The practice of breastfeeding has always been mired in problems — physical and psychological — for the mother, and it has only been made worse by the pandemic. Experts offer help.

By Kannalmozhi Kabilan

Express News Service

Nearly two decades since the start of World Breastfeeding Week (August 1 to 7) — a campaign dedicated to raising awareness about and galvanising action on breastfeeding themes — there’s still much left to be accomplished on the ground.

According to the World Bank collection of development indicators, exclusive breastfeeding (when the infant is fed nothing but the mother’s milk) of children under six months in India was reported at 54.9 per cent in 2016. A report by UNICEF and World Health Organisation in 2018 ranked India as 56th — among 76 countries surveyed — in early initiation of breastfeeding.

Even as WBW has proven that information and the right kind of support can go a long way in initiating and sustaining breastfeeding practices, it doesn’t always find easy replication across the board. Like with every aspect of pregnancy and childbirth, breastfeeding too is shrouded under the veil of sanctity, control and unforgiving responsibility, denying women the chance to express their concerns, learn from each other, and get the help they need.

Initial hiccups
For Naushin, the first ten days after childbirth turned out to be traumatic for these very reasons. For the first week or so, the baby had to be put on supplements because she wasn’t able to produce enough milk post the Csection. While her mother had been quite supportive through the pain, she didn’t get that courtesy from others in the family. “It was always the old people at home. My grandmother kept on about how the baby’s strength is compromised and its immunity would go down. My in-laws were the same. They insisted that I should feed the baby till it’s two years old.

They were not thinking about how I would cope with it,” she recounts. She had to go to counseling to be able to b ounc e ba ck fr om such pressure. Advice from her gynaecologist, and milk-boosting foods like garlic helped her get past the initial hiccup. After the 2018 report, Gayatri Singh, UNICEF’s childhood development specialist, was quoted as saying, “Generally, the focus is only on the mothers. However, we have to target the mother-in-law, the husband and the service providers as well to ensure that early initiation does take place.”

The same holds good for sustaining the practice and aiding in the mother’s recovery, it seems. For Lavanya*, it was her husband’s mother and aunt who came to her rescue. She found that her breasts had hardened when the baby slowed down the drinking; she was in a lot of pain. But the women in the family took charge, getting her to use warm presses and massage her breasts with oil to squeeze the milk out. She recently bought a breast pump to keep up the natural feeding.

ILLUSTRATION :TAPAS RANJAN

Pandemic adds to the pain
While breastfeeding has its own physical and psychological barriers, the concern over the coronavirus has only added to the long list of worries. For Naushin, it was the knowledge that her breastfeeding routine was coming to an end mid-April, after one and a half years of it, that gave her peace. For Rebecca*, a negative on the COVID test was the only thing that eased her mind while giving birth to her baby in the thick of the pandemic last month.

Yet, her breastfeeding schedule hasn’t been easy either. She has a terrible backache and has to deal with a baby whose sleep cycle has not set in yet. Subsisting on the calcium supplements prescribed for her, she is now considering getting a feeding pillow to help with the pain. It wasn’t till May 12 that the WHO announced that transmission of the virus through breastmilk and breastfeeding has not been detected.

Yet, keep prevention in mind, it advised mothers to follow basic hygiene measures — such as wearing a face mask and thoroughly washing hands — while breastfeeding to reduce the possibility of “droplets with COVID-19 being spread to her infant.” Even during such uncertain times, the benefits of breastfeeding outweigh the risks, says Dr Arockia Virgin Fernando, infertility specialist, gynaecologist, and obstetrician, and consults on Practo.  “Even if the mother has the virus — say she is not very stable, is mildly symptomatic but has good support — she can very well breastfeed the baby.

The infant needs the milk in the first few days to build its immunity. The basic precautions the mother would have to follow is personal hygiene — wearing a double mask, and handwashing (not just sanitising but proper handwashing) during the feeding time. The baby should be wrapped properly and given to the mother. The mother should be in contact with the baby only for breastfeeding; she should have the support from the husband or the immediate family to take care of the child. The mother and the baby should be isolated,” she advises.

Benefits aplenty
Ramya Ramachandran, dietician, lactation counselor and founder and director of Nectar Integrated Health Services, says there’s more to consider than just COVID. “There are risks associated with not breastfeeding the baby; especially when you improperly mix the formula. We have some evidence saying that formula contains so much sugar, more than the amount present in a soda or other drinks. Meanwhile, the baby’s kidneys mature only by the age of two years.

So the amount of sugars going into this tiny body is only going to do more harm than good,” she explains. While breastmilk is the only easily digestible, safe and freely available food, there’s plenty of research to prove that it also serves as life-saving, personalised medicine.

“The colostrum that is secreted during the sixteenth week of pregnancy and is the first milk that the baby gets for the first few days after childbirth, contains one to five million white blood cells (in just one ml of colostrum). This is hundred times more than what the blood of an adult carries. Besides, breastmilk also has anti-infective properties. Human milk is said to have more whey protein than bovine milk. But even this is present in the form of anti-infective elements that protect babies from developing respiratory infections,” she details.

Ditch the myths
Despite this many years of effort to raise awareness, the myths around breastfeeding still remain, points out Arokia. “There are still people refusing to give the mother adequate liquids post-delivery. So if she isn’t hydrated, she can’t breastfeed the baby. If regular feeding is not done in the first few days, breastfeeding becomes a big problem. The baby doesn’t get enough and gets used to the top feed. Then, the mother assumes she doesn’t have milk and stops the practice. This is still going on; even in cities. Some are aware that immediate breastfeeding has to be given as early as possible but not that they should keep trying when there is low supply too.

All this needs support, psychological support. Many women have this postpartum blues — the hormones are coming down, they cry when the baby cries, they are worried about the pain and bleeding, they feel that the partner is not supporting them — all this can affect them. If they have not emptied their breasts properly, some women can get breast abscess too. So, there is still the need to push for awareness,” she suggests. Pointing out that the hormones prolactin and oxytocin are the ones responsible for milk production, Ramya says that anything from negative thoughts to self-doubt to fear and pain can work against milk secretion. Ramya opines that lactation consultants have much to offer to bridge the gap between awareness and practice.

“While the initiation of breastfeeding is appreciable, it is not the same with exclusive breastfeeding. I think that’s partly to do with the formula industry. And doctors are also not accepting the need to have a lactation consultant in every hospita They think they can give this information to mothers, or the nurses in the NICU can support them. But with the amount of patient load they have, I don’t think they can invest as much time as a lactation consultant to counsel the mother. The first-hand help has to come from the lactation counselor as soon as the baby is born, so that the mother is not overwhelmed,” she elaborates. As always, this year’s World Breastfeeding Week too was marked by awareness campaigns, informative webinars and outreach efforts. Perhaps, it will show in the numbers next year.