Newsletter #32 – Mothering the Mother: Making Confinement Work for Breastfeeding

By Nabila Hanim (BMSG Editorial Team Member)
Photos courtesy of Far’ain Jaafar

Far’ain Jaafar, a BMSG EXCO member and one of BMSG’s breastfeeding counsellors, recently gave birth to her second baby. During her pregnancy, Far’ain, who advocates for mothers prioritising self-care during postpartum, took great efforts to prepare for her second round of confinement. We speak to Far’ain and a few experts who have worked with new mothers to find out how modern mums who are living on their own can have a restful and invigorating postpartum recovery that is also conducive for breastfeeding.

For many of us, confinement may mean a lot of things. For some, it would mean endless days of no showering, a lot of pain and discomfort, and worrying over how to take care of a new baby.

For Far’ain Jaafar, however, confinement is a period for a mother to heal inside and out, while bonding with the baby in as many ways as possible. Having read about the many ways to practice confinement across cultures and believing that the postpartum period, or fourth trimester, is one that should be focused just as much on the new mother, Far’ain decided that she would like to give more thought to her confinement this time around.

After the birth of her first child, Far’ain was well taken care of by her in-laws. Knowing that she would be on her own with her husband and son this time around as they are now living on their own, Far’ain prepared herself and got her husband on board to ensure the postpartum period eased her transition into becoming a breastfeeding mother again.

Far’ain did a lot of reading and research prior to the birth of her baby. Reading up about postpartum, or also known as the Fourth Trimester, helped her better understand the needs of a new mother.

Mothering the Mother

Knowing that her Estimated Date of Delivery (EDD) was going to be during the holiday season where her family members were going to be on vacation, Far’ain ensured that her husband was equipped to provide for her well-being first, above everything else. “In general, I made sure that there (he was going to) be able to meet my needs so that I will be able to meet the needs of my baby, especially when it comes to breastfeeding.”

Johanna Wagner, doula and founder at Bumpwise, which provides antenatal classes, workshops and doula services for expecting mothers, believes that care and recuperation for the mother is just as important, if not more, during the postpartum period. “It’s such a crucial time for mum and baby, and we must focus on nourishment, healing, and bonding. Often, sadly, mums and everybody around them focus only on the baby, but we must make a point of also holding the mother who is going through a transformation physically as well as emotionally.”

Giving birth takes a toll on a new mother’s body; having spent nine months carrying baby and going through childbirth is enough to make a mother feel weakened. Yen Lim, owner at Madam Partum, a Traditional Chinese Medicine (TCM) company for pre- and post-natal care, says it is normal and expected for a new mother to feel this way. “The rigours of childbirth deplete the postpartum body of Qi (energy or life force) and blood. It is common for most mothers to experience a weakened body constitution after birth. Hence, the confinement period is a crucial moment where mothers are nursed back to their pre-pregnancy health and vitality through a proper confinement care and nourishment plan.”

Importance of Nourishment in Postpartum Care

Having understood this, Far’ain spent plenty of time during her pregnancy discussing with her husband how she will be cared for during confinement. “I knew that I needed to nourish myself with nutrient-dense food and eat in a timely manner so that I’ll be able to nourish my baby and meet her needs. Hunger, or even food not pleasing to me, will affect my emotional state during confinement,” said Far’ain.  This is a common occurrence with mothers going through postpartum, who go through drastic hormonal fluctuations as the body regulates itself to the pre-pregnancy state. “I ensured that my husband was equipped to prepare my confinement meals by discussing with him about the topic during my pregnancy and curating my confinement meals menu for him to refer to,” said Far’ain, who spent hours researching and reading up on confinement practices during her pregnancy.

“I made sure that there was someone who’ll be able to meet my needs so that I will be able to meet the needs of my baby, especially when it comes to breastfeeding.”

The Confinement Diet

While there was plenty of confinement catering options in the market, it was never an option for Far’ain. As she prefered to customise her diet to her needs, she felt that it was logistically easier for her husband to prepare confinement food that was also suitable for everyone in the family to consume. However, since she knew that a lot fell on her husband’s shoulders, she ensured that the recipes were easy to prepare. “Nothing complex or time-consuming. Anything that required long periods of time on the stove were prepared using the slow cooker,” she said.

Far’ain designed a diet plan and menu that was easy for her husband to refer to during her confinement. This was then printed and placed somewhere visible in their kitchen. *For explanations of some of the meals stated above, scroll to the end of this post.

Managing Expectations During the Postpartum Period

Far’ain admitted that confinement this time around was more challenging due to the presence of her older child who turns five this year. Feeling left out, as what is normal for children after receiving a new sibling, he threw a lot of tantrums and displayed attention-seeking behaviour when visitors fawned over the baby. This distressed her a little, but she knew that she needed the mental capacity to focus on breastfeeding and caring for her new baby. “I also kept in mind the rigour needed to meet the breastfeeding needs of a newborn. That greatly helped to strengthen my resolve,” added Far’ain.

As a second-time mother, Far’ain knew to expect and manage some breastfeeding challenges. She faced engorgement and also had to tackle her baby’s initial shallow latch. Managing her expectations actually made her feel more confident about her body and how to manoeuvre around the roadblocks along the way. “I religiously did my breast massages and kept a positive mindset to pull through the discomfort. I also made sure that I kept correcting my baby’s shallow latch in order to help her achieve a good latch. I varied my nursing positions in the day mainly to prevent any blocked or clogged ducts, and avoided underwired bras.” Far’ain found that going braless for many hours in the day also helped her to avoid any pressure on her already-tender breasts.

Prioritising Self-Care & Rest

Far’ain made sure to also allow time for her body to rest significantly during this period despite the demands of breastfeeding and caring for a baby and an older child. Doing what she called “breastsleeping”, Far’ain said: “Baby co-sleeps with me and I’ve mastered the art of nursing while side-lying. I’m still physically at rest while nursing!”

Whenever her husband was occupied with her first-born, Far’ain was open to having to carry her baby during meals as she knew he needed time to tend to their son. Sometimes, she was also alone at home with the baby when her husband brings him out to spend some time together. Maintaining a flexible and positive mindset helped her adapt to the little changes she had to make, as opposed to her first confinement period where her in-laws took care of everything.

Far’ain also coped with having to carry baby around by babywearing. “Babywearing helped me to meet the needs of my baby and took care of my sanity!” she laughed.

Having an older child and living on their own meant that at times, Far’ain still had to carry her baby during meal times when her husband was occupied with her first-born. Learning to manage expectations and developing a positive mindset was a good mental shift for her to cope with her expanding role as a mother of two, yet still being able to maintain her health and well-being.

As many proponents of postpartum would agree, focusing on self-healing is a crucial aspect of postpartum recovery. Far’ain, who followed the Malay cultural tradition of massage after confinement, went through daily postpartum massages for a few days in order to regain her physical strength and to pamper herself as many other mothers would. This did not stop her from continuing to breastfeed her baby.

“I scheduled my massages around the times that baby would feed. This meant that I would have to either feed her before or after the massage session, or on some days, express a little bit of breastmilk for others to feed her while I was in a massage session. My masseuse was also fine with me taking a little interval to feed my baby,” said Far’ain, who also added that mothers should be comfortable and open to discussing arrangements such as these with their masseuse and family members in order to give baby access to the breast as much as possible.

The postpartum period is focused on recovery, but it is also a period of adaptation and can be very overwhelming, what with the fluctuating hormones of a new mother. “Honestly, it was a really difficult and tiring time for me. But I knew that it’s not forever. So I ensured that I put in place whatever I could to make my recuperation smooth. The days get better as I regained my strength. There were bad days and there were good days. It’s all right to have bad days, cry, forgive, repair, reflect and learn to make it better.”

“I scheduled my massages around the times that baby would feed. This meant that I would have to either feed her before or after the massage session, or on some days, express a little bit of breastmilk for others to feed her while I was in a massage session. My masseuse was also fine with me taking a little interval to feed my baby.”

Recipe for Success

Far’ain also advises mums to breathe and adopt a positive mindset. Especially when it comes to breastfeeding, the people who make up the support system of the breastfeeding mother must be equip to help her achieve her goals, not prevent it.

Tips for Breastfeeding Success after Delivery:

  • Empower yourself, your spouse and your caregiver on how to get through the challenging early days of breastfeeding – read widely to gain knowledge or attend breastfeeding workshops
  • Know where to get breastfeeding support For example, BMSG has put in place multiple avenues for mothers to receive support. Also, request to see the lactation consultant before being discharged from the hospital, to ensure that your baby’s latch is corrected and checked for any possible issues in order to rectify them early. This is also a good time to ask any questions or concerns.
  • Assemble your support team! This is so essential during and after confinement. The people you place around you can make or break your breastfeeding efforts. Keep close the ones who will make breastfeeding easy and uncomplicated and who would help you to successfully breastfeed and learn to wear imaginary earplugs for those who would affect you negatively but whom you have to face daily/regularly during your confinement. Remember a “simple” remark such as “Are you sure you have enough milk?” can affect your greatly (thanks to fluctuating hormones and being new to breastfeeding)
  • Prioritise nutrient-dense diet – Remember to have your proteins, fats, carbohydrates, vitamins and minerals in your food. Drink water and consume lots of healing fluids in the form of soups/non-caffeinated teas/herbals. Confinement is not the time to be concern about weight loss. The goal is to regain health and vitality through nutrient dense food and being gentle to our body. Our bodies went through a life force of pregnancy and birth.

Words Can Make or Break

Echoing Far’ain’s view of how important it is to keep a strong support team near the breastfeeding mother, postpartum doula Fauziah Abas, who founded prenatal and postnatal care company Revivify, feels that it is important for family members or anyone who will be caring for the mum during the confinement period to be educated on how to treat her sensitively. “Family members need to be mindful about words that may have a negative impact on a new mother,” said Fauziah, who has been a birth and postpartum doula for several years now. Having spent a lot of time caring for new mums, she finds that well-meaning remarks can make or break a new mother, on top of the other physical and mental challenges that she may feel are insurmountable.

“The job of family members is to physically assist the mother and refrain from making hurtful comments especially when she faces breastfeeding challenges,” said Fauziah. “(Family members ought) to respect  the mother’s wishes to breastfeed as long as she intended to and not to impose their opinions about breastfeeding based on their own negative experiences,” she said. She also added that the immediate family can do more to control the number of visitors and help to give the mother as much space as she can to rest and breastfeed her baby.

Forty Days for Forty Years

Regardless of which cultural confinement practices you choose to follow or not, postpartum is a period for the mother to find herself and rejuvenate her body, mind and spirit to her old self. While it is particularly challenging in this period of time where the new mother may feel isolated and alone without her “village” of help and support, new families must be open to learning how to support a new mother and especially if she is new to breastfeeding. As many elders across cultures and ethnicities have widely advised, investing in these forty days (or more!) of confinement will bring meaningful returns for forty years to come.

[We have also previously written on Indian Confinement Practices. Click here to read.]

*** About the Confinement Recipes***

  • Most of the recipes Far’ain consumed were adapted from the book “The First Forty Days” by Heng Ou
  • Air Kunyit – Turmeric Water; helps with reproductive and womb health
  • Jamu Wanita – Women’s Jamu; traditional Indonesian herbal concoction meant for a woman’s overall well-being
  • Talbinah – A prophetic dietary tradition from the Arab culture; made from barley cooked with milk and sweetened with honey. It is believed that this dish soothes the heart and treats sadness.
  • Sourdough Waffles – Unlike the usual waffle made from plain flour, the sourdough waffle is made from the addition of a sourdough starter to the waffle mix. Sourdough is believed to have benefits for the human digestive system and is a good alternative to commercial bread or dough.

October 2018 Newsletter: Breastfeeding After Breast Cancer [Special]

By Yu Li P’ing

It is truly terrifying when cancer rears its ugly head – what more when the person affected is in the prime of her life. To commemorate Breast Cancer Awareness Month, here is the story of how one brave mama battled breast cancer and refused to let it stop her from nursing her precious firstborn.

Li Ping survived breast cancer and went on to breastfeed her first child. [Photos courtesy of Yu Li Ping]

MY DIAGNOSIS

I was diagnosed with breast cancer at the age of 33. My husband was the one who first discovered the lump and so we quickly scheduled an ultrasound followed by a biopsy. I still vividly remember the room where the ultrasound was conducted. I immediately knew something was wrong when the technician asked me to wait while she summoned the radiologist, who redid the ultrasound. They were silent while they gazed at the screen, nodding at each other in acknowledgement. I suppose they could not say anything about their diagnosis until it was verified by an oncologist.

That same afternoon, I received the dreaded call from the oncologist. I was asked to go to the hospital immediately. I went with my husband where we were informed of the diagnosis – a Stage 3 ductal carcinoma. In medical terms, the tumour was ER/PR +ve, Her2Neu negative; no lymph nodes were affected and the tumour had not metastasized, so staging was T3N0M0 (see sidebar). Over the course of two hours, we asked loads of questions and were given a detailed treatment plan. I managed to hold it up until the drive home, where I fell apart, devastated. I felt as if I had been completely broken.

Because I was quite young when I was diagnosed (I’d be rich now if I had a dollar for every “oh but you’re so young!” comment), I was hit with every treatment possible – a mastectomy, chemotherapy, radiotherapy and hormonal therapy. I gave myself the superhero persona of ‘Chemo Girl’ to cope with the cocktail of chemicals that the doctors were pouring into me. Thankfully, I responded to treatment very well. After my third chemotherapy session, my tumour had disappeared and a biopsy showed huge, clear margins. Full of relief, I thought I could stop chemotherapy then, but my oncologist said no. I went on to complete all six sessions, followed by the mastectomy and 18 sessions of radiotherapy.

GETTING SUPPORT

Throughout everything, my husband was my solid rock. He was there by my side every step of the way, taking care of everything at home and staying strong for me in the face of so much uncertainty. He supported me completely when I was going through the emotional rollercoaster of accepting and understanding my diagnosis.  My family was another source of strength, encouragement and support throughout the journey. My siblings were my number 1 fans, cheering me on at every milestone I achieved (be it the next round of chemotherapy, radiotherapy or the additional 1km I added to each run I completed). My parents took turns to live with me and care for me round the clock. My father accompanied me throughout my runs on the bicycle and encouraging me to push on. My mother cooked for me tirelessly, making nutritious and delicious food for me. Without their love, prayers and support, I would certainly not be able to have gotten through all that I did. Above all else, my faith in God as well as the prayers of my friends and family lifted me to heights I would’ve never known. My church friends even put a schedule together to bring food for my husband and me. I was surrounded by so much love and blessings!

My oncologist also gave me some great advice. He has the worst bedside manners (bless him!) – he once asked me, “How do you feel?” I replied, “Some days I’m upbeat and other days I just cry non-stop…” He interrupted me uncomfortably and said “No… I meant how do you feel physically? Any pain anywhere?” Being the professorly type, he would willingly debate with me whenever I challenged him on my treatment plan and tried to bargain with him on cutting out treatment that I hoped was unnecessary (of course this was based on my oncology “experience” – namely, Google and heaps of medical research papers). You see, I’m a business developer and I negotiate for a living. I remember printing document after document and highlighting paragraphs to argue my case. But one day very early in the diagnosis, and after he was quite frustrated with my arguments, he told me: “I know you’re battling something that is completely out of your control. You are used to being in control and I’m sorry, but the sooner you realize this is never going to be in your control, the better. Instead, why don’t you spend your energy on what is still in your control – what makes you, you.”

He explained that I need to still keep alive the things that drive me, whether it was my work or my regular exercise. He told me that I needed to protect that and not let the battle with cancer and the treatments take over. So I did just that. I spoke to my manager and made plans to continue working albeit at a much more flexible schedule. I continued running and working out at the gym as much as possible. I would give myself a couple of days rest post-chemo and then got back up running and back to the office. Of course I got weaker due to the cumulative effect of my treatment, and my intermittent breaks got longer before I could get back to work or the gym. A month after my chemotherapy treatment was completed, I joined a 10-km run and never looked back.

Li Ping with her daughter.

MAKING BABY

I took Tamoxifen for three years and due to the good prognosis, my oncologist allowed me to temporarily come off the medication to try for a baby. I would have to complete the remaining two years of my course of Tamoxifen after I weaned. Our conception journey was not easy. We had been informed that with all my treatments, we had less than a 50% chance of conceiving naturally. We tried for 1.5 years, enduring a miscarriage during that time, so when I saw that the pregnancy test was positive again, I remained cautious and could not let myself believe I was truly pregnant until I had completed the first trimester. We were ecstatic about the coming baby! After all that we had been through, the pregnancy was like a ray of light.

I knew I wanted to breastfeed fully and made sure that I read up as much as I could. Ultimately however, I was not prepared for the challenges of breastfeeding. In addition, my gynaecologist and doctors were not too encouraging. They wanted me to get back on Tamoxifen as quickly as possible and I wouldn’t be able to do that if I was breastfeeding. There was unfortunately not much medical support or follow-up provided on breastfeeding after I left the hospital. I depended a lot on breastfeeding forums and websites.

I had to equip myself with information about breastfeeding as a breast cancer survivor but there are very limited resources on this, and no support groups available. I was searching but could not find one. The general breastfeeding support groups were not too helpful for me as the challenges I faced were very different from the average mother.

BREASTFEEDING AS A CANCER SURVIVOR

It was a very difficult time for me after the birth of my child. I was always worried about her wellbeing and if she was thriving on my breast milk. I didn’t want to rely on formula and so I put in the effort to breastfeed and express. At one point I was expressing every two hours, waking through the night in the hope of training my one breast to produce more. I tried every supplement and every galactagogue possible. I had known that I was not likely to be able to fully breastfeed but I still wanted to breastfeed exclusively for as long as I could. On hindsight, I wish I had come to terms earlier about the challenges of only being able to breastfeed with one breast, which had then resulted my baby not getting enough milk from me. I had hoped that my body could compensate and produce enough from just one breast. In the end, I needed to supplement with formula as she was losing too much weight. I developed postnatal anxiety and became completely obsessed with feeding her and making sure my milk supply did not drop. I was not myself and it was one of the hardest times of my life, even worse than when I was battling cancer.

I felt so blessed during this difficult phase because no matter how anxious I was or how down I was feeling, I remember fully enjoying breastfeeding my child and being able to bond with her and comfort her even though my supply was not sufficient. Between the tears of emotional turmoil and physical pain, being able to continue to breastfeed my child and having my husband’s support helped to pull me out of my anxiety. Slowly but surely I recovered and was able to return to work after maternity leave. I decided to seek out donor milk so that I could take my child off formula supplementation. She is now fully breastfed – half from my own supply and half from the kindness of so many amazing mothers on Human Milk for Human Babies. I am so thankful for all of you!

It has been a long and hard journey but I am so proud to have made it through to the other side, with the support and love of my husband, father, mother, sisters and brother.

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ABOUT BREAST CANCER

After someone is diagnosed with breast cancer, doctors will try to figure out if it has spread, and if so, how far. This process is called staging and describes how much cancer is in the body. It helps determine how serious the cancer is and how best to treat it. Doctors also use a cancer’s stage when talking about survival statistics.

The staging system most often used for breast cancer is the American Joint Committee on Cancer (AJCC) TNM system, which is based on 7 key pieces of information:

  • The extent (size) of the tumor (T): How large is the cancer?  Has it grown into nearby areas?
  • The spread to nearby lymph nodes (N): Has the cancer spread to nearby lymph nodes? If so, how many?
  • The spread (metastasis) to distant sites (M): Has the cancer spread to distant organs such as the lungs or liver?
  • Estrogen Receptor (ER) status: Does the cancer have the protein called an estrogen receptor?
  • Progesterone Receptor (PR) status: Does the cancer have the protein called a progesterone receptor?
  • Her2/neu (Her2) status: Does the cancer make too much of a protein called Her2?
  • Grade of the cancer (G): How much do the cancer cells look like normal cells?

(taken from cancer.org)

CAN BREAST CANCER SURVIVORS BREASTFEED?

Happily, research indicates that most breast cancer survivors can breastfeed – albeit with a little help. Whether you’ll be able to breastfeed successfully depends on the sort of treatment you have received. Mothers with lumpectomies that have preserved as much ductal tissue as possible may be able to produce some milk from the affected breast. Mothers who have had single mastectomies can most likely produce milk from the remaining breast. By nursing and pumping frequently (things that any mother would have to do to build supply), and with the support of family and a lactation expert, most breast cancer survivors can breastfeed successfully.

Studies show that the highest chance of success is attained when breast cancer survivors receive help from IBCLCs as soon after birth as possible. This ensures that both baby and mother are properly supported through their breastfeeding journey, which may be a little different from most, but achieves the same amazing goals. Don’t be discouraged if your milk supply is not enough for exclusive breastfeeding. You can also consider donor milk, as Li P’ing did, and use a supplemental nursing system (SNS) to feed your child at the breast.