Monday, October 2, 2017

Breastfeeding Helps Babies with Neonatal Abstinence Syndrome

Dr. Yvonne Vaucher talks about breastfeeding and NAS at an SDCBC meeting.

Neonatal abstinence syndrome (NAS) is a term for a group of problems a baby experiences when withdrawing from exposure to narcotics. It is a concern because when a mother uses illicit substances, she places her baby at risk for many problems.

Most neonatal clinicians are acutely aware of the increase in neonatal abstinence syndrome: a nationwide increase from 7/1000 births in 2004 to 27/1000 births in 2013 is reported. Here in California, about 1,190 newborns were diagnosed with drug withdrawal syndrome in 2014, up more than 50 percent from a decade earlier.

Symptoms of withdrawal in full-term babies may include:

  • Tremors (trembling) 
  • Irritability (excessive crying) 
  • Sleep problems 
  • High-pitched crying 
  • Tight muscle tone 
  • Hyperactive reflexes 
  • Seizures 
  • Yawning, stuffy nose, and sneezing 
  • Poor feeding and suck 
  • Vomiting Diarrhea Dehydration 
  • Sweating 
  • Fever or unstable temperature 
The cost of care for infants with NAS is quite high as many of them are admitted to the NICU for withdrawal symptoms and associated care. The length of stay is 16.4 days, comparing with an average 3.3 days of stay for healthy infants. A 2015 study cites more frequent readmissions for these infants. Researchers found these infants were 2.5 times more likely to be readmitted within 30 days than healthy infants.

The current standard care for narcotics-exposed infants involves limiting exposure to lights and noise, promoting clustering of care to minimize handling and promote rest, swaddling and holding the infant, and providing opportunities for non-nutritive sucking. These soothing techniques, though commonly used to comfort infants, have not been evaluated in relation to such outcomes as the severity of the neonatal abstinence syndrome or the length of the hospital stay.

The strongest evidence from systematic reviews for improving outcomes is in support breastfeeding, with emerging evidence that favors rooming-in. Studies have consistently shown that infants with NAS who are breastfed tend to have less severe symptoms, require less pharmacologic treatment, and have a shorter length of stay than formula-fed infants. Breastfeeding should therefore be encouraged for mothers who are stable and receiving opioid-substitute treatment, unless there are contraindications, such as HIV infection or concurrent use of illicit substances. Similarly, emerging evidence suggests that babies who stay in the room with their moms have a shorter hospital stay and duration of therapy and are more likely to be discharged home with their moms. Rooming-in has also been associated with improved breastfeeding outcomes, enhanced maternal satisfaction, and greater maternal involvement in the care of the newborn.

The increased incidence of the NAS and soaring increased in associated health care costs warrant a consistent and comprehensive approach to mitigating the negative outcomes for affected infants, their mothers, and the health care system. Recent innovations in management include standardized protocols for treatment, which have positive effects on important outcomes such as the duration of opioid treatment, the length of the hospital stay, and the use of empirically based dosing protocols. Breastfeeding and rooming-in are promising nonpharmacologic strategies that may also improve outcomes for babies and moms.

This is an original post for San Diego County Breastfeeding Coalition by To-wen Tseng. Photo courtesy Heidi Burke-Pevney.

Friday, September 8, 2017

Parents As Seen Through The Eyes Of Children


My husband is a software engineer who specializes in smart phone application development. Our four-year-old son described his father’s job as “very challenging.” He said, “Dad is always fixing phones, lots of phones. His lab is loaded with phones.”

I am an independent journalist and a freelance writer. Our son described my job as “very easy.” He said, “Mom is always playing with her computer, chatting on the phone, and traveling by air.”

So this is how my son looks at writing to deadline, phone interviews, and business trips. How cute, yet how annoying! My husband and I joked about this, and I told him, “So our son thinks your job is challenging and mine is easy. That’s not fair. I don’t want to be looked down on—not by our own child!”

For the first time I saw myself through my child’s eyes. I was both surprise and amused to realize that I actually have a fear of being looked down on by my child. Then I thought about my mother, and what she was like in my eyes when I was four years old.

Back then, I was afraid of my mother. She was a so-called “tiger mom” who spanked me often. Most of the time, I didn’t know what I had done wrong. I was constantly scolded for my “bad attitude” when I was too young to even understand what an attitude is. I vividly remember how scary my mother was when she was beating me, but I barely remember what I did to anger her.

There are a few things that I remember, though. Here is one memory. My mother used to make fried rice noodles and throw in a lot of dried shrimp. The smell of the dried shrimp totally covered the flavor of the shiitake mushrooms and the sweetness of the cabbage.

I asked my mom, “Can you not put so much dried shrimp in the fried rice noodles?”

She effectively silenced me with an angry shout: “This amount of dried shrimp is necessary in fried rice noodles! Shut your month and eat up, or I’ll beat you up.”

When we visited my mom's brother, his wife made fried rice noodles, but without the dried shrimp. It was delicious. I ate two bowls and happily said to my mother, “Look, Auntie made fried rice noodles with no dried shrimp! It’s good! Let’s try this, too!”

When we got home that day, my mother grabbed a tennis racquet standing by the door and started to strike me with it. She was too upset to find the rattan that she usually used. The racquet strokes fell on me like raindrops; the pain was great. I started to cry, “Why are you hitting me?”

She shouted, “Because you have a bad attitude! Stop crying or I’ll beat you even more!”

For a long time, I didn’t know why I was punished. My mother was an irritable and horrible person in my eyes. I guessed she hated me, but I wasn’t sure. I dared not ask.

Later, when I was in middle school, a friend of mine lent me her CD of Blur’s. I brought it home, totally forgetting that we didn’t even have a CD player. I put the CD on my desk.

My mother saw it and asked me, “What’s this?”

I said, “It’s a CD I borrowed from a friend. But we don’t have a CD player at home, so never mind.” 

My mother asked me what a CD was. I said, “A CD is a compact disc. You don’t know that?”

She suddenly raged, grabbed a clothes hanger and hit me in the face. I cried, “Why are you doing this?”

She shouted, “Because you have a bad attitude!”

I was fourteen years old. While I was being hit by that hanger, I started to hate my mother. I thought she was being unreasonable. I thought she was just randomly beating me up because she happened to be in a bad mood, or worse, for no reason at all. I vowed that I would never become somebody like her.

Then I grew up. I left my parents a long time ago, but I’m still searching for the answer to the tough question, “Why my mother physically abuse me?” I tried to look at her from a mature woman’s eyes, and not from a child’s eyes. I finally figured out that maybe, just maybe, I knew one of the reasons behind my mother’s abuse. She spent her whole adult life as a housewife, and was kept at home for the whole time. My father’s parents did not have a harmonious marriage. My grandmother once ran away from home, and as a result, my father was insecure about relationships. He limited my mother’s social and career life. My mother hated to be isolated from the outside world, but she was helpless. She was afraid of being despised, especially by her children. And when I showed the attitude that she considered scornful—for example, by criticizing her cooking or questioning her knowledge—she beat me to maintain her dignity.

When I was a child, I first feared and then hated my mother, but I didn’t despise her until I became a teenager. Now, when I think of her sense of inferiority, my heart almost aches. But I don’t want to be sympathetic. My mother had a big ego, and it would be painful for her to know that her daughter had sympathy for her.

When my own son described my job as “very easy,” I realized that I too did not want to be underestimated by my child. So I reminded myself about my own mother. She was eventually despised by her own daughter, not because she made bad fried rice noodles, not because she didn’t know what a CD was, and not because she was an isolated housewife, but because she had abused her child. Ironically, she abused her child exactly because she didn’t want the contempt.

I realized that children are not confused. They only despise parents when the parents despise themselves.

I asked my son, “Surely Dad is great! When you grow up, do you want to be an engineer just like him?”

He said, “No. I want to be a writer just like you. So that I can play with my computer, chat on the phone, and get on airplanes all the time.”

This is an original post for World Moms Network by To-Wen Tseng. Photo credit: Mu-huan Chiang.

Wednesday, September 6, 2017

How hard (or easy) breastfeeding can be


A mother shared a tearful photo about the pain of breastfeeding, saying that “I cannot hide the struggle.” She wrote, “I love seeing all these beautiful women in their beautiful nursing clothes smiling down at their babes as they lovingly look up back at them hand in hand while breastfeeding…That is not my reality.” As the post going viral, we have to ask, how hard breastfeeding can be?

The truth is, it can be as hard as one can imagine, for both stay-at-home and working moms.

Breastfeeding moms can have a variety of issues: Whether the baby is latching on properly; whether the mom is producing enough milk; whether the mom’s nipples are adequate. Maybe the new role overwhelms the mom; maybe the hormones have her; maybe the nipple shield is ill-fitted. Some babies demand nursing every 10 minutes and it exhausts their moms. Some breastfeeding moms are starving all the time and have to get up at 3 a.m. and eat. Some moms struggle with nursing twins. Some preemies are too small to nurse.

And it’s even harder if the mom’s breastfeeding while working. Even before going back to work, these moms have to build up their breastmilk supply and store extra milk. Pumping can be an unpleasant, sometimes hour-long process. And pumping at work sucks for many women. In spite of the workplace support in federal law, many of the working moms are still stuck pumping in bathrooms, or attempting to find privacy. Those lucky moms who actually get support at work still have to block off at least two 30-minute increments on their calendar to protect pumping time. The stress at work can impact breast milk production, not to mention some mothers are facing breastfeeding discrimination situation at workplace.

The “breast is best” message has returned after the formula-filled decades from the not-so-distant past. Breastmilk helps build crucial antibodies. Breastfed babies are less likely to face obesity, diabetes or other problems. Breastfeeding moms will lose the pregnancy weight easier… Most moms learned all of these in the lead-up to their babies’ birth and set their breastfeeding goals. But this kind of determination is not enough to help moms to reach their goal. According to a 2016 study, only 40 percent babies were breastfed at 12 month, though 63 percent of the mothers had planned to go to a year. What helps mothers to reach their breastfeeding goal, said the lead author of the study, is support.

Breastfeeding is a team effort. During this period of time, moms need their partners to be patient and assist them with a variety of houseworks. They need nurses in the hospital to assess their milk production. They need lactation consultants help them with the various holds until finding the one that feels quite right. They need encouragement from family members and friends.

Breastfeeding is hard. But with proper support, it can be wonderful like a breeze. Let’s help breastfeeding moms thrive, not just survive.

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

Monday, August 21, 2017

A Dream Deferred


Do you remember Joaquin Luna Jr.?

I do. He was a high school kid living in Texas. His family were undocumented immigrants. He was born in Mexico and brought to the U.S. as an infant. In his senior year he applied to college, only found out that he wasn’t an American on paper. After the Senate’s failure to pass the Dream Act, Joaquin felt despair over his immigration status and lost hope of becoming the first in his family to go to college. On the day after Thanksgiving, he put on a maroon shirt and a tie, lay down next to his mother and told her he was sorry he was never going to be the person he wanted to be. Then he went into the bathroom, put a handgun underneath his chin and pulled the trigger.

It was in 2011, the same year I heard about Keish. She was a college student living in Georgia. Her family were also undocumented immigrants. Keish was born in Korea and brought to the U.S. as a young child. After finishing high school, she couldn’t enter public college due to her immigration status, and her family couldn’t afford private college. She had no choice but to work at a flee market. Later that year, a group of professors at University of Georgia started a Freedom University, providing tuition-free education to undocumented students banned from public higher education in Georgia. Keish immediately enrolled in the university.

Freedom University doesn’t offer diplomas recognized by the U.S. Dept. of Education, but Keish said she had no regrets, “I’m happy to be here. I’m here to learn, not to get a diploma.”

There are many people who would say, “why should we as taxpayers pay for these illegal immigrants to go to school?” They don’t know that undocumented immigrants are also tax payers. It’s this kind of bias defer the dreams of the young immigrants who were brought to the U.S. as children and were raised here like Joaquin and Keish.

On June 15, 2012, President Barack Obama announced that his administration would stop deporting young illegal immigrants who match certain criteria previously proposed under the DREAM ACT. After that I heard that Keish won a scholarship to college. I sincerely felt happy for her. And then I thought of Joaquin. His death was unfortunate. He probably didn’t have to die if he waited for another year.

These young immigrants are DREAMers. On September 5th, 800,000 of them will be at risk of losing their legal status that allows them to be able to work, go to school, and continue to contribute and live in the communities where they have grown up.

Please join MomsRising in urging Congress to protect DREAMers from losing the protections that allow them to be an active part of our communities and our economy by quickly passing the bipartisan DREAM Act 2017.

Let’s not forget about Joaquin Luna Jr.

Watch a story I reported on Freedom University and Keish for KSCI in 2011:

Friday, August 18, 2017

Breastfeeding and Postpartum Mood Disorders: Milk, Tears, and Hope


While many women experience mood changes during or after the birth of a child, 15 to 20 percent of women experience significant symptoms of postpartum depression and anxiety. This World Breastfeeding Week, UCSD and SDCBC mini-seminar discussed how to treat a women suffering from perinatal mood and anxiety disorders (PMADs) and help her with her breastfeeding goals.

Many healthcare providers have not received adequate refining in how to recognize, screen for PMADs, and refer mothers for help. This is unfortunate because “recent research has confirmed that the optimum development of an infants social and emotional health hinges on the responses of and relationships with their caregivers, often the mother,” according to Bethany Warren, licensed clinical social worker and the president of Postpartum Health Alliance.

There are effective and well-researched treatment options that can prevent worsening of symptoms and help women fully recover. “New moms are going through an identity shift, and our goal is to help them recognize their expectation, reducing the perfectionism and comparison, manage the anger, and resolve the conflict and grief,” explained My Hanh Nguyen, a psychiatric-mental health nurse practitioner of UCSD Dept. of Psychiatry. “Not all expectations happen and that’s okay.” Common strategies including interpersonal psychotherapy, cognitive behavioral therapy, mindfulness, support groups, and of course, medication.

Because of the possibility of exposing the baby to medication through the breastmilk, many are hesitate to treat breastfeeding moms with drugs. However, as Jason Sauberan, Doctor of Pharmacy of Sharp Mary Birch, pointed out, “we don’t want the drug to hurt the baby, but we don’t want to tell moms that you cannot be treated while breastfeeding, either.” The important thing is to help medicated moms reach their breastfeeding goals by understanding the physiochemical drug properties and milk transfer, judging infant risk and making the right decision. This is crucial because breastfeeding has a protective role for both mother and infant.

When supporting a breastfeeding mother with postpartum depression or anxiety, clinicians need to employ messages to all mothers experiencing the symptoms, “You’re not alone. You’re not to blame. With help, you will be well.” When identifying the mom at risk, “the most important aspect of assessment is to listen to the women’s story,” said SDCBC’s Rose deVinge-Jackiewicz, RN, MPH, IBCLC, “Her story is unique to her.” Moms need to be heard, clarified, validated and categorized. “Sometimes, even what you see tells a lot,” deVinge-Jackiewicz told the seminar attendees. Is the mom holding her baby? How’s she interacting with her husband, boy friend or in-laws?

To understand what’s PMADs really like, Jessica Furland, clinical social worker of UCSD recommended three documentaries: The Dark Side of the Full Moon, When the Bough Breaks and The Emily Effect. Each of the documentary delves into the unseen world of maternal metal health in the U.S, brings attention to this public health issue and illustrates the lack of awareness and appropriate treatment options for postpartum mood disorders by looking into a woman’s journey to recovery.

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