Starting next week (August 1- 7) a National Breastfeeding Week organised by the World Alliance for Breastfeeding Action (WABA) will bring together all levels of society to help support working mothers to breastfeed their infants for optimum health benefits. The Sunday Observer spoke to eminent neonatologist from the University of Colombo in charge of the University Neonatal Unit at the De Soysa Hospital for Women, Dr. Nishani Lucas to find out why so many working mothers are now switching to formulae feeding despite breast milk being the best source of nutrition for their newly born infants ensuring healthy growth and development besides providing natural immunity against diseases.
Excerpts
 Dr. Nishani Lucas |
Q: The theme chosen for 2023 by the World Alliance for Breastfeeding Action (WABA) is “Enabling breast feeding: making a difference for working parents’’. What is the significance of this theme for Lankan working mothers in particular who reportedly rank among the leading countries in the region in exclusive breast feeding?
A. While I’m proud that Sri Lanka ranks as number 1 in exclusive breastfeeding along with Rwanda, with a rate of 80.9 percent as per latest UNICEF data, I regret that continuing breastfeeding in working mothers is still a real problem in our country where a significant number of women comprise the labour force.
Q: Why? Is it due to ignorance of the many benefits of exclusive breastfeeding for six months as recommended by the WHO and UNICEF? For their sake, spell out some of these benefits of breastfeeding.
A: They include:
* Higher levels of intelligence.
* Immunity coupled with a lower risk of allergy and non-communicable disease including cancer for the baby,
* In addition it lowers risk of cancer, depression, obesity and anemia for the mother.
I also understand that almost all babies at state hospitals are exclusively breast fed at the time of discharge and thereafter given 84 days of paid maternity leave as well to continue with breast feeding their new born.
Q: With so many benefits for mother and child, why do many mothers, especially working mothers, switch to formula feeding earlier than the WHO recommended six months for exclusive breast feeding?
A. The biggest challenges to exclusive breastfeeding for Lankan working mothers are: Not receiving timely skilled support for breastfeeding: Misleading advertisements about artificial milk and inappropriate prescription of formula milk by health care workers.
Q: How do media advertisements influence breast feeding habits in mothers?
A. Advertisements falsely associate healthy growth and development with different types of powdered milk leading to the common misbelief that the child will get healthier if an expensive milk powder is given. Also, media does not enlighten the viewers about the harmful effects of formula milk like Enterobacter sakasazaki meningitis.
Q: So what are the most significant negative impacts of formulae feeding to a child’s healthy development and growth?
A. * Children who are formula fed are at higher risk of developing obesity and metabolic syndrome resulting in a higher risk of dying young.
* They are also likely to have inferior brain growth leading to lower IQ.
* Formula feeding also increases the risk of sudden infant death, leukemia, multiple sclerosis, ulcerative colitis, Crohn disease, respiratory infection, diarrhoea, ear infection and urinary tract infection as well as asthma and eczema.
* In addition, Formula feeding also increases the risk of coronary artery disease, diabetes, hypercholesterolaemia and hypertension by altering epigenetics and microbiome. Enterobacter sakasazaki that may be contained in formula milk increases the risk of meningitis.
Q: What about pregnant mothers who have pre-existing conditions like diabetes, hypertension and heart? Can they breastfeed while taking treatment for these conditions?
A. Most medications are not contraindicated for breastfeeding, as only minimal amounts, get transferred to breast milk. Mothers on medication, other than chemotherapy and radiotherapy can breastfeed their babies without any problem at all.
Q: Can a working mother store her breast milk and use it to feed her baby when she returns to work? If so, how?
A. Yes definitely. Every mother should be aware that they are legally entitled to a minimum of 84 days paid maternity leave and a one-hour breastfeeding break, irrespective of where they work. If they are spending long hours away from their baby (from 8 am to 5 pm working hours) they should start on complementary feeds at the completion of 4 months, while continuing to breastfeed. Those who can work from home or are working for a shorter number of hours, should continue exclusive breastfeeding until the completion of 6 months.
Mothers should start expressing and storing milk from about 2 weeks, before they plan to return to work, so that they have a fall back stock. Expressed breast milk should be stored in containers with a tight-fitting lid, that can be sterilised / boiled, that can be labelled with date and time and kept in the refrigerator freezer section. Each container should have only one expressed milk feed, as it has to be discarded after thawing. Expressed breast milk can be kept in the refrigerator main compartment for upto 4 days, in the freezer compartment in the refrigerator for 2 weeks and in a -18C freezer for up to 6 months (CDC and NHS guidelines). Expressed milk containers can be placed in a separate box to avoid contamination from other meat products in the freezer.
Feeding cups should be used instead of bottles for storage and feeding the baby, as bottles are more difficult to clean, leading to higher risk of infection and causing ”suck confusion” due to different techniques that need to be used by the baby for suckling.
Q: Another deterrent to Breastfeeding are the wrong ideas that some new mothers have. One is that the size of their breasts will interfere with feeding the baby. Your response?
A. Breast size does not affect breastfeeding and is determined by the amount of fat tissue, while breastfeeding capacity depends on the quantity of lactating tissue. Every woman has enough milk, provided she gets the necessary support.
Q: Another myth is that there is inadequate milk production, when the mother does not get milk when trying to express the breast soon after delivery. Your response?
A. Not true as all mothers get only a few drops of milk in the first few days, that increases only in response to suckling by the baby.
Q: Another belief is that breastfeeding will cause their breasts to sag?
A. Breastfeeding will not sag breasts, provided breasts are adequately supported between breastfeeds. Supporting ligaments of the breast can be damaged due to inadequate support with increasing breast size, making it very important to use an appropriately sized, well-fitting brassiere between breastfeeds.
Q: If the baby falls asleep while being fed, how does a mother know he/she has had sufficient milk?
A. It is common for babies to fall asleep on the breast once their stomach is full. About 5-6 days after birth, when the milk comes in and the breast size increases, the mother would feel heaviness of the breast, prior to the feed and that the breast is lighter and emptier after the baby has completed the feed.
Babies may lose upto 10 percent of their birth weight within the first week, after which they slowly gain weight and regain their birth weight by 2 weeks of age. So, a decrease in the trend of daily weight loss or weight gain is the best indicator that the baby is getting enough breast milk.
Q: Another question worrying new mothers breastfeeding for the first time, is how to hold the baby in the right position while still ensuring that he/she gets the full amount of milk needed. Could you explain how this is done?
A. She must hold the baby completely turned towards her, with the head and neck in a straight line, by supporting the nape of the neck, without compressing the back of the baby’s head. She can use her hand or elbow to support the baby’s head.
Baby’s nose should be pointed towards her nipple, just below the breast so that the baby can easily get attached to the breast containing the whole areola inside the mouth, when opening his/her mouth to indicate that he/she is hungry.
Q: Most newborns have a windy problem. Is it due to not being burped properly?
A. Yes, it is. Carrying the baby upright against the chest does not work well, when carried out by women, due to baby’ s stomach not being compressed against the soft breast tissue compared to being effectively compressed against the rib cage in a male (father.)
Therefore, it is more effective to turn the baby face down with head to a side and compress the tummy between your hands by pressing down on the back of the baby, while keeping one hand under the baby’s tummy, when burped by a female.
Q: Can fathers also take over this role to support their wives?
A. Yes, fathers play a very important role, by encouraging the mother and boosting their self-confidence, thereby increasing the mother’s oxytocin level releasing more breast milk. Fathers can also burp the baby after the feed as well as help with housework, so that the mother can sleep when the baby sleeps and get adequate rest.
Q: Sri Lanka is still not free of Covid-19 and we also see many new infections entering the country following travel rules being relaxed. How safe is it for a Covid-19 infected mother to breast feed her baby without infecting the baby? What are the precautions she should take?
A. Yes, it is safe to breastfeed with Covid-19 provided the mother washes her hands and wears a mask when handling her baby. Breastfeeding is protective against Covid-19 as it will arm the baby with the antibodies produced by the mother that are transferred via the breast milk.
Q: Your advice on breast feeding to all working mothers out there?
A. All working mothers can exclusively breastfeed their babies and ensure that the baby gets optimal nutrition in the form of exclusive breastfeeding for a minimum of 4 months and ideally 6 months, to have a healthy growth and development. Demanding support with breastfeeding is your right. Beware of health care workers prescribing formulas for their convenience. While it takes only a few seconds to prescribe formula, it takes at least ½ hour to support breastfeeding.
You may obtain support for breastfeeding at any Lactation Management Centre attached to state hospitals or from your public health midwife, right in the comfort of your home.
