Category Archives: Breastfeeding

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.

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Good news/bad news or environmental contamination of breastmilk

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

Breastfeeding and the law – where to get information?

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!

Great latch article

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!

How can doulas support their breastfeeding clients?

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.

Where’s the mother?

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.