Tuesday, October 21, 2014

EVERYONE can help make breastfeeding easier

Thank BreastfeedLA, I had a chance to share my experience of fighting for workplace breastfeeding right at last week's 2014 LA breastfeeding summit:

My name is To-wen Tseng. I'm a journalist, a former TV reporter turned freelance writer, based between Los Angeles and Taipei. 
I'm also a wife to my husband who is a computer engineer, and a mother to our little one who is now 17 months old. 
I didn't really have a breastfeeding plan when I first got pregnant. I came from a culture that is relatively breastfeeding unfriendly. Currently in China, less then 30% of newborns are being breastfed. Being raised in Taiwan, I've never seen anybody breastfeed when I was growing up. However, after a prenatal interview with my then future pediatrician, I decided to breastfeed. 
 So I became a mother with an exclusively breastfed baby. In August of last year, I returned to work when my baby was 3 months old. I was writing for World Journal, the largest Chinese-language newspaper serving North America.
On Oct 21st, the newspaper published an article titled "Breastfeeding Photos Embarrass Chinese-American to death," describing breastfeeding in public and/or sharing breastfeeding photos on social media as "disturbing" and "disgusting."
As a breastfeeding mother, I was shocked and offended. I talked to my editor, but he didn't think there was any problem with that article. The newspaper received complains from readers but had no response. 
 I was very, very disappointed. The truth is, the company wasn't friendly to breastfeeding mothers. We didn't have a nursing room, even though California law requires appropriate reasonable space for pumping.
I had to pump in the restroom. When I washed my pump parts in the kitchen, some of my colleagues would say, "don't wash your dirty panties in the office." I reported this to Human Resources, but they never dealt with it.
Later they published another article claiming that it is impractical for employers to provide lactation accommodations.
I spoke with my editor, a newsperson whom I once admired. We sat down for a 3-hour-long conversation and my editor insisted that there was nothing wrong with the article, that I was overreacting, that I had a personal issue.
 So I quit, ending a 10-year-long relationship with them. I sued the newspaper for sex discrimination.
The suit is settled and one thing I didn't agree was confidentiality. They wanted to pay for my silence which I refused. Other than that I'm happy about the agreement, it requires the company to change its policies regarding lactation accommodations and to share these policies with staff in multiple languages. Moreover, all supervisors will be trained on the policy and how to respond to requests for lactation accommodations.

Ten year is a long time to devote to a career. I loved my job but had to end it because of a hostile reaction to breastfeeding. I turned down the financial compensation in my lawsuit, so that I could speak out about this type of discrimination. My hope is to use my example to encourage other Chinese-American mothers. I'm glad that my Chinese blog is getting lots of responses.
Everyone can help make breastfeeding easier. This is what I did. What would you do?

Saturday, October 18, 2014

Breast Cancer Awareness Month: Breastfeeding cuts the risk of breast cancer

October is breast cancer awareness month. And I'm pleased that there is a new, large study done by my alma mater, Boston University, shows that breastfeeding cuts the risk of breast cancer!

Here is the deal. Estrogen receptor(ER)-negative breast cancer is a tumor subtype that is more common in black women and carries a higher risk of death. This new study published in the Journal of the National Cancer Institute suggested that the reason why black women are at higher risk for this aggressive type of breast cancer may be because the breastfeeding rate among them is lower.

In other words, mothers who choose to not breastfeed may be at a higher risk of breast cancer than those who do.

The research effort is led by researchers at Roswell Park Cancer Institute, Boston University’s Slone Epidemiology Center and the University of North Carolina Linebarger Cancer Center.

The team looked at questionnaire data from several studies, including two cohort studies and two case-control studies of breast cancer in African-American women. They analyzed data from nearly 3,700 black breast cancer patients. About one-third of them had ER-negative breast cancer.

Researchers founded that women with children were one-third more likely to develop these type of breast tumors compared to those who never had children. However, whether or not a mother breastfed her infants seem to influence her risk for the tumor even more.

For example, the results indicated that women who had four or more children but had never breastfed were 68 percent more likely to develop an ER-negative breast cancer, compared to women who had only one child but did breastfeed.

“Promotion of lactation may be an effective tool for reducing occurrence of the subtypes that contribute disproportionately to breast cancer mortality,” Julie Palmer, a study co-leader and professor of epidemiology at Boston University’s Slone Epidemiology Center wrote.

The authors concluded that this study may explain, in part, why African-American women, who typically have more children but a lower prevalence of lactation than U.S. white women, are disproportionately affected by ER-breast cancer.

The study also found that black women who breastfeed have a lower risk of being diagnosed with triple-negative breast cancer, in which tumor cells test negative for three key hormone receptors thus is hard to treat. The authors suggest that triple-negative breast cancer in African-American women who have given birth could be lowered by almost two-thirds if they breastfed at a similar rate as non-Hispanic white women.

“These findings showing that breastfeeding can reduce the risk for African American women of getting aggressive breast cancers are exciting because this is something that can be acted upon, where we can actually prevent some cases of these often-deadly cancers,” said Dr. Christine B. Ambrosone, a study co-leader and chair of the department of cancer prevention and control at Rosewell Park Cancer Institute in Buffalo, New York, in a statement. “We already know that breastfeeding has so many benefits to babies and their mothers. This is one more reason to encourage and support breastfeeding.”

The new study provides the most conclusive evidence to date, but is not the first and/or only study that has shown a connection between the number of times a woman has given birth and increased risk of ER-negative tumors, and that breastfeeding reduced risk of these aggressive cancers.

Breastfeeding has long been recognized as one of the factors that reduce the risk of breast cancer. In her recent article published in Huffington Post, Dr. Marisa Weiss, the president and founder of breastcancer.org, wrote, “You can take steps to reduce your risk of the disease by maintaining a healthy weight…and breastfeeding your baby.”

With my LO in North Carolina.

Thursday, October 2, 2014

Ouch! Nipple Pain, Damage & Infections

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

Nipple pain, damage, and infections can happen to any breastfeeding mother. According to a 2008 research published on Pediatrics, pain is one of the major reasons why women stop breastfeeding. At the most recent San Diego County Breastfeeding Coalition general meeting, Vicki Wolfrum, RN, CNM, IBCLC, discussed these breastfeeding challenges with her colleagues.

Breastfeeding is not supposed to be painful. Wolfrum said many mothers came to her with nipple pain and said, “I waited for a while before seeking help because they told me it’s supposed to be painful in the first few days.” However, Wolfrum said, “That is not true!”

She said, “If breastfeeding is extremely painful, something is not right.”

Sensitivity during the first week is normal. For example, during the first one to three days after birth, mother’s nipples are extra sensitive because of estrogen, a hormone. However, anything more than the normal sensitivity is not right and needs to be investigated.

Wolfrum recognized three common causes of nipple pain: mechanical problems such as poor latch, poor positioning, and disorganized suck; nipple problems such as flat, inverted, or short nipples; diseases such a bacterial infection, inflammatory breasts, and eczema.

Ankyloglossia can also present as nipple pain.

Poor positioning is much more common then imagined. Not leaning back, mother slumped forward, baby below the breasts, baby handing on nipple, and baby’s head twisted can all be considered poor positioning.

“The best first latch is skin to skin touch. The first thing is to get the mother comfortable, and then just put baby on the chest and he will find his way to the breasts. It works a lot of the time,” said Wolfrum, “Bring baby to the breasts, not breasts to the baby.”

Poor or shallow latch is also common. While latching well, the baby’s mouth should be widely open and the lops should be flared.

Ankyloglossia is another common cause of mild to severe nipple trauma and pain. “If there is ‘pinch’ with every suck, pain from first latch, severe pain when no trauma evident, persistent pain regardless of great latch, post feed crease and nipples of great latch or linear scabs on nipples,” Wolfrum explained, “then it’s probably ankyloglossia.”

She shared a classic story with her fellow IBCLCs, “a mother with her third baby is feeling extreme pain in nipples. Her pediatrician told her to stop breastfeeding for three days to let her nipples healed. She did, and the nipples were healed,but she still had pain. Then a lactation consultant told her that she had thrush because the baby’s tongue was white. she asked her OB for Diflucan but nipples were continually painful.”

When Wolfrum saw the mother, the baby was 4 weeks old and the mother was ready to quit breastfeeding. She found that the baby had posterior tongue tie and labial tie.

The mother had her baby laser frenotomy of both tongue and lip. There was an immediate relief. In one week the baby was sucking peacefully with loud swallows.

However, Wolfrum reminded that not all ties cause nipple pain and the decision for frenotomy should be carefully discussed with doctors.

The coalition’s Dr. James Murphy (MD, FAAP, FABM, IBCLC) also pointed out that thrush is a mouth infection, but it is perfectly normal for a baby’s tongue to be white. White tongue doesn’t necessary mean thrush.

Some nipple pain can be relieved by natural remedies, while others require medication. Common treatment for nipple healing and comfort includes lanolin, lanolin mixed with breast milk, hydrogel gel pads, APNO (all-purpose nipple ointment), miconazole cream, and epsom salt bath.

Wolfrum recommended using lanolin and breast milk mix and hydrogel gel pads together, “Mothers often ‘ahhhhhh’ with use of hydrogels!”

Cute, but incorrect breastfeeding position--mom not leaning back, baby's mouth not widely open.