SUPPORTING BREASTFEEDING

HEALTH CARE

dr. Muhammad Ilham Aldika Akbar, SpOGDept/SMF Obgyn RSUA – RSUD Dr. Soetomo

Fakultas Kedokteran UNAIR Surabaya

dr. Muhammad Ilham Aldika Akbar SpOG, FK UNAIR

BREASTFEEDING SITUATION WORLDWIDE

dr. Muhammad Ilham Aldika Akbar SpOG, FK UNAIR

• Only 39 % of all infants 0–5 months of age in the developing world are exclusively breastfed

• Less than 60 % of 6- to 9-month-olds continue to be breastfed while also receiving solid, semi-solid or soft foods.

Percentage of infants 0–5 months old exclusively breastfed (2000–2007)

Percentage of Infants (0–5 months) Exclusively Breastfed, by Region (2000–2007)

INDONESIA ? Anak Usia 0-23 bulan yang:• Pernah Disusui 90.3 %• Masih Disusui 80.1 %

RiskesDas, 2010

dr. Muhammad Ilham Aldika Akbar SpOG, FK UNAIR

Presentase Pola Menyusui Bayi Usia 0-5 bulan Menurut Kelompok Umur

RiskesDas, 2010

dr. Muhammad Ilham Aldika Akbar SpOG, FK UNAIR

Presentase Kategori Menyusui Eksklusif Bayi Usia 0-5 Bulan Menurut Umur

RiskesDas, 2010

BENEFITS OF BREASTFEEDING

dr. Muhammad Ilham Aldika Akbar SpOG, FK UNAIR

• For The Babies:– Spesies spesific and age

spesific nutrients– Immunologic protection– Infection Protection– Changes composition to

meet the infants need– Biologic signals– Allergy prophylaxis– Psychological and

cognitive benefits

• For The Mothers:– Psychological– Enhancing postpartum

recovery– Contraception – Facilitating return to

prepregnancy state– Decreasing the risk of

ovarian and breast cancer– Lowering the incidence of

osteoporosis and hip fracture after menopause

Benefits Of Breastfeeding

dr. Muhammad Ilham Aldika Akbar SpOG, FK UNAIR

• Benefits for Society:– Fewer illnesses & fewer visit to psychian– Lower medical expenses– Less absenteeism from work– Lower cost for families and public program– Ecological issues – disposal of cans, bottles and

liners

dr. Muhammad Ilham Aldika Akbar SpOG, FK UNAIR

• Inadequate instruction, poor support, and lack of workplace accomodation

• Some are under psychian/obstetrician control (breastcrawl, rooming in)

• Ethnic and racial• Culture

Obstacles to Breastfeeding

dr. Muhammad Ilham Aldika Akbar SpOG, FK UNAIR

Purpose of Breastfeeding Promotion During Antenatal Care:

• Giving adequate information about the importances of breastfeeding

• Developing mothers confidence and self esteem about breastfeeding

• Provide special attention and support to special condition

dr. Muhammad Ilham Aldika Akbar SpOG, FK UNAIR

• 3rd steps from WHO Ten Steps to Succesfull Breastfeeding is: “Inform all women about the benefits and management of breastfeding”

• Breastfedding education as early as possible vital role of obstetricians and midwifes

• Informed consent informed decision

• Informed decision, needs:– Factual and accurate information– Understand the information– Self Confident– Social, family, and health provider Support

dr. Muhammad Ilham Aldika Akbar SpOG, FK UNAIR

DISEASE RISK

Infectious Morbidity Breastfed infants have lower risk of infectious morbidity in the first year of life, compared to formula-fed (Hamosh M, 2001)

Explained by spesific and innate immune factors present in human milk. Plasma cells from mothers bronchial tree and intestine migrate to mamary epithelium spesific Ig A (Nathavitarana KA et al, 1994)Oligosaccharide prevent attachment of respiratory pathogens such as Haemophilus influenza and Streptococcus pneumoniae to respiratory epithelium (Peterson JA et al, 1998)

Glycoproteins prevent binding of intestinal pathogens such as Vibrio Cholera, Eschericia coli, and rota virus (Peterson JA et al, 1998)

Otitis Media The risk of infants have otitis media is doubled in formula-fed compared with exclusively breast-fed infants (Ip S et al, 2007)

DISEASE RISKLower Respiratory Tract Infection Infant who were not breastfed faced a 3.6 fold increased risk of

hospitalization for LRTI, compared to exclusively breastfed infants (Metaanalisis, Bachrach & asc, 2003)

Gastrointestinal Infection Formula fed/ mixed formula-human milk infant were 2.8 times more likely to develop GI infection than exclusively breast-fed (Chien & Howie, 2001)

Necrotizing Enterocolitis (NEC) Among preterm infants, not being breastfed is associated with 2.4 fold risk of NEC with an absolute risk difference of 5% (Ip S et al, 2007)

Obesity and Metabolic Disease Formula fed infants were 1.1-1.3 times more likely to become obese than in breastfed (Owen CG et al, 2005; Arensz et al, 2004)

Also associated with 1.6 fold risk of type 2 DM (Ip S et al, 2007; Horta BL et al, 2007; Owen CG et al, 2005)

Increase risk for cardiovascular disease, higher blood pressure (Horta BL et al, 2007; Owen et al, 2006, 2003), and less favorable lipid profile (Owen CG et al, 2003)

DISEASE RISK

Neurodevelopment

Sudden Infant Death Syndrome Formula fed infants is associated with 1.6 to 2.1 fold of SIDS compared to breastfed (Ip S et al, 2007; McVea KL, 2000)

Infant Mortality Formula feeding is associated with 1.3 fold risk of infant mortality compared to breastfed (Chen A et al, 2004)

dr. Muhammad Ilham Aldika Akbar SpOG, FK UNAIR

ROLE OF EXCLUSIVE BREASTFEEDING IN INFANT HEALTH OUTCOME

Infant Health Outcome

Information Increasing Risk

Authors

Asthma Compared risk of developing asthma in formula fed baby than 3 month breastfed baby on children with positive family history

1.7 fold Ip and co, 2007

Compared risk of developing asthma in formula fed baby than 3 month breastfed baby on children without positive family history

1.4 fold Ip and co, 2007

Compared risk of developing asthma in less and more than 3 month breastfed baby

1.9 fold Gdalevich and asc, 2001

Atopic Dermatitis Compared risk of developing atopic dermatitis for infants with family history of atopy, for less 3 month and exclusively breastfed infant

1.7 fold Gdalevich and asc, 2001

Infant Health Outcome

Information Increasing Risk

Authors

Type I Diabetes Compared less and more than 3 month breastfed infants, associated with risk of developing type 1 diabetes

1.2-1.4 fold

Norris JM, Scott FW, 1996

Childhood cancer Acute Lymphoblastic Leukemia, compared formula fed children and breastfed children less than 6 month

1.3 fold Kwan ML, Buffler PA, Abrams B et al, 2004

Acute Myeloid leucemia, compared formula fed children and breastfed children less than 6 month

1.2 fold Kwan ML, Buffler PA, Abrams B et al, 2004

dr. Muhammad Ilham Aldika Akbar SpOG, FK UNAIR

INFANT FEEDING AND MATERNAL HEALTH OUTCOME

Maternal Health

Outcome

Information Authors

Breast Cancer Metaanalisis 47 study, Each year of breastfeeding was associated with 4.3% reduction risk of invasive breast cancerAssociation was stronger among women with first degree relative with breast cancer

Collaborative Group on Hormonal Factors in Breast Cancer, 2002

Ovarian Cancer

Never breastfeeding is associated with 1.3 fold higher risk of ovarian cancer

Ip S et al, 2007

Women who had never breastfeeding faced a 1.5 fold risk of ovarian cancer compared to 18 month breastfeeding women

Danforth and co, 2007

dr. Muhammad Ilham Aldika Akbar SpOG, FK UNAIR

THE OBSTETRICIAN’S ROLE IN PROMOTING AND SUPPORTING BREASTFEEDING

• Multiple study show evidence of higher risk in formula feeding baby & mothers compared to breast feeding

• Supporting breastfeeding ObGyn has powerfull and vital role improving health outcomes across 2 generation

dr. Muhammad Ilham Aldika Akbar SpOG, FK UNAIR

ObGYN Understimate The Importance of Breastfeeding Counseling During Antenatal

Care

Study of breastfeeding prevalence at 6 weeks post partum, DiGirolamo and co, show:

• 70% of women who thought their physician favored breastfeeding were still breastfeedingcompared to:

• 54% of those who thought their physician had no preference

dr. Muhammad Ilham Aldika Akbar SpOG, FK UNAIR

Textbooks Title Breastfeeding Chapter

Obstetrics, 4th ed (Gabbe et al) 28 pagesWlliams Obstetrics, 23rd ed (Cunningham et al)

6 pages

Management of High Risk Pregnancy, 5th ed (Queenan et al)

6 pages

Creasy and Resnik’s Maternal-Fetal Medicine, 6th ed (Creasy et al)

18 Pages (Gold Standard)

Protocols for High-Risk Pregnancies, 5th ed (Queenan et al)

7 pages

THE OBSTETRICIAN’S ROLE IN SUPPORTING BREASTFEEDING

During Antenatal Care

• Do not participate in formula marketing programs!

• Ask the patient, “What have you heard about breastfeeding?” Respond to her concerns and educate her about medical recommendations for 6 months of exclusive breastfeeding

• Provide anticipatory guidance about early initiation of breastfeeding, skin-to-skin care, feeding on demand, and rooming in

• For women with a history of breast reduction surgery or a difficult feeding experience with a prior child, refer to a lactation consultant for an antenatal consult

Intrapartum

• Provide anticipatory guidance about establishment of breastfeeding

• For women undergoing cesarean deliveries, encourage skin-to-skin contact in the recovery room to facilitate establishment of breastfeeding

• Educate labor floor staff about the importance of skin-to-skin contact.

During the Postpartum Hospitalization

• Ask “How is breastfeeding going?” Respond to specific concerns and emphasize recommendations for exclusive breastfeeding for the first 6 months

• Encourage rooming in and feeding on demand

• Ensure involvement of a lactation consultant if there is pain during feeding beyond the initial latch

• Collaborate with pediatric providers regarding maternal medications that may be of concern during breastfeeding. Use LactMed as a reference for evidence-based reviews of medication safety

• Provide referrals to breastfeeding resources in the community

At the Postpartum Visit

• Ask “How is breastfeeding going?” Respond to specific concerns and emphasize recommendations for exclusive breastfeeding for the first 6 months

• Provide guidance on expression of milk for return to school or work

• Offer to sign a letter to her employer regarding the importance of accommodations to allow continued breastfeeding. (Sample available at http://www.womenshealth.gov/breastfeeding/programs/business-case/outreach-marketing-resources.pdf.)

• Work with lactation consultants in your community to manage pain, low milk supply, or other breastfeeding concerns.

At Annual Well-Woman Visits

• Assess whether patients are currently breastfeeding.

• Be aware that the World Health Organization recommends a minimum of 2 years of breastfeeding for each infant.

• Refer to Breastfeeding Support Groups in community

dr. Muhammad Ilham Aldika Akbar SpOG, FK UNAIR

What World Organizations Recommend About Breastfeeding?

Organization Recommendation

The American Academy of Pediatrics (AAP)

Exclusive breastfeeding for the six months of life, followed by continued breastfeeding with the gradual introduction of solid food in the second six month of life. AAP recommends breastfeeding beyond the first year as long as mutually desired by both the mother and the baby

The American Dietetic Association (ADA)

Exclusive breastfeeding for the first 6 months of life and breastfeeding with complementary foods for at least 12 month in order to provide optimal nutrition and health protection.

The World Health Organization (WHO)

Breastfeeding continue for the first two years of life or longer.

Healthy People 2010 Goals of at least 75% of women initiate breastfeeding, at least 50% continue breastfeeding past six month, and for exclusive breastfeeding 60% at 3 month, and 25% at 6 month.

dr. Muhammad Ilham Aldika Akbar SpOG, FK UNAIR

WHAT QURAN SAY

لمن كاملين حولين أوالدهن يرضعن الوالداترزقهن له المولود وعلى ضاعة الر يتم أن أرادال وسعها إال نفس ف تكل ال بالمعروف وكسوتهنوعلى بولده له مولود وال بولدها والدة تضارتراض عن فصاال9 أرادا فإن ذلك مثل الوارثأن أردتم وإن عليهما جناح فال وتشاور منهماما متم سل إذا عليكم جناح فال أوالدكم تسترضعوابما ه الل أن واعلموا ه الل قوا وات بالمعروف آتيتم

بصير تعملون

dr. Muhammad Ilham Aldika Akbar SpOG, FK UNAIR

“Para ibu hendaklah menyusukan anak-anaknya selama dua

tahun penuh, yaitu bagi yang ingin menyempurnakan penyusuan. Dan kewajiban ayah memberi makan dan pakaian kepada para ibu dengan cara ma’ruf. Seseorang tidak dibebani melainkan menurut kadar kesanggupannya. Janganlah seorang ibu menderita kesengsaraan karena anaknya dan seorang ayah

karena anaknya, dan warispun berkewajiban demikian. Apabila keduanya ingin menyapih (sebelum dua tahun) dengan

kerelaan keduanya dan permusyawaratan, maka tidak ada dosa atas keduanya. Dan jika kamu ingin anakmu disusukan oleh orang lain, maka tidak ada dosa bagimu apabila kamu

memberikan pembayaran menurut yang patut. Bertakwalah kamu kepada Allah dan ketahuilah bahwa Allah Maha Melihat

apa yang kamu kerjakan.” [QS al-Baqoroh : 233]

THANK YOU dr. Muhammad Ilham Aldika Akbar SpOG, FK UNAIR