THERE are many reasons why a mother fails to breastfeed or to continue breastfeeding. One reason often overlooked is birthing practices.
What happens in the labour room and immediately after birth can affect breastfeeding and whether the mother continues breastfeeding.
Dr Noor Haliza Yusoff, Hospital Selayang obstetrics and gynaecology senior consultant, said that when we institutionalise labour practices, sometimes it can be unhelpful; not unhelpful to the women in terms of delivery, but unhelpful to the women, in terms of breastfeeding.
She was speaking on “Impact of Birthing Practices on Breastfeeding” at the recent PRISMA 2015 conference, organised by the Malaysian Breastfeeding Peer Counsellor Association.
Explaining how the whole process of childbirth in the hospital is unhelpful to breastfeeding, Dr Noor Haliza said, “Usually they come to the hospital and they are made to lie on the bed during labour and birth. Some of them don’t have support and might be alone in the hospital room or in the labour room with no husband or family with them. And, they will have all the IV (intravenous) lines and monitors and sometimes they are not allowed to have any drink or food, and we give them pain medication which makes them sleepy, and when they are about to deliver we give them an episiotomy which is to assist in the delivery process.
“Once the baby is born, we wrap the baby tightly and then only we give the baby to the mother. So, the baby is separated from the mother immediately after birth,” she said, explaining the regular practices in a hospital delivery.
All these procedures and practices are not conducive to breastfeeding.
Lying in bed, instead of moving around will make the labour prolonged. By the time the baby is delivered, the mother will be tired and will not be able to respond to the baby.
She might also be drowsy because of the pain medication.
With the lack of support, the mother might become depressed and this will reduce the release of oxytocin hormones, which in turn reduces the release of milk.
According to Dr Noor Haliza, all these practices contribute in one way or another to provide the woman with a less than ideal labour experience. In fact, it may even make the labour process traumatic for her and as a result she is not able to respond to her baby and because of that she does not initiate breastfeeding early.
If you do not initiate breastfeeding early enough, then you will have problems establishing breastfeeding and so, you will not be able to sustain when you go home, let alone continue for six months as recommended.
When mothers do not breastfeed their baby, the baby is given formula milk and this gives rise to certain problems such as acute gastroenteritis and infections, and that can kill the baby faster than any other condition, informed Dr Noor Haliza.
“We know that for the mother to breastfeed her baby, we need to give her a positive birth experience because it will affect her motivation to breastfeed. If we look at all the practices that I mentioned earlier, all those are hindrances to breastfeeding because they do not allow the mother to interact early enough with the baby and do not allow her to initiate breastfeeding at a very early stage,” said Dr Noor Haliza, informing that studies have shown that events that occur during the birthing process will enhance or deter the woman from breastfeeding.
According to her, scientific evidence shows that if we return the birthing process to what it used to be before, when women gave birth at home, it can accomplish many things in the form of faster, easier births, and healthier, alert and more active mothers and newborns.
When you have healthier and more alert mothers and newborns, they will be able to interact physiologically and optimally they will be ready to breastfeed.
“That is what we want – a return to normalcy or a more natural birth.
“But, please bear in mind that we do not advocate that for all mothers. Mothers who have problems or medical conditions will definitely need some form of monitoring, not just for the mother but also for the baby.
“Those with problems and medical conditions cannot do that. They need to be monitored and go through all those processes in the hospital to ensure that they have a safe delivery,” said Dr Noor Haliza.
She explained that the medical profession is beginning to realise the emphasis should not just be on the baby, but also the mother, and that hospitals need to be mother-friendly.
For mothers to be able to initiate and establish breastfeeding, there needs to be a good start. This begins during the delivery process in the labour room, and not after birth.
For those who have been assessed and conditions are met for a safe delivery, five components should be emphasised for mother-friendly care during delivery:
1) To have a companion of their choice for support throughout the labour and birth.
Even if they have risks or they have medical conditions, they are still encouraged to have a companion of their choice in the labour room for the support.
The aim of this is to provide support, not just moral, but also physical. Evidence shows that continuous labour support reduces the need for many labour interventions. And labour interventions often delay initiation of breastfeeding.
When there is support in the room, mothers feel that the labour process is not as long as it would feel if they are alone. The person offering support would be able to help the mother take her mind off the pain. It then also reduces the need for medication to reduce the pain.
“What it really does is empower the mother to feel supported and in control throughout the process of labour,” said Dr Noor Haliza.
2) To be allowed to have light food and drinks during labour.
Childbirth is very labour-intensive and energy-intensive. If the mother is fasted and starved, it will definitely slow down or complicate the labour process, and if they are not given anything to drink, they would become dehydrated.
Previously, the fear was that a mother might have to go for caesarean section or surgical intervention, which is why she would need to fast.
“But now, we have sat down with the anaesthetists and agreed on who can be allowed water and up to what stage they can be allowed to drink until we fast them again,” said Dr Noor Haliza.
According to her, IV hydration is something that is not advocated now because some of the commonly-used IV solutions have electrolytes in them and can lead to electrolyte imbalances, jaundice and other problems in the newborn. These problems in the newborn would also result in prolonged separation of the mother and baby, which in turn will affect the initiation and continuation of breastfeeding.
3) To be encouraged to consider non-drug methods of pain relief.
This is where the support comes in, to help the mother move about as she goes into labour, massage her, to help relief the pain or keep her mind off the pain and provide a more natural form of pain relief.
The room environment should also be right – no bright lights, so the room is soothing.
All these non-drug methods for pain relief have been shown to be helpful in ensuring that mothers are able to breastfeed their babies as soon as the baby is born because they are alert and the baby is alert and they are able to interact immediately and therefore initiate and establish breastfeeding.
4) To be encouraged to assume the birth position of their choice as far as possible.
Not all hospitals can provide alternative birthing positions, so you have to be realistic, said Dr Noor Haliza. At the end of the day, the safety of the mother and baby is the primary concern of hospitals. Mothers can’t force hospitals to allow them to deliver in the birth position of their choice if the hospitals don’t have the facilities nor the skills for it.
Some hospitals can provide alternative modes of delivery like a water birth. But if the hospital cannot provide alternative modes of delivery and if they are not trained for it, then you can either find another hospital that can accommodate your request, or go through a normal delivery process at that hospital.
5) To provide care that does not involve invasive procedures.
Dr Noor Haliza said that invasive procedures should only be done if it provides more benefits than disadvantages. This includes the use of suction, intubation, forceps and even a caesarean section.
Any invasive procedure can injure the physiology of the baby’s suck-swallow-breathe coordination, and any injury, even a minor one, to the cranium of the baby will impede the baby’s ability to signal the need for breastfeeding.
All these invasive procedures will impact the mother’s comfort, or might affect the baby’s response because of the anaesthesia and other medication.
This will lead to a delay in interaction between mother and baby and thus a delay in initiating breastfeeding.
“I would like to stress that all these components are there for women who have no risks or who have been assessed and found to be at low risk, and they agree to go through all these processes. If at any one time, or at any time of their delivery process, things change, to a different situation, meaning from a low risk they become a high risk, then they can no longer go through this mother-friendly care,” she said, adding that sometimes a patient’s blood pressure shoots up during labour and she then becomes a high-risk patient.
Simply put, mother-friendly care avoids early separation and ensures that mother and baby are well and healthy so that the initiation of breastfeeding can be done as soon as possible.
However, this is not suitable for all women because of risks that may occur during labour.
Above everything else, the life and safety of the mother and child is the priority.