…Contemplating the Core Elements of a Modern Breastfeeding Lifestyle
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My Breastfeeding Article in the UN Chronicle

World Breastfeeding Week 2010 is drawing to a close.  The focus has been on the Ten Steps of the Baby Friendly Hospital Initiative which aims to have health professionals and health care facilities promote and support breastfeeding.

In August of 2009, I was honored to have my article Breastfeeding: the Mother in Charge published in the UN Chronicle.  (click on cover)

It poses the following question…

When cultural anthropologists of the future look back on this moment in human history, what will they find? Will they see a tipping point in breastfeeding advocacy where we were able to successfully support and preserve breastfeeding?

The Ten Steps can help move us in the right direction.   Ultimately, our actions must speak louder than our words or policies. We need to teach mothers the fundamentals of how to achieve a deep, pain-free  latch.   Conscious Breastfeeding will put them in charge of their breastfeeding outcomes.

“Change will not come if we wait for some other person, some other time. We are the ones we have been waiting for. We are the change we seek.”
~ Pres. Barack Obama

I invite you to read my article and share your thoughts.

August 6, 2010   No Comments

World Breastfeeding Week 2010: Health Care Worker Call To Action

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

The Nipple Monologues: Part 2: Points of View

To spare nipples pain and trauma during breastfeeding, it is essential that we re-examine our view of the latch. We must keep in mind that it is Breastfeeding and not Nipplefeeding!

The human nipple is comprised of responsive, erectile tissue which carries messages to the brain. However, unlike other body parts with such traits, it does not lengthen that dramatically if there is a great latch during breastfeeding.

The nipple should never be the focus of attention. It is just the exit through which the milk fl0ws.

During breastfeeding, it should be the bottom of the breast, rather than the edge of the nipple/areola, which is actually on top of the baby’s tongue. This is described in some circles as a “sandwich” of breast tissue which needs to be deep in the babies mouth.

I am happy to report that there are thousands of breastfeeding pictures now posted on the internet. You would think that they might add some dimension to the teaching toolbox. However, there is a big difference between an artistic shot of breastfeeding such as this, by Marga Serrano,

FOOD TIME!!

and one that is instructional for a new mom with sore nipples!

Many of the photos that I found depicted babies that are clearly older, experienced breastfeeders. It would be fair to assume that sore nipples would no longer be an issue for their mothers.

Those shots that portrayed newborn babies were vague at best. Varying latches were seen from different angles; the details of each latch were unclear. Most of these breastfeeding photos were understandably focused on the baby and gave no clue as to the mother’s experience of the latch.

Unfortunately, the conventional wisdom is that the baby knows what it is doing and that an attachment of any sort is acceptable. Most people, health care workers, family members and the mothers themselves, believe if it looks like breastfeeding, then it is breastfeeding.

I beg to differ. Breastfeeding should be evaluated by how it feels and how well it works, rather than merely upon how it looks.

Please share your points of view.

June 22, 2010   1 Comment

Nipple Monologues: Part 1: What Sucks is Really Nipplefeeding

There are two things that you absolutely need in order to breastfeed…a baby and breasts. The way in which human milk is dispensed to the baby is through a fine spray that flows through its mother’s nipples. The nipples and areola are visually attractive to babies and, in combination with the scent of milk, they help them to find their way onto their mother’s breasts for feeding.

Therein lies the problem.

1. Nipples come in many shapes and sizes and are not standardized like the rubber and silicone models that can be purchased at your local drug store.

2. Nipples have nerve endings which carry messages from the baby to the mother’s brain causing the release of prolactin and oxytocin which are the hormones that guide milk production and release of milk.

3. Nipples can feel pleasure and pain sensations depending upon what is being done to them.

4. Unfortunately everyone seems to think it’s all about the nipples.

The real truth of the matter is that the nipples are only a means to an end. They are meant to serve as a guide for the mother to draw her baby onto the breast during latch-on and are the exit through which the milk flows. If too much focus is put on the nipples by the baby’s tongue and gums they will become sore and may crack and bleed. Sore nipples are one of the top reasons a mother will stop breastfeeding.

New mothers will often be subjected to an ongoing commentary about their anatomy when they begin breastfeeding; much will be said about the shape or size of their nipples. They never seem to be just right. Many health care workers make faulty assumptions, or have been taught, that the baby will not be able to latch without a prominent nipple. This is absolutely not true.

Can anything be done?

Breast Shells worn during the pregnancy will help soften the tight bands of tissue that cause inverted nipples. They also can be worn in the early days after giving birth if swelling of the breast changes the shape of the breast and makes the nipple appear to be flat or less defined.

Pumping can reshape the nipple and breast tissue temporarily so that the mother can draw the baby on past the nipple. However, this can cause some discomfort as the pump primarily pulls on the nipple.

Proper hand postitions using preferably a C-Hold, or alternately a U-Hold to shape the breast will help the mother to steady the breast during latch-on. She should actively put the baby on the breast rather than the nipple.

Nipples are the guides, not the destination. They should be used as a stationary navigational tool that will help the mother with her visual line up for a great latch. The mother’s nipple should be opposite the baby’s nose rather than in front of its mouth during latch-on. *More on this point in Part 2*

A piece of candy has the juice extracted from it by rubbing it between the tongue and palate. This is one image that comes to mind when we use the verb sucking. Given that definition, the breastfeeding baby would seem to be focusing its attention solely on the nipples. Milk, however, can actually be expressed without any direct manipulation of the nipples; compressing deeply with the hands where the jaws would be situated will produce milk flow.

Babies are really not sucking but using their jaws to compress the breast with a “chewing” action and swallowing as needed. The tongue should be under the breast covering the bottom gum and not manipulating the nipple at all as this will cause injury and pain.

It is all about the depth and angles. Ultimately the baby needs to be guided past the edges of the nipple to a place deep on the breast. It is here that they will access a great flow without hurting their mother. You want them to be oblivious to the fact that a nipple exists. You want them to be breast-centric rather than nipple-centric.

They call it Breastfeeding and not Nipplefeeding for a reason!

June 21, 2010   1 Comment