http://doi.org/10.33698/NRF0128- Suksham Chopra ,Raman Kalia,Indarjit Walia
Abstract : Breastfeeding practices play important role in growth and development of child. Breastfeeding patterns established in the immediate neonatal period influence long term breastfeeding practices. Continuation of breastfeeding depends on mothers’ knowledge and opinions related to breastfeeding. The present study was conducted with the objective to assess Knowledge and Opinions of mothers of hospitalized neonates related to Breastfeeding. In this study mothers’ were aware of initiation of breastfeeding and advantages of giving colostrum to the infant but in practice less number of actually followed it due to cultural beliefs and taboos. Presence of mother at the time of admission of neonate for the purpose of treatment can help in continuation of breastfeeding. Nurses can play important role in providing psychological support to mothers when they are under stress due to sickness of their neonates. Appropriate training programmes should be organized for nurses to provide hospital and home based counseling for mothers.
Key words :
Neonates, Breastfeeding, Knowledge and Opinion
Correspondence at : Suksham Chopra,
Medical Social Worker,
National Institute of Nursing Education, PGIMER, Chandigarh
Introduction
Breastfeeding practices play an important role not only for proper growth and development of child, but also in reducing the infant mor tality rate. In India, and other developing countries, infant mortality rates continue to remain high as compared to other developed countries. According to a UNICEF repor t, although there is decrease in the number of deaths below five year of age, not much progress has been made in this regard, due to poor living conditions and overcrowding.1 World-wide, about 38 percent of deaths among children, ‘younger than five years of age, occur during the first 28 days of life, and 75 percent of neonatal deaths occur in the first 7 days. 2-3 The exact cause of neonatal mortality rate remains unknown because most of the deliveries are conducted at home.4 Thus reduction in neonatal mortality rate depends on a great deal of proper breastfeeding practices.
Breast milk is considered as a natural and the most economical food for infant. Breast milk is easily digestible to the infant as it contains various nutrients.5 In India, breastfeeding is universal but there are state- wise variations, regarding the initiation and continuation of breastfeeding. Infant breastfeeding and caring remain important activities which are dependent of sucking, reflex action, gestation and general well-being of the neonates.6 Breastfeeding is promoted internationally as a preferred method of infant feeding. It is well known that mothers’ knowledge as well as their opinions related to breastfeeding plays an important role in initiation and continuation of breastfeeding. It is from this consideration that the present study had been undertaken.
Materials and Methods
The present study was carried out in the Neonatal Surgical Intensive Care Unit (NSICU) of Advanced Pediatric Centre of PGIMER, Chandigarh, during 2007-2008 with the following objectives:- (1) To assess breastfeeding practices among mothers of neonates admitted to NSICU; A group of 125 mothers (respondents) of hospitalized neonates were selected and interviewed with the help of a semi – structured interview schedule, which was thoroughly pretested. Data were gathered from respondents on their socio-demographic characteristics, including family type, and family income. In addition, data were also gathered about characteristics of neonates and about their mothers’ knowledge and opinions related to breastfeeding practices. Some of the selected findings of this study are presented here.
Findings of the Study
- Socio-Demographic Profile Respondents
In the present study, more than seventy percent of the respondents were from rural areas (72.0%) and rest belonged to urban areas, Age-wise 72.0 percent were below twenty five years of age. More than one third of them were illiterates (36.4%) and 63.6 percent had studied up to the 10th standard and above. Only four of the respondents (3.2%) were working and the rest all were housewives (96.8%). More than seventy five percent of them represented joint/extended families (76.0%) and sixty percent (64.8%) of them had a monthly income of less than rupees 5000/- per month.
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Table – 1: Socio-demographic profile of Respondents and Characteristics of Neonates N=125
- Characteristics and Diagnosis of Neonates
In this study, eighty percent (80.8%) of neonates were males. Weight-wise one third of them were below 2500 gms i.e., they were premature babies. However, one third of the respondents were unable to recall the bir th weight of their neonates. It was believed that weighing the infant may have a bad effect on its growth and development. Age-wise 60.4 percent of neonates were above 16 days. (Table I). It was found that 38.4 percent of them were suffering from intestinal obstruction and anorectal malformation (20.8%). Rest of them were suffering from hydrocephalus (8.0%) respiratory infections, stricture urethra and other infections (32.8%). Presence of mother at the time of admission and stay during treatment of neonate plays important role in continuation of breastfeeding. It was considered necessary as in cer tain cases breastfeeding is withdrawn especially when mothers are recovering from some postnatal sickness or when they are under stress due to some disease or disability of neonate. In the present study 46.5 percent of the respondents were present at the time of admission and most of them came from northern states.
- Delivery Related Aspects
In India, normally most of the deliveries are conducted at home and by the traditional birth attendants. But in the present study it was found that only one third of the deliveries were conducted at home by the traditional bir th attendants, either skilled or unskilled.
More than sixty percent of these deliveries were conducted in the hospitals (government or private) and attended by a doctor and a nurse. (Table II). More than fifty percent (53.6%) of the respondents had one child and as many as 46.4 percent of them had two or more than three living children.
Table – 2: Respondents, Delivery and Related Aspects
| Aspects | percentage |
| Type of delivery
– Normal – Ceseraren |
78.4 21.6 |
| Place of delivery
– Home – Hospital |
32.0 68.0 |
| Awareness related to Initiation of breast feeding
– Within few hours after delivery – After 2-3 days |
68.8 31.2 |
| Practices regarding initiation of breast feeding
– Within few hours after delivery – After 2-3 days |
30.2 69.8 |
| Awareness about colostrum
– Yes – No |
57.6 42.4 |
| Practice Related to giving of colostrum
– Yes – No |
27.2 72.8 |
- Mothers’ knowledge, opinions and practices related to breastfeeding
It has been well documented that breastfeeding practices established in the immediate neonatal period, influence long term breastfeeding practices.7-8 Review of studies provides enough evidence how cultural beliefs and taboos influence initiation of breastfeeding within few hours after delivery.9-11 In this study 68.8 percent of the mothers were aware about the importance of initiation of breast feeding within the few hours after delivery but it was found that only 31.2 percent of them had actually followed it. Similarly, 57.6 percent of respondents were aware about advantages of giving colostrum which also play important role in strengthening the immune system of the infant but only 27.2 percent of them followed this practice. (Table II).
As regard their opinion about duration of breastfeeding 46.4 percent of respondents were of the view that breastfeeding should be continued till six month only 19.2% were of view that it should be continued till 9 months and another 15,6% wanted to continue for one year. Regarding supplementary diet they were of the view that semisolids, mashed vegetables and fruits juices should be introduced in the diet before infant complete six months. Only 27.2% wanted to introduce it after six months. (Table III).
It is well known that exclusive breastfeeding for first six months is highly effective way to reduce child mortality. In India, exclusive breast feeding is not common and mothers start complementary feed either too early or too late.12-13
Table – III: Opinions regarding duration of breastfeeding and introduction of supplementary food N-125
| Feeding | n (%) |
| Duration of Breast feeding (months) | |
| – Upto 3 | 12( 9.6) |
| – 4-6 | 58(46.4) |
| – 6-9 | 24(19.2) |
| – Up to one year | 19(15.2) |
| – No idea | 12( 9.6) |
| Initiation of Supplementary food (months) | |
| – Within 3 months | 31(24.8) |
| – 3-6 months | 60(48.0) |
| – 6-9 months | 25(20.0) |
| – No idea | 9( 7.2) |
According to breastfeeding promotion network of India (BPNI), children below five months of age are not breastfed and have increased risk of death from diarrhea than those who are exclusively breastfed. Bottle fed children are also more susceptible to illnesses and it is not good as breastfeeding because it has more nutrients. In the present study, more than fifty percent (54.4%) of the respondents were against bottle feeding, believing that this could lead to infection due to improper sterilization. However, 58.4 percent of them were of the view that bottle feeding should be continued when there is insufficiency of breast milk and also during travel. In addition, they also believed that during mother’s sickness and subsequent pregnancy, breastfeeding should be discontinued because this may affect the growth and development of foetus (Table IV).
In this regard, there is evidence suggesting the impor tant role of health professionals including doctors and nurses who come in close contact with the mothers of neonates. Nearly one third of the respondents were of the view that doctors (34.1%) and nurses (65.1%) played an important role in taking care of their problems related to continuation of breast feeding. Some of the problems handled by them included, expression of breast milk, soreness of nipples, engorgement of breast, insufficiency of breast milk and proper positioning of neonate while breastfeeding.
It was perceived that low breast milk supply was the main reason for partial and early cessation of breast feeding.
Table – IV : Respondents views regarding continuation /avoidance of breastfeeding
| Avoidance/continuation | Responses (%) | ||
| Breastfeeding to be avoided during
– Sickness of Mother – Next pregnancy – When child gets teeth |
Yes
(46.4) (47.2) (69.6) |
No
(34.4) (28.0) (11.2) |
Do not know
(19.2) (24.8) (19.2) |
| Bottle feeding should continue because of
– Insufficiency of milk – During travelling |
(66.4) (58.4) |
(12.0) (20.0) |
(21.6) (29.6) |
| Feeding (Bottle/Breast) should be avoided At public places |
(88.8) |
( 6.4) |
( 4.8) |
Disscusion
Initiation of breast feeding within few hours after delivery also helps in saving the life of infant. In the present study 30.2 percent of the neonates were breast fed during the first few hours after delivery and 27.6 percent had given colostrum to the infant Studies from Asian countries have also repor ted delay in initiation of breastfeeding and avoidance of colostrum due to various reasons.13-14 In a Bangladesh study, breastfeeding was delayed until three days after delivery.15 In Indian setting women are not allowed to go outside, home either due to postnatal problems or certain cultural factors. It is believed that women must have complete rest during the postpartum period and this might enable and encourage woman to breastfeed during this period. In the present study also only 46.4 percent of the mothers were present at the time of admission of their neonates. The rest of neonates were admitted by their relatives for the purpose of treatment. Studies have also reported that breastfed children for a longer duration are more protected against childhood overweight.16-18 Breastfeeding is also beneficial in the case of premature babies. In this study more than one third of neonates weighed less than 2500 gms at the time of bir th. Thus breastfeeding practices can help low bir th weight babies for proper growth and development. Obviously, health professionals especially nurses can play important role in promoting continuation of breastfeeding in the hospital setting. Nearly one third of respondents stated that they were helped by a doctor in overcoming problems related to continuation of breastfeeding.
Nurses are repor ted to lay more emphasis to post operative care of the new born and not provide adequate information. Studies have documented that infant feeding counseling is often of poor quality and unavailable to for many women.19-20 Nurses should also provide psychological support to mothers and clarify their doubts related to continuation of breast feeding. During the first few days after delivery, women lack the experience of handling the sick newborns and are often under stress due to sickness or disability of the neonate. To conclude there is need to evolve hospital-based policies and procedures to improve breastfeeding practices, and in this nurses can play important role.
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