Breastfeeding Stories of Hope

November 27, 2012 by 8 Comments

After watching a video of good deeds caught on security cameras, it brought to mind something that I’ve often thought about. We see and hear so much negativity in the news, in print media and on-line, that it is bound to have an impact on our perceptions of our world. I wonder how different things would  be if we were exposed to more of the positive stories. They’re out there, but it’s easy to forget at times when we are surrounded by constant stories of hate, intolerance and tragedy. We need reminders that there is still a lot of good in the world.

I feel the same way when it comes to breastfeeding. A while ago I asked the following question on Twitter and Facebook: “When you were pregnant, what did you hear more of about breastfeeding – positive stories or horror stories?”. The answer was overwhelmingly that people had heard mainly horror stories from their friends, family and even complete strangers. I think we hear the horror stories because birth and breastfeeding have a big impact on how we perceive ourselves as mothers, and it is something that stays with us. For those who have had a bad experience, it is natural to have a need to talk about it as it is part of the healing process.

What kind of impact does this have though on us as women when it comes to our confidence in our bodies to nourish our children? I believe that it often causes women to doubt their abilities before their child even arrives. This doubt often sets into motion a series of events that can lead to premature weaning, which of course just reinforces the belief that breastfeeding is difficult and not possible for many women.

Breastfeeding is a natural event that our bodies are specially designed for, and the vast majority of women are capable of breastfeeding their babies without any problems.  The fact that there are so many horror stories out there is a very sad reflection on the state of today’s maternal and newborn care practices. Unfortunately, hospital policies and the curriculums for health care providers are very slow to catch up to what the evidence is telling us is best practice. Many of the current practices in hospital sabotage breastfeeding before it really even gets started. This is why it’s so important to be educated before your baby arrives.

There are lots of positive stories out there, but they can be much harder to find than the negative ones. Because of this, I’d like to collect breastfeeding stories to highlight on my website. Research tells us that the higher a woman’s confidence in breastfeeding is, the more likely she is to meet her breastfeeding goals. Stories from others mothers who have had positive breastfeeding experiences, or (perhaps more importantly), stories from mothers who faced difficulty with breastfeeding but overcame those difficulties and went on to breastfeed successfully, can be inspiring and a source of hope for other mothers who are currently struggling. Even if you didn’t end up exclusively feeding at breast, if you found a solution to your struggles that you were happy with and worked for your family, that’s still success!

Please share your story, or leave some encouraging words for other mothers, in the comments below or e-mail me at fleur(at)nurturedchild(dot)ca. Help other breastfeeding moms by getting the word out that it is possible to meet your breastfeeding goals, even if you’ve had a rough start!

To read the stories that have been submitted so far, see Breastfeeding – You Can Do It!

 

Filed Under: Breastfeeding, Challenges, Expectations, Mothering

The Best and Worst Places in the Industrialized World for Breastfeeding Support

May 11, 2012 by 7 Comments

Every year, the non-profit organization and registered charity Save the Children looks at the health status, nutrition, education, economic well-being and political participation of women around the world to come up with their annual  State of the World’s Mothers report. Along with providing rankings for 165 countries around the world, each report has a different theme. This year, the report focuses on the critical impact of nutrition in the first 1000 days of life, starting with pregnancy. The report also contains an Infant and Toddler Early Feeding Score for 73 developing countries and a Breastfeeding Policy Scorecard which looks at breastfeeding practices, support and policies for 36 industrialized countries. You can read more about the best and worst places in the world to be a mother and the Infant and Toddler Early Feeding Score in this companion blog post.

The Breastfeeding Policy Scorecard for Developed Countries is new this year, and it provides an interesting look at support for breastfeeding in the industrialized world. Rankings are based on maternity leave laws, right to daily nursing breaks, percentage of hospitals that are baby friendly, state of policy support for the International Code of Marketing of Breastmilk Substitutes and breastfeeding practices. Of the 36 countries listed, Norway ranks first with a score of 9.2 and the USA ranks last with a score of 4.2. Canada ranks 31st with a score of 5.4.

From the report, we see that Norway is doing a wonderful job of supporting breastfeeding mothers:

“Norway tops the Breastfeeding Policy Scorecard ranking. Norwegian mothers enjoy one of the most generous parental leave policies in the developed world. After giving birth, mothers can take up to 36 weeks off work with 100 percent of their pay, or they may opt for 46 weeks with 80 percent pay (or less if the leave period is shared with the father). In addition, Norwegian law provides for up to 12 months of additional child care leave, which can be taken by both fathers and mothers. When they return to work, mothers have the right to nursing breaks as they need them. Nearly 80 percent of hospitals have been certified as baby-friendly and many provisions of the International Code of Marketing of Breast-milk Substitutes have been enacted into law. Breastfeeding practices in Norway reflect this supportive environment: 99 percent of babies there are breastfed initially and 70 percent are breastfed exclusively at 3 months.”

Compare this to the USA:

“The United States ranks last on the Breastfeeding Policy Scorecard. It is the only economically advanced country and one of just a handful of countries worldwide where employers are not required to provide any paid maternity leave after a woman gives birth. There is also no paid parental leave required by U.S. law. Mothers may take breaks from work to nurse, but employers are not required to pay them for this time. Only 2 percent of hospitals in the United States have been certified as baby-friendly and none of the provisions of the International Code of Marketing of Breast-milk Substitutes has been enacted into law. While 75 percent of American babies are initially breastfed, only 35 percent are being breastfed exclusively at 3 months.”

The differences between Norway and the United States is staggering (and Canada isn’t doing much better than the United States). For all the talk about “Breast is best” North America is doing a very poor job of providing parents with the support they need to actually give their babies the “best”. Most mothers want to breastfeed. Breastfeeding initiation rates are high, but breastfeeding drops off rapidly in the early weeks after birth. This happens not because mothers don’t want to breastfeed anymore, but because they haven’t received the support they need to continue. Breastfeeding is natural, but it is also something that requires community support. Conditions during birth and the first 72hrs after birth are critical for establishing breastfeeding (hence the importance of hospitals being Baby Friendly) and it is important that mothers have sufficient time off of work to establish their breastfeeding relationship which encourages a longer duration of breastfeeding.

Although not specifically about breastfeeding, below are some other key points about the United States from the report that should really be cause for alarm:

In the United States, mothers face a 1 in 2,100 risk of maternal death the highest of any industrialized nation. In fact, only three developed countries Albania, Moldova and the Russian Federation perform worse than the United States on this indicator. A woman in the U.S. is more than 7 times as likely as a woman in Ireland or Italy to die from a pregnancy-related cause and her risk of maternal death is 15 times that of a woman in Greece

The U.S. under-5 mortality rate is 8 per 1,000 births. This is on par with rates in Bosnia and Herzegovina, Montenegro, Slovakia and Qatar. Forty countries performed better than the U.S. on this indicator. This means that a child in the U.S. is four times as likely as a child in Iceland to die before his or her 5th birthday.

The United States has the least generous maternity leave policy of any wealthy nation. It is the only developed country and one of only a handful of countries in the world that does not guarantee working mothers paid leave.

The United States is also lagging behind with regard to preschool enrollment and the political status of women. Performance in both areas places it among the bottom 10 in the developed world.”

An interesting (and again alarming!) point about Canada from the Save the Children Canada website:

“Norway’s under 5 mortality rate is half that of Canada (3 deaths per 1000 live births vs 6 deaths per 1000 live births)”

The risks of not breastfeeding are well documented, and there is plenty of research on the best ways to encourage breastfeeding duration and exclusivity. The statistics from this report for the countries at the top of the Breastfeeding Policy Scorecard show that interventions such as requiring hospitals to be Baby Friendly, providing adequate paid maternity leave and supporting the International Code of Marketing of Breastmilk Substitutes DO work.  This report should be a wake-up call for the countries at the bottom of the scorecard!

Below is the full list of where the 36 countries placed on the Breastfeeding Policy Scorecard. For the full details, and to see the score for each country, please refer to section 1:43 of the full report:

1. Norway
2. Slovenia
3. Sweden
4. Luxembourg
5. Austria
6. Lithuania
7. Latvia
8. Czech Republic
9. Netherlands
10. Germany
11. Estonia
12. Poland
13. Portugal
14. France
15. Belgium
16. Ireland
17. Italy
18. Switzerland
19. New Zealand
20. Cyprus
21. Denmark
22. Greece
23. Slovak Republic
24. Spain
25. United Kingdom
26. Finland
27. Israel
28. Japan
29. Hungary
30. Liechtenstein
31. Canada
32. Iceland
33. Monaco
34. Australia
35. Malta
36. United States

 

 

Filed Under: Birth, Breastfeeding, Challenges, Mothering, Research Tagged With: , , , ,

The Best and Worst Places in the World to be a Mother

May 11, 2012 by 3 Comments

Every year, the non-profit organization and registered charity Save the Children looks at the health status, nutrition, education, economic well-being and political participation of women around the world to come up with their annual  State of the World’s Mothers report. Along with providing rankings for 165 countries around the world, each report has a different theme. This year, the report focuses on the critical impact of nutrition in the first 1000 days of life, starting with pregnancy. The report also contains an Infant and Toddler Early Feeding Score for 73 developing countries and a Breastfeeding Policy Scorecard which looks at breastfeeding practices, support and policies for 36 industrialized countries. You can read more about the Breastfeeding Policy Scorecard in this companion blog post.

So what are the best and worst places in the world to be a mother?

Top 10 best places in the world to be a mother :

1. Norway
2. Iceland
3. Sweden
4. New Zealand
5. Denmark
6. Finland
7. Australia
8. Belgium
9. Ireland
10. Netherlands

Top 10 Worst places to be a mother:

1. Niger
2. Afghanistan
3.Yemen
4.Guinea-Bissau
5.Mali
6. Eritrea
7.Chad
8.Sudan
9. South Sudan
10. Democratic Republic of the Congo

From the report:

“The gap in availability of maternal and child health services is especially dramatic when comparing Norway and Niger. Skilled health personnel are present at virtually every birth in Norway, while only a third of births are attended in Niger. A typical Norwegian girl can expect to receive 18 years of formal education and to live to be over 83 years old. Eighty-two percent of women are using some modern method of contraception, and only 1 in 175 is likely to lose a child before his or her fifth birthday. At the opposite end of the spectrum, in Niger, a typical girl receives only 4 years of education and lives to be only 56. Only 5 percent of women are using modern contraception, and 1 child in 7 dies before his or her fifth birthday. At this rate, every mother in Niger is likely to suffer the loss of a child.”

“Conditions for mothers and their children in the bottom countries are grim. On average, 1 in 30 women will die from pregnancy-related causes. One child in 7 dies before his or her fifth birthday, and more than 1 child in 3 suffers from malnutrition. Nearly half the population lacks access to safe water and fewer than 4 girls for every 5 boys are enrolled in primary school.”

Malnutrition is a global crisis and it affects millions of children. Save the Children’s 13th annual report highlights the impact of this crisis and makes suggestions for improving conditions for mothers and children worldwide.

From the report, in answer to the question “Why focus on the first 1,000 days?”:

“Malnutrition is an underlying cause of 2.6 million child deaths each year.1 Million more children survive, but suffer lifelong physical and cognitive impairments because they did not get the nutrients they needed early in their lives when their growing bodies and minds were most vulnerable. When children start their lives malnourished, the negative effects are largely irreversible.”

Save the Children has identified six key nutrition solutions that have the greatest potential to save children’s  lives in the first 1,000 days and beyond. These solutions are ones that could be easily implemented at minimal cost if only there was the political will to do so:

“Three of the six solutions iron, vitamin A and zinc are typically packaged as capsules costing pennies per dose, or about $1 to $2 per person, per year. The other three solutions breastfeeding, complementary feeding and good hygiene  are behavior-change solutions, which are implemented through outreach, education and community support…… All combined, the entire lifesaving package costs less than $20 per child for the first 1,000 days.”

Save the Children has estimated that nearly 1.3 million children’s lives could be saved each year if the six interventions they identify were  fully implemented in the 12 countries most heavily burdened by child malnutrition and under-5 mortality.

One of the things that I really like about the report is that it highlights breastfeeding as an important way to combat child malnutrition, and in their section on barriers to breastfeeding, they address the aggressive marketing of infant formula. For more information about the devastation that is caused in developing countries by this unethical marketing, please read the article Milking it.

This year’s report from Save the Children includes an Infant and Toddler Early Feeding Score for 73 developing countries. The score is based on the percentage of children who are put to breast within one hour of birth, exclusively breastfed for the first six months, breastfed with complementary foods from ages 6-9 months and breastfed at age 2. The scorecard also looks at each countries progress towards the Millennium Development Goal of reducing child mortality by two-thirds by 2015 and the degree to which they have implemented the International Code of Marketing of Breastmilk Substitutes (although these last two indicators are not included in the calculation of the overall score). Only 4 countries out of 73 score “very good” on these indicators, and more than two-thirds fall into the “fair” or “poor” category. The top 4 countries are Malawi, Madagascar, Peru and Soloman Islands. The bottom 4 are Equatorial Guinea, Botswana, Côte d’Ivoire and Somalia. The top 4 countries on the Infant and Toddler Early Feeding Scorecard have made an effort to address child malnutrition, and their efforts are paying off. Change is possible!

Malnutrition in developing countries may seem like a distant problem and one that doesn’t affect us, but the children of the world not just our own neighbourhoods, are our future. The malnutrition crisis in the developing world is not new. It is an ongoing problem, and what is so frustrating is that the means exist to address the issue! Despite this fact, children in these countries have been suffering for years and will continue to do so unless the governments of the world decide to stop their posturing on these important issues and take action. Imagine how much good could be accomplished if some of the hundreds of millions of dollars that are spent every at the G8 and G20 summits were actually spent on taking action on some of the issues they are discussing. We don’t need more research or discussion, we need for people, governments and individuals alike, to step up and say “We’re going to do something about this“.

 

Filed Under: Breastfeeding, Mothering, Research Tagged With: , , , ,

The Truth Behind Common Breastfeeding Myths

January 30, 2011 by 90 Comments

There are many common misconceptions about breastfeeding, and they often cause damage to the breastfeeding relationship. Here are some of the ones that are frequently held by parents and health care providers alike, and the truth behind them.

Myth: It’s normal for breastfeeding to hurt. Truth: If breastfeeding  hurts something is wrong. Nursing may be a little uncomfortable during the early days as your body adjusts to a new sensation, but it should never be painful. Poor latch is the most common cause of pain in the early weeks, but there are other possibilities including sucking issues with baby from birth interventions or physical characteristics such as tongue-tie. If nursing hurts, get help as soon as possible. The earlier breastfeeding problems are addressed, the easier they are to fix. If you go to someone for help and the problem isn’t solved, keep trying until you find someone with the knowledge and experience to help.

Myth: Moms with small breasts can’t make enough milk. Truth: Breast size doesn’t matter.  Milk production has nothing to do with breast size.  It’s even possible for women with smaller breasts to have an oversupply of milk! Following your baby’s lead and nursing whenever your baby cues to feed will help to ensure adequate production of milk.

Myth: Many moms can’t produce enough milk. Truth: The vast majority of mothers can make more than enough milk for their baby (or babies!). It is estimated that only 2-5% (some believe this number is lower, closer to 1-2%) of women are truly unable to produce enough milk for their baby. Our species never would have survived if we weren’t able to provide for our young. Low milk production is usually the result of not enough stimulation of the breast from nursing or pumping.

Myth: There is no milk in the first few days. Truth: Colostrum *is* breastmilk! The small amounts are perfect for a new baby’s tiny stomach. Newborn stomach capacity: Day one 9-10ml (1/3 oz), day three 22-27ml (3/4-1 oz), day 10 60-81ml (2-2.5 oz).

Myth: Babies usually nurse every 3-4 hours. Truth: Babies often need to eat every 2 hrs or less. Babies have small stomachs and breastmilk is digested quickly. This is not a flaw in nature’s design, babies need to be held and interacted with frequently to aid in the development of  their brains. Frequent feedings help to ensure this!

Myth: Night feedings aren’t important. Truth: Prolactin levels (the hormone responsible for milk production) are highest at night, so those night feedings (or pumping sessions)  are important for milk production.

Myth: Breastfeeding mothers get less sleep. Truth: Recent research has shown that breastfeeding mothers get more sleep, and enjoy better quality sleep, than formula feeding mothers do. Another recent study found no difference in the amount of sleep that breastfeeding and formula feeding mothers get.  Giving formula at night to try to get more rest doesn’t work (and may make things worse if your baby doesn’t react well to the formula), and missing night time nursing sessions can have a negative impact on your milk production.

Myth: Breasts need time to fill up between feedings. Truth: Your breasts are continually making milk as your baby drinks. You don’t need to wait a certain amount of time before putting your baby back to breast.

Myth: There is no way to tell how much baby is getting. Truth: To know whether or not your baby is getting enough breastmilk, look at your baby! If your baby is gaining weight, having plenty of wet and dirty diapers, is content after feedings, meeting developmental milestones, outgrowing clothes and diapers etc, then he’s getting everything he needs.

Myth: If your breasts feel soft you don’t have enough milk. Truth: Many women worry that they don’t have enough milk if their breasts are soft, or they can’t feel their milk “let-down”.  After the early weeks, your body adjusts to your baby’s needs, and the full feeling that you may have experienced early on disappears. This does not mean that you don’t have enough milk, it simply means that your milk production is in sync with your baby’s needs. Being able to feel your milk let down is also not an indicator of milk production. Many women never feel their milk let down.

Myth: If your baby is nursing frequently, he’s just using you as a pacifier. Truth: Breasts are the original pacifier! Babies don’t nurse just for food. This often comes as a surprise to parents, but babies go to the breast for many reasons. They’re hungry, thirsty, tired, hurt, overstimulated, bored, lonely, in the mood for cuddles, etc. All are equally valid reasons to nurse. Believing that babies only nurse because they are hungry can lead to problems if parents try to hold off feedings because “he can’t be hungry he just ate!”. I’m sure most of us have heard someone say “Don’t let your baby use you as a pacifier. My response to this is “I’m not pacifying, I’m mothering!“ Pacifiers were invented to allow babies to satisfy their sucking needs when mom is not available, not the other way around. Mothers are not meant to nurse their babies only when a pacifier isn’t available.

Myth: Frequent nursing and holding will spoil your baby, make him too dependent etc. Truth: Research tells us that babies who are held and nursed frequently, actually go on to be very outgoing and adventurous children. Babies’ first relationships set the tone for all future relationships in life. By responding to our babies’ needs quickly, consistently and with love, we teach our children that the world is a safe and wonderful place. This gives them the courage to go out and explore because they know that they have a safe and loving place to return to.

Myth: If you let your baby fall asleep at the breast, he’ll never learn to go to sleep on his own. Truth: All children eventually learn to settle themselves to sleep. Babies fall asleep at the breast because nature designed it that way. Nursing is a peaceful and easy way to help our babies and young children settle to sleep during a time when they do not yet have the ability to self soothe.

Myth: pumping shows how much milk you have. Truth: The amount you are able to pump is not a good indicator of milk production. Many moms don’t respond well to pump, and a baby who is able to nurse effectively is far more efficient than any pump.

Myth: You have to drink milk to make milk. Truth: Cow’s milk is not a necessary component of anyone’s diet. We are the only mammals who drink milk past the time of natural weaning and yet every other mammal manages to produce milk for their young.

Myth: Eating gassy foods will make your baby gassy/breastfeeding moms have to be careful about what they eat/drink. Truth: Breastmilk is made from what’s in your bloodstream not your stomach. Most babies have no trouble with “gassy” or “spicy” foods, caffeine etc. Everything in moderation unless your baby’s behaviour is telling you otherwise. There is no need to unnecessarily limit your diet.

Myth: You can’t breastfeed if you’re taking medication. Truth: Most medications can be safely taken while breastfeeding. If you have questions about medications and breastfeeding, make sure you have accurate information by calling an IBCLC or the Infant Risk Centre.

Myth: you have to pump & dump after having x-rays, a CT scan or an MRI. Truth: Most scans (even those that use contrast dye) are safe while breastfeeding. Scans using radioactive isotopes are usually the only ones that require a temporary cessation of breastfeeding. If you have questions, check with an IBCLC or call the Infant Risk Centre for more information.

Myth: If you don’t have enough milk with your first baby, it will be the same with your next baby so there’s no sense in trying. Truth: Breasts usually develop more glandular tissue with each pregnancy, so if you didn’t have enough milk with a previous baby, that may not be the case with your next one. Also, most cases of low supply are due to not enough stimulation of your breasts through either nursing or pumping in the early weeks, so arm yourself with good information and support as you prepare for your next baby.

Myth: foremilk-hindmilk imbalance is a common problem. Truth: True foremilk-hindmilk imbalance is rare, and usually only happens in cases of oversupply of milk or timed feedings. Many parents are concerned about their baby getting the fatty “hindmilk”, but all breastmilk has some fat in it. When looking at fat intake, one feeding is not important. What is important is the fat intake over 24 hours. Fat content of breastmilk naturally varies throughout a feeding, and throughout a day. The emptier your breast is, the higher the fat content. So early in the day when milk volume tends to be higher, fat content will naturally be lower. Later in the day when milk volume is naturally lower, the fat content will higher. If you follow your baby’s cues and nurse your baby whenever he is looking for the breast, your baby will get what he needs.

Myth: Once your child gets teeth, can talk etc it’s time to stop nursing. Truth: According to anthropological research, the natural age of weaning for humans is between 2.5-7 years of age. Breastfeeding can and should continue for as long as is mutually desired.

Myth: Breastmilk is a dairy product. Truth: You’re not a cow! Breastmilk is considered a clear fluid.

Myth: Formula is just as good as breastmilk. Truth: Breastmilk is the biological norm for our species. It is a complex and living substance that scientists are still trying to unravel. Breastmilk has over 300 ingredients including white cells, antibacterial and antiviral agents etc. Formula has only 40 (non-living) ingredients.

Myth: After x number of months, breastmilk has no nutritional value. Truth: Breastmilk does not suddenly turn to water just because your baby has reached a certain age. Breastmilk continues to have fat, protein, carbohydrates, vitamin and minerals, antibodies etc, for as long as your child is nursing.

Myth: Doctors and nurses know a lot about breastfeeding. Truth: Most doctors and nurses (including pediatricians) have little to no education about breastfeeding (unless they pursue it on their own) as it is not part of their curriculum in school. If you need information about breastfeeding, call someone knowledgeable such as an IBCLC, La Leche League Leader or breastfeeding peer counsellor.

Myth: many mothers give up on breastfeeding too easily. Truth: Most moms want to breastfeed. Breastfeeding initiation rates are high, but the numbers of women exclusively breastfeeding drop off dramatically in the first month. Most moms run into problems and eventually switch to formula feeding due to  lack of accurate info and a lack of support.

Myth: breastfeeding is easy. Truth: Breastfeeding is natural, but in today’s culture it is often not easy. Mothers don’t fail at breastfeeding, society does. In a society where doctors and nurses have little to no training in breastfeeding and are frequently handing out harmful advice, where birth interventions that interfere with breastfeeding are the norm, formula marketing is rampant and mothers are made to feel ashamed to nurse their babies in public, it’s amazing that any woman manages to meet her breastfeeding goals. You can even the odds by educating yourself and establishing a support network. We are not meant to breastfeed or parent in isolation, so don’t be afraid to ask to for help!

Filed Under: Breastfeeding, Expectations, Mothering, Parenting

The Problem with Breastfeeding Research & Rules

January 21, 2011 by 5 Comments


Parents are often confronted these days by news headlines that question the benefits of breastfeeding, or present new information about the “right” way to approach breastfeeding. The often sensational headlines are great for selling more papers, but they do little for parents who are often left feeling confused and wondering whose advice they should follow.

Why is there so much conflicting research? Well, breastfeeding research is hard to do. With all that is known about the risks of not breastfeeding, it would be unethical to randomly assign mothers to either exclusively breastfeed, or exclusively formula feed. This means that researchers are looking at women who have already made the decision about whether or not to breastfeed, and it is impossible to account for those confounding factors that may have played into the mom’s decision. It is also rare for breastfeeding studies to have adequate control groups. Because exclusive breastfeeding is the biological norm, that is what anything else should be compared to. Many studies do not include what their definition of “exclusive” breastfeeding is, or they allow a certain amount of formula to be given while still saying that the baby is being “exclusively” breastfed.  Any amount of formula in the control group is going to alter the results of the study. It is also important to look at who is doing the research. If breastfeeding research is being funded by formula companies for example, how biased are the results?

Breastfeeding research is fascinating to read, but I really can’t help wondering what ever happened to common sense and listening to our babies and instincts? How on earth did our ancestors survive without knowing about all the breastfeeding “rules” that we have these days. Nurse 10 minutes each side, feed every 2-3 hours, introduce solids at 6 months etc. etc. Breastfeeding is an art, not a science. There is nothing black and white about it. What applies to one baby isn’t necessarily going to apply to every other baby. Breastfeeding “rules” aren’t really rules at all. They are guidelines, and it’s important to remember that babies don’t read the books or watch the clock or calender. Some babies will be ready for solids around six months, some will be ready sooner, and some later. Most babies will need to eat every 2-3 hours, but some may be content for longer between feeds, and some may need to feed more frequently. There is a wide range of normal when it comes to breastfeeding and babies.

It’s important for parents and health care providers alike to understand that breastfeeding is not black and white, because rigid “rules” create problems. Parents who have been told by their nurse or doctor in hospital that their baby should be feeding every 3-4 hours, worry that they don’t have enough milk when their baby wants to feed every 2 hours (which is very normal). Babies are often pushed to eat solids before they are ready, or made to wait even though they are showing clear signs of readiness due to the “rule” of starting solids at 6 months. Parents worry about their baby’s weight gain, worry because their baby isn’t sleeping through the night yet, is feeding too often or not enough, isn’t getting enough hindmilk, wants to nurse to sleep, etc. etc.

So with all the conflicting information out there, what is a mother to do? The answer is simple. Arm yourself with credible information (La Leche League International, Dr. Jack Newman and Kellymom are good places to start), and then follow your baby’s lead! If you are having trouble with breastfeeding, or have questions about the latest headlines, talk to an IBCLC or LLL Leader in your area.

What breastfeeding rules have you struggled with?



Filed Under: Breastfeeding, Expectations, Mothering, Research

Breastfeeding and Feminism

January 12, 2011 by 16 Comments

I’ve just finished reading the recent interview in Macleans with author Joan B. Wolf, titled “Why breastfeeding is overrated”.  Wolf is the author of the new book Is Breast best?: Taking on the Breastfeeding Experts and the New High Stakes of Motherhood.  In the interview, Wolf discusses her opinion that “Science has not demonstrated that breastfeeding is medically superior to formula-feeding”

Breastmilk is not a “magical elixir”, it is biologically normal. As much as some people would like to forget the truth, we are all in fact mammals, and mammals nurse their young. Common sense should tell us that milk from our own species is better for us than the milk of a species whose stomach has four chambers. Cow’s milk is meant for baby cows and has to be extensively processed, with some components taken out and others added, in order for it to be somewhat of an approximation of human milk. Formula has it’s place, and thank goodness we have it available in those times when it is truly needed, however the risks of not breastfeeding are well documented and supported by a large body of evidence. You can read more about why Ms. Wolf’s arguments against the breastfeeding research don’t make sense at Analytical Armadillo.

What amazes me though, is the fact that so many people need “evidence” to tell them that  breastmilk is better suited to human biology than formula. How did we, as a society get that so bass ackwards? (I do know the answer to that, but that’s another post). Breastmilk, and breastfeeding are the biological norm for our species and the reason the formula companies spend billions of dollars every year on marketing, is because they don’t have the evidence to prove that their product is better than breastmilk. The research about breastmilk is fascinating, but it shouldn’t be news to anyone that all of the various components of breastmilk have an important impact on the health of our children. It also shouldn’t be news that there are negative consequences to our children missing out on human milk and the breastfeeding relationship.

Ms. Wolf feels that breastfeeding is a feminist issue, and that there is too much pressure on mothers to breastfeed. The article in Macleans got me thinking about my own ideas about feminism, and for me, it isn’t about demanding to be equal to men in every aspect of society. Sure, women can do almost anything a man can, however as women and mothers, we have a unique contribution to make that is different from what a man can contribute (just as men have their own unique contributions that are different from women’s). That unique contribution should be valued and integrated into society without forcing women to reject their own biology.

In trying to conform and be accepted into a patriarchal society, women have learned to ignore their instincts for mothering.  Those who are still able to hear their instincts are not supported in trying to follow them.  Why are we as women so desperate to ignore our own biology in order to fit into an outdated model of what society should be? My idea of an inclusive society is one where mothering is valued for the profound impact it has on our children. Women would be supported and possibly compensated in their choice to stay home, but also supported and included in the workforce if they choose to return to work. On-site daycares, flexible scheduling, dedicated pumping rooms, etc. would allow women to maintain the closeness to their children that is so important for their development, and yet still remain as an active part of the workforce.

All mothers want what is best for their children, and most mothers want to breastfeed (which is why breastfeeding initiation rates are high).  Many women stop breastfeeding however, in the first few weeks after birth. This is not because mothers are failing at breastfeeding, or because breastfeeding isn’t natural. It is because society is failing mothers. Doctors and other health care providers have little to no training about breastfeeding, there is a lack of publicly funded support for breastfeeding mothers, formula marketing and misinformation about breastfeeding are rampant, and mothers are made to feel ashamed to nurse their children in public.  To me it is the opposite of feminism to be trying to fit ourselves into our patriarchal society rather than demanding that society change to welcome and include mothers. The fact that many women in North America still do not have at least one full year of maternity leave shows how little our society values the role of the mother. It also shows how little understanding there is about the importance of mothering.  I don’t think that we expect too much of mothers, I think we expect far too little from society.

Filed Under: Breastfeeding, Feminism, Mothering

Breastfeeding: It’s not just about the food

January 6, 2011 by 22 Comments

Babies don’t nurse just for food. This often comes as a surprise to parents, but babies go to the breast for many reasons. They’re hungry, thirsty, tired, hurt, overstimulated, bored, lonely, in the mood for cuddles, etc. All are equally valid reasons to nurse. Believing that babies only nurse because they are hungry can lead to problems if parents try to hold off feedings because “he can’t be hungry he just ate!”. I’m sure most of us have heard someone say “Don’t let your baby use you as a pacifier!”. My response to this is “I’m not pacifying, I’m mothering!” Pacifiers were invented to allow babies to satisfy their sucking needs when mom is not available, not the other way around. Mothers are not meant to nurse their babies only when a pacifier isn’t available!

Rather than becoming “spoiled” as is commonly believed, research shows that babies who are held and nursed frequently, actually go on to be very outgoing and adventurous children. Babies’ first relationships set the tone for all future relationships in life. By responding to our babies’ needs quickly, consistently and with love, we teach our children that the world is a safe and wonderful place. This gives them the courage to go out and explore because they know that they have a safe and loving place to return to.

Breastfeeding is a relationship that is about much more than just food. The whole experience of being close to mom, having skin-to-skin contact, smelling mom’s familiar scent, hearing her voice and seeing her face, receiving the comfort of warm milk, and the biologically specific components of human milk, all work together to provide the necessary environment for healthy growth and development of your baby.

I have heard people say that comfort nursing is bad because it teaches children to associate food with comfort, but breastfed babies aren’t thinking “I need comfort, so I need to eat”. They are thinking (or probably more accurately, feeling) “something’s not right, I need Mom”. Any milk they get while nursing is an added benefit, but what baby really wants and needs is the comfort and security of being close to mom. Research is showing us that babies who are not breastfed are more likely to be obese, and one theory as to why this is, is that breastfed babies have control over how much milk they take in, and they learn to eat only until they are full. For babies who are not being fed at the breast, someone else has control over the feeding, and bottle fed babies often end up taking in more milk than they really need/want. It is theorized that the overeating that bottle fed babies often experience can set the baby up for overeating later in life as well. There are also hormones present in breastmilk that help to control hunger and  metabolism. These hormones are absent in infant formula.

Breastfeeding is the ultimate mothering tool. You can’t go wrong putting your baby back to breast even if he did eat only an hour ago. Your baby may not be looking for food, but rather the comfort and security that comes with breastfeeding. You’re not being a pacifier, and you’re not creating any bad habits, you’re responding to your baby’s needs. The only time that frequent nursing may be cause for concern is if your baby is not gaining weight appropriately, isn’t having lots of wet and dirty diapers, or consistently seems unsatisfied right after coming off the breast. If this is the case, it would be a good idea to follow up with an International Board Certified Lactation Consultant to determine if something else is going on.

Filed Under: Breastfeeding, Expectations, Mothering, obesity

Baby-led Bottle Feeding

December 10, 2010 by 243 Comments

Unlike breastfeeding, we’ve all seen bottle feeding, and we all know how to do it. We’ve been surrounded by it growing up. If someone handed you a baby and a bottle you would know what to do right? Of course you would, but would you know how to do it without causing a stressful feeding? Despite the large number of parents who use bottles in today’s society (whether those bottles contain breastmilk or formula), there are very few who have actually been taught how to bottle feed their baby in a manner that is respectful of the baby’s airway and natural feeding rhythm.

Bottle feeding may seem like a strange topic for a lactation consultant to be blogging about, but I feel it’s an important one. Conventional bottle feeding methods can cause problems for both breastfed and bottle fed babies, and all babies deserve to be fed in a respectful manner. By “conventional” bottle feeding, I mean the method of bottle feeding that most of us are used to, which is baby more or less on his back, and the bottle being tipped up to ensure there are no air bubbles.

This baby is being overwhelmed with milk and is showing clear stress signs.

Although I work with breastfeeding moms and babies, I do a lot of teaching about bottle feeding. The moms  that come to me, are usually having difficulty with breastfeeding, and are sometimes supplementing breastfeeding with bottles of expressed milk or formula. There are of course alternate methods of supplementing (supplemental nursing system, finger, syringe or cup feeding) but many moms are either already using bottles when I see them, or find that bottles are simply easier to deal with because they are familiar.

I often hear from moms who are afraid that they aren’t producing enough milk because their baby will gulp down a bottle after breastfeeding. It’s important for parents to understand that with conventional bottle feeding methods, babies have no choice but to gulp down everything in their bottle in order to protect their airway. If you hold a bottle upside down (even one with a slow flow nipple), it drips. When a baby being given a bottle swallows, the negative pressure created draws more milk into the baby’s mouth, meaning the baby has to swallow again to avoid choking. This is stressful for the baby, and babies will often display stress cues such as splayed fingers or toes, milk running out of the corner of the baby’s mouth, trying to turn their head away, or trying to push the bottle away. The picture above is a good example of this.

It’s not normal for babies to gulp down their entire feeding in a few minutes. When you watch a baby breastfeeding, you see that they drink for a while then take a little break before drinking again (with the exception perhaps of oversupply/forceful let down, which is a different situation). Breastfeeding is the biological norm for infant feeding. This means that with any other feeding method used, care should be taken to mimic breastfeeding as much as possible.  I have seen conventional bottle feeding methods lead to overfeeding, spitting up, reflux, wheezing and  difficulty breathing while feeding, and even feeding refusal (due to feeding being so stressful). Bottles being given to a breastfed baby can also cause problems with breastfeeding. Babies suck differently from a bottle than they do at the breast, and babies can become accustomed to the faster flow of milk from a bottle, causing them to become impatient at the breast. The tips below can help to minimize some of the problems associated with bottle feeding.

Good positioning for bottle feeding, and a baby who is relaxed and enjoying feeding.

 

Tips for bottle feeding any baby (not just a breastfed one!)

1. Hold your baby sitting upright, and start by placing the nipple of the bottle against your baby’s top lip. Wait for your baby to open up before putting the bottle in his mouth. Never force a bottle into a baby’s mouth.

2. Your baby should be sitting up enough that the bottle is horizontal (parallel to the floor). Tip the bottle just enough to keep the tip of the nipple filled with milk (as the bottle empties, you will have to tip the bottle up more). It’s fine if there is an air bubble at the base of the nipple as long as the tip is filled with milk. This works much better with a straight bottle rather than an angled one.

3. If you are supplementing a breastfed baby, or pumping and bottle feeding in the hopes of getting baby back to nursing, it is beneficial to let your baby suck on the nipple for a minute or two without getting anything, and then tip the bottle so your baby is getting milk. When breastfeeding, babies have to wait a minute or so for mom’s milk to let down, and they have to suck to trigger that let down. Babies who have been bottle fed sometimes get used to the immediate reward from the bottle and then are impatient at the breast and don’t want to wait for let down. By letting baby suck for a short while without getting anything from the bottle, you are mimicking the process at the breast, and it can help with the transition. There is no need to worry about your baby taking in air, one end or the other it will come back out!

4. Watch your baby’s cues All babies, whether breast or bottle fed should be fed whenever they show signs of being hungry, and not according to any kind of schedule. During feeding, if your baby starts to show any signs of stress (splayed fingers and toes, milk spilling out of mouth, turning head away, pushing bottle away – see picture above) then your baby needs a break. Keep the bottle in your baby’s mouth, but tip the bottle so that the nipple is pointing towards the roof of the baby’s mouth. By doing this, your baby knows that the bottle is still there and will start sucking again when ready. At that point you can tip the bottle back up so that baby is again getting milk. It is frustrating for your baby if you take the bottle out of his mouth to give him a break because he doesn’t know where it has gone or if it’s coming back. If your baby is showing signs that he is done (turning head, trying to push bottle away etc), then respect those cues and end the feeding.

5. Alternate sides part way through the feeding to mimic breastfeeding and allow stimulation to both eyes and both sides of the body. This also helps to prevent the development of a side preference when feeding.

6. Find a nipple that works well for your baby. There are no black and white answers as to which bottle nipple is “best” for a breastfed baby, because all babies are different. For young babies, make sure you are using a slow flow nipple. Even with older babies a slow flow nipple may be best if your baby is struggling with the flow of milk. Don’t worry about the recommended ages on the bottle nipple packaging, watch your baby to determine what works best for them. Unfortunately, “slow flow” is not something that is standardized, and some “slow flow” nipples actually flow quite quickly, so again, watch your baby. I do not recommend the “Nuk” or orthodontic type nipples because mom’s nipples don’t look like that! (If mom’s nipples are pinched or flattened after baby feeds, it’s a sign that baby isn’t latched on properly, or some other issue is causing baby to compress the nipple). Your baby should be able to “latch” onto the base of  whichever nipple you use. Some bottle nipples that are advertised as having a wide base and being “more like mom’s breast”, are so wide that baby ends up being just on the nipple, which is something to be avoided. There are some good pictures of how your baby should look when latched onto a bottle nipple on this post from Best for Babes titled How to Bottle-feed as You’d Breastfeed, and more information at the website www.breastandbottlefeeding.com.

Things to avoid:

1. Never prop a bottle. It’s a dangerous practice that is stressful for your baby.

2. Don’t bottle feed your baby while he’s swaddled. You need to be able to see your baby’s hands to watch for stress signs, and your baby needs to have his hands free to participate in feeding.

3. Don’t feed your baby with him facing away from you. Feeding is an important time for the development of social interaction in babies. Make eye contact with your baby, talk to him and enjoy the feeding as a fun interaction with your baby rather than another task to get through as quickly as possible.

4. Don’t force your baby to finish a bottle by twisting it or moving it around in baby’s mouth. Let your baby decide when he’s done. Overfeeding can lead to an uncomfortable and unhappy baby!

 

More information about the baby-led method of bottle feeding can be found in Dee Kassing’s article Bottle-Feeding as a Tool to Reinforce Breastfeeding

 

Use of formula

Along with bottle feeding, I also do a lot of teaching about correct formula preparation because many parents are not informed about the dangers of giving powdered formula to young or ill babies, and haven’t been taught how to prepare powdered formula properly.

Powdered infant formula is not a sterile product and there have been cases of powdered formula being contaminated with the bacteria E. sakazakii which can easily be fatal for young children. Babies under the age of one year are at particular risk of infection with E. sakazakii, with the greatest risk being for those who are less than 28 days old, or who are preterm, low birth weight, or immunocompromised (have a weakened immune system). For these babies, liquid formula should be used because it is sterile.

If you are using  powdered formula it is very important for it to be properly prepared in order to kill any potential bacteria. Powdered formula needs to be mixed with water that is at least than 70 degrees Celsius (boil the water and let it cool for no more than 30 minutes before mixing it with the powder). It can then be cooled to an appropriate temperature for feeding or cooled and stored in the fridge for no more than 24hrs. You can read more detailed information about the proper preparation of powdered infant formula here.

If you are using liquid formula, make sure you follow the directions on the can closely. There are two types of liquid formula – ready to feed and liquid concentrate. The liquid concentrate must be mixed with the proper amount of water (as outlined on the can) before feeding. Failure to mix liquid concentrate formula with the right amount of water can have severe consequences for your baby.

 

 

Filed Under: Bottle Feeding, Breastfeeding, Mothering, Parenting

Expectations

November 29, 2010 by 8 Comments

When I was pregnant with our first child, I had a picture in my mind of what it was going to be like staying at home with our baby. I envisioned my husband coming home from work each day to a clean house, with supper ready and our baby peacefully sleeping. Reality was of course a far cry from what I had envisioned! With a baby who nursed every hour and a half for an hour at a time, My husband was lucky if I had managed to get dressed during the day let alone have a shower, clean the house or make dinner.

Looking back, my expectations were of course very unrealistic. I was the first in our family to have a baby however, and also the first of my friends, so I had no experience with the realities of motherhood. My expectations were based on what I had seen on TV, in movies, and in books and magazines. Those idealized images of “Supermom” having a spotless house, dinner on the table, and hair and makeup done all while caring for a young baby, were all I had to go on.

Because of this, the transition of going from working woman to stay at home mom was a difficult one. During the many hours that I spent nursing our son, I would often get frustrated by his frequent nursing. I had other things that I needed to get done. Whatever happened to newborns sleeping most of the day?! I was used to being on the go and busy, so spending most of the day sitting on the couch felt like wasted time, and I felt guilty when the household chores went undone. Other parents could manage a baby, house and husband, so why couldn’t I? My husband was very supportive, and certainly didn’t care that dinner wasn’t ready or that the house hadn’t been tidied up, but I did care, and I felt guilty for not being able to “do it all”.

By the time I was nursing our second child, my expectations were more realistic, however I still struggled with the difference between my expectations and reality (especially with another child to look after!). It was not until our daughter was much older that I came to the realization that during all those hours of sitting on the sofa nursing, I was actually doing something very important. The most important thing I will ever do in my life. I was feeding her, comforting her, stimulating her brain growth and development, and teaching her about trust and loving relationships (all by just nursing!). Once I came to the realization that nursing her was my job, and an important one, it became much easier to ignore the laundry that was piling up and the fact that we were having sandwiches for dinner (again) because I hadn’t had time to cook. I was able to adjust my expectations, and accept the fact that I was going to be spending a lot of the day (and night!) nursing. These days, I really miss those evening periods of cluster nursing when I had an excuse to put my feet up, put the TV on and stay there for 3 hours!

Unrealistic expectations can lead to a lot of problems. They can be damaging to the breastfeeding relationship, and can often lead to early weaning. When a newborn baby is hungry every 2 hours (which is very normal), the expectation that babies only need to eat every 3-4 hours can cause a mother to doubt her ability to produce enough milk for her baby. Expectations can be damaging to a woman’s sense of herself as a mother. It’s easy to feel like a terrible mother when you’re struggling (as I was) with an unrealistic view of what it’s like to be a mom. When you’re out in public and seeing mothers around you who look happy with their perfectly behaved children, you start questioning your abilities as a parent. Expectations can also cause unnecessary struggles with your children, when (for example) you are trying to get your young baby to sleep through the night because that’s what the books say your child should be doing.

Considering the fact that most of us have grown up in a society where detached parenting has been the norm, and the supermom stereotype is readily perpetuated, it’s not surprising that many of us do have very unrealistic expectations. Combine this with the fact that many women have never even held a newborn baby, let alone seeing someone else breastfeed or parent their child, and many of us are sadly unprepared for the realities of motherhood. We are not meant to parent in isolation. We learn from watching others, and sharing ideas and experiences. This is why it is so important to establish a good support system. In my early days as a parent I found a lot of support on-line, and eventually with my daughter, I found La Leche League. As friends and family started having babies of their own, they also became a valuable source of support.

As I grew as a mother, and saw those around me struggling with the same things I had struggled with, I realized that when you see those happy mothers in the store with their perfect children, there is something you haven’t seen. You haven’t seen that same mother yelling at her perfectly behaved children moments before they entered the store because she’s having a rough day and her children were fighting non-stop in the car. During my time as a La Leche League Leader, I would often hear mothers who were new to our group comment on how well behaved the children were and how relaxed the mothers were during meetings. Usually they were commenting because they felt like that would never be them, and they were feeling insecure about their abilities as a mother. That is why I used to make it a point during some meetings to talk about the things that we are less than proud of as mothers. Those were the times when you would hear about those calm mothers yelling at their children because they just can’t take the whining anymore, or the frustrations of constant tantrums. You would hear about the less than healthy meals that their children have had during those times when the moms are so tired from late night feedings, or being up with a sick child that they can’t find the energy to cook. You would hear about the piles of laundry and the fact that they hadn’t cleaned their bathroom for 2 weeks, and you would start to realize that you’re not such a bad mother after all!

There is no such thing as a perfect parent, and we certainly do ourselves no favours as a society by holding up an unattainable ideal for mothers. I still struggle at times with my own expectations of myself as a mother, but I have made a lot of progress. I have surrounded myself with a strong support system, I’ve learned to listen more to my heart and my instincts, and most importantly, and I’ve learned to be gentle on myself when reality doesn’t live up to my expectations.

Filed Under: Breastfeeding, Expectations, Mothering, Parenting

Beware of Holiday Weaning

November 21, 2010 by 27 Comments

With the holiday season fast approaching, I am anticipating getting calls about fussy babies and low milk production. Why does the holiday season bring about these calls? Because moms get busy. There’s Christmas shopping to do, cards to write and mail, parties to attend, groceries to do, meals to be planned and prepared, traveling and visiting with friends and family etc. The holidays are a busy time, and sometimes in all the hustle and bustle and excitement, breastfeeding is often (unintentionally) disrupted.

It’s easy for feedings to be missed when your baby is being passed from family member to family member. For some babies this might not be a problem if they are the type of baby who will protest loudly (usually prompting a quick return to mom). For babies who tend to be very easy going however, two things can happen in this situation. One, is that your baby becomes overwhelmed by the stimulation and shuts down by going to sleep. The other is that well meaning family members, in an attempt to “give you a break”, try to soothe your baby rather than handing him over for you to nurse, and again, your baby shuts down and goes to sleep (and misses a feeding). Older babies may be too distracted by all the excitement to actually settle down and nurse. Sometimes feedings may be missed or held off because you’re in the car (out shopping etc), and it’s not a convenient time to nurse.

Because milk production works according to supply and demand, these missed feedings can have an impact on the amount of milk you produce. Another factor is that stress can inhibit letdown (and lets face it, the holidays are often a stressful time!). If letdown is slow, this can result in a baby who is fussing at the breast which can cause a mom to doubt her ability to feed her child. Baby is fussing not because milk production is low, but because the milk isn’t letting down fast enough and he’s getting impatient. Sometimes however, depending on how patient your baby is, he may not take in as much milk as usual. This sends a signal to your body to slow down milk production and if the situation is prolonged, it can result in true low production of milk.

Along with this is the inevitable unsolicited advice from family members and friends which can sometimes shake a mother’s confidence that she is doing the right thing “How can he be hungry again? You just fed him!” “You’re going to spoil him by nursing him and holding him so much”. “Are you sure you have enough milk?” Comments like these can cause a mother to question her abilities and choices.

A temporary dip in milk production due to a few missed feedings and holiday stress, is usually easily fixed by increasing the frequency of nursing and spending as much time as possible skin-to-skin with your baby. Sometimes however, the holidays are a slippery slope to early weaning. Missed feedings, fussiness due to over stimulation and a mom’s decreased confidence in herself due to comments from friends and family can lead to the introduction of bottles. If mom is not pumping every time her baby gets a bottle, her body gets the message to slow down milk production. Combine this with the possibility of baby developing a preference for the fast flow of milk from a bottle, and soon you have a baby that isn’t happy at the breast. With perseverance the situation can usually be resolved, but more often than not it leads to complete weaning from breastfeeding, and can leave mom with a lot of self doubt.

In order to avoid holiday weaning, remember: family first, and people before things. It’s OK to set limits and say no to family and friends if you feel that you (or your baby!) can’t cope. Try to make sure that your baby is nursing according to his/her usual pattern, and be alert to your baby’s cues. Be prepared to intervene if your baby is getting over stimulated, needs some extra nursing etc. If necessary, find a quiet place to nurse so that your baby is not distracted while nursing, and most important of all, don’t allow yourself to feel guilty if nursing is preventing you from “helping out”. Your baby doesn’t know it’s the holidays, and his needs don’t change just because it’s a busy time of the year. Frequent nursing will make sure that your baby continues to get what he needs, will help to protect both of you from the stresses of the holiday season, and will prevent holiday weaning. Happy Holidays!

 

 

Filed Under: Breastfeeding, Holidays, Mothering
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