Rapid Responses to:
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Rapid Responses: Rapid Responses published:
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Support must continue beyond hospital
- Julie Burgess (22 May 1998)
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Government support essential to create a breastfeeding culture
- Carolyn Hastie (23 May 1998)
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Prelacteal feeds and the initiation of breastfeeding
- C Vidyashankar (23 May 1998)
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UNICEF UK's community breastfeeding initiative
- Hannah Hulme Hunter (1 June 1998)
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Breast Feeding in Sri Lanka
- D P Gunasekera, P C Gunasekera (8 June 1998)
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Breast feeding, Media and the arts.
- O O Ejidokun, J Norton, Sam Ramaiah (29 June 1998)
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Julie Burgess, Secretary University of East Anglia
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I was interested to read the article on baby friendly policies for hospitals and the encouragement of breastfeeding. I agree with most of the points raised. Part of the problem is the lack of experience by nursing/medical staff of breastfeeding - it is one thing to be told how to do it and quite another to manage it. In the past, older women in the family or community would have provided this expertise from their own personal experience. The second point I'd like to make is that support must continue beyond the maternity hospital. Once outside the confines of the hospital the outside world is a hostile place for nursing mothers, especially those who need to return to work. Despite the assurances by the NCT and other interested organisations, it is difficult to combine work and breast-feeding. I think maternity leave that extends up to six months after the birth and not 3-4, as it generally is at present, would be a big step forward. Of course, not every woman would want to take that amount of leave, but that's their choice. If a woman is breast-feeding it is fairly traumatic to have to leave the baby at the age of 3-4 months, when they would probably not be naturally fully weaned until much later. Workplaces are supposed to provide somewhere for mothers to express and store milk in hygienic conditions, but what about the time to do it? Generally, in modern society, women who breat-feed are seen as 'earth mothers' with time to 'waste' on such things. Until our culture changes and the mother and baby is protected as a unit from social and work pressures that threaten their time together during the first year, many women will give up. After all, they don't want to be seen as being inefficient, unproductive and time-wasting, do they? |
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Carolyn Hastie, Community midwife Central Coast Area Health Service
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A breastfeeding culture has been created, supported and promoted in Norway by firm government committment, attention and enthusiasm. The breastfeeding rates and longevity are wonderful. For breastfeeding, the most basic of all health promoting/ensuring behaviours, to become the norm, it is essential that governments wholeheartedly work at making it a priority. That means ensuring breastfeeding is promoted, providing legislative backup, and consistently and continually working to convert the bottle feeding culture which currently exists in much of the western world. Here in Australia, the news stories, media presentations etc are heavily centered around bottle feeding, when anything about babies is shown. The subliminal messages everywhere is that bottle feeding babies is 'normal'. No one sees people breastfeeding, and if perchance a woman is breastfeeding in public, she is asked to stop or leave the premises. Without enthusiastic, prolific government action, breastfeeding is doomed, like most of women's biological processes. There is no money in it in the short term, so the corporate money makers whose interest lies in promoting bottle feeding can spend huge amounts of money convincing everyone, including health professionals, of the superiority of formula, because the return on formula is guaranteed. |
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C Vidyashankar, specialist in pediatrrics Base Hospital, Delhi, India
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In India and other developing countries prelacteal feeds (feeds given neonates before the initiation of lactation) are very common and are an important factor in delaying the initiation of breast feeding. Common feeds given on the first day of life are honey, sugar water, and water. These delay the milk letdown reflex and could contribute to lactation failure. Hence patient education should include curtailing the use of prelacteal feeds in addition to promoting early initiation of breast feeds . | |||
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Hannah Hulme Hunter, breastfeeding counsellor, midwife, writer home
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Readers may be interested to know that on May 15th 1998, UNICEF UK Baby Friendly Initiative launched their new 'Seven Point Plan for the Protection, Promotion and Support of Breastfeeding in Community Healthcare Settings'. UNICEF UK BFI : bfi@unicef.org.uk |
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D P Gunasekera, Senior Lecturer in Paediatrics & NPPP, UNFPA Dept: of Paediatrics, University of Kelaniya, Sri Lanka and UNFPA, Sri Lanka, P C Gunasekera
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Promotion of breast feeding (BF) in Sri Lanka is not confined to the hospitals of the Baby Friendly Initiative (BFI), but is carried out island wide, through the mass media and posters in hospitals and maternal and child health clinics. In Sri Lanka, advertising and promoting formula milk as a substitute for BF is prohibited. Artificial milk tins must cary the slogan "Breast Milk is Best for your Baby". To promote BF, obstetricians, paediatricians and family physiciansmust be competent to advice mothers. However, a national survey showed that most obstetricians and paediatricians were dissatisfied with the training they received on BF. Furthermore, there was no consensus regarding certain BFI practices which are being promoted.(1) It is imperative that there be a concensus on current BF policies to avoid confusing mothers with contradictory advice. In Sri Lanka full pay maternity leave is 3 months. Hence, early supplementation is commenced in order to return to work. Although legislation exists which allows a mother to take time off to BF once she returns to work, many are unaware of their rights. Traditional herbal supplements and water are often recommended by elderly relatives and this advice is willingly or unwillingly accepted by the new mother. Only 24% of babies under under 4 months are exclusively BF, while 41% of babies under 2 months are supplemented with water.(2) Promotion of BF should be continued in the community once the mother returns home but only 69.2% of deliveries receive postnatal care by the public health midwife at least once within the first 10 days of delivery. (3) The importance of updating and training maternity and infant health care givers both in hospitals and the community about BF must be emphasised. Mass media promotion of BF, legislative control regarding promotion of artificial feeds and leave entitlements and working hours of mothers who BF would also help promote the BFI References 1. Gunasekera DP, Gunasekera PC, Mendis SN. A survey of obstetricians and paediatricians training and views on breast feeding. Proceedings of the Sri Lanka College of Paediatricians. Annual Scientific Congress. 16-20th July 1997. Colombo, Sri Lanka. 2. Feeding patterns and nutritional status of children. Sri Lanka Demographic and Health Survey 1993. p133 3. Annual report on Family Health - Sri Lanka 1995. Evaluation Unit, Family Health Bureau, Colombo, Sri Lanka |
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O O Ejidokun, Specialist registrar in public health medicine, Director of Public health medicine Walsall health authority, J Norton, Sam Ramaiah
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BREAST FEEDING, MEDIA AND THE ARTS Dear Sir, Malik and Cuttings’s May 23 editorial1 drew attention to the great potential in the imaginative use of the media in promoting breast feeding especially among mothers in their teens and twenties. In Walsall, UK we are working towards achieving the "ten steps" to successful breast feeding2 and developing a "survival card" informing mothers where they can feed their babies while shopping locally. We also have a multi-agency working group promoting breast feeding within the hospital and in the community. This group, in collaboration with the Health Authority, wrote to five producers of the leading UK based "soaps" shown during prime viewing time requesting them to assist us in our efforts to promote breast feeding. Of these, only three responses were received. The responses varied from a total lack of interest in our campaign to one of great enthusiasm. Particularly, we would like to mention the BBC production EastEnders, which have not only commissioned research on breast feeding but they have also made positive references to breast feeding in their story line. We welcome the interest of soap producers in community health issues. Increasingly, the arts and media are being recognised as effective ways to provide health education messages to people and obtain feedback from service users. The Health Authority has commissioned a theatre company to research women’s choices around childbirth and the company has delivered workshops for health professionals on the issues of informed choice and breast feeding3. All these initiatives are likely to have a cumulative effect on Walsall women and we expect that the number of mothers who will take up breast feeding will increase. References 1) Malik A N J, Cutting W A M. Breast feeding: the baby friendly initiative BMJ 1998; 316:1548-1549. 2) Vallenas C, Savage-King F. Evidence for the ten steps to successful breast feeding. Geneva: WHO Child Health and Development Unit, 1997. 3) Norton J, Connolly J, Belbin A, Patel B (Women and Theatre). Changing Childbirth: What choices for Walsall women? A research project. Walsall: Walsall Health Authority, 1997. 4) World Health Organisation Protecting, promoting and supporting breast-feeding: the special role of maternity service (a joint WHO/UNICEF statement) Geneva: WHO 1989. 5) National Breast feeding Working Group: Breast feeding: Good Practice Guidance to the NHS. Department of Health 1995. DR O O EJIDOKUN Specialist Registrar in Public Health Medicine MS J NORTON Primary care Development Manager DR SAM RAMAIAH Director of Public Health Medicine |
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