Breastfeeding is not unique to African mothers and neither is it a new thing, however many issues around this simple act of feeding a baby are unique to Africa and they warrant discussion. After working in a neonatal as well as a paediatric unit for a few years I have noted with great concern a lot of beliefs, myths, misconceptions and fears that should be addressed, mainly because most of them do more harm than good.
Breastfeeding is not merely holding a baby to the breast so that they feed. A lot of first time mothers get this wrong, a fair number of experienced mothers get it wrong as well. There is a correct way of positioning a baby on the breast and every mother should take time to learn it, ask your nurse or doctor to show you before you take your baby home, if you are already home you can watch online videos ( beware of fake news ). Many mums have come to me complaining that their nipples hurt when breastfeeding or the baby seems to have a lot of gas in the tummy, guess what, their breastfeeding techniques are usually the cause.
When done correctly, it is a painless process. A wrongly positioned baby swallows a lot of air and will feel “gassy”. They will also stop feeding not because they have had enough milk but because their tummies are full of air, you will then wonder why your baby is not gaining weight adequately. A good technique is not all about the baby, it’s also good for the mothers health. Some mums develop backache because they lean forward or assume some strange positions while breastfeeding, the proper thing is to sit back and relax ( whatever your breast size )
Then there is the issue of alternating between the right and the left breasts. I have heard mothers who say their baby prefers the right one to the left or vice versa. Personally I sometimes pause to figure out which is right and which is left, how smart is your baby? Feed your little one from a different breast at each time, making sure they empty each breast at each feed. Besides relieving you from the pain of engorged breasts, there is a medical reason. When your baby starts suckling, the milk that comes out first is called foremilk and consists mainly of water and less fat. This will quench your baby’s thirst but will not provide the nutrients needed for growth and development. The milk that follows, called hindmilk, is rich in fat and other nutrients essential for the baby. When you switch your baby from one side to the other during the same feed, they will only be getting the foremilk from each breast.
Introducing solids and water
I have seen mothers who have started giving their babies porridge at 1 week, some at 2 months others at 7 months. Those who start early usually say the baby was not getting enough milk or mother in law said we should start solids ( in Africa mothers in law are a recognized super power ). Research has shown that breast milk is adequate in every way for a baby up to the age of 6 months, an infant’s digestive system is also not developed enough to handle other things that are not breast milk. These studies are the basis of the 6 months exclusive breastfeeding that we recommend, and exclusive means no porridge, no water and no cooking oil. Save yourself the money you will need it later. We however understand that most mothers need to go back to work and leave their babies at home, if this is the case discuss with your baby’s doctor for a plan, every baby is different and so are their needs. Do not continue exclusively breastfeeding beyond 6 months, breast milk is no longer sufficient for the baby at this point, but it is still necessary.
More and more modern mothers are choosing to formula feed their babies instead of breastfeeding for several reasons. I will discuss the more common ones. Younger mothers usually say they do not breastfeed because they do not want their breasts to sag. This is quite a genuine concern which we would encourage every young mum to consider seriously if it were true, however it is not. Studies have been done and they have shown that your breasts may change after pregnancy, this change however has nothing to do with breastfeeding and has everything to do with genetics and the weight you gain during pregnancy.
Breastfeeding has many advantages over formula feeding, one of them is creating a bond between mother and child. Ever wondered why mothers are usually closer to the children than fathers are, at least the ones that were breastfed. The process and the intimacy of the act itself has been shown to result in a lifelong closeness. Formula feeding in most cases is usually left to the child minder (maid) and we have often seen babies becoming closer to their maids than their mothers.
My biggest concern as a doctor is the safety of formula feeeding in an African context. Several studies in sub saharan Africa has shown that formula fed babies have an increased risk of developing diarrhoeal diseases and dying. In a previous article I noted that diarrhoea is the leading cause of death for children under 5 years, here is a link to that article https://drtendai.wordpress.com/2017/04/02/lives-barely-lived-africas-loss/ The process of mixing baby formula exposes it to the risk of getting contaminated with disease causing organisms. You can claim to be a very hygienic mum but can you vouch for the babysitter who spends the day with your baby while you are at work? Another factor is the municipal water that comes out of our taps, several typhoid outbreaks have occurred in recent months in the city of Harare and the safety of our water has been questioned. In Botswana the government came up with an initiative to provide free formula milk to mothers who opted not to breastfeed, it was later realized that cases of diarrhoea started to increase and children were dying, the World Health Organization mentions this in their report http://www.who.int/bulletin/volumes/87/8/09-069476.pdf?ua=1 Why would you expose your baby to this risk when God (or evolution) has provided you with a system that produces clean and sufficient milk at no cost.
In the next article I will discuss the very topical issue of HIV/AIDS in relation to breastfeeding as well as the process of weaning, when and how to do it. Other breastfeeding myths will also be discussed. Feel free to highlight any other areas that you feel should also be discussed, in the comments or on twitter ( @conmut ).
End of part 1