By Dr Lim Yin Sear, Dr Khine Pwint Phyu & Assoc Prof Dr Ganesh Ramachandran

Since 2016, World Breast Feeding Week has been aligned with the United Nations Sustainable Development Goals. Breastfeeding can help achieve many of the 17 SDGs including goals on poverty, hunger, health, education, gender equality, and sustainable consumption. This year’s theme is apt to the modern environment of today: Enabling Breastfeeding: Making a difference for working parents.

Since the implementation of the Baby Friendly Hospital Initiative in 1993 in Malaysia, 100 per cent of government hospitals had been designated as baby friendly in 1998. Malaysia is the third country in the world to have done so.

Many significant efforts and initiations have been employed so far by the Ministry of Health and other government agencies to improve conditions. Nevertheless, most women today lead demanding lives with busy work schedules and many other challenges, so breastfeeding their children has become an option less and less accessible. Therefore, to foster positive changes for working parents, we should explore the following aspects:

Government policies

Under the Ministry of Health’s National Breastfeeding Policy, nursing mothers are encouraged to breastfeed their babies for at least six months. In addition, Malaysia’s Employment (Amendment) Act 2022 introduced a string of new benefits for employees that include seven days of paid paternity leave and 98 days of maternity leave These measures will encourage more mothers to breastfeed their child.

Nevertheless, many working mothers struggle to sustain breastfeeding when they return to work due to inadequacy of breastfeeding facilities or rooms for nursing mothers to express their breast milk. Besides this, a lack of regulations and legal guidance on breastfeeding breaks to express and store breast milk, or to feed a baby in the workplace as well as the lack of facilities to express breast milk in private further contribute to the decline in breastfeeding among working mothers especially in certain microeconomic sectors.

Lactation breaks at workplaces are not provided by any laws. Therefore, to further enhance the practice of breastfeeding, the employers should grant eligible employees a few breaks in a day to express breast milk and proper storage of breast milk. The lactating mother can bring back their milk at the end of their work schedules.

Prepare working mothers and children to continue breastfeeding

The process should be started from the antenatal period until the mother returns to work. Once a family decides to start breastfeeding and the mother intends to return to work after her maternity leave, the mother, the child, the caretaker, and the employer should start making the necessary preparations soon after delivery, including the following:

1. Establishing a good milk supply

After delivery, the baby should be put on the mother’s breast in the first hour of life to establish early good milk supply. The baby should not be given complementary milk at this time which may hamper the establishment of maternal breast milk production. The mother should be referred to a lactation nurse if she has difficulty to establish breast milk and breastfeed exclusively for the first month.

2. Preparing for Expressed Breast Milk (EBM)

After a month of exclusive breastfeeding, mothers should learn to express and store breast milk. There are various methods available, and the lactating mother should choose one that is most suitable to her.

Start by expressing once a day before gradually increasing the frequency according to the number of feeds which the baby will miss while the mothers are at work. Meanwhile, she should continue to breastfeed her baby directly when possible. Expressing breast milk can be done by hand, hand pump, or with a battery-operated or electric pump.

By using a hand pump, the mother can control the suction. As for battery-operated and electric pumps, mothers are advised to begin with minimum power before increasing the intensity to which she is comfortable with. Fully automatic electric pumps and those that allow for double pumping reduce pumping time and promote milk production.

3. Safely and effectively storing EBM

It is important to always store the expressed breast milk in feed-size amounts in sterilised bottles as this will prevent wastage and make it convenient during feeding time.

Expressed breast milk can last for 48 hours in the refrigerator at four degrees Celsius, and for three to six months in the freezer at zero degrees Celsius. Label all the bottles with the dates and time of collection. Always remember to use the milk expressed at the earlier date.

When transporting expressed breast milk, the bottles should be placed in a cooler box with ice packs. Once the destination has been reached, transfer the bottles into the refrigerator. Babies should always be given freshly expressed breast milk. It is not necessary to freeze breast milk unless there is excess supply that a baby is unable to consume within 48 hours.

To feed your baby with the expressed breast milk, simply thaw and warm the milk by putting the bottle in warm water for 10 minutes. Frozen breast milk can be transferred to the refrigerator earlier before standing the bottle in warm water just before feeding. Do not boil the milk or warm in a microwave oven. Once thawed, do not refreeze the milk as it may be contaminated, and discard any excess milk left after feeding.

4. Weaning from the breast

The lactating mother can start preparing the baby for direct breastfeeding for about four weeks once she has established a good breastfeeding habit. When introducing the bottle with EBM, it is advisable the baby is fed by the father or future caretaker rather than the mother to avoid confusing the baby.

Mothers may start to bottle-feed the baby with expressed milk once a day when they are one month old. Two weeks before returning to work, slowly increase the frequency of bottle feeds according to the number of feeds which your baby will miss while you are at work. This will help the baby gradually adjust to the change.

5. Educating the caretaker about expressed breast milk.

6. Preparing the mother to return to work with appropriate information about breast pumps, frequency and techniques of EBM, and storage of breast milk. Besides, the employer should be informed about the plan so that an appropriate and conducive room with privacy can be arranged.

7. The mother can opt for total or partial breastfeeding after returning to work. Partial breastfeeding is encouraged as it can continue to stimulate and have a good flow of milk.

A majority of working mothers will be able to successfully breastfeed while working once they are able to establish their milk supply before they start to work. There will be some adjustments during the initial period when she has returned to work. Most important of all, she should cherish the time spent with her baby.

Implementing supportive policies and providing appropriate facilities, resources, and public education can enable working mothers to continue breastfeeding, promoting both maternal health and wellbeing as well as the best start for baby.

-- BERNAMA

Dr Lim Yin Sear is Senior Lecturer in Paediatrics, School of Medicine, Faculty of Health and Medical Sciences, Taylor’s University.

Dr Khine Pwint Phyu is Senior Lecturer in Obstetrics and Gynaecology, School of Medicine, Faculty of Health and Medical Sciences, Taylor’s University.

Assoc Prof Dr Ganesh Ramachandran is Head of School, School of Medicine, Faculty of Health and Medical Sciences, Taylor’s University.