Countdown to August

August is my most favorite month of the year and I am sure you can guess why.   It is breastfeeding awareness month and it is the month when I get to promote the reason for why this blog exists.   This year's theme for World Breastfeeding Week is Breastfeeding Support: Close to Mothers and you can read more about that here. 

I am pleased to share about kick-off activities that support breastfeeding month that will be starting this July!  There will actually be more activities in August and I am excited to share them with you in a future blog post.  But for this month, let us focus on a peer counsellor training and a milk sharing activity.

Pearls from the Compostela Valley Breastfeeding Mission Experience - Part 3

This is the last of three parts.  Please refer to Parts 1 and 2. This is a guest post written by Dr. Lei who participated in all the aspects of the breastfeeding mission. Dr. Lei also runs an online store, Caleb's Closet and shares her thoughts in her blog, Lei's Anatomy.

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4. Human Milk transport and storage requires a lot of logistics but tapping on to the right network, we have available resources to make things work. 
Breast milk is a precious commodity that requires care in handling. Refrigerated human milk is good for 3-4 days. In the usual one-door domestic freezers, this extends to 3 weeks. For deep freezers, viability stretches from 6 months to 1 year. However, when frozen breast milk is thawed, it should be refrigerated, consumed or discarded within 24 hours.

Pearls from the Compostela Valley Breastfeeding Mission Experience - Part 2

This is the second of three parts.  You can read Part 1 here.  This is a guest post written by Dr. Lei who participated in all the aspects of the breastfeeding mission.  Dr. Lei also runs an online store, Caleb's Closet and shares her thoughts in her blog, Lei's Anatomy.


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3. Substantial amounts of human milk can be collected and stored for the above babies.

We were able to collect 67 liters of milk in less than 2 weeks. (Having talked with Velvet, they actually came up with 100 liters in a single day, involving just one barangay!!). Substantial amounts of human milk can be collected and preserved properly.

After UNICEF’s call for milk donations went out to our Team UnangYakap, the response was crazy. In a matter of 24 hours, we helped mobilize private individuals (e.g. Maricel Cua of Medela Moms, Davao-based childbirth educator/advocate Alex Hao, blogger/advocate/lawyer Jenny Ong and mother support groups at the BangkoSentralngPilipinas etc,), the Lactation Units of The Medical City, St. Luke’s Global Hospital (through the leadership of Dr. Cristina Bernardo, IBCLC and Breastfeeding Committee Head of the Philippine Pediatric Society), and the 3 Human Milk Banks in NCR (Fabella, PCMC and the UP-PGH through the coordination of Dr .Fay de Ocampo, kangaroo mother care expert and Team UnangYakap).

Pearls from the Compostela Valley Breastfeeding Mission Experience - Part 1

I was quite blessed to be part of the breastfeeding drive for babies of Compostela Valley.  Through this drive, I was finally able to meet Dr. Lei Camiling Alfonso of Caleb's Closet Ecostore.  We had been email and FB-mates but never got to meet each other in person.  She was very involved in the drive and we finally met in my hometown when she flew in to transport breastmilk to ComVal.  I asked Lei to share her story and experiences during the trip to ComVal and she generously agreed.  Aside from her online store, Lei also shares her thoughts and blogs at Lei's Anatomy.  Read on and learn!

This is the first of three parts.
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Face it, our country is disaster prone. And relief work is something that has really sparked my interest because of the sheer need and urgency. This has taken a whole new meaning with my new understanding of breastfeeding and its implications for infants in disaster areas. Most health workers have little knowledge of breastfeeding and lactation management during crisis. I have read the theories and the expert recommendations, but I haven’t seen them work on the ground. During the holidays, I was privileged to be with my Team UnangYakap mentors, Dr. Maria Asuncion Silvestre and Dr. Donna Isabel Capili supported by WHO Philippines (thru the United Nations Central Emergency Fund) to conduct a breastfeeding mission for Pablo victims in one of the evacuation sites. I am thrilled to report to you some realizations:

Visting Fabella Hospital and KMC

Last month, I was privileged to visit to Fabella Maternity Hospital and to the very popular human milk bank.   OCMominManila Kris invited me together with some of the SoMoms to experience the Touch Therapy advocacy of Johnson's Baby at Fabella Hospital.

Johnsons' Baby sponsored the construction of two Touch Therapy centers where moms and their babies can stay for infant massage.  While the hospital is not airconditioned, the 2 centers are, allowing moms some relief from the heat while they are massaging their babies.

The touch therapy center, Dr. Santiago talks about the touch therapy center,
Dr. Pinky Imperial talking about KMC, the daily birth census at the hospital,
breastmilk collected from new moms and the facade of the human milk bank

PSA: Alay na Gatas mo. Sagip sa Buhay ko

There will be a milk letting activity in CAMANAVA on 11 October 2012.  This is to show their support for the No to the Milk Monster Bill Campaign.  See details below.

We are pleased to inform you that the Breastfeeding TSEK (Tama, Sapat, Eksklusibo) campaign has been effective in raising mothers’ awareness on the benefits of breastfeeding in the cities of Caloocan, Malabon, Navotas and Valenzuela.

To date, our exclusive breastfeeding rate have significantly increase from 41% in 2010 to 74% in 2011in Caloocan City, 66.24% in 2010 to 82.23% in Malabon City, 49% in 2010 to 61% in Navotas City and 74.54% in 2010 to 80% in Valenzuela City. We are most grateful for ARUGAAN for training and mentoring the peer counsellors and equipping them with the necessary skills and knowledge to guide and assist pregnant moms with their babies in their breastfeeding journey. 

Photo by Anne Marxze D. Umil/Bulatlat.com

Our campaign does not stop here and we are in fact on our way to implementing the program on a wider scale through the conduct of a simultaneous breast milk letting activity “Alay na Gatas mo. Sagip sa Buhay ko” on October 11, 2012, Thursday to be participated by all health centers in CaMaNaVa District. 

A total of at least 3,000 lactating mothers will participate in the activity that aims to advocate that infant formula is not needed during calamities, crisis and emergencies since mothers who breastfeed can donate their expressed breastmilk to infants in need. Breastmilk to be collected will be donated to the milk bank of Philippine Children's Medical Center to help premature and sick children in need of mother's milk. We are working with the local government units and breastfeeding advocates who can help with our cause. 

We hope to provide tokens of appreciation to the breastfeeding mothers and breastfeeding support group members who will join the breastmilk letting activity. Special prizes will also be given to mothers who are most participative, breastfeeding icon, best breastfeeding practice barangay etc. We hope that you can support us by providing tokens and prizes for the mothers involved. A donation in cash or in kind would be highly appreciated.

What is urgently  needed would be breastmilk bags to store the milk that will be collected during the event.  If you would like to pledge milk bags, please do contact the City Combi Officer, Kenneth Samaco at 09164632165.

Milk Mama Diaries: Wet Nursing

Welcome to the Milk Mama Diaries Carnival (September). For this month, we will tackle milk sharing and how it can nurture the community, and how this spirit of giving can be sustained. Participants will share their thoughts, experiences, hopes and suggestions on the topic. Please scroll down to the end of the post to see the list of carnival entries.

Wet nursing has been in existence for several centuries.  I previously wrote about a UK TV show which talked about other people's breastmilk.  Locally, milk sharing is done through milk banks or mother to mother donations.  And of course, we have all heard of Salma Hayek breastfeeding another baby.

A Mother's Commitment: Giving without Counting the Cost (a Johnson's Baby Sponsored Post)

I previously shared with you how I admired Johnson & Johnson as a company especially when it comes to taking care of their employees.  I am even happier to report that in contrast with other multinationals, J&J certainly lives up to their ethics - to listen to their consumers.  So when their consumers raised their concerns about certain ingredients in their products, J&J took action and announced that they will reformulate their products.

According to the Environmental Working Group, "Johnson & Johnson is the first major personal care products manufacturer to take such an important action in favor of its customers' safety."  In fact, EWG has a petition to thank Johnson & Johnson for its action.

Join our September Milk Mama Diaries Carnival - World Milksharing Week 2012

It is time for another Milk Mama Diaries Blog Carnival.  I apologize if my co-host Mec (Mec as Mom) and I have not been able to regularly host the carnival for the past 6 months.   However, this is a perfect time to host a carnival as next week, September 24-30 is World Milksharing Week 2012.  The theme is: Sharing Milk, Nurturing Community.

I have previously written about donating breastmilk and its importance especially during emergencies and calamities.   Milk banks are also constantly in need of donated milk to provide for the NICU babies who rely on them.

For this carnival, Mec and I are inviting mom/dad bloggers to share their thoughts/experiences on and hopes for sharing milk.   The carnival is also open to families who are milk recipients and would like to share their own experiences or challenges being a milk donee. Check out my previous carnival posts to get an idea of how the blog carnival works and how posts look like. To join, please fill up the form here or below.

Responsible Milk Sharing

Sometime ago, I shared a program of UP-PGH Milk Bank - Operation Foster Milk and a human milk sharing page on Facebook known as Human Milk for Human Babies - The Philippines.  Advocates have been divided and have mixed reactions to this informal milk sharing.

Donor moms are receptive to the idea of having donee-moms get the milk directly from them while moms who are looking for breastmilk usually find it difficult to get pasteurized milk from human milk banks and find the informal milk sharing network more accessible.

I was a donor to both milk banks and individual moms at the height of my milk-making career.  I donated to PCMC (a representative from the bank picked it up) and UP-PGH (I had to drop off the milk) and to individual moms who pick-up the milk from my place.  Honestly, I preferred to donate milk to individual moms as they do so at my own convenience e.g. they bring their own coolers and pick-up from my place.  Whereas donating to UP-PGH was so cumbersome since I had to pack up the milk in the cooler, look for parking, pay for parking and bring the milk up - with their elevators usually jampacked.  Although now,  PGH has volunteers to pick-up the milk upon schedule. Plus, the thank you that you receive from individual moms is much more satisfying.

Milk Banks, Milk on Motorbikes and BPA-free bottles

Benz' milk stash for Laya

Remember the FB milk sharing group Eats on Feets (we have a Philippine chapter!)? Well, it has gotten both praises and criticisms. But the good thing about this is that it has made the US FDA sit up and take notice of the dearth of milk banks in the USA. Locally, the main milk bank we have is that of UP-PGH while other milk banks available are the PCMC and Fabella (where you can buy breastmilk for P200 per 200ml. Check out my post about milk banks in the Philippines here.

Dr. Jessa Sareno of the UP-PGH milk bank has raised that sometimes they have mothers who are willing to donate but are unable to bring their milk to UP-PGH. I'm sure she'd be interested in this news about volunteer bikers transporting milk for the National Health Service in the U.K. Wonder if any of our local biker groups are willing to take on this advocacy?

Finally, Massachusetts is the newest addition to the list of US states to ban BPA in bottles. Canada was the first country to ban BPA, followed by the European Union. Are you using bottles to feed your baby? Have you checked if they are BPA-free?

Operation Foster Milk and Eats on Feets Philippines

When Naima was younger and my milk was plentiful, I used to donate milk to various persons/organizations, foremost of which is the UP-PGH's Milk Bank. I recently received an email from Dr. Jessa Sareno asking for milk donations for their NICU babies.

Dr. Jessa is one of the fellows at the PGH Neonatology Unit. I asked her why they had so many patients needing milk and I was wondering where the mothers were. She shared that usually, the mothers are discharged before the babies and go home - often to the South, e.g. Cavite. These moms are asked to express milk at home then visit their babies daily so they can leave the expressed milk and directly nurse their babies.

Sadly, however, the moms are unable to scrape up enough money for even just the jeepney fare to PGH. Thus, it often takes a week or so before the mom can come back to visit her baby. I would also imagine that even if moms are asked to express milk at home, most of them are not able to do so because of lack of storage facilities or the need to go back to work (with no milk expression time/facilities) to provide for the needs of their other children. Thus, the never-ending request by the UP-PGH to ask lactating moms with excess milk to donate to their milk bank.

Meanwhile, for moms needing breastmilk, I was able to get some information about Fabella Milk Bank. You can purchase milk from their milk bank at the cost of P400 per 200ml. However, breastmilk is not always available as this depends whether they have ward mothers donating breastmilk. The milk is pasteurized and tested. Before you can buy however, you need to bring a medical abstract of your baby. The ward mothers are eager to donate breastmilk because donors receive a huge discount off their hospital bills. Sometimes, they only pay P50! To get in touch with the Fabella Milk Bank, call 734-5561 local 156.

Finally, because of this blog, I have been receiving numerous requests for milk and offers of excess milk. I had previously toyed with the idea of having a milk share page, where moms can meet up to discuss milk requirements - but never found the time to do so. I stumbled upon the Eats on Feets Global Network and with the help of the global founder, Emma Kwasnica, I was able to set up Eats on Feets Philippines - a facebook page. The Eats on Feets GLOBAL network chapter pages provide an online space to facilitate woman-to-woman milk sharing. Through this page, moms can post their requests and offers for milk and hook up with one another. I'm still looking for an administrator and if you're interested in becoming an administrator of this page, please do contact me. Check out the press release sent out by Emma early this morning:

FOR IMMEDIATE RELEASE :


CONTACT :
Emma Kwasnica
Eats On Feets GLOBAL
(514) 656 1560
Montreal, CANADA
http://www.facebook.com/emma.kwasnica
emma.kwasnica@gmail.com



World's Largest Breast Milk Sharing Network Spreads Across Facebook: "Eats On Feets" Goes Global

Within a matter of days, women around the world have mobilized on the social networking site Facebook to organize an international, woman-to-woman milk sharing network. Human milk is for human babies, and formula-feeding is associated with risks to both the mother and infant. Women today are aware of this fact and are taking their life-sustaining power back into their own hands --they are now converging on Facebook to freely share their breastmilk with one another.

Montreal, Canada, November 7, 2010 - The announcement last month from internet health guru, Dr. Joseph Mercola, of his plans to launch his own brand of powdered infant formula onto the US market, has spawned the Eats On Feets GLOBAL breastmilk sharing network. In retaliation against yet another needless and harmful artificial breastmilk substitute to hit the market, mothers on Facebook from around the world have come together to take a stand for infant health. They have now established the world's largest human milk sharing network, an initiative spearheaded by Canadian lactating mother and passionate breastfeeding activist, Emma Kwasnica.

The "Eats On Feets" name is the brainchild of Phoenix, AZ midwife, Shell Walker. A mother to young children in the '90s, Walker and her friends had this thought: "Hey, why don't we just become wet-nurses? Instead of 'Meals on Wheels', we can call our business 'Eats On Feets'." Walker took this idea and made it a reality in July, 2010, when she created a Facebook profile page under the same name, and began a free, community-based breastmilk sharing network for mothers in Phoenix. She has since been successful at matching up local women who have an excess, or are in need of, human breastmilk.

Meanwhile, Kwasnica has also been using her personal profile page and her large network of international birth and breastfeeding activists on Facebook, in order to match up human milk donors and recipients around the world. One such story involves a fellow Canadian friend, living in Bandung, Indonesia; the school teacher and single father to a newborn son wondered if he could source human milk for his baby instead of feeding his son a powdered breastmilk substitute. Aware of his situation, Kwasnica put the call out to her vast network via a simple status update on Facebook, and a breastfeeding peer counselor in a neighbouring city in Indonesia responded. A string of lactating women on the ground was assembled to provide human milk locally for the infant boy. Now three months old, this baby has never tasted anything other than human milk.

The announcement of Dr. Mercola's plans to market formula was the final catalyst that spurred Emma Kwasnica on to convene with Shell Walker and launch Eats On Feets GLOBAL. Regarding the inception of this initiative, she states: "Shell Walker is a friend and the midwife in Phoenix, AZ who came up with the name 'Eats On Feets'. She graciously allowed me to use her catchy name in order to launch the global initiative: a woman-to-woman, grassroots milk sharing network here on Facebook. As for Dr. Mercola, he should be injecting his burgeoning wealth into breastfeeding support, not trying to make more money off a product that is harmful to infants and their lifelong health."

With the help of nearly 200 women online from the global mothering Facebook community, the initiative has taken off. Donor and recipient milk matches are being made right now all over the world on the pages of Facebook. There are now 87 Eats On Feets chapter pages spanning 18 countries (a quick Facebook search for "Eats On Feets" yields dozens of results). This movement is proof that Facebook can, indeed, be used for the good of humanity. By encouraging the biologically normal way of feeding babies, and reviving an age-old practice of human milk sharing, it is clear that social networking has the power to revolutionize infant health.



ABOUT Eats On Feets GLOBAL - The Eats On Feets GLOBAL network chapter pages on Facebook provide an online space to facilitate woman-to-woman milk sharing. We assert that women are capable of making informed choices and of sharing human milk with one another in a safe and ethical manner. Eats On Feets GLOBAL does NOT support the selling or corporatism of human breastmilk.

For a current list of all of the Eats On Feets chapter locations in operation around the globe, or to find your local Eats On Feets Facebook chapter page, please see this document at the following URL: http://tinyurl.com/EatsOnFeetsGLOBAL

To listen to the radio show podcast (from October 30) where Emma Kwasnica discusses the events that lead to the launch of Eats On Feets GLOBAL, and how the ethics of Dr. Mercola were the catalyst for this initiative, visit: http://kopn.org/archive and click on "Momma Rap".

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Update: 3/24/2011

Eats on Feets Philippines is now Human Milk for Human Babies - The Philippines. Check out the Facebook page for milk offers/requests. To read why there was a name change, click this LINK.

Other People's Breastmilk

I came across this very interesting series entitled "Other People's Breastmilk". It is on a UK channel - Channel 4 and unfortunately, although the entire episode can be viewed online, it doesn't seem to be allowed outside the UK. A synopsis of the series is as follows:

Kate Garraway - herself the mother of a two-year-old daughter - investigates the pros and cons of cross-feeding, breast-milk donation and wet-nursing by meeting some of the growing numbers of women who share each other's milk.

'I'm on a journey to find people who believe milk has to be from the breast,' says Kate, 'people who buy it, sell it, people who give it away and people who even feed each other's babies. To many this might seem weird, but they challenge us that it's actually much weirder to give our babies cows' milk than it is to drink milk from another woman. It's a journey I won't forget in a hurry.'

The people Kate meets include sisters who cross-feed their babies; women who are able to breast-feed even though they have never been pregnant; surrogate mothers who produce two gallons of milk a week for donation; and a cancer sufferer who believes breast milk has cured his condition.

I was really interested to watch about milk sharing since I have shared milk, my niece has received milk and I have a sister-in-law pregnant with triplets who is considering a wet nurse. Channel 4 also links to a "Breastfeeding Help and Information" Page filled with resources, links and organizations in the UK that can help moms successfully breastfeed.

I'm not sure how big Channel 4 is in the UK (their programs do include popular US series such as How I Met Your Mother, Desperate Housewives, Ugly Betty, The Closer, Smallville, etc.) but I am intrigued that they included a program specifically about breastfeeding/breastmilk plus they have a link on their homepage about breastfeeding resources.

Locally, we do have QTV airing breastfeeding commercials (only during August) but apart from being featured in talk shows or the news (if there are newsworthy events), I haven't come across a local channel airing a documentary entirely about breastfeeding. One episode on I-Witness entitled "Kape Para Kay Lean" focused on malnutrition in the children of Pasacao, Camarines Sur where children never taste milk from their mothers but are fed with rice coffee instead. Looking at the local major stations's TV show line-up, I think that a breastfeeding documentary could be a proper topic forThe Correspondents or Dokumentado or I-Witness.

Brownouts and Breastmilk

I received several texts and emails from friends and acquaintances as a result of the power outages brought about by the recent storm Basyang. I decided to compile information and tips on brownouts and breastmilk in this post.

According to La Leche League International, the accepted practice is not to refreeze thawed milk:

Previously frozen milk that has been thawed can be kept in the refrigerator for up to 24 hours. While there is limited evidence to date that milk thawed for a few hours may be refrozen, this results in further breakdown of milk components and loss of antimicrobial activity. At this time, the accepted practice is not to refreeze thawed milk. While some mothers and caregivers reheat expressed milk that was leftover 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.

Breastmilk is food and the general rule is that once it is defrosted, you don't freeze it again, unless you cook it. In the Philippines however, it is common practice for households to defrost huge slabs of meat, then if they don't use it all up, freeze it again. Even in supermarkets - frozen meat is placed outside then back in the freezer at the end of the day. In my opinion, the statement that thawed milk can't be refrozen follows that same principle - primarily to prevent bacteria contamination. In the first place, once breastmilk is frozen, it already loses some of its immunological properties - which is why the hierarchy of feeding is direct, room temp, cold (refrigerated milk) then last is frozen.

Another comparison would be that of reusing previously unfinished milk. The general rule is once the breastmilk is warmed and fed to baby, any leftover milk should be thrown away. I don't *strictly* follow this rule because (1) I don't want to waste my precious breastmilk; and (2) other studies have shown that it is okay to save milk leftover from a feeding for reuse immediate at the next feeding. So what I do is, when I've thawed or warmed milk then Naima doesn't use it all up this feeding, I put it back in the refrigerator and use it again for the next feeding. If she still doesn't finish it, that's when I throw it out. I go by the taste/smell test -- I ask Naima's nanny to taste or smell the milk before giving to baby before giving it to her or deciding to throw it out.

Anyway, back to brownouts and breastmilk. I'd like to share this article which I got from fellow N@Wie Mimi. This article cites a 2006 Breastfeeding Medicine Article entitled "Effect of Environmental Conditions on Unpasteurized Donor Human Milk" and states that even if the milk thaws, it is good to use provided it was not at room temperature for more than 8 hours:

The even better news is that, according to new findings in the journal Breastfeeding Medicine, checking breastmilk is actually a fine option. The researchers took frozen breastmilk and thawed it, refroze it, refrigerated it and left it out at room temperature. Essentially, they beat it up. What did they find? Breastmilk is fairly robust and does not grow bacteria easily nor lose vitamins A and C or free fatty acids (FFA) to any degree that would harm a full term baby. Breastmilk fresh from the breast or thawed in a clean container can be left at room temperature for less than 8 hours.

The author was actually writing about traveling with expressed breastmilk. Here is another portion of her article which I find to be highly applicable for breastmilk during brownouts.

What do you do with frozen milk you pumped on your trip? Don't mess with ice. Ice is warmer than frozen milk and will actually hasten to thaw your milk —who knew? This is because water freezes at 32° F and milk freezes at around 0° F. Use frozen gel packs to keep your frozen milk frozen longer in your insulated cooler in your checked luggage. Crumple paper all around the milk and gel packs to further insulate it. The study in Breastfeeding Medicine found that even if the milk thaws, it is good to use provided it was not at room temperature for more than eight hours. If it is cool when you unpack it—it is good to go. It is also safe to be refrozen. This is important because moms think they have to use it right away if thawed and may feed it to the baby instead of actually breastfeeding as soon as they get home. Better to get baby on the breast as soon as you return home, and refreeze or refrigerate the pumped milk for the next mother-baby separation.

To find out whether your milk indeed thawed during the power outage, here is a tip from Dot:

I read also to put an icecube in a plate inside your freezer. In case of brownout, check the ice. If the shape changed (which means that the ice cube melted then froze again). The same thing happened to your milk.

Note however - according to the Mothering Article, water has a higher freezing point than milk. Makes me wonder though if it defrosts faster than breastmilk? The ice cube tip still helps as it makes you aware if the cold level in your freezer changed.

Meanwhile, if you don't want to use the thawed milk, don't throw it away. Here is a tip from Mi'Ann:

Instead of throwing it away, you can donate it to the hospital where you gave birth. Just call the nursery nurse before going so you can check if you still need to be screened or if they ll just accept it when you give your pedia's name. For ex. cardinal santos said that theyll accept my thawed out milk.

Aside from your birth hospital, there are also several institutions which accept donated milk. Check out my previous post on milk banks for the contact details of these institutions. It's still the 2nd storm of typhoon season and I'm sure that more power outages will come. Breastfeeding mamas certainly need to make extra preparations to prevent wastage of that precious milk.

Check out this related post - Preventing Freezer Burn on Breastmilk


Update: 28 September 2011
Here's a quick note that Babymama Mi'Ann posted on her Facebook page during the height of Typhoon Pedring:

If you want to read the full text of the study - "Effect of Environmental Conditions on Unpasteurized Donor Human Milk", you can do so by clicking HERE.

Preventing Freezer Burn on Breastmilk

With the frequent rotating brownouts all over the country, one of the concerns of pumping moms is freezer burn on their frozen breastmilk. I found this informative video on how to prevent freezer burn:

Meanwhile, if your frozen milk already shows signs of freezer burn, should it already be discarded? According to Britannica Online, freezer burn occurs when "improperly package frozen foods lose small amounts of moisture during storage, resulting in surface dehydration. If you have lots of extra stored milk, I would suggest that you throw out the frozen milk bags exhibiting freezer burn. However, considering that freezer burn is really just loss of moisture and doesn't mean that the milk is spoiled, my opinion is that you can also do the taste and smell test. Thaw out your milk in the refrigerator, then smell and taste if it is sour and spoiled. If you're lucky to have a baby who is not picky (like Naima), then you wouldn't have problems giving it. But if your baby refuses it, you can either throw it out or donate it to a milk bank with a pasteurizer. Don't forget to inform the nurse that it has already been thawed out and should be pasteurized immediately!

Enough please!

Last month, it was all about Daniel Angerer and his breastmilk cheese.  This month, the spotlight is on Abi Blake who claims to be the Nigella Lawson of breast milk cookery. She has more than enough breast milk and sells breast milk cupcakes at various festival to customers who are intrigued by the novelty.  She has even developed a modest menu - from main course (lasagne) to drinks (fruit smoothie) to desserts (milk fudge) - where the main ingredient is her breast milk!  She claims to have gotten the idea during her stay in India where women regularly use breast milk in their cooking. She now regularly serves her breast milk dishes during dinner parties at her home, with vanilla breast milk cheesecake as her specialty.
Some comments in the article are just plain irritating and ignorant but seriously, I think serving food made out of breast milk to adults is just strange.  I have no qualms about serving food made out of my breast milk to my daughter or my niece.  But I believe that breast milk is for babies and there are other better uses for extra milk than making breast milk cheese or breast milk cupcakes for sale!  If you have extra milk, please choose to make food for YOUR baby or donate your milk instead.

Hierarchy of Infant Feeding Choices

Two days ago, I received a text message from R, a nursing mom I previously counselled. She was very worried with the amount of milk she stored for her baby. Apparently, her baby was drinking more milk that she could express at work. She was already down to about 12oz. which was less than what her baby drinks while she was at the office.

R's baby just recently turned 6 months but did not start solids yet. Her baby's pediatrician had already given the go-signal for them to start solids but she was still hesitant unsure what to feed her baby. I suggested that at 6 months, her baby could already start solids and referred her to my previous post. However, this does not mean that her baby's milk feedings will decrease. Until 1 year old, babies still need to get their primary nutrition from milk while solids are only for complementary feedings.

R did not want to give her baby formula so she asked if she could give water or dilute her breastmilk with water instead. I was reminded of the hierarchy of infant feeding choices which the World Health Organization established, in paragraphs 18-19 of the WHO's Global Strategy for Infant and Young Feeding:

The vast majority of mothers can and should breastfeed, just as the vast majority of infants can and should be breastfed. Only under exceptional circumstances can a mother’s milk be considered unsuitable for her infant. For those few health situations where infants cannot, or should not, be breastfed, the choice of the best alternative – expressed breast milk from an infant’s own mother, breast milk from a healthy wet-nurse or a human-milk bank, or a breast-milk substitute fed with a cup, which is a safer method than a feeding bottle and teat – depends on individual circumstances.

For infants who do not receive breast milk, feeding with a suitable breast-milk substitute – for example an infant formula prepared in accordance with applicable Codex Alimentarius standards, or a home-prepared formula with micronutrient supplements – should be demonstrated only by health workers, or other community workers if necessary, and only to the mothers and other family members who need to use it; and the information given should include adequate instructions for appropriate preparation and the health hazards of inappropriate preparation and use. Infants who are not breastfed, for whatever reason, should receive special attention from the health and social welfare system since they constitute a risk group.

As summarized by IBCLC Diane Wiessinger, the hierarchy is (1) breastfeeding; (2) mother's own milk expressed and given to her child in some other way; (3) milk of another human mother; and (4) artificial milk feed.

For premature babies, a publication entitled "Global health policies that support use of banked donor human milk: a human rights issue" authored by Lois DW Arnold presents a further classification within the hierarchy - between premature mother's milk vs. mother's milk and premature artificial milk feed vs. regular artificial milk feed, as can be seen from the author's diagram reproduced below:

Clearly, for both full-term and premature babies, water is not a safe option for feeding your baby. Water is included as an option only for infant feeding during emergencies.

The choice of donated breast milk is also a difficult subject. The American Academy of Pediatricians frowns upon using unpasteurized donated milk and recommends only using pasteurized milk from human milk banks.

In the Philippines, we are not too particular and although I know some pediatricians who would prefer to use pasteurized human milk, for some moms this is just not an option. I only know of 3 pasteurizers in our country and these pastuerizers do not run until the milk banks receive enough donated milk to operate the pasteurizers at full capacity. I myself have donated to moms and babies who come by my place to pick up my frozen unpasteurized milk.

When donated milk is not available, I believe that formula would be the remaining option. Some lactivists might disagree with me but I believe that formula is not at all evil. Diluting your breastmilk or giving your baby water is WORSE than giving your baby formula milk. If you are faced with this choice, call your pediatrician and ask what formula to give your baby. Then don't beat yourself up about it - stressing about the one bottle won't help you. Work extra hard to bring your supply back up so you can get rid of the artificial milk feeds.

The cup of life

Photo by Rudy Liwanag, Manila Bulletin

I was quite excited to read the feature about the Philippine General Hospital's Milk Bank in Friday's Manila Bulletin. As I shared in my previous post, I was trying to get my milk pasteurized but they could't run the pasteurization machine because of lack of milk donations. Also, this article ran contrary to the practice at the other hospital used bottles for their premature babies. At the UP-PGH, premature babies were cupfed with their own mother's milk or pasteurized donor's milk.

UP-PGH Milk Bank is where I regularly donate milk in the past year. As emphasized by Dr. Jessa Sareno, a neonatologist fellow, their credo is as follows:

Human milk has no substitute. Breast milk also has immunoprotective properties that fight against life-threatening infections like sepsis, pneumonia, diarrhea, and enterocolitis. It likewise has components, which help the newborn’s intestinal tract to mature, allowing for easy digestion, better absorption, faster growth, and better health. Plus, it also has nutrients in a combination that no artificial product can duplicate.

This article is close to my heart because of my niece Anya Carissa. UP-PGH is a public hospital but I was amazed to read that their lactation unit took time out to teach mothers how to hand express milk and had the patience to cup-feed the babies. As opposed to my niece's hospital - where the doctor just told her breastfeed without details on how to breastfeed a premature baby or how to keep up her supply. My sister has been having problems with supply and Anya is still not up to her birth weight -- so now, Dr. Q is suggesting that my sister purchase Spirulina to mix to her breastmilk!

When my sister first breastfed her, Anya was removed from the NICU and taken to the breastfeeding room. Since only the mother and baby could stay in the breastfeeding room, I asked my sister if a nurse stayed with her to show her how to properly position and latch Anya. She said that the nurse only stayed for a short while and she was left to her own devices. I wish this hospital -- with all its expensive equipment, gear, marketing ploys - would set aside some of its budget to purchase a pasteurization machine and hire an honest-to-goodness lactation consultant. This hospital even has its own cord banking unit -- but no breastfeeding support.

Anyway, the article suggests some ways you can be a milk angel to the UP-PGH Milk Bank - by becoming a financial or milk donor, or by becoming a volunteer to cup-feed babies. Dr. Jessa even suggests celebrating your birthday in a unique way by volunteering to cup feed the babies. I'm guessing that the PGH neonatal unit is a much more loving setting and a far cry from Anya's cold, sterile own NICU.

To know more how you can help, contact the Lactation Unit and Human Milk Bank, 4th Floor, LCB, Philippine General Hospital, 5218450 local 3418/3409.

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.

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.