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We Need To Stop Saying Breastfeeding Is “Easy”

We Need To Stop Saying Breastfeeding Is “Easy”

And focus on supporting mothers instead

Nicole Parakrama | BSc Hons Molecular Cell Biology, UCL (UK) | 14th August 2021 |
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Just recently, we all tuned in to watch the Olympic Games held in Tokyo. We admired the beautiful performances of the athletes, and we acknowledged and celebrated all the sacrifices, hard work and preparation that led up to that day.
breastfeeding

What if we viewed breastfeeding the same way?

What if instead of glorifying only the ‘highlights reel’ of breastfeeding, we all agree that breastfeeding needs education, preparation and hard work to get through the first few weeks. What if we supported and empowered mothers on this journey filled with sacrifices and challenges and collectively took responsibility for it? What if we celebrated them loudly and genuinely when they achieved their goals?

The recently concluded ‘World Breastfeeding Week’ was triggering for a lot of mothers. For many women, any mention of breastfeeding brings back feelings of pain, anxiety and a lack of support. It serves as a reminder of the guilt and shame that they felt for stopping breastfeeding, the feeling that their bodies weren’t doing what they were meant to do.

Changing the Messaging

A Sri Lankan mum recently told me:

“Breastfeeding is hard… everyone tells you how painful labour is and how difficult pregnancy is, but no one tells you how hard breastfeeding is! All you see are images of moms with babies on their breasts and they make it look like it’s the easiest thing!”

Amy Brown, Professor of Child Public Health, Swansea University says: “When we gloss over the realities of breastfeeding, women feel unprepared for what it’s really like. If we tell women to expect easy, and they hit a hurdle, they may think they’re doing something wrong. . Women then end up depressed, blaming themselves, thinking they didn’t try hard enough because after all, isn’t breastfeeding easy?”

Without swinging towards ONLY the positive or the negative, perhaps the good, the bad and the ugly all need to be portrayed together. We need to find a balance.

So what are the benefits of breastfeeding?

  • We sometimes refer to breastmilk as “liquid gold”! Mums often joke that breastmilk is the cure for nearly everything:baby acne, sore eyes, heat rash,eczema and healing our cracked and sore nipples.
  • The composition of breastmilk is biochemically and nutritionally complete, giving numerous long term and immunological advantages.. It protects from infections, diarrhoea, UTIs, and chronic diseases like diabetes, childhood cancers, obesity, inflammatory bowel disease, asthma and allergies. In preterm babies, it reduces the risk of sepsis and necrotising enterocolitis (NEC).
  • For mothers, it has been proven to reduce the risk of hypercholesterolaemia, diabetes, hypertension, cardiovascular disease, as well as reduce the incidence of breast and ovarian cancer and osteoporosis. It stabilises endometriosis and confers partial contraception.
  • The process of breastfeeding stimulates the release of oxytocin, the bonding chemical. Babies don’t only breastfeed to eat, but also to help themselves settle: it provides them comfort and helps them regulate their emotions.
  • From a practical standpoint, breastfeeding is free and convenient! No stumbling around in the dark to boil water and prepare a bottle! Your baby has access to fresh milk straight from the source.

OK, I’m convinced of the benefits. Now hit me with the challenges of breastfeeding!

Here in Sri Lanka, we are seeing a rise of an ‘Instagram mum brigade’ who raise awareness on issues surrounding motherhood whilst sharing experiences and building community. They are finding their voices and being the support that they wished they had as new mums.

One of these Instagram mothers, Ameena (IG handle @raisingimaan) – expresses the challenges of breastfeeding so beautifully in a recent post. She said:

“Breastfeeding isn’t simply putting a breast into a baby’s mouth and transferring milk. It is SO MUCH more than that. And women pay for it with a unique currency of time, commitment, energy, mental and physical health, as well as bodily autonomy. That’s a massive price to pay. And to tell women that it’s all on themselves alone to manage. Frankly, it’s quite a raw deal”.

sore nipples
  • The first few weeks of breastfeeding, in particular, require a considerable investment of time. It IS time consuming, and new mothers can feel that all they do in the early days is feed!
  • In addition, the breastfeeding technique can take a bit of practice to get right. Mums need to experiment with different holds and find solutions for attachment and positioning issues.
  • There are potential physiological challenges, such as sore/cracked nipples, breast engorgement, blocked ducts, and mastitis/abscess which mums may have to navigate.
  • Feeling like there is not enough milk can be a significant challenge for many mothers in their breastfeeding journeys. However, as I have written about in a previous article, this is mostly a perception issue. In as many as 95% of cases, it is easily surmountable with the proper support.

How important is it to have a supportive community?

I cannot stress enough the huge role a supportive community plays in successful outcomes for breastfeeding. In “the fourth trimester”, women adjust to being mothers just as much as their babies adapt to life outside the womb. This postnatal period seems to be universally defined as 40 days.

Kimberly Ann Johnson, author of the book “The Fourth Trimester” says:
“Everything that a new baby needs, a new mom needs. So you know a new baby needs swaddling, you know a new baby needs a constant food source, you know a new baby needs eye contact, you know a new baby needs soothing. That’s everything a new mom needs.”

But the best way of caring for a breastfed baby is to care for their mother. Feed her, love her, support her by taking care of other stuff. Do housework, run errands, look after older children. The same goes for supporting women who are bottle feeding.

How can we as a society make breastfeeding easier for mothers?

As a society we can further encourage breastfeeding mothers when it comes to feeding in public. Public bathrooms are not acceptable places to feed infants! Establishments can train their staff on how to respond compassionately to a mother whose infant needs to feed, and to take a step further to provide a private space in which to do this, if required. Far too often this is left to the discretion of the staff, and so mothers have mixed experiences. Just one negative experience can be a huge setback to a mother’s breastfeeding journey, making her feel that she has to stop breastfeeding in order to leave the house and ‘have a life’.

Alongside all of this, the government MUST step up and make things easier for new families. In 2018, a significant amendment to the Shop and Office Act was passed in Sri Lanka which mandated the “provision of nursing intervals for nursing mothers” (previously only mandated in the state sector, although sometimes practiced informally in the private sector). This means that working mothers are now entitled to 2 paid feeding breaks of 1 hour per working day until their child is 1 year old.

This is a significant step forward – however longer, better paid leave for both mothers and fathers, as per the Swedish model, would do wonders for the well-being of the whole family, and in increasing breastfeeding figures.

If you are a new mum and are having trouble breastfeeding, you can speak to a doctor on oDoc. You can video call them from your home, baby in hand, even while breastfeeding! You can download the app here.

HOW I BECAME ‘THE MILK COACH’

When my first child was born, I was quite unprepared for what lay ahead. Particularly when it came to breastfeeding… I was naïvely expectant that I could just place him onto my chest, and let nature take its course. What a surprise I was in for! Cracked nipples from sub-optimal positioning, and my milk taking its own sweet time to come in, led to terrible pain. This pain became excruciating when my son developed oral thrush which travelled into my milk ducts. Fortunately, thanks to a lot of research and some wise mummy friends, I was able to power through the awful first few months. Most crucially, I was able to advocate for myself with health professionals, when the ‘system’ didn’t really support me.

This birthed a passion to counsel, support and advocate for my fellow Sri Lankan mums. To this end I am working to add to a science background (in Molecular Cell Biology) with an accreditation by La Leche League International (LLLI). My heart is to help YOU to achieve your breastfeeding goals – whether that is one week, one month, six months, or even a year and beyond.

Join the conversation, follow @themilkcoach on Instagram or Facebook.

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Family planning? Know your available contraception methods

Family planning? Know your available contraception methods

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Almost all women who are sexually active would have Googled contraception methods. Figuring out which method of contraception is the best for you and your partner can be frustrating. It isn’t spoken about freely and it can be difficult to find out what methods are available to you.  Below we’ve collected all the important information you need to know. We have also explored the pros and cons of each contraceptive method to help you compare your options easily. 

So, here we go.

Firstly, what is contraception?

Contraception, also known as birth control, is the use of artificial methods and techniques to prevent pregnancy.

Birth control – the different types 

There are 5 general types of birth control methods and each works in a different way. Some are temporary and some are more permanent. Some prevent the sperm from meeting the egg whilst some prevent the egg from releasing. Either way, the goal of all the contraception methods is to prevent unwanted and unplanned pregnancies.

It is also important to note that birth control and contraception is not the same as prevention of sexually transmitted infections (STI). Condoms are the only method that prevents the spread and transmission of STI’s so it is advised that you combine the use of condoms with other types of contraception. 

1. Short-acting hormonal contraception

Short-acting hormonal contraception methods adjust the hormone level in the woman’s body making pregnancy much less likely to happen. Some of the commonly used short-acting hormonal contraception methods are the daily use birth control pill and the hormonal injection. Both of these methods require a prescription from your doctor. 

The birth control pill 

There are 2 types of birth control pills available: the progestin-only pill and the combination pill (which contain both progestin and estrogen). 

The hormones released by the pill prevent the release of the egg, the thickening of the uterus and the cervical muscle making it harder for the sperm to enter the uterus. By taking the pill at the same time every day, you maintain a steady level of the hormones in your body, making it a very effective form of pregnancy prevention. 

With perfect use, it’s over 99% effective.

control-pill

Pros

  • Easy to use
  • Highly effective if taken regularly 
  • Doesn’t interfere with sexual activity 
  • Helps with heavy and painful periods

Cons

  • Mood swings, headaches and other similar physical side effects 
  • Effectiveness is time-sensitive, you have to take it regularly at the same time every day for maximum effectiveness
  • Does not protect against STIs

The Hormonal Shot

The hormonal injection is administered by the doctor every 1 or 3 months to the woman. Like the birth control pill, this too prevents the release of the egg and thickens the cervical muscle making it difficult for the sperm to enter the uterus. 

Pros

  • Easy to use
  • Highly effective if taken regularly 
  • Doesn’t interfere with sexual activity 
  • Helps with heavy and painful periods

Cons

  • Mood swings, headaches and other similar physical side effects 
  • Once off the shot, it may take up to a year for your menstruation to return to normalcy
  • Does not protect against STIs 

2. Long-term contraception 

This is a good option if you want lasting contraception with little maintenance. Available options include an implant inserted into your arm or an intrauterine device (IUD) inserted into your uterus. These methods are 99% effective at preventing pregnancy. They’ll work for 3–10 years, depending on the particular method you choose. 

Implant

The doctor will place 1 or 2 silicone rods under the skin in the arm of the woman. The rods will release the hormone, progestogen into your bloodstream that prevents the release of egg into your uterus. The hormone also thickens the cervical muscle thus stopping the sperm from entering the uterus. Further, It thins the muscle of your womb making implantation of the egg less likely. 

Pros

  • The most effective type of contraception 
  • Long-term, can be kept for 3-5 years
  • Does not affect sexual activity 
  • Not time sensitive 
  • A good option for women who can’t take oestrogen pills

Cons

  • Requires medical attention to insert and remove
  • Does not protect against STIs
  • May have side effects such as headaches and breast tenderness
  • Your periods may be irregular or stop

Intrauterine Device (IUD) 

The IUD is a T-shaped copper device which is inserted into your womb by your doctor. There are 2 kinds of IUD you can get implanted, the hormonal IUD or the non-hormonal version. 

The hormonal version releases the hormone progestin, which prevents sperm from fertilizing an egg. It also thins the uterine lining making implantation of the fertilised egg less likely and thickens the layer of mucus over the cervix to help block sperm from entering in the first place. 

The non-hormonal device releases copper ions which has similar effects to progestin. The ion immobilises the sperm making it difficult for them to swim to the egg. 

Pros

  • One of the most effective methods to prevent pregnancy 
  • Requires no effort from you 
  • Long term, can be kept in for 5-10 years
  • Does not affect sexual activity

Cons

  • Requires medical attention to insert and remove
  • Does not protect against STIs

3. Single use barrier contraception 

Male and female condoms, spermicides and cervical caps are all types of single use barrier contraceptives. As the name suggests, they act as a barrier between the sperm and the egg, preventing the sperm from fertilising the egg.

Condoms

Condoms are a sheath-shaped barrier device made of latex or polyurethane. The male condom is placed over the erect penis and when ejaculation occurs the semen is collected in the condom acting as a barrier preventing the sperm from entering the uterus. The female condom is inserted into the vagina preventing the sperm from reaching the egg. Condoms when used properly are the only form of contraception that effectively prevents pregnancy and STI transmissions. 

Pros

  • They are hormone-free
  • Protects against STIs
  • Has no effect with other medications 

Cons 

  • Interfere with sexual activity and pleasure 
  • Chances of tearing during sex 

Permanent contraception 

If you plan on never having kids you can opt for the permanent contraception methods of Tubal ligation (for women) or vasectomy (for men). They are both simple procedures and they’re almost 100% effective at preventing pregnancy. Recovery time from these procedures usually takes only a few days and have close to no impact on your sex drive and sexual functions. 

During a tubal ligation, both the fallopian tubes are blocked or cut off and during a vasectomy, surgery cuts are made in the vas deferens ( a tube that transports sperms) preventing the sperm from reaching the semen in the testes. Women will still continue to have their periods every month after tubal ligation and men after vasectomy,  will continue to release semen during ejaculation but it will not contain any sperm. 

Pros

  • Permanent contraception 
  • Does not affect sexual activity

Cons

  • Both surgeries are reversible but does not guaranty fertility 
  • Does not prevent STIs

Emergency contraception 

Emergency contraception can help you prevent pregnancy if you have unprotected sex or your birth control fails. There are 2 kinds of emergency contraception pills you can take in Sri Lanka. Please note that emergency pills should not be used as a substitute for contraception.  

Postinor-1 

Postinor One (morning after pill) is a single dose oral emergency contraceptive pill that should be taken within 72 hours of unprotected sexual intercourse. The sooner you take the pill, the higher the effectiveness. Postinor-1 has releases levonorgestrel which delays ovulation and in turn, reduces the chances of fertilisation occurring. Several studies claim that Postinor-1 has the potential to stop 85% of anticipated pregnancies. The tablet is safe to take and does not alter fertility. 

This pill does not have any abortive effect, so if you are already pregnant it will not impact it. 

Postinor-2 

Postinor-2 is a double dose pill. Both the tablets can be taken at once or separately with a 12-hour gap between each. It works the same as Postinor-1. 

It should be noted that the emergency pill will not cause abortion and should not be used as a contraceptive method.

Wondering what the best contraceptive method for you is?

Well, that depends on you and your goal. Speak to your partner and your doctor to decide on the most convenient and most suited method for you. Also, remember there is no 1 method that suits all. Feel free to experiment with each method till you find one that suits your liking. 

If you want more information or would like to speak to a Gynaecologist on the best form of contraception you do so via the oDoc app. 

Sources

  1. FPA Sri Lanka. (2017, January 6). Contraception | Family Planning Association of Sri Lanka. http://www.fpasrilanka.org/content/contraception
  2. Tesch, D. (2021, July 23). 5 types of birth control options: which is best for you? HealthPartners Blog. https://www.healthpartners.com/blog/how-to-figure-out-which-type-of-birth-control-is-right-for-you/
  3. WebMD. (2016, November 18). FDA Explains Pros, Cons of Permanent Birth Control. https://www.webmd.com/sex/birth-control/news/20161118/fda-explains-pros-cons-of-permanent-birth-control
  4. Vasectomy: Treatment & Information – Urology Care Foundation. (202–12-01). Urology Health. https://www.urologyhealth.org/urology-a-z/v/vasectomy
  5. Johns Hopkins Medicine. (n.d.). Tubal Ligation. Retrieved August 3, 2021, from https://www.hopkinsmedicine.org/health/treatment-tests-and-therapies/tubal-ligation
  6. WHO. (2020, June 22). Family planning/contraception methods. https://www.who.int/news-room/fact-sheets/detail/family-planning-contraception
  7. NHS website. (2021, March 12). Contraceptive implant. Nhs.Uk. https://www.nhs.uk/conditions/contraception/contraceptive-implant/
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