GREAT REASONS FOR BREASTFEEDING

Mihai Corciova

Action Plan Adopted During the International Convention on Population and Development -
Cairo, 1994

As part of this Action Plan that was signed among others by the Romanian
government, a series of priority fields has been delineated. Reproductive health and child
health has been two such fields. Actually, even the conclusions of the World Conference on
Child Rights (September 29-30, 1990) emphasized again as a necessity "creating the
presuppositions that would allow all women to exclusively breastfeed their children up to six
months of age and to be able to continue breastfeeding along with solid foods including the
second year of age."
Exclusive breastfeeding means the infant is fed only mother's milk, with no other
foods, water or other fluids, except for medications and vitamins or minerals.
According to the Action Plan adopted at Cairo, promotion and counseling for natural
feeding are included among the services that should be made available in the context of
Reproductive Health at the level of primary health care. Furthermore, it is emphasized the
fact that "programs for reproductive health and family planning should stress the training for
natural feeding of the newborn and the development of adequate services for this purpose."
In the same Action Plan, at the chapter on child health, the following actions are
described: "Breastfeeding needs to be protected, promoted and supported so that both
newborns and children could benefit from the best nutrition and protection against different
diseases. Mothers should be helped through all legal, economical, practical and emotional
support means to exclusively breastfeed their children for the first 4-6 months of age () and
then to continue breastfeeding together with introducing solid foods until 2 years of age or
even more. To this purpose, governments should educate the public regarding the benefits of
natural feeding. Medical professionals needs to be trained in the management of
breastfeeding, and all countries should look for ways and means to carry out the WHO
International code of Marketing the Human Milk Substitutes.
What are the benefits for breastfed babies?
First of all a decrease of the incidence of acute diseases - viral respiratory diseases,
pneumonia, gastro-enterocolitis, otitis media. Generally speaking, breastfeeding is associated
with less bacterial infections that require hospitalization and a lower risk of sudden infant
death syndrome as compared to bottle feeding. Likewise, breastfed children score higher on
intelligence tests at 18 months of age compared to bottle fed children. Breastfeeding prevents
neurological development disturbances caused by the lack of essential fatty acids and
chlorine products. Differences in visual acuity have also been observed.
Benefits for mother include a lower incidence of ovarian and breast cancer, as well as
the prevention of post-menopausal osteoporosis. Properly used, breastfeeding is an effective
contraceptive method, which allow a better spacing of pregnancies.
 Another major benefit is economical, both for the family and country health budget.
One of the characteristics of all these benefits is the fact that they are long-term
benefits.
In Romania, according to study done by the Institute for Children and Mother Care
(IOMC), the percentage of breastfed infants at 4 months of age is, depending on the year of
birth, as follows: 1990 - 38%, 1991 - 36,9%, 1992 - 34%, 1993 - 29,2%, 1995 - 36,8%, 1996
- 40,4%.
According to another study, done by IOMC in 1997, the average weaning age is 3,4
months in urban areas and 3,9 months in rural areas. Other fluids are introduced at 1, 1
months in urban areas and 1,6 months in rural areas. According to this study, weaning or the
administration of another milk were the result of a recommendation of the family doctor
(44,6%), nurse (19,6%) or has been the decision of the mother (30,4%).
IOMC has been and continues to be a major factor in promoting natural feeding of
infants. Among its remarkable achievements we are mentioning here only the designing of
new protocols, the ongoing training programs for health professionals or the carrying out of
the initiative "The Friendly Hospital to Mother and Child" in 10 maternities. However, there
is a need to continue the efforts to create a generous framework in order to support and
inform the population, to train health professionals and to get all the decision factors in
supporting these efforts.

IF YOU DON'T HAVE MIDWIVES, BUY SOME!

Vania Limban, President of Midwives Association, Romania

The Romanian Midwives Association supports the acknowledgement of the midwife

status (obstetrics-gynecology nurse) in conformity with the responsibilities of this profession.
One of the essential conditions for improving the present situation would be the
establishment of an specialized educational system in line with international standards.
Some of the programs carried out by the Midwives Association are "The Parent
School" - designed to train parents to be - and "The Program of Midwives Training" attended
by midwives from Bucharest and the whole country.

Midwifery is on old profession in human history. It is mentioned even in the Bible.

The art of midwifery started originally from a primitive practice: the woman assisting another
women giving birth had affective or family links between them. In time it has become a
professional practice.
Although there was a time in Europe - especially in England and France - when
midwives were considered witches due to "dubious" practices. This trend reached its climax
during the XVII century, but gradually it was abandoned. They have eventually been
recognized as part of the medical profession in their countries. The course of this profession
has been variable over time, but the midwife has maintained its place as a key piece in the
care of pregnant women due to its specificity and uniqueness.
 Once the obstetricians made their entrance on the medical scene, a clear cut in the
care of pregnant woman came to light: the midwife took care of normal pregnancy and
childbirth, while the obstetrician took care of pathologic pregnancy and childbirth. This
increased the safety of caring for the pregnant woman ant its child. With time though
obstetricians extended more and more there area of activity, and they ended up by taking over
the caring of normal pregnancy and childbirth in many countries. This caused the midwives
to lose some of their legitimate rights.
This is what happened in Romania, too. Things are even worse here due to the lack of
any professional training for midwives for over 20 years now (1978!).
In time, obstetricians not only took over a part of the midwives' field, but due to the
lack of professional training, midwives also lost even the small tasks they were left with, like
the caring for the pregnant woman and her child during the ante, intra and postnatal period,
which were taken over by nurses.
Unfortunately, none of these could ever replace these highly qualified professionals
who gained their respect and reputation in this field of mother and child health. Few realize
that the reason Romania has one of the highest newborn mortality in Europe is largely due to
the fact that midwives have disappeared from the system of pregnant women and infant care.
The midwife is the professional health worker who takes care of all the aspects of
normal pregnancy and childbirth. By her continuous relationship with the pregnant women
throughout the pregnancy she has the duty to detect any pathological change and to take the
emergency measures until the case is handed over to the obstetrician - according to the
definition given by ICM (International Confederation of Midwives) in 1972, adopted,
improved and ratified by FIGO (International Federation of Obstetricians and Gynecologists)
and WHO in 1992.
The midwife has the duty to prepare the mother or the couple through training courses
about childbirth (respiration, massage, positions, relaxation), breastfeeding, post-partum
challenges. She oversees normal labor and stays all the time close to the pregnant woman,
reassuring and calming her while detecting as early as possible any mother or child risk and
taking the necessary measures to counteract them. She is also assisting normal childbirth (all
stages of labor) and takes care of the normal newborn baby while examining her (first
examination, first breastfeeding). After birth she continues to be close the new mother,
preventing post-partum depression and helping with the care of the newborn.
During the last years it became more and more apparent the importance of this
profession in counseling the pregnant women wishing to have a normal and healthy baby, the
pregnant women who does not want to keep the child or the new mother suffering from post-
partum depression or who is trying to get rid of her baby. Challenged by extreme attitudes
more than any other professionals, midwives may have to fight more than anybody else for
their "right to live."
Given the very complex needs the care of the pregnant woman, new mother and
newborn baby raise (and which involve internal medicine, surgery and psychology
competence), the midwife as health professional cannot afford the risk of losing two lives at a
time by practicing her profession in an amateur manner. The health of the baby and mother,
and by extension of the whole nation, is directly related to her expertise. There is an urgent
need for a special college for midwives, as well as specific legislation.
But if the noble aims of this little understood and underestimated profession are to
become part of the public awareness, the midwife herself has to keep reaching for ever higher
standards. And it takes a very sensible soul as well as professional competence to be able to
keep fighting for "the right of life" in this profession.
It is hard to believe that in a country that had one of the first schools for midwives in
Europe at the middle of the last century, that professions underwent such degradation that is
in danger of disappearing during the next 10-15 years.
And if we rather not think of midwives, at least we should keep in mind and ring an
alarm signal for the hundreds of women who continue to use abortion as a means of birth-
control with no idea about the risks involved, or those that keep their pregnancies but have no
medical examination until delivery, jeopardizing both their life and that of their child.
Isn't nobody out there to remember us we need those midwives that saved the lives of
hundreds of women and children in this country?