Family

After a long labour and birth, sleep deprivation, a sore perineum and hormone levels declining rapidly, a new mum is given her baby to hold and within half an hour encouraged to breastfeed her new arrival. Breastfeeding looks so simple to the untrained eye. Mother Nature gave us our wonderful breasts but unfortunately they came without instructions on how to use them.

Breastfeeding for some women is much more difficult than labour and birth itself. It’s such a natural thing to do but it’s a skill that has to be learnt. Most of us underestimate the challenging early weeks of breastfeeding. In most ante natal classes women focus on the labour and birth and although many hours are spent teaching breastfeeding it’s seen as secondary to the pregnancy and birth itself. Inevitably, this leaves many women unprepared for some of the early breastfeeding difficulties she may encounter.

Partners, family and friends are the most important resource women have to help them through the first few challenging weeks or months of breastfeeding. After birthing my son 15 years ago, I was at home with sore nipples and engorged breasts. Charles was breastfeeding every couple of hours which was extremely tiring. ;I was determined to persevere knowing I was doing the best for my baby. My mother visited and advised me that if I needed to feed Charles every two hours my milk was obviously not rich enough. I felt so guilty for not producing good quality milk. I phoned my maternal and child care nurse and asked for her advice. Thankfully, she was extremely knowledgeable about breastfeeding and encouraged me to continue. I went on to breastfeed my son for many months and thoroughly enjoyed the experience.

A few negative comments can mean the end of breastfeeding for many women. Educating yourself about normal feeding patterns of a breastfed baby is one of the kindest gifts a partner; friend, work colleague or family member can give a pregnant woman who is planning to breastfeed her baby. ;It’s normal for a term, healthy newborn breastfed baby to feed as often as every two hours and then have a period of sleep for anything up to seven hours. Four to six short feeds from both breasts over an hour is also normal in the early days. Restrictions should not be placed on frequency or length of feeds. ;It is also normal for breasts to become full with milk any time from day three or four onwards. It is at this time mothers need encouragement to feed their babies regularly to keep the breasts well drained. Once again restrictions should not be placed on feeds as this can interfere with normal milk production.

The support from a baby’s father can be invaluable at this time, whether it’s bringing food and drink while a mother feeds her baby or an extra cushion for her comfort; it will reiterate his support and help the woman through these early days of breastfeeding where commitment may waver due to tiredness and tender nipples.

When someone we know is experiencing difficulties breastfeeding it is important to remember not to give advice unless we are trained to do so. Encourage her to speak with a health care professional or contact a breastfeeding advice group such as the Australian Breastfeeding Association.

With the ever increasing research in favour of breastfeeding, all women should be encouraged to breastfeed their babies. This encouragement should come from partners, family members and friends not just health professionals or voluntary breastfeeding groups. ;The World Health Organisation recommends that all babies be exclusively breastfed for at least the first six months of life and together with complimentary food, breastfed ideally up to two years.

There has been significant reliable evidence produced over recent years to show that breastfeeding reduces the risk of some diseases for both mother and baby. A breast fed baby has a lower risk of developing childhood leukemia. (1) Babies suffer less ear infections. (2) It lowers the risk of urinary tract infections and type one diabetes in young children. (3)(4) ; Breastfeeding has been associated with a significant reduction in the incidence of food allergies, eczema and asthma. (5) (6) ; Its also been attributed to higher intelligence.(7) There is some research that links bottle fed babies and childhood obesity.(8) ; Breastfeeding also promotes bonding between mother and baby by stimulating the release of the hormone oxytocin which promotes the development of maternal behavior. (9) ; Breastfeeding mothers may have a lower risk of developing rheumatoid arthritis (10), ovarian cancer (11) and breast cancer. (12) It lowers her risk of bone fractures (13) and has the added bonus of helping our bodies regain their pre pregnancy shape.

When you read the benefits of breastfeeding it’s difficult to understand why we, as a nation have such low breastfeeding rates. Research shows that 83% of Australian women leave hospital breastfeeding their baby but unfortunately these figures dramatically decline after discharge and by 25 weeks only 18.4% of babies are fully breastfed. According to some recent research by the University of Melbourne these figures have remained the same over the past ten years even though there is a national push for babies to be fully breastfed for six months. (14)

As a country we now have 51 hospitals accredited as Baby Friendly and many more working towards this accreditation. The Baby Friendly Hospital Initiative (BFHI) was developed jointly by the World Health Organization and UNICEF and launched in 1991. It is an international project that aims to give every baby the best start in life by creating an environment where breastfeeding is the norm and practices known to promote the health and well being of babies and their mothers are followed. Mothers who attend a Baby Friendly Hospital are not obliged to breastfeed their baby but assisted to make an informed choice.

Australia introduced the BFHI in 1993. Hospitals accredited as Baby Friendly have to demonstrate that it offers a high standard of care to all mothers and babies. To achieve this standard of care midwives and other health professionals obtain increased knowledge of infant feeding to help facilitate breastfeeding.

Hospitals have to implement the “Ten steps to successful breastfeeding” which are as follows: ; 1. Have a written breastfeeding policy that is routinely communicated to all health care staff.

2. Train all health care 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 half ; hour of birth.

5. Show mothers how to breastfeed, 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. Practice rooming- in, allow mothers and ; infants to remain together 24 hours a day.

8. Encourage breastfeeding on demand.

9. Give no artificial teats or pacifiers (dummies) to ; breastfeeding infants. ; 10. Foster the establishment of breastfeeding support ; groups and refer mother to them, on discharge from ; the hospital or clinic. ;

With the Baby Friendly Hospital Initiative increasing across Australia we can only hope that in the next ten years we will see our static breastfeeding figures increase. However more education in our communities amongst family and friends, our schools and work places is needed before we see these figures change. The nation needs to see Government sponsored advertising of women breastfeeding on billboards and in magazines other than parenting magazines. We need an environment that creates freedom for women to breastfeed whenever baby is hungry or thirsty.

It’s only when our whole community accepts breastfeeding as the norm do we stand any chance of our breastfeeding rates increasing. ;

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Bibliography:

1. Kwan ML et al (2004) Breatfeeding and the risk of childhood leukemia: A meta- analysis. Public Health ; ; Rep 119: 521-35.

2. Alho, O `Risk Factors for Recurrent Acute Otitis Media and Respiratory infection in infancy` INT J PED ; Otorhinolaryngology 1990; 19: 151-161

3. Marild S et al (2004) Protective effect of breastfeeding against urinary tract infection. Acta Paediatr 93 ; ; (2): 164-8

4. Sadauskaite- Kuehne V et al (2004). Longer breastfeeding is an independent protective factor against ; development of type 1 diabetes mellitus in childhood. Diabetes ; Metab Res Rev 20 (2);150-7

5. Journal of Allergy and clinical immunology ; (Dec 1999)

6. Wendy H.Oddy (2002) Journal of Allergy and clinical Immunology (JACI)

7. Morley R et al `Mother’s choice to provide breastmilk and developmental outcome` ; Arch Dis Child 63: ; 1382-1385 1988

8. Harder T, Bergmann R , Kallischnigg G, Plagemann A. Duration of breastfeeding and risk overweight: a ; ; meta-analysis. Am J Epidemiol 2005 SEP 1; 162 (5): 397-403

9. Uvnas-Moberg, Eriksson: Breastfeeding: physiological, endocrine and behavioral adaptations caused by ; oxytocin ; and local neurogenic activity in the nipple and mammary gland Acta Paediatrica, 1996 May, ; 85 (5): 525-30

10. Karlson EW et al (2004). Do breastfeeding and other reproductive factors influence future risk of ; ; rheumatoid arthritis? Results from the Nurses health study Arthritis Rheum 50: 3458-67

11. Tung K-H et al (2003) Reproductive Factors and Epithelial Ovarian Cancer Risk by Histologic Type: A ; ; Multiethnic Case-control Study. Am J Epidemiol 158: 629-638. ; 12. The Lancet (2002; 360: 187-95- July 2002).

13. Royal Australian College of Physicians working party on osteoporosis. ‘Osteoporosis: its causes, ; prevention and treatment’. Mod Med Aust 1991; Aug; 3 7-41

14. Australian and new Zealand Journal of public Health. (Vol 29 No 2 2005)

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