La dolce vita of breastfeeding in Trieste

La dolce vita in Trieste…

The conference is over, the bills are paid, but it still resounds in my memory: the 4th ABM European Regional Meeting for Physicians, held on 19th-20th of May in Trieste, Italy.

The meeting was organized by a team of BURLO Trieste under the leadership of Adriano Cattaneo and myself. The main organizer was the Academy of Breastfeeding Medicine and cosponsor was Burlo Trieste, who supported us wholeheartedly.

It is not easy to communicate with people who come from all over the world. Only 14 attendees were participating in their native language, English. All others were expressing themselves in (for them) foreign languages. But that didn’t matter. There was a wish to understand each other. As Dr. Adriano Cattaneo put it at the beginning of the conference: No more discrimination: 98 participants from 29 countries, speaking many, many languages, were interacting, were becoming friends and were planning for future collaboration and mutual support. And many ABM members met each other, sometimes for the first time, sometimes it was a happy “nice to see you again” after former meetings in Göppingen, Vienna and Torun.

In general the meeting took place in a very good atmosphere with very lively discussions, both in the sessions and during the breaks and dinner. The only real problem was that there was much too little time for discussion during the sessions. The lectures were excellently received and many participants reported afterwards, that they were inspired by the event.

I want to share with you some of the feedback that was given to this conference:
– “Excellent preparations, excellent that topics like BN and peristaltic were discussed in a differentiated way, very good that each level of English is accepted; this allows really international participation. Lots of impulses, lots of missing puzzle pieces!
– “It was my first ABM Meeting and I enjoyed it very much. Trieste is a nice place for such a congress. Listening to people from different countries and talking to them is very inspiring! Thank you!

A highlight of the conference was a small bus trip on the end of the first day to a central church in Trieste with a wonderful view on the city and the Adriatic Sea. Afterwards the busses took all participants to a restaurant near Miramar directly on the seashore, where there was much time to speak about experiences and to enjoy the evening. A real dolce vita in Trieste, with discussions, but also with warmth and laughter, with tumbling of ideas and exchange of opinions.

Because of the conference, some European collaboration projects have started, most notably a project under the leadership of Dr. Pat Hoddinott on an RCT of proactive telephone support for parents of premature babies (FEST). As a result of the conference many participants asked if it is possible to have a European Regional Meeting in their country. We have offers from Romania (Bucharest), Croatia (Split), Spain (Barcelona), Slovakia (Bratislava), the Netherlands (Amsterdam) and Denmark (Copenhagen – in connection with the next European conference of lactation consultants). So we can at least organize 5 or 6 further regional meetings!

And being a breastfeeding conference, it is only appropriate to mention, that this meeting was very nourishing for all of us. The meeting inspires us to continue to work for the best of children and their mothers – and fathers – around the world.

Elien Rouw, MD, FABM, is a member of the board of directors of the Academy of Breastfeeding Medicine.

Posts on this blog reflect the opinions of individual ABM members, not the organization as a whole.

Improving the world, one breastfeeding dyad at a time

This fall, I had the honour to represent the Academy of Breastfeeding Medicine (ABM) at the 64th annual conference of the UNO DPI/NGO in Bonn (Germany). The theme of this conference was “Sustainable Societies, Responsive Citizens”. This theme was discussed in plenary discussions, panel discussions, Round Tables and workshops. Emphasis was also placed on youth participation. They partly had their own program but also joined in the regular discussions. There was a large NGO exhibition, and between the discussions and through an official invitation for a reception by the city of Bonn, there was much time to meet with persons of organisations from around the world.

Mountains and hills in infant nutrition

How do you imagine the Alps? Let’s have a look in Switzerland, Austria, Italy, France or Germany. Here you will find a wonderful panorama view: the mountains, lush green meadows, the flora and fauna, the rocks and stones, but also cultural elements like alpine farms, the goats and cows.

Breastfeeding is, in a way, the “Alps” in infant nutrition -- and not only in nutrition.

Breastfeeding is, in a way, the “Alps” in infant nutrition — and not only in nutrition. Just as the Alps are not only about the mountain tops, but the whole landscape, so is breastfeeding is more than nutrition. The german word “stillen”, which means “soothing” actually expresses this much more clearly than the word breastfeeding. It is interplay between mother and child with many contributing factors: nutrition, immunisation and most of all an intensive bonding between a mother and her child. It is the seamless transition from the intra-uterine environment with constant contact and constant nourishment to extra-uterine world, with lots of skin-to skin contact and a very frequent feeding. It is the normal adaptation process of a newborn, a baby, and at the same time the normal adaptation process of the mother.

I am from the Netherlands. And we, in the Netherlands, are longing for the Alps. We already have the beginning. The Vaalserberg, at the borders of the Netherlands, Germany and Belgium, would be suitable. But it is not quite what it should be. So this mountain should be heightened-up a little bit. We could make it a 100% higher. That would do, wouldn’t it?
Now this Vaalserberg is 326 meter above sea-level (360 meters with the tower on it), and even if we would heighten it up 100% it still doesn’t have the height of the Alps. Try to further heighten it up? You have to be honest: It is not just the height: essential elements of the Alps are failing in the Netherlands. Flora and Fauna will never be that of the Alps landscape. And you cannot solve this problem with heightening up. Of course it is a good alternative, when you cannot have the Alps. It is a good recreation area, it has its own value for the people in the region and for holidays, but you cannot honestly say it is the Alps (even when some hotel owners want us to believe this – they call their hotel: Alpenblik – Alpview).

The Vaalserberg will never be the Alps

And so we have the parallel: formula is infant nutrition of acceptable quality, and in principle this quality can be improved. But as much as you can (and should) enhance this quality, it never will reach the standard of the original. It brings risks with it and disadvantages, for mother, child and society. When we do have the quality of the Alps, we should not be content with the Vaalserberg.

Elien Rouw is a physician in Bühl, Germany, and a member of ABM

Opinions expressed on the ABM blog are those of individual members, not the organization as a whole.

It takes a society to breastfeed a child

Breastfeeding: it is all about a mother and a baby… Or isn’t it? It takes a village to raise a child… this ancient African proverb is also, indeed very much applicable for the breastfeeding dyad. So many women in the world struggle with breastfeeding, not because they don’t want to breastfeed their child, but while the circumstances just don’t work. The support just after birth in the hospital is successfully addressed through the Baby Friendly Hospital Initiative, and this alone has greatly improved the breastfeeding practices worldwide. But more and more we are recognizing that it is not enough to give individual support. Two important ways of support are maternity leave and laws that give the mother the opportunity to breastfeed their child at the workplace, or, when this is not possible, to give mothers the opportunity to pump their milk. More and more countries are on their way to give this support to the breastfeeding dyad.

In the last week the Bangladesh Government announced that it grants a maternity leave for 6 months with full pay twice for female government employees during the tenure of her service in order to make the recommendation of the WHO for 6 months of exclusive breastfeeding possible for these mother-child-dyads. Only a relatively small group of women will profit from this regulation, but it is a strong signal that one of the poorest countries of the earth is willing to invest in mother-child relations and breastfeeding.

In Germany there is an extended legislation about maternity leave and breastfeeding protection. A maternity leave of 8 weeks after the delivery (twins and premature babies 12 weeks) with full payment is granted for all employees (partly paid by the insurance, partly by the employer). Thereafter the government pays one year of “Parents time,” with 67% of the full salary. It is possible to take 2 further years off without payment but with the guarantee that the employer has to take the employee back at the same level she was working before. When the mother starts working again, legislation says, that employers need to give their employees the opportunity to breastfeed their babies or to pump their milk. They can use at least twice for 30 minutes during an 8-hour working day, and this time doesn’t need to be compensated for, and can’t be counted as resting hour. A suitable room (not a bathroom) should be available to breastfeed or pump undisturbed. Of course in reality it is a bit more complicated. Many women don’t know their rights, are afraid to bother their employers, or are afraid for the reactions from their co-workers.

And the breastfeeding wonderland Norway? It isn’t surprising that we have wonderful regulations here: 44 weeks fully paid maternity leave (or 52 weeks with 4/5 of the last salary). And after this there is still the opportunity to take a one year parents’ leave without payment, but with job guarantee.

Only when breastfeeding is normal, when society allows space for this normal behaviour, when children are part of our society and when breastfeeding is part of our society, it is possible for the majority of women to fulfil their own breastfeeding goals. Breastfeeding rooms should be as normal as restaurants and bathrooms, just rooms to serve normal needs of human beings.

In the German „Bundestag“, the governmental building in Berlin, lactation rooms are also available, as in the regional parliaments and all other governmental institutions. The mothers in principle can nurse anywhere, although last year there was something of an uproar when a member of the parliament took her child (4 months) in the parliament room. Some representatives protested, because the child was not “officially” a representative, but she was defended by the leader of her party, and she was able to attend the meeting with her child. And that is how it should be: mothers doing their occupation with accommodations for the child to accompany them. Just normal behaviour in a normal society.

It takes a society to breastfeed a child.

Elien Rouw is a physician in Bühl, Germany, and a board member of ABM

Opinions expressed on the ABM blog are those of individual members, not the organization as a whole.