1. DATA & STATISTIC OF BREASTFEEDING

Breastfeeding provides numerous benefits for mothers and their children. However, currently, only 40% of the global average rate of infants below six months of age was exclusively breastfed, with only 23 countries managed to achieve rates of 60% or higher. World Health Organization (WHO) Global Nutrition Targets 2025 has set targets to achieve at least 50% rate of exclusive breastfeeding among members’ countries. The National Plan of Action for Nutrition of Malaysia III (NPANM III), 2016-2025 has set another indicator to achieve at least 70% of infants below 6 months of age to be exclusively breastfed by 2025.

In Malaysia, the prevalence of exclusive breastfeeding was 19.3% in 2006 and has increased to 47.1% in 2016. Even though there was an increment, this was still less than the targeted prevalence set by WHO and NPANM III.

2. BENEFITS OF BREASTFEEDING

Benefits of Breastfeeding 

Children who are breastfed experience improved dental health and neuro developmental outcomes. They have decreased risk of:

• Otitis media
• Diarrhoea
• Respiratory tract infection
• Necrotizing enterocolitis
• SIDS
• Atopic dermatitis
• Asthma
• Celiac Disease
• Crohn’s Disease and ulcerative colitis
• Late-onset sepsis in preterm infants
• Type 1 and type 2 diabetes
• Leukaemia
• Childhood overweight and obesity

Maternal Benefits

There are also maternal health benefits to breastfeeding such as decreased risk of the following:

• Decreased excessive menstrual blood loss
• Breast, ovarian, endometrial and thyroid cancers
• Hypertension
• Type 2 diabetes
• Rheumatoid Arthritis

Breastfeeding is also a great benefit to the environment and society. It was shown that breastfeeding families become sick less often and the parents miss work less. Breast milk will be always available, at the right temperature and ready to be fed,there is no risk of contamination, even in the case of emergency situations, such as natural disasters.

3. HOW MUCH & HOW OFTEN TO BREASTFEED

One of the most common questions new parents have is how often their baby should be fed. The best answer is surprisingly simple: in general, babies should be fed whenever they seem hungry.

Every baby is different. How much and how often your baby feeds will depend on your baby’s needs. Here are a few things to know about how much and how often babies breastfeed during the first days, weeks, and months of life.

First Days

• Your newborn baby’s belly is tiny. He or she does not need a lot of milk with each feeding to be full.
• Your baby may want to eat as often as every 1 to 3 hours. Frequent feeding helps increase your milk supply and gives your baby practice at sucking and swallowing.
• You may be able to hear your baby sucking and swallowing the breast milk.
• Most babies who are getting breast milk should not be fed infant formula in the first few days. If you are concerned about meeting your baby’s needs, talk to a lactation consultant, or your baby’s nurse or doctor, right away to find out how to address any breastfeeding problems and determine the best way to meet your baby’s needs.

First Weeks and Months

• Over the first few weeks and months, the time between feedings will start to get longer— on average about every 2 to 4 hours for most exclusively breastfed babies. Some babies may feed as often as every hour at times, often called cluster feeding, or may have a longer sleep interval of 4 to 5 hours.
• How often your baby feeds might change depending on the time of day. Some feeding sessions may be long, and others short. That is okay. Babies will generally take what they need at each feeding and stop eating when they are full. They should seem content and drowsy after feeding when they have had enough milk.
• Your baby will breastfeed about 8 to 12 times in 24 hours.

6 to 12 Months

• Breastfed babies’ feeding patterns (how often and how long they feed) vary and will likely change as they grow and start eating more solid foods.
• If your baby seems to be less interested in breastfeeding after you introduce solids, try breastfeeding first before you offer solids.
• Your breast milk is the most important source of nutrition, even after you start feeding your baby solids.

12 to 24 Months

• The number of times a day a toddler breastfeeds varies. Some want to breastfeed only before bed or in the morning, while others continue to drink breast milk as a bigger portion of their daily diet. Continue to follow your child’s cues to decide when he or she is hungry and wants to breastfeed.

4. PROPER STORAGE & PREPARATION

• 
• 
  
• Safe Storage of Expressed Breast Milk
• 
  Before expressing or handling breast milk:

• Wash your hands well with soap and water. If soap and water are not available, use an alcohol-based hand sanitizer that contains at least 60% alcohol.
• Mothers can express breast milk by hand or with a manual or electric pump.
• If using a pump, inspect the pump kit and tubing to make sure it is clean. Discard and replace mouldy tubing immediately.
• If using a shared pump, clean pump dials, power switch, and countertop with a disinfectant wipe.

Storing breast milk after expressing:

• Use breast milk storage bags or clean, food-grade containers to store expressed breast milk. Make sure the containers are made of glass or plastic and have tight fitting lids.
  • Avoid bottles with the recycle symbol number 7, which indicates that the container may be made of a BPA-containing plastic.
• Never store breast milk in disposable bottle liners or plastic bags that are not intended for storing breast milk.
• Freshly expressed or pumped milk can be stored:
  • At room temperature (77°F or colder) for up to 4 hours.
  • In the refrigerator for up to 4 days.
  • In the freezer for about 6 months is best; up to 12 months is acceptable. Although freezing keeps food safe almost indefinitely, recommended storage times are important to follow for best quality.

Storage tips:

• Clearly label the breast milk with the date it was expressed.
• Do not store breast milk in the door of the refrigerator or freezer. This will help protect the breast milk from temperature changes from the door opening and closing.
• If you don’t think you will use freshly expressed breast milk within 4 days, freeze it right away. This will help to protect the quality of the breast milk.
• Breast milk can be stored in an insulated cooler with frozen ice packs for up to 24 hours when you are traveling. At your destination, use the milk right away, store it in the refrigerator, or freeze it.

Safe Thawing of Breast Milk

• Always thaw the oldest breast milk first. Remember first in, first out. Over time, the quality of breast milk can decrease.
• There are several ways to thaw your breast milk:
  • In the refrigerator overnight.
  • Set in a container of warm or lukewarm water.
  • Under lukewarm running water.
• Never thaw or heat breast milk in a microwave. Microwaving can destroy nutrients in breast milk and create hot spots, which can burn a baby’s mouth.
• If you thaw breast milk in the refrigerator, use it within 24 hours. Start counting the 24 hours when the breast milk is completely thawed, not from the time when you took it out of the freezer.
• Once breast milk is brought to room temperature or warmed, use it within 2 hours.
• Never refreeze breast milk after it has thawed.

Feeding Expressed Breast Milk

• Breast milk does not need to be warmed. It can be served room temperature or cold.
• If you decide to warm the breast milk, here are some tips:
  • Keep the container sealed.
  • Place the sealed container into a bowl of warm water or hold it under warm, but not hot, running water for a few minutes.
  • Test the milk’s temperature before feeding it to your baby by putting a few drops on your wrist.
  • Do not heat breast milk directly on the stove or in the microwave.
• Swirl the breast milk to mix the fat, which may have separated.
• If your baby did not finish the bottle, use the leftover milk within 2 hours after the baby is finished feeding. After 2 hours, leftover breast milk should be discarded.

5. CONTRAINDICATION

• Mothers should NOT breastfeed or feed expressed breast milk to their infants if

  • Infant is diagnosed with classic galactosemia, a rare genetic metabolic disorder
  • Mother is infected with the human immunodeficiency virus (HIV) (Note: recommendations about breastfeeding and HIV may be different in other countries)
  • Mother is infected with human T-cell lymphotropic virus type I or type II (HTLV – 1/2)
  • Mother is using an illicit street drug, such as PCP (phencyclidine) or cocaine (Exception: Narcotic-dependent mothers who are enrolled in a supervised methadone program and have a negative screening for HIV infection and other illicit drugs can breastfeed)
  • Mother has suspected or confirmed Ebola virus disease

  Mothers should temporarily NOT breastfeed and should NOT feed expressed breast milk to their infants if

  • Mother is infected with untreated brucellosis
  • Mother is taking certain medications
  • The mother is undergoing diagnostic imaging with radiopharmaceuticals
  • Mother has an active herpes simplex virus (HSV) infection with lesions present on the breast  (Note: Mothers can breastfeed directly from the unaffected breast if lesions on the affected breast are covered completely to avoid transmission)

  In conclusion, mothers may resume to breastfeeding after consulting with a physician to determine when their breast milk is safe for their infant.

  Mothers should temporarily NOT breastfeed, but CAN feed expressed breast milk if

  • Mother has untreated, active tuberculosis

  (Note: The mother may resume breastfeeding once she has been treated appropriately for 2 weeks and is documented to be no longer contagious)

  • Mother has active varicella (chicken pox) infection that developed within the 5 days prior to delivery to the 2 days following delivery

  In conclusion, airborne and contact precautions may require temporary separation of the mother and infant, during which time expressed breast milk should be given to the infant by another care provider. Mothers should be able to resume breastfeeding after consulting with a physician to determine when there is no longer a risk of spreading infection.

  Are medications safe to take while breastfeeding?

  Few medications are contraindicated while breastfeeding. Although many medications do pass into breast milk, most have no known adverse effect on milk supply or on infant well-being. So, kindly consult your doctor if you have any doubts.

6. COVID-19 & BREASTFEEDING Q&A

• 1. Can COVID-19 be passed through breastfeeding?

  Ans: Transmission of active COVID-19 (virus that can cause infection) through breast milk and breastfeeding has not been detected to date. There is no reason to avoid or stop breastfeeding.

  2. Should mothers breastfeed in communities where COVID-19 is prevalent?

  Ans: Yes. In all socio-economic settings, breastfeeding improves survival and provides lifelong health and development advantages to newborns and infants. Breastfeeding also improves the health of mothers.

  3. Following delivery, should a baby still be immediately placed skin-to-skin and breastfed if the mother is confirmed or suspected to have COVID-19?

  Ans: Yes. Immediate and continued skin-to-skin care, including kangaroo mother care, improves the temperature control of newborns and is associated with improved survival among newborn babies. Placing the newborn close to the mother also enables early initiation of breastfeeding which also reduces mortality.

  The numerous benefits of skin-to-skin contact and breastfeeding substantially outweigh the potential risks of transmission and illness associated with COVID-19.

  4. Can women with confirmed or suspected COVID-19 breastfed?

  Ans: Yes. Women with confirmed or suspected COVID-19 can breastfeed if they wish to do so. They should:

  • Wash hands frequently with soap and water or use alcohol-based hand rub and especially before touching the baby
  • Wear a medical mask during any contact with the baby, including while feeding
  • Sneeze or cough into a tissue. Then dispose of it immediately and wash hands again
  • Routinely clean and disinfect surfaces that mothers have touched.

  It is important to replace medical masks as soon as they become damp and dispose of them immediately. Masks should not be reused or touched in the front.

  5. If a mother confirmed or suspected to have COVID-19 does not have a medical face mask should she still breastfeed?

  Ans: Yes. Breastfeeding unquestionably reduces mortality in newborns and infants and provides numerous lifelong health and brain development advantages to the child.

  Mothers with symptoms of COVID-19 are advised to wear a medical mask, but even if this is not possible, breastfeeding should be continued. Mothers should follow other infection prevention measures, such as washing hands, cleaning surfaces, sneezing or coughing into a tissue.

  6. If a mother has confirmed or suspected COVID-19 and is too unwell to breastfeed her baby directly. What can she do?

  Ans: If you are too unwell to breastfeed your baby due to COVID-19 or other complications, you should be supported to safely provide your baby with breast milk in a way possible, available, and acceptable to you. This could include:

  • Expressing milk
  • Donor human milk. 

  If expressing breast milk or donor human milk are not feasible then consider wet nursing (another woman breastfeeds the child) or infant formula milk with measures to ensure that it is feasible, correctly prepared, safe and sustainable.

  7. If a mother had confirmed or suspected COVID-19 and was unable to breastfeed, when can she start to breastfeed again?

  Ans: You can start to breastfeed when you feel well enough to do so. There is no fixed time interval to wait after confirmed or suspected COVID-19. There is no evidence that breastfeeding changes the clinical course of COVID-19 in a mother. Health workers or breastfeeding counsellors should support you to relactate.

  8. If a mother has confirmed or suspected COVID-19, is it safer to give her baby infant formula milk?

  Ans: No. There are always risks associated with giving infant formula milk to newborns and infants in all settings. The risks associated with giving infant formula milk are increased whenever home and community conditions are compromised, such as reduced access to health services if a baby becomes unwell, reduced access to clean water and/or access to supplies of infant formula milk are difficult or not guaranteed, affordable and sustainable.

  The numerous benefits of breastfeeding substantially outweigh the potential risks of transmission and illness associated with the COVID-19 virus.

  9. Can a breastfeeding woman get vaccinated against COVID-19?

  Ans: Yes, women who are breastfeeding can take the vaccine when it becomes available to them.   

  None of the currently approved vaccines use the live virus, so there is no risk of passing the virus to the baby through breastmilk.  

  There is also some evidence that, after vaccination, antibodies are found in breastmilk, which may help protect the baby against COVID-19.

7. SUPPLEMENTS FOR BREASTFEEDING MOTHER

• Supplements for breastfeeding mothers:

  1. Omega-3 fatty acids 

  Omega-3 fatty acids are essential to support baby’s brain, eye, immune system and nervous system development. Studies also show that maternal supplementation of omega-3 fatty acids during breastfeeding can reduce food allergies and eczema in baby.

  2. Calcium and vitamin D

  The recommended daily intake of calcium for breastfeeding women is 1200mg/day while an estimated of 600IU (15mcg) of vitamin D is required. Calcium is vital for the bone and teeth formation of baby while vitamin D is needed for calcium absorption.

  3. Iodine

  Babies require iodine for proper growth, development of brain, visual motor skills and hearing. Since breastfed babies depend on breast milk alone as their source of iodine, breastfeeding mothers need to get enough iodine for the baby and themselves. It is recommended that breastfeeding mothers take an iodine supplement of 150mcg per day.

  4. Vitamins B Complex (Vitamin B1, B2, B3, B5, B6, B7, B9, B12)

  Vitamins B group is important for the nervous system development and production of red blood cells. Since they are water-soluble and our bodies do not store them, daily supplementation is needed. These vitamins are mostly obtained from animal food sources and not found in plant-based food. Therefore, it is also crucial for breastfeeding mothers who are vegetarian to take supplements containing vitamin B group.

  5. Fenugreek

  Fenugreek is a herb that is commonly used as a galactagogue to increase breast milk production. Studies indicate that fenugreek may have mild galactagogue effect. Fenugreek can be taken in the form of capsules, powder mixed with drinks or tea, typically in doses of 1-6g daily. It is considered safe in nursing mothers but should be used with caution in people with diabetes as it can lower blood sugar if taken at higher doses.

  Although not considered harmful when used in moderation, fenugreek can cause your breastmilk, sweat, and urine to smell like maple syrup. Your baby’s urine and sweat may start to smell like maple syrup, too. Note that the latter should not be confused with maple syrup urine disease.

  6. Lecithin

  Lecithin is a phospholipid elements. It’s thought to help prevent the breast ducts from getting plugged by increasing the polyunsaturated fatty acids in the milk and decreasing its stickiness. A plugged duct occurs when the milk passageways in the breast become blocked.Reference:

  1. Farahana Mohamad Pilus, Norliza Ahmad, Nor Afiah Mohd Zulkefli. 2019. Predictors of Exclusive Breastfeeding Among Mothers Attending Rural Health Clinics in Hulu Langat District. Malaysian Journal of Medicine and Health Sciences (eISSN 2636-9346). Mal J Med Health Sci 15(SP3): 15-21.American Academy of Pediatrics. 2021. Breastfeeding Overview.
  2. Sanjeev Jain, MD, FAAP. 2020. How Often and How Much Should Your Baby Eat? American Academy of Pediatrics.
  3. Centre of Disease Control and Prevention. 2020. Nutrition: How Much and How Often to Breastfeed.
  4. Centers of Disease Control and Prevention. 2021. Breastfeeding: Proper Storage and Preparation of Breast Milk.
  5. American Academy of Pediatrics. 2021. Breastfeeding Overview.
  6. Centres of Disease Control and Prevention. 2019. Breastfeeding: Contraindication.
  7. World Health Organization. 2020. Coronavirus disease (COVID-19): Breastfeeding Q&A.
  8. 1.Cacho N, Lawrence R. Innate Immunity and Breast Milk. Frontiers in Immunology. 2017;8(584).
  9. 2.World Health Organization. Global Strategy for Infant and Young Child Feeding: The Optimal Duration of Exclusive Breast Feeding. 54th World Health Assembly. Document A54/INF.DOC./4. World Health Organization; Geneva: 2001.
  10. 3.Australian National Health and Medical Research Council (NHMRC). 2013 Australian Dietary Guidelines. National Health and Medical Research Council. Canberra: 2013.
  11. 5.Gunaratne A, Makrides M, Collins C. Maternal prenatal and/or postnatal n-3 long chain polyunsaturated fatty acids (LCPUFA) supplementation for preventing allergies in early childhood. Cochrane Database of Systematic Reviews. 2015;(7).
  12. 6.Kominiarek M, Rajan P. Nutrition Recommendations in Pregnancy and Lactation. Medical Clinics of North America. 2016;100(6):1199-1215.
  13. 7.Leung A, Pearce E, Braverman L, Stagnaro-Green A. AAP Recommendations on Iodine Nutrition During Pregnancy and Lactation. Pediatrics. 2014;134(4):e1282-e1282.
  14. 8.Allen L. B Vitamins in Breast Milk: Relative Importance of Maternal Status and Intake, and Effects on Infant Status and function. Advances in Nutrition. 2012;3(3):362-369.
  15. 9.Fenugreek. Bethesda: U.S. Dept. of Health and Human Services, National Institutes of Health, National Center for Complementary and Alternative Medicine; 2012.
  16. 10.Sim T, Hattingh H, Sherriff J, Tee L. The Use, Perceived Effectiveness and Safety of Herbal Galactagogues During Breastfeeding: A Qualitative Study. International Journal of Environmental Research and Public Health. 2015;12(9):11050-11071.
  17. Donna Murray. 2021. 10 Herbs to Increase Breast Milk Supply.
  18. Jacquelyn Cafasso. 2016. Using Lecithin While Breast-Feeding for Plugged Ducts.

What is breast cancer
Breast cancer is the most common type of cancer affecting women in Malaysia. Among 19 women in Malaysia, there is 1 woman are at risk, compared to one in eight in Europe and the United States.

What are the symptoms of breast cancer?

• A lump that is painless and hard in the breast
• A lump at the underarm area
• Swelling and redness of breast
• Nipple pain, tenderness or discharge, including bleeding
• Itchiness, soreness or rashes on nipple

How to lower the chances of breast cancer?

• Limit the consumption of alcohol to one per day for women, two for men.
• Do not smoke.
• Be physically active and exercise 1.5 to 2.5 hours weekly.
• Breastfeed your baby.
• Maintain normal body weight and reduce high-fat diet.
• Avoid staying up late frequently.
• Having clinical breast exam (CBE) starting from 20s.
• Having annual screening mammograms starting from 40 years old.
• Talk with your healthcare providers if you are on hormone replacement therapy.
• Self-examination

What is the diagnosis for breast cancer?

1. Mamogram

A mammogram is an X-ray for breast. It is the best way to find out breast cancer at early stage.

• Clinical Breast Exam (CBE)

This is an examination done by a doctor or nurse, who uses his or her hands to feel for lumps or other changes.

• Ultrasound

Ultrasound is done when a suspicious lumps are detected on your breast through breast self examination or mammogram.

• MRI

MRI can help the healthcare providers to differentiate between normal and diseased tissue.

• Biopsy

Biopsy diagnostic procedure that can be determine if the suspicious area is cancerous.

Any treatment can be done for breast cancer?

1. Surgery    

There are 2 types of surgery: breast-conserving surgery and mastectomy.

Both types of surgery are often followed by radiation therapy or other treatments such as chemotherapyor hormone therapy.

2. Radiotherapy  

Radiation therapy uses high-energy rays to kill cancer cells. 

           Common side effects of radiation therapy are:

• Swelling and heaviness in the breast
• Sunburn sensation at treated area
• Fatigue

3. Hormone therapy  

      Hormone therapy uses drugs that may either block the hormones (estrogen and progesterone) from reaching the cancer or lower the level of hormones in the body.

      Tamoxifen is an example of a hormone therapy.

     Common side effects of hormone therapy are:

• Fatigue
• Hot flashes
• Vaginal discharge or irritation
• Nausea and diarrhea
• Weight gain
• Changes in menstruation
• Bone and joint pain

4. Chemotherapy

Chemotherapy uses drugs to target cancer cells. The drugs will be injected

into the bloodstream through an intravenous (IV) needle that is inserted into a vein or through oral consumption.

Common side effects of chemotherapy are:

• Fatigue
• Loss of appetite
• Nausea and/or vomiting
• Diarrhea or constipation
• Weight change
• Mouth sores
• Short-term hair loss
• Increase the risk of infections or bleeding

Myths of breast cancer:

1. You have breast cancer if you found out there is a lump in your breast.

Actually, only small percentage of lumps will turn out to be cancer cells. However, you can seek for medical advice from doctor if you found any persistent lump in your breast.

• You are most likely to have breast cancer if you have a family history of breast cancer.

The truth is women who have a family history of breast cancer are in a higher risk group, but most women who have breast cancer have no family history. Statistic shows that only about 10% of individuals diagnosed with breast cancer have a family history of this disease.  

• Mammogram can cause the spreading of breast cancer.

The harmfulness of radiation from mammogram is extremely low, it won’t cause any spreading of cancer cells.

Reference:

1. https://www.health.ny.gov/diseases/cancer/breast/freq_asked_quest_breast_cancer.htm
2. https://www.nationalbreastcancer.org/breast-cancer-myths/a-mammogram-can-cause-breast-cancer-to-spread/
3. https://www.breastcancerfoundation.org.my/about-breast-cancer#how-breast-cancer-spreads
4. https://www.cdc.gov/cancer/breast/basic_info/screening.htm

What is Menopause?

Menopause is the end of a woman’s menstrual cycles, occurs when the ovaries stop producing  hormones that drive menstrual cycle. It is a natural process of aging and it is not a disease or disorder.  Menopause is diagnosed when you have not had a period for 12 consecutive months. This usually happens between the ages of 45 and 55. But some women can go through menopause early. It can be the result of surgery, for example if their ovaries are removed in a hysterectomy or if there have been damage to their ovaries, such as from chemotherapy. If it happens before age 40, for any reason, it’s called premature menopause.

Signs and Symptoms

Every woman experiences menopause differently. Some women barely have any complaints, while some woman may have very severe menopausal symptoms that could impact their life, including relationships, social life, family life and work. In the months or years leading up to menopause (peri-menopause), you might experience these signs and symptoms:

• Hot Flushes – A sudden feeling of heat in the upper part or all of your body, often with blushing and heavy sweating. Hot flashes can be very mild or strong enough to wake you up (called night sweats).
• Irregular Periods – They may be shorter or last longer. You might bleed more or less than usual. 
• Emotional symptoms – Such as mood swings, anxiety, depression, low self-esteem and problems with memory or concentration.
• Sleep disturbances – Often due to hot flushes, insomnia, stress or depression and make you feel tired and irritable during the day
• Vaginal dryness – The walls of the vagina lose volume and moisture and become thin, dry, and easily irritated due to lack of oestrogen. This can lead to painful sex, an increase in vaginal infections, and chronic vaginal discomfort.
• Palpitations
• Reduced sex drive
• Dry and itchy skin
• Thinning of hair
• Muscle ache and joint pain

Complications

Once you have gone through menopause, the risk of the development of a number of medical conditions increases. Some examples of possible complications include:

• Heart and blood vessel (cardiovascular) disease. When your estrogen levels decline, your risk of heart disease increases. So it’s important to get regular exercise, eat a healthy diet and maintain a normal weight.
• Osteoporosis. This condition causes bones to become brittle and weak, leading to an increased risk of fractures. Postmenopausal women with osteoporosis are especially susceptible to fractures of their spine, hips and wrists.
• Urinary incontinence. As the tissues of your vagina and urethra lose elasticity, you may experience frequent, sudden, strong urges to urinate, followed by an involuntary loss of urine, or the loss of urine with coughing, laughing or lifting. You may have urinary tract infections more often.
• Weight gain. Many women gain weight during the menopausal transition and after menopause because metabolism slows down. You may need to eat less and exercise more, just to maintain your current weight.

Treatment

There is no specific medical treatment for menopause. The treatments instead focus on the relief of symptoms and preventing or managing chronic conditions that may occur with aging. Common treatments include:

• Hormone replacement therapy (HRT). You take medications to replace the hormones that your body isn’t producing anymore. HRT comes in several different forms including tablet, implants, and skin patches. They can help with hot flashes and vaginal symptoms, as well as making your bones stronger.

• Topical hormone therapy. This is an estrogen cream that can be applied into vagina to help with dryness, discomfort with intercourse and some urinary symptoms.
• Non-hormone medications. Certain anti-depression drug related to the class of drugs called selective serotonin reuptake inhibitors (SSRIs) may decrease menopausal hot flashes. Gabapentin, which is used to treat seizures and the blood pressure drug clonidine has also been shown to help reduce hot flushes.
• Medications to prevent or treat osteoporosis. Depending on individual needs, doctors may recommend medication to prevent or treat osteoporosis. Several medications are available that help reduce bone loss and risk of fractures. Vitamin D supplements can also be used to help strengthen bones.

Lifestyle and home remedies

Lifestyle changes help many women deal with menopause symptoms. These steps may help relieving symptoms and improving quality of life during this transition.

• If you’re having hot flashes, drink cold water, dress lightly, take a cool shower and fan yourself; Avoid hot drinks, spicy food and caffeine.
• Use an over-the-counter vaginal moisturizer or lubricant for dryness.
• Exercise regularly to sleep better and prevent conditions like heart disease, diabetes, and osteoporosis.
• Strengthen your pelvic floor muscles with Kegel exercises to prevent bladder leaks.
• Stay socially and mentally active to prevent memory problems.
• Don’t smoke. Tobacco might cause early menopause and increase hot flushes.
• Limit intake of alcohol, to lower your chance of getting breast cancer and help you sleep better.
• Maintain a healthy weight and eat low-salt, low-fat, low-sugar, high-fiber diet that’s rich in a variety of fruits and vegetables.
• Practice things like yoga, deep breathing, or massage to help you relax.

Herbs and Supplements for Menopause

A number of supplements and multivitamins are available that may help ease these symptoms. Examples are:

• Evening Primrose Oil
• Calcium Supplements
• Dong Quai
• Ginseng
• Black Cohosh
• Red Clover
• Flaxseed
• Soy
• Valerian root
• St. John’s Wort

References

1. Menopause. NHS.[Internet].NHS.UK.2022[Cited 15 July 2022]. Available from: https://www.nhs.uk/conditions/menopause/#:~:text=Menopause%20is%20when%20your%20periods,chemotherapy%2C%20or%20a%20genetic%20reason.

• Menopause. Symptoms and Causes[Internet].Mayo Clinic.[Cited15 July 2022]. Available from: https://www.mayoclinic.org/diseases-conditions/menopause/symptoms-causes/syc-20353397

• Clinical Practice Guidelines on Hormone Therapy during Menopause in Malaysian Women. MOH/P/PAK/207.10(GU) [Accessed on 15 July 2022]

• Gabriela Pichardo, M. June 2022. Menopause. [Internet]. Available from: https://www.webmd.com/menopause/guide/menopause-basics

• Menopause: Understanding the menopausal transition. [Internet]National Institutes of Health (NIH). [Cited 15 July 2022] Available from: https://www.nia.nih.gov/health/what-menopause

• Jade Poole. How is menopause diagnosed and treated. [Internet]. MyMed. [Cited 15 July 2022] Available from: https://www.mymed.com/diseases-conditions/menopause/how-is-menopause-diagnosed-and-treated

• 10 Herbs and Supplements for Menopause. [Internet] Healthline. [Cited 15 July 2022]. Available from: https://www.healthline.com/nutrition/menopause-herbs

• 11 Supplements for Menopause. [Internet]. WebMD [Cited 15 July 2022]. Available from: https://www.webmd.com/menopause/ss/slideshow-menopause

Confinement​​​ is a period to allow a mother to recuperate and recover after childbirth. The idea of confinement is familiar to Asians but foreign to Westerners. In the past when infant and maternal mortality rates were high, it was a practice to keep both the baby and mother indoors during the period of confinement to protect them from ill health. However, many of these practises originated from Asian culture and hence, possess no scientific basis at all.

Myth #1: I cannot drink plain water at all during confinement

Fact: Adequate fluid consumption is advised especially if the mother is breastfeeding. In case one drinks less water, it could be hazardous as it may lead to the formation of blood clots in your body. New mothers tend to sweat a lot, and they are also producing milk. It is therefore even more important for them to stay hydrated. The kidneys will produce more urine in the first few weeks after the baby is born to remove the excess fluid that has accumulated during the course of the pregnancy.​

Myth #2: I am not allowed to bathe or touch water for fear of ‘wi​​​nd’ entering the body

Fact: There is no basis to these beliefs. In fact, bathing regularly ensures good personal hygiene and comfort. It also reduces the chance of skin and wound infections.

Myth #3: I must not consume cold food (fruits and vegetables)

Fact: In fact, half of a recovering mother’s diet should consist of fruits and vegetables to help her restore important nutrients and source of fiber. Fiber is important to help avoid constipation among postpartum mothers and prevent hemorroids to happen.

Myth #4: I cannot eat chicken

Fact: It is important to have a well-balanced diet during confinement to replenish the body’s stores rather than avoiding specific food types. Other than consuming fibers, the other half diet portion of a postpartum mother should include whole grains such as brown rice and whole-grain bread. Overall, following the food pyramid is still the way to go. In the case of vegetarians or vegans, iron or vitamin supplements may be taken to fulfill these nutritional needs. However, there are some foods that you should avoid, such as raw food, caffeine and alcohol.

Myth #5: I have been told not to read or cry

Fact: According to traditional Chinese beliefs, childbirth is thought to weaken the liver which is linked to the eyes. During confinement, it is believed that mothers should not read or cry to avoid exerting stress on the eyes. However, there is no scientific proof to back up this belief. While prolonged reading of fine print may cause eye strain, there is no evidence to suggest that it can directly cause damage to the eyes. The same can be said for crying. In fact, crying can be a way of relieving stress and dealing with the emotions that come with being a new mum.

Myth #6: I must not expose myself and my baby to any wind drafts or air-conditioning

Fact: For personal comfort, there is definitely no harm in switching on the air-conditioner or fan, as long as it makes you and your baby comfortable. It may even help prevent heat rash from developing under hot and humid climate.

Myth #7: I shouldn’t walk or move about

Fact: While it’s true that mothers who have just given birth especially those who gave birth via C-section need to rest, they should not be restricted to just lying in bed. Experts recommend new mothers to walk and move around once they feel comfortable as it can help decrease the risk of blood clots (deep vein thrombosis).

Postpartum care

Get plenty of rest
Get as much sleep as possible to cope with tiredness and fatigue. Your baby may wake up every two to three hours for feeding. It is advised that postpartum mothers should get enough rest, sleep when your baby sleeps.

Eat healthy meals
Eat healthy diet to promote healing. Increase your intake of whole grains, vegetables, fruits, and protein. You should also increase your fluid intake, especially if you are breast-feeding.

Seek help
Don’t hesitate to accept help from family and friends during the postpartum period, as well as after this period. Your body needs to heal, and practical help around the house hold can help you get much-needed rest. Friends or family can prepare meals, run errands, or help care for other children in the house hold.

Exercise
Your doctor will let you know when it’s OK to exercise. The activity should not be strenuous. Try taking a walk near your house. The change of scenery is refreshing and can increase your energy level.

References:

8 Confinement Myths Debunked [Internet]. Gleneagles Hospital. [cited 2023 Apr 19]. Available from: https://www.gleneagles.com.sg/healthplus/article/confinement-myths-debunked
Confinement After Pregnancy: 12 Myths and Facts – HealthXchange [Internet]. [cited 2023 Apr 19]. Available from: https://www.healthxchange.sg:443/women/post-pregnancy/confinement-after-pregnancy-myths-facts
Confinement Food in Chinese, Malay and Indian Cultures – HealthXchange [Internet]. [cited 2023 Apr 19]. Available from: https://www.healthxchange.sg:443/women/post-pregnancy/confinement-food-chinese-malay-indian
Myths About Postpartum Care – Healthcare Wellness Blogs – Ovum Hospital [Internet]. 2022 [cited 2023 Apr 19]. Available from: https://ovumhospitals.com/blog/myths-about-postpartum-care/
Confinement Practices and Myths: Part 1 [Internet]. [cited 2023 Apr 19]. Available from: https://www.healthhub.sg/live-healthy/1068/pregnancy-confinement-practices-and-myths
Postpartum Care: Tips for the Recovery Process [Internet]. Healthline. 2016 [cited 2023 Apr 19]. Available from: https://www.healthline.com/health/postpartum-care