I wrote a review of this study a year ago: Pediatricians Are Not A Good Resource for Breastfeeding Advice and Support and shows how most pediatricians do more to sabotage than to support the breastfeeding relationship between mothers and their babies. Today I want to share another resource you may find helpful.
Today I got an email from a new mother who had gotten poor advice from a pediatrician in regards to breastfeeding. This pediatrician is actually one that I find to be very supportive in many ways of the breastfeeding dyad. But this piece of advice was purely her own personal view not one that is supported by evidenced based medicine. I just wish moms would ask a pediatrician the hard questions regarding the advice they offer. Is this medical advice? Is this your personal parenting advice? Is this evidence based? Just as I encourage you to go to the Coalition for Improvement of Maternity Services to find out if your OB/GYN practice is really a supportive one for your care during pregnancy, I encourage you to visit the NBCI to read about how to insure your pediatrician is supportive of breastfeeding. Dr. Jack Newman is a foremost authority on breastfeeding worldwide! There are more resources out there that do a great job regarding breastfeeding information- LLLI being one of them. But be careful when getting advice that does not feel quite right to you- do your research and ask more questions!
Showing posts with label Breastfeeding. Show all posts
Showing posts with label Breastfeeding. Show all posts
Saturday, November 13, 2010
Friday, October 29, 2010
Jaundice and the Newborn
Folks come to me all the time talking about their baby being separated from them to go under bilirubin lights. Occasionally someone insists on bringing their baby home and they use light therapy there or even use the bilirubin blanket. I wanted to share what is actually the issue with bilirubin levels in an infant and some protocol that has been shared with me. I just feel you need to know the facts- know the Pediatric Guidelines and know what you can do to help your baby and your breastfeeding relationship not be interrupted.
Sunday, March 14, 2010
Atlanta Parent Magazine Editorial
In the March 2010 Atlanta Parent Magazine there was an article entitled "Mom to Mom: The Practical Side of Breastfeeding" by Kimberly Kennedy. I have no idea who she is and what her credentials are as the article does not say. But I was sooooo disappointed in the article. I thought I would share my dislike with you- I have already left the editorial staff a message on their voice mail.
The first paragraph was about how hard can it be. The suggestion is that they need to start by consulting a lactation consultant. And although I like using a lactation consultant if there is a problem- it is not the first course of action that is recommended. The studies actually show that the first thing- the most beneficial thing to preventing nipple trauma is taking a good lactation class prenatally. The writer does suggest consulting La Leche League- but there is no mention of attending a class or going to a LLL meeting prior to having the baby. Both of these things would make a huge difference- you know- prevention is worth a pound of cure!
The writer goes on to say wearing a sexy bra with a nursing pad after pumping first is ideal if you are going to have sex due to having a let down when having sex. I thought - what? Pump before having sex... there goes anything spontaneous- or one more thing to deter someone from having sex. Why not say, "You may have a let down if you are lucky enough to have an orgasm during sex... and I certainly hope you are. So, keep a small towel handy to press against your breasts when this happens." Now isn't that easier than putting the pressure on the mom to wear a sexy bra and pump beforehand? Come on we are talking what breasts were really made for here- nursing!
Then for the new mom who is already a bit neurotic about having enough milk- she puts in this comment, " babies have suffered brain damage, even death, from insufficient milk supply. Fortunately, this is rarely a problem." Rarely a problem- but now you have given that mom one more thing to worry about and perhaps even deter her from breastfeeding. Come on- if it is so rare- and it is- then why not give practicals about counting wet and poopy diapers- and encourage the mom that more nursing brings in more milk- so warn her about not scheduling a baby in the first few weeks!
And then she pops in one more negative piece, "Breast reduction surgery can affect supply." Why not then refer her to Defining Your Own Success, a great book regarding how to assist a mom with this issue. And why not say this is usually only a problem if the nipple was removed and then reattached. Again, yes this happens- but let's help this mom not offer a reason to not try.
Then this part about made me scream, "How long will the baby eat? She says they drink for 5-10 minutes for the first few weeks and then will work up to 10-20 minutes each side when well established. But if the baby drinks for 30-40 minutes there could be a problem." Hello??? This is not true at all. Every baby is different- every baby has different sucking needs. And it is not about drinking milk alone- it is about sucking needs as well. So giving rigid guidelines like this is a recipe for disaster for many moms.
Then the question is posed how often will he eat? And she says at first, "every 3 to 4 hours." She goes on to say that "demand feeding" many moms find "impractical and instead schedule feedings." She goes on to say if the baby is acting hungry after 1 1/2 to 2 hours and isn't sated with a pacifier or other distractions, feed him" And I had to scream out loud for a minute! Who is this article for? For the mom who does not want to breastfeed but does in a very token way to say she tried? Is breastfeeding all about her? I am sorry- I am a baby advocate here. Demand feeding is best- the studies show it is best for a mom's milk supply to be well established and for the baby's needs. Period. Scheduling in the first few months is a recipe for low milk supply, gassy babies who are full of gas due to pacifiers and crying, and nipple trauma from nipple confusion due to the pacifier. And everyone knows that most babies in the first few weeks if not a bit longer- nurse ever 2 to 2 1/2 hours from the start of a nursing to the start of the next nursing.
Then the next section of the article is subtitled; Meeting Your Needs. I thought the first section sounded like that- after all it did not sound like it was in the best interest of the baby at all! She then goes on to say how you have to plan when you are breastfeeding- for appointments and such. Hmmm- why? Because she also discusses later where to nurse- she suggests your car! Well why not explain the law regarding breastfeeding publicly. Why not discuss how you can learn to breastfeed publicly in a way that is comfortable for you. That may be the car. But that may be in the chair in the waiting room at the doctor's office. Why do we need to try to plan our nursing times in such a way to not have to nurse when we are out. The feeling that breastfeeding moms are banished to the bathrooms or cars makes me get out my soap box for sure!
Then she says, "after baby is a few months old and is able to sleep six hours at a time, you may choose to wean him from nighttime feedings." Well what is a few months old? And six hours? Come on! I thought the accepted term "sleeping through the night" was five hours. And the studies again show that usually occurs at 15 pounds and/or 3 months of age. She again suggests offering a pacifier. Augh!
And then the big push to offer a bottle begins. Does she realize that often times a mom can actually have a nursing dyad with her baby without a bottle or pacifier coming into play? She suggests starting too soon may cause nipple confusion- thank you! And then suggests waiting til 6 weeks could cause bottle rejection- "a nightmare for any mom who'd like an occasional break!" She then suggests "offering a bottle within the first month, after breastfeeding is well established. Keep her accustomed to bottles by offering them once every day or two." Well let me say- I wonder how long she was successful nursing her baby. This is the recipe for early weaning- in fact it is weaning a baby from the breasts. There is that not so subtle way of also implying that a mom needs a break from her baby and must bottle feed in order to do so. There are many moms who enjoy their breaks with their babies. And many who can find time to slip away for a few hours to grab dessert with their friends or hubby and not leave a bottle. And most moms are still establishing their milk supplies in the first month!
The pump advise is ludicrous. If you miss a feeding you do not need to necessarily pump to keep yourself from getting a plugged duct. You can massage your breasts and express a bit off while away from your baby- and nurse well when you are back with your baby.
The what do you need section sounds like you need a basket of stuff in two locations in your home... hmmm not true. You may not need any of these things she suggests- they may be helpful. But again to nurse you need a baby and a breast... not much else. It is really quite simple- in fact minimal things are even helpful to be honest- we make it sound like you have to have a bunch of stuff to make this work. I do not believe history or third world countries with nursing moms will agree with you!
The advice regarding what to wear is ludicrous as well. "Loose fitting tunics... bunched up around the breasts..." Hmm how about a camisole and a shirt that buttons down the front- unbuttoned from the bottom. You pull up the camisole or light weight tank and unbutton the shirt from the bottom- thus keeping your breast fairly concealed and nursing easily?
And I already addressed her "where do I nurse in public?" comments. But let me say- wherever YOU are comfortable. I have nursed while walking down the mall- wearing a baby in the sling- so discretely that my husband was not even aware I was doing so! I have nursed on benches, sitting on the floor, in booths at restaurants, on the curb at a street fair, in the stands at a fire works display on the fourth of July, in my car, on the swings at the playground, in church on the pew... you get my drift... but I have never nursed in the bathroom... or in a special nursing area in all my years of nursing three children.
So, Parent magazine... please tell me who this chick who wrote this is- what her background is- what made her an authority on breastfeeding? She certainly is not indicative of the places she refers to for web breastfeeding help. I am glad she at least put those resources in the article. Perhaps folks will forgo her advice and head there to get correct information.
The first paragraph was about how hard can it be. The suggestion is that they need to start by consulting a lactation consultant. And although I like using a lactation consultant if there is a problem- it is not the first course of action that is recommended. The studies actually show that the first thing- the most beneficial thing to preventing nipple trauma is taking a good lactation class prenatally. The writer does suggest consulting La Leche League- but there is no mention of attending a class or going to a LLL meeting prior to having the baby. Both of these things would make a huge difference- you know- prevention is worth a pound of cure!
The writer goes on to say wearing a sexy bra with a nursing pad after pumping first is ideal if you are going to have sex due to having a let down when having sex. I thought - what? Pump before having sex... there goes anything spontaneous- or one more thing to deter someone from having sex. Why not say, "You may have a let down if you are lucky enough to have an orgasm during sex... and I certainly hope you are. So, keep a small towel handy to press against your breasts when this happens." Now isn't that easier than putting the pressure on the mom to wear a sexy bra and pump beforehand? Come on we are talking what breasts were really made for here- nursing!
Then for the new mom who is already a bit neurotic about having enough milk- she puts in this comment, " babies have suffered brain damage, even death, from insufficient milk supply. Fortunately, this is rarely a problem." Rarely a problem- but now you have given that mom one more thing to worry about and perhaps even deter her from breastfeeding. Come on- if it is so rare- and it is- then why not give practicals about counting wet and poopy diapers- and encourage the mom that more nursing brings in more milk- so warn her about not scheduling a baby in the first few weeks!
And then she pops in one more negative piece, "Breast reduction surgery can affect supply." Why not then refer her to Defining Your Own Success, a great book regarding how to assist a mom with this issue. And why not say this is usually only a problem if the nipple was removed and then reattached. Again, yes this happens- but let's help this mom not offer a reason to not try.
Then this part about made me scream, "How long will the baby eat? She says they drink for 5-10 minutes for the first few weeks and then will work up to 10-20 minutes each side when well established. But if the baby drinks for 30-40 minutes there could be a problem." Hello??? This is not true at all. Every baby is different- every baby has different sucking needs. And it is not about drinking milk alone- it is about sucking needs as well. So giving rigid guidelines like this is a recipe for disaster for many moms.
Then the question is posed how often will he eat? And she says at first, "every 3 to 4 hours." She goes on to say that "demand feeding" many moms find "impractical and instead schedule feedings." She goes on to say if the baby is acting hungry after 1 1/2 to 2 hours and isn't sated with a pacifier or other distractions, feed him" And I had to scream out loud for a minute! Who is this article for? For the mom who does not want to breastfeed but does in a very token way to say she tried? Is breastfeeding all about her? I am sorry- I am a baby advocate here. Demand feeding is best- the studies show it is best for a mom's milk supply to be well established and for the baby's needs. Period. Scheduling in the first few months is a recipe for low milk supply, gassy babies who are full of gas due to pacifiers and crying, and nipple trauma from nipple confusion due to the pacifier. And everyone knows that most babies in the first few weeks if not a bit longer- nurse ever 2 to 2 1/2 hours from the start of a nursing to the start of the next nursing.
Then the next section of the article is subtitled; Meeting Your Needs. I thought the first section sounded like that- after all it did not sound like it was in the best interest of the baby at all! She then goes on to say how you have to plan when you are breastfeeding- for appointments and such. Hmmm- why? Because she also discusses later where to nurse- she suggests your car! Well why not explain the law regarding breastfeeding publicly. Why not discuss how you can learn to breastfeed publicly in a way that is comfortable for you. That may be the car. But that may be in the chair in the waiting room at the doctor's office. Why do we need to try to plan our nursing times in such a way to not have to nurse when we are out. The feeling that breastfeeding moms are banished to the bathrooms or cars makes me get out my soap box for sure!
Then she says, "after baby is a few months old and is able to sleep six hours at a time, you may choose to wean him from nighttime feedings." Well what is a few months old? And six hours? Come on! I thought the accepted term "sleeping through the night" was five hours. And the studies again show that usually occurs at 15 pounds and/or 3 months of age. She again suggests offering a pacifier. Augh!
And then the big push to offer a bottle begins. Does she realize that often times a mom can actually have a nursing dyad with her baby without a bottle or pacifier coming into play? She suggests starting too soon may cause nipple confusion- thank you! And then suggests waiting til 6 weeks could cause bottle rejection- "a nightmare for any mom who'd like an occasional break!" She then suggests "offering a bottle within the first month, after breastfeeding is well established. Keep her accustomed to bottles by offering them once every day or two." Well let me say- I wonder how long she was successful nursing her baby. This is the recipe for early weaning- in fact it is weaning a baby from the breasts. There is that not so subtle way of also implying that a mom needs a break from her baby and must bottle feed in order to do so. There are many moms who enjoy their breaks with their babies. And many who can find time to slip away for a few hours to grab dessert with their friends or hubby and not leave a bottle. And most moms are still establishing their milk supplies in the first month!
The pump advise is ludicrous. If you miss a feeding you do not need to necessarily pump to keep yourself from getting a plugged duct. You can massage your breasts and express a bit off while away from your baby- and nurse well when you are back with your baby.
The what do you need section sounds like you need a basket of stuff in two locations in your home... hmmm not true. You may not need any of these things she suggests- they may be helpful. But again to nurse you need a baby and a breast... not much else. It is really quite simple- in fact minimal things are even helpful to be honest- we make it sound like you have to have a bunch of stuff to make this work. I do not believe history or third world countries with nursing moms will agree with you!
The advice regarding what to wear is ludicrous as well. "Loose fitting tunics... bunched up around the breasts..." Hmm how about a camisole and a shirt that buttons down the front- unbuttoned from the bottom. You pull up the camisole or light weight tank and unbutton the shirt from the bottom- thus keeping your breast fairly concealed and nursing easily?
And I already addressed her "where do I nurse in public?" comments. But let me say- wherever YOU are comfortable. I have nursed while walking down the mall- wearing a baby in the sling- so discretely that my husband was not even aware I was doing so! I have nursed on benches, sitting on the floor, in booths at restaurants, on the curb at a street fair, in the stands at a fire works display on the fourth of July, in my car, on the swings at the playground, in church on the pew... you get my drift... but I have never nursed in the bathroom... or in a special nursing area in all my years of nursing three children.
So, Parent magazine... please tell me who this chick who wrote this is- what her background is- what made her an authority on breastfeeding? She certainly is not indicative of the places she refers to for web breastfeeding help. I am glad she at least put those resources in the article. Perhaps folks will forgo her advice and head there to get correct information.
Thursday, February 25, 2010
2 Wonderful Breastfeeding Videos
The studies show hands down that the best way to avoid nipple trauma is a class BEFORE you have your baby. So, please consider a great class to help you avoid problems. But here are two videos that may assist you if you have any problems.
Maximizing Milk Production
Hand Expression of Breastmilk
And if in doubt of a medication passing into your breastmilk- try this link LactMed.
Maximizing Milk Production
Hand Expression of Breastmilk
And if in doubt of a medication passing into your breastmilk- try this link LactMed.
Monday, November 2, 2009
Psychotropic Drug Use During Breastfeeding
Psychotropic Drug Use During Breastfeeding: A Review of the Evidence
Pediatrics 2009;124;e547-e556; originally published online Sep 7, 2009;
Filomena Fortinguerra, Antonio Clavenna and Maurizio Bonati
DOI: 10.1542/peds.2009-0326
OBJECTIVE: The objective of this study was to review the existing literature on the use of various classes of psychotropic medications during breastfeeding to provide information about infant exposure levels and reported adverse events in breastfed infants.
METHODS: A bibliographic search in the Medline (1967 through July 2008), Embase (1975 through July 2008), and PsycINFO (1967 through July 2008) databases was conducted for studies on breastfeeding and psychotropic medications for a total of 96 drugs. References of retrieved articles, reference books, and dedicated Web sites were also checked. The manufacturers were contacted for drugs without published information. Original articles and review articles that provide pharmacokinetic data on drug excretion in breast milk and infant safety data were considered, to estimate the “compatibility level” of each drug with breastfeeding.
RESULTS: A total of 183 original articles were eligible for analysis. Documentation was retrieved for 62 (65%) drugs. In all, 19 (31%) psychotropic drugs can be used during lactation according to an evidence based approach. For 28 drugs, the available data do not permit an evaluation of the drug’s safety profile during breastfeeding and, for an additional 15 drugs, the exposure dose or observed adverse effects make their use unsafe.
CONCLUSIONS: Although most drugs are considered safe during breastfeeding, compatibility with breastfeeding has not been established for all psychotropic drugs. There is a need for additional research and accumulation of experience to guarantee a more rational use of psychotropic drugs during breastfeeding. Pediatrics 2009;124:
e547–e556
AUTHORS: Filomena Fortinguerra, PharmD, Antonio Clavenna, MD, and Maurizio Bonati, MD
Laboratory for Mother and Child Health, Public Health Department, Mario Negri Institute for Pharmacological
Research, Milan, Italy
I love the way this article begins with this statement, “Breastfeeding is essential for the physical and psychological health of both mother and child, and its benefits are well documented.”
And then the comment that, “Despite the increased attention toward breastfeeding, however, information on breast milk drug excretion and knowledge of the adverse effects on the infant are often unavailable or still limited for many drugs that frequently are used by women of childbearing age, and misinformation abounds.” But the truth is it is not profitable for most pharmaceutical companies to research the small population of women breastfeeding to determine if a drug has an interaction with their baby’s breastmilk. It is easier to just determine that it is not okay for a mom to take most medications than to do the tests.
The article then makes this statement, “Worldwide, more than half of breastfeeding women take some type of drug and the concern about potential harm to the nursing infant from maternal medications is often cited as a reason to stop lactation,11 even if discontinuing breastfeeding is often the wrong decision. The Summary of Product Characteristics should not be considered a reliable source of breastfeeding information; it often indicates that a drug is not recommended during lactation, suggesting that it be avoided or that breastfeeding be interrupted. The warnings are not necessarily related to observed or reported adverse effects; they are often used as a defensive measure on the part of the manufacturer when the drug’s safety information is not available.”
What is astounding is how many women who could benefit from drugs are not getting them or not taking them or weaning their babies unnecessarily since no one is doing any real studies on drugs that could be helpful to them.
“It has been estimated that, each year, more than 500 000 pregnancies in the United States are complicated by psychiatric disorders such as depression, anxiety, and psychosis, which often develop, recur, and/or worsen during and after pregnancy. Furthermore, 13% of all psychiatric hospital admissions for women occur during the first postpartum year. Depression is the most frequent mental disorder in the perinatal period: 10% to 16% of pregnant women fulfill diagnostic criteria for major or minor depression, but up to 70% report symptoms of depression. Furthermore, 7% to 20% of women receive a diagnosis of postpartum depression in the first year after delivery. Untreated depression and anxiety can have a negative impact on pregnancy, and adverse short-term and long-term effects can have a negative impact on the developing infant and child.”
This article sited several studies to determine what is really known out there regarding drug interactions with breastfeeding infants from psychotropic drugs that their mothers were taking. They looked at several methods of determining how safe the drugs were- from dosage- to length of time the drugs were taken- to amount found in breastmilk to effect on babies in adverse ways. They looked at what may be compatible, what needed to be used very cautionary and what was contraindicated.
“A total of 19 (31%) psychotropic drugs can be used during lactation according to an evidence-based approach, whereas for 28 drugs, the available data do not allow an evaluation of their safety profile during breastfeeding.”
Antidepressants had been studied most. “In particular, among the antidepressants, sertraline, paroxetine, and fluvoxamine are the first-choice drugs for treatment of depression in breastfeeding mothers because they have the lowest degree of excretion into human breast milk.” “Antipsychotics are the class with the smallest number of studies concerning use during breastfeeding. The available data regarding the use of hypnotic and anxiolytic agents during breastfeeding are scant.”
I found it interesting that, “there have been no studies on infants’ long-term exposure to very low dosages of antidepressants.” It is as if the studies allows the mother to go on the drug but does not care once they determine it is okay what the long term effect on the infant could possibly be. Looking at long term effects seem the most important as that is what will cause the longer lasting issues.
The article stated, “The decision to prescribe psychotropic agents to breastfeeding mothers should depend on an individual risk/benefit analysis: the known benefits of breastfeeding and medication use for both mother and infant must be weighed against the risk of untreated maternal illness or the risk of infant exposure to medications through breast milk.”
But since so often physicians would rather just have the mom wean the baby and treat their patient without regard to the individual desires and needs of the nursing dyad, many moms wean unnecessarily. Or a mother who needs treatment will forgo the treatment at risk to herself and possibly her infant.
The conclusion of these authors was that more studies need to be done and the safety issue of many of these drugs is still unknown and quite controversial. So, this was their call to action report of sorts.
I attended a dinner that Dr Zachary Stowe, a renowned physician (Professor, Psychiatry & Behavioral Sciences Director, Women’s Mental Health Program Emory University School of Medicine in Atlanta, Georgia) presented information about psychotropic drugs and breastfeeding moms. He gave several ways to help a mom avoid depression, which included simple things like receiving postpartum help, going for walks outside in the sunshine and many others. But he stated that it is important in order to have a happy baby to have a happy mom. Getting moms the medication they need without unnecessarily weaning a baby is imperative. We know the benefits of breastfeeding on the baby and we need to stop throwing the proverbial baby out with the bath water. Research needs to be done more fervently and more physicians need to try to keep the baby and mother nursing dyad together. Mental illness needs to be treated like so many other diseases and illnesses- with avid research in order to be treated without putting the baby at risk- and that includes weaning the baby when we know the health benefits of nursing that are well documented.
Teresa Howard
Pediatrics 2009;124;e547-e556; originally published online Sep 7, 2009;
Filomena Fortinguerra, Antonio Clavenna and Maurizio Bonati
DOI: 10.1542/peds.2009-0326
OBJECTIVE: The objective of this study was to review the existing literature on the use of various classes of psychotropic medications during breastfeeding to provide information about infant exposure levels and reported adverse events in breastfed infants.
METHODS: A bibliographic search in the Medline (1967 through July 2008), Embase (1975 through July 2008), and PsycINFO (1967 through July 2008) databases was conducted for studies on breastfeeding and psychotropic medications for a total of 96 drugs. References of retrieved articles, reference books, and dedicated Web sites were also checked. The manufacturers were contacted for drugs without published information. Original articles and review articles that provide pharmacokinetic data on drug excretion in breast milk and infant safety data were considered, to estimate the “compatibility level” of each drug with breastfeeding.
RESULTS: A total of 183 original articles were eligible for analysis. Documentation was retrieved for 62 (65%) drugs. In all, 19 (31%) psychotropic drugs can be used during lactation according to an evidence based approach. For 28 drugs, the available data do not permit an evaluation of the drug’s safety profile during breastfeeding and, for an additional 15 drugs, the exposure dose or observed adverse effects make their use unsafe.
CONCLUSIONS: Although most drugs are considered safe during breastfeeding, compatibility with breastfeeding has not been established for all psychotropic drugs. There is a need for additional research and accumulation of experience to guarantee a more rational use of psychotropic drugs during breastfeeding. Pediatrics 2009;124:
e547–e556
AUTHORS: Filomena Fortinguerra, PharmD, Antonio Clavenna, MD, and Maurizio Bonati, MD
Laboratory for Mother and Child Health, Public Health Department, Mario Negri Institute for Pharmacological
Research, Milan, Italy
I love the way this article begins with this statement, “Breastfeeding is essential for the physical and psychological health of both mother and child, and its benefits are well documented.”
And then the comment that, “Despite the increased attention toward breastfeeding, however, information on breast milk drug excretion and knowledge of the adverse effects on the infant are often unavailable or still limited for many drugs that frequently are used by women of childbearing age, and misinformation abounds.” But the truth is it is not profitable for most pharmaceutical companies to research the small population of women breastfeeding to determine if a drug has an interaction with their baby’s breastmilk. It is easier to just determine that it is not okay for a mom to take most medications than to do the tests.
The article then makes this statement, “Worldwide, more than half of breastfeeding women take some type of drug and the concern about potential harm to the nursing infant from maternal medications is often cited as a reason to stop lactation,11 even if discontinuing breastfeeding is often the wrong decision. The Summary of Product Characteristics should not be considered a reliable source of breastfeeding information; it often indicates that a drug is not recommended during lactation, suggesting that it be avoided or that breastfeeding be interrupted. The warnings are not necessarily related to observed or reported adverse effects; they are often used as a defensive measure on the part of the manufacturer when the drug’s safety information is not available.”
What is astounding is how many women who could benefit from drugs are not getting them or not taking them or weaning their babies unnecessarily since no one is doing any real studies on drugs that could be helpful to them.
“It has been estimated that, each year, more than 500 000 pregnancies in the United States are complicated by psychiatric disorders such as depression, anxiety, and psychosis, which often develop, recur, and/or worsen during and after pregnancy. Furthermore, 13% of all psychiatric hospital admissions for women occur during the first postpartum year. Depression is the most frequent mental disorder in the perinatal period: 10% to 16% of pregnant women fulfill diagnostic criteria for major or minor depression, but up to 70% report symptoms of depression. Furthermore, 7% to 20% of women receive a diagnosis of postpartum depression in the first year after delivery. Untreated depression and anxiety can have a negative impact on pregnancy, and adverse short-term and long-term effects can have a negative impact on the developing infant and child.”
This article sited several studies to determine what is really known out there regarding drug interactions with breastfeeding infants from psychotropic drugs that their mothers were taking. They looked at several methods of determining how safe the drugs were- from dosage- to length of time the drugs were taken- to amount found in breastmilk to effect on babies in adverse ways. They looked at what may be compatible, what needed to be used very cautionary and what was contraindicated.
“A total of 19 (31%) psychotropic drugs can be used during lactation according to an evidence-based approach, whereas for 28 drugs, the available data do not allow an evaluation of their safety profile during breastfeeding.”
Antidepressants had been studied most. “In particular, among the antidepressants, sertraline, paroxetine, and fluvoxamine are the first-choice drugs for treatment of depression in breastfeeding mothers because they have the lowest degree of excretion into human breast milk.” “Antipsychotics are the class with the smallest number of studies concerning use during breastfeeding. The available data regarding the use of hypnotic and anxiolytic agents during breastfeeding are scant.”
I found it interesting that, “there have been no studies on infants’ long-term exposure to very low dosages of antidepressants.” It is as if the studies allows the mother to go on the drug but does not care once they determine it is okay what the long term effect on the infant could possibly be. Looking at long term effects seem the most important as that is what will cause the longer lasting issues.
The article stated, “The decision to prescribe psychotropic agents to breastfeeding mothers should depend on an individual risk/benefit analysis: the known benefits of breastfeeding and medication use for both mother and infant must be weighed against the risk of untreated maternal illness or the risk of infant exposure to medications through breast milk.”
But since so often physicians would rather just have the mom wean the baby and treat their patient without regard to the individual desires and needs of the nursing dyad, many moms wean unnecessarily. Or a mother who needs treatment will forgo the treatment at risk to herself and possibly her infant.
The conclusion of these authors was that more studies need to be done and the safety issue of many of these drugs is still unknown and quite controversial. So, this was their call to action report of sorts.
I attended a dinner that Dr Zachary Stowe, a renowned physician (Professor, Psychiatry & Behavioral Sciences Director, Women’s Mental Health Program Emory University School of Medicine in Atlanta, Georgia) presented information about psychotropic drugs and breastfeeding moms. He gave several ways to help a mom avoid depression, which included simple things like receiving postpartum help, going for walks outside in the sunshine and many others. But he stated that it is important in order to have a happy baby to have a happy mom. Getting moms the medication they need without unnecessarily weaning a baby is imperative. We know the benefits of breastfeeding on the baby and we need to stop throwing the proverbial baby out with the bath water. Research needs to be done more fervently and more physicians need to try to keep the baby and mother nursing dyad together. Mental illness needs to be treated like so many other diseases and illnesses- with avid research in order to be treated without putting the baby at risk- and that includes weaning the baby when we know the health benefits of nursing that are well documented.
Teresa Howard
Tuesday, October 13, 2009
Pediatricians- Not a Good Resource for Breastfeeding Information
Pediatricians’ Practices and Attitudes Regarding Breastfeeding Promotion
Richard J. Schanler, MD*; Karen G. O’Connor‡; and Ruth A. Lawrence, MD§
Pediatrics 1999;103;e35
ABSTRACT. Objective. Public awareness of the benefitsof breastfeeding is expected to increase during and after the national,federally funded Best Start BreastfeedingPromotion Campaign. It is anticipated that this will resultin more breastfeeding-based interactions between families and pediatricians. The American Academy of Pediatrics conducted a survey of its members to identify their educational needs regarding breastfeeding to assist in the design of appropriate information programs. Method. An eight-page, self-administered questionnaire was sent to 1602 active Fellows of the American Academy of Pediatrics. Results. The response rate was 71%. Breastfeeding, as the exclusive feeding practice for the first month after birth, was recommended by only 65% of responding pediatricians; only 37% recommended breastfeeding for 1 year. A majority of pediatricians agreed with or had a neutral opinion about the statement that breastfeeding and formula- feeding are equally acceptable methods for feeding infants. Reasons given for not recommending breastfeeding included medical conditions with known treatments that did not preclude breastfeeding. The majority of pediatricians (72%) were unfamiliar with the contents of the Baby-Friendly Hospital Initiative. The majority of pediatricians had not attended a presentation on breastfeeding management in the previous 3 years; most said they wanted more education on breastfeeding management. Conclusion. Pediatricians have significant educational needs in the area of breastfeeding management.
This study is one that is actually quite humorous to those of us who work with women who are nursing and have an issue that takes them to the average pediatrician. We understand not only the lack of information or education a pediatrician has regarding breastfeeding, but also the level of influence they still have on the breastfeeding relationship. Ironic that a non medical issue is one that parents still seek out medical opinions for.
This study cited that even though the big boy club of the AAP themselves promote breastfeeding as the best form of infant nutrition and encourage the infant to be fed that way, the very members of this association are failing miserably at conveying correct information to their patients parents. If the hospitals are not screwing up the relationship fairly quickly in the postpartum period, then the doctors then do their own lack of encouragement.
This study was timed to ascertain the physicians influence on breastfeeding as federally funded Best Start Breastfeeding Promotion Campaign was launched. “This campaign is targeted initially at 10 states to raise public awareness of breastfeeding through pre- and postnatal parent counseling and media promotion. Increased public awareness is expected to increase breastfeeding-related interactions between families and physicians.” They wanted to know how many of the doctors in the areas were going to be supportive of this endeavor and if they needed to do anything to help make this more likely.
The good news is this study was to “to assess breastfeeding attitudes, knowledge, and management skills of pediatricians, as well as awareness of their hospitals’ breastfeeding promotion activities. Results from this survey are expected to help in the design of appropriate breastfeeding education programs for physicians.” The bad news is the majority of the doctors definitely need more education in this area!
The conducted this study by first giving a survey to the physicians- mostly located in urban areas. The solo and group practices had better breastfeeding initiation and continuation than the clinic physicians. Tragically, only 65% of the pediatricians’ recommended exclusive breastfeeding to new parents during the early weeks of their infants’ births. 13% recommended formula supplementation while actually 2% said formula feeding was ideal. Although the AAP takes a stand on duration of exclusive breastfeeding being recommended for at least six months only 63% made any recommendation regarding duration. And only 31% made the recommendation that AAP suggested. But to be commended are the 61% who suggested the ideal time of at least one year.
Establishing breastfeeding and bonding time with the infant in the early hours after birth is a known factor in helping to increase breastfeeding success. Yet the doctors varied in their initial recommendation to do so. Only 44% recommended that the mom initiate breastfeeding in the first half hour after the birth. Only 59% suggested that demand feeding be established. Almost a quarter of the physicians were not opposed to formula or water be given to the breastfed infant. And keeping the mom and baby together by rooming in was equally divided in the study.
The use of pacifiers was only discouraged by a fourth of the doctors until breastfeeding was established. And the introduction of solids was not at the AAP recommendation either. Many recommended solids at a much younger age than 6 months. As this study states, “These infant feeding practices are known to impede successful breastfeeding and may be unnecessary.”
It was no surprise that in an office several people could be called on for phone consultations to assist new parents with breastfeeding questions. Only 76% of the time it was the doctors- who have proven they were not following suggested guidelines. Fewer than a quarter actually had lactation consultants. And few even knew how or if the staff that supplied information had ever been trained in the area of breastfeeding. Is it no wonder that misinformation was being handed out?
Only 58% of the actual physicians themselves had ever had any education regarding breastfeeding. The younger physicians (under 45 years of age) were more likely than the older physicians. And the female physicians had more training than their male counterparts. And yet although they mostly said they wanted to learn more and had not had sufficient training, 77% said they felt competent to manage common breastfeeding problems. Based on their lack of training or education in the area, it makes you wonder other areas they feel competent managing where they may also lack training and expertise.
It is no wonder that only 60% of the pediatricians had children of their own who were breastfed! Those with no personal experience were more likely to not recommend breastfeeding if the moms had common problems like breast or nipple problems- this was at 37%!
It is also no wonder that few hospitals are meeting the standard of Baby-Friendly Hospital Initiative since 72% of the doctors were unfamiliar with this initiative as well as the Ten Steps to Successful Breastfeeding statement. How can they be supportive and help promote these ideals if they are unaware of what they recommend? More then half of the doctors were unsure if there was a written policy regarding breastfeeding and if there was one what was stated within it.
The study stated, “These data suggest that the lack of clear recommendations may lead to confusion when parents question physicians about breastfeeding.” I find this an understatement. It also uncovered that very few pediatricians were even seeing their patients’ parents prenatally- where good information regarding breastfeeding could be conveyed.
The study was effective in uncovering the strong need to get the pediatricians on board with promoting breastfeeding. Helping parents prepare, initiate, be successful and continue to breastfeed is certainly an area where pediatricians can make a huge difference. But we need to get them up to speed on how to do this and it begins with more education.
Teresa Howard, CD (DONA), CLD, CLE, CCCE (CAPPA), CHBE
Richard J. Schanler, MD*; Karen G. O’Connor‡; and Ruth A. Lawrence, MD§
Pediatrics 1999;103;e35
ABSTRACT. Objective. Public awareness of the benefitsof breastfeeding is expected to increase during and after the national,federally funded Best Start BreastfeedingPromotion Campaign. It is anticipated that this will resultin more breastfeeding-based interactions between families and pediatricians. The American Academy of Pediatrics conducted a survey of its members to identify their educational needs regarding breastfeeding to assist in the design of appropriate information programs. Method. An eight-page, self-administered questionnaire was sent to 1602 active Fellows of the American Academy of Pediatrics. Results. The response rate was 71%. Breastfeeding, as the exclusive feeding practice for the first month after birth, was recommended by only 65% of responding pediatricians; only 37% recommended breastfeeding for 1 year. A majority of pediatricians agreed with or had a neutral opinion about the statement that breastfeeding and formula- feeding are equally acceptable methods for feeding infants. Reasons given for not recommending breastfeeding included medical conditions with known treatments that did not preclude breastfeeding. The majority of pediatricians (72%) were unfamiliar with the contents of the Baby-Friendly Hospital Initiative. The majority of pediatricians had not attended a presentation on breastfeeding management in the previous 3 years; most said they wanted more education on breastfeeding management. Conclusion. Pediatricians have significant educational needs in the area of breastfeeding management.
This study is one that is actually quite humorous to those of us who work with women who are nursing and have an issue that takes them to the average pediatrician. We understand not only the lack of information or education a pediatrician has regarding breastfeeding, but also the level of influence they still have on the breastfeeding relationship. Ironic that a non medical issue is one that parents still seek out medical opinions for.
This study cited that even though the big boy club of the AAP themselves promote breastfeeding as the best form of infant nutrition and encourage the infant to be fed that way, the very members of this association are failing miserably at conveying correct information to their patients parents. If the hospitals are not screwing up the relationship fairly quickly in the postpartum period, then the doctors then do their own lack of encouragement.
This study was timed to ascertain the physicians influence on breastfeeding as federally funded Best Start Breastfeeding Promotion Campaign was launched. “This campaign is targeted initially at 10 states to raise public awareness of breastfeeding through pre- and postnatal parent counseling and media promotion. Increased public awareness is expected to increase breastfeeding-related interactions between families and physicians.” They wanted to know how many of the doctors in the areas were going to be supportive of this endeavor and if they needed to do anything to help make this more likely.
The good news is this study was to “to assess breastfeeding attitudes, knowledge, and management skills of pediatricians, as well as awareness of their hospitals’ breastfeeding promotion activities. Results from this survey are expected to help in the design of appropriate breastfeeding education programs for physicians.” The bad news is the majority of the doctors definitely need more education in this area!
The conducted this study by first giving a survey to the physicians- mostly located in urban areas. The solo and group practices had better breastfeeding initiation and continuation than the clinic physicians. Tragically, only 65% of the pediatricians’ recommended exclusive breastfeeding to new parents during the early weeks of their infants’ births. 13% recommended formula supplementation while actually 2% said formula feeding was ideal. Although the AAP takes a stand on duration of exclusive breastfeeding being recommended for at least six months only 63% made any recommendation regarding duration. And only 31% made the recommendation that AAP suggested. But to be commended are the 61% who suggested the ideal time of at least one year.
Establishing breastfeeding and bonding time with the infant in the early hours after birth is a known factor in helping to increase breastfeeding success. Yet the doctors varied in their initial recommendation to do so. Only 44% recommended that the mom initiate breastfeeding in the first half hour after the birth. Only 59% suggested that demand feeding be established. Almost a quarter of the physicians were not opposed to formula or water be given to the breastfed infant. And keeping the mom and baby together by rooming in was equally divided in the study.
The use of pacifiers was only discouraged by a fourth of the doctors until breastfeeding was established. And the introduction of solids was not at the AAP recommendation either. Many recommended solids at a much younger age than 6 months. As this study states, “These infant feeding practices are known to impede successful breastfeeding and may be unnecessary.”
It was no surprise that in an office several people could be called on for phone consultations to assist new parents with breastfeeding questions. Only 76% of the time it was the doctors- who have proven they were not following suggested guidelines. Fewer than a quarter actually had lactation consultants. And few even knew how or if the staff that supplied information had ever been trained in the area of breastfeeding. Is it no wonder that misinformation was being handed out?
Only 58% of the actual physicians themselves had ever had any education regarding breastfeeding. The younger physicians (under 45 years of age) were more likely than the older physicians. And the female physicians had more training than their male counterparts. And yet although they mostly said they wanted to learn more and had not had sufficient training, 77% said they felt competent to manage common breastfeeding problems. Based on their lack of training or education in the area, it makes you wonder other areas they feel competent managing where they may also lack training and expertise.
It is no wonder that only 60% of the pediatricians had children of their own who were breastfed! Those with no personal experience were more likely to not recommend breastfeeding if the moms had common problems like breast or nipple problems- this was at 37%!
It is also no wonder that few hospitals are meeting the standard of Baby-Friendly Hospital Initiative since 72% of the doctors were unfamiliar with this initiative as well as the Ten Steps to Successful Breastfeeding statement. How can they be supportive and help promote these ideals if they are unaware of what they recommend? More then half of the doctors were unsure if there was a written policy regarding breastfeeding and if there was one what was stated within it.
The study stated, “These data suggest that the lack of clear recommendations may lead to confusion when parents question physicians about breastfeeding.” I find this an understatement. It also uncovered that very few pediatricians were even seeing their patients’ parents prenatally- where good information regarding breastfeeding could be conveyed.
The study was effective in uncovering the strong need to get the pediatricians on board with promoting breastfeeding. Helping parents prepare, initiate, be successful and continue to breastfeed is certainly an area where pediatricians can make a huge difference. But we need to get them up to speed on how to do this and it begins with more education.
Teresa Howard, CD (DONA), CLD, CLE, CCCE (CAPPA), CHBE
Does Income Affect Breastfeeding.... Does a Mom's BMI?
Maternal Variables Influencing Duration of Breastfeeding Among Low-Income Mothers
Anne Chevalier McKechnie, RN, IBCLC, RLC, Audrey Tluczek, PhD, RN, and Jeffrey B. Henriques, PhD
ICAN: Infant, Child, & Adolescent Nutrition June 2009
This is my review of their study….
Who breastfeeds longer? The study was performed on low income moms. The lack of long term breastfeeding is highest in this group. What the findings showed was that moms who had a high body mass index also fed for a shorter period of time. And the moms who fed longer were also moms who breastfed more exclusively. Younger moms did not nurse as long as the older moms in this study as well.
The study was done in hopes to figure out how to improve the outcomes for breastfeeding moms to nurse for a longer period of time. It stated, “US Department of Health and Human Services established the following goals for breastfeeding by the year 2010: a 75% rate of initiation, a 50% rate of breastfeeding for 6 months, and a 25% rate of breastfeeding for 12 months.“ They set a goal to lengthen the duration of breastfeeding and to help moms exclusively breastfeed.
So, let’s look at this study. It makes sense that if you begin weaning- and weaning meaning putting anything in the baby’s mouth besides the breasts- that the breastfeeding duration will be shortened. Many mothers do not realize that sucking needs are normal and should be met at the breasts as often as possible as to increase milk supply. Instead they begin using a pacifier too quickly and too often and wonder why their milk supply dwindles. They also think that just one bottle will not make any difference to their breastfeeding relationship. It does. One bottle quickly becomes more and soon others are feeding the baby and we are trying to pump to keep our supply going when nursing would automatically do that.
Poor women are more susceptible, I suspect, since often they are forced into the work environment to survive and our government assistance offers them free formula in order to feed their baby instead of a stipend to stay home and nurse. When my own daughter qualified for the WIC program I was amazed out how often she was encouraged to take the formula they offered and start supplements sooner. So, I was not surprised to find this study also showed, “Many mothers in low-income populations participate in Supplemental Nutrition Program for Women, Infants, and Children (WIC) programs, and numerous studies have shown that these mothers are less likely to breastfeed as compared with nonparticipants of WIC programs.”
I believe these women are also often encouraged to start solids sooner. The concern I am sure may be that the women themselves have poor nutrition, thus breast milk is compromised. But instead of providing the mom with better nutritional guidelines, the suggestion is made that she offer her infant something that is less nutritious than nursing her baby. This study indeed showed how, “the highest risk for poor health, tend to have the lowest breastfeeding rates.”
The other part of this study looked at how the B.M.I. of women affected their breastfeeding relationship with their babies. “Obesity may also adversely affect breastfeeding in several ways. First, mothers with a BMI at or above 30 kg/m2 may experience hormonal patterns that interfere with milk production.30-32 Second, the infants of obese and overweight mothers may have physical difficulty latching onto the breast.31 Finally, an elevated BMI may indirectly interfere with the initiation and duration of breastfeeding because obesity is also associated with complications of pregnancy and delivery, cesarean delivery, poor maternal self-esteem, maternal depression, and low socioeconomic status. A recent study34 found that mothers with a BMI ≥25 kg/m2 were more likely to have discontinued breastfeeding before 6 months than normal-weight mothers.”
I tried to think about how this factored into the relationships of moms and babies I had worked with over the years. Indeed I saw more women who were considered overweight having complications with their pregnancies. These complications did lead to more surgical births as well as inductions and the edema that inductions sometimes caused in the moms causing latch issues initially. I have not seen the hormonal shift issues but certainly can see where an out of balance hormonal issue can cause milk production issues as well. But recently I had a client who is obese have real issues with her third baby. She found herself unable to successfully breastfeed outside of her own home environment due to how she had to work to latch her daughter onto the breast. It was not something she could do easily or even the least bit discretely.
New moms are concerned with body image as their breasts are larger but their bellies are still on the post pregnancy form- and therefore they want to hide their bulges and are learning to manage the new larger breasts. This makes them uncomfortable initiating breastfeeding in many situations outside of their home. Part of this is how we make women feel about their bodies in general in the USA and how we make breastfeeding a sexual act instead of a natural one. But certainly not feeling good about our bodies makes us not feel good about some of the natural body functions we may have as well. Our environmental support systems are certainly lacking in regards to support for breastfeeding.
This study had a hypothesis of, “Mothers within a low-income population who chose exclusive breastfeeding would likely (a) continue breastfeeding longer than mothers, who chose partial breastfeeding, (b) be of an older age than mothers who chose partial breastfeeding, and (c) have a lower BMI than mothers who chose partial breastfeeding.”
The other factor that was mentioned in this study was age. The younger moms seemed to lack the support of their community in breastfeeding and therefore initiated breastfeeding less as well as length of time of breastfeeding was limited.
The study concluded with this statement, “Breastfeeding is a complex issue with lifelong consequences for both mother and infant. This study found that factors, such as exclusive breastfeeding, older maternal age, and lower BMI, were associated with longer breastfeeding duration. These findings move us closer to understanding the unique needs of low-income, WIC, breastfeeding mothers and support the notion that maternal readiness and capacity for breastfeeding are influenced by dynamic biopsychosocial processes.”
I wonder if we had more pictures of younger moms nursing their babies in ads, women who overweight were nursing their babies, and moms in general nursing in more public areas in ads and government promotional materials, if we would increase these numbers for both initiating breastfeeding as well as duration of nursing exclusively. I wonder if we increased awareness to the communities of the benefits of breastfeeding if we would see the support change in the communities to support all women and babies in breastfeeding.
When as a lactation educator I am still counteracting the negative and detrimental things that are being done in the hospitals to sabotage breastfeeding, in the WIC offices to undermine the moms and in the communities that still want to banish women and their nursling to the bathrooms to nurse, if BMI and socioeconomic conditions are just a drop in the bucket as to why breastfeeding numbers are dwindling in the US.
Teresa Howard, CD (DONA), CLD, CLE, CCCE (CAPPA), CHBE
Anne Chevalier McKechnie, RN, IBCLC, RLC, Audrey Tluczek, PhD, RN, and Jeffrey B. Henriques, PhD
ICAN: Infant, Child, & Adolescent Nutrition June 2009
This is my review of their study….
Who breastfeeds longer? The study was performed on low income moms. The lack of long term breastfeeding is highest in this group. What the findings showed was that moms who had a high body mass index also fed for a shorter period of time. And the moms who fed longer were also moms who breastfed more exclusively. Younger moms did not nurse as long as the older moms in this study as well.
The study was done in hopes to figure out how to improve the outcomes for breastfeeding moms to nurse for a longer period of time. It stated, “US Department of Health and Human Services established the following goals for breastfeeding by the year 2010: a 75% rate of initiation, a 50% rate of breastfeeding for 6 months, and a 25% rate of breastfeeding for 12 months.“ They set a goal to lengthen the duration of breastfeeding and to help moms exclusively breastfeed.
So, let’s look at this study. It makes sense that if you begin weaning- and weaning meaning putting anything in the baby’s mouth besides the breasts- that the breastfeeding duration will be shortened. Many mothers do not realize that sucking needs are normal and should be met at the breasts as often as possible as to increase milk supply. Instead they begin using a pacifier too quickly and too often and wonder why their milk supply dwindles. They also think that just one bottle will not make any difference to their breastfeeding relationship. It does. One bottle quickly becomes more and soon others are feeding the baby and we are trying to pump to keep our supply going when nursing would automatically do that.
Poor women are more susceptible, I suspect, since often they are forced into the work environment to survive and our government assistance offers them free formula in order to feed their baby instead of a stipend to stay home and nurse. When my own daughter qualified for the WIC program I was amazed out how often she was encouraged to take the formula they offered and start supplements sooner. So, I was not surprised to find this study also showed, “Many mothers in low-income populations participate in Supplemental Nutrition Program for Women, Infants, and Children (WIC) programs, and numerous studies have shown that these mothers are less likely to breastfeed as compared with nonparticipants of WIC programs.”
I believe these women are also often encouraged to start solids sooner. The concern I am sure may be that the women themselves have poor nutrition, thus breast milk is compromised. But instead of providing the mom with better nutritional guidelines, the suggestion is made that she offer her infant something that is less nutritious than nursing her baby. This study indeed showed how, “the highest risk for poor health, tend to have the lowest breastfeeding rates.”
The other part of this study looked at how the B.M.I. of women affected their breastfeeding relationship with their babies. “Obesity may also adversely affect breastfeeding in several ways. First, mothers with a BMI at or above 30 kg/m2 may experience hormonal patterns that interfere with milk production.30-32 Second, the infants of obese and overweight mothers may have physical difficulty latching onto the breast.31 Finally, an elevated BMI may indirectly interfere with the initiation and duration of breastfeeding because obesity is also associated with complications of pregnancy and delivery, cesarean delivery, poor maternal self-esteem, maternal depression, and low socioeconomic status. A recent study34 found that mothers with a BMI ≥25 kg/m2 were more likely to have discontinued breastfeeding before 6 months than normal-weight mothers.”
I tried to think about how this factored into the relationships of moms and babies I had worked with over the years. Indeed I saw more women who were considered overweight having complications with their pregnancies. These complications did lead to more surgical births as well as inductions and the edema that inductions sometimes caused in the moms causing latch issues initially. I have not seen the hormonal shift issues but certainly can see where an out of balance hormonal issue can cause milk production issues as well. But recently I had a client who is obese have real issues with her third baby. She found herself unable to successfully breastfeed outside of her own home environment due to how she had to work to latch her daughter onto the breast. It was not something she could do easily or even the least bit discretely.
New moms are concerned with body image as their breasts are larger but their bellies are still on the post pregnancy form- and therefore they want to hide their bulges and are learning to manage the new larger breasts. This makes them uncomfortable initiating breastfeeding in many situations outside of their home. Part of this is how we make women feel about their bodies in general in the USA and how we make breastfeeding a sexual act instead of a natural one. But certainly not feeling good about our bodies makes us not feel good about some of the natural body functions we may have as well. Our environmental support systems are certainly lacking in regards to support for breastfeeding.
This study had a hypothesis of, “Mothers within a low-income population who chose exclusive breastfeeding would likely (a) continue breastfeeding longer than mothers, who chose partial breastfeeding, (b) be of an older age than mothers who chose partial breastfeeding, and (c) have a lower BMI than mothers who chose partial breastfeeding.”
The other factor that was mentioned in this study was age. The younger moms seemed to lack the support of their community in breastfeeding and therefore initiated breastfeeding less as well as length of time of breastfeeding was limited.
The study concluded with this statement, “Breastfeeding is a complex issue with lifelong consequences for both mother and infant. This study found that factors, such as exclusive breastfeeding, older maternal age, and lower BMI, were associated with longer breastfeeding duration. These findings move us closer to understanding the unique needs of low-income, WIC, breastfeeding mothers and support the notion that maternal readiness and capacity for breastfeeding are influenced by dynamic biopsychosocial processes.”
I wonder if we had more pictures of younger moms nursing their babies in ads, women who overweight were nursing their babies, and moms in general nursing in more public areas in ads and government promotional materials, if we would increase these numbers for both initiating breastfeeding as well as duration of nursing exclusively. I wonder if we increased awareness to the communities of the benefits of breastfeeding if we would see the support change in the communities to support all women and babies in breastfeeding.
When as a lactation educator I am still counteracting the negative and detrimental things that are being done in the hospitals to sabotage breastfeeding, in the WIC offices to undermine the moms and in the communities that still want to banish women and their nursling to the bathrooms to nurse, if BMI and socioeconomic conditions are just a drop in the bucket as to why breastfeeding numbers are dwindling in the US.
Teresa Howard, CD (DONA), CLD, CLE, CCCE (CAPPA), CHBE
Wednesday, May 20, 2009
Breastfeeding Online Video
Jack Newman is one of the best supporters of breastfeeding! I have had the opportunity to hear him speak several times and love the fact that he has a great online video to help those who forget what they may have learned in a class or heaven forbid did not attend a class prior to their baby being born. Click on the link to view a fabulous video that will ensure a great latch for sure!
Video
Video
Thursday, April 9, 2009
What does the Law say about Breastfeeding in Public?
Many of you have heard me teach about how the law protects breastfeeding moms and babies in the state of Georgia. Some of my recent students asked me about where they could find the law. The suggestion was made that you make a sign with the law - perhaps laminate it and carry it in your diaper bag so that if you are stopped and asked to not nurse in public you could whip it out and enlighten those who were ignorant and give them the facts. So, here you go!
http://www.ncsl.org/programs/health/breast50.htm#g
"Health professionals and public health officials promote breastfeeding to improve infant health. Both mothers and children benefit from breast milk. Breast milk contains antibodies that protect infants from bacteria and viruses. Breastfed children have fewer ear infections, respiratory infections, urinary tract infections and have diarrhea less often. Infants who are exclusively breastfed tend to need fewer health care visits, prescriptions and hospitalizations resulting in a lower total medical care cost compared to never-breastfed infants. Breastfeeding also provides long-term preventative effects for the mother, including an earlier return to pre-pregnancy weight, reduced risk of pre-menopausal breast cancer and osteoporosis. According to the New York Times, approximately 70 percent of mothers start breastfeeding immediately after birth, but less than 20 percent of those moms are breastfeeding exclusively six months later. It is a national goal to increase the proportion of mothers who breastfeed their babies in the early postpartum period to 75 percent by the year 2010.
Forty-one states, including Georgia, allow a mother to breastfeed in any location where she is otherwise authorized to be, provided that she acts in a discreet and modest way. "
Ga. Code § 31-1-9 (1999, 2002) allows a mother to breastfeed in any location where she is otherwise authorized to be, provided that she acts in a discreet and modest way. (Act 304; SB 29) The statute was amended in 2002 to add that the breastfeeding of a baby should be encouraged in the interests of maternal and child health. (2002 SB 221)
Ga. Code § 34-1-6 (1999) allows employers to provide daily unpaid break time for a mother to express breast milk for her infant child. Employers are also required to make a reasonable effort to provide a private location, other than a toilet stall, in close proximity to the workplace for this activity. The employer is not required to provide break time if to do so would unduly disrupt the workplace operations.
So there is the law- unfortunately we fought to have the words discreet and modest removed - and I had thought they were - but there it is in the law. Yuck- words that are too subjective for my thoughts- but there none the less.
And disrupting your workplace operations is another one of those phrases... so if a worker goes downstairs to step outside to smoke- is that disruptive? I do think that is subjective but would be hard to prove to be a problem. So- if you were able to take a break at all it should be allowed to be one where you could pump.
This could easily fit on a card and slide into your diaper bag. Shoot perhaps we need to put it on a small chain around the strap of the diaper bag like those formula ads that show some safety tips.
Thursday, April 2, 2009
Formula with Rocket Fuel
Seems like a joke doesn't it? Well it is not a joke!
http://health.yahoo.com/news/ap/baby_formula_perchlorate.html
The beginning of the article says, "ATLANTA - Traces of a chemical used in rocket fuel were found in samples of powdered baby formula, and could exceed what's considered a safe dose for adults if mixed with water also contaminated with the ingredient, a government study has found.
The study by scientists at the U.S. Centers for Disease Control and Prevention looked for the chemical, perchlorate, in different brands of powdered baby formula. It was published last month, but the Environmental Working Group issued a press release Thursday drawing attention to it.
The chemical has turned up in several cities' drinking water supplies. It can occur naturally, but most perchlorate contamination has been tied to defense and aerospace sites.
No tests have ever shown the chemical caused health problems, but scientists have said significant amounts of perchlorate can affect thyroid function. The thyroid helps set the body's metabolism. Thyroid problems can impact fetal and infant brain development."
So just one more time that something harmful has been found in formula. We remember the articles last month that is at http://www.cnn.com/2008/HEALTH/11/27/infant.formula.melamine/index.html This is the same level that caused China to bring about Death Sentences Over Melamine Milk Formula Scandal to the company's leadership and determined that the melamine was way too high for baby's safety.
And if it is not formula then it is the carrier of the formula that is under investigation.
The article about this is located at http://health.yahoo.com/news/ap/baby_bottle_ban.html and starts with "NY county ban on baby bottle chemical is official
Associated Press
By KAREN MATTHEWS, Associated Press Writer - Thu Apr 2, 3:41 PM PDT
NEW YORK - A suburban New York county has adopted the nation's first ban on the chemical found in plastic baby bottles and sippy cups.
The measure banning the sale of baby bottles containing BPA was signed by Suffolk County Executive Steve Levy on Thursday after county legislators passed it last month.
Several states including California, Oregon and Hawaii are considering bans the chemical formally known as bisphenol A, but Suffolk County, on Long Island, is the first place in the nation to enact one.
Canada announced in October it was banning BPA in baby bottles, becoming the first country to restrict sale of the chemical, which is commonly used in the lining of food cans, eyeglass lenses and hundreds of household items."
So rather than being concerned about nipple confusion causing problems with breastfeeding or allergies to formula or issues of natural, healthy bacteria being destroyed by that one bottle- now we need to realize there are hidden dangers that can cause severe damage to our babies... so the quick answer is please breastfeed. Get help beforehand to learn the proper way to latch and the ways to avoid problems. Get help afterwards if you have problems. Realize that it is really the best way to feed your baby and is the safest too!
http://health.yahoo.com/news/ap/baby_formula_perchlorate.html
The beginning of the article says, "ATLANTA - Traces of a chemical used in rocket fuel were found in samples of powdered baby formula, and could exceed what's considered a safe dose for adults if mixed with water also contaminated with the ingredient, a government study has found.
The study by scientists at the U.S. Centers for Disease Control and Prevention looked for the chemical, perchlorate, in different brands of powdered baby formula. It was published last month, but the Environmental Working Group issued a press release Thursday drawing attention to it.
The chemical has turned up in several cities' drinking water supplies. It can occur naturally, but most perchlorate contamination has been tied to defense and aerospace sites.
No tests have ever shown the chemical caused health problems, but scientists have said significant amounts of perchlorate can affect thyroid function. The thyroid helps set the body's metabolism. Thyroid problems can impact fetal and infant brain development."
So just one more time that something harmful has been found in formula. We remember the articles last month that is at http://www.cnn.com/2008/HEALTH/11/27/infant.formula.melamine/index.html This is the same level that caused China to bring about Death Sentences Over Melamine Milk Formula Scandal to the company's leadership and determined that the melamine was way too high for baby's safety.
And if it is not formula then it is the carrier of the formula that is under investigation.
The article about this is located at http://health.yahoo.com/news/ap/baby_bottle_ban.html and starts with "NY county ban on baby bottle chemical is official
Associated Press
By KAREN MATTHEWS, Associated Press Writer - Thu Apr 2, 3:41 PM PDT
NEW YORK - A suburban New York county has adopted the nation's first ban on the chemical found in plastic baby bottles and sippy cups.
The measure banning the sale of baby bottles containing BPA was signed by Suffolk County Executive Steve Levy on Thursday after county legislators passed it last month.
Several states including California, Oregon and Hawaii are considering bans the chemical formally known as bisphenol A, but Suffolk County, on Long Island, is the first place in the nation to enact one.
Canada announced in October it was banning BPA in baby bottles, becoming the first country to restrict sale of the chemical, which is commonly used in the lining of food cans, eyeglass lenses and hundreds of household items."
So rather than being concerned about nipple confusion causing problems with breastfeeding or allergies to formula or issues of natural, healthy bacteria being destroyed by that one bottle- now we need to realize there are hidden dangers that can cause severe damage to our babies... so the quick answer is please breastfeed. Get help beforehand to learn the proper way to latch and the ways to avoid problems. Get help afterwards if you have problems. Realize that it is really the best way to feed your baby and is the safest too!
Monday, December 22, 2008
why do we stop prematurely...
...I had a delightful call today from a young lady who made nursing bibs. These are similar I am sure to the "hooter hiders" who due to poor name marketing changed to http://www.bebeaulait.com/. I told her politely that I did not want to sell anything like that because I felt it made a statement of shame in regards to breastfeeding- not just discretion but that the statement was that the mom should be hiding her breasts to nurse.
She asked some great questions regarding moms who were concerned about nursing publicly and felt they wanted discretion. I do sell mobeleez nursing bonnets for nursing discreetly- but it does not seem the same to me...does not scream- I am hiding my breasts and I am breastfeeding like I feel the bibs do. I encourage women to nurse in public- not in a nasty, germ filled bathroom- and to wear clothing that encourages ease at getting the baby latched on without flashing their breasts. (Although in our state you can flash all you want when nursing in any public place- you do not have to be discreet. We worked hard to make sure the law did not say that since it is so discretionary in what someone feels is discreet.) But...
I feel like if a mom tucks the corner of the blanket into her bra strap at the top and into the back band of her pants the blanket stays put. And for the baby who despises and fights with the blanket a nice bonnet helps and also wearing a button down shirt and a cami or nursing bra underneath and then buttoning the shirt from the top and leaving it open at the bottom also offers a great deal of discretion.
But we also talked about how her mom told her that you must wean a baby before they will potty train. And that the whiny, clingy stage that some babies go through is totally due to the nursing too- and they will not outgrow it until she weans. Hogwash!
So I thought about why we nurse for such a short period of time and here are my thoughts- I would love yours...
1. We just don't fully understand the benefits of nursing past the first few months- if we did we would continue it.
2. We get so much flack from others who do not understand the value of nursing that they wear us down.
3. We are still not the "norm" in our society so folks give us strange looks or comments.
4. We feel we need our lives back- and therefore we consider ourselves more highly than the baby or toddler who wants to nurse
5. Others make us feel we are strange for continuing to nurse and we cave to pressure from them.
6. We never did get the nursing in public thing down and we hate being banished every time we need to nurse.
7. Being banished led us to using bottles and now nursing is not something that the baby does very often- soon weaning.
8. We are afraid that if we don't wean the baby we will have a nursing teenager- have you ever really seen a nursing teenager?
9. We want our bodies back- we are tired of leaking- tugging- being demanded of- hmmm not sure if motherhood is what you are seeking to get away from here since nursing is not the cause - it is you have a baby or toddler!
10. We think the baby will...sleep better at night...sleep better during the day...gain faster...gain less...potty train...whine less...like others more...whatever.
11. We are afraid when they get teeth that they will bite.
12. We want to get pregnant again... or we want to go on birth control and not get pregnant again.
13. We think we will be happier if we quit nursing- although now you just got rid of the prolactin that was making you happier.
14. We want to diet- hmmm did you realize how many more calories you can have when you nurse?
15. We are afraid it will cause our breasts to sage...afterall look at National Geographics natives- could it be no support of their breasts all their lives? hmmm
16. We have sore nipples - hmmm a good latch will deal with this almost immediately. It is a lie that you have to get sore nipples when you nurse!
17. Rather than help a mom to learn to breastfeed, others including the medical establishment suggests supplementing and then it is a short time before milk production is diminished.
18. We don't know anyone else who is doing this- join La Leche League!
19. We see breasts only as sexual objects- we failed to understand why God made them- maybe they can be a two- fer!
20. We start offering solids- cereal is a solid ladies- and that is like giving dessert instead of a main course to our babies and soon they are not interested in what is best for them... wonder if they will ever brush their teeth when they are older?
It is disturbing to me that we have made breastfeeding such a difficult thing over the years. The ads in the magazines show the breastfeeding mom alone and banished in the nursing chair in the bedroom alone- while the bottle feeding mom has a cute husband- happy baby- huge diamond and is well dressed and out in the public having fun! It is a lie! But we have bought it!
I almost wish we could have a huge number of "brazen" women who would start nursing really indiscreetly in public- now wait before you say it will give nursing a bad name- perhaps it will become so common place that it causes no reaction at all... kinda like Victoria Secret bra ads on television with scantily clad women... or bikinis on the public beaches that only cover her pubic patch and her nipples... or violence on television... we have become numb to that. Wouldn't it be wonderful if when a mom met her baby's needs by unbuttoning her blouse and putting her nursling to her breast it did not cause a stir- instead elicited a smile!
Pinch me I must be dreaming!
She asked some great questions regarding moms who were concerned about nursing publicly and felt they wanted discretion. I do sell mobeleez nursing bonnets for nursing discreetly- but it does not seem the same to me...does not scream- I am hiding my breasts and I am breastfeeding like I feel the bibs do. I encourage women to nurse in public- not in a nasty, germ filled bathroom- and to wear clothing that encourages ease at getting the baby latched on without flashing their breasts. (Although in our state you can flash all you want when nursing in any public place- you do not have to be discreet. We worked hard to make sure the law did not say that since it is so discretionary in what someone feels is discreet.) But...
I feel like if a mom tucks the corner of the blanket into her bra strap at the top and into the back band of her pants the blanket stays put. And for the baby who despises and fights with the blanket a nice bonnet helps and also wearing a button down shirt and a cami or nursing bra underneath and then buttoning the shirt from the top and leaving it open at the bottom also offers a great deal of discretion.
But we also talked about how her mom told her that you must wean a baby before they will potty train. And that the whiny, clingy stage that some babies go through is totally due to the nursing too- and they will not outgrow it until she weans. Hogwash!
So I thought about why we nurse for such a short period of time and here are my thoughts- I would love yours...
1. We just don't fully understand the benefits of nursing past the first few months- if we did we would continue it.
2. We get so much flack from others who do not understand the value of nursing that they wear us down.
3. We are still not the "norm" in our society so folks give us strange looks or comments.
4. We feel we need our lives back- and therefore we consider ourselves more highly than the baby or toddler who wants to nurse
5. Others make us feel we are strange for continuing to nurse and we cave to pressure from them.
6. We never did get the nursing in public thing down and we hate being banished every time we need to nurse.
7. Being banished led us to using bottles and now nursing is not something that the baby does very often- soon weaning.
8. We are afraid that if we don't wean the baby we will have a nursing teenager- have you ever really seen a nursing teenager?
9. We want our bodies back- we are tired of leaking- tugging- being demanded of- hmmm not sure if motherhood is what you are seeking to get away from here since nursing is not the cause - it is you have a baby or toddler!
10. We think the baby will...sleep better at night...sleep better during the day...gain faster...gain less...potty train...whine less...like others more...whatever.
11. We are afraid when they get teeth that they will bite.
12. We want to get pregnant again... or we want to go on birth control and not get pregnant again.
13. We think we will be happier if we quit nursing- although now you just got rid of the prolactin that was making you happier.
14. We want to diet- hmmm did you realize how many more calories you can have when you nurse?
15. We are afraid it will cause our breasts to sage...afterall look at National Geographics natives- could it be no support of their breasts all their lives? hmmm
16. We have sore nipples - hmmm a good latch will deal with this almost immediately. It is a lie that you have to get sore nipples when you nurse!
17. Rather than help a mom to learn to breastfeed, others including the medical establishment suggests supplementing and then it is a short time before milk production is diminished.
18. We don't know anyone else who is doing this- join La Leche League!
19. We see breasts only as sexual objects- we failed to understand why God made them- maybe they can be a two- fer!
20. We start offering solids- cereal is a solid ladies- and that is like giving dessert instead of a main course to our babies and soon they are not interested in what is best for them... wonder if they will ever brush their teeth when they are older?
It is disturbing to me that we have made breastfeeding such a difficult thing over the years. The ads in the magazines show the breastfeeding mom alone and banished in the nursing chair in the bedroom alone- while the bottle feeding mom has a cute husband- happy baby- huge diamond and is well dressed and out in the public having fun! It is a lie! But we have bought it!
I almost wish we could have a huge number of "brazen" women who would start nursing really indiscreetly in public- now wait before you say it will give nursing a bad name- perhaps it will become so common place that it causes no reaction at all... kinda like Victoria Secret bra ads on television with scantily clad women... or bikinis on the public beaches that only cover her pubic patch and her nipples... or violence on television... we have become numb to that. Wouldn't it be wonderful if when a mom met her baby's needs by unbuttoning her blouse and putting her nursling to her breast it did not cause a stir- instead elicited a smile!
Pinch me I must be dreaming!
Tuesday, December 16, 2008
Breastfeeding Latch Issues
There is a misconception that early breastfeeding should hurt and cause cracked and bleeding nipples. IT IS A MISCONCEPTION! A good latch should cause this to never happen. Now one time latching wrong can cause a bit of soreness- but once it is corrected it will diminish greatly. Engorgement is not the same thing.
Engorgement is not only a huge supply of milk- after all your breasts do not know if you have had twins or triplets... but the blood supply increase and the swelling of tissues also adds to the engorgement issues. So for engorgement I encourage nurse often and on demand- but also massage your breasts before nursing- get out any spots that may be considering getting clogged. And fill a large mixing bowl- a metal one is perfect- fill it with very warm water... pour in a handful of salt- table salt, epson or sea salt- mix it with your hand. If the water is too hot for your hand it is too hot- but it needs to be very, very warm. Lean over the counter and put one breast in the water. Massage in a downward motion and soon the water is filled with milk.
This will help with not only engorgement but if you did have a poor latch- it helps heal any sore spots. You can do this several times a day- each breast. And the swollen tissues will appreciate an ice pack on them between nursings.
Okay now latch... I have an acronym BREASTS that I devised to help you with this:
B...bring the baby to the breast- make sure you are not leaning over- but instead you are leaning back and getting comfy and then you are bringing the baby to you... what came first the baby or the breasts? Never lean over to latch the baby on!
R...remember to velcro the baby on- belly button toward your belly. You should wear the baby like a bra- feet and legs are tucked into you as well. If you can see the baby's belly button you are not turning her into you enough.
E...eat a big mac! Point the nipple of the the breast toward the baby's nose intially. You can stroke the nipple between the nose and the upper lip or across the lip to initially get the baby interested- but for latch purposes have the baby climb up the mountain- like you do when you are eating a big mac sandwich. The baby climbs up the nipple with the bottom lip flanged out- this puts the nipple in the safe spot of the roof of the baby's mouth- and puts it in deeply so it does not rock back and forth thus creating a blister.
A...allow the baby to open wide... don't try to finagle the nipple into a small mouth. Babies are imitators- so open your mouth wide- say "open" and then allow the baby to imitate you with a wide open mouth. Then bring them in quickly to latch.
S...support the neck not the head. When you hold onto the baby's head you are not allowing the head to tilt back- and thus causing the nipple to be driven into the tongue rather than in the safe spot of the roof of the mouth. Create a little neck brace for the baby with either the crook of your arm or with your hand- do not touch the head at all.
T...too late if the baby is crying! It is so much harder to latch a baby on when they are distressed. The first sign they want to nurse is mouthing like a little bird- smacking their lips. Then they begin to mouth their hands. Lastly they cry- so watch for the early signs so as to not have to calm them down before you can nurse them. If they wake with a poopie diaper- nurse one side- then change them and then top them off on the second breast.
S...see the nose not the chin. If the baby is tucked in close- then you should have their head tilted up- tucking the chin in tightly to the breast but allowing the nose to have access to breathing easily. Keep the head tilted back and the body tucked in tightly. Some soreness comes from a baby sliding off to only the nipple and then beginning to vigorously nurse again but this time the nipple is not in the safe spot.
So enjoy the early weeks with your baby while you both learn how to nurse properly. It is well worth the time spent to get the latch correct every time. Plan to spend the first several weeks doing little more than rocking, cuddling, soothing and nursing your new baby. It is well worth if for a lifetime!
Friday, December 12, 2008
does one bottle make a real difference?
Marsha, a nurse and international certified lactation consultant wrote the following article and I wanted to share it- the italics are mine.
At many hospitals they will suggest and perhaps even almost demand that you offer your baby formula. This is probably a great article to print off and take with you to your labor. If it is suggested, perhaps you can help to spread the truth about one bottle of formula and the problems with receiving it.
Many people don't realize that one bottle of formula can begin a series of problems... read more below:
Supplementation of the Breastfed Baby
“Just One Bottle Won’t Hurt”---or Will It?
Marsha Walker, RN, IBCLC (Marshalact@aol.com)
*The gastrointestinal (GI) tract of a normal fetus is sterile
*The type of delivery has an effect on the development of the intestinal microbiota
...vaginally born infants are colonized with their mother’s bacteria
...cesarean born infants’ initial exposure is more likely to environmental microbes from the air, other infants, and the nursing staff which serves as vectors for transfer (this is one of the risks of a cesarean birth)
*Babies at highest risk of colonization by undesirable microbes or when transfer from maternal sources cannot occur are cesarean-delivered babies, preterm infants, full term infants requiring intensive care, or infants separated from their mother (again the reason why a vaginal, unmedicated (since it can lead to infant complications), non induced birth is ideal)
*Breastfed and formula-fed infants have different gut flora
*Breastfed babies have a lower gut pH (acidic environment) of approximately 5.1-5.4 throughout the first six weeks that is dominated by bifidobacteria with reduced pathogenic (disease-causing) microbes such as E coli, bacteroides, clostridia, and streptococci (the colostrum and milk of the baby's mom provide immune building protectants]
*Babies fed formula have a high gut pH of approximately 5.9-7.3 with a variety of putrefactive bacterial species
*In infants fed breast milk and formula supplements the mean pH is approximately 5.7-6.0 during the first four weeks, falling to 5.45 by the sixth week
*When formula supplements are given to breastfed babies during the first seven days of life, the production of a strongly acidic environment is delayed and its full potential may never be reached (formula dilutes the power of the immune building characteristics of breastmilk)
*Breastfed infants who receive supplements develop gut flora and behavior like formula-fed infants
*The neonatal GI tract undergoes rapid growth and maturational change following birth
*Infants have a functionally immature and immunonaive gut at birth
*Tight junctions of the GI mucosa take many weeks to mature and close the gut to whole proteins and pathogens (so adding something foreign like formula can cause issues with digestion)
*Open junctions and immaturity play a role in the acquisition of NEC, diarrheal disease, and allergy (one of the reasons for infants to be hospitalized early in life are due to diarrheal diseases)
*sIgA from colostrum and breast milk coats the gut, passively providing immunity during the time of reduced neonatal gut immune function
*Mothers’ sIgA is antigen specific. The antibodies are targeted against pathogens in the baby’s immediate surroundings
*The mother synthesizes antibodies when she ingests, inhales, or otherwise comes in contact with a disease-causing microbe
*These antibodies ignore useful bacteria normally found in the gut and ward off disease without causing inflammation
*Infant formula should not be given to a breastfed baby before gut closure occurs
*Once dietary supplementation begins, the bacterial profile of breastfed infants resembles that of formula-fed infants in which bifidobacteria are no longer dominant and the development of obligate anaerobic bacterial populations occurs (Mackie, Sghir, Gaskins, 1999)
*Relatively small amounts of formula supplementation of breastfed infants (one supplement per 24 hours) will result in shifts from a breastfed to a formula-fed gut flora pattern (Bullen, Tearle, Stewart, 1977) (so that little bottle due to borderline low blood sugar really does make a difference!)
*The introduction of solid food to the breastfed infant causes a major perturbation in the gut ecosystem, with a rapid rise in the number of enterobacteria and enterococci, followed by a progressive colonization by bacteroides, clostridia, and anaerobic streptococci (Stark & Lee, 1982) (a solid food is anything other than colostrum or breast milk)
*With the introduction of supplementary formula, the gut flora in a breastfed baby becomes almost indistinguishable from normal adult flora within 24 hours (Gerstley, Howell, Nagel, 1932)
*If breast milk were again given exclusively, it would take 2-4 weeks for the intestinal environment to return again to a state favoring the gram-positive flora (Brown & Bosworth, 1922; Gerstley, Howell, Nagel, 1932)
*In susceptible families, breastfed babies can be sensitized to cow’s milk protein by the giving of just one bottle, (inadvertent supplementation, unnecessary supplementation, or planned supplements), in the newborn nursery during the first three days of life (Host, Husby, Osterballe, 1988; Host, 1991)
*Infants at high risk of developing atopic disease has been calculated at 37% if one parent has atopic disease, 62-85% if both parents are affected and dependant on whether the parents have similar or dissimilar clinical disease, and those infants showing elevated levels of IgE in cord blood irrespective of family history (Chandra, 2000)
*In breastfed infants at risk, hypoallergenic formulas can be used to supplement breastfeeding; solid foods should not be introduced until 6 months of age, dairy products delayed until 1 year of age, and the mother should consider eliminating peanuts, tree nuts, cow’s milk, eggs, and fish from her diet (AAP, 2000)
*In susceptible families, early exposure to cow’s milk proteins can increase the risk of the infant or child developing insulin dependent diabetes mellitus (IDDM) (Mayer et al, 1988; Karjalainen, et al, 1992) (yes one bottle can make the difference in a life long situation)
*Ihe avoidance of cow’s milk protein for the first several months of life may reduce the later development of IDDM or delay its onset in susceptible individuals (AAP, 1994)
*Sensitization and development of immune memory to cow’s milk protein is the initial step in the etiology of IDDM (Kostraba, et al, 1993)
...sensitization can occur with very early exposure to cow’s milk before gut cellular tight junction closure
...sensitization can occur with exposure to cow’s milk during an infection-caused gastrointestinal alteration when the mucosal barrier is compromised allowing antigens to cross and initiate immune reactions
...sensitization can occur if the presence of cow’s milk protein in the gut damages the mucosal barrier, inflames the gut, destroys binding components of cellular junctions, or other early insult with cow’s milk protein leads to sensitization (Savilahti, et al, 1993)
References:
American Academy of Pediatrics, Work Group on Cow’s Milk Protein and Diabetes Mellitus. Infant feeding practices and their possible relationship to the etiology of diabetes mellitus. Pediatrics 1994; 94:752-754
American Academy of Pediatrics, Committee on Nutrition. Hypoallergenic infant formulas. Pediatrics 2000; 106:346-349
Brown EW, Bosworth AW. Studies of infant feeding VI. A bacteriological study of the feces and the food of normal babies receiving breast milk. Am J Dis Child 1922; 23:243
Bullen CL, Tearle PV, Stewart MG. The effect of humanized milks and supplemented breast feeding on the faecal flora of infants. J Med Microbiol 1977; 10:403-413
Chandra RK. Food allergy and nutrition in early life: implications for later health. Proc Nutr Soc 2000; 59:273-277
Gerstley JR, Howell KM, Nagel BR. Some factors influencing the fecal flora of infants. Am J Dis Child 1932; 43:555
Host A, Husby S, Osterballe O. A prospective study of cow’s milk allergy in exclusively breastfed infants. Acta Paediatr Scand 1988; 77:663-670
Host A. Importance of the first meal on the development of cow’s milk allergy and intolerance. Allergy Proc 1991; 10:227-232
Karjalainen J, Martin JM, Knip M, et al. A bovine albumin peptide as a possible trigger of insulin-dependent diabetes mellitus. N Engl J Med 1992; 327:302-307
Kostraba JN, Cruickshanks KJ, Lawler-Heavner J, et al. Early exposure to cow’s milk and solid foods in infancy, genetic predisposition, and risk of IDDM. Diabetes 1993; 42:288-295
Mackie RI, Sghir A, Gaskins HR. Developmental microbial ecology of the neonatal gastrointestinal tract. Am J Clin Nutr 1999; 69(Suppl):1035S-1045S
Mayer EJ, Hamman RF, Gay EC, et al. Reduced risk of IDDM among breastfed children. The Colorado IDDM Registry. Diabetes 1988; 37:1625-1632
Savilahti E, Tuomilehto J, Saukkonen TT, et al. Increased levels of cow’s milk and b-lactoglobulin antibodies in young children with newly diagnosed IDDM. Diabetes Care 1993; 16:984-989
Stark PL, Lee A. The microbial ecology of the large bowel of breastfed and formula-fed infants during the first year of life. J Med Microbiol 1982; 15:189-203
Thursday, December 11, 2008
Breastfeeding and offering a bottle...
A while ago I saw a mom and baby who had begun to add several bottles of breast milk bottles to the daily schedule. She was readying to return to work and wanted to also allow the father time to bond with the baby during feedings. The baby would fuss at the breast expecting to have a steady, fast flow of milk coming from the breasts, as she was used to getting from the bottles. After nursing on and off and fussing, the bottle of breast milk was used to top the baby off since she was not satisfied.
The mom had a goal of six months to nurse the baby. I knew with only being at the breast two times a day- morning and evening, this was not likely to happen. The baby was already showing signs of nipple confusion and a lazy suck at the age of 3 weeks. I could tell the baby was used to the faster flow of the bottle and was demanding the same of the mom.
When I explained this to the mom, she asked me for solutions. I called my favorite IBCLC, Anne Grider for her input. This is what was shared:
As far as providing the baby with slow flow nipples to make it more difficult to get the breast milk from the bottle, she said: Nipples have no regularity or quality control- so you have to buy a bunch and just try them over the faucet with water in the bottles and mark the ones in the package that are the real slow flow ones- there is just no telling without testing them if they are really slow flow. She said a package of nipples marked “slow flow” could have a plethora of different flows within the same package. The premie ones they make now are too small- use a slow flow instead.
Her recommendation was to not use Avent- it is too wide for most babies. She also said not to use Nuk, ironically it has shown too many orthodontic issues later. She said we all are different and we have to determine what kind of nipple is right for this baby. It is up to the size of the baby’s pallet. So put your finger in the baby’s mouth and take it back to the hard part of the pallet and mark on your finger how long the nipple needs to be to reach there. And notice the baby’s size of her mouth- not too wide or is it a large mouth and width is not an issue.
Get a symmetrical nipple- a silicone one is preferred. And use a regular shaped bottle. The slanted bottles actually were meant for babies with medical issues who had to feed lying on their tummies- they actually make the milk flow even faster- so don’t use that kind.
Sit the baby up in a full sitting position to bottle feed. For example sitting the baby where the baby’s back is against the provider’s chest is best- less mom and baby dyad confusion that way- mom nurses the baby everyone else feeds the baby this way. The bottle needs to be parallel to the floor. Don’t worry about keeping the nipple full of milk- the issue of air has been proven to not be as big of an issue as they once thought.
Listen to the baby- is she swallowing comfortably? No gulping and she has time to breathe in between swallows? If not you need to make sure the bottle is parallel and not tipped up too high. Check the flow of the nipple. And if need be you may need to pace the baby’s feeding.
Paced feeding is to sit the baby up and when the baby is gulping and not breathing- pull the nipple out so it only touches the lip and then when the baby breathes- put the nipple back in- do this several times. After the third or fourth time the baby catches on and does not protest when you do it. The ideal feeding is a comfortable one no gulping or problems breathing.
When a mom returns to work she needs to be prepared to have a lot of mother baby time when she returns home. Nursing on demand is what is best. No bottles should be given if the mom is available to nurse. This will help her keep her supply and also keep the baby satisfied during growth spurts as well as continue the breastfeeding bond between the mom and the baby. A side car- co-sleeper is best if the family does not share a bed so that the mom is fully accessible to the baby. A baby being fed on demand at the breast is usually essential for breastfeeding to be successful once a return to work has occurred. And night time nursings are important as well to this success. The family bed or side car allow the mom the rest she needs while still meeting the baby’s needs.
The mom had a goal of six months to nurse the baby. I knew with only being at the breast two times a day- morning and evening, this was not likely to happen. The baby was already showing signs of nipple confusion and a lazy suck at the age of 3 weeks. I could tell the baby was used to the faster flow of the bottle and was demanding the same of the mom.
When I explained this to the mom, she asked me for solutions. I called my favorite IBCLC, Anne Grider for her input. This is what was shared:
As far as providing the baby with slow flow nipples to make it more difficult to get the breast milk from the bottle, she said: Nipples have no regularity or quality control- so you have to buy a bunch and just try them over the faucet with water in the bottles and mark the ones in the package that are the real slow flow ones- there is just no telling without testing them if they are really slow flow. She said a package of nipples marked “slow flow” could have a plethora of different flows within the same package. The premie ones they make now are too small- use a slow flow instead.
Her recommendation was to not use Avent- it is too wide for most babies. She also said not to use Nuk, ironically it has shown too many orthodontic issues later. She said we all are different and we have to determine what kind of nipple is right for this baby. It is up to the size of the baby’s pallet. So put your finger in the baby’s mouth and take it back to the hard part of the pallet and mark on your finger how long the nipple needs to be to reach there. And notice the baby’s size of her mouth- not too wide or is it a large mouth and width is not an issue.
Get a symmetrical nipple- a silicone one is preferred. And use a regular shaped bottle. The slanted bottles actually were meant for babies with medical issues who had to feed lying on their tummies- they actually make the milk flow even faster- so don’t use that kind.
Sit the baby up in a full sitting position to bottle feed. For example sitting the baby where the baby’s back is against the provider’s chest is best- less mom and baby dyad confusion that way- mom nurses the baby everyone else feeds the baby this way. The bottle needs to be parallel to the floor. Don’t worry about keeping the nipple full of milk- the issue of air has been proven to not be as big of an issue as they once thought.
Listen to the baby- is she swallowing comfortably? No gulping and she has time to breathe in between swallows? If not you need to make sure the bottle is parallel and not tipped up too high. Check the flow of the nipple. And if need be you may need to pace the baby’s feeding.
Paced feeding is to sit the baby up and when the baby is gulping and not breathing- pull the nipple out so it only touches the lip and then when the baby breathes- put the nipple back in- do this several times. After the third or fourth time the baby catches on and does not protest when you do it. The ideal feeding is a comfortable one no gulping or problems breathing.
When a mom returns to work she needs to be prepared to have a lot of mother baby time when she returns home. Nursing on demand is what is best. No bottles should be given if the mom is available to nurse. This will help her keep her supply and also keep the baby satisfied during growth spurts as well as continue the breastfeeding bond between the mom and the baby. A side car- co-sleeper is best if the family does not share a bed so that the mom is fully accessible to the baby. A baby being fed on demand at the breast is usually essential for breastfeeding to be successful once a return to work has occurred. And night time nursings are important as well to this success. The family bed or side car allow the mom the rest she needs while still meeting the baby’s needs.
Sunday, November 30, 2008
What influenced the way you have raised your children the most?
This is an article I wrote in 1997
When I give thought to this question, beyond the religious influences that have had a great deal of impact on my family, I believe it is the influence that La Leche League had on me. I became pregnant at the age of 19, just after I was married. The pregnancy was something that did not figure into my plans- a newlywed entering a sophomore year of college. After all, due to severe endometriosis, I was told children would probably not be a part of my future. But all of a sudden, I found my plans turned upside down. At one of my office visits to the OB, it was strongly suggested that I consider Breastfeeding. My family history included both my mother and maternal aunt having had breast cancer, so my doctor felt it favorable for me to breastfeed since evidence was showing the decrease of breast cancer having done so. So, since I had no friends who were pregnant and no background that would support me in this adventure, I sought out the local LLLeague group that was advertised in the brochures at his office.
I started attending meetings finding this whole attitude toward Breastfeeding very a la natural and therefore a little intriguing. But the idea of nursing past 6 months was something that I found distasteful. But as time wore on and the pregnancy came to a conclusion, I found myself excited about the aspect of doing something so intimate yet so earthy. I was not really excited about the aspect of being pregnant or having a baby as much as doing something new and different. Once Julie was born, I found myself quite adept at this new venture.
I had changed pediatricians when the previous one had not been supportive during a bout with a stomach disorder. I don't think I could've done this without the support of my LLL leader. The women in my league group became my friends and support peer group. The older moms were helpful in teaching me to listen to my instincts and inner voice.
The library was filled with information on child rearing and such novel concepts as the family bed. I would chatter away with women who had the same common interests and who were empowered by their instincts, having listened to their inner voices. I found this whole process of turning into a woman and a mother almost instantaneously exciting! I found inner strengths that I never knew I had. I found myself exploring options that I did not know I would've even considered. Not only did I nurse past 6 months, but I planned to nurse at least one year!
At the one year mark, my LLL leader asked me to consider becoming a leader too. I nursed Julie into the third month of my pregnancy with my son. She weaned at 22 months with little encouragement due to my sore nipples. When John was born, I planned to let him nurse till he weaned on his own. He was born with some birth anomalies that caused him to have numerous surgeries. There were battles with the anesthesiologist when NPO was required- encouraging him to understand that breast milk was digested more quickly than formula but after 20 months- and two surgeries, I gave birth to my third child, Jami.
John had been interested in nursing through out the pregnancy and continued to tandem nurse with his sister for a year and a half longer. Jami nursed till she was 3 ½ years old.
When I look back on the experiences I had through these years, I am sure without the support of the friends I had made in those early years, and continued to build, I would not have had the confidence to try new things. I would not have gone against the system of our society that encouraged bottle feeding and schedules. I would not have ever welcomed our children into our bed. And I certainly would not have ever nursed a toddler much less two non twins at the same time!
The library of books available to me within LLL, The women who would listen to my concerns and share theirs, but mostly the friendships shared influenced the way I continued to mother my children throughout their lives thus far.
My oldest daughter will be 21 soon, a senior in college and in love herself these days. My son entered his freshman year in college this year, John is 18. And Jami is my baby. The one who would empty one breast and twirl around in my lap and say"empty, oder side". She is almost 17 and is in her next to last year of high school. No, they are all weaned. They are normal, well adjusted kids. They don't sleep with us anymore. They can spend time away without negative repercussions!
Julie has traveled to Africa, to Soweto, to work in orphanages for AIDS babies. John had worked with children coming from main land China into Hong Kong and inner city kids in Philadelphia. And Jami plans to have a home birth for her future children and wants to teach special needs children, she works as a teachers aid now as part of her curriculum in high school.
Do I feel blessed. Indeed. But I do think I owe a great deal of appreciation to LLL for the way they influenced a young 19 year old girl who began her journey as a new mom.
(In the last ten years a lot has changed... Jami did have her home birth almost six years ago and nursed her son well into toddlerhood. Julie has also given birth to two (almost six and fours years old) and soon to her third child. She also allowed her children to gradually wean into their toddler years. Our son is an architect in St Louis and was married a year ago- no children yet!)
Only a nursling for a short while
I am amazed at the pressure women still feel today regarding nursing an older child. Twenty years ago it was a very hush hush thing, but somehow I thought with more time passing, it would become something that was considered more the norm. I wish people would view the breast as a natural element of comforting a child, as do many other cultures, rather than a sex object.
I guess everyone may have the fears running through their heads when they nurse a toddler. Will they go off to school still nursing?, will they ever wean?, will I make my child overly dependent on me?, will my child be normal- what we really mean is like every other child? I am not sure we come up with these questions on our own, or if these are the questions others place into our minds.
There is something very special about nursing an older child. when an infant nurses, they look very angelic. Nestled in to the breast and dozing on and off. But when there is a toddler sitting in your lap, holding a cookie with one hand and wanting to nurse with that mouth full of cookie, there is some unpleasantness. But with time and tenderness, these can be worked around with a few rules.
There is nothing so special as to have a child crawl into your lap and ask you if they could please nurse. And then at the completion of one breast let you know it is empty and they would like the other. There is nothing so satisfying as for that sweet child to then let you know how warm and good it tastes, how special they feel and how much they love your milk.
I wish that others could experience this without the haughty comments from others who have no clue what this relationship is like. Don't let others opinions rob you of the joy that having an older nursling can bring.
Remember what your grandmother told you, they only stay little for a little time! My children are all weaned now and only one is left at home for a short while longer. Hopefully I will have nursing grandchildren to cuddle in a few years. But I hope that my children will remember to let a little one be little for that short while. And also that the nursling will be off in running quicker than they think.
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