FAY­OLA K J FRAS­ER

Au­gust 1 - 7 marks World Breast­feed­ing Week, and the theme of 2023 is “Let’s make Breast­feed­ing at work, Work.”

Ac­cord­ing to the World Health Or­ga­ni­za­tion (WHO), breast­feed­ing is one of the most ef­fec­tive ways to en­sure op­ti­mal child health and sur­vival. Breast milk is ide­al for in­fants as it has the prop­er­ties, en­er­gy and nu­tri­ents for in­fant growth dur­ing the first months of life, and al­so con­tains an­ti­bod­ies which help pro­tect the child against many com­mon child­hood ill­ness­es.

In T&T, the Na­tion­al Breast­feed­ing Co­or­di­nat­ing Unit at the Min­istry of Health spear­heads the ef­forts of pro­mot­ing and ad­vo­cat­ing for breast­feed­ing.

The Unit has the man­date to lead the ini­tia­tive in en­sur­ing that hos­pi­tals in T&T are ba­by-friend­ly. This ini­tia­tive of “ba­by-friend­ly” hos­pi­tals was a strat­e­gy cre­at­ed in 1991, at a time when many in­fants were suf­fer­ing from gas­troin­testi­nal ill­ness­es as a re­sult of in­ap­pro­pri­ate breast milk sub­sti­tutes. The WHO and UNICEF, along with oth­er in­ter­na­tion­al agen­cies, de­vel­oped a frame­work for coun­tries to im­ple­ment, to con­front in­fant mor­tal­i­ty.

Breast­feed­ing, as a nat­ur­al and com­plete source of nu­tri­tion, con­tain­ing the ad­e­quate amounts of fat, pro­tein, wa­ter and an­ti­bod­ies for the new­born, was seen as the so­lu­tion. The frame­work is a glob­al ini­tia­tive called the “Ten Steps to Suc­cess­ful Breast­feed­ing” (re­vised in 2018), which sum­ma­rizes the core prin­ci­ples to pro­mote best prac­tice for breast­feed­ing world­wide.

In 2020, the Min­istry of Health de­vel­oped and im­ple­ment­ed a Na­tion­al Breast­feed­ing Pol­i­cy at all the hos­pi­tals and at all five Re­gion­al Health Au­thor­i­ties in T&T. This pol­i­cy cov­ers teach­ing women to make the most in­formed de­ci­sions about their child’s nu­tri­tion, en­sur­ing all staff are skilled and equipped to sup­port new moth­ers in breast­feed­ing, and pro­vid­ing ac­cu­rate in­for­ma­tion to the women who are un­able to breast­feed.

All Re­gion­al Health Au­thor­i­ties have im­ple­ment­ed the ten steps, but are at vary­ing de­grees of progress in this im­ple­men­ta­tion. The Na­tion­al Breast­feed­ing Co­or­di­nat­ing Unit is al­so work­ing close­ly with hos­pi­tals so that they can be­come ful­ly ac­cred­it­ed as ba­by friend­ly hos­pi­tals.

Aside from be­ing ba­by-friend­ly, the Unit is im­ple­ment­ing moth­er-friend­ly care be­fore, dur­ing and af­ter child­birth. One of the changes the Unit has spear­head­ed is, where­as in the past, on­ly the moth­er was al­lowed in­to the de­liv­ery room dur­ing child­birth, now the moth­er can have a “sup­port part­ner” in the room with her dur­ing labour. An­oth­er change has been al­low­ing moth­ers to choose the most com­fort­able po­si­tion to de­liv­er their ba­by, and it is no longer re­quired that they be re­strict­ed to a ly­ing po­si­tion. The Unit is al­so very in­volved in ad­vo­ca­cy and teach­ing, and en­sures women re­ceive the best in­for­ma­tion dur­ing their preg­nan­cy.

Pre-child­birth, the unit strong­ly en­cour­ages ex­pec­tant moth­ers to at­tend Lamaze class­es (child­birth ed­u­ca­tion class­es) as part of their ef­fort to bet­ter ed­u­cate and in­form preg­nant women. Women who at­tend an­te­na­tal clin­ics at the var­i­ous hos­pi­tals are ed­u­cat­ed on the ben­e­fits of breast­feed­ing to both the moth­er and ba­by, and what they can ex­pect af­ter child­birth.

In the first few days af­ter giv­ing birth, breast­feed­ing is con­sid­ered crit­i­cal­ly im­por­tant, as colostrum is pro­duced in breast­milk, a sub­stance high in pro­tein and low in fat and sug­ar. Colostrum is de­scribed by the Man­ag­er of the Na­tion­al Breast­feed­ing Co­or­di­nat­ing Unit of T&T, De­bra Thomas, as “pow­er-packed”, filled with white blood cells that pro­duce an­ti­bod­ies and help the ba­by to de­vel­op its im­mune sys­tem.

The Unit al­so sup­ports moth­ers post-child­birth, by en­sur­ing doc­tors, nurs­es and sup­port groups are trained to guide women how to prop­er­ly po­si­tion the ba­by for breast­feed­ing. Moth­ers who are ei­ther med­ical­ly un­able to breast­feed, or de­cide not to, are re­ferred to the sub­ject mat­ter ex­perts - such as di­eti­tians and pe­di­a­tri­cians - who show the moth­er how to cor­rect­ly pre­pare al­ter­na­tive sub­stances.

Thomas stress­es the grave im­por­tance of un­der­stand­ing the need for ut­most at­ten­tion to hy­giene in the prepa­ra­tion of al­ter­na­tive sub­stances. Guid­ed by the WHO, Thomas al­so en­cour­ages women to “cup feed” rather than us­ing ba­by bot­tles, as it is more hy­gien­ic and car­ries less risk to the ba­by.

At the core of the Na­tion­al Breast­feed­ing Co­or­di­nat­ing Unit, is a fo­cus on ed­u­ca­tion. The Unit has de­vel­oped a guide on breast­feed­ing, avail­able at all pub­lic and pri­vate health fa­cil­i­ties, and can al­so be ac­cessed on the Min­istry of Health web­site. They al­so en­cour­age women to join sup­port groups well ahead of de­liv­ery, where in­for­ma­tion and ad­vice is shared via moth­er-to-moth­er coun­sel­ing, and pro­fes­sion­al health coun­sel­ing.