Breastfeeding Benefits, Barriers & Breakthroughs

Choosing how your new Baby will be fed is both a privilege and a completely personal decision. Moms who opt to breastfeed need a little extra information and support, both to acquire the skill and stay on the journey . We asked health science writer, Joy Sweeting, for an overview of the culture and resources available for breastfeeding mothers.

Prenatal education promotess the advantages of breastfeeding for infants, and there are many. Did you know...

Breast milk contains all the water, fats, carbohydrates, proteins, vitamins, minerals and nutrients a baby needs for the first six months of life. It doesn’t need to be purchased, sterilized, measured, heated, or cooled.

Breast milk is perfectly formulated to meet baby’s nutritional requirements as s/he grows. It changes color, composition, even flavour to appeal to the infant. Recent studies have shown that babies appreciate, and suckle longer, with flavors like garlic or vanilla in their mother’s milk. In fact, residual flavours in breastmilk seemed to help babies later accept the same tastes in solid food, and develop a broader palate.

Loaded with antibodies that boost immunity, breast milk also contains intriguing microbiomes that contribute to lifelong gut health and improved resistance to allergies, particularly in babies delivered by vaginal birth. Whether only for several days or months, breastfeeding improves a baby’s propensity for lifelong wellness.

The fatty acids in breast milk support brain development and have not been perfectly replicated by baby formula.

Breastfeeding babies within the first hour of life is directly correlated with a reduction in infant mortality. These babies are more likely to nurse well as they grow. They are also less likely to develop Sudden Infant Death Syndrome (SIDS), less likely to suffer certain childhood cancers, including leukemia. They are less likely to need orthodontic procedures.

Breastfed babies are less likely to contract Type 1 and 2 Diabetes later in life. As a 2019 study showed that almost 9% of Bahamians between 20 and 79 had some form of diabetes, breastfeeding is an important preventative practice.

Babies who have been nursed generally have higher IQ’s than bottle fed babies.

Close, skin-to-skin contact promotes a powerful bond between baby and mother. Once nursing is well established, fathers can bottle-feed with breast milk, nurturing their young as well.

Nursing also has abundant benefits for the mother.

The hormone, prolactin, promotes milk production and encourages a mother’s restful sleep after she has awoken to nurse at night. Prolactin works on milk for a baby’s upcoming feed.

Another hormone, oxytocin, is produced after birth. It stimulates contractions that loosen up the womb and assist with delivery of the placenta. Oxytocin is prompted by skin-to-skin contact with mother and baby. Through touch, or when a mother thinks about her baby, oxytocin signals a let down reflex, telling mother’s milk to begin flowing. Oxytocin is responsible for the feelings of pleasure, and calms a mother's experience while nursing. When a mother is stressed, the hormone is not produced, and milk flow is interrupted.

Breastfeeding is virtually free, and considerably more cost efficient than formula. The upfront costs of nursing clothing, a breast pump, breast pads, and milk storage bags, pay for themselves.

By far, breastfeeding is more efficient and convenient than preparing bottles.

It is also more practical; mothers can nurse their babies anywhere.

Breastfeeding burns between 200 to 500 calories per day.

In mothers who developed gestational diabetes, breastfeeding can help lower blood sugar right away.

A mother who breastfeeds for twelve months has a 4% decreased risk of developing certain breast cancers. The result is additive, so that a mother nursing each of her three babies for one year would have a 12% decreased risk.

A recent study of mothers with postpartum depression indicated that breastfeeding for at least two weeks was of significant psychosocial benefit. Depressed mothers who received appropriate support demonstrated selflessness and perseverance which helped them overcome feelings of maternal inadequacy. Breastfeeding helped improve their value and self-perception as mothers, and they cherished the intimacy it developed with their babies.

Exclusive, frequent breastfeeding, particularly at nighttime, has a 98% chance of preventing other pregnancies. Although not foolproof, it is a traditional prophylactic.

For all the benefits touted by public health experts, many developing countries do not meet global health targets for breastfeeding. The Pan American Health Organization (PAHO) has a target to improve longevity in the region by ensuring that 50% of all babies are exclusively nursed for six months. At present, 52% of babies in the region are not suckled within the first hour of life, a simple procedure that provides lifelong benefits. Just 38% of babies in Latin America and the Caribbean are exclusively breastfed during their first six months, and only 32% are breastfed for the first two years of life.

The statistics are even lower here in The Bahamas. In a 2017 interview Dr. Duane Sands reported general breastfeeding rates from 2005 to 2011 as fluctuating between 10.9% and 29.2%.

In an effort to encourage conversation around Breastfeeding and Infant Nutrition, prior to quarantine, Sandbox Bahamas recently hosted a FamilyTalks forum with pediatrician, Dr. Terlika Chisholm-Smith.

Dr. Chisholm-Smith consults at Princess Margaret Hospital and is an Associate Lecturer at University of the West Indies (Bahamas). She has a thriving private practice at The Pediatric Suite, located at the Collins Avenue Walk In Clinic.

Dr. Terlika emphasized the need for a shift in the perception of breastfeeding in some of our communities. Breastfeeding is natural. It has sustained the human race for centuries, while formula is a recent invention. Manufacturers are still always seeking to mimic breast milk, but they never manage to match its genius.

The FamilyTalk engaged lively guest discussion. Juana Mullings, a grandmother hailing from Spain shared her personal experiences. She stressed the importance of having a birth plan stipulating that the baby will be given to a mother immediately after birth, rather than being taken away to be cleaned, bathed, and probably given formula. Born with a rooting reflex, babies just need to be placed on the breast. With a little assistance, they have the best chance of latching on properly and enjoying the benefits of hour one, skin-to-skin contact. She warned that busy hospitals were unlikely to offer this care unless a mother specifically requests it.

Rosa Knowles, agrees. She has helped many mothers plan for, and receive effective breastfeeding support in local birthing rooms. A certified lactation consultant with over 40 years experience, she still attends regular workshops to review literature, explore new research, and upgrade her qualifications. She claims that without a birth plan, mothers asking for pain medications are often prescribed Baralgin by drip, which leaves newborns dozy and unable to latch for up to 24 hours. She recommends equally effective analgesics that are not diffused or secreted to the newborn. Ms. Knowles’ advocacy has helped many mothers and babies off to a great breastfeeding start from birth.

Tishka Moss, also a certified lactation consultant, observes several other barriers to establishing skin-to-skin breastfeeding in the first hour of life. In busy hospitals handling multiple, concurrent births, it may be more practical for the nurses to bottle feed babies, rather than listen to them cry, or have to take them to their mothers for nursing. The structure of birthing on public wards may need to become aligned with first-hour breastfeeding mandates. New mothers on private wards may also be reluctant to keep baby close by for breastfeeding, feeling guilty that her crying infant has awoken another mother.

Social changes around breastfeeding will require a comprehensive strategy.

In traditional Bahamian societies, babies were always breastfed. On islands with limited access to doctors and nurses, birthing and breastfeeding skills were an intimate and integral part of family life. Female elders like Vivian Knowles of The Ferry, Exuma, would get word via what they called the “conch shell horn” that a baby was coming. On one occasion, she took her own nursing baby, and sailed alone along the coast to assist with a birth in another settlement. Her husband, Jerome, helped deliver their babies at home, likely using his animal husbandry skills. Massaging her belly after births, he would help deliver, weigh, then bury the placenta.

As our family island populations migrated to the city, these traditional skills were lost. Births were now “processed” in hospitals. We began to lose the value of traditional wisdom and community support.

We might also examine other belief systems that have shifted our values. In the sixties, public health workers noticed a change in women who worked as domestics in privileged homes. Noticing the propensity of wealthier folk to bottle feed their babies, many working women followed suit. Community nurses noted the decline in breastfeeding.

It was a heady season for women, for in 1961, they won the right to vote. Six years later, The Bahamas gained Majority Rule, and by 1973, Independence. So many important things changed for us in those years, that perhaps we didn’t notice what we were losing.

The doors were flung open for women who came of age, but the hinge wasn’t fully extended. Some women had to leave their children with grandparents to study. In the hotels, banks, and offices where women worked, it was quite improbable that we would receive maternal support.

It may be time to have a plainspoken assessment of the socioeconomic factors that have shifted support for breastfeeding.

We have lost a treasury of knowledge from maternal elders who assisted with birth, breastfeeding and child rearing.

Breastfeeding is a lived experience. New mothers lack information and confidence about the journey. They need prenatal preparation and strong support from their partners and community. A mother’s journey with one child may be different with another.

Breastfeeding is a family experience. The more that husbands are involved, rather than excluded, the safer a breastfeeding woman will be. Children, too, must be taught that breastfeeding is natural. All family members can learn how to be unselfish with the newest, most vulnerable member of the clan.

Breastfeeding is a journey. The road may wind past unresolved body issues, may require honest communication with a partner. At times, it may be exhausting for mom, and dad may not understand why you’re always asking for another glass of water.

Breastfeeding has class implications. The poor woman most likely regards nursing as the privilege of the wealthy. She may come from generations of women who have raised families alone. Conditioned for independence, she may shun vulnerability, get on with work, have children, and be expected to rear them singlehanded. She may not breastfeed for long; it won’t do to have the baby so dependent on her. Paradoxically, the stressors of poverty actually lead to decreased milk production. Without intervention and intentional support, she is less likely to nurse her baby long term.

Traditionally, the middle class woman who needs her job is very unlikely to request breaks, a clean lactation room, or flex time for nursing. Although Bahamian human resource plans offer maternity leave, few make provisions for breastfeeding. Interestingly, 75% of the women in Tishka Moss’s lactation group are working women. Most have tertiary education, and that seems to make a significant difference in their determination to succeed at nursing once they return to work.

Breastfeeding can provoke shaming, a culturally accepted means of applying control. Family members may berate mom for “exposing” her breasts, or not covering the baby although the temperature is soaring. Even breastfeeding advocates can shame women who choose to transition from breast-to-bottle feeding.

Out in public, it is rare to see women openly nursing. On the other hand, women’s bodies are often sexually objectified by catcalling or harassment.

Crises and disasters make pregnant and nursing mothers more vulnerable. A married mother of six young children was nine months pregnant in Abaco during Hurricane Dorian. She delivered in Nassau after the storm, but suffered high blood pressure, likely related to the trauma she’d endured. She was unable to nurse her baby. Their family moved to another island when the baby was one week old. The husband was working full time until the Covid19 crisis, then the workplace cut his hours. As there was talk of food shortage, a friend helped the family stockpile several months of baby formula. The woman wishes that she had been able to establish breastfeeding, but these extraordinary circumstances have directly impacted her ability to feel safe enough to produce milk for her baby at a time it could have been easily established. With appropriate breastfeeding awareness and support, this mother could have been in a more resilient position today.

Changing Perceptions, creating solutions

Some local businesses are shifting the culture within their organization, led by determined and progressive families. One woman worked with her human resources department to designate times and privacy for breast pumping in their open-plan office. Her husband’s workplace, an international bank, gave him two weeks’ paternity leave--and set up a novel breast pumping station at his workplace. Significantly, the regional office of that bank is chaired by a woman. Pro-family changes in business environments are usually led by women who perceive the benefits of empowering other women in the workplace. The hard return on investment includes earlier return to work, fewer sick days for mom and/or baby, and long term employee retention.

There are several innovative nurses working in the two established hospitals in Nassau. One mother had no plans to breastfeed after her Cesarean. The presence and support of the nurse at birth changed her thinking, prompting the mother to start a maternal support group.

Local lactation consultants want to see hospitals redefine labour and delivery units as birth friendly centers. They are also lobbying for insurances to cover breastfeeding consultations and mental health support within maternity packages.

Similarly, they feel that a workplace must not discriminate against breastfeeding mothers. If employees are allowed to go outside to smoke several times per day, how is it just to forbid women time and space to be able to provide food for their babies.

The value of public sector, community, and social media forums like Facebook cannot be underestimated as a tool for changing social perceptions about breastfeeding. Long term success with breastfeeding absolutely requires education and adequate support from partners, family and community members, and in a kinder world, from society at large.
Did you find this article helpful or interesting? Did you receive the support you needed to breastfeed your baby? Do the women in your family have interesting stories around birth and breastfeeding? How can our communities advance healthier perceptions of breastfeeding?

Certified lactation consultants

Rosa Knowles: Email: buraska@yahoo.com. Cell: 427-5048.
Tishka Moss: Email: tishkanmoss@gmail.com. Cell: 424-6146.
Dabrielle Munnings :Email: dafmunnings@gmail.com. Cell: 468-2747.

Photo Credit: Kimberly Seals Allers, Mocha Manual, Mother

Bibliography

Transcribed presentation by Dr Terlika Chisholm-Smith, “Breastfeeding and Infant Nutrition.” FamilyTalk forum at Sandbox Bahamas, February 25, 2020.

Australian Breast Feeding Project: Breastfeeding Information and Support. Facebook Group. January 17, 2020 Post, retrieved April 26, 2020.

“Babies Should Be Breastfed Within The First Hour of Life.” Pan American Health Organization.

https://www.paho.org/bah/index.php?option=com_content&view=article&id=324:babies-should-be-breastfed-within-the-first-hour-of-life&Itemid=221, retrieved April 26, 2020.

Dewar, Gwen. “Flavors in Breast Milk: Can Babies Taste what their Lactating Mothers Ate for Lunch?” In Parenting Science, 2018, https://www.parentingscience.com/flavors-in-breast-milk.html, retrieved April 26, 2020.

Infant and Young Child Feeding: Model Chapter for Textbooks for Medical Students and Allied Health Professionals.

https://www.ncbi.nlm.nih.gov/books/NBK148970/, retrieved April 26, 2020.

Telephone Interview with Tishka Moss, Certified Lactation Consultant, April 26, 2020.

Telephone Interview with Rosa Knowles, Certified Lactation Consultant, April 26, 2020.

Pratt, Beth A. “The Lived Experience of Breastfeeding for Women with Perinatal Depression.” PhD Dissertation, Florida Atlantic University, August 2017. https://sigma.nursingrepository.org/bitstream/handle/10755/17212/BPratt_1.pdf?sequence=1, retrieved April 26, 2020.

Interview with Jeanne Kemp-Taylor, The Ferry, Exuma, November 14, 2019.

“The Bahamas – Diabetes Prevalence (% of Population Ages 20 – 79).” IndexMundi, 2019. https://www.indexmundi.com/facts/the-bahamas/indicator/SH.STA.DIAB.ZS, retrieved April 26, 2020.

“Breastfeeding with Diabetes: What to Know.” WebMD, 2019. https://www.webmd.com/diabetes/breastfeeding-and-diabetes, retrieved April 26, 2020.

“Bahamas Ranks High for HIV/AIDS and Obesity.” Jones Bahamas, 16 June 2017. http://jonesbahamas.com/bahamas-ranks-high-for-hivaids-and-obesity/, retrieved April 26, 2020.

The Business Case for Breastfeeding: Steps for Creating a Breastfeeding Friendly Worksite: Easy Steps For Supporting Breastfeeding Employees. US Department of Health and Human Services, Health Resources and Services Administration, 2008. https://www.womenshealth.gov/files/documents/bcfb_easy-steps-to-supporting-breastfeeding-employees.pdf, retrieved April 26, 2020.

Breastfeeding Benefits, Barriers & Breakthroughs