TWB in Review: Breastfeeding & Postpartum Mental Wellness (Part 2)

By BMSG Editorial Committee

While Dr Elizabeth Siak’s sharing was focused on the symptoms of PND and what sort of treatments are available for mothers, Cindy Khong, a counsellor of mental health at Clarity Singapore, highlighted the importance of social support that a mother needs during the postpartum period. She also spoke at great length about the need for self-care and how family members can be sensitive and support mothers appropriately.

Cindy Khong (top right), counsellor in mental health from Clarity Singapore, spoke at great length about social support and coping measures to help mothers find peace during postpartum. [Credits: BMSG Singapore]

Pressures of Societal Expectations

Cindy shared that the main struggle of mothers lies in the fact there is a difference between what society expects of motherhood with what mothers really experience for themselves. In popular culture, motherhood is often portrayed as natural, instinctive and enjoyable while in reality, mothers go through a lot of changes of which many are not prepared for. It is natural for new mothers to feel overwhelmed with the many new responsibilities on her shoulders. Cindy gave the analogy she received from her client about motherhood: that it is like filling up a fruit basket to the brim which then overflows. 

Wellness & Importance of Self-Care

When this happens, a typical mother then overlooks the need for her own self-care as she struggles to complete her tasks and duties. With guilt and the difficulty to find time, it was enlightening to hear from Cindy that self-care actually allows a new mother (or any mother for that matter) to cope with a new baby. “You need to care for yourself before you can care for others” was a quote that Cindy shared about the importance of mothers taking care of their own physical and emotional needs. 

One often overlooked aspect of self-care is that it allows a mother to be more emotionally present for her children and also allows her to build a strong connection with their partner.  This then allows her to turn to her partners for support and comfort, which then decreases the probability of depression in the mother. 

When a mother has time to recharge, she is better able to respond to her baby emotionally. [Stock Photo]

Self-care also prepares a mother for a secure attachment bond with her baby, which is a good foundation for child development. When a parent takes care of herself, she will be able to better respond to her child’s verbal cues. Such interactions optimize the baby’s nervous system and brain development, which are necessary for a child’s cognitive development. Babies with a history of secure attachment patterns have greater sense of self-agency, have higher self-esteem as teens and adults, and are better at regulating themselves emotionally.

One often overlooked aspect of self-care is that it allows a mother to be more emotionally present for her children and also allows her to build a strong connection with their partner.  This then allows her to turn to her partners for support and comfort, which then decreases the probability of depression in the mother. 

Recognising the Obstacles to Self-Care

Cindy then conducted a poll on the audience to understand what the audience felt about mothers taking time off for self-care. She then went on to explore the various reasons why mothers avoid taking the time to care for her well-being. 

It was interesting to note several reasons that mothers avoid finding time for self-care, among them being:

What Mothers Feel About Self-CareWhy They Feel this WayWhat Can Mothers Do to Overcome This
GuiltMothers do not find their needs as important as their children’sThey feel they are weak if they request for it as their parents were able to care for many children without needing itAsking for help and time to rest are not signs of weaknessAsking partners to be more involved actually increases their confidence to build strong relationships with the childrenUnderstand that self-care has positive side effects on caring for babyMake it a habit to put yourself first at least one a dayTake short breaks such as having 10 minutes of deep breathing or doing something you enjoyHave smaller tasks in a day to give you a semblance of control
Finding the need to be perfectExpecting ourselves to be as productive at home and work as before we had children is unrealisticWanting to do things in a specific, rigid wayBut nobody has it all togetherBe prepared to let some things go and prioritise what is critical and importantDo one thing well at a time instead of moreTell yourself there are good and bad days; don’t concentrate on the negative all the timeCelebrate small achievementsIf there are changes that need to be made, break up small steps into smaller plans to move towards that changeAllow yourself to feel sad, angry and irritable and get your partner to validate you; this may mean that you no longer have to put up a front
‘I don’t deserve it.’Mothers devalue themselves and think that ‘I am just a mother’These mothers may have issues with their self-worth and belittle themselvesMothers should avoid putting themselves down as they should recognise that their babies deserve the best mother and hence, mothers deserve to be cared forBe kind to yourself and give time to recover emotionally and physically after birthSeek professional help to make sense of these beliefs

Cindy also encouraged mothers to do several other things to help their recovery and adaptation during the postpartum period:

  • Seek suitable social support to share similar concerns and needs
  • When we see other mums who struggle with the same problem, we feel validated and not alone
  • Spend time with our partners to nurture the relationship and to understand that we are not alone in the struggle
  • Couple time is challenging to implement but promotes open communication and marital harmony
  • Couple time also lowers the risks for PND
  • Practise gratitude instead of comparing with other mothers or even our spouses; it can fuel loss of motivation, confidence and self-esteem 
  • Understand that every mother is different and we have different starting points, resources and capacities
Fathers who play an active role at home have greater confidence in managing their children and can build better bonds with them. [Stock Photo]

How Spouses, Family Members & Friends Can Support New Mums

If you are supporting a new mother, Cindy reminds us that mums are looking for someone to listen and find out what they need help with without judgment or sympathy. When a mother expresses her struggles, our reactions matter very much in what she feels after. 

  • Judgment vs Validating

    When we validate a mother instead of judging her abilities, she feels understood and will be more open to receiving help for her anxiety. When we judge a mother, she feels shame and not good enough and may perpetuate the behaviour she displays when having anxiety
Cindy shares with the audience how partners and even family and friends can better word their conversations with new mothers to respect her feelings and space. [Credits: BMSG Singapore]

Cindy shares how spouses and other people around a new mother can be more mindful in how they speak to her.

  • Partner Support

    Partners are one of the key contributing factors in the recovery of a mother’s postpartum well-being. For mothers who are not depressed, having good partner support shields the mother and her baby against stressors during this period.

    Spouses may find it helpful to praise a mother and validate her, and provide constant encouragement. Show appreciation instead of thanking her and encourage her to talk about her feelings. Understand that a mother wants to be understood so partners should try to reflect back her feelings.

    Being familiar with signs of postpartum stress and where to seek help are also important especially if her condition turns serious. It would be helpful for everyone if partners encourage mothers to seek treatment and support especially if symptoms get overwhelming and persistent over time.

Lastly, being active in the household can lay off a lot of the burdens on the mother. Be clear about your roles to avoid misunderstanding and conflicts with the mother.

Partner support is crucial in determining what kind of postpartum a mother will have and can largely prevent depression in mothers. [Stock Photo]
  • Family Members & Friends

    Many of us would fawn over newborn babies but never ask about the mother. For a start, showing care for a new mother would do well to help her feel appreciated and validated. Being available to talk to her and spending time to listen to her struggles, especially without comparing yourself or others to her, would be valuable for her well-being.

    Be very careful of appearing to be an “expert” as it can affect her confidence. Cindy suggested that it would be better instead to show more understanding and ask how you can help.
It takes a village to raise a family. [Stock Photo]

It Takes a Village

A lot of us would be familiar with the saying ‘It takes a village to raise a child’. But Cindy reminded us a village is also required to support parents, especially new mothers. Nurturing a strong circle of support will be valuable both for mother and baby to grow and thrive in the community that they are in. Mothers should also remind themselves that when they focus on their personal well-being, they will have more energy and peace of mind to care for their children.

Look out for Part 3 soon!

Newsletter #47: BMSG Interview with Dr Jack Newman

by Nabila Hanim, BMSG Staff

Last June, BMSG (Singapore) had the honour of recording a video conferencing session with the esteemed Dr Jack Newman, paediatrician and breastfeeding expert, who is also an International Board Certified Lactation Consultant (IBCLC). During the session, Dr Newman had responded to some pertinent questions about breastfeeding and jaundice. In this article, we summarise the interview for the benefit of our readers and followers.

Many of us would have recognised Dr Newman from our own readings and research on breastfeeding. His resource pages have been very popular and widely referenced. Dr Newman is also known for helping many mothers tackle breastfeeding challenges even in the early newborn days. His video on breast compression, among others, has been shared extensively in the breastfeeding community.

What is Jaundice?

Jaundice is usually detected a few days from the baby’s day of birth. Jaundice is typically diagnosed after a blood test is done on the baby to check bilirubin levels. Bilirubin, a by-product of the breakdown of red blood cells, are in abundance in babies while in the womb. Once baby has been birthed, baby’s body breaks down these excess red blood cells because they are no longer needed. Bilirubin is one of the products of this process.

Bilirubin is also an antioxidant and can help the body to manage Group B Strep, which can cause meningitis in baby. Dr Newman suggested that this is probably a huge clue as to why bilirubin may be present in many babies, particular in East Asian babies.

Bilirubin has a Function

Dr Newman spent a significant amount of time talking about how bilirubin levels may not necessarily be an indicator that something is wrong with the baby. He explained that since bilirubin is not normally produced by the body, there must be a reason why it exists in babies. He also compared the high levels of bilirubin in jaundiced babies to the Gilbert syndrome, a disease by which otherwise normal adults experience higher than usual levels of bilirubin as compared to other adults. It was found that persons with Gilbert syndrome will experience elevated bilirubin levels when they fall ill and are also protected from atherosclerosis. 

A baby receiving phototherapy. This is the usual treatment for jaundiced babies. Dr Newman, however, questions its safety and the high risk of it interrupting the breastfeeding relationship. [Stock Photo]

Is Breastfeeding to Blame?

Dr Newman then shared about how the problem is not breastfeeding but rather dehydration. Dehydration in jaundiced babies increases the risk that bilirubin will cross the blood-brain barrier, which is dangerous for babies.

On the question of whether formula is necessary for babies who are jaundiced, Dr Newman stated that breastfeeding does not have to stop because of jaundice. Introducing formula will affect the breastfeeding relationship since baby will not nurse as much.

In fact, Dr Newman believes the issue of hydration can be solved when breastfeeding is successful. A lot of times, jaundiced newborns are not breastfeeding optimally and therefore not drinking enough to hydrate themselves.

Birth Interventions Also Contribute to Breastfeeding Problems

Parents may also notice that some of their babies may not be interested in breastfeeding or are always falling asleep at the breast. Dr Newman explained that mothers who receive interventions during labour, such as epidurals, IV fluids (which are compulsory with epidurals) or taking other pain-killers while labouring, risk having babies born being sluggish, inactive or sleepy. This makes it difficult for babies to learn to breastfeed right after being born and he urged parents to become empowered to reject such interventions because it can obstruct breastfeeding later on.

Citing his experience of witnessing mothers giving birth in African countries while he was still working there, Dr Newman observed that mothers rarely received interventions during labour. He found that the babies to these mothers remain alert at birth and subsequently had little issues to latch onto their mothers’ breasts. In contrast, mothers in modern settings who birthed at hospitals frequently face the challenging tasks of breastfeeding sleepy babies. 

Birth interventions, such as IV drips and taking painkillers, can affect baby’s alertness levels and interest to breastfeed after birth. [Stock Photo]

While a jaundiced baby has always been thought to become sleepy because of their condition, Dr Newman, on the contrary, attributed this to the lack of hydration or being over-hydrated from the fluids that mums take during labour. Over-hydrated babies may show less interest to breastfeed because their bodies do not need excess fluids. He also added that taking painkillers such as epidurals allows the medicine to pass over to the baby through breastmilk, resulting in sleepy babies. 

He emphasised that parents need to be empowered to reject birth interventions and to know that these interventions “are not without consequences” and implications especially on breastfeeding. He also urged that all mothers should have the choice of not taking epidural and understand that birth interventions can impact breastfeeding drastically. 

Remedying Jaundice

Dr Newman was also asked if there was a need for phototherapy in the treatment for jaundice or exposing jaundiced to sunlight. Dr Newman replied that it is strange that we encourage adults and children to put on sunblock but have no issue with putting a jaundiced baby for long hours, sometimes days, under phototherapy light. He also mentioned that there is evidence that exposure to phototherapy can also alter the cells in babies’ bodies, which are precursors to cancers. There are also studies that show babies can experience DNA damage after undergoing phototherapy. 

While he acknowledged that phototherapy can be helpful when a baby is already hemolysing and to prevent exchange transfusions, it does not tackle the root of the matter which is the lack of hydration or the infrequency of breastfeeding. “Jaundiced babies need to breastfeed and drink well,” Dr Newman said. He mentioned that if breastfeeding was going well in the first place, there would be no need for phototherapy. If the mother and baby are already engaged in breastfeeding, having jaundiced babies undergo phototherapy also “disrupts the routines” of breastfeeding.

A lot of mothers worry about their diet causing a rise in their babies’ jaundice levels. There are no conclusive findings and the priority is to ensure baby is breastfeeding well. [Stock Photo]

Mothers’ Diet & Impact on Jaundice Levels

Some mothers had also voiced their concerns about the impact of food on jaundice levels and if certain food can cause jaundice or allow its levels to worsen. Dr. Newman responded that as long as babies are healthy, thriving and gaining good weight, mothers can continue to breastfeed their babies. Instead, mothers should troubleshoot early breastfeeding issues and ensure that babies are drinking sufficiently. “We have to remember that as long as baby is well there is no need to be concerned,” he said, emphasising the importance of good breastfeeding to help baby cope with jaundice.

Closing Remarks: Bilirubin is Not the Real Problem

As the conversation rounded up, Dr. Newman once again questioned why bilirubin is a problem when it is so abundant and normal in many babies. He believes that there is a link between this and the fact that babies who are healthy and still experiencing jaundice (also known as breastmilk jaundice in otherwise healthy babies with no other medical complications) can still thrive and grow well despite clearly still being jaundiced. At the end of the day, he urged the audience to embrace the fact that jaundice levels will rise when breastfeeding is not going well, and that to fix that first and foremost.