Milk Mama Diaries Carnival: Breastfeeding, A Winning Goal for Life!

I can't believe that it has been almost 2 years since our last Milk Mama Diaries blog carnival!  My co-host Mec (Mec as Mom) and I have been busy and not been able to regularly host the carnival.   However, with the prodding of our breastfriend, breastfeeding diva Velvet Escario-Roxas, we decided to revive the carnival this month to help the public understand more about this year's World Breastfeeding Week 2014 theme:  Breastfeeding, A Winning Goal For Life!

This year's theme refers to the 8 Millennium Development Goals (MDGs) which were set by governments and the United Nations way back in 1990.  These goals aim to fight poverty and promote healthy and sustainable development by 2015.   WABA would like to emphasize the importance of increasing and sustaining the protection, promotion and support of breastfeeding post-2015.   Likewise, by protecting, promoting and supporting breastfeeding, YOU can contribute to each of the MDGs in a substantial way.

Breastfeeding Plan?

For my first pregnancy, I never prepared a birth plan (or a breastfeeding plan for that matter) but this time, I am really hoping for an all natural albeit hospital birth so I took time to make my birth plan.

I realize now that a lot of moms do make birth plans but NOT breastfeeding plans.  And I have to admit I am quite nervous in making both plans.  I do realize that each birth and baby are different and despite all the planning and preparation I make for this birth, it is definitely possible that none of these plans will be followed.

Physicians vs. Breastfeeding

It has more than 1 year since I started volunteering as a breastfeeding peer counselor. A common complaint I have received from moms who were having breastfeeding problems is the lack of support from their pediatricians. Just recently, I received a complaint from a mother who gave birth at a hospital along Edsa sometime in June 2010. She shared that as soon as she gave birth, her husband was ordered to buy Enfalac A+ (the doctors specified the brand!), without any consultation or concern on their preferred feeding. The mom was also not instructed or advised on latching her baby. What's worse, it took 2 nights before her baby was roomed in. She had been constantly requesting that her baby be roomed in but was rebuffed by the nurses. One nurse even told her that she might regret her request to room in because she can't send her baby back to the nursery! Further, her ob-gyne and pediatricians did not offer any advice on direct breastfeeding and instead told her to use a breast pump. The pediatrician also issued an order directing them to feed the baby 1 oz. of Enfalac A+, every three hours!

I am really appalled by the ignorance and the audacity of her doctors to recommend formula AND specify a brand of milk! Mead Johnson must be paying their marketing people really well!

The experience of these parents are not uncommon in the Philippine setting. In fact, based on the numerous complaints and stories I've heard, this experience is a "norm" in our local birth setting. The parents are hell-bent on filing complaints against the physicians and hospitals. I've given her options of what steps she could take and sharing these steps here for other interested parents.

First, even before you go to the hospital, print a copy of this Department of Health Press Statement released on 21 May 2010, entitled "DOH Releases Guidelines on Physicians on Breastfeeding" Salient points of the guidelines would be:

Responsibilities of Physicians:

• Counsel pregnant women on the merits of breastfeeding starting at the first encounter, and reinforced with every subsequent visit;
• Prescribe non-human milk only when there are valid medical reasons and with information on the inherent hazards and risks of non-human milk;
• Strongly advocate for the adoption of essential newborn care, rooming-in and breastfeeding standards as mandated by law.

Prohibitions on Physicians:

• Accepting gifts or any sort of material or financial inducements from manufacturers of breastmilk substitutes and other products covered by the Milk Code;
• Accepting samples of non-human milk or similar products unless approved by the DOH, nor giving out samples or gifts of any sort coming from milk companies to pregnant women, mothers, and members of their families;
• Displaying, promoting or distributing non-human milk and other breastmilk substitutes in their offices or clinics.

Second, read up and be aware of the Essential Newborn Care Protocol which lists down 4 steps that need to be immediately undertaken to prevent newborn deaths which INCLUDES non-separation of newborn from the mother for early breastfeeding initiation. Check out this slideshow being used in the trainings and promotion for the ENC, prepared by Naima's pediatrician, Dr. Mianne Silvestre. Meanwhile, you can download Administrative Order No. 2009-0025, Adopting New Policies and Protocol on Essential Newborn Care HERE.

If you have been placed in a situation where your doctors refuse to listen and insist on giving formula and want to complain, then make sure you get a copy of their WRITTEN order, prescribing the artificial milk. Often, parents are berated by doctors when they insist on breastfeeding - and usually, parents don't argue (because as a culture, we, Filipinos are raised to believe that doctors are intelligent, always right, etc - and in fact, it is a common refrain/hope for parents to wish that their kids become doctors!!!). Once you have a copy of that written order, keep that for further action.

First step would be for the parents to write a complaint letter to the head of the hospital where you gave birth - include the particulars - name of the doctor, date, incident report AND a copy of the prescription. Don't forget to state your rights as provided in the ENC and DOH Protocol and Press Statement above.

Then, you can proceed to file a complaint against the doctors with the Philippine Medical Association. Call 929-6366 to check if the doctors are members of the PMA. If they are, write a notarized letter of complaint with supporting documents addressed to Dr. Nimfa Baria, Chairman, PMA Commission on Ethics and mail or personally deliver the letter to 2/F PMA Building, North Avenue, Quezon City. You can also file a complaint with the Professional Regulation Commission with the procedure outlined HERE. You can also file a complaint against the hospital with the Department of Health's Center for Health Development. You can download the flowchart of how to file a complaint HERE.  (*The links to CHD are broken.  You can access their Facebook page instead.) 

I would like to emphasize that filing a complaint means that you are serious and willing to follow through. It is not simply submitting the letter but you must be willing to testify during hearings if deemed necessary by the decision makers. I know that this will entail a lot of time and effort from the parents but steps like this will definitely make a huge impact in reforming the physician culture in the Philippines and hopefully, make it more breastfeeding friendly.

Birth Experiences and Its Effect on Breastfeeding

Welcome to the Carnival of Breastfeeding for October. This month's topic is about birth and breastfeeding - on how your birth experience affected your breastfeeding relationship with your child. Please scroll down to read the entries of the other carnival participants.

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breastfeeding cousins

Picture this:

Mom A gave birth to a full-term baby girl through normal delivery with epidural. Baby Girl A is 6 pounds, 5 ounces and healthy. She was whisked off for about 10 minutes to be checked, weighed and wiped down. Baby Girl A was returned to Mom A's arms and she was able latch within 1 hour from birth, roomed-in and constantly experienced skin-to-skin contact.

Mom B gave birth to a premature baby girl through normal delivery with epidural. Baby Girl B is 4 pounds, 4 ounces and born at 32 weeks, 6 days old. She was whisked off by the neonatologist and placed in the NICU. She was never roomed in and separated from her parents for 2 weeks. Mom B visited her at the NICU for breastfeeding opportunities but only after 1 week. Prior to that she was fed with glucose water intravenously as neonatologist thought that she would choke on colostrum.

One month later…

Baby Girl A is now being mixed fed. At 2 weeks, she was diagnosed with jaundice and pediatrician recommended that she be given formula for at least 24 hours. Since then, Mom A started having supply problems. Mom A was able to recover and up her supply only when Baby Girl A was 7 weeks. Earlier on, Mom A also experienced sore and bleeding nipples due to improper latch.

Baby Girl B is still exclusively breastfed. After having latched at 2 weeks, she was nursing like a champ. Mom B never experienced sore nipples. Mom B also had supply problems but received breastmilk from relatives and friends. Baby Girl B is exclusively on breastmilk and has never tasted formula.

At 6 months…

Baby Girl A is back to being on exclusive breastmilk and has started solids. Mom A is back to work and has sustained milk supply to be able to meet Baby Girl A’s needs and donate extra milk.

Baby Girl B is still on exclusive breastmilk and has started solids. Mom B is back to work, still has milk supply issues but managed to meet Baby Girl B’s needs.

I think by now you may have guessed that I’m talking about me and my sister’s birth experience. I have previously shared about my experiences and my niece’s birthing story. However, for this carnival, I’d like to emphasize that whatever the birthing experience of the mom, there are other more important factors that will impact the breastfeeding relationship.

Top most of these important factors would be INFORMATION. When my daughter’s pediatrician suggested that I give her formula for jaundice, I didn’t know better. I never attempted to find a breastfeeding friendly pediatrician (I assumed that all were BF advocates) and thus get a second opinion.

Meanwhile, my sister immediately switched to breastfeeding friendly pediatrician when my niece turned 1 month. Their old pediatrician had mandated a 1 kilogram weight gain each month. My niece gained about 800 grams per month which was okay with the new pediatrician. The new pediatrician understood that babies grew in different ways and watched the developmental milestones instead of the weighing scale. Had they stayed with the old pediatrician, my niece would’ve been prescribed formula to up her weight.

Why did we make the choices we make? I didn’t know better and was ignorant of available resources. Meanwhile, my sister already learned from my experiences and was also able to read breastfeeding books and research on breastfeeding friendly pediatricians.

Another factor is SUPPORT.

When I gave birth, I only had my husband, Stan with me. Although there were lactation consultants that we visited, we didn’t really get relevant and helpful information. One LC even gave us free Enfamil 2oz. bottles! Meanwhile, when my sister gave birth, she already had a knowledgeable nanny, my mom turned advocate and of course, persistent sister with breastfeeding experience (although I have to admit that it was more difficult to counsel my sister compared to strangers and friends). Plus, my sister had a network of friends and relatives to turn to when her milk supply was low. She also had a very supportive doctor who worked with her and encouraged her to continue giving breastmilk to her daughter.

Let me conclude by saying that the birthing experience can have a ripple but not lasting effect on your breastfeeding relationship with your child. However, in the long run, other factors such as information and support are more effective in enabling mom and baby to bond at the breast and establishing a successful and enduring breastfeeding relationship.

Here are the other carnival participants. Links will be added through the end of the day:

Leslie @ Confessions and Observations: How to Start Breastfeeding and Why the Birth You Have Matters

Crib Keeper @ Tales from the Crib: On Not Being Discouraged

Suchada @ Mama Eve: Birth and Breastfeeding

Christina @ Massachusetts Friends of Midwives: Early Intervention Lactation Help

Jenny @ Chronicles of a Nursing mom: Birth Experiences and Its Effect on Breastfeeding

Jenny @ Baby Fingers: My Breastfeeding Relationships: Hospital vs Homebirth

Michelle @ Mama Bear: Long, wide shadow of bad births

Sarah @ Reproductive Rites: Fighting for Breastfeeding

Terry @ Mother Mirth: Breastfeeding: We CAN Change Our Culture

Tanya @ Motherwear Blog: The Birth/Breastfeeding Continuum

Elita @ Blacktating: Did my birth experience set me up to fail at breastfeeding?

Kate @ Tumbling Boobs: Nursing After Surrogacy or Adoption

Andi @ Mama Knows Breast:

Unang Yakap

This is a wonderful promotional video by the Philippines' Department of Health on the Essential Newborn Care launched in 2009. Two of Naima's doctors are here - Dr. Silvestre and Dr. Bautista.


The campaign, entitled Unang Yakap - Yakap ng Ina, Yakap ng Buhay which translates to First Embrace - Embrace of Mother, Embrace of Life, seeks to cut down infant mortality rates. The steps enumerated in the above video are more explained in a slide from a presentation by Dr. Silvestre below:
The Essential Newborn Care categorizes post-natal procedures into time-bound, non-time bound and unnecessary actions. It is interesting to note that only 4 steps are time-bound - immediate drying with quick check, skin-to-skin contact, cord clamping (but not immediate! only after cord pulsations stop) and early initiation of breastfeeding.
Other procedures thought to be necessary e.g. bathing, immunization, cord care were considered to be less important than breastfeeding. The guidelines also consider routine suctioning, routine separation of newborns for observation, administration of prelacteals like glucose water or formula, and footprinting as UNNECESSARY procedures.
This is such an wonderful development since here in the Philippines, doctors considering taking the weights, APGAR scores, etc. to be even more important than breastfeeding. In fact, I know some moms whose babies were taken from them immediately after birth and they only saw their babies again after 24 hours! Really, how I would like to show these guidelines to several pediatricians in this country!
My office was lucky because during our breastfeeding festival last week, we had Dr. Silvestre with Dr. Jessa Sareno to explain the essential newborn care. Her talk was very well attended and I thought it was very good that most of her audience were pregnant moms. Now they know what the Department of Health mandates will learn better than to listen to those "medical experts".
Dr. Silvestre is not holding clinic nowadays because she is very busy promoting the guidelines all over the country. Hopefully, these guidelines will become established hospital policy and those unnecessary mom-baby separations will come to an end.
*Thanks Claire for the heads-up!