Posts

Counsellor Spotlight: Kwan Xiuwen – June 2018 Newsletter

By the BMSG Editorial Team

This month, we celebrate the graduation of our new counsellors who have completed their 10-week training in June. They have officially started their new duties a few days ago and are raring to go! One of them is Kwan Xiuwen, a full-time mother of two boys who was previously working as a technical writer for 10 years before leaving the workforce. We speak with her to find out how the training went and what her aspirations are, as a newly-minted breastfeeding counsellor with the BMSG.

Xiuwen (in blue) with her lovely family. [Credits: Kwan Xiuwen]

Congratulations on graduating from the 2018 intake of the BMSG Breastfeeding Counselling Training! How does it feel to finally become a #bmsgcounsellor?

Thank you! The BMSG counselling training was a great bonding experience, thanks to all the wise, warm, and generous ladies involved. I have mixed feelings about the completion of my training. I’m sad that I won’t be seeing everyone on a regular basis anymore. I’m nervous about whether I can identify what each mum who I will counsel really wants to know, and yet make sure that I’m also identifying what they need to know, so that mums can find the best solutions for both themselves and baby. However, I’m confident that the experienced counsellors will be compassionate and helpful in guiding me to improve my skills further. And I’m elated that I can do my bit to help mums make informed decisions about breastfeeding their babies.

Could you tell us about the whole training process from the start right up to graduation? What were some of the things you had to do during training to equip you with the necessary skills to become a breastfeeding counsellor?

The training process was focused on empowering each mum to make the right decision for her family’s unique situation. In order to do so, the training consisted of three parts: breastfeeding knowledge, counseling skills, and lastly how to interact with ethics and inclusiveness.

During the breastfeeding knowledge component, we learned the mechanics of breastfeeding: how the body is designed to work with the baby to produce milk. We also learned about many related areas: the importance of breastfeeding during the first hour after birth, the capacity of a newborn’s stomach as well as the benefits of skin to skin. The training also touched on areas that are not strictly breastfeeding-related, but essential to mothers of newborns: baby sleeping patterns, first foods, and how to deal with the chaos that is early motherhood. This first component of the training taught us the ‘hard skills’: the information to be communicated.

Our baby-friendly counselling training in session.

During the  second component of the course, we learned counselling skills: how to speak to mums that would make them feel heard and understood. To do this, we tried to internalize the concept of unconditional positive regard: supporting mothers without judging them, no matter what the situation. Besides this overarching mindset, we also learned ways of identifying what the mum wants  to know, filling in any knowledge gaps that she may not be aware of, while ensuring that baby is well. We also practiced many counselling micro-skills: for example, we learned responses that would help mums retain information even when they are frustrated and sleep-deficient. This second component of the training taught us the ‘soft’ skills: how to communicate the information in an appropriate way.

During the third component of the course, we learned about how the BMSG code of ethics protects the various participants: for example, it protects mums from exploitation, protects BMSG’s reputation, and protects counsellors from conflicts of interest. This component of the course also included elements of inclusivity: how to communicate in a way that respects people who may differ from ourselves in terms of culture, language, family type, or economic situation. The third component of the training taught us to be aware of the broader environment: the community of which the BMSG is a part.  

Our newly-minted counsellors will serve on board our remote and physical counselling platforms.

Any memorable moments during training that you would like to share?

One of our assignments required us to reframe a negative part of our real lives to put a positive spin on it. Many of us shared deeply personal experiences and showed how meaningful it is to reframe and shift stubbornly negative perspectives. In our current social-media-heavy culture, it seems that triumphs are celebrated and everyday frustrations swept out of sight, so I was amazed to hear that the other mums were facing problems similar to mine. I felt that although it is thrilling to achieve externally-validated results, what sustains the spirit in the long term is the ability to make such shifts in perspective that allow us to validate our own day-to-day experiences.

 

What would you say to mums who are aspiring to become breastfeeding counsellors? Any words of advice or encouragement?

Volunteering takes time, effort and resources, with seemingly little personal benefit. However, attending the training alone has convinced me that volunteering can be a fulfilling experience. Besides having a positive impact on the health of breastfeeding mums and their children, you can also remind mums that what they do is valuable beyond measure, even when they are neck-deep in newborns, toddlers, and yet-to-be-folded laundry. In addition, in the role of a breastfeeding counsellor, there are so many skills that you can practice that are relevant to building healthy relationships with those around you, such as active listening, respecting others’ choices, and developing empathy for those with different values and beliefs.

What a great win-win situation: helping others, while improving your own interpersonal skills!

 

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!

 

May 2018 Newsletter: Managing Breastfeeding & Diabetes

By Cheng Yong (BMSG Volunteer)

This month’s Mother’s Sharing strikes a chord as we speak to Cheng Yong, a stay-at-home-mother of 1, who has had Type I Diabetes Mellitus* for nine years now. Hear from Cheng Yong how diabetics can include breastfeeding as part of their parenting goals and how they can manage breastfeeding while maintaining their blood glucose levels.

*About Type I Diabetes Mellitus: Type 1 Diabetes Mellitus is an autoimmune condition in which the beta cells of the pancreas are destroyed by the body’s own immune system. It can occur at any age but is more common in children and young adults. The exact cause of Type 1 Diabetes is still not clear. It is likely to be due to both genetic factors and environmental triggers which include viruses. In general, T1DM comprises around 5-10% of the total diabetes prevalence. In Singapore, the incidence of childhood type 1 diabetes mellitus is the predominant form of diabetes affecting children in Singapore (1).

Pregnancy

Prior to being pregnant, I had heard from many relatives and friends that they could not breastfeed due to their various conditions. Thus, initially, I was not very confident myself about breastfeeding as a diabetic patient. However,  when I brought up the idea to my endocrinologist, she did not specifically raise any concerns. Hence, I worked on taking care of my blood glucose during my pregnancy and hoped that things would work out.

Medical & Healthcare Support

My health care team comprised an endocrinologist, a dietitian, a diabetic specialist nurse and an obstetrician. During pregnancy, my endocrinologist helped me switch from insulin pens to a pump. She helped me immensely in titrating my insulin dosage which doubled by the end of the pregnancy! She is still helping me titrate my requirements now that I’m breastfeeding. My dietitian helped me plan my caloric intake with regards to carbohydrate, protein and fat during pregnancy and breastfeeding. As my pregnancy was considered high risk, I had more frequent checkups and ultrasounds. Above all, my husband provided the most important support as he reassured me whenever I broke down crying over unexplained high blood sugars. He was also my personal nurse during labour and recovery.

 

Post-Birth: Initiating Breastfeeding

My baby was taken to the High Dependency Unit right after the C-section to monitor his blood glucose levels. He was born at about 10pm and I was only able to meet him the next morning. I was still recovering and had to go up in a wheelchair. The nurses at the Singapore General Hospital (SGH) were really helpful as they patiently helped me express colostrum and delivered it to my baby. My baby had a mixture of formula and colostrum after birth. When I saw my baby for the first time, there was a Lactation Consultant (LC) present who helped me latch. He did manage to latch but it was still a struggle the next few times and I always buzzed for the nurses to help.

Monitoring Glucose Levels

Diabetic patients need to monitor their blood glucose levels several times a day. For myself, the minimum would be four times (before bed, breakfast, lunch and dinner). However, now that I’m breastfeeding, I will check my sugar levels about eight to ten times a day as my blood glucose levels are much harder to predict. There is also an increased risk of hypoglycaemia*. I definitely check my levels after each breastfeeding session during the night and whenever I experience hypoglycaemia symptoms.

*hypoglycaemia: When blood sugar levels drop below what is normal.

I do experience hypoglycaemic symptoms frequently. I usually have a few in a week but thankfully I get symptoms before they go dangerously low. My symptoms are shaky hands, hunger, cold sweat and tingling tongue. Suggestions to prevent hypoglycaemia (or hypos for short) would be to count one’s carbohydrate intake as accurately as possible if you are doing dosage adjustment for normal eating. Never ignore hypo symptoms and always keep hypo treatments near you. I usually keep my test kit and sweets within reach whenever I am breastfeeding.

 

A Typical Day

I breastfeed on demand so my days are not really structured, just like many SAHMs. At one point, my baby would only go to bed between 1 to 2 am and his sleepy period would last till 1-3pm! I would get some sleep then and an uninterrupted lunch. Now that he is eight months old, he typically sleeps around 10 or 11 pm, feeds once or twice in the middle of the night and wakes up between 7 to 9 am. My day is spent breastfeeding, changing diapers and entertaining him. Whenever he is taking a nap or is contented playing by himself, I slot in some household chores, online courses and prepare dinner, all this while making sure that I never miss including my routines to check my blood sugar levels too.

 

Snacks to Maintain Consistent Blood Sugar Levels

If I’m having a hypo (below 4 mmol/L), I eat a piece of candy which is considered as 6g carbs, followed by another 5-10g carbs with a biscuit, milk or chocolate. During the night after a breastfeeding session, if my levels are between 5-6 mmol/L, I would have a 5g carb snack which could be a biscuit or 100ml of milk. I don’t usually snack in between meals unless my levels are dipping. I find the following bite-sized food handy to have around: soft jellies (these are fast enough for me to treat hypos), caramelised biscuits, digestive biscuits, mini chocolate bars, easy-to-eat fruits like kiwis, milk in the fridge and a tub of ice cream in the freezer which I can weigh out any amount of carbs that I like.

—————————————

Interesting Fact:

Scientific studies have shown that youths who received any breastfeeding for at least 12 months or full breastfeeding for at least six months had lower odds of developing Type 1 Diabetes(2) and children who were never breastfed had twice the risk of Type 1 Diabetes compared with those who were breastfed.(3)

Cheng Yong’s story shows us that breastfeeding with Diabetes is possible and can provide far-reaching benefits to both mother and child. Whether you have Type 1, 2 or even if you have had Gestational Diabetes, you can and should continue to breastfeed.

 

References:

  1. https://www.singhealth.com.sg/DoctorsAndHealthcareProfessionals/Medical-News/2012/Pages/Type1-Diabetes-Mellitus-Contemporary-Management.aspx
  2. Diabetes Care 2017 May; dc170016. https://doi.org/10.2337/dc17-0016 Martens PJ, et al. Abstract #0511. Presented at: World Diabetes Congress; Nov. 30-Dec. 4, 2015.
  3. Infant Feeding and Risk of Type 1 Diabetes in Two Large Scandinavian Birth Cohorts. Diabetes Care 2017 Jul;40(7):920-927. doi: 10.2337/dc17-0016. Epub 2017 May.