Starting tomorrow (August 1), a National Breastfeeding Week organized by the World Alliance for Breastfeeding Action (WABA) will bring together all levels of society to help working mothers breastfeed their infants for optimal health benefits. This year’s theme (Intensify, Educate, Support) is particularly appropriate for breastfeeding Sri Lankan working mothers who are currently facing several challenges due to the current economic crisis and fuel shortages across the country.
Eminent neonatologist from the University of Colombo in charge of the Academic Neonatal Unit at De Soysa Women’s Hospital, Borella, Dr. Nishani Lucas urges them to continue breastfeeding from the time of delivery until the first six month of birth and continue for as long as possible, arguing that breast milk is the baby’s best source of nutrition and the start of a healthy life.
Q: Working women in Sri Lanka are currently facing several challenges as a result of the economic crisis, with recent studies showing that even the practice of breastfeeding, which reached high levels a few months ago, is now showing signs of decline. Do you agree?
A. No. We started to feel the impact of the current economic crisis only a few months ago, for which Sri Lankan data is not yet available. However, along with the economic crisis, “working from home” has become an option for many women when it was not an option before, both in the state and in the private sector that served to support the feeding with milk. In addition, many pregnant women as well as mothers of young children have been granted paid leave from the time a pregnancy test is positive until the child is at least 1 year old or have been assigned to stations close to their homes during the Covid-19 pandemic as well as during the current economic crisis, which has also served to support breastfeeding.
Q: Fear of losing their job, lack of immediate family support are some of the reasons given by mothers for switching to formula early. Your comments?
A. Almost all babies born in public hospitals are exclusively breastfed upon discharge. Although all women are entitled to 84 days of paid maternity leave, the temptation to start formula milk comes later after returning home when faced with breastfeeding difficulties.
Q: Many young mothers are still unaware of the immense benefits of breastfeeding over the negative effects of formula feeding. Tell us how feeding a newborn with artificial preparations can have a negative impact on the growth of the child.
A. The many negative impacts of artificial formula on a newborn are: Formula is not sterile and contains many microorganisms, e.g. Enterobacter sakazakii which is responsible for neonatal meningitis. The child is missing out on the benefits of breastfeeding. Formula feeding slows brain development, lowers immunity, and increases the risk of malocclusion, respiratory infection, diarrhea, ear infections, sudden infant death syndrome, leukemia, asthma, allergy and eczema. Lancet, 2016, UNICEF, 2012 which I just quoted in the list above also mentions higher risk of obesity, diabetes, heart disease, hypertension in infants fed formula among other diseases adulthood.
Q: According to new evidence following island-wide awareness programs by the Department of Health and pro-breastfeeding NGOs, more working mothers now want to breastfeed their babies to full term. At the same time, many new mothers have expressed uncertainty and concern about basic breastfeeding techniques and whether the baby has had enough milk in the first few days of birth. What are the signs they should look for?
A. The most reliable sign is the amount of weight loss in the first few days followed by adequate weight gain after 2 weeks of age (10-30 g/day). The baby should return to birth weight within the first 2 weeks. Weight loss on the first day or 2 should be less than 5% of birth weight. For example, a baby with a birth weight of 3 kg, if the weight in 24 hours is 2.95 kg, the weight loss is 50 g, and the weight loss percentage = 50/3000 ~ 1%, which is less than 5% and indicates that the baby has received enough milk. (because breast milk is the baby’s only oral intake). day will be supported to breastfeed by changing technique/improving confidence.
Q: If the baby falls asleep while breastfeeding, how will a mother know if he has had enough milk?
A. Most babies fall asleep when their stomachs are full. The mother will feel that the breast is empty and light at the end of the feed compared to the full breasts felt at the start of the feed. The sufficient amount of milk is determined by the percentage of weight loss as described above.
Q: Does the size of the mother’s breasts matter to give the baby better quality and more milk?
A. No. The ability to produce milk is not related to breast size. Breast size depends on the amount of fat stored in the breast.
Q: Does the duration of feeding vary from the first hours of birth and decrease or increase as the baby grows?
A. Breastfeeding time tends to decrease over time as both baby and mother master the art of breastfeeding. A breastfeed that lasted 10 to 15 minutes soon after birth can be shortened to 5 minutes or less by 2 to 3 months of age.
Q: Another concerning issue for new mothers is how they should hold the baby while breastfeeding. What is the correct position?
A. They must ensure that the baby’s head and neck are aligned and in a straight line where the baby is fully facing the mother. The baby’s head should not be pressed against the breast. Instead, the head should be supported, keeping two fingers at the back of the neck.
Q: Most newborns have wind problems when feeding and crying. Is it normal for newborn babies to be windy? How and when should a mother burp her newborn?
A. Wind problems are common in newborn babies because they tend to swallow air while breastfeeding. A good latch, where most of the areola is inside the baby’s mouth (which should be wide open) would minimize swallowing of air. Keeping the baby in a prone position (tummy down) shortly after a feed and gently pressing down on the back will help release swallowed air. This is the most effective position for burping the baby. The baby should burp for 15 to 20 minutes after each feeding.
Q: Can the father also burp the baby?
A. Yes of course. Holding the baby upright in the carry position is only effective when done by a man (father) because the baby’s stomach is pressed against the rib cage which is a hard surface. It is not effective when performed by a woman (mother) due to the pressure of the baby’s stomach on the breast tissue which is a soft surface that does not compress the baby’s stomach enough to release the breast tissue. ‘air.
Q: Does a nursing mother’s diet, such as eating high-fiber foods, cause gas in newborn babies?
A. No. The mother can eat or drink anything she wants except alcohol, tobacco and illicit drugs.
Q: They also want to know if their normal diet is enough to produce better quality and more milk for the baby. Or if they need something special, especially if the mother is malnourished?
A. A normal, balanced diet is sufficient. Proper hydration helps. The mother should drink plenty of water. The answer to your second question is No. Even if the mother is malnourished, milk volume and quality are not affected except in cases of severe malnutrition.
Q: What about vitamin and mineral supplementation to replenish her stores used for lactation?
A. Yes. She must take the calcium and iron supplements prescribed by her doctor.
Q: Can a working mother express her own milk and store it in the refrigerator until she returns from work? How? For how long?
A. Certainly. It is best to start expressing breast milk at least 2 weeks before planning to return to work, as this will help build up a supply. Expressed breast milk should be given by cup to the baby. They should be kept in the same container used to feed the baby to minimize contamination. Bottles should not be used as they introduce infection and cause ‘sucking confusion’. Cups that can be tightly sealed can be stored in the fridge-freezer with a separate door for 3 months, without a separate door for 2 weeks, and in the lower refrigerator compartment for 24 hours. Milk should be thawed by keeping the cup in warm water and thawed milk should not be refrozen. Expressed breast milk can be stored at room temperature for 6 hours.
Q: Many myths and superstitions currently circulate around breastfeeding. What is your opinion on such myths?
A. Breast size is determined by the amount of fat in the breast. Breast milk is produced by alveoli lined with lactocytes which have no relation to breast size. Breast size does not affect the ability to breastfeed. Indeed, it is easier to breastfeed with a small breast compared to the difficulties encountered with a large breast, for which more qualified support is necessary.
Q: Are there gaps in breastfeeding promotion that you would like to see filled?
A. At this time, I think mothers will try harder to make breastfeeding work before prescribing formula milk themselves for their child, due to the recent price increases of all products, including milk maternity, for the same or reduced income.
However, the fuel crisis may make it more difficult for midwives to make their home visits as well as for mothers to travel to the Ministry of Health clinic or lactation management center for support. qualified for lactation, which may encourage more mothers to self-prescribe formula. child.
Q: So what will be the impact on the country’s economy?
A. Not breastfeeding costs the global economy $302 billion annually (Lancet 2016). Promoting breastfeeding would therefore be a step in the right direction, in addition to also solving the economic crisis.
Q: As a message to new mothers, what advice can you give on the importance of breastfeeding and its benefits?
A. Breast milk is something only YOU can give your child, to help shape their entire life. Seize this opportunity and make sure you give your child a good start in life. Every mother can do it. Seek help from the nearest lactation management center in case you have difficulty breastfeeding.