Tuesday, August 15, 2017
It is National Breastfeeding Month and I was just in an Asian Breastfeeding Task Force kick-off meeting last week. Healthcare providers in Los Angeles and Orange County came together and formed this task force because they feel it’s clear that there are special and unique cultural and education issues when working with the population and breastfeeding practices.
Los Angeles County is home to the largest Asian American population in the US. In 2015, 2/3 of the babies born in Garfield Hospital and half of the babies born in San Gabriel Valley Hospital were Asian, according to data from AHMC medical group. Garfield and SGV are the two of the largest hospitals in Los Angeles County. Also according to the hospital data, most of the mothers were first generation immigrants. Their parenting style is deeply rooted in their culture.
I was born and raised in Taiwan. I was not breastfed. Growing up in the 1980s I’ve never seen or heard of anybody breastfeed. Of infants born in 2013 in China, 20.8% were breastfed at 6 months and 11.5% were breastfed at 1 year of age, comparing with 49% were breastfed at 6 months and 27% at 12 months in the US.
Merely two generations ago, Asian mothers did breastfeed. But aggressive infant formula marketing changed everything. UNICEF’s Baby Friendly Hospital Initiative is not adopted in China. WHO’s International Code of Marketing of Breastmilk Substitutes was adopted by the Chinese government in 2011 but not enforced. In 2013, 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. 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.”
Back in Southern California, high percentage of foreign born Asian patients brought new challenges. Hospital staff found that some Asian mothers believe that “US formula is best, even better than breastmilk.” Many Asian mothers bring to hospital their nannies and family members who often encourage formula usage so that the moms can rest. On top of all these, there is language barrier and the trend of “birth tourism”—Asian, mostly Chinese, moms travel to the US for the purpose of giving birth.
In spite of the obstacles, nursing staff want to encourage Asian moms to breastfeed. They found that prenatal education is very important because it’s hard to persuade mothers to breastfeed after the birth if the mother doesn’t have any prior breastfeeding knowledge. Participants at the kick-off meeting decided to bring more Asian community leaders to the table and reach out more to the community.
The good news is, the younger generation of Asian mothers are aware of the benefits of breastfeeding and actually want to breastfeed. A medical staff from one of the Los Angeles hospital shared her experience at the meeting,
“Last year a young Chinese mother reported that our nurse gave her baby formula without her permission. When I questioned the nurse, she explained that it was the grandma asked for formula, and since the mom is of Chinese background, she assumed the family wants formula. But it turned out the mom actually wanted to exclusively breastfed.”
The incident tells a lot. The younger Asian generation is changing and it encourages the healthcare providers to reach out to them. The task force is a good start.
*This is an original post for MomsRising by To-wen Tseng.
Monday, July 31, 2017
Breastfeeding mothers, have you ever thought about becoming a human milk donor? Maybe you are producing more milk than your baby can eat and you feel responsible for what you have. Maybe you want to help vulnerable infants around the country. Either way, being a human milk donor is a deeply rewarding experience.
When thinking about milk donation, many mothers first consider finding someone in their area who need milk for their babies and casually sharing it with them. But there are safety issues. Last year, the American Academy of Pediatrics issued a policy statement against informal milk sharing because of the risk of bacterial and viral contamination. A 2013 study found that 74 percent of breast milk bought on the Internet had high levels of bacterial growth, particularly strep and staph.
So instead of casual sharing, you should look into human milk banks. There are currently 18 human milk banks in the United States and Canada that are affiliated with the Human Milk Banking Association of North America, which sets guidelines for ensuring donor breast milk safety. Milk banks pasteurize donor milk to kill bacteria, combine it with other donor’s milk to make sure the milk components are well balanced, and test the milk for contamination. They then provide the milk to premature babies and other infants whose mothers may not be able to breastfeed.
Last year, 9.6 percent of U.S. infants were born prematurely, which can cause a host of health issues, including necrotizing enterocolitis (NEC), a serious disease in which babies’ intestines are damaged or die, causing waste to leak into their bloodstream. In 2013, preterm-birth complications were responsible for one third of U.S. infants death, according to the Centers for Disease Control.
The World Health Organization says preemies should drink their own mother’s milk when possible. While donor milk is good for babies, it’s not as powerful as their own mother’s milk, because a mother’s milk composition rapidly changes to meet her baby’s needs. However, WHO does recommend donor milk as the best backup.
As you prepare to donate, you have to pass a month-long screening process, which included a phone interview, blood test for infectious disease, and releasing your baby’s and your medical records so the milk bank staff could ensure donating wouldn’t be detrimental to either of you. Your milk can help prevent infections in premature babies and encourage there mothers’ own breastfeeding efforts. Upcoming milk drive in San Diego area:
Date: Saturday, August 5, 2017
Location: UC San Diego Health East Campus Office Building
For more information, please visit https://health.ucsd.edu/specialties/obgyn/maternity/newborn/lactation/Pages/Mothers-Milk.aspx
Date: Monday, August 7, 2017
Time: 7:30 am
Location: Sharp Mary Birch Hospital
For more information, please visit https://www.sharp.com/hospitals/mary-birch/mothers-milk-bank.cfm
When breast milk goes big business
The dangers of buying breast milk online
Breast milk is love. Share love!
*This is an original post for San Diego County Breastfeeding Coalition by To-wen Tseng.
Monday, July 17, 2017
|Dr. Stellawagen speaks at San Diego County Breastfeeding Coalition meeting.|
According to Dr. Lisa Stellawagen (MD, FAAP) of UCSD Medical Center, It’s complicated. Marijuana usage during pregnancy and breastfeeding is an emerging public health problem. At a recent San Diego County Breastfeeding Coalition meeting, Dr. Stellawagen said that THC use is common in pregnancy. Survey shows that 10.9% of pregnant women used Cannabis in the past year.
In fact, it’s hard for medical staff to know how many mothers actually used Cannabis because self report is not accurate. A 1993 study tested 7470 pregnant women in five centers from 1984 to 1989. All women were asked about drug use and tested by serum analysis. While 31% of the women were confirmed with serum testing, only 11% of them admitted to use marijuana.
Currently we do not have good quality evidence that THC use is bad for infant. Fetal effects of prenatal Marijuana exposure includes small decrease in growth, double increase in stillbirth, but there is no association with birth defects, and the risk of prematurity is unclear. As for neurodevelopment, study found inconsistent effect on newborn behavior.
We do not have good quality evidence that THC use in lactation causes poor outcomes, either. A 1990 study looked at maternal marijuana use during lactation and infant development in one year. Researchers compared one year developmental testing with days of postnatal exposure if breastfeeding, and found that infant’s daily exposure to marijuana in the first month was associated with a 14% decrease in Bayley motor scores, but metal scores were not affected.
We don’t even know how much THC gets into the milk when mother uses marijuana. A 1982 study found that after using THC for one day, there were 105 mcg of THC detected and after using seven days, there were 340 mcg of THC detected per liter of maternal milk. But there was no metabolite detected in infant urine.
That says, before we tell mothers not to breastfeed, we should be sure the risk outweighs the benefit. Benefits of breastmilk for the neonate is of specific significance to the illicit drug exposed infant. Breastfeeding reduces SIDS, decreases risk of neglect, has neurodevelopment effects. Breastfed preterm infant has less NEC, less infection, and better neurodevelopment outcomes.
We do know that THC does get into the baby and mother’s milk, though. So instead of "do not breastfeed if you're using THC," we should tell mothers “do not use THC when you’re pregnant or breastfeeding.” What if mothers are using THC? Dr. Stellawagen suggested, “Others should be available to care for your baby if you use THC. And if you use THC, smoke outside and use a ‘smoking jacket’ to minimize baby exposure.”
*This is an original post for San Diego County Breastfeeding Coalition by To-wen Tseng.
Saturday, July 15, 2017
There’s a big global push in from experts to have mothers of newborns breastfeed exclusively for at least six months. And many new moms want to. But only about 60 percent who start off breastfeeding keep it up for six moths or more, according to the Centers for Disease Control and Prevention.
Here’s a quick guide to advice from lactation consultants, pediatricians and researchers who had tips for women on how to reach their breastfeeding goals.
Expect problems at first
Breastfeeding is natural, but that doesn’t mean it is automatic and easy, as many people think of.
People often think moms and babies will know exactly what to do, and they won’t even have to think about it. Some times that happens, but it’s not the most common outcome.
Even in traditional societies that don’t use formula or bottles, women often struggle to breastfeed, it turns out.
Take Himba mothers in the desert of northern Namibia for example. As NPR reported, essentially all Himba moms breastfeed their babies. But about two-thirds of these women have problems at the beginning, researchers found.
Line up a lactation coach before the baby comes
Since problems are likely, moms need to be ready.
Arrange to have somebody who’s experienced with breastfeeding present at baby’s birth or right after the birth to coach the new mom is suggested.
The coach can be a friend, a relative or a professional lactation consultant.
Many moms are looking on the Internet and on the YouTube about how babies should latch and what to do. That can be helpful, too, but moms still need hands-on guidance.
Many health insurers cover consultations from lactation consultants. Moms can check International Lactation Consultant Association’s website to find a nearby lactation consultant.
Create a support network for breastfeeding
Mothers still feel really isolated and confused about what they’re supposed to do after birth, reported BBC.
But being isolated with a newborn is the opposite of how humans evolved. Throughout evolutionary history, humans have relied so much on others to share the load of caring for babies. It’s one of things that make us human.
Traditionally, new moms all over the world have been taught how to breastfeed. They had their moms or aunts or close friends there to help.
Every new mother needs a support network for breastfeeding. It takes a whole village.
Don’t sweat a little supplementation with formula
New mothers often hear a lot from family, friends and experts about the importance about exclusively breastfeeding. That’s what the American Academy of Pediatrics recommends for the first six months.
Decades of scientific research proves the formula is nutritionally inferior to breastmilk. But, when a mother’s own breastmilk or human donor milk is not available, infant formula is an important third option that can, at times, save lives. Also, supplement option can be a tool that helps moms work to establish their breastmilk supply.
The bottom line is, supplementing with formula is no way means mom’s failed.
*This is an original post for San Diego Breastfeeding Coalition by To-wen Tseng.
Friday, July 7, 2017
|Me, into 29 weeks pregnant.|
Merely 26 weeks ago, I’d totally agree with the statement. I was a tough cookie during my first pregnancy. I stood under scorching sun for 11 hours to shoot the final landing of Space Shuttle Endeavour when I was two months pregnant. I covered smuggling stories from Mexico when I was eight months pregnant. I worked till the last day of my delivery, I even finished a short article while dilating in the delivery room. I traveled abroad several times through the entire pregnancy. Yes, everything I could do, I could literally do it while growing my first one inside of me.
Now that first one is four years old and I’m 26 weeks pregnant today. I thought I was going to be the tough cookie again. But this time I had pregnancy complications since the very beginning. I suffered from bad nausea, so bad that I have to move my computer to the restroom and do my works between vomiting sessions. I’ve been bleeding and had to cancel two business trips per doctor’s recommendation. I want to do everything I can do while growing my second one inside of me, but I’m trapped in this heavy, pregnant body.
I never realized how hard a pregnancy could be, and how essential supporting like paid family and medical leave could be. I’ve always been a supporter of paid family leave bills but I once thought I could live without them. Now I realized I can’t. Nobody can.
That’s why SB 5975, the paid family and medical leave bill the Washington State legislature passed last night was such a monumental victory, not only for working families and small business in Washington, but for the entire nation. I’m not saying this because I'm having a rough pregnancy myself. I’m saying this because maternity complications could happen to any woman, any family. Our country needs parents to work, also needs parents to have babies. For this very reason, all parents deserve supports.
Once it becomes law, SB 5975 will allow workers in Washington to take 12 weeks of family leave and 12 weeks of medical leave, with a maximum cap of 16 weeks of paid leave per year. In addition, the legislation provides for two more weeks of paid leave for women who experience maternity complications, offering much-needed relief to new moms who suffer difficult pregnancies. The legislation covers all workers in the state, even self-employed individuals who can opt in the program. It’s a great start and can be a model for the nation.
*This is an original post for MomsRising.org by To-wen Tseng.
Thursday, June 29, 2017
|Feeding my child at the intermission of a LA breastfeeding conference.|
A friend gave me an electric breast pump. Another friend gave me a cooler and some ice packs. I got serious.
I breastfed my child, relied on pre-pumped breastmilk to get through day care days. I faced breastfeeding discrimination situation at work by six months. I had four business trips by one year. But I insisted.
I insisted not because I am a true believer in the benefits of breastfeeding, but mostly because of the support I had.
Dr. Michael Kramer, a professor of pediatrics and epidemiology at McGill University Faculty of Medicine, led a research on the Promotion of Breastfeeding Intervention Trial, which studied 17,000 mother-infant pairs in Belarus starting in the mid-90s. Half of the mothers, who had all begun breastfeeding at birth, received addition support and encouragement to keep breastfeeding.
Dr. Maryam Sattari, an associate professor of medicine at the University of Florida, was the lead author of a 2016 study on the breastfeeding intentions and practices of 72 internal medicine physicians. The study found that 78 percent of the babies were exclusively breastfed at birth and 40 percent of them at 12 month, though 63 percent of the mothers had planned to go to a year. “These are moms who are highly educated, highly motivated, they all want to do it,” Dr. Sattari told New York Times.
What helped these mothers, she said, was encouragement from medical leadership, as well as appropriate space and time to pump.
According to the Centers for Disease Control and Prevention’s breastfeeding report card on women in the United States breastfeeding babies born in 2013 (the year my first was born), while breastfeeding overall is on the rise, the numbers show that many mothers in this country are not following the A.A.P. recommendations. Compared to 2003, more women in 2013 were initiating breastfeeding (81 percent, up from 73 percent), but only 31 percent still breastfeeding at a year. Cria Perrine, an epidemiologist in the C.D.C’s Division of Nutrition, Physical Activity and Obesity, said that our culture need to do a better job of supporting women who breastfeed.
With my first child, I made it to six months exclusively. We kept going till he was a little over two years old. I initiated breastfeeding with the support from my pediatrician and lactation consultants in the hospital. I made the business trips with my trusty electric breast pump and the help from airline and hotel staff members. I went through the breastfeeding discrimination lawsuit with the help from Legal Aid Society, local breastfeeding coalitions, along with others. The experience made me deeply aware of how hard it would have been to do this if I was less well supported.
*This is an original post for San Diego County Breastfeeding Coalition by To-wen Tseng.
Tuesday, June 13, 2017
A horror story about a mom being forced to dump her breast milk in an airport is circulating on Internet. It reminds me about the two years when I was breastfeeding. I travel frequently for work and flew a few times with my breast pumps during that two years. My impression is that traveling as a breastfeeding mom can be challenging, but not impossible. Most agents do understand breast milk security procedures, and mothers should be good if they know the TSA guidelines in regards to breast milk storage.
Here are several things to keep in mind when carrying breast milk on a flight.
Travel with an unlimited quantity of breast milk
According to the TSA guidelines, you can bring as much breast milk as you want. I once flew with a whole gallon of breast milk from Phoenix to Los Angeles, no problem at all.
Declare breast milk to agents
You can travel with as much breast milk as you want, but TSA guidelines recommend you inform a TSA officer at the beginning of a screening process. Alerting agents ahead of time makes the process smoother and faster for everyone involved.
Breast milk will be inspected
Your breast milk may still be subjected to the X-ray machine, but if you don’t want it to go through there you can request an alternative screening method. I tried the alternative method once at the Austin-Bergstrom International Airport. It includes a pat-down and was time-consuming. Personally I prefer they just run my breast milk through the X-ray machine.
Bring small coolers and ice packs
Accessories to keep breast milk frozen, partially frozen, or in a cool state are permitted per TSA guidelines. I always bring a personal cooler with ice packs. Yon can ask a flight attendant for ice if you forget.
Store breast milk safely
The best way to transport breast milk and keep it fresh while traveling is in sealed containers kept in a small, insulated cooler with frozen ice packs. The breast milk should be used within 24 hours. If you won’t be using your milk right away it should go in a refrigerator or freezer as soon as you get to your destination. Always make sure label your breast milk bags with the date you pumped.
Moms don’t have to travel with their children to have breast milk
As explained on the TSA website, you don’t need to have your baby or child with you to travel with breast milk. I often travel for work with my breast pump and breast milk, but not with my child.
Breast pump doesn’t count as a “carry on”
When bring your breast pump you don’t need to cut it as part of carry ons. Breast pump is considered a medical device and won’t need to be counted. But you should be prepared to keep telling agents that it’s a medical device. However, cooler does count as one of your carry ons. Personally I just bring the pump as a personal item and the cooler as a carry on.
*This is an original post for SDCBC by To-wen Tseng
Monday, June 5, 2017
|Serving as a substitute teacher at my local Chinese-language school.|
Then I saw a little girl in a dress and high heels, with a clear voice she said, “Winter is my favorite season because it reminds me the Chinese fairy tale ‘Snow Child,’ a story that describes the noble sentiments of Chinese people.” Then she wiped her eyes in an exaggerated way.
These children were all born in the States, of Chinese descent. It was surprising to see they speak Chinese in such crisp and clear voices. But the speech content was very confusing. I really wanted to ask the girl what she meant by “the noble sentiments of Chinese people,” or the boy what the “great things” he was going to do for his people. I’ve got the impression that most of the scripts were written by parents.
After the young children spoke, the older kids stepped on the stage. Next, I saw a couple of teenagers in T-shirts and shorts hesitantly walked up, muttering things like, “We should respect our teachers, because…because Chinese people believe in their teachers, well I’m American, not Chinese, but…oh well, let’s just respect our teachers” or, “We should respect our parents because…because they are too old to understand anything we say…let’s just listen to them when we are home.”
It was funny to see young people with apparent Chinese appearance speaking with such strong American accents--so strong that I could barely understand most of them. Nine out of ten parents sitting in the auditorium frowned, clearly not enjoying the speech. Were they sad because their teenagers were not speaking Chinese as well as they had in elementary school? Were they worried because their children’s speech was not good enough to get them into college?
While considering how to score, I thought of my own child. He was then nine month old. I couldn’t help it but wonder whether he would be able to tell the fairy tale Snow Child in fluent Mandarin Chinese. Will he become an American kid with an American accent and complain “Mom is too old to understand anything I say”?
I frowned, like all the parents in auditorium.
In my family, we speak Chinese at home and English at work or school. My son was a late talker, but our pediatrician comforted us, saying that although bilingual kids can be slow to speak at the beginning, they usually catch up quickly. He encouraged us to insist on speaking Chinese at home.
We tried to create a Chinese-only environment at home with the hopes that the my son's first word would be a Chinese word. But the hope came to naught. His first word was an English word he learned at daycare: “Daddy.” This was my first failure in raising a bilingual child. In spite of this, we continue to speak Chinese at home. Every night we read bed time stories together in Chinese. By the time he turned three, my son could speak fluent Chinese, could tell Snow Child and many other fairy tales without help. I was very proud.
But my pride didn’t last for long. Just a couple of months ago, his preschool teacher told me that he had a hitting problem. The theory was that because my son didn’t speak English as well as other kids, his ability to stand up for himself in arguments was limited, and he turned to physical means of expressing himself.
The teacher suggested that we set an “English time” at home to help my son improve his English. I didn’t like the idea: the more I exposed him to English, the less chance he got to speak Chinese. Didn’t he speak a whole lot of English at school already?
But the hitting problem got worse. After consulting our pediatrician and therapist, I finally gave in and started a daily English story time at home. Kids are really like sponges, and his English improved in no time. He stopped hitting his preschool classmates, but his Chinese language skills went backwards.
I started to understand why I would keep seeing the same thing at Chinese speech and recitation contests: the younger the children are, the better their Chinese language skills as. I started to understand my hope of raising a bilingual child fluent in Chinese might once again come to naught.
I worked as a staff writer at a local Chinese-language newspaper when I was young. Many times, I interviewed outstanding second or third generation Chinese-Americans. When I asked them for a Chinese name for publishing purpose, they often said, “I don’t remember my Chinese name.”
A Chinese-American anti-death penalty activist once “drew” down her Chinese name for me after an interview. I couldn’t read the symbols she had drawn. I tried to guess and wrote down two characters next to her drawing. She read my writing and happily announced, “Yes, that’s my name!”
The article was published the next day. I got a phone call in the newsroom. On the other side of the phone was an old lady speaking Chinese with a sweet Beijing accent. She identified herself as the mother of the anti-death penalty activist, and said that I had gotten her daughter’s name wrong. I apologized, and she said, “That’s okay, I understand. My daughter must made the mistake herself. She never remembered her Chinese name. But I just want to let you know.” Then she was silent. “Hello! Hello?” I said, wasn't sure if I should hang up. Then she started to talk again, asking me where I was from, if I’m married, and if I had children.
At that time I was married but no children yet. The old lady said earnestly, “Take my advice. When you have your own kids, always speak Chinese to them.”
“Sure, sure,” I said, just saying that to make her happy.
Through the years I’ve seen many second generation Chinese-American kids struggling to learn Chinese. Since having my own kid, I often think of the old lady and her daughter who couldn't remember her own Chinese name. The thought is almost painful.
It’s not just the America-born children who are struggling. The away-from-home adults are also struggling. I’m a professional writer who was born to Chinese parents and raised in Taiwan, but who spent her entire adulthood in the States. I struggled to improve my English during my first years in the States. Now I write English more then Chinese. I can see clearly that I no longer speak Chinese as well as I used to. When I was in my twenties, I was eager to get rid of my Chinese accent. Now I’m desperate to maintain my Chinese language skill.
My son will soon be four, old enough to go to Chinese language school. I decided to let him start this fall. He didn’t like the idea of going to school on weekends and asked, “Why do I have to learn Chinese?”
I didn’t know how to explain the concept of culture to a toddler. I just told him, “So you can read ‘Journey to the West’.” The other night I read him the chapter “Monkey Subdues White-Skeleton Demon” from the classic novel. He wanted to know if the Monkey eventually returned to his teacher Xuanzang. I wouldn’t tell him. I told him that he’ll read it one day by himself.
I still hope to raise a bilingual child who speak fluent English and at least understandable Chinese. I don't expect him to love Chinese language right away. Language is always first a tool and then an art. I hope my son will first learn how to use the tool, and then, maybe one day, he’ll truly fall in love with the art.
This is an original post for a World Moms Network by To-wen Tseng. Photo credit: David Sprouse.
Friday, June 2, 2017
|The best place I pumped.|
According to a study published in the journal Women’s Health Issues, 60% of pumping women don’t have basic workplace accommodations or adequate break times.
That’s no news. I personally have pumped in many weird places. I returned to work three month after giving birth as a staff writer at a Chinese-language newspaper based in Los Angeles. The company didn't have a nursing room, even though California law requires appropriate reasonable space for pumping.
I pumped in the restroom. When there is a line in the restroom, I pumped in my car. When the weather is too warm or the pump battery is too low, I sat on the floor under my office desk to pump, covering by a jacket. Some male colleagues claimed that I distracted them by sitting under my desk. Later a female colleague helped me to hide in the company storage to pump. It’s dirty in the storage and there were dead cockroaches on the floor, but I am forever grateful for her help.
My job requested frequent travel. Never a time during my entire life that I loved business trips that much. For that’s the only time I got to pump at decent places like an airport nursing station or a hotel room. Collecting and transporting breast milk while traveling is challenging, but not as challenging as sharing pumping room with roaches.
I eventually quit my job and sued the newspaper for sex discrimination. In spite of my effort of hiding myself when pumping, I was harassed. 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. I discussed the possibility of having a space to pump with my supervisor, but was told “nobody ever pumped in the office. We are Chinese company and we don’t follow American rules.”
The suit was settled and one thing I didn’t agree was confidentiality. They wanted to pay me for not talking about this incident again 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 accommodation.
I hope I would be the last mother who had to quit her job and go through a law suit simply for a reasonable place to pump. We can do better. Please join me and sign the petition that support all breastfeeding and working moms.
And MomsRising just launched #IPumpedHere campaign that demand to bring breastfeeding women into the pumping rooms they deserve. This campaign kicked in right on time because with the Affordable Care Act (ACA) being repealed, the situation can be worse for millions of working and breastfeeding moms. Please visit IPumpedHere and see what you can do to help your employer help you, and help other women pumping in a bathroom stall, inside a car, or under her office desk.
This is an original for MomsRising.org by To-wen Tseng.
Monday, May 22, 2017
|Left to right: deVigne-Jackiewicz, Wight, Fletcher and White.|
There has been lots of discussion about Baby-Friendly Hospital Initiative, a global initiative of WHO and UNICEF. How mommy-friendly is the Baby-Friendly Hospital Initiative? Is the breastmilk-only mandate putting babies in danger?
SDCBC’s recent Spring Mini-Seminar focused on this hot topic. Dr. Nancy Wight (MD, FAAP, FABM, IBCLC), Rose deVigne-Jackiewicz (RN, MPH, IBCLC), Ruth Fletcher (BSN, RN, IBCLC) and Nancy White (BSN, RN, IBCLC) talked about the challenges and strategies practicing Baby-Friendly Hospital Initiative.
What most think of when BFHI is mentioned is the famous 10 steps:
- Have a written breastfeeding policy that is routinely communicated to all health care staff.
- Train all health care staff in the skills necessary to implement this policy.
- Inform all pregnant women about the benefit and management of breastfeeding.
- Help mothers initiative breastfeeding within hour of birth.
- Show mothers how to breastfeed and how to maintain lactation.
- Give infants no food or drink other than breastmilk, unless medically indicated.
- Practice rooming in—allow mothers and infants to remain together 24 hours day.
- Encourage breastfeeding on demand.
- Give no pacifiers or artificial nipples to breastfeeding infants.
- Foster the establishment of breastfeeding support groups.
However, there are “problems” with the 10 steps, especially when it comes to medically fragile infant. A normal infant should loss no more than 8% of his birth weight by day 4 after birth. Certain conditions would make acceptable medical reasons for the use of breastmilk substitutes. The goals of supplementation is to establish and maintain a mother’s milk supply. Skin-to-skin and putting babies to mothers’ breasts are important even when using supplement. Research shows that through practicing in breastfeeding, mothers are giving an active and meaningful role in the NICU, which can build confidence and enable parents to handle their infants.
Baby-friendly in the NICU is possible, though there are barriers and difficulties. A Neo-Baby Friendly Hospital Initiative for neonatal wards has been established. There are three guiding principals: Staff attitudes toward the mother must focus on the individual mother and her situation. The facility must provide daily centered care. The health care system must ensure continuity of care from pregnancy to after the infants’ discharge. Lack of lactation support and mother-baby separation are some of the main difficulties when practicing baby-friendly in NICU. Parents education, access to pumps and other tools, and Increased lactation support can be the solution.
Even in daily nursing practice, there are challenges of maintaining BFHI. There are sociopolitical barriers such as patient mix. There are organizational barriers such as hospital policies. There are individual barriers. Personal bias and experience, lack of breastfeeding skills and knowledges among new nurses are all issues. We need cultural strategies, family strategies, patient and family education strategies, and staffing strategies to overcome the barriers. Take time to understand mother’s viewpoints and beliefs. Ask family members their opinions about the importance of breastfeeding. Manage expectations, starting with antenatal education. It’s also important to address staff personal bias.
This is an original post for SDCBC by To-wen Tseng.
Thursday, March 23, 2017
Camie Jae Goldhammer (MSW, LICSW, IBCLC): Culture,Trauma and Breastfeeding
Goldhammer explained how culture, trauma and breastfeeding all connected. She worked 11 years as MSW with intergenerational trauma in National American population. In mainstream culture, breastfeeding is seen primarily as a health choice. But in Native American culture, it’s been lost. Galdhammer’s family is an example. Her family’s history of five generations of women endured the shared trauma experienced by Native American population, by the time she was born, her ancestral parenting models had all but disappeared. Breastfeeding didn’t happen. She learned to breastfeed after her birth and that was the beginning of the healing and reclaiming of breastfeeding in her family. She has been serving families families with complex trauma histories since then. She believes that trauma may have been a weapon of mass destruction, but breastfeeding is a weapon of mass construction.
Collen Weeks (LCCE, FACCE, CLE, CSE, RTS): Adverse Childhood Experiences (ACEs) and their impact on Breastfeeding and Breastfeeding’s Impact on ACEs
ACEs impact more than 1 in 3 of the breastfeeding families that Weeks takes care of at Kaiser Permanente Hospital. These are serious traumas that result in toxic stress and can harm children’s brain and prevent learning. ACEs can include emotional, physical or sexual abuse, emotional or physical neglect, mother treated violently, household substance abuse and more. Exposure to childhood ACEs can increase the risk of adolescent pregnancy, alcoholism, depression, drug abuse and heart disease. It reduces one’s ability to respond, learn or figure things out, increase stress hormones which affect body’s ability of fighting infection, lower intolerance for stress. The good news is, resilience can trump ACEs and bring back health and home. ACEs is a really sensitive issue. When teaching resilience, Weeks recommended:
- Gently address parents and how they may impact breastfeeding or how breastfeeding may impact them.
- Initially discuss the issue with the mom when alone with her; follow her lead as the topic comes up.
- Be positive and encouraging.
Tista Ghosh (MD, MPH): Marijuana and Breastfeeding
Ghosh is the Deputy Chief Medical Officer atColorado Department of Public Health & Environment. The State of Colorado legalized Marijuana in November 2012. In 2014, 11.2% Colorado women were reported using marijuana prior to pregnancy with a high using percentage among childbearing aged women, 5.7% women reported using marijuana during pregnancy, and 4.5% reported using marijuana lactation. It does create more headaches for the medical community. There is no known safe amount of marijuana use during pregnancy, but THC (the chemical responsible for most of marijuana’s psychological effects) can pass from mother to the unborn child through the placenta. Also, maternal use of marijuana during pregnancy is associated with negative effects on exposed offspring, including decreased academic ability, cognitive function and attention. Effects may not appear until adolescence. THC can also be passed from the mother’s breast milk, potentially affecting the baby. There are moderate evidence showing that maternal marijuana use during pregnancy an breastfeeding can decrease growth in offsprings. For more information on the 2017 California Breastfeeding Summit, please visit http://californiabreastfeeding.org/annual-summit/2017-summit-program-presentations/
This is an original post for San Diego County Breastfeeding Coalition by To-wen Tseng. Image courtesy California Breastfeeding Coalition.
Monday, February 27, 2017
As San Diego flu cases reach new high this season, many mothers are asking, “Can sick moms breastfeed?”
From my personal experience, sick moms can totally breastfeed—I once breastfed in an emergency room when down with stomach flu. And my husband was attacked the second day. Our breastfed son, then eight month old, turned out to be the only one of the family who didn’t get sick. Our pediatrician said the antibodies in breast milk protected our child.
Of course, I’m not a medical personal and may not be persuasive enough. Here is what experts have to say.
Moms should continue to breastfeed when they’re sick:
According to Alanna Levine, pediatrician, under most circumstances, sick moms should continue breastfeeding. If the mom has a standard cold, flu, or stomach virus—even if she has a fever—it’s fine to breastfeed. In fact, she probably exposed the baby to her illness days before she began showing the symptoms. And since the mom’s body is mounting an immune response, she pass those illness-fighting antibodies to her baby when she breastfeed, which will help protect the baby.
According to Kelly Bonyata, IBCLC, the best thing a mom can do for her baby when she’s sick is to continue to breastfeed. Withholding breast milk during an illness increases the possibility that baby will get sick, and deprives baby of the comfort and superior nutrition of nursing.
Tips for breastfeeding while sick:
Anne Smith, IBCLC, has the following suggestions.
Mom can take measures to prevent baby from getting sick while continue to breastfeed. Illnesses are most often transmitted through skin contact and secretions from the mouth to nose. It helps to wash hands often, avoid face-to-face contact and sneezing near the baby.
Breastfeeding the baby while the mom is sick makes it easier for mom to rest. Mom can tuck the baby into the bed with her to nurse, then have someone take him away when she’s done.
Mom needs to make sure that she get plenty of fluids when she’s sick, because it is not good if she becomes dehydrated. The milk supply may decrease during and immediately after the illness, but it will quickly build bak up when the mom fells better. Every year, over 4.3 million women in the U.S. have babies.
Nearly all of these moms will use at least one drug while they are pregnant or nursing. A mom must always consider the risk/benefit ratio when making decisions regarding whether or not to take a medication while lactating, and always consult doctor before taking any drug when you are nursing.
When NOT to breastfeed:
It is very, very rare for a mom to need to stop breastfeeding for any illness. There are only a few very serious illness that might require a mom stop breastfeeding for a period of time or permanently. Per Dr. Ruth Lawerence in her 1985 book, “HIV and HTLV-1 are the only infectious diseases that are considered absolute contraindications to breastfeeding in developed countries.”
This is an original post for San Diego County Breastfeeding Coalition by To-wen Tseng.
Friday, February 24, 2017
|My son's class with their Iranian immigrant teacher.|
I was in Taipei with family for Chinese New Year when President Donald Trump first announced the travel ban on citizens from seven predominantly Muslim countries.
For days, concerned relatives and friends asked if the ban would affect us.
In one way, it doesn’t affect us—we are naturalized U.S. citizens.
But in many ways, it does affect us.
My 3-year-old son’s preschool teacher is from Iran. We love her and truly worried that we would lose a great teacher over that ban. For days my husband and I tried to come up with a good explanation for our child, but we couldn’t.
At dinner table when the child was not listening, my mother-in-law said, “You don’t have to tell him anything. He’s gone through several teachers before, he’ll be fine. He probably won’t even notice that she's gone.”
My father-in-law said, “If he does notice and ask questions, simply tell him that the teacher left. He will forget about it soon anyway.”
My in-laws were wrong. Kids are not as ignorant and forgetting as we thought.
We came back to the States on the same day protesters against President Trump’s travel ban gathered at Los Angeles International Airport. When we were in the customs line, an immigrant officer asked the woman in front of us, “Does what happening in America these days worry you?”
“Yes, it really worries me,” the woman answered. She wore a Hijab.
My son overheard them and asked me, “Mama, what’s she worrying about?”
We stepped out of Tom Bradley International Terminal, and he saw the protestors.
“Mama, what are these people doing?”
We had to start the difficult conversation early. “Look, baby. Our new President just made a new rule that stops people from some Muslim countries from coming to our country. But there are people who think the rule is wrong, so they are here to tell everybody what they think. And the woman with Hijab at the custom is probably a Muslim, so the rule worries her.”
I tried to use small words. I wasn’t sure if he understood. He thought about it, and then asked, “Do we know any Muslim?”
“Well, Ms. Parvaneh is from a Muslim country.”
He stared at me. And then all in a sudden, he started to cry. Not crying, but wailing.
While we were driving home, my son fell asleep in the car. He woke up two hours later, and never asked any questions about the ban again.
Luckily, the government suspended enforcement of the ban after a couple of days.
When I picked my son up from preschool on the day of his return there, I asked him how school had been.
“Great,” he said. “I’m very happy because Ms. Parvaneh was still there.”
I was surprised. I thought (or I hoped) that he had already forgotten about that ban thing.
But apparently he hadn’t. He asked me if the President was still trying to “kick Ms. Parvaneh out.”
“Well, he may try again. But don’t worry. The ban is not fair. People will speak up and help out.”
“Who will? Will you, Mama?”
“Mama, will you speak up and help Ms. Parvaneh?”
“I will, baby.”
This week, Trump is preparing to release a second executive order halting travel from citizens of the seven nations. And I’m taking time to write this post, because I promised my son that I would speak up. It is wrong to attack immigrant families with Executive Orders. Immigrants or the children of immigrants started 40% of all Fortune 500 companies. They own and run many small and medium businesses, and they are a critical part of our national labor force and community – including my son’s preschool teacher.
Trump has said that citizens of the seven countries pose a high risk of terrorism. But the 9th Circuit made it clear that the Trump administration “pointed to no evidence that any alien from any of the countries named in the order has perpetrated a terrorist attack in the United States.” This ban is simply not reasonable. As an American, I refuse to lose a critical part of my country – or lose a great teacher – over an unreasonable ban.
Please join me and spread the word about the rights of immigrant families.
This is a cross post originally for World Moms Network by To-Wen Tseng.
Friday, January 6, 2017
My husband and I recently purchased a new house and had a handyman came over to remodel our bathroom. The handy man asked me, “Now, To-wen, you’re a health journalist. You know what’s gonna happen to Obamacare?”
To us, this handyman is not just a handyman. He is also a family friend. We had him remodel our kitchen seven years ago when we bought our first house. Through the years he’s done several floor and other works for us. I knew he never had any health insurance before the Affordable Care Act (ACA), colloquially known as Obamacare.
“Don’t worry, I doubt that Obamacare will really be overhauled,” I told him, “Just pay attention to the political climate in case there’s more conversation surrounding the overhaul of Obamacare later, okay?”
“But I wouldn’t know,” he said.
I know what he meant. He is an immigrant from China and doesn’t speak English very well.
“You know, if there’s anything going to happen, it’s gonna take a while, at least a year. So do nothing different now and pay attention to the legislative process, okay? And I’ll let you know if I hear anything. It’s definitely going to be a very high profile, highly publicized process.”
I said that. But I was actually very concerned. Representative Tom Price, President-elect Trump’s nominee for Secretary of Health and Human Services, and his allies in Congress could make things difficult for American families, as they want to roll back advances in healthcare coverage and cut current healthcare programs.
Trump has said he would repeal the Obamacare during his campaign. It could pose challenges to many Americans, and I’m especially worried about pregnant women and nursing moms.
Obamacare includes pregnancy, maternal and newborn care in its list of 10 essential health benefits insurance companies must provide for consumers. It states on its site, “Health insurance plans must provide breastfeeding support, counseling, and equipment for the duration of breastfeeding. These services may be provided before and after birth.” It amended the Fair Labor Standards Act so employers with more than 50 workers have to give new mothers, for up to one year after a child’s birth, with reasonable time to take unpaid breaks to express breast milk for their nursing children. Under this standard, employers also need to provide mothers a private room that is not a restroom to fulfill her breastfeeding and/or pumping responsibilities.
Now, because Trump has threatened to overhaul Obamacare, these services are at stake.
Personally I’ve never used Obamacare, Medicaid, CHIP, or Medicare. My family is insured through my husband’s employer. But I know Obamacare is credited with many American families’ health. Like our handyman’s family. And I’ve been blogging about breastfeeding rights for years; I’ve received messages from my readers with stories about how Obamacare helped them with nursing.
Some experts have expressed doubt that Obamacare will really be overhauled. I hope they are right. But we cannot count on that. If Obamacare is repealed in its entirety, women would incur serious costs. Without changes in the law and the implementation and enforcement of Obamacare, women will continue to face unfair and discrimination practices in the health insurance system.
A group of MomsRising volunteers will be dropping by their members of Congress’s office between January 9th and 12th to deliver a collection of personal healthcare experiences of moms and dads around the country to educate leaders about how programs like Obamacare are critical to families. It’s not too late to join the action. On January 9th, the USBC will be welcoming the 115th Congress by delivering a welcome kit to every Senator and Representative with the message breastfeeding saves dollars and makes sense. There is still time to add your voice. The more of us do it together, the stronger message we send.