In the heart of Thailand, Ang Thong Hospital stands as a beacon of hope and support for new mothers, offering comprehensive care that empowers them to embrace the journey of breastfeeding. Despite the well-documented benefits of breastfeeding for both babies and mothers, only 29% of infants in Thailand are exclusively breastfed for the first six months, far below the global target of 70% by 2030. Many mothers face challenges in successful breastfeeding due to complex factors which include, but are not limited to a lack of confidence in their ability to breastfeed exclusively, low milk quantity, inadequate support from partner, family, community and workplace, and marketing of commercial milk formulas. Ang Thong Hospital is dedicated to overcoming these barriers and improving breastfeeding rates through a comprehensive, supportive approach by healthcare workers.
The Director of Ang Thong Hospital, Dr. Duangporn Asawarachan, emphasizes the importance of a comprehensive approach to breastfeeding support. "Breastfeeding has been a key policy of Ang Thong Hospital for many years. We ensure that our staff are properly trained on supporting mothers to breastfeed and that they work closely between relevant units to deliver the best possible continuum of care for mothers. We also monitor closely to ensure that commercial milk formulas, bottles, teats, and pacifiers are not accessible on our premises, including in the minimart," says Dr. Duangporn.
Dr. Duangporn Asawarachan, Director of Ang Thong Hospital, spearheads the hospital's commitment to breastfeeding support, ensuring mothers receive the highest standard of care and support. 2024 © WHO / Ploy Phutpheng
The hospital's commitment to breastfeeding support is exemplified by its adherence to the WHO/UNICEF 10 Steps to Successful Breastfeeding. These steps include having a written breastfeeding policy, training healthcare staff, educating pregnant women, and initiating breastfeeding within the first hour after birth. Additionally, they show mothers how to breastfeed, ensure exclusive breastfeeding for the first six months, and practice rooming-in, where the baby stays in the same room as the mother 24 hours a day to promote bonding and on-demand feeding. The hospital also encourages breastfeeding on demand and avoids the use of artificial nipples, such as pacifiers and bottles, to prevent nipple confusion and support effective breastfeeding. Furthermore, they foster breastfeeding support groups. This comprehensive approach promotes early initiation and continued breastfeeding for up to two years.
“At Ang Thong Hospital, mothers receive support for breastfeeding from their first visit at the antenatal clinic where the obstetrician will check their breasts, give advice, and refer them to a breastfeeding clinic for hands-on practice. Immediately after delivery, we promote early initiation of breastfeeding by putting babies to the breast soon after birth. We also ensure that mothers are confident to breastfeed and demonstrate their ability to do so prior to discharge from the hospital. For mothers who find it difficult to breastfeed after returning home, they can always contact us through our breastfeeding line so that they can continue breastfeeding as long as possible”, said Dr. Yaowaret Kittithanesuan, the head of Department of Obstetrics and Gynaecology who leads a team of dedicated nurses.
Education is a cornerstone of Ang Thong Hospital's approach to breastfeeding support. The Expert professional nurse in the Breastfeeding Clinic, Nurse Wanpen Kawayawong , plays a pivotal role in this. "We offer comprehensive classes that cover everything from breastfeeding techniques to managing common challenges. Our goal is to empower mothers with the knowledge and confidence they need to successfully breastfeed,". These educational efforts are complemented by a parenting class where mothers and their partners receive information about the benefits of breastfeeding, how partner and family can support mothers in successful breastfeeding, and preparation of mothers’ breasts before childbirth.
Nurse Wanpen Kawayawong demonstrates effective breastfeeding techniques to a new mother, empowering her with the knowledge and confidence to breastfeed successfully. 2024 © WHO / Ploy Phutpheng
Village Health Volunteers (VHVs) help extend the hospital's reach into the community. One such volunteer, Mrs. Jumroen Sukum, shares her experience, "We provide continuous support to mothers, offering advice and encouragement based on our training and personal experiences. Seeing the positive impact of breastfeeding on both mother and child motivates us to keep advocating for it."
A nurse at Ang Thong Hospital teaches expectant mothers about breastfeeding in the Parent School, empowering them with knowledge and confidence for their breastfeeding journey. 2024 © WHO / Ploy Phutpheng
Expert professional nurse (delivery room), Nurse Achara Kaewsin, highlights the crucial support provided to mothers during and after delivery. "Our team is trained to assist mothers with the first latch, which is vital for establishing successful breastfeeding. We ensure skin-to-skin contact between the mother and baby within the first hour of birth, promoting early initiation of breastfeeding. We address any immediate concerns and provide continuous support to ensure both mother and baby are comfortable," shares Nurse Achara. This sustained support continues in the Neonatal Intensive Care Unit (NICU) for infants who require special care, such as those who are born premature or are sick. Dr. Sirisuda Anyapho, Pediatrician, underscores the significance of breast milk for sick infants. "Breast milk is crucial for the recovery and growth of our neonatal patients. We encourage and facilitate mothers to pump and provide milk for their babies, even if they cannot be physically present. Our newborn team works closely with maternal health team to address any concerns related to breastfeeding and ensure that both mother and child are thriving." states Dr. Sirisuda.
A mother in the NICU at Ang Thong Hospital tenderly cares for her baby, highlighting the hospital's support in providing expressed breast milk to promote the recovery and growth of neonatal patients. 2024 © WHO / Ploy Phutpheng
Several factors contribute to the success of Ang Thong Hospital's breastfeeding programme. Strong leadership and belief in the benefits of breastfeeding and vaginal birth by the head of the gynaecology division, sustained support at the policy level by successive hospital directors, and the establishment of focal points on breastfeeding support in all clinics ensure that support is available throughout the hospital. Committed labour ward nurses provide critical support for skin-to-skin contact and early initiation of breastfeeding. Additionally, comprehensive support for mothers from pregnancy through the postpartum period, involvement of partners in the parenting classes, and strong coordination between gynaecologists and paediatricians create an integrated support system for breastfeeding mothers.
Ang Thong Hospital's innovative approaches include a randomized controlled trial study to introduce music as a method to improve breastfeeding outcomes in the labour room setting. This study demonstrated positive results, highlighting the hospital's commitment to enhancing breastfeeding support through evidence-based practices. Despite its successes, Ang Thong Hospital faces challenges such as a limited career path for breastfeeding nurses, an increasing number of mothers using drugs or alcohol, and managing the temperature in the operating room in the case of caesarean section delivery to ensure the newborns' stability. "Addressing these challenges requires ongoing commitment and innovative solutions," notes Dr. Yaowaret.
Ang Thong Hospital is also taking proactive steps to create a supportive environment for breastfeeding in the workplace. Hospital staff provide advice to employers on the setting up of breastfeeding rooms ensuring mothers have comfortable spaces to nurse their babies and raise awareness among employees on the benefits of breastfeeding. This comprehensive approach aims to empower mothers and their partners and enable them to provide the best nutrition for their children.
The collective efforts of Ang Thong Hospital's dedicated staff and community volunteers create a nurturing haven for mothers and their babies. As World Breastfeeding Week 2024 emphasizes, empowering parents and enabling breastfeeding is a community-wide endeavour. Through education, support, and unwavering commitment, Ang Thong Hospital is leading the way in fostering a breastfeeding-friendly culture in Thailand.
The WHO recommendations on maternal and newborn care, highlighting the hospital's commitment to ensuring a positive postnatal experience for mothers and their babies. 2024 © WHO / Ploy Phutpheng
Following the WHO recommendations, Ang Thong Hospital exemplifies good practice in breastfeeding support. "By adhering to these international guidelines, we strive to provide the highest standard of care for mothers and their babies," says Dr. Duangporn.
This story highlights the collaborative efforts and dedication of various professionals at Ang Thong Hospital, showcasing their commitment to supporting breastfeeding mothers and ensuring the health and well-being of their infants. By sharing these experiences, the hospital hopes to encourage healthcare workers to continue and accelerate their efforts in supporting mothers in breastfeeding and to build the confidence of mothers and their families in the support they can expect from healthcare workers.