BREASTFEEDING is not an easy task, nor is it a simple issue. There are many challenges and issues faced in breastfeeding, from politics and law to dental development, postpartum blues, hormones, pain management, jaundice, birthing practices, tongue tie and weight gain.
At the recent PRISMA 2015 conference, organised by the Malaysian Breastfeeding Peer Counsellor Association, held at the Holiday Villa in Subang Jaya, all of these topics and more were covered over just two days.
There was also a half-day pre-convention where the topics of disaster relief work and how to support breastfeeding mothers under such situations were discussed.
The turnout was fantastic – there were 150 participants for the pre-convention and 250 participants for the convention. About 60% were Ministry of Health staff – medical officers and specialists, nurses, and nutritionists/dieticians from all over Malaysia, including Sabah and Sarawak.
Besides the almost full-capacity ballroom, the enthusiasm of the presenters and the participants was overwhelming – a clear indication that breastfeeding is thriving in Malaysia.
In her opening speech, convention director Dr Nadrah Arfizah Arifin spoke of the theme for the inuagural convention – “Embracing Your Role, Knitting Our Network, Normalising Breastfeeding”.
“In PRISMA 2015, we bring our local experts in lactation and introduce them to our lactation activist community and all who are searching for local breastfeeding experts.
“We believe that this convention will serve as a platform to share and learn from the experts and individuals. This will allow us to meet new challenges together and enable us to move towards better breastfeeding support. I hope the convention will shape better practices in breastfeeding support,” she said.
The convention, which was a great platform to share information and network, saw many of the prominent local breastfeeding advocates in attendance, including Datuk Dr Anwar Fazal, chairperson emeritus of the World Alliance for Breastfeeding Action (WABA), Nor Kamariah Mohamad Alwi, chairperson of the Malaysian Breastfeeding Peer Counsellor Association, Rita Rahayu Omar of Susuibu.com, Gina Yong, founder of The Breastfeeding Advocates Network (TBAN) and paediatrician Dr Koe Swee Lee.
Datuk Dr Anwar, of WABA, in his keynote address, gave the participants a history lesson on breastfeeding in Malaysia and the world.
“We were one of the first countries to have a breastfeeding code. We were the third country in the world to adopt baby-friendly hospitals. But our breastfeeding ways are still stuck.
“We have to all work together to make something much more happen in this country in terms of the structure of support, in terms of the code becoming the law, and community support systems. All the knowledge with regards to these matters is out there. The only thing lacking is the political will and the kinds of resources. It’s not a problem of knowledge. It’s a matter of getting it done and we can get it done,” he said.
According to him, next year is the 25th anniversary of WABA and he is determined to set up a virtual breastfeeding museum in time for World Breastfeeding Week 2016.
Tongue tie affects breastfeeding
Paediatrician and much sought-after lactation consultant Dr Koe spoke on “Tongue Ties: When is it a Problem in Breastfeeding?” at the conference.
According to her, milk transfer from the breast occurs when negative pressure is created in the babies mouth with jaw dropping.
“When the baby drops the jaw, it creates negative pressure there and it transfers a bolus of milk from the milk ducts into the nipple. Then the tongue will have peristaltic movements to move the bolus of milk from the mother’s nipple to the back of the baby’s mouth. This is how suckling transfers milk from the mother to the baby.
“In a tongue tie, the movement of the tongue is limited, peristaltic movement is limited and milk transfer is limited. The tongue is unable to draw the nipple into the mouth, resulting in nipple feeding.
“The effect on the baby is that, breastfeeding is ineffective, milk may leak from the side of the mouth, there’s poor weight gain, there’s risk of supplementation, dehydration, hyperbilirubinaemia, hypernatraemia, risk of admission to hospital, and very soon there will be termination of breastfeeding.
“The mother may express milk only and the mother will stop direct latching, if she is not aware that the baby has problems suckling due to tongue tie,” explained Dr Koe.
According to her, these are the effects of tongue tie on the mother:
- Nipple feeding
- Difficult latch
- Painful, sore and bleeding nipples
- Unsustained suckling
- Blocked ducts
- Breast abscess
She explained that the best treatment for tongue tie is a frenotomy. This is a procedure where the frenulum is snipped.
Dr Koe said that the risks are that there will be a spot of bleeding after the procedure. The bleeding is usually momentary, only for about one or two minutes.
There will also be a diamond-shaped ulcer under the tongue. This ulcer will heal after two or three days.
“After the frenotomy, improvement in breastfeeding is observed immediately in only about 50% of patients. You cannot expect the baby who has not been feeding well all these weeks, suddenly to be able to breastfeed once you release the tongue tie. Some babies need time to relearn the normal movements of the tongue for breastfeeding,” she said, adding that this could take a few days up to several weeks.
She even explained to the conference participants how to detect if an infant has tongue tie.
Also presenting at PRISMA 2015 was Dr Zubaidah Jamil @ Osman, senior lecturer and clinical psychologist at Universiti Putra Malaysia.
Her talk was on “Challenges in Breastfeeding: Pain and Managing Emotions”.
According to her, studies have shown that 80-90% of breastfeeding women experience some nipple soreness, with 26% progressing to cracked nipples and extreme nipple pain.
Dr Zubaidah said that pain and discomfort while breastfeeding is one of the reasons why mothers give it up.
She reminded the participants that often pain can cause psychological distress and too much psychological distress itself can aggravate pain – making it a vicious cycle.
“We give so much attention to the pain that we forget our ability to cope with the pain.
“A lot of methods to handle breastfeeding pain do not involve using drugs. We use psychological approaches,” she said.
To counter the pain, she suggested that mothers breastfeed a bit at a time rather than over longer periods as it may be more painful if done over a longer time.
She recommended that mothers experiencing pain during breastfeeding to practise deep breathing exercises and to motivate themselves with positive thoughts.
Another important component is social support. Dr Zubaidah said it is important to surround yourself with family and friends who empathise with you and tell you that it will be okay and that a lot of people face this pain.
“The psycho-social part is very important in your decision to continue breastfeeding,” she added, emphasising the importance of the mother to remain relaxed even when she is in pain.
“When the mother is stressed it will affect the lactation, so the mother is advised to stay calm, even when in pain,” she added.
A surprise addition to the speakers list was Yeong Joo Kean, International Code Documentation Centre (IBFAN-ICDC) legal consultant.
She spoke on the legal aspects of gaining sponsorship from milk formula companies and the risks of endorsing their products.
In her “Breastfeeding – What’s Law Got To Do With It?” presentation, Yeong said even having a pen with the name of the milk product company in the doctor’s office can be seen as endorsement of the product.
She gave the medical practitioners in the conference the do’s and don’ts to comply with the code of conduct for milk in Malaysia.