Month: July 2018

The Benefits of Breastfeeding

- Abraham Mathew Saji on the importance of breastfeeding a newborn.

As parents, we are willing to sacrifice all that we have to ensure the happiness, health and safety of our children. It is every mother’s wish that her newborn baby is happy and healthy forever. One of the biggest and most crucial decisions that a mother makes – very early in her child’s life – is that of breastfeeding her baby. This decision will go a long way to help both the baby and mother for the rest of their lives. Breast milk is a perfect blend of vitamins, minerals, proteins, antibodies and an array of other nutrients at the perfect temperature, ready for the baby to consume. It has been prepared personally by a mother, especially for her baby. Thus we see a happy, healthy and personal touch in the act of breastfeeding. 

According to a World Health Organization (WHO) factsheet, nearly nine million children died in 2008 from preventable illnesses before even reaching their fifth birthday, with more than two thirds of them during the first year of life. Millions more survive only to face diminished lives, unable to develop to their full potential. Under-nutrition is a contributing cause of more than one third of these deaths. Poor nutrition during the mother’s pregnancy or the child’s first two years can slow a child’s mental and physical development for life.

WHY BREASTFEED?

According to the WHO and American Academy of Pediatrics (AAP), breastfeeding for at least six months can decrease worldwide infant morbidity and mortality rates (mainly due to diarrhoea, respiratory diseases and other infectious diseases) by at least 55 per cent.

Breast milk alone is the most ideal source of food and drink for an infant for the first six months of life. After six months, infants need other nutritious foods, in addition to breastfeeding up to two years and beyond, to meet their growth and development needs. Babies who are breastfed are generally healthier and achieve optimal growth and development.

If the vast majority of babies were exclusively fed breast milk in their first six months of life – meaning only breast milk and no other liquids or solids, not even water – it is estimated that the lives of at least 1.2 million children would be saved every year. If children continue to be breastfed up to two years and beyond, the health and development of millions of children would be greatly improved.

Infants who are not breastfed are at an increased risk of illness that can compromise their growth and raise the risk of death or disability. Breastfed babies receive protection from illness through their mothers’ milk. Breastfeeding is the natural and recommended way of feeding all infants, even when artificial feeding is affordable, clean water is available, and good hygienic conditions for preparing and feeding infant formula exist. Breastfeeding helps in the development of the baby’s jaw and helps in the overall oral structure, from the alignment of teeth and tongue to prevention of an over-crowded mouth.

A 2013 MRI study conducted at Brown University adds to growing body of evidence that breastfeeding improves brain and cognitive development in infants.

MECHANISM OF PROTECTION AND BENEFIT

As the immune system of a newborn is under-developed, mother’s milk provides protection against a wide variety of enteric and other diseases. Breast milk contains components that inhibit the attachment of microorganisms like streptococcus pneumoniae and Hemophilus influenzae to host cell surface receptors. Breast milk is also a rich source of colostrum.

Also referred to as “liquid gold” for its colour, it is the first perfect food prepared by a mother especially for the baby. It is easy for the newborn’s immature system to digest and it coasts the intestinal tract, thereby acting as a barrier to prevent the invasion of harmful microorganisms. It also provides important nutrients and antibodies.

Breast milk and colostrum are very potent and rich sources of immunogobulin A (lgA). These antibodies are produced by the mother when microbes, food or other antigenic material pass through her gut. lgA is secreted by the mammary and other exocrine glands during lactation. lgA helps prevent attachment of bacteria and viruses to the host epithelial cells, thereby preventing infection. lgA antibodies protect against vast array of microorganisms like vibrio cholerae, enterotoxic escherichia coli, campylobacter, shigella and giardia liamblia, to name a few common ones infecting infants.

In addition to lgA, breast milk is also rich in a variety of oligosaccharides. These complex sugars from human milk also help to prevent the attachment of microorganisms like streptococcus pneumoniae escherichia coli to the epithelial surface of host cell receptors.

Lactoferrin is another important constituent of breast milk. It is the main source of protein that not only acts as a source of nutrition, but also exhibits microbicidal activity against certain bacteria and viruses. It measures up to about 4 grams per liter of breast milk.

Other bioactive components of breast milk are B lymphocytes, T lymphocytes, immunoglobulin G (lgG), immunoglobulin M (lgM), neutrophils and eosinophils. These factors – transported in the baby’s body system via feeding – are absorbed and help to not just provide protection, but also share some of the immune responses from the mother to the child.

A gastrointestinal hormone, cholecystokinin (CCK) signals sedation and a feeling of satiation and well being. During breastfeeding, CCK release in both mother and baby produces a sense of satisfaction and sleepiness. The infant’s CCK level peaks after being breastfed, which enables the infant to be calm and rest comfortably.

The essential fatty acids in human milk optimise cognitive function and vision. Human milk has a significant impact on the growth of the central nervous system. Also, breastfed infants have higher visual acuity. These benefits of human milk can be attributed to the presence of long-chain polyunsaturated fatty acids, docosahexaenoic acid (DHA) and arachidonic acid (AA).

 

Mothers need to be aware of the numerous benefits of breastfeeding to her baby and herself. The role of healthcare professionals and other support medical staff in this educational approach is deemed highly beneficial and significant.

BENEFITS THE MOTHER AND THE ENTIRE FAMILY

Breastfeeding enhances the release of oxytocin and prolactin (also called as bonding hormones) that help to relax the mother, enable smooth flow of milk and strengthen the bonding between mother and child. It helps the baby feel more comforted, secure and warm. 

Frequent breastfeeding can delay the return of fertility through lactational amenorrhea. By this indirect method of spacing birth, it provides enough time for the mother to recuperate before she conceives again.

Breasfeeding also helps in the process of weight loss, keeping modern risks like diabetes, hypertension, obesity and associated cardiac diseases at bay. Mother can burn calories during lactation. The weight gained during pregnancy serves as the source of energy for lactation.

Breastfeeding plays a great role in reducing the risks of certain cancers. According to data derived from 47 epidemiological studies in 30 different countries, both pre-menopausal and post-menopausal women can expect a significant reduction in any risk of developing breast cancer with breastfeeding. In fact, the data also suggested that the risk of breast cancer decreases with ans increased duration of lifetime lactation and feeding. Breastfeeding also exhibits a protective effect againt uterine, ovarian, endometrial and thyroid cancers.

Breastfeeding helps to replenish the lost bone mineral density, thereby preventing osteoporosis and rheumatoid arthritis. Breastfeeding also enables the mother to get much-needed rest while she sits or lies down to feed her baby. She gets an opportunity to nurse and understand the needs of her baby.

Breastfeeding enables easy baby care in the sense that there are not bottles or accessories to be cleaned and maintained. Breastfeeding helps to save money, make travelling easy and reduce waste.

Upon hospital discharge it is not unusual for mothers to discontinue breastfeeding. Although for some mothers, this change may be beyond their ability and resources; for others it appears to be based on a conscious choice. Mothers need to be aware of the numerous benefits of breastfeeding to her baby and herself. The role of healthcare professionals and other support medical staff in this educational approach is deemed highly beneficial and significant.

Credits: InfoMed ( Malaysia )

Website: Infomed.com.my

Urinary Incontinence

Millions of women experience it, the involuntary loss of urine called urinary incontinence (UI). UI is a loss of bladder control resulting in urine leakage or an uncontrollable and immediate need to urinate. Women experience UI thrice as often as men and it can be slightly bothersome to totally debilitating. UI can cause emotional stress and for some, the risk of public embrassment will keep them away from enjoying many activities with family and friends. InfoMed sat down with Dr. Warren Lo Hwa Loon, consultant urologist from Hospital Kuala Lumpur, Ministry of Health Malaysia, to discuss this important and common medical condition.

“It is a taboo subject,” says Dr. Lo, who sub-specialises in neuro reconstructive and female urology. “No one wants to talk about how they’re leaking every time they cough.”

The problem affects 10 to 30 per cent of the general population with age and gender playing a factor. Older people are more susceptible to UI due to the lost of muscle strength while women are more susceptible to UI due to anatomical differences and childbirth that loosens the pelvic floor.

UI is an under-reported problem, partly due to the fact that it is not fatal, so people’s attitudes are more “grin and bear it” rather than “know and fix it”. There’s also the fact that many people accept it as a part of growing old, not realising treatment options are available. Young people affected with UI on the other hand, may simply not report it due to shame.

UI isn’t simply “not being able to hold your pee”, as there are several types and thus different associated causes and risk factors. The two most common type of incontinence are Stress Incontinence and  Urge Incontinence. It is not uncommon for people to be affected by a mix of the two, or other types of incontinence, like overflow incontinence.

There is no effective medication to strengthen the pelvic floor muscle, so if Kegel exercises (a type of pelvic strengthening exercise) do not work, surgery may be necessary. For men, a male sling procedure can be performed on those with mild to moderate stress urinary incontinence but artificial urinary sphincter (with a pump that allows for manual urine control) should be performed in severe cases. Both procedures have up to 90 per cent success rates.

Women suffering from stress urinary incontinence are usually fitted with a tension free vaginal tape, which sits around the mid urethra to tighten the urinary passage without obstructing it. For those who do not respond to the tension free vaginal tape, Burch colposuspension, which involves lifting the bladder neck by suturing the tissue around it to the strong ligaments of the pelvic floor muscle. There is also an outpatient alternative for elderly candidates or those unsuitable for surgery to undergo a process where a bulking agent is used to occlude the passage and stop the leaking.

Sharing horror stories, Dr. Lo said he’s come across male patients who have used penile clamps to stop the leaking. It is not a method endorsed, as there is a high risk of infection and erosion to the skin.

Most importantly, Dr. Lo says, is the need for general practitioners to have frank discussions and diagnose the problem, as patients are not likely to bring it up on their own. As one of the few practitioners in the country who specialises in and performs these surgeries, Dr. Lo also mentioned that more public awareness is needed to highlight that UI is a treatable condition and does not have to be an inevitable part of ageing. With greater public education, more treatment options can be made available so people don’t need to suffer in silence.

Practise Your Kegels

  • Practise Your Kegels

To identify your pelvic floor muscles, stop urination in mid-stream or tighten the muscles that keep you from passing gas. These are your pelvic floor muscles.

  • Perfect your technique.

Empty your bladder in the toilet and then lie on your back comfortably with your knees bent and spread apart. Tighten your pelvic floor muscles, hold the contraction for three seconds, and then relax them for another three seconds. When your muscles get stronger, try doing Kegel exercises while sitting, standingvor walking.

  • Maintain your focus.

For best results, focus on tightening only your pelvic floor muscles. Be careful not to flex the muscles in your abdomen, thighs or buttocks. Avoid holding your breath. Instead, breathe freely during the exercises.

  • Repeat three times a day.

Aim for at least three sets of five to eight repetitions a day.

RISK FACTORS

STRESS INCONTINENCE

Up to 43 per cent of men develop stress incontinence after a prostatectomy, while more than 50 per cent of women develop stress incontinence as they age above 40 years old, with probabilities doubling if they had multiple vaginal childbirths or traumatic deliveries. Obese individuals are likely to develop stress incontinence due to the additional pressure caused by excess weight in the abdominal area.

URGE INCONTINENCE

Caffeinated products (tea, coffee, soda) and alcohol should be avoided or consumed in moderation. Neurological conditions like Parkinson’s disease, Alzheimer’s disease and spinal cord injury can result in poor control of the bladder muscles, leading to urge incontinence. Urinary tract infection can also result in overactive bladders with incontinence.

TREATMENTS

Stress Incontinence

The first hurdle is in recognising the need for medical care, Dr. Lo says, as patients are apt to ignore the problem and suffer in silence or modify their lifestyle. Modifying lifestyles, he says, are things when patients stop themselves from laughing or sneezing because of stress incontinence, or cutting off their favourite latte rather than admitting they have incontinence. In fact, it’s not until the problem is severe enough to require pads and diapers do they seek medical attention.

The first line of treatment is always pelvic floor exercises (Kegel exercises), involving a very specific set of movements. Dr Lo recommends his patients perform about three minutes of Kegel exercises, repeated five times throughout the day. Kegel exercises are effective for both urge and stress incontinence.

Mixed Incontinence

Various treatment options for both urge and stress incontinence should be offered.

Overflow Incontinence

Intermittent self-catheterisation or indwelling urinary catheters are treatment options. Unfortunately there is no medication at the moment that can be prescribed for this condition.

Dr. Warren Lo Hwa Loon, consultant urologist from Hospital Kuala Lumpur, Ministry of Health Malaysia

Credits: InfoMed ( Malaysia )

Website: Infomed.com.my