It is the joy of every new mother to initiate breastfeeding as soon as she is delivered of her new-born. The endorsement of this importance practice by the World Health Organisation (WHO) explains why it is widely advocated for both mother and baby immediately after birth.
However, this high expectation of many mothers is sometimes abruptly truncated, as they start struggling with milk let-down, making it difficult to give their babies colostrum – the first yellowish milk produced after delivery to fortify the neonate’s antibody against infections. This sudden disappointment has led many a mom to doing the unimaginable just to get their mammary glands functioning effectively.
To prevent such occurrence, the WHO has always encouraged proper discussion of breastfeeding with pregnant women, as well as advocating that their healthcare givers should facilitate immediate and uninterrupted skin-to-skin contact between mother and baby to initiate breastfeeding as soon as possible after birth.
In spite of this, a good number of mothers still experience this unanticipated delayed onset of milk flowing from their breasts, a development experts have attributed to various factors surrounding labour and childbirth.
Experienced gynaecologists and obstetricians have listed likely factors responsible for this delay to include structural and anatomical issues with the nipple, positioning and placement of the baby’s mouth, usage of drugs and psychological factors, such as stress, among others.
Findings, according to a study published in Breastfeeding Medicine, established similar causes of delayed onset of lactation in new mothers as asserted by gynaecologists. The researchers found perinatal stressors, including high pre-pregnancy body mass index, preterm birth, caesarean section and others as factors that increase the risk for short breastfeeding duration.
Professor Sule Odu, an obstetrician and gynaecologist at Olabisi Onabanjo University, however stated that delayed lactation is an uncommon development, adding that about 10 to 25 per cent of women who pass through this are those who do not attend antenatal care sessions in the hospitals.
He said: “So many factors may be responsible and that is why breast and lactation management are part of ANC. There may be structural and anatomical problem with the nipple. The ideal position and placement of the baby mouth must also be maintained. Some drugs could also cause it but these are only used to dry the milk in those who had stillbirths. It could also be psychological and it bothers on mental health.”
Odu further explained that there are scientifically proven the health implications of delayed lactation, which include proneness of babies to faulty developmental growth, diseases, diarrhoea, low IQ, etc.
Considering these potential health risks for babies, some mothers who have suffered this condition have described it as a traumatising one. Ifeoma Igwe, a mother of two, narrated her two-time harrowing experience from delayed lactation, saying it is never a pleasant experience for any mother.
Igwe, who wondered what could have predisposed her to the condition, narrated how she went through the painful moment during the birth of her first child, adding however that being in the village at that time made it a bit bearable as she got help from other women.
Her second experience was not so bearable, however.
She said: “I can’t explain all I suffered both night and day, as the milk production from the breasts was not fast coming. In fact, this almost turned sour the flowing stream of joy brought by the birth of my new-born.
“Initially, I thought it was occasioned by the size of my breast, as I was not endowed like some other women, but I later discovered it was not. The cries of the baby for suck both day and night, without breast milk, was a difficult one to stand. And this was coupled with my own health condition, as I was yet to recover from labour induced stress at that time.
“I want to urge our health experts to use their technical knowhow to assist new mothers in this condition, because it is not a good development by any means.”
For Adaku Obi, a teenager, who was impregnated by her boyfriend who denied the pregnancy at a very late stage, it was triple tragedy.
Adaku said she went through the pregnancy all alone without any support from the supposedly father of the baby. According to her, delayed lactation aggravated her pains and she eventually lost the baby to lack of proper care.
Eyewitnesses recalled how Adaku became psychologically distressed and was almost becoming mentally deranged before good Samaritans took her for medical care, after which she came back to her senses.
She lamented: “I don’t know what on earth will prevent a new mother from breastfeeding her newly born baby days after delivery.”
Role of antenatal care
In response to the questions of these mothers, Prof. Odu says the condition can actually be prevented if pregnant women regularly go for antenatal care sessions, where they will be counselled on essentials of appropriate and best breastfeeding practices.
“And these include correction of any anatomical problems like asking the woman to take time to pull the nipples out daily with the aid of her hands, husband and some simple equipment like a five ml syringe.
“Infection around the areola and the nipple and cracked nipple can prevent the woman from breastfeeding. Even the cramps that comes along with good suckling by baby as a result of involution of the uterus could also prevent it,” he explained.
Dr Modupe Adedeji, consultant obstetrician and gynaecologist, Lagos State University Teaching Hospital, LASUTH, also shed more light on the likely causes of delayed lactation.
She said: “It is not as common to have delayed onset of lactation if the proper mechanism is put in place in the first few hours of birth.”
Adedeji however stated that delayed bonding between the new-born and the mother, could be a culprit in the condition. “If the bonding is delayed, it can be one of the reasons for delay in milk production.
“This is why we encourage the milk let-down reflex. This entails the baby latching on the breast which stimulates the nerves and encourages the production of the oxytocin hormone for milk production and also helps the womb to get back gradually to its pre-pregnancy size. This definitely will let the milk production,” she said.
Explaining further, Adedeji added: “It is worth mentioning as well that if the baby finds it difficult to latch on the breast – note that I said breast, not just the nipple – the baby should latch on the whole nipple; meaning that the entire nipple should be in the neonate’s mouth, and almost the whole areola – the darkened part around the nipple and the breast. This positioning is confirmed as suitable.”
The consultant obstetrician and gynaecologist also admitted that there could be others issues with breast that could make breastfeeding challenging. For instance, she said the case of inverted nipple or flat nipple or even absent nipple should have been picked up during antenatal visit at the clinics.
She also noted that first-time mothers are usually encouraged to start stimulating the nipple even before delivery, while breast pump can be handy too just after delivery when this challenge is there.
“There could be prematurity too and it would need sometime before the baby can latch on the nipple”, she submitted.
The story of Omolara Adejare, another first-time mother, was not different from that of her counterparts. Being a first-time mother, her case was pathetic as the COVID-19 interstate lockdown prevented her mother from coming down to Lagos from Ekiti State to render necessary assistance.
Hers was more of ignorance, as she didn’t notice the delayed lactation for well over a week, as all she just noticed was the continuous cry of the baby, whenever she put him to suck. She added that she and her husband were eventually counselled by neighbours to buy infant formula for the neonate.
Adejare added that it was three weeks after delivery during the visit of her elder sister that she examined her breasts and discovered there was no lactation. Thereafter, she was advised to get foods that would aid easy flow of milk such as pap, beverages, etc.
She was also advised to eat hot meals to stimulate easy flow of milk. Her words: “I never knew that my baby wasn’t getting milk from the breasts. He just cried whenever I put him at the breast to suck. Little wonder he hasn’t gained any weight since three weeks after delivery.”
To assist such new moms, Dr Adedeji said there are midwives who are designated to ensuring success of breastfeeding. She added also that there are breastfeeding consultants who can render assistance.