Where there is no lactation consultant

Where there is no lactation consultant

9th March 2006

Where there is no lactation consultant
District Gajapati (Orissa), January 2006

A year after our first visit to Rasuru village near JITM, we had a few programs going in this and a few more villages in Gajapati District. Desilting/soil support, electricity connections, childrens libraries, and a team of artisans designing products and training new people to earn livelihoods in cane, bamboo, tailoring, and pottery. With our new packets of sprouted ragi [millet] flour, we talked to the families about nutrition, with special attention to mothers and young children. Devi and Nirmala went house to house to call parents to the meeting, and several came with babies in arms. As they introduced themselves and their children, we found that most children between ages of 0-4 years were twice as old as we would have guessed by looking. We asked each of the mothers what the children were eating or drinking. A few mothers said that they did not have milk for their babies and therefore were using powdered milk or diluted cow’s milk. Having strongly imbibed the message that every mother has milk and that it is extremely rare for a mother not to have milk, though quite common for her not to get the support and confidence to breastfeed, I said, “I also was not able to feed for several days. Because there were people to help me, I kept expressing my milk and eventually I could breastfeed normally. If you want I can also help you so that you can breastfeed.”

To my immense relief, the women said yes. Why was I relieved? Because mother’s milk is so important for babies as well as mothers, because of all the nutrients in perfect balance that it provides, all the immunity and bonding and empowerment. And because it was more than obvious that these newborn infants taking bottles were the weakest among those present, while the babies who were exclusively breastfeeding were as curious and plump as any baby anywhere. Breastmilk does not discriminate.

Next morning we went house to house to meet the mothers and in many cases the fathers, who were home because they had no work or because of the Sankranti holidays spilling over into the week. We talked to the families, weighed the children and peddled the ragi. In many cases the grandparents came to see what we were talking about and piped in, “ragi tinTE cAlA balam” [If we eat ragi, we will be strong.] There were also people who derided the ragi – why are you talking about ragi, no one eats that any more. And in fact, when we asked people one by one if they were eating ragi, many of them giggled and only after we said that we ate ragi did they admit to eating the ragi. They had it in their homes – they would buy whole ragi and take it to the mill for grinding periodically.

Our ragi was sprouted, increasing its iron and calcium values, so we described how we made it and asked them if they would try it. We gave out samples and went back in two days to ask if they ate it. Whomever we asked, had opened the packet and at least one child in the family had eaten it. We encouraged the mothers also to eat it as it would give them good iron, calcium and other nutrients. One mother expressed doubt whether it would affect her milk. We said that it would improve her milk and the baby would only derive benefits from her eating healthy food. Moreover, she would have the strength she needed to keep on nursing.

Many people were eating two meals per day with a tea here and there. Candy and cigarettes were also in use. Some said the children fell asleep before dinner and therefore did not eat dinner. We asked if they got access to bananas, guava, or any other fruits to eat in the middle. They said that they did not eat bananas in the “winter” because it would give them a cold. We assured them that although a banana might not be a good thing to eat if you already have a cold, it would not lead to catching cold. If they had any doubt, they should go for bananas that were very ripe, with as many spots as possible.

Regarding the formula, they told us that they were putting 2 or 3 scoops in the bottle and using 2 – 3 bottles in a 24 hour period. Whereas according to the instructions on the box, they were to mix 4 scoops and give 6 bottles in 24 hours. Some showed us some vitamin drops that they had bought as well.

I spent extra time with the mothers who told me they had no milk. One child was already a month old and the other 6 weeks, so I was really unsure that I could help them establish lactation at such a late stage. But bravely I sat with them and asked them if they had tried putting the baby to the breast. They had. Did s/he drink? Yes, s/he had. Could they try again now? Yes. One of these babies was asleep so I asked her mother to call me when the baby woke up and I would come back and watch her feed, and proceeded to the next house. After some time the mother found me and we sat down together. She put the baby to the breast and she began sucking right away.4 week old Tulasi latches on for mother's milk
I visited another mother who said she had no milk. Her baby was also asleep in the sari-swing, but he woke up while we were there and she took him in her lap. He did not latch on. He had just had a few ounces by bottle. But she was able to express milk from both sides and I assured her that she had enough milk. The next day I visited her and watched as she breastfed her son.

Actually in both cases it was a case of the glass being half full or half empty. When the mother said, “pAlu lEvu” [no milk] it was similar to saying of a child, “burra lEdu” [no brains]. It is not something to be taken literally. She just did not consider the milk that she had as worthy of the name, “mother’s milk.” Each of these mothers had nursed their babies even before I visited them – they just were not confident that it was enough and therefore bought the formula and bottles.

Both the babies were extremely small and I encouraged them to use a sling so that the babies could feed more frequently. I explained how milk reached the breasts and that when the baby fed it was like turning the system “on” and when there were long gaps between feeds then less milk would be produced. So if they were concerned about their milk supply, the best way to increase the supply would be to feed more often. Demand would naturally increase the production. And they should eat more often as well. I told them that everything we eat will go into our milk, and asked them about their diet. They usually had rice and dal two or three times a day. Sometimes they also get fish and vegetables. No telling how often. They also made idlis and we saw many people preparing idli dough by hand as we toured the homes. I described the nutrients in all the things that they were eating and then asked them what the cows are eating. Grass. And junk by the side of the road. So which milk had better things to offer for their babies?

It has been a week of emotional highs and lows. I told the mothers whom I helped to nurse that I had been awake all the previous night worrying about them and that I was simply elated to see them nursing today. Part of me was worried that I was entering their lives out of the blue and I should fully understand what all they were doing, why, what all constraints they were facing, what might be the strengths of some of the things they were doing and only then offer any counseling from my side. But I drew confidence from my own experience with nursing, which did not come easily for me at first either, and also with slinging, another art which may soon be lost, at least among the poor. To guard against my own zeal, I always asked for their consent before I offered help either with nursing or with slinging, and asked them what they thought of what I said. I emphasised that I myself was doing each of the things that I was recommending to them. Devi and Nirmala, our village volunteers were somewhat in the middle, wanting to help ‘translate’ what I was saying – either literally into Oriya for those who did not know Telugu, or effectively into the local context which they knew first hand. However when the villagers would put the question back at them, “do you eat mandya [ragi]?” our volunteers would be giggling as well.

It is interesting to note the similarities across states – for example we hear that in other parts of India people have expressed the fear that eating bananas – a nutritious fruit that is readily available and affordable, would cause a cold. I was relieved that no one objected to having their baby weighed, as has happened in other places. In fact the anganwadi worker has records from the monthly weighings that she conducts in the months when she has food to offer and parents actually come. Her next weighing is scheduled for Jan 22 and if her grains come in time she will make the khichdi and offer it and then probably most of the children will come and be weighed. Mothers of newborns need support right away and at more frequent intervals than once a month. If we can start by complementing the efforts ofthe anganwadi probably more avenues can open up to raise awareness on nutrition.

2 Responses to “Where there is no lactation consultant”

  1. Radhika Says:
    March 17th, 2006 at 4:00 pm eAravinda! Bless your heart for taking this up; something I too feel so deeply about. If people like me with post-graduate degrees, access to internet, libraries and La-leche-leagues can feel inadequate and uncertain about nursing, how isolating and unsupported it can feel for a young mother with none of these facilities :-( Its a very sad thing that there seems to be less and less traditional knowledge and support for nursing, which is by far the best food for an infant. Helping mothers build their confidence is probably one of the most worthwhile and commendable efforts…Advocacy for breastfeeding – support for moms in different situations, whether working in offices or in the fields, its all so sadly lacking and I would love to come help in any way I can.
  2. Mansoor Khan Says:
    April 17th, 2006 at 2:59 am eHi Aravinda,Excellent article. Got to read it because I just got an invite from aidindia that I confirmed with a reply. Thought of you and the Narmada days. I sent an email but maybe address is old. It has been a while. Sorry I am using this space to connect but had no other way to reach you. Do write and we can exchange notes.

    Mansoor Khan