Last year a new law was passed that requires employers to provide a space and break time for breastfeeding mothers to pump for their babies. These links have information about what the law provides and how to file a complaint. One nice thing about the law is that it acknowledges the variation between mothers in how often and how long they need to pump (“Employers are required to provide a reasonable amount of break time to express milk as frequently as needed by the nursing mother. The frequency of breaks needed to express milk as well as the duration of each break will likely vary.”)
My friend Nora just gave me a heads-up on this article by Fleur Bickford on the Best for Babes site. There are so many unhelpful things out there about latch – so many detailed instructions about specific positions that don’t actually work for all mothers and babies. Many of these detailed instructions seem to put mothers and babies out of sync with one another – but successful breastfeeding depends on mothers and babies working together. We are learning more all the time about how babies use their hands, how they get information from touch and smell, how they will try to adjust themselves to be comfortable. Mothers can support these inborn skills to help babies succeed at breastfeeding. Fleur Bickford’s article pulls together the thoughts that many people have been having about babies’ inborn breastfeeding skills in a user-friendly way. It’s good stuff!
I just added a category of links on my library page for health care providers. These are resources for people that are working with breastfeeding women and babies that need information about medications, evidence-based protocols for common situations, and donor milk. I will add more over time.
This post is a summary of what I’m talking about at a local doula meeting this evening. Anyone that wants to suggest additional ideas please comment. References for many of the facts that I cite can be found in Linda Smith’s book, Impact of Birthing Practices on Breastfeeding.
First and most important, doulas support their breastfeeding clients just by being doulas. Research shows when women have doulas supporting them at their births, they have lower rates of medication use and fewer c-sections. Initiating breastfeeding is much easier when mothers are not also recovering from surgery and babies aren’t groggy from pain medication.
Additional things doulas can do before the birth:
- Talk about choosing a baby doctor. While all doctors will say that they support breastfeeding it is important to look at the what they do – not just what they say. Important questions for parents to ask include how many of this doctor’s patients breastfeed exclusively to 6 months and how many breastfeed beyond a year. For additional indications of how supportive a health care provider is of breastfeeding, check out Dr. Jack Newman’s list.
- Recommend some good books. The new Womanly Art of Breastfeeding (the 8th edition – the earlier editions are not nearly as good) and Breastfeeding Made Simple are both very helpful.
- Connect clients with local peer breastfeeding support groups. La Leche League has meetings at different times and locations in Dane County. Happy Bambino, Meritor, and the Madison Birth Center also have mother support group meetings. While these meetings don’t always focus on breastfeeding it can be a good place to connect with other breastfeeding mamas.
- Talk about the ideas of skin-to-skin care (kangaroo mother care) and biological nurturing. These aren’t the typical images of breastfeeding that women have in our culture so it is easier if they’ve encountered them before giving birth.
- Make sure that families know that formula is not the only alternative to mother’s milk at the breast. When a baby needs supplementation, expressed mother’s milk and donor milk are both better options. If it is important to parents to avoid all formula, they should figure out where they could get donor milk before they are in the crisis situation (like before birth).
After the birth:
- Give mothers confidence. Breastfeeding is a normal thing to do, something that doesn’t take a superwoman. It is easy for a mother to doubt herself, particularly in a hospital setting surrounded by people that seem to know more than she does.
- Remind women that they can choose whether or not they want breastfeeding interventions – just like with birth interventions. These interventions range from being directed to change her position, having her baby/breast moved by someone else, using nipple shields, pumping, or supplementing. The same questions are useful (benefits? risks? alternatives? intuition? doing nothing?).
- Get to know the local lactation professionals. Doulas know their clients well and have a sense of what kind of care is the best fit for them. Get a feel for services and prices and care style so that clients don’t have to do all that research themselves when they are under stress with an unhappy baby and mama.
I have been listening to a talk by Dr. Joy Noel-Weiss on how breastfeeding professionals talk about breastfeeding (GOLD11 conference). She notes that we refer to the breast instead of mother’s or your breast. She also points out that many or even most breastfeeding photos show just the baby with maybe a little bit of breast (check out the photos at the top of INFACT Canada’s website for an example). We emphasize the value of breastmilk but down play the value of breastfeeding.
She asks the question “Are we missing something?” I say yes. My own experience has been that the breastfeeding relationship is very important – it is more than just the milk. That is why the photographs that I use for my business cards show the lovely mothers as well as their beautiful babies.
I just discovered this collection of photographs on the Stanford Medical School Newborn Nursery website. It has pictures of things that are common and uncommon, of concern and not. It has pictures of mature breastmilk, green expressed milk (not a problem by the way), baby poop, tongue-tie, and many other things. This looks like a handy resource.
Since nursing babies that wake at night usually want to breastfeed, nighttime waking concerns are often seen as a breastfeeding problem. A new study in Pediatrics presents information about how babies sleep that could lead to problems for breastfeeding families if it is seen as how babies should sleep. It says in summary:
CONCLUSIONS The most rapid consolidation in infant sleep regulation occurs in the first 4 months. Most infants are sleeping through the night at 2 and 3 months, regardless of the criterion used. The most developmentally and socially valid criterion for sleeping through is from 22:00 to 0:600 hours. At 5 months, more than half of infants are sleeping concurrently with their parents.
Unfortunately this study does not talk about feeding choices. Many breastfeeding mothers find that milk production drops significantly when they go for many hours without breastfeeding or pumping. The Academy of Breastfeeding Medicine has just blogged about problems with this study – particularly if it is used as a guide for parents:
I am dismayed by the publication of the study of Henderson et al which ostensibly documents the normal patterns of sleep in infants in the first year of life. The population studied was non-random, self selected and not representative of the varied ethnic, cultural, socioeconomic diversity of a normal population. Thus, just on these grounds this inevitable selection bias precludes any conclusions.
Anthropologists and sleep researchers Helen Ball and James McKenna write in their letter to the editor:
The publication of this paper perpetuates the western cultural notion that infants can and should sleep “through the night” from a very young age. However, encouraging young babies to sleep “through the night” is one of the most effective means of killing a mother’s ability to sustain breastfeeding and denies a young infant a third of its daily nutrient intake. Regular nighttime suckling is crucial for successful lactation and is an important modulator of infant sleep architecture and arousal patterns. How can a research paper published in 2010 on infant sleep development possibly overlook or ignore the relevance of night-time breastfeeding? How could the reviewers overlook or ignore such a fundamental omission?
I hope that this study does not get used to undermine breastfeeding by making parents feel like there is something wrong with their breastfed babies that do not sleep through the night in the first year.
The exclusion of breastpumps from accepted flexible medical spending account spending made the front page of the New York Times this week. Breastfeeding advocates have been frustrated by this apparent lack of support for breastfeeding but a thoughtful post from Alison Stuebe of the Academy of Breastfeeding Medicine points out how complicated this issue is:
I’m strangely ambivalent about the decision to exclude pumps from flexible spending accounts. I worry about the pervasiveness of breast pumps in breastfeeding in the US. Pump companies have pushed mightily to convince every American mother that an electric breast pump is an essential, regardless of whether she plans to return to work. If FSAs covered pumps, I’m certain that pump manufacturers would step up their marketing to make sure that every American mother sets aside $300 tax-free dollars to buy that pump that she can’t possibly breastfeed without. Such a policy would be a windfall for pump companies – But I’m not convinced it would be good for breastfeeding.
One of the most disturbing facts that Dr. Stuebe cites is that about 1 in 7 women that uses a breastpump is injured by the pump. Pumping is not always a simple, harmless option that all women should feel like they need to choose.
Like with so many public policy issues there is no simple on-size-fits-all right answer here. For the health of women and children we need to support breastfeeding but we also need to be thoughtful about what that support includes. There needs to be a conversation about maternity leave options, peer support, and professional lactation support rather than just assuming that providing pumps is that same as being breastfeeding-friendly.
New video from the organization that certifies International Board Certified Lactation Consultants about how IBCLC’s are trained and what they do to help families:
The video is a little bit dry but has useful information about what to expect. Also some really cute footage of babies in good positions with good latch.
The video is about promoting our profession so it does not address the issue of deciding whether a lactation consultant is the best person to help with a particular problem. To help with that, read this from Diane Wiessinger some guidelines to help families choose whether an IBCLC is the appropriate helper for their situation:
What do you need? Help with medical care? With a standard birth? A sympathetic ear? Household help? Someone who can help you figure out why breastfeeding isnít going well? Someone who can help you fix it? When you match the helper to the need, you’re more likely to have a satisfying outcome.
Just a note about my summer… I’m a mom with a bunch of kids at home so between work spending time with new mamas and babies and my own kids’ stuff I haven’t had time for writing about breastfeeding. I have been posting current breastfeeding news and research on Happy Bambino’s facebook page, though, so if you’re interested check it out. It is also a good place to have a conversation about parenting in the Madison area.
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