1. BREAST FEEDING FRIENDLY
GENERAL PRACTITIONER
DR Varsha Atul Shah
Senior Consultant
Singapore General Hospital
Dept NN and Devt Medicine
Visiting Consultant, K K Hospital
Dept of Child Development

2. Breastfeeding Data in Singapore
Initiation to breastfeeding 94.5 %
Exclusive breastfeeding at
 1 months 22%
 at 2 months 18%
 at 4 months 7%
 at 6 months near zero !!!
 Mean duration of breastfeeding 12.7 weeks
Reference: Breastfeeding prevalence and practices among Singaporean Chinese,
Malay and Indian mothers, L. L. FOO1, S. J. S.
QUEK2, S. A. NG1, M. T. LIM2 and M. DEURENBERG-YAP1 Health Promotion
International Advance Access published April 5, 2005

3. The Baby-Friendly Hospital Initiative
(BFHI)
 The Baby-Friendly Hospital Initiative (BFHI) is a global
program sponsored by the World Health Organization
(WHO) and the United Nations Children’s Fund (UNICEF)
 to encourage and recognize hospitals and birthing
centers that offer an optimal level of care for infant
feeding.
 assists hospitals in giving mothers the information,
confidence, and skills needed to successfully initiate and
continue breastfeeding their babies
 gives special recognition to hospitals that have done so.

4. Baby Friendly Hospital
Initiatives
 More than 20,000 facilities in 152 countries
have been certified Baby-Friendly
 In seven countries, 100% of facilities have
been designated baby friendly: Sweden
(66), Comoros Island (190), Ertrea (46)
Maldives (5), Namibia (35), Iraq (23) and
Oman (51) by 1999
 Amongst developed countries, the highest
rates of baby friendly facilities are in
Scandinavian countries

6. Why GPs are important?
Mother or baby will see a doctor at
least six to seven times within the
first year

7. Breastfeeding in Singapore
 The 2001 National Breastfeeding Survey found
that although 94.5% of Singapore mothers
initiated breastfeeding
 only 21% continued up to six months.
 Advice from health professionals, maternal
awareness of breastfeeding benefits
 and maternal regard for bottle-feeding were
significant predictors of continued breastfeeding
at six months. Over
 50% of mothers in the survey did not receive
lactation advice from their physicians

8. 10 Steps of successful Breast Feeding
and Baby friendly Hospital
 Have a written breastfeeding policy that is routinely communicated to all he
 Train all health care staff in skills necessary to implement this policy.
 Inform all pregnant women about the benefits and management of breastfe
 Help mothers initiate breastfeeding within a half-hour of birth.
 Show mothers how to breastfeed and how to maintain lactation, even if the

9. 10 Steps of successful Breast Feeding
and Baby friendly Hospital
 Give newborn infants no food or drink other than breast milk unless med
 Practice rooming-in - allow mothers and infants to remain together - 24 h
 Encourage breastfeeding on demand.
 Give no artificial teats or pacifiers (also called dummies or soothers) to b
 Foster the establishment of breastfeeding support groups and refer moth

10. Why GPs are important?
 The World Health Organization and AAP,
recommends exclusive breastfeeding for at least
six months of an infant’s life
 breastfeeding practice among women in
Singapore falls short of this standard.
 Exclusive breastfeeding offers a multitude of
benefits to both mother and child.
 Family physicians are in an ideal position to
influence
 should be equipped with practical knowledge to
alleviate parental anxieties

12. 10 Recommendations for a breastfeeding-
friendly family practice-1
 Avoid giving the patient samples of formula or literature
from a formula company during pregnancy or after delivery
 Educate the patient on the differences between
breastfeeding and bottle-feeding
 Avoid telling the patient that formula is better than breast
milk
 Avoid promoting one formula over another
 Educate the patient before and after her pregnancy on the
importance and benefits of putting the baby to the breast
immediately
 Educate the patient about nipple confusion, and how to
avoid this problem by not bottle-feeding, and instead using a
cup, spoon or syringe

13. 10 Recommendations for a breastfeeding-
friendly family practice-2
 Reassure the patient that she can and should
continue to breastfeed when she is ill or if her baby
is ill
 Praise the patient if she is still breastfeeding at six
months and encourage her to continue for 2 years at
least
 Remind the patient that breast milk still has
nutritional value for the baby who is six months or
older
 Suggest to the mother of a sick child warded in
hospital that she stays with the child in the ward, so
that she can continue to nurse and comfort her child

14. Common concerns:
Regarding breastfeeding in a GP practice
1. Is my baby getting enough to eat?
2. How can I tell if I'm making enough milk? NOT ENOUGH MILK?
Usually baby feeds for 5 -30 minutes at most feeds and at
the end of the feed the baby lets go spontaneously or does
so when the breast is gently lifted and the baby is content
after most feeds. The mother feels softening of their breast
during the feed and her nipple shape is the same as when
feed began or slightly elongated. When you feed, audible
and visible swallowing, initial rapid sucking pattern which
changes to slower sucks with pauses and soft swallowing,
the infant is calm, the arms and hands are relaxed the
mouth is moist . The regular soaked nappies, on days 1-2 -
1-2 or more, on days 3-4 - 3 or more, and on day 7+ - 6 or
more are and steady weight gain is signs of enough
breastfeeding

15. How can I increase breast milk
output?
 All mum should feed early, frequently
and feed only breast milk for 6
months. Do not use pacifiers and
bottles. Sleep with your baby and
bring your baby wherever you go for
first several weeks. Feed your baby
when she's hungry, on demand, not
by clock!

16. M
y newborn won't latch on. What do I d
 If this happens after you leave the
hospital, it generally requires immediate
attention by a lactation consultant. If your
baby has been crying hard, it may help to
cuddle and perhaps burp her to calm her
down first. If your breasts are overly full,
your baby may not be able to get her
mouth around your breast, just squeeze
out a few drops of milk first, to soften the
breast and let baby latch on.

17. Can I breastfeed if I am sick
with flu?
 Generally, if you fall sick while
breastfeeding, it is usually fine to continue
to breastfeed your baby. Antibodies
produce by you are passed on to your
baby through your milk, are protective.
Illnesses are most often transmitted
through skin contact and secretions from
the mouth and nose. Be sure to wash your
hands often, and try to avoid face-to-face.

18. Do I have to eat a special diet
while breastfeeding?
 No. Your body will make the perfect milk
for your baby no matter what. For your
own health, of course, it is best to eat a
balanced diet regardless of how you feed
your baby. Nursing mothers need to drink
plenty of fluids 2-3 liters a day, enough so
that you are never feeling thirsty. You
may recommend that you continue to take
your prenatal vitamins while you

19. If I have small breasts does this
mean I will produce less milk?
 Breast size has nothing to do with milk
production.
 It is due to the amount of fat tissue in the
breast and not to the amount of milk
producing tissue.
 Feeding on demand and having regular
meals or snacks will ensure that mum
produce just the right amount of milk to
meet baby's needs.