Milk Storage - Part II

Where to store milk:
1. Hard-sided containers, such as hard plastic or glass, are the preferred containers for long-term storage. These containers should have an airtight seal. Check here for tips on how to use glass containers for milk storage.
2. Choose containers that are bisphenol-A free --> not polycarbonate plastic.
3. Containers must have been washed in hot, soapy water and rinsed. People have been asking me if we sterilize the bottles. We don't have a sterilizer and rarely sterilize. Instead, I just pour boiling or hot water on the containers after they've been washed. We stopped doing this when Naima turned 1.
4. Plastic bags specifically designed for human milk storage can be used for short-term milk storage. Use of plastic bags is not recommended for long-term storage as they may spill, leak or become contaminated more easily than hard-sided containers, and some important milk components may adhere to the soft plastic and be lost. Disposable bottle liners are also not recommended.

• Although not recommended, Playtex liners are usually promoted as milk storage bags in the Philippines. I myself have used these liners since I was able to get several free bags. When I store my milk using bottle liners, I make sure that they are securely closed using those bag clips to keep snacks fresh. My refrigerator also has separate drawers and we have reserved one of the drawers exclusively for breastmilk.

Storage Tips:

• Store milk in small portions (1-4oz.) to minimize waste. -- Especially for young babies. Naima normally took 3-4 oz. of milk and was only able to go up to 5oz when she was past 1 year old. The most milk she ever took was 6oz.
• Refrigerated milk has more anti-infective properties than frozen milk. -- Naima usually consumes refrigerated milk and I donate my frozen milk.
• Label and date the containers before storing.
• Milk from different pumping sessions/days may be combined in one container – use the date of the first milk expressed. --> I never combine milk from several days. I combine milk pumped in different hours of the SAME day only.
• Chill freshly expressed milk for at least 1 hour before adding it to previously chilled milk expressed on the same day. --> Milk temperature must always go down and never up. By mixing freshly expressed warm milk immediately with refrigerated milk, you cause the cold milk temperature to go up, making it more prone to spoilage.
• Do not fill the container. Leave some room at the top because breast milk expands as it freezes.
• If you use breastmilk storage bags, make sure that you squeeze out the excess air.  When frozen, the excess air create pockets in the storage bags which become brittle.  So when you drop your milk bags or when they get hit by sharp corners during handling, they may get broken or pierced, leading to milk leaks when thawing.  
• If you are unsure if your milk storage bags have holes, put them inside another ziplock bag before thawing.  This way, the milk leaks will get caught and won't get wasted. 

Thawing and Warming the Milk

• The oldest milk should be used first.
• Thaw slowly in the refrigerator (this takes about 12 hours – try putting it in the fridge the night before you need it). Avoid letting milk sit out at room temperature to thaw.
• For quicker thawing, hold container under running water - start cool and gradually increase temperature.
• Previously frozen milk may be kept in the refrigerator for up to 24 hours after it has finished thawing. Do not refreeze.
• To warm milk, heat water in a cup or other small container, then place the milk container in the water to warm; or use a bottle warmer.
• NEVER microwave human milk or heat it directly on the stove. This will leave hot spots (which may burn your baby’s mouth) and will also destroy antibodies.

*Because human milk is not homogenized, expect that the milk will separate during storage and the cream will rise to the top of the milk. Before feeding, gently swirl milk (do not shake or stir) to mix the cream back. Read this if you want to know why breastmilk should not be shaken.

Milk with a Soapy smell?
Breast milk is not spoiled unless it smells really bad or tastes sour. Sometimes thawed milk may smell or taste soapy. This is an indication that the mother’s milk is high in lipase (the enzyme that breaks down milk fats). The milk is safe and babies will still drink it. To prevent the soapy smell and taste, freshly expressed milk should be immediately scalded (bubbles around the edges, not boiling), then quickly cooled and frozen. This deactivates the lipase enzyme. Scalded milk is still healthier than infant formula. Read here for more instructions on scalding breastmilk.
You can also read my post on excess lipase in breastmilk.

The foregoing is compiled from the following sources:
1. La Leche League International
2. Australian Breastfeeding Association
3. KellyMom
4. The Academy of Breastfeeding Medicine, Protocol #8

Part I here.

Milk Storage - Part I

As a working mom, knowing how to properly store milk was one of the very first thing I mastered. Properly storing milk is very important especially since I was not one of those moms who was able to produce 50oz or so of milk everyday. It is also important that the caretaker be taught how to correctly store, thaw, handle and feed expressed milk. During my August talk in Davao, one of the topics I focused on was milk storage. I made a summary of various guidelines I relied on in deciding how to store Naima's milk. I've had several inquiries about milk storage and recently learned about a donee having the throw away several ounces of milk because her pediatrician felt that the milk was improperly stored. So I decided to post the summary I previously compiled to help nursing moms avoid wastage.

For freshly expressed into a closed container, here is the guide which I follow:

1. Room Temperature - 6-8 hours at 25°C# --> actually, I am conservative and store at 6 hours only, given the warm temperature that we have in the Philippines.
2. Insulated Cooler with Icepacks - 24 hours at 15°C#%
3. Refrigerator (store at back, away from door) - Up to 5 days at 4°C#
4. Freezer (store at back, away from door/sides)

• 2 weeks in freezer compartment inside refrigerator (-15°C) #
• 3-6 months in freezer with separate door (-18°C) #
• 6-12 months in deep freezer (-20)°C#

If milk has been previously frozen – thawed in refrigerator but not warmed, milk can be stored for 4 hours or less (keep for next feeding) at room temperature. It can be stored in refrigerator 24 hours (from the time milk is completely thawed) but cannot be refrozen.
If the milk was thawed outside the refrigerator in warm water, it can be stored only for completion of feeding at room temperature. If refrigerated, it can still be stored for 4 hours or until next feeding but also cannot be refrozen.
Meanwhile, if your baby has begun feeding, a lot of authorities recommend that the milk be used only for the completion of feeding then should be discarded. In our case, if Naima does not finish the milk in the bottle, I allow yaya to keep it in the refrigerator for the next immediate feeding on the same day. If the milk is still not consumed, then yaya throws the milk out. Please note however that this practice is not recommended and if you do decide to keep the milk for the next feeding, taste or smell the milk before giving to baby to ensure that the milk is not spoiled. (see note from LLLI below)

*General information is taken from the Australian Breastfeeding Association, unless otherwise indicated.
#The Academy of Breastfeeding Medicine
%Kellymom
@According to La Leche League, the accepted practice is not to refreeze thawed milk. While some mothers and caregivers reheat expressed milk that was unconsumed and refrigerated after a previous feeding, there is no research on the safety of this practice. There is also no research about whether freshly expressed milk left unfinished at room temperature should be discarded, or can be saved for a short time (perhaps up to one hour as reported by some mothers and caregivers) to finish the feeding if the baby wakens from having fallen asleep or still appears hungry.

Update:

In an article to be published in the Journal of Pediatrics, January 2010 issue, researchers led by Dr. Richard J. Schanler of North Shore University Hospital in New York have found that fresh breast milk can be refrigerated for up to 96 hours without compromising its integrity.

Over that time, the researchers found either no or minimal changes to the breast milk's composition -- including bacterial levels, acidity, immune-system proteins from the mother, beneficial fatty acids and protein.

Part II here.

Breastfeeding and Catholicism

Our Lady of La Leche from inquirer.net

In today's Philippine Daily Inquirer, there is an article about the Vatican approving breastfeeding photos or images of the Virgin Mary and Jesus. In a predominantly Catholic country, having the Vatican's support breastfeeding is a major step towards establishing breastfeeding as an infant-feeding norm. In 2008, it was reported that the Vatican wanted more "“artistic and spiritual rehabilitation” of 'loving and tender images' of Mary breast-feeding."

In the Philippines, the group of Dr. Elvira Esguerra and Ms. Nona Andaya-Castillo has "commissioned the creation of a sculpture showing a full-breasted Virgin Mary in the act of feeding the Baby Jesus. The sculpture is expected to be completed next year and will show a 'humanized' Mary looking lovingly at the Baby Jesus as she feeds him, in the proper, 'full latch' breastfeeding position."

Interestingly, as early as 2000, there has been a group of Marian devotees who organized the Our Lady of La Leche Movement in the Philippines. I'm not quite sure where the image is housed and there doesn't seem to be any updates to their website. Still, it is heartening to read about the increasing acceptance of breastfeeding in the Philippines and to know about the support that various sectors have accorded it. Thanks to Claire for the article heads-up!

Don't Forget the Pump!

Welcome to the Carnival of Breastfeeding for December. I'm making my reappearance after missing the Carnivals for October and November. For this month's carnival, the theme is taking care of yourself during the holidays -- specifically tips for nursing moms on how to get reast & relacation during the holiday season and avoid becoming stressed, overtired and getting plugged ducts and mastitis. Please check out the other contributing writers linked at the bottom of this post.

For the holidays, my family usually goes to to cities - Cebu (Stan's hometown) and Davao (my hometown). These cities are about 1 hour and 1.5 hours away from Metro Manila and are 45 minutes away from each other by plane. Since we go home as a family only once a year, we have a list of relatives to visit and parties to attend (especially in Cebu).

I really don't have tips to cope with the schedule since I pretty much just tried to "wing it". I've seen 2 other websites with great tips which I'd like to share here and here. For me, however, one important (and painful) lesson I learned was to always bring my breast pump when on vacation. When Naima was about 3 months old, we went to Cebu to attend a wedding. At this time, Naima was exclusively breastfeeding so I didn't see any reason to bring my pump. Plus, we just pulled out from our nipple confusion troubles so I really didn't want to give Naima any bottles during our trip.

What I didn't expect was for Naima to change feeding schedules - she started feeding for longer intervals and I ended up getting engorged with plugged ducts! Naima nursed from me as much as she could but even then, I couldn't get everything out. I tried hand expressing unsuccessfully. I tried calling my first lactation consultant but she wasn't answering my texts/calls. I was eventually able to resolve the plugged ducts when we got back to Manila but hot compresses, pumping and taking lecithin. It really did hurt and I think I could've avoided this if I brought my pump.

This holiday break, I am trying to wean from the pump. I expect that Naima will be nursing but I'm hoping to stop pumping by year-end. So, I will still be bringing my pump to avoid any more plugged duct nightmares. Happy Holidays everyone!

Other Carnival Participants:

Cave Mother: A Mother's Christmas
Mama Knows Breast: A Breastfeeding Poem: Twas the Breastfeeder's Nighttime
Chronicles of a Nursing Mom: Don't Forget the Pump!
Blisstree.com's Breastfeeding 1-2-3: Breastfeeding and Dehydration
Accidental Pharmacist: Motherhood Statement
Hobo Mama: Breastfeeding and the holidays: How to take care of yourself

Mommy News & Views Blog: The Holidays and Being a Breastfeeding Mom

Breastfeeding Moms Unite: Caring for a High Needs Baby During the Holidays

Motherwear Blog: Taking Care of yourself and your baby during the holidays

The Adventures of Lactating Girl: Breastfeeding and the Holidays

Happy Bambino: How to Take Care of Ourselves during the Holidays

Breastfeeding Mums: Looking After Yourself During the Holidays: 7 Tips for Breastfeeding Mothers

2009 Working Mom Balance Awards

I'd like to congratulate L.A.T.C.H. President Buding Aquino-Dee for winning the public service award at the 2009 Working Mom Balance Awards!

Public Service awardee Anna Lisa Dee, meanwhile, was honored for her breastfeeding advocacy as co-founder of the non profit group Lactation Attachment Training Counseling and Help (L.A.T.C.H.).

She works as a breastfeeding counselor, resource speaker and contributing writer to various “mom and baby” publications and web sites.

Dee is also a loving wife to her high school sweetheart Dudu and a doting mother to her children.

You can read the entire article here. Congrats Budge!

New WHO recommendations for Pregnancy and Breastfeeding

I recently received an email from Alex, a WHO/UNICEF consultant in the Philippines. He shared that the World Health Organization just released new recommendations for pregnancy and breastfeeding in the context of HIV. Alex shares:

In line with several recent clinical studies that have demonstrated the efficacy of (anti retro viral) ARVs in preventing HIV transmission from mother to child during breastfeeding, the new guidelines call on all HIV-infected pregnant women to begin ARV treatment during pregnancy and for the mother or baby to continue ARV treatment for the duration of breastfeeding.
The new guidelines encourage HIV-positive mothers taking ARVs to exclusively breastfeed their infants for the first 6 months, introducing appropriate solid foods while continuing to breastfeed for the first 12 months of life.
WHO states that there is now enough evidence to support the use of ARVs while breastfeeding.
"We are sending a clear message that breastfeeding is a good option for every baby, even those with HIV-positive mothers when they have access to ARVs," said Daisy Mafubelu, WHO's Assistant Director General for Family and Community Health.

You can access the full text of the release here.

Nursing in the News

Just some interesting news I read about breastfeeding:

1. I'm always happy to read about celebrities who share that their babies are breastfeeding. Latest celebrity is Top Chef judge Tom Colicchio who shares that his 4-month old son is "only on breast milk right now, and even at night time, when he wakes up, you just stick a bottle in mouth or breastfeed him and he goes right back to sleep." I'm not too happy to read about him sticking bread or strawberries in his son's mouth though.

2. Meanwhile, Today presenter John Humphreys had been enjoying breastmilk with his morning drink. His co-worker, Rosie Millard, a former BBC arts correspondent had been expressing milk which she stored in a common fridge. Someone spiked Humphreys' coffee with her milk. Humphreys was unperturbed -- he had drank breast milk for the first year of his life.

3. Finally, I was really disturbed with the article that a breastfeeding mother may have accidentally smothered her infant during a United Airlines flight. The mom was on her way to Kuwait from Washington DC with her 4-week old baby smothered her baby while allegedly breastfeeding. Although United Airlines refused to confirm reports, almost all headlines related to this incident screamed "breastfeeding mother smothers baby". Experts were quick to point out however that it was not breastfeeding but rather sleepsmothering (falling asleep with an infant in arms) which put the baby at risk. I have to agree -- whether or not you were breastfeeding or bottle-feeding your baby, the danger lies in the act of falling asleep on your baby and NOT in the act of breastfeeding your baby.

Last Meeting of the Year for La Leche League Manila

La Leche League Manila will be having its last meeting of the year on 12 December 2009, 9-11a.m. at Mary the Queen Parish Hall, Greenhills. LLLI meetings are informal and not really breastfeeding classes. Each month, a LLLI leader usually takes charge and discuses a certain topic. However, attendees can ask any question or concern they may have about breastfeeding. There are usually experienced moms, pregnant moms and new moms in attendance. It's a great mix of moms with a variety of experience (from none to advance! :D). You can read about my experiences here.

This Saturday's meeting is special as it will be the last meeting of the year and LLLI will be having a potluck. If you would like to attend and meet other nursing moms, do get in touch with LLLI Leader Cris Rosenthal via email or 09178941099. Having the support of like-minded moms is one of the things that helped me successfully breastfeed and La Leche League meetings are great venues to meet other nursing moms in a casual setting.

Bittersweet

my little girl during her birthday weekend

My milk supply is going and it's a bittersweet time. Naima just turned 2 over the weekend. She still nurses at night but during the day, she is busy being a busy toddler. She has started school and goes for about 2.5-3 hours in the morning. She also does not drink milk anymore when she naps in the afternoon. However, when I come home from work, she still nurses - even if she just ate a snack. But I think that this session is more for comfort because she missed me during the day :).

I have been dropping pumps and now do only 1 session a day. Still, the milk I get is more than enough for Naima's needs - which is why by the end of this year, I am hoping to completely stop pumping at work.

What don't I miss about pumping? As I started dropping pumps, I've stopped watching the clock. I've also lessened the bottles and pump parts I bring to work daily. I've also started to enjoy a longer lunch break (no more quick eating to squeeze in pumping time!).

However, I miss the feeling of being the only source of nutrition for my little girl. She has become little miss independent and seems to need me less and less. Pumping has become part of my daily routine that I feel that my day isn't complete without the pumping session. Plus, I feel guilty about not being able to store milk for the day (although Naima never drank my frozen milk and I just ended up donating the milk I stored from my work day).

Naima's yaya told me that for the past week, Naima doesn't drink milk anymore when we are separated. She waits until I get home before she starts asking for milk. I still have lots of milk stored in the refrigerator and freezer. Since I stopped my early morning pump, I haven't been able to leave freshly expressed milk for Naima. So yaya has started to use the refrigerated milk. But she tells me that it's always a battle for Naima to drink the milk I leave.

One more thing that’s stopping me (aside from mommy guilt) is the requests for donations I get. So far, I have always donated milk to moms who have yet to produce milk. Lately though, I’ve started turning away some moms because, I simply do not have enough milk to give. But with Naima refusing to drink expressed milk, I think it’s about time I wean from the pump.

I have 3 pumps (1 for work, 1 for home and 1 for traveling) and they’ve been my very good friends these past 2 years. I’m very happy with my pumps performance but I won’t be sad to see them go. I initially just wanted to reach 6months of breastfeeding Naima – here we are, still nursing at 2. But I’m definitely looking forward to the end of this year when I can finally drop that last pump of the day, comfortably and without regrets.

Happy 2nd Birthday Naima!

Naima's turning 2 and I'm having a promotion and raffle on my online store to celebrate. Please check out Mama.Baby.Love for details. Meanwhile, we're heading out to the beach in the Visayas tomorrow for a yaya-less, family bonding weekend! :D