By JoBeth Williams, BMSG Staff
Deciding to Work from Home
I’m a work-from-home mom, or WAHM. I quit my job a few years ago because my older daughter was not adjusting well to me going back to work. Truth to tell, I probably wasn’t adjusting well myself, so it seemed like the only option was to stay home with her for a little while. The funny thing is, I quit my job at the end of the year, and unexpectedly found myself pregnant with my second baby by February!
Thankfully, I had always wanted to take a long break to stay home with my kids, so I took the opportunity to fulfill my dream. I’m glad that I have a supportive husband who also thinks that it’s a good idea. I ended up looking for some work to do while at home so that finances wouldn’t be too uncomfortably tight, and was lucky enough to find some great work arrangements. While it has been really wonderful to have that flexibility and freedom to arrange my work/life schedule, it also means that I have to work with my younger one home with me during the day.
The WAHM Schedule
My working day can get quite hectic because with my little one around, she basically doesn’t allow me to work at all! Almost every day I end up working late into the night, sleeping at 1 to 2am, so that I can work uninterrupted. I find it much easier to get into work mode at night when the kids are in bed. I think a lot of working mothers can relate to this especially after COVID-19 when everyone was stuck at home. It’s virtually impossible to do anything when you have a child (or children!) to manage all day long.
Managing Breastfeeding While Working
I nursed my older daughter until she was 3 years old. My younger one will turn 3 in November and doesn’t look like she will stop nursing anytime soon, though we have been trying half-heartedly to night wean. The good thing about online video conferences is that I can nurse discreetly even while in virtual meetings: it’s either I switch off my screen for a little while or I just nurse her out of the scope of the camera. I can also toggle my camera and/or microphone off for a little while. It helps, of course, that I have understanding colleagues but I think after Circuit Breaker (CB), lots of people have become a lot more tolerant about accommodating small interruptions and disturbances since we are all in the same boat.
It’s great that this time, with my second child, I don’t have to bother with bottles because it was really tough with my firstborn. She rejected bottles until she was nearly 11 months old and was happy to go without a single drop of milk the entire time I was away at work during the day. I ended up donating litres of frozen milk, and watered my chilli plant with thawed milk that my daughter simply refused to touch (I couldn’t bear to pour it down the drain). I was a teacher then, and we didn’t have a pumping room in my school. It was really tough for me so I am really thankful for MP Louis Ng’s initiative that has led to more schools installing lactation rooms for nursing mothers over the next three years. Back then, I ran out of options and places to express milk. I was asked to express in the meeting room (which had a window in the door AND full glass wall, by the way), but people kept trying to come in and I felt like I was hogging a work space. In the end, I resorted to simply pumping at my table under a cardigan, in full view of everyone, because it was an open-plan office. Luckily, I had really supportive colleagues, many of whom were parents themselves.
It’s certainly not as easy as it seems, being a WAHM, because it feels like I’m working a double shift every day – my day shift is mothering and my night shift is my work (which of course is also occasionally interrupted by a restless toddler). But this arrangement grants me the freedom to take my kids out during weekdays and enjoy spending time and doing fun things with them. I’m not ready to go back to the office just yet!
By BMSG Editorial Team
If you have been on the BMSG’s private Facebook support group, you might have seen our advisory to members not to recommend formula feeding in their comments and replies to mothers who post on the group. Perhaps you’re wondering – what’s up with that stand, and why?
Typically, recommendations to give formula are quite common in threads which talk about a drop in milk supply or when mums are unable to match the amounts that their babies drink in a bottle.
The BMSG’s stand is that formula feeding should only be an option where medically indicated. This may mean that a mother has a medical condition that renders her too unwell to feed her baby, or that human milk donations are not readily available. There can also be situations where both the mother and baby are warded in the Intensive Care Unit (ICU) and are unable to establish a breastfeeding relationship.
Echoing the Stand of the WHO
The stand that we follow is in line with the World Health Organization’s hierarchy of infant feeding. A mother’s own milk is naturally the top priority, but it may surprise you that donor milk from another mother is the second best option, whether it has been expressed or if baby is nursed directly from another lactating woman. This may seem foreign to us urban dwellers in (almost) squeaky clean Singapore, but if we think about the lack of clean water and sanitation in some environments and situations, it is clear what is the obvious and, often, the life-saving choice.
The truth of the matter is that although we do have access to clean water, breastfeeding is something that we need to preserve especially when a breastfeeding mother seeks support. In our comfortable lives, it can be convenient for us to reach out for infant formula when breastfeeding challenges arise. However, there are a few reasons why providing formula may not be the best way to get over a breastfeeding challenge.
- Giving formula can make baby too full to latch on mummy’s breasts
When a new mother is just starting out with breastfeeding, the apparent low milk volume is often easily mistaken for milk insufficiency or “low milk supply”. Formula is often quickly given as a stop-gap measure, as parents are afraid of dehydration.
However, it is important for parents to be aware of how much (or how little!) milk is actually needed by babies at this stage. Newborn tummies are tiny and need very little milk – at best, the size of a newborn’s tummy at birth is about the size of a shooter marble (3-5ml). Furthermore, newborns drink colostrum, which appears in low volume but is incredibly rich in nutrients. We are so used to the media portrayal of a full bottle of formula that it makes us uneasy to think that an infant may only need a few millilitres of breast milk! It‘s time to recalibrate and understand that in nature, newborns drink less than what we might expect.
As a result, when a baby receives formula, often more is given than what the baby actually needs. Baby’s tummy can become distended, leading to baby feeling too full to nurse. We also know that newborns are sleepy beings so an uncomfortably full tummy may mean longer sleep before the next feed as baby’s body works to assimilate the harder-to-digest formula. This contributes to the cycle of the formula top-up trap where the mother constantly feels resigned that she just does not have enough milk.
This can also happen when water or even too much top-up of mother’s milk is bottle fed to baby. Excessive water can cause toxicity in baby.
- Mother’s Supply will be Affected
Naturally, when a mother chooses to supplement with formula, she needs to ensure that she is also removing milk from her breasts. Just like in economics, the demand (or milk drank) by the baby is the amount that is signalled to the body to produce – thus, the more baby drinks, the more the body produces.
However, when the breast is replaced by a bottle, mothers often miss out on pumping and may not remove the amount that baby would need. It becomes necessary for the mother to play catch up by taking more time to pump and remove the amount that has been drunk.
In the event that the mother does not return to latching her baby or is not able to express the amount of milk equivalent to that which baby drinks in the bottle, the mother is at risk of facing a dip in her supply. This will then sabotage her efforts to continue latching at the breasts because a drop in supply will make it hard for her baby to be satisfied at the breast. Inevitably, this is highly likely to lead to a premature end to breastfeeding when the mother is unable to catch up with expressing the amount of breastmilk that is required.
- There are risk of allergies with formula
It can be tempting to provide a baby with formula in times of desperation but it is a temporary solution to a problem that can be fixed. While it is natural, breastfeeding is a skill that takes time to learn. With the right support, most mothers should be able to breastfeed. In the event when a mother is unable to provide breastmilk for her baby for whatever reason, it has also become socially acceptable to provide an alternative in the form of human milk donations.
We don’t talk enough about this but there are babies in the world who cannot take formula milk. For a mother of a newborn, introducing formula milk for the first time can be a make-or-break moment. If the child has an undiscovered allergy to dairy or cow’s milk, there is always a possibility of an allergic reaction to the said formula milk.
A newborn baby has a stomach that is vulnerable to pathogens. It is a built-in mechanism that prevents a baby from having harmful germs enter its system. Breastmilk has the natural ability to protect the linings of baby’s intestines as it forms a layer that prevents the intestines from absorbing these harmful stuff. But when you introduce formula or other substitutes that are not appropriate for a baby, this protective layer is destroyed.
Babies then are at risk of developing digestive issues as well such as lactose intolerance, reflux and constipation, which can lead to discomfort in the baby.
- Economic sustainability of formula milk
It can be “helpful” for a stressed-out mother at first to use formula, but as the breastfeeding journey begins to end prematurely, the baby will then become dependent solely on formula milk.
We don’t know what the situation of the mother’s family is like when we suggest formula. Formula milk can be economically unsustainable for a family in the long run, should the family income be decreased. With a dried-up milk supply and a limited amount of powder left in the can, a mother may be forced to stretch out her baby’s feeding, or dilute her baby’s milk. In fact, this has happened and is already happening in Singapore, and even in more dire situations where the baby is very, very young. The baby will not be receiving enough nutrients to grow and develop properly.
We hope the explanation above has provided a clearer picture on the reasons why formula feeding is not always the one-size-fits-all solution for mothers who are still trying to overcome breastfeeding challenges. We, all of us as women, help the mother to help the baby – it is a community effort.
by Nabila Hanim, BMSG Staff
Last June, BMSG (Singapore) had the honour of recording a video conferencing session with the esteemed Dr Jack Newman, paediatrician and breastfeeding expert, who is also an International Board Certified Lactation Consultant (IBCLC). During the session, Dr Newman had responded to some pertinent questions about breastfeeding and jaundice. In this article, we summarise the interview for the benefit of our readers and followers.
Many of us would have recognised Dr Newman from our own readings and research on breastfeeding. His resource pages have been very popular and widely referenced. Dr Newman is also known for helping many mothers tackle breastfeeding challenges even in the early newborn days. His video on breast compression, among others, has been shared extensively in the breastfeeding community.
What is Jaundice?
Jaundice is usually detected a few days from the baby’s day of birth. Jaundice is typically diagnosed after a blood test is done on the baby to check bilirubin levels. Bilirubin, a by-product of the breakdown of red blood cells, are in abundance in babies while in the womb. Once baby has been birthed, baby’s body breaks down these excess red blood cells because they are no longer needed. Bilirubin is one of the products of this process.
Bilirubin is also an antioxidant and can help the body to manage Group B Strep, which can cause meningitis in baby. Dr Newman suggested that this is probably a huge clue as to why bilirubin may be present in many babies, particular in East Asian babies.
Bilirubin has a Function
Dr Newman spent a significant amount of time talking about how bilirubin levels may not necessarily be an indicator that something is wrong with the baby. He explained that since bilirubin is not normally produced by the body, there must be a reason why it exists in babies. He also compared the high levels of bilirubin in jaundiced babies to the Gilbert syndrome, a disease by which otherwise normal adults experience higher than usual levels of bilirubin as compared to other adults. It was found that persons with Gilbert syndrome will experience elevated bilirubin levels when they fall ill and are also protected from atherosclerosis.
Is Breastfeeding to Blame?
Dr Newman then shared about how the problem is not breastfeeding but rather dehydration. Dehydration in jaundiced babies increases the risk that bilirubin will cross the blood-brain barrier, which is dangerous for babies.
On the question of whether formula is necessary for babies who are jaundiced, Dr Newman stated that breastfeeding does not have to stop because of jaundice. Introducing formula will affect the breastfeeding relationship since baby will not nurse as much.
In fact, Dr Newman believes the issue of hydration can be solved when breastfeeding is successful. A lot of times, jaundiced newborns are not breastfeeding optimally and therefore not drinking enough to hydrate themselves.
Birth Interventions Also Contribute to Breastfeeding Problems
Parents may also notice that some of their babies may not be interested in breastfeeding or are always falling asleep at the breast. Dr Newman explained that mothers who receive interventions during labour, such as epidurals, IV fluids (which are compulsory with epidurals) or taking other pain-killers while labouring, risk having babies born being sluggish, inactive or sleepy. This makes it difficult for babies to learn to breastfeed right after being born and he urged parents to become empowered to reject such interventions because it can obstruct breastfeeding later on.
Citing his experience of witnessing mothers giving birth in African countries while he was still working there, Dr Newman observed that mothers rarely received interventions during labour. He found that the babies to these mothers remain alert at birth and subsequently had little issues to latch onto their mothers’ breasts. In contrast, mothers in modern settings who birthed at hospitals frequently face the challenging tasks of breastfeeding sleepy babies.
While a jaundiced baby has always been thought to become sleepy because of their condition, Dr Newman, on the contrary, attributed this to the lack of hydration or being over-hydrated from the fluids that mums take during labour. Over-hydrated babies may show less interest to breastfeed because their bodies do not need excess fluids. He also added that taking painkillers such as epidurals allows the medicine to pass over to the baby through breastmilk, resulting in sleepy babies.
He emphasised that parents need to be empowered to reject birth interventions and to know that these interventions “are not without consequences” and implications especially on breastfeeding. He also urged that all mothers should have the choice of not taking epidural and understand that birth interventions can impact breastfeeding drastically.
Dr Newman was also asked if there was a need for phototherapy in the treatment for jaundice or exposing jaundiced to sunlight. Dr Newman replied that it is strange that we encourage adults and children to put on sunblock but have no issue with putting a jaundiced baby for long hours, sometimes days, under phototherapy light. He also mentioned that there is evidence that exposure to phototherapy can also alter the cells in babies’ bodies, which are precursors to cancers. There are also studies that show babies can experience DNA damage after undergoing phototherapy.
While he acknowledged that phototherapy can be helpful when a baby is already hemolysing and to prevent exchange transfusions, it does not tackle the root of the matter which is the lack of hydration or the infrequency of breastfeeding. “Jaundiced babies need to breastfeed and drink well,” Dr Newman said. He mentioned that if breastfeeding was going well in the first place, there would be no need for phototherapy. If the mother and baby are already engaged in breastfeeding, having jaundiced babies undergo phototherapy also “disrupts the routines” of breastfeeding.
Mothers’ Diet & Impact on Jaundice Levels
Some mothers had also voiced their concerns about the impact of food on jaundice levels and if certain food can cause jaundice or allow its levels to worsen. Dr. Newman responded that as long as babies are healthy, thriving and gaining good weight, mothers can continue to breastfeed their babies. Instead, mothers should troubleshoot early breastfeeding issues and ensure that babies are drinking sufficiently. “We have to remember that as long as baby is well there is no need to be concerned,” he said, emphasising the importance of good breastfeeding to help baby cope with jaundice.
Closing Remarks: Bilirubin is Not the Real Problem
As the conversation rounded up, Dr. Newman once again questioned why bilirubin is a problem when it is so abundant and normal in many babies. He believes that there is a link between this and the fact that babies who are healthy and still experiencing jaundice (also known as breastmilk jaundice in otherwise healthy babies with no other medical complications) can still thrive and grow well despite clearly still being jaundiced. At the end of the day, he urged the audience to embrace the fact that jaundice levels will rise when breastfeeding is not going well, and that to fix that first and foremost.