Ai Pei Sheah


Sunday, April 13, 2008

Breastfeeding—Starting Out Right

I am experienced a lot of problem during my bf. It most due to lack of bf information and misleading by old generation people. They also know nothing much about bf and thought bf is troublesome. I am glad i still continued bf after I read the information that i have. The information enable me to understand some myths about bf and resolved the problems that i face during my bf. I really like to share out these info so that new mother would not suffer like me and try to give the best to your bb. Please do not step back whenever you have problem with bf. The vast majority of mothers are perfectly capable of breastfeeding their babies exclusively for about six months. In fact, most mothers produce more than enough milk. Unfortunately, outdated hospital routines based on bottle feeding still predominate in too many health care institutions and make breastfeeding difficult, even impossible, for too many mothers and babies. For breastfeeding to be well and properly established, a good start in the early few days can be crucial. Admittedly, even with a terrible start, many mothers and babies manage. The trick to breastfeeding is getting the baby to latch on well. A baby who latches on well, gets milk well. A baby who latches on poorly has more difficulty getting milk, especially if the supply is low. A poor latch is similar to giving a baby a bottle with a nipple hole that is too small—the bottle is full of milk, but the baby will not get much. When a baby is latching on poorly, he may also cause the mother nipple pain. And if he does not get milk well, he will usually stay on the breast for long periods, thus aggravating the pain. Unfortunately anyone can say that the baby is latched on well, even if he isn’t. Too many people who should know better just don’t know what a good latch is. Here are a few ways breastfeeding can be made easy:
1. A proper latch is crucial to success. This is the key to successful breastfeeding. Unfortunately, too many mothers are being "helped" by people who don’t know what a proper latch is. If you are being told your two day old’s latch is good despite your having very sore nipples, be sceptical, and ask for help from someone else who knows. Before you leave the hospital, you should be shown that your baby is latched on properly, and that he is actually getting milk from the breast and that you know how to know he is getting milk from the breast (open mouth wide—pause—close mouth type of suck). See also the website for videos on how to latch a baby on (as well as other videos). If you and the baby are leaving hospital not knowing this, get experienced help quickly (see handout When Latching). Some staff in the hospital will tell mothers that if the breastfeeding is painful, the latch is not good (usually true), so that the mother should take the baby off and latch him on again. This is not a good idea. The pain usually settles, and the latch should be fixed on the other side or at the next feeding. Taking the baby off the breast and latching him on again and again only multiplies the pain and the damage.
2. The baby should be at the breast immediately after birth. The vast majority of newborns can be at the breast within minutes of birth. Indeed, research has shown that, given the chance, many babies only minutes old will crawl up to the breast from the mother’s abdomen, latch on and start breastfeeding all by themselves. This process may take up to an hour or longer, but the mother and baby should be given this time together to start learning about each other. Babies who "self-attach" run into far fewer breastfeeding problems. This process does not take any effort on the mother’s part, and the excuse that it cannot be done because the mother is tired after labour is nonsense, pure and simple. Incidentally, studies have also shown that skin-to-skin contact between mothers and babies keeps the baby as warm as an incubator (see section on skin to skin contact). Incidentally, many babies do not latch on and breastfeeding during this time. Generally, this is not a problem, and there is no harm in waiting for the baby to start breastfeeding. The skin to skin contact is good for the baby and the mother even if the baby does not latch on.
3. The mother and baby should room in together. There is absolutely no medical reason for healthy mothers and babies to be separated from each other, even for short periods. • Health facilities that have routine separations of mothers and babies after birth are years behind the times, and the reasons for the separation often have to do with letting parents know who is in control (the hospital) and who is not (the parents). Often, bogus reasons are given for separations. One example is that the baby passed meconium before birth. A baby who passes meconium and is fine a few minutes after birth will be fine and does not need to be in an incubator for several hours’ "observation". • There is no evidence that mothers who are separated from their babies are better rested. On the contrary, they are more rested and less stressed when they are with their babies. Mothers and babies learn how to sleep in the same rhythm. Thus, when the baby starts waking for a feed, the mother is also starting to wake up naturally. This is not as tiring for the mother as being awakened from deep sleep, as she often is if the baby is elsewhere when he wakes up. If the mother is shown how to feed the baby while both are lying down side by side, the mother is better rested. • The baby shows long before he starts crying that he is ready to feed. His breathing may change, for example. Or he may start to stretch. The mother, being in light sleep, will awaken, her milk will start to flow and the calm baby will be content to nurse. A baby who has been crying for some time before being tried on the breast may refuse to take the breast even if he is ravenous. Mothers and babies should be encouraged to sleep side by side in hospital. This is a great way for mothers to rest while the baby nurses. Breastfeeding should be relaxing, not tiring.
4. Artificial nipples should not be given to the baby. There seems to be some controversy about whether "nipple confusion" exists. Babies will take whatever gives them a rapid flow of fluid and may refuse others that do not. Thus, in the first few days, when the mother is normally producing only a little milk (as nature intended), and the baby gets a bottle (as nature intended?) from which he gets rapid flow, the baby will tend to prefer the rapid flow method. You don’t have to be a rocket scientist to figure that one out, though many health professionals, who are supposed to be helping you, don’t seem to be able to manage it. Note, it is not the baby who is confused. Nipple confusion includes a range of problems, including the baby not taking the breast as well as he could and thus not getting milk well and/or the mother getting sore nipples. Just because a baby will "take both" does not mean that the bottle is not having a negative effect. Since there are now alternatives available if the baby needs to be supplemented (see handout #5, Using a Lactation Aid, and handout #8 Finger Feeding) why use an artificial nipple?
5. No restriction on length or frequency of breastfeedings. A baby who drinks well will not be on the breast for hours at a time. Thus, if he is, it is usually because he is not latching on well and not getting the milk that is available. Get help to fix the baby’s latch, and use compression to get the baby more milk (handout #15, Breast Compression). Compression works very well in the first few days to get the colostrum flowing well. This, not a pacifier, not a bottle, not taking the baby to the nursery, will help.
6. Supplements of water, sugar water, or formula are rarely needed. Most supplements could be avoided by getting the baby to take the breast properly and thus get the milk that is available. If you are being told you need to supplement without someone having observed you breastfeeding, ask for someone to help who knows what they are doing. There are rare indications for supplementation, but often supplements are suggested for the convenience of the hospital staff. If supplements are required, they should be given by lactation aid at the breast (see handout #5), not cup, finger feeding, syringe or bottle. The best supplement is your own colostrum. It can be mixed with 5% sugar water if you are not able to express much at first. Formula is hardly ever necessary in the first few days.
7. Free formula samples and formula company literature are not gifts. There is only one purpose for these "gifts" and that is to get you to use formula. It is very effective, and it is unethical marketing. If you get any from any health professional, you should be wondering about his/her knowledge of breastfeeding and his/her commitment to breastfeeding. "But I need formula because the baby is not getting enough!" Maybe, but, more likely, you weren’t given good help and the baby is simply not getting the milk that is available. Even if you need formula, nobody should be suggesting a particular brand and giving you free samples. Get good help. Formula samples are not help. Under some circumstances, it may be impossible to start breastfeeding early. However, most “medical reasons” (maternal medication, for example) are not true reasons for stopping or delaying breastfeeding, and you are getting misinformation. Get good help. Premature babies can start breastfeeding much, much earlier than they do in many health facilities. In fact, studies are now quite definite that it is less stressful for a premature baby to breastfeed than to bottle feed. Unfortunately, too many health professionals dealing with premature babies do not seem to be aware of this.

Saturday, April 12, 2008

A bad experience with Air Asia & Changi Airport

I just back from Singapore business trip last Thursday. My very terrible experience trip. I almost missed my flight back to Malaysia. It was the worst flight trip i ever had. I was a good supporter for AirAsia before as they always offered a competitive air fare and the service quite OK. I even proposed to company use it for business trip.

However, I totally disappointed with Air Asia after I came back from this trip. Their unprofessional customer service and impolite stewardesses brought me bad image to them. I think Tony should do something in order to maintain a reputable image of Air Asia.

During my departure to Singapore last Wednesday (9 April) at LCCT, I was queueing in front of senior citizen at the age of 60++yo, awaiting to load hand luggage onto X-ray machine. Two stewardesses & a sterwarder dressed AirAsia uniform came and cut queue.

First of all, I don't know whether they have priority and authority to do so. I could understand they need to arrive the flight earlier than us, but why they don't them come earlier and just queueing with us. Everybody was queueing and they could just simply cut queue.

OKlah, if they really need to cut queue, no problem, but please do it in polite way. I saw the AirAsia strewardress very rude to the pakcik in front of me. She showed her irritating face expression and said rudely to the old man: "Pakcik, minta laluan, kami kena masuk dulu!" Halo, is this the way to talk to senior citizen? Moreover, they were wearing AirAsia uniform and representing AirAsia. Is it the way a staff acting who working in customer service industry? What did Air Asia training to have this kind of staff? Terrible! terrible! terrible!Unfortunately, I do not have chance to see her name. If not, i surely will complain to AirAsia.

During my trip back to Malaysia on Thursday (10 April), my flight with AirAsia was departure on 2120hr. I reached Singapore Changi Airport by City train on 1945hr. FYI, there are four terminal inside Changi Airport. Terminal 1,2,3 and budget terminal.Different airline will departure at different terminal. You need to make sure which terminal to depart. City train will stop at terminal 2, then go by skytrain to terminal 1 & 3 while by free shuttle bus to Budget terminal. Since this is my first time taking AirAsia back from Singapore, I was not sure which terminal to go but my guess was budget terminal as it is low cost air fare.

Anyway, I reconfirmed with a custom officer during my way to bus station. I stopped
a customer officer and asked :"Should I go to budget terminal if I go by AirAsia flight?" then the officer told me with a confirmed voice and knocked her head so hard to reassure me :"YES!!"

When I was waiting at the bus station, I could see the signboard showed budget terminal only have tiger airway and another airline. I did not see AirAsia. I started to wonder if i was wrong? But due to the assurance of the custom officer, I choosed to believe her.

I fount i was wrong when i reached budget terminal. Shit! i need to take bus again to terminal 2!! I started worry if I might missed my flight. I quickly go back to terminal 2. Alamak! I need to wait skytrain again to go to terminal 1. Anyway, I managed to reach AirAsia Check in counter 2040hr.

Here came the story about AirAsia again. First thing was wrong is the display monitor did not showed which counter to check in Kuala Lumpur. There was 3 counter opened when I was there. I asked one of counter lady clearly : "Excuse me, which counter to check in Kuala Lumpur?" The indian lady told me firmly: "Kuala Lumpur? All these three counter also can!"

Since i saw only three people queueing in front of her counter, so i just queueing behind them. Then, I could show this lady unfamiliar check in the customer. I could see our next queue finished three customer but she not even finished one. I anxiously watching my watch and the gate almost closing.

Finally, it until my turn. I passed her my passport and she using "one finger" to type my name on laptop. Then, she said" oh! madam, you cannot check in Kuala Lumpur in this counter, you need to go to the last counter." I was so angry as i already wait more than ten minute and then she couldn't check in. I scored her and she just asked to go the next counter.

When i went to the counter, the staff told me:"Sorry mdm, KL counter just closed on 2055hr, you can't check in." I repeated again to tell her about their staff fault. So, she tried to call back her colleague in charge which is only few meters away from counter. Anyway, that lady just refused to check me in without listening to my reason. So bad! Didn't they think a customer feeling if the customer was rejected to check in even that is not their fault. How poor is the customer unable to go on the flight? How is the customer have urgent matter awaiting? What is the "good" customer service provided by a big reputable AirAsia. Airlines business is customer service provider, who should to provide the best service to customer. Is this they should do to customer?

I was very angry and shouted to staff so that everyone queuing behind can hear me:" Your staff told wrong information. I waited there more than ten minutes, they told me cannot check in, now counter is closed.This is your staff fault and now you told me i should bare the responsible?"

She suggested to talk to another counter officer if he could solve for me. Then, she took me to that counter and explained my situation to that officer. Finally, the officer called the boarding gate PIC to let me check in. He also instructed the lady to guide me to boarding gate so that i could given priority to go through custom counter. Luckily, i able to make my flight, or else i slept at changi airport. I was so relief when i reached Malaysia. If not, my baby cried for missing mother.

Wednesday, April 09, 2008

Some Breastfeeding Myths

This is an article my hb got it online. It would be quite useful so that they could understand some breastfeeding myths.

1. Many women do not produce enough milk. Not true! The vast majority of women produce more than enough milk. Indeed, an overabundance of milk is common. Most babies that gain too slowly, or lose weight, do so not because the mother does not have enough milk, but because the baby does not get the milk that the mother has. The usual reason that the baby does not get the milk that is available is that he is poorly latched onto the breast. This is why it is so important that the mother be shown, on the first day, how to latch a baby on properly, by someone who knows what they are doing.

2. It is normal for breastfeeding to hurt. Not true! Though some tenderness during the first few days is relatively common, this should be a temporary situation that lasts only a few days and should never be so bad that the mother dreads nursing. Any pain that is more than mild is abnormal and is almost always due to the baby latching on poorly. Any nipple pain that is not getting better by day three or four or lasts beyond five or six days should not be ignored. A new onset of pain when things have been going well for a while may be due to a yeast infection of the nipples. Limiting feeding time does not prevent soreness. Taking the baby off the breast for the nipples to heal should be a last resort only. (See handout #3a Sore Nipples).

3. There is no (not enough) milk during the first three or four days after birth. Not true! It often seems like that because the baby is not latched on properly and therefore is unable to get the milk that is available. When there is not a lot of milk (as there is not, normally, in the first few days), the baby must be well latched on in order to get the milk. This accounts for "but he's been on the breast for 2 hours and is still hungry when I take him off". By not latching on well, the baby is unable to get the mother's first milk, called colostrum. Anyone who suggests you pump your milk to know how much colostrum there is, does not understand breastfeeding, and should be politely ignored. Once the mother's milk is abundant, a baby can latch on poorly and still may get plenty of milk.

4. A baby should be on the breast 20 (10, 15, 7.6) minutes on each side. Not true! However, a distinction needs to be made between "being on the breast" and "breastfeeding". If a baby is actually drinking for most of 15-20 minutes on the first side, he may not want to take the second side at all. If he drinks only a minute on the first side, and then nibbles or sleeps, and does the same on the other, no amount of time will be enough. The baby will breastfeed better and longer if he is latched on properly. He can also be helped to breastfeed longer if the mother compresses the breast to keep the flow of milk going, once he no longer swallows on his own (Handout #15 Breast Compression). Thus it is obvious that the rule of thumb that "the baby gets 90% of the milk in the breast in the first 10 minutes" is equally hopelessly wrong. To see how to know a baby is getting milk see the videos at

5. A breastfeeding baby needs extra water in hot weather. Not true! Breastmilk contains all the water a baby needs.

6. Breastfeeding babies need extra vitamin D.Not true! Everyone needs vitamin D. Formula has it added at the factory. But the baby is born with a liver full of vitamin D, and outside exposure allows the baby to get the vitamin D from ultraviolet light even in winter. The baby does not need a lot of outside exposure and does not need outside exposure every day. Vitamin D is a fat soluble vitamin and is stored in the body. In some circumstances (for example, if the mother herself was vitamin D deficient during the pregnancy) it may be prudent to supplement the baby with vitamin D. Exposing the baby to sunlight through a closed window does not work to get the baby more vitamin D.

7. A mother should wash her nipples each time before feeding the baby. Not true! Formula feeding requires careful attention to cleanliness because formula not only does not protect the baby against infection, but also is actually a good breeding ground for bacteria and can also be easily contaminated. On the other hand, breastmilk protects the baby against infection. Washing nipples before each feeding makes breastfeeding unnecessarily complicated and washes away protective oils from the nipple.

8. Pumping is a good way of knowing how much milk the mother has. Not true! How much milk can be pumped depends on many factors, including the mother's stress level. The baby who nurses well can get much more milk than his mother can pump. Pumping only tells you have much you can pump.

9. Breastmilk does not contain enough iron for the baby's needs. Not true! Breastmilk contains just enough iron for the baby's needs. If the baby is full term he will get enough iron from breastmilk to last him at least the first six months. Formulas contain too much iron, but this quantity may be necessary to ensure the baby absorbs enough to prevent iron deficiency. The iron in formula is poorly absorbed, and the baby poops out most of it. Generally, there is no need to add other foods to breastmilk before about 6 months of age.

10. It is easier to bottle feed than to breastfeed. Not true! Or, this should not be true. However, breastfeeding is made difficult because women often do not receive the help they should to get started properly. A poor start can indeed make breastfeeding difficult. But a poor start can also be overcome. Breastfeeding is often more difficult at first, due to a poor start, but usually becomes easier later.

11. Breastfeeding ties the mother down. Not true! But it depends how you look at it. A baby can be nursed anywhere, anytime, and thus breastfeeding is liberating for the mother. No need to drag around bottles or formula. No need to worry about where to warm up the milk. No need to worry about sterility. No need to worry about how your baby is, because he is with you.

12. There is no way to know how much breastmilk the baby is getting. Not true! There is no easy way to measure how much the baby is getting, but this does not mean that you cannot know if the baby is getting enough. The best way to know is that the baby actually drinks at the breast for several minutes at each feeding (open mouth wide—pause—close mouth type of suck). Other ways also help show that the baby is getting plenty (Handout #4 Is my Baby Getting Enough Milk?). See the videos at

13. Modern formulas are almost the same as breastmilk. Not true! The same claim was made in 1900 and before. Modern formulas are only superficially similar to breastmilk. Every correction of a deficiency in formulas is advertised as an advance. Fundamentally, formulas are inexact copies based on outdated and incomplete knowledge of what breastmilk is. Formulas contain no antibodies, no living cells, no enzymes, no hormones. They contain much more aluminum, manganese, cadmium, lead and iron than breastmilk. They contain significantly more protein than breastmilk. The proteins and fats are fundamentally different from those in breastmilk. Formulas do not vary from the beginning of the feed to the end of the feed, or from day 1 to day 7 to day 30, or from woman to woman, or from baby to baby. Your breastmilk is made as required to suit your baby. Formulas are made to suit every baby, and thus no baby. Formulas succeed only at making babies grow well, usually, but there is more to breastfeeding than nutrients.

14. If the mother has an infection she should stop breastfeeding. Not true! With very, very few exceptions, the mother’s continuing to breastfeed will actually protect the baby. By the time the mother has fever (or cough, vomiting, diarrhea, rash, etc) she has already given the baby the infection, since she has been infectious for several days before she even knew she was sick. The baby's best protection against getting the infection is for the mother to continue breastfeeding. If the baby does get sick, he will be less sick if the mother continues breastfeeding. Besides, maybe it was the baby who gave the infection to the mother, but the baby did not show signs of illness because he was breastfeeding. Also, breast infections, including breast abscess, though painful, are not reasons to stop breastfeeding. Indeed, the infection is likely to settle more quickly if the mother continues breastfeeding on the affected side. (Handouts #9a and b You Should Continue Breastfeeding).

15. If the baby has diarrhea or vomiting, the mother should stop breastfeeding. Not true! The best medicine for a baby's gut infection is breastfeeding. Stop other foods for a short time, but continue breastfeeding. Breastmilk is the only fluid your baby requires when he has diarrhea and/or vomiting, except under exceptional circumstances. The push to use "oral rehydrating solutions" is mainly a push by the formula manufacturers (who also make oral rehydrating solutions) to make even more money. The baby is comforted by the breastfeeding, and the mother is comforted by the baby's breastfeeding. (Handouts #9a and b You Should Continue Breastfeeding).

16. If the mother is taking medicine she should not breastfeed. Not true! There are very very few medicines that a mother cannot take safely while breastfeeding. A very small amount of most medicines appears in the milk, but usually in such small quantities that there is no concern. If a medicine is truly of concern, there are usually equally effective, alternative medicines that are safe. The risks of artificial feeding for both the mother and the baby must be taken into account when weighing if breastfeeding should be continued (Handouts #9a and b You Should Continue Breastfeeding).

Handout #11 Some Breastfeeding Myths. Revised January 2005
Written by Jack Newman, MD, FRCPC. © 2005

My Breastfeeding experience

Time pass fast. My bb, Aivan is 7+mth olds now. I fully breastfeed him till now. He is healthy, strong and free from illness.

Breastfeeding really brought a lot of advantages to my bb. Try to imagine he is only 2.5kg when he born, just like a kettle, so small and really like glassware, 'handle with care'. Now, he is approx. 8kg and everybody said he is strong and solid.

There are more advantages of breastfeeding which had been widely published and a lot of people well understand about it.However, I found a lot of my surrounding peoples such as friend, colleagues and relative not really support breastfeeding. None of them fully breastfeeding their baby. A lot of reasons given.

I recalled back my breastfeed experience. My initial intention is only fully breastfeed my son until 6 weeks then mix with powder when i started work. However, my hb insisted fully bf to provide the best to our bb. Bf really need to be determined or else you will gave up easily.

We facing a lot of problems when we wants to bf bb. My parents and family protested dramatically. They said I can't recovered and rest well if i need to bf bb. Not enough sleep due to bf bb throughout the night. Aivan have jaundice after 3 days his birth. Doctor recommended to bf him every three hour in order to recover. If the condition getting serious, he may need admitted to hospital. So, I need to wake him up every three hours. He is sleepy and refuse to get up due to jaundice, i almost took half to an hour just to wake him up. Try to imagine, i only slept about every 2-3 hours and wake up to bf him again. That is why i could understood my parents concern. I never told my parents about this.

My family also worried bb did not get enough milk supply like most of people. They thought bb not enough nutrient and will be weak. They called me everyday during confinement month to pressure me gave milk powder to bb. They tried to scare me if bb not well grow and not healthy.

I was so stress up during that time. Too many pressure from few parties. My parent wanted me to give up bf while my hb wanted to fully bf bb. On the other hand, my colleagues also advised me not fully bf bb. I also worried about bb healthy after too many negative stuff from friend and family due to lack bf information. Bf technique is an issue to me too. i could not bf to bb well due to incorrect technique. Very painful. My breast just like cut by knife every time i bf him.I have no support except my hb. I felt anxious during that time and cried a few time. I can say during confinement month is the period i cried most ever in my life.

I hope to share the information about bf next time. There are a lot of myths about bf make people step back. I experienced it and I would like to share it so that people would not suffer like me before.

I was glad i have a determined hb. He is the one always support and comfort me. Whenever, i worried about bf bb, he tried to search a lot information from website to convent me. I would not go so far till now without his support.