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母乳喂养支持在亚洲 Breastfeeding Support in Asia

母乳喂养支持在亚洲 Breastfeeding Support in Asia

The importance of mother-to-mother support from an Asian perspective

I live in Wakkanai in the northernmost point of Japan, only 43 kilometers away from the Russian island of Sakhalin. I grew up when breastfeeding was very common in Japan. I saw mothers nursing in public often during my school years. When I attended college in the USA, I found out that my experience was not necessarily so for young women in the US. I still remember clearly a conversation I had with some friends in the college dormitory about marriage and children. I mentioned that I was planning on breastfeeding and was shocked at the other girls‘‘ horrified response.

Although my American mother gave birth to me in Japan, where all six of my children were also born, our circumstances were very different. I gave birth in a culture and language I was familiar with, while my mother was unfamiliar with both. She had only been in Japan a year when she first gave birth. Although breastfeeding was encouraged at the hospital, she could not ask questions or understand most of what was being explained to her. There was no peer support available and her baby was not latching on. I had a weak suck and either fell asleep too quickly or gave up trying. My mother lost confidence in being able to breastfeed me and switched to formula. I cannot help but wonder if she would have been able to breastfeed longer if she had mother-to-mother support.

Why I breastfed my children and became a La Leche League Leader is very much due to these personal experiences. Many women give up breastfeeding before they and their babies are ready because of a lack of support and information. Many of the questions mothers have about breastfeeding are practical ones best answered by other breastfeeding mothers who have nursed their own babies.

Mother-to-mother support can be a key factor in providing information and encouragement, giving mothers the confidence to continue breastfeeding on a day-to-day basis even when they may be facing cultural hindrances or pressure from family and friends to supplement or wean.
Traditional beliefs or misconceptions about breastmilk, marketing of infant formula, lack of or insufficient maternity leave and provision of time and space to pump can hinder breastfeeding.

Supplementing breastmilk
Some mothers in Asia face pressure from family to supplement from fear that they aren’t producing enough milk or an incorrect belief that formula is as good as or better than breastmilk. Sometimes there’s a desire to take over the feeding of the baby, or the mistaken impression that the baby will sleep longer at night and the mother will be able to catch up on her sleep if someone else feeds her baby.

The culture of living with extended family, abiding by family obligations and never questioning "the experts" is quite strong yet in many countries in Asia. Mothers may be much more comfortable sharing their problems with breastfeeding with other mothers in a non-judgmental atmosphere, where concerns are similar.

Starting solids
Pressure to introduce solids early and as the main source of nutrition rather than as a complement to breastfeeding can cause mothers great stress. This pressure may come from grandparents who want the best for their grandchild but may be misinformed about the continuing benefits of exclusive breastfeeding and extended nursing. Or these grandparents may want to be active participants in feeding the grandchild. It might come from husbands who are feeling pressured and awkward when questioned about the advisability of exclusive or extended breastfeeding. It may come from siblings or friends who have different ideas, or it may come from other mothers with babies of similar age who are already eating solids in larger and more frequent quantities. Sometimes the source of stress comes from conflicting information in magazines and childcare books about when and how solids should be introduced. These sources give the impression of being "expert" advice on what is expected for children at certain ages.

Typical misconceptions are that breastmilk is lacking in sufficient nutrients for older babies or causes dental caries. Sometimes the father or grandmother wants to take charge of child care. Weaning early follows quickly behind pressure to start solids.

Cultural misconceptions
Misconceptions about the benefits of colostrum are common. In India and Bangladesh, many believe that this first milk is polluted and should be discarded. It is often replaced by feeds made with unclean water, cereal, animal milk, herbal concoctions, or other liquids, which are lower in nutrients and may expose the baby to disease or damage the baby‘‘s digestive system.

In China many people think a fat baby means a healthy baby. Due to the government policy of only one child, parents and grandparents are under a lot of stress to get it right! Bottle-feeding is very popular in China and many have forgotten or not had the opportunity to see for themselves that breastfeeding is the natural way to feed babies.

Aggressive marketing of formula and misleading claims by formula companies give the wrong impression that formula is just as good or better than breastmilk. New mother talks and information include free formula milk samples handed out by formula company representatives in hospitals or at other well baby checkups in public health centers. The image of the baby bottle-feeding predominates in media portrayals of infant feeding.

Traditional beliefs can also be an obstacle. Many Asian cultures still practice some form of confinement. The pregnant mother returns to her parent‘‘s home to prepare for the birth. The confinement period allows mothers to do very little work beyond caring for their new baby and eating nutritious foods, some of which are specially prepared postpartum foods. This can be a wonderful time for mothers to get to know their new baby while recovering from the physiological stresses of pregnancy and birth.

In some cases, however, grandmother has been taking on the care of the new baby and wants to be a more active participant in feeding the baby. She starts to question whether the mother has enough breastmilk and suggests she should supplement with formula, ultimately resulting in a lowered milk supply. Following the confinement, the mother is not adequately prepared for meeting the needs of her baby, household chores, and taking care of older children. Mothers lose confidence in being able to meet their baby’s needs and the cycle of supplementing deepens.

Encouragement and support from other breastfeeding mothers can be the catalyst for continuing to breastfeed rather than mixed feeding or switching completely to formula. Hearing how other mothers have handled similar pressures to supplement, how to manage meeting the needs of a new baby and older children simultaneously, and tips on household care can give breastfeeding mothers options for handling all of this.

For some cultures fasting is a traditional religious belief practiced on a regular basis at specific times. Information and tips from other breastfeeding mothers for how they can manage fasting times without harming themselves or their babies can give them reassurance and confidence.


Complementary foods
The traditional introduction of other liquids or solids at a young age may hinder breastfeeding. In some Asian families it is thought that the mother-in-law must give newborn sons the first feed. In China babies are often given a porridge made out of wheat flour and vegetable water, which is water that vegetables or fruit have been boiled in, at around four months of age. In Japan mothers are often encouraged to give their babies cooled boiled water unnecessarily after the baby‘‘s daily bath to prevent dehydration. Mothers can be reassured that breastmilk can just as easily prevent dehydration while providing nutrition and comfort at the same time.

"Babies are born bringing three days worth of meals with them." Is a well-known Japanese saying that helps reassure Japanese mothers that their baby will do fine on the small amounts of colostrum they receive during the first few days until the mature milk comes in, which is often around the third day.

Pressure to give solids or complementary food early and as the main source of nutrition for babies and toddlers causes much stress to both mother and child, especially if the child refuses to eat solids.

摄影:Melanie Aldridge

I like the term "complementary foods" because it implies that breastfeeding continues. In Japanese the word for cooked rice is ごはん (gohan) which means a meal. I frequently compare breastfeeding to "gohan" or the main part of the meal, while complementary foods are the おかず (okazu), the side dishes, during the first half-year or so of offering complementary foods to a baby. If a baby is still nursing well, then you do not need to worry about how fast or slow, or how much or how little of the complementary food is being consumed.
我喜欢“补充食物”这个说法,因为它意味着母乳喂养还在继续。在日本,煮熟的大米叫做ごはん (gohan)指的是一顿正餐。我经常把母乳喂养比喻成”gohan”或者一餐饭的主要部分。而补充食物叫做おかず (okazu),小菜,在婴儿的第一个半年左右给孩子提供补充食物。如果孩子哺乳情况良好,那么你就不需要担心补充食物或快或慢,或多或少的摄取了。

Mothers should be encouraged to follow their baby‘‘s readiness signals, NOT "the book" and be reminded that there is no set age he must start eating solids and that children vary greatly as to when they are ready to eat solids, how much, and how often. It is helpful to hear from other mothers about when, how, and what they offered their babies for first foods. This gives mothers who are feeling pressured to do it the "right way" other options. It is reassuring to know that there are other babies who won‘‘t eat, to know that theirs are not the only ones.

Patience, flexibility and variation can help make this big milestone less stressful and more enjoyable.

Breastfeeding in public
Being able to breastfeed in public can help mothers who feel cooped up indoors and hungry for adult female conversation.

Many factors can affect how people view breastfeeding in public. Mothers in Taiwan, Shanghai, Beijing, Korea, and Japan shared that they had relatively few comments or criticisms to their breastfeeding in public. Mothers in Hong Kong and Malaysia expressed similar views but added that it would be best to expose as little as possible of the breast.

Clothing that allows easy access for nursing, practicing discreet nursing at home, nursing in a sling, responding quickly to a baby‘‘s needs, using body language that does not convey you are self-conscious, finding a comfortable place to nurse, and going out with another nursing mother or two can make breastfeeding in public go a lot more smoothly. It is also helpful to find recommendations for breastfeeding-friendly shopping places and eating establishments.

It used to be common for mothers to learn about breastfeeding by watching their own mother nurse their younger siblings and from watching their sisters, friends, and neighbors nurse their children. La Leche League helps provide opportunities for this very crucial but often missed learning experience.

The workplace
Although there are some workplaces that provide ample maternity leave, are supportive of employees who are breastfeeding, and may even have a breastfeeding policy, there are many workplaces that only provide a short leave or make mothers feel obligated to cut their leave short or quit work instead.

To continue breastfeeding on the return to work mothers need a quiet location with somewhere to plug in their breast pump, breaks to express their milk, access to a wash basin, a place to safely store expressed milk, and the support and understanding of their employer and colleagues. A member of La Leche League Hong Kong and a teacher of Special Educational Needs at the English Schools Foundation was determined to continue breastfeeding after she returned to work. She helped her employers formulate a Breastfeeding Friendly Workplace Policy that incorporated all her needs in a flexible way that would guarantee support and respect to future breastfeeding employees.

Maintaining a breastfeeding relationship after returning to work not only assures the continuing benefits of sustained nursing but allows the mother and child opportunities to bond closely after hours of separation. Being able to discuss with other breastfeeding mothers about how to prepare for returning to work can be helpful in acquainting the mother with what to expect. Covering how to dialogue with your employer, find a caregiver, learn about pumping, storing, and handling breastmilk will help make breastfeeding manageable.

Finding out how other mothers coped with separation from their child, pumping difficulties, pressure to switch to formula, making up for lost breastfeeding time, and adjustment to routine helps the breastfeeding mother to be prepared emotionally for what she may face when she returns to work and arms her with some possible solutions.

Breastfeeding while pregnant
Breastfeeding while pregnant can be a very hot issue for some obstetricians with the pat answer being "Don’t!" and that it can cause miscarriage or increase the risk of premature delivery. Many mothers are not even aware that it is possible to continue breastfeeding while pregnant. This was the question I asked at a La Leche League meeting while pregnant with my fifth child and still nursing my fourth. Neither of us was ready to wean, but my obstetrician was adamant about not breastfeeding while pregnant. It was a relief to hear and read about mothers who had breastfed happily throughout pregnancy and some who went on to tandem nurse.

Tandem nursing is a topic rarely addressed in basic breastfeeding information. Tandem nursing can be challenging but also very rewarding for mother and siblings. It is reassuring to know that you are not breaking the mold but filling it. Connecting with mothers who have breastfed twins or who have experience supporting mothers of multiples can give an extra boost of encouragement. Building up a support base while pregnant through LLL can help assure a mom that there will be someone there for her when her needs are high and immediate.

Breastfeeding an older child
Many mothers who had relatively little criticism when breastfeeding their baby through the first year encounter negative comments and unasked for advice on weaning when nursing an older child. Nursing a toddler has its own challenges. It may not be easy to breastfeed discreetly when a toddler is squirming about, unbuttoning or pulling up a shirt to gain access to your breast, and proclaiming for all to hear that he wants to breastfeed. It helps to know that you are not alone. Sharing tips for handling criticism with other mothers can give insights into what might work in certain situations.

New baby/new sibling adjustments can seem difficult, at times insurmountable. Some mothers feel guilty about neglecting their older child to care for the needs of a newborn. Opportunities to see mothers interacting with a baby and older child, meeting the needs and demands of both, can be a great learning experience. Time to share about perceived failures and concerns can help restore self-confidence in mothering.

LLL in Asia
You can find La Leche League Groups and contact information for Leaders on the "Choose a Country" drop down bar located at the top of the La Leche League International website www.llli.org, which will take you to websites for specific countries and there are some direct links in the Global LLL column in this magazine. La Leche League China and Hong Kong have websites with a smorgasbord of information ranging from FAQs, Leader contact information, meeting dates and locations, special events, educational opportunities, publications, and more.
在国际母乳会的网站www.llli.org上方,你可以通过“选择国家”这个下拉菜单, 连结至特定国家的网站,找到母乳会的小组和哺乳辅导的联系方式,在《今日哺乳》杂志里Global LLL专栏也有直接的链接。母乳会-中国和香港都有自己的专属网站,从常见问题,哺乳辅导的联系方式,会议时间地点,特别事件,教育机会,媒体出版物等等,信息无所不包。

Two of Asia‘‘s oldest La Leche League entities are La Leche League Hong Kong, which started up in 1978, and La Leche League Japan, which started functioning as an organization in 1992. La Leche League Asia & Middle East publications include ALL Around Asia (for Leaders), Close to the Heart (a mothers‘‘ magazine), a Chinese mothers‘‘ newsletter, and translations of information sheets and pamphlets into Arabic, Hindi, Simplified Chinese and Traditional Chinese. With the help of grants and donations, translation and distribution projects have been made possible, including the distribution of 60,000 copies of the bilingual LLL pamphlet When You Breastfeed Your Baby to all hospitals in Hong Kong. Information about breastfeeding during disasters and emergencies can also be found on La Leche League websites in Asia.

LLL truly is an international organization!
RuthAnna Mather I am the mother of six breastfed children, a La Leche League Leader, the Area Coordinator of La Leche League Leaders in Asia and the MIddle East, and the Area

Translations Coordinator of La Leche League in Asia and the Middle East.
作者介绍:RuthAnna Mather,六个母乳宝宝的母亲,母乳会哺乳辅导,母乳会亚洲及中东地区的哺乳辅导协调人和地区翻译协调人。


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