Wednesday, August 6, 2014

Breast milk is love. Share love!

Breast milk is liquid gold. Some mothers are blessed with more breast milk—more than what her baby needs—and are able to share the gift with others through milk banking or selling.

There is, however, a gap between evidence-based breastfeeding guidelines and practice, thus compromising the ability of the mother-baby dyad to meet established breastfeeding recommendations. Physicians have been lagging behind in their knowledge and use of banked donor human milk. They also may not be aware that their own patients may be obtaining milk—donated or sold—off the internet.

In light of the World Breastfeeding Week 2014, San Diego County Breastfeeding Coalition provided a mini-seminar, discussing the benefits and the risks of the various forms of donor human milk.

At the seminar that attracted dozens of health care providers, the coalition’s Dr. Nancy Wight (MD, IBCLC, FABM, FAAP) pointed out that because of the dissemination of research, quality improvement projects, and the best practice recommendations, the use of donor human milk in the NICU across the country has increased dramatically in the past decade.

“Historically,” Dr. Wight explained, “In the 1950s, people used mom’s milk and fresh donor milk for almost all infants.” Started 1970s, people started to use premature infant formula for preterm babies. Baby grow very fast with premature infant formula because this kind of formula is very high in protein. “But faster is not better!” noted Dr. Wight.

What helps the babies grow better in the NICU is, Dr. Wight said, human milk. Mother’s milk is the best choice, and donor human milk is the second best choice. “Human milk is food for nutritional management and a therapeutic agent that protects from, and reduces incidence and severity of various morbidities,” said Dr. Wight, “It a programming agent for genetic and biologic pathways. It’s a mechanism to involve mother and families in NICU care.”

Benefits of human milk for preemies includes host defense and immunologic programming, gastrointestinal development, special nutrition, improved neurodevelopment outcome as well as a physically and psychologically healthier mother. There are also economic and environmental benefits.

The breasts supplies what the baby lacks . Lactose supplies nutrients that meet baby’s energy requirements; lipase provides digestive enzymes to support the immature pancreatic function; sIgA provides protective factors to support immature gastrointestinal barrier function; epidermal growth factor supplies trophic factors for mucosal differentiation; and oligosaccharides provide prebiotics that support normal anti-inflammatory bacteria.

According to a California neonatologist survey done by Dr. Wight in 2001, 97% of California neonatologists always or usually recommend human milk for their NICU patients. However, the survey also found that there was little familiarity with the use of pasteurized donor human milk. It is likely that there is even less familiarity and usage of PDHM in many areas of the United States.

Some key areas of neonatologist’s concern identified were accessibility and logistics of obtaining milk, safety and infection control issues, social acceptability and legal issues, and nutritional adequacy and efficacy questions. A subsequent study done by Parker et al. 10 years later (2013) revealed a significant increase in knowledge about, and use of, pasteurized donor human milk in NICUs across the US.

Dr. Wight explained human milk processing and handling, saying that currently there are no federal regulations governing milk banks. Guidelines were established by the Human Milk Banking Association of North America (HMBNA), written in cooperation with Centers for Disease Control (CDC), American Academy of Pediatrics (AAP), and the Food and Drug Administration (FDA). in some states a Tissue Bank License is required.

According to HMBANA donor milk processing guidelines, all the mothers are carefully screened. That is to say, it is safer and important for mothers to donate and obtain milk through a licensed milk bank.

Meanwhile, informal sharing of human milk or buying human milk through the Internet is more risky. According to a retrospective review of serologic testing of potential human milk donors, among 1,091 potential donors, 3.3% came back with positive serology screening results including syphilis, Hepatitis B, Hepatitis C, HTLV, HIV.

Dr. Wight encouraged all to help increase milk donation to human milk banks so that all preterm and ill infants enjoy the benefits of human milk.

Precious gift from Mother Nature: Sunshine, water, air, and...breast milk!

Saturday, August 2, 2014

Not just one mother's battle

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

Today's is the first day of 2014 World Breastfeeding Week. Just earlier this year, 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 now one year old, 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.

I had 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 had 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. I was shocked.

In addition to that, my coworkers harassed me about breastfeeding. When I was attempting to clean my pump supplies in the office kitchen, one coworker made a derisive comment that I was washing panties in the office. 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 here 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, so that other women don't have to experience what I have experienced.

No mother should have to choose between doing what is best for her baby and her job. 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.