Dr Smita Dashora with her daughter Shinjini. Courtesy: Smita Dashora).
Dr Smita Dashora, 36, was back to work just five weeks after she delivered a girl in November 2011. She runs an antenatal clinic at Jaipur’s Santokhba Durlabji Memorial Hospital (SDMH) where she offers holistic care to pregnant women. Being a gynaecologist, Dashora knows that a new mother needs to be at home for at least six months to ensure that the baby is exclusively breastfed. But under immense pressure to return to work, she admits that she “couldn’t practice what I preach.” When Dashora had had her first child six years earlier she had managed to take off for the full six months, but since then work pressures have mounted. “This time around, I couldn’t enjoy that luxury since I had a lot of patients counting on me,” she reveals.
For a new mother, Dashora has a tough daily grind. After taking care of the morning chores at home, she rushes off to the Reserve Bank of India (RBI) dispensary where she sits from 9 a.m. to 11 a.m. Then she is off to SDMH. At around 2 p.m., she goes back to the RBI dispensary for an hour and she also has patients waiting for her at her home clinic between 5.30 p.m. to 6.30 p.m.
To take care of baby Shinjini’s nutritional needs, Dashora manually expresses two feeds before she leaves for work at around 8.30 am and one feed is given at night. “But I don’t think I can continue doing this for long. After four months, I’ll have to add at least one formula feed. There’s so much work pressure and my diet is also not what it should be,” she says.
Although awareness of the six-month rule has increased, busy city women like Dr Dashora find it hard not to add a formula feed after four months. But even those like Deepti Lal, 36, who gave up her job after she delivered her second child recently, are unable to adhere to the six-month breastfeeding guideline. “I don’t think I can keep her exclusively on breast milk for more than three months. Doctors do say that it should be done for four to six months but it’s tough. It curtails ones freedom and it’s a problem if one has to travel,” observes Lal.
Lal plans to add a formula feed after three months. “Once Shambhavi reaches 4-5 months I will give start giving her mashed bananas, avocado and rice. Total weaning would be after 5-6 months, when my baby starts on solids,” she adds.
Banker Bharti Sharma, 33, did exactly what Lal has in mind. Sharma worked for the Bank of Rajasthan, which was taken over by ICICI Bank when she was having her baby in 2008. “The bank only gave me four months of maternity leave. However, I was given an extended lunch break so that I was able to go home and feed the baby. The working hours were from 11 a.m. to 8 p.m. so I added two feeds of cow’s milk to my child’s diet. There was no other option,” she recalls.
Early weaning may have become commonplace today but there are multiple reasons that have led to this negative trend. Dr S.D. Sharma, Professor in Department of Paediatrics at the city’s SMS Medical College, feels that a delay in the first feed is an important cause. “If the first feed is delayed, the sequence of events is dangerous,” he says. “The breast gets engorged and hard and the baby then refuses to take the breastfeed. This usually leads to a top feed.”
Of course, all methods of top feeding, including cotton swabs and the bottle, are detrimental to the newborn’s health. “Not only can the child catch an infection but there is also an immediate risk of aspiration pneumonitis,” says Dr Sharma, who is also the superintendent of Sir Padampat Mother and Child Care Hospital, the children’s hospital associated with Jaipur’s well-known Sawai Man Singh Hospital.
Socio-cultural norms, too, play their part and Dr Sharma shares some of them. Certain families follow a ritual according to which the first feed has to be given by the newborn’s grandparents or the father’s sister. But if they are not in the same city then, until they arrive, the child goes hungry. “This is not good because when the umbilical cord is cut there is a sudden drop in calorie and glucose in the baby’s blood, which produces an urge for suckling. The newborn needs breast milk immediately,” he adds. Another ritual dictates that the baby can only be fed when the stars appear. “If the baby is born in the morning, it doesn’t get anything until nightfall,” he says.
Customary practices aside, neonatologist Dr Tushar Dashora considers the false notion – that breast milk cannot provide adequate nutrition – one of the biggest reasons for early weaning. “If the baby cries for any reason, the mother thinks s/he is under-nourished and immediately adds a bottle feed. This is wrong. Breast milk provides complete nutrition with a balance of calories, fat, proteins and minerals,” he says.
A member of the Breastfeeding Promotion Network of India (BFPI), Dr Tushar also points to the lack of feeding areas in public spaces that lead urban mothers today to add bottle feed to their newborn’s diet. “Most malls or multiplexes do not have an exclusive place where mothers can feed.
What do they do if they are shopping or in a movie theatre? Either they leave the baby at home when they go out, or they don’t go out at all. But shouldn’t there be infrastructure that facilitates breastfeeding?” he asks.
While he understands the pressures on today’s mothers, Dr Tushar is not happy about is the way they tend to experiment with weaning foods. According to him, most often before the baby can develop a taste for one food, s/he is fed something new. “The correct way to do it is to follow a pattern for at least one week so that if something goes wrong with the newborn’s health, you know what food caused it,” he advises.
Bottle feed also leads to other problems. “When the baby suckles at mother’s breast, s/he is making an effort and loses some calories in the press-and-swallow action. Bottle feed involves no effort and invariably leads to overfeeding and weight gain,” observes Dr Tushar.
For new-age moms, who have no option but to give in to the pressures of an urban lifestyle, paediatricians do have a way out -- expressed breast milk (EBM). Breast milk can be expressed manually, or by using a pump, which stimulates the breast like a baby’s suckle. Dr Kailash Meena, who runs the neonatal intensive care unit (NICU) at Zenana Hospital, one of the biggest maternity centres in Rajasthan which handles over 60 deliveries a day, says, “EBM can be stored at room temperature for 6-8 hours or in the fridge for 24 hours. It should be stored in a glass container and given with the help of metallic utensils. Also remember, it should not be boiled or heated.”
Dr Smita Dashora’s colleague at the SDMH, psychiatrist Dr Aarti Midha, has taken to doing this since she had to go back to her desk six weeks after giving birth to her second child. It seems to be working for her. Says Midha, “I use a pump to express two feeds of 100 ml each for the three-and-a-half hours I am at the hospital. In the evening, I am back at the clinic for an hour at 5.30 p.m. and so I leave one feed of 60 ml for my baby daughter.”
(Women’s Feature Service)