June 2019 Newsletter: EXCO Spotlight – Khatim Hamidon

by BMSG Editorial Team

1) Tell us more about yourself! What got you started in BMSG?

Khatim and her two children. [Credits: Khatim Hamidon]

Besides being President of BMSG as an EXCO member, a peer counsellor and a trainer, I am  a mother of two, a wife, and an executive with a local charity (not BMSG). My boys are aged 9 and 3.5. 

About 10 years ago, a former colleague had told me about BMSG. She was a volunteer counsellor, and almost every conversation I had with her, she slip in some snippet about breastfeeding and natural birthing, and how these empower women. It made me rethink the idea of breastfeeding and how natural and normal it is. I then started researching about breastfeeding when I found out that I was pregnant, and started influencing my husband all about it. 

When my firstborn was a few months old, I joined a Facebook group that gives breastfeeding support to local Malay-Muslim mothers. After following the posts for some months, I found out that I could start providing suggestions to other  breastfeeding mothers needing support too! The administrators then encouraged me to attend the BMSG volunteer counsellor training and I jumped at that chance to be able to provide better advice and support.

2) You are also one out of a few of our longest serving volunteers. How has the organisation evolved?

Khatim (2nd from left, top row) with her fellow BMSG volunteers at the launch of the KKH Milk Bank in 2017. [Credits: Khatim Hamidon]

I joined the BMSG in 2011 – and goodness knows the amount of change has occurred. The most impressive change, in my opinion, is our widening pool of dedicated and trained volunteer counsellors. Years ago,  it was a struggle to maintain volunteers for our services, such as manning the hotline and facilitating our breastfeeding workshops.

Now, we have over forty active volunteer counsellors who are rostered for our counselling hotline, email account and facilitating our workshops. They are also the ones who fill the ranks for our Facebook groups, WhatsApp line, mother meet-ups, and various talks and events.

 I am so humbled that we have managed to attract mothers to volunteer to spend their free time and attend the counselling training sessions, and then continue to help empower other mothers!  It is very satisfying to know that over the years, BMSG will continue to play a part in increasing local awareness and understanding on why breastfeeding matters.

 

3) Now that you are President, what are some of the things you wish to work on during your term?

Khatim (top right in pink hijab) with the BMSG team during the talk by renowned breastfeeding advocate Maureen Minchin (bottom row, 2nd from left) in 2018.

The previous EXCOs have done amazingly well at growing the organisation to what it is now. I consider myself lucky to be helming BMSG at this period where awareness on breastfeeding is much higher than what it was less than ten years ago. 

During my term, I aim to improve our volunteer management and welfare, so that my team of volunteers will continue to give awesome breastfeeding support to mothers and families.

 I want BMSG to reach out to the younger generation of students to tell them why breastfeeding is important and that it is what mammals do to feed their young. Such that as they mature and become adults, breastfeeding then becomes their new normal. 

I would also like to work on getting stronger support from the community as a whole. We are a small charity run by volunteers, providing breastfeeding support across Singapore. We are as lean as can be, but to grow further for more accessibility we need regular contributions from our supporters. 

 

4) You also represent the BMSG at SIFECS and IBFAN. Could you tell us a bit more about these advocacy efforts that you are part of as BMSG’s representative?

Khatim (seated, 2nd row, first from left) at the IBFAN regional meet in Jakarta, 2018. [Credits: Khatim Hamidon]

SIFECS stands for the Sale of Infant Foods Ethics Committee Singapore. It is an ethical code that guides the sales and marketing of infant foods in Singapore in order to protect and promote breastfeeding. SIFECS can simply be said to be the Singaporean version of the World Health Organisation International Code of Marketing of Breast-Milk Substitutes.

 The code is targeted at formula and baby food companies, healthcare institutions and businesses so that they comply with the rules. With the new update of the SIFEC codes, including expanding its scope from infants 0-6 months to 0-12 months, increased restrictions on sponsorships received by healthcare institutions among other developments, I am proud of the efforts of the SIFECS committee who has worked very hard on the revisions. A strict code will help consumers make better decisions on what is best due to higher ethical marketing standards. This is important, as predatory marketing – when the information received by consumers are inaccurate and/or misleading – moots informed consent. 

 It is important to note that the SIFECS website encourages the public to also be part of the effort in spotting any breaches of the code. Anyone can send feedback to the Health Promotion Board (HPB) for action here.

BMSG would also continue to educate and empower parents to become informed consumers, when making decisions on infant and toddler feeding. My goal is that the near future, the SIFECS code will be further expanded to include follow-on formula milk and baby food for babies beyond the age of 12 months old, just as the WHO Code does.  

IBFAN, on the other hand, or the International Baby Foods Action Network, is a network of public interest groups across the world whose goal is to protect, promote and support breastfeeding and optimal infant feeding practices. BMSG is proud to be an affiliate of IBFAN Southeast Asia.

In the recent years, BMSG representatives have attended its workshops and I have been blessed to have participated in its meetings in Hong Kong and Jakarta (I wrote about my experiences here.) It has honed my views to be more critical on what breastfeeding protection and promotion are truly about: it is definitely more than just a mother’s choice. The knowledge that breastmilk can sustain a baby to survive and thrive, without the need for baby formula and foods up till toddlerhood, is one that empowers women and families not to rely on expensive and imported foods to raise healthy children.

We shared experiences and information with fellow delegates from the Asian nations, and I am amazed by their level of ingenuity to make breastfeeding work. They made breastfeeding supported by all stakeholders in a society: families, communities, health institutions and even their governments. Everyone played a role, because they understand that breastfeeding is a public health concern, not just for the dyad. I look forward to learning more from fellow breastfeeding advocates from around the region and beyond. 

 

5) What would be your goal for breastfeeding in Singapore?

Khatim (left) with President Halimah Yaacob and Elaine Chow, BMSG’s immediate past President, at an Istana event in 2018 when Khatim was then BMSG’s Vice-President. [Credits: Elaine Chow]

 BMSG exists because breastfeeding is still not seen as something normal. In generations past, breastfeeding support was innate within a community; mothers breastfed their babies, because that is what their mothers did. The confinement period ensured that both the mother and baby dyad are well taken care of. If a mother could not breastfeed her baby, cross-nursing and/or wet-nursing were accepted as an good alternative.

Unfortunately, today many new mothers are unable to access postpartum help or even get help from their families.  My goal is for breastfeeding to be NORMAL and to be expected in Singapore, and that it is understood as a public health concern.

We have seen progress, with the swelling number of membership in our breastfeeding support group on Facebook (over 16,000 online members now), with more hospitals certified as BFHI, and with the proliferation of breastfeeding paraphernalia in baby shops.

We can still do more. We should expect more. We would wait for a governmental action but we mothers could still affect change on the ground– every action works to permeate into the community (just like how I was convinced with my colleague!).

So we ask you to nurse your baby (or your toddler) anyway and everywhere.  Do not be intimidated if you need to ask your doctor for breastfeeding-friendly medication from your doctor. Stand firm to what you believe in and that you are doing the best that you can for your baby and yourself. 

 

6) Any last words?

Khatim (top row, first from left) at a Lactation Massage workshop by Filipino breastfeeding advocate Inez Fernandez (seated, first from right) in 2019. [Credits: Khatim Hamidon]

I am thankful for the confidence shown to me to lead this organisation. We have a great team for this term and we will achieve our goals during these two years.

 I am thankful for the mothers and their families for trusting us and believing that we are respected as a source for breastfeeding support.

 I am also thankful for the past contributions of former BMSG activists. We will pass on this legacy to future teams!

 Last but not least, I am thankful for the understanding from my family – BMSG work is extra work and sometimes it keeps me away from my loved ones. But I believe the little that I do will benefit the future generations to live in an environment where breastfeeding is seen and appreciated as part of life. 

June 2019 Newsletter: Breastfeeding a Baby with Tongue-Tie

By Applie Wan (BMSG Volunteer)

Stay-at-home mum Applie Wan was eager to start breastfeeding when she gave birth to her baby girl. Things seemed to start off rather smoothly on the day of the birth. However, on the second day, her nipples began to crack and breastfeeding grew increasingly painful. This is the story of how Applie figured out that her daughter was tongue-tied and how it affected their breastfeeding journey.

I am a SAHM of a 22-month-old girl. We first knew of the tongue tie when our paediatrician checked our baby in the early morning after she was born. The doctor asked if I experienced any pain while breastfeeding, to which I replied that my nipples were sore but I thought it was all very normal since it had only been a day since we had started breastfeeding. She suggested that we discuss this further with our postpartum doula and see a paediatric dentist for a proper diagnosis. 

Initially, we felt a little discouraged, as we hadn’t expected our baby to have any issues. Having a tie seemed almost like she wasn’t a perfectly healthy baby. Thankfully, our doula assured us that tongue ties are actually quite common and our baby was doing very well. Coincidentally, her child also had a tongue tie and she was able to tell us in depth how it might potentially affect breastfeeding and what our options were. 

It is best to catch a baby’s lip or tongue tie as early as possible. If you have your doubts, see a paediatrician or a paediatric dentist.

On the second day after delivering my baby, my nipples began to crack and breastfeeding started to become really painful. We worked on baby’s position as much as we could to get baby latching as deeply as she could, but the pain continued to persist as I could feel the raw wound on my nipples every time she nursed. We decided to book an appointment to see a paediatric dentist as soon as possible so that we could make the necessary decisions without delay. However, the earliest appointment we got was four days later. 

By the next day, my breasts started to get engorged. My milk had started to come in and shortly after, I started to get fever and chills. Our postpartum doula helped me to hand express and found out that there was pus, which may have been due to the cracked nipples leading to an infection. In addition, even though I had been nursing baby on demand every two to three hours, I ended up with blocked ducts. I started to dread latching her because of the pain and tried to pump instead to give my nipples a break. However, I didn’t yield much as I was still new to pumping so I bit my tongue and persevered to latch baby, even though I was in tears each time.

As our baby also had jaundice, she was very sleepy and had to be woken up to nurse. I also started to research about tongue ties, and found out that tongue-tied babies can also be very sleepy as it takes a lot of energy for them to extract milk from the breasts. Their milk transfer is not as efficient, hence they may fall asleep while suckling due to the effort they take. It dawned on us that our baby was gaining weight very slowly, she rarely pooped and her skin seemed loose and wrinkled.

A paediatric dentist will be able to properly advise you on whether your baby’s tongue and lip ties are severe and require a revision. Comparing your child’s lip or tongue tie with other children’s or guessing just from observation will not be helpful. See a professional instead.

Finally, the day of our appointment with the dentist arrived. We saw Dr Tabitha Chng on the advice of our paediatrician and she diagnosed that our baby had both tongue and lip ties. She also did a thorough evaluation of our breastfeeding journey. By the end of that evaluation, it was clear that the ties were impacting breastfeeding adversely. She went through all the procedures that we could do to resolve the ties before allowing us to make a decision. At that moment, I knew that we needed to proceed with the release if I wanted to continue breastfeeding exclusively so we went ahead with the release on the day itself. Within ten minutes, the procedure was finished and I was able to latch baby immediately to comfort her.

Surprisingly, I felt the difference the moment she latched on. I could feel more of her tongue moving against my breast when previously, I could only feel the tip of her tongue. She was also able to flange out her upper lips more than before. Even though she took some time to relearn how to latch with her newfound tongue mobility, I was immensely relieved that breastfeeding was no longer painful. 

We engaged a lactation consultant to continue working with us to improve her latch over the next few days, and diligently did the stretching exercises that were crucial in preventing the tongue and lip from reattaching. Within a week, my nipples had healed, our nursing sessions were pain-free and I was able to enjoy bonding with my baby much more. She started to gain more weight also. Baby is now 22 months old and is still breastfeeding. I am proud to have come this far!

After the revision, your baby may need to relearn how to latch. It will be best to work with a lactation consultant during this period.

If you suspect that your baby has a tie, I would definitely recommend that you seek a proper diagnosis from a paediatric dentist trained in tongue and lip ties. The dentist can help to evaluate how the tie is affecting breastfeeding. Some parents decide not to do the procedure as their babies are able to breastfeed without much issue despite the tie, so it is important to consider if the benefits of doing the release would outweigh the risks.

A release is also harder to do when the child is older. For example, the procedure may have to be done under general anaesthesia if the child is already very mobile, and the baby also has to relearn how to latch after the revision. Hence, I strongly believe that seeking help and advice as early as possible is very important.

June 2019 Newsletter: Breastfeeding & Sports

By BMSG Editorial Team

*DISCLAIMER: You should seek the opinion of your doctor or your gynaecologist before doing any forms of exercise after giving birth.

If you have read Sophie Power’s story, you would not cease to be in awe!  She is the amazing mother who stopped to latch her baby AND pump in the midst of a  48-hour marathon through the Alps.  The image of her at a pitstop latching her son while also pumping milk from the other breast, is one that will resonate with many mothers, who are avid sportswomen. Power is an example of a mother who would not let her passion stop her from doing what she needed to do for herself.

Here in sunny Singapore, we are not short of mums who truly love sports. We spoke to several breastfeeding mothers who are avid sportswomen themselves, to find out just how possible it is to juggle the act of breastfeeding with sports. 

Does Exercise = Decline in Supply & Quality of Breastmilk?

One of the greatest concerns that many mothers may have when it comes to exercising, would be whether it impacts milk supply and its quality. According to the US Academy for Nutrition & Dietetics, as long as the breastfeeding mother is drinking and eating enough to replenish the resources she has lost to exercise, there is no evidence to link a dip in supply with exercising. 

Heng Wen Xiu, who has been breastfeeding for less than a year, exercises daily. The swimmer and elliptical trainer said,  “It does make me hungry, so I make sure to eat enough to avoid impacting my milk supply”.

Having balanced meals before and after a workout can help to replenish nutrients in the body.

Jasmin, an avid road cyclist who exercises several times a week, said that it is important to stay hydrated: “I have to drink more water to replenish the liquid lost, in order to ensure a good supply.”

Dr Mythili Pandi, a family physician, and an EXCO member with the Breastfeeding Mothers’ Support Group, resonated with this. “Plenty of water and good quality foods from all the food groups are all that a mother needs to maintain her milk supply,” said the mother of three who enjoys running even when her three children were babies. She added, “I also find that when I am doing a lot more anaerobic work or long-distance runs, I tend to have more protein rich foods to quicken muscle recovery.”

Some mothers are concerned that exercise can impact the immunologic factors in their breastmilk. Research has found that the IgA compound which is responsible for the immunity factor in the milk, can be reduced after exhaustive exercise. However, this dip is only for the short term and is found to be insignificant. Dr Mythili also added that levels of IgA can remain stable throughout the day: “It is probably best to not exercise to exhaustion especially if the mother has not been active regularly. Even so, the drop in the levels of sIgA are only for a short time (15-30mins) and it will then return to normal levels again. So the total levels of sIgA over the course of the day may be quite stable.” 

Timing Matters

While we know fatigue from sports may trigger a reduction in milk supply, mothers we spoke to discussed arranging feeding or pumping times to fit in with exercise. Jasmin, an avid cyclist, finds that pumping just before and after her riding sessions is important to help her sustain her milk supply, as a single ride could take a few hours!

Others, like Vicki, who usually goes to a gym during lunchtimes at work, deciding to pump or to workout, can be a challenge. She sees both as important to her, but believes that pumping should take priority. “I tell myself pump(ing milk) for my baby is more important than exercise so I make sure I get to the gym as soon as I finish” said Vicki, who also added that it can be more comfortable for mums to exercise on emptier breasts. 

Wearing the Right Exercising Gear

Grace, who does High Intensity Interval Training (HIIT), also agrees on exercising on empty breasts. She encouraged other mums to empty the breasts before exercising. “I did it (exercise) once without pumping and ended up with mastitis!”

Sports bras and tops, which have large bands underneath the breasts for better support, may pose risks of blocked ducts leading to mastitis if unresolved. Tight clothing, too, can impose similar risks. It is important that the attire you opt for is loose and comfortable, and that you do not wear it for long periods of time. You should remove the clothing as soon as possible and to check for blocked ducts frequently.

Exercising while breastfeeding should be extra comfortable and breasts should be well-supported. However, avoid constricting clothes to prevent blocked ducts and mastitis!

Exercise for Your Sanity

Even with all the logistical organisation required, all the mothers we spoke to concurred that exercising helped them to cope better with their roles as a mother and maintain their emotional and physical well-being.

Agnes Nemes-Chow, a stay-at-home mother to seven children, says, “Running helps me to reduce my general stress level. As a stay-at-home mum, it gives me a break from looking after my children and helps me to maintain my physique.” She also added that she did not notice that it had any negative impact on her milk supply as she latches her baby before and after her runs.

A mother who enjoys yoga and pilates, Hwee Min, says exercise has actually helped her improve her resolve to breastfeed. “Staying active by engaging in sports helps me be refreshed and to reset my mind. It gives the emotional strength and tenacity to continue my breastfeeding journey,” says the mother who has been breastfeeding for almost a year. 

There is no particular exercise or sport to avoid while breastfeeding but focus on your nutritional and physical well-being.

No Particular Sports to Avoid

Dr Mythili also advised mothers to do the sports they love and enjoy and that there is no particular sports that mothers should avoid. 

She also added that mothers could consider exercise in a bid to get over the baby blues. “Being active was the best way I could deal with my postnatal blues and the massive shifts in my life – being a full time medical officer in a bustling public hospital to a full time mummy to a brand new baby.”

So mummies, if there is a particular sport you like or one in which you are hoping to try, don’t hesitate! Prepare yourself and your loved ones for the hour or two that you will be away from baby, and get active! You will find that it may actually help you to feel much more energetic and happier! And a Happy Mummy means a Happy Baby!