Monday, July 17, 2017

Milk and Marijuana: “First Do No Harm”

Dr. Stellawagen speaks at San Diego County Breastfeeding Coalition meeting.
When California voters approved Proposition 64 and legalize marijuana last year, the basic idea was simple: a majority of people in the state believe that adults should be able to consume marijuana if they feel like it, just like a glass of wine at 5 o’clock. But how about pregnant and/or breastfeeding women? Shall we tell mothers not to breastfeed if they use marijuana?

According to Dr. Lisa Stellawagen (MD, FAAP) of UCSD Medical Center, It’s complicated. Marijuana usage during pregnancy and breastfeeding is an emerging public health problem. At a recent San Diego County Breastfeeding Coalition meeting, Dr. Stellawagen said that THC use is common in pregnancy. Survey shows that 10.9% of pregnant women used Cannabis in the past year. 

In fact, it’s hard for medical staff to know how many mothers actually used Cannabis because self report is not accurate. A 1993 study tested 7470 pregnant women in five centers from 1984 to 1989. All women were asked about drug use and tested by serum analysis. While 31% of the women were confirmed with serum testing, only 11% of them admitted to use marijuana.

Currently we do not have good quality evidence that THC use is bad for infant. Fetal effects of prenatal Marijuana exposure includes small decrease in growth, double increase in stillbirth, but there is no association with birth defects, and the risk of prematurity is unclear. As for neurodevelopment, study found inconsistent effect on newborn behavior.

We do not have good quality evidence that THC use in lactation causes poor outcomes, either. A 1990 study looked at maternal marijuana use during lactation and infant development in one year. Researchers compared one year developmental testing with days of postnatal exposure if breastfeeding, and found that infant’s daily exposure to marijuana in the first month was associated with a 14% decrease in Bayley motor scores, but metal scores were not affected.

We don’t even know how much THC gets into the milk when mother uses marijuana. A 1982 study found that after using THC for one day, there were 105 mcg of THC detected and after using seven days, there were 340 mcg of THC detected per liter of maternal milk. But there was no metabolite detected in infant urine.

That says, before we tell mothers not to breastfeed, we should be sure the risk outweighs the benefit. Benefits of breastmilk for the neonate is of specific significance to the illicit drug exposed infant. Breastfeeding reduces SIDS, decreases risk of neglect, has neurodevelopment effects. Breastfed preterm infant has less NEC, less infection, and better neurodevelopment outcomes.

We do know that THC does get into the baby and mother’s milk, though. So instead of "do not breastfeed if you're using THC," we should tell mothers “do not use THC when you’re pregnant or breastfeeding.” What if mothers are using THC? Dr. Stellawagen suggested, “Others should be available to care for your baby if you use THC. And if you use THC, smoke outside and use a ‘smoking jacket’ to minimize baby exposure.”​

*This is an original post for San Diego County Breastfeeding Coalition by To-wen Tseng.

Friday, July 7, 2017

Anything we can do, we can literally do it while growing a human inside of us?

Me, at 26 weeks pregnant. 
There has been a video circulating on the Internet. It shows Serena Williams playing in the Australian Open, Gal Gadot doing Wonder Woman reshoots, Alysia Montano racing at U.S. Championships, Beyoncé dancing on the stage, Nur Syryani Mohd Taibi shooting at Olympics, all during their pregnancy. The video concluded with “Anything you can do, we can literally do it while growing a human inside of us.”

Merely 26 weeks ago, I’d totally agree with the statement. I was a tough cookie during my first pregnancy. I stood under scorching sun for 11 hours to shoot the final landing of Space Shuttle Endeavour when I was two months pregnant. I covered smuggling stories from Mexico when I was eight months pregnant. I worked till the last day of my delivery, I even finished a short article while dilating in the delivery room. I traveled abroad several times through the entire pregnancy. Yes, everything I could do, I could literally do it while growing my first one inside of me.

Now that first one is four years old and I’m 26 weeks pregnant today. I thought I was going to be the tough cookie again. But this time I had pregnancy complications since the very beginning. I suffered from bad nausea, so bad that I have to move my computer to the restroom and do my works between vomiting sessions. I’ve been bleeding and had to cancel two business trips per doctor’s recommendation. I want to do everything I can do while growing my second one inside of me, but I’m trapped in this heavy, pregnant body.

I never realized how hard a pregnancy could be, and how essential supporting like paid family and medical leave could be. I’ve always been a supporter of paid family leave bills but I once thought I could live without them. Now I realized I can’t. Nobody can.

That’s why SB 5975, the paid family and medical leave bill the Washington State legislature passed last night was such a monumental victory, not only for working families and small business in Washington, but for the entire nation. I’m not saying this because I'm having a rough pregnancy myself. I’m saying this because maternity complications could happen to any woman, any family. Our country needs parents to work, also needs parents to have babies. For this very reason, all parents deserve supports.

Once it becomes law, SB 5975 will allow workers in Washington to take 12 weeks of family leave and 12 weeks of medical leave, with a maximum cap of 16 weeks of paid leave per year. In addition, the legislation provides for two more weeks of paid leave for women who experience maternity complications, offering much-needed relief to new moms who suffer difficult pregnancies. The legislation covers all workers in the state, even self-employed individuals who can opt in the program. It’s a great start and can be a model for the nation.

*This is an original post for MomsRising.org by To-wen Tseng.

Thursday, June 29, 2017

Breastfeeding: It takes a whole village

Feeding my child at the intermission of a LA breastfeeding conference.
When my first child was born, I did not have a breastfeeding plan. Then my pediatrician advised me about the American Academy of Pediatrics guidelines: exclusive breastfeeding for the baby’s first six months. Then, as foods are introduced, continuing breastfeeding until at least his first birthday.

A friend gave me an electric breast pump. Another friend gave me a cooler and some ice packs. I got serious.

I breastfed my child, relied on pre-pumped breastmilk to get through day care days. I faced breastfeeding discrimination situation at work by six months. I had four business trips by one year. But I insisted.

I insisted not because I am a true believer in the benefits of breastfeeding, but mostly because of the support I had.

Dr. Michael Kramer, a professor of pediatrics and epidemiology at McGill University Faculty of Medicine, led a research on the Promotion of Breastfeeding Intervention Trial, which studied 17,000 mother-infant pairs in Belarus starting in the mid-90s. Half of the mothers, who had all begun breastfeeding at birth, received addition support and encouragement to keep breastfeeding.

Dr. Maryam Sattari, an associate professor of medicine at the University of Florida, was the lead author of a 2016 study on the breastfeeding intentions and practices of 72 internal medicine physicians. The study found that 78 percent of the babies were exclusively breastfed at birth and 40 percent of them at 12 month, though 63 percent of the mothers had planned to go to a year. “These are moms who are highly educated, highly motivated, they all want to do it,” Dr. Sattari told New York Times.

What helped these mothers, she said, was encouragement from medical leadership, as well as appropriate space and time to pump.

According to the Centers for Disease Control and Prevention’s breastfeeding report card on women in the United States breastfeeding babies born in 2013 (the year my first was born), while breastfeeding overall is on the rise, the numbers show that many mothers in this country are not following the A.A.P. recommendations. Compared to 2003, more women in 2013 were initiating breastfeeding (81 percent, up from 73 percent), but only 31 percent still breastfeeding at a year. Cria Perrine, an epidemiologist in the C.D.C’s Division of Nutrition, Physical Activity and Obesity, said that our culture need to do a better job of supporting women who breastfeed.

With my first child, I made it to six months exclusively. We kept going till he was a little over two years old. I initiated breastfeeding with the support from my pediatrician and lactation consultants in the hospital. I made the business trips with my trusty electric breast pump and the help from airline and hotel staff members. I went through the breastfeeding discrimination lawsuit with the help from Legal Aid Society, local breastfeeding coalitions, along with others. The experience made me deeply aware of how hard it would have been to do this if I was less well supported.

*This is an original post for San Diego County Breastfeeding Coalition by To-wen Tseng.

Tuesday, June 13, 2017

Things To Know About Storing Breast Milk For A Flight


A horror story about a mom being forced to dump her breast milk in an airport is circulating on Internet. It reminds me about the two years when I was breastfeeding. I travel frequently for work and flew a few times with my breast pumps during that two years. My impression is that traveling as a breastfeeding mom can be challenging, but not impossible. Most agents do understand breast milk security procedures, and mothers should be good if they know the TSA guidelines in regards to breast milk storage.

Here are several things to keep in mind when carrying breast milk on a flight.

Travel with an unlimited quantity of breast milk
According to the TSA guidelines, you can bring as much breast milk as you want. I once flew with a whole gallon of breast milk from Phoenix to Los Angeles, no problem at all.

Declare breast milk to agents
You can travel with as much breast milk as you want, but TSA guidelines recommend you inform a TSA officer at the beginning of a screening process. Alerting agents ahead of time makes the process smoother and faster for everyone involved.

Breast milk will be inspected
Your breast milk may still be subjected to the X-ray machine, but if you don’t want it to go through there you can request an alternative screening method. I tried the alternative method once at the Austin-Bergstrom International Airport. It includes a pat-down and was time-consuming. Personally I prefer they just run my breast milk through the X-ray machine.

Bring small coolers and ice packs
Accessories to keep breast milk frozen, partially frozen, or in a cool state are permitted per TSA guidelines. I always bring a personal cooler with ice packs. Yon can ask a flight attendant for ice if you forget.

Store breast milk safely
The best way to transport breast milk and keep it fresh while traveling is in sealed containers kept in a small, insulated cooler with frozen ice packs. The breast milk should be used within 24 hours. If you won’t be using your milk right away it should go in a refrigerator or freezer as soon as you get to your destination. Always make sure label your breast milk bags with the date you pumped.

Moms don’t have to travel with their children to have breast milk
As explained on the TSA website, you don’t need to have your baby or child with you to travel with breast milk. I often travel for work with my breast pump and breast milk, but not with my child. 

Breast pump doesn’t count as a “carry on”
When bring your breast pump you don’t need to cut it as part of carry ons. Breast pump is considered a medical device and won’t need to be counted. But you should be prepared to keep telling agents that it’s a medical device. However, cooler does count as one of your carry ons. Personally I just bring the pump as a personal item and the cooler as a carry on.

*This is an original post for SDCBC by To-wen Tseng

Monday, June 5, 2017

Raising a bilingual child while losing my accent

Serving as a substitute teacher at my local Chinese-language school.
I’ve served as a judge at some local children’s Chinese-language speech and/or recitation contests on several occasions. I still remember my first time. I saw a little boy in a suit and tie, speaking with a crisp voice, saying, “Summer is my favorite season because the sunny days are cheerful and inspire me to do great things for my people.” When speaking, he raised his two fists high in the air.

Then I saw a little girl in a dress and high heels, with a clear voice she said, “Winter is my favorite season because it reminds me the Chinese fairy tale ‘Snow Child,’ a story that describes the noble sentiments of Chinese people.” Then she wiped her eyes in an exaggerated way.

These children were all born in the States, of Chinese descent. It was surprising to see they speak Chinese in such crisp and clear voices. But the speech content was very confusing. I really wanted to ask the girl what she meant by “the noble sentiments of Chinese people,” or the boy what the “great things” he was going to do for his people. I’ve got the impression that most of the scripts were written by parents.

After the young children spoke, the older kids stepped on the stage. Next, I saw a couple of teenagers in T-shirts and shorts hesitantly walked up, muttering things like, “We should respect our teachers, because…because Chinese people believe in their teachers, well I’m American, not Chinese, but…oh well, let’s just respect our teachers” or, “We should respect our parents because…because they are too old to understand anything we say…let’s just listen to them when we are home.”

It was funny to see young people with apparent Chinese appearance speaking with such strong American accents--so strong that I could barely understand most of them. Nine out of ten parents sitting in the auditorium frowned, clearly not enjoying the speech. Were they sad because their teenagers were not speaking Chinese as well as they had in elementary school? Were they worried because their children’s speech was not good enough to get them into college?

While considering how to score, I thought of my own child. He was then nine month old. I couldn’t help it but wonder whether he would be able to tell the fairy tale Snow Child in fluent Mandarin Chinese. Will he become an American kid with an American accent and complain “Mom is too old to understand anything I say”?

I frowned, like all the parents in auditorium.

In my family, we speak Chinese at home and English at work or school. My son was a late talker, but our pediatrician comforted us, saying that although bilingual kids can be slow to speak at the beginning, they usually catch up quickly. He encouraged us to insist on speaking Chinese at home.

We tried to create a Chinese-only environment at home with the hopes that the my son's first word would be a Chinese word. But the hope came to naught. His first word was an English word he learned at daycare: “Daddy.” This was my first failure in raising a bilingual child. In spite of this, we continue to speak Chinese at home. Every night we read bed time stories together in Chinese. By the time he turned three, my son could speak fluent Chinese, could tell Snow Child and many other fairy tales without help. I was very proud.

But my pride didn’t last for long. Just a couple of months ago, his preschool teacher told me that he had a hitting problem. The theory was that because my son didn’t speak English as well as other kids, his ability to stand up for himself in arguments was limited, and he turned to physical means of expressing himself.

The teacher suggested that we set an “English time” at home to help my son improve his English. I didn’t like the idea: the more I exposed him to English, the less chance he got to speak Chinese. Didn’t he speak a whole lot of English at school already?

But the hitting problem got worse. After consulting our pediatrician and therapist, I finally gave in and started a daily English story time at home. Kids are really like sponges, and his English improved in no time. He stopped hitting his preschool classmates, but his Chinese language skills went backwards.

I started to understand why I would keep seeing the same thing at Chinese speech and recitation contests: the younger the children are, the better their Chinese language skills as. I started to understand my hope of raising a bilingual child fluent in Chinese might once again come to naught.

I worked as a staff writer at a local Chinese-language newspaper when I was young. Many times, I interviewed outstanding second or third generation Chinese-Americans. When I asked them for a Chinese name for publishing purpose, they often said, “I don’t remember my Chinese name.”

A Chinese-American anti-death penalty activist once “drew” down her Chinese name for me after an interview. I couldn’t read the symbols she had drawn. I tried to guess and wrote down two characters next to her drawing. She read my writing and happily announced, “Yes, that’s my name!”

The article was published the next day. I got a phone call in the newsroom. On the other side of the phone was an old lady speaking Chinese with a sweet Beijing accent. She identified herself as the mother of the anti-death penalty activist, and said that I had gotten her daughter’s name wrong. I apologized, and she said, “That’s okay, I understand. My daughter must made the mistake herself. She never remembered her Chinese name. But I just want to let you know.” Then she was silent. “Hello! Hello?” I said, wasn't sure if I should hang up. Then she started to talk again, asking me where I was from, if I’m married, and if I had children.

At that time I was married but no children yet. The old lady said earnestly, “Take my advice. When you have your own kids, always speak Chinese to them.”

“Sure, sure,” I said, just saying that to make her happy.

Through the years I’ve seen many second generation Chinese-American kids struggling to learn Chinese. Since having my own kid, I often think of the old lady and her daughter who couldn't remember her own Chinese name. The thought is almost painful.

It’s not just the America-born children who are struggling. The away-from-home adults are also struggling. I’m a professional writer who was born to Chinese parents and raised in Taiwan, but who spent her entire adulthood in the States. I struggled to improve my English during my first years in the States. Now I write English more then Chinese. I can see clearly that I no longer speak Chinese as well as I used to. When I was in my twenties, I was eager to get rid of my Chinese accent. Now I’m desperate to maintain my Chinese language skill.

My son will soon be four, old enough to go to Chinese language school. I decided to let him start this fall. He didn’t like the idea of going to school on weekends and asked, “Why do I have to learn Chinese?”

I didn’t know how to explain the concept of culture to a toddler. I just told him, “So you can read ‘Journey to the West’.” The other night I read him the chapter “Monkey Subdues White-Skeleton Demon” from the classic novel. He wanted to know if the Monkey eventually returned to his teacher Xuanzang. I wouldn’t tell him. I told him that he’ll read it one day by himself.

I still hope to raise a bilingual child who speak fluent English and at least understandable Chinese. I don't expect him to love Chinese language right away. Language is always first a tool and then an art. I hope my son will first learn how to use the tool, and then, maybe one day, he’ll truly fall in love with the art.

This is an original post for a World Moms Network by To-wen Tseng. Photo credit: David Sprouse.