Nisha, a 38-year-old marketing professional from Bengaluru, always thought of breastfeeding as a natural part of motherhood. Her complicated pregnancy, marked by fluctuating hormone levels and multiple IVF cycles, changed her outlook towards breastfeeding.
Post her emergency C-section, Nisha waited eagerly for her milk to come in but to no avail. Her baby girl attempted to latch frequently but her breasts remained stubbornly dry and the milk didn’t flow.
Impact of hormonal medication
Nisha, like many mothers, doesn’t know that hormonal medications like progesterone and estrogen, which are prescribed during her fertility treatments and pregnancy, can delay the onset of lactogenesis II (occurring about two or three days postpartum, milk production intensifies during this stage). At 38, when she couldn’t conceive naturally, Nisha had to resort to fertility treatments for which doctors put her on medication. The medication, in turn, affected her milk let-down. The post-surgical fatigue, stress, and sleeplessness caught Nisha in a physical and emotional whirlwind. “It’s like a vicious circle. A late, complicated pregnancy causes dependence on medications and treatments, which, in turn, interferes with lactation. I wish more people knew that not all breastfeeding journeys start the moment you give birth,” says Nisha.
Breast milk packed with antibodies and nutrients is essential for a baby’s development. It ensures wellness for babies and mothers, both. However, hormonal treatments, C-sections, or health issues, common in late pregnancies, can affect a mother’s ability to breastfeed. The hormonal shift needed for milk let-down may be delayed due to the disruption in the body’s natural rhythm. Those who conceive later in life struggle during the first few days, as their bodies need more time to adjust.
Breastfeeding: Why and how?
International health agencies such as WHO and UNICEF also recommend breastfeeding a newborn within the first hour of birth and exclusively breastfeeding the baby for the first 6 months of life.
According to an article published on The Lactation Network, a breastfeeding support system based in Chicago, “One study found first-time mothers who were 30 years old or older were more likely to have a delay in their milk “coming in” after delivery. If the reason you’re having a baby later in life is because of fertility challenges that stem from hormonal or medical issues, those conditions could also affect your milk production. And sometimes, high-risk pregnancies can lead to a more complicated delivery, which in turn may delay or lower your milk supply.”
Age do matter!
“Mothers who are delivering for the very first time at the age of 35 or above, they do face a few problems. There can be delayed ovulation and lactation, and that can be because of multiple reasons. The increased age induces more anxiety issues. Some IVF pregnancies can be complicated or high-risk pregnancies, which may undergo cesarean section. The mothers are in the ICU after the delivery and they are not allowed to meet the baby. So the first hour, the important hour where the skin contact happens between the mother and baby, is delayed. This skin contact is important for the milk let-down or lactogenesis,” says Dr Sapna Raina, Clinical Lead, Obstetrics & Gynecology, Narayana Hrudalaya City, Bangalore.
Dr Raina says that lactation doesn’t take a hit in older women if they have delivered before, as the breast tissue is already well developed. “She has already experienced it, so there is not much anxiety about lactating the baby. The problem is, if she’s an elderly primary caregiver, that means she’s delivering for the first time,” she adds.
Babies need to be fed multiple times during the day and night and it may cause exhaustion in older mothers who could already be struggling with postpartum recovery. Gestational diabetes, thyroid, and hypertension bring their own set of challenges for lactating mothers.
Dr Chetna Jain, Director, Department of Obstetrics & Gynecology, Cloudnine Group of Hospitals, Sector 14, Gurgaon, notes, “A majority of the women will have an adequate amount of hormones to produce milk even at the age of 35 and beyond but there would be certain other conditions wherein if the woman is sick, then possibly she is not able to feed because sickness in pregnancy is more common in older women compared to younger.”
The senior gynecologist says since older women tend to have greater chances of high blood pressure, diabetes, preterm deliveries and C sections, they can delay lactation. “The lactation is much superior if the woman has a normal delivery. These conditions could cause a delay in latching and bonding and thereby a reduction in the speed and delayed and probably inadequate lactation.”
With age comes challenges
A lot of new mothers who come to her also complain of severe pain in the breast. “The older the women, the greater are the chances of complaining about severe pain in the breast. This could be because of an increase in the fat tissue and less of the glandular tissue. When we are younger, the body is more flexible, and as we grow older, we are firmer. The tolerance also reduces and we get more irritable, nervous, and anxious with age,” explains Dr Jain.
Lactation support can come in through family, preparing your body and mind for lactation, attending lactation consultations and increasing awareness. During consultations, would-be mothers are taught to prepare their nipples, pull-out techniques, latching techniques, softening the nipples.
Dr Raina emphasises, “Lactating mothers need proper rest and sleep and should be encouraged to take ample amounts of vitamins and minerals, especially calcium and vitamin D. They are very important because her bone health is important when she’s feeding her baby. During her antenatal visits, it’s important to meet lactation consultants to get mentally prepared for the lactation.”
Health practitioners feel that rural women, even if older, are less likely to struggle with lactation issues because they are less anxious and stressed. “Urban women read a lot and feel stressed and fatigued very soon,” says Dr Jain.
Late motherhood is becoming increasingly common but its hidden challenges including the breastfeeding, are rarely discussed. Awareness, family support and preparation can make it easy but it’s also important to understand that every breastfeeding journey is different from the other.
(Some names have been changed to protect anonymity.)
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