Breastfeeding: Excerpts from experts and mothers
World Breastfeeding Week is observed annually from 1st to 7th August to commemorate the Innocenti Declaration of 1990, which states that all women should be able to practice exclusive breastfeeding and that all newborns should be nourished exclusively on breastmilk up to the age of 4-6 months. World Breastfeeding Week has been connected with several Sustainable Development Goals (SDGs) since 2016. The goal of World Breastfeeding Week (WBW) is to educate, encourage, empower and motivate people to take action on breastfeeding. Breastfeeding support should be viewed as a critical public health obligation. This year, for WBW 2021, World Alliance for Breastfeeding Action (WABA) has selected the theme: Protect Breastfeeding: A Shared Responsibility. This blog shares the importance of breastfeeding from four perspectives- a gynecologist, lactation consultant and two mothers.
My Breastfeeding Experience
Ms. Heena Khokha, Mother
Before I had a baby, I always thought that I’d breastfeed for a full year or longer. I imagined sweet moments feeding my child on the rocker as she gently fell asleep in my arms. I couldn’t wait for those moments. But what actually happened was a far cry from my daydreams.
To begin with I had an emergency caesarean delivery while I was in labour due to the umbilical cord being around my daughter’s neck, and needless to say I had zero prior breastfeeding experience. The nurses instructed me to feed her within hours of her birth. My daughter Arya latched within minutes of being born but nothing would come out of my breast, which was both traumatic and painful to an extent that tears were streaming down my face. The nurses then fed her hand expressed colostrum (the initial breast milk) with a syringe, which was even more painful than the latch. It was brutal.
After a few more attempts and counselling by lactation experts, breastfeeding was adequately initiated. After weeks of breastfeeding my baby girl, the initial pain subsided and we got into a good groove physically. Emotionally, it was another story. Arya was feeding well, but many times she would still be hungry after being nursed, which made me feel helpless. There were times when I would just cry with the thought that I was under-nourishing my child. I wanted to be the kind of mother who could be strong and face everything for her child. So despite my fears and anxieties, we kept it up. We added formula (manufactured food for feeding babies and infants under 12 months of age), but only for emergencies, and kept up with our efforts of breastfeeding. I changed my diet drastically and started consuming Panjiri (a North Indian whole wheat flour dish that is cooked in sugar and ghee and then laced with dried fruits and herbal gums, used by women as a nutritional supplement after giving birth) on my mother’s insistence; this did wonders for the production of my breast milk.
In the meanwhile, I was repeatedly told by well wishers that my breasts were large enough to make enough milk, so I should try harder. I'm not sure where this came from, but it certainly didn't help me when I was already trying so hard.
Surprisingly, on the contrary to what I had heard about weaning the child being difficult, Arya weaned herself off easily by 8 months of age.
Although breastfeeding is difficult, stressful, emotionally taxing, and time-consuming, women need the right information and patient people around them to overcome these situations. If despite repeatedly trying, a woman is unable to breastfeed, other options like formula feeds should be discussed with a gynaecologist or lactation consultant. Breastfeeding is difficult, and women should not be made to feel inadequate if it does not come naturally to them.
About the Author-
Ms. Heena Khokha, in addition to being a full-time mother to a 14-month-old, is a Computer Engineer with experiences in e-commerce, productions, and modelling. She belongs to Panchkula, Haryana.
My Breastfeeding Experience: As narrated by my domestic help
As told to Ms. Katyayani Jha
This piece of information will absolutely not intrigue you. It is of common knowledge amongst the circles of health professionals and new mothers alike- breastfeeding is really important for your baby. Have we ever taken into account how women from lower socioeconomic backgrounds think about it?
Bhagyashree Shinde has been providing for her two-year-old son while simultaneously working as a domestic help for the last seven years. Her whole understanding of how to keep her infant well came from her mother-in-law and other women in the neighbourhood, in addition to guidance offered after the hospital birth. In conversation with her, it was also interesting to note that a community woman advised her to shift to formula based milk when the baby was unable to form a proper latch in the initial days of breastfeeding her first born. It was then that she approached a community health clinic and a nurse guided her through the process of establishing the right latch so that the posture is convenient for the mother and the baby.
She was very hesitant with her first born about the entire process. It seemed very challenging at first. She was especially concerned having heard instances of mishaps that happen with the baby due to incorrect or incomplete burping. Fortunately, she says the women in the vicinity of the chawl always stepped up to help. New mothers often have multiple apprehensions about the process and the only way to clear it out is by solving their doubts with demonstration, she suggests.
Throughout the journey she says, elder women in the household played a very critical role. Her mother-in-law used to accompany her to all the prenatal visits and even visits to a local daii (midwife), who was a woman in her 80’s who used to help around when the neighborhood babies had ‘sikri’ or infantile spasms. It was also extremely common to rub a little honey on the infant’s tongue in the hope of them ‘speaking sweetly’, at the age of around 8 months to 1 year; or usually preceding the ‘annaprashan’ or the first solid food feeding that the baby is given.
Breastfeeding is in fact considered extremely vital and sacred for the new mother and the baby, but along with it, come many rituals that may not exactly be in the best interest of the infant. The key is to strike a balance in understanding and respecting traditions while recognizing and educating against those which cause harm.
(As told to Katyayani Jha by Bhagyashree Shinde)
About the Author-
Katyayani Jha is a second year MBBS student from RCSM GMC Kolhapur. She is constantly on the run for wanting to be more than just a medical student. With COVID occupying a huge part of her college life, she has been wanting to explore all the extracurricular avenues that med school offers. She enjoys reading, writing, and watching sunsets with cold brews.
The Importance of Breastfeeding
Dr Renu Chakravarty, Gynaecologist
A good foundation is essential for any building to be strong and resilient. Similar is the way for any society or nation.
Children are the building blocks which play a pivotal role in framing the present and future of any country. A robust physically and mentally healthy childhood should be the priority of all parents and society. The process of producing and developing healthy children starts right from pregnancy. The onus lies on not only the pregnant woman and her family, but also the health system of the country to provide optimal care, support and education to the mother to equip her for nurturing a newborn.
In adequately nurturing a newborn, breastfeeding is indispensable. It is a natural phenomenon in all mammals of the animal kingdom to breastfeed their offspring in order to nourish them and protect them from various diseases. Breast milk provides the required nutrition and immunity to the fragile and helpless newborn who is otherwise susceptible to many infections and health hazards.
Breastfeeding strengthens the physical and emotional bond between the mother and her child. The benefits of breastfeeding to the mother are many. It prevents excessive bleeding after pregnancy, helps with weight loss, protects her from different gynecological cancers and also helps make the mother’s bones strong. Breastfeeding is a boon for both the mother and the child and the first step towards a healthy and strong nation. Breastfeeding can sometimes be difficult for the new mother, but it is crucial. Breastfeeding is 90% determination and 10% milk.
About the Author-
Dr Renu Chakravarty is an MD (Obstetrics & Gynecology) from PGIMS Rohtak , Haryana. She has been practicing Obstetrics & Gynecology for the last 33 years addressing health concerns of women across various ages with a special emphasis on preventative aspects of healthcare in pregnancy and cancer screening in post menopausal women. She’s been a Convener and an active Executive member of Chandigarh Obstetrics & Gynecology Society (COGS). She has been actively engaged with Haryana State Institute of Health & Family Welfare (SIHFW) in educating and training Medical Officers across the state in important areas of women healthcare.
Breastfeeding Issues Mothers Face and How To Overcome Them
Dr Manisha Gogri, Lactation Consultant
The World Breastfeeding Week (WBW) is celebrated each year between August 1-7 in order to create awareness about the benefits of breastfeeding and hazards of artificial feeding. It also highlights the need for support to breastfeeding mothers from all sections of the society. This includes her health care providers, family members, friends, relatives and work colleagues, whose knowledge, involvement and help is critical to breastfeeding success.
Breastfeeding is the normal, physiologic, natural way of feeding babies. It provides not only nutrition, but also closeness, warmth, security as well as protection from diseases. The World Health Organization recommends skin-to-skin contact and breastfeeding initiation within an hour of birth, exclusive breastfeeding till the baby completes six months of age, introduction of appropriate complementary foods after six months of age and continued breastfeeding for up to two years or beyond.
Although breastfeeding is natural, many mothers do face challenges and are unable to meet their breastfeeding goals. It is often the lack of knowledge about the process of breastfeeding or some myths and misconceptions which cause problems. For example, many mothers feel that they don’t have adequate milk in the early days after birth. The mother’s body is actually producing colostrum in the first three days-this is liquid gold, precious because of the high level of antibodies and immune factors in it. However, it seems less in quantity and the mother needs to feed her baby frequently, at least 10-12 times in 24 hours. As she continues skin to skin contact and feeds often, her milk supply automatically increases. The mother should be taught to recognize early feeding cues and feed the baby on demand.
Another common problem is related to the baby’s latching and positioning. “My baby is unable to latch” or “it hurts when my baby feeds” are the complaints we receive from new moms. On examination we find that this mother is not aware of the proper latching technique. Once taught how to achieve a deep latch, in a position that is comfortable for her as well as the baby, the baby starts drinking well at the breast and the mother has no pain.
There is a misconception that mothers having a C-section cannot initiate breastfeeding within one hour as recommended. In fact, the nurses and anesthetist can help her initiate skin to skin contact and breastfeeding on the operation table itself. Family awareness and support is crucial. Usually, we find the family asking the doctor to ‘let her rest’ and the baby ends up getting artificial feed on day one. This is completely unnecessary. The C-section mother, if helped, can breastfeed successfully in a lying down position.
Lastly if the baby is sick or premature or separated from the mother for any medical reasons, the mother can express her milk by hand or with a breast pump and can feed the baby her expressed milk till the baby is well enough to nurse again.
I feel really sorry when a mother does not get skilled and timely breastfeeding support in the face of challenges. No mother should have to suffer in order to breastfeed her baby. It is best to educate parents while pregnant and give them access to skilled breastfeeding support resources. Just telling a mother she can breastfeed if she tries harder- doesn't help. Her problem has to be diagnosed and treated. Artificial feeding has proven risks and is nowhere close to breastfeeding. The parents can make an informed decision only after understanding the risks of artificial feeding and the innumerable, irreplaceable benefits of breastfeeding. Giving the right knowledge and support to mothers can ensure the best possible outcomes for the baby's health and development.
Women in rural areas have even greater challenges. One of the biggest contributing factors to malnutrition is inappropriate and inadequate breastfeeding practices. Hence the grassroots workers are regularly trained in breastfeeding support. Artificial feeds carry even greater risks of infection, disease and deaths in this population due to lack of safe hygienic alternatives.
Well-begun is half done. Parents are encouraged to seek help early from professionals if they are unable to deal with breastfeeding challenges themselves. This help can be sought from not only gynecologists and lactation consultants, but also from the midwives and ASHA workers in the rural areas. Timely help ensures that the problems are resolved and the baby gets the right foundation of good nutrition and immunity which will ensure his long term physical and mental well-being.
About the Author-
Dr. Manisha Gogri is an International Board Certified Lactation Consultant practicing in Mumbai for the last twelve years. She leads a mother support group under La Leche League International (LLLI) and is Secretary of Breastfeeding Promotion Network of India (BPNI) Maharashtra.
ASAR thanks Dr. Renu Chakravarty, Dr. Manisha Gogri, Ms. Heena Khokha & Ms. Bhagyashree Shinde for their insights.