From mastitis and the hidden hindrances of breastfeeding to baby pain and constipation, motherhood is fraught with highs and lows
Lisa Properjohn, registered nurse specialising in paediatrics at Pharmacy 777 Whitford City, WA, says pharmacy is in an ideal position to support mums in caring for their baby through practical advice and reassurance.
“When you travel by airplane you’re told to put the oxygen on yourself first before helping your children; I often give lactating mums this analogy.
“It’s not a selfish act for mothers to look after themselves; they need to do so in order to give optimal care and nutrition to their child. It can be helpful for pharmacy staff to remind them of this and also reassure them that they’re doing a good job,” says Properjohn.
Jodie Warburton, midwife and sleep consultant, says it’s common for women, especially first time mums, to underestimate the change to their lives that a new baby brings.
“During pregnancy, the main focus tends to be primarily on the labour and birth. There isn’t as much information and preparation provided in classes for once parents get home with their newborn baby. The lack of sleep however is something I don’t think anyone can really prepare for and it can come as quite a shock.
“Once you become a mum, you never really switch off. Even when their child is asleep, mums are usually thinking about the next feed, the next day, when they’re going to wake up next, it can be a truly overwhelming time.” As one of the most frequently visited healthcare providers, pharmacists and their staff can offer new mums practical advice to help them cope with the change to their lives. Warburton promotes the following tips:
- Fresh air—encourage new mums to get outside every day. Go for a walk or just sit in the garden. What you do doesn’t matter as much as the fresh air and sunshine.
- Bond with baby—tell mums not to worry about strict routines in the first three months, but just to focus on feeding and helping the baby get the sleep they need.
- Help and rest—check that they have adequate support and advise on local services they may find useful. Promote any services your pharmacy offers such as a lactation consultant, sleep consultant, postnatal doulas, maternity nurses, etc.
- Nutrition—remind mums of the importance of fuelling their body with healthy and nourishing foods and drinking plenty of water as this is vital for milk supply as well as energy levels and recovering from birth.
A common concern for breastfeeding mums is mastitis. General practitioner Dr Daria Fielder advises, “Mastitis is best treated with antibiotics as it can spread very quickly causing complications such as an abscess, which needs surgery. It’s essential that breastfeeding women present to their doctor as early as possible.”
However, pharmacy can play a role in ensuring that lactating women are aware of mastitis, the symptoms and how to prevent it.
According to the Royal Women’s Hospital Victoria, common causes of mastitis include:
- poor attachment to the breast;
- long breaks between breastfeeds;
- breasts that are too full;
- blocked milk ducts;
- stopping breastfeeding too quickly;
- an overly tight bra.
“The symptoms of mastitis include pain, redness and swelling in thebreast area, fever, muscle pains and aches,” says Dr Fielder.
“To help prevent mastitis, breastfeeding women should regularly feed their baby—every three hours and avoid long interval between feeding.
“The breast should be completely emptied before changing sides and if the ducts become blocked it can be gently massaged during feeding or in the shower.”
Placing a heat pack on the breast immediately before feeding can help with milk flow while a cool pack after feeding can ease discomfort.
“Being able to offer the services of a lactation specialist who can make sure the baby is attaching properly and feeding well is invaluable for mums and can help alleviate many of the common issues. Mums come here and they know they will get a solution to their problem,” says Properjohn.
“We also hire out hospital grade breast pumps and offer a free home delivery service, which can be particularly helpful for women who have had a caesarean birth and can’t drive for six weeks.”
Eating well postpartum
“The most important thing is to increase fluid intake because women lose a lot of fluid when breastfeeding. Staying hydrated is really important,” says Melanie McGrice, accredited practising dietitian and spokesperson for the Dietitians Association of Australia.
She explains that the macronutrient ratio of breastmilk is 55.6% fat by calories, 38.8% carbohydrate and 5.6% protein. As such, she says pharmacists and their staff can promote the importance of eating a typical healthy diet but with a few extra vegetables and grains.
“The vegetables provide fluid and fill you up without adding too many kilojoules while the grains provide the additional carbohydrates that you need when breastfeeding.
“Two serves of fruit and two and a half serves of dairy are recommended per day. In some instances a little added protein can be recommended during the first couple of weeks after delivery to assist with wound healing— for example if the mum tore during delivery or had a caesarean birth.”
While vitamins are commonly discussed during pregnancy they can be overlooked once the baby comes along. Pharmacy staff can remind women of the importance of adequate nutrition postpartum.
“Calcium intake is very important during lactation so just check in with mums to ensure they’re aware of the recommended daily intake and are achieving this.”
“Iodine is particularly important throughout breastfeeding. Foods rich in iodine include seaweed, iodised salt (found in bread), seafood and fish.
“Iron (recommended daily intake for lactating women is 9mg a day), vitamin D and omega 3 are the other key nutrients recommended throughout breastfeeding. As long as adequate amounts are being consumed through diet, supplementation is not necessary,” says McGrice.
According to NAQ Nutrition, the following guidelines can be offered to lactating women:
- enjoy a wide variety of nutritious foods but choose foods mainly from the Five Food Groups and limit your intake of ‘discretionary’ foods and drinks that are high in saturated fat, added sugars and added salt. For example, cakes, lollies, biscuits, potato crisps and soft drinks;
- increase vegetable intake up to 7.5 serves per day;
- it is recommended to consume 9 grain serves (mostly wholegrain) per day;
- protein needs decrease slightly compared to pregnancy, and it is recommended to consume 2.5 serves of meat and alternatives per day;
- maintain adequate calcium in your diet;
- drink plenty of water as fluid needs increase markedly when breastfeeding;
- eat regularly throughout the day to help maintain energy;
- maintain good food safety and personal hygiene to help minimise risk of food poisoning for mum and the baby; and
- continue to limit alcohol and caffeine—especially in the first month after the baby is born.
“The most common queries we hear about the baby focus on symptoms of colic, sleeping problems, feeding issues, weight and length, constipation, eczema and teething,” says Properjohn.
She says that while some babies are born with teeth and others can start teething as young as three months, it’s more common for babies to cut their first tooth between four and six months.
“More often than not when a mum presents with a baby under theage of four months who is irritable, producing a lot of saliva and putting their hands in their mouth—this is part of a developmental phase; it’s not actually teething.
“Of course for babies that are teething we have plenty of OTC products and advice we can offer. For example, Brauer has a teething gel and liquid and Weleda offers a teething powder. If the baby is on solids, Tommee Tippee has a Fresh Food Feeder that the baby can bite down on.
“Teething can take weeks to months and while it might be tempting to give the baby an analgesic, I advise mums to try all other options first and to refrain from using Panadol or Nurofen on a regular basis.”
Mums will often present to the local pharmacy for a solution to their baby’s pain or symptoms of reflux. Properjohn advises it’s vital to engage in conversation and to rule out other more serious causes.
“A baby’s cry communicates everything, so we need to identify whether pain really is the source of the cries and then what’s causing the pain. Is the pain due to reflux? Is an overly full stomach causing the pain?
“Start with the simple things and drill down to the more serious considerations, always keeping red flags in mind. In the case of reflux we might consider a thickened formula to hold the milk down or perhaps there’s the need for prescription medication.
“It’s possible that constipation might be the source of the pain. Again, in the back of your mind you need to consider the potential emergency situations. Is there projectile vomiting? Is the pain particularly intense or causing spasms?
“Constipation is common, often due to the baby being overfed. If the baby is on infant formula, we might ask if they are remembering to level off the scoops, using a different scoop (not the one provided with this particular brand of formula) or perhaps they’re feeding too often. Quite often we identify volume as an issue with bottle-fed babies,” says Properjohn.
McGrice adds, “A lot of mums are unsure what a baby’s stools should look like and they can get concerned. Constipation is ‘difficulty and pain on defecation’ and the stools are usually hard and can be described as ‘rabbit droppings’. We define constipation as less than three stools a week.
“If the stool is soft, even if the baby is straining, then the baby is not constipated. In this case, making sure the baby is having enough fluid through increased water intake can help.”
McGrice notes that pre and probiotics in formula are proving beneficial. In fact, emerging research is showing that while breastmilk remains the gold standard, infants fed on formula with added prebiotic oligosaccharides(galacto-oligosaccharides, fructooligosaccharide, polydextrose, and mixtures of these) have a lower stool pH, a better stool consistency and frequency and a higher concentration of bifidobacteria in their intestine compared to infants on a non-supplemented standard formula.
Properjohn explains that engaging women at this vital life stage and providing the advice and support they need can result in a customer for life.
“We had a lady come into the pharmacy who had just emigrated from Sweden with her husband and newborn baby. She had no idea where to get her baby weighed so I provided this service and then also linked her in with a child health nurse, gave her information on schools and playgroups in the area as well as the details of a local GP that specialises in paediatrics.
“She comes here all the time now. Her children are school age, she has all her scripts delivered here and sees our naturopath on a regular basis. She’s become a loyal and lifelong customer. I see this as one of the many success stories. She chose us as her pharmacy because of the optimum level of service she received on her first visit.”