To-wen Tseng

Paternity Leave—Not Just Maternity Leave—Is Crucial Support for Breastfeeding

I’m having a miserable day. So miserable that I feel an urgent necessity to write this post.

Earlier this week, my husband flew to Asia for work on the day our new baby turned 6 weeks old. At this age, the baby still eats every two to three hours, and sleeps only a few hours at a time, day or night. Surely I always get out of the bed much more quickly than my husband when our baby cries in the middle of the night, but still, breastfeeding is much easier when there is someone who does the laundry, washes the dishes, and watches the older children.

My husband is a supportive partner and has been doing all these for me—until he has to return to work six weeks after the baby was born. Now on top of breastfeeding every three hours, I’m cooking, washing the dishes, doing the laundry, and running after our 4-year-old. I’m ridiculously tired. Right now I’m covered in spit-up, which really adds insult to injury when being sleep-deprived. Unfortunately, I don’t have the energy to do anything about it. So I’m sitting here, with the baby in my left arm, and typing this article with my right hand.

And that’s not a bad version of what most working parents in the US experience. At least my husband has six weeks of paid family leave. According to OECD, out of 41 countries, the US is the only one that does not mandate any paid leave for new parents. The Family Medical Leave Act ensures that women cannot lose their jobs for 12 weeks after having a baby, provided the company they work for has more than 50 employees. It does not concern itself with how to cover the parent’s lost earnings. Only 16% of employers offer fully-paid maternity leave, fewer offer paid paternity leave.

And paternity leave—not just maternity leave—is crucial for breastfeeding. Breastfeeding is team work; it actually takes three people—mom, baby, and dad—to breastfeed. Research shows that the chance of a baby being breastfed for six months is significantly higher if the dad supports breastfeeding. Among other things, a supportive father can offer rest, food, water, and encouragement. Paid paternity leave can empower dads to be supportive dads.

When it comes to baby feeding, the science is clear—there’s nothing better than breastmilk for baby, mom and the environment. Breastfed babies get fewer infections, mother who breastfeed have lower risk of osteoporosis, and breastfeeding leaves no foot print. However, breastfeeding would never work without paid family leave.

My husband is flying home next week. I miss him. He is a very hands-on dad. He burbs and holds our baby after each feeding, he reads with our 4-year-old every evening. I only wish men in this country could have a longer paternity leave. Japanese fathers have 30 weeks. Korean dads have 16 weeks. I’d be happy with just 12 weeks.

To-wen TsengPaternity Leave—Not Just Maternity Leave—Is Crucial Support for Breastfeeding
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Tell Me About Tongue Ties and Lip Ties

It all started with one fuzzy baby and two sore nipples.

I gave birth at midnight on Sunday. It wasn’t my first baby—I’ve breastfed for two years, and I thought I knew exactly what to do. Yet the latch was painful, even worse than what I experienced when my first child was teething.

By the end of Monday, my baby was hungry and angry, and my nipples were cracked and bleeding. On Tuesday, the nurse came to check on me and kindly offered some infant formula to supplement the baby. I didn’t like the idea. I had lots of milk; I could feel it. But by Wednesday, the baby had already dropped his birth weight by 7%.

Then on Thursday the baby dropped weight by another 3%. We were discharged from the hospital with two boxes of infant formula. When I saw the pediatrician on Friday I almost burst into tears while telling him that I wasn’t able to breastfeed even though I know I have milk.

“He might not suck efficiently. You should see a lactation consultant and see what she says. Before we find out what’s going on, I want you to supplement him with 1 oz of formula after each feeding.”

The baby started to gain weight after we supplemented him. It’s embarrassing, felt like being told that my own milk was not good as formula.

I saw the lactation consultant on the next Friday. It turned out the baby had tongue tie! It’s almost funny because I’ve been writing for the breastfeeding coalition for years and tongue tie was a topic that has been brought up often. Yet I was clueless when it actually happened to my baby.

Knowing what’s causing all those problems, we immediately scheduled an appointment with a pediatric dentist. At the dentist’s office she showed us how my baby didn’t only have a tongue tie but also a lip tie. It did look abnormal. I wondered how I didn’t notice it earlier.

We decided to have the ties released on the same day. The dentist explained to us how a frenotomy is performed and how to take care of the baby’s tongue and lips after the procedure, including massaging his mouth with coconut oil and giving him Tylenol to control the pain.  She suggested us to wait in the reception so that we wouldn’t hear the baby cry during the procedure, “it might be upsetting.”

But I could still hear the baby cry at the reception even though we were three rooms away from where the baby was being treated.  That was scary. I told my husband, “Oh my goodness it sounds like he’s in great pain!” For one minute I wanted to stop the procedure and just formula feed. My husband stared at me, “are you out of your mind?”

The dentist brought us our baby in 10 minutes, probably the longest 10-minute in my life. I saw a diamond-shaped wound under his tongue and a little bit of blood in his mouth—just a little, but was enough to freak me out.

That night the baby was very difficult. Every time I tried to massage his mouth with coconut oil, he cried as if I was trying to cut his head off. I worried that our neighbors might call the police; thank God that did not happen. We gave the baby two doses of Tylenol to control the pain.

 

But things became very easy after that first night! Latching was a breeze, and the baby effortlessly gained one whole pound in just one week after the procedure (without formula!) I’m glad we had it done early. He turned one month today. We have two more years to breastfeed.

To-wen TsengTell Me About Tongue Ties and Lip Ties
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For Dads: Breastfeeding and You

A Maryland mother was ordered to give her breastfed infant formula at father’s request because the judge considered “giving a father time with his child is more important than breastfeeding a baby.”

Mom’s milk is powerful stuff, so is the relationship between dad and the baby. It is unfortunate that parents have to choose between the two. Of course, in this case, the couple are separated and embroiled in a court battle. But, in most cases, there shouldn’t be any conflicts between breastfeeding and father-baby-time. In fact, breastfeeding can help dad build a meaningful relationship with the baby.

Breastfeeding takes teamwork. Research shows that moms whose partners support their breastfeeding efforts breastfeed longer. As a dad, there are many ways you can be helpful.

During pregnancy, you can encourage mom to make a breastfeeding plan and set goals, letting her know that you’ll be there to help along the way. You can plan the delivery together, that means choosing a doctor and hospital that supports breastfeeding, going to doctor’s appointments, and going to prenatal classes. You can tour hospitals or birthing facilities together and choose one that supports their breastfeeding goal. You can also start learning about baby behavior so that you’ll be prepared to help the mom when baby comes.

After delivery, you can support skin-to-skin time for mom and baby during the first hour after delivery. Even babies who are delivered by cesarean can do skin-to-skin in the first hour. You can request rooming-in at the hospital so that you and mom have more time to get to know your baby and settle into a healthy routine. You can get plenty skin-to-skin time where you cuddle the baby on your bare chest. This is great bond time with lots of benefits for both of you.

Back at home, you should be prepared: newborns eat at least 8 or more times a day and sleep only a few hours at a time. You can be encouraging by letting the mom know you’re proud of her. You can be helpful by holding the baby after a feeding until he falls sound asleep, changing diapers, learning how to calm the baby when he cries, taking care of meals and household chores, and giving mom a break so she can shower or nap. She will be grateful, and you’ll get more time with the baby.

If the mom plans to return to school or work, she needs your support so she can keep breastfeeding. You can encourage her to pump and store her breastmilk once she’s gotten the hang of breastfeeding and her supply is set. Mom should start pumping at least two weeks before going back to work. At first she may not get a lot of milk, but pumping once a day will help build a supply of milk in the freezer to use while the is away. When mom and baby are together, regular breastfeeding will keep her milk supply up.

To-wen TsengFor Dads: Breastfeeding and You
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How hard (or easy) breastfeeding can be

A mother shared a tearful photo about the pain of breastfeeding, saying that “I cannot hide the struggle.” She wrote, “I love seeing all these beautiful women in their beautiful nursing clothes smiling down at their babes as they lovingly look up back at them hand in hand while breastfeeding…That is not my reality.” As the post going viral, we have to ask, how hard breastfeeding can be?

The truth is, it can be as hard as one can imagine, for both stay-at-home and working moms.

Breastfeeding moms can have a variety of issues: Whether the baby is latching on properly; whether the mom is producing enough milk; whether the mom’s nipples are adequate. Maybe the new role overwhelms the mom; maybe the hormones have her; maybe the nipple shield is ill-fitted. Some babies demand nursing every 10 minutes and it exhausts their moms. Some breastfeeding moms are starving all the time and have to get up at 3 a.m. and eat. Some moms struggle with nursing twins. Some preemies are too small to nurse.

And it’s even harder if the mom’s breastfeeding while working. Even before going back to work, these moms have to build up their breastmilk supply and store extra milk. Pumping can be an unpleasant, sometimes hour-long process. And pumping at work sucks for many women. In spite of the workplace support in federal law, many of the working moms are still stuck pumping in bathrooms, or attempting to find privacy. Those lucky moms who actually get support at work still have to block off at least two 30-minute increments on their calendar to protect pumping time. The stress at work can impact breast milk production, not to mention some mothers are facing breastfeeding discrimination situation at workplace.

The “breast is best” message has returned after the formula-filled decades from the not-so-distant past. Breastmilk helps build crucial antibodies. Breastfed babies are less likely to face obesity, diabetes or other problems. Breastfeeding moms will lose the pregnancy weight easier… Most moms learned all of these in the lead-up to their babies’ birth and set their breastfeeding goals. But this kind of determination is not enough to help moms to reach their goal. According to a 2016 study, only 40 percent babies were breastfed at 12 month, though 63 percent of the mothers had planned to go to a year.

What helps mothers to reach their breastfeeding goal, said the lead author of the study, is support.

Breastfeeding is a team effort. During this period of time, moms need their partners to be patient and assist them with a variety of houseworks. They need nurses in the hospital to assess their milk production. They need lactation consultants help them with the various holds until finding the one that feels quite right. They need encouragement from family members and friends.

Breastfeeding is hard. But with proper support, it can be wonderful like a breeze. Let’s help breastfeeding moms thrive, not just survive.

To-wen TsengHow hard (or easy) breastfeeding can be
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Breastfeeding and Postpartum Mood Disorders: Milk, Tears, and Hope

While many women experience mood changes during or after the birth of a child, 15 to 20 percent of women experience significant symptoms of postpartum depression and anxiety. This World Breastfeeding Week, UCSD and SDCBC mini-seminar discussed how to treat a women suffering from perinatal mood and anxiety disorders (PMADs) and help her with her breastfeeding goals.

Many healthcare providers have not received adequate refining in how to recognize, screen for PMADs, and refer mothers for help. This is unfortunate because according to Bethany Warren, licensed clinical social worker and the president of Postpartum Health Alliance, “recent research has confirmed that the optimum development of an infants social and emotional health hinges on the responses of and relationships with their caregivers, often the mother.”

There are effective and well-researched treatment options that can prevent worsening of symptoms and help women fully recover. “New moms are going through an identity shift, and our goal is to help them recognize their expectation, reducing the perfectionism and comparison, manage the anger, and resolve the conflict and grief.” explained My Hanh Nguyen, a psychiatric-mental health nurse practitioner of UCSD Dept. of Psychiatry. “Not all expectations happen and that’s okay.” Common strategies including interpersonal psychotherapy, cognitive behavioral therapy, mindfulness, support groups, and of course, medication.

Because of the possibility of exposing the baby to medication through the breastmilk, many are hesitate to treat breastfeeding moms with drugs. However, as Jason Sauberan, Doctor of Pharmacy of Sharp Mary Birch, pointed out, “we don’t want the drug to hurt the baby, but we don’t want to tell moms that you cannot be treated while breastfeeding, either.” The important thing is to help medicated moms reach their breastfeeding goals by understanding the physiochemical drug properties and milk transfer, judging infant risk and making the right decision. This is crucial because breastfeeding has a protective role for both mother and infant.

When supporting a breastfeeding mother with postpartum depression or anxiety, clinicians need to employ messages to all mothers experiencing the symptoms, “You’re not alone. You’re not to blame. With help, you will be well.” When identifying the mom at risk, “the most important aspect of assessment is to listen to the woman’s story,” said SDCBC’s Rose deVigne-Jackiewicz, RN, MPH, IBCLC, “Her story is unique to her.” Moms need to be heard, clarified, validated and categorized. “Sometimes, even what you see tells a lot,” deVigne-Jackiewicz told the seminar attendees. Is the mom holding her baby? How’s she interacting with her husband, boy friend or in-laws?

To understand what PMADs are really like, Jessica Furland, clinical social worker of UCSD recommended three documentaries: The Dark Side of the Full MoonWhen the Bough Breaks and The Emily Effect. Each of the documentary delves into the unseen world of maternal metal health in the U.S, brings attention to this public health issue and illustrates the lack of awareness and appropriate treatment options for postpartum mood disorders by looking into a woman’s journey to recovery.

 

To-wen TsengBreastfeeding and Postpartum Mood Disorders: Milk, Tears, and Hope
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Why Donate Your Breast Milk?

Breastfeeding mothers, have you ever thought about becoming a human milk donor? Maybe you are producing more milk than your baby can eat and you feel responsible for what you have. Maybe you want to help vulnerable infants around the country. Either way, being a human milk donor is a deeply rewarding experience.

When thinking about milk donation, many mothers first consider finding someone in their area who need milk for their babies and casually sharing it with them. But there are safety issues. Last year, the American Academy of Pediatrics issued a policy statement against informal milk sharing because of the risk of bacterial and viral contamination. A 2013 study found that 74 percent of breast milk bought on the Internet had high levels of bacterial growth, particularly strep and staph.

So instead of casual sharing, you may choose to look into human milk banks. There are currently 18 human milk banks in the United States and Canada that are affiliated with the Human Milk Banking Association of North America, which sets guidelines for ensuring donor breast milk safety. Milk banks pasteurize donor milk to kill bacteria, combine it with other donor’s milk to make sure the milk components are well balanced, and test the milk for contamination. They then provide the milk to premature babies and other infants whose mothers may not be able to breastfeed.

Last year, 9.6 percent of U.S. infants were born prematurely, which can cause a host of health issues, including necrotizing enterocolitis (NEC), a serious disease in which babies’ intestines are damaged or die, causing waste to leak into their bloodstream. In 2013, preterm-birth complications were responsible for one third of U.S. infants death, according to the Centers for Disease Control.

The World Health Organization says preemies should drink their own mother’s milk when possible. While donor milk is good for babies, it’s not as powerful as their own mother’s milk, because a mother’s milk composition rapidly changes to meet her baby’s needs. However, WHO does recommend donor milk as the best back-up.

As you prepare to donate, you have to pass a month-long screening process, which included a phone interview, blood test for infectious disease, and releasing your baby’s and your medical records so the milk bank staff could ensure donating wouldn’t be detrimental to either of you.

Your milk can help prevent infections in premature babies and encourage there mothers’ own breastfeeding efforts.

Upcoming milk drive in San Diego area:

Date: Saturday, August 5, 2017

Time: 3pm – 5pm

Location: UC San Diego Health East Campus Office Building

For more information, please visit https://health.ucsd.edu/specialties/obgyn/maternity/newborn/lactation/Pages/Mothers-Milk.aspx

 

Date: Monday, August 7, 2017

Time: 7:30 am – 2pm

Location: Sharp Mary Birch Hospital

For more information, please visit https://www.sharp.com/hospitals/mary-birch/mothers-milk-bank.cfm

 

Read more:

When breast milk goes big business

The dangers of buying breast milk online

Breast milk is love. Share love!

To-wen TsengWhy Donate Your Breast Milk?
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“Milk & Marijuana: First Do No Harm”

When California voters approved Proposition 64 and legalize marijuana last year, the basic idea was simple: a majority of people in the state believe that adults should be able to consume marijuana if they feel like it, just like a glass of wine at 5 o’clock. But how about pregnant and/or breastfeeding women? Shall we tell mothers not to breastfeed if they use marijuana?

According to Dr. Lisa Stellwagen (MD, FAAP) of UCSD Medical Center, it’s complicated.

To-wen Tseng“Milk & Marijuana: First Do No Harm”
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A Quick Guide to Successful Breastfeeding

There’s a big global push in from experts to have mothers of newborns breastfeed exclusively for at least six months.

 

And many new moms want to. But only about 60 percent who start off breastfeeding keep it up for six moths or more, according to the Centers for Disease Control and Prevention.

Here’s a quick guide to advice from lactation consultants, pediatricians and researchers who had tips for women on how to reach their breastfeeding goals.

To-wen TsengA Quick Guide to Successful Breastfeeding
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Breastfeeding: It Takes a Whole Village

When my first child was born, I did not have a breastfeeding plan. Then my pediatrician advised me about the American Academy of Pediatrics guidelines: exclusive breastfeeding for the baby’s first six months. Then, as foods are introduced, continuing breastfeeding until at least baby’s first birthday.

A friend gave me an electric breast pump. Another friend gave me a cooler and some ice packs. I got serious.

I breastfed my child, relied on pre-pumped breastmilk to get through day care days. I faced breastfeeding discrimination situation at work by six months. I had four business trips by one year. But I insisted.

I insisted not because I am a true believer in the benefits of breastfeeding, though I myself was bottle-fed, along with many in my cohort. But my insistence was mostly because of the support I had.

To-wen TsengBreastfeeding: It Takes a Whole Village
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Things To Know About Storing Breast Milk For A Flight

A horror story about a mom being forced to dump her breast milk in an airport is circulating on Internet. It reminds me about the two years when I was breastfeeding. I travel frequently for work and flew a few times with my breast pumps during that two years. My impression is that traveling as a breastfeeding mom can be challenging, but not impossible. Most agents do understand breast milk security procedures, and mothers should be good if they know the TSA guidelines in regards to breast milk storage.

Here are several things to keep in mind when carrying breast milk on a flight.

To-wen TsengThings To Know About Storing Breast Milk For A Flight
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