…Contemplating the Core Elements of a Modern Breastfeeding Lifestyle
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Breastfeeding Instruction: What Gets Lost in Translation?

I have taught thousands of hours of breastfeeding classes in the multicultural, urban environment of New York City. 

We live in a world that revolves around information; knowledge on any given subject appears to be just one google search or click away.  This may explain why an increasing number of students who come to my classes lately seem to be there merely to confirm what they think they already know versus wanting to actually learn something new.  

Adult learners, often find it difficult to be open to the richness of a learning experience when they fear judgement or criticism.  It is often more important to be right than to risk being wrong or feeling like a complete newbie.

I am reminded of my first day in Japanese class. 

The appearance of a diminutive teacher who immediately began speaking in a foreign tongue made me feel at loose ends.  I ultimately mastered enough spoken Japanese that I was able to spend several wondrous holidays travelling throughout Japan.  I immersed myself in the culture and made many new friends.  My language skills have gotten rusty, but rudimentary communication is still  possible for me with little effort. 

A love of learning has impacted my approach to teaching.  There are several learning styles auditory, visual, kinesthetic.  It is not uncommon for some of us to use more than one at any given time to learn and anchor an experience into our memory. 

When your brain is under the misimpression that it already knows something you tend to filter for new data or for things that do not fit your preconceived notions.  Often that filtering process impedes learning because the mind is only attentive to parts of the whole. 

When participants ask me questions using terms and words that I have not uttered and ascribe them to me, it becomes clear that they are at best only selectively listening during class.  When these queries come from their own internal dialogue and are not directly related to content delivered, I thank them and clarify what I had actually said.  Hopefully, this helps them to take in a piece of new information. 

It turns out that cultural differences, apart from language, can also have a bearing on how the students in my classroom may interpret and receive the information.  According to the article published in the Winter edition of Tufts Magazine, ‘The Brain in the World-A Burgeoning Science Explores the Deep Imprint of Culture’, the field of cultural neuroscience is only about two years old. 

Tufts psychology professor Nalini Ambady puts it this way: cultural neuroscience shows that “there is malleability in the neural structure depending on cultural exposure.” The brain, she says, is a “sponge that absorbs cultural information.” What she and other cultural neuroscientists have discovered is that although the brains of people from different cultures do not exhibit large structural differences, certain neural pathways do become more ingrained from immersion in a particular culture. They’ve also learned that those differences in brain function can influence our emotions, our behavior, and our attitudes toward people from cultures other than our own.

It goes on to describe a study done with American and Japanese subjects who were shown groups of photographs and asked to rate them according to the characteristics of dominance, maturity, likeability and trustworthiness.  The researcher, Rule, then broke those down into two sub-groups of power and warmth.  The Americans overwhelmingly favored the powerful faces and the Japanese the warm ones.  When fMRI scans were done it was noted that the Americans were using the analytical parts of their brains and the Japanese the emotional areas.

But what he discovered surprised him: both groups were using the same part of the brain—the amygdala. Sometimes called the “lizard brain,” the amygdala, which has been with us since the early days of our evolutionary journey, helps us detect threats, but it has a more general function as well, signifying increased attention to any object in the outside world. In this case, the amygdala was firing for both the American and the Japanese groups when they saw the picture of the leader they preferred.

It should be noted that the amygdala is also a prime area for the infant’s experience of breastfeeding.  

As a teacher, I am left to wonder how I might better engage these amygdalas, the cultural command central of the brains of these mothers-to-be? The answer may lie in the common thread of child-like wonder that is a constant in every culture while we are young. 

So it not just the words, visuals and the practice of positions, but a cultural sensitivity that may ensure breastfeeding instruction does not get lost in translation.

What do you think? What has worked for you?

July 9, 2010   No Comments

Got Milk? Part 3: Let’s Pump and See

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

Got Enough Milk? Part 2: Feeding Methods do Matter

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.

June 26, 2010   1 Comment

Got Enough Milk? Part 1: Why Volume does not Correlate with Value

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

Michael Jackson: Gone Too Soon

Today is the first anniversary of the passing of Michael Jackson.  It was a shocking and unexpected loss just as he was about to make his big come-back.    He was a creative genius, an innovator of dance and music that  appealed to a wide variety of fans across the globe. 

In his  final decades, this relatively young man had become an ever more eccentric and controversial figure.  The trials and negative publicity had taken a toll on him.  Sadly, he was not able to quiet his critics and satisfy his fans by delivering the promise of  the “This is It” tour.   He died just a few days before the magic could be fully revealed.

Like Van Gogh, Jane Austen, Elvis to name a few, Michael Jackson’s fame and fortune continues to grow even larger since his death.  The spotlight was put on his vast muscial archive for an extended period beginning last summer.  

His song,  ”We Are the World” written with Lionel Richie, has raised over $63 million for African humanitarian aid.  It is hard not to move, or sing along, when one hears a snippet from his acclaimed album, ‘Thriller’.  Not to mention taking a stab at moonwalking.

Those of us who lived during his lifetime, including many of the current and recent breastfeeding mothers, will most likely have some special memories associated with Michael Jackson’s music.  

We can all agree that this talented man is “Gone Too Soon”.  He sang that very poignant song, (below) in honor of his friend Ryan White, at the Inauguration of President Clinton in 1992.  RIP Michael.

June 25, 2010   No Comments