dr. Arien Himawan,M.KesPPDS Gizi Klinik

Th 2012

Breast-Feeding

Culture and Breast Feeding

a Interviews with caregivers of children born in 2009 will continue through December 2012. Provisional rates for children born in 2009 will be updated with final estimates once data becomes available in August 2013.  See survey methods for details on study design.bExclusive breastfeeding is defined as ONLY breast milk — NO solids, no water, and no other liquids.

Provisional rates of any and exclusive breastfeeding by age among children born in 2009, National Immunization Surveya,b

Historical Trends in Breast Feeding

THE DEMOGRAPHICS AND

DETERMINANTS OF BREAST-FEEDING

Ethnicity and Breast Feeding in US

10 LANGKAH MENUJU KEBERHASILAN MENYUSUI Protecting, Promoting and Supporting Breastfeeding: The Special Role of Maternity Services, suatu pernyataan bersama WHO dan UNICEF

1.Sarana Pelayanan Kesehatan (SPK) mempunyai kebijakan Peningkatan Pemberian Air Susu Ibu (PP-ASI) tertulis yang secara rutin dikomunikasikan kepada semua petugas.

2.Melakukan pelatihan bagi petugas dalam hal pengetahuan dan ketrampilan untuk menerapkan kebijakan tersebut.

3.Menjelaskan kepada semua ibu hamil tentang manfaat menyusui dan penatalaksanaannya dimulai sejak masa kehamilan, masa bayi lahir sampai umur 2 tahun, termasuk cara mengatasi kesulitan menyusui.

4.Membantu ibu mulai menyusui bayinya dalam 30 menit setelah melahirkan , yang dilakukan diruang bersalin. Apabila ibu mendapat operasi Caesar, bayi disusui setelah 30 menit ibu sadar.

5.Membantu ibu bagaimana cara menyusui yang benar, dan cara mempertahankan menyusui meski ibu dipisah dari bayi atas indikasi medis.

6.Tidak memberikan makanan atau minuman apapun selain ASI kepada bayi baru lahir.

7.Melaksanakan rawat gabung dengan mengupayakan ibu bersama bayi 24 jam sehari.

8.Membantu ibu menyusui semua bayi semau bayi, tanpa pembatasan terhadap lama dan frekuensi menyusui.

9.Tidak memberikan dot atau kempeng kepada bayi yang diberi ASI.

10.Mengupayakan terbentuknya Kelompok Pendukung ASI (KP-ASI) dan rujuk ibu kepada kelompok tersebut ketika pulang dari Rumah Sakit/ Rumah Bersalin/ Sarana Pelayanan Kesehatan.

The good news is that the U.S. has achieved the first goal

Indonesia

Data Dinkes Jatengjuga menyebutkan bahwa pencapaian

sasaran ASI ekslusif dari tahun 2007 terus mengalami peningkatan yakni dari 27,35 persen (2007); 28,82 persen (2008), 40,06 persen (2009), dan 52,3 persen (2010).

SOCIOCULTURAL DETERMINANTS OF BREAST – FEEDING IN THE UNITED STATES

• The major determinants of breast-feeding in the United States, include : Age : Younger mother breast-feeding much less

frequently than older mothers (tend to breast-feed for longer periodes)

Parity : Multiparious and Primiparious women initiate breast-feeding at similiar rates

Geographics differences : Women from western states are much more likely to breast-fed than women from Souther or Eastern states

Marital status : Unmarried women are much less likely to breast-feeding than mmarried women

Education : At least one year of college-level education is a strong postive predictor of breast-feeding

Income : Poverty is associated with decreased rates of breast-feeding. Women from households with the lowest family income are only half as likely to nurse their infants as those with family incomes more than $25,00/year.

Employment : Maternal employment outside the home influences breast-feeding mothers working full time are less likely to initiate breast-feeding and much less likely to breast-feeding at six months compared with women working part time or not working

Sociocultural Determinants ofBreast –Feeding in US

BREAST-FEEDING IN THE DEVELOPING WORLD

Breast-feeding was nearly universal in the developing regions of the world until the middle of the twentieth century

During 1940 – 1970 as formula feeding displaced breast feeding in the industrialized country

1950 to 1970, breast-feeding rates sharply declined in many developing regions, particullary among the urban poor effects on infant morbidity and mortality

In impoverished developing countries, formula feeding is associated with sharply higher rates infection and lower rates of infant survival, compared with breast-feeding Manufactured formula lacks the immunological and other health-promoting factors of breast milk

In the poor countries of the developing world, water supplies are often contaminated and unsanitary water used to clean bottle and mix formula carries pathogenic bacteria, viruses and parasites

In these enviroments, bottle feeding can be a dangerous source of infection more susceptible to infectious diarrheal illness

in 1981 documented the high cost to infant health 1 milion infants deaths were attributable to contaminated infant formula WHO/UNICEF approved the International Code for marketing of breast Milk substitutes

Breast-feeding is the most important form of contraception in many highly populated developing countries.

Anovulation during breast-feeding contributes to child spacing by providing a period during which the mother can recover from her previous pregnancy before beginning a new one

1978 guidelines endorsing breast feeding by american Academy of Pediatrics and The Canadian Pediatric Society

Many developing country have taken firm step to discourage use of breast milk substitutes

In the mid 1970s Papua New Guinea enacted low forbidding the advertisement of leading bottles and formulas and made both available only by prescription

In1989 WHO reported on rate of breast feeding in 15 developing countries in Asia, Africa and Latin America

To reaffirm the impotance of breast feeding WHO and UNICEF issued the Innocenti Declaration in1990 This report put forth major goals designed to protect, promote, and support beast feeding around the world

MATERNAL EMPLOYMENT AND BREAST-FEEDING

Over half of all women in the United Stated with children 3 year old are in the workforce and most work full time

Many of these women return to work during lactation and some continue to sucessfully breast-feeding while working

However depending on the life situation and type of job, breast-feeding while working can be a challenge

The mother can continue to breast-fed when she is home but have her infant consume formula when she is away at work

When the mother is away, the infant can be fed stored milk-milk that is expressed from the breast and frozen for that purpose

Less commonly, she can have the baby brought to her at work for feedings or she can return home througouht the day for feeding

The Family and Medical Leave Act (FMLA), makes it easier for a new mother to breast-feed her infant during early pregnancy.

The FMLA says that workers at large firms have a right to take up to 12 weeks of unpaid leave to care for a new baby or a close family member with a serious health condition.

When possible, the working mother should have a minimum of four to six weeks at home with her baby after birth.

This period allows the mother and infant to develop a close attachment and enables the mother who chooses to breast-feed time to fully establish lactation.

The Baby Friendly Ten Steps to Successful Breastfeeding

1. Have a written breastfeeding policy that is routinely communicated to all health care staff.

2. Train all health care staff in skills necessary to implement this policy.

3. Inform all pregnant women about the benefits and management of breastfeeding.

4. Help mothers initiate breastfeeding within 1 hour of birth.

5. Show mothers how to breastfeed and how to maintain lactation, even if they are separated from their infants.

6. Give newborn infants no food or drink other than breast milk, unless medically indicated.

7. Practice "rooming in"— allow mothers and infants to remain together 24 hours a day.

8. Encourage breastfeeding on demand.

9. Give no pacifiers or artificial nipples to breastfeeding infants.

10. Foster the establishment of breastfeeding support groups and refer mothers to them on discharge from the hospital or clinic

A STEP–BY- STEP APPROACH TO BREAST-FEEDING

THE DECISION TO BRAEST-FEEDThis important decision is usually made early :

about 30% of families decide before pregnancy over 90% by the end of the first trimester of pregnancy

(Post and Singer 1983)A mother choice of feeding methode is

determined by a number of individual, family and sociocultural factors :The emotional motivations The attitude of family members and friendsSocial trends and role models

BREAST-FEEDING EDUCATIONMany hospitals and clinics have developed

breast-feeding education programs

PREPARATION FOR BREAST- FEEDINGNIPPLE CONDITIONING

Mothers should be reassured that breast size does not influence lactation

NIPPLE INVERSION

EARLY BREAST-FEEDINGTHE POSTPARTUM ENVIRONMENTINITIATING BREAST- FEEDINGTHE FIRST FEEDINGSADVANTAGES OF EARLY FEEDINGS

THE FIRST TWO MONTHS OF BREAST-FEEDING

FEEDING PATTERNSBy the third or fourth postpartum day, an infant

typically breast-feeding about 7-8 times a dayconsume 300-400 ml of milk/24 hours Feeding periods average about 10 minutes each breast

The small size of the infant’s stomach the infant will need to be fed frequentlysome infants feeding up to 12-14 times a day

MATERNAL–INFANT BONDINGa sense of belonging security and attachment from

the warmth of the mother’s bodyThe closeness and time spent together in the first

month postpartum are important factors in maternal-infant bonding

IMPORTANCE OF SUPPORT FOR THE MOTHERSupport and guidance for the mother during this

periode are critical to continued breast-feeding, especially for young, first –time mothers

New mothers struggling with sore nipples or breast engorgement need to be reassured that frequent feedings are not a sign of insufficient milk and infant hunger, but the normal breast –feeding pattern

STOOLING PATERNS OF THE BREAST–FEEDING INFANTStooling begin shortly after birth and during the first several

days, meconium is passed and the stool appears black and tarry. With each successive feeding , the stool lightens in color and becomes more liquid

After the first week, the breast-feedig infant’s stools are a mustrad yellow liquid with a yeasty odor.

The mother of the breast-feeding infant shoud be aware that many small, yellow, liquid stools are not diarrhea, but the normal pattern for reast-fed infants.

BREAST–FEEDING FROM TWO TO SIX MONTH

FEEDING PATTERNSAPPETITE SPURTSPOTENTIAL PROBLEM FOODS IN THE

MOTHER’S DIET

BREAST–FEEDING SIX MONTHS AND BEYOND

ADDING SOLID FOODSTEETHINGPSYCHOLOGICAL BENEFITS OF NURSING

WEANING

HOW LONG SHOULD A MOTHER BREAST – FEED ?

THE PROCESS OF WEANINGMATERNAL HEALTH DURING WEANINGWEANING AND INFANT HEALTH IN THE

DEVELOPING WORD

RELACTATION AND INDUCED LACTATION

EXTRACTION AND STORAGE OF BREAST MILK

MANUAL EXPRESSION OF MILKBREAST PUMPSMILK STORAGE

MATERNAL CONCERNS DURING BREAST-FEEDING

INSUFFICIENT MILK AND FAILURE TO THRIVE

TOO MUCH MILKBREAST PROBLEM

EngorgementLeakingNipple sorenessPlugged Milk DuctsMastitis and Ereast Abscesses

Breast-Feeding in Special Situations

Casarean BirthBreast feeding twinsBreast feeding after Breast surgeryMaternal Disorders

Diabetes MellitusChronic diseasesMaternal infections

Infant DisordersRespiratory infectionsCleft lip and palateBreast milk JaundiceMetabolic Disorders

Breast-Feeding and The Human Immunodeficiency

Virus

Mothers infected with the human immunodeficiency virus (HIV) can pass the virus to their infants during breast feeding

HIV has been isolatedMother who develop HIV infection postnatally, the

risk of transmission during breast feeding In 1985 the US center for diseases recommended

that HIV infected women be discourages from breast feeding, a policy widely adopted by the other industrialzed countries

A recent study in Africa found that HIV positive mothers deficient vitamin A are more likely to transmit the virus during the perinatal period

Breast Fedding and Infant Health

Human breast milk, is specific : evolved to meet the unique nutritional

requirements of human newborns ensure optimal growth and development

The best source of nutrition for full term infants during the first four to six months postpartum (AAP 1993)

No manufactured formula can duplicate the biologically specific physical structure and nutrient composition of human milk

Protein in Human MilkMature human milk contains much less protein(0.8

g versus 3.5 g / 100 ml) than cow’s milkA major difference is the concentrations of the

whey and casein protein80% of the protein in cow’s milk are casein

proteins, 40% of human milk protein is caseinDuring digestion in the infant’s gastrointestinal

tract, whey and casein proteins have distinct characteristics

Caseins precipitate into sizable curds in the newborn’s stomach that are tougher and less readily digestible than the softer, more flocculent clumps formed when they whey protein presipitate

Whey proteins are consequently often better toleranted by the newborn

The protein content of breast milk is considered ideal for human infants

Human milk proteins are complate and balanceSupplying optimal anounts of the essential and

nonessential amino acidsRich in cystine and taurine (taurineis found at

levels 30 times that in cow’s milk)Human milk contains only moderate amounts of

phenylalanine, tyrosine and methionineThe enzym system that metabolize these amino

acids mature late in fetal life (Rassin 1991)Preterm infants over consumption of these

amino acid can increase blood level to potentially detrimental levels

Vitamins, Minerals, and Enzymes in Human Milk

Protection from Infectious DiseasesProtectionFromAllergies

Breast feeding, maternal diet and Infant Allergy

Breast feeding and Chronic Diseases of Later Life

Breast Feeding and Infant Mortality

In the developing countries of the world formula fed infants have sharphy higher mortality rate

The protective effect of breast feeding is particulary strong during the first year mortality rate reduced in infants up to age 3 years

Differences in mortality are primarily due to differences in rate of infection between formula fed and breast fed infants(Wray 1991)

In US mortality rates are low for both breast fed and formula fed infants it is not clear whether breast feeding still confers a protective effect (Wray 1991)

Structures, Policies, SystemsLocal, state, federal policies and laws to

regulate/support healthy actions

InstitutionsRules, regulations, policies &

informal structures

CommunitySocial Networks, Norms, Standards

InterpersonalFamily, peers, social networks,

associations

IndividualKnowledge, attitudes,

beliefs

Levels of Influence in the Social-Ecological Model

Thank You