Air Susu Ibu Oke Banget!

Pelatihan konseling merupakan pelatihan reguler yang dilaksanakan sentra laktasi indonesia, dimana dari sana diharapkan menjadi persemaian para konselor muda dalam laktasi yang mempunyai kecakapan klinis dan komunikasi. dua keterampilan yang sangat ditekankan dalam pelatihan ini.

Pada tahun ini 2008 selasi kembali mengadakan pelatihan ini yang bertempat di auditorium puskesmas pembina Kecamatan Tebet. dengan jumlah peserta 13 orang dengan calon fasilitator dan 4 fasilitator senior.

Tepat jam 09.00 pelatihan dimulai, diawali dengan daftar ulang peserta dan dan perkenalan yang dipimpin oleh course director, perkenalan ini diharapkan dapat mempererat hubungan diantara para peserta, dalam perkenalan peserta diminta menyebutkan `kenapa orang tuanya memberikan nama itu?` canda tawa pun mengubah kebekuan diantara peserta. "nama saya Faishal, saya megister sosial politik, status saya sudah nikah, akan tetapi saya siap memperpanjang masa berlaku saya kok". celetuk salah seorang calon fasilitator dari Riau itu dengan nada canda.

Pada 09.30 dr. Utami Roesli datang, dan langsung berkenalan juga langsung membawa sesi pembuka, yaitu inisiasi menyusu dini dan ASI Eksklusif juga seberapa penting pelatihan ini diadakan. disela-sela kesibukan beliau di Advokasi, dr. Utami masih dengan setia mengayomi para calon konselor Sentra Laktasi Indonesia, bahkan sesaat setelah berbicara dr. Utami langsung berangkat ke Aceh. kemudian acara dilanjutkan dengan coffee Break dan langsung memasuki sesi pertama, Mengapa Menyusui Penting, yang dibawakan oleh drg. Wida Firnadasari.

Peserta terlihat antusias, bahkan beberapa peserta sudah bertanya tentang bagaimana memposisikan bayi dengan benar, padahal sesi memposisikan bayi masih pada sesi ke-10. diantara pertanyaan yang menarik juga yaitu "apakah ASI itu ada kelasnya?" atau apakah ASI itu berbeda tiap ibu, ada yang berkualis pertama, kedua, ketiga dan seterusnya. dr. Dian Nurcahyati yang kebetulan mendampingi para Fasilitator junior angkat suara, bahwa ASI itu memang berbeda-beda, tetapi perbedaan komposisi ASI pada setiap ibu dikarenakan ASI memang menyesuaikan dengan kebutuhan bayi.

Pelatihan selesai pada pukul 14.00 dan dilanjutkan dengan Fasilitator Meeting.

Saya mempunyai tetangga, Ibu Fatimah namanya.... baru mempunyai 1 anak saat ini berusia 3 bulan...Beliau melahirkan di luar kota sehingga kami baru bertemu setelah Dede Husein nya sudah berumur 3 bulan...

Beberapa hari yang lalu kami bertemu, dan saya menanyakan mengenai ASI yang diberikan untuk anaknya... ternyata dari anaknya lahir sampai dengan umur 3 bulan..anaknya tidak pernah menyusui langsung dari ibunya... dengan alasan anaknya tidak mau disusui..jadi selama ini ASI nya hanya di perah lalu diberikan menggunakan botol susu...dan karena produksinya ASI tidak banyak ( pastinya lah ya..kan tidak pernah dihisap ) jadi anaknya minum susu formula juga...duh miris dengarnya... karena beliau ini adalah ibu rumah tangga bukan ibu bekerja yang mana bisa mendampingi anaknya setiap saat... ( i wish i can.. hiks..)

Karena semangat peduli ASI...saya sudah mereferensikan klinik laktasi di rs. saint caroulus untuk konsultasi kesana...

tapi mungkin suami tidak mendukung ato ada alasan dan sebagainya...

Saya ingin tanya adakah konselor yang bisa membantu sang ibu ini ?

Terus terang saya prihatin...berhubung sang ibu juga umurnya masih belia..20 th ( kalo ga salah ) dan sudah tidak mempunyai ibu sejak beliau kecil sehingga pengalaman dlm mengasuh dan merawat bayi kemungkinan minim sekali pengetahuannya...

saya hanya bisa berusaha membantunya semampu saya...dengan memberikan informasi2 yang bermanfaat buat beliau... ( karena anak saya sudah 3..hehehe..)

Terima kasih atas kesempatan yang diberikan untuk memposting masalah ini.

Dian

http://fadlanzikra.multiply.com

 

For full article, click here

This writing is to compare two breastfeeding experiences: Noe's first two weeks and Kei's.

---

Preparation

Noe: I decided to fully breastfeed my baby because of what international health organization and experts recommends for baby's first six months. But I thought that breastfeeding should be natural and should not be learned. So I made no effort in looking for any information about breastfeeding at all. Despite that, I was really confident that I wouldn't face any difficulty breastfeeding. Later, it turned out that I was too cocky.

Kei: Having volunteered with Breastfeeding Mother Support group and received counseling training from them, plus, having purchased the Breastfeeding Answer Book, and having engaged a lactation consultant to counsel me during the first few days after birth, I am (hopefully) better equipped to breastfeed my baby. I roughly know the basics of breastfeeding and I know where to look for help if anything goes wrong. I am more confident but hopefully not as cocky as during Noe's time.

---

Birth and The First Few Hours

Noe: (Details are here, here, and here)  Noe was delivered vaginally with only two pushes and I had very few stitches. It was relatively easy labor but with severe complications post-partum. After clamping the umbilical cord, Noe was given to me for cuddling, but I didn't know that I could breastfeed him at the very moment. I thought I had to finish all the childbirth procedures; stitching and all; before beginning to breastfeed for the first time. Hence I handed him back to the nurse to be taken to the nursery, because Noe was crying (stupid decision by me). A few minutes later I had severe post-partum hemorrhage which was caused by lack of contraction in my uterus. The bleeding could've been reduced if I had been breastfeeding when Noe was given to me for cuddling, but I didn't know that. The bleeding was so bad and I ended up feeling cold, shivering, and very tired. After the critical condition ended, the nurse asked me whether I wanted to breastfeed, and I declined saying that I was too tired. The nurse asked again, "But you asked for total breastfeeding.." and I insisted, "Yes.. but I am really tired now, please just give him formula if he's hungry. I will try to breastfeed him when I feel stronger". I regret this decision even until now, and this decision caused Noe to have nipple confusion which later caused a series of breastfeeding problems. I was then brought into Intensive Care Unit, and stayed there for 18 hours, before seeing Noe again for the first breastfeeding.

Kei: I decided to prepare for ideal condition to begin breastfeeding. First, I intend to have drug-free birth, because anasthesia is known to cause drowsiness in newborn and inability to breastfeed right after birth. Secondly, I engaged a lactation consultant during labor to assist breastfeeding during the first hour. I was glad that my birth plan was mostly followed. Kei was put on my breast for skin-to-skin contact within 10 minutes after birth, but he was not really interested in breastfeeding at the moment. So we quickly weigh him and measure him, and put him back into breast at the second 10 minutes after birth, and this time Kei is more interested in breastfeeding. The first time he nipple-feed me, which is wrong, so we had to break the suction and attempt for a more correct latch-on. Kei managed to latch-on beautifully during his second attempt, and despite his "weak" suck (compared to Noe's suck, which is a toddler) I could feel the effect instantly. I felt a bit of pain in my uterus which means that it is contracting, hence reducing the bleeding. I think Kei breastfed nicely for about half an hour before dosing off to sleep. When Kei was bathed for the first time, he expelled meconium instantly since he had drunk the colostrum. The expulsion of meconium is very important as it will help to reduce the risk of jaundice.


Noe

Kei

---

The Second Day

Noe: Noe breastfed for the first time 18 hours after childbirth. Since he had been given formula while I was in ICU, he latched-on incorrectly to my breast just like he was sucking bottle. Noe was basically nipple-feed, and I did nothing to correct it because I didn't know it was wrong. Ami Prasetyo, a friend who was visiting, pointed out my mistake, but I ignored it because I haven't yet felt any pain. Meanwhile, no lactation consultant or nurse helped me with my latch-on, hence the mistake was not corrected. By early evening, I began to have sore nipple, but the massive dose of painkiller given to me masked out the pain. At night, Noe did cluster feeding. This means Noe feeds non-stop from 2am to 4am. I didn't know that such condition is normal during the first few days. But I was too tired due to my bleeding and low hemoglobin rate, and I didn't understand why Noe wasn't satiated at all. At the end, I was overly tired and I asked the nurse to take Noe away to nursery and feed him with a bottle of formula.

Kei: Three hours after birth, Kei was brought in to breastfeed, but he wasn't interested. I attempted to feed him for one hour but he stayed asleep. I thought that this might be a normal situation, whereas in the beginning the baby was a bit sleepy, and this might be nature's way to help the mother rest after childbirth. I sent Kei back to nursery so I could sleep: making the most out of baby's sleepy time. Kei breastfed for the second time approximately six hours after birth, and during the first day he fed every five to six hours. I tried to sleep as much as possible, because I expected that Kei would do cluster feeding sooner or later. During Kei's third feeding, at around 10am, Doris (lactation consultant) came for a visit and helped me with a "refresher course" on breastfeeding. I learned that I had to catch Kei's big mouth opening (say AAH!) in order to produce a good latch-on. This is a bit challenging because Kei's behaviour was random (like most babies) and I was the one who has to be observant of his behaviour. Basically both mother and child are learning about each other's ability and limitation. Kei's was a quick learner, he learned that he would be rewarded with milk if he opened his mouth really big. As a result, Kei has always done good latch-on and I didn't have any soreness. Later on, at night, true to my prediction, Kei began to cluster feed. This time, I was physically fit and prepared, so I said to Kei, "Let's have a battle, who is stronger and who will survive the night with cluster feeding". I fed Kei non stop from 1am to 4am, going from left to right breast and repeat the cycle, nonstop. At the end, at 4am, Kei fell asleep by himself, being too tired of cluster feeding. I was glad I won the battle. I then sent him back to nursery and I slept comfortably for four hours straight. After that cluster feeding session, Kei feeding hours began to become more regular and predictable.


Noe

Kei

---

The Third Day

Noe: During the second day I received blood transfusion in order to boost my hemoglobin rate. Noe roomed in with me during the day, and sent to me from the nursery every 3-4 hours during the night. My sore nipple was getting worse with the nipple skin peeling off. The painkiller started to lose out to the pain of sore nipple. I asked the nurse for a help to cure the sore nipple, and she was aghast to see such a bad nipple condition. She gave me medela ointment to apply to the nipple before and after nursing. The problem is, the nurse was not fixing the latch-on problem, which was the source of the problem, and I didn't know it. In the mean time, no lactation consultant paid me a visit (and I didn't know that there is such thing as a lactation consultant). Meanwhile, most people told me that sore nipple is normal for the first week and it will subside by itself. So I took it for granted that sore nipple is the normal pathway towards breastfeeding. Little did I know that sore nipple is not a normal condition and that it could all be resolved by a quick visit to IBCLC (certified lactation consultant).

Kei: Since I had a vaginal delivery without complication I was able to come home the second day. So far Kei has been breastfeeding well, as indicated by his pee and poo cycle. I saw that Kei has been having more than four poos, which was very good for a two-day old baby. Kei also didn't show any sign of jaundice, so doctor let him out of hospital without prick test. We were discharged in the afternoon. Kei's weight upon discharge was 2630 grams. Losing weight during the first days was normal because the baby shed meconium and excess water in the body. Back home, Kei feed every 1-1.5 hours. At night, he was again having cluster feeding, this time it was for six hours straight. I fed him in cradle hold position and fell asleep sitting down cradling Kei. Lucky that I managed to maintain the cradle position while I was asleep, and Kei was latched on all the way. That was the last cluster feeding session for the first two weeks.

---

The Fourth Day

Noe: Since my blood transfusion result was good, I was discharged at the third day. It turned out that going home was a struggle for me. I was considerably weak due to the blood loss, this means I was easily tired. Compounded with difficulty breastfeeding with sore nipple and baby blues, I became sad easily. Noe was feeding quite frequently and it tired me, and he was given formula. When my husband gave Noe the first formula bottle at home, it dawned to me that I did not want to bottle-feed him, because it seemed to be really cumbersome: preparing the formula, ensuring the right temperature, feeding the milk, and washing/sterilizing the bottle afterwards. Knowing me, I would be too sloppy and too careless to bottle feed Noe. Besides, my weak condition didn't spare me enough energy to do the extra chore of making formula milk and cleaning it afterwards. From that moment I decided to go back to total breastfeeding, despite the pain of sore nipple.

Kei: So far the breastfeeding experience has been really painless (but still a bit tiring with its high frequency). And my mature milk has begun to come in: I experienced breast fullness and I could see white milk when they're squeezed. Meanwhile, Kei's poo has turned yellow and grainy like curry. His breastfeeding frequency has also begun to space out to 2-2.5 hours.

---

The Fifth Day

Noe: Away from the hospital and away from the painkiller, I just realized that sore nipple pain was worse than labor pain. I literally broke down to tears every time I breastfed because it was really really painful. My mother was really puzzled to see me crying and screaming out of pain of the sore nipple. People reassured me that the pain will subside after one week, so I decided to stay put despite the pain. Of course, with crying and screaming. The nipple skin peeled off leaving a really painful gaping wound. I decided to do away without bra, because the friction of the nipple with the bra aggravated the pain. Meanwhile, my mature milk began to come in and I began to leak all over the house. I also began to have slight engorgement. All the changes in my body had never happened before, and I was really stressed out because of it. Meanwhile, my husband went off to buy breastpump and nipple shield because he couldn't stand to see me in great pain.

Kei: I began to have breast engorgement but no leak yet. There's also lump in armpit. I gave cabbage compress for 2 hours and it was soothing. Noe helped empty the breast but didn't help alleviating the engorgement. I also had a low grade fever, and I took panadol to cure it. This time I know that all those changes in my body were normal and it was my body's attempt to calibrate the right milk supply. I was more prepared, especially with the breastfeeding book, and had known the first-aid measure to overcome engorgement. And by the way, I don't have sore nipple at all, and this makes breastfeeding really enjoyable.

---

The Sixth Day

Noe: This time I tried to pump the milk so that I didn't have to go through the pain of breastfeeding directly. To my horror, while pumping, the sore nipple wound opened up and blood was expressed alongside milk. I was totally freaked out seeing the bloody breastmilk. Not knowing what to do with it, I threw away the bloody milk and quit pumping at the very moment. I decided, again, to bear with the sore nipple pain, instead of having to bear seeing my nipple exploding with blood.

Kei: The low-grade fever subsided, but the slight engorgement stayed on. Due to the engorgement, latching on became more challenging. Luckily the "sandwich" technique as taught by Doris helped to ease the latch-on process. Kei adapted really well to the changes in my body. Despite all those changes, I managed to catch all Kei's big mouth openings, and latching-on was easy. Kei had learned that his reward of milk comes with the big AAH that he made.

---

The Beginning of the Second Week

Noe: Breastfeeding and baby caring becomes a dreaded task for me. I felt really miserable. Compounded with baby blues, I really didn't enjoy having a baby. At this stage, a baby is not yet responsive to eye contact, and this made me feel unappreciated. I felt really incompetent because my mom always criticized the way I care the baby. Moreover, breastfeeding was really painful with sore nipple. Breastfeeding was also a hassle. I had to change clothes very frequently because of bad leaking. I had to ensure that I install the breast shield to protect the sore nipple, and milk drips inside the shield,  onto the tshirt, onto the floor, creating a big milky mess all over the house. The whole house smells like stale milk. In short, I was feeling really miserable. But somehow I didn't stop to change to formula feeding. Most probably because I didn't have the energy to make formula milk, clean the bottle, sterilize it, etc. My hemorrhage made me fall tired really easily, and I just wanted to avoid extra work related with house chores, including cleaning the bottle. This is mainly why I stuck with breastfeeding. It wasn't at all any noble goal to give my baby the best nutrition. It was mainly out of my weak physical condition and my own laziness.

Kei: At the beginning of the second week the engorgement had subsided and the milk supply seemed to have stabilized. The leak was not as bad as in 2005, surprisingly. Nevertheless, both Kei and Noe seemed well satiated. BTW, I am doing tandem nursing, which means I breastfeed both Kei and Noe. But I only do tandem at night. It is a bit tiring, but it seemed to lessen the sibling rivalry between the two. Despite having to feed to kids, so far I don't have nipple soreness. Baby care and breastfeeding are now enjoyable for me, mainly because it is not a painful experience. Oh this time I also experienced baby blues during the first week, but by the end of second week it has subsided.

---

The End of the Second Week

Noe: At the end of the second week I truly regret my negative feeling towards breastfeeding Noe. This is because suddenly Noe was unable to breastfeed anymore (Details are here and here). At that point, I realized that I would take whatever pain caused by breastfeeding as long as Noe wants to breastfeed. Noe's inability to feed came very suddenly, and I felt really rejected. Although I'm not a religious person, at that time, I prayed to God that I was really sorry to Her, to be so negative about my breastfeeding pain, and I prayed that Noe would return to breastfeeding. The story went like this. Suddenly, one morning, on Tuesday 29 March, Noe lost his ability to latch on. We tried for many hours to put him into the breast but he was just unable to do it. Indi was so worried that he took sick leave from the office to help me. We gave up trying to breastfeed after six hours trying when we heard grueling sound from Noe's stomach, indicating bad hunger. We finally gave him formula, and Noe fell asleep, satiated. It was really weird because he couldn't latch on my breast, but he would take the bottle. We went to a lactation consultant in our hospital for two days straight, but she was unable to give us a satisfactory answer. At the end, on Thursday 31 March, I went to Doris and she did a thorough analysis of my condition. Doris gave a clear diagnosis: an overactive milk ejection reflex, which means I have too much milk and Noe was like trying to drink out of a fire hydrant. She also gave me three steps to overcome the problem: 1. Pump before breastfeeding so that Noe didn't have to cope with the let-down; 2. Breastfeed in lying-down position to defy gravity; or; 3. Pump and feed through bottle. At home, we tried the second way. Our good friend Karyn, who was active in La Leche League, also lent us her support by trying to get Noe back to the breast again. The situation was really bad that even my mom flew back from Jakarta (she thought Noe went on strike because Noe missed her). But amazingly, at night of 31st March, Noe went back to breastfeeding! It was the best birthday present for me ever, and I thank God that She answers my prayers. After two weeks, my breastfeeding problem didn't stop. I had three times mastitis attack within the first three months. My hemorrhage had left me with a physical condition that is vulnerable to infection. But I could cope better because I knew how to look for breastfeeding information and where to find help.

Kei: Except for dripping and leaking all over the house, so far I didn't have significant problem. I hope that breastfeeding would stay to be a breeze like this until Kei is at least six months, and hopefully, two years.

---

Conclusions and Lesson Learned

My first month breastfeeding experience with Noe was really bad and painful, plus, it was further aggravated with baby blues. The only thing that kept me from shifting to bottle-feed was my laziness and my weak condition after hemorrhaging. Moreover we don't have permanent live-in helper (maid), and my husband couldn't afford to be sleep deprived. Hence I simply didn't have enough energy to do the extra effort of making formula milk and cleaning the bottle. Apparently my weak condition was the silver lining of my childbirth complication, that had forced me to breastfeed. Despite the rough beginning, eventually it became really easy. I am glad to be able to continue breastfeeding until now.

My experience with Noe taught me that breastfeeding is not easy and it is something to be learned by the mother and baby. If I have read breastfeeding references and prepare myself, I might have better and more pleasant beginning. But I was too cocky.

My second child birth taught me that good breastfeeding start is important to avoid the compounded problems that will arrive later. The first two days is good time to learn to achieve effective latch-on and learning about the baby's cues (like, how to catch the big AH for a perfect latch-on), because the early days is not yet troubled with engorgement or leaking. I would highly recommend close contact with lactation consultant or counselor during the early days.

It is very important to know where to find breastfeeding help. Breastfeeding difficulty often needs to be addressed fast, that's why, most breastfeeding support groups and hospitals provide breastfeeding support hotlines. First and foremost I would like to thank Google for helping me to find information really fast. And I'm very grateful of my lactation consultant and breastfeeding guru, Doris Fok (Thank Google from which I found her contact info). Too bad, many people didn't know that there is a profession called lactation consultant that gives help for breastfeeding difficulties. Moreover, it is too bad that the modern urban culture has put breastfeeding as something to be embarrassed about, hence women nowadays couldn't easily find reference about breastfeeding in public sphere.

http://www.lalecheleague.org/FAQ/bm.html

Is my breastfed baby constipated? Does he need a laxative? He is three
months old and has bowel movements only every three days.

While the amount and frequency of a breastfed baby's wet diapers and bowel
movements can be a valuable indicator of his well-being, there is a wide
range of normal in infant stooling patterns.

THE FIRST FEW DAYS OF LIFE

In the first two or three days of life, it would be typical for a baby to
wet only one or two diapers per day. As the mother's milk increases, his
urine output will increase markedly. Newborns in the first few days after
birth will pass dark, tarry stools called meconium, the substance he has
stored since before birth. As the baby receives milk, it clears the
meconium out of the intestinal tract, so that within a few days the stools
will become softer and much lighter in color. The stools are normally
yellow, yellow-green or tan. It's not abnormal for an occasional stool to
be green. The odor should be mild, and not particularly unpleasant. The
consistency may be described as being similar to scrambled eggs, custard,
pea soup, or even prepared mustard. There are often small, seedy-looking
solid particles in the stool.

THE FIRST SIX WEEKS

Most babies, after the first few days, have two to five bowel movements
every 24 hours, until they are about six weeks old. The stools should be
as large as a US quarter to "count" in this number. Some babies will have
more frequent bowel movements, and it is possible for a healthy baby to
have fewer bowel movements. If a baby younger than six weeks has fewer
than two bowel movements a day, that can still be a variation of normal
provided that the baby has an adequate number of wet diapers, is known to
be gaining weight at an adequate rate, and the stools produced are
substantial in volume.

After the first few days, a breastfed baby should have at least six to
eight wet cloth diapers, or five to six disposables, in 24 hours. To gauge
the wetness, pour 2-4 tablespoons (30-60 ml) of water on a dry diaper.
This is how the normally wet diaper of a young baby feels. It is easier to
judge wetness in cloth diapers. If you are using disposables, know that
there is a wide variation in brands and types. One brand may not "feel
wet" while another may feel soaked with the same amount of fluid. It may
be helpful to place a facial tissue inside the diaper to help judge
wetness.

AFTER SIX WEEKS

It is normal for the bowel movements of a breastfed to decrease in
frequency when the colostrum, which has laxative properties, is completely
gone from the mother's milk after about six weeks of age. A baby this age
may continue to have bowel movements as frequently as five times a day,
sometimes even after every nursing. It is also normal for a breastfed baby
older than six weeks to have only one bowel movement every few days. Some
healthy babies will have only one bowel movement a week. When bowel
movements are less frequent, they should be more profuse in volume. As
long as the baby is gaining well, wetting sufficiently, and is happy and
content there is no cause to be alarmed by infrequent bowel movements, and
it is not necessary to give the baby a laxative, fruit juice, or any other
"helpers." In fact, attempting to force bowel movements can have harmful
consequences to your baby.

After the baby is about six weeks old, he may wet only five to six cloth
diapers per day, but if so these diapers will be much wetter. As the
baby's bladder grows, he can produce and hold more urine at a time. To
judge wetness of a diaper for an older baby, pour 8 tablespoons (120 ml)
onto a dry diaper. That would be considered a normally wet diaper.

AFTER SOLID FOODS

Once solid foods or other liquids are introduced to your breastfed baby,
there will be many changes in his elimination patterns. The stools will
have a stronger odor and different color and consistency. It is normal to
find bits of vegetables in the diaper, as even cooked vegetables are
harder to digest than many other foods. Now it is indeed possible for your
baby to experience constipation and even diarrhea, which are good clues
that he is not tolerating a new food or juice. For more information, see
our FAQ on starting solids at http://www.lalecheleague.org/FAQ/solids.html

Last updated Tuesday, December 11, 2001 9:34 PM by sak.

Frequently Asked Questions
Our FAQs present information from La Leche League International on topics
of interest to parents of breastfed children. Not all of the information
may be pertinent to your family's lifestyle. This information is general
in nature and not intended to be advice, medical or otherwise. If you have
a serious breastfeeding problem or concern, you are strongly encouraged to
talk directly to a La Leche League Leader. Please consult health care
professionals on any medical issue, as La Leche League Leaders are not
medical practitioners.

(copy paste dr email Luluk L.Soraya)

Boleh gak sih ibu menyusui minum kopi ?

http://www.kellymom.com/health/lifestyle/caffeine.html

By Kelly Bonyata, IBCLC

Dirangkum bebas oleh Luluk Lely Soraya I, Juli 2007

Umumnya ibu menyusui boleh saja minum minuman kafein dalam jumlah wajar. Meski demikian kafein yang ibu minum akan mempengaruhi beberapa bayi (umumnya yang berusia <6 bl). Bayi yang ibunya tidak minum kafein sama sekali selama masa hamil akan lebih sensitif terhadap kafein. Meskipun demikian, seiring dengan berjalannya waktu tingkat sensitivitas bayi terhadap kafein akan menurun. Jika bayi anda sensitif terhadap kafein akibat dari minuman yg anda konsumsi, maka anda dapat mencobanya lagi saat ia lebih besar.

American Academy of Pediatrics (AAP) menyetujui konsumsi kafein pada ibu menyusui. Menurut Hale 2002 p. 100-102, kafein digolongkan dalam kategori L2 (aman) dalam Lactation Risk. Kadar kafein dalam ASI relatif rendah ( 0.06-1.5% of maternal dose) dan umumnya kadar kafein meningkat 1 jam setelah ibu mengkonsumsi minuman berkafein. Satu studi menunjukkan bahwa konsumsi kopi secara berlebihan akan mengurangi kadar besi dalam ASI (Nehlig & Debry, 1994).

Jika bayi anda sensitif terhadap kafein, seiring dengan bertambahnya usia sensitivitas tsb akan berkurang. Bayi baru lahir relatif sulit mencerna kafein daripada bayi yang berusia lebih besar. Demikian juga bayi prematur atau yang sakit relatif bermasalah dengan konsumsi ASI dari kafein yang diminum oleh ibu. (Tabel tdk Bisa ditampilkan).

Bayiku rewel dan gak mau tidur. Apakah ia sensitif dg kafein?

Menurut Breastfeeding Answer Book (LLLI 2003, p. 599-600), konsumsi kafein berlebihan oleh ibu menyusui ( > 750 ml per hari) dapat menyebabkan reaksi sensitif pada bayi. Seperti : mata membesar, aktif, bayi tidak dapat tidur dan bayi rewel sekali. Jika hal ini terjadi, kurangi atau hentikan secara perlahan konsumsi kafein hingga 2-3 minggu mendatang untuk melihat perubahan pada bayi. Butuh beberapa hari hingga seminggu hingga tubuh ibu menghilangkan kadar kafein dalam ASI, sehingga bayi tidak lagi rewel akibat kafein.

Bener gak sih kafein mengurangi produksi ASI ?

Tidak ada bukti bahwa kafein dapat mengurangi produksi ASI.

Mitos bahwa kafein dapat mengurangi produksi ASI tidak terbukti kebenarannya. Banyak ibu menyusui yang mengkonsumsi kafein tidak memiliki kendala dengan produksi ASInya. Memang belum ada penelitian khusus yang dapat menyatakan hal ini. Riset yang ada hanya mengenai pengaruh kafein dalam ASI dan bayi. Satu studi yang dilakukan oleh Nehlig & Debry 1994 mengindikasikan bahwa kafein dapat menstimulasi produksi ASI. Meski hal ini perlu diteliti lebih jauh. Produksi ASI dapat saja menurun, apabila bayi yang rewel dan tidak dapat tidur karena pengaruh kafein dalam ASI, relatif jarang menyusu dpada ibunya. Akibatnya produksi ASI menurun. Sekali lagi ini diakibatkan oleh frekuensi menyusu yang kurang, bukan karena pengaruh kafein.

Kafein ada dimana-mana

Kafein dapat ditemukan dalam kopi, teh, minuman bersoda, minuman berenergi, beberapa jenis obat bebas dan obat dengan resep dokter serta makanan yang mengandung kopi atau coklat. Produk herbal yang mengandung guarana/paullinea cupana, kacang kola/cola nitida, yerba maté, or the hijau juga mengandung kafein,(Tabel tdk bs ditampilkan).

Seberapa banyak kafein yang boleh ibu menyusui konsumsi?

Jawabannya sangat individual tergantung dari bagaimana reaksi bayi anda. Seperti yang telah dijelaskan di atas bahwa kadar kafein yang mempengaruhi bayi tergantung dari kondisi tiap bayi, usia bayi dan kesehatan bayi. Memang ada takaran "jangan lebih dari 500 mg per hari. Namun dari berbagai sumber menyatakan batas atas konsumsi kafein adalah 300-750 mg / hari.

<P align=left>Untuk ibu hamil, umumnya para ahli laktasi menyarankan agar membatasi asupan kafein < 300 mg/hari. Meski demikian, rekomendasi lain menunjukkan agar konsumsi kafein pada ibu hamil sebaiknya tidak melebih 150 mg/hari. (Tabel tdk bs di tampilkan).

For full article, click here

You might have read in Weaned that Noe has made an announcement of his wish to self-wean.  This is when Noe stopped night feeding (he had stopped daytime feeding for quite some time already). At that time, I noticed that my milk production is at its lowest point. I practically couldn't press anything out of my boobies and didn't feel any let-down anymore. It's totally empty!

Well, since a week ago, I noticed a change in Noe's night feeding pattern. He began to latch onto me for a longer period and seemed to enjoy breastfeeding again. Of course it is not fulfilling for him, so he still asks for other milk on top of the night breastfeeding session. I wonder why this change of pattern?

Then I noticed that I started to produce what I think is colostrum during pregnancy. Unlike breastmilk, it's not white and runny. It's very thick transparent slightly yellowish liquid, and tastes rather sweet (yes i tasted a drop of it, out of curiosity). And of course it's full with the colostrum goodness of protein and antibodies etc (no wonder Noe is rarely sick lately).

During BMSG meeting, I shared this experience with Ivy. She advised me that in some cases, toddlers who weaned themselves during the mothers' pregnancy comes back to breastfeeding when the colostrum begins to come in.

Later Peckyin highlighted to me her tandem nursing experience: A few days after the baby little sister's was delivered, her older son eyes were gleaming with joy, knowing that mummy's milk has come back with vengeance! I can't wait to experience this moment, knowing that Noe has the interest in un-weaning himself.

Another funny thing: Uncle Augie Rinaldy bought us a mug in the shape of breast. And Noe was aware of the mug shape and he pretended to breastfeed from the mug!

For full article, click here!

Noe has made an official statement that he has weaned himself off breastmilk.

You see, Noe would always say, "No more!" when he finishes his drink or food. But today, he suckled onto me for three minutes and said to me, "No more!". It means that I don't have enough milk anymore to satisfy his thirst.

By saying "No more!" I consider it as Noe's official statement that he has weaned himself. I'm glad that it has been a rather successful child-led weaning process. But I'm open to the possibility if he wants to return to tandem nursing once his little brother is born and my milk supply comes back.

Dari Milis Sehat

Dear all,

Dalam rangka turut menyukseskan ASI eksklusif, Yayasan Orang Tua Peduli (YOP) yang menaungi Milis Sehat, kembali mengadakan kuisioner utk bahan riset kami. Kami mohon partisipasi dari seluruh member untuk dapat mengisi kuisioner tsb.
Kuisioner tidak terbatas untuk para ibu menyusui saja, tetapi juga utk para ayah, calon, calon ayah, bahkan para eyang ataupun mereka yg sedang merencanakan pernikahannya.

Silahkan mengisi kuisioner dan mengirimkannya kembali melalui japri di email : anovita [at] cbn.net.id . Harap menuliskan judul di subject : Kuisioner ASI.
Kami harapkan juga untuk tidak mengirimkan jawaban kuisioner ke milis.

Terima kasih atas kerjasamanya.
Dengan mengisi kuisioner ini, berarti anda telah aktif membantu menyukseskan ASI eksklusif di masyarakat kita.

Salam sehat
Moderator Milis Sehat

======================================================

KUESIONER ASI

Data Pribadi

Nama : ________________

Usia : ________________

Jenis Kelamin : ________________

PENGETAHUAN

1.. Apakah Anda pernah memperoleh pendidikan/pengajaran mengenai ASI & menyusui?

1.. Ya (sebutkan dari mana) _______________________________________

2.. Tidak

2.. Tahukah Anda bahwa pada usia 0-6 bulan sebaiknya bayi hanya mengkonsumsi ASI?

a. Ya b. Tidak

3.. Menurut anda, apakah Susu Formula masa kini dapat menyamai komposisi dan keunggulan ASI?

a. Ya b. Tidak

4.. Apakah Rumah Sakit / Bersalin yang Anda kunjungi untuk memeriksakan kehamilan memiliki klinik laktasi?

a. Ya b. Tidak

5.. Apakah DSOG/Bidan Anda memberi penjelasan mengenai ASI pada saat pemeriksaan kehamilan dan menyarankan Anda untuk memberikan ASI Eksklusif?

a. Ya b. Tidak

SAAT KELAHIRAN

6.. Apa yang dilakukan DSOG / bidan / perawat anda setelah bayi Anda lahir?

1.. Memperlihatkan bayi pada Anda untuk dilihat saja (tanpa Anda pegang)

2.. Memberikan bayi pada Anda untuk dipeluk dan disusui

3.. Memandikan bayi

4.. Bukan salah satu di atas, sebutkan apa tindakannya

_____________________

7.. Kapan Anda pertama kali menyusui bayi Anda yang baru lahir?

1.. 0-30 menit setelah lahir sebelum bayi dibersihkan

2.. 30 menit - 1 jam setelah kelahiran

3.. 6 jam setelah kelahiran

4.. 6 - 24 jam setelah kelahiran

5.. Lebih dari 24 jam

8.. Apakah papan nama di box bayi Anda atau jam dinding atau kalender di Rumah Sakit / bersalin ada merek Susu Formula?

1.. Ya (sebutkan merek Susu Formulanya dan nama Rumah Sakit/Bersalinnya) ____________________________________________________

2.. Tidak

9.. Apakah bayi Anda tidur bersama dalam satu kamar dengan Anda di Rumah Sakit/ Bersalin (rooming in atau rawat gabung), termasuk di malam hari?

a. Ya b. Tidak

10.. Bila bayi Anda tidak tidur di satu kamar dengan Anda atau tidur di kamar bayi, apakah bayi Anda diberikan kepada Anda setiap kali bayi ingin menyusu, termasuk di malam hari?

a. Ya b. Tidak

11.. Apakah selama di Rumah Sakit / bersalin bayi baru lahir Anda diberikan Susu Formula atau cairan lain selain ASI?

1.. Ya (sebutkan apa yang diberikan)

____________________________________

2.. Tidak

12.. Apakah pada saat bayi pulang ke rumah, Anda dan bayi Anda dibekali contoh / sampel / hadiah dan brosur Susu Formula?

a. Ya b. Tidak

SUSU FORMULA

13.. Apakah anda pernah dihubungi oleh bagian pemasaran / produsen Susu Formula?

a. Ya b. Tidak

14.. Apa yang Anda lakukan ketika Anda dihubungi oleh produsen Susu Formula?

a. Langsung menolak

b. Mendengarkan aau menerima saja semua penjelasannya

c. Berargumentasi

d. Lainnya, sebutkan

_____________________________________________________

15.. (Bagi yang mengkonsumsi Susu Formula) Apakah Anda mengkonsumsi Susu Formula dari produsen tersebut?

a. Ya b. Tidak

16.. Pendapat Anda mengenai promosi Susu Formula saat ini:

a. Baik

b. Sedikit meresahkan namun tidak mengganggu

c. Sangat meresahkan dan menganggu

d. Lainnya, sebutkan

_____________________________________________________

17.. Pendapat Anda mengenai pelayanan kesehatan Ibu dan Anak terutama tentang Laktasi yang Anda peroleh:

a. Kurang sekali

b. Cukup memadai

c. Sangat memuaskan

IBU BEKERJA

18.. Selama Anda bekerja, apakah Anda memeras/memompa ASI dan kemudian disimpan untuk diberikan ke bayi Anda?

a. Ya b. Tidak

19.. Tahukah Anda bahwa Undang-undang Tenaga Kerja mengatur bahwa pekerja wanita patut diberi kesempatan untuk menyusui bayinya?

a. Ya b. Tidak

20.. Apakah tempat Anda bekerja memberikan waktu dan/atau kesempatan bagi Anda untuk memerah atau memompa ASI di tempat kerja?

1.. Ya, sebutkan dimana Anda memompa ASI?

____________________________

2.. Tidak

21.. Apakah di tempat Anda bekerja tersedia ruang khusus untuk memerah/memompa ASI?

1.. Ya

2.. Tidak, sebutkan tempat Anda memerah/memompa ASI selama di tempat bekerja ____________________________

Terima kasih atas waktu dan kesediaan Anda mengisi kuesioner ini -

Mohon kirimkan kuesioner ini hanya ke alamat email anovita [at] cbn.net.id dengan subject kuisioner asi.

Menyusui Selagi Hamil

17 June 2007
Oleh Suryatmaning Hany untuk http://asi.blogsome.com

For original article, click here

Breastfeeding as Enlightenment



Breastfeeding for me is an enlightenment. Breastfeeding is a "source of thoughts", as quoted in Breastwork (Bartlett 2005 pp. 21-22)

"The bosom" is regarded as the seat of thoughts and feeling. ... Lactating breasts become fertile grounds of wisdom, active organs producing food for the mind as well as the body.

I called it "enlightenment" because I started to think about things that I didn't think about before, both positively and negatively. Positively, I began to be enlightened on the difficult task of mothering, and I learned to appreciate mothers even more. Negatively, I began to be angry at the society and the social constructs that undermines femininity.

This is an on-going writing because there is so many things I want to write about this issue and I have so little time and limited eloquence to jot it down, to properly line it out in a coherent manner.



Naturalness of Breastfeeding and Its Difficulty

I did not know that breastfeeding is not easy and that it is something to be learned.

Many people refuted the naturalness of breastfeeding by saying that, "if it has to be learned, then it is not natural". They also say, "If breastfeeding is indeed natural, why not all people are able to breastfeed, and why babies who are not breastfed alive and well?" Further, Maher (1992) argued that breastfeeding is simply a cultural construct, and extended breastfeeding is just a vehicle in traditional societies to keep women under control.

However, I personally felt that the naturalness of breastfeeding does not lie in the necessity for it to be learned or the ability to survive without it. Every step that human babies are taken to progress is learning process, through analyzing its context and observing others. Even when one has sex for the first time, he or she won't find it very easy. Palmer (1993) even says that primates initiated breastfeeding through communal learning process between the females.

Nevertheless, in Breastwork, Bartlett (2005) tries to detach herself from the naturalness question, because, quoting Klassen, "constructing the natural is a political act". Yet Bartlett tries to simplify the naturalness debate in a more philosophical level:

I remember on  day after I had been breastfeeding for a while when I experienced a moment of epiphany because I finally felt that I felt that I knew what the word "natural" meant, and yet I struggled to define it. It was something to do with me liking breastfeeding, that it had an important place in my life and my relationship with my baby, that it felt "right". The actual word, though, was an empty sign, capable of carrying whatever meaning I wanted to fill it with.

I can totally relate with Bartlett's feelings during breastfeeding. The naturalness of breastfeeding as I felt it, and how mothers and children have survived for thousands of years just with breastmilk, have fostered my perseverance to keep breastfeeding despite many problems that I was having.



Femininity and Contradictions


Breastfeeding in Guanajuato City Square, Mexico

The enlightenment also made me angry. Angry towards societal norm and how my feminine body contradicts the society.

I began to hate the situation where I had to struggle to be discrete in breastfeeding, struggle with my crying baby to look for space for breastfeeding. Why can't I just breastfeed whenever and wherever my baby wanted to? From my anger, I began my silent protest to breastfeed whenever my baby want to and wherever we're comfortable with. From my anger, I started to ask and rethink about the current social norms.

Despite naturalness of breastfeeding, and the scientifically proven benefits of breastfeeding, women are still receiving mixed message.

Breastfeeding is highly encouraged, but current social norms govern that it has to be confined in an enclosed space or as long as it is as "discrete as possible". Basically, the segregation of breastfeeding into private sphere has marginalized women and children from the public sphere. As much as I hate to use slippery slope argument, this segregation has implicated into domestication of women and has formed the current perception that breastfeeding and breastmilk are lewd, perverse, and disgusting (Bartlett 2005). Therefore as women tried to "liberate" themselves, they avoid childbirth and breastfeeding to level themselves up with men, not realizing that the social norms that they're in are the ones that are flawed. Many feminist also see breastfeeding as a vehicle to confine women in private sphere, without seeing further that the private-public dichotomy is created by male-dominated social construct.

Let's began to read Yalom's 1997 work "The History of Breast". One needs to be aware that the gender segregation of private and public space is relatively a new phenomenon, beginning around 2500 years ago, and is mainly western / semitic culture. Compared to millions of years of human history, 2500 years is minute. Further, sensualisation (and hence the taboo) of breast is an even newer phenomenon, and again it is a western/semitic concept. For many societies, the breast is not at all sensual (Yalom 1997). The so-called-primitive culture does not have a clear-cut definition of privacy based on gender, as can be seen in primitive tribes where women bare themselves in the outdoor, breastfeeding their babies while doing their daily work.

Therefore, I just began with myself in breaking down the wall that segregates women, by breastfeeding in public, and I'm doing it for my hungry baby. That's why, when there was a suggestion to create a separate MRT compartment for women and breastfeeding mothers, I totally oppose it because segregation will only strengthen the notion that breastfeeding is really something to be ashamed or embarrased upon, and that it should not be done in public. If other people are disturbed by me breastfeeding, it is their problem. Philosophically this is my stance.



Working Women


Pumping at Work

Further delving into the issue of public space, the contradiction is apparent in the working environment. Recently, since the industrial revolution, the working environment has become a "male/public" space, that is created and regulated by norms derived from the predictability of male's body. There is no room for the unpredictability of women's body such as female period, child bearing, and breastfeeding (Bartlett 2005). I was lucky to be able to work in a place where the boss understands my need by providing time and space for pumping. But majority of working women do not have such luxury. Women had to return to work out of financial necessity or other reason, without adequate support from the working environment to maintain breastfeeding. This is not at all the women's fault, but a larger flaw in the working environment. Hence, the idealisation of breastfeeding does not translate into the reality that many women are now working. This has begun to change for the better, however, I'm skeptical that positive change is happening in third-world countries.



Female Body Awareness


Obsessed with Breast Shape

Through breastfeeding, I started to ask and rethink about my female body. The breastfeeding process taught me to be aware of the natural signs in my baby's body language as well as my own body. It is just amazing to see that my body will "know" when my baby's hungry and will have a leak. I started to believe that women's body is really amazing, and I started to ask, do we really need to buy all these formula milk and baby feeding gadgets, that had just been created recently?

It is sad to see that in the current society, women are not aware of their own body. Women have very low self esteem of their own body, dictated by the male concept of beauty and decorum. Bartlett 2005 and Palmer 1993 highlighted that in many case breastfeeding failures are attributed to male pressure, from husbands who detest wives with saggy breast to the notion that women should prioritize to keep their husband at her household. Eventually, women becomes subjected to corporate domination as consumers, where women are convinced that their self-worth is measured by the things they could afford, even having to go through painful procedures.

• I need to buy new clothes / shoes / bags / , as my old ones are outdated (need vs wants)
• I'm not beautiful, so I will get breast augmentation operation (breast as beauty object is defined by male)
• I have to get birth control pill to regulate my period or avoid pregnancy (in the western world this has become norms for teenage girls rather than medical necessity)
• I want to do caesarian delivery with total anasthetic so that my vagina won't become too wobbly (not because of medical necessity)
• I have to get expensive breastpump in order to breastfeed (women does not yet know about pump-free marmet technique of milk expression)
• I don't have enough milk, so I have to supplement with formula and bottle (relactation is possible except in a special medical case)
• I want my child to be smarter, so I have to keep buying this special formula. My milk is not good enough (special infant formula is not necessary unless medically indicated or when situation forces women to use it as a last resort)

Basically, the message women have been receiving from the social norms and pressure is that women as themselves are never good enough. This is made worse by corporate pressure, plus the male-oriented medical sciences that is detached from the traditionally midwives-based childbirth and breastfeeding knowledge (Palmer 1993).



Women Should not Be Blamed

At the end, Breastwork (Bartlett 2005) avoided to demonize formula feeding because the negativity attributed to formula is often aimed at the women and not the  corporate marketing that shaped the pro-formula social construct. To some extent I agree with her. There is a danger that the war between breastfeeding and formula put women into a dichotomy of good and evil. This should not be the case because one needed to address the contributing factors behind the success or failure of breastfeeding. Those are the availability of information, husband's and family support, communal support, the corporate power of formula companies, and the social norms. A struggle against unethical formula promotion should not put a mother into a judgment that she's a bad mother, because in almost all cases, mothers wants to be the best for their children. In all manner, whether she is breastfeeding or formula feeding, she is a good mother. She, with her noble goal to raise children, may have just lived in the wrong time and in wrong social norms.



References

• Bartlett 2005. Breastwork
• Maher 1992. Anthropology of Breast-feeding
• Palmer 1993. Politics of Breastfeeding
• Yalom 1997. The History of Breast

(sori pake bahasa inggris soalnya email ini di copy paste dari email yg saya kirim ke group Singapore)

Hi mommies,

Related to Nutrilon promotions, I have set up a Multiply Group and Flickr Group to pool up photos, videos, sound recording, and news related to (unethical) baby milk promotion and misleading media images on breastfeeding. In order to upload and view the items, you have to become a member, in multiply or in Flickr by using your Yahoo username.

I just think that it's good to establish a library containing various marketing strategies of baby milk promotion. Because, if we know well their strategy, we can cope with or refute their strategies better.

Please join the group in here

http://milkwatch.multiply.com

http://www.flickr.com/groups/milkwatch/

and please upload scanned image of the advertisement or photos of formula milk promotional in hospitals.

Once you become a member you can also invite other people who are interested in the same cause to join the group.

This flickr group is not affiliated specifically to Singapore, but also internationally. I have invited Baby Milk Action to participate, and hope that they will be participating.

Regards
meutia chaerani

Dear moms,

HANYA DIBUTUHKAN 3 MENIT untuk cut and paste....please ajak temen2 dan sodara untuk berpartisipasi....mudah2an dengan adanya banjir e-mail dari ibu2 yang peduli, maka NUTRICIA akan menghentikan penayangan iklan mereka yang MEMBANDINGKAN ASI DENGAN SUSU FORMULA (ASI memberikan imuniasi di awal kehidupan, tapi NUTRILON memberikan imunisasi seumur hidup).

All you have to do is:

1. klik kesini:
http://www.nutricia.co.id/index.php?option=com_contact&task=view&contact_id=6&Itemid=3&Itemid=3

atau

klik:
http://www.nutricia.co.id, kemudian klik lagi bagian "contact us"

2. isi kolom nama, alamat email, dan subject:
PROTEST OF ADVERTISING CAMPAIGN: NUTRILON ROYAL 3 WITH IMMUNOFORTIS

3. Cut and paste surat dibawah ini:

Marc de Rouw
President Director
PT Nutricia Indonesia Sejahtera

Dear Sir,

As you know, manufacturers of baby foods should abide by the provisions of the International Code of Marketing of Breastmilk Substitutes and subsequent, relevant Resolutions of the World Health Assembly.

I am very concerned and shocked to see your latest advertising campaign that was aired on Trans TV, Wednesday 25 April 2007 at 5.45pm, for the product NUTRILON ROYAL 3 with Immunofortis ("Product"). The ad clearly compared breatmilk to artificial milk, claiming that breatmilk provides the best immunization during the first years of life, but that as the child grows older, the Product provides Immunity For Life (suggesting that breastmilk does not).

Researches have shown that breastmilk provides optimum, and the best immunization not just during the early years of a child's life, but even throughout childhood and adulthood. Breastmilk lowers the risks of various diseases and illnesses, among others: (1) childhood leukimia and lymphoma, (2) juvenile onset diabetes, (3) bowel diseases and diarrhea, (4) ear infections, respiratory infections, pneumonia, asthma and eczema, (5) bacterial meningitis, (6)
adulthood rheumatoid arthritis, (7) osteoporosis, (8) breast cancer and ovarian cancer, (9) lower cholesterol, and (10) childhood and adolescent obesity.

In light of the overwhelming facts supporting the evidence of LIFELONG IMMUNIZATION BENEFITS (Immunity For Life) of breastmilk, I ask that your company instantly stop any and all public airing of this most recent media campaign, including each and every print and electronic advertising that directly or indirectly depicts breastmilk as inferior to, or even the same as artificial milk.

I also ask that you act immediately to review your baby food marketing practices and end any and all violations of the International Code and Resolutions immediately.

Please confirm that you will take this action.

Regards,
Mia Sutanto [Nama diganti nama sendiri]
Indonesian Breastfeeding Mothers Association

5. klik send.

That's all....just 3 minutes but you can make a difference!

Thanks ya moms!

Salam ASI!
Mia

smoga bermanfaat,
sori klo pada dah punya..

Sentra LAKTASI Indonesia:

Jl. Agung Perkasa Raya Blok J5 No. 16 Sunter Agung Podomoro, Jakarta
Utara Telp. (021) 651 0183

Jakarta

* PK. St. Carolus
Jl. Salemba Raya No. 41 Jakarta 10440 Telp. (390) 4441 pes. 7257

* RS Husada
Jl. Raya Mangga Besar No. 137-139 Jakarta Barat Telp. (021) 626 0108

* RSAB Harapan Kita
Jl. S. Parman Kav. 87 Jakarta Barat Telp. (021) 566 8284 pes. 1205

* RS Pondok Indah
Jl. Metro Duta Kav. VE Jakarta Selatan Telp. (021) 765 7525

* RS OMC
Jl. Pulomas Barat VI No. 20 Jakarta Timur Telp. (021) 472 3332

* RS Pertamina Jaya
Jl. Achmad Yani No.2 By Pass Jakarta Pusat Telp. (021) 421 1911 ext.
4254

* RSAL Mintoharjo
Jl. Bendungan Hilir Raya Jakarta Pusat Telp. (021) 574 9037/574 9038

* RS Bunda Jakarta
Jl. Teuku Cik Ditiro Jakarta Pusat Telp. (021) 3192 4917

* RS Medistra
Jl. Gatot Subroto Kav. 59 Jakarta Selatan Telp. (021) 527 7382 ext.
217-222

Bekasi

* RSIA Hermina Bekasi
Jl. Kemakmuran No. 39 Margajaya, Bekasi Telp. (021) 884 2121

Depok

* RSIA Hermina Depok
Jl. Raya Siliwangi No. 50 Pancoran Mas, Depok Telp. (021) 7720 2525

Bogor

* RS PMI Bogor
Jl. Pajajaran 80 Bogor Telp. (0251) 324080

* RS Azra Bogor
Jl. Pajajaran No. 129 Bogor Telp. (0251) 318456

Bali

* RSB Puri Bunda
Jl. Gatot Subroto VI/19 Denpasar, Bali Telp. (0361) 437999 Fax.
(0361) 433988

Makassar

* Poltekkes Makassar (Aswita Amir, Siti Mardiah, SKM) Jurusan Gizi
Jalan Paccerakkane KM 14 Daya Makassar Telp./Fax. (0411) 510197

Batam

* RS AWAL BROS BATAM
Jl. Gajah Mada Kav. I Baloi, Batam Telp. (0778) 431777

Riau

* RS Awal Bros Pekanbaru
Jl. Jendral Sudirman No.117 Tangkerang Pekanbaru, Riau 28282 Telp.
(0761) 47333 ext. 2300

* RS PT Caltex Pacific Indonesia
Pekanbaru Riau Telp. (0761) 594297

Banten

* RS Misi Rangkasbitung Jl. Multatuli No. 41 Rangkasbitung Lebak,
Banten 42311 Telp. (0252) 201014

* RS International Bintaro Jl. MH Thamrin No.1 Sektor 7 Bintaro Jaya
Tangerang, Banten Telp. (021) 745 5500

* RS. Siloam Gleneagles Jl. Siloam No. 6 Lippo Karawaci Tangerang,
Banten Telp. (021) 546 0055 pes. 7151

Surakarta

* Yayasan Kakak (Fajar Yulianta/Sofie)
Jl. Slamet Riyadi No. 534 B Telp. (0271) 711453

Medan

* RSU Dr. Pirngadi
Jl. Prof. H.M. Yamin SH. No.47 Medan 20217 Telp. (061) 453 6022 ext.
267

Yogyakarta

* RS Panti Rapih
Jl. Cik Ditiro 30 Yogyakarta 55223 Telp. (0274) 514845 pes. 227

Surabaya

* RS Mitra Keluarga Surabaya
Jl. Satelit Indah II Darmo Satelit Surabaya 60187 Telp. (031) 734
5333

Semarang

* RS St. Elisabeth
Jl. Kawi No.1 Telp. (024) 831 0076 pes. 7405

Kaltim

* RS Pupuk Kaltim
Jl. Oxygen, Bontang Kalimantan Timur 75313 Telp. (0548) 41118 pes.
237

3. Pemberian makanan padat (MPASI) sebelum bayi berusia 6 bulan memiliki resiko yang tinggi

Berbagai resiko akibat pemberian MPASI terlalu dini (< 6 bulan) antara lain :

• Bayi relatif mudah terpapar kuman penyakit.

Hal ini disebabkan sistem imun bayi < 6 bl belum sempurna. Pemberian MPASI dini sama saja dg membuka pintu gerbang masuknay berbagai jenis kuman. Belum lagi jika tidak disajikan higienis. Hasil riset terakhir dari peneliti di Indonesia menunjukkan bahwa bayi yg mendapatkan MPASI sebelum ia berumur 6 bl, lebih banyak terserang diare, sembelit, batuk-pilek, dan panas dibandingkan bayi yg hanya mendapatkan ASI eksklusif. Belum lagi penelitian dari badan kesehatan dunia lainnya.

• Bayi memiliki resiko lebih besar terkena gangguan sistem pencernaan

Beberapa enzim pemecah protein spt asam lambung, pepsin, lipase, enzim amilase, dsb baru akan diproduksi sempurna pada saat ia berumur 6 bl. Sehingga seringkali bayi mengalami gangguan pencernaan mulai dari diare, sembelit, dsbnya akibat pemberian MPASI terlalu dini.

• Resiko alergi lebih besar jika bayi mendapatkan MPASI terlalu dini (<6 bulan)

Beberapa ilmuwan menyatakan bahwa fase tidur yang lama relatif tidak "alami" bagi bayi baru lahir. Jeda tidur yang lebih singkat memang salah satu faktor pelindung bagi bayi baru lahir dari resiko SIDS. Penelitian-penelitian tersebut sebaiknya dapat mengubah pola pikir orangtua untuk tidak lagi beranggapan bahwa tidur lebih nyenyak (lebih lama) adalah yang terbaik untuk bayi berusia < 6 bulan.

Bayi baru lahir memang lebih singkat tidurnya. Hal ini dikarenakan lambungnya yang kecil, sehingga ia butuh lebih sering mendapatkan nutrisi. Tetapi tidak hanya untuk alasan tersebut, bayi juga membutuhkan sosialisasi dan sentuhan orangtuanya, sehingga ia memiliki fase tidur yang relatif singkat. Seiring dengan bertambahnya usia dan kematangan sistem syarat pusat, ia akan lebih tidur lebih lama. Jadi semata-mata tidak berhubungan dengan masalah kenyang atau tidaknya bayi.

Industri makanan anak balita di Indonesia termasuk industri makanan bayi berkembang pesat. Kesibukan ibu bekerja yang mengakibatkan kurang waktu untuk menyiapkan makanan segar, turut menyuburkan pertumbuhan tersebut. Cobalah tengok pada deretan rak di supermarket. Semua ada...., mulai dari snack yang katanya sehat dari berbagai rasa, makanan pagi jenis sereal, biskuit berbagai rasa dan bentuk, makanan kecil pencuci mulut hingga susu baik susu bubuk maupun susu cair. Bahkan makanan (bubur) bayi siap saji .... semua ada, campur aduk tidak ada lagi batasan umur. Semua menjanjikan kelebihan-kelebihan, dengan tambahan-tambahan multi vitamin dan berbagai macam unsur-unsur artifisial yang saya yakin, buat orang awam, sangat tidak dimengerti kegunaan pastinya .... Pokoknya, semua mengatakan produknya bisa mencerdaskan anak.

 

Dalam perbincangan dengan ibu bekerja dewasa ini, jarang sekali ditemukan ibu yang menyusui bayinya secara eksklusif selama minimal 6 bulan. Alasannya macam-macam. Ada yang mengatakan ASInya tidak keluar .... yang lainnya mengatakan, karena harus kembali bekerja, sehingga tidak lagi sempat menyusui anak. Stress karena pekerjaan memang dapat menyebabkan produksi ASI berhenti. Ironisnya .... keengganan menyusui bayi juga menjangkiti ibu-ibu yang tidak bekerja. Mungkin promosi gencar produk susu mengenai kelebihan-kelebihan produknya terutama yang menyangkut ”peningkatan IQ anak” membuat ibu tidak percaya diri untuk menyusui anak. Apakah mereka mengerti bahwa makanan yang terbaik bagi bayi terutama di awal tahun kehidupannya adalah ASI. Melihat kenyataan yang ada, saya menjadi sangat tidak yakin akan hal ini. Kecuali mengetahui tentang kegunaan ASI dari bacaan/majalah yang hanya dapat diakses oleh keluarga mampu yang biasanya diakhiri dengan pesan terselubung dari sponsor bahwa ”apabila ibu mengalami kesulitan untuk menyusui bayi, maka gunakanlah susu formula sesuai dengan umur bayi” lengkap dengan promosi keunggulan-keunggulannya.

 

Tidak salah lagi, bila banyak ibu yang menganggap susu formula bagi bayi sebagai bagian dari gaya hidup modern, gaya hidup masa kini. Tidak ada sarana lain dari ibu-ibu muda untuk mengetahui manfat menyusui baik bagi bayi maupun si ibu sendiri. Jangan lagi berharap pengetahuan itu dapat diperoleh dari sekolah. Sekolah kita kan mendidik anak supaya cerdas dari segi ”akademis”. Aneh-aneh saja ... masa pengetahuan tentang menyusui diajarkan di sekolah? Padahal itu kan pengetahuan praktis yang secara alamiah pasti dibutuhkan manusia, terutama perempuan.

 

Dengan jumlah penduduk 220 juta orang dan sebagian besar masih dalam usia produktif, Indonesia memang pasar yang besar dan luas bagi produk makanan anak. Apalagi generasi muda Indonesia adalah generasi yuppies yang baru tumbuh sehingga mereka mengganggap kuno gaya hidup alami dan lebih cepat termakan dengan gaya hidup instant dan praktis. Tidak heran, usaha pemerintah untuk memasyarakatkan pemberian ASI pada bayi tidak terdengar sehingga imbauan pemerintah untuk menarik produk makanan untuk bayi di bawah usia 4 bulan tidak didengarkan oleh produsen.

 

Ini berlainan dengan sekolah asing. Bos saya, pernah cerita; anaknya yang kala itu masih duduk di level SMU JIS – Jakarta International School, suatu hari pulang sekolah dengan membawa tas besar. Isinya ...... boneka bayi, dengan segala macam peralatan dan produk makanannya. Pada pergelangan tangan si anak juga sudah terpasang gelang. Apa yang terjadi ...? Ternyata, si anak perempuan diberi tugas untuk ”bersimulasi” menjadi ibu yang memiliki bayi usia di bawah 6 bulan. Jadi mereka betul-betul harus berfungsi sebagai ibu dengan seabrek kewajiban mengurus anak. Gelang tangan itu rupanya juga berfungsi sebagai alarm yang mengingatkan si anak untuk mengerjakan kewajibannya sebagai ibu,

 

Maka week end tersebut menjadi hari sibuk bagi si anak. Tidak bisa keluar rumah menghabiskan waktu dengan keluarga. Bagaimana mungkin keluar rumah dengan membawa boneka? Menyuruh si ”mbak” di rumah menggantikan? Itu juga tidak mungkin .... instruksi tersedia dalam bahasa Inggris dan dia juga harus membuat laporan tentang makanan si ”bayi”, kekentalannya, panas makanan saat disuapkan dll. Apalagi gelang tangannya juga berfungsi sebagai sensor dari aktifitas sianak dan interaksinya dengan ”bayinya”. Pendeknya, tidak ada kemungkinan untuk meminta bantuan orang rumah.

 

Jam 5 pagi, si anak sudah bangun. Hari dimulai dengan menyiapkan peralatan membuat susu, mensterilkan botol, masak air, dan menakar bubuk susu. Setelah selesai, lalu memberi susu kepada ”bayi”. Usai memberi susu, lalu menyiapkan air mandi buat ”bayi”, memandikannya, mengganti popok dan seterusnya.... Pendeknya segala kegiatan yang menyangkut pemeliharaan bayi sepanjang hari. Alarm di gelangnya sangat ”rigid” dengan waktu ... bahkan jadwal memberi susu dan mengganti popokpun persis seperti laiknya bayi manusia sungguhan. Ada waktu ”bayi menangis minta digendong, atau buang air. Hampir setiap 3 – 4 jam sekali ada saja ulah si ”bayi” yang telah diprogram tersebut .... Bahkan ulah itu juga yang membuatnya harus bangun pada jam 2 malam. Betul-betul seperti ibu mengurus bayi. Mengada-adakah kegiatan anak dan tugas dari sekolah itu..? Sepintas lalu ... ya, tetapi sesungguhnya, itulah pelajaran hidup yang nyata.

 

Bagaimana dengan sekolah di Indonesia? Wah ..... saya tidak yakin ada sekolah yang memberikan tugas semacam itu buat murid SLA nya. Bahkan Rumah Sakit Bersalinpun belum tentu melakukannya.

 

Pada saat saya melahirkan anak yang ke 2 pada usia menjelang 42 tahun di sebuah RS swasta di Bekasi. Wanti-wanti saya berpesan pada perawat dan dokter bahwa saya akan memberikan ASI. Tetapi yang terjadi adalah ... setiap kali bayi diberikan kepada saya untuk disusui, si bayi tidur dan menolak. Dua kali kejadian seperti itu, maka saat ketiga kali, saya tanyakan pada perawat, kenapa bayi saya menolak disusui? Perawat mengatakan ... bayi sudah diberi susu formula setelah dimandikan. Saya katakan : ”saya sudah bilang akan menyusui sendiri”. Jawabnya klise ”Ini standar. Ibu perlu istirahat banyak agar cepat pulih dari operasi caesar”. Saya marah ... ”Itu bayi saya, Adalah resiko saya akan kelelahan karena melahirkan bayi dan harus menyusui. Bukan anda yang mengatur saya untuk menyusui atau tidak! Sekarang... ambil box bayi dan letakkan di kamar saya ini!”

 

Perawat keluar dan mencari dokter anak yang langsung menanyakan kepada saya apa yang sudah terjadi. Kepada Dr W (belakangan saya tahu bahwa istri si dokter itu adalah teman sekelas adik saya di SMA), saya ulangi semua ucapan saya. Dokterpun menyatakan hal yang sama ... bahwa saya perlu banyak istirahat memulihkan kondisi. Lagipula belum tentu ASI saya mencukupi kebutuhan bayi. Saya betul-betul marah karenanya. Saya ulangi lagi bahwa ”hak saya untuk menyusui bayi dan saya minta anak saya untuk diletakkan dikamar rawat saya” Saya betul-betul tidak percaya lagi dengan niat perawat/dokter untuk menjamin pemberian ASI bagi bayi. Dengan muka masam, si dokter akhirnya mengijinkan perawat membawa box bayi ke kamar. Sejak hari itu dia tidak pernah lagi melakukan visit. Saya tidak perduli! Beruntung saya melahirkan dalam usia yang sudah mapan dan dirawat di ruang VIP. Bagaimana dengan ibu-ibu lainnya yang miskin pengalaman? Terlalu sekali....

 

Ini bertentangan dengan kelahiran anak saya yang pertama di l’hopital de la Fontaine – Saint Denis, Perancis. Pagi hari setelah melahirkan, perawat membangunkan saya dari tidur (saya masuk ruang perawatan pada jam 2 pagi setelah melahirkan pada jam 23.45), meminta saya untuk bangun, mandi karena tempat tidur akan dibersihkan dan menanyakan apakah bayi akan diberikan ASI atau tidak. Setelah saya mengatakan akan diberi ASI, perawat memberikan pil yang katanya akan memperlancar pengeluaran ASI. Sementara tetangga kamar yang tidak memberikan ASI diberi pil untuk menghentikan produksi ASI. Ternyata produk ASI menjadi sangat berlebihan dan karena saya belum berpengalaman bagaimana memberikan ASI, akibatnya buah dada menjadi keras dan ASI sukar keluar. Saya demam. Tetapi dengan sabar mereka membantu saya, mengurut dada yang bengkak, mengkompres dan mengajari saya mengatasi seluruh masalah yang ada. Sementara saya masih demam dan belum sanggup memberikan ASI langsung, maka saya diwajibkan ”memerah susu”, menyimpannya di dalam botol dan memberikan kepada bayi pada saatnya hingga akhirnya saya berhasil menyusui bayi secara langsung. Semua harus dilakukan sendiri, termasuk memandikan anak dan perawatan ”pusat” yang belum puput. Perawat hanya membantu manakala kita mengalami kesulitan.

 

Banyak penelitian yang menyatakan keunggulan ASI, terutama pada masa tepat pasca kelahiran, dibandingan dengan susu formula jenis apapun dan direkayasa bagaimanapun. Apapun usaha manusia untuk mendekati susu formula dengan ASI, secara alamiah tetap saja, susu itu susu sapi. Bukan susu manusia ..... Siapa yang menjamin bahwa tidak ada ”sel hewani” yang terbawa dalam formulanya. Kalau ya.... berarti ada gen ”hewani” yang masuk dalam tubuh anak kita.... Aduh.................

 

Mungkin akan banyak orang yang menyatakan ”penelitian sudah sedemikian canggihnya dan menjamin bahwa formulanya sudah mendekati ASI. Tapi kembalilah pada fitrahnya! Susu manusia untuk manusia, susu hewan untuk hewan... Jangan mencampur adukkannya. Allah SWT sudah mengatur semuanya dengan gratis buat kita... Jadi jangan disia-siakan. Anak-anak saya tumbuh sehat, walaupun tidak gemuk, mereka tumbuh secara proporsional, jarang sakit apalagi kena diare, walaupun mereka sama sekali tidak meminum susu formula. Saya memang beruntung, setelah cuti hamil, bos pun memperkenankan saya membawa bayi ke kantor. Jadilah dia karyawan termuda di kantor sampai usia 15 bulan. Jadi saya bisa menyusui bayi saya sepuasnya.

 

Ayo dong..... kita kembali ke alam... jangan tergiur oleh iklan yang menyesatkan itu!!!

 

Salam,

Lebak bulus 12 juni 2005

Untuk artikel asli, klik di sini

Saya Saiba, umi dari Sekar Kinasih (3 tahun) dan Tangguh Laskar Mujahid (1,5 bulan).

Kedua anak saya lahir dengan cesar, sehingga sangat disayangkan keduanya baru mendapatkan ASI hari kedua setelah melahirkan. Oleh pihak RS pada hari pertama di beri susu formula. Sebenarnya suami sudah meminta kepada bidan agar bayi saya sesegera mungkin dapat saya susui. Tapi waktu itu alasannya ibu dan bayinya masih dalam perawatan. Beginilah repotnya jika kita melahirkan di RS yang belum sayang bayi.

Sedih sekali rasanya, karena sebenarnya kami ingin anak kami bener-bener hanya mendapatkan ASI saja tanpa asupan lain selama 6 bulan pertama. Karena kami yakin akan keampuhan ASI dan itu terbukti anak-anak saya tumbuh sehat dan tidak mudah terserang penyakit.

Yang juga saya yakini adalah bahwa ASI juga bisa menjadi alat kontasepsi alami yang efektif. Anak pertama kami mendapatkan ASI sampai umur 2 tahun, dan selama itu kami tidak memakai alat kontrasepsi. Alhamdulillah setelah anak pertama kami di sapih, tidak lama ke