Breast feeding Support for Som ali Mothers Elinor A. Graham MD, MPH Elinor A. Graham MD, MPH Aliya Haq Haq RD, Harborview WIC RD, Harborview WIC Aliya Salma Musa, Somali speaking Case Musa, Somali speaking Case Salma Worker/ Cultural Mediator, HMC Worker/ Cultural Mediator, HMC Community House Calls program Community House Calls program Anab Abdullahi Abdullahi, Somali Interpreter , Somali Interpreter Anab Curriculum supported by NIH Grant
NIH Grant Support NIH Grant Support NIH grant: Infant overfeeding in immigrant NIH grant: Infant overfeeding in immigrant families: PI- - Mark Mark Doescher Doescher MD, MSPH, MD, MSPH, families: PI UW Family Medicine. Investigators: Elinor UW Family Medicine. Investigators: Elinor Graham MD, MPH, UW; Donna Johnson Graham MD, MPH, UW; Donna Johnson PhD, UW; Suzinne Suzinne Pak Pak- -Gorstein MD, Gorstein MD, PhD, UW; PhD, UW; Paul Spicer PhD, U Colo Colo; ; Aliya Aliya PhD, UW; Paul Spicer PhD, U Haq MC, RD, UW. MC, RD, UW. Haq Focus on Somali families Focus on Somali families Started 11/2005 Started 11/2005
Sources of I nform ation Sources of I nform ation Our personal experience caring for Our personal experience caring for and working with Somali families and working with Somali families Results infant feeding study focus Results infant feeding study focus groups at HMC and focus groups groups at HMC and focus groups from Minnesota from Minnesota Feedback from interpreters and Feedback from interpreters and Somali outreach workers with HMC Somali outreach workers with HMC Interpreter services and Community Interpreter services and Community House Calls Program House Calls Program
The Immigrant Mother-Baby Dyad Challenges to Bonding & Breastfeeding Cultural pressures • ‘your baby is too scrawny’ Lacking information • ‘breastmilk is never enough’ Maternal mental • How to enhance bmilk supply • ‘feed your baby solids now’ health • Hunger/Satiety cues • ‘a fat baby is a healthy baby’ • Comforting skills Work & Public Feeding Infant-Maternal • Lack of cultural experience w Bonding breastpumping / milk storage Breast problems • Painful nipples • Concerns about bfeeding in public in US • Engorgement Breastfeeding Life Experience • Refugee camps, malnutrition, life- Family demands threatening disease • Protected time for bfeeding • Failure to breastfeed prior baby • Extended family supported • Night feeds to quiet baby bfeeding in native country • Preschool siblings
Somali Cultural Experience Somali Cultural Experience Paradox: Paradox: Strong cultural & religious support for breastfeeding BUT Insecurity about breastmilk adequacy Most mothers breastfeed for more than one year Most mothers breastfeed for more than one year Belief that breastmilk breastmilk is inadequate is inadequate (supply, quality) Belief that --Belief -- Belief : : Breastmilk Breastmilk is spoiled if in breast is spoiled if in breast for more than 3 hours for more than 3 hours -- Belief Belief : : Colostrum Colostrum has no value since it has no value since it -- has been in breast before baby was born has been in breast before baby was born Colostrum is not considered milk is not considered milk ) ( Colostrum ( ) Practice: Early supplementation in Early supplementation in Practice: Somalia (formula, cow/goat milk, solids) (formula, cow/goat milk, solids) Somalia
Challenges to Exclusive Challenges to Exclusive Breastfeeding Breastfeeding Fear of inadequate milk supply Fear of inadequate milk supply No past or cultural experience with No past or cultural experience with pumping and breastmilk breastmilk storage storage pumping and Lack of extended family support for support for Lack of extended family breastfeeding in US; not enough breastfeeding in US; not enough rest for mothers rest for mothers Availability of formulas: “ “formula is formula is Availability of formulas: easier… …anyone can feed anyone can feed” ” easier
Practices Leading to Over Feeding Practices Leading to Over Feeding Fear of Inadequate Weight Gain: : Chubby children are healthy: “ “just the right plump just the right plump” ” Chubby children are healthy: Inability to visualize volume of breastmilk breastmilk fed causes fed causes Inability to visualize volume of anxiety anxiety Worry about insufficient quantity of breast milk Worry about insufficient quantity of breast milk Leads to: Leads to: Frequent formula supplementation Frequent formula supplementation Awakening infants for night feeds - - for months for months Awakening infants for night feeds Overfeeding commonly leads to commonly leads to overweight overweight or or failure failure Overfeeding to thrive to thrive
Prenatal Education Prenatal Education C ultural/ A ffirming: C ultural/ A ffirming: Breastfeeding Benefits Breastfeeding Benefits Breastfeeding has cultural and religious Breastfeeding has cultural and religious significance significance ‘ Breastmilk ‘ Breastmilk is natural, a gift to mother to pass on to her baby is natural, a gift to mother to pass on to her baby ’ ’ Exclusive breastfeeding is natural Exclusive breastfeeding is natural contraceptive and protects from allergy contraceptive and protects from allergy Breastfed babies are less likely to be sick Breastfed babies are less likely to be sick ‘ Breastmilk Breastmilk - - natural antibiotic from mother to protect baby natural antibiotic from mother to protect baby’ ’ ‘ ‘Breastmilk Breastmilk is as good as gold, Formula only silver is as good as gold, Formula only silver’ ’ ‘ ‘Breastmilk Breastmilk protects your baby from diarrhea protects your baby from diarrhea’ ’ ‘
Prenatal Education Prenatal Education Emphasis on how to produce breast milk supply and demand – – not all mother not all mother’ ’s agree with this idea s agree with this idea supply and demand early, frequent feeding – – tendency to give bottle in hospital tendency to give bottle in hospital early, frequent feeding and to give q 3 h timed feeds at home and to give q 3 h timed feeds at home fluids that increase milk supply- - drink large amounts of black drink large amounts of black fluids that increase milk supply tea with milk to stimulate milk supply… …introduce idea of introduce idea of tea with milk to stimulate milk supply decaffenated tea tea decaffenated Explain how exclusive breast feeding evolves Explain how exclusive breast feeding evolves over time… …lots of mother lots of mother’ ’s time first 1 s time first 1- -2 wks, 2 wks, over time less time later… …engorgement only at engorgement only at less time later beginning… …mature milk mature milk beginning
Prenatal Education Prenatal Education View that Colostrum Colostrum is not beneficial, old, is not beneficial, old, View that stale, not milk: Some mother’ ’s said that s said that stale, not milk: Some mother they listened to the message given by “ “the the they listened to the message given by doctor” ” and then decided to breast feed and then decided to breast feed doctor immediately post partum immediately post partum Provide written or video materials in Provide written or video materials in Somali… …messages from respected Somali messages from respected Somali Somali women or in their own language are going women or in their own language are going to be more effective to be more effective
Breastfeeding Breastfeeding Support Support Postpartum Postpartum doesn’t feel that she has enough milk First breast fluid or colostrum colostrum (not (not “ “milk milk” ”) is ) is First breast fluid or healthy and helps baby adjust helps baby adjust healthy and Increase supply: Frequent feed every 1- -2 2 Increase supply: Frequent feed every 1 hours hours Empty breasts to stimulate more milk Empty breasts to stimulate more milk Breasts may not feel large but still Breasts may not feel large but still produce milk: pre- - post feeding post feeding wgts wgts produce milk: pre Negotiate delayed bottle- -feeding feeding - - until 2 until 2- -4 4 Negotiate delayed bottle weeks at least weeks at least
Breastfeeding Breastfeeding Support Support Post-Partum Education Pump breastmilk - Introduce the concept of the breastpump - Provide means to rent or buy one – Feeding expressed breastmilk in a bottle may be a NEW concept
Breastfeeding Breastfeeding Discharge Support Support Discharge A ffirm mother’s fears / needs: Respond to fear of inadequate breastmilk, how to increase breastmilk Family support when goes home. Will she be able to Family support when goes home. Will she be able to have time to feed the baby, care for other children? have time to feed the baby, care for other children? Maternal fluid intake - - Limit caffeinated black tea but Maternal fluid intake affirm the idea of nutritious, non-caffeinated drinks Affirm Culturally appropriate foods for lactating Affirm Culturally appropriate foods for lactating mother: Misharo - Oatmeal porridge; Marakh - Goat meat soup; mother: Otka - Beef cooked in oil; Ambola - Green Beans
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