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:
I think one of the most interesting parts of this is the comparison of breastfeeding rates in the US at one year with the UNICEF survey of rates at two years. What is it about other cultures that makes long-term breastfeeding so much more achievable?
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!
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!
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.
You may have heard in the news that mothers’ milk is contaminated with toxic chemicals. It is true. It is also true that everyone agrees that breastmilk is the first choice food for babies. All major public health organizations promote breastfeeding. Even though we live in a world where harmful chemicals are in our environment and in our bodies and in our breastmilk, breastfeeding is still the first choice food. Even when a mother’s milk is known to contain particular contaminants, breastfeeding is still almost always the best choice for her baby.
Unfortunately we know that mothers’ milk is contaminated with a long list of harmful chemicals (persistent organic pollutants (POPs) and heavy metals are most often mentioned). Breastmilk is contaminated because mothers are exposed through what they eat, drink, breathe and touch. The fact that these chemicals appear in mothers’ milk is a reminder that mothers (and all people) are exposed. Steps to protect breastmilk are the same steps that are needed to protect everyone. Rather than thinking of breastmilk as a separate problem, we need to think about it as one small facet of the bigger problem. While all of us are exposed to toxic chemicals, babies are particularly vulnerable to the effects of many of these chemicals. As part of taking care of their future health, it is important to stop ignoring or accepting this contamination of their food.
While we know that babies do best with breastmilk, they would almost certainly be healthier in the long run if there were fewer harmful chemicals in that milk. So what can families do to give their babies the healthiest start on life that they can?
1) Become politically active because we can not protect just our own family. Some chemicals that are found in breastmilk got into the environment when they were used in another country. Many chemicals are in the water and air. An individual mother will not be able to stop all of her exposures with her individual lifestyle choices. We have to all work together to find alternatives and limit the ability of companies and individuals to expose all of us to harmful chemicals. When your babies are small it can be hard to find the time to be an activist. A good starting place is to donate to reputable environmental organizations and then follow up on any easy action steps they send to you. Some possible organizations are Environmental Working Group, League of Conservation Voters, Sierra Club, Environmental Defense Fund, Physicians for Social Responsibility.
2) There are some lifestyle choices that can decrease chemicals that a mother (and her breastmilk) are exposed to. This is a topic where there are always new recommendations and new information. An easy way for new parents to stay on top of research and recommendations is to check helpful websites like the Planned Parenthood Green Choices, the Environmental Working Group guides to personal care products, water, and produce, or the National Library of Medicine Household Products database. There is so much information here that it is easy to become overwhelmed. It is a good idea to work on one thing at a time, choosing what is manageable. If the idea of looking at these websites is overwhelming, take a look at the list of ideas at the end of this essay – then look up that topic on one of the websites and make their suggestions part of your lifestyle. (Of course in the better world that I dream of for our children, no mother should need to be up-to-date on toxicology research just to protect herself and her milk – see my first point above).
Some starting points:
– Choose foods that are low in pesticides.
– Eat organic meat, eggs, and dairy.
– Join a CSA farm.
– Learn about which fish are safest to eat.
– Use safer plastics.
– Choose safer sunscreen, shampoo, soap, detergent, makeup.
– Learn about food packaging and which options are safest.
– Check your home for sources of lead exposure.
Where to go to learn more?
MOMS: Making Our Milk Safe
American Academy of Pediatrics: Breastfeeding and the Use of Human Milk
Pediatric Environmental Health (AAP)
International Lactation Consultant Association position paper
Having Faith and Raising Elijah by Sandra Stiengraber
Slow Death by Rubber Duck, book by Rick Smith and Bruce Lourie
It can be hard to know how a breastfeeding mother and family will be affected by laws. First of all it can be hard to find out what the laws say. Then knowing what they say isn’t enough – most of us that aren’t lawyers (that is, most of us) need help understanding what the laws mean. This website by Jake Aryeh Marcus, breastfeedinglaw.com, has both the texts and the explanations to help. Check it out!