World Breastfeeding Week 2024: Breastfeeding Quiz Answers!

The result of this questionnaire revealed that this community has good knowledge of breastfeeding. I would like to believe that this is due to the information shared and discussed during my daily work and on social media platforms. These questions were compiled to challenge certain beliefs stemming from old ideas or misinformation, while others aim to educate on basic breastfeeding practices.

The timing of the initiation of breastfeeding is recommended by the World Health Organization (WHO) to take place within the first hour after birth for the best outcomes. They have found that this early initiation of breastfeeding can protect the newborn against acquiring infections, reduce the mortality rate, and aid in establishing the mothers milk supply quicker. (World Health Organization, 2024) Depending on the birth, the time may vary greatly. During a normal vaginal delivery, the baby should be dried off and immediately placed on the mother’s chest. In the case of a cesarean section, the mother and baby can often be separated while completing the surgical procedure. In this scenario the mother and baby should be brought together to initiate the feed as soon as possible after birth.

The exclusive breastfeeding rate for children under 6 months in South Africa was published by the South African Demographic Health Survey (SADHS) in 2016 as 32%. This is lower than the global target of 50%, which is set to be achieved by 2025 (Department of Health, 2022). It might be reassuring to know that South Africa’s exclusive breastfeeding rate is about 4% higher than the US, however we should aim to exceed the global target.

The definition of exclusive breastfeeding is described by the WHO as the infant receiving only breastmilk. No other liquids, solids or water should be given. Exceptions are made for oral rehydration solution, vitamins, minerals or medicines as prescribed by a medical practitioner (World Health Organization, 2024).

Newborns do not need a dummy to stimulate sucking. Yes, newborns have a strong urge to suck. It provides both nourishment and comfort. Using a dummy or pacifier before breastfeeding is established may actually negatively impact the stimulation of the mother’s milk supply. The American Pediatric Association recommends that the introduction of pacifiers should be delayed until breastfeeding is established, usually after 6 weeks. Breastfeeding is known to reduce the risk of Sudden Infant Death Syndrome (SIDS). Infants who are not breastfeeding may benefit from using a pacifier at night to aid in the prevention of SIDS (Stanford Medicine, 2024 ). Sucking on a pacifier does not directly translate to sucking at the breast and should not be used as an indicator for determining breastfeeding efficacy.

The frequency of breastfeeding is a complicated question to answer. Yes, babies should breastfeed on demand as recommended by the WHO. The demand, however, can vary greatly between babies and also changes throughout the breastfeeding journey. A newborn may request much more frequent feeds, due to the small stomach capacity and small amount of milk produced at that time. This may be as much as every 1 to 3 hours or sooner. Some newborns experience fatigue a few hours after birth and require a longer rest, such as 4 hours. During the newborn phase it is helpful to wake the baby every 2 to 4 hours to assist with their intake and the mothers milk production. As breastfeeding is established, the baby may wake well for feedings every 2 to 3 hours and feed more efficiently, allowing for longer sleep periods about 4 to 5 hours. The general consensus is to breastfeed between 8 to 12 times in 24 hours (CDC, 2024).

The transition from the first milk (colostrum) to mature milk is a great concern among many new mothers. There is often an expectation that there should be copious amounts of breast milk available once the baby is born. The disappointment that there are just a few drops of sticky, clear or yellow milk, often leads mothers to request additional formula feeds early on. The colostrum is a highly nutritious and rich in immune cells, which is vital for the newborn baby. Most babies receive all the nourishment they need from colostrum alone. After about 3 days of frequent breastfeeding or stimulation via hand expression, the mature milk may start to appear. For first time mothers or with certain disease conditions, this may take up to 5 days. The mature milk is more liquid, increases in volume and normally appears to be whiter in color. A mother might notice the change of milk when the breasts feel fuller, may be swollen, hard or even warm (CDC, 2024). This may require some additional support from a lactation consultant and subsides in a few days if breastfeeding is successfully continued.

Skin to skin contact with the baby remains beneficial after the first 24 hours after birth. Many parents often cease putting the baby skin to skin after the first hour after birth. Keeping the baby against the chest, without clothing is known to be a life-saving intervention. The benefits include:

• Improved regulation of temperature, breathing and heart rate.
• Stimulates digestion and interest in feeding.
• Aids in beneficial bacterial colonization from the mother’s skin, which builds up the immune system.
• Stimulates the release of oxytocin for both mother and baby, aiding in calming and bonding.
• Can contribute to the stimulation of the mother’s milk supply.

It can be performed at any point in time when the baby needs comforting and is not willing to breastfeed. It is especially vital in Neonatal Intensive Care Units to aid in the regulation of those vulnerable babies (UNICEF, 2024). Skin to skin contact can continue at home for as long as the mother (or father) is happy to do so (NHS, 2024).

The truth about nipple cream.

There are a lot of products marketed as being essential for breastfeeding. It is a common misconception that all mothers need nipple cream to be able to breastfeed comfortably. The conventional nipple cream that is often used, contains 100% lanolin. Lanolin is an organic, waxy substance derived from sheep. This may trigger an allergic reaction if a mother is sensitive to wool. Other conventional nipple creams contain lanolin, as well as other ingredients such as petroleum, paraffin and other preservatives which should not be ingested by infants. None of these ingredients are considered medicinal or healing, but merely adds a layer of fat or lubrication to the nipple area. This may create a type of barrier, much like you would add a barrier cream to the baby’s bum. There is one type of nipple ointment that is considered medicinal or healing, called All-purpose-nipple cream or APNO for short. This ointment needs to be mixed by a pharmacist and is comprised of a specific mixture of medications such as an antibiotic, corticosteroid and an antifungal agent. This ointment may be prescribed by a lactation professional in the case of nipple damage, while other corrective measures are implemented (International BreastFeeding Centre, 2024).

A fairly recent Cochrane review study concluded that there is insufficient evidence to recommend any intervention for the treatment of nipple pain. They also found that there was no evidence of significant improvements in nipple pain with the use of lanolin or all-purpose nipple cream. They highlighted the finding that, irrespective of the treatment or none at all, most signs of nipple pain resolved approximately seven to 10 days after the birth (Cindy-Lee Dennis, 2014).

The signs of a deep latch is one way that a mother can use to assist with achieving a comfortable latch and facilitate effective breastfeeding.

There are a few different aspects to consider, however I find that the CALM acronym is helpful to remember:

• Chin is touching the breast
• Areola is visible Above the baby’s mouth
• Lips flanged outward
• Mouth wide open

Seeing or hearing the baby swallowing is often a reassuring sign that the baby is transferring milk well (CDC, 2024). If a mother is experiencing constant pain during feeding, or has signs of nipple trauma, it is best to seek help from a lactation professional.

Babies should not receive additional formula without parental consent.

It is part of the Baby-Friendly-Hospital Initiative to protect and support breastfeeding, while avoiding giving artificial feeds unless medically indicated (UNICEF, 2024). Parents have the right to determine their baby’s mode of feeding, and this should be protected and supported.