Waiting......

*Naima at about 6 weeks old*

As a full time work out of home mom, I make it a point to spend all after-work time and weekends with Naima, to make up for the time that we are away from each other. Thus, when I have activities/meetings outside work, I always bring her with me. This hasn't been a problem since Naima is pretty well-behaved and loves meeting new people. Just 2 weeks ago, we went to Ormoc, Leyte to attend a friend's wedding where she danced the night away!

However, Naima has an unusual nap-time schedule. She's usually up for the day at around 7am and has her nap at lunch-time (12noon or later). We've been trying to get her to nap at around 1030am, to no avail. Thus, on weekends, whenever I have scheduled lunch-outs with family or friends, she always dozes off in the middle of lunch.
However, when we're home, she doesn't want to take her nap and just wants to play, play, play with me. Maybe it's also her way of making up for the work week. I'm usually able to put her to sleep at about 1pm. Most of the time, this is okay since I can do grocery shopping and other errands while she's asleep. This becomes a problem when I have activities scheduled at 2-3pm.
For instance, last week, I wanted to attend a breastfeeding toddlers class at 2pm. But since Naima woke up at almost 3pm + an unusually heavy Saturday traffic, we arrived at the venue at about 5pm and I missed the session! I thought about going without Naima but there was also a scheduled toddler playgroup and we were going out for dinner right after the session.
I really don't want to disturb Naima when she's napping since she just takes 1 nap per day - no matter how short that nap is. Sometimes, I have no choice but to wake her up from her nap (like when we're going out-of-town and need to catch a flight) and she gets REALLY cranky towards the end of the day. This makes me wonder how moms are able to schedule meetings/activities around their babies' naps. Waiting-for-Naima-to-wake-up-from-her-afternoon-nap seems to be an important and regular weekend activity for me before I can go out, participate in my various advocacies or meet friends. I guess I can only hope that her nap schedule improves as she grows older.

Jaundice and the Pinoy Baby: A Follow-up

I wrote about this topic and asked for comments from a medical expert. I was lucky that Dr. Francesca Tatad-To, respected pediatrician-neonatologist AND breastfeeding advocate took time out to clarify some issues about jaundice and breastfeeding. I will not be rephrasing her answers as I might misconstrue or misinterpret them. My comments will be in (parentheses and itals)

*Please note that this discussion was based on the facts I presented to Dr. Tatad-To in connection with Naima's specific case. This is no substitute for medical advice given after an actual examination by a board certified doctor of your particular case. This post is for informational purposes only.
==============
Physiologic jaundice follows a pattern - bilirubin increases until it reaches a peak level of about 14 mg/dl at the 5th day of life and then slowly declines. By the 14th day it should be at low levels (less than 10mg/dl) if there is any jaundice at all.

Breastfeeding jaundice, which is jaundice from inadequate caloric intake, common in the first few days of breastfeeding, resolves with more frequent nursing and should really be resolved within the 1st week of life. If it extends beyond this then this is no longer simple breastfeeding jaundice and needs to be addressed. As you know, it is normal for breastfeeding moms to produce small volumes in the beginning but this increases by the 3rd to 5th day, at which time breastfeeding jaundice should begin to resolve.

There are other causes of jaundice, not all are related to breastfeeding. One of the most common causes is G6PD deficiency (glucose 6 phosphatase dehydrogenase), a very common defect in the red blood cells that causes increased bilirubin production. This occurs in 1 in every 50 Filipinos, more commonly among males though. (Naima's Philippine pediatrician, Dr. Mianne Silvestre - also a breastfeeding advocate, suspected G6PD deficiency and requested that a test be conducted. Naima's test was negative - which means she was not deficient.)

Jaundice is concerning because a baby's ability to eliminate bilirubin, is poor. This means that it accumulates in the blood and at certain levels (we think around 25 mg/dl), it may actually enter the brain and cause long-term damage.

The treatment for bilirubin that is elevated ABOVE NORMAL/acceptable for age, is phototherapy - exposure to a special kind of light that turns bilirubin into a form that the baby can excrete. In serious conditions, a procedure called an exchange transfusion is necessary - the baby's blood is removed and exchanged with donor blood simultaneously. (Luckily, Naima's jaundice was resolved with phototherapy and didn't require exchange transfusion.)

We cannot pinpoint exactly what it is that causes breast milk jaundice, but many scientists feel that it is due to the presence of certain substances in breastmilk. These substances prevent the baby from breaking down bilirubin. THE PROBLEM HERE IS NOT A LACK OF MILK. THIS ALSO HAS NOTHING TO DO WITH THE QUALITY OF A MOTHER's BREAST MILK. It is a problem the baby encounters in metabolizing bilirubin. Temporarily withholding breastmilk for a period of no longer than 48 hours is normally sufficient treatment. It is important to know that breast milk jaundice cannot be prevented. However, babies with breast milk jaundice are expected to recover fully. There is no reason for a mother of an infant who develops breast milk jaundice to stop nursing completely. Breastfeeding should resume once bilirubin levels have decreased to an acceptable level. Once this occurs, bilirubin is no longer expected to climb to dangerous levels. The idea behind giving formula is that the baby's enzymes take a break, and can work harder once you resume breastfeeding/giving breastmilk in a day or 2. It is only necessary to stop breastfeeding when the bilirubin level is above normal or puts the baby in danger. If a baby is mildly yellow and the bilirubin level is low (let's say 10 mg/dl) then there is no need to worry as eventually, the baby will eliminate all excess bilirubin on its own.

While jaundice is very very common, it is a serious concern that should not be dismissed. When poorly managed, it can lead to life-long motor deficits and in the worst case, severe brain damage and death. (emphasis mine)

In physiologic jaundice, there is no treatment necessary. For other pathologic causes where bilirubin is elevated above normal, treatment with phototherapy is the gold standard. Water or sugar water have no place in the treatment of jaundice.
The treatment for breastfeeding jaundice is to feed more often, and the treatment for significant breast milk jaundice is to temporarily stop providing breastmilk.

The crucial points to determine in all cases of jaundice are 1)is it serious? (are levels above normal) 2) what is the cause and 3) does it require treatment. (emphasis mine)

The diagnostic test and treatment for breast milk jaundice are the same. If you stop breastfeeding for 2 days and the bilirubin comes down significantly then it's breastmilk jaundice. Stopping breastfeeding should not cause bilirubin levels to drop significantly in any other form of jaundice that occurs at that time period.
So if your baby had elevated levels (particularly as high as 24 mg/dl) and all your pediatrician did was to stop breastmilk for 2 days and it dropped to normal/acceptable then that was definitely breastmilk jaundice. (When Naima was discharged from the hospital, 2 days after birth, her bilirubin level was 9.8 mg/dl. Naima's bilirubin level at day 14 was 24.8 mg/dl. She was re-admitted to the hospital, placed under phototherapy and given exclusive formula. I was asked to express my milk. Within 24 hours, her bilirubin went down to 11.6 mg/dl.)

There is no other 'benign' cause of jaundice at that age (14 days) that would have bilirubin levels that elevated.

*Please note units of bilirubin as sometimes results are relayed in S.I., a different unit of measure

Bilirubin is almost never static. It's not like you get a high level and it stays that way. In brand new babies, it is either on it's way up or on it's way down, so every level/test result has to be taken in that context.
Another way of determining if breastfeeding jaundice/starvation jaundice was truly a factor is to look at her weight at the time and her poop/pee patterns. If her weight at 14 days was not significantly lower than her birth weight, it probably was not breastfeeding jaundice. (Naima's birth weight was 6lbs 5oz. At 14 days, her weight was 6lbs 90z.) Breastfeeding and breast milk jaundice do not co-exist as one is from starvation and the other is from when milk starts to increase in volume.
=======================
*Dr. A.M. Francesca Tatad-To specializes in pediatrics and newborn medicine. She can be reached at The New Medical City and also serves as medical consultant to L.A.T.C.H.

What I would like to emphasize is that jaundice is never a reason to end a breastfeeding relationship. I believe that you need to read and know about your baby's condition so you will understand why your doctor is prescribing a certain course of action and not just accept everything blindly. You also must WANT to continue to breastfeed despite this initial set-back. Tell your doctor about your plans and work with him/her towards re-establishing your milk supply and the breastfeeding relationship.

Setting Up a Lactation Program at Work, Employees' Association Meeting

Today, C and I had a presentation before our employees' association to request for support for our lactation program proposal. C was supposed to present during the last council meeting (in May). However, she had another seminar to attend to abroad. In the May meeting, a proposal for a breastfeeding station was brought up. However, there were no concrete plans made. Instead, it was proposed that the nursing moms be directed to the employees' association room to express their milk.

Jaundice and the Pinoy baby

This issue is a major concern of Pinoy breastfeeding mothers because this is one of the most common reasons why pediatricians tell moms to give formula. Naima was no exception. At 14 days, her pediatrician diagnosed her with breastmilk jaundice because her bilirubin was high. Her pediatrician then told me that I had to stop breastfeeding Naima (she had been exclusively directly breastfeeding at this point) for 24 hours while we give her Enfamil every 2 hours. This was the start of our descent into our various problems and issues.

In hindsight, I realized that I just wasn't that well-informed about the different types of jaundice that could have affected Naima. In the first place, Naima, being an Asian baby was naturally yellow. Secondly, she was born on a Wednesday, had her 1st well-baby check up on Saturday and did not see the doctor again until after 2 weeks. I keep thinking that if I scheduled Naima's 1st well-baby check-up later (on a Monday instead of Saturday), the type of jaundice that she had might have been correctly identified and immediately treated (without us resorting to formula).

There are 3 types of jaundice which I think affects Filipino babies most - the common physiological jaundice, breastfeeding jaundice and the breastmilk jaundice. Wiki has a comprehensive list of other forms.

When Pinoy babies get jaundiced, it is usually suggested that sugar water or formula be given. However, respected pediatricians such as Dr. Jack Newman and Dr. William Sears have recognized that jaundice is normal and in most cases breastfeeding need not stop nor does sugar water or formula be given to jaundiced babies.

This post explains how physiological jaundice may result in breastfeeding jaundice - which is actually lack of breastmilk jaundice because of the infrequency of feedings, leading to lack of milk intake. Because of this, bilirubin is not expelled from the baby, resulting in build-up. Both Dr. Newman and Dr. Sears recommend increasing feeding frequencies to overcome this type of jaundice.

In Naima's case, her US-based pediatrician claimed that she had breastmilk jaundice. True breastmilk jaundice is defined here as:

True breastmilk jaundice, also referred to as late onset jaundice, is relatively rare, in the range of 0.5 to 4 percent of births. (Riordan & Auerbach 1999) (Lawrence 1994)

Breastmilk jaundice is defined as serum bilirubin greater than 10 mg/dl in the third week of life, when other organic and functional causes have been ruled out. It is sometimes diagnosed by feeding the baby other milk in addition to, or in place of, breastfeeding to see if the bilirubin level drops. This method of diagnosis is controversial and may not be necessary. (Riordan & Auerbach 1999)

Although Naima's bilirubin was at 24mg, it was at the 2nd week of her life (not 3rd). Stan and I were new parents then and REALLY did not know better. Coupled with our belief that whatever the doctor said was 101% right, we didn't think of questioning their diagnosis or treatment. Now, I keep thinking that her jaundice might not have really been true breastmilk jaundice but rather "breastfeeding jaundice" or "lack of milk jaundice" which could have been cured if I increased the frequency of her feedings, instead of giving her formula. Well, considering that jaundice repeats in siblings, I will charge this to experience to teach me to be more prepared for my 2nd baby.

*As always, you need to consult with your doctor. However, it helps to read and know about the types of jaundice your breastfed baby may encounter. We are trained to never question our doctors. But I've learned that - especially when it comes to breastfeeding - most doctors do not know a lot about it. In fact, a friend shared that in medschool, there was only 1 chapter devoted to breastfeeding :(. So, on this topic, I think it is best to research and read to know what questions to ask your doctor.

Please check out this follow-up post with comments from a medical expert.

Why Worry About NIP?

Welcome to the Carnival of Breastfeeding for June.

Theme for this month is Nursing in Public. Please check out the other contributing bloggers linked at the bottom of this post. :)

My opinion is that anybody offended by breastfeeding is staring too hard. ~David Allen

One of the most talked about issues that breastfeeding moms have to contend with is NIP -- or nursing in public. I briefly mentioned my experience in a previous post about swimming pools. However, I've realized that nursing in public in the Philippines is not really as bad as in other Western countries.

During Naima’s 1st 2 weeks, I wasn’t shy about nursing in front of other people. I nursed in front of my aunt, cousin, uncle, my aunt’s best friend, her husband, etc. etc. At that time, I was more concerned with Naima gaining weight, my having to deal with sore nipples and making sure that I was producing enough milk. However, I do remember a conversation I had with my aunt and female cousin about how other people wouldn’t be as tolerant of me nursing in public as they were (since we were related). I asked why and my aunt just told me, it’s just how it is – people will think you are committing indecent exposure if you nurse in front of other people.

Fast forward to Naima at about 4 months (because in the 1st couple of months, I didn’t leave the house so I didn’t have to deal with nursing in public). When I started going out, I invested in a nursing bib and some good nursing tops. Initially, I always sought a private place to nurse Naima. I soon became *brave* enough and nursed her in public but used the nursing bib. However, as Naima became old enough to be curious about her surroundings, she began to hate the nursing bib and always struggled to get it off her. Eventually, I learned that for us to get a decent nursing session, I needed to nurse her without a cover.

I'm happy to report that despite my misgivings, nursing in public in the Philippines has fairly been uneventful. I haven't heard of any mom who nursed in public being sued for indecent exposure. Philippine law on indecent exposure refers to a general provision punishing a person who offends against decency or good customs by committing any highly scandalous conduct (Art. 200 of the Revised Penal Code). Given the definition and elements of the crime of "grave scandal," I don't think anybody would charge a mom who is nursing in public with this crime. Equating nursing in public with indecent exposure or grave scandal would demonize the complainant and make him/her news fodder.

Generally, the Filipino public doesn't really mind if you nurse in public. For one, we don't have a concept of personal space. So no one complains that you are violating their morals if you are "showing your breasts" by nursing in public. Second, Filipinos are generally good-natured and prefers to avoid confrontation. We call this "pakikisama" and thus, in my experience, people who are uncomfortable with me nursing in public tend to just look away instead of coming up to me and telling me to cover up. Also, moms and babies are considered special and need extra understanding, care and support - so the Filipino trait of "pagbigyan" (or let them be) also comes to play.

One good thing I noticed here is that there has been renewed interest and support for breastfeeding. Several malls have established breastfeeding rooms and we even have a breastfeeding bus in Mindanao! I think politicians have found that this is a very good platform which would make them look good. Recently, a German woman was even declared as the Philippine breastfeeding queen. To be honest, I find it strange why a German was chosen when there are in fact a lot of other Philippine advocates who are equally deserving of this title.

I've been reading articles about horrible experiences of other moms, especially Western moms, about nursing in public. Despite being irritated by the lack of personal space, pagbigyan and the pakikisama system, when it comes to nursing in public, I can happily say that these idiocracies/Filipino cultural traits have their good uses.

Check out the posts of the other carnival participants:
Lucy & Ethel Have a Baby: Nursing in Public (Boobs) Out and Proud
PhD in Parenting: Nursing in public (a breastfeeding parody of Green Eggs and Ham by Dr. Seuss)
Dirty Diaper Laundry: Breastfeeding in Public – Talents – I haz it
kim through the looking glass: Here? At the restaurant?
Grudgemom: Nursing in a room full of people you know
MumUnplugged: Aww, is he sleeping?
Massachusetts Friends of Midwives: Chinatown, the Subway, the Vatican, and More
Mother Mary’s Soapbox: Breastfeeding Oriana
Tiny Grass: Nursing in Public as an Immigrant
Mommy News & Views: Breastfeeding in Public
Breastfeeding 1-2-3: To Cover or Not to Cover
Stork Stories: Little Old Men... & Nursing in Public
Warm Hearts Happy Family: Breastfeeding and the Summertime
Blacktating: Thank You for Nursing in Public
Mama Knows Breast: Products that can help you breastfeed in public
babyReady: A wee NIP in the park
Tales of life with a girl on the go: Planes, trains and automobiles - we've breastfed in them all
The Motherwear Breastfeeding Blog: Get kicked off a bus for nursing in public? Here's how to respond
Breastfeeding Moms Unite: Nursing in Public: A Fresh Perspective on Nurse-ins
Pumpease: Breastfeeding Hats? YES! Nursing Covers? Uh... Not So Much
Breastfeeding Mums: What's a Breastfeeding Mother To Do!!
HoboMama: Easy, discreet way to breastfeed a toddler in public

Stan and Breastfeeding

Much has been written about the important role that dads play in ensuring breastfeeding success. In fact, BabyCenter Philippines has a good guide for new dads who want to play an active role in the breastfeeding relationship. On occasion of Father's Day, I'm writing a post for my husband, Stan, on how he helped me successfully overcome the early challenges of breastfeeding and continue to support me as I still breastfeed our 18month old toddler.

I gave birth away from home, without my family or yayas/helpers. It was only Stan who was present from Hour 1. Being my only assistant, he took over all diaper duties - with me just poking him every time Naima pees or poops. He also accompanied me during my visits with various lactation consultants. I was really surprised that he wasn't squeamish with talking about my breasts and participated actively during the consultation sessions.

Stan was my number one cheerleader. He kept me going during those days when I doubted myself, my milk supply, my capacity to soothe a wailing Naima. I have to admit that it wasn’t easy being married to me during those first 2 weeks. Even I couldn’t stand myself. I was irritable, weepy and not in the mood to talk to him. However, he kept quiet and took charge of bathing and singing to Naima.

I remember one night when I was pumping and spilled about 1 ounce of milk all over the floor. Stan had just dozed off when he heard me start to cry. He immediately jumped off the bed, comforted me and cleaned up the mess himself. I know that he must’ve gotten tired of hearing me complain all the time about me not pumping enough milk, Naima always wanting to nurse. But not once did he tell me to switch to formula and stop breastfeeding. He was just there listening and cheering me on.

Naima is now 18months old and I’m counting the days when I will hang up the horns. Stan and I have agreed that when Naima turns 2, I will stop pumping at work and just let Naima nurse whenever we are together. At the start of the breastfeeding relationship, I had a month-by-month success goal. Now, I’m on the countdown to the last 6 months (of pumping, at least). I really couldn’t have gone this long without Stan’s support. Naima and I are very lucky to have a patient, supportive, every smiling and good-natured Stanley in our lives.

Happy Father’s Day Stan and we love you! :D

Breastfeeding in the News

There is a recent study that says that breastfed babies do better in highschool and go on to college, as compared to their bottlefed babies. Moms also benefit, especially moms with multiple sclerosis. Another study showed that exclusive breastfeeding helps protect multiple sclerosis moms against relapses of their diseases.

Recognizing the benefits to the moms and babies, legislators from various governments have acted to encourage and promote breastfeeding. In Nigeria, the Muslim Rights Concern is seeking the passage of legislation to compel mothers to breastfeed their babies for 2 years. In the US, Representative Caroyln B. Maloney of New York and Senator Jeff Merkley of Oregon have reintroduced the Breastfeeding Promotion Act. US mombloggers are asking for support and have even created a Facebook page.

I'm happy to read all about these initiatives and benefits associated with breastfeeding. These will be very good material to add to the presentation before the employees' association in connection with our request for a lactation support program at my workplace.

Breastfeeding 303 at Medela House

There will be a Breastfeeding 303 Class at the Medela House on June 27, 2009 at 2pm. The following topics will be covered:

• toddler breastfeeding
• gentle and forced weaning
• special breastfeeding cases - relactation, induced lactation, adoption, pregnancy and breastfeeding, etc.
• attachment parenting ideals (like babywearing, infant potty training, etc)
• child development and resources

There will also be a toddler playgroup at Medela House that afternoon. I've been looking for a playgroup for Naima. She currently has a *playgroup* with the other toddlers at our condo complex but it's not a regular thing. Still on the look-out for a toddler play class for her to challenge all her *excess* energy. :)

To join, contact Abbie Yabot or Medela House at 29 1st St., New Manila, Quezon City (725-3723, 738-6272, 0917-5614366)

My experiences at LLLI meetings

Last Saturday I attended a meeting which was headed by Abbie Yabot. Abbie was my lactation counselor during the early days (when I had problems with latching, etc.) and she breastfed her 2 younger children (JM for about 4 years and Kyle who will be turning 3 and is still breastfeeding). It was actually my 2^nd LLLI meeting but my 1^st meeting in Manila.

My first meeting was in Tysons-Pimmit Library, when I was 8 months pregnant with Naima. During that meeting, there was a mom with a toddler running about and another mom who had a 3.5 year old toddler who attended the meeting because she wanted to ask about weaning tips. What was interesting was that this mom re-lactated. Her baby was adopted and she breastfed him for 3.5 years already! During this meeting, I listened mostly to other mom’s stories and asked some basic questions. Honestly, I didn’t really know what to expect about breastfeeding during this time.

My 2^nd meeting was with Abbie and came more than 18 months after that 1^st meeting. At this time, Naima was already 18 months old and still breastfed. (In hindsight, I think it was that relactating mom with a 3.5 year old toddler that inspired me to really push through with breastfeeding Naima despite my difficulties.)

For this meeting, there were about 7-8 moms (2 were pregnant), a couple of husbands and several babies and toddlers. It was held at a church hall with couches and tables. Even if the hall was quite big, I thought the meeting was cozy. We were gathered around in a circle and mothers were freely asking Abbie about their concerns and talking about their own breastfeeding experiences especially about pumping and working. I think this was especially helpful to new and pregnant mommies since they could hear the challenges of breastfeeding in the early days and how to resolve these problems.

For a new or pregnant mom, attending the La Leche League meeting is a good way to prepare for breastfeeding. Since the meeting was in a casual set-up, moms feel comfortable sharing their questions and chatting with other moms. My only beef is that meetings are held so far away. There is currently only 1 La Leche Group meeting for Metro Manila (the other one is in Cavite). Abbie mentioned that they are looking for more leaders. Hopefully, more people join, attend the meetings and step up to become leaders - so more meetings in other areas in MM can be organized.

The Breast Milk Formula

In my post on selling breast milk, a reader left a comment about Enfamil calling their formula as "The Breast Milk Formula". I took a screen shot:

You can see the claim "The Breast Milk Formula" on the tab and upper part of the screen shot. If this not unethical marketing, then I don't know what is. Motherwear's Tanya also blogged about this here.

In the Philippines, the applicable law is Executive Order No. 51 (2o October 1986), otherwise known as the "National Code of Marketing of Breastmilk Substitutes, Breastmilk Supplements and Other Related Products" which regulates the advertising and promotion of breastmilk substitutes. Its Revised Implementing Rules and Regulations issued by the Department of Health on 15 May 2006 was the subject of a huge controversy and court case. And contrary to the International Milk Code (which stipulates that there should be absolutely no promotion of breastmilk substitutes), the Philippine Supreme Court struck down provisions on the absolute prohibition of advertising, promotions, sponsorship or marketing materials for breastmilk substitutes and the adminstrative sanctions for violations of the rules and regulations. I've been meaning to make a digest (summary) of this case, which I will reserve for a future post.

I read a lot of parenting magazines and noticed that there have been several ads by formula companies promoting there products. Here are some samples:
These ads came from Smart Parenting - June 2008 issue and Baby Magazine's June 2009 issue and are both full page ads. There are many other ads in magazines, newspapers espousing the benefits of formula milk.

Aside from print ads, formula companies are very aggressive in releasing advertisements on TV. Here are a few ads running in Philippine television.

Pediasure Plus




Lactum Panatag





Gain




Enfakid - broken vase

The advertisements that I hate the most are those of Lactum and Enfa A+, which I believe are both manufactured by MeadJohnson. I am surprised that there is a Boycott Nestle organization but no boycott MeadJohnson action. In my experience, MeadJohnson is worse than Nestle in terms of unethical marketing.

When I gave birth, the hospital gave be an Enfamil hospital bag, which came with some free formula samples, a diaper changing pad, an ice cooler pack and a water bottle especially for mom. Subsequently, at Naima's 1st well-baby check-up, we received another cooler bag with formula milk again from Enfamil. Even during my consultation with my lactation consultant, I received Enfamilk Lipil from her after she informed me that I was not producing enough milk since Naima was only getting about 1 oz per session (she used a scale before and after feeding times).

As I mentioned, Lactum and the Enfa A+ commercials are the ones I hate the most. In the Lactum commercials, the celebrity moms promote Lactum to help your child gain complete nutrition, especially for picky eaters. While watching this commercial, I get the message that it's ok if your child is a very picky eater, e.g. eats fried chicken all the time, as long as she drinks Lactum. Lactum comes with the tagline "be a 100% nourished kid" and if you read closely enough, there is a disclaimer - "when coupled with a balanced diet". What a contradiction!

The Enfa A+ commercial I hate is the one where a woman (I believe its Daphne Osena) talks about how your child can gain +7 IQ points and shows a video of a nursery, some books and ends with a suggestion to the parents to ask your doctor how your child can gain +7IQ points. Throughout the commercial, no milk brand is being said or shown. However, at the bottom right corner of the screen, there is a symbol "A+" (which refers to MeadJohnson's Enfa products). So does it mean that I need to feed my daughter Enfa A+ products for her to get those +7 IQ points?!! A Filipina mom blogger explains how the study is inaccurately used by MeadJohnson to support its claim about the +7IQ points. I have been trying to get a Youtube copy of that voiceover A+ commercial but could not find it.

Enfa was also involved in another marketing issue, this time through a print ad in the Philippine Daily Inquirer as explained here. Really, I think it is high time for a MeadJohnson boycott aside from the Nestle one!

Will you pay for milk?

As early as 2006, The Lactivist already wrote about the black market for breastmilk. In 2007, Time Magazine had an article about wet nursing and featured a Los Angeles agency where you could hire a wet nurse. This issue was again in Fox News which reports that moms are now looking to the black market for donated breast milk and are in fact willing to pay as much as $1.90 per half ounce (or about 15ml).

When I was having supply issues, I never considered getting breast milk from another mom. Instead, we gave Naima formula. Since I started working and pumping at work last year, I've lost count of how much milk I have donated. Based on the Lansinoh, Nanny, Avent, Gerber and Playtex milk bags I've used up, I would believe that I have donated more than 400 6-8oz. bags of milk -- and this excludes the milk sticks which we stored using Sensible Lines storage system. Wow!! If I placed my milk in the black market, at current exchange rates, I would've gotten almost P1M for it!

Tempting.. but since I freely produce the breast milk, I find it unsettling to sell something which I know I got for free. Plus, I know the frustrations of not being able to feed your baby breast milk. Now that my supply is abundant, I feel happy whenever I have some extra to give. I also try to be a good donor by having all my tests ready when the donees ask for it.

I think having someone else wet-nurse my baby is something that I won't agree to - I will be very jealous of the wet-nurse and her closeness with my own baby. I also think I will feel very insecure knowing that someone else is performing my role in my baby's life. I probably will accept breast milk from friends but I don't think I am open to the idea of buying breast milk for my baby. I just find it wrong to sell something that you created for free and what you're selling is something that a desperate person is looking for.

MedelaMoms' PISA Promo

At last Sunday's baby fair, I met up with MedelaMoms' Maricel Cua and Beng Feliciano. Maricel excitedly shared their promo for the Pump In Style Advanced pump and emailed me the details yesterday:

We're excited to share with you our latest promo for our Pump In Style Advanced - the PISA bundle. If you purchase a Pump In Style Advanced from us, you also get the following: a softcup feeder, 30 disposable bra pads, purelan100 7g, milk collection shells, hydrogel pads, a Nursing Mom nursing bib, Planet Noah items, Prolacta, free membership (equivalent to 3 breastfeeding classes held monthly, conducted by La Leche League certified lactation counsellor Abbie Yabot) to The Breastfeeding Club, a manual pump, a cooler carrier with ice pack, and 8 bottles (4 with storage lids and 4 with storage lids, teats, and caps!). What a value for pregnant/breastfeeding mommies!

The PISA bundle costs P28K and is good until supplies last. The value of the freebies are at P7K-P8K, bringing down the actual pump cost to just about P20K. This is a great deal! However, supplies are limited and understandably, they don't accept reservations. Contact the Medela Moms for more details.

MedelaMoms, Inc.

29 1st St., New Manila, Quezon City

725-3729, 738,6272, 0917-5614366

Maricel Cua or Beng Feliciano

For Tech-Savy Mommas

The Massachusetts Breastfeeding Coalition has developed Breastfeeding Management, a reference for supporting breastfeeding mothers, available for download to your iPhone, iTouch and Palm OS.
This is great news as it gives easy and ready access to breastfeeding information. Features include: Approach to Early Breastfeeding (an evidence-based algorithm for evaluation and triage of breastfeeding in the first 2 weeks of life); Red Flags (uses the Approach to Early Breastfeeding algorithm to help those patients having difficulty initiating breastfeeding); Online Resources (access frequently asked questions about breastfeeding, even if there's no phone signal) and Medications (a database of safety information on commonly used medications, together with general guidelines on safe prescribing for lactating women and references to review articles. Includes rating information from the American Academy of Pediatrics and Thomas Hale’s Medications and Mothers’ Milk).
The Palm OS version also includes: information on the World Health Organization 10 Steps for Baby Friendly hospitals and the International Code of Marketing of Breastmilk Substitutes; and an article entitled "Making Milk is Easy" (10 steps to make plenty of milk).
I've given up my own Palm handheld. A lot of Filipino moms will welcome this application with the coming of the iPhone in the Philippines. This will be especially helpful not only to breastfeeding counselors but also to new breastfeeding moms. Hmm.. maybe it's time for me to go back to using a PDA :D

June Events

Here are a couple of interesting events this June.

First is a shopping bazaar called "Along Came Baby Fair" at the NBC tent (Fort Bonifacio, Taguig) on June 7, 2009 at 9am-7pm. This is a baby and toddler event featuring baby care products, clothes, furniture, food, etc. Friends from Mamaway, Plume and the Urban Baby will be there.

The week after, on June 13, 2009 (Saturday) will be La Leche League Philippines' (Best Friends in Breastfeeding) monthly meeting at Mary the Queen Parish from 9-11am. Abbie initially informed me about this meeting when Naima was just 2 months old. Naima will be 18 months tomorrow. Hopefully, I can still join La Leche League before Naima weans!

Mice Milk

Would you consider feeding your baby mice milk?!!! National Geographic reports that doctors in a Russian experimental farm are milking genetically modified mice and trying to harvest lactoferrin (human breast milk protein) to create healthier baby formula. YIKES!!! Sure, the researchers also said that should the human lactoferrin be successfully harvested, cows, goats and rabbits will be used to "manufacture" this in the future.

Still, it scares me to think about what the actual contents of the current formulas being marketed out there are. Sure, there are labels listing the ingredients - a dizzying scientifically worded list. Who knows where these ingredients are sourced from.

Aside from the contents, formula feeders have to contend with sanitary preparation! A very informative documentary created by UNICEF in 2007 entitled "Formula for Disaster" describes how the milk companies' goal to increase profits and effective market formula milk in my country has resulted in the decline of breastfeeding rates and more infant deaths (due to unhygenic milk preparations). More reasons to promote breastfeeding!

Interesting Giveaways

I started joining blog giveaways about 3 months ago. Since then, I have won 2 contests. The first one was from Alicia's The Soft Landing where I won a set of 3 Boon Bath Toys which Naima is very happily playing with - makes her look forward to bath times. The second contest I won was from Tanya's Motherwear Blog, the Latch-on DVD give-away. This will be very helpful in early breastfeeding, especially to first-time moms and I hope to share this with my L.A.T.C.H. "counselees".

I'm happy to share that there are a couple more giveaways which would be interesting to breastfeeding moms:

The first is from Elita of Blacktating in celebration of her first blogiversary! She is giving away 7 items - 4 breastfeeding books, a pack of organic diapers, a $50 gift certificate for online mommy shopping and a breast milk storage system. Contest ends on June 3.

The second is from Melodie of Breastfeeding Moms Unite - this is her first giveaway. She will be giving out 1 set of My Baby Experts Simply Breastfeeding DVD, which was created by Shari Criso (IBCLC) to help moms successfully breastfeed their babies. Contest ends on June 13.

I haven’t seen a local blog with baby/nursing product giveaways yet. Hopefully, this giveaway craze will soon attract local vendors which carry products for moms and babies and sponsor contests similar to the above. J

*You need a U.S. address to join these give-aways (Canadian addresses are accepted for Melodie's contest). This blog entry was created for the purpose of joining Elita's and Melodie's give-aways.

A Nursing Mom's Shopping Guide in Manila - Nursing Bras

*This is the 4th of a series.

When I started nursing, the nursing bra that I regularly used was the vest-like pull-over soft bra I got from motherhood maternity. It served its purpose since I didn't go out much in the first 2 months of Naima's birth. However, when I started to go out with Naima in tow, a good nursing bra (padded, good support, easy to unhook) was a necessity. Naima would nurse anywhere. Although I initially didn't want to nurse in public, I was usually faced with a wriggly and hungry baby -- so aside from nursing tops, I decided to invest in good nursing bras.
My first bra purchases were from SM - soen and sogo bras. They were cheap (about P350 a piece) but offered no support and not-so-good-quality materials -- after a couple of washings, my bras started to get holes, the fabric became rough and I needed to look for new bras to replace them.
My better bras came from Marks and Spencer in Glorietta 4. They were expensive, lacy and unpadded. But they were well-made - better than my soen/sogo bras. Thanks to my sister in law in Singapore, I also got a pair of Mothercare Moda bras - padded in black and white, I loved them. But since the padding was quite thick, I only started to use them when Naima had mastered the latch and could already control her head. The padded cup got in Naima's way when she was younger (and lacked neck strength/control).
Finally, my latest bra purchases were from Fabulous Mom - bras made in Malaysia which I bought in Singapore. These bras were also padded and best of all, they were affordable. The pads were soft enough and the designs were pretty. I liked them so much that I decided to become a reseller and bring them to the Philippines :)
Now, a lot of nursing bras are available in the market. However, they are still not generally accessible and are only found in specialty shops (unless you pick the department store bras). Even the bras in Marks and Spencer are usually out of stock. Here's a listing of available nursing bras in the Philippines.

Fabulous Mom from Malaysia - check them out in my Multiply site or here in Blogspot. 'Nuff said :D

Mothercare (Shangri-la - 6311896 and Trinoma - 9016352)
I'm happy to report that my Moda padded bras are now available in Mothercare. Aside from the Moda padded bras (P1,500 each), they also carry lacy unpadded bras (similar to Marks and Spencer), which cost P2300 for a pack of 2.

Marks and Spencer (several branches)
Nursing bras are often out of stock - so it is better to call before going! They carry 2 styles which are both non-padded and non-wired. Each pack comes in a pair of 2 (black and white) and you can choose from either lacy or embroidered. Each pack of 2 costs P2,450.00.

Debenhams (ShangriLa - 6329802, Glorietta - 8184783 , Trinoma - 9015653)
Debenhams (in Rustants) carry 6 styles of nursing bras. They have 1 style which is padded and costs P1,800 per bra. They also have 5 various styles of non-padded bras which come in a pack of 2 and costs P2450 per pack.

Hot Pink (Rockwell - 8981959)

Hot Pink also has a branch in Robinsons Place but their nursing bras can only be bought in their Rockwell branch. They have 2 styles both unpadded. One style has no brand, comes from Mexico and costs P995, while the other is from Canada (CG Grenier) and costs P2,200.

La Leche League bras
Roots and Wings Trading has brought in La Leche League bras in various styles and sizes. The bras are available in their showroom in Valle Verde 1, Pasig City. Call Joy at 6715826. *Update - 5/31/2010 - my online store now also carries La Leche League bras.  Please check them out. 

Bravado

One of the better brands is Bravado which is one of the top-selling bras in the United States. It's only available in Procreation (6354410 loc. 25) in Crossings, Shangri-La Plaza and costs P1960 (for the original), P2500 (padded) and P2300 (microfiber bra). I've been meaning to buy one but couldn't justify paying about P2K for just 1 bra. Luckily, I found Fabulous Mom :) *Update - 5/31/2010 - Rustan's now also carries the Bravado. You can read more about this brand in several blogs - manila fashion observer, Heart to Heart Online.

Others:

If it's an emergency and you really need the bra, easily accessible ones are in the department stores. I usually purchase mine in SM and buy Sogo or Soen. Also, if you have access to Triumph and Avon Direct Sales Marketing (think Avon lady), check out their catalogs for nursing bras. I've been looking for Triumph and Avon ladies but can't seem to find any.

For pumping moms, I was happy to see that the Easy Expression Bustier is now locally available. This bustier has a "patented zip-front strapless design design" for effortless and easy hands-free pumping. Youji&Me (7563838 or 7560767) at Greenbelt 5 sells them at about P1,950 each.

Update 5/31/2010.  Shameless Plug:
I've expanded the bra choices in my online store.  Aside from Fabulous Mom, I now carry QT Intimates, Dynabelly, Amara, PumpEase, La Leche League, Blissful Babes Bandeau and Mamaway nursing bras.  Do check them out.  Thanks!

Other posts in this series:
All About Malunggay
Clothes, clothes, clothes!
Cover-ups