How to bottle feed your breast(milk)fed baby

Baby learned to feed from my breast AND the bottle. He has always preferred direct breastfeeding over feeding from a bottle. If I had a choice I’d rather not serve breast milk using the bottle.  Breastfeeding is so much more intimate, since it establishes frequent skin to skin contact with my boy.  But for working moms like me, letting baby to take the bottle is inevitable.

It’s the next most convenient means of serving breast milk to baby. Before I went back to work last March, I agonized because I thought he’ll go hungry. But after six months since my leave, baby has learned to adapt and learned to feed from me AND from the bottle.

[caption id="attachment_801" align="aligncenter" width="229"] I used to bottle feed Pulo while waiting for his pedia. I wasn't confident then to nurse in public.[/caption]

Baby’s transition from breast to bottle and vice versa isn’t always seamless. My pedia says no synthetic nipples are soft enough to imitate a mama’s nipples. For this reason feeding problems like bottle refusal and nipple confusion are expected.

Here are some notes in giving the bottle to you breastfed baby:

Direct breastfeeding is the best method of feeding baby.

Hospitals play a critical role in breastfeeding in the first days of baby's life. Pedias also play a big role on baby's first feedings.

Most of our hospitals are still not breastfeeding-friendly. Although WHO discourages the use of bottles, doctors from private hospitals still instruct moms who can’t direct breastfeed to use a bottle instead of a cup. I’ve noticed the breastfeeding policies are more strict in government hospitals. Here's East Avenue Medical Center' breastfeeding policy stating that synthetic bottles and nipples are banned within the hospital. I'm not sure though if the policy is strictly being implemented. I hope so! When i was there to visit a cousin, i saw most new moms are breastfeeding.

[caption id="attachment_719" align="aligncenter" width="1024"] Bottles, nipples and pacifiers are banned in the premises of East Avenue Medical Center in Quezon City.                    (Sorry for the blurred photo.)[/caption]

I gave birth in a private hospital. Our pediatrician instructed me do use bottles.  She says she’ll have to check if baby can efficiently suck since he was a preemie. I guess this all depends on the pedia’s assessment of the baby. I did not know any better so I summoned hubby to buy a preemie bottle. I was allowed directly breastfeed him on the fourth day already.

I did attempt to directly breastfeed baby in the NICU, but just shortly because he was always dozing off while i held him in my arms. I did not know then yet that i can wake him so he can get a decent feeding.  Here's my post on getting ready to breastfeed for moms who had just gave birth.

My sister's baby, who was delivered in another private hospital, was also bottle fed in the NICU.

Could the pedia be instructing bottle feeding because it's much more convenient for the NICU nurses? Cup feeding can be cumbersome for NICU nurses who look after more than one babies at a time! This system is far from the ideal for breastfeeding hospitals!

Bottle feed only when breastfeeding has been established.

Well in my case, i had to reintroduce the bottle. We struggled to achieve  a good latch but all ended well. Babies are smart, they learn to adapt.

From the day when we took him home until after 6 to 8 weeks, i exclusively breastfed him directly.  I reintroduced him to the bottle, this time Avent small bottles with newborn nipples about 6 weeks after. Initially, I just let him take one bottle per day. I increased  bottle feeding as i neared the end of my maternity leave.  Remember to pump for those missed direct feeding!

Use slow flow (newborn) nipples.

With Avent, those are number 1 nipples. It’s slow flow and has only one hole. This will encourage babies to suck, like how we would extract milk from your breasts. Up to now that he’s 8 months he’s still using Avent# 1 nipples.

Babies on fast flow nipples can get used to the faster release of milk from bottles. This may cause baby to refuse your nipples, which releases breast milk only at baby's suckling.

Using slow flow nipples will lessen risks of  choking on breast milk. A pedia explains that the difference between a mothers ’s nipples and synthetic nipples is the flow of milk.  Milk keeps flowing from synthetic nipple, even if baby does not suck on it. No milk is released from the breasts if baby stops sucking. That's why it's a big no-no to let baby sleep with feeding bottles.

Test a variety a feeding bottles for baby. See which works best. We were lucky baby did not reject Avent bottles. My sister uses First Years Breastflow feeding bottles.

Use small feeding bottles for breastfed babies.

Breastfed babies need more frequent feedings than formula fed so give smaller bottles. I’m still using Avent 4 oz bottles, even if baby’s 8 months already. This system  works for me so I did not bother giving him bigger bottles.

After 6 months, baby has to be given solids so can expect a decrease in the volume of his breast milk intake.

I figure it's best to serve breast milk in smaller quantities, since breast milk has a short "expiry period".  It's safe to leave breast milk at room temperature for 4 to 6 hours. Using small bottles also lessens the amount of breast milk wasted.

Prepare his feeding bottles for the day yourself. 

This helps your caregiver a lot. She won’t have to thaw then transfer breast milk. This will also make it easier for you to measure his breast milk intake daily. You’ll feel closer to baby, even while you’re out because you personally prepared his meals for the day.

Number your breast milk bottles so they’ll know which ones should be served first. This will be of great help if you serve thawed milk and fresh expressed breast milk. Thawed milk must be consumed first since it can only be used within 24 hours.

Find out how many feedings and amount breast milk your little one takes on a daily basis. I’m at work from 1 pm to 9pm. I estimate that baby feeds three times a day. So I leave him 4 bottles (just in case)  with 4 ounces of breast milk each.  If you’re exclusive breastfeeding, use KellyMom’s milk calculator.

Clean your baby feeding paraphernalia yourself. 

Bottle feeding poses great risk for contamination so be on guard. I’m really OC when it comes to feeding baby so I personally clean his bottles and nipples.

I wash them in warm soapy water. I use mild cleaners from Messy Bessy. I  sterilize using Chicco Electric sterilizer. Until baby receives all his immunization shots, I’ll be sterilizing his feeding equipment. This will reduce any risk of diarrhea, stomach flu or any other gastric diseases.

Regularly inspect the nipples. Look for holes, tears or cracks. Replace worn out nipples to prevent choking.

Seek alternative breast milk feeding  choices. 

Hospitals with good breastfeeding policy highly encourage feeding from a cup. That’s if and only if mommy can’t latch. Direct breastfeeding is the priority.

Here's a post on cup feeding from M'ann Oblea of Baby Mama over at Chronicles  of a Nursing Mom.  I'm actually learning to cup feed P, since i'd like to get him off the bottle early.  I can't imagine P drinking from the bottle until one year!

Aside from cup feeding, modes of serving breast milk. You can use medicine dropper or rubber or silicone baby spoons. This manner is more tedious for your care giver since she has to serve in one milliliter container. Imagine how many times she’ll do this for a decent feeding. Older babies can also start feeding from training cups.

My MIL uses a big medicine syringe (without the needle of course) in serving BM.  I think my son does not really want to suck on synthetic nipples so my MIL sought several options of feeding milk. The medical syringe seems to work best for her.

Try giving the feeding bottle when baby’s sleepy. 

This is my MIL’s technique to feed using the bottle.  Babies comfort suck, so make use of this by giving him a bottle. This mimics me nursing him to sleep.

Don’t worry to much. When baby gets hungry, he’ll learn to suck the bottle!

Is this too harsh? Well kinda. But it’s true, babies adapt. My baby did. When he’s still full he doesn’t see the need to suck. When he gets hungry, he’ll munch on anything. Give him time and look out for hunger cues.

My baby manages to gulp down about 12 ounces of breast milk thru the bottle.  Honestly, i really don't bear the brunt of having to (force)feed him because i'm often at work.  But as my MIL reports, there are times when they still struggle when bottle feeding. Bottle feeding P is especially hard after weekends, since baby usually breastfeeds most of the time during Saturdays and Sundays. P  much prefers my breasts.

I guess i just have to accept that bottle feeding is among the sacrifices working moms and their babies have to make. For my next baby, i think i'll cup feeding early on.

When i'm with baby, he seldom takes the bottle from me. Whenever i gave him a bottle, he would just stick out his tongue. Or he would just turn his head away from the bottle.  As i said, babies are smart. He might be thinking, Why would you give me this bottle when i can have the real ones there?  So I never bothered preparing bottles when i’m with him. I don’t bring bottles and nipples when we travel.

I treat bottle feeding as a feeding option, given the chance and the choice, i would always direct breastfeed my darling boy.

Also worth reading:

• Breastmilk storage tips from a working mommy


• Working mom's guide to thawing and serving breastmilk

***

How to bottle feed your breast(milk)fed baby

Yes, it is possible! My baby learned to feed from breast AND the bottle. He has always preferred direct breastfeeding over feeding from a bottle. If I had a choice I’d rather not serve breast milk using the bottle. But for working moms like me, letting baby to take the bottle is inevitable.

It’s the next most natural and convenient means of feeding breast milk. Before I went back to work I agonized because I thought he’ll go hungry. But after six months since my leave, baby has learned to adapt and learned to feed from me AND from the bottle.

Baby’s transition from breast to bottle and vice versa isn’t always seamless. My pedia says no synthetic nipples are soft enough to imitate a mama’s nipples. For this reason feeding problems like bottle refusal and nipple confusion are expected.

Here are some important points when giving the bottle to you breastfed baby:

Direct breastfeeding is still the best feeding choice.

Most of our hospitals are still not breastfeeding-friendly. Although WHO discourages the use of bottles on the first few weeks of baby’s life, doctors from private hospitals still instruct moms who can’t direct breastfeed to use a bottle instead of a cup. I’ve noticed the breastfeeding policies are more strict in government hospitals. Feeding bottles and pacifiers are banned in East Avenue Medical Center in Quezon City. 

I gave birth in a private hospital. Our pediatrician instructed me do use bottles.  She says she’ll have to check if baby can efficiently suck since he was a preemie. I guess this all depends on the pedia’s assessment of the baby. I did not know any better so I summoned hubby to buy a preemie bottle. I was allowed directly breastfeed him on the fourth day already.

I did attempt to directly breastfeed baby in the NICU, but just shortly because he was always dozing off while i held him in my arms. I did not then yet that i can wake him so he can get a decent feeding. Read my post on getting ready to breastfeed. 

My sister's baby, who was delivered in another private hospital, was also bottle fed in the NICU.

Could the pedia be instructing bottle feeding because it's much more convenient for the NICU nurses? Cup feeding can be cumbersome for NICU nurses who look after more than one babies at a time! This system is far from the ideal for breastfeeding hospitals!

Introduce the bottle only when breastfeeding has been established.

Well in my case, i had to reintroduce the bottle. We struggled a bit to make him suck my nipple, but all ended well. Babies are smart, they learn to adapt.

Train your baby to take the bottle weeks before your scheduled return to work. I reintroduced him to the bottle, this time Avent small bottles with newborn nipples about 6 weeks after. Initially, I just let him take one bottle per day. I increased  bottle feeding as i neared the end of my maternity leave. Remember to pump for those missed direct feeding!

Use slow flow (newborn) nipples.

With Avent, those are number 1 nipples. It’s slow flow and has only one hole. This will encourage babies to suck, like how we would extract milk from your breasts. Up to now that he’s 8 months he’s still using Avent# 1 nipples.

Babies on fast flow nipples can get used to the faster release of milk from bottles. This may cause baby to refuse your nipples, which releases breast milk only at baby's suckling.

Using slow flow nipples will lessen risks of  choking on breast milk. A pedia explains that the difference between a mothers ’s nipples and synthetic nipples is the flow of milk.  Milk keeps flowing from synthetic nipple, even if baby does not suck on it. No milk is released from the breasts if baby stops sucking. That's why it's a big no-no to let baby sleep with feeding bottles.

Test a variety a feeding bottles for baby. See which works best. We were lucky baby did not reject Avent bottles. My sister uses First Years Breastflow feeding bottles.

Use smaller feeding bottlers for breastfed babies.

Breastfed babies need more frequent feedings than formula fed so give smaller bottles. I’m still using Avent 4 oz bottles, even if baby’s 8 months already. This system  works for me so I did not bother giving him bigger bottles.

After 6 months, baby has to be given solids so can expect a decrease in the volume of his breast milk intake.

I figure it's best to serve breast milk in smaller quantities, since breast milk has a short "expiry period".  It's safe to leave breast milk at room temperature for 4 to 6 hours.

Prepare his feeding bottles for the day. 

This helps your caregiver a lot. She won’t have to thaw then transfer breast milk. This will also make it easier for you to measure his breast milk intake daily. You’ll feel closer to baby, even while you’re out because you personally prepared his meals for the day.

Number your breast milk bottles so they’ll know which ones should be served first. This will be of great help if you serve thawed milk and fresh expressed breast milk. Thawed milk must be consumed first since it can only be used within 24 hours.

Find out how many feedings and amount breast milk your little one takes on a daily basis. I’m at work from 1 pm to 9pm. I estimate that baby feeds three times a day. So I leave him 4 bottles (just in case)  with 4 ounces of breast milk each.  If you’re exclusive breastfeeding, use KellyMom’s milk calculator.

Clean your baby feeding paraphernalia

Bottle feeding poses great risk for contamination so be on guard. I’m really OC when it comes to feeding baby so I personally clean his bottles and nipples.

I wash them in warm soapy water. I use mild cleaners from Messy Bessy. I  sterilize using Chicco Electric sterilizer. Until baby receives all his immunization shots, I’ll be sterilizing his feeding equipment. This will reduce any risk of diarrhea, stomach flu or any other gastric diseases.

Regularly inspect the nipples. Look for holes, tears or cracks. Replace worn out nipples to prevent choking.

There are several alternative breast milk feeding  choice. 

Hospitals with good breastfeeding policy highly encourage feeding from a cup. That’s if and only if mommy can’t latch. Direct breastfeeding is the priority.

There are several feeding choices to serve breast milk. You can use medicine dropper or rubber or silicone baby spoons. This manner is more tedious for your care giver since she has to serve in one milliliter container. Imagine how many times she’ll do this for a decent feeding. Older babies can also start feeding from training cups.

Serve bottle when baby’s already sleepy. 

This is my MIL’s technique to feed using the bottle.  Babies comfort suck, so make use of this by giving him a bottle. This mimics me nursing him to sleep.

Nurse directly when with baby.

My baby seldom, more often does not,  take the bottle when with me. As i said, babies are smart. He might be thinking, Why would you give me this bottle when i can have the real ones here?  So I never bothered preparing bottles when i’m with him. I don’t bring bottles when we travel. It’s much more convenient!

Don’t worry to much. When baby gets hungry, he’ll learn to suck the bottle!

We used to bottleed with EBM while waiting at  the pedia's clinic.

Is this too harsh? Well kinda. But it’s true, babies adapt. My baby did. When he’s still full he doesn’t see the need to suck. When he gets hungry, he’ll munch on anything. Give him time and look out for hunger cues.

***

Do's and Don'ts with Placenta Previa

To give a clear view of what to expect with placenta previa, let me recall what happened when baby was born.

Baby had very low birth weight. 

• Pulô's birth weight was just 4 pounds and 13 ounces or 2,177 grams. This was 300 grams less than what's considered normal. In the Philippines, babies less than 2500 grams at birth are considered low birth weight infants. That he was delivery prematurely contributed to such low weight.

I had emergency cesarian delivery.

• Husband and i were discussing which day in the third week of January 2012 was a good birthday for P.  But all the discussions were futile. I had severe bleeding, 10:30 am of  December 22, 2011.  Things happened very fast after that. We called the OB, she said i will be delivering baby that day so  I was brought to the hospital. At 11:30 am I was on the operating table. At 11:44 am, i heard my little one's first cries!

Baby was born premature. 

• We were all worried because baby wasn't due for another 3 weeks! When baby was finally cleaned and tested, we found out that baby was on his 36th week. According to the pedia,  37th week was considered full term.

Baby was in  NICU for one week.

• Bago pa ako manganak, sinabi ko na kay husband, "Ang sakit siguro kung madidischarge ka tapos maiiwan pa sa ospital si baby!" Totoo nga, base sa experience ko. I was discharged on Christmas Day and it was also the first time i ever held by baby boy! But it was also the first time we had to leave him. Since baby was 1 week short of a full term, he had to be left in the NICU. He was put under observation and was confined in an incubator. This was supposed to make up for the 1 week remaining of the time baby should have been inside my womb.

I had blood transfusion post delivery.

• I think i lost about 500ml of blood in that prebirth bleeding. Bleeding was painless but we were really alarmed. My husband was shaking when he saw all the blood. Akala ko kasi napaihi lang ako bigla. Yun pala, dugo na ung lumalabas sa akin!  One day before i checked out of hospital, i received blood thru transfusion. It was a painful experience, by the way, as blood kept flowing back into the pin.

Placenta previa is manageable. Extra effort is required to ensure your own and baby's safety.  Check my previous post if you want to know how this pregnancy complication is diagnosed.

[caption id="attachment_3267" align="aligncenter" width="300"] All your worries and fears about this condition melted when i finally held my newborn in my arms![/caption]

Here are some do's and don'ts when dealing with similar condition.

Do’s

Do take extra care.

• Placenta previa is considered high risk. Be careful and think twice before doing any activity. Seek clearance from your doctor if you need to take long trips, undergo an exercise routine or want to take any new medicine or supplement.

Take a break if you get tired.

• Pregnant moms get tired easily. Getting tired can cause contractions of the uterus, which is a no-no for previa patients.


• After my first bleeding episode I had to spend two weeks on bed rest. It was really frustrating.  Sayang, kasi na-imagine ko ang sarili ko na nagwa-walking sa UP habang buntis.


• Not all previa cases need to take full bed rest for the remainder of their pregnancy. It’s based on one’s situation: how far along is the woman and how severe the bleeding is.


• I was working while pregnant. I had many absences when after i had  bleeding on the fourth month. That's when i was diagnosed with placenta previa. After that i went back to work, but i was extra careful - no climbing stairs, no comutes, no standing for too long.


• My OB wanted me to take a maternity leave as early as 7th month, but i couldn't bear to leave work. I couldn't take any more forced bed rest! I really thought going on leave that early was OA! I pleaded with my husband so i could just take the leave in the 3rd week of December, that's on my 8th month.  I said i'd die of boredom at home. He said yes but made me promise to be extremely careful, that i'll go home if i feel any contractions! My last day at work should have been December 23.But  baby wanted to get out early! He made his grand entrance on December 22.  We were prepared, but we could have been MORE prepared!!!

Be on the look out for any spotting in any stage of your pregnancy.

• Always wear light-colored undies so any spotting will be seen easily.


• Inform your doctor at once of any bleeding.

Follow your checkup schedule and if possible, heed your OB’s instructions.

• Your OB will give you clear and proper advice. Ask any questions, no matter how no brainer you think they are. It pays to be makulit!

Eat lots of fiber.

• Fiber softens your poop. Pooping should be effortless, so you don’t strain.  You’ll be instructed to drink iron supplement, which tend to harden your poop. Banana was off limits as well since banana hardens poop. Some fiber rich foods include pears, oatmeal, whole wheat breads. It's also good to include prunes and yogurt in your diet, these aid digestion.

Consider getting steroid shots.

• Past 7 months our OB instructed us to get Diprospan (betamethasone) shots.  Steroids will help mature  baby’s lungs.  We were hesitant to get the shot but my doctor explained why we needed it.  In my case daw kasi, bleeding is imminent, lalo na habang mas lumalaki ang tiyan ko. Our OB says that steroids will help prepare baby’s lungs if I had any bleeding in my last trimester. Getting the shot was a life saver because my baby was born one week before full term!


• OB gave us the steroid prescription. We had to scour hospital pharmacies because steroids are not readily available in most drugstores. Once we have the right drugs and enough dosage, we went to the hospital emergency room, where a nurse administered the steroids. She injected half of the dose on my left arm. Then the other half was injected on the right arm the next day. As i remember i was on my 32nd week when i got the shot.

Pack your hospital bag early.

• Severe bleeding beyond 7 months will lead to delivery. We didn’t pack our bags early on so we were caught off guard. Our baby was born earlier than expected. We haven't prepared the baby bag yet! Sure, we bought and washed all his clothes and other supplies but it was still a mess. As a result, we really had a hard time getting organized at the hospital. Prepare your actual hospital bag and its contents on the early part of the 7th month, to be safe and ready!

Don’ts

Don’t climb stairs, even just 1 storey.

• Always use the elevator when getting from one floor to another.  Climbing can be tiresome for pregnant moms, especially in the last trimester because she's getting heavier.

Don’t ever allow pelvic exam or internal exams.

• This was one of my OB's strict orders. Internal exams can reach into your cervix, then into your placenta. Any poking of  sorts can lead to bleeding. Explain this to any physician or nurse who intend to examine you.

Don’t do excessively strenuous activities.

• Unlike other moms-to-be who were advised to exercise, I was limited to bed rest. My OB says it’s better to be safe than be sorry.


• Speaking of strenuous activities, we were also banned from having sex. This was really a bummer. Husband and I had to be  celibate for the remainder of my pregnancy. Hayyyy… My boobs were also off-limits since breast stimulation can induce contractions.

It made me very thankful i had a safe pregnancy. Husband and I are lucky because we knew of the complication early in the pregnancy. We're also thankful that we had a good OB, who, aside from being an expert ,  was very  patient in answering all our questions.

Having conquered placenta previa, I wondered. How about those pregnant women in the far flung barrios? Access to an ultrasound is limited in these areas, how can they know if they have this condition? This could be why maternal mortality is high in our country!

Also worth reading:

• My pregnancy complication: Placenta Previa

***

My Pregnancy Complication: Placenta Previa

My pregnancy story is not at all riddled with groans and pains of labor in a vaginal delivery, as i imagined it would be.  I had to undergo cesarian delivery, not by choice but out of necessity. My baby had to be delivered via c-section because of a pregnancy complication known as placenta previa.

What is it?

The American Pregnancy Association defines placenta previa as a "condition where the placenta lies low in the uterus and partially or completely covers the cervix."  I understood it as the condition wherein my baby can't pass through my vagina because the placenta blocks his passage.  The placenta is the pancake-shaped sac inside uterus that holds blood, nutrients and food for my unborn baby.

[caption id="attachment_465" align="aligncenter" width="300"] Source of Photo: tbh.org[/caption]

How it was diagnosed

Four months into my pregnancy, i was rushed to the hospital because of spotting.  We got worried because it was the first time ever that i leaked some blood.  The OB in the emergency room ordered an ultrasound. I  had to be admitted for overnight observation.

At the ER i was asked several questions like:

• "Nararamdaman mo ba parang may menstruation ka before ung bleeding?"


• "Napagod ka pa recently?"


• "Kailan ang last contact nyo mag-asawa?" Translation: Kailan kayo last nagsex?

Yup. That intrusive. But ok lang, para maliwanagan ako, saka ung mga doctor kung anong nangyari.

When the ultrasound results came out, my OB confirmed it. Placenta previa nga.  Hindi lang basta previa ha. Sa ultrasound report ang nakasulat: Placenta Previa Totalis. This means, sobrang laki nung overlap ng placenta at nung opening. This means the placenta completely covers the cervix. Argghhh...

It was the first time i ever took placenta previa seriously. I read about this haphazardly in the book "What to Expect When You're Expecting" but it didn't really strike me as important. From then on i tried to know everything about this condition.

Doctor's orders

I was ordered to have a 2-week bed rest after the scare of my first spotting event. So bale, naka-emergency leave ako for 2 weeks. Complete bed rest daw talaga kailangan para ma-relax ang uterus ko. Tumatayo lang ako sa kama pag kailangan mag-weewee at mag-poopoo.  OB also prescribed duvadilan twice a day and once when i feel any contractions. In my medical certificate, i was ordered bed due to threatened abortion...yikes!

A note on bed rest, not all previa cases require bed rest. According to my OB, some get by even without bed rest.  It really depends on two factors: how far along in the pregnancy and how profuse the bleeding is.

My OB says the condition isn't really that bad. Having this condition is not life threatening. I just have to take extra care and be on guard for any spotting at any point in your pregnancy. She said i should avoid getting tired.

Complication

The worst scenario is excessive blood loss. The danger is, according to the OB, once you have severe spotting, she’ll need to deliver baby even if i'm months before due date. Ito ay kapag sobrang dami ng dugo ha.  Nung narinig ko ito talagang natakot ako. For the first time sa pagbubuntis ko, napraning ako. Posible pala ako makunan!

We asked our OB about the implications of placent previa on my pregancy.  My OB says that i'm more prone to severe blood loss, so i'm more likely to undergo a cesarian delivery.  According  to her,  I should not reach the point of active labor since placenta previa cases are prone to excessive blood loss. As soon as baby has reached his full term, he'll be delivered.

However i'd like to point out that not all previa pregnancies end with cesarian. Placenta previa may clear up in the late stages of pregnancy.  My OB said the position of the placenta can shift as the uterus muscles stretch to accommodate my growing baby. She said she had one patient whose previa cleared up in the last trimester.

Well we did pray and hoped that later in my pregnancy, it will improve. But in our last ultrasound (7th month), I still had it. So we had to accept that in deed, I had to deliver baby via C section. We were  scheduled for a C section any day from January 6  to 13, 2012, which corresponds to baby's 38^th week of gestation.

[caption id="attachment_3269" align="aligncenter" width="277"] This was baby's last prenatal ultrasound. Can visualize the placenta on the upper left portion? It lies right next to baby's forehead. At 7 months, my placenta still blocks the cervix, which is baby's natural way out![/caption]

Who's at risk?

While doing a research on my condition, I came across a list of risk factors why some women are prone to placenta previa. Here's the list as stated in the Mayoclinic article.

Women are at higher risk for placenta previa if they've 
had previous surgeries involving the uterus, such as:
• A C-section
Surgery to remove uterine fibroids
• Dilation and curettage (D&C), though this is a much lower risk
Placenta previa is also more common among women who:
• Have already delivered at least one baby
• Had placenta previa with a previous pregnancy
• If you are carrying twins, triplets or other multiples
• Are age 35 or older
• Are Asian
• Smoke

I’m really baffled because I did not  fit into these characteristics, except for being  Asian. I don’t smoke. It was my first time to pregnant. I was just 29 when I got pregnant. Hindi ko talaga matanggap noong una na considered "high risk" na agad ang pagbubuntis ko.

So I asked my OB, why and how i had this condition. What did I do that put my placenta in such problematic position? Could i have prevented this? Bakit ako pa eh wala naman akong risk factor?  She said there’s really no clear explanation why and how placenta previa develops. They're no really sure what causes this pregnancy complication.

Moms, if you're diagnosed with placenta previa, you need to take extra care.  Be on guard for any bleeding.  Avoid excessive activities as this can cause uterine contractions. After i was diagnosed, i was not allowed to climb stairs, go on long walks and even have sex. (Sadddd)

The good news is: Placenta previa has no long term effect on baby or on you. Once you pass the 7^th month, you can relax a bit because at this stage almost all of baby’s organs are formed. Past seven months, it’s a matter of waiting for (and preparing for) your baby's full development and maturity.

Also worth reading:

• Placenta previa do's and don'ts!


• Learnings from an emergency cesarean delivery

***

Breastfeeding Beyond 6 Months: Problems and Solutions

I'm glad i was able to pass, with flying colors,  the 6-month exclusive breastfeeding hurdle. And it's been more than 2 months since baby started taking in solid foods.

Honestly, i'm kinda sad about the fact that i'm no longer baby's lone source of nutrition. He's no longer exclusively breastfed and he seems to be delighted by all the new foods he's been tasting! Hayyy... I have mixed emotions about this.

On one hand, i'm glad that he's introduced to solids and he seems to have no adverse reactions so far. On the other hand, the selfish me is tearing up inside as i struggle to breastfeed him some more!

[caption id="attachment_354" align="aligncenter" width="300"] P enjoying frozen fruits in a mesh.[/caption]

According to Unicef, breast milk is best for babies even until 2 years. It's written in the agency's publication entitled  Facts for Life:

 "Breast milk remains an important source of energy, protein and other nutrients such as vitamin A and iron, even when babies begin to consume additional foods after 6 months of age. Breast milk helps protect a child against disease for as long as the child breastfeeds. It is recommended that a mother continue to breastfeed her child up to two years and beyond – as long as she and the child wish to continue. Breastfeeding can comfort a child who is upset and is an important source of nourishment during a child’s illness." 

My husband and I agreed that we'll breastfeed for at least two years. Now, 8 months on, it's getting harder to nurse my son. I keep on thinking, "He seems to be more interested in the outside world than my boobs!"

Here are some of the breastfeeding challenges that  i deal with everyday and some ways to handle them.

Baby’s teething!

My son now bites during our breastfeeding session.  Although he has no teeth yet, it still hurts. I can feel his gums as he bites my nipple and the skin near it.

• When baby does this I ask him to stop and then I unlatch. This way, he'll learn that we can't go on if he continues to bite.  I’m still teaching baby how to stop biting. I expect more hurt from cuts in my nipples as baby has yet to get his pearly whites. But i'm determined to breastfeed even until the time he gets his teeth. I’m keeping my fingers crossed and I hope I get to do this!  Here are more suggestions when baby bites.

Baby’s often distracted.

Since he passed the 6-month mark, I noticed that baby has been more distracted. He's more busy and alert now. He stops breastfeeding for anything.... like  dogs barking, sounds from TV, voices of his lolo or lola. His only decent feeding is during bed time!

I  try to rid him of distractions so he can continue breastfeeding. Here's what i do:

• I dim the lights in our room so he can focus on breastfeeding.


• I close the door to avoid outside noise so he continues feeding


• I turn down the tv or radio volume so he's less distracted

Here are more tips to deal with a distracted baby.

It’s now getting harder to find time for a decent feeding session.

When he was still a newborn, he fed almost every 2 hours. Now i struggle to breastfeed even at 4 hour intervals! Since baby learned to sit upright (with support) and to stand with support. He seemed to be enjoying his new perspectives, he can't stay put and breastfeed for at least 10 minutes!

• I  try to breastfeed at least 6 times per day to ensure that he gets enough milk.  I let him nurse all he want in the morning, before i go to work and at night, when we're about to sleep.


• Just like any prodding mom, i offer him my breast on any chance i get. Sure, i feel hurt when he snobs them. But i still insist and hope that he sucks some more.


• I'm also exploring new breastfeeding positions to keep up with my now semi-mobile son.  I expect that my acrobatic moves will be put to test.

It's getting harder to squeeze in a pumping session while at work.

It's almost 5 months since i got back after my maternity leave and work has been more and more demanding! I was given special treatment as a new working mom. But after 5 months, i'm a less new working mom already. People have been less lenient in the office. More and more deadlines are given to me, like any other ordinary employee. As i  get more busy at work, it's getting harder to squeeze in a pumping session. Read this more for tips for working moms who breastfeed.

Expressing breast milk is important at this stage because baby directly breastfeeds less. Pumping will help maintain your breast milk production so never miss a chance to pump when you can't directly breastfeed.

• When i'm really too busy, i just pump for 10 minutes instead of the usual 15 minutes per session. Frequent short pumping sessions are better than just one long pumping session.


• There are times when i do work outside the office and get back later in the day. I bring an extra manual pump and a cooler bag during these days just in case it's too late and my breasts feel engorged while out of the office. So far, i'm still not able to pump outside the office.


• I squeeze one more pumping session when i get back from work if baby's sleeping.  Eight months on and my mantra's still the same - pump, pump, pump!!!

Since I’m away for about 8 to 10 hours daily, I’m not sure anymore if baby is  dutifully offered breast milk.

My MIL is overly excited to introduce many types of food for baby. I really get paranoid and i hope she delays giving baby meats, eggs and citrus fruits. I  plan to give such foods later, may be in 10 months, so we can reduce risks of an upset stomach. Delaying such food will also allow time to ready baby's stomach for more complex foods.  I've also noticed that his expressed breast milk intake dwindled. From the usual 16 ounces, he just drank  about 10 - 12 ounces while i'm at work!

• What i do to lessen overfeeding of solid baby food is to "ration" his baby food. I just bring out 2 small jars of baby food for baby to consume while i'm away. I put these jars with the 4 baby bottles for his consumption while i'm at work.


• I also give clear instructions that only the food i prepared shall be given to baby. And i pray that these clear instructions are followed by the caregiver, hopefully.

Introduction of complementary food 

This is the main culprit why baby gets less milk.  From the wording itself, baby food is  complementary food! I just want to point out even more, baby food at 6 months is meant to complement breast milk. Kelly Mom says that breast milk should be the main source of nutrition until 1 year.

I'm not undermining the benefits of baby food. Baby food is vital so that he can get nutrients like protein. Introducing  baby food will also ensure that  he'll get used to different tastes and texture of foods.

My pediatrician already warned that baby's breast milk intake will decrease once solid foods are introduced. So here's what i do to ensure he's getting adequate amounts of breast milk:

• I nurse him before i give him solids. This ways he'll be less hungry and be satisfied with just 3 to 4 spoonfuls of solids.


• I limit the amount of  baby food, just 3 to 4 tablespoons per feeding. I serve  solids 3 times a day. I plan to increase to 4 times by 10 months.


• I let him drink 1 ounce of expressed breast milk from the cup after feeding solids. This also serves as his practice sipping from a cup.


• I use breast milk to dilute his baby food, which includes pureed fruits and veggies and infant cereals.


• I also serve frozen breast milk in a mesh feeder. Baby enjoys munching on a feeder because it relieves his itchy gums.

I'm committed to breastfeed until at least two years, so i'm intently researching on ways how i can deal with these struggles.  I really to hope to get through these breastfeeding blunders.

Click here to read about breastfeeding beyond one year!

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Keeping your Breast Milk Stash Safe during Brownouts

Rains have been pouring hard in the Metro and nearby provinces in the last few days. I'm reminded on the colossal floods caused by Ondoy in September 2009.

On a weather like these, I get worried a lot, especially when brown out strikes! Now that i'm a mom, i have one more reason to be wary about brownouts. I’m afraid my breast milk stash in the ref might spoil.  I remember during Typhoon Milenyo in 2006, power outage in our place lasted for almost one week!

Breast milk is not sterile, it’s full of good bacteria. Spoilage is imminent so handling and storing breast milk calls for extra care. Be on guard, otherwise, you may end up losing your supply of precious gold!

[caption id="attachment_292" align="aligncenter" width="300"] My Refrigerated Milk Stash[/caption]

[caption id="attachment_293" align="aligncenter" width="300"] Frozen EBM[/caption]

Here are some tips on keeping your expressed breast milk safe during times like this.

• First and foremost, manage your breast milk efficiently. Only freeze breast milk that you won't be using in the next 7 days. Breast milk is easier to manage when it's refrigerated. Frozen milk will have to be consumed within 24 hours once it's thawed.  Refrigerated milk can last for 5 to 8 days. For more tips about freezing breast milk, read this.


• Keep the freezer door closed. Opening the door frequently will  only let the cold air out, raising the temperature inside the freezer. Open freezer only when absolutely necessary.


• Consider transferring refrigerated milk to the freezer, where it’s colder.


• If breast milk hasn't completely thawed (if there are still some frozen blocks or crystals),  I can still refreeze.  Locally, there's not much literature on refreezing breast milk.  The Breastfeeding Coalition of Washington  conclude that refreezing EBM with ice crystals is ok. M'ann Oblea of Baby Mama,  also says that as long as it has a frozen core, it's ok to refreeze breast milk.


• Don’t refreeze breast milk that has completely melted. Thawed breast milk is good in the refrigerator for 24 hours. At room temperature, it will  keep for about 4 hours.


• Contact Meralco for brownout schedule in your area. This may give you an idea on just how long the power outage will last and whether you'll need extraordinary means to keep you milk frozen.

If unfortunately, your entire breast milk stash completely thaws, consider sharing you milk. It’s better than wasting you breast milk by letting it spoil!

• Donate to milk banks. I donate breast milk to the Philippine Children’s Medical Center. Contact Ms. Rose of Milk Bank at 9266601. PCMC is located Quezon Avenue corner Agham Road,  Quezon City. PCMC has the equipment to pasteurize breast milk for their baby patients.


• Contact Human Milk for Human Babies – Philippines on Facebook which is a platform for those looking for and sharing their breast milk.


• Share thawed breast milk to your friends and co-workers who are also  breastfeeding.

Add thawed breast milk  to baby food. This is better than using water to thin out pureed veggies and fruits to feed your baby.

Always check the smell and taste of thawed breast milk before giving to baby. Discard  milk that smells foul or sour.

If you are a breastfeeding mom affected by the floods, here are some reminders:

• According to Unicef, direct breastfeeding is the best way to feed your infant especially during disasters. With direct breastfeeding, there’s low risk for contamination which is common in disaster situations.  There’s no sure supply of  potable water during emergency situations.


• Breast milk will provide your baby protection against diseases like diarrhea and respiratory infection, which is common during the rainy season.


• Stress will only slow you’re milk production so try (hard as it is) to be calm. Breastfeeding will release hormones that can lower your stress levels.


• Find a quiet private place where you can directly breastfeed.

Good luck moms and stay safe!

Also worth reading:

• Breast milk storage tips from a working mama


• A working mom's guide on thawing and serving breast milk

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Alarming Facts about Breastfeeding in the Philippines

August is Breastfeeding Month!

I would like to highlight some alarming facts about breastfeeding in our country. Statistics mentioned here are from 2008 National Demographic Health Survey by the National Statistics Office.

[caption id="attachment_251" align="aligncenter" width="256"] Source of Photo: Unicef[/caption]

Average duration of exclusive breastfeeding is only 21 days! 

[caption id="attachment_2568" align="aligncenter" width="268"] Source: NDHS, 2008[/caption]

This means that on the  average, Filipino babies are fed with breast milk alone for just 3 weeks! From day 22 onward,  most moms needed to supplement with formula or water. This is alarming because baby’s first few weeks are crucial in establishing breastfeeding. Breast milk alone is sufficient until 6 months.

I’ve encountered moms who stopped breastfeeding early on. Here are some of the reasons why they stopped:

•  She thinks she doesn't have enough milk


•  She said her milk came in late


•  She said she had to work

To take on the breastfeeding challenge, moms need to toughen up! The first weeks of breastfeeding will be a test of your patience and determination.

My sister was reduced to tears at times when no milk came out. This was at the first 2 weeks postpartum. She panicked and pleaded my parents to let her give formula to baby. Thankfully, they resisted and now she's continuing to breastfeed. If this happens, just stand back for a while and relax. Moms need to get through the agony of doubting if she can produce enough milk for baby. But I dare say that formula should be the last option.

While sharing the a hospital room with a mom who had just delivered and just started to breastfeed, we heard a lot of screams and shrieks from the newborn. After about a whole day of baby’s crying while attempting to latch, the MIL seemed worried and summoned a relative to buy formula.  She thought giving formula would suffice baby’s hunger. True enough, baby stopped crying as he happily downed a bottle. But this does not solve the “learning to latch problem”. I think crying is just a phase. Resist the urge to supplement with formula early on. The key to producing milk is to empty breasts regularly. You won’t be able to do this if you add formula to the equation.

When you’re just starting to breastfeeding, it’s normal for baby (and you ,too) to cry because both of you are still learning. Crying is baby’s only way to say what she’s feeling so best to decode her cries first before deciding that you breast milk is not enough. Check if your posture and latch position are correct. Put hot compress on your breast before latching to encourage milk production.

Before offering any formula to baby, make sure to check with your pedia.  Here are some clues to check if baby's getting enough breast milk:

• if he's gaining weight (it's normal for newborns to shed some weight in the first week as he excretes black waste called meconium)


• if he wets more than 6 diapers in 24 hours


• if he seems satisfied after a feed (to the point of sleeping)

Only one of three babies under 6 months are exclusively breastfed

[caption id="attachment_2569" align="aligncenter" width="300"] Source: NDHS, 2008[/caption]

Breast milk alone has enough nutrients to cover baby’s needs. Read this if you want to know more about the benefits of breastfeeding both for baby and mom. Both Unicef and World Health Organization recommend 6 months of exclusive breastfeeding for optimal growth and health of the baby.

Introducing formula can sabotage your breastfeeding plans. At the early stage it's normal that you produce just a few mL.  Always take note that the amount milk you produced is enough to suffice your baby's need. At just days old,  your baby's stomach is as large as a cherry, so you produce that much milk.  Don't be pressured if you don't see milk oozing out at this this stage.  Focus on learning to latch and soon enough, you'll see satisfaction as your baby begins to swallow your breast milk.

Don’t be misinformed about formula. Check the can of every formula. It's indicated there that "Breast milk is best for babies!"

College graduates are less likely to breastfeed than other moms with lower educational attainment. 

[caption id="attachment_2570" align="aligncenter" width="300"] Source: NDHS, 2008[/caption]

Breastfeeding rate drops as educational level rises. Yes, there’s an opposite relationship between breastfeeding and mom’s education. I guess this may be related to moms’ career. Most moms need to go back to work after a month or so after having a baby so they opt to stop breastfeeding.

Again I’d like to remind moms that breastfeeding while working is possible! Here’s my previous blog post about pumping at work.  Your commitment to breastfeed will be tested during this time. Except some adjustment as you squeeze in pumping in your busy schedule. But keep in mind that you're extracting the best milk there is for your little one. That should be motivation enough for you!!

Pump at work, it’s your right!  Read the Expanded Breastfeeding Promotion Act  so you know your rights.  The internet has been abuzz recently about the proposed revisions of the Milk Code. One of my beef regarding the revisions is the changes regarding lactation period. What's previously paid lactation period is now being proposed to be unpaid.  Imagine how hard it will be for pumping moms if such revisions are passed!

Babies from poor households are more likely to be breastfed than babies from richer households 

[caption id="attachment_2571" align="aligncenter" width="265"] Source: NDHS, 2008[/caption]

I'm glad about this fact! This means that the poor won’t need to spend on formula milk. I hope more and more poor families opt to breastfeed. I do hope the richer population realize that breast milk is superior to formula. No pricey formula can bump off the benefits breastfeeding brings.

The biggest purchase, if a mom decides to breastfeed is a breast pump, which could be worth  at least P5,000 depending on the model. But in the long run, breastfeeding is still more economical than opting to regularly buy formula.  I  checked out formula milk prices from several stores. A big can of formula costs about P1,500, depending on the brand.  According to Unicef, the minimum cost of formula feeding an infant per month is P2000!

Mothers who delivered baby in hospitals are less likely to breastfeed than those who delivered at  home. Those assisted by health personnel are less likely to breastfeed than those assisted by a hilot. 

[caption id="attachment_2573" align="aligncenter" width="300"] Source: NDHS 2008[/caption]

This mirrors the sad state of most of our hospitals. Most of our hospitals are  not breastfeeding-friendly. I do hope government programs like the Unang Yakap, improve the breastfeeding policies of hospitals (public, at least).

Always assert baby’s right to be given breast milk. Hospitals should accommodate breastfeeding moms.  I was disappointed at the hospital where my sis gave birth. The nurses turned down my expressed breast milk for my nephew. At that time he had to be bottlefed in the NICU.  The nurses said there's no more space in their freezer. What? Why don't they have a freezer that's big enough to accommodate donated milk? Oh well, i'm just sharing my frustration.

Look for breastfeeding - friendly ob and pedia who will guide you in the first steps to establish breastfeeding.  Let them know of your intention to latch right away after baby's birth. This will hasten milk production.

Inform your pedia that you intend to breastfeed you baby. I've noticed that some pedia are keen on recommending formula to their newborn patients.  Here are some guidelines when looking for a breastfeeding-friendly pediatrician. Read up of breastfeeding so you can be informed.

•  Know that the decision on what to feed baby belongs to you.

The facts mentioned above call for vigilance from breastfeeding moms and their families. More so now that proposals to jeopardize the very law that protect the rights of breastfeeding moms.  Atty. Jenny Ong of Chronicles of a Nursing Mom gave a comprehensive primer on the bills pending in congress that will spread (mis)information about formula and make breastfeeding harder for working moms.

Ever since i started breastfeeding, it's been my goal to encourage fellow moms to try it as well. I also believe that breastfed babies make healthy children and healthy children make good citizens.

Kudos to all breastfeeding moms!!!

Also worth reading:

• Is your pediatrician breastfeeding friendly?


• For breast milk givers and takers