BREAST IS THE BEST, OR IS IT?

A relook at common wisdom

 

DR SHANTANU ABHYANKAR, WAI

shantanusabhyankar@hotmail.com 

Image Source: Google

Breast milk invigorates and nourishes the newborn like nothing else. It’s the baby’s first food, ensuring good health right into adulthood. Not surprisingly, almost every Bollywood hunk has sworn to the goodness of ‘Ma ka doodh’ on screen.

Successful breast feeding is the rich dividend following investment in the form of prenatal counselling, good preparation, a positive attitude, institutional and government policies and time.

‘Breast is the best’ and we need lactation friendly facilities even in public spaces. But there can be exceptions. The dictum, that all mothers should feed all babies, exclusively for six months, needs to be looked at again. Some special situations need to be factored in.

Such blanket advice overlooks the physical, social and economic constraints of the mother. Ignorance or unwillingness to try hard enough aren’t the only reasons why a mother gives up breastfeeding. Many mothers need to get back to education/earning due to socioeconomic reasons. A six month sabbatical may not be affordable. If the cost of time invested, cost of giving up a job, refusing a promotion or a raise, is factored in, we will realize that breastfeeding isn’t cheap and certainly not free.

Over glorification of breastfeeding can create guilt in the minds of women forced to give it up. Such mothers need positive support without guilt and judgment. Of course it is the mother's duty to feed the newborn but then it is the father's duty as well. It’s the responsibility of the family too. In fact just as not procreating is a personal choice, not breastfeeding can be a valid personal choice and needs to be respected.

Low birth weight and preterm babies can accept only small aliquots of milk. They may not be able to cry aloud and are too weak to latch effectively and suckle vigorously. They need to be fed every hour or two, for the first three to four months. This leads to sleep deprivation and a lot of other physical and psychological challenges. In such situations, milk substitutes under medical supervision, may be given a thought. Insisting on exclusive breastfeeding can be counterproductive. The baby needs to be well fed and well-nourished; the source matters little in the face of such adverse conditions.

Babies larger than expected, especially those born to diabetic mothers, become too hungry, too soon. They may need supplement, till lactation is properly established.

Even normal babies often suffer hunger, for lactation is not well established in the first few days of life. The standard medical response to this is; ‘in the first few days of life, all that is secreted is all that the baby requires’.

However hunger in the early days of life can be life threatening. Emergency NICU admission with intravenous glucose may become necessary. Long term neurological consequences of unrecognized low blood sugar can be disastrous. Hunger leads to excessive crying, lethargy, dehydration, convulsions, very low blood sugar and even sudden death.  

The mother is exhausted after labor and readily breaks into tears when she realizes that she is failing to feed the child. This inferiority complex and accompanying anxiety leads to reduced milk flow. Elderly mothers, comorbidities, cesarean section, a baby girl when a boy was expected; are stressful enough. A wailing toddler due to failed lactation is the last thing one would want. Lactation doesn't happen instantaneously. Suckling happens to be the strongest stimulus but suckling the child every two hours is easier said than done. Delayed onset of lactation is neither the mother’s fault nor the baby’s.

Traditionally such problems have been tackled with wet nurses, cow’s milk etc. Since milk powder is sterile and has known constituents in known proportion that closely match the composition of human milk, it’s preferred over animal milk. Some cities now boast of milk banks, which is a good option too.

Breastfeeding is the obvious choice between sumptuous feeds and milk substitutes. However between reconstituted milk powder and emergency intravenous glucose; milk powder is obviously the better choice. Substitutes create problems because of improper reconstitution and unsafe water. We've made a lot of progress as far as safe drinking water is concerned. A properly constituted and safely prepared powdered milk is a good option. It is important to see that the baby is adequately and safely fed till the time lactation is well established. Once that happens, top feeds should be stopped forthwith.

Policies supporting milk substitute appeasing the market forces and abetting profiteering are bad but milk substitutes aren’t bad by themselves. Milk and milk substitute should be used judiciously according to their wishes needs and abilities off the mother and her family.