Dr. Modia Batterjee, the author of A Fading Art: Understanding Breastfeeding in the Middle East, is an International Board Certified Lactation Consultant with a private clinic, and has a masters degree in public health. As such, she is able to understand both the day-to-day issues facing young mothers as well as the larger, global forces that influence infant feeding patterns. These feeding patterns play a role in the high infant mortality rate in the Muslim world, about 60% in the first year of life. This post continues Part I of this review of A Fading Art: Understanding Breastfeeding in the Middle East.
Pitfalls in Saudi Arabia Leading to Breastfeeding Failure
There are many cultural practices and beliefs that prevent both exclusive and long-term breastfeeding of babies in Saudi Arabia and the rest of the Arab world.
- Separation after birth. Babies should be placed on the mother’s stomach immediately after birth, and kept with the mother throughout the hospital stay. Even in the case of a cesarean section the mother can breastfeed immediately after the surgery, as long as she is alert and has help. Early feedings are important to establish the milk supply and for baby to get colostrum, the early milk that coats the stomach and prevents harmful bacteria from entering the baby’s system.
- Teas and formula. In Saudi Arabia, babies are often served tea or formula to soothe tummy aches or help baby sleep. But these interfere with the mother’s milk supply, which works according to supply and demand. If the breast is not emptied frequently enough, they gradually produce less milk.
- Nipple confusion. Some babies start to prefer the bottle after having been fed a supplement. It’s not always the nipple itself that is the issue. Sometimes it’s the mother’s low supply, or the baby’s inability to breastfeed well that leads a baby to prefer the bottle. Fixing these problems usually reverses the preference.
- Questions about milk supply. This is a major concern among Saudi women. According to Batterjee the important signs are satiety after each feed, the number of urine-filled diapers, and the color of the stools. She emphasizes night-feeding as an important factor in maintaining supply. Her recommendation to nurse on only one side may not work well for all mothers especially in the early weeks when the supply is being established. Current recommendations are to let baby finish the first side at each feeding, then offer the second.
- Correct latch-on. Babies need to suckle in a way that allows the nipple to reach back against the baby’s soft palate to avoid pain and transfer a good supply of milk.
- Birth. Pain medications during labor cross the placenta and affect both the baby and the mother in the early stages of breastfeeding.
Breastfeeding and Fasting During Ramadan
Dr. Batterjee advises Moslem women to eat and drink well in between fast days during the holy month of Ramadan. She also writes:
As soon as she begins to feel the exhausting pressures of breastfeeding and fasting, such as feeling ill, feeling dizzy, or passing dark yellow urine indicating dehydration, it is okay for her to break her fast and give her kafarah (compensation) for that day. Muslim women who are pregnant or breastfeeding might be exempt from fasting if they feel that the fasting would negatively affect their health or their baby’s health. A mother might be expected to make up for the missed fasting at a later time or pay some compensation for not fasting. Consulting a scholar or a book of fiqh is recommended to determine the appropriate guidelines.
Breastfeeding and the environment
Dr. Batterjee doesn’t forget ecology, “the least familiar benefit of breastfeeding.” In Pakistan, the number of feeding bottles sold annually, if placed end to end, would reach Mt. Everest. One liter of water a day is needed to mix the formula, and another two to wash the bottles. This doesn’t take into account water used to raise cows and manufacture formula.
A Fading Art: Breatfeeding in the Middle East by Modia Batterjee is an unusual and fascinating first-hand account of family life, public health, and breastfeeding in the Islamic world.
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