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42 MOTHER & BABY FROM PAGE 41 but it does get a lot easier with time: try not to judge yourself against others.” However, for some women, despite best efforts, complications with breastfeeding may still arise. “There are a number of difficulties that mothers can often face when breastfeeding,” Ms Hull said. “This is why support from organisations such as the Australian Breastfeeding Association (ABA) is extremely important. A recent study published in The Lancet showed that with phone support (eg, the ABA’s 24-seven Breastfeeding Helpline), mothers breastfed for longer.” Nipple creams and ointments, as well as well-fitting bras, are also available to help mothers facing challenges with breastfeeding. “There are various topical creams and products that some mothers use to help prevent or treat sore nipples,” Ms Hull said. “Speak with your midwife, lactation consultant or medical adviser about the options that may suit you.” Ill-fitting bras are uncomfortable at the best of times, and even more so when breastfeeding. Ms Hull adds that “bras that don’t fit well can cause nipple soreness and even blocked ducts and mastitis”. “Bras made of synthetic materials cause sore nipples in some women because they don’t allow the skin to breathe,” she said. For support at night, Ms Hull suggests “a soft cotton sleep or sports bra or crop top” to provide support and to “hold breast pads in place at night if you leak milk”. For women who face challenges with attachment/latching and milk supply, Ms Hull emphasises the importance of speaking with a professional for support. (She recommends a call to the ABA’s Breastfeeding Helpline: 1800 686 268.) “A baby who attaches well to the breast can help prevent many breastfeeding problems,” Ms Hull said. “Sore, grazed or cracked nipples usually mean your baby isn’t attached properly and has damaged your nipples. A poorly attached baby is not usually taking enough milk. This can lead to a blocked duct or mastitis.” If all possible aids and solutions have been attempted and if significant issues continue to arise when breastfeeding, infant formula may be needed to ensure the baby continues to thrive. However, Ms McGrice makes it clear that “formula is only needed for mothers who are unable to breastfeed”. “If a woman is really struggling with breastfeeding, then formula may need to be considered,” she said. “It’s a good idea to speak with a postnatal dietitian about the best formula for the mother and baby. “There are a variety of different formulas available. It’s best to get personalised advice about the best formula for each baby.” Breastfeeding in the time of COVID-19 The message from the ABA for times of viral outbreak is “to continue breastfeeding” and to, “wherever possible keep mother and baby together”. “If a mother has been diagnosed with or is suspected of having COVID-19, care should be taken to follow usual precautions while continuing to keep her babe with her and to breastfeed,” Ms Hull said. “If a mother has stopped breastfeeding \[during this time\], there is help available to start again.” “\[The\] Breastfeeding Helpline is available 24/7 on 1800 686 268 with a Breastfeeding Counsellor available to answer any questions or issues with breastfeeding and COVID-19,” Ms Hull said. Health professionals are encouraged to visit the ABA website for further information and factsheets: abaprofessional.asn.au/ download/covid-19 The experts agree that some of the challenges with breastfeeding may arise due to: • Concerns around milk supply. • Attachment or latching concerns. • Sore/cracked nipples. • Thrush. • Blocked ducts/mastitis. • Inverted/flat nipples. “Ninety-six per cent of Australian mothers initiate breastfeeding but less than half (39 per cent) \[of these infants\] are still being exclusively breastfed at three months of age,” Ms McGrice said. This figure drops further at the five-month mark, with “less than 15 per cent of babies being \[breast\]fed to five months exclusively”, she adds. “The primary determinants for ceasing breastfeeding include a lack of time and confusion, such as thinking that their baby isn’t getting adequate calories,” Ms McGrice said. Breastfeeding aids and support Fortunately, for many women who struggle with breastfeeding for any of the above reasons, many products and solutions are at hand. One is the nipple shield, which is described as great for those with inverted or flat nipples. “Some mums may need a nipple shield,” Ms Hartley said. “This can usually be purchased on the maternity ward or at the pharmacy. A nipple shield can be used when a mum’s milk is coin-in. Nipple shields are usually temporary, and \[women\] will need follow up support with \[their\] lactation consultant for when to cease using it.” Not easy but worth it According to Ms Hartley, it’s important to remember that breastfeeding, especially in the “early days and weeks” is “difficult”, but there is help available because breast is definitely best where possible. “The average first-time mum can take about six weeks to master this new skill,” she said. “Sometimes just reassuring a mum that these challenges are normal is enough to encourage her on the harder days. “Seek professional help. A breastfeeding plan will help reduce conflicting information and empower mum with the knowledge that she is following the right steps. “If the baby has lost more than 10 per cent of its birth weight ... this is a red flag for midwives, paediatricians to implement a feeding plan ... if a mum has very low supply and the baby continues to lose weight, then we’ll look at supplement feeds, like formula. This would always come after breastfeeding and after you’ve given the baby expressed milk.” References: World Health Organisation 2020. ‘Breastfeeding’. who.int/health-topics/breastfeeding#tab=tab_1 \[Accessed 6/4/20\]. The Women’s. The Royal Women’s Hospital, Melbourne. ‘Breastfeeding’. thewomens.org.au/ health-information/breastfeeding \[Accessed 6/4/20\]. RETAIL PHARMACY ASSISTANTS • MAY 2020