Walking On Egg Shells

Had an interesting call this week from a dad.  He wondered what were the chances of relactating at 7 weeks? 

And no, before you go there, it wasn’t a crank trying to get a rise out of this passionate lactation advocate.  This call was legitimate.  He was a friend of a father in my practice who had encouraged him to reach out to me across state lines to sort out his dilemma.

He called me to suss out the situation and shared a very sad, but typical scenario.  His wife, had been buffeted on the seas of lactation support with inconsistent advice, emphasis on pumping and after two weeks was summarily dismissed and told to bottle-feed.  For approximately 6 weeks now his son has been bottle-fed formula.

In general, I always prefer to speak directly with the mother.  However, his voicemail touched a heart string as he confessed that he was calling without having yet broached this subject with his wife.  He was genuinely concerned and felt badly that they were missing out on breastfeeding because of the questionable support and consultation they had received in the early weeks.  

The reason for the abrupt weaning was the usual  ”Not Enough Milk”.  This was determined, of course, by his wife’s inability to pump enough to bottle-feed after the delivery.   More bottles and pumping led to formula and weaning.  The reason it was bothering him so much was that he noticed her leaking tons of milk a few days ago.  He didn’t understand why she didn’t just offer the breast to their son as clearly there was milk.

This dad was walking on egg shells. He was the support team during the initial battles and was now fearful of incurring her wrath by bringing up the notion of trying it again.   

I can empathize.  I’m often called in for these kind of situations and find the solution is not as simple as merely choosing between offering the breast or a bottle filled with human milk or formula.  The weeks of reinforcing a behavior other than breastfeeding and living a bottle-feeding lifestyle with their new baby could make the transition difficult on many levels.  

 I complimented this dad on his thoughtful and loving inquiry.  My suggestions were simple:

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1.  He could now share honestly some of his impressions about that stressful time with his wife.  Sharing empathy without the stress and pressure biting at their heels.

2.  He could share some of his conversation with his friend that led him to call me.  It would be helpful to emphasize that these situations are usually not truly black and white, but rather if she were empowered and given consistent support much would be possible.

3.  He could gently suggest that she offer their son the breast without worrying now if she had enough. Without pressuring her, he could point out it would be a shame if what she was still producing for their son would ultimately go to waste.

4.  He could share what he intuitively knew, and I corroborated, that milk supply is not increased by the pump, but rather by the baby breastfeeding.  Any amount of breastfeeding would greatly increase the odds of them being able to shift the balance of feeds away from the bottle and back to the breast.

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5.  He could continue to offer his love and support reassuring her that it was ultimately her decision.  Sometimes knowing that it is a real team effort can make these transitions seem more possible.

Breastfeeding is a relationship and is relational.    It is the mother who ultimately breastfeeds and chooses whether or not she will continue or resume if there have been challenges.  However, her choices do indeed have an impact on everyone in her inner circle.  Breastfeeding does not exist in a vacuum and is very much a family affair.

How many of us sisters, moms, friends, partners, spouses, and  even lactation consultants, can identify with this dad? Have you ever been afraid to further encourage or advise a mom who had been beaten down and had weaned because of a negative experience with breastfeeding ?

Have you ever felt like you were walking on egg shells?  And what did you do?

I have been noticing an alarming trend among the mothers calling me for lactation support. Almost all of them are actively supplementing their breastfeeding. Of great concern to me is that they are using more and more formula and reporting they feel pressured into doing so by their pediatricians.  Driven by concerns over weights and measures, these mothers have no confidence in their own milk and are finding little support for exclusive breastfeeding from the medical establishment.

I caution you to remember the old adage…actions speak louder than words.  I have yet to meet or hear of a pediatrician in my tri-state area who blatantly discourages breastfeeding to consumers who are planning on breastfeeding their babies.  But they are wolves in sheeps clothing.  While paying lip service to breastfeeding, they manage formula feeding. 

This problem often starts in the hospital.  One of the loop holes of the 10 Steps for Baby Friendly Hospitals is that formula can be offered when medically indicated.  Tired after labor and left largely on their own with a new baby, the parents are often scared into supplementing for “health reasons”.  Under the guise of a medical need for formula : ”your milk is not in yet” “your baby seems very hungry” “you need your rest” “your baby is dehydrated” “your baby has lost too much weight”…The dye is cast.

Once parents succumb to the pressure, their baby’s patterns of digestion and state will have changed.  They quickly notice that after supplements, especially of formula, that their baby sleeps much of the time between feedings.  Their expectation of what a successful breastfeeding session looks like has thus been altered.

When they resume exclusive breastfeeding, after days of supplementation, they may find their baby is fretful or awake after a feeding.  This may prompt them to pump to check if they have enough milk; they often get negligible results since they have just breastfed.  If a breastfeeding session has been skipped, they may pump a larger amount the first time, but the amounts will drop and/or plateau if pumping is done in lieu of breastfeeding during the early days of developing a milk supply.

I was thrilled a while back to see a thread on this topic going back and forth among my friends on Twitter.  Sadly, it does seem that you may have to defend your decision to breastfeed every step of the way.  Tara, on Growing Up Green outlines 5 strategies that can help counteract medical misinformation and questionable support.

Doctors express, no pun intended, their shock and awe when exclusively breastfed babies grow as well or better than their formula-fed peers.  If the growth patterns are different, they assume it is a problem with the mother’s milk or her baby’s digestion of her milk and immediately suggest formula.  

It is disappointing to me that fewer pediatricians these days even suggest pumping and giving extra human milk when the only issue is weight gain.  When they do include adding extra EBM after breastfeeding as part of their care plan, they often recommend amounts that ensure the need to make up the difference with formula. 

 A local doctor used her trump card, or so she thought, on one of my moms by telling her it would damage her baby’s brain because her daughter had gained only 4 oz in about 5 days. She tried to instill guilt and scare her into using formula when her baby was gaining too slowly for her taste.  Brain cells by the ounce?

It appears that this reliance on weights alone for assessing the health of newborns has gone global. Danielle from Born.In.Japan.net wrote of a similar experience in recent months. She did not mention supplementation in her post, but shared feeling that the doctor wanted her baby to “fit in a box”.

So many babies are now being double-fed that no one really knows what is a normal growth pattern.  We are mixing gene pools and methods of feeding and are expecting standardized outcomes.

An important breastfeeding survival strategy must be for us all to question this one-size-fits-all model of management.  The emphasis should always be on achieving a conscious breastfeeding connection that is optimized to be pain-free. 

As long as there is evidence of steady growth, even if it is slow, there should be no reason to be concerned if your baby isn’t the “fattest baby on the block”.

This week just passed, 4 October- 10 October, marked the 20′th anniversary of the second Nestle Boycott.  The first began in 1977 and was suspended in 1984 when Nestle appeared to be undertaking measures to abide by the International Code of Marketing of Breastmilk Substitutes.  Monitoring over the intervening years showed many violations and the boycott was resumed in 1988 and continues today.

As a nurse, lactation consultant and passionate advocate for breastfeeding mothers and their babies, I have engaged in my own personal boycott.  This has not always been easy as the long arm of the Nestle corporation has extended its reach by expanding its businesses to include bottled water, pet food and cosmetic companies among many others in their vast empire.   The list of their holdings includes many popular consumer brands.  Nestle Boycott List

In the very informative blog put out by Baby Milk Action, Boycott Nestle-and other action to promote infant health, Mike Grady recounts the legal challenges posed by Nestle for the launching of the new website, http://www.nestlecritics.org  which was timed to coincide with this anniversary. 

Mike says, “The whole point of the site is to provide objective, independent information to people who want to know if Nestlé’s words are reflected in its actions.”

Nestle is the largest food company in the world. The recent contaminated formula tragedy in China and Asia causing the illness of so many infants involves them as well as their competitors.  We need to be vigilant in protecting our food supply, especially for our babies.  Formula and pet food have been shown to be susceptible to breaks in manufacturing quality control causing illness, and in some cases death, for large numbers of infants and pets.

I encourage you to continue Consciously Breastfeeding…

And, join me in the Nestle Boycott.  Buy a different mascara, cereal or water.  Check the list and exercise your power as a consumer.  Nestle puts profits before health and thus it is only when they notice an impact upon their bottom-line that they will they take heed of the need to abide by the Code.

 It is especially important that we lend our voice and our support to these efforts. 

As we enter the height of the election season with the start of the Democratic Convention tonight, I am wondering about …the Politics of Breastfeeding.   Did Michelle Obama breastfeed?  And more importantly, what, if any, impact will that have on future health policies if her husband is elected?

This World Breastfeeding Week 2008 came and went with very little fanfare or controversy that I could find in the mass media.  There was the odd article here and there which caught my eye.

This article in The New York Times published during that week, reported the rather dismal stats on long term breastfeeding in the Western World.  Oops, I mean in the States.  I think it would be worth a look to read the article, but more so for the comments.

I found my blood pressure was quite labile reading some of the posts…they were entertaining, encouraging, frustrating and some were infuriating!

What is up with all this political correctness?

It really does feel a bit ridiculous that you can’t state a fact without stepping on toes.  It reminds me of comments that I have gotten a few times in my breastfeeding class that I teach to the target audience of Tara Parker-Popes’s article.  Something to the effect that I was unduly biased against formula.  What prompted that feedback was this simple statement… “The only thing that changes from ounce to ounce with formula is the number of calories… as it is a processed food.”

Makes you wonder why they even came to a breastfeeding class.   It does get a bit tiring fighting such ignorance.

I long for the day when breastfeeding is not only the biologic norm, but it is also recognized as the politically correct and ideal way for mothers to nurture their babies.

I’ll be listening closely tonight with that agenda in the back of my mind!

There is a reactionary trend back toward the fat baby model and it is one of the most vexing issues that I contend with as a lactation consultant. While it is true that breastfed babies can be quite plump, it is by no means a standard.  Take one look around the world at our breastfeeding sisters in various cultures and you will find a wide range of baby sizes and most will never be as fat as those in the Western world.

Over the past twenty to thirty plus years, the women who actually breastfed would have babies that were sometimes literally off the charts. Some would be huge, and others would seem to be lagging behind their formula fed counterparts.  What accounted for this disparity was multifactorial. 

• Growth patterns are genetic.  No matter what you give some babies they will grow at their own rate and follow in the footsteps of ancestors in their gene pool.
• The nutritional status of the mother and yes, her fat stores, may lend itself to a more high octane milk.
• Feeding styles vary.  High frequency with a quality latch will lead to increased intake.  Frequency without a focused latch may not.
• The definition of breastfeeding is not consistent; it can be exclusive or topped up by only extra breastmilk, by breastmilk and some formula, or solids.

Fast forward to today… an era in which childhood obesity and juvenile diabetes are increasing at an alarming rate in the industrialized nations.  Obesity in general is on the rise, but more alarming is that we may be setting up our breastfeeding infants to join the ranks of at risk adults.  

It is no longer true that you can’t overfeed  a breastfeeding baby, because you can increase their intake with a quality latch and very frequent feedings or supplementation with breastmilk or formula.

How did this happen that fat is where it’s at for a baby?  How have we managed to make breastfeeding a possible risk factor for obesity?”  Why are so many breastfeeding babies on drugs for reflux which is generally associated with over-eating?

 Mothers often feel so anxious about weight checks these days that their babies are being double-fed, both breast and bottle at many feedings. There is an increasing pressure to feed more and more at the breast and beyond, even when their baby spits up a lot.   This skews the mean and makes it more difficult to know what is the normal weight gaining pattern for a fully breastfed baby. 

The official growth charts still do not adequately represent babies who are exclusively breastfed.  Has your baby ever been off the charts?