Newsletter #43: Total Defence Day – Protecting Babies During Emergencies

By BMSG Editorial Committee

It is significant that we commemorated Total Defence last week on 15 Feb just as the nation is coming to terms with the recent outbreak of COVID-19 (previously also known as the coronavirus). While we grapple with the possible impact of the virus on our community, our resilience was tested as fearful members of the public took to stockpiling household supplies when Singapore raised its DORSCON level to Orange. Racks were swept clean, especially those that housed rice, instant noodles and toilet paper previously.

Sadly, formula milk also fell victim to the hoarding of the public. Some mothers on online forums were lamenting that they were worried about the shortage of formula milk stocks. While the government eventually swooped in to assure Singaporeans of our supplies, the incident is a strong reminder that young babies and infants remain vulnerable in the event of an emergency, whether real or perceived.

As a charity committed to upholding the rights and welfare of young children to be fed and taken care of in times of crises, we line out several measures in this article that parents can take to ensure sufficient feeding of their infants in the event of a national crisis.

Singaporeans took to panic buying when Singapore raised its precaution levels. [Credits: @ikansumbat / Twitter]

Emergency Preparedness
While a disaster or nation-wide crisis may appear unlikely to happen in Singapore, the tagline “Not if but when” on our national security campaigns clearly reminds us that threats such as terrorist attacks and other unexpected dangers are always lurking. The current COVID-19 situation here was something none of us would have expected just a few months ago. Its impact on our economy and safety is unprecedented.

In such situations, especially because threats are unpredictable, it is all the more important that we equip ourselves with knowledge on what infants and/0r young children would need in the event of an emergency.

Australian Bushfires: Lessons Learnt for Feeding Children in Emergencies
The recent Australian bush fires endangered many civilians and affected infrastructure across the country; an annual affair especially with scorching summer heat they were particularly bad this bushfire season. While cyclones, floods and bushfires are common occurrences for the continent, a recent research study by Australian academic Dr Karleen Gribble last year discovered that one-quarter of families who evacuated during the 2011 Queensland flooding and Cyclone Yasi were unable to pack adequate supplies for infant feeding despite the fact that such natural disasters have been happening in Australia almost every year for decades.

It was also found that guidelines for emergency packing were more detailed for adults and pets, as compared to very young children.

Families may not be sufficiently equipped to provide enough supplies for babies in an emergency, which was what academic Kate Gribbles discovered in her study. [Stock photo]

Current Situation in Singapore
While such emergency situations may sound extreme for a country such as Singapore not known for emergencies or natural disasters, BMSG (Singapore) recommends parents, caregivers and agencies remain up to date on the requirements for emergency kits for infant babies, whether breastfed or formula-fed. We also cannot afford to be complacent and expect that supplies will be readily available in the event of an emergency.

Currently, the Singapore Civil Defence Force (SCDF) recommends that citizens prepare a Ready Bag (P43) as written in its Emergency Handbook. The Ready Bag should be pre-packed with items that individuals require, preferably one bag per family member including infants and young children.

The SCDF also writes in its handbook (P44) that there should be food rations enough for two weeks of non-access to food and water for each individual in the household. For infants, it is recommended that one to two tins of formula milk be stocked up for emergencies depending on the age of the baby.

Screenshot of P44 of the SCDF Emergency Emergency Handbook. [Credits: SCDF]

Suggestions for Changes
Unfortunately, current recommendations do not fully detail what are the exact needs for young babies and children.

  • First and foremost the current guidelines assume that babies are formula fed, and the public is encouraged to keep tins of formula. There is a possibility that families who are not formula-feeding may mistakenly feel that formula milk is prefered to breastmilk in emergency situations for some reason. We would like to see guidelines updated to include breastfeeding, expressed breastmilk feeding and mixed feeding. It should be made clear that mothers who are breastfeeding should continue to do so, in fact they should consider taking steps to relactate if they have recently stopped breastfeeding as dried formula milk can only be fed with access to clean potable water which may be limited or even unavailable.

    In fact, it is precisely this that poses danger to vulnerable infants where the threat of contaminated water, unsanitized preparation areas and the lack of hot water make safe formula preparation problematic. In Gribble’s recommendation of guidelines for baby food and milk in times of disasters, she recommended that 15 L of water be set aside for washing of hands and milk preparation areas alone. She also mentions other specifics that would be mandatory for sanitised preparation of formula milk that is safe to drink.

  • Secondly, in the event that parents are not able to secure tins of formula milk to be stocked up, there seems to be no alternatives in place for infants that rely on formula milk. There would also be the likelihood of inflated costs of supplies, including formula milk, in the event that demand is excessive – families with a lower income would be particularly vulnerable. How then do we ensure that all children are able to receive adequate nutrition and hydration during times of crisis, regardless of how they are fed?

  • Thirdly, human milk sharing should be considered in the updated guidelines, i.e. cross-nursing and/or feeding donated expressed breast milk. This is arguably one of the best ways to sustain young infants in emergencies as breastmilk can be transferred without a receptacle in the case of direct latching, or hand expressed into a sterile container and fed to babies straight away.

    While storing expressed breast milk may be challenging when there is limited electricity, the supply of breast milk to vulnerable infants could be maximised by encouraging breastfeeding mothers in disaster areas to come together to help breastfeed or hand express breast milk for other babies. You can read more about similar efforts that have been practiced by the breastfeeding support groups in the Philippines in our interview with a veteran Filipina breastfeeding advocate, Ines Fernandez, last year. Such an example sets precedence for situations we can never imagine.

AP Gribble’s Guidelines for Baby’s Sustenance in Emergencies

Taking a closer look at AP Gribble’s recommendation, we can take stock of how specific these guidelines are. Note that these are supplies meant for three days without any access to clean food, potable water and electricity. It is assumed that after three days, the family would be evacuated or rescued.

Breastfed Babies

Expressed-Milk Fed Babies

Formula Fed Babies

• 10 L water for mother to drink

•36 nappies

•100 nappy wipes

** Gribble and Berry also recommended that mothers learn the national breastfeeding hotline.
** BMGS (Singapore)’s hotline is +65 6339 3558

• 10 L water for mother to drink

•10 – 20 L of water for hand washing

•30 cups/bottles for expressing and feeding

•Detergent to wash receptacles

•100 nappy wipes

** Keep in mind milk storage guidelines e.g. milk can be stored at room temperature for 3 hours in Singapore’s climate and to do a taste test before every feed.

** Feeding cups must only be used once.

• 1 unopened tin of baby formula

•27 feeding bottles and teats

•14 bottles of still water for reconstitution

•15 L of water for washing of hands and preparation areas

•Detergent for washing of hands and preparation areas

•100 sheets of paper towels for drying wet hands and preparation area

•Large storage container with sealing lids for storage; lid can be used as preparation area

•36 nappies and 100 wipes

 

[Image credits to: Dr Karleen Gribble & Dr Nina J Perry]

Extra Precautions for Formula-Fed Babies

Referring to the table above, you will find that for formula fed babies, preparations are a little more extensive. Additional guidelines include:

  • Each storage bottle must be sterilised and fully dried before being put in a ziplock bag and then stored
  • Washing hands and drying them are important when preparing infant formula
  • Use small bottles of water for reconstitution
  • Always use the correct amount of infant formula. It is not advised to dilute formula to extend its shelf life, especially for babies younger than 6 months old
  • Prepared formula should be fed to baby straight away
  • It is not recommended to keep unfinished formula for feeding later on as it can be a breeding ground for bacteria. In emergency situations, tummy issues would be something unwelcome and challenging to manage, not to mention dangerous, for young children.

Babies Over 6 Months

Babies over 6 months who have started on solids would need sufficient packaged baby food, disposable spoons (unless there is sufficient potable water) and drinking water prepared for emergencies. This is on top of the amount of milk the baby needs as per the guidelines above.

It is also worth noting that babies over 1 year old need not consume any form of formula milk. You can stick to clean plain water for baby’s hydration. 

In times of crises and natural disasters, children remain one of the most vulnerable groups of people who will need extra care. [Stock Photo]

Conclusion

As the number of breastfeeding mothers and babies is growing significantly and in view of the times that we are in, there is a need to unlearn and relearn new ways to support the breastfeeding mother and baby in emergency situations.

Just last year alone, BMSG (Singapore), the sole charity for breastfeeding support, provided counselling to nearly 7000 individuals, including mothers, spouses and family members. This shows that there is a significant number of families who comprise of a breastfeeding baby or child. Their needs remain paramount just like other babies and children.

The recent panic-buying episode also shows how especially vulnerable non-breastfed infants are in times of public anxiety, where there were anecdotes of parents unable to purchase their babies’ formula milk powder in supermarkets due to hoarding. 

We sincerely hope that our suggestions and recommendations will be useful for agencies and families alike who can help citizens and residents of Singapore be better prepared for any forms of emergencies, expected or otherwise.


If you need breastfeeding support, contact our breastfeeding counsellors at no charge on the following platforms:

Newsletter #42: Preparing to Breastfeed Before You Meet Your Baby

by BMSG Editorial Team

With greater awareness of the importance and benefits of breastfeeding, many expecting mothers want to prepare themselves for this momentous journey. But how can you actually get ready to breastfeed when you haven’t even met your infant yet?

 

Information is Power

Pregnancy often makes mamas attracted to peaceful, calm photographs of mothers breastfeeding their infants. It looks like the easiest, most wonderful thing in the world – and, of course, it can be.

However, the truth can be very different for many mothers after delivery, when your body feels as though it has been torn into two and you are battling with blood loss, pain, fatigue and hormones. Breastfeeding may look natural but it is in fact a learned skill that takes time and effort to figure out.

Yes, the truth is that many mothers may face difficulties breastfeeding in the beginning. These issues could range from flat nipples, sleepy jaundiced babies, tongue ties, extra-large breasts or nipples, or even just trying to figure out the best way to hold your floppy newborn.

Breastfeeding can be hard work but with some support and mental preparation, it can be a satisfying journey. [Credits: Lisa Matthews]

 

On the bright side, most of these problems are common ones with established solutions, and being empowered with information before you give birth can be the best way to prepare. If you know beforehand the kind of issues that many mums face, you will be less thrown off if it happens to you, and you and your partner will know that there are solutions you can employ to help make your journey a little easier.

Some ways which you can prepare yourself:

  1. Speak to mummy friends who have breastfed their children and ask them to share with you honestly what their pitfalls and problems were, and how they addressed them
  2. Join the Breastfeeding Mothers’ Support Group Facebook group and read posts as they pop up on your feed. This is an easy way for you to get a quick handle on the common issues that many mamas face
  3. Attend prenatal classes (including BMSG’s Breastfeeding 101 workshops) to find out more about the journey ahead of you and how you can make it easier for yourself and your baby

 

Knowing where to find support, including seeking comfort in other mothers, can be helpful if you are overwhelmed or just need reassurance. [Credits: Lisa Matthews]

Form Your Support Team

Although much is made about the breastfeeding mother, the reality is that we create breastfeeding families. A mother is never alone in her journey and the best way to make sure you can succeed is to ensure you have everyone on the same page.

First and foremost, it is crucial that you have your spouse on your side. It is a wonderful way to bond and prepare for baby’s arrival by attending prenatal breastfeeding classes together and understand how important the role of each parent is. 

Fathers must also buy in to breastfeeding, fully understand and support the decision to breastfeed. After giving birth, mothers are often disoriented, in pain, and may find it difficult to advocate for themselves. This is where Dad needs to step in and step up to support Mom. Be the guardian and a wall to block off unhelpful advice and unnecessary comments that may come from people who have good intentions but do not know better.

Daddies, don’t undermine your presence – mummies need you more than ever especially in the challenging early days of breastfeeding. [Stock Photo]

 

Choose Postnatal Support That Suits You

As mentioned before, being prepared is the best plan of attack. It would be useful to have the contacts of some good International Board Certified Lactation Consultants (IBCLC) whom you can speak to if you have any problems.

Many newly-delivered mothers in Singapore also hire confinement nannies to help out in the first month or more. Very often, mums hire these nannies based on word of mouth and friends’ recommendations.

However, it is really important to note that different mothers have different needs and requirements. A nanny who worked out well for your friend may not be as helpful for you if your needs are different. Therefore, if you intend to breastfeed your infant, look specifically for a confinement nanny who is fully supportive of breastfeeding and who can help you succeed. She should be up-to-date with breastfeeding knowledge and be willing to assist you as needed.

For example, while many confinement nannies try to make themselves useful by offering to take the baby at night so that you can “rest”, remember that night feeds are crucial to establish and maintain your milk supply and avoid engorgement, blocked ducts and mastitis. A breastfeeding-supportive confinement nanny can help by changing baby’s diaper at night and then passing baby to you for a feed. 

Confinement nannies and any other family member who is helping the breastfeeding mum should support the mother without imposing on her wishes. They can focus on helping mum on other mundane tasks such as changing baby’s diaper, cooking meals for her or doing other household chores to keep mum comfortable. [Stock photo]

Ditch the Pump

Many mothers are told to bring the pump to the hospital and to start pumping diligently from the beginning. Wanting to ensure they have sufficient milk supply, mums bring out their expensive dual electric pumps and go at it in the hospital room – only to be devastated and panic when they find they are getting nothing.

 In the first few days, your breasts make colostrum, a thick, rich, sticky liquid that is highly concentrated, full of protein and nutrient-dense. It’s the perfect food for your newborn and helps to fight infection, supports baby’s immune system and gut, and flushes out bilirubin through baby’s poop. Did you know that colostrum is similar to amniotic fluid? It’s the best bridge between the fluid baby has been swallowing in the womb, and the mature breast milk which he will eventually drink.

The keyword in all that information up there is “sticky”. Because colostrum is so thick and sticky, it is hard for a pump to extract it efficiently from your breast. Because your newborn baby has a tiny little belly, your breasts do not need to make a lot of it to fill baby’s tummy. Because of both these things, when a new mother tries to pump, most of the colostrum will stick to the flanges or on the sides of a bottle – wasting all that precious goodness.

Credits: Morgan Temple, IBCLC

 

 New mums expect to see a bottle full of milk when they express milk; it is what we are naturally conditioned to see. So when we look at a handful of viscous droplets sprayed all over the flange and barely covering the base of the bottle, we panic.

What is the solution? Ditch the pump and hand express instead. Massage your breasts gently in circular motions to loosen the sticky colostrum from your milk ducts. Learn how to hand express effectively and gather the droplets in a 3-5ml syringe rather than in a bottle. The colostrum can be chilled and fed to baby, which can be especially useful just in case baby has jaundice or other unexpected medical issues which may result in prolonged separation from mum. A very helpful resource to watch and learn hand expressing from is this video by the Stanford School of Medicine, which explains and demonstrates via real mothers how hand expression can be especially helpful for new mums and newborns. 

The pump is not a need as long as your baby is with you right from birth and breastfeeding well. When your milk supply is well-established, pumping may cause an oversupply. Use it wisely and only when necessary. [Stock Photo]

 

You Are Not Alone

Last but not least, remember that millions of women around the world have been where you are and come through on the other side. You are not alone, even though the nights can feel lonely. When your baby arrives earthside, cuddle that soft, sweet little infant (even when she’s bawling and angry and red in the face) and know that you have made a strong, wonderful choice to breastfeed. Hang in there Mama! We are rooting for you.

Credits: Illustration by Paula Kuka from Common Wild

 


Looking for resources for your partner? Read the following articles written by the BMSG to help dads learn how they can better support the breastfeeding mum: Role of Dads in Breastfeeding Families Part 1 and Part 2.

If you need help with breastfeeding, reach out to our BMSG volunteer counsellors by calling or sending a WhatsApp message to +65 339 3558 between 9am and 9pm daily.