Newsletter #32: Never Say Never – Story of an EP Mum

As told to Nabila Hanim (BMSG Editorial Team Member)
Photos courtesy of Andrea Salleh

Being an exclusive pumping mum does not stop Andrea Salleh, a mother of two, from doing what she needs to do.

No baby but a breast pump underneath that cover! Andrea calmly pumps while on the move as it has become second nature to her.

If you ever bump into Andrea Salleh along the streets, you might spot her with a big bag and a huge nursing cover. Don’t be fooled; underneath the pretty cloth is her double breast pump strapped to her chest.

The mother of two children, a two-year old girl and seven month-old boy, is no stranger to pumping on-the-go, even while on public transport. “I have pumped in the MRT, the bus and even in taxis and Grab Cars,” quipped Andrea, an art educator and also a passionate face painter.

Being invited to parties and booths form part of the demands of her job. Andrea, who has to be mobile for work due to the nature of her job, does not allow her work demands to stop her from providing breast milk for her children. As she is contracted by the hour, and sometimes has long queues at the booth, pumping while working is not a choice but a need!


Pumping while at work. Pumping doesn’t stop Andrea from doing what she loves!

Andrea, who is still breastfeeding her seven-month-old second-born, had managed to breastfeed her first child up till one year old. She attributed her success at exclusively pumping (EP) to a friend, who was the first to suggest that she learn to pump on-the-go. “I was initially using a single manual pump and pumping was such a chore. But once my friend taught me how to pump while on the move, I was hooked and loved the experience so much,” said Andrea, who also pumps regularly even when bringing her children out.

Having trouble latching her firstborn after her birth and coupled with oversupply, Andrea turned to pumping with the encouragement of her husband. With inverted nipples and her baby’s shallow latch, Andrea felt a lot of pain when she tried to breastfeed her child. Feeling dejected after bouts of mastitis that plagued her weekly during her early postpartum days, Andrea came to terms with having to pump although she initially struggled having to keep up with frequent pumping at regular intervals.

For now, pumping has become so natural to her that she can even pour her bottle of expressed milk into a milk storage bag right after pumping under her nursing cover in a moving vehicle! She also makes things easy by putting everything she needs into a large cooler bag that contains several compartments. The bag can even fit her pump, although she admits the bag is heavy for her.

A screen-grab from Andrea’s social media page shows her pumping in a bus.

Andrea also tries to maximise her time when she is out for work assignments. Although pumping while working is a given, Andrea also makes it a point to pump on the way back home. “This saves me a lot of time. Since I have been away from my family, especially the children, for a number of hours, I don’t want to waste more time pumping as soon as I reach home,” she added. With this time saved, she is able to attend to her children’s needs right away when she reaches home.

Andrea admits that exclusively pumping while taking care of one baby was still manageable as she had the help of family members to take care of her child as she pumps. However, pumping with two children in tow is another challenge altogether. She tries not to stress herself when her pumping schedule gets delayed due to her kids’ cries for attention. “If my toddler is having a tantrum, I calm her down first (before proceeding to pump),” Andrea said. She also invested in a front and back double pram so that she is able to put both her children down to pump when they are out.

Nothing stops Andrea from pumping when she needs to. In the middle of having supper with her husband and their friends, Andrea took a moment to pump milk for her baby.

“Managing expectations was probably one of the most important things I learnt as an EP mum,” said Andrea, who succeeded to provide her daughter breast milk up till one year old. Although she had to supplement her daughter with donated breast milk when she was seven months old due to a stressful period of her life that dwindled her supply, Andrea feels satisfied over the long battle she has gone through. Andrea has also started to mix feed her second-born after making an informed decision not to accept donated milk. As her first child has already had three wet nurses*, she feels that keeping in touch with them is already challenging.

Having religiously kept to a strict pumping schedule of two hours for the first five months of his life and maintaining a good milk supply, she found her supply drying up when she could not keep up with his demand. “I started pumping every four hours instead and sometimes dragged my pump (session) because I was occupied,” said Andrea.

However, Andrea is determined to continue providing whatever amount she can for her son. “Embrace your choices and make an informed decision. Do not ever compare yourself to another mother. Just do your best and take things a step at a time,” she declared with well-deserved pride.

Embrace your choices and make an informed decision. Do not ever compare yourself to another mother. Just do your best and take things a step at a time.

– Andrea Kauthar

*Wet Nursing in Islam

In Islam, wet nursing and/or milk-sharing are seen as a noble act, and comes with its own stipulations and guidelines. When a nursling receives five full feeds from a different mother, a consanguine relationship is established between the two. This nursling will also be considered as a milk sibling to the other lady’s own biological children, and as such are not permitted to marry one another. Hence, the implications of this is that Muslim families who practice wet nursing and/or milk-sharing are encouraged to have each other’s details and to keep in close contact to one another so as to ensure that the relationship is rendered as common knowledge. You can read more here (section under Wet Nursing & Adoption).


Sept 2018 Newsletter: Breast pumps – A Useful Tool, Not a Silver Bullet

By BMSG Editorial Team

When Susan Chen gave birth to her firstborn, she did not expect to face any trouble with breastfeeding. Having read up a lot on breastfeeding during her pregnancy, Susan was surprised when she struggled to latch her baby. The lactation consultant (LC) at the hospital she birthed at had diagnosed her as having short nipples. She was also told that one of her nipples was almost inverted, a reason she was made to believe caused her baby difficulties in latching.

After the initial struggle, she discovered that her baby was diagnosed with jaundice. At a loss, she gave in to pressure from the people around her to feed her baby formula milk; she was made to believe that formula could bring her baby’s jaundice down. Wanting to  attempt breastfeeding, she began pumping milk at home to kickstart her milk supply as well as to manage engorgement. When she tried to latch her baby a few days later, however, she still refused to latch.

“By the time I sorted out my painful engorgement, my daughter had gotten so used to bottle feeding that getting her to latch was a struggle,” said Susan. Still adamant on attempting to breastfeed, she went thrice for LC consultations and also purchased nipple shields and a Supplemental Nursing System (SNS), which are tools to help babies latch. Unfortunately, latching continued to be a struggle.

After suffering from a bout of postnatal blues and feelings of failure, Susan sought support on several Facebook groups on pumping milk for her daughter. “(It) slowly made me realize that I could exclusively pump for my baby and that would not make me less of a mother.” Coupled with the fact that her daughter had multiple allergies, including being allergic to cow’s milk, she pressed on to continue providing breastmilk despite the challenges of exclusive pumping. She managed to provide breastmilk to her daughter, who is now four years old, for 13 months.

Susan and her children. While she started off exclusively pumping, Susan has managed to latch her son when he turned 10 weeks old.

Like Susan, teacher Jessica Xie, a mother of two, also resorted to breastpumps when she had no support for breastfeeding after the birth of her first child. Struggling with an overactive letdown, her baby struggled to latch and Jessica exclusively pumped, although she still needed to supplement with formula during this time.

Breastfeeding was also tough for Jessica as she was experiencing Dysphoric Milk Ejection Reflux (D-MER), an anomaly of the letdown reflex in lactating women. This is a physiological reflex where a mother experiences depressive thoughts, due to an imbalance of brain chemicals, when oxytocin levels rise during letdown. While D-MER is a fairly rare condition, it is a difficult one to live through, and it drained Jessica. With her struggles in pumping and getting enough milk, she gradually stopped pumping after six months when her supply dried up.


Better postpartum support a growing demand to help initiate breastfeeding

For mums like Jessica, Susan, and many others who struggle to breastfeed during the initial days post-birth, breastpumps are a lifesaver for those who still want to provide breastmilk for their babies. It is, however, a signal that more needs to be done in helping mothers initiate breastfeeding right after birth.

For her second baby, Jessica obtained the right breastfeeding support from the hospital during birth. “(The hospital) insisted on one hour of skin-to-skin and latching right after delivery, which wasn’t insisted on during my first delivery. It helped a lot in allowing my baby to latch well, myself to gain confidence in latching instead of relying on pumping and for the milk to kick in on the second day.”

Her experience with her first child made her prepare better this time around. On top of getting good support, she also purchased a hospital-grade pump which worked better for her. She was also motivated to establish a good supply of milk for her baby, to help her sustain breastfeeding more easily after returning to work, so she focused her efforts on feeding exclusively at the breast during her maternity leave. Furthermore, she also had to return to work earlier this time and she was motivated to ensure that her supply was in good shape. In the end, she was able to establish good milk flow and supply with the help of a good diet, which included lactogenic foods, as well as being consistent in stimulating her milk supply through nursing on demand and pumping extra for storage.

Despite still experiencing D-ME, with stronger bouts of depressive thoughts the second time round, the positive experience of successfully latching her baby and her eagerness to breastfeed for as long as possible motivated her to continue. “I usually try to distract myself with happy thoughts during those times or tell myself that it has nothing to do with me, and that it’s just an emotion due to hormones,” Jessica added, when asked how she coped with her condition.

Jessica (left) with her family. Jessica had a better post-birth experience for her second baby, which gave her more confident to initiate breastfeeding right from birth.

Postpartum support at the hospital is especially important in determining successful rates of breastfeeding. When maternity wards are not aware of steps to help initiate breastfeeding, as lined out by the Baby-Friendly Hospital Initiative (BFHI), breastfeeding can go downhill. For example, giving the bottle runs the risk of nipple confusion for a newborn baby. Nipple confusion occurs when a baby has difficulty latching on, or may even reject latching completely, and develops a preference for the quick flow of the bottle teat. Latching at the breast requires more work for the baby as compared to sucking from a bottle, since milk can flow from the bottle teat without much effort. However, since we know that direct latching is still superior to the bottle, the best alternative to bottles when a baby has to be supplemented is cup, syringe or even finger feeding.

While some parents may still prefer to use a bottle at some point in a baby’s life, it is recommended that babies only be introduced to bottles when breastfeeding has been well established.


Nipple confusion, lack of stimulation of mums’ milk supply common reasons for breastfeeding relationships to suffer

Early introduction to bottles was once again the cause of difficulties in latching when Susan gave birth to her second baby. While she had sought advice from an LC before giving birth on how she could do better in latching this time around, her son had to be admitted to the Neonatal Intensive Care Unit (NICU) for respiratory issues at birth. There, he was also given formula via bottles and subsequently struggled to latch when they reunited. Just like her first baby, she resorted to pumping again when he became impatient at the breast.

“I was resigned to the fact that maybe, because of my short and inverted nipples, I was not meant to breastfeed. At that point, I just wanted him to have breast milk and if that means exclusively pumping again, then it’s OK,” said Susan.

Things took a surprising turn, however, when Susan managed to latch her son at ten weeks. After following a pumping routine, she decided one day that she wanted to try to latch her son. “I thought maybe I should just try putting him at the breast and see what happens. He was sleepy and after an initial period of confusion, he latched on and fed from the breast and fell asleep. I was on cloud nine!”

She gradually increased his feeds via direct latch till she was able to replace all his feeds at the breast, dismissing the myth that mothers with short or inverted nipples are unable to latch their babies. It also shows that nipple confusion can be overcome, though not without some effort.

Michelle Ng, a mother of three, agrees that the lack of robust breastfeeding support right after birth makes it difficult for new mothers to start breastfeeding on the right note. She ended her nursing relationship with her firstborn just after two months. “I had no support at all,” said Michelle, who also struggled to learn the ropes of breastfeeding and pumping back then.

She eventually managed to breastfeed her second child for up to six months, citing better support as a reason for success. “I even had a friend who came over to my house to teach me how to direct latch my baby while sitting up and lying down.” Indeed, many mothers find that comfortable and suitable positions are helpful in sustaining breastfeeding, especially since a lot of time is spent at the breast in a newborn’s early days of comfort latching and cluster feedings.

Pumping is a learned art, requires the right support

Mothers who pump also need the right support and knowledge, as well as a pump that fits well and that which they can respond well to. It is important for mums who exclusively pump to understand that the use of the pump must mimic that of direct latching, especially when it comes to the frequency of emptying the breasts. Michelle, who is already back at work after the birth of her third baby, said that she struggled to exclusively pump previously as she was unaware that she needed to pump so frequently to provide sufficient milk for her two older children.

She has been breastfeeding her third child since birth for more than six months now, and pumps regularly at work. “Now, I try to pump every three hours. I also try to pump on time.” Pumping at the time baby would feed and providing the necessary stimulation of the breasts to sustain the supply of breastmilk in the body are crucial when a mother pumps for her baby. This is especially important because the pump is not able to extract as much milk as a latching baby can. Hence, consistent  and frequent pumping helps to send signals to the body that it needs to make milk.

Michelle (left, in black) initially struggled to breastfeed as she did not receive ample support in the early days after giving birth. She was finally able to exclusively breastfeed her third baby.

Mothers who pump also face the arduous and repetitive process of setting up their pumps, washing and sterilising bottles and pump parts, and then having to feed baby as well. “Exclusive pumping got a bit tiresome after 1 year,” said Susan, who stopped pumping when her daughter reached the one year mark. Mums who exclusively pump may also require accessories to help ease the backbreaking work of frequent pumping throughout the days and nights. Susan could not imagine how she was able to pump for 13 months for her firstborn without a handsfree bra. “I was literally holding on to the bottles for each pump session, which lasted 15 minutes each time, up to six times a day.”

With the prevalence and ubiquity of breastpumps now, coupled with mothers’ mobile lifestyles, the breastpump is here to stay and proves to be helpful for mothers who need to provide breastmilk when they are away from their babies. The price points of breastpumps have also widened, as with the specifications, to provide for the differing and evolving needs of mothers. Nonetheless, its growing demand also signals and necessitates the need for every mother to receive accurate and encouraging breastfeeding support for herself and her newborn that they truly deserve right from the birth of her baby.