Posts

Dec 2018 Newsletter: Why Artificial Feeding for Infants Should be the Last Resort: Observations from Maureen Minchin’s talk

By Khatim Hamidon, Vice-President, BMSG
Photos courtesy of Alexandria Neoh, Picspirations Photography

Formula milk shrinks penises.

At least, that was one of the revelations about artificial feeding that stuck in my mind during a talk by Maureen Minchin, a renowned Australian breastfeeding researcher. The talk, titled Infant Feeding and Modern Epidemics: Obesity, Allergy, Autism, Diabetes, was organised by the BMSG  last November.

Maureen Minchin has studied the effects of artificial feeding for the short and long term.

Minchin, who pioneered the field of lactation consultancy, was in Singapore under the invitation of the Association for Breastfeeding Advocacy (Singapore) (ABAS), and was also promoting her book, Milk Matters: Infant feeding & Immune Disorder, which took almost five years and not without sweat, tears and sacrifices to complete.

Formula feeding is wrought with sensitivity, with mothers pitted against each other on which mode of feeding is “better”. Minchin, however, did not shy away from the fact that formula milk should only be used as the last resort on what an infant should be fed during her talk. This was also an important tenet that underlies her writing.

Many people know about the benefits of breastfeeding (which is not a “benefit” to begin with, because breastfeeding should be the norm!). Breastfeeding reduces childhood illnesses, improves mothers’ health and promotes bonding between mother and child.

Minchin bravely delved into this further. She posited the milk hypothesis, in which breastfeeding is critical in transitioning a baby from a life inside the womb to a thriving life outside of it.

From health professionals, to breastfeeding counsellors, mothers and members of the public – all were interested to hear what Minchin had to share.

Breastmilk is the species-specific building blocks of the baby’s growth and development. An infant’s gut is permeable for this reason: to absorb stem cells and growth factors, besides the nutrients and antibodies in breastmilk, so as to develop optimally.

When breastfeeding is not realised, and the baby is exposed to formula milk instead, this will trigger epigenetic changes.

Babies exposed to formula milk are developing on ingredients that are not easily absorbed by their tiny bodies, and instead can be harmful to their gut – for example, synthetic nutrients derived from marine algae – which results in the baby’s development not following the same trajectory as that of a breastfed baby. This in turn affects babies right to the cellular level, skews the gut microbiome and this may be manifested both in the short and the long term hence why the various list of modern epidemics that Minchin shared with us in the title of her talk: obesity, eczema, PCOS, precocious puberty…and shrinking penises.

That is not all. These changes are also vertically communicated from the parent (either mother or father) to their children, and compounded through generations, as more and more babies are introduced to the supposedly modern artificial feeding.

It goes without saying that Minchin’s position is not shaming parents who are not breastfeeding their infants. On the contrary, she means that the majority of parents are not fully informed on the harms of artificial feeding. “How many OBGYNs actually talk to mothers about the importance of breastfeeding?” she asked the audience.

Minchin shared that a mother of a sick child cried when she read Minchin’s book, and exclaimed that she was relieved that whatever that her child was going through, was not her “fault” as a mother. That truly pierced my heart, because this was essentially a mother trying her best caring for her child and fighting the inadvertent product of previous generations.

It goes without saying that Minchin’s position is not shaming parents who are not breastfeeding their infants. On the contrary, she means that the majority of parents are not fully informed on the harms of artificial feeding. “How many OBGYNs actually talk to mothers about the importance of breastfeeding?” she asked the audience.

Some of BMSG’s volunteer counsellors and EXCO members with Minchin (centre, in black).

It feels quite bleak when you think about the generations of populations around the world introduced to unnecessary artificial feeding, and the well-meaning but damaging belief that it is a cure-all for almost any ailment: jaundice, weight loss, ineffective suckling, etc. Perhaps so many illnesses and health conditions could have been averted should young infants receive only what their sensitive tummies are meant to only fully digest: breastmilk.

But all is not lost. “Epigenetic changes do persist, but don’t persist forever,” Minchin explained, “…if we can manage to get the right care for breastfeeding babies for a few generations, we may be able to revert back to a better baseline genome.”

As the saying goes, when we know better, we do better. Let’s hope we continue to breastfeed, not just for ourselves, but also for our communities and society.

Minchin concluded with a stirring dénouement that, to me, simply cannot be summarised:

“Every one of you who is actually breastfeeding or has breastfed, has changed history for the better. You’ve helped to make the world a healthier place. You can regard yourself as (a) positive miracle worker, having succeeded in a society that stacked against success, structurally, in every way. If society just understood how really good breastmilk is, every mother would have been paid to stay home and breastfeed, or employ a wet nurse to do the job for her.”

I wanted to burst out crying. Mothers; we are miracle workers. Continue to advocate for breastfeeding for your child’s health, and for your child’s child’s health. We can make this world a better place.

Visit Maureen Minchin’s site here for more information on her work. You may also want to consider getting her book, Milk Matters: Infant feeding & Immune Disorder, which is sold at the BMSG website for $95. Part of the proceeds will go towards the BMSG.

Ramadan for the Breastfeeding Mother

UPDATE: 

We have included the Women & Ramadan Booklet produced by MUIS for public reference at the end of the article.

By Khatim Hamidon
Vice-President, BMSG

With the coming of Ramadan tomorrow, many Muslim mothers would definitely feel the anxiety of managing fasting with breastfeeding. In this write-up, we will discuss how breastfeeding mothers can prepare themselves for Ramadan. We also acknowledge that there are concessions in Islam about fasting for the pregnant and breastfeeding mothers. We urge you to consult your religious teachers with respect to the rulings on fasting and paying back the fast for breastfeeding and pregnant mothers.

Counting Calories

On average, a woman needs about 2,000 calories a day. If she is exclusively breastfeeding a baby, she would need an extra 300 to 500 calories. If she consumes a lot less calories than this, her milk supply may be affected.

How many extra calories that she needs also depends on her activity level, body fat reserves, her nutritional status and the type of food she is eating (e.g. processed food is not calorie-dense and hence won’t help her store energy).

Furthermore, it also depends on the demand – how much her baby takes, how many babies she is feeding and if she is also pregnant. Of course, if she is tandem-feeding twins, she would need double the extra calories, which is 600 to 1,000 more calories. Do consider the age of your baby if you decide to fast.

As for water, it is important for the mother to take sufficient fluids. On average, we need to drink approximately 1 litre of water for every 20 kg of body weight. Breastfeeding mothers need about 3 litres of water a day. Some people erroneously believe that during confinement, mothers should avoid drinking a lot of water. This is untrue, as it may affect her milk supply.

Knowing the above facts, how then can breastfeeding mothers prepare themselves to manage fasting in Ramadan?

Preparing to Fast

Breastfeeding mothers must prepare adequately to start fasting for Ramadan: physically, mentally, spiritually.

Hopefully by preparing in terms of food intake, this may ensure that she has enough intake and milk supply to last throughout the day. Preparing to fast is only being fair to her body and her baby.

  1. Water is important to avoid dehydration. We often suggest to mothers to do water parades after the start of sunset, which is to drink at least a cup every half hour while she is awake, to avoid feeling bloated. She can also eat juicy fruits like watermelon and oranges, and soups, which account for the daily fluid intake as well.
  2. Aim for food that make you sustain more energy throughout the day. Take food with high fibre, low glycemic index and which are less or not processed. Instead of white rice, take brown rice.
  3. Fruits and vegetables remain an important part of your diet with at least four servings a day. Dates remain as important as ever for its high fibre content and complex sugars to sustain your energy level.
  4. If you can’t take rice so early in the morning for the pre-dawn meal (sahur), you can make power shakes, like mangoes with baby spinach and chia seeds, or yoghurt, honey and oats.
  5. Some mothers find that natural health supplements and lactogenic food might help them with energy levels and milk supply, such as habbatus sauda’ (black seed). Please note that supplements are just that: to supplement your diet and not a full substitute.
  6. Avoid foods and drinks that are overly processed, oil-laden and sugar-laden, as they won’t help you sustain yourself. These foods may also burden your digestive system since they are harder to digest.
  7. Throughout the day, try not to over-exert yourself if you can help it. Prioritise what you need to do to conserve energy.

Besides taking care of food intake, some moms acclimatise their bodies slowly to fasting, by having “test fasts” before Ramadan to see how they will take to fasting during the month. Some will find it helpful to take alternate days to fast – be it for the whole month, or for the first week. Some moms will attempt to fast the whole month and break their fast early if they get unwell or feel that they babies may benefit more from a mother who is not fasting.

When to break your fast during the day

Be in tune with your body and with your baby, so that you won’t miss the signs if you need to break your fast early.

Signs that you should probably break your fast:

  • Signs of hypoglycemia such as giddiness, cold sweat, shivering, pale face, fatigue
  • Signs of dehydration such as inadequate supply of milk, headache, dizziness, irritability, dry skin

Whenever you feel that any of the above impedes your function and your ability to care for your baby, it’s time to break your fast.

Signs of dehydration for your baby:

  • restlessness and being fussy at the breast (perhaps due to less supply or flow of milk)
  • less wet diapers than normal
  • listlessness
  • dried, chapped lips, mouth and skin
  • eyes and fontanelle (soft spot on baby’s head) appear sunken
  • sleepiness (due to less energy)
  • weight loss is a VERY late sign of dehydration

You do not ever want your baby to reach this level – be responsible. You are your baby’s source of food and comfort, so take charge.

Breaking Your Fast

So you have prepared for fasting, but for some reason you cannot continue for any of the reasons above – it’s okay. Every person is unique and has different strengths, threshold and limitations.

There is reason why women are given rukhsah (concessions or keringanan in Malay) to break their fast, when breastfeeding and/or pregnant. It is a rahmah (mercy) from Allah. He knows, in His infinite wisdom, that He made certain people with certain limitations, and wants them to take advantage of any consolation that He has awarded to special people – and that is perfectly normal and nothing to be ashamed of.

Continuing to fast despite all of the signs of extreme dehydration is harmful to you and/or your baby. What is important is what is happening at the present moment. If you can’t fast now, you can pay fidyah (the monetary penalty for not paying back missed fast by the next Ramadan) or pay back your fast at a different time later on in the future when you are more capable.

This is especially important for mothers whose babies are less than six months of age. During this period, an exclusively fed baby is recommended to take nothing but his mother’s milk, as per World Health Organization (WHO) guidelines.

Ramadan is not merely just for fasting; it is a month of ‘ibadah (worship). There are other acts of worship that a mother can do to attain the rewards of this holy month. In fact, with proper intention, taking care of yourself and your baby is an act of ‘ibadah as you are fulfilling an amanah (responsibility bestowed by God).

For more information on legal rulings of fasting for Muslim women, please refer to the following links. More links will be updated soon: