Breastfeeding is just like most modern relationships, sometimes it is difficult to define.
More often than not, the romantic ideal of a blissful nursing couple is threatened by the addition of pumps and bottles. These artifacts alter the experience greatly for both the mother and her baby. She is likely to feel overwhelmed.
Breastfeeding Status: It’s complicated.
Tongue-in-cheek, my green logo above and query are inspired by Facebook. The irony is that it has, on several occasions, banned breastfeeding photos.
What is your Breastfeeding Status?
Do you exclusively breastfeed your baby? Do you breastfeed, then pump, then feed a bottle of your expressed milk? Do you breastfeed, then offer a formula chaser? Do you pump exclusively?
Ideally breastfeeding should be a relationship with your baby, not the pump. Couple therapists typically recommend banning the computer and television in the bedroom in order to foster greater intimacy. In the same vein, focusing on direct breastfeeding will enhance both bonding and the milk supply.
There is a time and place for the gadgets, but in the bloom of new love or breastfeeding it is best that the focus be on the partner. Being in the moment and keeping things simple can help lay down the most solid foundation for long term success.
It is all about making positive, conscious breastfeeding connections and upgrading your status to: In Relationship with your breastfeeding baby.
August 26, 2010 8 Comments
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
Mothers are literally buying into the idea that pumping is the magic ticket for breastfeeding success. Thanks to the ‘pump pushers’ it is a rare woman who actually believes that she can only breastfeed. I have written about this “Pump Mania” extensively in Are You All Pumped Up?
Many lactation consultants and health professionals are encouraging a dependence upon pumping. They have been sold on the notion that the pump is as good, if not better than a baby feeding directly from the breast. They tell mothers, “Pump to see how much milk you are making.” Another common piece of advice is “Pump after every feeding to increase your milk supply.”
Clinical evidence shows that pumping is always second best when compared to direct breastfeeding with an excellent latch. What is obtained from pumping is only a percentage of what the baby can get when properly positioned on the breast.
The impression of increasing the milk supply often comes from the fact that the breast seems fuller with the combination of breastfeeding and pumping. Assessing the quality of breastfeeding is essential because the appearance of fullness can be misleading.
- If the baby has a poor latch and the mother is relying more heavily on the pump for removal of her milk, the breast will build up its storage capacity.
- An excellent latch leads to a breast in equilibrium rather than having a leaky, full and uncomfortable breast.
Pumping most definitely has a place in the breastfeeding experience of some, but not all, new mothers. Those mothers who encounter challenges due to prematurity, maternal/infant illness or those who work outside the home, will most likely need to pump if they are to maintain their milk supply.
It is both ironic and disturbing that such a profound lack of confidence in milk supply by mothers has grown in an environment where there are legions of lactation consultants and breastfeeding advocates now among us. It turns out that the allied health profession of lactation consulting (IBCLC) and Medela, the leading manufacturer of pumps world-wide, have been closely linked throughout the past 25 years. (I don’t seem to be alone in voicing my concerns.) Read more here.
- A rise in individual pump ownership and use since the mid-1990’s is directly proportional to this increased focus on breast milk supply versus direct breastfeeding.
As far as I can tell, mothers do not lose sleep worrying about how many ounces of amniotic fluid their placenta is making for their babies. They trust in the wisdom of their bodies to manufacture what is needed to get the job done. Before the advent of routine sonograms, “the bag of waters” was not even on the radar until time for labor.
Breasts would be see-through or come with alarm systems if the volume was the critical factor to be considered. The notion of volume being important comes from a formula feeding model-nothing changes in that processed food save for calories delivered by the ounce.
This collective obsession, pun intended, with proving how much breast milk we have, makes me think of the biblical figure, Doubting Thomas.
Why do we need to see our milk in order to believe in the ability of breastfeeding to nurture our babies?
June 27, 2010 6 Comments
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.
- 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.
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.
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
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