• Can you tell me more about post-natal blues?
• What do I do if my child has a suspected head injury?
• Can I give my child “pearl powder”?
• Does frozen porridge cause wind?
• Can I get pregnant while nursing?
• I find it uncomfortable to have sex while I’m still breastfeeding. What I can do about it?
• What methods of birth control are suitable during breastfeeding aside from condoms and withdrawal?
• I think my baby is suffering from nipple confusion. Can you help?

Can you tell me more about post-natal blues?
Post-natal blues is common and unrecognised most times. I think it helps to learn to let go a little, ie. take mothering one step at a time, let someone else looks after the baby on and off, and go out of the house often!

You will find that with the second baby onwards, mums generally are get better very quickly. I think it comes with confidence. So, I think assurances helps and it is transient. Medically, as doctors, we step in when there is clear post-natal depression. – A lady ob-gyn in KL

What do I do if my child has a suspected head injury?

I got this flyer from my paed's office about head injuries. The hospital has a neuro-surgeon, paed surgeon and 3 paeds. So, they often get references for head injuries. Here goes:

See the doctor immediately if your child hurts his or her head and shows any of the following signs and symptoms:
1. Nausea and vomiting
2. Inconsolable cry and irritable
3. Fluid/blood draining from ears or nose
4. Increasingly severe headache
5. Weakness or numbness of body
6. Difficulty in walking or talking
7. Drowsiness
8. Confusion or unusual behaviour
9. Fits

According to my paed, normal falls rarely cause blood clots. If there is blood clot present, the first thing they suspect is child abuse because it takes a very hard trauma direct to the head to result in blood-clots. Unless of course, falling from very high places, which will result in very nasty knocks. (Do you all remember I mentioned about the 4 year old boy who fell down 4 floors and died while his dad was carrying him? They were walking along the corridor and the boy was very boisterous and the dad lost his hold.)

Once I shared a room with a mom whose 2-3 year old son was in a coma. The doctor told her he is blind and handicapped but miraculously, he recovered after surgery. The parents insisted the boy got the injuries (several clots) from falls sustained while at the babysitter’s (fell off baby walker) but the doctor refused to believe her.

Falls (i.e. hard knocks, injuries) also can result in a fever. It is not due to frazzled nerves but injuries to the body tissues and some other medical explanation. – Lilian

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Can I give my child “pearl powder”?
Pearl powder not excreted out will stay in the body and turn into gallstones. I will remember to ask the paed for a medical explanation next time. – Lilian

Does frozen porridge cause wind?
The paed confirmed that frozen porridge can cause wind. There’s also a medical explanation, too. Best to have freshly cooked food but if there is no other option, then we have to make sure that the food is stored at the right temperature and is not kept for too long– Lilian

Can I get pregnant while nursing?

The failure rate compares well with other forms of contraception but there are certain rules (not going into them all). It is an important form of family spacing in third world countries where women are not so well nourished and breastfeeding. We, who are well-fed, should expect the return of our fertility sooner.

Suppression of ovulation (fertility) is directly linked to duration and frequency of nipple sucking, ie baby having direct access day and night.

I have no information/evidence to suggest that expressing may make this suppression less effective but I have a feeling that it may. Expressing may also mean longer gaps between feeding/expressing.

As has been mentioned, ovulation comes before menstruation, so we are not always warned that fertility has returned. - Eirian, midwife

I find it uncomfortable to have sex while I’m still breastfeeding. What I can do about it?

There are medications available to help ease off the feelings of anxiety, inadequacy. The most important thing is to allow someone else to look after the baby for a night or two, so that mom can sleep or for mum to take some light sedatives, all of which can be obtained from the doctor. Things like EPO will only help marginally. If a mum is getting up to breast-feed many times a night, then maybe expressing the milk and having someone else give it to the baby will help.

I am also not surprised by the questions of vaginal dryness during breastfeeding as the oestrogen levels fall during breastfeeding. Therefore the vagina and vulva becomes thin, inelastic and dry. Application of oestrogen cream to the area will help. Generally, application of this cream every night for one week, then two to three times a week will solve the problem throughout the breastfeeding period without affecting milk supply. Generally things become better once the periods become regular again. By the way, milk supply should not be reduced by the return of the periods. - A lady ob-gyn in KL

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What methods of birth control are suitable during breastfeeding, aside from condoms and withdrawal?
There is the injection method: IM depo provera. Others: Implanon, progestogen (pills only). Normal OCP generally will reduce supply and therefore not recommended. - A lady ob-gyn in KL

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I think my baby is suffering from nipple confusion. Can you help?
This is what was suggested in "The Nursing Mother's Companion":

"If you have waited longer than a month (to give a bottle) and the baby refuses to take a bottle, be sure to have someone else try. Frequently a baby is more confused and upset by the bottle when her mother tries to persuade her. Trying to force the baby is upsetting for everyone, and rarely successful. Some parents have succeeded by offering the bottle while walking with the baby. Hold the baby facing away from you and bounce her gently as you walk. Some babies dislike the taste of formula; try breastmilk instead. Tasteless silicone nipples may be more readily accepted than rubber types. Recently I've been successful in getting babies to take a bottle fitted with the Avent Fast-Flow nipple or the Evenflo HealthFlow nipple. Another technique that has been sucessful for some mothers is to nurse the baby for just a few minutes, then unlatch the baby and slip the bottle into her mouth. If she objects, you can try again after a few minutes more.

The baby who refuses a bottle may do surprisingly well with an ordinary cup, particularly if she is about six months or older."

Here is my personal experience:

Laura (aged 3 1/2 and breastfed for 28 months) was given a bottle too early, so refused the breasts for the first few weeks until she was re-trained to nurse directly from about 5 weeks. In the first few weeks, she was fed bottle fed EBM. My mom was ill at that time, so I spent a lot of time in the hospital with my mom which took me away from her. I nursed her whenever I could and only give her a bottle if I can't make it back in time for her feed. I was afraid she would regress and not take to the breasts again but she didn't, so everything was fine until she was about 3 months old. My mom had to be admitted into hospital again and the admission took a long time. I was away from Laura for more than 6 hours. She refused to drink from a bottle and chose to sleep instead after crying her lungs out. Since I was and still am a SAHM, I didn't pursue trying to get her to use the baby bottle again and just worked around her feeding time and brought her with me whenever I could.

Adam (aged 9 1/2 months and still breastfed) was born with a tongue-tie, so couldn't nurse directly in the first month. He was cup fed EBM for 4 weeks until he could nurse directly with the help of nipple shields. He drinks a lot and I work part-time, so he has to be fed EBM by my maid while I am away. At about 2 1/2 months, he refused the bottle too and would cry before taking to the bottle again. Initially, he was fed with a fast flowing nipple and he drank a lot because he still wanted to suck after the milk had finished. I was reluctant to give him pacifier but decided to try. He refused the pacifier! With some struggle at each bottle feeding time, he eventually accepted the bottle and now knows that when he wants milk and I am around he will nurse directly. When mama is no where in sight, he accepts the bottle from Dita. He still uses a slow flow nipple which seems to fulfill his sucking needs while giving him nourishment.

Julia, perhaps you can try cup feeding your baby while trying to get her to accept the bottle again. You can either get a feeding cup (especially made for cup feeding infants) from Medela or just use an ordinary cup. Pour small amount into the cup so your caregiver won't risk spilling your precious EBM. – Min

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