Breastfeeding 101: When in doubt, reach out

Mothers encouraged to manage expectations and ask for help

Wednesday, September 1 2021

The arrival of a new baby is often accompanied by certain expectations – the perfect birth plan, for example, or ideas around the outfit your little bundle of joy will wear going home from the hospital, and visions of breastfeeding calmly and with ease. However, as most mothers discover, newborns come with surprises.

Breastfeeding may be one of the most difficult hurdles that many mothers of new babies have to overcome, even when it is not their first child. This is according to Sr Ana Frawley, who owns and runs two mother and baby wellness clinics at Netcare Mulbarton and Netcare Sunward Park hospitals, and who has specialised in lactation for 11 out of her 25 years as a midwife.

“Breastfeeding is a natural process but that does not mean it is instinctual – it is in fact a learned skill, which requires practice. There was a time when girls would grow up observing mothers breastfeeding their children, in families and communities, and such exposure would be educational. However, modern day life is very different and many women do not have the opportunity to learn by example in this way. 

“Furthermore, just as every pregnancy is different, so too is every baby. It is therefore important that mothers manage their expectations and prepare themselves for the strong possibility that they will need help in getting breastfeeding right,” she says. 

Sr Ana Frawley has specialised in lactation for 11 out of her 25 years as a midwife.

It’s baby’s earliest form of communication
“Once you’ve found your groove with breastfeeding, it becomes the most wonderful form of communication between you and your baby, over and above the important nutritional benefits that it provides to their developing bodies. When breastfeeding, you offer your baby the support they need, giving them their first experience of this type of interaction,” says Sr Frawley. 

“As time passes, your baby may well use breastfeeding to offer you support in return – I have seen this first-hand in my practice, for example when a mom who was upset about an unrelated issue was comforted by her little 12-month-old. He sat next to her as she cried and waited until she was a little calmer, then latched to her breast for just a moment before getting down and exploring the room. This baby was not hungry but was trying to comfort her in the way he was used to being comforted.”

Sr Frawley notes that consulting a lactation specialist from the outset can make the experience far simpler and less stressful. She points out that while there are some women who are fortunate enough to have a smooth start to breastfeeding, many need help and the sooner they get it, the better. 

Am I doing it right?
Sr Frawley says there are three simple guidelines to help first-time mothers with breastfeeding concerns:

  1. Baby needs to feed eight to 12 times in 24 hours.
  2. There should be a minimum of six wet nappies in 24 hours.
  3. There should be two to three poo nappies in 24 hours within the first six weeks of birth, thereafter the poo nappies become less frequent – up to once in seven to 10 days is considered normal. More frequently than this is no cause for concern, provided the stool has a granular or seed-like appearance, as with diarrhoea there are no ‘seeds’ in the stool, in which case medical attention should be sought.


When to consult a lactation specialist
Sr Frawley suggests getting help if having any of the following experiences:

  1. Sore or sensitive nipples while breastfeeding, or misshapen nipples after baby delatches.
  2. Milk not coming in or coming in late.
  3. Baby not gaining sufficient weight (between 140g – 200g per week).
  4. Milk not draining completely, which can lead to mastitis – a painful infection in the breast.

How a lactation specialist can help
“You will need about three sessions or so, with the first session most likely to be the longest. The specialist will obtain a detailed history from the mom, including her psychological wellbeing. The specialist also does an examination of mom’s breasts, as well as a head-to-toe examination of the baby. The main focus is on getting baby to latch correctly so the specialist needs to find the cause of the breastfeeding issue, and work out a manageable care plan with the mom and her support people for her to achieve her goals. Sometimes there may be other factors to be considered, such as additional therapies that baby may need. 

“It is important that baby is well positioned and aligned, that all or almost all of the nipple and areola is taken into baby’s mouth and that there is no pain or discomfort whatsoever to the mother while baby is feeding. Breastfeeding is a process that requires patience, perseverance and practice. When baby is latching correctly the breasts will naturally produce the amount of milk the baby needs.

“There can, however, be certain conditions that may prevent mom from producing a sufficient supply for exclusive breastfeeding, such as diabetes type 1, obesity and polycystic ovarian syndrome, for example. 

“All of this will be discussed during the consultations with your lactation specialist, who will also touch on the importance of a balanced diet, plenty of liquids – at least two litres per day, not including soft drinks – and resting while baby sleeps to ensure adequate volumes of milk,” Sr Frawley explains. 

Family support
Sr Frawley notes that mothers taking care of new babies need a great deal of support. “Moms who are struggling with the mental and emotional load of taking care of a new baby need ongoing support and encouragement from those close to them. Her morale is very important and can affect the breastfeeding experience, both for her and baby. 

“Partners and other family members wishing to be of help can offer kind words about how well the mom is doing and can assist with practical things like bringing her some healthy snacks and a glass of water while she is feeding, for example. If she or the baby is really having a difficult moment, kindly offer to give her a break, even if just for a few minutes, so that she can take a breath. ‘Constructive criticism’ is not helpful at this stage,” she says. 

COVID-19 and breastfeeding
According to Sr Frawley, the ongoing advice to breastfeeding women is that they should continue to breastfeed even if COVID-19 positive, as this continued contact and nutrition is beneficial for the baby and has not shown to be dangerous to infants. 


Notes to editor
Looking for a medical appointment? Netcare appointmed™ will make appointments for YOU with specialists practising at Netcare hospitals, GPs and dentists at Medicross medical and dental centres, and specialists at Akeso mental health facilities. Simply request an appointment online at or phone Netcare appointmed™ on 0860 555 565, Mondays to Fridays between 08:00 and 17:00.
To find out more about the services offered through Netcare hospitals and other of the Group’s facilities, please visit or contact the Netcare customer service centre either by email at [email protected] or phone 0860 NETCARE (0860 638 2273). Note that the centre operates Mondays to Fridays from 08:00 to 16:00.

Issued by:            MNA on behalf of Netcare 
Contact:    Martina Nicholson, Meggan Saville, Estene Lotriet-Vorster or Clemmy Forsthofer
Telephone:    (011) 469 3016
Email:    [email protected], [email protected], [email protected], [email protected] or [email protected]