‘Why some women do not produce enough breast milk’

Mr. Friday Enaholo is the Marketing Manager, Fidson Healthcare Plc. Enaholo in this interview with The Guardian ahead of the World Breastfeeding Week explains among other things why some women do not produce enough breast milk and what can be done to enhance flow on breast milk and promote exclusive breastfeeding. CHUKWUMA MUANYA writes. Excerpts: 

WHY breastfeeding week? Ordinarily, breastfeeding is a natural interaction between mother and baby, without any need for a special week to raise awareness for it.

However, urbanisation, globalisation, work-life imbalance, fear of breast sagging, etc. have reduced the frequency and duration of breastfeeding. Normally, mothers derive joy from suckling their babies and their commitment to this noble duty is high.

But things are changing. Motherhood is suffering because of career. I believe the World Breastfeeding Week is intended to draw attention to and raise awareness of this natural responsibility of a mother.

It will also drum support for the working class mother who is nursing a baby. It may also compel employers and policy makers to spare a thought for the hard-working, lactating mother when developing labour-related policies that have to do with the workplace.

A happy mother is a productive employee. When is breastfeeding not advised? Mothers may be advised not to breastfeed their babies in some of the following situations.

A Human Immuno-deficiency Virus (HIV)-positive mother who has a high serum level of the virus; Mothers with cancer in both breasts or on anti-cancer medication or undergoing radiotherapy; Mothers on medications that are secreted in breast milk and unsafe for the baby; Mothers who have highly infectious diseases, such as tuberculosis; Mothers who suffer from conditions that make them prone to violence or neglect; Mothers who are addicted to hard drugs and also Mothers who are alcoholic.

Roles of employers, government and fathers to ensure that babies are breastfed Talking about the roles of an employer, many women are usually reluctant to expose their breasts in public and will never suckle their young at the workplace, even if the child is crying.

Employers can support lactating mothers by providing a private room where such women can breastfeed their babies. They can also support by allowing for a five or six-month maternity-leave so that they can practice exclusive breastfeeding before resumption at work.

They can show support by allowing lactating mothers to close from work two hours earlier than other workers. Also, they can support by organising workplace seminars on breastfeeding for women at least once in a year, using medical personnel as a resource person.

This will expose them to global best practice in breastfeeding. Talking about the roles of Fathers, essentially, a father’s role is supportive and could include helping to care of the older children while mummy breastfeeds baby; sit with his wife while she breastfeeds baby, touching baby’s cheeks, smiling or singing for baby.

A father can also help to carry and rock baby to sleep after breastfeeding so that mummy can catch some sleep; he can also change diapers (if he knows how to do it) while mummy rests. A typical Nigerian father would have none of these.

But the truth is that he is not really busy all day: he comes home after work, he has weekend to himself, he goes for a drink with friends, and he watches football for hours.

So he can spare a little time to encourage his wife to breastfeed ‘his’ child. For Government, the roles of government actually appear simple.

They are to enact laws that support and protect the breastfeeding employee, and also enforce existing labour laws in this regard. The Local Government Councils can organise monthly seminars or awareness campaigns on breastfeeding.

They can partner with bodies of health care providers such as National Association of Nigerian Nurses and Midwives on the benefits of breastfeeding to mother and child and the risk associated with failure to breastfeed children adequately.

What people need is information. Nigerian women are intelligent and want the best for their babies. Why is breastfeeding rate low in Nigeria, especially on urban centres? Breastfeeding rate is low in Nigeria and a number of reasons may be adduced for this.

First, there is an aggressive marketing by manufacturers of infant formula. These companies visit paediatricians and nurses; sponsor programmes organised by professional bodies and indirectly secure subtle endorsement of their infant formula.

A pregnant or lactating mother who sees a brand of infant formula nicely and conspicuously advertised in a clinic can assume it is a good substitute for her breast milk.

After all, it is advertised in a clinic. Secondly, a working-woman in a city wants to combine motherhood with a career. The balance can be difficult. She leaves home early, comes home late.

Even if she expressed and stored her breast milk, storage can be an issue. So by the time the nanny feeds her baby, the milk is stale.

That baby gets inadequately breastfed in frequency, quality and quantity. More also, many women are obsessed with this idea of “my figure, my shape”.

They believe that prolonged breastfeeding can make their breasts lose firmness and sag. They would rather breastfeed for three months and supplement with infant formula so that their breasts stand “firm and pointing”.

There is the part of employers too. Most employers of labour have no provision that support and encourage breastfeeding mothers. This contributes to the low rate of breastfeeding.

All these put the urban nursing mothers under serious pressure and impacts negatively on the rate of breastfeeding. What can be done to address these? I think a number of things can be done.

Government can enlist the support of religious bodies and leaders, socio-cultural groups and so on to advance the case for adequate breastfeeding. Government can also compel employers of labour to grant nursing mothers a 6-month maternity leave.

Government can compel marketers of infant formulas to sponsor campaigns for breastfeeding, ensure that their products carry a statement that says ‘breast milk is the best option for babies’.

Beyond this, such companies should be restricted from advertising directly or indirectly at government hospitals and clinics. Why is it that some mothers do not produce enough breast milk? Looking at it from the health perspective.

Previous clinical studies had linked difficulties in producing adequate breast milk by some women to difficulties in metabolism of glucose in their bodies.

Women that are particularly prone to this are; overweight and obese mothers, women who conceive and give birth at an advanced age, women who deliver babies with high birth weight.

Recently, a research led by Dr. Daniels Lemay of the University of California, David’s Research Centre, found a link between insulin production and inadequate breast milk production.

The breast glands become highly sensitive to insulin. Other scientific researches have also shown that inadequate breast milk production might suggest low thyroid function or insufficient development of glandular tissue of the breast.

Foods that enhance breast milk production There are a number of foods that can enhance breast milk production in a woman. Spinach (Efo in Yoruba) and other green leafy vegetables are believed to have natural ingredients that boost lactation and quality of breast milk.

They also contain vitamins and micronutrients. Carrot, whether eaten whole or blended into juice is also a very good breast milk enhancer. Garlic too is very good and can be eaten whole or used as spice in soup and food.

Watermelon also helps to increase the quantity of breast milk. Ripe paw paw, rice and clean water are also valuable. Then, some sources of omega 3 fatty acids, such as salmon fish and walnut (Asala in Yoruba) help in the cognitive development of the baby’s brain.

What are the alternatives to breast milk? Honestly, I don’t think it would be proper to be making a strong case for increased breastfeeding and also be talking about substitutes or alternatives to breast milk.

I believe that if a nursing mother has a compelling health reason why an alternative to breast milk is necessary, her doctor would not hesitate to consider it. There is aggressive marketing of human breast milk, even for an adult in the developed world.

Why? In our culture and most cultures of the world, breast milk is for infants, not adults. I guess the development stemmed from some health benefits claims on the Internet many years ago.

Those claims generally remain unsubstantiated. I am not sure there is any scientific data to support such claims. Apparently, it was a marketing stunt put together by venture capitalists that wanted to make money from the gullibility of some Internet users.

Unfortunately, a lot of body builders have bought onto the claim that human breast milk can help them build their muscles. It is largely a western world myth. Nigerian men are less likely to buy the dummy.

Breastfeeding, cancer and sagging of breasts I am not aware of any direct association between breastfeeding and breast sagging. Normally, as we get older, our bodies change, including the breasts.

Many women who have not had children (and therefore, had not breastfed any child) have sagged breasts as they age. The breasts do not have muscles, so no issues of slacking of the muscles. Scientists have argued that at a younger age, oestrogen helps to maintain the firmness of the breasts.

As a woman ages, there is a decline in the level of oestrogen and so, that firmness is gradually lost. Cigarette smoking (which weakens the elasticity of the skin), wearing of large cup sized bra before conception, frequent childbirth and advanced age have all been implicated by several medical experts.

One of the arguments is that with advanced age, the breasts become fattier and less glandular than they were in their 30s. Also implicated is the stretching of the fibres that usually hold the breast tissues firm in their younger years.

All these may lead to sagging. Also, frequency in activities that make the breasts bounce up and down may contribute to the stretching of the fibres.

According to the Breast Cancer and Environmental Risk Factors Programme (2010), “breastfeeding may offer some modest protection against the development of breast cancer, particularly in younger women.”

Is there any legislation to enforce exclusive breastfeeding? I am not sure if there is or not. If such legislation exists, then it is obviously not being enforced.

What are your recommendations? Rather than promote infant formula as an alternative to natural breast milk, my recommendations would include; good and frequent intake of clean water by breastfeeding mothers to increase the flow of breast milk, consumption of natural foods as listed above, to increase the quality and quantity of breast milk, intake of nutritional supplements, especially micronutrients that are known to optimise good health for mother and child.

They provide energy to the mother and adequate micronutrients to the child in the first few years of life. The major problem is that even some mothers who know the benefits of these food types do not even consume them.

That makes the use of quality micronutrient supplementation very essential. An example of a micronutrient supplement that contains all the micronutrients, vitamins and other requirements in the right types, quantity and combinations for optimal growth and wellbeing of mother and child is Cestra Prenatal.

Women generally find Cestra Prenatal very beneficial before conception, during pregnancy and during lactation.