Breastmilk Storage Guidelines for Pinay Moms

A handful of working moms asked me on milk storage guidelines. Different sources would have different guidelines, and I thought somebody should put down a localized guideline for a temperate country like ours.

Months ago, I tagged along one of my mentors in a breastfeeding lay forum and she shared the one laid out by Philippine National Committee on Human Milk Banking. Credits to Dr. Jessa Sareno for this table.

Here it is:

Recently, I underwent the UNICEF/WHO module on Breastfeeding Management for health-workers in Dr. Jose Fabella Memorial Hospital. The guidelines are pretty much simplified. Here is the set of guidelines for a healthy term baby at home:


Milk should NOT be stored above 37 degrees.
4 hours at 25-37 degrees Celsius
8 hours at 15-25 degrees Celsius
8 days refrigerated (2-4 degrees Celsius)
However, many refrigerators do not keep a constant temperature. Thus, it's safer to use refrigerated milk within 3-5 days of storage and freeze* milk that will not be used within 5 days  right away.
Source:  Unicef/WHO Baby Friendly Hospital Initiative Section 3: Breastfeeding Promotion and Support in a Baby-Friendly Hospital, Jan 2006

* Do not fill up a container completely, only up to 3/4 full because milk expands when frozen.

* You may refrigerate milk collected over 24 hours and then batch freeze.
 Author's note: If you are pumping milk in the office, or elsewhere you still need to transport milk you plan to store, it is best to store temporarily in a REFRIGERATOR and then just batch freeze when you get home. Why? If your milk partially or completely froze, and   you transport home, then there is a chance of it thawing to some degree. This can affect the quality of your milk.

*If you must, COOL freshly obrained milk before adding to the frozen batch.
Author's note: Again remember the principle of thawing. If you add freshly express milk (usually warm from our breast), it may thaw the frozen milk it gets into contact with. The viability of this combined milk will then take on the oldest milk collected.

*If you are using the cooler transport your pumped milk home, make sure that the milk is in contact with the ice/frozen gel packs. Frozen gel packs are better than ice cubes to keep milk cold or frozen.

*Domestic refrigerators are the ones that we usually have at home or the office. One-door types have more fluctuating temperatures so the two-door types keep milk longer. It's important to keep milk where the temperature is most constant (at the back, NOT on the door especially if you are using your office refrigerator to temporarily store).

*Preparing a Container of Expressed Breastmilk at Home
1. Wash the container with warm soapy water and thoroughly rinse.
2. Drip dry on a clean towel.
3. Pour hot water into the container.
4. When ready to express milk, pour the water out of the container.

*Preparing to Express Milk with a Breast Pump
1. Read the instruction sheet in the pump prior to first use.
2. Wash the parts of the pump that touch the breast or milk with clean warm soapy water. Thoroughly rinse and air dry.

(*Source: Strengthening Human Milk Banking Practices: A training manual for human milk bank personnel on the best practices of handling human milk and educating breast milk donors). Created by the UNICEF Technical Working Group on Human Milk Banking, reviewed by the Philippine National Committee on Human Milk Banking)
 

Here are some more practical tips:

1. As a rule, wash your hands properly before you collect milk. 
2. If you plan to store your milk, store it in the coldest storage RIGHT away. If you are placing milk on a temporary cold storage, you may keep it cold and then freeze it within 24 hours. 
3. Once frozen milk is thawed, NEVER freeze it again. If kept in the refrigerator, it should be consumed within 24 hours. 
4. Left over thawed milk should be consumed on the next immediate feeding. When in doubt, it's better to just discard it than give spoiled milk to your child. Thus it's very practical to freeze and thaw in small portions to prevent wastage or overfeeding (1-2oz blocks).  
5. Do NOT shake or overheat human milk, as this will destroy the nutrients - particularly the proteins that are supposed to protect your baby. Did you know that antibodies are actually tiny intricately folded proteins? Shaking and microwaving/overheating will actually cause them to unravel so they loose their protective powers. It's normal for milk to separate into layers, and you may swirl gently before offering it to your child. NEVER shake vigorously.
6. It's actually ok to give cold milk to babies :) To date, there is  no evidence that cold milk causes harm or colic. But for those who wouldn't want to give cold milk, be careful not to overheat (as this may cause scalding) and stay away from the microwave as much as possible. 
7. It's best to store milk in small cloudy-colored BPA-free plastics. Leukocytes may stick to the sides of some bottles. For short-term storage, there are special commercially available milk bags. In a milk bank I know, they use recycled BPA-free containers of a commercially available sterilized water brand.

There, that's it for now. Will try to come up with more practical guidelines and sources soon :)

Have a great weekend!

Dr. Lei

When I say I am a breastfeeding advocate...

1. I believe that every mom is created fearfully and wonderfully - fully capable of nurturing each offspring.

A lot of moms are made to feel inadequate. That they can't produce enough milk. Too many times, the natural process of supply and demand is not well understood and this leads to frustration..

Did you know that an average newborn's stomach is just about the size of a calamansi or jackstone ball? This little tummy expands as the mom's milk builds up. Little by little until the milk "comes out". (Even this is not accurate, because mommy has milk even though she can't see it dripping yet!) And what increases mom's milk? It's the cues that the nursing baby sends mommy's brain, releasing substances that prompt her body to produce more milk. 

But how can her baby ask for more milk if it's tiny capacity is brimming with water or formula? And as this crucial demand for her milk decreases, so does her milk production. 

Moreover, some make moms feel that certain products or services are necessary to sustain lactation. And it doesn't help that these commodities are usually not that accessible, not that affordable, and not even evidence-based. Though enterprises that arise from breastfeeding should be encouraged to make the lives of moms easier, integrity and accountability should still be foremost.

2. I understand its benefits for my own child, and I hope you would consider it for your own too...

I am not shoving it down your throat. Most moms obsess about keeping everything clean and giving their kids shots on time to protect them. We all love talking about antibodies because they fight infection. 

ABPro

Did you know that mommy's body remembers most nasty microbes and produces antibodies against them? And when her body meets those bugs again, she won't get sick anymore because the antibodies stay for life and protect her system. 

A whole bunch of these antibodies, developed throughout her lifetime of fighting nasty bugs, gets passed on to the baby through breastmilk!

Talk aboout "sana ako na lang ang nagkasakit". This, to some extent is literally possible - simply, and only through breastfeeding. 

And this is is why solid medical evidence confirm that formula-fed babies are more sickly. Of course milk companies won't say that in their gimmicks, and that is where the Milk Code comes in to protect mothers' and babies' best interest.

I bet NO formula milk will be able to mimic antibodies in breastmilk even if they attempt for the next 50 years. And having a molecular biology background, I am definite that they won't even attempt because the effort is not going to be worth it. Lugi sila.

Of course, this is just one of the countless benefits. The IQ, the EQ, the cancer protection for the mom and everything else - just google it up.

3. I believe it is every Filipino mother's right to breastfeed.

Photo taken from  http://breastfeedingpinay.wordpress.com

Breastfeeding is not just for moms who get around with a driver, a yaya and a personal assistant. It is the right of the boss, and the right of the janitress who just gave birth. It is the right of the urban mom, and the right of a mother in an isolated island.

Furthermore, it is not just the right of the mother. Isn't it the right of the baby to eat and survive? And everything must be done to protect this right.

As breastfeeding becomes trendy these days, something's fishy when commercial areas set up breastfeeding rooms that can be accessed only by their VIPs.

Or when establishments throw out breastfeeding moms, just because they are breastfeeding.

And something seems fishy when legislators start to weaken the very laws that protect this right. (Read more about this below)

4. I am not against formula-feeding mothers. 

For those who work and choose to breastfeed, it takes a lot of determination to sustain the commitment. But a lot of working moms intentionally choose not to breastfeed and they can't be blamed.

Getty Images

It's just natural for any parent to decide on what is perceived to be the best choice. With all the marketing gimmicks and the apparent convenience it offers, it's easier to choose formula. Each of us make decisions based on our unique circumstance and on the kind of information that we have (especially if this comes from sources that we trust, like our doctors or favorite celebrities?).

To breastfeed or not is mostly decided prior to the baby's arrival. Some moms decide not to breastfeed altogether because they worry about getting back to work. It has been known that the length of maternity leave impacts breastfeeding success. (Did you know that in other countries, the maternity leave is 1 year and paid? And that there is a four-year-old house bill that aims to increase ours from 60 to 120 days?).

These days, there are so many reasons for moms not to breastfeed. But when they are provided with accurate information and good social support, they tend to breastfeed.

5. I am not claiming to be a better mom. 

But I want you to know that I care, I understand, and you can find company in me. I am a doctor, but was not spared of the problems other breastfeeding moms typically encounter - the pressure to give formula, the bleeding nipples, the sore engorged breasts. I have been in your shoes. I am not saying that I am a better mom than you, but I am telling you that if I was able to do it, you definitely can too.

I hope you'd drop your biases and give it a shot. There are so many moms out there who understand and are willing to help. 

And as I watch my own son peacefully drift off to sleep while nursing, I felt all the more 

compelled to share this post with you.

“But we proved to be gentle among you, as a nursing mother tenderly cares for her own children.”

1 Thessalonians 2:7

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Read about the House bill against breastfeeding. I am appalled that 3 women (one's even a doctor*) co-authored it. Sign a petition against this bill and help protect Filipino babies!
*in defense of Dr. Bondoc, I quote Atty. Jenny Ong of Chronicles of a Nursing Mom below:  "the original bill sponsored by one of the doctors, Dr. Bondoc is a good bill - HB 3396 which aims to extend the marketing restrictions to 3 years. but it has been corrupted when it was consolidated to other bills. the author is on leave due to a delicate pregnancy.. that's when rufus rodriguez and anthony golez stepped in". 

Read about a Filipina doctor, Dr. Natividad Clavano - well-respected all over the world for her studies at the Baguio General Hospital. Her startling findings caused a global movement to promote breastfeeding.

"What you need to know about breastfeeding." - a brochure by the respected Joint Commission.

Learn about Unang Yakap (Essential Intrapartum and Newborn Care) - the best standard of care for mothers and newborns as dictated by medical evidence, a process jointly endorsed by the WHO and DOH in order to decrease illnesses and deaths among newborns and mothers. Among it's core steps are non-separation of mother and baby and early initiation of breastfeeding.

How to Shop Online through Multiply

When I got an email from MULTIPLY asking me to represent them at the Expo Mom @ Rockwell Tent, I got so excited! First, they trusted me (hey are you sure you're making me do it?). Second, I am just new to the scene. And third, there are thousands of great shops out there in Multiply (naks, why me?)! I am just thankful for this opportunity.   

Sharing an excerpt of my presentation. Specifically, some background on my store and a simple online shopping guide for your reference :)

____________________________

 

  Now here comes the SHOPPING GUIDE!!! 

Welcome to my store front...

 

The best way to navigate is to click on the "VIEW ALL PRODUCTS", so that all the goodies will come up!

 For example, you might want to buy Charlie's Soap (one of our bestsellers!) so you click on the encircled item...tada! Related items will show up:

 

For this particular example, you see right away that the Trial Pack is SOLD OUT. No need to ask which items are available. As long as you can click on it, as long as the item is not hidden, it's with me and ready to ship. I keep my inventory updated 98% of the time to keep you happy. Save the 2% for me and Caleb :) After all, I am still a full-time mommy!

  

Moving forward, you want the whole jar so you click on the item..

  

There is a drop down menu for the quantity of items you might like, also for items with applicable options (e.g. diaper color). I also try my best to describe the items that I carry, sometimes even providing external links. It would really make me happy if you could read them up!

Clicking the BUY NOW button, your order goes into your shopping cart. Here is what happens: 

If you don't have a Multiply account or haven't signed in yet, this is the point where you will be prompted to create one or sign in. It's easy don't worry :)

Now, you've decided to buy some more so you shopped until you are done...

Note that I took an extra mile to be a Trusted Seller, yipee! This is good for you :)

Upon check out, everything is so neat! 

 

Multiply automatically computes shippping rates based on the details you have entered. Right now until the end of June, it's FREE SHIPPING up to P100 worth for minimum orders of P400.

Upon choosing your payment mode, Multiply gives you clear directions on how to go about with the payment. If you encounter any problems, you can always contact them .

Items are shipped the same day if payment was posted before the courier picks up (usually at 12 noon. They arrive the next day if within Manila, and in 2-3 days if Provincial. I usually update completed transactions with tracking numbers.

I must admit that it has been quite a challenge to keep up with all the queries lately. But with this system, you can always check on the availability of stock and buy even while I am asleep or out of town. Multiply always notifies the buyer and the seller of any payments made, so don't worry about it. All payment modes post real time anyway, except for BDO which usually reflects the next day.

Oh, my sister Mae is already doing her on-the-job training with me. So don't be surprised if she is the one who responds to your orders. She is nicer than me, actually :)

  

Hope this shopping guide showed you how convenient it is to shop via my Multiply platform. See you there!

-- Lei

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Thanks Maurice, Erben and Rianna for giving me a reason to do this. Been putting this off for a looong time! Haha! :)

What First-Time Bazaaristas Should Know!

It's almost Expo Mom!!! Nope we are not joining this time. But I am sharing this post because I owe one mompreneur.

At the very last minute, we joined Mommy Mundo's Expo Kid event last March in Rockwell. The first thing I did after confirming our slot was google up " bazaar 101, bazaar for dummies, bazaar tips, etc." but nothing substantial showed up.

Sharing with you some practical notes I gained during the activity:

1. Get a booth early. Simple. So you can choose your spot well.

2. BARYA. Pambalot. Calling cards. Flyers. Thanks for this tip, Love and William!

Prepare lots of change and make sure you have packaging materials. Be eco-friendly. Get paper bags or reusable bags if possible. And always ask buyers if they need one. Many would decline anyway. You can never have enough flyers and calling cards! Bazaars, beyond the sales, are a good venue to connect with fellow entrepreneurs and new markets :)

3. Know in advance what to expect of your booth. I was shocked to find out that it was a bare space we were renting!! Good thing, we were adjacent to Stork Studio's nice sturdy wall, and the wooden toy stalls somehow "framed" everything well. Take this into consideration, so that your display would be nice :)

4. Plan your store layout properly. I had tons of stuff barely able to fit in the little space. Twenty minutes before opening, my booth was still a complete chaos! I have to credit my suppliers for helping me out before I froze in panic.

I was hoping buyers would come in to see more stuff inside my booth. But most didn't!! So display all your stuff well and don't expect people to really come in. They have a very short attention span too. So display your best in front!

5.  Make sure that your brand is visible so that people can easily identify you. But because I didn't know #5, I wasn't even able to make use of my standee.

6. BE ORGANIZED.  In our case, it's just 2 people allowed to man the booth because the space was limited. It was me, my husband and my sister rotating and taking turns with Caleb. There were times when foot traffic was overwhelming and it got a little bit confusing.

Suggestions: Keep an area or a box for essential items (like ORs, packaging materials, pens, inventory lists) so you won't need to scurry for their whereabouts.  Prepare an easy system to track down your sales. My supplier suggested to list down all the items in stock and tick beside it for every item sold. This worked for us. The person who received the money did the ticking so that there's no duplication.

7. I suggest you keep the cash close to you by all means. It may not be the most fashion-forward thing to do, but a belt bag or something like it is convenient.

8. If you are a breastfeeding mom, it may be convenient to pump ahead (I didn't! Didn't expect to be busy the whole day!). Isotonic drinks, granola bars and wipes for freshening up would also be great. The Expo Kid bazaar was such a hit that I was only able to step out of the booth to breastfeed and change my baby's cloth diapers. We also just took turns eating our lunch. I didn't even pee the whole day!! (oops, too much disclosure)

9. Document. If we had good photos, this article could have been more interesting. Haha! Don't forget to take pictures, and grab photo ops that would boost your credibility.

10. Have FUN!!  Don't be shy to talk talk talk! And don't feel bad if the sales doesn't turn out as well as you have expected. My suppliers cautioned me on dull moments - that the ROI will come in later, especially if the bazaar organizer is really good in promoting the event! (THIS IS SO TRUE!) Don't be overly concerned about the sales, but try to sincerely connect and share, and the sales will follow. Thanks Mommy Mundo!!

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Ok no pictures and no linkies  because this was written in haste. Apologies for that. If I have not put you to sleep and have come this far , you probably need this for your first bazaar. Go and have fun!!

OR you're a professional mompreneur!!  Any tips to add for the rookies ? :)

Stay-at-home no more?!

Caleb is turning 16 months soon and my stint as a stay-at-home mom is getting a new twist. The 16 months were fast-paced and insightful. Becoming a mother changed me.

First, I became more conservative in two major aspects. I have always been the adventure-seeking type and never had any second thoughts about small plane rides or routine open-sea boat trips. 

That changed.

I also had the tendency to splurge when I am sad. That also changed.

Scariest ever. Didn't know I was 2 weeks pregnant.

Flight out via a chartered plane in Pamalican. ~16  weeks pregnant

Official summer travel costume during boat rides. Don't laugh.  Did I tell you I can't swim?

Transferring to smaller boats called "bote-bote" during low tides.

Second, I found new passions.

Mommies ask what kind of doctor I am (a tiny one?! haha!). Back ten years ago, all I knew was that I wanted to become a doctor but didn't know that there were many different kinds of doctors. And that to be this or that kind, 3 to 5 years of study, on top of 5 years of medical school, on top of a college degree is a must. Had somebody warned me, I wouldn't have pursued medicine anymore - nah! 

When I was training, I enjoyed almost all fields thoroughly except Psychiatry. (Untoward patient experience. Interns should have salaries or should be insured.). When people asked me what I wanted to be, I tend to answer the specialty where I was rotating in (meaning my answer changed almost every month). I have always dreamed of going to a far-flung place so I felt eager-beaver with all the procedures I can get my hands into. For possible future application, I thought. Served well, great foresight, I had a screaming and kicking psych patient under my care during a tedious 16-hour boat ride. I will never forget that for the rest of my life.

Got this from a kid's nose. The tamarind seed, not the coin. Mother was so happy she brought me a chicken the next day.

Upper GI Bleed.  December 24. Thank heavens, it resolved.

Stab wounds (the involved parties, all  3 of them at the same time, this was the least graphic). Christmas day.

After my barrio stint, I was left with 2 loves to choose from -- obstetrics and ophthalmology. While pregnant, I have seen how my obstetrician cared for me (love her so much!). Knowing my tendency to be OC with patients, I felt I might not be able to adapt to a similar future lifestyle. What a vocation. They have my utmost respect.

When Caleb arrived, I came to terms with my motivation for wanting to become an obstetrician. It was not the prenatal trips. It was not the rush that a bloody surgical field gives. It wasn't even the "baby out" frenzy. 

It is the magical moment when the mother sees her baby for the first time. And equally magical, almost sacred, is when the baby starts to latch on at her mother's breast. 

(Nope, I am not going to say Pediatrics yet. It's still Ophtha for the past 20 months.) 

At the time I delivered,  the WHO and DOH were putting into place a set of  simple guidelines (with emphasis) proven  to result in less infection and less harmful events for both mother and child (ergo less deaths, less hospital stay, less hospital bills, happier experience). The guidelines were relatively new but my attending physicians were proponents of it, so I was confidently delighted. 

To my dismay, the hospital failed to apply it to me and my boy despite the standing orders.

I lovingly prepared a bonnet for my baby as the guidelines called for. The first ever garment that will touch him, I thought. It was lost forever.

Caleb stayed all night in the nursery,  alone in an unfamiliar environment instead of hearing my soothing voice that sang to him every night while he was in my tummy.

He lay in a bassinet, with all the hospital bacterial flora he gets into contact with instead of getting the protective bacteria that my skin can afford.

He was bathed the soonest he could be washed - babies can't cope in the cold like us adults, and early bathing is proven to be a cruel thing to do to a newborn! (Can you imagine dipping a newborn puppy in water? Yep, this is what is being done in most hospitals to newborns. I will tell you more soon why this doesn't make much sense).

I was told that I had to be rolled all the way into the nursery, in all my post-Ceasarean glory, IF and IF I wanted to breastfeed my baby.  (There was no medical indication for Caleb to stay in the nursery by the way).

My bouncing baby boy was wheeled away from Mama :C

I spent my first night as a mother sobbing to have my child taken to my side. And I, a doctor, can't do anything about it. It was terrible. When my attending neonatologist came, I broke down into inconsolable tears and garble. Was my frustration justified or was it the hormones? I think both.

In fairness, Caleb was latched on to me after he was dried and while I was being stitched up. For less than 5 minutes, if my Nubain-tainted memory serves me right. I am not blaming the well-meaning hospital staff or the hospital. In fact, what they did was the norm in most hospitals. And this is what we are trying to change.

Going back to my new life twist.. 

My teacher, a well-respected neonatologist,  was commissioned by the WHO and DOH to form UNANG YAKAP. It's a group of gentle doctors - general practitioners, pediatricians, obstetricians, anesthesiologists, neonatologists and public health specialists - who advocate simple and life-saving birthing and newborn care practices. So far, they have trained health staff from different provinces - from the ARMM to the different military hospitals, from small birthing clinics to big wig (yup, I am talking about big and famous) private hospitals. I got excited when she invited me hang out with them so that I can expand my horizons.

The Unang Yakap team also recently held a workshop in the hospital where I delivered. Hopefully, they will choose to abide.

The idea is all Filipino mothers and newborns, rich or poor, deserve the best care. Our desire is to make it so viral, that all health-care providers will adapt the practices OR all pregnant mothers would ask for it, whichever comes in first.

WHO-DOH Unang Yakap Essential Intrapartum and Newborn Care Team Workshop in V. Luna Hospital. Me in plaid.

If you are pregnant, or if you have a loved one who is pregnant, tell them about UNANG YAKAP.  If you are a doctor, a hospital or a local policy maker who wants to bring UNANG YAKAP to your community, you can also get in touch with us. 

I am still a stay-at-home mom out on occasional advocacy stints with the team. And I am still breastfeeding my toddler. Residency training is in 7 months!

Excited to live in between :)


Lei
"..by the grace of God I am what I am, and his grace to me is not without effect” (1 Corinthians 15:10)