…Contemplating the Core Elements of a Modern Breastfeeding Lifestyle
Random header image... Refresh for more!

Breastfeeding With A Baby Nurse: Is it Less Work For Mother?

Bethenny Frankel, from the reality show Bethenny Gets Married, rationalizes the supposed luxury of having a baby nurse in the video clip included in yesterday’s post, “Breastfeeding on Reality TV“.

This notion of hiring a baby nurse aka “infant care specialist” so that there will be less work for the mother is not a new one. Indeed, it is viewed in some social circles as a necessity to make the transition to motherhood.  It has been a prevailing message directed toward affluent new parents in New York City throughout my professional life as a registered nurse and lactation consultant.

The article by Marie Brenner in New York Magazine, October 4, 1982 “Less Work for Mother” is a social commentary in and of itself.  It is worth a quick read to see how our world has changed over these past 28 years.

It is interesting to note that now, more than a quarter of a century later, the majority of  baby nurses welcomed into the homes of  New York City mothers are no longer Irish or European, but  hail mainly from the Caribbean or Philippine’s.  They own the niche.  These women are usually not medical professionals.  They bring to each assignment a knowledge base gleaned from their own life experiences as mothers and/or the on-the-job training they received while in the employ of various families over the years.

Lactation consulting has been a stand alone profession for exactly 25 years.  Initially many of the baby nurses were threatened by these breastfeeding experts entering the picture.  LC’s would come in for short visits and rock the boat.  Accustomed to being completely in charge of the care and feeding of their infant charges, this emphasis on breastfeeding made it seem as though the services of the baby nurse were not really needed.  (A sentiment that Bethenny voiced at one point in her interview.)

It is interesting to note how these two specialties have learned to co-exist during my tenure as a lactation consultant.   The growing trend by many LC’s  to encourage frequent pumping and a greater emphasis on measuring volume of intake has been embraced by the baby nurses.  They dutifully assist the mothers with pumping and urge that supplements be given to “satisfy” their babies when they are the least bit unsettled after a breastfeeding session.  On average, one or two direct feedings per day are skipped so that the baby nurse can give a relief bottle and the mothers can sleep.

The net result for these mothers who are pumping and breastfeeding much of the day is a feeling of being a milking machine.   There is little time to really relax and bond with their babies.

There must be a better way to manage this resource, or as Bethenny puts it, the luxury of having a nurse.   What do you think?

To be continued…

August 10, 2010   1 Comment

World Breastfeeding Week 2010: Health Care Worker Call To Action

This is the 19′th annual celebration of World Breastfeeding Week.  The Theme of 2010 is commemorating the Innocenti Declaration made by WHO and UNICEF policy-makers in August 1990 to protect, promote and support breastfeeding.

In the past 20 years there has been some progress in the rates of  initiation of breastfeeding.  Yet, only 28% of Maternity facilities world-wide have fully implemented the Ten Steps and have been certified by the Baby Friendly Hospital Initiative.  Were this an analysis of anything else, this would not be a passing grade.

 I’ve been in the trenches throughout this period and beyond.  At first glance, it appears as though we have made great strides.   According to the NYC Dept. of  Health and Mental Hygiene report put out in April 2009,  an impressive 85%  of women initiate breastfeeding.  However, after 2 months the number falls to 32% who are still exclusively breastfeeding their babies.  Surveys reveal that the top two reasons for stopping were related to concerns about the milk supply either having enough (39%) or that it was adequately satisfying their babies (39%).

The fall off rate here in NYC is quite dramatic, but not surprising to me.  Despite health code regulations that prohibit formula discharge packs, many families will leave the hospital with generous samples of formula in tow.  Mothers who have had cesarean sections report that their babies were given at least one bottle, if not more, of formula during the first few days after delivery.  

Many of the New York hospitals have lactation consultants on staff or nurses “trained” to support breastfeeding.  Nonetheless, their focus seems to increasingly be on feeding a measurable amount of fluid to the newborns.  They get  moms to sit on the pump getting drops of colostrum and encourage them to give their babies formula until the “milk comes in”. 

 Using the pump as a  first line of breastfeeding support relegates direct breastfeeding to the back seat.  New mothers leave the hospital knowing how to pump rather than how to achieve a deep, pain-free latch.

New parents are set up to believe that artificial baby milk or formula and human milk can be exchanged ounce for ounce in bottles without consequence .  Unwittingly they are weaning from the beginning or setting themselves up to experience the top two reasons many of them will choose not to breastfeed beyond two months.

Without a doubt, the Ten Steps are a helpful tool to focus our attention on the importance of consistent breastfeeding education and support.

To pack a punch and ensure successful breastfeeding beyond the first few weeks, the Ten Steps must be embraced by unequivocal  and truly breastfeeding-friendly health care workers:  nurses, doctors and lactation consultants. 

To be continued…

August 2, 2010   2 Comments

Breastfeeding Success: Less Than Six Degrees of Separation

Living in NYC, there are many opportunities to interact with celebrities.   However, one of the reasons John Lennon loved it here is that, for the most part, his privacy was respected.   

I stood on line behind Kevin Bacon at my Starbucks.   I could feel my father desperately channelling through me an urge to engage him in conversation.   Although I inherited my dad’s ”gift of the gab,” I could not utter this joke forming in my mind.  “So, this is what they mean by six degrees of separation?”   If only I had remembered at that moment that his wife Kyra had breastfed.   Given my penchant for marketing at Starbucks , who knows what I might have been able to say. 

All kidding aside,  I have found that there is less than 6 degrees of  separation for breastfeeding success.  

  • Your mother, partner, a sibling or close friend, doctor (pediatrician or obstetrician), lactation specialist can all impact your choices and the trajectory of your experience. 

Six Degrees of Separation For BF Success

One of the most important considerations is surrounding yourself with positive breastfeeding role models and enthusiasts.   Given the barrage of hormones, any lack of support, whether real or imagined, can shake your confidence.  Those who love you do not want to see you exhausted and overwhelmed.  They may try to relieve you by offering to give a bottle or encourage you to consider an exit strategy. 

Breastfeeding is natural, but it is also a learned skill for both mother and baby.   Tensions can build when couples are not on the same page about this essential aspect of caring for their newborn.  Attend a breastfeeding class together if at all possible.   Remember that coaching does not end after labor.  

Many of you will defer to the “authority figures” such as the doctor and lactation consultant.  

  1. No Pediatrician will hang out a shingle saying they are opposed to breastfeeding.  However, early supplementation with formula is a big clue about their knowledge and support of breastfeeding. 
  2. A survey of Pediatricians published in late 2008 verifies that their promotion of breastfeeding is down.
  3. Lactation consultants that rely too heavily upon gadgets and pumping may further overwhelm a mother. 
  4. Check out your local parenting boards and read them carefully.  Look for someone who has the clinical expertise to fix your latch rather than manage your pumping.
  5. Ask your friends to  honestly share their breastfeeding experience and judge if you want some of the same.
  6. Follow me on twitter or become a member of  The Breastfeeding Salon

We live in an interesting period of human history where popularity and affiliation are highly valued.   With some preparation you can assemble your dream team of breastfeeding support within six degrees of separation.

June 27, 2010   No Comments

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

Breastfeeding Survivor: A Mother’s Day Reflection

Survivor is a popular television program here in the States that has run for 16 seasons.  It’s motto is outwit, outplay, outlast and be the ultimate survivor.  The season finale is today, Mother’s Day.  It has been quite fascinating to watch as the final four women used a great deal of cunning and collaborated to eliminate all of their stronger male challengers. 

Watching Survivor made me wonder…

What if the contestants were all nursing moms, babies and their partners?  What would they do without pumps, bottles, nipple shields, supplemental nursing systems and weighing scales?  Would they survive?  How would they know what their baby’s percentile was out there in the wilderness?  Would bottles of formula drop out of the trees along with the coconuts? 

You might recall a news item from a few years back about an African mother  caught in a flood who sought refuge, labored and delivered her baby in a tree.  Although not ideal, birth and breastfeeding began there before she was rescued by the South African military.

Breastfeeding may be natural, but it is definitely a learned behavior.  Peer pressure, combined with token support, leaves many mothers vulnerable to advice and interventions which can destroy their confidence.  Doubts about their milk supply and a sense of being overwhelmed by the work load may cause them to waiver in their desire to continue breastfeeding.

Modern mothers need to outwit, outplay and and outlast the pseudo-science which has been embraced by the medical and lactation establishment and the ubiquitous and clever marketing of formula by the drug companies.  

You should not have to “survive” breastfeeding.  When in doubt, reflect upon what you would do were you on a desert island?  Get back to the basics.

On this Mother’s Day celebrate the power and mystery of your female body which enables you to nurture your baby in the womb and beyond through Conscious Breastfeeding.   

 

 

May 11, 2008   No Comments