New-age moms struggle to breastfeed their babies for the recommended six months.
Dr Smita Dashora was back at work just five weeks after she gave birth to a girl baby last November. The 36-year-old gynaecologist runs an antenatal clinic at Jaipur's Santokhba Durlabji Memorial Hospital (SDMH), where she offers holistic care for pregnant women. As a doctor, Smita knows that a new mother needs to be at home at least six months to ensure the baby is exclusively breastfed. But under immense pressure to return to work, she admits she “couldn't practise what I preach”. When she had her first child six years earlier, she managed to take off for six months, but work pressures have since grown. “This time around I couldn't enjoy that luxury because a lot of patients were counting on me,” she says.
For a new mother, Smita has a tough daily grind. After taking care of the chores at home, she rushes to work at the Reserve Bank of India (RBI) dispensary from 9 a.m. to 11 a.m., after which she goes to SDMH, and around 2 p.m. returns to the RBI dispensary for an hour. She also sees patients at her home clinic between 5.30 p.m. and 6.30 p.m.
To take care of baby Shinjini's nutritional needs, Smita manually expresses two feeds before leaving for work at around 8.30 a.m. and gives the baby one feed at night. “But I don't think I can continue doing this for long. After four months, I'll have to add at least one formula feed. There's so much work pressure and my diet is also not what it should be,” she says.
Breaking the rules
Although awareness of the six-month rule has increased, busy city women find it hard not to add a formula feed after four months. But even some like 36-year-old Deepti Lal, who gave up her job after her second child was born recently, are unable to adhere to the six-month breastfeeding guideline. “I don't think I can keep her exclusively on breast milk for more than three months. Doctors recommend four to six months, but it's tough. It curtails one's freedom and it's a problem if one has to travel,” says Deepti.
She plans to add a formula feed after three months. “Once Shambhavi reaches 4-5 months, I will start giving her mashed bananas, avocado and rice. Total weaning would be after 5-6 months, when my baby starts on solids,” she adds.
Bharti Sharma, a 33-year-old banker, did the same. Her employer, Bank of Rajasthan, was taken over by ICICI Bank at the time of her baby's birth in 2008. “The bank only gave me four months of maternity leave. But I was given an extended lunch-break, so I could go home to feed the baby. The working hours were from 11 a.m. to 8 p.m., so I added two feeds of cow's milk to my child's diet. There was no other option,” she recalls.
There are several factors that have led to the negative trend of early weaning. Dr S.D. Sharma, Professor, Department of Paediatrics at Jaipur's SMS Medical College, says that a delay in the first feed is an important cause for it. “If the first feed is delayed, the sequence of events is dangerous,” he says. “The breast gets engorged and hard, and the baby then refuses to take the breastfeed. This usually leads to a top feed.”
Baby's health
Of course, all methods of top feeding, including cotton swabs and the bottle, are detrimental to the newborn's health. “Not only can the child catch an infection but there is also an immediate risk of aspiration pneumonitis,” says Dr Sharma.
Socio-cultural norms also play a part in influencing this trend. In certain families, the first feed is traditionally given by the newborn's grandparents or the father's sister. But if they happen to live in a different city, the baby often goes hungry until they arrive. “This is not good — when the umbilical cord is cut, there is a sudden drop in the baby's blood glucose level, which produces an urge for suckling. The newborn needs breast milk immediately,” Dr Sharma explains. Another ritual dictates that the baby can only be fed when the stars appear. “If the baby is born in the morning, it doesn't get fed until nightfall,” he says.
Rituals aside, neonatologist Dr Tushar Dashora believes the misconception that breast milk cannot provide adequate nutrition is one of the biggest reasons for early weaning. “If the baby cries for any reason, the mother thinks she is under-nourished and immediately adds a bottle feed. This is wrong. Breast milk provides complete nutrition with a balance of calories, fat, proteins and minerals,” he says.
A member of the Breastfeeding Promotion Network of India (BFPI), Dr Dashora also blames the absence of feeding areas in public spaces for the growing reliance on bottle feed for newborns. “Most malls and multiplexes do not have an exclusive place where mothers can breastfeed the baby. Either they leave the baby at home, or they don't go out at all,” he says.
While he understands the pressures on today's mothers, Dr Dashora however is critical of the growing tendency to experiment with weaning foods. According to him, often, even before the baby can develop a taste for one food, she is fed something new. “The correct way is to follow a pattern for at least one week, so that if something goes wrong with the newborn's health, you know what food caused it,” he advises.
Bottle feed also leads to other problems. “When the baby suckles at the mother's breast, it loses some calories during the press-and-swallow action. Bottle feed involves no effort and invariably leads to overfeeding and weight gain,” Dr Dashora says.
For new-age moms beset by the pressures of an urban lifestyle, paediatricians do have a way out — expressed breast milk (EBM). Breast milk can be expressed manually or by using a pump, which stimulates the breast like a baby's suckle. Dr Kailash Meena, who runs the neonatal intensive care unit at Jaipur's Zenana Hospital, one of the biggest maternity centres in Rajasthan that handles over 60 deliveries a day, says, “EBM can be stored at room temperature for 6-8 hours or in the fridge for 24 hours. It should be stored in a glass container and given with the help of metal utensils. Also remember, it should not be boiled or heated.”
Dr Smita's colleague at SDMH, psychiatrist Dr Aarti Midha has been doing this since she had to return to her work desk six weeks after giving birth to her second child. It seems to be working for her. Says Dr Aarti, “I use a pump to express two feeds of 100 ml each for the three-and-a-half hours I am at the hospital. I am back at the clinic for an hour in the evening, so I leave one 60 ml feed for my baby daughter.”
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