Weaning Concept, Next Pregnancy and Breast Feeding 

Bowel Pattern
in Breastfed Babies

    While on breast
milk, the baby passes yellowish, sticky, semisolid sol which may be slightly
curdy or greenish at times. The number varies a great deal, but most babies
pass six to seven stools a day, usually alter feeds. They may pass a small
amount of stool every time they pass wind.

    This is often mistaken for diarrhea,
which is followed by administering all types of drugs. This is a perfectly
normal pattern and needs no treatment. On other hand, some babies are
considered to have constipation because they pass a stool every other day, even
though it is perfectly normal in consistency. This, too, reeds no treatment.

Breastfeeding
and Child Spacing

    With frequent
breastfeeding, both during the day and night, most women do not menstruate for
a few months, and this contributes to child spacing However, after three to
four months, breastfeeding alone is not a reliable method of preventing the
next pregnancy, even if menstruation does not start again. 

    At this stage, the
use of a contraceptive should be advised. An intrauterine device (IUD) is a
very suitable contraceptive and can be inserted six weeks after delivery. A
condom too is suitable for contraception.

Breastfeeding
and Another Pregnancy

    Some mothers
believe that if they become pregnant again they should stop breastfeeding the
baby. They often do it very suddenly, with the result that the breasts get
engorged, and the baby is put on artificial feeding which she may not like and
may refuse. Besides, there is a risk of infection The health worker should
assure the mother that there is no harm in breastfeeding the baby during
pregnancy and that there is nothing wrong with her breast milk. However, if she
insists on discontinuing breast- feeding, it should be done over a couple of
weeks.

    HIV and
Breastfeeding

    The issue of
breastfeeding by HIV infected women has become a complex problem for health
workers in developing countries.

    There is a 16
percent additional risk of mother to infant transmission of HIV by
breastfeeding Maximum transmission of HIV virus occurs during the first few
months after birth. 

    Current opinion is that the best option for HIV infected
women would be to avoid breastfeeding if it is safe and economic option for the
family, This would be particularly true for children born to mother who have
spent money and efforts on anti-retroviral therapy to prevent mother in child
transmission or infants who have a negative PCR at 1 month of age Counselling
of HIV positive mother should start early in pregnancy. 

    Parents should be able
to make “fully informed decisions” about infant feeding options and
then supported to carry out their decision as safely as possible.

    Replacement
feeding whenever introduced could be accomplished by commercial infant formula
and/or home prepared formula made with fresh animal milk. The latter is a
better option for resource poor families. 

    The latest research however, shows
that among mothers infected with HIV, infants exclusively breastfed for 3
months or more have no excess task of HIV infection over six months than those
who have never been breastfed According to some researchers the dangers of
breast milk have been exaggerated in the fight against HIV/AIDS and
disadvantaged and poor women are better off breastfeeding exclusively for 6
months and then switching to other family foods. 

    A mother, not breastfeeding,
is also likely to get pregnant again, further endangering her own health and
that of the next infant.

    Anti-retroviral treatment (ART) is a strategy for prevention of mother to child
transmission of HIV in resource poor setting. Combining breastfeeding with
several weeks or months of anti-retroviral therapy with weaning at six months
of age has been suggested. 

    The Delhi Government has planned to provide
nevirapine (NVP) to mother during labor and to the baby, with that of
Zidovudine (AZT), through various hospitals. The choice of regimens to be
included in a mother to child transmission (MTCT) prevention program should be
determined by assessment of feasibility, efficacy, acceptability and cost.

• Practical
  Consideration In Choosing Anti-Retroviral
• Regimens For
  Mtct Prevention
• Availability of
  voluntary counselling and testing services
• Quality and
  frequency of antenatal visits Access to early postnatal care
• Access to and
  cost of drugs