Wednesday 20 February 2013

The First Hour After Birth: No Child Born To Die Campaign

The debate over feeding choices in the UK is a highly emotive one. Whenever and wherever breastfeeding is mentioned as superior to formula feeding, it is often met with a backlash from formula feeding women wishing to defend their feeding choices in public. As an Antenatal Teacher, I have been taken to task for mentioning breastfeeding in my classes, typically by women who have already decided to formula feed their babies and perceive me to not be respecting their choices.

The World Health Organisation recommends that babies should be exclusively breastfed for at least six months, and that breastfeeeding should continue for up to two years after birth. On the face of things, the choice to breastfeed or formula feed can appear to be an equal choice - especially in this country. However, breastfeeding does have significant health benefits for mother and baby.

For the Mother
  • Releases oxytocin to help uterus contract, which helps prevent post-partum haemorrhage.
  • Protects against various cancers and illnesses including Breast Cancer and Ovarian Cancer
  • Keep's a woman's periods from starting until her body is ready
  • Natural Contraceptive (although not completely foolproof so other contraception should be used!)
For the Baby
  • Provides immunity in the early months after birth
  • Protects from pneumonia and diarrhoea - two of the world's biggest killers in childhood
  • Protects against asthma, diabetes, coeliac disease, colitis, chrohns disease and obesity.
  • A mother's milk is specifically designed for her baby. The nutritional make-up of a mother's breastmilk adapts according to the needs of her infant at that time for their individual development, as long as the supply and demand mechanism is not interrupted. 

Promoting breastfeeding is not about making women feel guilty about their feeding choices, it is more about raising awareness of the despicable tactics which formula companies use to make formula appear an equal, and sometimes superior choice to breastfeeding.

With a formula milk business worth £16 billion pounds per year worldwide, formula companies are keen to keep mother's believing that formula milk is equal to breastmilk. If you have ever read "The Politics of Breastfeeding" by Gabrielle Palmer, you would be familiar with the underhanded tactics which formula companies use in both in wealthy and developing countries. In the UK, formula companies are not supposed to advertise formula for babies under six months, just as retailers are not supposed to promote, advertise or discount formula for babies under six months.

However the saving grace is at least in this country, parents who choose to formula feed have access to running water, sanitation and sterilisation facilities. Therefore, throughout the first world, formula feeding is much safer than in other countries where the concern is that sanitation is not as good, and where formula is being made with contaminated water, in bottles left in unsanitary conditions, and babies are being fed food which contains parasites, leading to babies becoming ill.

The Golden Hour after Birth 
The first hour after birth, often known as "the golden hour" or "the power hour" is a special time in a baby's life. The baby is adjusting to life outside of the womb and discovering the world using it's senses. Bonding behaviours are taking place between the mother and the baby, and typically, breastfeeding is initiated, transferring the vital antibodies which boost the immune system from the mother to the baby.

This initiation of breastfeeding in the first golden hour can be the difference between 
life and death for a baby.

Seven million children worldwide under the age of five die each year because they were not breastfed during the golden hour after birth and so did not receive the vital antibodies to boost the imnmune system and protect against disease. If every baby were breastfed within the first hour of life, 830,000 deaths per year could be avoided in developing countries and throughout the world.

In the UK, 81% of mother's initiate breastfeeding within the first 24 hours. In developing countries, this figure stands at around 40%, and in some places such as Burkina Faso, and Cameroon, breastfeeding in the first hour can be as low as 20%.

So how is childhood mortality linked to breastfeeding in the first hour of birth?

From birth and until around three days after birth, a mother produces a type of milk called Colostrum. Colostrum is nature's way of providing as much goodness to the baby as possible. Rich in nutrients, it works to boost immunity and protect against unwanted bacteria. Colostrum also has a laxative effect to help the baby pass it's first poo called meconium, which helps to get the baby's bowel and digestive system working, prevent jaundice and stop bacteria and allergens attacking the baby's throat, lungs and intestines. A baby's stomach is only around the size of a marble at birth, so the baby only needs continuous small amounts of this nutrient rich colostrum to reap the benefits. Often mother's may feel that the tiny amount of colostrum they are producing is not enough, and is not worth anything, however, an infant who receives colostrum in the first hour after birth is three times more likely to survive than one breastfed a day later. Even if mother's who wanted to formula feed gave their child this colostrum in the first hour, it would help to boost their immune system in the early weeks.

Breastfeeding in Developing Countries
Unlike the UK, in  poorer countries, many women are not able to make their own informed choice to breastfeed. Practices such as denying colostrum, or giving other foods and liquids to the baby leave the baby open to disease and malnutrition, and also cause the baby to become confused about which sucking reflex to use. The sucking reflex a baby needs to employ for feeding is different for breast and bottle feeding, plus, it is easier to suck from a bottle, so the baby becomes used to this, even after one feed. 

Often women in poorer countries are given bad advice, or pressurised into harmful alternatives to encourage women to purchase formula. In Pakistan, 56% of women cite husbands and mothers-in-law as the decision makers in how their child is fed. Father's and Grandparents naturally want to be able to feed the baby as many link feeding with love - as we see in this country also. Additionally, midwives and health professionals often receive a kickback from formula companies when they persuade women to purchase formula. Formula companies provide free samples to midwives to help entice women into giving formula to their baby.

Changing the power and gender dynamics in communities will empower women to be able to make their own decisions about how they feed their babies. The health systems needs to be stronger to protect and promote breastfeeding. International code should be enshrined in law in all countries, and regular monitoring of formula promotion in countries should be employed, along with health warnings on formula and detailing the benefits of breastfeeding.

No Child Born to Die

Save The Children has launched their "No Child Born To Die" Campaign, in a bid to promote the importance of the first hour after birth, and to drive down childhood mortality rates.

According to a Save the Children report – Superfood for Babies –  which was launched this week, there are three key factors which undermine women worldwide's ability to make an informed choice about their feeding choices:

  • A significant shortage of midwives – 350,000 worldwide. In poorer countries, one third of babies are born without a skilled birth attendant present, meaning that the opportunity for new mother's to be supported to breastfeed is lost. As a Birth Companion who attends women in labour, to me, this is a shocking statistic. Women need support through birth and help to breastfeed in the first hours after birth. 
  • Cultural factors play a part too. Without a health worker providing accurate advice, some women receive advice which tells them that the colostrum (first milk) is actually bad for their babies. Indeed in some countries, it is considered unclean. This leads to babies receiving sugar water, herbal tea or butter as the first feed, or being given formula which is being made up with unclean water, unsterilised equipment and in unsanitary conditions. 
  • The marketing tactics and lobbying of some multinational breast milk substitute companies, can lead mums to become confused and believing that formula is beneficial for their babies. The international Code of Marketing of Breastmilk Substitutes means that providing free samples, targeting mothers. and making health claims on packaging is not permitted. In many countries, this is not monitored and implemented into practice, and so companies are able to violate the code. Of great concern is also the way that health workers are targeted to promote formula to mother's and infants for rewards. 

Save the Children's Campaign aims for world leaders, international institutions and multinational companies to take action to ensure every infant receives the life-saving protection which breastfeeding can offer. Breastfeeding should be at the centre of government strategy and policy so that optimal breastfeeding practices are being undertaken. Even in the UK currently, companies such as Bounty and formula milk companies are still schmoozing the NHS and gaining access into hospitals to give midwives literature to pass onto women promoting formula.

Save The Children believe - and I do too:
  • No Child should be born to die because they don't get the basic nourishment they need.
  • No Child should be born to die because their mother does not have access to a health professional to help them give birth, and breastfeed within the first hour.
  • No Child should be born to die because because their mother's milk does not protect them against pneumonia and diarrhoea.
  • No Child should be born to die because their mother is led to believe formula is the baby's best option.
  • No Child should be born to die because because they are fed formula produced in unsterile, unsanitary conditions.

Save the Children are ensuring that babies get the vital essentials they need to help them survive in the first hour of life. 

  • In Liberia, midwives are being trained to spot signs of danger and act in a heartbeat if danger occurs, whilst respecting the mother's ability to birth her baby by providing a safe and hygienic environment for her to birth in, and making sure baby is breastfed within the first "golden hour" of birth. 
  • In Mongolia, where children are born into temperatures of -40C, Save the Children are providing woolly hats, thermal clothes and blankets to protect babies from hypothermia and pneumonia. 
  • In Tanzania, Malawi and Nigeria, health workers are learning about ‘kangaroo care’, where mothers of premature babies keep their newborns warm through skin-to-skin contact – providing a ‘human incubator’ in those vulnerable first hours and days. This is great for all babies as it helps babies to regulate their temperature and helps them bond with their parents.
  • In Indonesia, health workers are teaching expectant mums about the benefits of breastfeeding to make sure they’re ready to give their baby that vital first feed.
  • Across the world, Save the Children are campaigning for more doctors, nurses and midwives so that no new mum or newborn baby is out of reach of a health worker when they need one.

What Can You Do?:
2. You can make a donation to help babies survive their first hour.
3. You can spread the word about this campaign. Follow @savechildrenuk on Twitter, and like their page on Facebook. Use the hashtag #firsthour to share links and posts on the campaign or use this bloggers toolkit to write your own post.
Please Take Action to help save half a million lives and ensure that No Child Is Born to Die

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