Ssuubi gives hope to mothers struggling to breastfeed

Rebecca Ssuubi was not sure what she wanted to do after university.

But as she waited to graduate after completing her Bachelor of Science and Food Technology course at Makerere University in 2014, she joined the Mwanamugimu Nutrition Unit at Mulago Hospital and asked to train in the management of severe malnutrition in children.

Now an International Board Certified Lactation Consultant (IBCLC), Ssuubi says, “I am  a scientist but I was not very sure about what career path I wanted to take. I had had access to industries during internship and I made a choice never to work with machines.”

An IBCLC is a health professional that is trained in the clinical management of breastfeeding. As a new parent,  an IBCLC helps you with all your lactation needs, from helping you design a workday pumping schedule and storage plan to finding the best breastfeeding position for you.

IBCLCs can also assist you with common lactation pitfalls, like low milk supply, breastfeeding pain, and conditions like mastitis and plugged ducts.

Ssuubi also wanted to steer away from Medicine as a course and hospitals in general and that is why she took on Nutrition.

At Mwanamugimu, she met a teenage mother with a five-month old severely malnourished child.

Almost one-third of children under five years in Uganda are stunted. Stunting increases with age, peaking at 37 percent among children 18–35 months. Stunting is greater among children in rural areas (30 percent) than urban areas (24 percent) with some regional variations.

“The nurse training us asked the mother  whether she was interested in breastfeeding again. But she said she did not have breastmilk and that this had brought about unbearable stress,” she says from the comfort of her chair at the offices of Breastfeeding and Lactation Centre in Kansanga, Kampala.

“But the nurse insisted that she could help the mother breastfeed her child again.”

This, Ssuubi says, intrigued her because at the time, she had a friend who had given birth but was unable to breastfeed.

“In my mind I was thinking, ‘she just said she did not have breast milk how are you going to make this happen’?” she recalls.

Then the nurse introduced the mother with the malnourished child to a supplemental nursing system (SNS).

SNS helps a mother supplement their baby at the breast with breast milk or formula.

 Within a few days, there was some breast milk.

“We could see the milk had returned but now it was a case of increasing supply,” Ssuubi , whose name means ‘Hope’ in several local dialects, says.

The baby started breastfeeding again and we counselled the mother, told her what to do and what not to do.  Eventually, she became the one teaching other mothers at the centre on what to do.

At Mwanamugimu, Ssuubi would go on to learn why people get problems breastfeeding and how to increase breast milk among others. She also got to know about the different challenges some new mothers face and why it is not okay to feed babies other feeds as soon as they are born.

Her interest in breastfeeding and child nutrition would start from here that at one point she planned a meeting of breastfeeding mothers in Kampala. Finances let her down then but that did not stop her desire to learn more and take breastfeeding to the highest level.

Road to becoming an IBCLC

Ssuubi’s former classmates at Gayaza High School, describe her as a ‘top tier student who was able to make it back to A-Level on merit to offer Physics, Chemistry and Biology and Nutrition.’

“At Gayaza High School, I was the head girl. I was a bright girl. I used to be the best. Everybody knew about me,” she says.

But naturally, she always took on more challenges; the harder, the better.

Her journey to becoming an internationally certified lactation consultant came about following a discussion she had with a paediatrician at the children’s clinic in Bugolobi.

“My daughter, who was 14 months then, contracted Rotavirus. This was the first time she was falling sick because I exclusively breastfeed all my children. And so I took her to see a doctor. While in his office, I started breastfeeding my baby and he wondered how I could still be breastfeeding her at her age yet he was struggling with other mothers who abandon breastfeeding after three months,” she says.

Exclusive breastfeeding was found to be effective in prevention of Rotavirus infection and in reducing the risk of Rotavirus infection among children.

She adds that she rumbled on about the advantages of breastfeeding, child obesity and how to train children about what to eat.

“Then he asked me if I could become a lactation consultant at his clinic,” Ssuubi, who continued to breastfeed her daughter even while pregnant with her second child, says.

She said she would think about it.

At home later that day, she told her husband about her new offer.

“He always knew breastfeeding was my passion. On that day he just listened. And then he asked, ‘so you are going to get a job’? I told him yes but I wish I was an IBCLC. It is the highest point of this profession. I had googled about it, and I knew how expensive it was with registration for exams alone costing about Shs3million,” she says, adding that the cheapest books cost about Shs700,000 and they had to ship them.

“You cannot just google anything breastfeeding because this material is very precious. There are courses of $120 (Shs 457,000)  for 45 mins. It is an expensive course.”

Luckily, her husband urged her to take up the course that he was ready to pay for it.

In 2020, she enrolled at the Lactation Education Resources (LER) which provides comprehensive online lactation specific education.

To sit the exam, a student must also have at least 1,000 hours of proven clinical experience, working with breastfeeding mothers and babies.

The statistics

“I had more than 1,000 hours of hands on training in lactation so it was easy for me to get in. Also, there are centres here that teach you the basics which you can also find on the Internet. But what I wanted was to take breastfeeding to the highest level but you can only attain that with an IBCLC,” she says.

Her certificate as the first Ugandan to attain this level hangs on the wall of the Breastfeeding and Lactation Centre, a lactation consultancy firm promoting maternal child health and wellness.

“This is a real profession,” she jokes.

“I was certified in the US which has Re-lactation protocol that Uganda does not have. I can run this Non-Profit Organisation because I am certified. I am bound by a code of conduct being the first IBCLC here.”

Breastfeeding and Lactation Centre is registered with the Uganda Registration Services Bureau.

At least 135,000 newborns are at risk of death annually due to failure of their mothers to initiate breastfeeding within the first one hour of delivery, according to the Ministry of Health.

According to Unicef, globally about 77 million newborns are not fed on breastmilk in the first one hour of life, adding that delayed breastfeeding increases the risk of infant death up to 80 percent.

Breast milk also has that very healthy bacteria which helps with the child’s growth.

“Research shows that he first 1,000 days of a child, nutrition is so important it is engineering the health of this child for the rest of their life. The brain development happens in the first two years and it is nutrition based. So when you get cow milk and make it into formula and you give it to a baby you are not meeting 80 percent of the nutritional needs of that child,” Ssuubi argues.

That is why she opened the lactation consultancy that targets mothers, health workers and policy makers.

“Here, you will get two things: Quality professional lactation care and evidence based scientific information and education,” she says. 

She is not just sitting on her laurels.

Ssuubi, who speaks passionately about breast milk and child nutrition, has plans to open a school for lactation and to teach lactation classes in the country.

She has already started attending conferences in lactation that matter. Between April and June, she attended the GOLD Lactation Conference and is gearing up for next year’s International Lactation Consultant Association (ILCA) conference.

ILCA is an international association representing lactation professionals at the table where global health decisions are made.

“If I am to pursue a PHD, it will be in lactation,” she says.

IBCLC ROLES as defined by ILCA

Advocate:

The IBCLC is the advocate for breastfeed¬ing women, infants, children, families, and communities. The IBCLC role is integral to the function of the mother’s and infant’s healthcare team.

Clinical Expert:

As a clinical expert in the management of breastfeeding and human lactation, the IBCLC is trained to counsel mothers and families on initiation, exclusivity, and duration of breastfeeding, and to assist amidst any difficul¬ties or high-risk situations. IBCLCs are sensitive to and support the needs of mothers, infants, children, and various family structures in working toward breastfeeding goals

Collaborator:

Partnership is central to IBCLC practice. The IBCLC collaborates with mothers, infants, children, families, and communities to meet their breastfeeding and lactation needs. IBCLCs are members on healthcare teams that care for mothers, infants, and children. IBCLCs also collaborate with policy makers at all levels in various organizational settings, to implement evidence-based, practical, and economically sound lactation policies and programs

Educator:

The IBCLC shares current, evidence-based infor-mation in breastfeeding and lactation to provide anticipato¬ry guidance, as well as to empower mothers and families to manage breastfeeding challenges if they arise. IBCLCs also provide staff and clinician education on the science of lacta¬tion and clinical management of breastfeeding. Therefore, the IBCLC is required to keep up-to-date with the science of clinical lactation via mandated recertification.

Facilitator:

The IBCLC is trained to facilitate breastfeeding mothers and families in reaching their breastfeeding and lac¬tation goals. IBCLCs facilitate program and policy develop¬ment to support breastfeeding and lactation.

Investigator:

The clinical expertise and skill of the IBCLC is in breastfeeding and lactation management. Thus, the IBCLC supports, directs, and participates in research and evidence-based practice that moves forward the body of empirical

Lactation knowledge

Policy Consultant:

The clinical expertise and practice experience of the IBCLC provides substantial insight into the viability of practice changes that affect lactation and breastfeeding initiatives. In light of the strong evidence to support the health and economic benefits of breastfeeding, the IBCLC is well-posi¬tioned to be the primary consultant for any institutional or legislative initiatives that influence breastfeeding, breastfeed¬ing mothers, families, and communities.

Professional:

The IBCLC is a healthcare professional with a multi-disciplinary role that straddles generalized support for breastfeeding, and allied health care. As a professional cadre, IBCLCs are guided in practice by a set of standards, a code of ethics, and a defined scope of practice. These regula¬tions are aimed at protecting the public and ensuring that IBCLCs provide safe care. Standardization of specialized knowledge and skill is accomplished through one interna¬tionally administered exam and movement towards ap¬proved or accredited collegiate-based educational programs

Promoter:

The IBCLC is trained to promote breastfeeding, i.e., carry out activities to increase interest in breastfeeding and breastfeeding support. IBCLCs support breastfeeding and lactation by providing skilled support for mothers in their breastfeeding journey. The presence of an IBCLC sends the message that breastfeeding is supported in that setting.