Of the nine respondents, one was less than 28 years of age, two were 28–32 years, two were 33–37 years, and three were 38 years and older, and one did not respond. Two respondents reported living in the U.S. for 13–18 years and seven reported 19 or more years. Seven respondents were currently married, one divorced and one single. Three respondents did not finish high school, two were high school graduates, two had some college and two were college graduates. Four of nine respondents were living with an extended family member. All nine respondents reported speaking Khmer at home "most of the time". Eight respondents reported having ever been in the WIC program. All respondents were either close to or below 150% of the 2006 poverty level . Respondents had a range of 1 to 4 children with an average of 3 children per mother. The average age of the youngest child was 2 years. All children born to respondents were born in the U.S. and in hospitals.
Participant knowledge and practice of traditional Cambodian pregnancy, postpartum, breastfeeding diets and other Cambodian practices
All respondents knew of and participated in several traditional Cambodian diet and rituals surrounding postpartum and lactation. Eight women knew of and participated in some traditional dietary customs during pregnancy. Foods such as soup, tnam sraa (herbs mixed with either wine or tea), black pepper, and ginger were reported as foods that help women make enough milk. Foods for lactating women to avoid were spicy foods and 'stinky' foods such as fish sauce and bahok (fermented fish). These foods were said to give the baby diarrhea, cause an upset stomach, and make the baby susceptible to colds and fever. One woman said that part of her decision to wean was because she did not want to follow the breastfeeding diet any longer and worried about the health of her children.
"[Breastfeeding mothers should eat] a lot of soup. They say it makes the milk come out more...Sometimes the baby can get diarrhea if you don't eat a lot of soup."
All of the respondents had heard of, but did not participate in roasting, ong klung, which is a traditional postpartum practice in Cambodia that does not allow the baby to be breastfed for hours to days after the birth. None of the diets or rituals, such as spung (modified sauna for the postpartum mother) and hot rock (warmed rock or brick wrapped in a towel and placed on the postpartum mother's stomach), were seemingly harmful to the baby nor mother and the baby did not need to be fed by an alternative care giver during any of the rituals.
Infant feeding during the early months
During the first month, one respondent exclusively breastfed, five women gave about half breast milk and half infant formula, and three women gave mostly infant formula and some breast milk. Eight women thought that breast milk was healthier for babies than infant formula and one woman thought that breast milk and infant formula were equally healthy.
Infant feeding in hospital
All respondents reported that they breastfed their baby while in hospital; however, eight of the nine women started giving infant formula while in hospital. All continued to do partial feeding (breastfeeding and infant formula) after discharge. One respondent exclusively breastfed in hospital and continued to exclusively breastfeed until stopping breastfeeding at six months. All received infant formula samples when discharged from hospital.
The eight women were asked who it was that had requested that the baby be given infant formula: a doctor/nurse, or did they request the infant formula, and why. Six women reported that the doctor or nurse gave them infant formula to feed the baby. The two women who self-requested infant formula while in the hospital did so because they felt that they did not have enough milk.
"I think the nurse brought it, the formula. And they asked me [if] I want to breastfeed and I said yes, she asked if I wanted formula and I said yes...Well, I was thinking that maybe I wasn't producing enough milk... I just didn't know if I had enough."
Role of the family
All of the respondents reported that their family had helped them during the first month after their baby was born. Eight reported that they received and followed the advice from their mother or other relatives on what to feed their babies during the first year. For the first three months, five of the mothers reported that they were advised to breastfeed as much as they can. Almost all were advised to start rice soup as their baby's first solid food. Eight gave water to the baby before the introduction of solids, even though five of them had been advised by a doctor or other person to not give water. Three of the mothers reported that they were advised to give water by their mother or other relatives even if that contradicted what the doctor or WIC counselor told them. Relatives were also involved in preparing traditional foods and postpartum rituals for the women.
"My mom has experience, she has eight kids. And she raised really, really tough back home and so I believe her and we're alive even though we don't have that much food to eat and it's really hard to find food in that time during the Khmer Rouge, it was the killing fields...so I believe her more."
Low milk supply
The eight women who started supplementing with infant formula while in hospital were asked why they decided to continue partial feeding during the first month. Six reported having a low milk supply with one or all of their children and that was the main reason they decided to supplement with infant formula. The women reported that they had a low milk supply for reasons such as: when they squeezed their breast, no milk came out; the other breast did not drip when feeding; the baby still cried after nursing; not much milk came out when she pumped; the baby lost weight; and the baby refused the breast and seemed to like infant formula better. Many of the women reported that they tried to boost their milk supply by eating certain foods such as: soups, pumpkin, and herbs; but these remedies did not work. Some had stated that they wanted to breastfeed, but they did not know why they did not make enough milk.
"They [mother or other relatives] said eat more soup to make more milk. They say, 'How come you don't have milk? If you like that in Cambodia your baby is going to starve to death.' Everything here we have, but I don't have enough milk...When I try to press out, it's not coming out. When I try to pump, it's not coming out, only when the baby suck."
Returning to work and stopping breastfeeding
Seven of the women completely weaned all of their children from the breast at or before three months of age. The range varied from two weeks to twelve months. The one mother who exclusively breastfed weaned her infant to only solids over a period of two weeks when the child was approximately six months old. The mother who breastfed for twelve months, combined infant formula feeding and breastfeeding the entire time. She was the only respondent who continued breastfeeding after returning to work.
All the women who practiced partial breastfeeding reported that they had planned while they were pregnant to return to work or school around two to three months postpartum, which they did. Five of the women stated that returning to work affected their decision to do partial bresatfeeding. One woman practiced partial breastfeeding so that the baby would get used to the infant formula when she went back to work. Some of the respondents mentioned that their babies refused the breast after a few weeks or months and since they were returning to work or had already started working, they went along with the weaning and switched to infant formula, exclusively. Several of the mothers mentioned that they tried to express milk by pumping; however, they did not get very much milk and stopped. Others knew that they would not pump when returning to work and would switch over completely to infant formula within two or three months after the birth.
"She [my mother] say when she have a baby she's breastfeeding for a year or two year. But in the United States I cannot do like her because we work and we do not have time."