…Contemplating the Core Elements of a Modern Breastfeeding Lifestyle
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Got Enough Milk? Part 2: Feeding Methods do Matter

As discussed in Part 1, there is a difference between breast milk and formula. However, it is not only the type of milk, but also the delivery method and style of feeding that can greatly affect the behavior of a baby.

It is not a very accurate scientific analysis when any amount of breastfeeding is weighted equally across the board. There are definite differences between exclusive breastfeeding, breastfeeding with occasional supplements of expressed breast milk and breastfeeding with formula supplements.

The types of milk offered, the delivery methods and styles of feeding can significantly impact any evaluation of breastfeeding success.

Milk:

  • Human milk, being lighter and easier to digest, does not make the baby go into a heavy sleep for the entire interval between feedings.
  • Formula, being heavier and more difficult to digest, and usually given in larger amounts by the bottle, seems to make the baby sleep much of the time, especially in the beginning.

Delivery Method:

Breastfeeding with a decent latch eliminates intake of additional air.

  • The flow rate of milk directly from the breast is slower being delivered in a fine spray that can be more easily handled by the baby. This reduces the need for much burping post feeds.

Bottles, no matter what the manufacturers may claim, always have additional air in the system which can add to the sense of fullness experienced by the baby.

  •  They tend to deliver the milk much more quickly than does the breast; the baby may gag and pull away or develop techniques to pinch off the nipple with its tongue to stem the flow. Obviously this action would not be pleasant if it was then applied to the human nipple.

Feeding Styles:

Exclusive Breastfeeding can vary a great deal from one nursing couple to the next. Much depends upon who is running the show.

Baby-led, or what I call free-style breastfeeding, tends to be more frequent and assessment of intake or quality of each feeding can be somewhat unclear to the mother, especially in the beginning of the breastfeeding relationship.

Conscious Breastfeeding, the term I coined to describe the mother putting the baby on with intention to ensure a qualitative feed, will lead to more defined patterns of feeding that can be optimized over time. NB. This does not mean a schedule, but rather a definite feeding rhythm.

Breastfeeding with Expressed Milk Supplements:

  • The lighter, species specific nature of human milk causes much less digestive upset in the baby.
  • Expressed milk given by a bottle is a pooled sample of milk and the ratio of water, fats, proteins, etc. may vary from one serving to the next.
  • Nonetheless, it will be clear that all growth is taking place solely due to the nutritional value and calorie content of human milk whether taken directly from the breast or via the bottle.
  • Additional air in a bottle of expressed breast milk may make the baby feel more full than when it feeds directly at the breast. This is one possible reason that premature babies only given human milk in a bottle, for days or even weeks prior to discharge, seem unsatisfied initially when switched to exclusive breastfeeding.

Breastfeeding with Formula Supplements:

Several variables are in play with this approach. The breast milk and formula are inherently different as has already been discussed.

  • Caregivers tend to be very generous with the readily available, heavier formula when feeding by bottle. There is a belief that the baby will sleep longer.
  • When formula is given there is usually an unlimited supply compared to the output that results from the mother’s pumping.
  • Since formula is harder to digest, breastfeeding more frequently will not be as productive. The baby needs to be alert and truly hungry to breastfeed well. Otherwise, it will snack on the breast and wait for the bottle.
  • The mom will think she is breastfeeding, but she is quickly becoming the aperitif rather than the main course.

Babies who have been on expressed breast milk and/or formula via bottles for a period of time are often difficult to transition back to the breast:

  • They have developed a taste for the method (firm bottle nipple) and speed of the delivery system (fast flow bottle).
  • The more bottles, the greater will be their discontent while breastfeeding.
  • Their mother who has become accustomed to measuring volumes of milk being given via the bottle will soon become insecure and worry that she doesn’t have enough milk in her breasts.

Babies react differently when breastfed only or breastfed and given bottles of breast milk and/or formula. For this reason it is essential that the utmost effort be made to optimize the baseline of direct breastfeeding.

Judicious use of supplements, preferably of human milk whenever possible, will foster a less complicated analysis and more enjoyable breastfeeding experience.

June 26, 2010   1 Comment

Got Enough Milk? Part 1: Why Volume does not Correlate with Value

Breast milk is a bioactive fluid that contains so many amazing and dynamic constituents that it is impossible to memorize all of them; it packs food and fluids into small amounts and cannot be exactly duplicated in a lab or from one mother to the next. Formula, although the name sounds scientific, is just a processed food. It is always the same. Whether you give one ounce or 20, the only thing that changes is the calorie count.

Dr. Sears, a renowned Pediatrician and advocate of Breastfeeding, has a very helpful chart on his site comparing some of the key constituents of Breast milk and Formula.

Breastfeeding without any supplements is a very different experience for the baby and its parents than when formula supplements are added. Unfortunately, breastfeeding mothers are often encouraged to add supplements of formula by health care workers and family members. This suggestion is especially common during the early days of breastfeeding when the milk supply is being established.

Although no harm is intended, most parents do not realize that implementing this strategy, without any restrictions, can negatively impact the breastfeeding dynamic of supply and demand.  Supplementation changes the timing and frequency of feedings and can adversely affect the quality of direct breastfeedings.  To further complicate matters, giving different milks and using different delivery systems can skew the perception of what satiety looks like in a baby.

When assessing if a mother has enough breastmilk, these facts need to be considered.

  • Human milk is an energy-rich, bioavailable milk which nourishes and hydrates the baby in smaller volumes.
  • Attempts at pumping human milk, especially in the early days, will yield misleading results. What is pumped does not correlate directly with what the mother is making and what is available to the baby with direct breastfeeding.

Formula, on the other hand,  is a processed food. It is always the same except when the “additives” and “chemical formulations” are periodically changed to generate some kind of brand loyalty among members of the medical establishment and consumers.

  • Breast milk and Formula are very different foods; they each impact digestion, gas formation, appetite and linear growth and weight gain in differing ways.
  • When both milks are mixed together in the same stomach any negative reaction will generally be blamed on the mysterious Breast milk, rather than on the cow or soy based artificial baby milk.

Comparing the two milks is like trying to compare apples and oranges. They are both fruit, but the taste, texture and impact on digestion will vary. You could never tell if you were allergic to apples by eating oranges. However, an analysis of breastfeeding is often based upon how the baby takes formula when offered.

Formula is often added because it so readily available and convenient. Marketing 101.

  • If the baby needs to have its appetite stimulated by giving it supplements, the first milk of choice should always be human milk.
  • Even if only small amounts of extra breast milk are available at first, the biological impact is far more powerful than that of formula.

Technically, whenever formula is added to a breastfeeding relationship, it is the beginning of the weaning process. If more women were truly aware of this fact, I believe the use of formula by breastfeeding mothers would be far more judicious.

Mothers cannot help but question their own milk supply when the analysis is too often based upon adding in a different milk.

In Got Enough Milk? Part 2, we will examine how style of feeding and delivery method of the extra milk provided will further impact the mother’s confidence in her milk supply and breastfeeding success.

June 25, 2010   1 Comment

Michael Jackson: Gone Too Soon

Today is the first anniversary of the passing of Michael Jackson.  It was a shocking and unexpected loss just as he was about to make his big come-back.    He was a creative genius, an innovator of dance and music that  appealed to a wide variety of fans across the globe. 

In his  final decades, this relatively young man had become an ever more eccentric and controversial figure.  The trials and negative publicity had taken a toll on him.  Sadly, he was not able to quiet his critics and satisfy his fans by delivering the promise of  the “This is It” tour.   He died just a few days before the magic could be fully revealed.

Like Van Gogh, Jane Austen, Elvis to name a few, Michael Jackson’s fame and fortune continues to grow even larger since his death.  The spotlight was put on his vast muscial archive for an extended period beginning last summer.  

His song,  ”We Are the World” written with Lionel Richie, has raised over $63 million for African humanitarian aid.  It is hard not to move, or sing along, when one hears a snippet from his acclaimed album, ‘Thriller’.  Not to mention taking a stab at moonwalking.

Those of us who lived during his lifetime, including many of the current and recent breastfeeding mothers, will most likely have some special memories associated with Michael Jackson’s music.  

We can all agree that this talented man is “Gone Too Soon”.  He sang that very poignant song, (below) in honor of his friend Ryan White, at the Inauguration of President Clinton in 1992.  RIP Michael.

June 25, 2010   No Comments

Nestlé Boycott Reaches My Conscious Breastfeeding Sweet Spot

My Guilty Pleasure

Those closest to me know that my guilty pleasure is Häagen-Dazs Chocolate and Peanut Butter ice cream.  I have found a local store near my home that has had the wisdom to keep it in stock for me.  I admit that I have eaten it in on a regular basis during every season since making that discovery.  Now that it is summer, I am chagrined to find out that Häagen-Dazs is now among the brands owned by Nestlé.

As a nurse, lactation consultant and passionate advocate for breastfeeding mothers and their babies, I have engaged in my own personal Nestlé boycott since the late 1970’s.   This has not always been easy.   Over the years the long arm of the Nestlé corporation has continued to extend its reach by expanding its business holdings to include bottled water, pet food and cosmetic companies among many others in their vast empire.   The brands owned by them are listed here.  

Nestlé is the largest food company in the world.  It continues to systematically violate the World Health Assembly’s marketing requirements for baby foods.  This second incarnation of the boycott has been active for almost 22 years duration and  has had some impact upon their practices.   However, they continue to come up with ways to break the Code.   A 6.16.10 press release, excerpted below, outlines their latest scam and includes a link to their email campaign page.

 

Protest Nestlé’s claim that breastmilk substitutes ‘protect’ babies, public urged for UK breastfeeding awareness week
(21 – 27 June 2010)

 

Mike Brady, Campaigns and Networking Coordinator at Baby Milk Action (who plays the role of Mr. Henry Nastie in the 3 minute youtube clip below which explains the strategy), said:

“Breastfeeding week promotes the message that breastmilk protects babies. It is a living substance containing antibodies and other protective factors. Nestlé competes with breastfeeding by claiming its baby milk ‘protects’ babies. The boycott campaign helped force companies to put ‘breast is best’ messages on labels, but Nestlé is trying to trump these with its more prominent colourful ‘protect’ logos and false claims of health benefits from using baby milk.” 

 

 

Please join me in the Nestlé Boycott.  Choose to buy a different mascara, cereal, water and ICE CREAM whenever possible.  Check the list and exercise your power as a consumer.  Nestlé puts profits before health and thus it is only when they notice an impact upon their bottom-line that they will take heed of the need to abide by the Code. 

It is especially important that we lend our voices and our support to these efforts.  Conscious breastfeeding and retail discretion are my call to action for you! 

Oh, and yes, if anyone has a killer recipe for home-made chocolate and peanut butter ice cream send it my way!

  

Nestlé-Free Zone

June 24, 2010   1 Comment

Nipple Monologues: Part 3: What’s Wrong with This Picture?

I found multiple references that led back to this  photo guide  for proper latching technique.   I will address the accompanying directions in the next post.  

What is wrong with this picture? 

Plenty.  I’ll list a few of the issues.  There are limits to any two-dimensional portrayal of a baby latching onto a breast. You are literally getting only snapshots of an activity which often looks similar to the untrained eye. 

www.breastfeeding.com/helpme/helpme_images_latchon.html

Frame 1

Looks like the baby here in Frame 1 is taking the breast as if it were a bottle.    

  • It should be noted that most people would not point a bottle nipple down into a baby’s mouth as it would cause him/her to gag.  They may go in centered, but immediately aim the artificial nipple toward the palate. 
  • This is one of the most common mistakes made by new mothers initiating breastfeeding.  They aim the breast as if it were a bottle and end up putting their nipple on their baby’s tongue. 

The mother’s posture is unclear throughout this photo essay.  

Frame 1 looks like she is upright and in frames 2-4, it looks like she could be lying on her back or side.  Is it even the same baby in all of these shots?  The first baby looks different from frames 2-4. 

Frame 2

Frame 3

Frame 4

The impression is that the nipple should be centered in the baby’s mouth for latch-on.  

  • If it is done this way the nipple will be captured by the tongue and gums causing pain and trauma. (Frame 2 & 3)
  • The breast should be stabilized during the latch.  Nose, not mouth opposite the mother’s nipple.   Move the baby, not the breast.

The angles of the baby to the mother’s body are all wrong. 

  • The nose is in deeper than the chin. The baby is barely past the nipple. (Frames 2-4)
  • Baby should not be parallel to the  mothers body, but rather at a 10-15 degree angle to the plane of her body.

 A well-positioned baby should be tucked in very close to the mother’s body.

  • The chin should be deeply planted on the cleavage side of the breast around ~7 o’clock; the top lip would be around ~1 o’clock. This deep mouth position would tip the nipple up into the palate and there would be no contact with the tongue.
  • The lips would automatically evert or fan out if these angles were corrected. You cannot see the phlanging of a newborn’s lips if there is a good latch. (Frame 2, 3, & 4)

The saying goes…A picture is worth a thousand words.   However, a latch photo series is never as simple as it looks and much can get lost in translation. 

As a conscious breastfeeding coach, I remind you that it is all about perspective.  Ideally, a breastfeeding latch taught  through the eyes of the mother and evaluated by the sensation of her nipples.

June 22, 2010   1 Comment