Lalitha is in tears… she has not slept in two nights and the baby is not easy to feed. The little one is cranky and crying, refusing to suckle for more than few minutes at a time. Everyone, family and friends, around her is saying the milk is not enough, but the doctor says no additional feeds…
The image of a baby content and suckling at the breast of a gently smiling mother is the image that comes to mind when we think of a newborn and a new mother.
Breast feeding is a “by default” activity — it is expected to come naturally and be the easiest and most intuitive thing in the world. For many it is and for many it is not. The initiation and sustaining of breast feeding requires constant support and motivation especially when the woman has had a long and tiring labour and is exhausted. Sometimes it is because some babies don't take to the breast as easily and there is a need to support establishing a good hold, grip and latch.
Oftentimes today, even in “baby friendly” hospital environments there is very little hands-on support for new mothers to help them adjust to the demands of breast-feeding.
Equally, the traditional family support systems that we prided ourselves with in India are fast disappearing. The grand mothers and aunts of today are as clueless as the new mothers sometimes — with the nuclear family structure of today oftentimes the last baby they may have handled is the one who has just had a baby now. So they are as anxious, if not more, than the new parents.
Support systems
It is, therefore, as important to educate the family care-givers and husbands about the importance of breast-feeding, the value of support and positive reinforcement. It is a fact that the more the mother gets stressed, the less milk she may produce. Constantly hearing that there is no milk is not a positive reinforcement at all. Colostrum that is produced is vital and important to the baby and most term normal weight babies need not have any supplement or formula in the first 24-48 hours it takes to establish good lactation.
Maternity units and neonatal units must be dedicated to ensuring breast milk is the only milk given except in situations where it is not possible or medically indicated. They must work to provide support for this. It is here that the role of nurses or people trained in lactation support becomes important. While as doctors we talk about the importance of breast-feeding, we do not have the time to stand there and help a mother and baby who have difficulty through a feed. When we have dedicated personnel or a named nurse to help with feeding they can focus time and supervise feeds for those who are having a problem.
Initiation and motivation is one thing — sustaining breast-feeding is another completely different issue. It is strongly recommended that babies are exclusively breast fed for six months. Sounds simple? But reality can be quite different. Working mothers hardly ever get six months maternity leave. Why go outside the healthcare industry? As doctors, nurses and other paramedics, we ourselves never get that luxury of six months of maternity leave.
Kerala is the only state where maternity leave is officially available for six months, since 2009. In most situations though, given our tradition of delivering in the mother's home, women need to take six weeks pre delivery and this cuts back even further into the three or four months that most places offer as maternity leave.
Alternatives
What then is the solution? Mothers can express breast milk and leave it for the baby to be fed when they are at work. For this there must be a facility to express milk at work — because, otherwise it is not possible for the woman to feed the baby when at home and also express enough in that time period to last for the day. So, in reality, they end up having to substitute feeds. As a mother feeds less, the milk production also decreases and so over time there is not enough to feed the baby even when at home.
Most work environments, whether they be hospitals or high tech software firms, do not have rooms and private places where a mother can express milk and collect/ store or indeed can feed the baby if work and home are nearby. When large companies can have beautifully landscaped gardens and good gyms for their employees, there is no reason why they cannot have a feeding room or a policy to facilitate breast feeding — after all, a significant proportion of work force in most places is women. Giving working new mothers limited time off/ flexible hours/ work from home when possible to increase the amount of breast-feeding is another possibility.
We as doctors are constantly asked by women for maternity leave extension to help facilitate feeding. If we give a certificate saying the baby needs to be fed, it is often time not accepted. We need to give a “medical” reason for the extension which actually means we need to give a reason such as back pain etc which does not exist. This must change.
Hospitals and maternity units must become mother- and baby-friendly and provide support to initiate and motivate breast feeding. Work environments must become “baby friendly” and new mother friendly as well. Otherwise it is hard for women to stay motivated and practise exclusive breast-feeding.
Vital facts
Breastfeeding is the normal way of providing young infants with the nutrients they need for healthy growth and development. Virtually all mothers can breastfeed, provided they have accurate information, and the support of their family, the health care system and society at large.
Colostrum, the yellowish, sticky breast milk produced at the end of pregnancy, is recommended by WHO as the perfect food for the newborn, and feeding should be initiated within the first hour after birth.
Exclusive breastfeeding is recommended up to 6 months of age, with continued breastfeeding along with appropriate complementary foods up to two years of age or beyond.
Ten Steps to Successful Breast-feeding
Every facility providing maternity services and care for newborn infants should:
1. Have a written breastfeeding policy that is routinely communicated to all healthcare staff.
2. Train all healthcare staff in skills necessary to implement this policy.
3. Inform all pregnant women about the benefits and management of breastfeeding.
4. Help mothers initiate breastfeeding within a half-hour of birth.
5. Show mothers how to breast-feed, and how to maintain lactation even if they should be separated from their infants.
6. Give newborn infants no food or drink other than breast milk unless medically indicated.
7. Practise rooming in — allow mothers and infants to remain together — 24hours a day.
8. Encourage breast feeding on demand.
9. Give no artificial teats or pacifiers (also called dummies or soothers) to breast-feeding infants.
10. Foster the establishment of breast-feeding support groups and refer mothers to them on discharge from the hospital or clinic.
Objectives of WBW 2010-07-30
To draw attention of policy makers and programme managers to the importance of baby and women friendly ‘Ten Steps’ in enhancing optimal breastfeeding rates.
To encourage and revitalise action of the health systems, healthcare providers and communities to enable women, to increase rates of optimal breastfeeding practices.
To inform people everywhere of the vital role of optimal breastfeeding for their child’s development and lifelong health
To ensure that health and nutrition care providers are trained in skills needed for counselling women on infant and young child feeding especially exclusive breastfeeding for the first six months.
To call for enabling systems and programme reforms for women to realise their rights to health care and nutrition to enable them to fulfil the rights of their children to food, nutrition, survival and development.
