New studies on factors affecting breastfeeding

Two recent news on breastfeeding made me sit up and take notice this week. The first one was about the impact of caesarean births on the length a mom breastfeeds. Almost all of the breastfeeding advocates I've talked to promote normal or epidural free births, saying that this results in an alert baby, encouraging immediate latch-on to ensure a lengthy breastfeeding relationship.
A recent UK study conducted by the University of Manchester and East Lancashire Primary Care Trust, (who followed more than 2,000 mothers receiving breastfeeding help from the same peer support group, to enable a fair comparison of other factors) found that "[w]hat did have an impact was ethnicity, and the number of previous births."
Interestingly, "[w]hite mothers were 70% more likely to stop than non-White contemporaries" and "the relative economic status of the women made no difference, with the poorest as likely to continue or abandon breastfeeding as the wealthiest, nor did it matter whether the mothers were married."
The study also found that "babies who were put to the breast within an hour of being born - as recommended by the World Health Organisation - were not breastfed any longer than those with whom breastfeeding was initiated within 48 hours." But it was the "number of babies a mother had previously delivered impacted upon breastfeeding duration, with women having their third or fourth baby more likely to continue than those having their first."
Meanwhile, a study to be published in an upcoming issue of the Journal of Clinical Endocrinology & Metabolism concluded that "antidepressants called selective serotonin reuptake inhibitors (SSRIs), which include such drugs as Prozac and Paxil, may be linked with delayed secretory activation -- a delay in the initiation of full milk secretion."
According to the American Congress of Obstetricians and Gynecologists, about 70-80% of new moms experience baby blues with 10% developing into a full blown postpartum depression. I'm unsure if there's a similar study conducted in the Philippines but I do know that unlike in the US, antidepressants are not regularly prescribed to new mothers here.
I would think that the presence of extended family and yayas (nanny) contribute to the low incidence of postpartum depression here - which is probably why there are no studies or news on baby blues or postpartum depression being experienced by Pinay moms.
Despite the abundance of studies on effects on breastfeeding, I find that most of them are not applicable to Pinoy moms. We have certain cultural and lifestyle idiosyncracies that make the experiences of Pinoy moms unique. In my opinion, the most important factor affecting breastfeeding length here would be support from boss/work colleagues for a working mom while the successful initiation of breastfeeding hinges on a supportive pediatrician and family.

Welcome Home Anya Carissa

Finally, after 2 weeks in the NICU, my niece Anya Carissa was brought home. My sister and brother-in-law brought her home at about 930pm last Saturday, 24 January 2010. We had a small welcoming party with all the in-laws. My sister has also been directly breastfeeding her and happily, Anya's latch is perfect! My sister's breasts were definitely made for breastfeeding and she did not experience the sore and bleeding nipples that I did. Anya is also pooing about 4-6 times and peeing 6-8 times a day.

Yesterday was their first check-up back to Dr. Q. Happily, Dr. Q didn't tell my sister to stop breastfeeding or supplement with formula as Anya gained weight. However, she did tell my sister to give cell light/spirulina as supplement. They bought 1 box but are still deciding whether to give the supplement. *Sigh*

According to my sister, Anya hated having her photos taken and usually protests when there is a flash. But Anya seems to be following Achi Naima's footsteps and behaved very well during the photoshoot. Sharing with you some photos taken last Sunday by my husband, Stan. Isn't she just precious?!

Increasing Milk Production

Welcome to January’s Carnival of Breastfeeding

For this month, bloggers are tasked to compile the best breastfeeding blog posts and website pages on a specific breastfeeding topic they are passionate about. In my case, the top question that Pinoy moms always ask me is about tips on maintaining or increasing their milk supply. I edited the standard email I send out to these moms and included several links from webpages or blogs which I believe are particularly useful.

Check out the other bloggers’ posts which will be updated throughout the day and you will get a comprehensive compilation of the best breastfeeding resources arranged according to topic.

Here are my tips on increasing milk production:

1. As you know, baby is more efficient in drawing out milk than a breast pump. So you need to pump MORE TIMES than your baby feeds. I pump before my baby wakes up and I pump during weekends (even when am not working) either before or after she nurses. I previously wrote a post on maintaining my milk supply which outlines my pumping schedule during the work day.

2. Schedule power pumping sessions.A lot of moms swear by power pumping sessions. I've tried it a couple of times and it does add to my output for the day. You can read about power pumping here.

3. Eat well and eat lactogenic foods such as oatmeal, flaxseed, coconut juice. You can find more about lactogenic foods from MobiMotherhood or download a list of foods from here.

4. Take galactagogues (substances that increase milk). Locally, the most common galactagogue Pinay moms use is the humble malunggay. Very rich in calcium and other vitamins, it is plentiful and cheap. If you're a Pinay mom abroad and don't have easy access to malunggay, there are several other galactagogues you can take like fenugreek, blessed thistle, even Horlicks! Kellymom has a comprehensive index on herbs to increase milk and herbs to avoid while breastfeeding.

5. Having a double pump and learning how to balance the pump with one hand allowed me to do breast compressions while pumping. I'm not sure if it does increase production, but my milk output always increases when I do breast compressions while pumping. Although technically, under the theory of "more milk out, more milk production", milk production should increase when you do compressions. According to Dr. Jack Newman, the purpose of breast compressions is to help a sucking baby drink more milk and simulate let down or the milk ejection reflex. You can check out a video on breast compressions from YouTube.

6. In one of my e-groups, several moms also take prescription drugs such as domperidone (locally known as Motilium) or Reglan. Domperidone is said to be really effective but was banned by the US FDA, although pro-breastfeeding doctors have made their position about this matter clear here. I have not tried taking domperidone or reglan to increase my milk production -- the thought of prescription drugs mixing in my milk just scares me. You can read all about domperidone here.

7. Stay hydrated but not overly so. Among the tips I heard about milk supply was to drink to thirst but not more than that. Apparently, too much water can also kill your supply. Read about that here.

8. Finally, the one thing that all new moms forget about but is very important for increasing and maintaining milk production is to rest, relax and sleep!

Check out the other compilations here:

Breastfeeding 1-2-3: Thrush and Breastfeeding

Good Enough Mum: Filling the Information Gap

Baby Dust Diaries: Inspiration For a Nursing Mama's Soul

Hobo Mama: Full-term breastfeeding posts and pages
Motherwear: My favorite web resources for some common breastfeeding concerns

The cup of life

Photo by Rudy Liwanag, Manila Bulletin

I was quite excited to read the feature about the Philippine General Hospital's Milk Bank in Friday's Manila Bulletin. As I shared in my previous post, I was trying to get my milk pasteurized but they could't run the pasteurization machine because of lack of milk donations. Also, this article ran contrary to the practice at the other hospital used bottles for their premature babies. At the UP-PGH, premature babies were cupfed with their own mother's milk or pasteurized donor's milk.

UP-PGH Milk Bank is where I regularly donate milk in the past year. As emphasized by Dr. Jessa Sareno, a neonatologist fellow, their credo is as follows:

Human milk has no substitute. Breast milk also has immunoprotective properties that fight against life-threatening infections like sepsis, pneumonia, diarrhea, and enterocolitis. It likewise has components, which help the newborn’s intestinal tract to mature, allowing for easy digestion, better absorption, faster growth, and better health. Plus, it also has nutrients in a combination that no artificial product can duplicate.

This article is close to my heart because of my niece Anya Carissa. UP-PGH is a public hospital but I was amazed to read that their lactation unit took time out to teach mothers how to hand express milk and had the patience to cup-feed the babies. As opposed to my niece's hospital - where the doctor just told her breastfeed without details on how to breastfeed a premature baby or how to keep up her supply. My sister has been having problems with supply and Anya is still not up to her birth weight -- so now, Dr. Q is suggesting that my sister purchase Spirulina to mix to her breastmilk!

When my sister first breastfed her, Anya was removed from the NICU and taken to the breastfeeding room. Since only the mother and baby could stay in the breastfeeding room, I asked my sister if a nurse stayed with her to show her how to properly position and latch Anya. She said that the nurse only stayed for a short while and she was left to her own devices. I wish this hospital -- with all its expensive equipment, gear, marketing ploys - would set aside some of its budget to purchase a pasteurization machine and hire an honest-to-goodness lactation consultant. This hospital even has its own cord banking unit -- but no breastfeeding support.

Anyway, the article suggests some ways you can be a milk angel to the UP-PGH Milk Bank - by becoming a financial or milk donor, or by becoming a volunteer to cup-feed babies. Dr. Jessa even suggests celebrating your birthday in a unique way by volunteering to cup feed the babies. I'm guessing that the PGH neonatal unit is a much more loving setting and a far cry from Anya's cold, sterile own NICU.

To know more how you can help, contact the Lactation Unit and Human Milk Bank, 4th Floor, LCB, Philippine General Hospital, 5218450 local 3418/3409.

A Nursing Mom's Shopping Guide - Update on Clothes

I haven't been updating my shopping guide. I was supposed to write a post on breast pumps available locally but I keep postponing it and it's still languishing in my drafts folder. However, my sister is now a new nursing mommy and I've been checking out stuff that is available for her. Since my last post on nursing clothes, I'm quite amazed at the variety of new brands now available in the Philippine market.

Procreation/GlamourMom

Last weekend I went to Procreation at Shangri-la Mall to purchase some things for my sister. I normally don't buy things from Procreation because I don't like the styles of their nursing tops (frumpy) and I find that their items are more expensive than other stores.

For instance, I was looking for a Palmer's Anti-Itch Oil for my sister's tummy. We first checked availability at Rustan's but only a small bottle, packaged with an anti-stretch mark cream was available for about 1K. The large bottle costing about P450.00 was sold out. I found a similar bottle in Procreation selling for P600.00 -- P150 more than Rustan's which was just at the other end of the more.

Aside from an overpriced bottle of anti-itch lotion, this trip to Procreation yielded a great find - Glamourmom nursing tanks at just P1K each. I recently purchased 1 at a baby-centered one-deal-a day site and paid a little over P1k for it. Definitely, Procreation's Glamourmom tanks are great bargains! And while you're there, you may want to check out their other nursing clothes.

My Lovely Closet

This is a Malaysian brand which has been part of my online store for sometime now. This is also from the makers of Fabulous Mom nursing bras. The clothes are very well made and the fabrics are quite soft. Best of all, they are pretty affordable, ranging from P600 to P1000 per item.

Check out the available designs here.

Mia Bella

This is a new brand being developed by 4 moms from Davao City. This line will focus on mom and son/daughter clothes but since 2 of the moms are nursing moms, they convinced their other partners to develop a nursing line as well. The first collection will soon be completed and will be available at Mama.Baby.Love soon.

Mama Au Lait

A brand which is also locally developed by Jane Lim, new owner of the TerraBabies Boutique. Her first collection is a mix of casual and party clothes. I first saw this brand during the Expomom in November 2009.

Au Lait
This is the newest clothing store that is focused on pregnant and nursing mom. Run by Audrey Chua Uy, they are the exclusive distributor of the Mothers En Vogue line from Singapore. Mothers En Vogue is a very popular but pricey line and their designs are very stylish. Au Lait is a free standing store located at 34 Wilson St., Greenhills, San Juan, with store hours from 11 am - 8 pm (Monday - Sunday).

Spoiled

Spoiled is actually a store located at Mezzanine Flr. Goldland Millenia Suites, Escriva Drive, Ortigas Center, Pasig. It is run by Funfy Basa (a college batchmate) who also designed her own nursing wear line under the Spoiled label. The store also carries several nursing wear brands such as Plume, Mamaway and Mommy Matters.

Prepimom

Another local brand which is owned by co-N@wie Hannah Ballarta. I think her family owns a fashion house and she branched out to create a nursing line. Her line is displayed at their sotre located at GF Waypoint Building, 4 Bayani Road, Phase 5 AFPOVAI, Fort Bonifacio Taguig City (beside AFPSLAI).

Bleupram
A couple of nursing tanks from the Fresh Mums brand, as well as locally-made maternity delivery gowns are available here. I first saw them during the St. James Bazaar. This store also carries Milk Bands which are nursing bracelets to help you remember which side baby last nursed on, how long the session was and what time.

I already previously covered other brands such as Mamaway, Blissful Babes, Plume, Mommy Matters and Bosom Buddy in my first post. Check it out here. Let me know if I missed out a brand or store!

I think it is a great thing for nursing moms to have a variety of brands available. When I was a new nursing mom and attending classes, I was always on the look-out for other moms wearing the same top as I was (it happened a couple of times) since there was only 1 popular brand then. But now, the influx of various brands allow nursing moms to cater to their fashion whims while still being able to comfortably nurse in public :)

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

Nursing Bras

Preemies and Breastfeeding

anya carissa just after birth

Anya Carissa is getting bigger and improving! They've removed all her tubes today, except for her IV which will be removed after her last dose of antibiotics at about 11pm tonight. She has been in the NICU for 1 week and 3 days. For the first time today, her parents were able to hold her, albeit briefly. Having a preemie niece made me think about several questions or issues on breastfeeding, hospital policies some of which I was able to clear up with Dr. Z.

1. No colostrum

As I mentioned in my earlier post, Anya's doctor did not want to give her colostrum for fear that she might choke. Instead, she was given glucose water via IV and for her first 2 feedings. After that, she was given my sister's breastmilk.

2. Use of bottles at the NICU

Anya started using a feeding tube. The tube was eventually replaced by a bottle. I asked why a bottle was used instead of a cup. The hospital prided itself as being breastfeeding friendly and in their nursery, I was under the impression that they used cups to feed the babies. I clarified this with Dr. Z who shared that for premature babies, there are experts who prefer bottlefeeding because of the risk of choking/aspiration and more effort required and calorie usage from the baby. This is why although full-term babies are cup-fed, NICU babies at this hospital are bottle-fed. Little Anya is now up to 30ml per feeding, although she feeds slowly. I think that slow feeding is quite normal -- Naima used to take 1-1.5hours to finish 2oz of milk.

3. Direct Breastfeeding

There are certain guidelines for breastfeeding preterm babies which are quite different. As Dr. Z emphasized, feeding is a very big issue in the NICU, and is a skill that a baby needs to be competent at before he or she goes home. La Leche League has a comprehensive resource page on feeding premature babies. You can also check this page from About.com for a quick overview. I wish I had read the About.com article earlier. One of the tips she had was: "Even if your baby is being fed intravenously, you can swab the colostrum inside her cheeks." -- this would've certainly been helpful in our case since my sister could just produce drops of colostrum then.

4. Kangaroo care
It was only today or more than 1 week after she was born that Anya was held by her parents. Since she was born, she was placed inside the incubator, with her parents just being allowed to hold her briefly through the holes of the incubator with gloves. Just recently, ABC News ran a story about how premature babies get lift from kangaroo care that helps give moms (and dads) purpose. It was actually identified as one of the greatest gifts NICU staff can give the preemies' parents. Then again, the article goes on to discuss about how some doctors draw the line when the baby's on a breathing tube -- and don't allow kangaroo care.
Baby Anya had been either on canula (oxygen tube) or ventilator since she was born. It was just last night when her breathing tubes were removed. Maybe this was why kangaroo care was only practiced by Anya and her parents today.

5. Milk Donations
In the course of my breastfeeding career with Naima, I have donated gallons of milk to different babies - singletons, twins, triplets, preemies, full-terms. Except for the milk I donated to the PCMC and PGH milk banks, I'm pretty sure that my milk was not pasteurized before being fed to the babies. Dr. Z again reminded me that the safest alternative to mother's milk is pasteurized donor milk OR directed donor milk from a screened donor.
I tried checking with UP-PGH on how to get my milk pasteurized for Anya but was unsuccessful. The PGH milk bank has a huge pasteurizer which runs only when they have collected 71 8oz. Dr. Edwards bottles. This is equivalent to about 568 ounces and they were nowhere near that! (side note: if you have extra milk, now would be a good time to donate -- PGH continuously accepts donated breastmilk). Even if I donate all my old stocks of milk in my freezer, we still wouldn't be able to run the pasteurization machine.
I still collected milk once daily and whatever milk I collected was stored in the NICU freezer for Anya in case my sister couldn't express enough. I felt that my milk also served to boost up my sister's confidence and prevent her from stressing too much about her milk production. Since she was relaxed when pumping, she was able to make enough for Anya's demand and so far, it was only once that they had to give Anya my breastmilk.

Once her IV tubes are removed, she will be transferred to a transition room where my sister will be allowed to try direct breastfeeding. Hopefully, Anya's improvement will be continuous and we will be allowed to bring her home by the end of this week.

Breastfeeding Classes on January 2010

If you're looking for breastfeeding classes this weekend, here are a couple of classes you can check out on:

1. Start the year with the strength of having a breastfeeding support group, raise concerns, get information or counseling that you may need from experienced moms and/or from breastfeeding counselors. La Leche League Philippines will be having its first meeting for the year this Saturday (January 9), 9am at the Parish Hall of Mary the Queen in Greenhills, across Xavier. To confirm your attendace, text Jane (09176260585) or Cris (09178941099).

2. Free Breastfeeding Class at Shaw Blvd.

This class is conducted by Cher Anonas (of Plume Nursing Wear) and Zeny Feliciano. Topics to be discussed include: Benefits of Breastfeeding, Different Positions and Correct Latch, Getting Breastfeeding Off to a Great Start, Overcoming Common Challenges, Lactation and Relaxation Massage, etc.! Registration starts at 1:30 pm. Class starts promptly at 2:00 pm. Class is on January 16, 2010.

Admission is free but pre-registration is a must. Please text BREASTFEEDING CLASS PARTICIPANT, your full name/s and number of participants (dads, nannies, and other support people are very welcome!) to 0917 898 24 37 or email Cher. Please bring: your baby or a doll, food and drinks to share with 4-6 people.

Location: Organics Asia, Inc., Unit 401 Emerald Place, 604 Shaw Boulevard, Pasig City

• Directions to Location: Coming from Edsa Central side :
• Take Shaw Blvd going to Capitolyo-C5
• At the 2nd stoplight, you will pass by Tropical Hut - 10q store (this is at corner Pioneer St.)
• You will see Caltex and then Pan de Manila
• 604 Emerald Place Bldg is right after Pan de Manila
• There is a Ganzklar Signage at the ground floor
  Please proceed to elevator for unit 401 Organics Asia Inc. Parking is very limited - most of the time there are no available slots.

3. L.A.T.C.H. class on January 23, 2010. This will be at The Medical City and will start at 9am.

Great News for the New Year!

Last news for 2009

The last news I read about breastfeeding in 2009 was about Taiwan's government who will be drafting a bill to protect the rights of the nursing mothers in public. The fine is NT30,000 or almost US$1,000.00.

Such a similar law would be welcome in the Philippines and more so in North American countries. I did say before that Filipino moms should not have to worry much about nursing in public. But recently, with now that Naima is a noisy 2-plus toddler, I sometimes get those "looks" whenever she nurses in public -- which thankfully is not very often.

I am unsure if there are any other Asian countries who are proposing to fine harassers of breastfeeding moms. Kudos to the Taiwanese government for responding to the calls of nursing moms.

First news for 2010

I was pleasantly surprised to read about breastfeeding in a business news website. The article, written by a HealthDay reporter, summarizes the breastfeeding benefits for both mom and baby. Dr. Ruth Lawrence, Chairman of the American Academy of Pediatricians' section on breastfeeding emphasizes how breastfeeding experts focus on "brain growth [and its importance] for a number of years," while those from the formula industry "focus more on how much weight babies can gain with their product."

This will be an exciting 2010. L.A.T.C.H. has several activities lined up (including trainings for more counselors). At my workplace, we are looking forward to the opening of more lactation rooms. Looking forward to more great breastfeeding news!