I stood on line behind Kevin Bacon at my Starbucks.   I could feel my father desperately channelling through me an urge to engage him in conversation.   Although I inherited my dad’s ”gift of the gab,” I could not utter this joke forming in my mind.  “So, this is what they mean by six degrees of separation?”   If only I had remembered at that moment that his wife Kyra had breastfed.   Given my penchant for marketing at Starbucks , who knows what I might have been able to say. 

All kidding aside,  I have found that there is less than 6 degrees of  separation for breastfeeding success.  

• Your mother, partner, a sibling or close friend, doctor (pediatrician or obstetrician), lactation specialist can all impact your choices and the trajectory of your experience. 

Six Degrees of Separation For BF Success

One of the most important considerations is surrounding yourself with positive breastfeeding role models and enthusiasts.   Given the barrage of hormones, any lack of support, whether real or imagined, can shake your confidence.  Those who love you do not want to see you exhausted and overwhelmed.  They may try to relieve you by offering to give a bottle or encourage you to consider an exit strategy. 

Breastfeeding is natural, but it is also a learned skill for both mother and baby.   Tensions can build when couples are not on the same page about this essential aspect of caring for their newborn.  Attend a breastfeeding class together if at all possible.   Remember that coaching does not end after labor.  

Many of you will defer to the “authority figures” such as the doctor and lactation consultant.  

1. No Pediatrician will hang out a shingle saying they are opposed to breastfeeding.  However, early supplementation with formula is a big clue about their knowledge and support of breastfeeding. 
2. A survey of Pediatricians published in late 2008 verifies that their promotion of breastfeeding is down.
3. Lactation consultants that rely too heavily upon gadgets and pumping may further overwhelm a mother. 
4. Check out your local parenting boards and read them carefully.  Look for someone who has the clinical expertise to fix your latch rather than manage your pumping.
5. Ask your friends to  honestly share their breastfeeding experience and judge if you want some of the same.
6. Follow me on twitter or become a member of  The Breastfeeding Salon

We live in an interesting period of human history where popularity and affiliation are highly valued.   With some preparation you can assemble your dream team of breastfeeding support within six degrees of separation.

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?

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!

I have been teaching breastfeeding classes in New York City since the 1980’s. For more than 10 years, I have exlusively taught at the premier prenatal program for expectant families in NYC at St. Luke’s- Roosevelt Hospital. 
                                                                           
I have been surveying the participants of all of my classes to find out what are their expectations of their upcoming breastfeeding experience. This has been enlightening, and at times a bit disturbing, to see that so many of these moms continue to worry about whether they will be able to breastfeed and/or like it. Pain, having enough milk, difficulties with latch-on, infections, pumping, weaning and returning to work were among their top concerns. Many reported having received both positive and negative feedback from close family members and friends who have breastfed. Everywhere they turn they find inconsistent information and support leading them to believe that breastfeeding is a matter of opinion.

One of my pet peeves is that most classes are teaching “Generic Breastfeeding”. This is patently ridiculous since pregnancies are not the same from conception to completion. There are different ways to conceive, a variety of types of delivery and babies come in all different sizes. Most classes give too much information without practical, simple specifics; there is a tremendous emphasis on the use of gadgets and equipment. This “Pseudo-Science of Lactation” does not translate well across the board into positive outcomes.

Some of you may have attended a prenatal breastfeeding class, perhaps you may even be an alumni of one of my classes or of The Breastfeeding Salon. I am trying to track and fill in the gaps between the fantasy and reality of breastfeeding. I invite you and your breastfeeding friends to join in the conversation.

What information or tips did you find helpful, confusing or plain wrong? Did you get these ideas from a class, a book, word of mouth, the hospital staff or your OB or Ped? Your feedback and comments contrasting pre and post breastfeeding class impressions should make a this a lively discussion!

We cannot change things if we continue to maintain the status quo.

Breastmilk is the bio-available, species-specific food which is perfectly crafted for human babies.  It is delivered by the elegant and  nurturing act of breastfeeding.  Literally organic, it is made by the mother’s body, and delivered to her baby via her breasts.  In contrast to artificial baby milk,  human milk is a raw food that does not require processing and distribution. It does not use valuable resources nor does it pollute the environment .

Breastfeeding is a feeding practice that is almost completely self-contained; the supply depends upon maintaining a synergistic connection between the baby and the breast. The baby, breast and hormones released by the pituitary gland of the mother set up the milk supply after birth. Supply adjusts to removal of milk by the  baby over time.

Unfortunately, the modern practice of pumping and bottle feeding human milk does exert an impact on the environment in terms of use of electricity, cleaning products, bottles and other gadgets that will eventually become waste in a landfill or elsewhere.  However, relative to the elements that go into the production of formula, it is far less of an ecological burden.

Conscious breastfeeding  mothers make a positive contribution to the ecology and environment in which they are raising their children  by actually breastfeeding whenever possible.  A shift in emphasis away from an over-reliance on pumping will reduce their carbon footprint.

On this Earth Day, and everyday, we need to create a world in which breastfeeding is the norm rather than the exception.