By Burgie Ireland
Studies have shown that among the other advantages of breast-feeding, breast-fed babies risk fewer infections, especially gastrointestinal and ear infections and pneumonia.
As early as the 1990s, the World Health Organisation warned that if the decline of breast-feeding continued, infections could threaten the lives of babies in all countries, but particularly in poorer and third world countries.
Many countries, including South Africa, signed a document called the Innocenti Declaration in 1990, committing themselves to protect, promote and support breast-feeding around the world.
Sadly, though, breast-feeding has, for the most part, taken a back seat and bottle-feeding has become the norm - especially among poorer people who can least afford to bottle-feed, and where clean water and hygiene are problematic.
Today we rely on modern technology, anti-bacterial soaps, disinfectants, detergents and antibiotics to do the dirty work and fight infections. In retaliation, these bacteria, viruses, bacillus and fungi are fighting back and winning the war. They're becoming stronger, and resistant to the chemicals we have created in the laboratory.
Health Minister Aaron Motsoaledi has publicly apologised for the deaths of six babies at Charlotte Maxeke Johannesburg Academic hospital and 12 babies at Natalspruit hospital in Katlehong this month, admitting that "overcrowding and a lapse in infection control" were to blame.
It seems we have learnt little from the tragedy five years ago when 22 babies died of the same outbreak at the Mahatma Gandhi Memorial hospital in Durban.
Encouragingly, one academic hospital seems to be getting it right. Marlene Gilfillan, dietician at Kalafong Hospital near Atteridgeville in Tshwane, said that it's been seven years since there has been an outbreak of any nosocominal (hospital acquired) infections in its maternity and paediatric units.
This may well be as a result of Kangaroo Mother Care, exclusive breast-feeding and vigilant hand-washing protocols that were introduced to these departments by Professor Susan Delport and Dr Elize Van Rooyen.
These are three easy, inexpensive yet practical ways to manage infection control. It just takes dedication, determination and team effort to put them into practice.
Kangaroo Mother Care
Incubators that are used in hospitals are expensive. They also need specific maintenance, and if they're not cleaned properly they can become a source of infection.
Nurses need to keep a vigilant eye on babies in these glass boxes to ensure that the temperature and oxygen supply are correctly set at all times.
Premature babies snatched from their mothers' wombs before their time whinge and cry on the hard, unyielding surface of the incubator. They are also confused by the lack of human contact and traumatised by procedures such as heel-pricking for blood tests, inserting a tube into the stomach for feeding and needles (usually most conveniently attached to their skulls) for drips and medications.
When Kangaroo Mother Care (KMC) is introduced, the mother becomes the incubator. Her baby is strapped skin-to-skin between her breasts, where he is kept warm by her body and comforted by her soft skin, her familiar smell and the rhythmic beating of her heart.
Her baby breast-feeds as often as he needs to, and sleeps contentedly between feeds, conserving energy to grow and recover.
Hospitals that have introduced KMC have found that not only is there an improved recovery rate, but mothers are less likely to abandon their babies because KMC has helped them to bond.
Hospital costs are reduced and infections are minimised.
There's also a happier atmosphere in the unit, where mothers can sit and chat to one another, rest and eat three meals a day.
Exclusive breast-feeding
According to Marlene Gilfillan, there is no formula feeding in either the neonatal ICU or the KMC unit at Kalafong hospital - even for HIV-positive mothers.
Lactation consultant Dr Jennifer Naude, who also works at Kalafong Hospital, added that "the hospital also has a lodger facility for mothers whose babies are in ICU - this means that their babies always have access to their mothers' milk".
Gilfillan explains: "If mothers are HIV-positive, they receive antiretroviral therapy to keep the viral load as low as possible, and babies are also put onto Nevirapine syrup. HIV-positive mothers express their breast milk, pasteurise it and feed it to their babies with tiny plastic cups - not bottles. This helps to minimise infection.
"Mothers accept that formula-feeding is not an option. They're told that breast milk is not only food for their babies, it is also 'medicine' that can help to make their baby better."
Naudé confirmed that the system worked very well. "Even in circumstances where the mother is extremely ill or for some reason cannot breast-feed, we have a breast milk bank where healthy mothers donate expressed breast milk which is pasteurised and fed to these babies," she said.
Sadly, many mothers today don't believe they can breast-feed. They're discouraged by stories of "mismanaged" breast-feeding when cracked nipples, engorged breasts and mastitis have disillusioned women, leaving them feeling miserable and inadequate, with hungry, frustrated babies.
The secret to successful breast-feeding is to have a positive attitude towards it while you're pregnant, to get good family support, and to obtain the correct information and help from a professional lactation consultant, nurse or midwife who knows what she is doing.
Hand-washing and infection control
Maternity units insist that the number of visitors for each patient is kept to a minimum to control the influx of infections. Nurses' uniforms should be white so that they're always seen to be clean.
Visitors to the nursery are restricted to mothers, doctors and nurses only. Where there are sick babies, gowns must be worn over clothes and uniforms. Hands must be washed before working with the baby, and washed again before working with the next baby. Mothers are shown how to wash their hands before they pick their babies up.
The deadly Klebsiella bacteria has made us all sit up and realise the importance of the daily hygiene that we take for granted. But it has also exposed a host of underlying issues that have not been addressed - HIV contributing to premature labour, complications of previous abortions that leave the cervix weak, hospitals that are understaffed and staff who are undertrained.
If you want to protect your baby from infections, minimise the risk of food allergies and feed your baby's brain with proteins unique to humans, research the benefits of breast-feeding.
Speak to a friend who has successfully breast-fed and find out from the hospital where you are going to have your baby if it is a recognised "Baby-Friendly Hospital" with written breast-feeding policies and guidelines, and all the better if it offers KMC in its ICU.