In an ideal world, we wish all our babies will be given an equal and fair chance in life. However, we are not in an ideal world. According to UNICEF The State of the World’s children 2016 report, compared to the richest children, the poorest children are almost twice as likely to die before the age of 5 years. In 2017, I was in my first MSF (Doctors without Border) mission in Afghanistan where Infant mortality rate is 66 per 1000 live births, which means 66 babies out of 1000 will not live to see their first birthday. Compared to babies born in Malaysia, babies born in Afghanistan are 6 times more likely to die before the age of one, and 17 times more like than those in U.K. Research has shown the low cost care packages such as effective antenatal care, safe delivery and essential newborn care can dramatically improve prospects of safe pregnancy and child survival. Part of essential newborn care is EXCLUSIVE breastfeeding, that means babies should be breastfed only, without water or any other food, till six months of age. This is proven to be a protective factor to improve child survival.
In the MSF Khost Maternity Project I was stationed in 2017, we have an average of 2000 deliveries per month, so as many as 132 of these may die before reaching their first birthday. We work hard to make sure babies are breastfed as soon as the mother has recovered from the delivery to ensure they have that natural protection from the day 1.
World Breastfeeding Week is celebrated each year from 1-7 August, and the theme in 2017 is about “sustaining breastfeeding together”– we work together for the common good. In the field, we organised one game a day for nurses in the hospital during the week, which consisted of quiz, word finding, multiple choice questions, role-play and demonstration. We also went round the hospital to ask nurses to demonstrate how to explain to mothers how to breastfeed, with our gynaecologist as a reluctant mother armed with a manikin baby and DIY boobs with different nipples. Many mothers also crowded around to see the demonstration. There were giggles and laughter as my colleague pretended to shout, “Oh, my nipple hurt!”, “ I don’t have enough milk?” ,“my baby doesn’t like my breastmilk!”, “oh.. I am too tired, let’s feed baby formula”. We were very proud of all nurses responded to the challenge and advised the “mother” breastfeeding is the BEST milk to her “baby”, addressing each “problem” presented with best possible solution.
|DIY teaching boobs with normal, flat and inverted nipples, including once made by my beloved BMC nursing team|
I always find a child being breastfed in her mother’s arm is the most beautiful moment one can witnessed. I was working in a refugees camp near Khartoum, Sudan last year. The camp hosts almost 1 million refugees freeing from nearby conflict zones, majority are women and children. I remembered a woman attended our clinic with a 2-month-old baby, apparently the baby’s mother has delivered along the journey from South Sudan and died shortly afterward. The woman is the mother’s older sister, she last breastfed her own child a year ago, so she merely took in the orphaned baby and started breastfeeding. Voila! Just like that, her breastmilk came. That is true love. (In medical term, we call it RE-lactation, where women have stopped lactating for a period, then start breastfeeding. This is different to INDUCED lactation, where women have not been pregnant, and plan to breastfeed a child, which requires more lengthy preparation. Please ask your doctor for further details on this)
In my last mission in Sierra Leone, I worked as a Paediatrician in therapeutic feeding centre. Here we helped many women to re-lactate their own children, even grandchildren. Just as in Malaysia, mothers often complain that their milk supply is insufficient. Here I learnt a new technique called “double suction”- we will attach a soft feeding tip at the nipple and the other end to a cup filled with milk, therefore the child with suck on the nipple with the feeding tip to receive adequate milk. This will solve the frustration of a hungry baby unable to suckle enough milk at that moment, and meanwhile stimulate milk production. This technique requires support from clinical team, and family. With this support, we will empower the family to give the best to their children.
As a Paediatrician for more than two decades, I still feel breastfeeding moment remains the most powerful therapeutic method for sick and healthy children. It is not an easy task for lactating women, therefore it is our job to support, and empower them. I truly believe that breastfeeding saves life, and it is the best gift one can give to a child.
By Dr. Saw Sian Chin (General Paediatrician)
MBChB (Dundee), MRCPCH (UK), MSc ID (LSHTM), PG Dip Teaching and Learning