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As everyone knows, breastfeeding is beneficial for both mother and baby. But breastfeeding mothers, especially those who are working, because of the stress and challenges of breastfeeding, are often overlooked.

In line with World Breastfeeding Week, two pediatricians, two working mothers, and the president of the Breastfeeding Mothers’ Support Group, were interviewed and shared their views on the difficulties of breastfeeding and the strategies to overcome these challenges, so as to encourage breastfeeding mothers, and to remind everyone – breastfeeding mothers need the support of their family, employer, colleagues and society, in order to breastfeed smoothly and happily.

Breastfeeding working mothers are not alone on their journey 
by Tan Ying Zhen

World Breastfeeding Week begins today. Its theme, Sustaining Breastfeeding Together, emphasizes that breastfeeding mothers need the support of the family, employers, coworkers and society, and reminds us that breastfeeding is definitely not the sole responsibility of the mother.

If there is lack of support and understanding, many breastfeeding mothers, especially first time working mothers, face immense stress.

When she had her first child three years ago, Wang Yan Jun (35, administrative assistant) said, “Breastfeeding actually can create stress for mothers. For example, when milk supply is insufficient, you will easily feel discouraged, and feel that you are unable to provide the best nutrition for your baby. Not only are some elders not encouraging, they even try to persuade the mother to stop breastfeeding. They also feel that baby needs to drink formula to be full, and for us to easily know how much milk baby is drinking.”

During her maternity leave, Wang Yan Jun persevered in breastfeeding. But after her return to work, because of insufficient milk supply, she stopped breastfeeding.

She said, “I told myself, at least baby drank a bit of breastmilk, better than nothing.”

Huang Mei Yan (34, PR consultant) had her older son two years ago. Her baby could not suckle well, leading to insufficient milk production. Her nipples also started bleeding, which caused her pain.

She said, “Many mothers, before giving birth, don’t know the actual difficulties of breastfeeding. Then when they are unable to breastfeed smoothly, they will blame themselves, and feel that they are not good mothers. On top of that, many mothers who have strong opinions on breastfeeding will say that you should continue to try, no matter how difficult or painful. This is where the stress of a new mother comes from. Is it that if I give up on breastfeeding, I am an incompetent mother?”

Huang Mei Yan emphasized – letting baby have a good latch is a learning process for mother and baby. Even though she knew this, after birth, hormonal fluctuations caused her to feel negatively.

In order to learn the correct latching technique, Huang Mei Yan, other than learning eagerly from the nurses during her hospital stay, also engaged a private lactation consultant for a home visit after her discharge from hospital. With more practice, baby’s suckling got better. But she admitted that she could not enjoy the breastfeeding journey unlike other mothers. Furthermore, because of work, in order to have better control of her time, she stopped nursing her son at about four months of age, and switched to bottle-feeding her expressed breastmilk.

Feeding of expressed breastmilk is also considered breastfeeding

Visiting parenting websites and discussion forums online brought this discovery: some mothers insist that you need to feed baby from the breast, in order to be considered as breastfeeding. If a mother expresses her breastmilk and feeds it in a bottle to her child, it is not really breastfeeding.

On this, the president of the Breastfeeding Mothers’ Support Group (Singapore), Elaine Chow (35, stay at home mother) states – it is not so much about the form that breastfeeding takes. Whether you are direct latching or expressing breastmilk, it can still be considered as breastfeeding.

She said, “There are indeed unique benefits to letting babies direct latch. But working mothers who have to return to work are unable to do so, so the best way is to give expressed breastmilk. Regardless of which method of feeding, the mother has to expend her effort and time, and baby is still able to drink mother’s milk. So both can be considered as breastfeeding.”

Studying to be an International Board Certified Lactation Consultant, Elaine Chow has three children, aged 1 year, 5 years and 8 years. When asked to summarize the reasons why mothers stop breastfeeding, she listed the various challenges, starting from the time that the baby is born till the time that the mother has to return to work.

The many challenges of breastfeeding

Firstly, there are only three hospitals in Singapore that have been certified under the Baby Friendly Hospital Initiative – KKH, NUH and SGH. So if you choose any of the other hospitals, especially private maternity wards, you may not get suitable support after giving birth.

During the confinement period, the mother’s mother, mother-in-law or confinement nanny may be unfamiliar with breastfeeding, and so cannot properly support a mother in her efforts to breastfeed. For example, they may think that it is necessary to supplement with formula. Or they may want to let the mother rest, and hence insist on bottle feeding the baby.

Elaine Chow said, “Early introduction of bottle can make it difficult for baby to return to the breast, which then makes it hard for a mother to continue breastfeeding after that. And many mothers then find that their desire to breastfeed gets quashed during the confinement period.”

Even if there is success in breastfeeding during the confinement period, whether or not breastfeeding can continue is still unknown.

According to the World Health Organization, babies should be exclusively breastfed until six months of age, and continue till two years or beyond, with the addition of complementary foods. But when it comes to working mothers, maternity leave is insufficient, superiors or colleagues not understanding enough, or her workplace does not have a suitable place for expressing breastmilk. These are all obstacles on the path of breastfeeding. To continue breastfeeding till six months may not be as easy as imagined.

Elaine Chow said, “When breastfeeding, a mother has to pump at regular intervals every day. But they may have employers, supervisors or co-workers who do not respect this need. Or the company may direct a mother to express her milk in the toilet, when that is really an unsuitable and unhygienic place for a mother to make milk for her baby to drink.”

Success in breastfeeding requires adequate preparation

To understand the challenges of mothers in breastfeeding, so as to administer the right medication, so as to encourage mothers to breastfeed.

Dr Chua Mei Chien, head of KK Women’s and Children’s Hospital’s Neonatology Department, and head of the “Baby Friendly Hospital” taskforce, is herself a model for working mothers who breastfeed. After her maternity leave, she succeeded in managing both the needs of her work and breastfeeding. Her three children each breastfed for 20 months, 28 months, and 34 months.

Dr Chua Mei Chien quoted the results of the national breastfeeding survey in 2011: “Maternal breastfeeding rate was 50% at discharge and reduced to 0.8% after six months. The most common cause of breastfeeding for professional women was milk deficiency (60%), and because they had to return to work (24%).”

Dr Chua said, “As long as there is sufficient preparation and adjustment, mothers can continue breastfeeding after return to the workforce. But must begin preparations soon after giving birth.”

These preparations include: Ensuring adequate milk supply, accumulating a store of breastmilk, and helping baby’s caregiver be prepared. For example, if baby will be in the care of a nanny, then let the nanny know the importance of breastfeeding, and to also clarify any misunderstanding about breastfeeding. Some nannies think that drinking breastmilk that has been stored in the fridge will give baby a stomach ache; but actually after taking the breastmilk out from the fridge, you will warm it before feeding it to baby.

Even more suggestions can be found on the KKH website.

Success in breastfeeding requires support on multiple fronts

Successful breastfeeding is not a battle that a mother can fight on her own. Other than preparations by the mother herself, she also needs support from her spouse, family, employer and society.

Dr Chua gave these suggestions:

1. The partner’s encouragement and support will help the mother breastfeed for longer, and also strengthen the relationship between husband and wife.

2. Partners and family members, other than providing moral support, can also take over the household chores, and other aspects of childcare, such as changing diapers or bathing, so as to allow the mother time to rest.

3. Employers can provide a nursing room, to give privacy to mothers when pumping

In KKH, for example, the nursing room is well-equipped, with items such as a pump, steam sterilizer, kettle, bottle brush, storage cabinet and fridge, which are available for their employees’ use.

4. Employers can give flexible work arrangements, allowing mothers to pump regularly.

Dr Chua said, “Some mothers are unable to find time to pump because of their work. I will encourage them to store more milk during maternity leave, so that she can continue breastfeeding after maternity leave, allowing her to rest after work and on rest days. This is better than not breastfeeding at all.”

5. Public places such as malls or bus interchanges should have nursing rooms.

6. Through public education, increase the public acceptance of mothers breastfeeding in public.

Neonatal specialist shares her breastfeeding experience

KKH neonatal pediatric consultant doctor Jiang Zuan Yi had a son last September. During the hospital stay, breastfeeding went well, but problems emerged after discharge.

Dr Jiang Zuan Yi had to nurse her child every two hours, but her milk supply was very low. She made an appointment with the hospital lactation consultant, and during the examination, discovered that she was having blocked ducts. So the milk was stuck in the breast, resulting in engorgement. The lactation had to use her hands to massage, and so resolved the situation.

Dr Jiang Zuan Yi said, “From then, after every time I breastfed, I would diligently massage my breasts. If there was any residual milk, I would squeeze it out. Milk supply because to increase, and with some improvement in baby’s latching technique, the problem of breast engorgement was also resolved. If not for timely assistance, to diagnose and resolve the issue of breast engorgement, I think I would have failed at breastfeeding.”

Now that she is back at work, Dr Jiang Zuan Yi’s biggest challenge is not having being able to pump regularly. With a decrease in the number of times she can express milk, milk production will also go down. But she will let her son latch on once she reaches home, and he is also nursing on demand at night.

Dr Jiang Zuan Yi said, “I hope to continue breastfeeding my son till one year old or more. Every day after work, when I get home, the time I spend breastfeeding is very special, and is also something that I look forward to. Seeing my son suckle, as well as his satisfied smile after feeding. even the stress and tiredness of my long hours of work will disappear.”

Public activities promoting breastfeeding

1. KKH Healthy Breastfed Baby Contest 2017

To encourage and support mothers in breastfeeding, other than organising the Healthy Breastfed Baby contest, KKH is also holding a group breastfeeding activity, encouraging mothers to participate. Members of the public may also cast a vote in the most popular baby contest.

Date: August 5th, Saturday
Time: 10am-4pm
Venue: United Square B1 atrium

2. Breastfeeding Mothers’ Support Group (Singapore), The Big Latch On

BMSG is organizing the 6th round of The Big Latch On, with lots of activities for the whole family. Mothers can learn more about breastfeeding and childcare, children can listen to story telling and enjoy balloon sculpting, dads who have been supporting breastfeeding can get a free burger from Fat Papas.

Date: August 5th, Saturday
Time: 9am-11am
Venue: 20 Upper Pickering Street