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?

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.

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!

Early in the 20′th century, drug companies started selling commercial artificial baby milks, aka formula. Gradually women were persuaded that breastfeeding was a choice, rather than the natural food needed to ensure the optimal growth and development of their infants during the first year of life and beyond. In the late 1960’s, formula began to be marketed directly to the medical community and a sharp decline in the initiation and duration of breastfeeding was noted throughout the world. In less than a century, it was no longer the birth right of human babies to be fed their mother’s milk.

What’s a breastfeeding advocate to do to combat the marketing prowess of Big Pharma? For the past 25 years legions of dedicated lactation professionals and breastfeeding women have pondered this question, myself included.

The basic approach has been to promote breastfeeding by proclaiming that it is natural and full of health benefits for both the mother and her nursling. Education and peer support have been the primary tactics to shift the global paradigm back to breastfeeding as the accepted norm.

Unfortunately, modern breastfeeding advocacy has been fashioned from a defensive mindset. Marketing efforts take on formula, tit for tat, pun intended. The activity of breastfeeding has been steadily taking a backseat to the commodity of expressed breast milk.

In their efforts to create an evidence-based model, many lactation consultants have moved their attention away from direct breastfeeding and are promoting pumping and breastmilk to go up against the competition, one-on-one, bottle by bottle.

The current breastfeeding marketing strategy is in desperate need of an overhaul. What do you think?