HOW TO MAKE EXCLUSIVE BREAST FEEDING POSSIBLE

Initiation of breastfeeding within first hour of life reduces jaundice risk

The World Alliance for Breastfeeding Action (WABA) has listed 10 ways of ensuring successful exclusive breastfeeding.

Also, several local researchers and the Lagos State Ministry of Health are championing the call for breastfeeding immediately a child is born to prevent the consequences of blood incompatibility with the mother, which includes neonatal jaundice, brain damage and death.

But most mothers find it difficult to adhere to this recommended practice. Several studies in Nigeria show that this is basically due to the absence of crèches in most working places and ignorance.

WABA is a global network of individuals and organisations concerned with the protection, promotion and support of breastfeeding worldwide based on the Innocenti Declarations, the Ten Links for Nurturing the Future and the World Health Organisation (WHO)/United Nations International Children Fund (UNICEF), Global Strategy for Infant and Young Child Feeding (GSIYCF).

World Breastfeeding Week is celebrated every year from August 1 to 7 in more than 120 countries to encourage breastfeeding and improve the health of babies around the world. It commemorates the Innocenti Declaration made by WHO and UNICEF policy-makers in August 1990 to protect, promote and support breastfeeding.

Jaundice is a yellowish discoloration of the skin, the conjunctival membranes over the sclerae (whites of the eyes), and other mucous membranes caused by hyperbilirubinemia (increased levels of bilirubin in the blood).

Bilirubin is the yellow breakdown product of normal heme catabolism. Heme is found in haemoglobin, a principal component of red blood cells.

A Consultant Paediatrician at Optimal Specialist Hospital, Surulere, Lagos, Dr. Adejoke Chukwunenye, told The Guardian that neonatal jaundice is usually harmless. “This condition is often seen in infants around the second day after birth, lasting until day eight in normal births, or to around day 14 in premature births. Serum bilirubin normally drops to a low level without any intervention required. The jaundice is presumably a consequence of metabolic and physiological adjustments after birth. A common case is blood incompatibility of the baby with the mother,” she said.

Chukwunenye said in extreme cases, a brain-damaging condition known as kernicterus can occur, leading to significant lifelong disability. She said there are concerns that this condition has been rising in recent years due to inadequate detection and treatment of neonatal hyperbilirubinemia.

Chukwunenye said a Bili light is often the tool used for early treatment, which often consists of exposing the baby to intensive phototherapy. “Bilirubin count is lowered through bowel movements and urination so regular and proper feedings,” she said.

Kernicterus could be prevented by making sure the baby starts taking breast milk immediately after birth. “No matter the condition of the mother after birth, ensure that the baby is made to feed from the mother’s breast milk. The first milk contains all the baby needs to fight off jaundice and most other diseases, and prevent brain damage. It can indeed reduce child deaths,”

To enable mothers to establish and sustain exclusive breastfeeding for six months, WHO and UNICEF recommend: Initiation of breastfeeding within the first hour of life; Exclusive breastfeeding – that is the infant only receives breast milk without any additional food or drink, not even water; Breastfeeding on demand – that is as often as the child wants, day and night; and No use of bottles, teats or pacifiers.

WHO recommends exclusive breastfeeding until a baby is six months old, and continued breastfeeding with the addition of nutritious complementary foods for up to two years or beyond.

Breastfeeding has been shown to be an unequalled way of providing ideal food for the healthy growth and development of infants; and also an integral part of the reproductive process with important implications for the health of mothers.

A recent review of evidence has shown that on a population basis, exclusive breastfeeding for six months is the optimal way of feeding infants. Thereafter infants should receive complementary foods with continued breastfeeding up to two years of age or beyond.

According to the WHO, breast milk is the natural first food for babies, it provides all the energy and nutrients that the infant needs for the first months of life, and it continues to provide up to half or more of a child’s nutritional needs during the second half of the first year, and up to one-third during the second year of life.

Breast milk promotes sensory and cognitive development, and protects the infant against infectious and chronic diseases. Exclusive breastfeeding reduces infant mortality due to common childhood illnesses such as diarrhoea or pneumonia, and helps for a quicker recovery during illness. These effects can be measured in resource-poor and affluent societies. Kramer M. et al have measured the effect in Belarus in a study titled “Promotion of Breastfeeding Intervention Trial (PROBIT): A randomized trial in the Republic of Belarus” published in Journal of the American Medical Association, 2001, 285 (4): 413-420).

Breastfeeding contributes to the health and well-being of mothers, it helps to space children, reduces the risk of ovarian cancer and breast cancer, increases family and national resources, is a secure way of feeding and is safe for the environment.

While breastfeeding is a natural act, it is also a learned behaviour. An extensive body of research has demonstrated that mothers and other caregivers require active support for establishing and sustaining appropriate breastfeeding practices.

WHO and UNICEF launched the Baby-friendly Hospital Initiative in 1992, to strengthen maternity practices to support breastfeeding. The foundation for the Baby Friendly Hospital Initiative (BFHI) are the Ten Steps to Successful Breastfeeding described in Protecting, Promoting and Supporting Breastfeeding: a Joint WHO/UNICEF Statement. The evidence for the effectiveness of the Ten Steps has been summarized in a scientific review document.

The BFHI has been implemented in about 16.000 hospitals in 171 countries and it has contributed to improving the establishment of exclusive breastfeeding world-wide. While improved maternity services help to increase the initiation of exclusive breastfeeding, support throughout the health system is required to help mothers sustain exclusive breastfeeding.

WHO and UNICEF developed the 40-hour Breastfeeding Counselling: A training course to train a cadre of health workers that can provide skilled support to breastfeeding mothers and help them overcome problems. Basic breastfeeding support skills are also part of the 11-day Integrated Management of Childhood Illness training course for first-level health workers, which combines skills for adequate case management with preventive care.

Evaluation of breastfeeding counselling delivered by trained health professionals as well as community workers has shown that this is an effective intervention to improve exclusive breastfeeding rates.

The GSIYCF describes the essential interventions to promote, protect and support exclusive breastfeeding.

The objectives of World Breastfeeding Week 2010 are: to increase attention to the contribution of the Ten Steps to exclusive Breastfeeding; to revitalise activities within health systems, and among healthcare providers and communities to support women to achieve their breastfeeding intentions; to inform people everywhere that protection, promotion and support of breastfeeding is a mother’s right, a child’s right, and a human right; to enable women and all who care about human rights to fight for health care systems which support breastfeeding; and to ensure that health workers who care for mothers and babies are adequately trained to counsel and support them in optimal infant feeding.

A statement from WABA reads: “Health care facilities play a vital role in the establishment of breastfeeding. The Ten Steps to Successful Breastfeeding provide a supportive pathway enabling women to achieve their breastfeeding intentions and guiding the training of healthcare workers in breastfeeding support.

“World Breastfeeding Week this year commemorates the 20th anniversary of the Innocenti Declaration that called for implementation of the Ten Steps in all maternity facilities. During these 20 years, more than 20,000 maternities, or about 28 per cent of all maternities in the world, have fully implemented the Ten Steps and have been certified by the Baby-friendly Hospital Initiative (BFHI). During this time, rates of exclusive breastfeeding have increased significantly.

“However, reduced BFHI programming worldwide, inadequate training, and weakened compliance with the Ten Steps in accredited maternities are contributing to stagnant or declining exclusive breastfeeding rates in many settings. It is time to revisit this approach and to determine where we must go from here.”