & professional experience have all shown that restoring normal biomechanics of the neck and shoulders, reducing pressure on the skull and cranial nerves, improvements in breastfeeding is often observed.
If you have any questions or would like more information on any of the above, please contact us. We would love to help & support you with breastfeeding and make it more enjoyable for your both; or help you figure out the alternatives. We have a team of professionals we work alongside, and we will ensure you get the approach required. It takes a village to raise a child. We would love to be a part of your village.
References:
For more information included in the full breastfeeding policy document written by the Australian College of Chiropractic Paediatrics and a full list of references go to:
1. World Health Organization, 2011. Exclusive breastfeeding for six months best for babies everywhere. World Health Organization - Media Centre.
2. National Health and Medical Research Council, 2012. Infant feeding guidelines, Canberra: National Health and Medical Research Council.
3. Australian Bureau of Statistics. 2017
4. Ballard O, Morrow AL. 2013. Human Milk Composition: Nutrients and Bioactive Factors. Pediatr Clin North Am 60(1):49–74.
5. Victora, C.G. et al., 2016. Breastfeeding in the 21st century: epidemiology, mechanisms, and lifelong effect. Lancet (London, England), 387(10017), pp.475– 490.
6. Kaplan, J.L., Shi, H.N. & Walker, W.A., 2011. The role of microbes in developmental immunologic programming. Pediatric Research, 69(6), pp.465–472.
7. Binns, C., Lee, M. & Low, W.Y., 2016. The LongTerm Public Health Benefits of Breastfeeding. Asia Pacific Journal of Public Health, 28(1), pp.7–14.
8. Smith, J.M., 2015. Breastfeeding and language outcomes: A review of the literature. Journal of Communication Disorders, 57, pp.29–40.
9. Horta, B.L. et al., 2007. Evidence on the long-term effects of breastfeeding. World Health Organisation, pp.1–57.
10. Luby, J.L. et al., 2016. Breastfeeding and Childhood IQ: The Mediating Role of Gray Matter Volume. Journal of the American Academy of Child & Adolescent Psychiatry, 55(5), pp.367–375.
11. Sauve, R.S., 2005. Breast is best for babies. Journal of the National Medical Association, 97(7), pp.1010–1019
12. Miller, J.E., Newell, D. & Bolton, J.E., 2012. Efficacy of chiropractic manual therapy on infant colic: a pragmatic single-blind, randomized controlled trial. Journal of manipulative and physiological therapeutics, 35(8), pp.600–607.
13. Stewart, A., 2012. Paediatric chiropractic and infant breastfeeding difficulties: A pilot case series study involving 19 cases. Chiropractic Journal of Australia, 42, pp.98–107.
14. Vallone, S. & Carnegie-Hargreaves, F., 2016. The infant with dysfunctional feeding patterns – The chiropractic assessment. Journal of Clinical Chiropractic Pediatrics, 15, pp.1230–1235.
15. Fludder, C.J. & Keil, B.G., 2017. The prevalence of extremity joint dysfunction in neonates and infants within a paediatric chiropractic clinic. Chiropractic Journal of Australia, 45(4), pp.360–367.
16. Lavigne, V., 2016. Lactation Consultants' Perceptions of Musculoskeletal Disorders Affecting Breastfeeding: A Cross-Sectional Survey. Clinical Lactation, 7(1), pp.30–36.
17. Hewitt E. Chiropractic care for infants with dysfunctional nursing: a case series. 1999. J Clin Chiropr Pediatrics. 4(1):241–244.
18. Francis, D.O., Chinnadurai, S., et al., 2015. Treatments for Ankyloglossia and Ankyloglossia With Concomitant Lip-Tie.
19. Srinivasan, A. Al Khoury, A.A. & Puzhko, S. (2018) Frenotomy in Infants with Tongue-Tie & Breastfeeding Problems. Journal of Human Lactation. Dec 13.