Thursday, July 31, 2014

Caffeine use while breastfeeding

Recently a mother told me she chose formula feeding over breastfeeding because she “just can’t help having coffee, tea, and chocolate.”

That is one of those myths that many mothers believe are true—unless the mother eat healthy, her breast milk is no better than infant formula, or if the mother drink coffee or tea, her milk does more harm to the babies than formula.

The truth is, however, it is safe to have caffeine while breastfeeding as long as the mother doesn’t over do it. When caffeine enters the mother’s bloodstream, a small amount of it, usually less than 1 percent, ends up in her breast milk. The caffeine amount in her milk peaks a couple of hours after she consume it.

Since a newborn’s body can’t easily break down and get rid of the caffeine, it may accumulate in his system. At about three months, the baby will begin to process caffeine more efficiently, and over time it will become easier and easier for hime to excrete it.

Experts say that a moderate amount of caffeine, which means no more than 300 milligrams per day, or the amount in about 16 ounces of brewed coffee, is fine for nursing moms and should cause no changes in most babies’ behavior. Only when mother drinking more than two or three cups of coffee a day could cause the baby to become irritable, jittery, or agitated.

Many foods contain caffeine, coffee is one, obviously. The amount of caffeine in a serving of coffee varies widely, depending on the type of bean, how it’s roasted, how it’s brewed, and, of course, on the size of the coffee cup. For example, although espresso contains more caffeine per ounce, it’s served in a tint cup, so a full cup of brewed coffee will deliver more caffeine.

To manage the caffeine intake, a mother need to be aware of other sources, like tea, soft drinks, energy drinks, and coffee ice cream. Caffeine also shows up in herbal products and over-the-counter drugs, including some headache, cold, and allergy remedies. So read the label carefully.

Below is a chart of amount of caffeine in common beverages,

coffee, generic brewed8 oz95-200 mg
coffee, Starbucks brewed16 oz (grande)330 mg
coffee, Dunkin' Donuts brewed16 oz211 mg
caffé latte, misto, or cappuccino, Starbucks16 oz (grande)150 mg
caffé latte, misto, or cappuccino, Starbucks12 oz (tall)75 mg
espresso, Starbucks1 oz (1 shot )75 mg
espresso, generic1 oz (1 shot)64 mg
coffee, generic instant1 tsp granules31 mg
coffee, generic decaffeinated8 oz2 mg

black tea, brewed8 oz47 mg
green tea, brewed8 oz25 mg
black tea, decaffeinated8 oz2 mg
Starbucks Tazo Chai Tea latte16 oz (grande)95 mg
instant tea, unsweetened1 tsp powder26 mg
Snapple16 oz42 mg
Lipton Brisk iced tea12 oz5 mg

Soft drinksAmountCaffeine
Coke12 oz35 mg
Diet Coke12 oz47 mg
Pepsi12 oz38 mg
Diet Pepsi12 oz36 mg
Jolt Cola12 oz72 mg
Mountain Dew12 oz54 mg
7-Up12 oz0 mg
Sierra Mist12 oz0 mg
Sprite12 oz0 mg

Energy drinksAmountCaffeine
Red Bull8.3 oz77 mg
SoBe Essential Energy, berry or orange8 oz48 mg
5-Hour Energy2 oz138 mg

dark chocolate (70-85% cacao solids)1 oz23 mg
milk chocolate1.55-oz9 mg
coffee ice cream or frozen yogurt8 oz2 mg
hot cocoa8 oz8-12 mg
chocolate chips, semisweet4 oz53 mg
chocolate milk8 oz5-8 mg

Every baby is different, though. Some babies seem to be bothered when the mother have even a small amount of caffeine. My little one was one of those babies, so I cut caffeine out of my diet for two years. It’s not I love coffee less, but I love my baby more.

My last coffee. Photo taken 2 weeks before I found being pregnant.
Related to this article: 17 Effects of Caffeine on the Body 

Tuesday, July 22, 2014

When breastfeeding is a stress

I often hear my follow new mothers say that breastfeeding is a stress.

Breastfeeding can be hard, I know. I have a baby who was exclusively breastfed until the age of six months, and breastfeeding did stress me out at one point.

I come from a culture that is relatively breastfeeding unfriendly. My parents were from China, where less than 30% of babies are breastfed. Being born and raised in Taiwan, I have never seen anyone or heard of anyone breastfeeding while growing up. After giving birth I hired a postpartum caregiver, a very nice Chinese lady, so nice that she constantly reminded me that a new mother should rest well and nursing every three hours is bad for my health. Debating with my parents, my in-laws, and my caregiver over breastfeeding was stressful.

And I did have some health concerns about breastfeeding. I have a strong family history of breast cancer, and before I was pregnant, my doctor found two fibromas in my left breast during a regular check-up. Even though I was assured that fibromas would not interfere with breastfeeding, I could not help but worry about it. That worry was stressful.

Then I returned to a very breastfeeding unfriendly working environment when my baby turned six months old. I was forced to pump my breast milk in a bathroom stall. When I attempted to wash pump accessories in the office kitchen, my colleagues made nasty comments that I was washing “dirty panties” in the office. The situation was stressful.

My milk started to dry up. I started to feel that I may not have enough milk to feed my baby. I started to consider breast milk substitutes. I started to feel that my lactation consultant was annoying for constantly telling me how breast milk is superior to infant formula.

Finally, that day came. My application for nursing accommodation at work was rejected. When I came home, an infant formula coupon was waiting in my mail box. Exhausted and disappointed, I told myself, “this was it.”

And then I drove to a grocery store with that coupon. I was going to buy the first container of infant formula. So here I was, standing at the baby food aisle, holding a can of formula in my hand.

All in a sudden a question came to me, “is this really the answer to my stress?”

Would I stop worrying about my fibromas? Probably not. All the research results that I could find show that fibromas have nothing to do with breastfeeding. If I were going to worry about those lumps in my breasts I would just continue to worry, regardless of whether I was breastfeeding or not.

Would I feel better at work? Certainly not. Apparently my employer disrespected the labor law enough to resist accommodation to an employee’s breastfeeding needs. I was persuaded that the company would not protect my employee rights one way or another, even if I were not breastfeeding.

Would I stop being annoyed when hearing breastfeeding advocates lecturing about the benefits of breastfeeding? Most definitely not. I would be even more annoyed, because I knew that they are right. I knew that in spite of the pressure from my family, my employer, and my health condition, the sole reason for me to give up breastfeeding was my personal choice.

I realized that it was not breastfeeding that was the cause of my stress.

So I put that infant formula back on the shelf. I walked out of the store. I went home and submitted a letter of resignation to my supervisor. Now my baby is 14-months old and still being breastfed.

I am saying this from the bottom of my heart: If you are a new mother, and you feel that breastfeeding is really stressful, please do ask yourself if giving up breastfeeding is the real solution. The answer might surprise you.

"Mommy I don't want formula!"

Monday, July 14, 2014

Pacifiers: Boon or Boondoggle?

Pacifiers are used world-wide and often believed by health professionals to be harmless, and some lay people even consider them necessary and beneficial for the infant’s development. I used pacifier myself--I gave my little one a pacifier when he was one month old simply because I received a cute, free NUK pacifier in my mailbox; I stopped giving him that pacifier when he turned three month old simply because he seemed to lose interest in it. In shorts, as a new mom, I did no research on the pros and cons of pacifier (though I should have!) I just used it, and then quit it. So is a pacifier really a boon? Or a boondoggle?

I did not find out until the most recent San Diego County Breastfeeding Coalition meeting, where Nancy E. Wight (MD, IBCLC, FABM, FAAP), secretary of the coalition, discussed this topic. She said that although pacifier use has its benefits, there is enough evidence to show that pacifiers CAN effect breastfeeding, when used early in the hospital, and when maternal motivation to breastfeed is not strong.

Non-nutritive sucking on pacifiers may be beneficial. Sucking calms and decreases the pain response. Pacifier use is associated with a decrease in the incidence if SIDS. For premies, non-nutritive sucking may facilitate the development and strengthening of muscles used in sucking, and lead to better weight gain and shorter length of stay.

Still, there are several risks of pacifier use. During the first two days after giving birth, the mother's breasts need stimulation to begin producing milk and the baby’s time spent on the breast should not be limited. However, “the time sent sucking on a pacifier is time not spent suckling at the breast,” said Dr. Wight, “Pacifiers reduce time spent suckling at the breast, thus delay and decrease the milk production, and result in early termination of breastfeeding.” She pointed out that most observational studies show an association of early pacifier use and shorter duration of breastfeeding.

Pacifiers interfere with demand feeding. Some mothers use pacifiers to delay feeding, as a consequence, “less feeding equals to decreased milk supply,” said Dr. Wight, “decreased milk supply leads to supplementation and decreased breastfeeding.” Formula remains in the stomach twice as long as human milk, leading to less breastfeeding.

Pacifiers can alter oral dynamics and cause dental malocclusion. Pediatric Dentists recommend discontinuing pacifier use by two years of age. Pacifiers increase incidence of acute and chronic otitis media, may carry infection, possibly increase the incidence of thrush.

Pacifier also come with possible safety hazards, including chocking on separated pieces of pacifier materials, use of potentially harmful materials in manufacture, and entanglement in pacifier attachments.

Most studies suggest not using a pacifier until breastfeeding is well established. The Ten Steps to Successful Breastfeeding by Baby Friendly Hospital Initiative includes “give no teats or pacifiers, also called dummies or soothers, to breastfeeding infants” as its ninth step.

American Academy of Pediatrics suggests avoiding routine pacifier use in the postpartum period, stating “pacifier use should be offered, while placing the infant back-to-sleep position, no earlier than three to four weeks of age, and after breastfeeding has been well established.”

She reminded her fellow IBCLCs that pacifier use may indicate a breastfeeding problem, not cause the problem. “Pacifier use may indicate a breastfeeding problem that requires intervention,” she said, “or a mother’s desire to stop breastfeeding.”

To sum up, pacifiers can be beneficial, but only when they are used properly. Good lesson. Thank you Nancy!

The only photo I can found of my little one sucking a pacifier.


Monday, July 7, 2014

Better late than never! Michigan fights discrimination against breastfeeding mothers

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

Michigan had decided that our most precious and sweetest citizens should not be eating in a bathroom. Last Tuesday, Michigan governor Rick Snyder signed “Breastfeeding Anti-Discrimination Act” into law. Now Michigan mothers who nurse their children in public will be protected from discrimination and prosecution under the bipartisan legislation.

The “Breastfeeding Anti-Discrimination Act,” sponsored by the state Sen.Rebekah Warren (D-Ann Arbor), gives women the right to nurse a child in any place that is open to the general public, including stores, restaurants and municipal buses.

“We hope that with Gov. Snyder’s signature on this bill, we will start a culture change so that our mothers feel comfortable nursing their babies where they’re allowed to be.” Warren said that with this bill, mothers will be breastfeeding longer, “and the health benefits to both baby and mother will be maximized. ”

Under the new anti-discrimination law, owners and operators cannot deny goods, services, facilities, privileges, advantages, or accommodations to a woman simply because she is breastfeeding, nor post signs prohibiting public nursing.

A woman who is subject to discrimination because of breastfeeding can file a civil suit seeking injunctive relief, actual damages, or presumed damages of up to $200. A court could also award the mother full reimbursement for any legal costs.

Companion legislation sponsored by Rep. Amada Price (P-Park Lark), and Lisa Posthumus Lyons (R-Alto), will ensure that nursing mothers cannot be charged under state laws prohibiting indecent exposure or disorderly conduct.

Supporters say the new laws will guarantee the right of women to breastfeed in places of public accommodation and clear up any confusion for store owners, employees, and security guards.

Before the law, a Target Store in Harper Woods, MI, reportedly called the police on a breastfeeding mother in 2009. A SMART bus driver ordered an Eastpointe mother to cover up or exit in 2011. Security guards reportedly boarded the bus at the next stop and questioned her.

In this country, 45 states already have some form of law allowing women to breastfeed in public or private locations. Twenty-nine (29) states exempt breastfeeding from public indecency laws. Michigan did not have such a law until last week, and the state ranks in the bottom third of states for breastfeeding rates.

Health experts believe that normalizing breastfeeding will benefit babies in Michigan. The state’s chief medical executive for the Department of Community Health, Mr. Matthew Davis, said that breastfeeding provides optimal nourishment for children, shields them from infection and helps fight obesity. “A woman afraid of persecution or prosecution may decide not to breastfeed, thereby losing all the potential benefits of breastfeeding,” said Dr. Davis.

Dr. Paula Schreck of Michigan’s St. John Providence Health System said breastfeeding can also have a positive impact on the health of mothers by reducing the risk of breast cancer, ovarian cancer, and postpartum depression. “Breastfeeding improves the health of a society, of a city, of a country, of a state,” she said.

“There’s nothing more natural than giving birth and there’s nothing more natural than feeding your child using your body,” said Shannon Polk, executive director of the Michigan Breastfeeding Network, at a press conference in Lansing, MI.

“You wouldn’t eat your lunch in a bathroom. Why should our most precious and sweetest citizens have to eat in a bathroom?”

Here in California, mother’s right to breastfeed in public has long been protected. California is one of the first states that not only has a law that protects a mother’s right to breastfeed in public, but also an enforcement provision to uphold that law.

At Reading Terminal Market in Philly, everybody is eating. So am I :)