Prerequisite for Exclusive Breastfeeding in Multiple Births

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As mothers with multiple births in Lagos communities continue to live with the challenge of exclusively breastfeeding their babies, experts recommend sustained expressing and proper positioning of babies, as well as patience as a prerequisite, Rebecca Ejifoma reports

When 29-year-old Favour Williams set out for childbirth, having multiple babies was not part of her plans, partly because none of such existed in her lineage – at least, none that she was aware of.

After tying the nuptial knot, Favour and her husband, Chukwuemeka, said their plans were to have three children. But the family, who occupy a single room apartment at Babalola Crescent in Alaba area of Lagos State, quickly expanded from two to five.

In 2019, she had her first child – a baby girl, who is exactly two years and three months old. As a concerned new mum in Alaba area of Lagos State, she went about for vital information for her baby on adequate nutrient, bonding and protection from childhood diseases. “The doctor told me I should only give my baby breast milk, no water, for six months”.

With this knowledge, Williams, a teacher, set her heart to practise exclusive breastfeeding for her other babies when they come given that
exclusive breastfeeding for babies makes them smart, strong, and healthy.

While she planned not to relent, her zeal was soon tested on Friday, February 5 this year when she became mother of twin girls. Indeed, in the case of Williams, her spirit is willing, but the flesh is weak. This is as she soon realised that single birth and multiple births come with different handouts. “I can’t do exclusive breastfeeding (EBF) for them. They eat a lot.”

Favour Williams is one of several mothers in Nigeria feeding her babies with a blend of formula milk and breastmilk.

While many mothers complain about milk not flowing enough to feed twins, Favour, an Abia State indigene is not in that league. For her, constant intake of pap and milk are her source of refilling. “I take enough pap with milk and sometimes tea. I drink the pap morning or night.”

Over time, personal and indirect experiences of these mothers have shown that exclusive breastfeeding does not only benefit babies and mothers, it also saves money for buying tins of baby formula almost within days.

In the case of Williams, she buys each infant formula between N2,300 and N2,500 , whereas in her first birth, she didn’t spend money on infant milk for six months.

Like Favour, Mrs. Ogechi Cynthia is a mother. It was a Friday evening. Mrs. Ogechi Cynthia Miracle still had her baby powder around her neck as I walked into her living room on the first floor. “The babies are sleeping”, she whispered to her two boys – aged seven and four – who leaped with screams of delight as they got back from school.

Sharing her experience with THISDAY, “I did exclusive for my first child only for one month. I did for my second child for three months. But for the twins, it is not easy”, she sighed, glaring at the window.

Miracle is a mother to four children – three boys and a girl. She had her twins on Tuesday, December 22 last year – both sexes. Together with her kids and her husband, a dark skin senior police officer, they find comfort in their Ikoyi residence in the state.

Truly, this young mother and caterer insisted on her desires to do exclusive breastfeeding, but she couldn’t attempt it, as her twins “suckle almost all the time”, she mumbled, “after one month exclusive, I stopped”.

In her words, “I can’t do exclusive for the twins. I tried it for a month and I couldn’t cope because they are always sucking,” adding that “every five minutes this one will cry. As I’m dropping this one the second one will cry,” she said, walking towards the room to check on her crying babies.

And because she couldn’t cope with their frequent demands, Miracle capitulated, “I had to introduce milk. Even when I got to the hospital and explained, the nurse said ‘Okay, they can cope since they are two’.”

Obviously, Miracle’s twins are among the list of 83 per cent of children under six months that are not being exclusively breastfed as stated in the NDHS of 2013.

Mrs. Kemi Ajala-Moses is a proud mother of four – all girls. Her first daughter is 10 while her triplets are one year and three months old. Unlike other mothers with multiple births, Ajala-Moses did exclusive breastfeeding for her triplets for one month, and quit.

Sitting with her in her provision store on the ground floor of a two storey-building at Atere street Dopemu, Iyana-Ipaja area of Alimosho Local Government Lagos, Ajala-Moses said she had her first child, a girl, 10 years ago, and had her triplet, all girls, last year. “I did exclusive for my first child. I didn’t do exclusive for my triplets; they are three.

“I decided to do exclusive. I even said I would not change my mind if I had twins. Eventually, God gave me three,” as she stressed their increasing cravings.

While this trader pitched in that she would stop breastfeeding her one year six months old triplet at age two, they have always enjoyed a blend of baby milk and breast milk.

Interjecting as her triplet toddled into the shop
“buying baby food is something else. People give me at times: my brother in-law gives me cartons of formula milk. When they got to age one, they stopped drinking baby milk,” she says, carrying two of the triplets on both laps while the other grappled her by the legs.

Indeed, these three mums with multiple births have same need-to exclusively breastfeed their babies but because of the inherent challenges associated with it, they relied on infant formula to complement breast milk.

Benefits
As seen on its website, the World Health Organisation (WHO) explained the countless health benefits of breastfeeding for both mother and child. It assured that breast milk contains all the nutrients an infant needs in the first six months of life.

The benefits are: it shields against diarrhoea and common childhood illnesses such as pneumonia, reducing the risk of overweight and obesity in childhood and adolescence.

Meanwhile, WHO describes exclusive breastfeeding as a process where children receive nothing but breastmilk for the first six months of life for optimal growth, development, and health.

NDHS Survey

According to NDHS 2018 survey, children who are not exclusively breastfed are missing out on the 29 per cent of children under six months who are exclusively breastfed in Nigeria. This is a considerable increase from 17 per cent in 2013.

Whereas the 2013 Demographic Health Survey of four countries shows in Gambia, 47 per cent of babies are exclusively breastfed; 34 per cent in Mali; Sierra Leone remains at 32 per cent, while Liberia records 55 per cent. Sadly, Nigeria, Sierra Leone, Mali, and Gambia are yet to attain the Organisation’s Global Nutrition Target of 50 per cent EBF prevalence by 2025.

Whereas, the NDHS recommended to mothers that complementary foods (infant formula among others) should be introduced when a child is six months old to reduce the risk of malnutrition

Expert Proffers Solution

Getting the solutions from an expert like Dr. Oluseyi Asaolu, a Consultant Obstetrician and Gynaecologist in Wuse District hospital Abuja, was anything but strenuous.

Indeed, this expert could relate with the women’s needs, obstacles, and resolve to complement. He responded to THISDAY over the phone on a Friday morning, “For twins,’ he chipped in without stuttering, “exclusive breastfeeding could be possible most of the time, but triplets is difficult”.

The expert added: “if a woman is a first timer and has multiple births as her first babies it could be a little difficult in the initial stages because it takes a while before breast milk starts to come. That may be due to many things.”

Explaining further, Asaolu stressed the need to “check the mothers’ nipples, positioning of babies, timing and all that; they may not be used to that because once they give birth automatically the body tells the brain ‘let the milk come’. “The milk automatically is let down into the breast.”

In the words of the gynaecologist, there is a reflex called the suckling reflex. “Once the baby latches on the breast and starts to suckle, it tells the brain to send more milk to the breast. As long as the baby keeps doing that, milk will start to come.”

“However”, he cautioned, “If the nipple has an issue either by virtue of being flat or by virtue of positioning the baby in the wrong way and the mother already has wounds around the nipple, the milk reflex will not come”.

While noting that milk would probably not easily come to the breast, the expert said “If you’re doing exclusive, you’ll get a little tired and frustrated, the baby too will get hungry and worried the more.

“Thirdly the baby also feels food should come and starts grappling on the nipple instead of just latching on it and that predisposes,” emphasising that not minding the baby has no tooth, the gums are as sharp as anything – you start seeing wounds around the mother’s nipple, which can be very painful. “That also makes the mother a bit reluctant to put the baby to breast on the bruised side, and so it becomes more of a vicious cycle.”

Having practised for 21 years as an expert and nine years as a gynaecologist, Asaolu shared, “I usually tell my clients”, the obstetrician told this reporter, “breastfeeding is a lot of work; the baby won’t tell you I’m going to feed for 10 minutes, five minutes. No, they feed until they are satisfied.

“In the early days, they may not be able to suckle for too long because their stomach is a bit small so it can take just a little maybe about 10 to 30 minutes”.

In his words, babies have to feed more often. “As they grow, they can feed for longer period of time because their stomach is also expanding,” harping that “you may have a bit of rest in between. You must resign to the fact that you shouldn’t be in a hurry”.

As an authority in mother and child health, Asaolu lent his voice, “Get a good, comfortable sitting position, because patience is key. Once you know you are expecting multiple births, your doctors should prepare you for breastfeeding by checking your nipples, advising and talking to you about breastfeeding methods so that it won’t be a challenge when the babies eventually come.”

He further amplified the importance of expressing once the breast milk starts to flow. Express and store in the fridge. “You can’t be feeding 24/7; you need to rest. At times when you know that you can’t put the baby to breast someone can feed the baby on your behalf with the expressed breast milk.”

He revealed: “In fact in some cases the milk flows so much that people now are thinking of establishing a breast milk bank; that actually happens outside the country like UK, US and others. That is to tell you that the breast can produce so much if you do the right thing.”

To express and save and breast milk, Asaolu, describes it as “quite easy to store”. According to him, “You put it in the fridge; it can last for 24 hours and anytime you want to feed just bring it out. Leave it under room temperature for about 30 minutes it will warm up because you don’t want to feed the baby with cold milk.”

However, the gynaecologist has a word for mothers, “When the baby is not feeding that is not the time to start entertaining guests; you are doing the work of two mothers. That is the time to go and rest.”

Also noting was the challenges people have when they have two babies, Asaolu, said they feel the milk is not coming; the milk can never be enough; they won’t have the time to be able to breastfeed two babies; and then for some people they just believe tiredness. “All these are things that can easily be surmounted,” says the obstetrician.

While the three mothers seem unhappy about breast milk not flowing enough to feed the babies, the expert listed fluids like custard, Quaker Oat, and lots of drinks. “That helps as well. It helps lactation a great deal. Don’t forget that a large percentage of breast milk is water, then you now have the nutrients to compliment that and that is what nourishes the baby.”

The gynaecologist suggested a minimum of four months exclusively breastfeeding for twins, and a minimum of three months for triplet, after which mothers with multiple births can introduce baby formula.

For mothers like Miracle, Williams and Ajala-Moses, the expert advocated that they must express breast milk, exercise more patience, as well as ensure proper positioning of babies if they must exclusively breastfeed their babies.