Children's commissioner to lobby for breastfeeding

Aggressive marketing of formula milk coupled with family members who put unnecessary pressure on the mother to give up breastfeeding were causing considerable damage, according to Children Commissioner Sonia Camilleri.

"All these negative inputs can be resisted when the parents realise that they are after what is best for their child - breast is best," she said.

On the first day of World Breastfeeding Week, Ms Camilleri referred to the sad statistic that Malta had the second lowest breastfeeding rate in Europe.

According to statistics released last year Malta stood wedged between Ireland, which had the lowest breastfeeding rate of 39 per cent, and the UK with 69 per cent. Malta still had a long way to go to attain the goal of 90 per cent established in Malta's Breastfeeding Policy in 2000.

Ms Camilleri said that in the UK, breastfeeding had been on the rise ever since the government had started investing resources into its promotion, yet "in Malta there is no budget to promote breastfeeding".

The United Nations Convention on the Rights of the Child specifically mentions in Article 24 that governments are "to ensure appropriate pre-natal and post-natal health care for the mother" and ensure society is supported "in the use of basic knowledge of child health and nutrition, the advantages of breastfeeding..."

In the light of this Ms Camilleri will be writing to Health Minister Louis Deguara next week to insist that this convention is respected.

"Governments are obliged to do all they can to promote awareness about the advantages of breastfeeding," she added.

Ms Camilleri was yesterday speaking at a half-day seminar on Breastfeeding: The Right Start, part of a week of events organised by the Midwifery Services, St Luke's Hospital and the Association of Breastfeeding Counsellors (ABC), supported by Svea Distributors Co. Ltd.

The events include the opening of ABC's first headquarters at The Mall, Floriana on Monday, which will be open daily between 9 a.m. and 1 p.m. A walk is also being organised to promote the benefits of breastfeeding on Tuesday starting at City Gate at 10.30 a.m.

Simon Attard Montalto, head of St Luke's Hospital's Paediatric Department and one of the speakers, insisted that the medical benefits of breastfeeding were undisputed and not just a fad or fashionable lifestyle choice.

Despite the dismal breastfeeding rates, figures were "creeping up slowly", though there remained the need for a cultural change in attitude. "There remains the cultural phenomenon of an odd person tut-tutting next to you when you happen to be breastfeeding outside," he said.

A mother's fear of unknown intake was the "commonest excuse" and it didn't need a rocket scientist to determine whether the baby was gaining weight or not.

The only instances when breastfeeding shouldn't take place are when the mother has HIV, TB, malaria, typhoid, breast cancer or when the baby has a rare illness and cannot tolerate milk. However, there were less than 20 babies, out of 80,000, in Malta who had this rare condition.

Excluding these babies, Dr Attard Montalto said he has only advised one mother to stop breastfeeding in his 10 years at St Luke's Hospital.

"On medical grounds breast milk is far superior to formula milk - it is a nutritionally adequate package with the correct amount of protein, fat and carbohydrates," he assured.

Breast milk fortified the baby's immune system and reduced complications against gastrointestinal and respiratory infections. There was also a chance of reduced colic and allergies, while a mother's milk led to visual and neurodevelopment growth regulation.

Apart from all this there were also the economic benefits - Dr Attard Montalto compared the zero cost of breastfeeding to an average of Lm250 spent on formula milk a year.

Breastfeeding mythsA woman who has just given birth is usually bombarded with breastfeeding myths, at a time when she most needs support. These myths confuse and undermine her confidence in success.

Parent Craft Services coordinator Louise Bugeja spoke of a modern disease - the insufficient milk syndrome - where women become increasingly convinced that they are incapable of feeding their baby.

"It is practically unknown for a mammal to produce live young and not be able to suckle them," she pointed out.

"Having said that we do not want to make you feel guilty if you are not breastfeeding. What is required is the promotion of breastfeeding with good, knowledgeable and skilful support," she said.

Here Ms Bugeja attempts to dispel the myths:

¤ Many women do not produce enough milk. Not true. The vast majority produce more than enough. Most babies that gain weight too slowly, or lose weight, do so because the baby is most likely poorly latched onto the breast.

¤ Women with small breasts produce less milk than those with large breasts. Nonsense!

¤ There is no, or not enough, milk during the first three to four days after birth. Not true. Once the mother's milk is abundant a baby can latch on poorly and may still get plenty of milk. However, during the first few days the baby who is latched on poorly cannot get milk. This accounts for "but he's been on the breast for two hours and is still hungry when I take him off". This would mean the baby is unable to get the mother's first milk, called colostrums.

¤ Frequent nursing leads to poor milk production, a weak let-down response and ultimately unsuccessful nursing. Fact: Milk supply is optimised when a healthy baby is allowed to nurse as often as he/she indicates the need.

¤ A mother only needs to nurse four to six times a day to maintain good milk supply. Fact: Research shows that when a mother breastfeeds early and often, an average of 9.9 times a day in the first two weeks, her milk production is greater, her infant gains more weight and she continues breastfeeding for a longer period.

¤ A breastfeeding mother should space her feedings so that her breasts will have time to refill. Fact: A lactating mother's body is always making milk. Her breast function in part as a storage tank. The emptier the breast, the faster the body makes milk to replace it; the fuller the breast, the more the production slows down.

¤ Poor milk supply is usually caused by stress, fatigue and/or inadequate fluids and food intake. Fact: The most common causes of milk supply problems are infrequent feedings and/or poor latch-on and positioning; both are usually due to inadequate information provided to the mother.

¤ Frequent nursing causes a child to be obese later in life. Fact: Studies show that breastfed babies who control their own feeding patterns and intake tend to take just the right amount of milk for them. Formula feeding and early introduction of solids, not breastfeeding on demand, have been implicated in risk of obesity later in life.

¤ If the mother has an infection she should stop breastfeeding. Not true. With very few exceptions, the baby will be protected if the mother continues to breastfeed. There are also few medicines that a mother cannot take safely while breastfeeding.

¤ If the baby has diarrhoea or vomiting, the mother should stop breastfeeding. Not true. The best medicine for a baby's gut infection is breastfeeding. Stop other food for a short time, but continue breastfeeding.

¤ Some babies are allergic to their mother's milk. Fact: Human milk is the most natural and physiologic substance that the baby can ingest. If a baby shows sensitivities related to feeding, it is usually foreign protein that has piggybacked into the mother's milk. This can be easily handled by removing the offending food from the mother's diet.

¤ It is normal for breastfeeding to hurt. Not true. Though some tenderness during the first few days is relatively common, this should be a temporary situation which lasts only a few days and should never be so bad that the mother dreads nursing. Any pain that is more than mild is abnormal and again is almost always due to the baby latching on poorly.

¤ Modern formulas are almost the same as breast milk. Not true. Formulas contain no antibodies, no living cells, no enzymes and no hormones. The proteins and fats are fundamentally different than those in breast milk. Your breast milk is made as required to suit your baby; formulas succeed only at making babies grow well.

Useful contacts

¤ Mothers can go for advice to Breastfeeding Walk-in Clinic at St Luke's Hospital without any appointment on Tuesdays and Thursdays between 8 a.m. and 1 p.m. On other days an appointment has to be made by calling on 2123 3370.

¤ Parent Craft Services at the hospital has a helpline service: 2123 4637. The labour ward can be reached on 2595 132, the post-natal ward on 2595 1477 or the nursery on 2595 1628.