Several weeks ago I mentioned in casual conversation that I loved the staple Ethiopian spice mix berbere and had finished the supply I brought back from Ethiopia last year. Edna asked around and discovered there was an Ethiopian spice shop in a poor but busy market area of the city known as Radio City, for its proximity to the Radio Hargeisa headquarters.
The shop, really an open-sided tin shack, is run by an Ethiopian man and filled with giant bags of spices imported from Ethiopia.
He's also got Ethiopian staple grains.
And roots...
And frankincense, which people throw in their fires for the scent. Lots of this is packaged in tiny bags hanging from the rafters, amounts that people in the area can afford.
I somehow ended up with a kilo of berbere, which given that I usually don't use more than a pinch of it at a time, will probably last me between 7 and 10 years, unless of course my bags are searched at Dulles and I have to explain a kilo of random red powder.
Back at the hospital, labor and delivery was empty, which was okay since I've been busy in postpartum. The group of post-basic and community midwives that had been here more or less since I arrived went on vacation, and the group that had been on vacation started up again. This means that I have been starting over with my teaching, which means I get to have this conversation over and over again, again.
Me (looking at chart): This baby is 6 hours old. Has he been breastfed?
Midwife: No.
Me: Why? And why did he get sugar water?
Midwife: (Giggles) The mother, she is empty/tired/both.
Me: (Pulling out hair) No, the mother is not empty! No mother is empty! She has colostrum! They all have colostrum! And NO BABY SHOULD EVER GET SUGAR WATER UNLESS THEIR BLOOD SUGAR IS LESS THAN 50.
After I've taken some deep breaths, we go see the mother, and usually with minimal effort she immediately produces some colostrum, and then probably 90% of the time the baby almost immediately latches pretty well. The babies who don't (often premature or c-section babies or ones who had difficult births), though, are often written off as unbreastfeed-able after that first encounter.
For a poor country without a reliably clean water supply, I cannot grasp the midwives attitude towards breastfeeding. All the mother has to say is that she doesn't have milk and the midwives will cheerfully let her feed the baby sugar water and formula. This is a problem because that's generally pretty dirty water. It's a bigger, and longer-term problem, because when the baby doesn't spend time at the breast, the mother's body doesn't start producing the same quantities of milk (a sort of self-fulfilling prophecy of not having enough milk). Even when the mother does produce adequate milk after not breastfeeding the first few days, the baby has often been spoiled with the easy-flow nipples on the bottles here. This is generally referred to as "nipple confusion" but the truth of it is, that baby isn't confused. It knows exactly what's going on: it was easy to suck from the bottle, it's hard to suck from the breast, I'll just refuse and I bet that easy flow nipple will come back! And, without some pretty time-intensive teaching about how to get that baby back to the breast, that baby is usually right about the easy flow nipple coming back.
As a result, I've become a bit, well, aggressive, about teaching the midwives about breastfeeding, because promoting breastfeeding is an essentially free way to drastically improve neonatal, infant and child health (and increasingly it's understood, even adult health and intelligence). I saw huge progress with the last group but it took awhile. I only have a week with this group since I leave next Saturday (how did that happen so quickly?), so I'm a little bit on the warpath, hunting through charts for babies' feeding records and checking in on the moms and whenever I find problems taking as many of the midwives with me to learn how to fix the problem as I can.
It's usually pretty straightforward: explaining that there is colostrum now and milk will come in a couple of days, but the colostrum is very nutritious and enough for the baby, or help positioning the baby on the breast, or unwrapping the baby so it wakes up to eat. For the babies who have serious trouble latching, it can be a time-consuming, intensive process to get the mom and baby on the same page and eating well, but it almost always ends up succeeding if the effort is put in. Every now and then a stern lecture on the dangers of formula feeding, but usually it doesn't come to that: these mothers WANT to breastfeed, they just need help figuring out exactly how to do it and reassurance that their baby won't go hungry (like mothers all the world over do).
The midwives, especially the community midwives, are pretty willing learners, but it's a process because we literally have to start at the beginning. I really like teaching them, and seeing them get it and start to use what they've learned, but it is also insanely frustrating to see things like "10 ml dextrose" written in the chart next to a blood sugar of 100, or a 8-hour old baby crazily sucking at its fist, alone in its bassinette, not having been breastfed yet.
And then there's always women like the one who delivered her 16th baby yesterday, about 12 minutes after going into labor and popped that baby on her breast like she'd done it a million times before, which she more or less had.
SIDE NOTE: I don't think formula is inherently bad, I just think it has to be used APPROPRIATELY. There's always going to be babies that need formula for some reason and in a pre-formula era might have died of malnutrition. It is the midwife's responsibility to identify these babies, and then do it right: clean water, and no bottles (cup feeding or finger feeding) so that when the baby is able she can go back to the breast, and to have the mother pump so that her milk doesn't dry up.
No comments:
Post a Comment