Indian J. Prev. Soc. Med. Vol 34 No. 3 £4, 2003 | EDITORIAL: BREAST FEEDING - NATURE’S GIFT NEEDS TO BE PROPAGATED! Nisha Rani Agrawal’ & Deepali Gupta” Breast-feeding is an art and a skill. For successful breast feeding it requires matemal confidence and consistent information. As the knowledge about the advantages of lactation advances, it is imperative that the health care team continues to promote and nurture the art breast-feeding. The children are the hope of the world and the fountain of life, therefore, the national health programmes give priority to their needs. Among the international agencies, UNICEF has been at the forefront in the global promotion of a ‘child survival revolution’ (GOBLFP). It is here where breast-feeding came to be recognized as one of the global challenges. The breast-feeding is natural and has been practiced throughout the world since time immemorial. However, the first half of the twentieth century was marked by decline in breast-feeding in the industrialized world and little research concerning human milk was carried out whereas, the latter half of the century witnessed an upsurge in breastfeeding and a revival in its scientific interest due to its uniqueness for the newborn. Promotion of breast feeding begins with prenatal counseling of parents by the obstetrician. The pregnant woman if educated, should also be encouraged to read the literature available on breast feeding, as well as talk with other women who have nursed their babies successfully. Nipple assessment should be made to determine nipple potractability. The counseling includes making the mothers to be aware of the various benefits of breast-feeding to herself and the child. 1, Reader, 2. Resident, Dept. of Obstet. & Gynae. Institute of Medical Sciences, Banaras Hindu University, Varanasi, 221 005 {Indexed in : index Medicus (IMSEAR), INSDOC, NCI Current Content, Database of Alcohol & Drug Abuse, National | Database in TB & Alied Diseases, IndMED, Entered in WHO CD ROM for South East AsiaNisha Rani Agrawal & Deepali Gupta Breast Feeding- Nature’s gift needs to be propagated The breast-feeding lowers the risk of pre-menopausal breast cancer, ovarian cancer, postmenopausal fractures and certain infection delays the return of fertility, reduces blood loss and thereby prevents anaemia. It supports bonding with the infant, fosters an improved sense of self-esteem and successful mothering. Benefits to the child include- better cognitive development, better |.Q., decreased incidence of allergies, eczema, upper respiratory tract infections, NIDDM, gastroenteritis, otitis media, meningitis, pneumonia, sepsis, sudden infant death syndrome, and above all they experience lesser febrile illnesses thereby reducing health care cost. Thus, greater investment in the promotion of breast-feeding in our society would be a healthy and‘prudent step. Counseling of the mother includes answering all her queries, reinforcing the cultural and religious practices supporting breast feeding, displaying the materials showing correct techniques of breast feeding, discouraging the free formula distribution and advertisements and emphasizing on its contraceptive benefits. There are various guidelines for beginning of breast-feeding. They are: Baby should be nursed as soon as possible after the birth as ‘suckling reflex is strongest within half an hour of birth, repeat feeding on demand without any supplementation. Both breasts should be used for at least 7-10 minutes. The let down of the milk in first timers may take 3 to 5 minutes therefore strict time schedule for suckling can lead to ineffective let down. Breastfeeding for humans is a natural process therefore, it needs slight help and counseling from the health care providers to motivate mothers for breastfeeding. The signs of good breast-feeding are - hearing sound of swallowing at least at every third suck, adequate output of urine (light coloured six times or more), several stools each day (semi liquid and mustard yellow in colour), infant should regain birth weight by two weeks. Acceptable weight gain on an average is 500 gm per month or approximately 20 gm a day. Mothers can always gauge the adequacy of breast feeding by seeing parameters like counting the wet diapers- one on day 1, two on day 2, three on day 3, six per day from day 6 with 3 or more stools per day. She should inform the doctor if there is dehydration, jaundice or extra weight loss. Hunger cues are to be appreciated by the mother who is Indian J. Prev. Soc. Med Vol. 34 No.3 4 82 Juby-Dec., 2003Nisha Rani Agrawal & Deepali Gupta Breast Feeding- Nature’s gift needs to be propagated feeding the baby on demand, and these are - awakening at soft sounds, licking of lips, sticking tongue out, rooting towards breast, hand to mouth activity and crying which is soft to begin with, and gradually grows in intensity. A few common problems faced by the mothers are sore nipples, engorged breast, too little milk, breast refusal by the baby etc. These are usually due to wrong breastfeeding practices like incorrect latching, overanxious mother, timed feeding and lack of social support etc. - For sore nipples applying hind milk or any edible oil is very effective. Engorgement can be taken care by hand expression and cold compressions, at times it require pumping out and analgesics. Too little milk is a very common concern of the over anxious mothers. which only require continuous support and reassurance. A very important segment in 21% century is of working mothers, which requires innovations in breast feeding patterns for its continuation on resumption of their jobs like, they can feed their baby in the moming and night, pump and store the milk in the afternoon, can keep the baby around the work-place etc. Expressed milk can be stored at room temperature for 8 hrs, in refrigerator for 72 hours, in freezer for 3 months and in deep freeze for 12 months. There are certain perceived barriers to breast-feeding, which include loss of freedom, embarrassment, physical discomfort and lack of confidence e.g. mother's fear of insufficient milk, formula milk is superior and status symbol. This can easily be tackled by information, education and counseling of mothers banning the advertisement of formula by the mass media; statutory display on the formula cartons (in bold) ~“ the benefits of breastfeeding and hazards of formula”. Baby Friendly Hospital Initiative (BFHI) is a global effort to promote and support breastfeeding in 21% century by assuring that all maternity centres promotes protect and support breastfeeding and all women are provided with sound information regarding infant feeding. UNICEF/WHO guidelines of BFHI are : Indian J. Prev. Soc. Med Vol. 34 No.3 L 4 83 Juky.Dec., 2003