Evelyn Mercedes Niño*
Pediatrician – Children’s Gastroenterologist, Venezuela
Citation: Evelyn Mercedes Niño. «The Big House and My Drop of Milk: Two Friendly Initiatives of Breastfeeding!». EC Paediatrics 7.5 (2018): 465-469.
*Corresponding Author: Evelyn Mercedes Niño, Pediatrician – Children’s Gastroenterologist, Venezuela.
Received: March 03, 2018; Published: April 28, 2018
There is a great disinformation in breastfeeding and infant feeding, both in mothers, as in their families and the community in general, to which the presence of multiple factors that conspire against their practice are added, such as: social pressure, detractor influence of myths, advertising bombardment by companies that produce breast milk substitutes, reincorporation of mothers to work and lack of support in their environment. All these factors decrease the confidence of the mothers and make them doubt about their natural capacity to breastfeed, inducing them to supply formula or another type of food as a complement or substitute for human milk, which usually determines an abandonment of breastfeeding. This situation can only be reversed and overcome the possible difficulties that may arise in the practice of breastfeeding, providing continuous, close and timely support to breastfeeding mothers, by a trained and experienced health staff as a health adviser human lactation, to achieve a successful process that allows to maintain and prolong it. The following work presents the successful experience and the services offered by two initiatives that are friendly to breastfeeding, which in an institutional alliance carry out a collaborative work of promotion, defense and support for breastfeeding as a successful prevention strategy in maternal and child health
Keywords: Breastfeeding; Promotion; Advocacy and Timely Support; Successful Strategy
The World Health Organization (WHO) and the United Nations Children’s Fund (UNICEF), through documents such as «The Ten Steps to a Successful Breastfeeding» of the Joint Declaration (1989) , basis of the Hospital Initiative Amigo del Niño (IHAN 1991, updated and expanded in 2007, aimed at the humanization of birth and breastfeeding assistance)  and the Global Strategy for Infant and Young Child Feeding (2002) , recommend starting breastfeeding in the first hour of life, maintaining breastfeeding at free demand, exclusively during the first six months of age (exclusive breastfeeding) and then continue breastfeeding at the same time that the baby is given complementary feeding, prolonging breastfeeding until 2 years or more (optimal breastfeeding). Breastfeeding (feeding with mother’s milk) should be the norm and the use of formula the exception. Women in general are endowed by nature, anatomically and functionally, to breastfeed their children. To achieve a successful practice of breastfeeding, in addition to their natural and instinctive condition, mothers need support in their environment, learning, perseverance and patience, to consolidate and maintain it.
Scientific evidence shows that fulfilling this recommendation, it is possible to save one million babies a year if breastfeeding starts early and reduce by 13% the mortality rate in infants under five years, if they are fed with human milk , the perfect food that brings multiple benefits. However, even when breastfeeding is an effective public health prevention strategy with high social impact and low cost, in developing countries the average rate of exclusive breastfeeding is 36% (range 8 to 64%) in infants under six months of age, being in Venezuela only 27.8% (National Institute of Nutrition/Study 2006-2008). However, even when breastfeeding is an effective public health prevention strategy with high social impact and low cost, in developing countries the average rate of exclusive breastfeeding is 36% (range from 8 to 64%). In infants under six months of age, being in Venezuela only 27.8% (National Institute of Nutrition/Study 2006-2008). This low incidence determined the launch of the Communication for Development Campaign: Breast Milk, the Best Product in the World for Infants, which was executed by UNICEF Venezuela from 2010 to 2011, through awareness, training and social mobilization activities, with the goal of increasing the prevalence and duration of breastfeeding in the country. Since 2009, within the framework of Technical Cooperation Agreements between the Venezuelan Society of Child Care and Pediatrics (SVPP) and UNICEF Venezuela, Workshops on Approach and Defense of Breastfeeding for Pediatricians (2009-2012) and Promotion Courses have been carried out, Protection and Support for Breastfeeding for the Implementation of the Amigo del Niño Hospital Initiative – IHAN – WHO/UNICEF, aimed at Pediatricians, Neonatologists, Obstetricians-Gynecologists and Physicians in general who provide maternal and child care (2013-2014); Both trainings were facilitated by the members of the Breastfeeding Commission of the Venezuelan Society of Childcare and Pediatrics (SVPP). Since 2015, a new Technical Cooperation Agreement has been implemented between the Ministry of the Popular Power for Health (MPPS), the SVPP and UNICEF, based on the training of health personnel in the BFHI, for the reinvigoration of the same in Hospitals prioritized at the national level due to its high birth rate, with the goal of increasing the prevalence rate and duration of breastfeeding in the country.
Both initiatives function as Breastfeeding Centers, directed by its founder, Dr. Evelyn Niño, Pediatrician Puericultor and Infant Gastroenterologist, Expert Advisor in Breastfeeding (Breastfeeding Counselor, Facilitator and Director of Breastfeeding Training Courses), who serves as Head of the Service My Drop of Milk Breastfeeding Center and President of A.C.U.R.N. The Big House. Professional who during the years 1990 to 2009 focused on the assistance and management of infants with nutritional and/or gastro-intestinal disorders. Started training in human breastfeeding and feeding of infants and young children since 1995, actively works on these issues. Dedicated since 2000 to the Clinical Consultancy of Human Breastfeeding in all its phases (from pregnancy to prolonged lactation) and maternal-infant feeding, as well as to the training of health personnel (doctors, nutritionists and nurses) in these topics, since 2003.
These Breastfeeding Center in turn develop a collaborative work through the establishment of an institutional alliance. The professionals and technicians who make up their respective work teams, promote, protect and support breastfeeding, through the implementation of services and assistance programs, community and training aimed at the pairs mother-child, pregnant women, families, health personnel, teachers and the community in general. The accompaniment begins from pregnancy and extends during the first years of the infant, offering personalized advice and all the support that mothers may require, during all stages of breastfeeding. Offering the following services:
Clinical Consultation of Breastfeeding
Specialized consultation that provides: A) Direct, continuous and timely support to mothers, through counseling during all stages of human breastfeeding, from pregnancy to prolonged lactation. Solving difficult situations, clarifying doubts and demolishing myths related to the practice of it. B) Practical advice on complementary feeding from six months of age, maintaining breastfeeding, if possible until 2 years and more. C) Orientation and support to the pregnant mother and the breastfeeding mother about their adequate nutrition and feeding. D) Support to the breastfeeding mother who rejoins the work or studies, through advice on the Legal Norm of Protection to the Breastfeeding and Maternity in force in Venezuela, as well as training in the implementation of the homemade lactation or «bank of homemade milk», through training in the extraction, preservation and supply of their milk, in order to maintain and prolong breastfeeding, when they have to temporarily separated from your baby; so that the expressed breast milk is provided by the caregiver (with a cup, teaspoon or injector), when the mother is absent. E) Encourages relactancia, restarting exclusive breastfeeding, in those cases where for some reason the mother abandoned it or is supplementing with formulas or other foods (before six months of age). F) Follow-up and follow-up in the induction process of breastfeeding in adoptive mothers. G) Information and support to HIV positive mothers on adequate and timely feeding for their babies, taking into account the risk factors of HIV transmission during breastfeeding. In Venezuela, according to State policy, the National Program of HIV/AIDS has been implemented, which incorporates the infant from the moment of diagnosis and contemplates the supply of formula during the first year of life and antiretroviral medication for the binomial mother-son.
Destined to the attention of the mother who breastfeeds and who requires training in the extraction, preservation and supply of human milk. Very useful in case of babies that cannot be fed directly to the breast of the mother, when assisted lactation is required to complete intakes in case of premature and/or low birth weight babies, when it is necessary to increase production or when there are mammary pathologies conditioned by inadequate grip of the chest and/or deficient emptying. My Drop of Milk has an Institutional Lactarium, while La Casa Grande is community.
Breastfeeding Support Groups – «Mother to Mother» Interactive meetings, where mothers receive information about breastfeeding, as well as providing ideas, sharing experiences with other mothers, encouraging solidarity between them and establishing bonds of friendship. They are carried out 1 – 2 times a month according to the Schedule of each Center.
Open Clinical Consultation on Optimal Feeding during the First Thousand Days of Life
To bring information to a greater number of mothers, pregnant women and families, thus encompassing food and nutrition from the moment of conception until 2 years of age; period of great vulnerability and of great importance in the growth and development of every infant, which represents food security and guarantees maternal and child survival; being a priority at present when our country faces a severe social, economic and health crisis. This activity has been carried out successfully and in an institutional alliance between La Casa Grande and Mi Gota de Leche, 1-3 times a month, since May 2017, both in the open spaces of the Divine Child Jesus Church in Guarenas, and in the Auditórium de Children’s Hospital «J.M. of Los Ríos «in Caracas. This type of consultation emerged due to the significant increase of more than 30% in infant mortality (death in children under 1 year of age, conditioned by an increase in the rate of malnutrition and in the incidence of preventable infectious diseases, due to a shortage of food, medicines and vaccines, as well as the precarious conditions in which health facilities are located at the national level), the disproportionate 60% increase in maternal mortality (before and after childbirth), as well as an alarming increase in the rate of Adolescent Pregnancy, occupying Venezuela the first place in Latin America, which determines higher risk of prematurity at birth and therefore higher neonatal mortality risk (according to statistical data of the Ministry of the Popular Power for Health, corresponding to the year 2016, published in 2017). Through this new service, we clarify doubts, eliminate myths about the subject and provide timely support to mothers and babies who face difficulties in the practice of breastfeeding, which will then be followed up in the respective Clinical Consultations of Breastfeeding, of both Centers. The goal is to contribute to the reinvigoration of the practice of breastfeeding as a strategy of prevention in maternal and child health of high impact and low cost in the framework of a severe national food crisis!
Continuous Training in Nursing and Healthy Nutrition
Activity developed through colloquia, induction talks and workshops. Directed to health personnel, interns, teachers, community promoters and the community in general. Developed in health institutions, educational institutions, shelters and in communities that require it.
Training in Breastfeeding and Infant Feeding
With the purpose of training in breastfeeding counseling skills, which provide timely support to mothers during all stages of br eastfeeding, Courses are held for the Promotion of Breastfeeding as well as the formation of Counselors. and Trainers (as) of Breastfeeding and Infant Feeding Counseling. Directed to health personnel, teachers and community promoters. Both Breastfeeding Centers are recognized as Training Organizations by the National Maternal Breastfeeding Program of the Ministry of People’s Power for Health (MPPS) and the United Nations Children’s Fund (UNICEF), which endorse the programmatic content and the facilitation of the Courses. My Drop of Milk, since 2009, runs such courses at the Children’s Hospital; while La Casa Grande has made them at its headquarters (2003-2004) in Miranda State, as well as in other federal entities such as: Caracas (2010-2011-2014-2015-2016), Lara State (2011), Amazonas State (2011-2012), Táchira State (2012), Nueva Esparta State (2012) and Zulia State (2013), at the request of public and private health establishments, which have respectively paid for their logistics expenses.
Both initiatives follow the guidelines of the National Breastfeeding Program (of the Ministry of the Popular Power for Health) and are allies of the Campaign promoted by UNICEF Venezuela, being a public and a private one, acting synergistically and in an institutional alliance, jointly developing some activities, such as: the Days in Breastfeeding and the Graduations of Breastfed Infants. The Breastfeeding Days for the purpose of updating breastfeeding knowledge, as well as exalting the reason for the World Week each year (in 2017 we celebrate the 9th Day). The Graduations of Breastfed Infants, as a symbolic recognition to mothers and babies who have attended such Breastfeeding Centers, for confronting difficulties to breastfeed or simply to receive information and/or dispel doubts in this subject; succeeding in successfully breastfeeding; thus contributing to consolidate breastfeeding, how the best diet that favors optimal growth, provides immunological protection and strengthens a lasting affective bond between mother and baby. This event becomes a great sharing attended by entire families and motivates mothers to continue breastfeeding, managing to prolong it if possible up to 2 years or more, as recommended by WHO and UNICEF (in 2017 we celebrate the 13th Graduation ). These two activities are carried out annually, since 2004, within the framework of the Celebration of the World Breastfeeding Week (SMLM), in the first week of the month of August [4-15].
Providing advice from pregnancy favors the implementation of friendly hospital practices for the mother and her baby before, during and after birth, such as early attachment, joint accommodation and exclusive breastfeeding, at free demand and guided by the baby, during her stay in the maternity service. The mother who is approached since pregnancy, will be informed and empowered of breastfeeding and consequently will defend her right to breastfeeding, contributing with the humanization of assistance at birth and breastfeeding.
It is essential to support the mother who breastfeeds and access to accurate information, in order to strengthen her confidence and cultivate patience and perseverance as keys in the practice of breastfeeding. Through the clinical consultation of breastfeeding, mothers are informed about the benefits of human breastfeeding, how it works in a simple way, the appropriate technique of breastfeeding and the variations of human milk as a living, changing product with properties adaptive, with the goal of achieving successful breastfeeding. In addition, doubts are clarified, myths are eliminated and timely support is given to mothers and babies who face difficulties in the practice of breastfeeding, followed up in successive consultations.
In practice, these successful initiatives can be replicated with sustainability criteria over time, in other public and private maternal and child care centers, if there is a staff duly trained as a consultant in human breastfeeding (doctors and/or nutritionists), with experience, always willing and committed to provide continuous, close and timely support to mothers and infants who require it.
«If mothers learn and practice the art of breastfeeding, guided and supported by trained personnel, the defense, maintenance and prolongation of this universal right of mothers and babies is guaranteed, as well as the full enjoyment of all its benefits and blessings» E.M.N.
In Venezuela there are several public and private organizations that work hard in the promotion, protection and support of breastfeeding, promoting this practice among the population, among them Mi Gota de Leche and La Casa Grande, for the multiple activities that both develop. A public initiative, such as Mi Gota de Leche Breastfeeding Center, founded in February 2002, specialized medical service of assistance, promotion and training in breastfeeding, Children’s Hospital «José Manuel de Los Ríos» (Health Center, of national reference), located in the San Bernardino Urbanization of Caracas. On the other hand, a private initiative such as A.C.U.R.N. The Big House (The Big House Nutritional Recovery Unit Civil Association), a non-governmental organization (NGO), of social service, made up entirely of volunteers, which functions as a Nutrition and Breastfeeding Care and Training Center, founded in May 2000, initially located in Guatire and since October 2015 in Guarenas, Miranda State.
- WHO/UNICEF Joint Declaration, Geneva, WHO (1989).
- Amigo del Niño Hospital Initiative. Revised, Updated and Extended for Integral Attention. Breastfeeding, Promotion and Support in a Friend of the Child Hospital. 20-hour course for Maternity Staff. WHO/PAHO/UNICEF (2008).
- Global Strategy for Infant and Young Child Feeding. WHO-UNICEF (2002).
- International Code of Marketing of Breast-milk Substitutes (Adopted by the World Health Assembly Resolution WHA 34.22-1981) and Subsequent Resolutions. WHO/UNICEF. Edition (2005).
- Spanish Association of Pediatrics. Manual of Breastfeeding from Theory to Practice. Editorial Pan Americana S.A. (2008).
- Practice and Promotion of Natural Breastfeeding in Friends of Children and Mothers Hospitals. UNICEF (1993).
- Counseling for infant and young child feeding: Integrated Course. WHO/PAHO/UNICEF (2009).
- The Female Breastfeeding Art. The International Milk League (2012).
- WHO. Breastfeeding (2016).
- Analysis of the situation regarding the practice of breastfeeding in maternity services in Venezuela. UNICEF (2018).
- Caritas Venezuela (2017).
- Caritas Venezuela (2018).
- UNFPA Venezuela (2016).
- UNFPA Venezuela (2017).
- Child E. «Legal Norms for the Protection of Breastfeeding in Venezuela». Venezuelan Child and Pediatric Archives 76.4 (2013): 162-168.
Volume 7 Issue 5 May 2018
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