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Have you ever been told by well-meaning relatives not to breastfeed when tired from a day’s work? How about not to breastfeed when you’re anxious or stressed, lest the baby “suckles” your sadness or worries?
A lot of Filipinos, especially those who still believe in such concepts as usog,pasma and kulam, still pass on a myriad of beliefs (pamahiin) about breastfeeding. Dr. Anthony Calibo, supervising health program officer of the National Center for Disease Prevention and Control’s Family Health Office (Department of Health), said that thesepamahiin are still prevalent and actually affect breastfeeding efforts in the country.
“Some of these beliefs specifically affect exclusive breastfeeding rates,” Dr. Calibo, a pediatrician at St. Luke’s Medical Center and a diplomate of the Philippine Pediatrics Society, says.
He explains: “When families (mothers and their relatives) give other substances aside from breastmilk or start breastfeeding at an inappropriate time, exclusive breastfeeding rates drop.”
Dr. Calibo says that there are two sides of breastfeeding practices that doctors encounter in local clinics. The first involves “practices” that receive little attention from medical practitioners (pediatricians, obstetrician-gynecologists, family medicine specialists, midwives and nurses) due to a lack of formal lactation management training or lactation counseling courses.
The second, according to Dr. Calibo, encompasses the socio-cultural-anthropological context of breastfeeding as it takes place in the communities. These communities are located mostly in rural, geographically isolated, and disadvantaged areas where there is a lack of health workers adept in breastfeeding concepts and practices.
It is usually in these areas where pamahiin are widespread.
Dr. Calibo sheds light on the truth behind these folk beliefs and practices:
Belief No. 1: Babies cry and therefore need breastmilk right away.
Belief No. 1: Babies cry and therefore need breastmilk right away.
Dr. Calibo: “Crying is not always a sign of hunger or a need to breastfeed the baby. When mothers who have just given birth choose not to room-in their newborn babies and insist that their babies should be in the “nursery” because they need to “rest,” they miss the opportunity to observe their babies’ feeding cues.
With the implementation of the essential newborn care (ENC) protocol (fondly called “Unang Yakap” or First Embrace) in all government and private health facilities (DOH Administrative Order 2009-0025—Adopting Policies and Guidelines on Newborn Care), newborn babies who are immediately and thoroughly dried and placed on skin-to-skin contact with the mother, are able to initiate breastfeeding at birth within the first hour of life (hence Unang Yakap).
Feeding cues can be appreciated by a non-sedate mother after she has delivered her newborn baby. These include tonguing, licking, rooting, sucking of his/her fingers and locating for his/her mother’s nipple-areola complex. These feeding cues manifest as early as 20 minutes after the baby is born up to the first 90 minutes of life.
While the obstetrician-gynecologist performs the proper cord clamping and cutting, skin-to-skin contact is maintained and the baby is not separated from the mother until they are transferred to their room.”
Belief No. 2: Babies will get hungry because there is no breastmilk coming out of the breasts.
Belief No. 2: Babies will get hungry because there is no breastmilk coming out of the breasts.
Dr. Calibo: “This is a common notion that health professionals in birthing homes and health facilities encounter. Thus, violations of the Milk Code (Executive Order 51—National Code of Marketing for Breastmilk Substitutes) continue.
If only babies go through the four time-bound interventions of the essential newborn care protocol, they are assured that they would not get hungry in the first 24-48 hours of life. The immediate drying, aside from maintaining a delivery room with temperature of 25-28°C (air-conditioners turned off), will prevent hypothermia. Thus, the babies’ caloric reserves will not be used up.
This is further enhanced by the skin-to-skin contact between mother and baby, which increases the body temperature of the newborn courtesy of symptothermal synchrony of the mother (the mother’s temperature automatically adjusts to the temperature needs of her baby). Aside from the transfer of good maternal skin flora, skin-to-skin contact also increases blood sugar levels.
Eventually, the properly timed-clamping and cutting of the umbilical cord transfers not only hemoglobin but also blood sugar to the baby.
Therefore, the baby should just be kept with the mother and allow her newborn to suckle her breasts so that breastmilk production will proceed.”
Belief No. 3: There is very little breastmilk coming out, hence there’s a need for additional milk aside from breastmilk.
Belief No. 3: There is very little breastmilk coming out, hence there’s a need for additional milk aside from breastmilk.
Dr. Calibo: “As the Department of Health Breastfeeding TSEk (Tama-Sapat-EKsklusibo) campaign emphasizes, little breastmilk coming out from the mother is enough for her newborn (“Ang kaunting gatas ng ina ay sapat na para sa kanyang sanggol”).
The stomach (“sikmura” in Filipino) of a newborn is just the size of the Philippine lemon (calamansi). Therefore, the traditional milk formula ounces being fed to the newborn (in the nursery or in the private room) in the first hours of life are not needed.
This artificial milk will just be vomited because the newborn’s stomach cannot hold the volume given to him/her. These isolated vomiting episodes (without any risk factors) have unfortunately been seen as a sign of neonatal sepsis that cascades to antibiotic treatment and the prolonged hospital stay of the newborn.”
Belief No. 4: Babies need water when breastfeeding.
Dr. Calibo: “Breastmilk has 88-90% water, hence no water is needed.”
Belief No. 4: Babies need water when breastfeeding.
Dr. Calibo: “Breastmilk has 88-90% water, hence no water is needed.”
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Part 2
Part 3
