I am a female doctor, and I often get asked different questions about breastfeeding. Doctor, what is the right way to breastfeed? Does my baby get enough breast milk? How do I tell if she is getting enough breastmilk? Do I need to increase my breast milk supply? And how can I achieve that? I am about to get back to work, what is the best formula on the market in Kigali? My breasts/nipples hurt from breastfeeding my newborn baby; what should I do? Oh, and I have breast engorgement! Having worked in pediatrics and on maternal and child health research for a while and listening to all these questions from my sisters, relatives, friends, and mothers of children I treat, I thought I would write this article. I will not discuss the benefits of breastfeeding for both the mother and infant in this article. Breastfeeding rates in Rwanda are high. According to the UNICEF Rwanda report, an estimated 87% of infants under six months of age are breastfed. Some estimates are reported as high as 90.1%, with 85% reporting exclusive breastfeeding for the first six months. Early initiation of breastfeeding is practiced as well. 81% of newborns are breastfed within one hour and 96% within one day of birth. I have had discussions with my colleagues about the general techniques of breastfeeding and the approach specific to Rwanda. I realised that in Rwanda, breastfeeding might be considered as an innate skill. Once a woman gives birth, the know-how comes to her immediately and automatically. Unfortunately, breastfeeding is not an ingrained or innate skill. It is more complex than we often think. Getting it done “right” if that even exists is an achievement. There are so many resources out there that describe how to breastfeed. In my online search, I found about 250 good scientific papers written about breastfeeding. I think this says it all. It is not as easy as we believe. Luckily, there are plenty of resources that can be used for self-education. I remember one time during the round of newborn babies in the maternity ward; I saw a mother on the second day postpartum. She was bending over with difficulty to breastfeed her newborn baby. Her mother, the grandmother to the newborn, stood next to her daughter’s bed. She observed how both the baby and the mother were in distress. The mother was sweating and nervous because the baby had been crying for a while. The grandmother looked helpless. I was mildly surprised to find out that that was the mother’s fourth child. Thank God I was with a midwife, and she knew what to do! She raised the mother’s hospital bed, and she showed her how to sit and hold the baby. She repositioned the baby very well on the breast, and the distress stopped immediately. The mother raised her head, and our eyes met. She smiled at the midwife and me. “How I wish I had met you when I had my first baby,” she said. “Why didn’t I meet you when I had just given birth the first time?” This is a good illustration of how breastfeeding may be overlooked. There are several positions used to breastfeed. Some of these positions are the cradle, cross-cradle, clutch, and side-lying positions. Does one need to try them all? No. It is good to try a few and see which one feels comfortable for you and your baby. Also, keep in mind that your baby may feel comfortable in a different breastfeeding position compared to her older siblings, and that is okay. Please don’t feel shy to ask the midwife to help you figure out the breastfeeding position that works best for you and your baby while you are still in the hospital. As you may know, more and more deliveries are taking place in hospitals now. So, use that opportunity to practice while you have someone to guide you. I would recommend a proactive approach that lets you learn about breastfeeding before the baby arrives, and if you have any questions or clarifications, write them down and ask your gynecologist at the antenatal care visits. With any breastfeeding position, you may choose, remember that you need to make sure that the baby is well attached to the breast. Oh, there is something called the baby latch, also known as breastfeeding attachment. It simply means the way the baby takes the nipple and areola into their mouth to suckle or breastfeed. A good latch is when both the nipple and a large portion of the areola are in the baby’s mouth with the lower lip turned outward. Getting a good latch can be learned, and it takes practice. There are several benefits of a good latch like the fact that it promotes high breastmilk flow and while minimising nipple pain for the mother. There are ways you can help your baby latch well on the breast. For example, you need to encourage your baby to open his mouth, bring your baby to your breast not your breast to the baby, keep your baby close to you with his chin in contact with your breast, look at his jaw movement and listen to his sucking and swallowing as he breastfeeds. Keep looking at your baby, smile, chat, and sing to him as well. This simple routine helps your baby’s brain development. Lastly, remember to check if your baby is producing wet and dirty diapers; this is the only way you can cross-check if he is getting enough. If you are interested in learning more about this, let me know in the comments below. Also, as I was writing this article, I thought that having some pictures or videos may be helpful to visualize what I just covered above. Let me know your thoughts about this. The writer is a Rwandan medical doctor. The views expressed in this article are of the author.
