A need for a paradigm change for human milk and breastfeeding education for sick infants: Lessons from Botswana

Abstract

Abstract: Background: Human milk is an effective intervention to prevent illness among premature and sick neonates. Research shows effective establishment of lactation requires early, frequent breast stimulation and emptying of breasts. Challenges exist to ensure infants receive sustained human milk. “Ten Steps to Promote and Protect Human Milk and Breastfeeding in Vulnerable Infants” is a model that has been implemented in the USA and Asia.
Methods: This study used semistructured in-depth interviews with stakeholders to evaluate the climate and identify facilitators and barriers to adaptation of the 10 steps for a tertiary neonatal unit in Botswana.
Results: Mothers and staff lacked knowledge of key benefits of human milk for sick neonates alt h o u g h t h e y we r e p r o - breastfeeding. All lacked an understanding of the importance of expressing early, often and completely. No mothers used any type of breast pump. No one knew about oral care of colostrum. Although many described colostrum and fore and hind milk they could not state the benefits of each. Skin -to-skin was seen as important for growth and bonding but missing was its importance for breastfeeding.
Conclusion: Healthcare workers must be equipped with knowledge about the science of human milk and be able to translate that evidence
for families so that all families make informed feeding decisions for their infants. Once a family chooses breastfeeding, there must be a sense of urgency about the establishment and maintenance of milk supply. Without a change in these two elements, human milk rate in neonatal units worldwide will remain suboptimal