Women around the world wear tattoos as a form of self-expression and/or cultural tradition. But tattooing is an invasive procedure and breastfeeding mothers often wonder about the safety of having art added to their body while they are breastfeeding.

From bushfires to earthquakes, Mother Nature is a powerful woman! But mankind can also create disruptions through conflict and infrastructure breakdowns.

As one of the most vulnerable groups in our community, it is extraordinary that the needs of those who are exclusively or partially milk-fed is rarely considered as evacuation centres and refuges are rolled out. In many cases, there is more information about evacuating with pets than there is about infants! This is why parents need to plan for natural or societal disasters, whether their infant is breastfed, breastmilk or formula fed.

Gastroenteritis, - also known in some countries as stomach flu - commonly known in Australia as “gastro”, is a common illness caused by viruses like norovirus and rotavirus. Most of us have probably experienced the unpleasant symptoms of vomiting and diarrhea. In adults and older children, this usually presents as a day or two of feeling ill and not moving very far from the bathroom. But for infants and young children, these symptoms can lead to dehydration and are among the most common reasons for hospital admissions.

Globally, breastfeeding is recognised for reducing infant deaths from diarrheal diseases. This is just one factor behind the World Health Organization recommendations of six months exclusive breastfeeding and two years or more continued breastfeeding alongside family foods.

People of Islamic faith practice a period of religious fasting during the month of Ramadan, when no food or drink is consumed between dawn and dusk. The time of year Ramadan is celebrated varies according to the lunar cycle.

Parents who follow the teachings of the Quran are encouraged to breastfeed their babies for two years. This means the question of fasting while breastfeeding is one faced by many mothers.

All mammals use touch to stimulate milk flow when feeding, including humans. Your tiny baby strokes, pats or holds your breast while they feed and the hormone oxytocin surges in your body in response. This increases the flow of breastmilk and the baby sighs in satisfaction. Watch a mother cat, dog, pig or other mammal feeding and you will observe activity among her babies: kneading the breast tissue rhythmically with their paws, nudging their snout into the breast tissue or grasping at nipples with tiny fists. Baby mammals instinctively know that this stimulation releases milk and enthusiastically activate the response when they want to get things going. Keeping babies unwrapped during breastfeeds and their hands free to move helps this valuable interaction happen naturally

Often referred to as blocked or plugged ducts, inflammation of the breast can occur at any stage of your breastfeeding journey. When breasts become over-full due to delayed breastfeeds or pumping, when feeding patterns change suddenly or when outside pressure from tight clothing etc, swelling can happen inside the breast tissue.

How we refer to this common condition and the best management of it has changed recently, with better understanding of how breasts make and store milk leading to new guidelines globally. So let's look at what you need to know.

Language to describe the changes in the breast has been refined to be more accurate.

You have probably heard of mothers losing their milk. You might even have been told it happened - or is happening - to you. You might be surprised then to learn the following facts:

Right now, in the UK, families are facing the cost of living crisis in its harshest form. The cost of infant formula has increased by around 25% in the past two years. Parents are left with the choice to put infant feeding costs ahead of other expenses like housing or utilities or - the most dangerous option - water down their baby’s milk feeds or use non-recommended alternatives. 

This situation is not new - it has played out around the globe for decades - but in the UK and other western countries, the impact is hitting higher up the socio-economic ladder than before and questions are being asked.

Breastfeeding. It's natural. Humans have been doing it since the dawn of time. How hard could it be?

So. Hard. Sometimes.

Most mothers and babies take time to get breastfeeding established. Now, you might expect this to mean days but it means weeks. Just because it's natural doesn't mean it comes naturally to everyone: mothers and babies.

Learning to breastfeed is like learning to dance. It is a partnership where two people need to independently do their bit, then combine their parts together. And, like dancing, there is a lot of getting in each other's way.

In the past, when babies were fed strictly four-hourly, mothers were sometimes advised to offer boiled water if the baby was “unsettled” between feeds. Unfortunately, these babies were hungry and showing feeding cues and needed to go to the breast. Filling their tummy with warm water made them think they had been fed but they had received no calories or nutrition and were soon hungry again. 

Boiled water was also suggested to bring up wind in unsettled babies. This was totally without evidence and might calm a baby signalling for more time on the breast than the clock allowed, perhaps even leading them to burp the air they swallowed from sucking at a bottle.

However, it is no longer recommended to give young babies water at all.

Both breast milk and infant formula contain the fluid babies require. Additional fluid can stress their system and even lead to water overload in extreme cases, where the kidneys struggle to process the extra fluid and natural electrolytes can become unbalanced.

In hot weather, some people worry that babies need water as well as milk. This is not the case. Breastmilk is 87% water and infant formula is around 85%. A baby who is thirsty will show feeding cues seek the breast, often for short feeds more often. Even formula fed babies can be offered extra feeds during hot weather.

Human babies survive around the world without bottles of water, as do all the other primates and mammals!

As our world evolves over coming decades, facing climate change, global unrest, vulnerable supply chains and uncertain economies - has anyone asked this question?

The obvious answer is breastfeeding but it is not as straightforward as that. Increasingly, babies are being mixed-fed - breastfeeding and/or expressed milk plus infant formula. Many are exclusively formula fed before they are 6 months old.

This is not about your personal choices or circumstances: we are considering the options and challenges parents in the coming decades will have.

Many parents track their babies progress on charts which record the rapid weight gain in the first year of life. They use this data as a scale of breastfeeding success: high weight gain = good milk supply, low weight gain = poor milk supply. And they also use the clock to determine how well breastfeeding is going: long periods of sleep between breasts equals good supply, short periods of sleep equals poor supply. Even though that isn’t how it works.

This obsession with numbers is a modern construct entirely influenced by the infant formula industry in the 20th century and entirely overlooks the most important role of human milk in infant growth.

While babies need the basics they can get from infant formula: protein, carbohydrates, fat, vitamins and minerals - it is the less well-known components of human breastmilk which are uniquely suited to developing a human brain.

Many babies leave hospital receiving complementary feeds - comps - of infant formula, used to “ top up” after breastfeeding. Usually this is because the baby has lost more weight than desirable and has yet to begin gaining weight. Up to 10% of birth weight is acceptable but beyond this doctors and nurses will routinely recommend topping up with expressed breastmilk and/or infant formula. This begins around the same stage as discharge from hospital and the mother will go home with instructions to pump after every breastfeed, give the expressed milk to the baby plus formula so the combined total meets the recommended amount. This is often called “triple feeding”.

Many parents want their baby to be breastfed because of the recognised protection it offers the immature immune system. Yet most people have little understanding of what this protection is or how it works. 

Research had shown how the balance of fat and volume in human milk changes as a feed progresses. Words to describe the process were created: Foremilk to describe the milk at the beginning of a feed and Hindmilk to describe the milk later in a feed.

To avoid babies being swapped from the first breast before they were ready, mothers were now advised to “Finish the First Breast First”. Rather than following the clock, following the baby recognised the unique way individual babies feed. The second breast was to be offered but if the baby indicated they were satisfied, the feed was concluded and the next feed would begin on the alternate starting breast.

It is hard to think of any other natural human behaviour which has come as close to extinction as breastfeeding did in the 20th century.

Although commercial infant foods were developed in the late 1800s and were being promoted prior to the first world war, it was after the second global conflict when their use became so widespread that it led to a recognised decline in breastfeeding.

Around the world, the importance of mother to mother support for breastfeeding women has been proven over decades. The growth of grass- roots advocacy and support runs parallel to increasing breastfeeding rates in those communities.

In 1956, mothers in Chicago USA came together to create what would become the Le Leche League International (LLLI). Nearly 70 years later, LLLI has a global presence with chapters around the world providing peer support, resources and information to mothers.

Across the Pacific, another group of mothers were inspired by LLLI and established the Nursing Mothers Association in early 1964. Later the Nursing Mothers Association of Australia, NMAA quickly grew with branches across the country and a network of local groups. In 2001, the organisation changed its name to the Australian Breastfeeding Association (ABA). Almost 60 years later, ABA continues to offer evidence based support through a range of services to parents Australia-wide.

It is routine for newborn babies to be weighed soon after birth. This is not just to inform the happy family and friends but o give a baseline for ongoing recording. Weighing and measuring should wait until the baby has had uninterrupted skin to skin contact and the first breastfeed in the hours after the birth.

All full-term babies are born over-hydrated. Floating around in amniotic fluid in the womb, which they sip and swallow as well as absorb through the skin, this extra hydration supports the concentrated colostrum which is the first milk babies receive from the breast. As they process and excrete this extra fluid, babies lose weight in the first week of life which is typical and expected. Up to 7% of birth weight is considered normal but many babies lose as much as 10% - the point where medical staff will usually recommend the following protocol:

The management of breastfeeding and lactation is constantly evolving as research informs updated guidelines. When health care facilities clearly communicate best current practice to staff and patients, parents can be confident they are getting the best support as they establish and maintain breastfeeding.

Personal experience and opinion have no place in breastfeeding support. When staff are held accountable to clear policy and procedures, there can be no confusion.

A breastfeeding policy should reflect the World Health Organization and UNICEF Baby-Friendly Hospital Initiative Ten Steps to Successful Breastfeeding.