Breastfeeding in Shanghai

Shanghai Living

Everything you need to know about lactation, baby formula, and feeding your baby

What are some of the myths about breastfeeding you’ve encountered since working here in Shanghai?

I have heard so many over the 10 years of supporting breastfeeding families in Shanghai…Here are a few that seem to linger:

Myth: A breastfeeding mother must wait until her breasts “fill up” before feeding the baby.

Fact: The breast makes more milk with a higher fat content when milk is frequently removed. Supply and Demand are the keys to an abundant milk supply.

Myth: A mother must pay a specialist for a ‘milk massage’ to maximize her milk production.

Fact: This is not true and an aggressive massage can damage the fragile lobes inside the breast by causing inflammation and bruising.

Myth: A mother who has had breast enlargement or reduction surgery will be unable to breastfeed.

Fact: While each situation requires independent evaluation, the vast majority of breast surgeries can preserve the milk duct structure so breastfeeding isn’t impacted.

Myth: Mothers are often told their milk loses its nutrients after a year so they should wean.

Fact: While the overall protein levels decrease over time, the antibodies remain stable and the mineral count actually increases as the baby grows to toddlerhood. The mother’s body will actually increase immune protection to her milk when her own immune system detects pathogens to prevent her child from becoming ill.

Breastfeeding mothers are also given many lifestyle restrictions that aren’t based on evidence- they are told they can’t drink any alcohol, should refrain from coffee, avoid many of their favorite foods, don’t dye their hair or get a tattoo, limit exercise, etc. In fact a breastfeeding mother can drink alcohol within moderation, eat /drink whatever she wishes, and make other lifestyle choices without having breastfeeding restrict her freedom.

What advice do you have for first time mothers as they prepare for childbirth and the first days of breastfeeding?

I encourage mothers (and fathers) to read in advance and have an understanding of what to expect in the first few days. Parents are often bombarded with confusing and conflicting instructions so it’s helpful to have a good framework of evidence-based information. I also recommend mothers to attend a support group such as La Leche League or to connect with other mothers who are currently breastfeeding to ask questions and set realistic expectations. I encourage mothers not to purchase a lot of breastfeeding products in advance of baby’s arrival since it’s difficult to foresee what they will need. Instead, walk around the shops and make notes about where to buy ointments, pumps, etc. so partners or friends can quickly buy them if needed…save some money and be eco-friendly by avoiding buying things not needed.

Are there any foods and beverages you recommend to new mothers to help with milk production?

There is a lucrative industry built upon telling mothers they need various supplements, products, teas, or foods to have good milk supply. In fact, the key to assuring a good milk production is supply and demand. The more a baby eats, the more milk a mother will produce. If her breasts are not adequately stimulated, milk production will not be enough for baby even with every milk-enhancing product on the market. A mother eating a well-balanced diet from a variety of sources will make plenty of excellent quality milk for her infant. It is generally best to avoid quick weight loss diets while breastfeeding.

When should a woman NOT breastfeed?

A woman shouldn’t breastfeed if she doesn’t want to breastfeed. It is a very personal choice that a mother must make for her own body once she has looked at the research and thoughtfully considered the risks and benefits. If she feels that breastfeeding isn’t for her, she could consider exclusively pumping or feeding commercially available infant formula.

However, there are rare medical situations that preclude a mother from breastfeeding, though I always encourage families to seek a second opinion from a health care provider with a lactation background if they are advised to not breastfeed or to prematurely wean for any reason since research is constantly changing.

How often should a new mother breastfeed her baby?

In the early days, a breastfed baby typically eats between 10-12 times per day. As the baby gets more efficient and milk supply becomes more established, they usually eat 8-10 times per day. In the early weeks, this works out to be roughly every two hours (from the start of one feed to the start of the next) though a baby will often cluster feed (eat more frequently), so I advise it’s best to watch the baby not the clock.

Can a baby gain too much weight with breast milk?

If a baby is solely taking breast milk, there is no need to worry about the upper spectrum of weight gain. The old adage ‘you can’t overfeed a breastfed baby’ is true. A chunky breastfed baby’s weight gain in the first six months of life is not an indication that they will be obese or have weight gain issues later in life, and usually slows during the second half of the first year.

Will breastfeeding have a detrimental effect on the mother’s figure (i.e., sagging breasts, lack of muscle tone, inability to lose weight)?

A 2007 study by an American plastic surgeon has shown that it’s actually breast growth during pregnancy that impacts sagging of the breasts- not breastfeeding. Many mothers report that they lose weight when breastfeeding since the body is burning an average of an extra 500 calories per day. The upswing of this means that her appetite increases as well, so some mothers find it challenging to lose weight when they find their hunger is increased. Seventy-five percent of mothers report weight loss with breastfeeding despite having an appetite that was higher than while pregnant.

How long (months, a year, more) should women breastfeed their babies?

The World Health Organization (WHO), American Academy of Pediatrics (AAP), and most global infant health experts recommend exclusive breastfeeding for the first 6 months with continuing to offer breast milk as the primary source of diet through the first year. The WHO also recommends breastfeeding at least two years. I think it’s entirely up to the baby and the mother for how long they wish to continue since it’s a personal family choice. There are numerous benefits to continuing to breastfeed past the first year since the quality of the mother’s milk never decreases. While it may not be widely discussed in parenting circles, it’s very common for mothers to breastfeed well into toddlerhood.

Is there a “milk bank” here in Shanghai?

Yes, there is a milk bank that is operated through Shanghai Children’s Hospital. My understanding is that it is only for premature and immune compromised babies and full-term healthy babies are not eligible to request donations. The Milk Bank opened in middle of 2016 and seems to be thriving- hopefully their services will expand soon. They are actively seeking donors, and foreigners are welcome to donate after undergoing a screening process. The application hotline is 180-499-59279 between 8am and 5pm on workdays. English service is available.

Sometimes some women have an over-abundance of milk and can pump and donate for either preemies or other children whose own mothers might not produce enough-is this something that exists here?

There is a thriving informal milk sharing network operated through volunteers on WeChat where mothers can donate milk to babies in need. Mothers have been sharing milk for ages, and now there is technology to facilitate the connections. However, there are risks associated with informal milk donation and we encourage mothers to make an informed choice before pursuing this option (e.g recipient can pasteurize donor milk themselves).

If a baby cannot take mother’s breast milk, or the mother just cannot produce enough, and the baby is allergic to the compounds in some of the formulas-what happens then?

a) In a situation like this, we would look toward the pediatrician’s opinion since this situation indicates an underlying medical condition that needs attention. If the baby is reacting to something in the mother’s milk, we would look very carefully at her diet to attempt to isolate the compound that is causing baby’s reaction. It is exceptionally rare for a baby to be truly allergic to mother’s milk, but far more typical for baby to react to a food that she is ingesting (top suspects are dairy, soy, eggs, wheat, nuts, etc). Depending on the severity of the baby’s symptoms, we would start her on an elimination diet to discover what is causing baby’s reaction.

b) If mother’s supply is low, we would work on strategies to maximize the amount she can produce using all available options.

c) If baby is allergic to the hydrolysate formulas, then we could try an elemental formula or amino-acid formula (with no milk proteins) to see if this helps baby to thrive. Donor milk would probably not be a great option for a severely allergic baby unless a committed donor would be willing to eliminate the allergens from her diet also.

What do you recommend to mothers who must use formula? Is there a specific brand you would advise?

I don’t have a specific brand to recommend since they are essentially all the same product. Formula content is highly regulated and doesn’t tend to vary significantly between brands. I encourage parents to buy the brand they can consistently find on the shelves, and are confident about its authenticity. If direct importation is not an option, I recommend buying an international brand at a store that has clear supply-chain tracking and proper storage practices. Carefully check expiration dates and assure the packaging includes the lot number. Be cautious about buying formula from classifieds, Taobao vendors (Tmall shops not included), or small size shops that wouldn’t purchase directly from an authorized distributor. It is also a red flag if baby formula is sold at any discount since this is not legal and wouldn’t be authorized by the manufacturers.

Do moms import formula for safety reasons?

I suspect it is distrust of the manufacturing and supply chain process that motivates parents to import baby formula. From a practical standpoint, parents need to be able to clearly read the mixing instructions in their own language- and if their friend brought them 6 cans from Amsterdam and they don’t read Dutch, this makes those 3am feeds especially difficult!  For example, it’s very important that powdered formula be prepared using using 70°C water (158°F) then cooled to body temperature. I don’t recommend parents who are planning to breastfeed to import baby formula ‘just in case’ since this can be a huge waste of money and precious suitcase space. They can research in advance to know which brand they would choose and where they can find it if necessary, but no need to purchase (ahead of time) In preparation.

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