Hospital births and breastfeeding

Having a medicalized birth in a hospital can have long term impacts on the chances of exclusive breastfeeding. In this area I have to hand it to the Philippine Milk Code, their regulations in hospitals work really well, although in its present form the code is unnecessarily restrictive in other areas.

The Medical City adheres to some basic rules which are listed in the nursery. First, regardless of manner of delivery, the baby is put to the boob as soon as he is cleared by doctors, in our case under 2 minutes even if I had a c-section. Second, babies are not given any formula by hospital staff and all the staff we encountered encouraged breastfeeding. Third, rooming-in is encouraged by the floor staff, although it was discouraged by our OB. Rooming the baby with you as soon as possible I think is critical to bf success, that baby will want to be on your boob constantly, and scheduled visits to a nursery will derail this. Fourth, even when we pressed, our pedia never recommended a baby formula brand.

Most important, Medical City had midwives making rounds every couple of hours checking in on mom and baby. They are the de facto lactation consultants. Be prepared though, if you have never had a baby, you will be surprised at how midwives will just reach in there and pinch your nipple to get the baby to latch properly. At that moment you will realize, those are milkbags and no longer your property but your kid's. They taught me to use warm compresses to make the milk flow and made me feel better that the little droplets of colostrum I would get at every feeding is enough because the baby's stomach is only as big as a calamansi.

Digression: One warning about midwives in hospitals, they will teach you how to swaddle and bathe your baby, don't try to do those fancy moves at home! They have the most complicated expert ways of swaddling, very hard to replicate, find a simpler method or buy a swaddler. They bathe the baby with one hand while holding his entire body in the other, moving him from batya to batya, not safe if you're not an expert, stick to a little tub.

Sling, Wrap and Carry

From:http://www.hybridrastamama.com
/2011/04/babywearing-around-world.html

 My first piece of babywearing gear was a Baby Bjorn, bought online and shipped here from Amazon. It was around $60 and looked incredibly cool and hip with a babywearing dad on the box. I used this until the baby was too heavy for front carry. Then a pouch sling from an IndigoManila kiosk at the SM baby sale, really cheap. Finally a ring sling bought from Rustan's, Next9 brand. Reviews below:

1. Baby Bjorn. It's really cool and modern. Baby can face front and be completely entertained as you walk around. If the kid faces your chest he can sleep. The downside is that it's hot in there for the little man, the thick foamy cushion is wrapped around his entire torso down to his bottom. A serious consideration for us tropical dwellers. The thing is supposed to be good for until he is 25 pounds but once he hit 16 pounds we started throwing our backs from carrying him. This would last longer with slower growing babies, but our kid was 20 pounds by the time he was 6 months so the Bjorn was sent to storage earlier than anticipated. 

2. Pouch sling (P500 on sale). I kept this sling in the diaper bag all the time. It's not adjustable so only has the fabric you absolutely need to sling around your baby. Problem is, it's not adjustable. I bought the biggest size and since I'm a tad taller than the typical pinoy mom it was still about 4 inches too short for my taste. I could still use it, the baby was just higher up on my hip than I would prefer. Now that the baby is 7 months he has almost outgrown it. Since it was cheap I'd still recommend this, not as a primary carrier but as a backup to bring around with you.

3. Ring sling (P1000 at Rustan's Next9 brand). (*Update below) Ring slings are notorious for having a steep learning curve. The accompanying DVD helped with step-by-step instructions on the many ways you can carry a baby with a ring sling. I was afraid it would not feel secure because it is so easily adjustable, but it actually does, although at this point I wouldn't sling him to my back. There are more options for carry styles on this. The problem with the one I have is the fabric, I chose based on color, a color my husband wouldn't feel too undignified in (i.e. no pink teddy bears). Got the green one with little prints on it, but the fabric was way too thick and stiff for a ring sling! I had it laundered to try to make it softer, had it doused with fabric softener, but no dice. It was practically impossible to adjust while the baby is on, which is supposed to be a big advantage of the ring sling. It know it was the construction because I've seen a ring sling (a friend's) that works well, but I can't find that brand in Manila, I'd have to order it from Amazon. 

So far local brands have been disappointing, and i'm not likely to buy anymore as it feels like having 3 carriers is already too much and the baby is already 21 pounds. I might change my mind though since he is getting to that needy age of wanting to be carried all the time, and I don't have the arm strength for long periods of carry.

*Update on ring sling: The very nice proprietress of Next9 was so kind to send me a replacement ring sling (thank you!). Very thoughtful to send over a sling in a manly blue color as well. The fabric on this one is much thinner and it made a huge difference in terms of adjustability. So, if you do decide to buy a ringsling (the Next9 ones are the most widely available in Manila and online), pick the one with thin slippery fabric for ease of use. Those rings are very very sturdy so you'll find that it will still feel robust even if the fabric is thin. 

Stuff that Helped me Breastfeed

Ok so as I said before, I needed a lot of gadgets to help me get through all the challenges that nursing my tenacious little infant presented. Below is a list of the ones that helped the most and where I got them. 

1. Nipple shields. The ones I used often were Avent brand that my mother-in-law found at SM Megamall (around P800 for a pair). I’ve also seen them at the Hypermarket in libis and in Rustan’s. They were recommended by the midwife at the hospital when she noticed that baby J just couldn’t latch on properly. Frustrated and scared, I asked my mother-in-law to find me nipple shields so these were sort of an emergency purchase, no time to read reviews or comparison shop. Eventually I found a better kind, Medela brand available at Rustan’s (I think 1,200 a pair), but by then the baby wasn’t using them as much anymore. Take note that these things have sizes! I made the mistake of buying smalls and ended up never using them, buy the mediums to be safe.

I used these not so much to prevent soreness, they don’t do a good job of that, but to help baby latch. For latch these are great. You place them on top of the nipple and the baby’s suction will pull your nipple into the shield’s shape. For us the problem I think was that my nipples were flat and almost inverted, then the baby’s mouth was too small. So I credit these shields for my success in nursing, used them until he was about 3 months old. There are certainly downsides to these, including inefficient milk transfer (see kellymom for a full discussion), but women like me just cannot nurse without them. Just wean as soon as you are able, when baby is big enough to learn how to nurse without them.


For more see: Medela site on nipple shields

2. Breast shells. Great invention these things. Also used Avent brand since these were cheapest at Amazon when a friend was able to bring them home. I have seen them at SM stores as well for P1200, really expensive considering they were $12 on Amazon. When nipples get sore from friction with the baby’s tongue as he nurses, the pain sometimes gets worse when it then chafes against your bra or top. The shells protect your boobs from friction against clothing, giving them time to heal up and you some freedom to move around without pain. Put on some Lanolin (available at most baby sections in department stores and possibly Mercury Drug) after nursing then wear the shells.

3. Manual breast pump. I had an expensive brand electric pump which I used at home, a Medela that a friend gave me, that one is for the everyday pumping. For travel and overall mobility, have a manual pump. I bought a cheap one at Shopwise (P700), it doesn’t even have a brand, but it works well. These actually feel like they have more suction than the electric pump. You will need it for when you’re on road trips, on weekends out of town, for dealing with plugged ducts when you need stronger suction.

4. Warm compress. Warm wet heat is best for dealing with plugged ducts and mastitis. Believe me these are a b*tch to deal with and you want to make sure you are vigilant about checking for them and getting to fixing them before they get infected. If you don't feel like spending, make your own: put some bigas (uncooked rice) in a couple of socks, sew up the open ends, microwave for 30 seconds until warm. 

Some of these are tricky to find the Philippines. If you are not in a terrible hurry I suggest going online and checking if you can find these on the many mommy sites on multiply.