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.

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!

Human breasts and nipples come in different shapes and sizes. The function of the mammary glands remains a constant, but their form has great variability. It is a modern paradox that the visuals often stop breastfeeding success in its tracks.

Never before in human history has there been such a lack of faith in the packaging and delivery system of direct breastfeeding. 

Nipple Shield  

Nipple Shields are fake silicone nipples which a mother can use over her own nipple. These nipple “condoms” are intended to protect the mother’s nipples. In some instances, they are used if the nipples are less prominent or inverted to get the baby onto the breasts.   

The problem with shields is that they are huge and get dirty; they can complicate the latch issues by not helping the baby to learn to latch directly onto its mother’s breast.  They have been associated with low milk supply. The baby using the shield with a shallow latch gets a diminished amount out of the breasts and over time this has a negative impact not only on intake, but on overall milk production.  In addition, this poor latch can cause bruising beneath the areola and increased intake of air by the baby.

SNS

Gadgets such as tube feeding systems (SNS)  have gone in and out of fashion over the past 20 years.  They can interfere with getting a proper latch. When the system is used at the breast, babies can learn to by-pass a deep latch, opting instead to sip while hanging out on the tubes and their mother’s nipples. 

A mother can experience a sense of redundancy, guilt, overwhelm and increasing nipple soreness when using the SNS. She is breastfeeding and pumping, often supplementing with formula; her focus is on ensuring intake of measurable volumes rather than perfecting her latch.

There are instances where the use of both Nipple Shields or the SNS may be appropriate. However, these tools were never meant to be the first line of defense. They were intended to be a bridge to success while the fundamentals of latch and Conscious Breastfeeding connections are optimized.

Beware of these nipple add-ons. They will have an impact on the quality and duration of your breastfeeding experience.

  
Your Baby’s Latch-On

I critiqued the latch-on from a visual perspective in  Nipple Monologues: Part 3:  What’s Wrong with This Picture?    

As promised, I will now fine tune the written directions that accompanied that photo essay.  (read them here).

Step 1:  Get baby to open mouth wide.  Use nipple to encourage him to open wide.

• Although this has been the party line for years, it is not good advice to use your nipple as bait.  If you position your baby at an incline with your nipple opposite his/her nose they open wide without need of any prompting.

• You just need to be patient as they may open and close their mouth a few times before holding it open wide with a long pause.  Wait for this to happen and notice that the tongue is forward and down.

Step 2:  When mouth open wide, quickly pull him onto the breast by pulling the baby toward you with the arm that is holding him.  Make sure you move the baby towards you and not move yourself towards the baby.

• To ensure a deep, pain-free latch you need to put your baby on your breast with a firm hugging action.  Compact the breast slightly and stabilize with a C-hold or U-hold being careful not to block area above the milk sinuses. Follow-through deeply so that his/her jaws will land farther onto the body of the breast.

• The chin will be deeper than the nose because your baby is fitting snugly into the crook of the supporting arm at a 10-15 degree angle to the plane of your body.  (It would be like pledging allegiance to the flag with your baby inside your arm.)  The energy starts in the elbow and the whole arm hugs him deeply onto your breast.

Step 3:  The baby’s gums should completely bypass the nipple and cover approximately one inch of the areola behind the nipple.  Make sure the baby’s lip are everted (rolled out) 

• This advice makes mothers typically bend the baby onto the breast.  By worrying about covering a certain amount of the areola and/or seeing if the lips are rolled out they create conditions where the baby can focus their gum action on the nipples.  (They either bend them in too much or pull them back down onto the nipple to see their lips.)

• The focus should be to have your baby with his/her head to bottom aligned, at an incline (not level or parallel to your body) inside the supporting arm which will put him/her on the breast.  You do not lift your baby.  You hug him/her deeply against your body.

• Key is to move the baby, not the breast.  Be patient waiting for a wide open mouth with tongue forward and down.  Your baby needs to come on as a unit.

 Mother and baby should be calm and comfortable throughout the breastfeeding session.   If there is a shift in comfort, slide your index finger into the mouth beneath your baby’s nose, covering your nipple as you detach him/her from the breast.   A conscious, deep latch puts the mother-in-charge and should always pain-free.

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. 

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.