Human milk Matters

Breastfeeding should be promoted not just among full-term newborns but also among sick and premature babies

That breastfeeding is fundamental to the growth and development of newborns is a foregone conclusion. But for sick babies, breastfeeding is far more important than that.

"For unhealthy infants, human milk is more than food. It's medicine," said Dr Kannika Bangsainoi, a paediatrician and member of the Thai Breastfeeding Centre Committee.

According to Dr Kannika, breastfeeding is actually considered medical intervention as it can help save life of critically ill babies. Even though Thailand's Ministry of Public Health has been promoting and implementing breastfeeding as one of the significant neonatal protocols, when it comes to unwell babies, a number of medical personnel and healthcare providers fail to realise the importance of human milk and raise awareness about breastfeeding especially among new mums.

Dr Kannika cited "Ten Steps for Promoting and Protecting Breastfeeding in Vulnerable Populations" _ a comprehensive guideline drafted by Prof Dr Diane L. Spatz of the Children's Hospital in Philadelphia, the US. Dr Spatz was recently in town to deliver a lecture at the International Conference on Breastfeeding Sick Babies.

Involved in breastfeeding research for more than 20 years, Dr Spatz believes that breastfeeding should be promoted not just among full-term infants. Rather, for newborns with complex birth defects including premature babies, breastfeeding should be treated as their healthcare priority. Yet unfortunately, in the majority of life-threatening cases, urgent medical treatment is regarded as best cure for the little ones _ the only hope for all family members.

"Human milk has lots of factors to prevent inflammation such as antioxidants. Human milk is medicine. It can help prevent damages," Dr Spatz commented during the lecture.

So here is Dr Spatz's "Ten Steps for Promoting and Protecting Breastfeeding in Vulnerable Populations" guideline which the Children's Hospital in Philadelphia put into practice more than nine years ago.

STEP 1:Informed decision

It is crucial that healthcare personnel provide new information regarding the importance of breastfeeding so mothers are aware of health benefits of human milk and able to make informed decisions.

It is important, Dr Kannika noted, to make mothers understand that breastfeeding is not a lifestyle choice. In other words, it is not a choice for mothers to choose whether or not to breastfeed. On the other hand, breastfeeding especially for sick babies is a public health issue which needs to be properly highlighted.

"Both pre-term and critically ill babies have low immunity level," explained the paediatrician. "Properties in human milk can therefore help save babies' lives. And the longer the period a child is breastfed, the higher chance he or she will grow up with good physical and intellectual health and with lower risk of developing chronic diseases."

Besides, white blood cells in human milk function as a shield against infection. Human milk can also help decrease incidence and severity of several diseases including asthma, obesity, respiratory infection, urinary tract infection, diabetes and so forth. For mothers, breastfeeding helps lower the risk of developing bleeding, fertility problems, breast cancer and ovarian cancer.

So both mums and dads must be clearly informed of the benefits of breastfeeding even before the delivery of the baby, the specialist added.

STEP 2:Establishment and maintenance of milk supply

In normal circumstances, babies are usually brought to mothers soon after delivery and made to suck from the breasts as often as possible to stimulate production and flow of milk. But in case of sick babies requiring to be kept in incubators and thus cannot be brought to mums after labour, initial breast pumping is recommended as soon as possible.

"Initial pumping must be carried out within two hours in case of vaginal delivery and within four hours when it is by cesarean section. After that, mothers should be encouraged to pump breasts 8 to 12 times a day in order to ensure constant supply of milk," Dr Kannika explained.

In the first two weeks after delivery, mothers are expected to be able to produce at least 500cc of milk. Otherwise, pumping, massage or even medicinal aid might be required.

STEP 3:Human milk management

While in hospital, according to Dr Spatz's guideline, it is paramount to ensure mothers are provided with instructions regarding milk management including proper bottle labelling, storage, transport of milk and cleaning of pumping equipment.

Milk should be stored in a glass or food-grade plastic container. And it is ideal to feed fresh milk to infants, ideally within four hours after pumping. If refrigerated, milk should be used within 96 hours.

Human milk can be kept for one year in a deep freezer, six months in a home separate freezer and three months in a home combination unit.

STEP 4:Oral care and feeding human milk

Due to the fact that a lot of sick babies cannot be breastfed after birth, Dr Spatz's "Ten Steps" guideline recommends fresh colostrum or mother's first milk as a good and healthy start for babies' mouth care.

"Instead of using saline solution to clean babies' oral cavity, the guideline suggests that we opt for colostrums. By doing so, healthy properties from the milk will be absorbed through oral lining and colostrum will help boost the babies' immunity and help save their lives," explained the paediatrician.

STEP 5:Skin-to-skin contact

Skin-to-skin care, sometimes referred to as "kangaroo care", is key to successful breastfeeding as it helps enable babies to become familiar with their mothers' breasts as well as with the breastfeeding process, given the skin of babies and mothers comes in contact all the time.

Benefits of skin-to-skin care in newborns include heart rate stabilisation, increase of oxygen in the body, temperature stability, rapid weight gain, rapid brain development, longer sleep periods and increased deep sleep, pain and stress decrease, as well as earlier transition to breastfeeding.

STEP 6:Non nutritive sucking

Non nutritive sucking means allowing the babies to suck breasts even though they are yet to produce milk. Being exposed to breast on coming out of the incubator, babies are prompted for transition to oral feeds.

STEP 7:Transition to breast

These days, there are a number of technologies to help with babies' transition to breasts. The use of nipple shield, for example, helps increase both the duration of sucking bursts and the volume of milk consumed. It also leads to successful milk transfer and breastfeeding.

And recommended positions for mothers while breastfeeding are cross cradle _ position in which the baby is supported on a pillow across mother's lap to help raise him or her to the nipple level _ and football holds in which mother holds the baby at her side with the elbow bent and the mother's open hand supports the baby's head and face him or her towards the breasts while the baby's back rests on the mum's forearm.

Proper transition to breasts allows maximal breastfeeding attempts prior to introduction of bottle.

STEP 8:Measuring milk transfer

For normal babies, one of the most commonly used ways to check whether they are fully fed is to see whether they look happy after breastfeeding. But for sick ones, the quantity of milk they consumes is a better and more appropriate indicator to whether or not they are satisfied.

Dr Spatz recommended mothers to measure babies' weight both before and after breastfeeding. Infants normally consume an average of approximately 15gm of milk per feed.

This is the only method to accurately know what infants are getting at breast and to ensure they are not over or under fed.

STEP 9:Preparation for discharge

Healthcare personnel are to make sure mothers can maintain successful breastfeeding after they and their babies return home.

They should advise mothers to set a realistic plan regarding breastfeeding and remind them to continue to pump. Mums also need to have an accurate scale at home to assess milk transfer after they are out of the hospital.

STEP 10:Appropriate follow-up

This final step encourages mothers to get access to healthcare providers who have comprehensive knowledge regarding breastfeeding sick infants and this is important to ensure that babies are properly fed after they return home.

About the author

Writer: Arusa Pisuthipan
Position: Muse Editor