First hour feeding

The statistics are sobering. The Philippines is one of 42 countries that account for 90 percent of worldwide deaths of children under the age of 5. In fact, 82,000 of those deaths happened here. And as the World Health Organization (WHO) marks World Breastfeeding Day on August 1 by raising an alarm for the sorry state of infant health in the Philippines, it is no coincidence that such early deaths come hand in hand with these facts: only 16.1 percent of infants in the Philippines are exclusively breast-fed until their fourth or fifth month; 13 percent of infants were never breast-fed; and 39 percent of infants are on infant formula before they turn 1.

“It’s an ongoing and increasing problem,” says Dr. Howard L. Sobel, a pediatrician and medical officer of the WHO in the Philippines since 2003, who is working with the Expanded Program on Immunization that covers many areas of infant care. “No matter what the statistics are, what’s important is that they are that way, and they’re dangerous.”

It has been proven beyond doubt that breast milk is truly best for babies. “Children exclusively breast-fed are protected from illness and death,” says Dr. Sobel. “If you look at children who are formula-fed throughout the world, they are many times more likely to die than exclusively breast-fed children.” In fact, they are 15 times more likely to suffer from diarrhea, and 3.6 times more likely to develop pneumonia.

The World Alliance of Breastfeeding Action (WABA) has focused on the theme “Breastfeeding: The 1st Hour – Save One Million Babies!” in an effort to increase awareness of the critical value of early initiation into breast-feeding – that is, introducing an infant to the breast within an hour of its birth. That’s when colostrum, that potent mix considered a baby’s first immunization, is flowing. “Breast milk at the very beginning is filled with the mother’s antibodies, Vitamin A, God’s own mix meant for the newborn baby,” says Dr. Sobel. “This is meant for full protection, as babies are most vulnerable in their first month of life – their immune system is not yet mature, and they don’t have a lot of reserves.”

The concentration and potency of this colostrum diminishes with time, until it gets replaced with regular mother’s milk – still better by a long shot than anything you can buy on the market. Dr. Sobel cites a study in Ghana that proved how babies who were mix-fed with breast milk and infant formula within the first three days of life were nine times more likely to die than babies who were exclusively breast-fed in the first hour of life.

In fact, the earlier you bring a baby to the breast, the easier time you’ll have and “the more likely you are to continue breastfeeding,” says Dr. Sobel. The pediatrician calls it one of the “coolest things” he has seen in his line of work: “After a baby is born, clean it up a bit and put it on the mother’s belly, and it will crawl to the nipple and start sucking. Once you wash the baby, clean it, examine it, and hand it to the mother some four hours later, as is standard procedure in the US, it becomes disoriented, and that early reflex can be lost.”

With breastfeeding being both critical to infant health and an economic boon to mothers in developing countries, why isn’t it being done more? Dr. Sobel cites many factors, including the alarmingly aggressive marketing of substitutes in TV commercials and through the medical profession. A 2006 AC Nielsen report revealed that milk companies spent almost US$ 100 million (a whopping P4.6 billion pesos) on the advertising of breast milk substitutes.

“Women are quite confused by messages that come out,” says Dr. Sobel. That’s why a big part of Dr. Sobel’s work entails talking to urban and rural health workers, and making sure they know the details – not just that breastfeeding is healthier, but why, and how much healthier.

Dr. Sobel zooms in on some misconceptions that actually get in the way of practicing breastfeeding. First, there is the fact that mothers overestimate the size of their newborn’s stomach. “When asked, many mothers show me their fist.” Actually, it’s about the size of the top part of your thumb, from the middle joint to the end of the thumbnail. Mothers feel that they will be unable to fill up their baby’s stomachs, so they rely on formula. “What many mothers don’t know is that as a baby’s stomach gets bigger, more milk comes in, because the baby’s sucking reflex tells the mother’s brain to produce more milk.”

Second, many mothers think that even as they breastfeed, the baby may not be getting any milk. Dr. Sobel recalls when his own wife gave birth to their son. “I just watched his little Adam’s apple moving, and I knew he was swallowing.”

The biggest mistake, however, is when mothers think “I don’t have enough milk,” or worse, “I don’t have any milk.”

“A pure misconception,” Dr. Sobel says. “Every mother has milk. It’s exceedingly rare that there’s a medical problem and there’s no milk, but more than 99 percent of the time they should be able to breastfeed. It’s just a matter of proper breastfeeding – starting early, and doing it frequently.”

Then there’s the hurdle of the working mom. Even when they do opt for breastfeeding, many mothers stop doing so when they return to work after three months. Sobel believes these problems can be addressed, as well. “We need baby-friendly workplaces with areas for breast-pumping, and a refrigerator for storing expressed milk. But the important thing is to help companies understand that we should be prioritizing breastfeeding, and not promoting a shift to substitutes.”

In a statement for World Breastfeeding Week this coming August 1-7, WHO country representative Dr. Jean-Marc Olivé says in no uncertain terms that, to save their lives, “infants should be exclusively breastfed for the first six months of life, and at six months of age should receive adequate complementary foods while breastfeeding continues for up to two years of age and beyond.” Indeed, breast milk is free, it’s portable, it’s abundant, and it was made especially for your baby. Does it really make sense to deprive your child of the very substance of life?