Supporting mothers to re-establish lactation
© UNICEF India/2011/Gulati
Arti Tiwari (left), the feeding demonstrator at the nutritional rehabilitation centre in Shivpuri district hospital in Madhya Pradesh helps Geeta initiate supplementary feeding technique to motivate suckling by his son Deepak.
By Anil Gulati
SHIVPURI, India, 1 August 2011 – Deepak, Phoolwati Bai’s three-month-old grandson had difficulty in feeding on mother’s milk and had stopped gaining weight. He had become malnourished and Phoolwati, also the village Anganwadi or health worker, decided it was time to take the baby and his mother Geeta to the nutritional rehabilitation centre (NRC) in Shivpuri district hospital in the central Indian state of Madhya Pradesh.
“He weighed just 3.4 kg and showed no signs of improvement. His mother was not lactating enough,” says Phoolwati.
Till six months of age, every infant can survive exclusively on breast-feeding. Though Geeta was able to breastfeed two of her girl children earlier, she was not able to breastfeed Deepak properly. Geeta had remained in an unconscious state for three days after giving birth to Deepak and thus could not initiate breast feeding after the first hour of delivery.
Shivpuri’s NRC provides support to Severe Acute Malnourished (SAM) children and helps mothers who experience difficulty in breastfeeding.
“Some infants have problems feeding either because of lactation failure or the infant is too weak to suckle. Also there could be a problem with the mother’s feeding technique,’’ says, Dr. Nissar Ahmad, pediatrician at Shivpuri NRC.
Geeta and Deepak were admitted to the NRC for 14 days to manage the feeding problem. Apparently Geeta’s problem was partial lactation failure and incorrect feeding technique.
NRC gives new start to life
Arti Tiwari, the feeding demonstrator at the NRC started by showing Geeta diagrams and pictures to explain the correct positioning for breastfeeding.
“She was made to sit comfortably and support the baby with her right arm while supporting her breast with her left hand,” says Arti.
The NRC also initiated a supplementary feeding technique to motivate suckling by Deepak. Formula milk was provided to Deepak through a slim tube and the baby was made to believe that the milk was coming from his mother’s breasts.
“The end of the sterilised tube is attached on the mother’s nipple with an adhesive or paper tape. When Deepak suckles, he thinks it’s the breast milk while it is actually the formula milk in a bowl coming through the tube,’’ adds Arti.
Geeta was instructed to breast feed her son 16 times during the day - eight times with the formula milk through the tube and another eight times without the tube.
“Production of breast milk depends on a demand and supply mechanism. The more the child suckles, the more milk will be produced. Unless the child suckles, the breast does not get the message for production of milk,’’ says Arti.
After six days, Geeta started lactating again and Deepak’s weight also increased to 3.66 kilogrammes. “On average, Deepak has started gaining 10 grams per day,” adds Dr Ahmad.Once back home, Mahato ensured Geeta exclusively breastfed her child till he was six-month old.
District hospital records show that 21 cases of lactation failure were admitted in the NRC in 2010 and support could help re-establish lactation in 13 cases.
“Nutrition Rehabilitation Centres in Madhya Pradesh are providing supplementary suckling technique support to mothers to re-establish lactation,” says Dr. Tania Goldner, Chief, UNICEF office for Madhya Pradesh. "The technique infuses the much needed confidence and self-belief among mothers like Geeta towards adopting optimal breastfeeding practices, which is key to providing healthy start to a baby's life.”
Two million children in India die before their 5th birthday. “Unquestionable global evidence demonstrates that breastfeeding counselling and support is the most important child survival intervention,” says Dr. Victor Aguayo, Chief of Nutrition at UNICEF.
There are now 93 such nutritional rehabilitation centres in Madhya Pradesh which are providing supplementary suckling technique and support mothers like Geeta to re-establish lactation and prevent their children from becoming malnourished.
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