母乳絕地大反攻

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1992 / 10月

文‧陳雅玲 圖‧邱瑞金


母乳是否能戰勝奶瓶,嬰兒是否能重回母親的「懷抱」,未來仍有一場硬仗好打。


使跌入谷底的母乳哺育率止跌回升,已是政府既定政策;民間團體、醫界人士也有了相當共識。接下來的問題是——要怎麼做?

大家首先想到的是打擊奶粉,限制它的促銷活動。「嬰兒奶粉絕對不能視為商品,它是母親不能親自哺乳時的代用品,應該列為醫療用品加以管制」,主婦聯盟秘書長林玉珮表示。

母乳與奶粉的共存

「全世界都把問題歸咎於奶粉公司,這實在很不公平」,一家知名的美國藥廠台灣分公司董事長張鐘聲指出,以台灣為例,此地職業婦女的產假僅次於菲律賓,在亞洲各國中是第二短的;一般婦女工作場所又沒有設置托兒所或擠乳室,使得勞基法五十二條「子女未滿一歲須女工親自哺乳者,雇主應每天給予哺乳時間二次,每次以卅分鐘為度」的規定淪為空談。「上班媽媽實在無法哺餵母奶。不吃嬰兒奶粉,難道要讓寶寶餓死嗎?」他反問。

衛生署保健處科長劉丹桂也認為不宜對嬰兒奶粉「趕盡殺絕」。「職業婦女絕對需要奶粉,只要奶粉公司不去影響孕產婦哺餵母乳的意願,雙方是可以共存的」,她指出,衛生署現在推廣的目標並不是要嬰兒全吃母乳,而只要產婦坐月子的兩個月中,能親自餵奶,就很好了。

奶粉公司推展母乳?

事實上,一些歐美品牌的奶粉公司早就在先進國家體會到,只有鼓勵母乳哺育,做好形象,他們才能在當地生存。

奶粉公司為什麼做好人?張鐘聲對此說得坦白:「嬰兒一至三個月吃得很少,何必擔心少賺這些錢?有多少媽媽可以餵到孩子一、兩歲呢?」

深諳生存之道的這家藥廠,最近還委託廣告公司邀集國內知名的小兒科、婦產科醫師,拍攝了一支母乳宣導影片,將在各醫院、圖書館等地放映、供民眾借閱。

在衛生署的母乳推廣計畫中,則要儘量協調奶粉廠商不再贈送樣品給孕產婦,並要求醫院不得陳列奶粉樣品,再以補助經費方式,鼓勵醫院、診所舉辦母乳教育,以及規定未來產婦所打的退奶針,公勞保不再給付。

「很多醫生都是在產婦還沒下產檯,就問:要不要打退奶針?這一問,就打消了許多產婦親自哺乳的意願」,林玉珮指出說。

不准媽媽偷餵奶粉

根據台北市各醫院婦產科懸殊的母乳哺育率來看,關鍵確實在醫院。

目前母乳哺育率高達百分之七、八十的私立台安醫院,就是因為其外籍婦產科主任葛瑞德堅持「自然主義」,而奠下基礎的。

該院不但開設每期長達三週、每週兩次的產前教室,教授有助自然分娩的「拉梅茲呼吸法」及母乳哺育,葛醫師還有一項特殊規定:不打算親自哺乳的產婦他不接生;他每天查房,即使產婦一開始奶量不足,也絕不准偷偷給孩子補充奶粉。

在公立醫院中做得最好的婦幼醫院,則得到國防醫學院研究計畫之助,以「教育介入」方式,對參與實驗的孕婦提供足夠的資訊及哺乳技巧。經過實驗發現,產前原本沒有意願餵母乳者,經過醫院教育影響,產後有百分之六十哺餵母乳,而且成功率較未受過母乳教育者高出甚多。

讓嬰兒和媽媽一起睡

「世界母乳哺育行動聯盟」提出的「十個成功促進母乳哺育步驟」,也把重點放在醫院。例如將母乳哺育政策經常地傳達各醫療人員;對醫療人員實施母乳教育,包括技巧與方法;幫助母親在生產完卅分鐘內開始哺乳;實施廿四小時的母嬰同房;不要讓嬰兒吸奶嘴……等。

「對我們來說,目前最難做到的是母嬰同房。因為台灣的醫療資源,不管是人力還是病房都不夠,要做到一對一,除非是小型的貴族醫院;而且國人生產住院時探望的人太多,一下阿公抱,一下阿媽抱,容易造成新生兒感染」,婦幼醫院院長李鎡堯建議,不妨在醫院建立兩套系統,讓產婦視自己的經濟及身體狀況自行選擇。

沒有條件而強行實施,的確非明智之舉。據了解,中國大陸目前儘管平均母乳哺育率有將近百分之五十,但一些大城市如上海、北平,比例已降為百分之十,中共也打算在公元兩千年時,將母乳哺育率提升為百分之八十。

但據張鐘聲到大陸考察市場時發現,他們在衛生條件不夠的情況下實施母嬰同房——把嬰兒小床用一根繩子吊在產婦病床的上方,孩子餓了要吃奶,媽媽將繩子一放,把小床拉過來就成了。「但是他們的嬰兒死亡率很高呀!」張鐘聲搖頭嘆道。

媽媽餵奶,閒人止步

除了無法全面母嬰同房,以台灣目前的社會環境,要爭取更長的產假及育嬰假也困難重重。

衛生署的折衷辦法是,鼓勵各事業單位及公共場所設置哺乳室,讓上班媽媽可以自備擠奶設備,將工作期間分泌的乳汁帶回家給寶寶享用。公共場所多設哺乳室,更能讓媽媽外出時方便地哺餵母乳。「社會上已經不習慣公開哺乳了,現在重新提倡,在過渡期,確實有必要提供一個令人安心的空間」,劉丹桂說。

這種種措施,真能讓我們已連跌廿五年的母乳哺育率逆勢挺升嗎?

「美國七○年代也是由百分廿六的谷底向上反轉,今天已經達到百分之五十四,而且還在繼續回升」,衛生署食品衛生處科長曾明淑根據研究報告指出,目前台灣雖然鄉村的母乳哺育率還在下降,但都市已有止跌回升的趨勢。

讓母奶重新流行

「我有信心,現在推廣時機已經成熟,百分之四十的目標一定可以達成」,劉丹桂認為,只要各界一起努力,蔚為社會運動,一定可以讓母奶「重新流行」。

我們的社會也正在進行反思。主婦聯盟在這次北中南巡迴座談會上,原本用了一句她們認為十分動人的口號——「母乳是給孩子的第一份禮物」,沒想到被一位台中的媽媽駁斥:台灣有句俗諺「糧草要自己帶」——就像植物要發芽,種子堣w有足夠的養份;哺乳類動物一生下來,母獸的乳房也準備好了。母奶是嬰兒自己帶來的,這是「嬰兒人權」,無論是母親抑或社會大眾,都沒有人有權利剝奪。怎麼能說,這是母親給孩子的「恩惠」呢?

她的話令人默然。今天,我們這些大人真該好好想想,如何將原本屬於孩子的,還給孩子。

〔圖片說明〕

P.82

哺乳是天賦,但技巧仍需教育與學習。

P.83

餵奶時間到了,把小寶寶推到產婦病房讓母子相聚,不失為「母嬰同房」的變通方式。

P.85

準媽媽們在先生的陪同下學習拉梅滋呼吸法幫助自然生產,是不是也打算用自然的母乳餵養寶寶?

P.86

主婦聯盟決定把提昇母乳哺育率列為長期會務加以推動。圖中他們展示的,是「國際嬰兒食品行動網」推廣母乳的T恤。

相關文章

近期文章

EN

Mother's Milk Makes a Comeback

Elaine Chen /photos courtesy of Diago Chiu /tr. by phil Newell

Whether mother can really outdo the milk bottle, and whether infants will return to their mother's "embraces," is a hard-fought battle that will continue to be fought.


Raising the rate of women who breast-feed their infants, which has reached an all time low, is now official government policy. Private groups and the medical profession also share this view. The next question, then, is--how can we go about doing this?

The first thing everyone thought of was to attack powdered infant formula, by limiting promotional activities. "You absolutely can't look at infant formula as if it were just another product. It is a substitute for when women are unable to breast-feed on their own, and it should be subject to the same oversight as medications," says Lin Yuh-pei, secretary-general of the Homemakers' Union and Foundation.

Peaceful coexistence: "Everybody blames the problem on the formula manufacturers--this is really unfair," says Brian Cheung, managing director of the Taiwan subsidiary of a well-known American pharmaceuticals company. For example, in Taiwan a professional woman's maternity leave is the second shortest in Asia after the Philippines, and most places of employment lack nurseries or feeding rooms, making a mockery of Article 52 of the Labor Standards Law which says, "Wherever there are infants under the age of one who require breast-feeding by the mother, the employer must provide two feeding periods per day, each one thirty minutes in duration." "So working mothers really have no way to feed their infants. If the children don't drink infant formula, would you rather have the babies go without?" he retorts.

Nancy Liu, section chief in the Bureau of Health Promotion and Protection at the DOH, also believes there is no point in "annihilating" formula. "Working women definitely need it. We just have to make sure that the formula companies do not affect the willingness of mothers to breast-feed on their own, then both methods can peacefully coexist," she notes. The goal the Department of Health is now promoting is not for children to exclusively drink mother's milk; for now it would be quite good if the mother could just breast-feed the baby for the first two months.

Formula companies promoting mother's milk? In fact, some European and American corporations have long understood that to stay alive in the advanced country markets, they would have to encourage natural feeding to improve their own images.

Why would the formula companies play Mr. Nice Guy? Brian Cheung says baldly, "Children don't consume much from the first to the third month, so why should we worry about earning the small profits from this period? But how many mothers can breast-feed their children until they are one or two years old?"

Pharmaceutical companies well-versed in market survival have recently commissioned an advertising company to invite the leading pediatricians and obstetricians in the country to make a promotional film for breast-feeding. It will be screened in hospitals, libraries, and such places for public viewing.

The Breast-Feeding Promotion Plan of the Department of Health aims at the least to get the formula manufacturers to stop sending free samples to expectant mothers, and is requesting that hospitals stop displaying formula products. They are also using subsidies to encourage hospitals and clinics to undertake education about mother's milk. The plan also stipulates that in the future public health insurance will no longer cover the costs of lactation suppression shots (which stop the production of milk in new mothers).

"A great many doctors ask the patients if they want the shot even before the baby has been born. This simple question right away reduces the willingness of many mothers to do breast-feeding," states Lin Yuh-pei.

No secret formula: Based on vast differences in the figures for the rate of mothers who do natural feeding from the hospitals in Taipei City, the hospital is definitely decisive.

The rate of 70% or 80% breast-feeding at the private Adventist Hospital in Taipei is due to the foundation laid down by G.A. Gryte, the foreign doctor who heads the Department of Pediatrics, who insists on "naturalism."

The hospital has set up a class lasting three weeks, meeting twice a week, which teaches the Lamaze Method and breast-feeding. Dr. Gryte has a special rule: He will not help deliver the baby of anyone who does not plan to breast-feed. Moreover, he checks the rooms of the patients daily, and even if lactation in the mother is at first not quite up to par, he absolutely forbids the nurses or mom secretly sneaking in some formula to compensate.

Taipei Municipal Hospital for Women and Children, the best among the public hospitals, with the help of the National Defense Medicine Research Plan, used the method of "learning by doing," providing women who agreed to participate in their study with adequate information and techniques for breast-feeding. The study showed that 60% of women who had originally not planned to breast-feed their children did so after undergoing hospital instruction, with the success rate being far higher than for mothers who had not undergone the instruction.

Letting baby and morn sleep together: "Ten Steps to Successful Breast-Feeding," put out by the World Alliance for Breastfeeding Action (WABA), also puts the main focus of attention on hospitals. These points include, for example, frequently informing hospital staff of breast-feeding policy; educating medical personnel about breast- feeding, including methods and techniques; helping mothers to begin breast-feeding within 30 minutes of birth; implementing a policy of joint mother-baby rooms 24 hours a day; not letting children suck on bottle nipples, and so on.

"For us, the hardest thing right now is the joint mother-infant room, because medical resources in Taiwan are inadequate, whether you are talking about manpower or space. If you want to get one-on-one, unless it's a small-scale hospital for the wealthy, it's unworkable. Also when Chinese go into the hospital for a birth, there are far too many people who want to visit, with Grandpa now holding the baby, then Grandma, so new-borns can easily be exposed to contagious illness," suggests Tigris Lee, superintendent of Taipei Municipal Hospital for Women and Children. There's no harm in having both systems available in each hospital, so that each mother can choose based on her economic and physical conditions.

Its really not the right way to go about it to compel people to follow one policy unconditionally. It is understood that at present the rate of breast-feeding in mainland China is nearly 50%, but in some big cities like Shanghai or Peking, the rate has already fallen to 10%. Mainland China is thus planning to get the rate of natural feeding up to 80% by the year 2000.

Interestingly, according to what Brian Cheung discovered in a survey of the mainland market, given the inadequacy of health and medical conditions there, they already have "mother and infant in the same room." The child's bassinet is suspended over the mother's bed with a rope, and when the child is hungry the mother just needs to pull the rope over to do the job. "But their infant mortality rate is very high!" he sighs with a shake of the head.

Don't intrude when a woman is breast-feeding: Besides it being impossible to fully implement a policy of keeping the mother and child in the same room, given Taiwan's society at present, there are all kinds of difficulties in the way of winning more maternity leave or nurturing time.

The compromise method of the Department of Health is to encourage all enterprises and public places to set up a feeding room, and let working mothers bring their own materials to take the milk they produce during working hours back home for the baby. If there were feeding rooms in public places, this would make it much easier for mothers to naturally feed their infants when out of the house. "Society is at the point where it cannot accept public breast-feeding, so now we have to start promoting it all over again; in the transitional period, there is definitely a need to provide a safe space where people can feel comfortable," says Nancy Liu.

Can these policies really bring the rate of breast-feeding, which has been falling steadily for 20 years, back up?

"The rate in the U. S. is now climbing back up from its low of 26% in the 1970s, and is up to 54% today. Moreover, it's still on the upswing," says Tzeng Min-su, section chief in the Bureau of Food Sanitation at the DOH, basing her comments on studies. Although the rate of breast-feeding in the countryside in Taiwan is still falling, in the cities it has already begun to shown signs of stabilizing and going back up.

Making mother's milk mainstream: "I am confident that the time is ripe for spreading the word and that we can definitely reach the target of 40%," contends Nancy Liu. If only everyone would work together and see this as a social movement, then mother's milk can once again become the mainstream.

Our society is in the midst of a reassessment. In its seminar tours of north, central, and south Taiwan, this year the Homemakers' Union and Foundation adopted a moving slogan: "Mother's milk is the first gift you can give to your child." Little did anyone expect they would be taken up on it by a mother from Taichung: She said that there is a Taiwanese folk saying that "each blade of grass carries its own food with it." That is to say, in plants which bud, the seeds already contain all the nutrients they need to blossom; when mammals in the animal kingdom give birth, the mother's nipple is ready and waiting. Mother's milk is something the infant brings along with it--it is an infant's "human right"--and no one, not the mother or society at large, has the right to deprive the child of it. So how could you say that this is some "benefaction" bestowed by the mother?

Her words silenced everyone. Today, we adults must truly think well how to give back to the child what belongs to the child.

[Picture Caption]

Mother's milk is a gift of nature, but proper technique requires education and practice.

Feeding time is here! Taking baby to mom's room is, by and large, equivalent to making "joint rooms for mothers and children" commonly available.

Mothers-to-be practice the Lamaze method with their husbands to help with natural childbirths. But will these same mothers use natural feeding for their babies?

The Homemaker's Union has set raising the proportion of women who breast-feed their children as a long-term goal to be promoted. The photo shows a T-shirt they display put out by the World Alliance for Breastfeeding Action.

 

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