Multitasking Mama: Breastfeed While You RSS Feed

Stay abreast with Birth Walk

Stay abreast with Birth Walk

I get a lot of reading done while I breastfeed.  I especially like to catch up on current news and trends in the birth, breastfeeding and parenting world.

Here are a few of my favorite blogs:

Science and Sensibility–This research blog from Lamaze International is a go-to for me as I help parents navigate through the world of birth.

Evidence Based Birth–I don’t know what birth professionals or parents did before this one came along.  This blog by Rebecca Dekker,PhD, RN, APRN, does an excellent job dissecting the research available about different pregnancy and child birth practices to determine best practice and it does it in a way that breaks it down for those of us who are not researchers.  I also love the printable practice bulletins that she puts together that parents and professionals can share with care providers.

Improving Birth–This is a great site for maternal health advocacy.  This is another one that puts together really accessible summaries of evidence based birth.

Best For Babes–These ladies know how to help women succeed with their breastfeeding goals!  Their Booby Trap series does an amazing job breaking down the barriers that many women face while trying to breastfeed in today’s medical and social culture.

The Leaky Boob–Advice on breastfeeding as well as a very active community of peer support, especially on their Facebook page.

PhD in Parenting–Articles ranging from birth and breastfeeding to every day parenting. Decidedly “attachment parent” in its philosophy.

Peaceful Parenting–As the name implies, gentle parenting with a mission.  This blog is a great resource for all things parenting, but is an especially wonderful resource for research and articles about circumcision.

Literary Mama–This is my new favorite to satisfy my more cerebral and literary leanings.  It has been a huge inspiration for my new blog, Mama on The Margins.

Remember to add Birth Walk to your RSS feed and never miss a post!

What’s in your feed?

When the Pediatrician Says to Supplement Your Breastfed Baby: What to Do–on birth walk blog

What goes in the bottle?

So you have a brand new baby in your arms that you just birthed days ago.  You stare adoringly into her little face as you breastfeed her.  You take her for her first pediatrician appointment and are informed that she’s not gaining weight as quickly as they’d like to see.  And then you hear the dreaded words, “we’d like you to supplement”.

First of all, don’t panic, it’s time to do some investigation.

Before supplementing with ANYTHING, see a lactation professional such as and IBCLC.  Many hospitals have IBCLCs on staff and provide free help to mothers that birthed at their hospital.  Some hospitals have free programs for anyone, regardless of where they birthed.

When we don’t see optimal weight gain, there can be many minor things that can be contributing to the issue, such as:

  • A latch that needs adjustment to help baby get more milk at the breast.
  • breastfeeding management–are you following baby’s hunger cues and feeding immediately or are you scheduling feedings too far apart?  A newborn baby has a tiny tummy and needs to eat very frequently, as many as 10-12 times a day (around the clock).
  • Anatomical issues that need attention such as a tongue tie or lip tie.
  • Delayed milk production.  For some women, it takes longer than “average” for their mature milk to come in fully.

Most of the time, correcting any breastfeeding issue such as those above, will correct the weight issues.

If it is determined that supplementation will be necessary for the health of your baby, you HAVE CHOICES.  Many people in the health care field are not trained in lactation.  This means that even pediatricians and nurses may mistakenly recommend formula automatically when a baby needs additional nutrition.

The American Academy of Pediatrics recommends the following “hierarchy” for supplementation of infants:

  1. Your own expressed breast milk
  2. Donated human breast milk
  3. formula

In other  words, your own expressed breast milk is by far the best option, if you are able to provide it!

If you decide that formula is the best choice for your situation, it is not the end of the world! Overall, human breast milk is the optimal food for human babies.  It is more calorically dense than formula, meaning that breastfed babies need less of it than they would formula.   Ultimately, I think what’s most important is that you get to know your options and make your own choice.

How I Learned to Love Breastfeeding: A Lesson in Biology

I have been breastfeeding for two years without a break.  As a person who was fortunate to be breastfed (and grow up in a household where that was normal), I’ve always thought breastfeeding is an amazing gift to give your baby.  Naturally, then I have been happy to share the nourishment, wellness, and love of the breastfeeding relationship with my son.  But I had the breastfeeding epiphany the other day as I nursed my 5 week-old daughter that  I don’t think I ever truly loved breastfeeding until now.

Let me clarify, I think like most moms I’ve had my ups and downs with breastfeeding.  Sometimes I just desperately want some space–to feel like my body belongs to me and me alone.  But most of the time I love cuddling up with my kiddos and giving them food and comfort from my own physical being.  I wouldn’t trade it for anything.

As a brand new mother the first time around; however, I was shocked by how challenging it was to get comfortable with breastfeeding.  I dealt with breast pain, cracked, bleeding nipples and a baby who would cry and “fight” at the breast (as I later learned, that had to do with fact that my strong letdown and oversupply was probably a little like water-boarding for baby.  I might have been pissed off and had a narrow latch too.  Sorry baby.)  Somehow in my idealized vision of motherhood, I never imagined it would work this way and I’m afraid I took it a little personally.

Unfortunately, I’m also a figure-it-out-on-your-own-or-people-might-think-you’re-a-failure kind of gal; so, it took me WAY to long to get help from a lactation counselor (when my husband put the phone  and number for the hospital lactation center in my hand).  The good news is that we got through it with the support of a a lactation professional and an amazing husband.  And by the time River was about 6 weeks old, we were merrily rolling along.  (Later, breastfeeding through pregnancy and now tandem breastfeeding have brought other kinds of challenges and rewards, but that’s another post!)

Now, here we are the second time around and I’m an old pro.  This time I knew how to help my little girl so that breastfeeding would be easier for her, and by extension, me as well.  But it’s not simply because I’ve got the “mechanics” down, so to speak.  This is where my epiphany comes in.

As many of you know, this past spring I became a doula and a certified lactation counselor.  During the course my studies and training, I learned a lot about breastfeeding (duh!) and managing oversupply (by using a laid back or “down under” position).  I also learned a lot about breastfeeding in a larger biological context.

In the book, Breastfeeding Made Simple:  the 7 Natural Laws for Nursing Mothers, Nancy Morbacher and Kathleen Kendall-Tackett write about human lactation in comparison to other mammals. First of all, they explain that humans are a “carry” species, meaning Mom is biologically designed to be a baby’s natural ecological habitat, providing for all of the needs of the infant:  food, warmth/shelter, comfort, etc.  A human infant cannot be left alone for any period of time such a “cache” animal (like a rabbit) or follow its mother around to meet it’s needs as they arise such as a “follow” animal (like a cow or deer).  From a strictly biological point of view, humans must be cared for “in arms” or carried.  There’s a reason why babies can really wail when they need to:  they are utterly helpless without a caregiver.  In an earlier time, to leave a baby alone would mean a likely death.

For me, it has been a fascinating revelation to think about breastfeeding and the mother-baby relationship in this context.  I think humans–sitting pretty near the top of the food chain, in concrete towers, and living in virtual worlds–forget that we are actually animals.  We are born with in-bred reflexes and instincts to survive and to live symbiotically with our mothers.  Programmed to find a breast (without assistance!) and latch on, to squirm closer to a body for warmth, or to cry out for comfort.

This is what I realized nursing my daughter: as I laid her on my body and truly stopped to watch her breastfeed.  I watched her dig her perfect, tiny toes in to my legs and hips to help her move closer to my breast.  I marveled as she lifted her head and moved it side to side to locate the nipple (better than any tummy time!).  And it took my breath away to see the seemingly effortless right hook of her arm that pulled the nipple from her mouth when she was finished and sleepily lay her head on my chest–milk drunk, oxytocin high.

When an infant is in its natural ecological environment (on mom’s body), it starts to look far less helpless and far more like a full, intelligent person.  The whole deal looks damn elegant when you truly stop and observe the miracle that this is.  Our species would not exist if this mama-baby dance didn’t exist. Mind-blowing beautiful–and one more reason I love breastfeeding.

The Breast Start: 5 Tips for Breastfeeding Success

Learning together

When I was pregnant with my son, like most moms, I read all the books everyone says you’re supposed to read about breastfeeding, I went to a breastfeeding class at the hospital and felt confident that when the time came, I would know just what to do.  After all, I even had the advantage of growing up in a family where I saw my mother breastfeed younger siblings (during the years that breastfeeding in this country was at an all-time low).  Yet, when the nurse placed my son in my arms for the first time, I suddenly forgot all the “rules” I thought I was supposed to know and I thought, “what the heck do I do with this thing?!” Well, in the long run, we got there (with some challenges) and two years later, we’re still riding the breastfeeding boat.

Since that time, I have learned so much more about breastfeeding, have become a certified lactation counselor and am working toward becoming an IBCLC.  The more I learn, the more I realize there are actually far fewer “rules” about breastfeeding than I initially thought as a new breastfeeding mother.  Here are my picks for 5 tips that I think will help mothers get off to a great start in reaching their breastfeeding goals.

5 Tips for Early Breastfeeding Success

1.  First 48 hours–Your baby is hardwired to breastfeed!  As it turns out, newborn humans, like other species of mammals have all of the reflexes they need to help them get to the breast and self-attach.  Babies are the most alert and ready to do this in the first hour or two after birth.  When this happens, your baby is telling your body to make milk.  The more you breastfeed in those first few days, the more you are setting the “program” for your body to make enough milk for baby for as long as you breastfeed.  Nurse whenever your baby “cues” that he or she is hungry (entering light sleep, mouthing, rooting with hand to mouth, alert or active behavior).  Lay back skin-to-skin, find a comfortable position and enjoy learning together.

2.  Frequency–As I said above, feeding your baby frequently, on cue ,  is the best way to tell your body to make milk (don’t watch the clock!).  Newborn babies will want to nurse every couple of hours because breast milk digests quickly and easily in your baby’s body.  This means that you will probably nurse as many as 10-12 times a day at first.  (Don’t panic.  This phase will not last forever!)  Nursing frequently will ensure that your body is receiving the hormonal signals it needs to make plenty of milk.

3. Feed the Baby–Sometimes things happen that can slow down this process:  a cesarean section or unexpected separation from baby, a birth defect, or other health concern.  The most important thing to remember is that no matter what happens we need to feed the baby and help mom build a milk supply.  If you are unable to nurse your baby at the breast, you should plan to use a high quality double breast pump as frequently as you would normally nurse to continue stimulating your breasts and removing the milk.  Also, if the decision is made that your baby needs supplemental feeding, remember that you have options.  The American Academy of Pediatrics has recommended a “hierarchy” for breastfeeding substitutes.  They recommend that when milk from the breast is not available that we look first to mom’s pumped milk or donor human milk.  If those are not options, then formula becomes the next choice.  In the end, babies need to eat and no mom should feel ashamed if she has to feed the baby in some other way than besides at the breast.  And do remember, even if you have a baby that needs some supplementation in the beginning, with some work, most mothers will still be able to build a full supply that meets their babies needs.

4.  Find Help–If something doesn’t feel like it’s going well, ask for help.  This was the lesson I learned far too late when I became a breastfeeding mother.  If you are experiencing pain, difficulty getting baby to latch well, baby isn’t gaining well, or your something just doesn’t seem right, don’t suffer through it.  Most challenges can be overcome with help from a trained lactation professional (and the sooner you do this, the better).  Don’t know where to find an IBCLC, CLC or other trained help?  Try finding a breastfeeding support group at the hospital where you gave birth or go to a local La Leche League meeting. 

5.  Feel Confident–Parents receive so many conflicting messages about what they are “supposed” to do to care for their baby.  In our current information technology age, we try to find answers about what to do as parents from all kinds of sources:  social networking sites, blogs, best selling books, or if you’re a science nerd like me–the latest scientific journals.  In the end though, no amount of advice can make up for your own instincts and love for your child.  As you apply this to breastfeeding know that nourishing your child cannot bet wrong no matter how or where it happens.  Feel proud that you are nurturing a new, amazing human being.

Winning the Breastfeeding Culture War

Every week there seems to be some new sensational story about breastfeeding in the media.  Everyone is weighing in on the breastfeeding debate.  First there was that now notorious Time Magazine cover with a strange and over-sexualized image of a young (beautiful) mother nursing an older toddler.  More recently, we’ve seen breastfeeding fedishized on reality television and headlines peppered with stories about nurse-ins or nursing mothers being scolded or kicked out of business establishments for breastfeeding in public (despite legal protections). At the same time, as the public health rhetoric has shifted to encourage more mothers to breastfeed, women talk about feeling ashamed or criminalized for needing to use or choosing to use formula to feed their babies.

When I look at this picture, I wonder:  Who is winning the breastfeeding culture war anyway?  The answer:  The media, for one and probably the formula companies are a close second.  Sadly, the biggest losers in the the “mommy war” debacle are the moms.   While moms are busy defending their choices or criticizing others’ decisions, we are losing site of the real battle–working for a culture that provides real supports for families, allows for choices and encourages the health and wellness of future generations.

Let’s take a second to breathe and get some perspective on this. Humans, as all other animals on the planet fall neatly into their own family and species classifcation.  We are mammals.  Mammals are set apart from other animal species by the way in which they reproduce and nurture their young.  Mammals have mammary glands which provide all of the nourishment (via species-specific milk) that babies need to grow and thrive.  Rabbits make the perfect milk to help baby rabbits survive unattended in a burrow for long  periods of time.  Cows specifically make milk that help calves grow big and strong so that they can follow its herd independently.  In contrast, humans make precisely formulated milk for immature babies to help their brains grow, their immune system to develop, and their bodies to grow and develop over a relatively long period of time. This means that breastfeeding is the biologically normal way to feed an infant for all mammals. (See:  Morbacher, N. Breastfeeding Made Simple)

Historically speaking, as we became increasingly more technology dependent and simultaneously more socially independent from traditional family and community structures, mothers began to seek out other feeding methods for their babies.  For women of another era, formula was the key to independence–to career advancement and other freedoms (and indeed was a saving grace for women for whom work outside the home was not a choice, but a necessity).  This change was great for the dairy industry and formula companies, but maybe not so great for the health of future generations.

Fast forward to 2012 and we can all acknowledge that here in the U.S. we are mired in a complex health care crises and find ourselves standing at the precipice of major change to our health care system.  Did we get into this mess simply because  a few generations of mothers didn’t breastfeed?  Of course not.  However, as we learn more and more about the risks of feeding babies non-human milk (and therefore, the reciprocal benefits of breastfeeding), we have to acknowledge that breastfeeding will play a pivotal role in bringing us back to a healthier center.

Babies who are fed formula are far more likely to get pneumonia, diarrhea and ear infections.  Moreover, they are more likely to develop allergies, asthma, diabetes and become obese.  Women who breastfeed are more protected from breast and ovarian cancer and actually have a net gain in bone density after breastfeeding.  With these kinds of potential protections in a time of health care crises for so many, it’s no wonder that the U.S. Surgeon General and the American Academy of Pediatrics are now championing breastfeeding as a matter of public health.

Assessing risk is a funny business.  We take risks all of the time.  We choose to travel in motor vehicles, take medications, use exercise equipment or any number of things that we take for granted, but are not risk-free.  Earlier this week an opinion piece in the New York Times titled “The Milk Wars” argues that as a risk oriented society, pushing exclusive breastfeeding is “…part of a collective dream of reducing all danger to nil.” While I can appreciate her feeling that it may be unreasonable to remove all danger from the world (especially in the short term), I also think it’s important not to rationalize away the potential risks to the overall population of not breastfeeding.

What we are dealing with here is culture change.  Anyone who has ever worked in a human care or services industry knows all about culture change in the work place setting.  Culture change is the process of learning from new available information and changing practice in response.  This isn’t like enforcing a new rule or policy.  It’s a matter of valuing people’s wellbeing and re-envisioning what is possible.  Unfortunately, lasting change does not happen instantly.  It requires a shift in people’s awareness about the issue.  At the same time it requires flexibility and and sense of realism about where we actually are on the culture change spectrum.  Mothers didn’t stop breastfeeding at once.  It’s unreasonable to think we’ll be able to get all new mothers breastfeeding to 1 year and beyond all at once either.

The New York Times article asks for a balanced look at the issue of breastfeeding. This is absolutely correct. If we want women to be the winners in the breastfeeding debate, we need to stop blaming women for their choices and recognize that women will make different choices if reasonable choices are available to them AND if our culture truly supports breastfeeding as the norm.

According to the CDC, while breastfeeding initiation rates are going up in this country (currently about 74%), only about 14% of moms are still exclusively breastfeeding by 6 months (the age to which the American Academy of Pediatrics agree that babies should only receive breastmilk).  We have a lot of work to do if we want this picture to change.

First, women need positive examples of other breastfeeding mothers.  Very few current mothers (and fathers!) grew up in a household where breastfeeding was taking place.  Breastfeeding will seem more normal if we see it as a daily part of life.  This also means that women need to be supported to breastfeed whenever and wherever their baby is hungry–yes this includes when women are out of the house living life, in public. (Currently, we need to create and/or honor legal protections that give women the right to breastfeed in all places to help this happen.  And for those of you who think that public breastfeeding should happen under a cover–would YOU like to eat your meals under a hot blanket where you can’t see or breathe? Neither do squirmy babies.)

Secondly, many women who do initiate breastfeeding decide to call it quits around six weeks when many women are forced to return to work.  Therefore, longer paid maternity leave and breastfeeding supports from employers (e.g. breaks for pumping, designated pumping stations, flexible scheduling options) would help to sustain breastfeeding efforts for a longer period of time.

Interestingly, as important as the above supports are, research shows that the reason many women choose to end breastfeeding is simply a lack confidence, such as fear that they do not make enough milk to feed their baby (after all you can’t see it or measure it like you can a bottle of formula).  This lack of confidence is no surprise when you listen to women’s stories of the stumbling blocks they encounter when trying to breastfeed.  These stumbling blocks or “booby traps” as they’ve been dubbed by the breastfeeding advocacy organization, Best for Babes,  can come from surprising places:  comments from nurses, doctors, and family members; or free samples and marketing from formula companies, for example.

Changing our overall culture and support for breastfeeding is the only way we will change attitudes about breastfeeding in this country.  In the meantime, no more mommy wars.  Let’s support, advocate, change policy, change hearts and minds and for goodness sake, just feed the baby!

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