Experts insist on the benefits of breastfeeding. Should mothers who can't feel guilty, asks Gihan Shahine It's a special moment. You have your newborn baby in your arms, a little thing sniffing at you with a small mouth yearning for your breast milk. The only thing you can do at that moment is to hug your baby and try to let him suck. The pleasure is irresistible for both mother and baby, and an aura of peace and warmth descends. However, that pleasure can easily be spoilt should things go wrong. Problems may appear, ranging from sore nipples to insufficient milk, and some mothers may feel that breastfeeding is simply not convenient for them. In the absence of proper guidance, some mothers may find it easier to switch to formula milk, perhaps feeling tired or bored or that their milk is not enough for their baby to thrive. And the question remains whether such mothers should feel guilty about deciding to stop breastfeeding. There is a consensus among experts that breast milk is the best food a mother can offer her baby on the physical, psychological and mental levels. Breastfeeding creates a special bond between mother and child, and specialists insist that breast milk also has at least 400 nutrients and hormones that have brain-building and infection-fighting benefits that no formula can offer. The colostrums, or "liquid gold", which is the thick yellow breast milk that a mother produces right after delivery, gives the baby the best start in life. It is rich in nutrients and antibodies that protect the baby as he/she enters the world. But breast milk also has all the nutrients a baby needs to thrive during the first six months of life, which is why the World Health Organisation (WHO) recommends that babies are given nothing besides breast milk during that period. Even after six months, when solids are introduced, experts insist that breast milk remains a vital and healthy dietary component. "Breast milk is simply the best a mother can offer her child," says Dr Rania Hosny, assistant professor of paediatrics at Cairo University and an international lactation consultant. "It is as sacred as religion -- no compromise." Research shows that breast milk has antibodies that protect against infection, including from gastroenteritis, respiratory illnesses, urinary infections and ear infections. In addition, it reduces the risk of childhood diabetes and leukaemia, diarrhoea, obesity, sudden infant death syndrome (SIDS) and of allergic conditions, such as asthma and eczema. "In addition to anti-infective properties that are always there, the breastfeeding mother makes specific antibodies as soon as she comes into contact with an infection," write experts at the website babycentre.com. "These antibodies transfer to her milk, ready for the baby to receive as soon as he comes next to the breast." Researchers also suggest that breastfeeding promotes brain development, since it contains vital long-chain polyunsaturated fatty acids. Some studies suggest that, on average, breastfed babies are more intelligent than their formula-fed counterparts, though this may also be due to genetic or environmental factors. Research also suggests that breastfeeding may have long-term health benefits as, according to one review on babycentre.com, "people who were breastfed as babies had lower blood pressure, lower cholesterol levels and were less likely to develop type two diabetes in adulthood than those who had been formula- fed." Breastfeeding is also healthy for mothers, with research finding that it reduces the risk of pre-menopausal breast cancer, ovarian cancer and fractures from osteoporosis later in life. That said, many mothers may still find breastfeeding too difficult, painful or time consuming, or they may complain that their babies are not thriving on breast milk. In Egypt, breastfeeding specialists are few and far between, and mothers often get little or no advice. Had they had it, they could have developed better breastfeeding skills. Hosny concedes that breastfeeding is "a skill, sometimes even a difficult one, that could be a pleasure if the mother could get the hang of it." She provides maternity classes to expectant mothers on how to handle breastfeeding, but also insists that the wrong advice is often the biggest enemy. Mothers, Hosny says, should get mentally and psychologically prepared for breastfeeding, and they should also know the positions that will help their babies get a good latch. "Positioning and latching are important skills a mother should master to make sure her baby is feeding properly," Hosny says. One of the biggest problems that breastfeeding mothers encounter during the first days after birth is telling whether their babies are getting enough milk. During the first two days, the newborn child may seem quiet and sleepy, but by the third day babies generally want to feed all the time. They seem to be hungry all the time as breast milk is easy to digest within a couple of hours of consumption. According to experts, a two-hour feed does not mean there is anything wrong with a mother's milk. Newborns want to breastfeed eight to 15 times a day after the first three to four days of life, which will probably reduce to six to eight times a day by the end of the first week. According to Hosny, weight gain is usually the way mothers and paediatricians tell if a baby is getting enough milk. Newborns normally lose five to 10 per cent of their birth weight in the first three days. If the baby starts regaining his or her birth weight on the fourth day, and gaining weight after the fifth or seventh, then he or she will be getting enough milk. A baby should gain an average of 120 to 240 grammes per week in the first three months, Hosny says. If a baby is not gaining enough weight, wetting fewer than six to eight nappies per day, and feels unsettled and lethargic, Hosny recommends that "the mother should consult a lactation consultant before hastening to use formula, because there might be another problem that can be easily tackled." One of the main reasons why many mothers end up using formula milk is that they are not properly guided, Hosny says. "All the efforts we exert with expectant mothers sometimes go down the drain in hospitals after delivery," she laments. In most hospitals, babies are given glucose, which makes babies feed less, affecting the mother's milk supply. In many hospitals babies are not allowed to sleep with their mothers in the same room, and few hospitals care about first-hour breastfeeding or skin-to-skin touching upon delivery. Yet, "the first hour after delivery is known as the 'golden hour', and it is of the utmost importance in stimulating colostrums and creates a special bond between mother and child," Hosny explains. Using bottles and pacifiers in the first months can affect a mother's milk supply, causing nipple confusion in newborns and ultimately leading to the mother suffering from sore nipples due to bad latching, she says. An ardent believer in the virtues of breastfeeding, Hosny sticks to the classic school of paediatrics, which insists that breastfeeding mothers should not try to establish a pattern of feeding or sleeping in the breastfeeding period. She insists that mothers breastfeed their babies on demand, for as long as they want, throughout the night, and without introducing any pacifiers, bottles or formula to build a good supply of breast milk during the first six months of a baby's life. "Some would advise mothers to quit breastfeeding for six hours during the night to organise their sleep, but that would immediately reduce the supply of breast milk since night feeds stimulate the hormone responsible for milk production," Hosny says. For her, restricting the duration of feeds is equally detrimental. Babies should be given as much time as possible, in order to get the calorie-rich milk that comes towards the end of a feed and is five times higher in fat than the milk at the beginning. Yet, with all these restrictions many mothers may find breastfeeding tiring and hard to adapt to, especially when they have other children to look after. Sleep deprivation may lead to depression and tiredness that can affect family dynamics. Breastfed babies get hungry more quickly because breast milk is easier to digest, and so they wake more often and generally take longer than formula-fed ones to establish a pattern of feeding. Is there any way in which mothers can breastfeed without losing their sleep? Some paediatricians allow a mix of breast and formula milk, a three-hour spacing between feeds, and a six-hour spacing between night feeds, though this is a compromise that Hosny ardently resists. Babies generally start establishing a pattern of feeding when they become more expert and when they become more stimulated by their surroundings. For Hosny, establishing a pattern is difficult for breastfed babies during the first six months, and perhaps even the first two years. For those who cannot afford to lose their night's sleep, a tip from babycentre.com may help: separate breastfeeding from the act of falling asleep, even by a few minutes, so that the baby will not depend on breastfeeding every time he or she wakes during the night. All babies wake up several times during the night, but those who depend on feeds to get back to sleep are more likely to wake their mothers. To avoid this, "make the breastfeed a part of your bedtime routine, but do it early, so that your baby doesn't learn to directly associate that part of his bedtime routine with sleep," says the site. If breastfeeding still sounds inconvenient for some mothers, Hosny says that there is no need for them to feel guilty. "All we say is that you should try to give your baby the best, but bear in mind that nobody is perfect, and if you find it inconvenient it will do you no good to feel guilty. Breastfeeding is not the only way you can care for your child. You can be a good mother with or without breastfeeding." Tips for beginners - Make sure that you and your baby are in a relaxed position before you start feeding. "The baby should be positioned on his side, in a chest-to-chest position, without any twist or tilt. Make sure his mouth is widely opened, taking in a big mouthful of breast tissue," Hosny says. - If latching hurts, break the suction by gently inserting your little finger between your baby's gums and your nipple and try again. - Find a quiet place to nurse your baby. Atmosphere is important, since babies can get distracted by noise, especially during the first weeks when they are still learning. - Let your baby finish your first breast first to let him get the calorie-rich milk that comes towards the end of a feed. Try to wake him up if he starts to sleep, perhaps changing his nappy and then offering the second breast. - Think of breastfeeding as a skill you have to learn. Breastfeeding can be a pleasure if done in the right way.
