Wednesday, November 15, 2017

Feeding my baby during a follow-up check after the tongue-tie release treatment. 
It all started with one fuzzy baby and two sore nipples.

I gave birth at midnight on Sunday. It wasn’t my first baby—I’ve breastfed for two years, and I thought I knew exactly what to do. Yet the latch was painful, even worse than what I experienced when my first child was teething.

By the end of Monday, my baby was hungry and angry, and my nipples were cracked and bleeding. On Tuesday, the nurse came to check on me and kindly offered some infant formula to supplement the baby. I didn’t like the idea. I had lots of milk; I could feel it. But by Wednesday, the baby had already dropped his birth weight by 7%.

Then on Thursday the baby dropped weight by another 3%. We were discharged from the hospital with two boxes of infant formula. When I saw the pediatrician on Friday I almost burst into tears while telling him that I wasn’t able to breastfeed even though I know I have milk.

“He might not suck efficiently. You should see a lactation consultant and see what she says. Before we find out what’s going on, I want you to supplement him with 1 oz of formula after each feeding.”

The baby started to gain weight after we supplemented him. It’s embarrassing, felt like being told that my own milk was not good as formula.

I saw the lactation consultant on the next Friday. It turned out the baby had tongue tie! It’s almost funny because I’ve been writing for the breastfeeding coalition for years and tongue tie was a topic that has been brought up often. Yet I was clueless when it actually happened to my baby.

Knowing what’s causing all those problems, we immediately scheduled an appointment with a pediatric dentist. At the dentist’s office she showed us how my baby didn’t only have a tongue tie but also a lip tie. It did look abnormal. I wondered how I didn’t notice it earlier.

We decided to have the ties released on the same day. The dentist explained to us how a frenotomy is performed and how to take care of the baby’s tongue and lips after the procedure, including massaging his mouth with coconut oil and giving him Tylenol to control the pain. She suggested us to wait in the reception so that we wouldn’t hear the baby cry during the procedure, “it might be upsetting.”

But I could still hear the baby cry at the reception even though we were three rooms away from where the baby was being treated. That was scary. I told my husband, “Oh my goodness it sounds like he’s in great pain!” For one minute I wanted to stop the procedure and just formula feed. My husband stared at me, “are you out of your mind?”

The dentist brought us our baby in 10 minutes, probably the longest 10-minute in my life. I saw a diamond-shaped wound under his tongue and a little bit of blood in his mouth—just a little, but was enough to freak me out.

That night the baby was very difficult. Every time I tried to massage his mouth with coconut oil, he cried as if I was trying to cut his head off. Baby Tylenol wasn't seem to work. I couldn't help but worry that our neighbors would call the police; thank God that did not happen.

But things became very easy after that first night! Latching was a breeze, and the baby effortlessly gained one whole pound in just one week after the procedure (without formula!) I’m glad we had it done early. He turned one month today. We have two more years to breastfeed.

This is a post originally for San Diego County Breastfeeding Coalition. Photo credit to Mu-huan Chiang.

Friday, November 3, 2017

Baby Doe: Why Can't We Stop Child Homelessness?


Last October, I attended an Interfaith Memorial Service for the homeless at Sacred Heart Catholic Church in East Los Angeles. The service remembered the 472 homeless people who died on the streets in Los Angeles County in 2016. Seven of the deceased were under three years old.

At the service I thought of a girl who called herself Latoya, who I met eight years ago while covering an adolescent drug dealing story. She moved into a teenage drug dealer’s tent under an overpass in downtown San Diego after running away from her foster family. One year later she gave birth to a baby girl. She was fifteen; her boyfriend was eighteen. Social workers took away their baby because apparently, the parents were too young, on drugs, and homeless.

When I met Latoya, I was fresh out of journalism school and she was long out of school. She was seeking help from a volunteer attorney with a non-profit organization helping homeless children. 

“She wanted to go back to school, get a real job,” the lawyer told me. “And eventually get her daughter back.”

That surprised me. I had assumed that drug-using, homeless, teen parents were irresponsible and careless people. The reality is that they love and care their children just like any other parent.

When the adolescent drug dealing story was done, I wanted to follow up with Latoya’s story, but my assignment editor decided to cut it because “following a homeless teen mom is way too resource consuming, we cannot afford it.”

In the end I wrote a short article about Latoya and her efforts. The piece was included in my first book “Wēi Zúyǐ Dào”, published in 2011. The book sold 80,000 copies in five years, but Latoya’s story remains incomplete. I lost contact with her, but in eight years I have never forgotten her. In fact, over the years I have met many Latoyas and their children.

One of the Latoyas was 25-year-old Venessa Ibarra, who last June set her SUV on fire, threw in her three-year-old daughter Natalie, and then got in herself. They both died.

The death of a homeless child gets very little attention, and the authorities have many difficulties determining their identities. These children are called “baby doe” and their stories are rarely told.

In the cases where these stories do get attention, the media tends to sensationalize them, playing up the deaths of the poor children, especially babies. A negative connotation that has arisen from these over-sensationalized stories is that less advantaged women are not to be trusted with babies. This has a backlash for homeless mothers who also need help.

I tried to follow up with Ibarra’s story, but it was difficult. The authorities said that she had experienced “issues and a little bit of a drug problem.” But many questions remained unanswered. There weren’t even records to show whether she had received medical attention, or whether any efforts had been made to prevent the tragedy.

I can’t stop thinking about Latoya, Ibarra, and other mothers who live out of cars, in tents, under bridges and on the streets with their babies. How well could they be coping while living on the streets? Homelessness affects every facet of a child’s life, inhibiting his or her physical, emotional, cognitive, social, and behavioral development. And without proper maternal care, the pregnancies of homeless women can be at risk from many preventable obstacles. As a journalist, I don’t just want to present the statistics stacked up against homeless mothers and their children, I want to listen to them. Yet they are so hard to reach, with most of them fleeing from the media and social workers. That is one of the reasons why this country’s child welfare program is unable to help homeless children. In addition, most programs serving the poor are underfunded.

Los Angeles has seen another sharp rise in homelessness and outdoor tents over the last year, as local officials struggle to identify funding for billion-dollar plans they approved last year to combat homelessness.

Last November, Los Angeles County voters approved Measure HHH, a proposal to create 10,000 units of permanent supportive housing and affordable housing for the city’s homeless population. The measure has not yet translated into visible effects, and homelessness remains an ongoing public health issue.

Two days after the Interfaith Memorial Service, the remains of the 472 deceased, including the children, were cremated and interred in a common grave with only one plaque marking the year of interment. Baby does didn’t get a name. Their story remains untold. It is Autumn again and the church is preparing for another service. More baby does will soon join those buried.

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

Sunday, October 8, 2017

ANNOUNCEMENT

Heading to the hospital for baby's birthday party! No blog updates till the end of October.

Heading to the hospital for birthday party 🏥 👶 🎉

A post shared by To-wen Tseng 曾 多聞 (@twtseng) on

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.

Monday, September 18, 2017

For Dads: Breastfeeding and You


A Maryland mother was ordered to give her breastfed infant formula at father’s request because the judge considered “giving a father time with his child is more important than breastfeeding a baby.”

Mom’s milk is powerful stuff, so is the relationship between dad and the baby. It is unfortunate that parents have choose between the two. Of course, in this case, the couple are separated and embroiled in a court battle. But, in most cases, there shouldn’t be any conflicts between breastfeeding and father-baby-time. In fact, breastfeeding can help dad build a meaningful relationship with the baby.

Breastfeeding takes teamwork. Research shows that moms whose partners support their breastfeeding efforts breastfeed longer. As a dad, there are many ways you can be helpful.

During pregnancy, you can encourage mom to take a breastfeeding plan and set goals, letting her know that he’ll be there to help along the way. You can plan the delivery together, that means choosing a doctor and hospital that support breastfeeding, going to doctor’s appointments, and going to prenatal classes. You can tour hospitals or birthing facilities together and choose that supports their breastfeeding goal. You can also start learning about baby behavior so that you’ll be prepared to help the mom when baby comes.

After delivery, you can support skin-to-skin time for mom and baby during the first hour after delivery. Even babies who are delivered by cesarean can do skin-to-skin in the first hour. You can request rooming-in at the hospital so that you and mom have more time to get to know your baby and settle into a healthy routine. You can get plenty skin-to-skin time where you cuddle the baby on your bare chest. This is great bond time with lots of benefits for both of you.

Back at home, you should be prepared--newborns eat at least 8 to 112 times a day and sleep only a few hours at a time. You can be encouraging by letting the mom know you’re proud of her. You can be helpful by holding the baby after a feeding until he falls sound asleep, changing diapers, learning how to calm the baby when he cries, taking care of meals and household chores, and giving mom a break so she can shower or nap. She will be grateful, and you’ll get more time with the baby.

If the mom plans to return to school or work, she needs your support so she can keep breastfeeding. You can encourage her to pump and store her breastmilk once she’s gotten the hand of breastfeeding and her supply is set. Mom should start pumping at least two weeks before going back to work. At first she may not get a lot of milk, but pumping once a day will help build a supply of milk in the freezer to use while the is away. When mom and baby are together, regular breastfeeding will keep her milk supply up.

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