National Breastfeeding Week August 1 to 4:

Breastfeeding brings the best benefits

By Nilma Dole

Breastfeed points

There are three important ways to hold your baby. The cradle position is popular where you put your baby’s head on the side of your arm. Then support your baby’s back and bottom with your arm and hand like a cradle and your baby will now be lying sideways with baby’s face to your breast. The football position consists of tucking your baby under your arm like a football resting on your hand. Support your baby’s body with your forearm. This may be a good position if you’re recovering from a caesarean section or if your baby is very small. You can also lie on your side with your baby facing you.

?The signs that your baby is getting enough milk is that the baby acts satisfied after each feeding, gains weight constantly after the first three to seven days after birth, has about six to eight wet nappies a day, has about two to five or more stools a day at first and then may have two or less a day.

? Feed your baby as often as he or she wants to be fed as this may be eight to 12 times a day or more. How often your baby wants to feed may change over time as he or she goes through growth spurts. Growth spurts occur at about 2 weeks and six weeks of age and again at about three months and six months of age.

? Let your baby nurse until he or she is satisfied. This may be for about 15 minutes to 20 minutes at each breast. Try to have your baby nurse from both breasts at each feeding. The box lists the signs to watch for so you’ll know your baby is getting enough milk. If you’re nursing fewer than eight times a day, be especially aware of these signs.

Courtesy : www.babycenter.com

Sri Lanka is a leader in promoting breastfeeding awareness not only within the region but outside as well, said UNICEF Country Representative, Reza Hossaini at an event to mark National Breastfeeding Week at the Castle Hospital.

Even though Sri Lanka has been maintaining high figures in breastfeeding statistics, it is imperative that these figures are maintained. He said: “Sri Lanka should be proud of achieving MDGs (Millennium Development Goals) ahead of others in the region but this does not mean they should take it for granted but keep working at these figures.”

It will not only be the Government’s role in advocating breastfeeding but primary health care workers to pregnant mothers too should be educated on the importance on breastfeeding.

In times of modernisation where there are plenty of career-oriented women, there needs to be more emphasis on breastfeeding and maternity leave to suit the working lifestyles. Today, women are sometimes the sole breadwinners so it is important for companies to recruit women based on their skills and not on whether they are a burden to the company for taking maternity leave.

“What is important is that Sri Lankan mothers should know that breastfeeding is compulsory for six months from the time of the birth of their child and it is vital that we advocate a good strategy in order to offer working mothers the benefit of a maternity leave or nursing breaks,” said Dr. Deepthi Perera of the Family Health Bureau.

She said that it is a benefit for a company where a woman will take paid maternity leave to breastfeed which will save an immense cost later. “Rather than taking leave to care for a child, a woman should take her allocated maternity leave. This is a small price to pay to ensure that they bring up a healthy child,” she said.

Moreover, Sri Lanka was the first to raise the importance of breastfeeding as early as the 1970s and it has been in the news ever since. Today, the Western world now only realises the importance of breastfeeding after bottlefeeding their babies for several years due to modernising too quickly.

It is apparent that the health benefits of breastfeeding is high especially when the child grows older. “It is known that breastfeeding for as much as one year can increase the immunity of a child and there is the less chance of the child becoming obese or having juvenile diabetes,” said Dr. Perera.

According to the doctor, breastfeeding contains antibodies in the form of colostrum which helps the baby fight diseases which is vital for not only physical development but mental development too.

“The relationship between baby and mother is more and there is mental satisfaction when the child feels close to their mother,” she said.

Sri Lanka’s impressive maternal mortality rates where there are hardly any maternal deaths in childbirth is a good boost to taking breastfeeding awareness to the next level.

However, while the topic of maternal nutrition is addressed, malnutrition in children tends to be common after six months because mothers do not know what to give the child to eat and how to train the child to eat.

Senior Consultant at UNICEF and government medical doctor, Dr. Deepika Attygalle said that semi-solids should be given at the early age as opposed to the liquid food such as porridge or mashed rice.

“Then the child will use their teeth and gums to start to eat. By the time they reach the age of two, adult food can be given because the child needs nutrition more than milk,” she said. Dr. Attygalle said that the problem of malnutrition is not because of lack of food but lack of giving the right food to the child.

“As medical professionals, we are always glad to assist would-be mothers so please be careful of taking other people’s advice especially those who aren’t qualified.

"As doctors we know best and it’s our duty to educate our mothers not only on breastfeeding but also proper nutrition,” she said.

Speaking at the event was Deputy Health Minister who said, “As a son, I’ve valued my mother and can say that I’ve achieved success because of having mother’s milk when I was born.

"I hope this trend continues because it’s not just for the government to spread awareness but mothers should be educated and ask for advice from those who know because their child’s health is at stake,” he said.

Mental illness and the stigma associated with it

The stigma that is so deeply attached to mental illness has caused many authorities in the psychiatric and psychological field to believe that it has become institutional. One of the troubling aspects of the stigma is that a large number of people suffering from symptoms of mental illness do not seek any assistance – despite the availability of effective treatment – because they are embarrassed, shy or concerned about what others might think.

Many don’t share their thoughts or feelings even with close friends due to these aspects.

Those who do seek help sometimes find their own self-image eroded by what’s known as self-stigma, internalizing all these negative perception.

Most of the patients say they feel a stigma when they are first diagnosed as having a mental illness. Most say that it is a big blow to their self-esteem, because then they seen them in that light. And as the treatment continued, their families too begin it see them in that light – it began to influence the way they looked at them.

Some psychiatrists and psychologists say that the stigma extends to primary healthcare.

They say that they had patients whose valid complaints of physical ailments were ignored once the mental health history was disclosed.

For decades psychiatrists and psychologists have been trying to eliminate this misconception – to get society to look past this label to reduce discrimination against people suffering from mental illness. For those struggling with mental disorders the stigma attached to it is indeed a beast.

Research has shown that prejudice and discrimination against those with mental illness can cause more problems than the disorders themselves.

For example there is clear evidence that finding a partner for a person identified with mental illness is a difficult task, landlords won’t rent out to people with mental illness, employers won’t hire then, police will over-respond and the media will misrepresent.

In fact, analyses of newspaper content in many countries show a clear pattern of such misrepresentation.

Stories linking mental illness with violence are given more prominence, more space, and more emphasis than stories about violence where the suspect did not have a mental disorder.

The overall impression left by such coverage is that people with mental illness are dangerous. Despite the fact that people who do not have a mental disorder commit more than 95% of violence in the community.

The ‘axe-wielding psycho’ is just one of numerous commonly held myths about mental ill health.

Many still believe that ‘once crazy, always crazy’, despite the fact that the majority of people with mental disorders recover. Most of the people cling to the misconception that people with mental disorders are lazy unpredictable and unreliable.

There is no powerful mental health lobby. Because of this, funding for mental health programs and research is always substandard – when you compare with other physical illness funding for mental illness despite the vast number of people being affected is very poor.

In Sri Lanka, funding for mental health programs has been minimal for a long time.

For example for research on mental health – the funds allocated is less than 1% of the population – when there is 25% of the population that will develop mental illness.

Dr. R.A.R. Perera

Local efforts can stem increasing unnecessary Caesarean sections

Caesarean section rates are steadily increasing globally.

Requiring two doctors to agree that a Caesarean section is the best way to deliver a baby, rather than just needing one opinion, providing internal feedback to doctors on the number of operations performed and seeking support from local opinion leaders may reduce the use of this procedure.

For low-risk pregnancies, nurse-led relaxation classes for women with a fear or anxiety of childbirth and birth preparation classes for mothers may decrease Caesarean sections.

On the other hand, providing prenatal education and support programs, computer patient decision-aids, decision-aid booklets and intensive group therapy to women have not been shown to decrease Caesarean sections effectively.

Likewise, insurance reform, legislative changes, external feedback to doctors on their performance and training of public health nurses to provide mode of delivery information in childbirth classes do not decrease Caesarean section rates.

These were the findings of a systematic review carried out by researchers in Thailand and Australia and published in The Cochrane Library.

“Around the world more and more women are opting to deliver their babies by a Caesarean section rather than have the discomfort and perceived greater risk of a standard vaginal delivery,” says study leader Suthit Khunpradit, who works in the department of Obstetrics and Gynaecology at Lamphun Hospital, in Thailand.

He points out that while reported Caesarean section rates vary, studies have shown that in England, Scotland, Norway, Finland, Sweden and Denmark Caesarean section rates rose from around 4 to 5% in 1970 to 20% to 22% in 2001.

Furthermore, in 1997 up to 40% of women in Chile opted for a Caesarean section and current figures show that 46.2% of deliveries in China are by Caesarean section.

“In 1985 an expert panel of the World Health Organisation suggested that you could expect up to 15% of women to benefit from a Caesarean section, but if more were having them, then many were unnecessary,” says Khunpradit.

While it can be a life-saving procedure for both the mother and the unborn child, Caesarean sections are also used in situations when neither the mother nor the unborn child has a greater risk of complications than the rest of the peripartum population. Caesarean section itself has risks, including maternal infections, haemorrhage, transfusion, other organ injury, anaesthetic complications and psychological complications.

“In some settings, maternal mortality associated with Caesarean section has been reported to be two to four times greater than that associated with vaginal birth,” says Khunpradit.

“There is a clear need to halt the escalating use of Caesarean sections, and from the studies published so far the strategies that had clearest evidence of reducing the proportion Caesarean sections were those that focused on the clinicians,” says Khunpradit. He believes there is clear need for further studies that get higher quality evidence about interventions that could help women see whether a Caesarean really is the best option or whether a natural birth would be better.

Sources: Wiley-Blackwell, AlphaGalileo Foundation.

Inherited risk greater for heart attacks than for strokes

People are significantly more likely to inherit a predisposition to heart attack than to stroke, according to research reported in Circulation: Cardiovascular Genetics, an American Heart Association journal. The study results have implications for better understanding the genetics of stroke and suggest the need for separate risk assessment models for the two conditions.

“We found that the association between one of your parents having a heart attack and you having a heart attack was a lot stronger than the association between your parent having a stroke and you having a stroke,” said professor of clinical neurology at Oxford University in England.

“That suggests the susceptibility to stroke is less strongly inherited than the susceptibility to heart attack.”A second analysis, which included patients’ siblings as well as parents, yielded the same result: Family history proved a stronger risk predictor for heart attack than for stroke. Rothwell and his colleagues conducted the study to clarify and confirm evidence suggesting a great difference in genetic predisposition between heart attacks and strokes.

“We had found previously that much of the heritability of stroke is related to the genetics of high blood pressure, which doesn’t seem to be the case for heart attack,” Rothwell said. Hypertension appears to be closely related with stroke rather than heart attack, which is why a family history of hypertension is related to a higher risk of stroke.

In the report, all patients were enrolled in the ongoing Oxford Vascular Study. OXVASC, as the study is known, that began in 2002 to study strokes, heart attacks and other acute vascular events in a part of Oxfordshire County where more than 91,000 people are served by one hospital. Previous analyses in the same population conducted by lead author, Amitava Banerjee MPH PhD, have shown the particular importance of family history in mother-daughter transmission in both heart attacks and stroke. “Family history of heart attacks and family history of strokes have rarely been studied in the same population,” Banerjee said. The researchers used data from 906 patients (604 men) with acute heart ailments and 1,015 patients (484 men) who suffered acute cerebral events. Among the study’s findings:

*In the heart patients, 30 percent had one parent who’d had a heart attack, 21 percent had at least one sibling who had suffered a heart attack. Seven percent had two or more siblings who had heart attacks and 5 percent had two parents with heart attack.

*Among the patients with a stroke or transient ischemic attacks (TIAs, often called a mini-strokes or warning strokes), 21 percent had one parent who had a stroke, and 2 percent had two parents with stroke.

Eight percent had at least one sibling with a stroke and 14 percent had at least two siblings with stroke.

*The risk of a sibling developing acute heart problems was similar for those with heart attack or stroke.

*The risk for an acute cardiac event was six times greater if both parents had suffered a heart attack and one-and-a-half times greater if one parent had a heart attack. In contrast, the likelihood of stroke did not change significantly with parents’ stroke history. The findings, if confirmed by additional studies, hold two significant implications, Rothwell said.

“First, the way physicians predict the odds of a healthy person suffering a heart attack or stroke needs refining,” he said.“Currently, most risk models lump a patient’s family history of stroke and heart attack together. We probably should model family history of stroke and heart attack separately in the future.”

Source: Maggie Francis American Heart Association