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Tuesday, January 17, 2012

Guest Post: Busting Those Breastfeeding Myths and Beliefs - Part 1

I'm quite lucky to have my officemate Margaux offer to write this article about busting breastfeeding myths.  She was able to rally the expertise of Dr. Anthony Calibo, a pediatrician who has made breastfeeding his number one advocacy.  Margaux has divided the article into 3 parts and throughly tackled the myths and beliefs through a Q&A with Dr. Calibo.  Read and learn.

  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.
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.

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.

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.”

Part 2
Part 3


Claire said...

Thank you so much for sharing, Jenny and Margaux! I can show these to the new moms I am counselling because these are the top myths that are often asked of me. Lalo na yung No.1! Oftentimes the dad would tell the mom, painumin na natin ng formula si baby kasi iyak ng iyak. And the, dagdagan pa ng mom in law na magsasabing - kasi wala naman milk na lumalabas. Hay!

Kvalenciano said...

Thank you for sharing this

Mom-Friday said...

Great post!! I was and "uneducated" new mom so I succumbed to these myths.  There really should be aggressive efforts to share and educate all of us.
My babies was not roomed-in, and with my second, I was sedated. C-sec for both. It's more difficult for CS moms to breastfeed since we're discouraged to "move" around for like a day! :(

Faye Paras said...

great post Jenny! Thank you for sharing. I'm bookmarking this now and sharing with soon-to-be mommy friends.

Zarah_21 said...

Thank you for sharing. I hope all pedias should be properly equipped with sufficient breastfeeding knowledge. My pedia told me to give my baby water and after he wasn't gaining a lot of weight he instructed me to supplement with formula. He even told me that baby might only be getting air from me and when my baby skipped days of pooping he said he might be suffering from some gastro intestinal problem which scared me so much but when I looked it up, its normal for breastfed baby to skip days.

Dima Hernandez said...

thank's for sharing this information... I would like to ask if it's ok to breast feed a newborn baby by other nursing mom? it is said in this article that a stomach of a newborn is a size of calamansi. i once breast fed my niece when she was born and now we are waiting for another new born and i'm planning to do the same thing, breastfeeding the newborn until the mother is ready to nurse her new born.

ria denamarca laab said...

I breastfed like 5 babies including mine. :) I have had breastmilk to spare since my supply was greater than my son's demand. So I gave some to my niece (who was not breastfed by her mum), to my friends son (because his mum was not able to produce bmilk) , and to my foster sisters twin boys (whom I have fed directly when I visit them because she cannot cope up with their demands).

jennifer laceda said...

I have a problem with belief #3. I breastfed my 2 girls up until they were 18 months. But...(there is a BUT)...they suffered from jaundice-related dehydration in the first 1 - 2 days of their life, losing more than 10% of their birth weight BECAUSE there was no breast milk coming from me. My breast milk typically comes 8-10 days after delivery (that's just how I am - and each mother is unique). I've had to work hard to initiate milk production by letting baby suckle, by pumping, and also supplementing with formula until my own milk came in. So, yes, I had to supplement my new born from day 1 with 30cc breastmilk per 3-4 hours to avoid dehydration. But as I continue on and when my milk comes in, I proceed with the breastfeeding course without any more problems. So, I say, YES, if indicated, there is a need for additional milk for newborn.

Kendra said...

infants can also loose a very high amoutnof their birth weight when the mother has IV fluids during labor. Mother gains a lot of water weight and the infant so does the baby. so the birth weight that is recorded actually has a high amount of fluid that the infant needs to rid. These infants will often loose a high percentage of body weight over 2 days time( due to peeing it off) then stabalize and begin togain weight regardless of  supplementation. This phenomenon is only now being given attention in the medical birth community. Also jaundice is not always harmful if you had delayed core clamping then your infant recieved has/ her full blood volume causing in increase in iron. when the newborn's body breaks down this iron the immature liver is temporarily overloaded and as a result becomes jaundiced. This too is usually harmless but since medical practitioners are not familiar with determining if a newborns condition is harmful or benign, they treat first and ask questions later.
All of that to say you supplementation could have been needed but unless your baby was lethargic, had crystals in the urine, or other troubling behavioral signs; the treatment was likey prophylactic and an over reaction caused by the need to err on th side of caution.

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