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Breast feeding vary substantialy, but the vast majority of infants worldwide are breast-fed
In most cultures, breast- feeding a newborn infant is perceived as the traditional, natural order of life
In United States, The cultural context of breastfeeding is very different most women view breast-feeding as the optimal way to feed their infants, societal norms and customs discourage it Many women work outside the home and are unable to take extended maternal leave from their job The powerful influence of this culture can be seen in the paterns of breast feeding in women who immgrate to US from southeast asia very few breast feed
Provisional rates of any and exclusive breastfeeding by age among children born in 2009, National Immunization Surveya,b
Interviews with caregivers of children born in 2009 will continue through December 2012. Provisional rates for children born in 2009 will be updated with final estimates once data becomes available in August 2013. See survey methods for details on study design. bExclusive breastfeeding is defined as ONLY breast milk NO solids, no water, and no other liquids.
in 1982
slow decline since then 52% (62%)of women in the United States initiating breastfeeding, but only 20% (40%)continuiting at five to seven month ( Fomon 1993)
Research began to identify the complex and potent immunological properties of human milk scientists became increasingly aware of the biological specificity of breast milk its unique benefits to infant health
Coates 1993
Black mother initiate breast-feeding (23%) & continue it at six month (7%) compared with White mothers (58% and 23%, respectively) Why Black mothers breast-feeding less frequently than White mothers is not clear the differences remain when income, parity and marital status are taken into account Southeast Asian women tend to consider formula feeding the norm in the United States. They associate it with the general good health of infants in this country (Coates 1993)
10 LANGKAH MENUJU KEBERHASILAN MENYUSUI Protecting, Promoting and Supporting Breastfeeding: The Special Role of Maternity Services, suatu pernyataan bersama WHO dan UNICEF 1.Sarana Pelayanan Kesehatan (SPK) mempunyai kebijakan Peningkatan Pemberian Air Susu Ibu (PP-ASI) tertulis yang secara rutin dikomunikasikan kepada semua petugas. 2.Melakukan pelatihan bagi petugas dalam hal pengetahuan dan ketrampilan untuk menerapkan kebijakan tersebut. 3.Menjelaskan kepada semua ibu hamil tentang manfaat menyusui dan penatalaksanaannya dimulai sejak masa kehamilan, masa bayi lahir sampai umur 2 tahun, termasuk cara mengatasi kesulitan menyusui. 4.Membantu ibu mulai menyusui bayinya dalam 30 menit setelah melahirkan , yang dilakukan diruang bersalin. Apabila ibu mendapat operasi Caesar, bayi disusui setelah 30 menit ibu sadar. 5.Membantu ibu bagaimana cara menyusui yang benar, dan cara mempertahankan menyusui meski ibu dipisah dari bayi atas indikasi medis.
6.Tidak memberikan makanan atau minuman apapun selain ASI kepada bayi baru lahir.
7.Melaksanakan rawat gabung dengan mengupayakan ibu bersama bayi 24 jam sehari. 8.Membantu ibu menyusui semua bayi semau bayi, tanpa pembatasan terhadap lama dan frekuensi menyusui. 9.Tidak memberikan dot atau kempeng kepada bayi yang diberi ASI.
10.Mengupayakan terbentuknya Kelompok Pendukung ASI (KP-ASI) dan rujuk ibu kepada kelompok tersebut ketika pulang dari Rumah Sakit/ Rumah Bersalin/ Sarana Pelayanan Kesehatan.
The good news is that the U.S. has achieved the first goal
Breastfeeding at 6 months: 43 %
Breastfeeding at 12 months: 22 %
Indonesia
Th 2010 Data Kementerian Kesehatan jumlah bayi di Indonesia sekitar 4,4 juta
69 % bayi Indonesia tdk mendapatASI eksklusif Direktur Jenderal Bina Gizi dan Kesehatan Ibu dan Anak, Kementerian Kesehatan, Slamet Riyadi Yuwono
Hanya 31 % bayi saja yang mendapatkan ASI eksklusif usia 0-6 bulan
Data Kementerian Kesehatan menunjukkan hanya 41 % anak usia 6-23 bulan yang mendapatkan MPASI sesuai rekomendasi WHO
ASI ekslusif dari tahun 2007 terus mengalami peningkatan yakni dari 27,35 persen (2007); 28,82 persen (2008), 40,06 persen (2009), dan 52,3 persen (2010).
frequently than older mothers (tend to breast-feed for longer periodes) Parity : Multiparious and Primiparious women initiate breast-feeding at similiar rates Geographics differences : Women from western states are much more likely to breast-fed than women from Souther or Eastern states Marital status : Unmarried women are much less likely to breast-feeding than mmarried women
education is a strong postive predictor of breastfeeding Income : Poverty is associated with decreased rates of breast-feeding. Women from households with the lowest family income are only half as likely to nurse their infants as those with family incomes more than $25,00/year. Employment : Maternal employment outside the home influences breast-feeding mothers working full time are less likely to initiate breast-feeding and much less likely to breast-feeding at six months compared with women working part time or not working
Income
Employm ent
developing regions of the world until the middle of the twentieth century During 1940 1970 as formula feeding displaced breast feeding in the industrialized country 1950 to 1970, breast-feeding rates sharply declined in many developing regions, particullary among the urban poor effects on infant morbidity and mortality In impoverished developing countries, formula feeding is associated with sharply higher rates infection and lower rates of infant survival, compared with breast-feeding Manufactured formula lacks the immunological and other health-
supplies are often contaminated and unsanitary water used to clean bottle and mix formula carries pathogenic bacteria, viruses and parasites In these enviroments, bottle feeding can be a dangerous source of infection more susceptible to infectious diarrheal illness in 1981 documented the high cost to infant health 1 milion infants deaths were attributable to contaminated infant formula WHO/UNICEF approved the International Code for marketing of breast Milk substitutes Breast-feeding is the most important form of contraception in many highly populated developing countries. Anovulation during breast-feeding contributes to child spacing by providing a period during which the mother can recover from her previous pregnancy before beginning a
american Academy of Pediatrics and The Canadian Pediatric Society Many developing country have taken firm step to discourage use of breast milk substitutes In the mid 1970s Papua New Guinea enacted low forbidding the advertisement of leading bottles and formulas and made both available only by prescription In1989 WHO reported on rate of breast feeding in 15 developing countries in Asia, Africa and Latin America To reaffirm the impotance of breast feeding WHO and UNICEF issued the Innocenti Declaration in1990 This report put forth major goals designed to protect, promote, and support beast feeding around the world
year old are in the workforce and most work full time Many of these women return to work during lactation and some continue to sucessfully breast-feeding while working However depending on the life situation and type of job, breast-feeding while working can be a challenge The mother can continue to breast-fed when she is home but have her infant consume formula when she is away at work When the mother is away, the infant can be fed stored milk-milk that is expressed from the breast and frozen for that purpose Less commonly, she can have the baby brought to her at work for feedings or she can return home througouht the
makes it easier for a new mother to breast-feed her infant during early pregnancy. The FMLA says that workers at large firms have a right to take up to 12 weeks of unpaid leave to care for a new baby or a close family member with a serious health condition. When possible, the working mother should have a minimum of four to six weeks at home with her baby after birth. This period allows the mother and infant to develop a close attachment and enables the mother who chooses to breast-feed time to fully establish lactation.
BREAST-FEEDING EDUCATION
Many hospitals and clinics have developed breast-
EARLY BREAST-FEEDING
THE POSTPARTUM ENVIRONMENT INITIATING BREAST- FEEDING
MATERNALINFANT BONDING
a sense of belonging security and attachment from the
warmth of the mothers body The closeness and time spent together in the first month postpartum are important factors in maternalinfant bonding
are critical to continued breast-feeding, especially for young, first time mothers New mothers struggling with sore nipples or breast engorgement need to be reassured that frequent feedings are not a sign of insufficient milk and infant hunger, but the normal breast feeding pattern
STOOLING PATERNS OF THE BREASTFEEDING
INFANT
Stooling begin shortly after birth and during the first several days,
meconium is passed and the stool appears black and tarry. With each successive feeding , the stool lightens in color and becomes more liquid After the first week, the breast-feedig infants stools are a mustrad yellow liquid with a yeasty odor. The mother of the breast-feeding infant shoud be aware that many
APPETITE SPURTS
POTENTIAL PROBLEM FOODS IN THE
MOTHERS DIET
TEETHING
PSYCHOLOGICAL BENEFITS OF NURSING
WEANING
HOW LONG SHOULD A MOTHER BREAST FEED
? THE PROCESS OF WEANING MATERNAL HEALTH DURING WEANING WEANING AND INFANT HEALTH IN THE DEVELOPING WORD
BREAST PUMPS
MILK STORAGE
Chronic diseases
Maternal infections
Infant Disorders
Respiratory infections
Cleft lip and palate Breast milk Jaundice Metabolic Disorders
virus (HIV) can pass the virus to their infants during breast feeding HIV has been isolated Mother who develop HIV infection postnatally, the risk of transmission during breast feeding In 1985 the US center for diseases recommended that HIV infected women be discourages from breast feeding, a policy widely adopted by the other industrialzed countries A recent study in Africa found that HIV positive mothers deficient vitamin A are more likely to transmit
requirements of human newborns ensure optimal growth and development The best source of nutrition for full term infants during the first four to six months postpartum (AAP 1993) No manufactured formula can duplicate the biologically specific physical structure and nutrient composition of human milk
versus 3.5 g / 100 ml) than cows milk A major difference is the concentrations of the whey and casein protein 80% of the protein in cows milk are casein proteins, 40% of human milk protein is casein During digestion in the infants gastrointestinal tract, whey and casein proteins have distinct characteristics Caseins precipitate into sizable curds in the newborns stomach that are tougher and less readily digestible than the softer, more flocculent clumps formed when they whey protein presipitate Whey proteins are consequently often better toleranted by the newborn
nonessential amino acids Rich in cystine and taurine (taurineis found at levels 30 times that in cows milk) Human milk contains only moderate amounts of phenylalanine, tyrosine and methionine The enzym system that metabolize these amino acids mature late in fetal life (Rassin 1991) Preterm infants over consumption of these amino acid can increase blood level to potentially detrimental levels
ProtectionFromAllergies
Obesity
Artherosclerosis
Immune Disorders
infants have sharphy higher mortality rate The protective effect of breast feeding is particulary strong during the first year mortality rate reduced in infants up to age 3 years Differences in mortality are primarily due to differences in rate of infection between formula fed and breast fed infants(Wray 1991) In US mortality rates are low for both breast fed and formula fed infants it is not clear whether breast feeding still confers a protective effect (Wray 1991)
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