Friday, April 29, 2016

The Difficult Feeder

Breastmilk is well established as optimal nutrition for nutritional, immunologic, and psychosocial child health. The ability of the newborn to latch and suckle effectively at the breast is critical to establish successful breastfeeding. Some newborns have significant difficulty, often related to anatomic and musculskelatal problems, thus requiring referral to specialists who have expertise in correcting newborn breastfeeding problems including lactation consultants, occupational therapists and physicians trained in the musculoskeletal basis of feeding dysfunction.

To address these issues, The San Diego County Breastfeeding Coalition (SDCBC) hosted a mini-seminar earlier this month for physicians and other health care providers. The purpose of this seminar is to familiarize maternal and newborn health providers with the types of expertise and interventions that different specialties—lactation consultants, occupational therapists, osteopaths—can offer and to aid in appropriate referral in order to assure successful breastfeeding.

Many issues might prevent a newborn from achieving a deep, effective latch to a normal mother’s breast. SDCBC’s Rose deVigne-Jackiewicz (RN, MPH, IBCLC) pointed out that premature babies and babies with real anatomical issues or jaundice are among those difficult feeders. An IBCLC should be able to recognize a “normal latch,” and form the strategy to establish a normal breastfeeding. She also believes that when having a long-term feeding plan, reasonable supplement and bottle usage is okay.

Bottle can be necessary when supporting the breastfeeding relationship for the infants who is hospitalized. However, “no nipple that resembles breastfeeding, ” said Robyn McMasters (MS, OTRL, SWC, CLEC) of Rady Children’s Hospital. She suggested evaluate every mother and baby before recommending a certain bottle system.

Bottle and breast are two different feeding systems. In strategies of supporting the transition to breastfeeding, McMasters recommended “educating moms early on being at bedside and participating in cares,” “kangaroo care,” “oral care with EBM,” and “exposure to breast.” Kangaroo care, also known as non-nutritive suck, can be a good transition to breastfeeding.

DeVigne-Jackiewicz said that an IBCLC should also be willing to acknowledge what s/he doesn’t know, refer the mom and baby promptly, and know who can refer to. This is where the cranial sacral therapy and osteopathic care kick in.

Cranial Sacral Therapy is a gentle, noninvasive form of bodywork that addresses the bones of the head, spinal column and sacrum. The goal is to release compression in those area which alleviates stress and pain. Cranial sacral therapy, said Bridgette K. Chelf (DC, CST) can help breastfeeding infants, for there are at least five bones of the cranium that effect suck. They are frontal bones, occipital bones, parietal bones, temporal bones and sphenoid bones. These bones also relate to nervous system that effect suck. When these bones are properly adjusted, baby’s sucking motion can be improved.

Dr. Hollis H. King (DO, PhD) introduced an osteopathic approach to treating the difficult feeder at the seminar. From his perspective OMT in pediatrics begins not at birth, but during pregnancy.

Dr. Viola Frymann, the founder of Osteopathic Center for Children, once said that the most important thing to do in treating children is to treat the mothers during pregnancy. Prenatal OMT helps the delivery process. And a traumatic delivery can result in somatic dysfunction that can have long term affects on the child.

Even delivered smoothly, 73% of newborns had at least one asymmetry, 10% had more than one. Both somatic dysfunction and asymmetry can lead to breastfeeding difficulties. They can both be corrected with osteopathic approach.

Eating is a learned behavior. Normal babies aren’t born with eating skills, they born with reflexive ability. The establishment of effective and successful breastfeeding often needs assistance from IBCLC and other professionals.

This is an original post for San Diego County Breastfeeding Coalition by To-wen Tseng. Photo credit to Mu-huan Chiang.

Thursday, April 14, 2016

Moms in Chinese hospitals told not to breastfeed their babies?

Seven years ago when Jane Wang was preparing for the birth of her first child in Beijing, she came across a very unexpected obstacle. 

During a hospital prenatal interview, she asked about the breastfeeding arrangements for after the baby was born. The staff simply told her, “You don’t have to breastfeed. The hospital will arrange high-quality infant formula for your baby.” 

“But I want to breastfeed.” 

“You don’t have to.” 

“What if I insist?” 

“You can’t. Your baby will be in a separate ward which is safe and clean. You can only see the baby according to a fixed schedule.” 

“What? That’s ridiculous!” 

“We’re doing this for security and hygiene reasons.” The staff member added, “Don’t worry; we know what’s best for your baby.” 

Jane was not persuaded. She interviewed a dozen hospitals until she finally found one where she was allowed to freely ask for her baby and breastfeed whenever she wanted after giving birth. 

Jane Wang is actually my cousin, and I know her as a tough and knowledgeable woman. But the majority of Chinese mothers, unlike Jane, find themselves accepting their local hospital’s arrangement out of convenience and are prevented from ever starting to breastfeed. 

One mother’s issue is actually a broader issue in China. Often, mothers are not allowed to breastfeed their newborns in hospitals. Three years ago, a CCTV reporter who went undercover posing as a mom at a hospital in Tianjin was told on camera, “You are not allowed to feed your own baby.” 

Each year, there are more than 20 million babies born in China. For the infant formula industry, the hospitals are a large market. UNICEF’s Baby Friendly Hospital Initiative was not adopted in China. WHO’s International Code of Marketing of Breastmilk Substitutes was adopted by the Chinese government in 2011 but not enforced. As a result, the aggressive infant formula industry spoiled China’s breastmilk. CCTV exposed how infant formula companies bribe doctors and nurses to force formula on parents in order to hook the babies to specified branded formula.

In fact, China is one of the developing countries with the lowest breastfeeding rates in the world. WHO 2013 statistics show that in China, less than 30% of newborns are exclusively breastfed from the start. And a massive demand of infant formula from large numbers of Chinese parents led to a baby formula shortage not only in the country, but also in neighboring areas/countries, such as Hong Kong and Australia.

This is unfortunate. The benefits of breastfeeding are well documented. A research paper published in Lancet shows that an increase in breastfeeding could prevent more than 800,000 deaths worldwide, or 13% of all deaths, in children under five annually in developing countries. Further research shows that breastfeeding drastically reduces deaths from acute respiratory infection and diarrhea, two major child killers.

Also, according to UNICEF, breastfed children have at least six times greater chance of survival in the early months than non-breastfed children. In developing countries an exclusively breastfed child is 14 times less likely to die in the first six months than a non-breastfed child.

The good news is the young and educated generation of Chinese mothers are making changes and the organizations around the world are helping. Last year, hundreds of breastfeeding moms staged several sit-ins in the Chinese cities of Chongqing, Guangzhou, Shanghai and Shenyang to raise awareness of the importance of breastfeeding. Supporting breastfeeding mothers has also been a focus of UNICEF China. In 2013, the organization called for public buildings and shops to set aside spaces for breastfeeding mothers.

BabyCenter, the #1 pregnancy and parenting digital resource, is dedicated to helping parents around the world which, of course, includes China. BabyCenter’s text and audio messaging programs provide breastfeeding support, including the Mom-Baby Messenger program it launched in China last year. The mobile messaging programs are proving to help women achieve their breastfeeding goals.

My cousin Jane eventually gave birth in the Beijing OB/Gyn Hospital, which later started the country’s first breastfeeding counseling clinic in 2010. The clinic has been so popular that two other Beijing hospitals followed their example over the next six years. It’s a good step toward change.

This post is provided through a special collaboration with BabyCenter’s Mission Motherhood™ and World Moms Blog to empower women everywhere to have safe and healthy pregnancies and babies. Photo credit to Mu-huan Chiang.

Friday, April 8, 2016

Call for Breastfeeding-Friendly Workplaces!

San Diego County Breastfeeding Coalition (SDCBC) is now accepting nominations for the 2016 Breastfeeding-Friendly Workplace Awards! Nominate a Breastfeeding-Friendly Workplace here.

The SDCBC has been promoting breastfeeding friendly workplace so mothers feel easier breastfeeding when return to work after giving birth. According to the US Department of Labor, 56% of women with children under three are employed outside the home. These women form an important part of our workforce. The benefits of lactation-friendly work environments to both employees and employers are readily documented by plenty of researches. Companies both large and small benefit from providing a lactation supporting program. Lactation supports can be simple and cost-effective. When the components are provided companies enjoy the biggest savings.

What makes a workplace breastfeeding friendly?

1. Privacy for milk expression
Under the Fair Labor Standards Act (FLSA), employers are required to provide “a place, other than a bathroom, that is shielded from view and free from intrusion from coworkers and the public, which may be used by an employee to express breast milk.”
A bathroom, even if private, is not a permissible location under the Act. The location provided must be functional as a space for expressing breast milk. If the space is not dedicated to the nursing mother’s use, it must be available when needed in order to meet the statutory requirement. A space temporarily created or converted into a space for expressing milk or made available when needed by the nursing mother is sufficient provided that the space is shielded from view.

2. Flexible breaks and work options
Under the FLSA, employers are required to provide “reasonable break time for employee to express breast milk for her nursing child for after the child’s birth each time such employee has need to express the milk.” The frequency of breaks needed will likely vary.
The FLSA requirement of break time for nursing mothers to express breast milk does not preempt Sate laws that provide greater protections employees (for example, providing compensated break time, providing break time for exempt employees, or providing break time beyond 1 year after the child’s birth).

3. Education
Employees value information they receive during their pregnancy about continuing to breastfeed upon returning to work. Pamphlets, resources, lunchtime prenatal classes, and access to a lactation consultant can help employees feel more prepared.
Education helps employees understand why breastfeeding is important and how to continue breastfeeding when return to work. It helps a company’s supervisors and managers recognize the importance of accommodating breastfeeding employees. It also helps employers stay in compliance with the law and keeps the new mothers in the workforce.

4. Support
Supportive policies and practices that enable women to successfully return to work and breastfeed send a message to all employees that breastfeeding is valued. Management can encourage supervisors to work with breastfeeding employees in making reasonable accommodation to help them reach their breastfeeding goals and can encourage other employees to exhibit a positive, accepting attitude. 
Providing support is a temporary need for each breastfeeding employee. Once babies being eating solid foods at 6 months, milk expression requirements gradually diminish.

5. Written Policy 
Mothers and employers agree that having a lactation policy made a huge difference.
“Before the policy, I had to search for rooms to borrow—some of which did not have locks,” said Nina C. Iwanaga, a mother and an employee at County of San Diego’s Health and Human Services Agency. “After the policy, I felt I had a lot more support and knew of appropriate, secure rooms that I could use. I was even able to exceed my goals.”

Know a breastfeeding-friendly workplace? Nominate it here by MAY 15!

This is an original post for San Diego County Breastfeeding Coalition's Blog by To-wen Tseng. Photo courtesy Mu-huan Chiang.