DISCLAIMER: It’s important to note that the posts in this page are NOT intended to be a medical reference or to replace professional care during pregnancy, labor, or birth.

Thursday, 19 June 2014

A Natural Protein in Breastmilk That Fights HIV

For decades, public health officials have puzzled over a surprising fact about HIV: Only about 10-20 percent of infants who are breastfed by infected mothers catch the virus. Tests show, though, that HIV is indeed present in breast milk, so these children are exposed to the virus multiple times daily for the first several months (or even years) of their lives.
Now, a group of scientists and doctors from Duke University has figured out why these babies don’t get infected. Human breast milk naturally contains a protein called Tenascin C that neutralizes HIV and, in most cases, prevents it from being passed from mother to child. Eventually, they say, the protein could potentially be valuable as an HIV-fighting tool for both infants and adults that are either HIV-positive or at risk of contracting the infection.
The research, published today in Proceedings of the National Academy of Sciences, was inspired by previous work by other researchers showing that, both in tissue cultures and live mice, breast milk from HIV-negative mothers was naturally endowed with HIV-fighting properties. Scientists suggested that a few different proteins in the milk could potentially be responsible, but no one knew which one.
As part of the study, the researchers divided breast milk into smaller fractions made up of specific proteins via a number of filters—separating the proteins by size, electrical charge and other characteristics—and tested which of these fractions, when added to a tissue culture, prevented the cells from being infected by HIV. Eventually, using mass spectrometry, they found that one particular protein was present in all the HIV-resistant fractions but in none of the others: Tenascin C.

“The protein works by binding to the HIV envelope, and one of the interesting things is that we were even able to narrow down exactly where on the envelope it binds,” says Sallie Permar, the study’s lead author. Her team found that the protein binds to a crucial region on the virus’ envelope that normally locks onto a receptor called CCR5 on the outside of human T cells,allowing it to fuse its membrane with the cell’s. With the region covered up by Tenascin C, HIV’s normal route of attack is blocked, and the virus’ effectiveness is greatly diminished.
Still, the researchers say that other natural elements in milk might play a role in fighting HIV as well. “It’s clearly not the whole story, because we do have samples that have low amounts of this protein but still have HIV-neutralizing activity,” Permar says. ”So it may be acting in concert with other antiviral and antimicrobial factors in the milk.”
Whatever those other factors are, though, the finding vindicates recent changes to UN guidelines that recommend even HIV-positive mothers in resource-poor countries should breastfeed, if they’re taking anti-retroviral drugs to combat their own infection. That’s because—as statistics bear out—the immense nutritional and immune system-boosting benefits of breast milk outweigh the relatively small chance of transmitting HIV through breastfeeding. Tenascin C, it seems, is a big part of why that transmission rate is surprisingly low, and sufficient access to anti-retroviral drugs can help drive it even lower—as low as 2 percent.
The next steps, Permar says, are determining which area of Tenascin C is active in binding to HIV and whether it can effectively prevent transmission in a live animal, as opposed to a tissue culture. If it works, it could potentially be incorporated into an HIV drug with broader applications. Possible uses include giving it in a concentrated form to infants who can’t breastfeed or even administering it to those who do to increase their level or resistance. It’s even conceivable that it could someday be adapted to reduce the risk of HIV transmission in adults as well.
One immediate advantage, says Permar, is that “it’s like to be inherently safe, because it’s already a component for breast milk. It’s something babies eat everyday.” Other potential treatments, on the other hand, must be screened for toxicity.
Tenascin C’s presence in breast milk, though, prompts a deeper question: Why would milk naturally include a protein that battles HIV, a virus that evolved extremely recently in our evolutionary history, sometime in the early 20th century?
“I don’t think it’s in breast milk to combat HIV specifically, but there have been other, related infections that have passed through breastfeeding,” Permar says. “Our work has shown that Tenascin C’s activity isn’t specific to HIV, so we think it’s more of a broad-spectrum anti-microbial protein.”
In other words, Tenascin C is effective at combating a large variety of infections (perhaps related to its role in adults, where it holds various types of tissue together, necessitating receptors that can bind to a wide array of different cells). The fact that it happens to bind at just the right spot on HIV’s outer envelope so that it combats the virus’ transmission, as Permar puts it, is “a gift from evolution.”

Original article from: http://www.smithsonianmag.com/science-nature/discovered-a-natural-protein-in-breast-milk-that-fights-hiv-3189537/?no-ist

Monday, 9 June 2014

Mother's Rights to Work, Worker's Rights to Motherhood


On the 5th of June 2014, I had the chance to attend the Lactation Management Workshop at the 23rd Congress of Obstetrics & Gynaecology Society of Malaysia.
The Theme was: Mother's Rights to Work, Worker's Rights to Motherhood

I sincerely would love to share this information with women out there for you to know your rights as a breastfeeding mother.

The information which I am going to disclose here was presented at the congress and  is adapted from the following file. Do read it if you have the time to do so :-)


Maternity protection at the workplace is a legal and social recognition of the contribution that women make by having babies. The International Labour Organization (ILO) first recognised the importance of maternity protection in 1919 in its third convention (C3). In 1952, a second ILO maternity protection convention was adopted (C103), and in 2000 a third.
During the 20th Century, most countries of the world have enacted maternity protection legislation at national level.

Seven Key Elements of Maternity Protection are:
1. Scope
    -Covers all employed women including those in atypical forms of dependent work (meaning those in part time, temporary work who have an employer).

2. Leave
    -Length of leave increase from 12 weeks to 14 weeks. (compulsory 6 weeks postnatal leave).
3. Benefits
    -Cash benefits of no less than 2/3 of salary.
    -Prenatal, childbirth and post-natal care and hospitalization 
where necessary.
4. Health Protection
    - protection for women and their babies from hazards in the workplace
5. Job Protection
   - Job protection and non-discrimination: holding a woman’s job or a job at the same level to which she can return after leave; forbidding discrimination on the grounds of maternity
6. Breastfeeding Breaks
   - A woman has the right to one or more daily paid breaks for breastfeeding or a daily reduction of working hours. 
7. Breastfeeding Facilities
   - a place where a worker can feed her baby or express her milk

The ultimate goal is to have these elements implemented as a minimum standard in national legislation on maternity protection. 

Do correct me if I am wrong, but currently in Malaysia, maternity protections has not reached the level of "LEGISLATION" yet. This is what we as Breastfeeding Advocates are currently aiming for and working towards it step by step.

Below are the comparisons of Maternity Leaves and practice of Breastfeeding Breaks in various countries:

So what are the ILO Recommendations for future Maternity Protection? (R191)

Below are some things Medical Proffessionals can help to assist in helping a working mother achieve successful breastfeeding:

Sunday, 8 June 2014

My 2nd Pregnancy & Birth Story

Assalamualaikum :-)

I am indeed sorry that I took such a long time to write up this 2nd birth story.


I found out I was pregnant with my 2nd one at about 5 weeks of gestation. The line on the pregnancy test I took was really faded, so I took another test 1 hour later ( I was working in a clinic at that moment, so it was convenient for me to grab another test right away :-) ) The other test was also faded, but both tests did darken with time.

As a working doctor, with ultrasound at the clinic at that time, I decided to do an ultrasound right away on myself (too excited!). And indeed I saw a gestational sac! Was so excited, over the moon, MashaAllah!
We really wanted a sibling for my eldest daughter.

I went for my first antenatal check-up with OBGYN. Everything seem normal at that time except that I started having quite sever nausea and vomiting.


At about 7th week of gestation, while I was bathing my eldest daughter, suddenly I felt a sharp lower abdominal pain, and a gush of blood came..and the amount was so scary! It was literally a pool of fresh blood! I called for my mother in law and hubby who came rushing to help me lie down on the bed.

I was a bit panicked at that moment of time even though I experienced similar bleeding problem with my first pregnancy. However, this time around, the bleeding came gushing with fresh blood as compared to menses-like bleeding the first time around. We went to the hospital that night and at the ER they gave me a progesterone jab along with some progesterone tablets to start on. Ultrasound showed subchorionic bleed and there was fetal heartbeat (so I was relieved!).

A week went by, and the bleeding subsided Alhamdulillah!


As for my nausea and vomiting, it started at about 6 weeks gestation but became worse at about 10 weeks gestation. I was wondering why it became worse when it was supposed to subside with time..
It came to a point when I could not even take liquids, I would throw everything up..and I had this aching pain at my right hypochondrial area for a few days..went to the OBGYN but could not find anything on her ultrasound..she suggested I make an appointment with the radiological department for further detailed ultrasound of the abdomen..

Next day, while I was at work, I developed fever with nausea, vomiting and chills. Went to the ER and they referred me to radiological department after taking my blood for blood tests. According to the radiologists, they saw my appendix was swollen with fluid around it and alerted the surgeons. I was scheduled for an emergency appendicectomy and was put on General Anaesthesia (because the appendix will most likely rupture if they do not remove it, and that could be fatal for me) . Only God knows how worried I was at that moment, a surgery under general anaestesia at 12 weeks gestation! But the benefits outweighed the risks and my husband and I surrendered to Allah Almighty to save me and the baby.

Alhamdulillah, surgery went well, I recovered quite fast and was able to eat and drink normally again! Ramadhan came along soon after that, and Alhamdulillah, I managed to fast for the whole month without missing a day :-)


I gave birth to Nur Nabeeha while she was just 36 weeks of gestation..which is 4 weeks earlier than my expected due date.

Just two weeks before giving birth, which is about 34 weeks of pregnancy, I found out that I had pregnancy-induced Hypertension..which was quite a surprise for me as my blood pressure had always been on the lowish side. I was negligent too I guess, was too confident that everything is fine and was busy with household stuff and work that I neglected my last follow up and went for check-up two weeks later..It was an irony too, because I was working in a clinic at that time, and the blood pressure machine was always just beside me all the time, but never did I bother to check on my blood pressure!!
So anyway, doctor told me to monitor my blood pressure 4 times daily and get plenty rest, and didn't start me on any medication yet.

Besides the hypertension, I also started to leak some liquor (that's the main reason I  went for the check-up that day)..So again, I was told to monitor the leaking and given a follow-up the following week.

Interventions were taken that day too, like steroid injections for baby's lung maturity (just in case I deliver earlier that 36 weeks..) The doctor was hoping to buy some time before planning to induce my delivery until baby is 36 weeks and until more that 2kg..(at that moment of time, she was merely 1.8kg)..

So a week went by and I went for my follow up the following weeks..still leaking, and blood pressure fluctuating. So the OBGYN suggested to induce delivery on the 29th of December 2011 and although we were reluctant with the thought of induction, at that point of time, that was what we thought was the right thing to do in the best interest of the baby..


The following morning after the check-up, I woke up for Fajr prayers, and realized that my waterbag has broken..It was about 6.45am..I woke hubby up and told him..
Then I packed up my hospital bag..and also packed up my elder's daughter bag (to send her to her grandma's).
I told hubby to get some rest as it's gonna be a long day :-)
Then he woke up at about 9.30a.m, saying he's worried that I would be in pain and couldn't sleep anymore. At that point of time, I had no pain yet, just discomfort from the water gushing out.
So we had roti canai for breakfast, and left house at about 11 a.m. We sent off my elder daughter and the maid to my MIL before going to the hospital.While on the way, I took sips of water which I soaked Bunga Kembang Fatimah with (it's suppose to help to accelerate labour).

We reached hospital at about 12 p.m and went straight to labour room. I felt my first contraction while we were in the car. At the labour room, the midwife checked and said that it was going to be a long way till delivery because cervix wasn't favourable at all..At about 1pm, my OBGYN came and did a V.E. She said I was already 2cm open..Alhamdulillah! However, she suggested that I was started on Pitocin to speed up the labour (with the reasons that I had been leaking liquor for some time and she did not want any infection to develop if the labour took "too long". She also was worried that a long labour might accentuate my hypertension). At that moment, I consented.

So she asked if i wanted epidural..I declined because I didn't like the idea of a needle poking nearby my spinal cord and also didn't want the side effects afterwards. I didn't take it for my first delivery, so I thought probably I might not need it this time as well..

At about 2p.m, I felt intense pain, and was already 3cm open. I requested for pethidine, and was given a shot. My BP shot up at that moment of time too so they gave me some anti-hypertensives and off the lights and told me to rest..
After that, I couldn't remember quite clearly anymore..All I knew was I keep waking up because of the intense pain..and at about 5pm, was told that I was 5cm open..and about 30 minutes later, I felt like pushing already..I told the nurse to check and to her surprise, I was already fully dilated and baby's head was ready to pop out..

So I started pushing, but to my despair, the nurse took a sanitary pad and blocked the opening, told me to stop pushing until the OBGYN comes. I was so angry at that point, I started shouting away. Luckily, the OBGYN  arrived soon and only after 1 push, the baby was out! Alhamdulillah, I heard her cry and all the pain went away after that. To my delight, I was told that perineum was intact and no stitches were needed.

My 2nd Daughter (Nur Nabeeha)

When two sisters meet for the first time :-)

I was saddened that they did not allow me skin to skin time with my baby with the excuse that baby was small and had to be put to warmer. It really did hurt me but I was too weak to fight for it at that moment.
All I was thinking about was how glad I was to have delivered a healthy baby!

So overall, my active phase of labour this time was only about 5 hours, Alhamdulillah..compared to the 12 hours the previous time. I probably could give some credit to me making a habit to walk at least 15 minutes daily this time around :-) Hubby was there all the way beside me, giving me support and reminding me to be patient and salawat as much as I can..He was a gem at that moment, I cound't thank him enough..I held his hand all the way through the contraction pains..

Alhamdulillah for the fast and safe delivery :-)

As for my blood pressure, it went back to normotensive state about 2 weeks post-partum :-)

Even with the bad experiences during the labor this time around, I am thankful for a safe delivery and healthy baby, Alhamdulillah!

The past two birth experiences has encouraged me to look deeper into Gentle Birthing and hopefully I get a peaceful, calm gentle birth the next time around, InshaAllah!