More Baby Blues

I really enjoy checking out Baby Blues - more so when they feature breastfeeding!

Wednesday, 10 February 2010

I previously posted a compilation of Baby Blues strips on breastfeeding in April 2009 and again in July 2009. Although this strip is mainly about homeschooling, if you look closely, you can see Wren nursing. I really don't think I can handle homeschooling Naima and I really admire parents with the patience and dedication to homeschool their kids! :)

Update 7/19/2010

Here's another Baby Blues Breastfeeding sighting.

Check out little Wren still nursing

World Breastfeeding Week 2010

Thanks to Claire for the heads-up! World Breastfeeding Week just released their theme for 2010: "Breastfeeding Just 10 Steps! The Baby Friendly Way". I checked their website but only the calendar is available for download.

In Protecting, Promoting and Supporting Breastfeeding: The Special Role of Maternity Services (a joint WHO/UNICEF statement published by the World Health Organization), ten steps are identified for succesful breastfeeding, which each facility providing maternity services and care, ideally should adopt. These are:

• Have a written breastfeeding policy that is routinely communicated to all health care staff.
• Train all health care staff in skills necessary to implement this policy.
• Inform all pregnant women about the benefits and management of breastfeeding.
• Help mothers initiate breastfeeding within half an hour of birth.
• Show mothers how to breastfeed, and how to maintain lactation even if they should be separated from their infants.
• Give newborn infants no food or drink other than breast milk, unless medically indicated.
• Practise rooming-in - that is, allow mothers and infants to remain together - 24 hours a day.
• Encourage breastfeeding on demand.
• Give no artificial teats or pacifiers (also called dummies or soothers) to breastfeeding infants.
• Foster the establishment of breastfeeding support groups and refer mothers to them on discharge from the hospital or clinic.

The World Alliance for Breastfeeding Action (WABA) has seen it appropriate to revisit the ten steps issued by the WHO in 1989 due to reports of "lack of commitment, deteriorating hospital practices, and inadequate training of health workers to counsel mothers." Although more than 20,000 maternities, or about 28% of all maternities in the world, have fully implemented the Ten Steps and have been certified by the Baby-friendly Hospital Initiative (BFHI), reduced BFHI programming worldwide, inadequate training, and weakened compliance with the Ten Steps in accredited maternities are contributing to stagnant or declining exclusive breastfeeding rates in many settings.

World Breastfeeding Week 2010 also commemorates the 20th anniversary of the Innocenti Declaration that called for implementation of the Ten Steps in all maternity facilities. The Innocenti Delcaration was produced and adopted during the WHO/UNICEF policymakers' meeting on "Breastfeeding in the 1990s: a Global Initiative" held in Italy in 1990.

Among the objectives of this year's World Breastfeeding Week which I find particularly important would be: To ensure that health workers who care for mothers and babies are adequately trained to counsel and support them in optimal infant feeding. My recent experience with a Metro Manila hospital on breastfeeding wasn't too good.

Another objective which I think is also particularly important is "to inform people everywhere that protection, promotion and support of breastfeeding is a mother’s right, a child’s right, and a human right." We often take several weeks of childbirth preparation classes and spend an equal amount of (if not more) time shopping for baby's clothes, gear etc. However, reading or preparing for breastfeeding is relegated to a half day or even less.

For World Breastfeeding Week 2010, the WABA calls advocates to reassess and consider what needs to be done to revitalize and expand the Baby-Friendly Initiative. Some of the things they suggest that can be done would be:

1. Help your friends, colleagues and community to find the path.
2. Find out what the status of the Ten Steps and BFHI is in your country and advocate for changes in hospitals
3. Create change at the national level. Advocate for changes in hospitals, maternities adn in the wider health care system - health centers, primary care and communities.
4. Improve our world for mothers and children and for our future.

For World Breastfeeding Week 2009, we had a Breastfeeding Festival at my workplace and also started a Lactation Policy Program. However, the program has not yet been completed although a breastfeeding room has been estblished. This year, hopefully, we will finally be able to establish a permanent lactation program and execute it in time for Breastfeeding Week. I also hope that L.A.T.C.H. or Children for Breastfeeding or other breastfeeding organizations in the Philippines will be able to focus on hospitals and reestablish or reiterate the need to promote, support and protect breastfeeding especially to new moms!

Milk of Sorrow

One of the nominees for the Academy Award's (a.k.a OSCARS) Foreign Language Film Category is a Peruvian film "La Teta Asustada" or Milk of Sorrow. This film previously won the Golden Bear Award at the Berlin film festival. The film revolves around Fausta who is suffering from the "frightened breast" which she got from her mother (who was raped) through breastfeeding. Read Variety's review and the Wiki entry.

I'm happy that a film featuring breastfeeding was given an Oscars nod. But I'm not too happy about the "frightened breast" theory. I would love to watch this film to see how breastfeeding during the war is depicted - whether positively or negatively.

Interestingly, a report released mid-January by Simon Fraser University in Vancouver, Canada found that breastfeeding during war helped lower infant mortality.

Exclusive breastfeeding can decrease the risk of two of the deadliest war-related health threats children face, a recent study shows. Breastfeeding's greatest impact on declining wartime deaths has been in sub-Saharan Africa, though more work is needed.

As with calamities, war victims normally do not have access to clean water or facilities, and subsequently, use of breastmilk substitutes often result to higher infant mortality.

My internet research do no show any detailed synopsis about "Milk of Sorrow". I do hope it wins the Oscars for Best Foreign Film as this will increase its chances of being shown locally, allowing me to watch and decide if this film is good for the breastfeeding advocacy.

New growth charts for babies - now out!

When I posted about growth charts based on breastfed babies in May last year, Kate (a fellow nursing mom who works at the National Nutrition Council) shared that the the NNC was working on the adoption of the 2006 WHO charts to the Philippine setting. About 2 weeks ago, I got an email from Kate telling me that the chart was now ready and they are now trying to disseminate it among health professionals. You can check out the National Nutrition Council's growth chart here.

From what I understand, the NNC's growth charts are more forgiving especially if your baby is not quite that big. For instance, in the NNC charts, at 3 months, normal weight for a baby girl would be 4.5-7.5kg. However, if you check the CDC chart, at 4.5kg, your baby will be between the 5th and 10th percentile and I'm sure your pediatrician will be saying that you are not feeding your baby enough and will direct you to supplement. How's that for a confidence buster?

On the other side, if your baby is about 7kg, she would still be considered within the normal range under the NNC charts but be overweight in the CDC charts as she will be above the 95 percentile.

In Naima's case, she is almost 26 months and currently weighs about 28lbs. or 12.7kg. Using the NNC chart, the normal range for her age would be 9.4-15.4kg. In the CDC chart, it's at 10.25kg (3 percentile) to 15.5kg (97 percentile). I realize that the difference in the charts would really matter if your baby is on the borderline of underweight and overweight. And usually, it would mothers with borderline babies who would be more vulnerable to supplementation or eventual cessation of breastfeeding.

You can download the CDC growth charts here and download this for the girls height/weight charts for birth-36 months.

Breast Milk for Haiti

Since the Haiti earthquake, I've been reading a lot of blogs and news about the call for breastmilk donations for children. Then came the news articles and more blogs on the "controversial call".

On 21 January 2010, the UNICEF issued a statement discouraging breast milk donations:

Human milk donations while safe when processed and pasteurized in a human milk bank also require fully functioning cold chains. Such conditions are not currently met in Haiti and human milk donations cannot be used at present. All queries and any donations that do appear should be directed to UNICEF, the designated nutrition coordinating agency in Haiti.

Then came the International Breast Milk Project and Human Milk Banking Association's calls for breast milk donations. About 500 ounces of milk was couriered on 28 January 2010 to the US Navy's ship called Comfort which was stationed near Haiti. However, this donated milk remains unused to date. Plus, the U.S. Navy spokesman has been promoting the use of infant formula rather than this donated milk!

But the staff on the U.S. Navy ship said they haven't used the milk out of concerns raised by OFDA and other agencies. Mothers aboard the Comfort are urged to nurse their own babies and there’s infant formula available to children whose mothers cannot or will not breast-feed, said Lt. David Shark, a U.S. Navy spokesman.

Comfort has been identified as the world's only nautical milk bank but apparently it is ill-equiped to handle the flood of breast milk donations.

Eager to do something to alleviate the suffering of the smallest, many lactating women are wishing the Comfort had more storage space to handle donated milk. At least one Navy staffer, who had to leave her 10-week-old baby behind when she deployed, was "pumping and dumping" — nursing slang for pumping then discarding milk. Now that there's a use for her milk, she's ferrying it to the ship daily from the mainland, where she is currently working. Beard Irvine has a name for that milk: "Comfort food."

It is just sad that instead of addressing the upgrade on the facilities or promoting relactation or cross nursing, Dr. Nune Mangasaryan, senior adviser on infant nutrition for UNICEF, instead promoted the use of ready to drink formula and this is despite the joint statement issued by WHO, UNICEF and WFP discouraging the donation and use of breastmilk substitutes or formula.

Dr. Mangasaryan: At this point what we recommend for them is ready-to-use infant formula, that's already in a liquid form, meaning no risk of contamination by mixing powdered formula with water, for example. It's already ready-to-use, and there are certain numbers already available in the country.

The Philippines faced a similar disaster (Ondoy and Parma) in October 2009. We were also involved in breastfeeding missions and brought donated, pasteurized breast milk in coolers to evacuation sites. But as I previously shared, out of the 15 liters (about 507 fl. oz.) of milk we brought, only 1.5 liters (50.72 fl. oz.) were used up. We wanted to leave the unused milk there but the health workers told us that they had no facility to keep the milk cool and prevent spoilage. So we ended up lugging it back to the milk bank.

I learned that in times of calamaties such as this, what is more important or useful would not be breast milk donations but rather breastfeeding information - relactating, switch nursing, protection of milk supply, encouragement. As fellow LATCHer Mec also shared, sharing of strategies, loot bags and the use of wet nurses were also particularly useful.

I'm not saying that moms with extra milk should stop donating milk. Even without calamities, milk banks are continuously asking for donations. In fact, every time I call up the PGH Milk Bank, they always excitedly ask me if I have extra milk to give. Moms should continue to donate milk but just have an expectation that their milk may not be directed towards Haiti but to other needy babies within their locality. I'm not sure if it is feasible in evacuation centers in Haiti but instead on focusing on calls for milk donations or promoting ready-to-drink formula, maybe international organizations can instead focus in information drive with strategies, tips and tricks on relactating and the promotion of direct breastfeeding.