Newsletter #45: How Has Covid-19 Affected Mothers?

By BMSG Editorial Team

The presence of Covid-19 in our lives has been hugely unexpected. For mothers, it brings about multiple reasons to cause anxiety and worry. Over the past months, we have read many stories in the news about how mothers have been affected by Covid-19. From mothers who could not send their milk home to their babies living overseas back home, to new mothers who face isolation and lack of family support with a newborn in hand – the challenges seem endless.

The fear is real and the struggle is even more. We highlight other struggles that mothers have faced based on a survey that we conducted in early 2020 as well as from our interactions with mothers who have reached out to us via our social media platforms.

Fear of Being Separated from Baby if Mum Gets Infected

From the very beginning, what is probably on every mother’s mind is what happens when she or her baby gets infected with the virus. For some mothers, the worry of being separated especially when baby is breastfeeding is a terrifying thought. Applie Wan, a mother of two, had a wake-up call when a member of her family had become infected early this year. The breastfeeding counsellor, who has a young baby and toddler, was concerned about having enough breastmilk for her baby in the event that she has to be warded or isolated from the family. 

“There is a constant worry about whether I will be separated from my three-month-old baby if ever I was to contract the virus, and whether I am still able to breastfeed her because of that,” said Applie. She also started to pump extra breastmilk if she had to be separated from her child suddenly. “I’m also motivated to have a bit of oversupply to provide my toddler with breastmilk, too, to try and boost her immunity,” she added.

It is understood that one parent is able to accompany a child who gets infected with the virus. However, not much information is available on the arrangement when a breastfeeding mum is the one who catches the virus. According to KK Women’s and Children’s Hospital, in a letter responding to BMSG’s queries on the matter above, each hospital adopts individual protocols to suit the needs of patients best. It is still not clear if a lactating mother is allowed to have her nursing baby with her if she is to be under isolation or warded at the hospital, especially since no visitors are allowed to see patients who contract the illness.

Challenges for Mums who want Urgent Lactation Care

For some mothers, receiving urgent lactation services from lactation consultants has proven to be challenging. 

Two mothers whom we interviewed had faced difficulties in trying to receive care for mastitis. One mother, Marissa Lee (not her real name) who developed mastitis when her two week-old son had been warded at a hospital for high fever, was turned down from the same hospital when she presented herself at the A&E department.

“It was disappointing to be turned away when I was already having a high fever and pain in my breast. Because I was not a mother who had given birth at that hospital, I was not able to receive emergency lactation care right away. I was, in fact, redirected to a nearby hospital, which did not have any lactation service,” she said.

After being discharged when her fever subsided, Marissa decided to go to another hospital when her fever returned on the same day. Thankfully, it offered her outpatient lactation service through a lactation consultant and helped her resolve her mastitis. Unfortunately, due to having a long separation from her son and coupled with the complications of mastitis, the mother eventually had to resort to exclusively pumping as her baby had developed a preference for bottle feeding. She has not had her issue completely resolved and has had to depend on breastfeeding support groups and advice from fellow mums to resolve her recurring milk duct. “It has been such a long and emotional rollercoaster ride,” she said.

For another mother Shena Ng (not her real name), Circuit Breaker (CB) measures had made it impossible for her to reach lactation consultants and a paediatric dentist when she sensed something was amiss with her newborn’s latch. As CB measures were already put into place by then, she was disappointed to discover that lactation consultants were no longer allowed to conduct home visits. “I desperately wanted to seek expert advice regarding my daughter’s latching. Breastfeeding has been painful and unbearable,” she said. 

While Shena attempted to return to the hospital she birthed at to set an appointment with a lactation consultant, she was gently turned away as they had discovered that her baby was taking the bottle, possibly due to hospitals wanting to prevent seemingly unnecessary visits. “The lactation consultant had been really helpful and contacting me via phone calls. She said the hospital has been very strict about setting appointments for lactation care. I’m still trying to latch my baby on and off, but I really want to see a paediatric dentist or anyone who can tell me what is going on with my baby,” she said.

A Challenging Time to Give Birth

In the same survey, four pregnant mothers shared their concerns about precautions in the hospital, particularly in the delivery suites.

With limitations on visitors at the hospitals, pregnant mothers are anxious to know if their partners will be allowed to enter the delivery suite during labour. Wen Xiu, a pregnant mother of two, shared her real worries: “I am most worried that my husband will not be allowed in the delivery suite.”

According to Shaheeraa Khan, a doula and EXCO member of Doulas of Singapore, such anxieties are valid. “Having a support person to be there with the laboring mother is essential for her needs. Thankfully, all hospitals in Singapore do allow husbands or an immediate family member  into the delivery suite,” said Shaheera. All accompanying partners or family members must also not have been issued a SHN or be under quarantine orders. They must also comply with safety measures imposed by the hospital.

Unfortunately, for mothers who desire to have a doula with them during labour, doula services have been suspended across all hospitals except for Thomson Medical Centre.  

This has not dampened the spirit of doulas and clients alike; many doulas continue to provide prenatal support virtually or on mobile to parents. “Doulas can still be part of your birth team. Prenatally,  the doula will work with both parents to prepare them for their birth; go through comfort measures, types of pain relief and address any other concerns which the parents may have to guide them to have (a) positive birth.”  

According to Shaheera, from the 37th week onwards (although this may vary from doula to doula), the doula will still be on standby remotely to answer any questions which the parents may have.  During labor, she will support the labouring mother closely via phone. “We will help in answering any questions the couple has, encourage the mother and advising the father on what to do and ensuring that everything is going well while not physically being there. She will guide the father on what to say or what not to say and how to offer comfort measures. She is also there to offer encouragement,  advice and really holding the space virtually to encourage the mother to have a pleasant birthing experience,” said Shaheeraa.

Babies Not Allowed in Other Hospital Wards

For mothers who are hospitalised for other medical reasons, such as an illness, having baby be with mother has proven to be impossible. We spoke to Emma Bell, who recently gave birth to her second baby, on her harrowing experience when she had to be hospitalised for post-birth complications. Emma had to be hospitalised when she developed a fever due to a womb infection. As she was a breastfeeding mother, she expected to be able to have baby with her at the hospital so that she could latch baby on demand.

She was warded at two hospitals, the first being just before CB was implemented. “They allowed baby in during visiting hours (at the first hospital) but not at night, so I pumped at night,” said Emma, whose husband brought baby to the hospital daily so that she could nurse her.

However, when she decided to transfer to another hospital, CB had just been implemented on the same day. Unlike at the first hospital, this time, baby could not join her at all. “They did not allow (my) baby in at all. My husband brought her in the first day but the nurses insisted that she leave and couldn’t come back so I didn’t see her again until I was home. I pumped the whole time I was there,” said Emma, who decided to go home after six days at the hospital so that she can rejoin her baby.

For a new mother, being totally separated from baby is extremely distressing. While Emma is now back home with her baby, she has not fully recovered and is facing the struggles of managing a newborn while trying to recuperate.

Extended Confinement

The confinement period can also be taxing on mothers during this CB period. An earlier article by TODAY Online interviewed many new mothers who had to struggle and make do with a lack of family support especially for those whose parents or family were not living in the same household.

For another mother we interviewed, the start of the CB coincided with the end of her confinement period. Having looked forward to being able to leave the house to get some fresh air and spend time with her husband and baby outdoors, she has had to deal with isolation and negative emotions of being confined at home instead.

“I took awhile to decide to visit the psychological services available at the hospital I gave birth at. I managed to book my initial appointment and had been looking to see a psychologist for some issues that I am currently facing,” she said. However, with the new CB measures in place, such services have not been able to be carried out and she has had to halt her visits. 

No Access to Other Services: Antenatal Classes, Masseuse, Confinement Nannies & Alternative Therapies

Mothers also reported that many things that they had planned for their pregnancy and postpartum during their pregnancies were now out of the question. 

One mother who had been looking forward to antenatal classes at the hospital she is due to give birth at has been sorely disappointed that these classes have been cancelled. A few mothers also lamented that postpartum masseuse services were regrettably unavailable since home visits are not allowed. As reported earlier this month, confinement nannies were also difficult to obtain as a lot of them hail from Malaysia; with the extended lockdown in Malaysia, and subsequently Singapore, mothers have had no choice but to grin and bear it during confinement.

Some mothers also mentioned their disappointment at the closure of alternative medicine and therapies such as osteopathy and chiropractic clinics.  

Seek Whatever Support is Available

With the extension of another month of CB, things may look bleak for mothers. However, we would like to offer some tips that can help you achieve some self-care and to constantly remain connected to services that would be of benefit to you:

  1. Take advantage of virtual support – consultations, support groups, helplines

    It may be easy to slip into an abyss of helplessness, but looking out for online platforms to connect with professionals and other mothers are imperative for your mental health at this point.

    Here are a list of helplines and online consults that may be useful for mothers:
  • General Support Hotlines:
    • National Care Hotline (24 hour) – 6202-6868 – emotional support for anyone who is in need
    • Samaritans of Singapore (SOS) – 1800-221 4444 / Email befriending:
    • HEAR4U (set up by CARE Singapore for Singaporeans to have a space to seek advice and express their concerns arising from the current COVID-19 situation) – WhatsApp 6978 2728
  1. Know that CB is temporary; you are doing your part by staying at home
    • Speak to your partner or trusted family member about your struggles
    • Have regular virtual meetups with other friends, mummy confidantes, and family members to find solidarity and support
    • Avoid being alone for long periods of time; seek human connection at least once a day
  2. Prioritise your health and well-being
    • Have complete meals and eat nourishing foods
    • Stay away from self-destructive thoughts – focus on positive affirmations (e.g. I am a good mother, I am enough, I can do this no matter how long it takes)
    • Find a hobby or do something that you like for at least an hour every day

We know that with pregnancy or with a baby in tow can be isolating and frustrating, but taking stock of your feelings and taking the proper steps to remain calm and in control can help you manage these challenging times.

If you need help, seek them early and inform your spouse or family members.

We are all in this together! We support you mummies, and we have your backs!

Newsletter #45: Mother’s Sharing – Bringing Baby to Work

As told to Nabila Hanim, BMSG Staff

For some breastfeeding mothers, flexible work arrangements allow them to still be able to be with their babies while they go to work. Nurul Huda Khamsani, a religious teacher who works and manages a religious education centre, has been bringing her two children to work since their infancy. Currently still nursing her second child, Nurul Huda shares with us why she continues to bring her children to work and what keeps her motivated to breastfeed despite the struggles of teaching while breastfeeding.

[Do note that this interview was conducted in February before the Circuit Breaker was implemented. All learning centres have been closed and many religious teachers like Nurul Huda now teach from home online.]

Hi! Tell us more about yourself!

A: My name is Nurul Huda Binti Khamsani. I’m 32 years old and I’m married with two beautiful children. I teach Quranic Literacy at a Qur’anic training centre that I also manage as it is a family business. I tutor some children at home on some days during the week, too. 

How long have you been breastfeeding?

Breastfeeding is a very crucial and special part of my life. I had breastfed my firstborn Fursan for 26 months since November 2016. He was in the Neonatal Intensive Care Unit (NICU) for three weeks, having been born premature at 32 weeks. 

The first week after giving birth, I couldn’t get him to latch on. Finally, after getting tips from a lactation counsellor, I was elated when Fursan took his first sips of direct breastmilk. All the while my husband (a.k.a. my number one supporter) had been delivering my expressed breast milk to NUH everyday without fail as I was recovering from a caesarean section. 

Fursan was a hungry baby indeed, and I almost gave up because my expressed breast milk was barely enough for him. I tried my best to fully breastfeed him, and after a while, I got the hang of it. This was in part because I constantly asked and sought support from other breastfeeding mothers and counselors. 

I’m now nursing my second child with more confidence, but if ever in doubt I usually seek advice from a breastfeeding counsellor friend, Khatim. I am truly grateful for all her help in my breastfeeding journey.

My children also have a milk sibling (also known as anak susuan in Malay), Izzi, who is my nephew. I would express my milk and send it over to my sister-in-law’s home every week. 

Nurul Huda (centre) with her family members. The 3 children include 2 of her own and her nephew, whom she is a wetnurse to. [Credits: Nurul Huda binti Khamsani]

We hear that you bring your baby to work! What is your work arrangement like? Do you bring your baby along with you all the time?

I work five days a week; three days at the centre and two at home. I bring my second child (nursing) to my centre as I prefer to latch her directly. I consider myself lucky to have such understanding students who do not mind me teaching and breastfeeding at the same time. 

It is definitely not easy to be bringing children to work, especially with an infant in tow. This is a challenge whether I am at the centre or at home. Nonetheless, my father, Khamsani Karim – also the founding director of the training centre that I work at – is a staunch advocate of providing a child-friendly working environment for his staff. 

We are taking steps to making our centre even more child-friendly for students and staff, which include our main administrator and one of our full-time teachers – both breastfeeding mums. 

While we are not able to provide a specific nursing room due to space constraints, we do allow our staff who are mums to make themselves comfortable while at work and especially if they bring their babies. 

We provide three foldable baby rockers, a foldable changing station, a breastfeeding pillow, a refrigerator and a water dispenser. Not only are staff allowed to bring their young babies, we also allow our students who come to study at our centre to bring their babies. All mums are definitely allowed to nurse their babies when they need to. They simply bring their own nursing covers or breastfeed under their hijab (headscarf). Staff and students are allowed to breastfeed their babies anytime they like.

What are your breastfeeding goals? How long do you foresee yourself breastfeeding and having an arrangement like this?

Breastfeeding is encouraged in Islam, and as a Muslim I naturally incline towards my religion’s teachings. Additionally, I wish to develop a closer bond with my nursing child and strengthen her immune system at the same time. I hope to breastfeed my daughter for two years, if God wills.

I have been bringing my first child to work since he was an infant till he turned two; this is something I also foresee doing with my second child. 

There must be challenges that you face in this work arrangement. Tell us more about what these challenges are and how you cope with them.

Baby feeding positioning, fatigue, time management – where do I start?  I’ll latch my daughter for about half an hour before I go to work so she can get a good 1 to 2-hour nap while I commute and then teach. I have to use my breaks wisely so that I can do my obligatory prayers, eat, breastfeed and tend to my older child in between lessons.

With the current Circuit Breaker in place, Nurul Huda still conducts lessons at home but via video conference. She is still able to teach while nursing under a cover. [Credits: Nurul Huda binti Khamsani]

As I have mentioned before, I also teach at home on some days. Whether it is at the centre or at home, breastfeeding while teaching is a huge challenge at both places. However, despite the struggles, I believe in bringing my babies to work because I want them to grow up in a positive environment. Where I work, we are surrounded by the Qur’an everyday and there is plenty of role-modelling in such an environment towards good habits such as studying the Qur’an and being tolerant of young babies and children. 

It is tough now but I strongly believe that this is good for their future as it moulds their character. 

From your experience, what would be the best advice you can give mothers out there who are struggling to breastfeed their child while working?

Don’t give up. Keep on learning. Seek support and don’t be shy to ask questions. If you have a religion, pray to God to ease your journey. Enjoy and treasure your breastfeeding journey even though there are so many challenges, because you will miss it dearly once it’s done.

I have felt very demoralised before by the fatigue of having to latch my daughter during one of my trying moments. However, I remind myself that these years are very short and that I am contributing so much to her immune system. The miraculous thing is that my children both rarely fall sick – if they do, I know I can always take childcare leave but this has been rare so far. It has affirmed my decision that what I am doing right now is for my children’s best.

Don’t give up. Keep on learning. Seek support and don’t be shy to ask questions. If you have a religion, pray to God to ease your journey. Enjoy and treasure your breastfeeding journey even though there are so many challenges, because you will miss it dearly once it’s done.

Ustazah Nurul Huda

Any memorable experiences with your babies?

To be honest, I have had several serendipitous moments especially during trying times. As you would know, I teach the Quran and interact with it many times while I work. There was once where I felt really tired and helpless as I was endlessly direct-latching my firstborn. It was also during Ramadhan, one of the holiest Islamic months, and I was very eager to do as many good deeds during that month. However, many times he would start to cry just as I was about to start reciting the Qur’an. I was a little disappointed at that moment.

However, during one of these moments, I chanced upon a verse from the Quran on breastfeeding: “Breastfeed your child till the age of two” (2:233). While it is not an injunction or an obligation, that moment moved me very much because I felt as if God was talking to me and comforting me in the midst of my struggles. 

A similar incident happened again another time when my student was reciting. Such moments have been comforting and humbling, and I would remember them every time I felt tired from feeding my child. 

With the arrival of Ramadhan, we know that many mums are anxious or have questions about breastfeeding during this holy month. We answer some of your questions here. Do share it with a Muslim friend or a mother you know who may need it. We wish all Muslim mothers a blessed Ramadhan!