October 2017: Milk Talk

By Melissa Kirwin, BMSG volunteer

EBF…EBM…IBCLC…BFHI?
What are all these acronyms and what exactly is the Baby-Friendly Hospital Initiative?

Expecting a baby, especially your first, can be an extremely exciting yet stressful time for new moms and dads. It does not help when it feels like you are reading code language while doing research to make plans for the pending arrival. Here we will provide you with the information to help make a very important and personal decision – if you plan to breastfeed, (and we obviously strongly encourage you to!) where should you deliver your baby?

The World Health Organization (WHO) in partnership with UNICEF launched the Baby-Friendly Hospital Initiative (BFHI) to promote and support breastfeeding in hospitals and maternity units. Since the BFHI began in 1991, more than 15,000 facilities have been award Baby-Friendly status across the world, including a number of hospitals and medical centers
here in Singapore. (1) The WHO recommends that babies be breastfed exclusively for the first six months of their lives for optimal infant growth and development as well as for health benefits for the mother. (2) To become Baby-Friendly, a facility must not accept free or low-cost breast milk substitutes, feeding bottles or teats and have implemented the following ten steps for successful breastfeeding. (1)

Ten steps to successful breastfeeding

 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 one half-hour of birth.
 Show mothers how to breastfeed and 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.
 Practice 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.

As of June this year, all three public hospitals in Singapore are BFHI certified and many of the private hospitals indicate that they are either working towards becoming certified or will review their practices to align further with the BFHI. (3) If you have your heart set on a hospital for delivery and they are not certified, have this list of 10 steps to successful breastfeeding handy at your hospital tour and/or include it with your birth plan. A good hospital and its staff will always give their best efforts to accommodate your requests. If you encounter resistance or questioning, it may be a good idea to move on to hospital choice number two to see if they will better support your efforts to breastfeed.

NOTE: To decode the other acronyms – EBF is exclusively breast-fed, EBM is expressed breast milk and IBCLC is International Board Certified Lactation Consultant

Reference:

1)The Baby-Friendly Hospital Initiative
https://www.unicef.org/programme/breastfeeding/baby.htm
2) Exclusive breastfeeding
http://www.who.int/nutrition/topics/exclusive_breastfeeding/en/
3) Bigger push for private hospitals to adopt standard breastfeeding-friendly practices
http://www.straitstimes.com/singapore/bigger-push- for-private- hospitals-to- adopt-standard- breastfeeding-friendly- practices

September 2017: Milk Talk

By Namrata Trivedi, BMSG Board Member and Dietitian

Once breastfeeding is well established, our breastmilk volume would increase from a meagre 50ml to as much as 750ml a day to meet a baby’s demand. So it would be prudent to assume that the rise in our milk volume coupled with the hot climate we live in would increase our requirement for fluids during this crucial time. We should aim to drink at least 1.5 to 2 litres of water each day in general, although requirements may vary, as some mothers may need to drink more water each day when breastfeeding is well established. Some mothers may end up getting hemorrhoids when they don’t drink enough water.

Thirst is a good indicator of your fluid needs. If you are worried that you may forget, pour out water in a jug in the morning and try to drink it all up by the end of the day. Your water needs can be also be met by including a variety of nutritious fluids such as milk, unsweetened juices and soup. (1)

Whilst the long term risks of consuming alcohol during breastfeeding are not as well defined as during pregnancy, it is established that alcohol passes through to the breastmilk and excess consumption may decrease your milk supply and cause the baby to suckle less. (2) Therefore, it would be wise to limit alcohol to an occasional glass and wait for a few hours before breastfeeding to minimize the amount of alcohol that’s passed on to your baby.

Some extra fluid tips when breastfeeding:

– Keep a large bottle of water at the places where you usually breastfeed or pump.

– Drink a glass of water or other beverage every time you sit to breastfeed or pump.

– Limit tea and coffee to in-between meals in order not to interfere too much with iron absorption.

– Caffeine, found in coffee, tea and some soft drinks is a diuretic that causes us to pass out more fluids and cause dehydration so limit your caffeine intake. Do note that alcohol is also a diuretic.

– Some beverages, such as soft drinks and fruit drinks, also contain added sugars. Limit your intake of these beverages especially if you are gaining too much weight.

Reference:

1) Ministry of Health, HealthHub, contributed by Health Promotion Board 2015, accessed 16 August 2017, https://www.healthhub.sg/live-healthy/159/eating_guide_breastfeeding_mothers

2) American Academy of Pediatrics. Policy Statement. Breastfeeding and the Use of Human Milk. Pediatrics 2012;129;e827; originally published online February 27,2012. http://pediatrics.aappublications.org/content/129/3/e827.full