WHY SOME WOMEN DON’T BREASTFEED

Dr. REBECCA B. SINGSON, MD, FPOGS

In 1950 some 90% of babies were breastfed, while in the year 1978 the percentage dropped to 66 among the urban poor population while, not more than 27% of babies in the elite brackets of society were breastfeeding their babies (1). Current statistics show that at six to seven months of age less than two percent of Filipino infants are exclusively breastfed. (Source: National Demographic and Health Survey)

1. No pre natal preparation – many women get poor advise, or even no advise from their obstetrician during their prenatal check up. On the 1st meeting, ideally, the mother should already start psychological preparation for breastfeeding by reading books on breastfeeding, accessing websites on pregnancy & breastfeeding. It is never too early because those mothers who decide to breastfeed during the pregnancy are those who end up successfully breastfeeding. Especially with pregnancy adolescents, the chances of getting them to breastfeed increases over fourfold if they are given. Younger women and women with moderate to poor emotional support visitor were less likely to still be breastfeeding at three months.

2. No intrapartum/postpartum support – women who had a rough labor, prolonged labor and end up with a C-section usually want to sleep to recover from the exhausting experience and prefer to defer breastfeeding for a later time. Studies also show that mothers who spent 1 night in the hospital were almost twice as likely to breastfeed than mothers who spent 2 or 3 nights in the hospital. This may mean that hospitals, perhaps because of the Nursery set up, tend to separate the mother from the baby unless rooming- in occurs.

3. Poor latch on – Women who experience pain when the baby starts to breastfeed and try to withstand the pain it instead or re-latching. can end up with cracked and sore nipples. This can result from wrong positioning of the baby. The mother & baby should ideally be in the tummy-to-tummy position with the ears of the baby directed to the ceiling. The baby’s mouth should include not only the nipple but the areola too and must not be allowed to tug on the nipple. Upon withdrawal of the nipple, it must not assume the shape of the end of a lipstick but should be a round structure.

4. Wrong feeding pattern – Some women think that babies should feed only every two or 3 hours and only for 10-20 minutes. Babies should be fed on demand because it may take up to 2-4 weeks to establish a good milk supply. Most babies will gain weight if they are fed on demand or at least every 1 1/2 to 2 hours. Waiting more than 2 hours may cause the breasts to become engorged and painful. This decreases milk production. Women who think they will gradually build up breastfeeding by supplementing with formula or glucose water are setting themselves up for a higher likelihood of failure to establish breastfeeding. This is because introducing alternatives to breastmilk in the first 6 months will cause the baby to become full and decrease its demand of breastmilk which in turn will decrease its supply.

5.”Did not produce enough milk” – so many women are so insecure and so unempowered to believe that if nature had allowed them to bear a child, nature would also equip them with the means to keep their baby alive. It is all based on supply and demand. The moment you start to mix fix with formula, the demand for breastmilk decreases since the baby is fuller for a longer period of time. Logically, this is because the proteins of formula milk stay undigested for upto 60 mins (allowing the proteins to reach the intestines and cause major allergies) while breastmilk is digested within 15 mins.

6. Unrelenting frustration – Women who end up with a comedy of errors that can start with a poor latch on then end up frustrated when she gets sore nipples or baby rejects her. The problem is the moment Mom gets stressed, she won’t release the hormone prolactin which is released from her pituitary gland at the base of the brain & is responsible for the milk let down reflex.

7. Poor home support - Some of the first people who may discourage you from breastfeeding may be your very own mother, aunt, or relative who grew up in a generation brainwashed by ads to believe that formula is superior to breastmilk. Some overbearing Moms may find it ridiculous why you should make like difficult for yourself when there is formula milk to free up your body and your time. This may lead one to believe that since your family members didn't breastfeed you won't be able to either (so untrue).

8. Illness/infection – Sometimes a hospitalization for a serious illness, a fever or infection can prompt your pediatrician to shift you to formula feeding. Even during a fever or an infection, as long as it is not AIDS or active tuberculosis, one may continue to breastfeed. Research suggests strongly that any risk of transmission associated with breastmilk is negligible compared to the high risk of exposure to maternal blood and body fluids at birth. However, cracked or bleeding nipples or lesions with serous exudates could possibly expose the infant to infectious doses of Hep B.

9. Work Interference – Many women stop breastfeeding once they go back to work 6-8 weeks after delivery. Leaking breasts can be embarrassing during a corporate meeting or the stress of the work itself can jeopardize the release of prolactin essential to the milk let-down reflex.

10. Simply don’t want to – Some Women, however, who pregnant under adverse circumstances, like after a rape, are not psychologically prepared to breastfeed since they feel further violated.

a. fear of pain – Those who imagine themselves being bitten on the nipples or have seen the suffering of some women with engorged nipples are afraid to undergo the experience themselves.

b. uneasy with the thought - women don’t have the confidence that they have it within them to keep their baby alive through their natural faculty of breastfeeding.

c. suits her lifestyle – some women don’t want to be tied down at home because of work or leisure reasons. Breastfeeding just simply cramps her style. The truth is, we can bring the baby everywhere and feed as needed. With a drape over your breast and the baby’s head, one can continue to breastfeed without even being noticed. All the baby really needs after all is is to be fed and changed.

11. Our breastfeeding culture has disappeared – We live in a society where we do not see women breastfeeding if public. So if you haven't grown up seeing women around you breastfeeding successfully, if it's something that's hidden away, then it becomes even harder for you to succeed yourself. Many women feel embarrassment with public exposure.

What Can Be Done?

1. Consult a lactation consultant – a breast massage with lactation counseling does wonders to make your milk flow within the hour. Contact them through ReBirth Spa at 7719206/09178063339.

2. Inquire about donated breast milk - If despite lactation counseling and best intentions, the milk is inadequate, (evidenced by less than 6-8 wet diapers per day after the 1st week, less than 3 stools in 24 hours or birth weight is not regained after the 10th day), you can ask your pediatrician or friends to patch you up with other breastfeeding moms willing to donate breast milk to you. It has been done and you can make it happen if you so desire.

1. SANTOS OCAMPO P. "Country Reports: Philippines". In Valyasevi A. Baker J. (eds.) Proceedings of Workshop on Breastfeeding and Supplementary Foods. Bangkok: Bangkok Medical Publisher, 1980, p.35.

HOW CAN YOU BE SO WRONG ABOUT BREASTFEEDING!!

REBECCA B. SINGSON, M.D, FPOGS

In a third world country such as the Philippines where more than 50% of the population live below poverty line (defined in terms of a least-cost consumption basket of food that provides 2,016 calories and 50 grams of protein per day and of nonfood items consumed by families in the lowest quintile of the population) it is so disheartening, not to mention shocking to know that the minimum wage earner spends 26% of his wage buying formula milk when breast milk can guarantee less malnutrition, less diarrheal and upper respiratory infections for the neonate translating to less hospitalizations and best of all is available at no cost at all.

DID YOU KNOW?

Breastmilk is such a dynamic fluid that it is absurd to think that any brand of formula milk can even come close to it. The main proteins in milk are casein and whey (the more digestible between the two). The proportion of whey to casein differs in colostrum, in mature milk and in late lactation. The composition of breastmilk also varies during the time of the day and during the feeding. The hind milk (in the latter part of breastfeeding) has a much higher fat content than milk produced during the beginning portion of the feeding.(1) In fact, if your baby was premature, your breastmilk has a composition appropriate for premature babies. Furthermore, the odor and/or taste of breastmilk may change depending on the mother's diet. Food preferences in adulthood are apparently developed in infancy so breastfeeding may actually help infants get used to different tastes and help prevent them from being picky eaters when they grow up.(2) How can any artificial milk formula duplicate these properties?

So dynamic and perfect is breastmilk as your baby’s food that you don’t need for any formula, glucose water, water, pacifier, teas, juices or vitamins during the first six months. Human milk has over 300 ingredients, including interferon, white blood cells, antibacterial and antiviral agents, while formula has only 40 ingredients. Breastmilk favors the growth of beneficial bacteria so breast-fed infants have a level of lactobacillus that is typically 10 times greater than that of formula-fed infants. This is the reason why they are better protected against diarrheal diseases. Because of the protective antibodies, your baby will have a much lower incidence of pneumonia and urinary tract infection if fed with breastmilk. In fact, adding formula milk in the first three months of life has been proven to triple the baby’s risk of getting admitted in the hospital for pneumonia (3). Furthermore, infants fed formulas of intact cow's milk or soy protein compared with breast milk have a higher incidence of atopic dermatitis and wheezing illnesses in early childhood.(4)

BREASTFEEDING PROTECTS AGAINST CANCER

Did you know that breastmilk goes even so far as protecting the child from cancer before the age of 15? The risk of artificially fed children was 1-8 times that of long-term breastfed children. (5) And if that’s not reason enough for you, breastfeed for your own sake because breastfeeding confers some protection to you against uterine cancer (6), ovarian cancer(7) and breast cancer if you breastfeed for at least 2 years (but some benefit is already seen even if you only breastfed for 6 months). A study by Yale University researchers showed that women who breastfed for two years or longer reduced their risk of breast cancer by 50 percent (8).

LOCAL RESEARCH

In Baguio General Hospital & Medical Center (BGHMC), research shows that when they shifted over in 1975 from a practice of separating the mother and infant immediately after birth to a policy of immediate rooming in and breastfeeding, within two year time, breastfeeding increased from 40% to 92%. This simple practice also brought a dramatic reduction of mortality and morbidity because by 1977, the incidence of diarrhea droped from 27.5 to 1.5 per 1000 newborns and the mortality rate from diarrhea dropped from 8 per 1000 babies to none at all!(9)

KILLING THE INSTINCT TO BREASTFEED

Living in a civilized society has also killed our human instinct to breastfeed. Women are embarrassed to breastfeed in public and people are likewise uncomfortable to see a woman breastfeeding in public. Hospitals whisk out the baby to the nursery soon after birth separating the mother and baby. Although the Dept. of Health has implemented the Baby Friendly Initiative among hospitals to mandate rooming in immediately after birth, patients are made to sign waivers, oftentimes, without even explaining to them that the document they are signing is a consent NOT to room in the baby to actually allow milk formula to be given to their babies. In fact, soon after birth, the pediatrician is already discussing with the Mom what milk formula she would prefer to give the baby!! Family support is so hard to find since the now Mom’s own mother will discourage her from breastfeeding with words like “Bakit magpapakahirap ka pa eh may bote naman!” Many of our common practices with babies end up driving a wedge between Mommy and baby and keeps them separated. We create a separate Nursery room in the house for baby to stay in with her crib. We use a stroller to transport the baby instead of carrying her on a harness or sling like tribal societies do so the baby can sleep and breastfeed at will.

LACTATION SUPPORT

It is important that women feel supported during breastfeeding since many insecurities about her motherhood abilities surface when the going gets rough. Breastfeeding can cause a lot of distress to a Mom when her baby continues to cry despite giving her breast. Babies cry for many other reasons than hunger but Moms usually misinterpret this to mean, “I don’t have enough milk. My baby is starving.” The mere anxiety will interrupt the release of hormones that cause the letdown reflex of breastmilk thereby, decreasing the milk supply. In fact, research in Sweden has shown that every second mother experienced transient lactation crises on at least one occasion (the crisis group). The crises were mostly caused by emotional disturbances in the mothers (e.g. anxiety, stress and discomfort), or by the infant's refusal to suckle, by unmotivated crying, or by illness. Within the crisis group no significant difference was found between the infants' intake of breast milk during the crises compared with control measurements one week later. Nor had the crises any immediate impact on the growth of the infants. (10)

Research has shown that lactation counseling improves the rate of breastfeeding of women. (11)

1. Lawrence RA and Lawrence RM. Breastfeeding, A Guide for the Medical Profession, 6th Ed. Elsevier Mosby, Phila, PA. 2005: p6-12, p73-86, p105-214, p377-388, p397-405, p747-749, p832-993
2. Mennella JA and Beauchamp GK. Maternal diet alters the sensory qualities of human milk and the nursling's behavior. Pediatrics. 1991: 88(4): 737-744.
3. J.A. Cesar et al, Impact of Breastfeeding on Pneumonia on admission in the postnatal period in Brazil: Nested case control study, British Medical Journal, 1999 318:1316-20.
4. Friedman NJ, Zeiger RS. The role of breast-feeding in the development of allergies and asthma..J Allergy Clin Immunol. 2005 Jun;115(6):1238-48.
5. Davis, M.K. Infant Feeding and Childhood Cancer. "Lancet 1988.
6. Brock, K.E., "Sexual, Reproductive, and Contraceptive Risk Factors for Carcinoma-in-Situ of the Uterine Cervix in Sidney.”Medical Journal of Australia, 1989.
7. Schneider, A.P. "Risk Factor for Ovarian Cancer. "New England Journal of Medicine, 1987.
8. Tongzhang Zheng, et al., Lactation Reduces Breast Cancer Risk in Shandong Province, China. American Journal of Epidemiology Vol. 152, No. 12 : 1129-1135.
9. Relucio-clavano N, How can hospitals encourage breastfeeding? Example from the Philippines. Mothers Child. 1982 Spring 2(2):4-5.
10. Hillervik-Lindquist. Studies on perceived breast milk insuffienciency. A prospective study in a group of Swedish women.. Acta Paediatr Scand Suppl. 1991;376:1-27.
11. Aidam BA, et al. Lactation counseling increases exclusive breast-feeding ratew sin Ghana. J Nutr. 2005 Jul;135(7):1691-5.