Wednesday, May 21, 2008

You thought your in-laws were bad! On breastfeeding...

Last Sunday night, just as I was putting the girls and myself to bed for an early night, a friend from my breastfeeding group called. Her Khmer friend was in hospital with her six-hour-old baby and having problems breastfeeding. Her first baby (now one year old) was not breastfed because the woman’s mother insisted that her daughter had wrongly shaped nipples for breastfeeding. The baby was given rice milk from birth.

So off I went to the hospital. I have done this before but I am always amazed by the sheer number of people congregating in the maternity units. There is one benefit to be gained from not offering food or drinks in hospital – your family rallies round. Each room, not to mention the corridor, was crammed full of family members, from small children to grannies, all fussing around the mother, offering home cooked food, another blanket, and lots and lots of advice. Did I say benefit? Well I do love the idea in theory. In practice unfortunately, the sheer volume of people can interfere with the mother’s bonding with her new baby, and the well-meant advice is often harmful and misguided.

My new friend’s room was just as packed. I was nervous that they would wonder who this western woman thought she was, coming in and offering advice about breastfeeding. Little did I know that her father was interrogating James outside:

“Is your wife a doctor?”
“oh, she’s a nurse right?”
“Urm, no”
“What is…”
“She’s a breastfeeding counsellor!” he sort of lied.
“Oh, good!”
Apparently a peer counsellor, untrained but experienced, might have been confusing, what with the language barrier… so James explained to me later. But I know he was just scared. There were a lot of people.

They were all very friendly however and it was quite clear that the mother herself desperately wanted to breastfeed her second child. So we chatted, I helped her latch her baby on, reassured her that her nipples looked perfectly normal to me and that her daughter was latching on and sucking perfectly. Then it became clear that the whole family thought that she did not have enough milk, so I explained about colostrum and the fact that her milk would not really come through until day three or four. Then I encouraged her to take off the baby’s clothes, and her own layers, and hold her skin to skin for as much time as possible. This actually goes against Khmer culture where they believe that a newborn baby and mother lose dangerous amounts of body heat during labour so they each wrap up in several layers of towels and blankets, which of course prohibits the breastfeeding hormones from doing their job. In the countryside they still practice ‘roasting’, whereby mother and child spend a month in a hut lying over hot coals, sauna style. Luckily this woman was educated enough not to throw away the colostrum, which many Khmers believe is dirty and bad for the baby.

I left the hospital feeling hopeful that she would enjoy a happy breastfeeding relationship with her new daughter. The next day she called again with the same concern. “I have not got enough milk”. I went over the facts once more and received a text a few hours later: “My baby is now absorbing milk. Thank you so much for your help”. Hoorah! I knew she would need lots of encouragement but it seemed as though the case were closed. I got distracted with other things and that was that. Until this evening, when my friend updated me on the woman’s progress. I am gutted. Despite her education, her parents have convinced that her milk is too yellow after all. It must be bad, they thought, so they went out and bought a tub of formula and that was that. Gutting.

I know it is no use getting upset or too involved (although I have texted her of course and offered to meet up with her tomorrow!) but it is hard not to feel angry. It was so disheartening in the hospital to see the number of brand new babies on bottles all along the corridors, and more so because the grandparents and mothers offering them were so proud of the fact. “Formula” they said to me happily, as I cooed over their babies. The laws against advertising formula milk mean nothing in a country like Cambodia. The image of a fat, formula-fed baby is desirable - just that morning James’ colleagues were expressing disapproval and disappointment over how small Bella is. (She is not small. She is just slim and long…but there were no tubby rolls for them to pinch and squeeze.) I am not angry with Cambodians. It is the formula companies I feel disgusted with. Infant mortality in Cambodia occurs at a rate of 65 deaths per 1000 live births. In 2000 it was 95 per 1000, so the situation is improving thanks to breastfeeding awareness campaigns. But while the formula companies continue their aggressive advertising campaigns, babies and children continue to die unnecessarily. In a country as poor as Cambodia, women, babies and children need all the health benefits offered by breastfeeding that they can get.

Grrrr. I'm off to bed. For a far more articulate read about very naughty formula companies check out Baby Milk Action. Good night all.


Kasia said...

So sorry to hear about this woman. That breaks my heart. Although it appears more extreme in Cambodia I even find it happens in Canada on occasion. My friend was told by her pediatrician to give up breastfeeding bc she obviously was not producing anything. There was no consultation to a lactation clinic or discussion on how to increase production just simply was told to stop. She regrets it to this day and wants to do things differently next time.

I also think its amusing that people think babies who are breastfed are skinnier. I know that is what the research shows. My two boys have been between the 95-100 percentile for height and weight (not that %iles are important) and were/are exclusively breastfed. Genetics are involved in the process. On the other hand, my one friend whose child was on formula was the skinniest of all the babies (they were all breastfed except for him). Its crazy.

I do you can talk some sense into this woman whose family obviously has some issues. I wonder if her mother breastfed and what her experience was like feeding her infants?

Georgie said...

Yes! The babies in my breastfeeding group are amazing - some really squidgy chubby delicious little cherubs... defies belief sometimes - they looked twice Bella's age when they were half! Scrumptious!

Jo Ann said...

doesn't that just suck? I went to visit a
friend in hospital last week who had just given birth and she was
not allowed to bathe or wash her hands, despite just having given
birth!! This poor girl, her whole family was around her telling
her what to do. It's no wonder so many of my cambodian friends are
so unconfident in their skills as a mother. I am actually off to
visit another friend with a newborn today, she showered the day
after she gave birth and her mother screamed at her. At least she
is breastfeeding successfully....

Oh the pressure of parents!

Jo Ann said...

P.S. visited my friend today who has a newborn and she is quite down. apparently her mother told her off for reading because it will make her go blind. apparently this is what happens after you give birth...!

Georgie said...

Arrghhhhh mind boggles...

Anonymous said...

Good on you Georgie for getting involved - very brave indeed in the context.

Sadly, this is a worldwide problem - adequate info and support for bf - and I was told by one Health Visitor in the UK that midwives in the UK only get a day's training on bf themselves....

One of your friends sent around an article about how bf can help reduce the risk of rheumatoid arthritis in the mother and the statistics on bf in the UK in that article were simply shocking:

'Breastfeeding 'may cut arthritis'

"The Infant Feeding Survey, published in May last year, showed that most
women are failing to follow government advice, with fewer than one in
100 women breastfeeding exclusively for the first six months.
While 76% of UK mothers started out breastfeeding - a rise of 7% since 2000 - most resort to formula milk within weeks.
Fewer than half of mothers are still breastfeeding by the time their child is six weeks old, and only a quarter do so at six months."

My daughter didn't latch on for 48 hrs and I was basically left no option 'she is making too much noise and will keep other babies up on the ward' but to give her 15ml of formula. I had a myriad of advice about bf from the different midwives in hospital in London, depending which shift I hit - some said I needed nipple shields, another said not to sleep with my baby 'as they get too cosy and don't wake up to feed' another kept grabbing her by the head to force her on (whilst she was screaming...) etc. If I hadn't looked into it enough before giving birth, I would not have known what to ask or who to turn to. In the end, we breastfed for 29 months - until she naturally weaned.

Anonymous said...

'Doesn't this just suck?' said Jo Ann! Well, NO .... and that's the point!!!!

Anonymous said...

Hi Georgie,
Clare Gardner put me on to your blog because she thought I might be interested in it and she was right! The first post I came across was a subject dear to my heart: breastfeeding (tomorrow, it will be 2 years and 5 months that I've been breastfeeding Natasha).
Like you, I despair at the unethical marketing practices of infant formula manufacturers in Cambodia; I was shocked by the extent of formula when I first arrived here, especially after reading about how culturally acceptable breastfeeding is in this country, and in light of how poor it is. I've been trying hard to get a Cambodian friend to wean his (still breastfed) toddler off formula, the cost of which is exhorbitant in terms of his weekly household budget; but it turns out I'm going against the advice of the doctor, who is probably receiving a commission from the formula manufacturer to promote the damn stuff (not that I blame the doctor, given the poor level of salaries here).
On top of that you have the cultural practice of colostrum denial, which has always baffled me. I understand culture is what people do to survive, but I've never been able to make sense of this practice.
I empathise with how frustrated you must have felt, being unable to protect your friend and her baby in the hospital from well-meaning but misguided relatives.
Feel free to check out my blog at
And here's to meeting up some time,

Georgie said...

Hi! Thanks for reading my blog I will go and check yours out! Hope you are encouraged by my news that mother is breastfeeding after all! Hoorah!

Georgie said...

Sorry yes and hope we can meet! drop me an email or I'll contact you through your blog gxx