It’s time to breastfeed

This year’s World Breastfeeding Week (August 1-7) calls upon policy makers, health workers, families and community members to ensure conducive conditions for mothers and babies to start breastfeeding during the first hour of birth.

Compiled by PAUL YEO

IT begins at birth. Our very first act after birth is to suck our mother’s ... milk. This is an act of affection, of compassion. Without that act, we cannot survive. That’s clear? That’s the way of life. That’s reality. – Dalai Lama and Howard C. Cutler, The Art of Happiness A Handbook for Living.

This year’s World Breastfeeding Week (WBW) theme further emphasises the importance of breastfeeding. In a study recently published in Pediatrics in 2006, babies who started to breastfeed in the first hour of life in rural Ghana were more likely to survive the neonatal period than those who did not. Babies who did not start breastfeeding until after 24 hours from birth were 2.5 times more likely to die than babies who did.

“In a world where more than 10 million children die before their fifth birthday due to preventable causes, and where malnutrition is still rampant and associated with over half of all childhood deaths, there is simply no time to waste. Let’s start with the first hour,” said Dr Margaret Chan, Director General of World Health Organization.

An examination of 37 countries, covering some 60% of the developing world population, by the Bellagio Child Survival Group, published in Lancet in 2003, has revealed an increase in the rates of exclusive breastfeeding from 34% to 41% in the first six months of children’s lives.

Some studies even suggest an additional 1.3 million children would be saved annually if this rate were increased to 90%, while neonatal mortality would be reduced by 22% when children are breastfed within an hour of birth.

The remarkable first hour of life
When healthy infants are placed skin-to-skin on their mother’s abdomen and chest immediately after birth, they exhibit remarkable capabilities.

They are alert. They can crawl, stimulated by mother’s gentle touch, across her abdomen, reaching her breast. They begin to touch and massage the breast. This first gentle touch of a baby’s hand or head at the breast stimulates release of maternal oxytocin, thus beginning both the flow of milk and enhancing the feelings of love for the baby.

Then the baby smells, mouths and licks the mother’s nipple. Finally, he or she attaches to the breast and feeds. This sequence of events is important for the survival of human young.

Although many authors describe these normal infant behaviours, we are just now discovering the importance of providing the opportunity for a mother and baby to have the experience.

Immediate skin-to-skin contact of the mother and baby is an important factor for successful initiation of breastfeeding as it restores the connection between mother and baby once the baby is out of the womb. This will keep the baby appropriately warm, induce maternal oxytocin release and ensures that baby receives colostrum during the first feeds.

The late Mary Kroeger, in the book Impact of Birthing Practices on Breastfeeding, urged, “Advocate for the mother-baby continuum by taking the stand that breastfeeding cannot be the physiologic norm without including physiologic childbirth and immediate and uninterrupted mother-baby contact.”

Why is skin-to-skin contact after birth and breastfeeding within the first hour of life so important

1. The mother’s body helps to keep the baby appropriately warm, which is especially important for small and low birth weight babies.

2. The baby is less stressed, calmer and has steadier breathing and heart rates.

3. The baby is exposed first to the bacteria from the mother which are mostly harmless, or against which the mother’s milk contains protective factors. The mother’s bacteria colonise the baby’s gut and skin and compete with more harmful bacteria from health providers and the environment, and so prevent them from causing infection.

4. The baby receives colostrum for the first feeds – liquid gold, sometimes called the gift of life. Colostrum is rich in immunologically active cells, antibodies and other protective proteins. Thus it serves as the baby’s first immunisation. It protects against many infections. It helps to regulate the baby’s own developing immune system. It contains growth factors, which help the infant’s intestine to mature and function effectively. This makes it more difficult for micro-organisms and allergens to get into the baby’s body

Colostrum is rich in vitamin A, which helps protect the eyes and reduce infection. It stimulates the baby to have bowel movements so that meconium is cleared quickly from the gut. This helps get rid of the substances in the baby’s body that produce jaundice and therefore may help reduce it

5. Touching, mouthing and suckling at the breast stimulates oxytocin release – this is important for many reasons:
Oxytocin causes the uterus to contract. This may help delivery of the placenta and reduce maternal bleeding after the birth.
Oxytocin stimulates other hormones which cause a mother to feel calm, relaxed, and some would say “in love” with her baby.
Oxytocin stimulates the flow of milk from the breast.

6. Women experience incredible joy with this first meeting of their child! And fathers often share this delight. The process of bonding between mother and baby begins.

Optimal breastfeeding
The WHO/UNICEF Global Strategy for Infant and Young Child Feeding recommends that children breastfeed exclusively for the first six months of life, and then continue breastfeeding with adequate complementary food up to two years or beyond.

Normal initiation of breastfeeding in the first minutes to first hours of life begins with skin-to-skin contact, and helps mothers and infants to achieve optimal breastfeeding. This is required in the Baby Friendly Hospital Initiative (BFHI, launched in 1991 by WHO and UNICEF) specifically in Step 4 of the WHO/UNICEF 10 Steps to Successful Breastfeeding.

The newly revised BFHI materials clarify this step to indicate the need for immediate skin-to-skin contact and ongoing support to achieve breastfeeding within the first hour.

We now understand that all babies should have skin-to-skin contact immediately after birth and the opportunity to breastfeed as soon as they show readiness to do so.

Other steps increase the likelihood of continued exclusive breastfeeding: help the mother to position and attach the baby at the breast; keep them together after delivery; encourage feeding on infant’s cue (demand feeding); avoid the use of artificial teats or pacifiers; and avoid any other food or drink unless medically indicated.

How to initiate breastfeeding in the first hour of life

1. Provide appropriate, culturally sensitive and supportive labour companionship to mothers.
2. Encourage non-pharmacologic measures to help support women through labour (massage, aromatherapy, water injections, movement.
3. Allow delivery to occur in the position preferred by the mother.
4. Dry the baby quickly, preserving the natural white cream (vernix) that soothes a baby’s new skin.
5. Place the baby naked skin-to-skin on mother’s naked chest, facing her, and cover them together.
6. Allow the baby to seek the breast. The mother will stimulate the baby with her touch and may help position the baby closer to the nipple. (Do not force the baby to the nipple.)
7. Keep the baby skin-to-skin with the mother until the first feeding is accomplished and as long as she desires thereafter.
8. Women who have surgical births should also have their infants skin-to-skin after delivery.
9. Delay intrusive or stressful procedures. The baby should be weighed, measured, and given preventive medications AFTER the feed.
10. No pre-lacteal liquids or feeds should be given unless there is a clear medical indication.

Is normal breastfeeding initiation in the first hour all that is needed to guarantee continued exclusive breastfeeding?

Absolutely not! Mothers need continued support to breastfeed exclusively for six months. The family, health workers, traditional healers and others in the community are all important contributors to their network of support.

Health providers, health visitors and others need clinical training in assessment of breastfeeding, identification of problems, as well as knowledge and skills for helping the mother resolve difficulties.

Follow-up by a health worker within 48-72 hours after the birth, again after one week, and at appropriate times thereafter provides the opportunity to intervene early if there are problems, as well as to reassure the mother when things are going well.

Source: World Breastfeeding Week –

http://worldbreastfeedingweek.org/