Can working mothers breastfeed exclusively?

Breastfeeding offers immense benefits to mothers and babies

Breast feeding month:

Breastfeeding, especially when done exclusively for the first six months, helps babies develop immunity against many diseases. Unfortunately, work prevents many mothers from exclusively breastfeeding their babies, writes Agnes Kyotalengerire

Real life experience

One would wonder why a woman would quit a well-paying job just to sit at home and nurse a baby. But Dorah Turinawe, a mother of three, did exactly that. Turinawe says she took the decision for a good cause.

According to Turinawe, her first two children often fell sick, so she was always in and out of hospital. Turinawe blames the children’s poor health on not exclusively breastfeeding them for six months. 

“When my maternity leave ended, I had to leave the children under the care of babysitters. I would never get an opportunity to run home during day to breastfeed the children because I lived far away from my workplace. Secondly, my job was so demanding that sometimes I got home at 8:00pm when the children were already asleep,” Turinawe recalls.

She says because she was never with the children, she missed out on a number of their milestones.

Turinawe felt that because she had faced many challenges with the first two children, she did not want to take chances with her third baby.

 When she reported back to work after her leave had ended, she realised the routine had not changed; reporting to work very early and leaving late with painful engorged breasts.

“The next week, I filed my resignation letter so that I could stay home to breastfeed my baby,” Turinawe narrates.

Although many people, including her friends and relatives, castigated her for the decision, Turinawe confesses it has paid off. 

Her baby Martha is healthier than her first two children. Since she chose to breastfeed exclusively, Turinawe says Martha has not suffered from conditions like diarrhoea, vomiting and pneumonia in the seven months of her life.

How organisations are supporting breastfeeding mothers

Although the work policy in support of breastfeeding permits maternity leave of up to 60 working days, these are insufficient to allow mothers to exercise exclusive breastfeeding for six months.

There is need for organisations to be more mother-friendly and consider the plight of working mothers. Below are initiatives different organisations have put in place to support working mothers to breastfeed.

Standard Chartered Bank

Harriet Musoke, the human resource manager, says

during maternity leave, breastfeeding mothers are allowed to spread out their leave. They can return  to work before their leave ends and work half day.

Also, each floor at the bank has a refrigerator, where breastfeeding mothers store expressed milk. In the course of the day, they take time off to express the milk and keep it in the fridge to take home for their babies.

This relieves mothers of breast engorgement and leakage and they are able to concentrate and perform better. 

National Social Security Fund,

Joyce Kasirye, the

acting human resource manager, says breastfeeding mothers are given one hour (flexy hour) to breastfeed their babies. A mother can choose to take the hour in the morning or lunch time or leave the office an hour earlier.

The breastfeeding hour contributes greatly to the mothers’ performance. The stress levels are managed and they are able to interact and care for their babies. Flexy hours and breastfeeding corners contributed greatly to the workers in her previous workplace in Nairobi. However, there is a cost implication and it calls for commitment. The organisation has to ensure good hygiene so that there is no disease outbreak.

International Baby Food Action Network

Esther Naluguza, the project officer, says mothers are given maternity leave of three months. They are allowed to  return with their babies to work. “Mothers have enough space in the office to lay their babies and breastfeed.

So a mother works in full view of her baby. This gives mothers satisfaction; they concentrate better.  It also enables mothers to breastfeed their babies exclusively (first six months). Besides, mothers do not have to worry about breast milk leaking since there is continuous breastfeeding.

Challenges 

Turinawe’s challenges are the common ones many working breastfeeding mothers are facing. 

Elizabeth Masaba, a breastfeeding counsellor with Ministry of Health, says unlike in the past, today most mothers are not the primary care-takers of their babies. The mothers are career-oriented and struggling to provide for their families. 

Also, some workplaces do not have policies that support breastfeeding. “The mothers spend most of the time away from their babies and as a result, suffer from stress of balancing work and the responsibility of caring for the babies,” notes Masaba.

She says some mothers are simply inclined towards the Western way of life. Masaba explains that because the mothers have money at their disposal, they prefer to buy breastmilk substitutes, for example, formula as opposed to breastfeeding the babies. 

Statistics

According to the 2011 Uganda Demographic Health Survey report, 62% of children born in the country are exclusively breastfed (for the first six months). 

How can organisations improve the situation of working breastfeeding mothers?

Agnes Baku, a nutritionist and breastfeeding expert at Ministry of Health, says the best way to ensure working mothers breastfeed exclusively is by creating a baby-friendly environment at workplaces, for example, breastfeeding corners or giving mothers flexible hours to enable them breastfeed. 

“This will enable mothers to take time off to breastfeed their babies or express the milk to ensure continuous production of breast milk,” she explains.

Florence Nalubowa, a public nursing officer at Mulago Hospital’s lactation unit, says it is impossible for a mother who has been breastfeeding while on maternity leave and interacting with her baby to stay up to eight hours without thinking about her baby.

She says emptying the breasts either through breastfeeding or expressing the milk prevents breast engorgement, which can result into complications hence absenteeism from work. 

Nalubowa estimates that in a month, the lactation unit at Mulago Hospital receives about 50 mothers with breast engorgement, blocked ducts and sore nipples, all complications caused by the long time lag of not breastfeeding.

Benefits to the employer

Dr. Jolly Nankunda, a senior consultant paediatrician at Mulago Hospital, says studies show that working mothers who breastfeed perform better.

“A mother who expresses milk or breastfeeds gets physical relief from engorged breasts. Besides, she is emotionally-stable since she does not have to worry about her breast milk leaking. In addition, a mother who expresses milk will not stress about buying formula to feed her baby, while she is at work,” Nankunda says.

On the other hand, Baku says breastfeeding protects the baby against common illnesses and a baby who breastfeeds falls sick less often. 

“A mother will not be absent from work because the baby rarely falls sick,” she says. 

Nankunda says exclusive breastfeeding or expressing milk continuously works as a method of child spacing.

She says enabling working mother’s breastfeed or express milk reduces the risk of employees conceiving too soon after maternity leave, which affects their performance at the workplace. 

Express milk to ensure continuous supply

Exclusive breastfeeding for the first six months means feeding a baby on breast milk without giving additional foods such as water, tea, glucose, other animal milks, infant formula or porridge. But it is difficult for working mothers to ensure exclusive breastfeeding because most of time they are away from their babies. This is where expressing breast milk comes in handy.

How to express breast milk

Florence Nalubowa, a public nursing officer at Mulago Hospital’s lactation unit, says you can express milk using a breast pump. A mother should ensure that the components of the pump are sterile to avoid infection.

To express, position the opening of the pump firmly over the nipple to form an airtight seal. 

Then squeeze the bulb rhythmically until the milk comes out to fill the reservoir. Empty the reservoir when it is full and start again. Prices for breast pumps range from sh60,000 to sh200,000 depending on the brand.

Alternatively, a mother can express by hand. 

Elizabeth Masaba, a breastfeeding counsellor, advises to wash hands first. Then cup the breast in both hands with the fingers underneath and the thumbs above directing in a clean container. 

Squeeze the outer part of the breast between the fingers and thumbs gently and firmly. Repeat for up to 10 times, moving around the breast. This stimulates the flow of milk down the ducts to the milk reservoir in the areola. 

While holding the breast in one hand, place the tips of the thumbs and fingers of the other hand on either side of the areola. Press the thumbs and fingers back in the ribs then squeeze them together gently and rhythmically until the milk starts to flow.    

Breast milk storage

According to Geoffrey Babughirana, a breastfeeding expert and manager at East African Maternal Newborn and Child health project, a mother can keep the expressed milk in sterile containers in the refrigerator, a freezer or at room temperature. 

Babughirana says breast milk can stay fresh at room temperature for up to eight hours, 24 hours in a refrigerator and up to six months in the freezer. 

A mother who does not have a refrigerator can use bottle bags for storing breast milk. The bottle bags cost between sh15,000 and sh25,000 in shops around town.