Wednesday 31 August 2011

My Breastfeeding Success Story

On this breastfeeding month of August, I decided to sit down and write these 5 salient points that made my breastfeeding a success. 

Belief that breastfeeding is the most natural thing in the world.

I personally believe that if the woman’s reproductive system can conceive and give birth, so can breasts produce milk.  It is the most natural thing in the world. It makes total sense too.  Nature provides mother’s milk for the baby to survive earthbound.  This is how man survived thousands and thousands of years.

As early as fourth month into pregnancy, colostrum is already produced.  From the start and all throughout gestation, breasts will enlarge, areolas darken and nipples become more erect to prepare for breastfeeding.  It will start to produce milk when hormonal changes signal the onset of labor, birth and delivery of placenta.  In fact, these internal signals are so well coordinated that if the baby is born prematurely, the mother produces milk with higher fat content to meet the baby’s special nutritional needs.  A mother’s body is indeed designed for breastfeeding.

Knowing more is succeeding more.

Knowing what to expect is key.  My milk only came out steadily on the 4th day but I did not panic.  I knew that for the first few days, only colostrum will come out but this is ok since babies are actually born with enough nutrients to sustain themselves for a few days and that they need the rest more from the trauma of birth.  Milk will slowly build up as the baby continues to suck and stimulate the production.  I expected to experience painful engorged breasts somewhere on the 4th day or so and knew that swollenness will be abated with cold cabbage and by massaging, latching and pumping.  I would have no idea how much milk the baby is getting so I counted her pee output – at least 4-6 wet diapers on the baby’s fourth day after birth and so on.  The more you know, the more you trust yourself.

I did miss out on one very important information, however, and it makes a rather funny story to share.  On our first night with baby Ava, the nurse kept waking us up every 2-3 hours to make sure the baby latched on.  I exclaimed indignantly to my husband, “Why does she keep on pestering us?!  Didn’t she know that we gave birth just a few hours ago and that we need our rest?!”.  To my great surprise and chagrin, I never knew that I had to breastfeed the baby every 2-3 hours nonstop - for months! 

Commitment or “can-do” attitude.

Knowledge on breastfeeding is apparently not enough.  I read an article sometime ago about qualities that company bosses are looking for when hiring a prospective employee.  Extensive knowledge and experience of course are essential but what sets someone apart is the “can-do” disposition.   It spells a huge difference when pressure and stress set in.  It means pursuing and excelling when the going gets tough.

In breastfeeding, two main challenges moms usually face are -  not getting enough rest and being so busy and stressed at work.  This results to lower milk output and has been the scapegoat for moms’ decision to stop breastfeeding.  I would know.  As an architect, most meetings happen outside the office and even at construction sites!  This means lugging my heavy dual pump, 8-pack battery adaptor and ice cooler bag with me.  In the middle of a meeting or site inspection, I find myself leaking and have to search for an extra room, most likely a storage room (I refuse to express in the toilet!) and would pump as fast as I could (turning the knob at high speed and strength – poor breasts I know!) while shoving a bread down my throat as I would be starving at the same time.

You get the picture.  It takes commitment.  There were plenty of times I would pump for a good 15 minutes and only 2oz. came out.  But I never got discouraged.  It only meant baby Ava needed to latch more and I needed to pump longer.  Of course, drinking more water and sipping more soup helped, too.

Support of husband and family makes all the difference.

Ask any breastfeeding mom and she will tell you that she could have not done it without the support of her husband or family. My sister breastfed her first for three years and still breastfeeding her second one for three years and running.   Through her, my husband and I got very well acquainted with the tremendous benefits breastfeeding offers as well as the challenges it poses. Also, I remember my sister-in-law who hand-carried my heavy breast pump all the way from US to Philippines and finally to Singapore when they came to visit. We are indeed lucky to have both families’ support.

A husband who believes that breast is best is most beneficial as there could be moments fatigue gets the better of you.  For me, I am very grateful that Alfred would take two night feedings (using my expressed milk) so I could sleep longer.   He also made sure I get to have my “me” time by spending plenty of bonding time with baby Ava.  The fact that he is also proud we exclusive breastfed our baby (stopped after 13 months, doctor’s advice after I got pregnant with our second) is an added inspiration that kept me going.

Natural birth = Alert Baby = Early Latch

I initially thought that my easy success with breastfeeding was all because of my knowledge, preparation and commitment.  Unbeknownst to me, I later realized that the effortlessness of it was also because of my decision to give drug-free natural birth.

Judith Lothian, a childbirth educator in Brooklyn, New York, and a member of Lamaze International Board of Directors believes that:

 Normal, natural birth sets the stage for problem-free breastfeeding—what nature intended—while a complicated, intervention-intensive labor and birth set the stage for problems”.

This rang true to what I have experienced.  Since both Ava and me were very alert when she came out, she was able to latch successfully from the moment she came out.  Probably high from endorphins and oxytocin, I also had all the energy to carry and keep her close to me.  Indeed, I was walking by myself to the loo after giving birth!  It reminded me of Scarlett O’Hara from the novel “Gone with the Wind” when she said something like “I could give birth in the morning and go out for a tea in the afternoon”.

I strongly feel that when you do things as natural as it can be (sounds like Taoism), it is just as less complicated. No rocket science there.   


Monday 22 August 2011

Featuring The POD: Prenatal Yoga Class

Going home to my hometown Davao City always means one thing – gaining extra weight! Moreover that I am pregnant, the license to pig out has never been so much fun!

On hindsight, it did worry me to gain almost 5 kilos for just a week and a half stay.  The last thing you want for a drug-free natural birth is an oversized baby!  That’s why I was elated when I found out about the opening of The POD at Plaza del Carmen, Barrio Obrero, which offers prenatal yoga classes.

A cozy place that instantly puts you at ease
Class size is small so ample attention is given for proper yoga poses

According to doctors, when paired with a cardiovascular exercise such as walking, yoga can be an ideal way to stay in shape during pregnancy.  This ancient practice keeps the body limber, tones the muscles and improves balance and circulation, with almost no impact on the joints.  More significantly, yoga helps to practice deep breathing and relaxation, which prepares the body on the physical demands of labor, birth and motherhood.

So I eagerly tried it out and had a blast! What makes it more enjoyable is that the yoga teacher, Alex Hao, a dear friend of my sister who shares a breastfeeding advocacy group Mommysense, is already an acquaintance of mine.  She is the classic sanguine, who loves being around people and is just full of energy.  Here, she shares some of her thoughts on pre-natal yoga, natural birth, and motherhood.

Christine: How did you get into prenatal yoga? What caught your interest?

Alex: I have been teaching childbirth class since 2004 and prenatal yoga is an excellent and complimentary thing to do.  Childbirth class has less exercise than a prenatal yoga class. Prenatal Yoga has no lectures, its just mom and baby together with other moms and babies. I enrolled in Prenatal Yoga teacher training with Dr Jean Byrne thru Yoga in Asia in Singapore last December. I saw the course a year earlier and saved up for it.

Christine: How does prenatal yoga helps mothers-to-be in childbirth? What are the benefits?

Alex: By spending time moving from one pose or asana to the next, moms get to feel how the body works and compensate. Holding some of the poses in prenatal yoga is like riding through a contraction. Also, chanting OM at the end of class is a great way for mom to hear herself in a deep relaxing sound that can be most useful in labor - specially for young moms who have watched a lot of screaming birth scenes in TV shows or movies. And working with one’s breathing calms most moms. I can see that a lot moms start the class breathing faster than at the end of class. Also, since prenatal yoga is an all women class there's less inhibition in the group.

Christine: The POD offers not just prenatal yoga but childbirth and Lamaze classes too. Tell us more about it.
Alex: I don't like to call the classes Lamaze as the class is not Lamaze Certified. I am a Lamaze international member but I am not Lamaze certified. I just call it childbirth preparation class. We discuss the 6 healthy Birth Practices of Lamaze International and the Department of Health Protocol "Unang Yakap", along with breastfeeding. And individually, moms ought to answer the question “what do I want - really really want”? It does not have to be a practical answer, just what she wants.

Christine: Did you give natural birth to all your four beautiful kids? If so, what made you commit to it?

Alex: Yes, I gave birth naturally to my 4 children with my partner by my side. My original plan back in 1997 was to give birth via Cesarean Section as the thought of going through labor alone was too scary and inhumane for me. But my OBGYN wouldn't do a c-section with out any complication. She said I was young and fit so she referred me to a Childbirth Educator, Gamay Dacanay. And so my husband and I attended her class. I've been an advocate ever since, telling strangers in the grocery to go and attend the class, and all my friends, and friends of friends. It was a beautiful birth. Looking back, my first birth could be improved, but that’s the thing with birth it only happens once. I am most grateful for my birth experiences though. I am so happy for my family.

Christine: Lastly, I know plenty of friends who cringe at the thought of giving birth drug-free. Why do you think natural birth is not a popular choice nowadays?

Alex: Here in Davao, there could be a chance that we have more drug-free births than in Singapore. I think this is mainly due to the fact that drugs have cost. Some moms come to class declaring that they will definitely need an epidural or can't imagine not having an epidural but end up not having any. This could be a matter of orientation or fear, or the mom is just unaware of the benefits of natural birth. I think the following plays a part in moms having sedatives or epidural: the length of labor, her mobility and the support she gets in her birthplace. A woman in labor is not in a position to defend what she wants, even with the fact that she has thought of and identified what she wants beforehand. The ideal situation is that she be allowed to go through labor and be encouraged to cope naturally without a fight. And this is where the rules and restrictions of her attendants or doctor and birthplace come to spell or spoil the birth experience. I do not know for sure why women would choose a medicated birth as oppose to a natural birth (I am sure the reasons will be as varied as the women) but when I was pregnant with my first I was scared to go through labor alone (my mom, aunts, cousins- gave birth alone). I'd rather have a major abdominal surgery back then. So in my case, I was sure I can't go through labor alone, more so natural birth because of fear plus it could be too much of a fight with an invisible opponent and the possibility of an inattentive birth attendant and all the other what ifs I could imagine.

The POD is located at Door 4 Plaza del Carmen Loyola Street Obrero, Davao City. Opening Time is 1:30pm to 6:30pm, Monday-Saturday.  Contact Number is (+6382)3022737.

Could not resist buying this wooden roller that works wonders on your feet

Tuesday 16 August 2011

Let My Baby Decide Part 2

So now that baby Ava and I initiated labor, you would think I was free from the gnawing claws of medical intervention.  So I thought too until recently when I read more about induced labor and concluded otherwise. 

For being a first time mom then, I was inexperienced not to have spent enough time discussing my birth plan with my doctor.  I just basically informed her that I wanted a natural birth without epidural and was not keen on I.V. drip as this would prevent me from moving around, except of course when medically necessary.  That’s it!  Short and straightforward.  I mean, I already felt ‘ahead of the game’ considering friends I knew never had any birth plan!  Right?!

WRONG. You would be surprised at how some doctors nowadays render birth as an illness requiring medical treatment.  The sooner the baby is out, the better.  In fact, the latest study done in 2005, published in the British Medical Journal, showed that homebirth with a CPM (Certified Professional Midwife) to be as safe as hospital birth (if not even safer!). The intervention rates will be a tenth to a half of what they would be in hospital.  It also showed a high satisfaction rate for mothers. 

In my preceding article, I noted that I was having regular contractions that grew stronger and stronger at five in the morning.  By noon, the interval got closer at approximately five minutes apart and so we decided to head to the hospital - only to find out that I have just dilated 2cm.  An hour passed with another cm of dilation.  As a general rule of thumb, the cervix takes approximately 1 cm every hour to dilate.  Now dilated at 3cm, everything is supposedly going as planned.  Unfortunately, my doctor thought it too slow.  Lest she would not have told me, “this is to make your labor faster” just as she inserted a thin hook to burst my water bag.

Medically termed as Artificial Rupture of Membrane (AROM) or known as Amniotomy, it is another method of inducing labor.  It is believed to speed up labor as the rupturing of membrane increases the production of hormone prostaglandin, which then causes to speed up contractions.  But at what price to pay?  The moment she broke my water bag, I was a ticking time bomb with 24 hours or less to deliver the baby (24 hours may seem a lot but some mothers dilate at 3cm for days or even weeks!). With no amniotic fluid to protect the baby, this is more prone to infection. 

I strongly feel AROM defeats the very purpose of speeding up labor in a natural birth.  I can personally speak from experience. Here lies the BASIC PROBLEM, with stronger contractions come stronger pain.  I did not have any epidural and now I am strapped with a contraction and fetal monitor, which prevented me from freely moving around. The pain was so intense, to the point I could barely breathe and was on the verge of passing out. Through clenched teeth, I was too uptight and confined to bed - just the right concoction for prolonging labor.  

According to World Health Organization (WHO) on BIRTH IS NOT AN ILLNESS: A Fortelesa Declaration, “Artificial early rupture of the membranes, as a routine process, is not scientifically justified.” Furthermore, “Birth should not be induced for convenience, and the induction of labour should be reserved for specific medical indications. No geographic region should have rates of induced labour over 10%.”

Several hours have passed with almost no progress.  Now, the doctor decided to insert I.V. drip on what I surmise was to give me extra energy and to “prepare” for further induction of   pitocin (artificial oxytocin) and God forbid resort to caesarean section if need be.  That brought me back from my delirium.  I want neither of those.  With utmost resolve, I concentrated on riding the waves and visualizing my baby in my arms – safe and sound.  At exactly 8:55pm, the commitment became a reality.

I share the sentiment with Gloria Lemay, a birth attendant who strongly advocates natural birth:

“Attending births is like growing roses. You have to marvel at the ones that just open up and bloom at the first kiss of the sun but you wouldn't dream of pulling open the petals of the tightly closed buds and forcing them to blossom to your time line."

Monday 8 August 2011

Let My Baby Decide

“Hmmm” the doctor’s nurse mumbles with creases on her forehead, “the contraction is irregular and weak”.  In other words - no imminent sign of labor.  I asked the more important question, “the baby is ok, right?” to which she confirmed baby’s heart rate is normal.  That is all that matters.

Two days before my expected date of delivery (EDD) with baby Ava, I was on my last scheduled check-up at the doctor’s clinic with a contraction and fetal heart monitor strapped around my abdomen.  With the printed graphs on hand, the nurse ushered me to the doctor’s office for the ultrasound.  After all the necessary checks, the doctor informed me everything is fine but if the baby still does not come out three days after the EDD, she may proceed with induction of labor.

The word induction rang an alarming sound in my head.  I have read so much about it and it does not spell g-o-o-d.  The major concern is premature birth even if believed the baby is term.  Other risks include fetal distress, placental abruption and uterine rupture.  For someone like me who would like to go for natural birth, it goes against nature’s way of allowing the baby and mom to initiate labor.  If labor is artificially started, it means longer labor and stronger pain.  An onset of interventions is performed (e.g. I.V. drip for pitocin, fetal monitor, epidural for intense pain) which could ultimately end up in a caesarean section.

I told my doctor that three days is too soon.  I was prepared to wait for another 2 weeks, so long the baby and I continue to do fine.  That means I was not suffering from any blood pressure, diabetes or any maternal illness and that the baby does not have an abnormal heart rate pattern or that the amniotic fluid level and placenta continue to provide a healthy living environment for my baby.

That night when everything was quiet, I reassured baby Ava that I will not allow the doctor to force her out if she is not ready.  If she is still comfortable inside, so be it.  She might need the extra time to make her lungs stronger or maybe to develop any other organs more fully.  When it is the right time, she will let me know.  Mommy can wait.

In fact, it is only right that we take the time to wait and not to rely on numbers alone.  To begin with, EDD speaks rightfully of the acronym it stands for – ESTIMATED date of delivery.  It is an estimate counting 40 weeks from the first day of the last menstrual period (which we know can be irregular too).  According to Dr H. Kieler, O. Axelsson, S. Nilsson, U. Waldenstrรถ in Ultrasound in Obstetrics & Gynecology, there is a standard deviation of 8-9 days surrounding due dates calculated with even the most accurate methods. This means that fewer than 5% of births occur at exactly 40 weeks; 50% of births are within a week of this duration, and about 80% are within 2 weeks.

Sometimes I wonder if this propensity for deadlines is born from our modern culture of fast-paced, highly scheduled lifestyle (at least in urban cities anyway).  We want to be in full control that a “wait and see” approach somehow makes us uncomfortable.   Unfortunately, expecting a birth at an estimated due date becomes just one of many.  The increasing incidence of social induction and elective caesarean is a testament to that.  These procedures are not medically necessary but rather arise from the convenience of the parents or doctor’s schedule (including that of the hospital) or for the sake of an auspicious birth date. Sadly, it is at the expense of the baby who is more likely to have medical problems compared to babies who initiated labor and delivered at full term (up to 42 weeks).  

Luckily, I was spared from the time-pressure of induced labor.  Two days after the checkup, at 5am in the morning, I was having regular contractions that grew stronger and stronger. I knew baby Ava was ready to come out.  She probably heard the doctor and got scared of the 3-day deadline, or maybe she just listened to Mommy’s gentle coaxing =)

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