Royal London Polyclinic Consultant Pediatrician Dr Abdirahman Farah during the interview in Parklands, Nairobi on July 26, 2024.
To kick off the breastfeeding awareness week that begins tomorrow (August 1), Dr Abdirahman Farah, a consultant paediatrician at Royal London Polyclinic, spoke to Nation Lifestyle answering commonly asked questions concerning breast milk.
Where does breast milk come from?
Prolactin is the hormone that helps in milk production. It can be low in certain situations… say, if somebody takes medication that interferes with it or has some thyroid conditions, that can be checked as we evaluate the reason for the low milk production.
Also, prolactin is present in both males and females. You can find a man who has female-like breasts and they have milk. There are situations where tumours in the brain increase your prolactin levels, which make you have breasts or stimulate milk production even when you are not lactating.
What are the common mistakes women make while breastfeeding?
Poor hygiene. You know, it is common for babies who are breastfeeding to get recurrent diarrhoea. So sometimes, when you see babies feeding on expressed milk and they have diarrhoea and infections from time to time, it is possible that the mothers are not maintaining good hygiene. Number two is storage. People use all manner of containers; some people even use disposable bags to keep milk. Well, if you want to use plastic, stick with the BPA-free type.
How should women express milk?
Expressing milk can be done either using your hands or an electric/manual pump. The technique is usually straightforward when using a pump, but if you are using your hands, you can press from where the areola starts (an area of skin that is darker than the rest of the breast). Start squeezing and releasing until you get the amount you are looking for or when you have emptied your breast. You can tell that the boob is empty by the weight of it; it is lighter.
And what are the signs that stored milk has gone bad? It is similar to any other ordinary milk. If it smells bad, tastes sour, and changes colour, it is bad.
Can you store breast milk without a fridge?
If you put breast milk out at room temperature, that milk can stay good for 6–8 hours. If you put it in the fridge, it will stay good for at least four days. When stored in a normal freezer, the milk can last at least two weeks. But if you use a deep freezer, you can keep it for at least 3-6 months, some as far as 12 months.
But why would someone want to store breast milk for a year?
See what happens; when you breastfeed and resume work, the milk production goes down. So, when you store for a longer period, you can have a reserve to give the baby. So, usually, it works well for those who are working. You know you are not always energetic; you don't always have enough milk, so from time to time, you will get your supply from the fridge.
Let’s talk about thawing and warming breast milk
It depends on where you have kept it. If you have kept it in the freezer, you can remove it a day earlier to put it in the fridge for it to become liquid. Then you can put that bottle in lukewarm or warm water. It is always good to give it within two hours after you have warmed it up. You are not supposed to refreeze that milk.
Is it important to take turns when breastfeeding to make sure the baby feeds from both breasts?
No! No! No! That is not right. You put the baby on the breast and keep it there until the breast is empty because the last part of the milk contains fat, which helps with growth. Initially, when you start to breastfeed, you are supposed to do that on both sides so that you can stimulate breast milk production symmetrically. Along the way, if you have enough milk, you can breastfeed on one side of each feed.
After how many hours are you supposed to breastfeed?
The baby cannot stay hungry for more than three hours. So, aim to breastfeed every 2-3 hours and each time try to breastfeed for 10–15 minutes. It is always good to take a break in between.
How then can you know that your child is full?
Initially, when they start breastfeeding, they will suckle vigorously but as they get full, they will become calmer, and slow down, and at some point, they will remove their mouth from the breast and turn away
Lactation cookies/teas, is it old wives’ tales or do they work magic?
Haha! There are so many products out there on the market that contain substances or herbs believed to help with lactation.
We do not have concrete evidence on whether they work or not, but people have used them for a long time, and many people think they work. From where I sit, we usually recommend natural ways of increasing breast milk: eating a balanced diet, taking more nutritionally caloric-dense foods, hydrating well, resting, and then lactating properly… the technique also matters. This is by how you hold your baby. Mothers are meant to relax; they are not supposed to be in an uncomfortable position.
Secondly, is to insert the areola in the mouth. Sometimes what mothers do is insert the tip (the nipple) and the baby does not get enough from that. It is good to keep skin-to-skin contact with the mother, which will stimulate and improve breast production.
So, doc where do we put the formula in this equation?
Nowhere. Well, formulas are not supposed to be given if breastfeeding is completely contraindicated. That means a mother is not supposed to breastfeed, so maybe at that time formula can be given. Or the mother has passed away and the child needs to be fed. If the child is abandoned, you can allow formula. It is not the work of a paediatrician to assist the mother in doing the wrong thing. If the mother is not producing enough milk, we need to find out why not. Is it because she is not getting enough nutrition? Is she stressed? Overworking? Or is she sick/ill? All this needs to be investigated.
