BREAST FEEDING FRIENDLY GENERAL PRACTITIONER

DR Varsha Atul ShahSenior ConsultantSingapore General HospitalDept NN and Devt MedicineVisiting Consultant, K K HospitalDept of Child Development

Breastfeeding Data in Breastfeeding Data in SingaporeSingapore

Initiation to breastfeeding Initiation to breastfeeding 94.5 %94.5 %Exclusive breastfeeding at Exclusive breastfeeding at 1 months 22%1 months 22% at 2 months 18%at 2 months 18% at 4 months 7%at 4 months 7% at 6 months near zero !!!at 6 months near zero !!! Mean duration of breastfeeding 12.7 Mean duration of breastfeeding 12.7

weeksweeks Reference: Breastfeeding prevalence and practices among Singaporean Reference: Breastfeeding prevalence and practices among Singaporean

Chinese, Malay and Indian mothers, L. L. FOO1, S. J. S.Chinese, Malay and Indian mothers, L. L. FOO1, S. J. S. QUEK2, S. A. NG1, M. T. LIM2 and M. DEURENBERG-YAP1 Health Promotion QUEK2, S. A. NG1, M. T. LIM2 and M. DEURENBERG-YAP1 Health Promotion

International Advance Access published April 5, 2005International Advance Access published April 5, 2005

The Baby-Friendly Hospital The Baby-Friendly Hospital Initiative (BFHI)Initiative (BFHI) The Baby-Friendly Hospital Initiative (BFHI) is a The Baby-Friendly Hospital Initiative (BFHI) is a

global program sponsored by the World Health global program sponsored by the World Health Organization (WHO) and the United Nations Organization (WHO) and the United Nations Children’s Fund (UNICEF) Children’s Fund (UNICEF)

to encourage and recognize hospitals and birthing to encourage and recognize hospitals and birthing centers that offer an optimal level of care for centers that offer an optimal level of care for infant feeding. infant feeding.

assists hospitals in giving mothers the assists hospitals in giving mothers the information, confidence, and skills needed to information, confidence, and skills needed to successfully initiate and continue breastfeeding successfully initiate and continue breastfeeding their babies their babies

gives special recognition to hospitals that have gives special recognition to hospitals that have done so. done so.

Baby Friendly Hospital Baby Friendly Hospital InitiativesInitiatives

More than 20,000 facilities in 152 More than 20,000 facilities in 152 countries have been certified Baby-countries have been certified Baby-FriendlyFriendly

In seven countries, 100% of facilities In seven countries, 100% of facilities have been designated baby friendly: have been designated baby friendly: Sweden (66), Comoros Island (190), Sweden (66), Comoros Island (190), Ertrea (46) Maldives (5), Namibia (35), Ertrea (46) Maldives (5), Namibia (35), Iraq (23) and Oman (51) by 1999Iraq (23) and Oman (51) by 1999

Amongst developed countries, the Amongst developed countries, the highest rates of baby friendly facilities highest rates of baby friendly facilities are in Scandinavian countriesare in Scandinavian countries

Why GPs are important?Why GPs are important?

Mother or baby will see a doctor Mother or baby will see a doctor at least six to seven times within at least six to seven times within the first yearthe first year

Breastfeeding in SingaporeBreastfeeding in Singapore

The 2001 National Breastfeeding Survey The 2001 National Breastfeeding Survey found that although 94.5% of Singapore found that although 94.5% of Singapore mothers initiated breastfeedingmothers initiated breastfeeding

only 21% continued up to six months. only 21% continued up to six months. Advice from health professionals, maternal Advice from health professionals, maternal

awareness of breastfeeding benefitsawareness of breastfeeding benefits and maternal regard for bottle-feeding and maternal regard for bottle-feeding

were significant predictors of continued were significant predictors of continued breastfeeding at six months. Overbreastfeeding at six months. Over

50% of mothers in the survey did not 50% of mothers in the survey did not receive lactation advice from their receive lactation advice from their physiciansphysicians

10 Steps of successful Breast 10 Steps of successful Breast FeedingFeeding

and Baby friendly Hospitaland Baby friendly Hospital Have a written breastfeeding policy that is routinely comHave a written breastfeeding policy that is routinely com

municated to all health care staff.municated to all health care staff.

    Train all health care staff in skills necessary to implementTrain all health care staff in skills necessary to implement

this policy. this policy.

    Inform all pregnant women about the benefits and manaInform all pregnant women about the benefits and mana

gement of breastfeeding.gement of breastfeeding.

    Help mothers initiate breastfeeding within a half-hour of Help mothers initiate breastfeeding within a half-hour of

birth.birth.   

Show mothers how to breastfeed and how to maintain Show mothers how to breastfeed and how to maintain lactation, even if they should be separated from their lactation, even if they should be separated from their infants.infants.   

10 Steps of successful Breast 10 Steps of successful Breast FeedingFeeding

and Baby friendly Hospital and Baby friendly Hospital Give newborn infants no food or drink other than breast Give newborn infants no food or drink other than breast

milk unless medically indicated.milk unless medically indicated.   

Practice rooming-in - allow mothers and infants to remain Practice rooming-in - allow mothers and infants to remain together - 24 hours a day.together - 24 hours a day.   

Encourage breastfeeding on demand.Encourage breastfeeding on demand.   

Give no artificial teats or pacifiers (also called dummies Give no artificial teats or pacifiers (also called dummies or soothers) to breastfeeding infants.or soothers) to breastfeeding infants.   

Foster the establishment of breastfeeding support groups Foster the establishment of breastfeeding support groups and refer mothers to them on discharge from the hospital and refer mothers to them on discharge from the hospital or clinic. or clinic.

Why GPs are important?Why GPs are important? The World Health Organization and AAP, The World Health Organization and AAP,

recommends exclusive breastfeeding for recommends exclusive breastfeeding for at least six months of an infant’s lifeat least six months of an infant’s life

breastfeeding practice among women in breastfeeding practice among women in Singapore falls short of this standard. Singapore falls short of this standard.

Exclusive breastfeeding offers a multitude Exclusive breastfeeding offers a multitude of benefits to both mother and child. of benefits to both mother and child.

Family physicians are in an ideal position Family physicians are in an ideal position to influence to influence

should be equipped with practical should be equipped with practical knowledge to alleviate parental anxieties knowledge to alleviate parental anxieties

10 Recommendations for a 10 Recommendations for a breastfeeding-friendly family breastfeeding-friendly family practice-1practice-1 Avoid giving the patient samples of formula or Avoid giving the patient samples of formula or

literature from a formula company during pregnancy literature from a formula company during pregnancy or after deliveryor after delivery

Educate the patient on the differences between Educate the patient on the differences between breastfeeding and bottle-feedingbreastfeeding and bottle-feeding

Avoid telling the patient that formula is better than Avoid telling the patient that formula is better than breast milkbreast milk

Avoid promoting one formula over anotherAvoid promoting one formula over another Educate the patient before and after her pregnancy Educate the patient before and after her pregnancy

on the importance and benefits of putting the baby on the importance and benefits of putting the baby to the breast immediately to the breast immediately

Educate the patient about nipple confusion, and how Educate the patient about nipple confusion, and how to avoid this problem by not bottle-feeding, and to avoid this problem by not bottle-feeding, and instead using a cup, spoon or syringeinstead using a cup, spoon or syringe

10 Recommendations for a 10 Recommendations for a breastfeeding-friendly family breastfeeding-friendly family practice-2practice-2

Reassure the patient that she can and should Reassure the patient that she can and should continue to breastfeed when she is ill or if her continue to breastfeed when she is ill or if her baby is illbaby is ill

Praise the patient if she is still breastfeeding Praise the patient if she is still breastfeeding at six months and encourage her to continue at six months and encourage her to continue for 2 years at leastfor 2 years at least

Remind the patient that breast milk still has Remind the patient that breast milk still has nutritional value for the baby who is six nutritional value for the baby who is six months or oldermonths or older

Suggest to the mother of a sick child warded Suggest to the mother of a sick child warded in hospital that she stays with the child in the in hospital that she stays with the child in the ward, so that she can continue to nurse and ward, so that she can continue to nurse and comfort her childcomfort her child

Common concerns:Common concerns: Regarding breastfeeding in a GP Regarding breastfeeding in a GP practicepractice

1.1. Is my baby getting enough to eat? Is my baby getting enough to eat? 2.2. How can I tell if I'm making enough milk? NOT ENOUGH How can I tell if I'm making enough milk? NOT ENOUGH

MILK?MILK?Usually baby feeds for 5 -30 minutes at most feeds Usually baby feeds for 5 -30 minutes at most feeds and at the end of the feed the baby lets go and at the end of the feed the baby lets go spontaneously or does so when the breast is gently spontaneously or does so when the breast is gently lifted and the baby is content after most feeds. The lifted and the baby is content after most feeds. The mother feels softening of their breast during the mother feels softening of their breast during the feed and her nipple shape is the same as when feed feed and her nipple shape is the same as when feed began or slightly elongated. When you feed, audible began or slightly elongated. When you feed, audible and visible swallowing, initial rapid sucking pattern and visible swallowing, initial rapid sucking pattern which changes to slower sucks with pauses and soft which changes to slower sucks with pauses and soft swallowing, the infant is calm, the arms and hands swallowing, the infant is calm, the arms and hands are relaxed the mouth is moist . The regular soaked are relaxed the mouth is moist . The regular soaked nappies, on days 1-2 - 1-2 or more, on days 3-4 - 3 or nappies, on days 1-2 - 1-2 or more, on days 3-4 - 3 or more, and on day 7+ - 6 or more are and steady more, and on day 7+ - 6 or more are and steady weight gain is signs of enough breastfeedingweight gain is signs of enough breastfeeding

How can I increase breast milk How can I increase breast milk output?output?

All mum should feed early, All mum should feed early, frequently and feed only breast frequently and feed only breast milk for 6 months. Do not use milk for 6 months. Do not use pacifiers and bottles. Sleep with pacifiers and bottles. Sleep with your baby and bring your baby your baby and bring your baby wherever you go for first several wherever you go for first several weeks. Feed your baby when weeks. Feed your baby when she's hungry, on demand, not by she's hungry, on demand, not by clock!clock!

My newborn won't latch on. My newborn won't latch on. What do I do?What do I do?

If this happens after you leave the If this happens after you leave the hospital, it generally requires immediate hospital, it generally requires immediate attention by a lactation consultant. If attention by a lactation consultant. If your baby has been crying hard, it may your baby has been crying hard, it may help to cuddle and perhaps burp her to help to cuddle and perhaps burp her to calm her down first. If your breasts are calm her down first. If your breasts are overly full, your baby may not be able to overly full, your baby may not be able to get her mouth around your breast, just get her mouth around your breast, just squeeze out a few drops of milk first, to squeeze out a few drops of milk first, to soften the breast and let baby latch on.soften the breast and let baby latch on.

Can I breastfeed if I am sick Can I breastfeed if I am sick with flu?with flu?

Generally, if you fall sick while Generally, if you fall sick while breastfeeding, it is usually fine to breastfeeding, it is usually fine to continue to breastfeed your baby. continue to breastfeed your baby. Antibodies produce by you are passed on Antibodies produce by you are passed on to your baby through your milk, are to your baby through your milk, are protective. Illnesses are most often protective. Illnesses are most often transmitted through skin contact and transmitted through skin contact and secretions from the mouth and nose. Be secretions from the mouth and nose. Be sure to wash your hands often, and try to sure to wash your hands often, and try to avoid face-to-face.avoid face-to-face.

Do I have to eat a special Do I have to eat a special diet while breastfeeding?diet while breastfeeding?

No. Your body will make the perfect milk No. Your body will make the perfect milk for your baby no matter what. For your for your baby no matter what. For your own health, of course, it is best to eat a own health, of course, it is best to eat a balanced diet regardless of how you balanced diet regardless of how you feed your baby. Nursing mothers need feed your baby. Nursing mothers need to drink plenty of fluids 2-3 liters a day, to drink plenty of fluids 2-3 liters a day, enough so that you are never feeling enough so that you are never feeling thirsty. You may recommend that you thirsty. You may recommend that you continue to take your prenatal vitamins continue to take your prenatal vitamins while youwhile you

If I have small breasts does If I have small breasts does this mean I will produce less this mean I will produce less

milk?milk? Breast size has nothing to do with Breast size has nothing to do with

milk production. milk production. It is due to the amount of fat tissue in It is due to the amount of fat tissue in

the breast and not to the amount of the breast and not to the amount of milk producing tissue. milk producing tissue.

Feeding on demand and having Feeding on demand and having regular meals or snacks will ensure regular meals or snacks will ensure that mum produce just the right that mum produce just the right amount of milk to meet baby's needs.amount of milk to meet baby's needs.