Monday August 11 2014

When a mother cannot breastfeed her child

Emergency contraception (plan B) involves use of a progesterone pill which will not harm the breastfeeding baby(s)



With the annual breastfeeding week getting off the way, the message from health experts to mothers has been clear: Breastfeed your babies as long as possible.
In fact, mothers are being encouraged to practice exclusive breastfeeding for the first six months of the baby’s life.

But what happens when a mother is in a situation in which she cannot breastfeed her baby? Jennifer Babirye is one such mother. A resident of Rubaga Division, Babirye says after she gave birth to her first child, she was not able to breastfeed because she could not produce any milk.
“For the first 10 days, I did not have a single drop of milk. Had it not been for the advice from the doctor to start my child on formula milk, she would have starved to death,” says Babirye.

She had contacted the doctor who recommended different foods that she could eat to stimulate breast milk such as millet and maize porridge, fruits and vegetables. To Babirye’s surprise, this did not solve the problem. She even had some people recommend herbs to stimulate milk, but still this did not help. However, 10 days later, Babirye says even though she started to produce some milk, it was not enough to keep the baby satisfied.“I felt my baby was already doing well with formula milk so that is what I continued to feed her on,” she adds.

The effect of stress
Jamiru Mpiima, a nutritionist at Family Nutritionist Uganda, says milk production is usually stimulated the moment the baby starts to suckle the mother’s breast. “However, if the mother is not comfortable and has psychological problems or stress, producing milk can be difficult,” says Mpiima.

Indeed part of Babirye’s trouble could have been stress. At the time she gave birth, she was jobless and as a single mother, her biggest worry was how she was going to take care of the baby and herself. But even after finding a job, Babirye’s income was not enough to buy the expensive formula milk, and so she had to change to buying milk from a local dairy farmer in her neigbourhood.

But the change came with other consequences. Babirye says it took some time before the child could get used to drinking cow milk. “It was thick compared to the formula milk, and I did not know how much to dilute. My baby ended up developing diarrhoea,” Babirye says.

Some conditions that may affect a woman’s ability to produce milk may be related to their diet. This is why it is recommended that mothers attend breastfeeding classes, where they will learn how to position the baby while it suckles, and also acquire knowledge on the types of foods they require eating.

Mothers may not have breast milk due to post-delivery depression or anxiety disorder. These conditions may cause a mother to produce less milk. “When this happens, they can take supplements as a way of generating milk,” says Mpiima.

Starting on solid foods
At six months, Babirye had to start her baby on solid foods. At two years now, she says the baby is healthy and does not suffer any illnesses.
But Mpiima says even though a baby who has not benefited from breast milk may look healthy, in the long run they are likely to suffer from conditions such as obesity and diabetes.

The benefits
Worldwide, breast milk is being championed as the best source of nutrition for infants and young babies below the age of two. Breastfeeding also helps to strengthen the bond between a mother and her baby. Breast milk also provides newborns with a combination of antibodies, vitamins and proteins, which help to build the baby’s mental and physical health.

“Even mothers living with HIV are encouraged to breastfeed for the good of their babies,” says Shivan Namatovu, a freelance nutritionist in Kampala.

Underlying health conditions
However, Mpiima says there are few scenarios when a mother cannot breastfeed. “A mother should only be stopped from breastfeeding if she has breast cancer or is undergoing chemotherapy. With chemotherapy, the mother’s body is full of radiations so she cannot breastfeed because they can harm the baby.”
Mastitis, an infection of the breast tissue that results in breast pain and swelling, and occurs in breastfeeding mothers can limit their ability to breastfeed. This condition is said to be common in the first three months after childbirth. However, Mpiima says while this condition is common, it should not be the reason for a mother to stop breastfeeding. “In fact, the wounds would heal quickly when the mother is breastfeeding than when she is not,” says Mpiima.

In some cases though, a mother may decide not to breastfeed because of odd work schedules, which keep them away from home for long periods of time. In such a case, most mothers opt for the bottle.
“Bottle feeding allows new mothers to be less restrictive with their diet since they are usually concerned that the food and medication they ingest may be passed along to their babies through breast milk,” says Namatovu.

She adds: “Mothers who smoke or take alcohol may also worry that the breast milk may be contaminated with nicotine, so they opt for formula milk as a safer alternative.”
Namatovu, however, cautions breastfeeding mothers against using alcohol, which she says works to inhibit the production of milk.

Other alternatives
If the mother of the baby dies, the relatives can breastfeed it. This is even easier for a woman who has never breastfed according to Namatovu. Breast milk is stimulated when the baby suckles and the more the baby suckles, the more chances of the adoptive mother producing milk.
Introduce other foods after six months. These may include fruits and foods such as Irish potatoes, rice and egg yolk.

World Breastfeeding week is celebrated in more than 170 countries, including Uganda to encourage breastfeeding and improve the health of babies.
The World Health Organisation actively promotes breastfeeding as the best source of nourishment for infants and young children.Breastfeeding is one of the most effective ways to ensure child health and survival.

If every child was breastfed within an hour of birth, given only breast milk for their first six months of life, and continued breastfeeding up to the age of two years, about 800 000 child lives would be saved every year.

Globally, less than 40 per cent of infants under the age of six months are exclusively breastfed. Adequate breastfeeding counselling and support are essential for mothers and families to initiate and maintain optimal breastfeeding practices.
Here are some of the many benefits of breastfeeding that should be promoted:

•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.
•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 in a quicker recovery during illness.
•Breastfeeding contributes to the health of mothers, it helps to space children and reduces the risk of breast cancer.