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
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.
June 21, 2010 1 Comment
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:
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.
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?
July 16, 2009 1 Comment
Single-use, high quality electric pumps have been available for consumer purchase since the early 90’s. During these intervening years, the amount of pumping has increased exponentially in the United States and across the industrialized world. Pumping is very much part of the popular culture, often being featured in sitcoms and instructional media geared to expectant parents. There is a not too subtle imperative to own a deluxe pump before the baby is even born. Doctors, Nurses and Lactation Consultants encourage pumping as a way to both evaluate and to increase a mother’s milk supply.
Pumping for some women is their idea of Breastfeeding. Are you all Pumped Up?
Symptoms include, but are not limited to the following:
You Breastfeed and pump after almost all feedings
You wake up in the middle of the night to pump
Your are pumping weeks worth of extra milk, just in case
You “power pump” if you get less milk out than usual in order to increase your supply
You pump whenever you feel something is wrong with your breasts
You pump to “empty” your breasts
I field inquiries in all my venues about pump management. Mothers have been sold on the idea that the pump tells the whole story about their Breastfeeding. They worry when they can’t extract the same amounts as their friends or in volumes that compete with ready-made formula bottles.
Those women who do obtain copious amounts of milk when they pump will often have issues in their breasts while breastfeeding. They tend to be out of sync with the baby and often contend with excessive leaking and engorgement. Some will report having had Mastitis which was the result of inadequate drainage from only pumping or mixing pumping with direct, but inconsistent patterns of Breastfeeding.
Pumping can actually compound any problem brewing in the breasts. Women who have sore nipples and engorgement are often advised to pump, rather than to correct the latch. Congestion can build up and if not relieved the mother will spike a temperature leading to a course of antibiotic therapy. Whenever, the health of the breast has been compromised it is essential to use the baby and not the pump to solve the problem.
Of course there is a time and place for Pumping…
- Premature Delivery
- Illness of mother or issues with the baby or babies that require a delay or interruption of direct breastfeeding
- To obtain human milk if supplements are medically indicated
- Returning to Work outside the home
Other reasons cited, may include:
- Mom needs a break from breastfeeding
- Dad/partner wants to participate in feedings
- To know how much the baby is getting at feedings
Since the mother is the only one pumping and Breastfeeding, it is not exactly a vacation. Pumping will increase her workload and can create additional anxiety as her milk output can vary greatly depending upon when she pumps. The mother who feels overwhelmed and worried about her milk supply may begin supplementing and make decisions that lead to early weaning.
If you are pumping or have pumped what has been your experience? Are you all pumped up?…or more aptly all pumped out? I invite your comments and concerns related to pumping.
June 30, 2008 2 Comments