|Teacher Li Jing and new mothers display breastfeeding pumps at a course run by the Homebase for Breastfeeding Mothers, which helps to promote the practice. [China Daily / Zou Hong]|
An increasing number of new moms are reviving the traditional approach to neonatal nutrition, but they need more help from professionals, as Yang Wanli reports.
Although China has seen greater awareness of the benefits of breastfeeding in recent years, the country still lacks qualified professionals and support staff members.
Now, to meet the rise in demand, authorities are formulating guidelines to provide training programs and favorable policies.
Experts say breastfeeding is highly beneficial, noting that mother's milk promotes sensory and cognitive development and protects infants against infectious and chronic diseases. In addition, exclusive breastfeeding reduces infant mortality by boosting immunity to common childhood illnesses such as acute diarrhea and pneumonia, and also promotes rapid recovery.
The recruitment and training of a greater number of support staff members is designed to prevent new mothers from falling prey to a variety of illnesses and common problems that have arisen as a result of the shortfall in qualified postnatal practitioners.
"If there is one thing that would prevent me from having another baby, it would be the horrible memory of breastfeeding for eight months after giving birth," said Lu Lu, whose son will be 3 in August.
The boy was born prematurely at 35 weeks, so he was sent to the neonatal intensive care unit for special treatment immediately after birth. Unfortunately for Lu, the lack of early skin-to-skin contact between mother and child resulted in her mammary glands malfunctioning and failing to produce enough milk.
The day after she gave birth, Lu's breasts became swollen and tender.
"A TCM (traditional Chinese medicine) doctor placed scalding hot towels on my breasts, saying it was a common way of treating the condition, which usually occurs in the first days after delivery when the mammary glands begin to work," the 33-year-old recalled. Lu knew little about health matters, so she didn't object.
However, two days later, the pain in her breasts intensified and she realized that the treatment was making her condition worse.
In response, Lu's mother introduced her to a retired doctor who was well-known for giving neonatal nursing lectures in Beijing.
"She gave me a breast massage, which is said to be very useful," Lu said. "But my breasts soon became as hard as rocks and I also developed a fever after the treatment."
It wasn't until Lu attended the Haidian Maternal and Child Health Hospital in Beijing, which houses the country's leading breast surgery clinic, that she was diagnosed with severe peracute mastitis - sudden onset, severe inflammation of the breast - which may have partly been a result of the inappropriate treatments she had undergone. The condition, which can cause fever, acute soreness and even abscesses, was so serious that she had to be hospitalized.
"During pregnancy, I conducted lots of research on delivery and infant nursing, but not on breastfeeding," Lu said. "It happened so unexpectedly; I thought breastfeeding was instinctive and most mothers would not have problems feeding their baby."
During the eight months Lu breastfed her son, the problem recurred about 10 times.
"All the suffering I endured resulted in other problems, such as depression, which, in turn, made breastfeeding much more difficult and a very unhappy experience," she said.
In March, Zhu Dan, a well-known TV anchor, used her Sina Weibo account to relate similar problems she had while breastfeeding.
She also complained about the shortage of qualified breastfeeding consultants, and urged women to share the contact details of consultants who had treated them. Within a day, the post had received more than 3,000 replies.
According to Wang Shicui, a self-styled breastfeeding consultant in Beijing, many new mothers experience similar problems.
"Not every mother will encounter severe conditions such as mastitis, but nearly all will have common breastfeeding challenges, ranging from low milk supply or engorgement (swollen breasts) to an impaired milk ejection reflex or the baby refusing to breastfeed. That's why our service is so popular."
Wang has no medical training; instead she gained experience through years of practice, and has become proficient at helping new mothers produce sufficient quantities of milk and relieving mammary duct blockage through massage. Despite her lack of qualifications, Wang's methods have often been successful and she always has a steady stream of patients.
"In our social circle, certificates mean nothing but reputation," she said, adding that most of her clients are introduced by women who have benefited from her services.
Her door-to-door service costs 500 yuan ($78) for a two-hour session, excluding the transportation fee. It's a profitable business, and in the past six years, Wang's consultations and apprentice training program have enabled her to buy two large apartments in Beijing.
While Wang is well-respected, some unqualified practitioners may be endangering their clients, according to many observers.
"China has an extreme shortage of professional consultants, and many mothers are grasping at phony solutions that might put them at higher risk," said Dong Mingzhu, the mother of twin girls, who co-founded the Homebase for Breastfeeding Mothers, one of China's biggest internet platforms for the dissemination of knowledge about mother and baby care.
Shortly after giving birth, Dong realized she had problems producing enough milk so she looked for a solution on the internet.
"I was astonished to discover that lots of Chinese mothers were having problems breastfeeding, but there were few sources of reliable information available," she recalled.
In response, she began collecting clinical research papers and studies, and sharing them via internet platforms. More women joined her activities, and in 2009 the Homebase was founded by tens of thousands of women from more than 100 cities across China. Nearly 10 years later, its website and accounts on Sina Weibo and WeChat have more than 1 million members.
Unlike countries such as the United States and Australia, where pediatricians, nurses and people with related backgrounds can gain certificates from the International Board of Certified Lactation Consultants, China has no equivalent professional qualification. Instead, licenses are issued by private training institutions, and many practitioners begin providing services after just one or two weeks' training.
Statistics based on thousands of questionnaires collected nationwide every five years as part of the National Health Survey show that the proportion of children age 6 months or younger who were breastfed exclusively was 58.5 percent in 2013, a significant increase from 27.6 percent in 2008.
However, according to Zhang Yue, director of the Children's Healthcare Department at the Chinese Center for Disease Control and Prevention, discrepancies in research methods mean it is difficult to establish if China has already reached the World Health Organization's target of raising the rate of exclusive breastfeeding in the first six months of life to at least 50 percent by 2025.
The picture is undoubtedly better than a few decades ago. Research shows that in 1990 the exclusive breastfeeding rate for children age 4 months or younger in Beijing fell to 13.6 percent as a result of many factors, especially the rising use of baby formula, she said.
To address the problem, the WHO and UNICEF launched the Baby-friendly Hospital Initiative in 1991, and China's more than 7,000 hospitals took part until 2002.
More recently, to foster wider adoption of breastfeeding, the 2015 Advertising Law of the People's Republic of China emphasizes careful monitoring of the promotion of baby formula and punishments for false claims.
In addition, the national health authorities provide annual training about breastfeeding to medical professionals nationwide, and all hospitals allied to the Baby-friendly Hospital Initiative are required to offer consultations via hotlines.
"Despite this, medical professionals are working under great pressure because of a shortage of resources. Many have very limited time to provide consultations, let alone a personalized service," Zhang said. "Both the public and the government need to make the effort to build a professional training system for people-oriented services to support breastfeeding."
Liang Qi, a breast surgeon at Chengdu Women's and Children's Central Hospital in Sichuan province, said medical schools do not offer lectures about the treatment of postnatal problems such as severely swollen breasts or malfunction of the mammary glands, and breast surgery specialists have conducted little related research.
"Those doctors focus on illnesses such as breast cancer and severe inflammation. We have a severe shortage of personnel to help mothers handle basic breastfeeding problems to prevent them turning into a serious illness," he said.
The outpatient department of the hospital's breast surgery clinic sees about 30,000 patients annually, and about 40 percent have inflammations as a result of inappropriate treatment during breastfeeding.
"Many use a wooden comb to scrape oil over their swollen breasts, which is a treatment from ancient times. Others were treated incorrectly by 'consultants'," Liang said.
Since 2012, the Homebase for Breastfeeding Mothers has taken the initiative by gathering together experienced support service providers and mothers passionate about promoting breastfeeding.
"We have used their experiences to devise standardized procedures and produce guidelines to train more practitioners," Dong said.
The group continues to post accredited research papers online, along with practical advice from doctors and other practitioners in the field. Moreover, in recent years, about 40,000 mothers have attended lectures given by qualified professionals and 3,000 breastfeeding consultants have been trained.
"As the benefits of breastfeeding become better known, more young mothers are trying to feed their babies on their own, so support services should be better regulated as soon as possible and treated with more respect," said Ning Ping, director of the breast surgery clinic at the women's and children's hospital in Chengdu.
The clinic is planning to cooperate with private groups to hold seminars to promote the exchange of medical knowledge and experience between doctors and providers of breastfeeding services, who have been invited to observe postnatal nurses at work and learn from them, he added.
Zhang, from the CDC, said the National Health Commission is drafting a strategy to establish a breastfeeding certificate system, and consultancies will be opened in hospitals involved in the Baby-friendly Hospital Initiative to provide mothers in need with reliable, personalized services.
(Source: China Daily)