Working mothers too can breastfeed

By Carol Aloysius

In spite of the enormous benefits of breastfeeding in terms of reducing child mortality rates and increasing child survival rates of those below five years, there are still many mothers who opt to switch to formulae feeding once they return to work.

The common excuses for depriving their child of the best milk it can have in the formative years of its life, are mostly related to issues they face in their work places. They include, lack of separate baby friendly rooms, and absence of baby care givers who could look after their infants while they are at work.

A recent discussion at the Health Education Bureau on the benefits of breast feeding while highlighting the intrinsic value of exclusive breastfeeding for six months of a child’s life, also brought to light a disturbing fact; Many working mothers worldwide and in Sri Lanka shortened the six months recommended by both the WHO and UNICEF to four months once they completed their maternity leave.

The collective opinion of the speakers at this discussion was that this decision on the part of working mothers could have drastic effects on the new-born with life long adverse health impacts.

Consultant Community Physician Dr Dhammika Rowel, Family Health Bureau was among several other health officials who made a strong case for all working mothers continue to breastfeed.

In her presentation “Why working mothers can breastfeed’, she cited WHO and UNICEF reports which stated that newborn deaths in the first 28 days which had now dropped dramatically due to improved health care and interventions, now represent around 44 percent of all child deaths under five years.

Most of these deaths were from preventable causes including prematurely, childbirth complications and new born infections.

Immediate skin to skin contact and early initiation of breastfeeding within an hour of birth could reduce b neonatal mortality significantly, she said.

“Due to the endless benefits of breast milk in helping children to have a good start in life, we must make sure that all working mothers continue to breastfeed their babies even when they go back to work”, she stressed. “Working mothers in Sri Lanka have excellent maternity benefits with full pay and half pay and without pay if they wish. So they should make use of these benefits if they want to ensure their children receive optimal benefits from breast milk which is the best milk a child can have,” she said.

But how, a question was raised.

“We need to educate working mothers of their rights and these benefits. We need to also educate the heads of institutions of the benefits of giving these mothers these rights and creating more baby friendly surroundings for new mothers”, she replied.

Stressed

She also noted that when a mother goes back to work after her maternity leave, she is often stressed and tense, and more likely to be worried how her baby is being looked after at home while she's at work.

“My advice to them is, treat the first two weeks of returning to work like the first two weeks post partum when mothers are stressed and anxious unduly.

Relax.

Things may not always go smoothly. But the chances are you will settle into a predictable rhythm.

Every mother can tailor-make her own program of how to feed her baby with her own milk even when she's away at work, she pointed out.

This was by expressing her milk before she leaves for work, and giving it to the caregiver to feed her child, while she’s away from home.

"This will ensure the child gets his full quota of breast milk for the scheduled six months. A working mothers knows at what time she needs to be at her workplace in the morning, or whatever time she’s expected to be there. So she must choose the time closest to her departure to express her milk into a cup or cups, sufficient to last for the time she’s away at work."

Q. Any guidelines on this procedure?

A. Leave yourself enough time to express the milk in a relaxed way.

Express as much as you can into several cups and store in a cool place.

* Leave about one cupful (100 ml) for each feed. Cover the cup and store it in the coolest place or in a fridge. Invest in a fridge if you can as it is the best place to store the milk.

Q. When is the right time to give baby its milk feed?

A. On demand. Whenever it cries.

Q. Should the milk be given straight from the fridge? Should it be boiled?

A. I say NO to both questions. Before feeding, the care giver must warm the milk by keeping it in a bowl of warm (not hot) water.

They must NOT reheat the milk either as heat destroys many of the proactive factors that can benefit the child. And they should NOT re-use milk that the baby has left over.

“Work according to your own time,” she advised mothers.

“That way you can exclusively breast feed your child for six months. If for some very good reason you cannot do this, you may start the child on complementary feeding with your doctor's advice.

But NO milk powder please! Even one bottle of artificial milk can harm your child. Continue to express your milk and breast feed your child when you return home. Each time you breast feed your baby; it increases the volume of milk as suckling is more efficient than hand expression.

Q. Any tips for mothers who may experience problems with sudden leaks from an excess of breast milk while at work?

A. My advice is that they should express milk every three hours.

Do this in whatever quiet place you can find. Keep a box of breast pads to avoid leakages and spills! Stay hydrated. Keep a bottle of H2O.

Finally give yourself a plus point and congratulate yourself every time you manage to go through another extra day of giving your child the benefits of exclusive breast milk!

Q. Advice to parents and husbands?

A. For a working mother to achieve this goal of exclusive breastfeeding for first six months of a child's life, she must have the support of her husband and her extended family.

They must encourage her to do this for the sake of the child's health.

They must recognise the rights of the child to enjoy the highest attainable health. When a mother is in the hospital, many parents are often in a hurry to take the mother back home even before breastfeeding is properly established.

They must wait till the mother's milk starts flowing well and the baby is sucking well, before the child is taken back home. This practice must be continued and sustained for the next six months even after the mother returns to work. The International Code of Marketing of Breast milk substitutes has banned the distribution of free supplies of infant formulae and samples to pregnant women, to encourage this habit.

Consultant Neonatologist, Dr Nishani Lucas in her presentation; ‘Why should we breastfeed? said that the high literacy rates in the country gave Lankan mothers an edge over mothers in the region since education and literacy went hand in hand with promotion of health habits - especially breastfeeding.

There were however knowledge gaps which needed to be identified and filled among pregnant women.

“All mothers who come to our hospital at De Soyza Maternity Hospital are counselled on the dangers of not breastfeeding their babies immediately after birth and advised against giving their babies other fluids.

We make it a point to ensure that even babies of disabled mothers who are critically ill, paralysed, in the ICU, or after a Caesarian Section, can still receive their mother’s milk by getting their care givers or our own trained nurses to express the milk from the mother and feed it to the baby in a cup.

Q. Do you allow bottle feeding of breast milk?

A. No. We never use bottles even to give breast milk to a baby, since bottles can do more harm than good as they can become contaminated and cause infections.

Nor do we give formulae milk unless we have absolutely no other option. Almost all our babies including triplets have survived and are in good health today because they have been fed with breast milk exclusively for six months.

If however you were to visit a paediatric ward and look at the sick children there today, you are likely to find that most of them have been bottle fed with artificial milk. Our policy is No bottle feeding, No teats and No pacifiers.

Consultant Community Physician, Family Health Bureau, Dr Hiranya Jayawickrama, endorsing her views explained how Sri Lanka contributed to achieving the ten Millennium Development Goals (MDGs).

These included: exclusive breast feeding for six months and continued breastfeeding together with appropriate complementary feeding for two years and beyond: achieving universal primary education for all children by giving them a healthy start to life with breast milk: reducing infant mortality rates (13 percent can be reduced with improved breast feeding practices and 6 percent with improved complementary feeding:) preventing malnutrition in under five year olds: decreasing maternal postpartum blood loss, breast cancer, ovarian cancer, endometrial cancer and: encouraging child spacing. She said even healthy mothers who have HIV and are receiving treatment can now breast feed their babies as new findings had shown that exclusive breast feeding together with antiretroviral therapy for mothers and babies can significantly reduce transmission of HIV from mother to child.

Our message is that, “Breast milk is the best and only milk a child should have for the first six months to help him/her grow and develop physically, mentally and emotionally”, she concluded.

Fighting HIV infection with the body's natural virus killers

Using the body's natural virus killers to prevent and treat HIV infection has been problematic until now because of the strong inflammatory response these molecules can arouse as they get rid of the invaders.

Now, collaborative research conducted by scientists have demonstrated how suppressing the activity of these molecules - interferons - around the time of infection could have long-term implications for the course of the disease.

Interferons, named for their ability to “interfere” with viral replication, protect us against disease, but they are also the source of inflammation when we are sick. Today, interferons are used to treat such viral diseases as hepatitis.

But in HIV, it has been thought that the inflammation and other side effects could be too harmful and the danger of a “runaway” immune response too great. Prof. Gideon Schreiber and team, including postdoctoral fellow Dr. Doron Levin and former postdoc Dr. Ganit Yarden, had, in previous research, designed an antagonist molecule that is able to block some of the activities of interferons while still allowing them to proceed to act against viruses. Their original motivation, says Schreiber, was to better understand the mechanisms of different versions of the interferon molecule.

This research revealed that that the activity of each interferon is tuned to specific cells and viruses. The molecule they had created, says Schreiber, “was not a true ‘antagonist’ in the biological sense: instead of blocking all IFN activity, it was able to target the mechanisms leading to prevention of replication and modulation of the immune system, leaving the antiviral activity mostly intact.”

Next, Schreiber and his group teamed up with Dr. Netanya Sandler and Prof. Daniel Douek at the NIH to understand what happens when full-out interferon activity is tampered with in HIV.

The research was done on simian immunodeficiency virus (SIV) - the animal equivalent to HIV. Their results show that the actions blocked by the molecule may have important functions,

even if they appear to be “detrimental.”

The team administered an antagonist, blocking a particular interferon known as Type 1 IFN for the first four weeks after infection. Even after this short period, they found that the natural immune system activities did not recover and compensate to the level they otherwise would have; and this led to a progression of the disease.

Schreiber: “These results clearly demonstrate the importance of an early, general IFN response in fighting HIV infection, and removing the ‘harmful’ IFN functions even for just a short period at the onset of infection can have devastating and permanent consequences in shaping the course of disease.” Taken together, these findings suggest that not only the type of treatment, but also the timing of IFN administration needs to be considered in the management and prevention of disease.

- medicalxpress

Heat stroke can be life-threatening for endurance runners

Heat stroke is 10 times more likely than cardiac events to be life-threatening for runners during endurance races in warm climates, according to a new study.

The authors noted the findings may play a role in the ongoing debate over pre-participation ECG screenings for preventing sudden death in athletes by offering a new perspective on the greatest health risk for runners.Two of the most recognised causes of sudden death during an endurance race are arrhythmic death, sudden death usually caused by undetected heart disease in a young and seemingly healthy person, and heat stroke; however, the authors noted sudden death from an undetected heart condition often receives more attention from the medical community and the media.

Due to the increasing popularity of races over 10 km (6.2 miles), or endurance races, researchers sought to determine how many life-threatening events during endurance races were caused by heat stroke compared to cardiac events.

A life-threatening event was defined as an event requiring mechanical ventilation and hospitalisation in an intensive care unit. Researchers reviewed data on all deaths and urgent hospitalisations at 14 popular long-distance races in Tel Aviv from March 2007 to November 2013.

Overall, 137,580 runners were studied. Only two serious cardiac events were reported during the time period and none were fatal or life threatening.

In contrast, over the same period, there were 21 serious cases of heat stroke, including two that were fatal and 12 that were life-threatening. Under Israeli sports law, ECG screening is required for participants who are organised in teams or associations, but not for individuals in public endurance races.

Runners were only required to submit a personal statement confirming a state of good health. Researchers, therefore, asked 513 runners who were surveyed at the 2013 race whether they had undergone an ECG screening. Only 35 percent reported an ECG in the previous year and 46 percent said they had an ECG in the previous five years, reducing the possibility that the low number of cardiac events stemmed from at-risk runners being screened out before the race.

- MNT

Stem cells from nerves form teeth

Researchers have discovered that stem cells inside the soft tissues of the tooth come from an unexpected source, namely nerves. These findings are now being published and contribute to brand new knowledge of how teeth are formed, how they grow and how they are able to self-repair.

Our health and quality of life is closely linked to our dental health. With age, our teeth become more susceptible to infection, wear and damage, and it is important for the health services to help people maintain good dental health. It was previously known that the living, soft part of the tooth, or the pulp, in addition to connective tissues, blood vessels and nerves also contains a small reserve of stem cells.

These stem cells are capable of repairing the tooth when it has been damaged by assisting the reformation of both hard and soft tooth tissue. Researchers have long been discussing the origin of these stem cells. By studying the teeth of mice, the researchers behind this new study have been able to map the fate of individual cells.“We have identified a previously unknown type of stem cells that surprisingly enough belong to the nerves of the tooth; these are nerves that would normally be associated with the tooth's extreme sensitivity to pain,” says Kaj Fried at the Department of Neuroscience, one of the head researchers responsible for the study.

The researchers discovered that young cells, which at first are part of the neural support cells, or the glial cells, leave the nerves at an early stage of the foetal development. The cells change their identity and become both connective tissues in the tooth pulp and odontoblasts, i.e., the cells that produce the hard dentin underneath the enamel. Today we do not have the possibility of growing new teeth in adults, but the discovery of this new type of stem cells is an important step towards the knowledge and technology that is required to make it a future possibility.

“The fact that stem cells are available inside the nerves is highly significant, and this is in no way unique for the tooth.

- MNT