More basic biology of milk-making

I was super excited to see this article reporting on research coming out of Cincinnati Children’s Hospital. So many women I see struggle with low milk supply and there are very few answers for them. There is just a lot of basic biology of making milk that we don’t understand. This research is trying to get at some of those answers. From the news release I followed the link to the original journal paper and got even more excited. This paper by Danielle Lemay and colleagues is awesome for several reasons:
– It is a new way to investigate how milk is made. They are looking at the genes that are active during different stages of milk production by getting RNA from milk fat globules. As I understand it, it is sort of a sampling of what’s going on inside the milk-making cells. It is a way to find out what proteins these cells are busy making at different times. Since the researchers are using expressed milk it is easy for the women that participate in the study to give samples (unlike most other ways of getting breast cells for study!).
– They find a connection between insulin and what milk-making cells are doing. I’m still working my way through the paper and don’t entirely understand what they’re saying yet but this general connection is exciting. It could lead to some practical ways to help women that are frustrated with low milk supply. It could also help explain why so many women seem to struggle with production. A quote from one of the authors : “Considering that 20 percent of women between 20 and 44 are prediabetic, it’s conceivable that up to 20 percent of new mothers in the United States are at risk for low milk supply due to insulin dysregulation.” (Laurie Nommsen-Rivers)
– They published in a peer-reviewed, open-access journal, PLOS ONE. That means that anyone can easily access their research – even people like me (or maybe you) that aren’t currently affiliated with a university library or have enough disposable income to purchase journal articles.

Hand Expression

Hand expression is so useful: engorgement, pump broken, away from baby longer than expected. It is a skill that is easier to learn by watching and doing than by reading about it. We’re lucky to have internet video now for learning by watching. Practicing in the shower can be a good way to learn by doing! I’ve got a collection of video links of hand expression on the library page of this blog. Here’s the one I just added to the list from Breastfeeding Medicine of Northeast Ohio:

The Basics of Breast Massage and Hand Expression from Maya Bolman on Vimeo.

Snuggling baby skin to skin

My fourth birth went from being a planned homebirth to a vacuum-assisted, epidural-numbed hospital birth. One of the things that worried me a lot about this transfer was how we would do with breastfeeding. My first birth and breastfeeding experience had been really challenging, at least in part because we had a rough birth and were separated for the first few days. I didn’t want the same thing to happen again. Actually I was terrified that it would happen again. The one thing that I felt I could influence was what happened after the birth. I had read Righad and Alade’s 1990 paper about how uninterrupted skin-to-skin contact after birth could help minimize the effects of labor medications on early breastfeeding. As soon as my daughter was born they handed her to me. I didn’t let go of her until she latched and nursed successfully – about 3 hours later. The staff kept suggesting that I might like to know how big she was and get her cleaned up. I just smiled and said that I wasn’t in a hurry. My husband and I kept smiling and thanking everyone for their help and ignoring any suggestions that we do anything other than keep her on my chest. We went on to have a long, and fairly trouble-free, nursing relationship.

This is just one story about skin-to-skin and of course one story doesn’t prove anything. But there a many studies now looking at how skin-to-skin time promotes infant well-being. Here are some good starting places if you want to learn more yourself or if you’d like to educate (convince?) someone else:
Massachusetts Breastfeeding Coalition handout. Cute picture of how to do it, short summaries of why it’s good. This is for when you just want the information without a lot of reading.
Cochrane Summary. This is a great resource for the statistics- and science-loving skeptics in your life. Cochrane summaries evaluate other studies and try to come to the best-supported conclusions about health care choices.
Kangaroo Mother Care. This website focuses on skin-to-skin care for preemies. There is information for parents and care providers.
Research study bibliography. This is for the geekiest of study lovers. All the peer-reviewed journal reading you could hope for!

Is eating good food too expensive?

Breastfeeding is about lots of things but one of the biggest ones is nutrition. Many families choose breastfeeding and breastmilk because it is the best food for babies. Breastfeeding is also generally the cheapest way to feed a baby. (I’m not going to get in to calculating some value attached to the time mamas spend breastfeeding or pumping – that just gets too complicated and controversial. If you want to read more about that you could start here.) Good food for the rest of the family, though, can get expensive, particularly if you care about avoiding pesticides. The Environmental Working Group has a guide, Good Food On A Tight Budget. Their description:

Stretching your dollars to get a month’s worth of healthy, filling food is a challenge. EWG assessed nearly 1,200 foods and hand-picked the best 100 or so that pack in nutrients at a good price, with the fewest pesticides, contaminants and artificial ingredients.

Check it out!

New AAP resolution

This may seem like a dry, legalistic-sounding (maybe even boring) document but it says something that I find really exciting:

Resolve that the Academy advise pediatricians not to provide formula company gift bags, coupons, and industry-authored handouts to the parents of newborns and infants in office and clinic settings

Until we have donor milk readily available for all babies that need more milk than their mothers provide, formula will have an important role in safely feeding babies. However, doctors shouldn’t be the (inadvertent) salespeople for the formula companies. Free samples from doctors effectively promote that particular brand of formula, generally a more expensive brand than a family might otherwise choose. Literature from formula companies generally doesn’t have good breastfeeding information. Families can get much better basic information and support from many other sources. There is no need at all for industry-authored handouts. I’m excited that the AAP is encouraging pediatricians to (as the Ban the Bags folks would say) “market health and nothing else”. To read more about this issue in general, check out Ban the Bags.