Exclusive Breastfeeding

Abstract

For infants, breast milk is the best food. It is clean and safe, and has antibodies that protect against a variety of common childhood diseases. Breast milk meets all of an infant’s nutrient and energy needs during the first few months of life, and it continues to meet up to one third and up to half of a child’s nutritional requirements during the second half of the first year. Breast milk, here in after abbreviated as breastfeeding, is the liquid produced by the secretion of the mother’s breast glands. Exclusive breastfeeding, is breast milk given to babies from birth for 6 (six) months, without adding and/or replacing it with other food or drinks. Exclusive breastfeeding is that babies are only given breast milk, without additional liquids such as formula milk, orange juice, honey, tea, water and without additional solid foods such as bananas, papaya, milk porridge, biscuits, rice porridge and team, for 6 months. There are many factors to get success exclusive breastfeeding.

1. Introduction

For infants, breast milk is the best food. It is clean and safe, and has antibodies that protect against a variety of common childhood diseases. Breast milk meets all of an infant’s nutrient and energy needs during the first few months of life, and it continues to meet up to one third and up to half of a child’s nutritional requirements during the second half of the first year [1]. In 1990, WHO-UNICEF made a declaration known as the Innocenti Declaration. The declaration, which was born in Innocenti, Italy, aims to protect, promote, and provide support for breastfeeding. In this declaration which was also signed by Indonesia, it was explained that in order to optimally improve the health and quality of baby food, all mothers are advised to give exclusive breastfeeding from birth to 4 months of age. After the age of 4 months, babies begin to be given complementary foods/solids that are correct and appropriate, while breastfeeding is continued until the age of 2 years or more. In 1999, evidence was found that feeding too early has a negative effect on infants. Since then, UNICEF has provided clarification regarding the recommended period for exclusive breastfeeding. UNICEF’s latest recommendation with the World Health Assembly (WHA) and many other countries is to set a period of exclusive breastfeeding for 6 months [2].

Breastfeeding, is the liquid produced by the secretion of the mother’s breast glands. Exclusive breastfeeding, is breast milk given to babies from birth for 6 (six) months, without adding and/or replacing it with other food or drinks. Exclusive breastfeeding is that babies are only given breast milk, without additional liquids such as formula milk, orange juice, honey, tea, water and without additional solid foods such as bananas, papaya, milk porridge, biscuits, rice porridge and team, for 6 months [3].

Exclusive breastfeeding is beneficial for both mother and baby. Exclusive breastfeeding for 6 months is the optimal method of infant feeding. Breastfeeding provides the baby with nutrients for growth and development, and boosting the immune system. There is some evidence to prove that exclusive breastfeeding for 6 months provides protection against gastrointestinal infections and iron deficiency anemia. Exclusive breastfeeding also makes women amenorrhea for 6 months postpartum and helps them avoid unplanned pregnancies that end in abortion. In addition, research evidence shows that breastfeeding improves sensory and cognitive development while protecting babies against chronic illnesses and respiratory infections (common cold, cough, or pneumonia). Exclusive breastfeeding arrangements aim to

1. ensure the fulfillment of the baby’s right to receive exclusive breastfeeding from birth to the age of 6 (six) months by taking into account their growth and development,

2. provide protection to mothers in giving exclusive breastfeeding to their babies and increasing the role and support of the family, community, local government, and the government for exclusive breastfeeding [4].

2. Exclusive breastfeeding

2.1 The composition of breast milk

The composition of breast milk consists of colostrum, foremilk, and hindmilk. From the beginning to the end of a feed, the composition of breast milk varies depending on the baby’s age. It may also differ at various times of the day and between feeds. The thick, yellowish, or clear milk that women produce in the first few days after giving birth is called colostrum. The special properties of colostrum are antibody-rich, many white cells, purgative, growth factors, and vitamin A rich so why it is important because it protects against infection and allergy, protects against infection, clears meconium, helps to prevent jaundice, helps intestine to mature, prevents allergy, intolerance, reduces severity of infection, and prevents eye disease. Therefore, it is critical for infants to consume colostrum during their initial feedings. When a baby is born, the colostrum is ready in the breasts. Before the mature milk arrives, it is all the majority of babies require. Drinks and foods should not be given to babies before they start breastfeeding. Particularly risky are artificial feeds given before a baby has colostrum [5].

The milk that is produced after a few days is called mature milk. The breasts feel full, hard, and heavy because there is more milk. Some refer to this as the “coming in” of milk. The bluish milk that is produced early in a feed is called foremilk. The whiter milk that is produced later in a feed is known as hindmilk. Colostrum has more protein than later milk, and hindmilk has more fat than foremilk. There are two distinct types of breast milk. Hindmilk appears whiter because it contains more fat. Because this fat provides much of the energy needed to breastfeed, it is important not to take a baby off the breast before he has had everything he needs. Larger quantities of foremilk are produced, and they contain a lot of protein, lactose, water, and other nutrients. Mothers sometimes worry that their milk is “too thin” because it looks watery. Milk never appears “too thin.” For a baby to have a complete “meal,” they must have both foremilk and hindmilk. The transition from “fore” milk to “hind” milk is gradual. From the beginning to the end of a feed, the fat content gradually rises [5].

2.2 How the breast works

The small amount of milk that accumulates between feedings is extracted from the milk ducts under the alveoli when the baby latches onto the breast. Two hormones are released as a result of this suckling: oxytocin and prolactin. Oxytocin causes the alveoli, the cells that produce milk, to squeeze the milk out of the ducts and toward the nipple, while prolactin instructs the alveoli to produce more milk.

The system of breastfeeding is based on the law of supply and demand. The quantity of milk produced is determined by the amount of milk taken from the breast. Milk production takes place both between and during feedings. The quantity of milk produced will be influenced by the baby’s breastfeeding frequency, duration, and quality. The breast produces foremilk at the beginning of a feeding. This has more fluid and lactose. The baby gets more fat and calories from the hind milk it gets later in the feeding process. To ensure that the baby receives the hind milk required to feel satisfied and gain sufficient weight, it is essential to allow the baby to finish the first side completely. Learning to breastfeed is a skill that may require some time [5].

2.3 Exclusive breastfeeding

Kramer & Kakuma (2004) repeated evidence of the effect of exclusive breastfeeding on the health and growth of infants, revealing that infants who were exclusively breastfed for up to six months showed a lower morbidity rate of digestive diseases and allergies. Provision of breast milk (breastfeeding) for premature babies greatly affects the level of their intelligence as adults, It’s conclusion of the experiment for 16 years there were 424 babies conducted by Prof. Alan Lucas and colleagues at the Institute for Child Care at Great Ormond Street Hospital, London. This research shows that food management immediately after birth has a similar effect on all babies, not just premature babies. In 1982 when research began, hospitals generally gave standard infant formula to premature babies. Since the late 1980s, most UK hospitals have switched from standard infant formula to formula fortified with breast milk [6].

In developing countries, WHO recommends exclusive breastfeeding until the age of 4–6 months and continued breastfeeding accompanied by adequate and complete food intake until the baby is 2 years old, even though the baby has growth delays [7]. Gibney et al. 2009 wrote that obstacles hindering the success of breastfeeding are the many unwarranted beliefs and attitudes toward the meaning of breastfeeding, which makes mothers not practice exclusive breastfeeding for their babies in the first 6 months period. The World Health Organization (WHO) and the United Nations Children’s Fund (UNICEF) both recommend that infants begin breastfeeding within the first hour of their birth and consume only breast milk for the first six months of their lives—no other foods or liquids, including water, are provided. Infants should be breastfed whenever they want to, throughout the day and night. Pacifiers, teats, and bottles should not be used. Children should begin eating safe and adequate complementary foods at the age of six months, and they should continue to breastfeed for up to two years and beyond. Common reasons why they do not exclusively breastfeed include the following:

1. An unfounded fear that the milk they produce is not enough and/or of poor quality

2. Delay in starting breastfeeding and the practice of throwing away colostrum

3. Incorrect breastfeeding technique

4. The mistaken belief that their baby is thirsty and needs extra fluids

5. Lack of support from health services

6. Marketing of breast milk substitute formula [8].

Exclusive breastfeeding can prevent nutritional problems in infants, from several research results showing that there is an effect of exclusive breastfeeding on the incidence of stunting as in a study conducted in Siaya which is the western part of Kenya with a cross-sectional study design. The results showed that 47% of toddlers there were stunted, the highest age group experiencing stunting is at the age of 13–24 months and 60% of toddlers experience stunting at the age of 2 years of life. It’s showed during the 3 months of life 67% of babies who suckle within 10 times a day. From the results of the study, it was also found that infants who breastfed less than 10 times in 24 hours were 48.1% of stunted toddlers [9].

Research Yovita Ananta et al. 2016 found significantly more babies in the formula-fed group had abnormal head circumferences than in the group that were exclusively breastfed. A previous study also found that babies who were exclusively breastfed had greater head circumference values ​​for age compared to those who were fed formula or mixtures. WHO and UNICEF recommend exclusive breastfeeding until the baby is 6 months old. Despite the many benefits of breastfeeding, the rate of exclusive breastfeeding at 6 months remains unsatisfactory. The results of a study by Yovita Ananta et al. in 2016 are as follows: The rate of exclusive breastfeeding varied from 10.5% in East Java to 66.9% in Jambi Province, with a total rate of 46.3%. In developed countries, exclusive breastfeeding at 6 months is found to be low: 16.3% in the United States, 13.8% in Canada, 13.4% in Hong Kong, 10.1% in Sweden, and 11 and 7% in Norway. In developing countries, the numbers are more favorable. As many as 49% of mothers breastfeed exclusively in Ethiopia, 13 and 46.4% in India, 14 and 27.7% in Iran. A study conducted in Peninsular Malaysia reported a rate of 14.5% [10].

The duration of exclusive breastfeeding continues monthly from 1 month to 6 months. Research in Sri Lanka found that the prevalence of exclusive breastfeeding for up to 6 months was 50.8% and up to 5 months or more was 81.3%. The average duration of exclusive breastfeeding is 6 months. The main reason for stopping early exclusive breastfeeding is that mothers think that breast milk alone is not enough for babies (52.9%). Items given to infants before 6 months were water (91.4%), fruit juice (83.9%), mashed rice (71.3%), and infant formula (16.1%). The majority of mothers (98.9%) know that the current recommendation for exclusive breastfeeding is 6 months. Only 27.7% of mothers could correctly define the term “exclusive breastfeeding.” The majority of mothers (92.4%) know that babies should be breastfed while traveling, while 62.4% believe that formula feeding is an option. The percentage of mothers who know breast milk can be expressed and stored as 68.4%. 65.3% mother have information about breast milk can be stored at room temperature, while 48% and 12.1% know can be stored in refrigerator and freezer compartments. Meanwhile, 12.1% of mothers said they were advised by health workers to start breastfeeding other than breast milk during the first 6 months. Of these mothers, 28 were advised by a doctor. Only 29 mothers (8.2%) started formula feeding in the first 6 months. The majority of babies (94.6%) were breastfed within 1 hour after delivery. Of them 77.7% of mothers believed that their baby was not allowed to finish the first breastfeeding, and 50.6% of mothers were advised by family members to stop exclusive breastfeeding early. Most commonly the family members referred to were their mother-in-law (55.9%) or their mother (44.7%), while 29.1% said their husband influenced them negatively. The majority of mothers (81.1%) have good family support. Some mothers feel that their family members have an encouraging attitude toward breastfeeding [11].

The prevalence of exclusive breastfeeding in Afar Ethiopia under 6 months is 55%. Infants whose mothers live in urban areas have knowledge about breastfeeding, are provided at health facilities, and are more likely to breastfeed exclusively than the referral group. In addition, mothers have a poor understanding of exclusive breastfeeding. Traditional beliefs, myths, and misconceptions about exclusive breastfeeding and lack of support from husbands and families were found to be barriers to proper exclusive breastfeeding practices [12].

The family plays a role in exclusive breastfeeding by supporting the mother in exclusive breastfeeding, supporting the mother to fulfill her nutrition by consuming nutritious foods, ensuring that the mother gets enough rest and creating a calm and peaceful home atmosphere.

2.4 Factors affecting exclusive breastfeeding

Breastfeeding is something natural but requires learning to be able to apply it. To be able to realize the success of breastfeeding requires strong support in achieving its sustainability. Among them, namely by improving the services provided to mothers by helping to increase the initiation of exclusive breastfeeding, consistent education and full support from the health system can help maintain the success of exclusive breastfeeding [13]. The International Confederation of Midwives provides support for exclusive breastfeeding in the form of collaborating with international organizations and government agencies engaged in the promotion and support of breastfeeding, ensuring scientific programs at international congresses to present breastfeeding including the development of HIV/AIDS, using communication media with midwives related to maintaining information on breastfeeding development and breastfeeding period, and ensuring documents related to care for mothers and their babies, which is part of the role of midwives in maintaining, supporting, and promoting breastfeeding [14].

There are ten (10) steps in successful breastfeeding, namely (1) having a policy from the hospital including the hospital providing support to mothers for breastfeeding by not promoting formula milk and using bottles and pacifiers, establishing standards of breastfeeding care practices, maintaining activities breastfeeding support, (2) having competent officers, including conducting training for officers in providing support to mothers for breastfeeding, evaluating the knowledge and skills of health workers, (3) providing pregnancy services that include discussing the importance of breastfeeding for mothers and babies, preparing mothers how to prepare food for the baby, (4) accuracy in providing maternal services after delivery includes encouraging the mother to immediately make skin contact between the mother and her baby after giving birth, helping the mother place the baby for continuous breastfeeding, (5) providing support to the mother for breastfeeding, including checking position, attachment and reflexes for sucking babies, providing breastfeeding support practices to mothers, helping mothers overcome problems that commonly occur in breastfeeding mothers, (6) giving supplements, including giving only milk, unless there is a medical/medication reason, and prioritizing giving milk assistance if needed, help the mother keep her safe if she wants formula food, (7) carry out in-patient care, including allowing the mother and baby to stay together for a day and a night, ensuring that the mother can stay with the baby even though she is sick, (8) caring about feeding, including helping mothers know when their babies are hungry, not limiting breastfeeding time, (9) bottles, pacifiers, and baby pacifiers, including explaining to mothers the use and risks of feeding using bottles, pacifiers, and baby pacifiers, and (10) exemption, including appointing mothers as a source of support for breastfeeding in the community, working with the community in improving breastfeeding support services [15].

Recommendations for increasing the practice of exclusive breastfeeding are increasing the habit of health professionals conducting breastfeeding counseling through training, involving husbands during counseling, and educating mothers and society as a whole to avoid traditional practices that hinder exclusive breastfeeding for up to 6 months [16]. From the results of other studies, it was found that the factors that influence the success of breastfeeding for up to 6 (six) months or exclusive breastfeeding at Cipto Mangkunkusumo Hospital are the mother’s sense of confidence in milk production and the support of the family [17]. Educating mothers and society as a whole avoid traditional practices that hinder exclusive breastfeeding for up to 6 months [16]. From the results of other studies, it was found that the factors that influence the success of breastfeeding for up to 6 (six) months or exclusive breastfeeding at Cipto Mangkunkusumo Hospital are the mother’s sense of confidence in milk production and the support of the family [17]. Several factors influence the practice of exclusive breastfeeding for 6 months, including the mother’s knowledge about breastfeeding, family support, and health care providers who educate mothers about breastfeeding. A study reported that antenatal education can increase the practice of exclusive breastfeeding for 6 months with RR 2.16 (95% CI 1.05 to 4.43), while postnatal education can improve practice with RR 2.12 (95% CI 1, 03 to 4.37) [10].

2.5 Benefit of exclusive breastfeeding

Exclusive breastfeeding is beneficial for both mother and baby. Breastfeeding provides the baby with nutrients for growth, development, and boosting the immune system. There is some evidence to prove that exclusive breastfeeding for 6 months provides protection against gastrointestinal infections and iron deficiency anemia. Exclusive breastfeeding also makes women amenorrhea for 6 months postpartum and helps them avoid unplanned pregnancies that end in abortion. In addition, research evidence shows that breastfeeding improves sensory and cognitive development while protecting babies against chronic illnesses and respiratory infections (common cold, cough, or pneumonia) [3].

Benefits of breast milk for the infant are as follows:

• A lower rate of cot death, also known as sudden infant death syndrome

• A lower risk of ear infections, diabetes, and cancer in children.

• A quicker ability to fight disease and a better response to vaccinations

• A decrease in the number of orthodontic and dental issues (no bottle-related tooth decay).

• Improved psychomotor, emotional, and social growth.

• Benefits to mothers’ health:

• Oxytocin, which is released during breastfeeding, helps to contract the uterus and reduce postpartum bleeding. Because of this, breastfeeding should begin immediately following birth and be continued frequently.

• Women who are nursing save energy; Even if they eat little, they can still make milk.

• The risk of ovarian and breast cancer is lower.

• Breastfeeding frequently helps prevent a second pregnancy and delays the return of menstruation. This helps children save space and iron stores.

• Breastfeeding as a means of delaying a new pregnancy. Breastfeeding can delay the return of ovulation and menstruation, making it an effective method for separating pregnancies. If the mother breastfeeds in the following manner, breastfeeding can provide effective protection against a subsequent pregnancy.

• She should breastfeed exclusively and frequently, night and day, whenever the baby desires it.

• She should breastfeed at least eight to ten times in a 24-hour period, with no break of more than 6 hours between feedings.

Breastfeeding is less effective for family planning when a baby is older than 6 months. Since a baby this age needs more than one food, breastfeeding can no longer be the only option. However, if the mother breastfeeds frequently, breastfeeding still provides some protection against a subsequent pregnancy. Every time she gives the baby complementary foods, she should breastfeed it. A mother who is unable to use any other method of family planning may benefit from this partial protection.

• A child’s protection decreases after 1 year. Before breastfeeding, the child must now consume food to ensure adequate nutrition. However, if menstruation has not returned, frequent breastfeeding may still provide some protection.

• The woman becomes fertile once more when her periods return. Even if her baby is still under 6 months old, breastfeeding will not protect her. She requires a new method of family planning.

Menstruation returns prior to conception in the majority of women. Therefore, a woman’s menstrual cycle is the primary indication that she is fertile once more. However, a small number of women ovulate and are able to conceive before returning to menstruation. When the baby is older than six months, this is more likely to occur.

• Breastfeed immediately after birth, within half an hour to one hour.

• Breastfeed whenever needed, eight to twelve times per day.

• One feeding lasts as long as you want.

• From the time a baby is 0 to about 6 months old, only breastfeed.

• Complementary foods can be started around the age of six months (the exact age varies).

• Beginning at 6 months of age, offer complementary foods to all children.

• Breastfeed until the child is two years old or older.

Calm your newborn by holding him or her against your skin right after birth. It will also keep baby warm and steady his or her breathing. Because baby will be awake and eager to eat within a few hours of birth, this is a great time to start breastfeeding first. Mother can get help with this from a midwife. Baby will be happier if mother feeds him whenever he is hungry and keeps him close to mother. During the first two days of life, a newborn may want to breastfeed frequently. She gets many small doses of colostrum from her frequent feedings, which helps her body remember to produce plenty of milk. Early breastfeeding is its name. Early breastfeeding involves placing the baby on their chest, smelling milk or breast milk, making eye contact with the mother, and the baby crawling up to feed [1].

2.6 What a health professional can do

Support the woman so that she does not need as many interventions during labor and delivery.

• Persuade the woman to try painkillers that would not stop her from breastfeeding. Medication that will eventually pass on to the baby transplacentally and have a sedative effect should be avoided whenever possible.

• From the moment the baby is born until the time the baby has finished eating, let the baby stay skin to skin with the mother.

• Allow mother and child to communicate at their own pace. Only provide assistance when you believe it is absolutely necessary or when the mother requests it. After the birth, postpone any routine procedures that can wait until the mother and baby are ready, which should be at least one to two hours. The baby’s measurement and dressing are two examples.

• Only when absolutely necessary should mother and child be separated. Typically, the baby can be observed briefly while remaining close to its mother. The process can be disrupted by even a brief separation prior to the first feed.

• If the mother is unconscious or exhausted, assist the searching baby in receiving the first feed at the breast without the mother exerting any effort.

• During the first few days after delivery, encourage and assist the mother to have as much skin-to-skin contact as possible with her baby. It is possible to “re-enact” their interaction in the first few days or even weeks after birth at any time if it was disrupted for any reason.

• When the baby is learning to breastfeed, discourage the use of pacifiers and bottles during the initial stages of lactation. Some babies develop a preference for feeding with an artificial teat, which can make them less enthusiastic about breastfeeding.

• When the baby shows that it is ready, let it start eating [1].

3. Conclusion

The infants begin breastfeeding within the first hour of their birth and consume only breast milk for the first 6 months of their lives and no other foods or liquids, including water, are provided. Infants should be breastfed whenever they want to, throughout the day and night. Pacifiers, teats, and bottles should not be used. Exclusive breastfeeding is a form of mother’s behavior in giving exclusive breastfeeding to her baby. The success of exclusive breastfeeding is influenced by many factors, both internal and external factors.