Happy Holidays from Chronicles of a Nursing Mom

I'd like to share this painting entitled "Savings in a Bao" by Norma Belleza from my employer's painting collection.

This was used by Claire's group for their Christmas card this year. As Claire shared, "the culture of breastfeeding and culture of saving are both depicted in this wonderful work of art." Thank you for posting this Claire! As Dr. Mianne says, truly the art of breastfeeding!

Happy Holidays everyone!

HMO and breastfeeding friendly pedias

image from http://user.pa.net/~nrwing/hmo/

The search of a breastfeeding-friendly pediatrician is a challenge to every nursing mom. No pediatrician will say that they are not breastfeeding friendly. Instead, it is up to the mom to find out if their pediatrician is REALLY an advocate or a "poser". This is why I highly recommend that moms (and dads!) interview prospective pediatricians for their children as early as the second semester of pregnancy. Instead of being limited to the partner of your ob-gyne, why don't you take time to determine if Dr. xxx will be match for your family. You can check tips in my previous post on finding a breastfeeding-friendly pediatrician.

If finding a breastfeeding-friendly pediatrician is already a challenge, much more so is finding one that is accredited with a health care or health plan. One of my office perks is a health plan for my beneficiaries (e.g. Naima and Stan). However, I was limited with my choice of doctors, as my preferred pediatricians for Naima were not included in the plan. I asked a doctor-friend why it was so difficult to look for a good doctor who was accredited with a health plan. According to her, health plans do NOT treat the health providers well, which is why a lot of preferred doctors are not included in the "accredited doctors" list of your health plan. Doctors get paid merely P150-P200 pesos per consult! After four years of medical school plus another 2-4 years of specialization, what doctor will agree to P150-P200 pesos per hour?! Perhaps new doctors who have yet to build a "patient base" would do so?!

So what do I do? I still go to my preferred doctors and pay out of pocket. But I also maintain a "health card accredited" pediatrician so in case Naima needs to go through a procedure, I can get a referral from the accredited pediatrician so the procedure is covered.

That said, my sister was quite lucky to have found a health care card accredited pediatrician who was breastfeeding friendly. However, one disadvantage here is the queue and the waiting time - which is anywhere from 1.5-3 hours! Luckily, they live near the doctor's clinic and are able to go home after getting a "waiting number".

Anyway, if you are still in search for a breastfeeding friendly pediatrician, L.A.T.C.H. has compiled a list. Please don't ask for xxx health plan or health card accredited pediatricians though as L.A.T.C.H. does not have that. Instead, just be resourceful, call the doctor's clinic and ask them directly if they are accredited.

Kindly note that list is not being published as it is constantly being updated, after receiving reports or feedback from moms who have been referred to these listed doctors. You can email L.A.T.C.H. though and ask for a list of breastfeeding friendly doctors in your preferred hospital/clinic to be emailed to you. L.A.T.C.H. however asks that you do not publicize the list emailed to you for reasons stated above. Instead, if your friends or relatives ask you for referrals, you can just refer them back to L.A.T.C.H. so an updated list can be emailed to them.

Milk Banks, Milk on Motorbikes and BPA-free bottles

Benz' milk stash for Laya

Remember the FB milk sharing group Eats on Feets (we have a Philippine chapter!)? Well, it has gotten both praises and criticisms. But the good thing about this is that it has made the US FDA sit up and take notice of the dearth of milk banks in the USA. Locally, the main milk bank we have is that of UP-PGH while other milk banks available are the PCMC and Fabella (where you can buy breastmilk for P200 per 200ml. Check out my post about milk banks in the Philippines here.

Dr. Jessa Sareno of the UP-PGH milk bank has raised that sometimes they have mothers who are willing to donate but are unable to bring their milk to UP-PGH. I'm sure she'd be interested in this news about volunteer bikers transporting milk for the National Health Service in the U.K. Wonder if any of our local biker groups are willing to take on this advocacy?

Finally, Massachusetts is the newest addition to the list of US states to ban BPA in bottles. Canada was the first country to ban BPA, followed by the European Union. Are you using bottles to feed your baby? Have you checked if they are BPA-free?

Ideal Workplace Lactation Room

My office already has 2 lactation rooms. Although they are not our ideal rooms, we're happy that management took time and resources to outfit our office with 2 rooms. We are working towards the

establishment of a third room in another building. Sometime in June, a reader, Bing emailed me and shared that her office will be moving to a new location with a lactation room and she was being given to opportunity to "outfit" the room on behalf of nursing moms! Lucky her!

In one of my email groups, the moms came up with a wish list of items they want in their lactation rooms. I chose my own wish list and split it into needs and wants

Naima's Triple Treats!

My online store is having a promotion for Naima's 3rd birthday. Last 2 days remaining. Please read promotion details HERE. Just a reminder - we will closed from Monday, 20 December 2010 until Monday, 3 January 2011. Orders must be completed by Sunday, 19 December 2010 for shipping on Monday, 20 December 2010. We will re-open on Tuesday, 4 January 2010. Happy holidays everyone!

Physicians vs. Breastfeeding

It has more than 1 year since I started volunteering as a breastfeeding peer counselor. A common complaint I have received from moms who were having breastfeeding problems is the lack of support from their pediatricians. Just recently, I received a complaint from a mother who gave birth at a hospital along Edsa sometime in June 2010. She shared that as soon as she gave birth, her husband was ordered to buy Enfalac A+ (the doctors specified the brand!), without any consultation or concern on their preferred feeding. The mom was also not instructed or advised on latching her baby. What's worse, it took 2 nights before her baby was roomed in. She had been constantly requesting that her baby be roomed in but was rebuffed by the nurses. One nurse even told her that she might regret her request to room in because she can't send her baby back to the nursery! Further, her ob-gyne and pediatricians did not offer any advice on direct breastfeeding and instead told her to use a breast pump. The pediatrician also issued an order directing them to feed the baby 1 oz. of Enfalac A+, every three hours!

I am really appalled by the ignorance and the audacity of her doctors to recommend formula AND specify a brand of milk! Mead Johnson must be paying their marketing people really well!

The experience of these parents are not uncommon in the Philippine setting. In fact, based on the numerous complaints and stories I've heard, this experience is a "norm" in our local birth setting. The parents are hell-bent on filing complaints against the physicians and hospitals. I've given her options of what steps she could take and sharing these steps here for other interested parents.

First, even before you go to the hospital, print a copy of this Department of Health Press Statement released on 21 May 2010, entitled "DOH Releases Guidelines on Physicians on Breastfeeding" Salient points of the guidelines would be:

Responsibilities of Physicians:

• Counsel pregnant women on the merits of breastfeeding starting at the first encounter, and reinforced with every subsequent visit;
• Prescribe non-human milk only when there are valid medical reasons and with information on the inherent hazards and risks of non-human milk;
• Strongly advocate for the adoption of essential newborn care, rooming-in and breastfeeding standards as mandated by law.

Prohibitions on Physicians:

• Accepting gifts or any sort of material or financial inducements from manufacturers of breastmilk substitutes and other products covered by the Milk Code;
• Accepting samples of non-human milk or similar products unless approved by the DOH, nor giving out samples or gifts of any sort coming from milk companies to pregnant women, mothers, and members of their families;
• Displaying, promoting or distributing non-human milk and other breastmilk substitutes in their offices or clinics.

Second, read up and be aware of the Essential Newborn Care Protocol which lists down 4 steps that need to be immediately undertaken to prevent newborn deaths which INCLUDES non-separation of newborn from the mother for early breastfeeding initiation. Check out this slideshow being used in the trainings and promotion for the ENC, prepared by Naima's pediatrician, Dr. Mianne Silvestre. Meanwhile, you can download Administrative Order No. 2009-0025, Adopting New Policies and Protocol on Essential Newborn Care HERE.

If you have been placed in a situation where your doctors refuse to listen and insist on giving formula and want to complain, then make sure you get a copy of their WRITTEN order, prescribing the artificial milk. Often, parents are berated by doctors when they insist on breastfeeding - and usually, parents don't argue (because as a culture, we, Filipinos are raised to believe that doctors are intelligent, always right, etc - and in fact, it is a common refrain/hope for parents to wish that their kids become doctors!!!). Once you have a copy of that written order, keep that for further action.

First step would be for the parents to write a complaint letter to the head of the hospital where you gave birth - include the particulars - name of the doctor, date, incident report AND a copy of the prescription. Don't forget to state your rights as provided in the ENC and DOH Protocol and Press Statement above.

Then, you can proceed to file a complaint against the doctors with the Philippine Medical Association. Call 929-6366 to check if the doctors are members of the PMA. If they are, write a notarized letter of complaint with supporting documents addressed to Dr. Nimfa Baria, Chairman, PMA Commission on Ethics and mail or personally deliver the letter to 2/F PMA Building, North Avenue, Quezon City. You can also file a complaint with the Professional Regulation Commission with the procedure outlined HERE. You can also file a complaint against the hospital with the Department of Health's Center for Health Development. You can download the flowchart of how to file a complaint HERE.  (*The links to CHD are broken.  You can access their Facebook page instead.) 

I would like to emphasize that filing a complaint means that you are serious and willing to follow through. It is not simply submitting the letter but you must be willing to testify during hearings if deemed necessary by the decision makers. I know that this will entail a lot of time and effort from the parents but steps like this will definitely make a huge impact in reforming the physician culture in the Philippines and hopefully, make it more breastfeeding friendly.

Milk Code Violations

UPDATE 1 September 2012:

The Department of Health has launched an online portal where you can report Milk Code violations! Visit this page: www.milkcodephilippines.org

Last Tuesday, I read about how religious organizations and the UNICEF teamed up in an effort to promote exclusive breastfeeding in the Philippines. I'm glad to read that these organizations recognized that their goal of improving lives and welfare of children can be done "by supporting the national breastfeeding policy as a means to improve child survival and nutritional status."

Despite policies and efforts by various groups in promoting and supporting breastfeeding, success is not easily attainable due to the marketing efforts and machinations of milk companies. Let me share with you two photographs from local supermarkets of blatant Milk Code violations:

As fellow mompreneur Jane says, here's what you can teach your toddler - "ARTIFICIAL MILK" - point out the words written on the can, "Breastmilk is best for babies up to 2 years and beyond." Help him write them down on that piece of paper to help him make better progress :D

This one was taken by breastfeeding advocate Velvet. The sign on the photo says" WE WELCOME CHILDREN BELOW 7 YEARS OLD WHEN ACCOMPANIED BY THEIR PARENTS OR GUARDIANS." After taking the picture, she saw a child (about 9-11 months old) with her dad, taking a sample for her to drink. Check out the little boy on the right side of the picture - potential captive consumer for Nestle?

Let me again emphasize the need for volunteers to police and report Milk Code violations. There are groups who do this but they need all the help they can get. Violations are just so numerous that sometimes, we think they are already the norm.

If you want to know how to report violations, check out this previous post.