Aug ’18 Newsletter: Trip to IBFAN – My Reflections

By Khatim Hamidon (Vice-President, BMSG)

As an affiliate of IBFAN, or otherwise known as the International Baby Food Action Network, BMSG has been sending representatives every year for the past two years to attend meetings that it organises frequently. IBFAN regularly trains trainers and advocates to share and spread the knowledge and best practices of breastfeeding, particularly at the governance level. Read more to find out about Khatim’s reflections on her recent Train the Trainers’ meet in Jakarta last July.

Members of IBFAN Asia. [Credits: Nia Umar]

It is my hope that more cooperation and synergy will happen in the future between ministries, hospitals and charities in empowering mothers and families to breastfeed. It goes without saying that breastfeeding is the normal way to feed an infant and for said infant to grow optimally – it is indeed natural, but it needs nurturing from every part of the community for it to be normalised.

Khatim Hamidon
Vice-President, BMSG

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Meeting breastfeeding advocates from around Southeast Asia: that was what I had looked forwarded to, when Elaine, BMSG President, and I, were recently invited to the second Train-the-Trainers workshop that was held in Jakarta.

The International Baby Food Action Network (IBFAN) is a coalition of public interest groups working towards a common goal: to protect breastfeeding.

BMSG was previously invited to IBFAN Asia meet-ups in Hong Kong and Bangkok within the past two years.

We arrived in Jakarta and were greeted by the newly minted IBFAN Southeast Asia, headed by its coordinator, the indomitable Nanay Ines Avellana-fernandez.

Sitting through various sharings by the other countries, such as Indonesia, Malaysia, Brunei and the Philippines, I realised that here in safe, cloistered Singapore, we are blessed with relatively good infrastructure in governance, health care and welfare services, that we take so many things for granted.

I would like to share my three main reflections from this trip, in the hope that BMSG will be reminded to stay true and committed to its mission, and that more people will be aware of the global breastfeeding landscape.

BMSG President Elaine Chow sharing about our counselling skills during a sharing session for IBFAN members.

 

1. Breastfeeding as Food Sovereignty and Empowerment

This would seem weird at first – what has breastfeeding got to do with these mumbo-jumbo? But hear me out!

Ines was part of a natural disaster relief effort a few years back when a typhoon ravaged an area in the Philippines. What Ines and her team did continues to amaze me. (Still nursing my chin, from when my jaw dropped to the floor).

She called up a number of breastfeeding mothers as volunteers and set up camp. The volunteers would come to feed the infants in the refugee camp, and to become coaches to mothers caught up in the disaster.

Often, these mothers would have formula-fed their babies. But in a crisis situation, clean, potable water was limited; much less was available to clean and sterilise feeding bottles and to safely mix infant formula with.

These mothers were then assisted to relactate so that they could begin to breastfeed their own babies. In fact, a number of grandmothers were recruited to be successfully relactated as well, who then chipped in the efforts to feed babies.

Food sovereignty and security – you do not need external aid for infant food. Food for baby is local, and not imported and priced exorbitantly. As long as the mother has sufficient nutrients and enough support, she is enough for her baby.

And how empowering and confidence-boosting that must be for the mothers! That even in difficult situations, she could feed her baby, that she could hand-express milk (without the need to use pumps) to extract milk and see for herself that she could produce milk, that she could count on the sisterhood of mothers for support. She could provide for her baby anywhere and anytime.

Mingling with IBFAN members from other nations has opened the writers’ eyes to how empowering breastfeeding is for mothers.

 

2. Health Workers as Partners in Breastfeeding Success

Singapore now boasts three Baby-friendly Hospital Initiative (BFHI) hospitals, which are National University Hospital (NUH), KK Women’s & Children’s Hospital (KKH) and Singapore General Hospital (SGH). There is news that a couple of private hospitals are following suit, so we are very happy to hear about this progress as more people recognise the importance of breastfeeding support within the hospital infrastructure.

Even so, our Bruneian and Indonesian counterparts still top us in this aspect!

There are five hospitals in Brunei, with four of them public. Even though none of them are BFHI-certified, the infrastructure supports BFHI and breastfeeding fully – infant formula is strictly regulated within their walls.

The Indonesian contingent, on the other hand, was made up of several doctors – general practitioners and paediatricians – who are also accredited as International Board Certified Lactation Consultants (IBCLCs), which is the gold standard as a breastfeeding clinician. Being a doctor and an IBCLC at the same time is indeed a powerful combination as the medical officer is informed in the breastfeeding management of both mother and child during consultations.

I would love to see more of our doctors, midwives and nurses, whose daily touch points are with babies and mothers, encouraged to be IBCLCs, and support mothers in breastfeeding their babies. With support from family and health workers, a mother is more likely to succeed in breastfeeding her child.

 

3. The Need to Continue Learning From Others & Improve the State of Breastfeeding in Singapore

I am thankful that Singapore is a safe and peaceful country. We do not have to worry much about clean water, natural disasters and so on.

But that doesn’t mean that we can remain obstinate by not improving the situation of low breastfeeding rates in Singapore. There will always be new challenges to come in the future that may shake the very foundations of breastfeeding.

For example, with the recent news of tainted infant formula milk, many parents simply move on to a different brand.

Even in Singapore, some mothers mistakenly believe that they cannot breastfeed or that formula milk is superior. But what happens when there are no other brands, or a cheaper brand, which is safe?

While the majority of families could head on to the supermarkets to purchase from the many other brands available, low-income families may not be able to afford formula. With more families in Singapore falling between the cracks, these families may stretch out the last can’s contents by diluting each feed with more water than needed, and when the last remaining powder finishes, make milk for baby using evaporated milk.

I don’t need to explain how the baby fares under this.

Learning from our neighbours on how they have changed and improved lives with breastfeeding awareness and assistance, even under mind-boggling circumstances, gives me hope that the best is yet to come.

But first, this haziness in the lack of breastfeeding awareness and literacy needs to be changed. Imagine if the culture of breastfeeding is truly alive in Singapore: mothers are supported in breastfeeding by family, the work place and the community. Lactation consultants are there to assist when challenges arise. When there is a need for human milk, cross-nursing and human milk donations are easily available. What an ideal situation it would be!

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IBFAN Asia is a subsidiary of the larger IBFAN network, which has representatives from all over the world. [Credits: Nia Umar]

Overall, I look forward to be meeting our counterparts in breastfeeding advocacy again in future events. There will always be so many things to learn from their collective wisdom, and how we, in Singapore, can gleam something out of this to apply to our own communities, in the right context.

It is my hope that more cooperation and synergy will happen in the future between ministries, hospitals and charities in empowering mothers and families to breastfeed. It goes without saying that breastfeeding is the normal way to feed an infant and for said infant to grow optimally – it is indeed natural, but it needs nurturing from every part of the community for it to be normalised.

Aug ’18 Newsletter: School of Hard Knocks – A Mother’s Sharing

By JoBeth Williams (BMSG Staff)

At our Annual General Meeting earlier this year, we were delighted when an unexpected attendee showed up – Mrs Anna Chin, who had served as Interim President of the then Singapore Breastfeeding Mothers’ Group (SBMG) back in the late 70’s. Petite and soft-spoken, Anna is nonetheless passionate when she speaks about the trials and tribulations of being a breastfeeding mother four decades ago.

Anna (in white), during our AGM earlier this year.

“New mothers suffered so much anguish and pain even though they looked forward to breastfeeding and motherhood,” she muses, recalling how in the 70’s, milk companies aggressively marketed their wares to them. Not only was formula promoted heavily in maternity wards, but the government was also pushing for new mothers to return quickly to the workforce.  Breastfeeding, obviously, was not seen to be compatible with a young nation’s fervour for progress. Infant formula was hailed as a wonder solution to this problem – a milk that supposedly contained all the nutrients a baby could possibly need, without the inconvenience and difficulty of breastfeeding. Formula samples were readily handed out to new mothers, compounding their free fall into low supply and leading to early weaning. “They looked forward to breastfeeding and motherhood, but there was a lack of knowledge at that time,” Anna adds. It was a prevailing belief then that Asian women, who have smaller breasts than their Western counterparts, would never make enough milk to sustain a baby. There was almost nothing going for it. Breastfeeding never stood a chance.

Anna served for a brief period as Interim President of the then-SBMG in the 1970s.

Anna felt this most keenly and most regrettably when she ran into difficulties after the birth of her first son. Hospitalised for a week due to her Caesarean section, she could only watch helplessly as the nurses insisted on caring for her baby for her, feeding him formula and ignoring her request to breastfeed. Without her baby to suckle, her breasts grew more and more engorged; it was so severe and she was in so much agony that in a moment of excruciating pain, she wished for death. Her mother-in-law was also unsupportive and told her in no uncertain terms to give up her ideas of breastfeeding. Disheartened, Anna stopped nursing her firstborn after only one and a half months.

When she fell pregnant again, she felt a renewed sense of optimism. This time, she thought, she would be prepared. She found the SBMG and attended their mothers’ meetings, where she saw for herself how natural, happy and easy breastfeeding was, and was utterly convinced that this was her path forward. “Good role models are important,” Anna says decisively. She points to the Australian model, impressed by the way mothers are welcomed to schools to share about breastfeeding with the students. “Breastfeeding must be taught to all school kids! It should be included in the domestic science curriculum so the children will become responsible parents later.” She adds with some sadness that many of her contemporaries dissuaded their own daughters from breastfeeding, showing just how damaging a lack of role models can be.

Anna, however, had surrounded herself with positive role models during her second pregnancy. That birth, another C-section, landed her in hospital for an extended stay again, but this time she refused to give in. Although her baby had a marked preference for the bottle he had been given in the nursery, Anna persisted. At home, she put the bottles away and painstakingly expressed milk after every feed to get her supply up and running. It was a great personal triumph when her baby finally became what Anna laughingly calls a “happy sucker”. She ended up nursing him until he was three years old.

A baby born via c-section.

Having been so thoroughly supported and aided by the expatriates who ran SBMG, Anna felt that it was vital that they reach out to more local mothers. When the group was searching for a new President, Anna stepped up to take on the interim role until someone could be found. She fondly recalls the good work they did and the exhaustive efforts of the SBMG volunteers. “We went to hospitals, met medical students and attended mothers’ groups,” she says. “We visited new mothers in hospital, making home visitations on request. We encouraged mothers to borrow books from our library so they could learn more about breastfeeding.” The group even helped to coordinate a milk bank at the Singapore General Hospital (SGH), collecting breast milk to distribute to babies allergic to cow’s milk protein. Their dedication led to them making home deliveries to ensure the precious milk reached their intended recipients in time.

Although Anna did not always know what the individual outcomes were, helping so many women feed their babies was a reward in itself. She helped to operate the SBMG hotline, doling out mother-to-mother advice and support. She remembers receiving a call one night from a mother who was desperate to latch her baby. He had been refusing the breast and she was at her wits’ end. After speaking at length to the mother, Anna heard nothing further from her and thought no more about that particular case. Yet about a year later, she received a surprise in the mail – a thank-you card from the mother for helping her with her breastfeeding issues. Most encouraging of all, the baby was still latching at 1 year old. “It was so good to know she succeeded,” Anna smiles.

More than 40 years after Anna’s breastfeeding journey started, the Breastfeeding Mothers’ Support Group is still going strong. Many of the programmes the pioneer generation began have been developed and pushed further. We have several communication channels set up to reach new mothers; we run workshops and mothers’ meetings and do our best to populate the country with the positive role models that Anna feels are so vital to breastfeeding advocacy. Things are somewhat easier for new mothers nowadays, Anna notes, with longer maternity leave, more helplines, and better access to information. Yet, she insists that she is glad she went through the school of hard knocks.

Anna with BMSG President Elaine Chow (centre) and JoBeth Williams, BMSG counsellor & staff (left). Incidentally, Anna had offered breastfeeding support to JoBeth’s mother when she had just given birth to JoBeth!

“I learned so much,” she says, “and it gave me great pleasure to impart what I have learned to other mothers.” She considers what parting advice might be best for our members, and with an impish smile she tells us to remember this: “the only difference between big and small bosoms is fat, and not less milk ducts.”

Aug ’18 Newsletter: Counsellor Spotlight – Ellen Nepilly

By BMSG Editorial Team

As part of recognising the work of our volunteer counsellors, we will be featuring our counsellors regularly in our monthly newsletter. Our counsellors come from all walks of life, which adds diversity to our counsellor team. This month, we feature Ellen Nepilly, a mum of three children who hails from Germany. Ellen has also recently obtained her International Board Certified Lactation Consultant (IBCLC) certification!

 

Hi Ellen! It’s been a year since you joined the BMSG! Tell us more about yourself and what inspired you to become a breastfeeding counsellor.

It all started with the birth of my twins in 2009. They were seven weeks early and I needed a lot of help and support, especially emotionally, to manage all the pumping and hand expressing. I had a lot of support from the wonderful nurses and lactation consultants (LCs) at the hospital in Japan back then when I was still living there.

I was also in touch with Iona McNab who is an IBCLC and a La Leche League (LLL) leader. She was my rock as I could always call on her when I thought I couldn’t do it anymore. I suffered from mastitis and all kinds of issues but she never ceased to be positive and encouraging. I will always thank her for that and wanted to pay it forward.

Ellen (in pink) at the recent Big Latch On held at NUH. [Credits: Ellen Nepilly]

We also hear that you recently have obtained the IBCLC certification. Congratulations! Could you tell us more about your experience going through the certification? Is it a route that counsellors can or should take?

Back then I already knew that I wanted to become an IBCLC one day but never thought I would get there because I have no midwifery or nursing background and had to catch up on extra college courses to sign up for the exam.

It was not easy having no background as a healthcare professional. It was certainly the hardest and most stressful exam I have ever taken. I was required to fulfil 1,000 hours as a breastfeeding counsellor helping mums and 90 hours of lactation-specific studying and complete 15 college level courses.

The college level courses can be taken online so it was possible and manageable for me. I had already obtained a Bachelor’s Degree, and as such I was used to studying and writing papers. I was also able to use my health coach certificate for the nutrition course, and had taken sociology already. I luckily found a group on social media that helped finding all the online courses I needed. Figuring out which courses to take is already quite a lot of work so I’m very thankful for that group. It helped me a lot.

Becoming an IBCLC is not necessarily something every counsellor should aim for. You can help mothers as a counsellor in many ways. Often emotional support and positive words are all that a mother needs in order to push through and keep going.

The reason I wanted to become an IBCLC was because I wanted to do it as a full-time profession, which may not be every counsellor’s goal.

Ellen (2nd from left, top row) and other counsellors at one of BMSG’s Mum 2 Mum Meetups this year. [Credits: Ellen Nepilly]

How has being part of the BMSG changed your life or impacted the way you help mothers?

As an expatriate here in Singapore, it has certainly helped me meet more locals. It feels like being part of a big family of breastfeeding supporters. Our counsellors are all awesome mums who spend a lot of their free time supporting fellow breastfeeding mums, so it’s a very special tribe.

As a counsellor with BMSG, I am really enjoying getting to know the different cultures and customs that come with all the different ethnicities here in Singapore. I met an Indian mum the other day whose aunt was there to help her with her newborn. She had a lot of breastfeeding knowledge and showed me an infant feeder that I had so far only seen in a textbook.

 

What is your dream for the breastfeeding community in Singapore and where you come from?

My dream is that governments will become much more supportive of breastfeeding by helping to provide increased education and awareness in this area, thereby weakening the influence formula milk companies have over doctors and hospitals. I will be happy if all hospitals could achieve the Baby Friendly Hospital Initiative (BFHI) status, as that would mean that mothers can easily receive all they help they would need after giving birth.

 

What is your best advice for individuals who are interested in becoming breastfeeding counsellors?

Just go for it. We have a new mentorship programme in our Facebook group. Unfortunately, we currently have more mentors signed up than mentees so we cannot assign them all. But starting out in our breastfeeding group by giving supportive advice to breastfeeding mums is a good way to see what other mums have to deal with and it will give you an idea of what to expect as a counsellor. Come to our breastfeeding group programmes and support mums there by sharing your story with them! Come to our events, get to know us and we’ll hopefully see you when our next batch of counsellors are being trained.

 

Interested in joining the BMSG as a breastfeeding counsellor? Email nabila@breastfeeding.org.sg to be placed on the waitlist for the 2019 intake of counselling training!