Tuesday, April 29, 2014

Not just one mother's battle

Earlier this week, Iowa Public Radio broadcasted a remarkable story about Linda Eaton.

Eaton was an Iowa City Firefighter. Thirty-five years ago, she continued to breastfeed her child at work against orders from her supervisor, and a breastfeeding discussion was launched locally and gained national attention.

Today, breastfeeding in America is treated a little differently, but it is also very different than other cultures. The program told Eaton’s story, and also discussed what businesses are required to provide for nursing employees, the challenges of refugee and immigrant women who breastfeed, and what barriers might prevent American mother from breastfeeding.

I burst into tears when listening to the story. It represents so much of my personal experience as an immigrant mother struggling to breastfeed against my company’s policy.

At the time I gave birth to my baby, who is one year old today, I was working as a staff writer at a Chinese-language newspaper in Los Angeles. I separated from that company when my little one was six months old after repeated incidents of harassment because of breastfeeding, ending a decade-long relationship with that company.

Before my maternity leave I looked into the employee handbook but was unable to locate any information about breastfeeding. I returned to work when my son turned three months old and needed an area to pump my breast milk. Because the company did not provide nursing employees with a place to pump, I was forced to pump in the bathroom or at my desk, covered by a jacket. When I talked to my supervisor and our HR about the lactation accommodation rights, they responded me with that they are not aware of the law.

In addition to the company’s failure to provide nursing employees an appropriate lactation space, my coworkers harassed me about breastfeeding. For instance, when I was attempting to clean my pump supplies in the kitchen, one coworker made a derisive comment that I was washing panties in the kitchen. A second coworker spread breastfeeding photos she found online and joke about them.

I was not alone. Every so often I heard my fellow Chinese-American mothers talked about quitting breastfeeding because their employer or their family (often the mother-in-law) don’t support them. It seems to be hard for non-English-speaking mothers to get breastfeeding support. I tried to invite some medical or lactation professional to my previous company and educate my previous colleagues about the benefits of breastfeeding, but I couldn’t find even one Chinese-speaking lactation professional or medical professional who was able to talk about breastfeeding. And that was in Los Angeles, one of the American cities with the biggest Chinese population.

Still, I am grateful that I now live in the United States of America, where breastfeeding mothers are better protected opposing to many other countries and regions around the world. Three months after resigning from my job, I received Unemployment Insurance Benefits from California Employment Development Department, which considered that I quit for a compulsive reason and any mother would make the same decision as I did. I doubt that I could receive the same understanding back in my home country.

Now I am working with Legal Aid Society Employment Law Center to ask my previous employer to include a clear stated lactation policy in the company manual, and to have training sessions in English and Chinese for all supervisors and employees regarding the policies.

Eaton fought for her rights of breastfeeding thirty-five years ago, and today, breastfeeding in America is treated differently. As immigrant mothers we are now fighting for our rights to breastfeed, and hopefully, thirty-five years from now, breastfeeding in ethnic communities will be treated differently.

By the way...today is my little one's first birthday! Celebrate one year of fresh breastmilk!!

Monday, April 21, 2014

Breastfeeding "Sexy"!?

Earlier this year when I was breastfeeding in a rest area in a North Carolina shopping mall, my husband snapped a shot of me feeding the little one with his smart phone. In the background was a portrait studio with many photos of women displaying on the wall. Most of the women in those photos actually have more breasts visible than I did. "But people would complain that you, not they, are showing the breasts." My hubby said, "I just thought it's funny."

He was, unfortunately, right. Some just couldn't get over the idea that breastfeeding equals to exposing breasts equals to sexual acting. Maybe that's why a press release on behalf of the Alaska state House majority called breastfeeding “smart and sexy”.

The release soon landed the lawmakers in hot water. Is breastfeeding smart? It can be smart. Is breastfeeding sexy? Probably not the best way to describe it.

Alaskan Republican reacted quickly and soon apologized for it. The release, titled “Smart and Sexy: Legislature encourages hospitals to promote breastfeeding,” was sent out last Monday and celebrated the passage of a bill that highlighted the benefits of breastfeeding and urged health centers to practice a breastfeeding program. The “Smart and Sexy” part has sense been taken off the web version of the release.

Last Tuesday, Alaska state Rep. Shelley Hughes (R-Plamer) who sponsored the bill and Alaska Speaker of the House Mike Chenault (R) apologized for the wording. “My intent was to draw attention to this incredibly important issue. Unfortunately, this is not the kind of attention I hoped to receive. I take full responsibility for the headline. I apologize for the poor choice of words, and am sorry if I offended anyone,” Hughes said in a statement.

Chenault stepped up and took responsibility, adding that “the wording used was unfortunate and I don’t want it to detract from the great work Rep. Hughes did in passing this resolution through the legislative process.” He said, “I take responsibility for this, as the release came form our Majority Office.”

Alaska State House Concurrent Resolution 18 (HCR 18), which was also passed by the Alaska Senate, encourages hospitals to promote the “Ten Steps to Successful Breastfeeding” program.

“As a legislature forever fond of natural resource development, it’s time to endorse the extraction of this God-given, abundant and renewable natural resource,” Hughes says in the release, which has been republished without the “smart and sexy” phrase.

Political blogger Amada Coyne battled by the line, “It’s also unclear for whom breastfeeding is supposed to be sexy: The baby? The mother? The viewer?”

The Stir contributor Maressa Brown thought the release offended more like everyone, “at least every woman who has ever fought to breastfeed in public but has a problem doing so because people can’t get over the idea that breasts = ‘sexy’ =‘inappropriate.’…Describe a smart, savvy, loving, giving mother as sexy? Knock yourself out!” she wrote.

The Huffington Post pointed out that calling breastfeeding “sexy” was a curious way to promote something that already suffers from a social stigma. Woman are regularly shamed for breastfeeding in public places, like Alabama mother Heanna Harris who was forced to leave a courtroom earlier this year after being told that feeding her child was offensive.

Breastfeeding has become a particularly political issue in recent years, as women have been pushed not to breastfeed in public. Breastfeeding initiatives have been fighting to build a more positive, healthy image of breastfeeding in public. Meanwhile, mothers continually being encouraged by experts to breastfeed.

In spite of the controversial wording of the press release, HCR 18 is a bill with good intentions to encourage hospitals to promote the “Ten Steps to Successful Breastfeeding” program. It was unfortunate that the attention was detract from the good work that the lawmakers did in passing the resolution.

Wednesday, April 16, 2014

When NOT to breastfed

By To-wen Tseng. Original posted on San Diego County Breastfeeding Coalition's Blog.

Photo Courtesy AP
This week, a South Carolina woman was found guilty of killing her daughter with a morphine overdose from breast milk. A Judge sentenced her to 20 years in prison for killing her than 6-week-old daughter back in 2010.

Sad story indeed. Yes, breastfeeding is the best. However, there are special conditions in which mothers should not be breastfeed. These instances include when a mother is taking certain medications or drugs, when she has been diagnosed with a specific disease, or when other specific conditions apply.

Medications and breastfeeding 

Although most maternal medications are safe for breastfeeding mothers and their infants, certain medications are known to be dangerous to babies and can be passed to the baby in mother’s breast milk. Mother taking the following medicines should speak with her health care provider when considering breastfeeding: 

In addition, mother who is undergoing radiation therapy should consult her doctors before breastfeed, although most therapies require only a brief interruption of breastfeeding.

This list of medications and other drugs is only a guideline. When breastfeeding, mother should discuss with her health care provider before taking any medication. These include prescribed medications, over-the-counter medicines, vitamins, and herbal therapies.

Medications that are safe during pregnancy are usually also safe for mothers to continue while breastfeeding. Medications that are given to infants and children are almost always safe for a breastfeeding mother. For more information regarding medications and breastfeeding please visit NLM ToxNet.

Health conditions and breastfeeding

Mothers with certain illness and infections may be advised not to breastfeed because of the danger of passing the illness or infection to the breastfed baby.

If the mother have any of the following conditions, she should speak with her health care provider before breastfeed her baby:

  • Infection with human immunodeficiency virus (HIV)
  • Infection with human T-cell lymphotropic virus type I or type II
  • Untreated, active tuberculosis

If the mother is sick with a cold or the flu, she shouldn't stop breastfeeding. With most viral infections, we are infectious before we develop symptoms. As the infant has already been exposed, stopping breastfeeding will only deprive the infant or child of the maternal antibodies in the breastmilk. These antibodies and activated T-cells can help prevent or lessen the severity of the infant's illness.

International guidelines on HIV/AIDS and breastfeeding

The potential for HIV transmission to a baby through breastfeeding has been knows for some time. However, recommending against breast-feeding is not a simple solution, because breastfeeding is beneficial to both the mother and her baby. Reducing HIV transmission, while simultaneously ensuring improved HIV-free baby survival, is one of the most pressing issues of HIV/AIDS research.

WHO guidelines currently recommend that an HIV-infected mother who is breastfeeding in the developing world should also take antiretroviral drugs, which help prevent HIV transmission to her baby. In addition, it is recommended that HIV-infected mothers breastfeed exclusively for 6 months, and continue thereafter up to 12 months while solid foods are introduced. In the US, where safe alternatives (artificial milks and weaning foods) are available, and health conditions and medical care are significantly improved, breastfeeding is not recommended.

Other considerations and breastfeeding

In some rare additional situations, or if the mother or the baby has certain health conditions, mother may be advised not to breastfeed.

Mothers with certain chronic illnesses may be advised to take steps to ensure their own health while breastfeeding. Mothers who actively use drugs or do not control their alcohol intake, or who have a history of these situations, may be advised not to breastfeed.

Babies with classic galactosemia, a rare metabolic disorder in which the body cannot digest the sugar galactose, should not be breastfed. Galactosemia is detected by newborn screening, allowing proper treatment and diet to being immediately. If not detected, the galactose guilds up and becomes toxic for the infant, leading to liver problems, intellectual and developmental disabilities, and shock.

Friday, April 11, 2014

Becoming a human milk donor

A Texas mother has donated 53,081 ounces of breast milk and is applying to the Guinness Book of World Records to officially be named the record holder. Her good deeds might inspire some mothers to follow her example. Thinking of donating your breast milk? Read this first.

Why become a donor?
In the absence of the baby’s own mother’s milk, donor milk offers many of the benefits of human milk, such as easy digestibility and immune substances to protect against diseases. Further more, because it is species-specific, complications which arise with the use of infant formula are not seen.

Donor milk bas a broad range of therapeutic uses. For the infant who is failing to thrive because of food intolerance, human milk can be a lifesaver. For the infant whose tissues and organ systems need to mature or heal, donor milk provides growth factors which facilitate these processes, helping tissues damaged by illness to repair themselves, and helping the individual to regain health. Donor milk may also help prevent certain conditions in prematurity that are life-threatening.

Why donate through a licensed milk bank?

Some mothers give their milk directly to the parents of babies in need, an exchange known as casual sharing. The intention behind casual sharing is wonderful, it’s a caring act of sister hood. However, in the age of potential transmission of HIV, hepatitis, and other viruses through human milk, there is an increased risk of casual sharing.

Donor milk banks have put several safeguards into place to prevent the possibility of disease transmission. All donors are carefully screened for diseases of various kinds before their milk is accepted.

What does it take to be a donor?

The human milk donor must be in good health, have a milk supply in excess of her own infant’s needs, and be motivated to express and donate to the milk bank using the collection protocols provided by the milk bank. She cannot be high-risk for transmission of blood-borne diseases. No donor to a non-profit milk bank receives payment for her milk.

The screening process for becoming a donor is a two-stage procedure. First the donor answers a detailed health history questionnaire. An additional form goes to her primary care provider to verify the accuracy of her health self-assessment. According to HMBANA, potential donors may be excluded for the following reasons:

Receipt of a blood transfusion or blood products within the last 12 months. Receipt of an organ or tissue transplant within the last 12 months. Regular use of more than two ounces of hard liquor or its equivalent in 24-hour period. Regular use of over-the-counter medications or systemic prescriptions. Use of megadose vitamins or pharmacologically active herbal preparations. Vegans who do not supplement their diet with B-12 vitamins. Use of illegal drugs. Use of tobacco products. A history of hepatitis, systemic disorder of any kind, or chronic infections. Had a sexual partner in the last 12 months who is at risk of HIV, HTLV, or hepatitis. Once the prospective donor has completed the health history, she then enters stage two of the donor process and is tested serologically through blood tests for HIV-1, HIV-2, HTLV, Hepatitis B, Hepatitis C, and syphilis. New tests may be added to this screening panel as new viruses emerge which should create potential problems for recipients. Milk banks will cover the cost of the serological screening. Repeat donors are treated as new donors with each pregnancy and must undergo screening again. 
How to become a donor?

Please contact your local human milk bank for details.
This is an original post for San Diego County Breastfeeding Coalition's Blog

Wednesday, April 2, 2014

Calling for restrictions on infant formula marketing

By To-wen Tseng. Original posted on San Diego County Breastfeeding Coalition's Blog.

Would baby formula ads contribute to a drop in breastfeeding rates?

Doctors in Australia think it would. And they are calling on the Australian federal government to ban the marketing of baby formula.

Australian Assistant Health Minister Fiona Nash has decided to scrap APMAIF, an independent panel that aimed to ensure the proper use of breast milk substitutes. A spokesman for Nash said because of the rise of awareness, the drop in complaints, and the industry compliance, the independent panel is no longer required.

But doctors are afraid that there will be a drop in breastfeeding rates once manufactures are allowed to oversee their own marketing practices. Royal Australasian College of Physicians (RACP) started a movement, calling to restrict the marketing of infant formula. RACP’s president of pediatric and child health division, Susan Moloney, said, “We’re very concerned that if there’s no independent oversight, then we need legislation to block advertising of infant formula.”

Without an independent panel to monitor complaints and advertising, the Infant Formula Council, which represents more than 95% of the infant formula industry in Australia, has offered to work with the government to help monitor manufacturers.

But Moloney said industry-led and funded oversight would be inappropriate because companies could act to protect their interests. “We need an impartial and independent body in place to monitor the marketing and complaints process for infant formula in Australia, guided and regulated by legislation that restricts public exposure to information that would undermine breastfeeding.”

Despite the current voluntary agreement prohibiting print and television advertising, she said tougher controls would prevent loopholes for companies to advertise in supermarket catalogues and pharmacies.

She said that there are always parents who need to formula feed their babies, but the community has to make sure that breastfeeding is most encouraged. “Breastfed infants have improved neurodevelopment outcomes and a lower incidence of infections, obesity, and diabetes.”

“We would like to see legislation that reflect the WHO’s International Code of Marketing of Breastmilk Substitutes, which recommends restrictions on the marketing of substitutes to ensure that mothers are not encouraged to unnecessarily abandon breastfeeding.” said Moloney.

She said that a ban on marketing, free sampling, gifts to health workers and pharmacy, and supermarket promotion of formula for babies less than one year old would reflect the International Code of Marketing of Breastfeeding Substitutes. Since the international code was adopted by the WHO in 1981, 84 countries have enacted legislation implementing many or all of the provisions of the code.

In some other countries, infant formula marketing is contributing to the low-rate of breastfeeding.

According to CCTV (China Central Television), it is common for manufacturers in China to give gift and even cash to doctors and nurses in exchange for promoting infant formula in the hospital. “Certain hospitals are ‘occupied’ by certain manufactures. Babies born in these hospitals will only be formula fed,” reported CCTV. “In some hospitals, mothers there are not even allowed to breastfeed their new-borns during the entire hospital stay.” In China, less than 30% of new-borns are breastfed.

Moloey said, “I don’t think we’ve had a government brave enough to legislate to comply with WHO code,” even “it’s something easy and sends a strong message that breastfeeding is good for mothers, babies, and the community.”

Rachel Fuller, the CEO of Australian Breastfeeding Association, said that she would absolutely support implementing the WHO code in full, “It’s not about saying no to formula, but giving parents information without subjecting them to marketing hype.”

She said Australian breastfeeding rates were falling below the Australian National Health and Medical Research Council recommendations. Only 39% of babies were solely breastfed up to the age of three months.