Sept 2018 Newsletter: Breastfeeding a Jaundiced Baby

By Nur Azrin Binte Abdul Wahab (BMSG Volunteer)

Nur Azrin, a mum of one, shares her initial struggle when she first started breastfeeding her jaundiced baby and how she persevered through the challenges.

Azrin and her beautiful daugther Azrah Adarina.

My pregnancy and birth were manageable with minimal to no issues. I was able to direct latch my baby immediately after I birthed her. The best part? My husband was also very supportive and encouraged me to breastfeed my baby. He even clapped when our baby girl burped on her own after latching. I was extremely grateful for this turn of events as I had been anxiously praying to have a smooth start to breastfeeding. It was beautiful in the hospital during my stay as the nurses and lactation consultants (LCs) praised my supply and how my baby girl had no pressing issues so far.

Unfortunately, the nightmare began the moment I was about to check out of the hospital. My daughter had developed a dangerously high level of jaundice, which caused her to have a fever. She had to be warded in the Neonatal Intensive Care Unit (NICU) and as a first time mother, I was at a loss and caved in to the hospital’s insistence that infant formula would reduce her jaundice. I was torn; a part of me wanted to continue giving my baby breastmilk while another part of me wanted my one and only daughter to get well as soon as possible as she was only three days old.

Upon reaching home, I continued to pump every three hours as suggested by my LC to keep up my milk supply. That same night, I received a call from the hospital that my baby girl did not want to drink or even have a sip of the formula milk the hospital was providing, not even through a syringe or a cup. However, the nurses told me to give it some time and that she would provide me with an update the following day.

Fortunately, she was discharged the next day in the morning at 8am with no fever. She was very hungry as she had drank very little the night before. I immediately latched her and, lo and behold, she latched like a champ for an hour. I wanted to cry because I knew deep down that she must have been extremely hungry.

A baby undergoing UV light therapy for treatment of jaundice. Azrin’s baby had to go through a similar treatment at the NICU.

We brought her home subsequently but her jaundice levels rose again on her third day at home, resulting in another episode of high fever. We rushed back to the hospital and the doctors said my baby girl and I had different blood types and that this was a case of breastmilk jaundice; it was suggested that I supplement with formula again to quickly bring her levels down. Knowing that my daughter was thriving on her breastmilk, judging from her healthy diaper output and very good latch as assessed by the LCs, I informed the doctor that I would like to continue to provide baby with breastmilk on demand. However, should her fever persists or gets worse, I will bring her back to the hospital and provide a supply of expressed breastmilk during her stay.

This time round, her fever did not subside as quickly as the first time and it took about three to four days before her fever went away. I latched her as much as possible and as much as she wanted to. I also carried her a lot so there was ample skin-to-skin contact between us. I did not feed her based on any sort of schedule but just waited for my daughter’s cues. I also noticed that her fever went down bit by bit after longer latching sessions so I picked up on that and latched a lot. However, I was extremely tired from it.

It was all good though because there was a follow up after a week from the second visit and by then her fever was completely gone. Although her jaundice level was still high, it was no longer in the danger zone and she didn’t need to be warded. We had follow-ups at the hospital once a month and by the third month, she was completely cleared of any signs of jaundice and was a perfectly healthy baby.

With God’s blessings, my baby girl has just turned a year old and has been purely on my breastmilk with direct latching. We’ve had no issues so far other than the fact that I was on oversupply. My goal is to continue breastfeeding her until she turns two. With my strong faith in my ability to breastfeed, I believe I can manage this. Because I fell in love with breastfeeding my daughter, I may just go beyond two years old.

I hope to inspire and create awareness to all mothers who are struggling or having issues to breastfeed. Don’t stop until your child wants to and is ready to. Believe in yourself and your ability to provide breastmilk for your child, especially if you are obviously making enough milk for your baby. If your baby is thriving on your milk, stand up for your right to breastfeed and trust that you are providing enough for your baby.

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.”