Confidence, according to dictionary.com is a noun.   

1.full trust; belief in the powers, trustworthiness, or reliability of a person or thing.  2. belief in oneself and one’s powers or abilities; self-confidence; self-reliance; assurance.

There is a familiar catchphrase.  ‘Fake it until you make it’.   Such attempts at  imitating confidence to produce success often fall short for breastfeeding mothers.   

• They worry about how the experience will be for them, and whether or not they will be successful. 
• There is no margin for error when it comes to feeding and nurturing their babies.

Jerry Stocking was interviewed on the subject of confidence.  If you have time, please check out his blog   where you can read and/or listen to his wonderful perspective on this subject.   He believes that confidence is  more of a process than a thing.  I agree with him, especially when discussing it in relation to breastfeeding. 

The kernels of wisdom from his interview are as follows:

• We want it all without the risk.
• We run into problems when we get caught up in the why’s.
• We should not opt for structure over possibility.
• Confidence and Competence should leap frog for best results.

Conscious breastfeeding is not a no-brainer.   It is a skill that is learned by the mother and taught to her baby.  In reality, there is a process that we must go through to learn any skill.  In his blog post, Learning = Change, Rowan Manahan discusses movement through the steps of lthe learning curve (photo) below. 

1. Unconscious Competence:  A mother acknowledges that breastfeeding is a skill to be learned.  She becomes pro-active in the learning process.  To move to the next level, she may need an intervention to assist her in learning the latch.
2. Conscious Incompetence:  The Aha moment comes when she realizes she must make a decision. Her choice is whether to change a sub-optimal latch, grin and bear the pain or abandon breastfeeding altogether.  This stage of learning can be as short as 3 weeks.  The key is not to give up because of  physical discomfort or mental frustration or exhaustion. 
3. Conscious Competence:  Modifications are learned and made which make the latch consistent and pain-free.
4. Unconscious Competence:  Breastfeeding is operating well without conscious thought.  It is ingrained in the body memory.  The skill has been mastered.

Confidence is a way to play with with the unknown, to learn.  It is present in the first steps of the learning curve as we pay more attention.  With the acquisition of skills, confidence becomes grounded in competence.  Ultimately, it becomes second nature, leaving us with a sense of mastery.  

Confidence can open us up to a much larger game.  The secret is to not become afraid of change.  The balance is struck when we maintain an on-going dance between having faith (confidence) and developing the ability to do something (competence). 

Conscious Breastfeeding mothers put their full attention on optimizing their experience. This is the ultimate confidence game for mothers.

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.

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.