Monday, November 30, 2009
Most healthcare practitioners say they are supportive of breastfeeding. But many are supportive only when breastfeeding is going well, and some, not even then. As soon as breastfeeding, or anything in the life of the new mother is not perfect, too many advise weaning or supplementation. The following is a partial list of clues that help you judge whether the health professional is supportive of breastfeeding, at least supportive enough so that if there is trouble, s/he will make efforts to help you continue breastfeeding.
How To Know A Health Professional Is Not Supportive:
1. S/he gives you formula samples or formula company literature when you are pregnant, or after you have had the baby. These samples and literature are inducements to use the product, and their distribution is called marketing. There is no evidence that any particular formula is better or worse than any other for the normal baby. The literature, CD’s or videos accompanying samples are a means of subtly (and not so subtly) undermining breastfeeding and glorifying formula. If you do not believe this, ask yourself why the formula companies are using cutthroat tactics to make sure that your doctor or hospital gives out their literature and samples and not other companies’? Should you not also wonder why the health professional is not marketing breastfeeding?
2. S/he tells you that breastfeeding and bottle feeding are essentially the same. Most bottle-fed babies grow up healthy and secure and not all breastfed babies grow up healthy and secure. But this does not mean that breastfeeding and bottle feeding are essentially the same. Infant formula is a rough copy of what we knew several years ago about breastmilk which is in itself only a rough approximation of something we are only beginning to get an inkling of and are constantly being surprised by. For example, we have known for many years that DHA and ARA were important to the baby’s brain development, but it took years to get it into formulas. But it doesn’t follow that the addition of these to formulas is doing what they are supposed to, as their absorption from formula is different from breastmilk. The many differences have important health consequences. Many elements in breastmilk are not found in artificial baby milk (formula) even though we have known of their importance to the baby for several years—for example, antibodies and cells for protection of the baby against infection, growth factors that help the immune system, the brain and other organs to mature. And breastfeeding is not the same as bottle feeding; it is a whole different relationship. If you have been unable to breastfeed, that is unfortunate (though most times the problems could have been avoided), but to imply it is of no importance is patronizing and just plain wrong. A baby does not have to be breastfed to grow up happy, healthy and secure, but it does help.
3. S/he tells you that formula x is best. This usually means that s/he is listening too much to a particular formula representative. It may mean that her/his children tolerated this particular formula better than other formulas. It means that s/he has unsubstantiated prejudices.
4. S/he tells you that it is not necessary to feed the baby immediately after the birth since you are (will be) tired and the baby is often not interested anyhow. It isn’t necessary, but it is often very helpful (See handouts Breastfeeding—Starting Out Right and The Importance of Skin to Skin Contact). Babies can breastfeed while the mother is lying down or sleeping, though most mothers do not want to sleep at a moment such as this. Babies do not always show an interest in feeding immediately, but this is not a reason to prevent them from having the opportunity. Many babies latch on in the hour or two after delivery, and this is the time that is most conducive to getting started well, but they can’t do it if they are separated from their mothers. If you are getting the impression that the baby’s getting weighed, eye drops and vitamin K injection have priority over establishing breastfeeding, you might wonder about someone’s commitment to breastfeeding.
5. S/he tells you that there is no such thing as nipple confusion and you should start giving bottles early to your baby to make sure that the baby accepts a bottle nipple. Why do you have to start giving bottles early if there is no such thing as nipple confusion? Arguing that there is no evidence for the existence of nipple confusion is putting the cart before the horse. It is the artificial nipple, which no mammal until man had ever used, and even man, not commonly before the end of the nineteenth century, which needs to be shown to be harmless. But the artificial nipple has not been proved harmless to breastfeeding. The health professional who assumes the artificial nipple is harmless is looking at the world as if bottle feeding, not breastfeeding, were the normal physiologic method of infant feeding. By the way, just because not all, or perhaps even not most, babies who get artificial nipples have trouble with breastfeeding, it does not follow that the early use of these things cannot cause problems for some babies. It is often a combination of factors, one of which could be the using of an artificial nipple, which add up to trouble.
6. S/he tells you that you must stop breastfeeding because you or your baby is sick, or because you will be taking medicine or you will have a medical test done. There are occasional, rare, situations when breastfeeding cannot continue, but often health professionals only assume that the mother cannot continue and very often they are wrong. The health professional who is supportive of breastfeeding will make efforts to find out how to avoid interruption of breastfeeding (the information in white pages of the blue Compendium of Pharmaceutical Specialties and the PDR are not a good references—every drug is contraindicated according to them as the drug companies are more interested in their liability than in the interests of mothers and babies). When a mother must take medicine, the health professional will try to use medication that does not require the mother to stop breastfeeding. (In fact, very few medications require the mother to stop breastfeeding). It is extremely uncommon for there to be only one medication that can be used for a particular problem. If the first choice of the health professional is a medication that requires you to stop breastfeeding, you have a right to be concerned that s/he has not really thought about the importance of breastfeeding.
7. S/he is surprised to learn that your six month old is still breastfeeding. Many health professionals believe that babies should be continued on artificial baby milk for at least nine months and even 12 months (and now that the formula companies sell formulas for up to 18 months and even three years, soon some health professionals will be urging mothers to use formula for three years), but at the same time seem to believe that breastmilk and breastfeeding are unnecessary and even harmful if continued longer than six months. Why is the imitation better than the original? Shouldn’t you wonder what this line of reasoning implies? In most of the world, breastfeeding to two or three years of age is common and normal, though, thanks to good marketing of formula, less and less common.
8. S/he tells you that breastmilk has no nutritional value after the baby is 6 months or older. Even if it were true, there is still value in breastfeeding. Breastfeeding is a unique interaction between two people in love even without the milk. But it is not true. Breastmilk is still milk, with fat, protein, calories, vitamins and the rest, and the antibodies and other elements that protect the baby against infections are still there, some in greater quantities than when the baby was younger. Anyone who tells you this doesn’t know the first thing about breastfeeding.
9. S/he tells you that you must never allow your baby to fall asleep at the breast. Why not? It is fine if a baby can also fall asleep without breastfeeding, but one of the advantages of breastfeeding is that you have a handy way of putting your tired baby to sleep. Mothers around the world since the beginning of mammalian time have done just that. One of the great pleasures of parenthood is having a child fall asleep in your arms, feeling the warmth he gives off as sleep overcomes him. It is one of the pleasures of breastfeeding, both for the mother and probably also for the baby, when the baby falls asleep at the breast.
10. S/he tells you that you should not stay in hospital to breastfeed your sick child because it is important you rest at home. It is important you rest, and the hospital that is supportive of breastfeeding will arrange it so that you can rest while you stay in the hospital to breastfeed your baby. Sick babies do not need breastfeeding less than a healthy baby, they need it more.
11. S/he does not try to get you help if you are having trouble with breastfeeding. Most problems can be prevented or cured, and most of the time the answer to breastfeeding problems is not giving formula. Unfortunately, many health professionals, particularly physicians, and even more particularly pediatricians, do not know how to help. But there is help out there. Insist on getting it. “You don’t have to breastfeed to be a good mother,” is true, but not an answer to a breastfeeding problem.
Questions? First look at the website nbci.ca or drjacknewman.com. If the information you need is not there, go to Contact Us and give us the information listed there in your email. Information is also available in Dr. Jack Newman’s Guide to Breastfeeding (called The Ultimate Breastfeeding Book of Answers in the USA); and/or our DVD, Dr. Jack Newman’s Visual Guide to Breastfeeding (available in French or with subtitles in Spanish, Portuguese and Italian); and/or The Latch Book and Other Keys to Breastfeeding Success; and/or L-eat Latch and Transfer Tool; and/or the GamePlan for Protecting and Supporting Breastfeeding in the First 24 Hours of Life and Beyond.To make an appointment online with our clinic please visit www.nbci.ca. If you do not have easy access to email or internet, you may phone (416) 498-0002.Written and Revised by Jack Newman, MD, FRCPC 1995-2005 Revised 2008
Sunday, November 22, 2009
The practice also has a brochure (attached) that states:
"Do not permit your child to nurse passively on the breast or bottle while sleeping... Your child should be weaned, and solid foods introduced in his diet, soon after the first birthday."
I'm sure you're familiar with the resources below... I intend to night-wean Claire (again) but not fully wean her. Oh, what misinformation is out there!
Is Breastfeeding Linked to Tooth Decay? (from Kellymom)
" In a baby who does have a genetic problem, weaning will not slow down the rate of decay and may speed it up due to lack of lactoferrin. "
(This link contains several additional links of studies...)
Preventive Oral Health Intervention for Pediatricians (from AAP)
"Parents and caregivers should be counseled on the importance of reducing exposure to sugars in foods and drinks. To decrease the risk of dental caries and ensure the best possible health and developmental outcomes, it is recommended that parents do the following:
- Breastfeed infants during the first year of life and beyond as is mutually desired.29
- After nursing, remove the breast from a sleeping infant's mouth and cleanse the gums and teeth after feedings and before bedtime..."
Breastfeeding and Oral Health Issues (from LLLI)
"Alternative health care options for dental issues are rarely discussed. Dr. Enzor discussed the use of essential oils, homeopathy, probiotics, and certain foods that she has seen good results with in her practice. Some essential oils with antibacterial properties, such as tea tree, clove, red thyme, cinnamon, and eucalyptus, may be especially useful as nighttime nursing aids. Parents should mix a few drops of the oil with a few ounces of water, and wipe the solution on the child's teeth and gums."
"Does Nighttime Breastfeeding Cause Cavities?" (from Dr. Sears)
"... in general, night-nursing does NOT increase the risk of a child getting cavities enough to cause parents to intentionally wean their babies at night. You may have other reasons to do so, but do not wean at night in order to decrease cavities."
Just to name a few sources. There are plenty more not listed. Knowledge is powerful!
Saturday, November 21, 2009
(Be sure to check out the photo, too!)
Women's Health Action
World Breastfeeding Week posters have developed a reputation for being controversial and edgy. As we work on our poster for this year, breastfeeding advocate Louise James looks at some of the issues raised by last years poster.
A simple beginning
A quiet morning in the park with a mother, her breastfeeding toddler, a banana and a top class photographer. Mother and daughter look fantastic and all is going well when the photographer asks the mother to take her breast out from the neck of her red top rather than lift it up from the waist. The resulting photograph is elegant, less clumsy and certainly less ungainly. All are pleased with the result. However, the repercussions of that decision were to reverberate again and again as the poster developed and ventured into the public domain.
The theme for World Breastfeeding Week internationally is set by the World Alliance for Breastfeeding Action (WABA). In 2005 the theme was Breastfeeding and Family Foods: Loving and Healthy. The focus was on the continuation of breastfeeding after solids have been introduced. Women's Health Action workshopped this theme with a small working group which grew out of an initial community consultation. The decision was to develop a poster which depicted a mother breastfeeding her toddler. It was agreed, though not unanimously, to have the toddler hold a healthy nutritious food to demonstrate that breastfeeding could happily co-exist with first foods. Across all cultures, the most common first food for young New Zealanders was a banana. It suited the theme beautifully, being easily recognisable, portable, non commercial and healthy.
The resulting photograph was great and mother, photographer and Women's Health Action were happy with the result. Off it went to the working group. These were all people who supported breastfeeding and the WHO Global Strategy supporting breastfeeding exclusively for the first six months and on up to two years and beyond. For some of these people the translation of the words into a real life image proved challenging.
There is one right way
Everybody loves a breastfeeding image when the baby is small and the mother is in a Madonna pose gazing adoringly at her progeny. An older child however is more challenging and the new poster was an affront to the set of unspoken rules and assumptions that many people carry unconsciously in their heads. The revelations started with the working group, but were confirmed by the wider community once the poster was released. The process uncovered a number of unwritten rules and assumptions that form real barriers to mothers breastfeeding older children and they are fascinating. We discuss some of them here.The unwritten rules for breastfeeding older children in public:
If the child being breastfed is not a baby then the child should be 'a little toddler', 'a younger child', 'a 9-10 month child', "I have a problem with a child breastfeeding when they can ask for it".
The act of breastfeeding needs to be: 'discrete', 'private', 'less exposed', 'top pulled up' and 'tasteful'.
The breastfeeding mother and child should be 'loving', 'arm wrapped around the child', 'a more likely feeding posture', 'baby on lap', 'motherly', 'held in mother's arms' the child cuddling up on mum's knees' and 'don't sit with legs apart'.
Everybody should breastfeed in the same way so the image has to conform to personal experiences of breastfeeding: "some of us have breastfed our own children through to toddlerhood but at no time found it necessary to pull our shirts down", "We have never in all our years, seen anyone breastfeeding their toddler in this position." "We are all mothers who have breastfeed our own babies and have nothing against breastfeeding in public if it is done in a sensitive and tasteful way".
Can't have the child holding a banana: 'the banana can be seen as a phallic symbol', 'a banana milk shake?'
Thanks for the mammaries
The reaction to the poster was indeed mixed: the 'Outstandingly Healthy' breastfeeding poster proved overwhelmingly popular with many: WABA from Penang wrote, "Thank you very much for sending us the posters. They are beautiful and the message comes out loud and clear". James Akre formerly of the World Health Organisation wrote, "Splendid new breastfeeding promotion poster. It superbly places the expression 'complementary feeding' into appropriate perspective." Positive comments came from far and wide recognising the great shot that it was, "I think this poster is just wonderful." "Beautiful photo", "looks good": and "She looks gorgeous".
However, given the high level of negative comment, the focus testing was important and would determine whether the poster saw the light of day. We took the image to numerous different places outside of the health profession and asked them what they thought the messages were. While some in the working group, and particularly health professionals, felt it "Could discourage rather than promote breastfeeding", "is not appropriate" and "would put many people off", the take home messages from the focus group were exactly what we were hoping for and more:
Breastfeeding is nothing to be ashamed of.
Fresh air, fresh food and fresh breast milk.
It is OK to feed in public.
The longer you breastfed the better.
Breastfeeding makes mother and child happy and healthy.
Breastfeeding is not difficult or problematic.
Should feed whenever the child needs to.
It's a normal and natural thing to do.
Breast milk is the best.
Doesn't matter where you breastfeed.
Breastfeeding doesn't have to stop with babies.
Women's breasts are put on their bodies to feed babies.
Breastfeeding is clearly part of a healthy diet.
Breastfeeding is just part of life.
We had a second picture up our sleeve for focus testing. In this one the child was on the mother's knee in the more traditionally seen Madonna pose. We ran this image through our focus groups as well: The 'safe' alternative "doesn't grab you", is a "friendlier image", is probably "acceptable to society" and "it looks more of an effort". Surprisingly, and happily, when choosing between the two, focus group participants liked the edgier, challenging version.
What lies beneath?What was going on for many people? Even those who agreed it was a lovely photo and supported breastfeeding, said they would not display it. A childbirth educator said, "Cool, but I wouldn't put it up in my classes." And a nurse felt "it would be demeaning to even ask mums to look at the poster." Different people reacted to different aspects of the poster. For some, it was the size of the breast. With the growing popularity and acceptance of breast augmentation, with magazines and movies showing large breasts in skimpy clothing it is amazing that naturally full breast is seen as somehow remarkable and obscene. "What a big boob!" said some and "The exposed breast is obviously enlarged." And some accused us of digitally enhancing it to make our point. Just for the record, we didn't.
Some disliked the poster at some incoherent level and were then asked to say just what their problem with it was. The most violently opposed immediately seized on the age of the child and inflated that. With no evidence at all, they decided the child was at least three years old and maybe as old as four or five. Again, without any evidence they were also more likely to assume the child was a boy. In fact, the child is 20 months old and a girl.
Clearly the poster brought out some deep seated barriers in attitude that can't help but hinder the widespread freedom to breastfeeding with in our society. A couple of comments on an internet forum about the poster sums it up nicely, "it's important to realise that our discomfort is about US not about what that child is doing. Breastfeeding isn't a 'glorious act' it's a way to nurture a young child, both physically and psychologically. "I am guilty of feeling a little uncomfortable by the poster as it doesn't portray what I thought breastfeeding was about for me." It's a societal issue with women's bodies in Western culture being viewed as sex objects.
Breastfeeding Week 2005 presented New Zealanders with a new image of breastfeeding to begin breaking down the barriers of stereotypes that have been infiltrating us through the years. Taking a look back in history at the images of the Madonna breastfeeding her child, there has been a variety of images. Continuing to only portray breastfeeding in one way, the romantic Madonna look, does not help the acceptance of breastfeeding as a normal and natural function that has many different looks.
Getting Over it
From the amount of debate and dialogue that has occurred from the release of the poster it became apparent that the image presented challenges to some peoples' way of thinking about breastfeeding. "At least it has promoted discussion, which is very healthy for our Public Health Unit." "It has created a lot of discussion about breastfeeding which is a good achievement."
Many people who were first taken back by the image, on reflection came to see its value: "Well done, at first I thought too much breast was showing, but you can almost see that amount on some people so I say go for it." "Throws you back a bit at first, but hey it's natural, it's acceptable to show the breast." One mother of a young baby suggested that the image should have been more discrete then went on to ask, "any tips for being able to feed that long?"
Just like me!
There was a wonderful unanticipated reward from the release of the image - the validation that small talking breastfeeding children received. The image remains of one such child excitedly tugging her mother to see the poster and beaming at her as she pointed to it with a big smile on her face saying "like me". Another child was determined to know the name of the child in the photo - the little girl breastfeeding in the park was her hero. A mother related; "Two and a half year old Clayton (still breastfeeding) saw the toddler breastfeeding poster and immediately said Nana and Nan-na. He had no trouble seeing it as an advertisement for food with his breastmilk.
Getting On with itBreastfeeding is the biological norm. However success is at least as reliant on the many non-biological social factors in our modern society. One of those factors is people's views, expectations and tolerance for what is seen as normal. The focus on breasts as sex symbols and their extensive use in selling almost everything is seen as normal by most and desirable by many. At the same time, the tendency to hide breastfeeding away and portray it as normal only for babies who are held in a Madonna pose, creates a situation where breasts are seen as indecent when they are being used for their designated purpose and decent when their display is gratuitous.
Variety is normal. Some mothers' breastfeed by lifting their tops up, others by pulling them down, both are acceptable. Mothers breastfeed two year olds, two month old babies and sometimes tandem feed new babies alongside pre-schoolers. All are acceptable practices. Babies feed comfortably in their mother's arms. Toddlers however are active and curious. Many feed 'on the run' and most have a wandering eye - they just hate to miss anything! Many a mother breastfeeding a toddler will testify to the fact that few breastfeeding toddlers focus entirely on the job at hand. Mothers sometimes look adoringly at their infants when they feed. Other times they take no notice of the child at the breast as they talk freely to friends. In this they are not unusual - most animals with suckling young pay them little heed as they get older!
For breastfeeding to move from a biological norm to a widespread and accepted cultural norm, we all need to look at how we react to the different breastfeeding styles and images that we see. When it is no big deal or nothing out of the ordinary we will have made progress. While we still gape and uncomfortably shift and shuffle at the exposed breast or the feeding child (in any position), we still have a way to go. And while we still have a way to go, children miss being breastfed and gaining major health benefits. Every one of us has a role in creating a breastfeeding society.
Friday, November 13, 2009
Breast is best for weight loss? Breast-feeding guilt trips aren't limited to talk of babies' health.
Breastfeeding moms *can* safely lose about one pound per week in a healthy manner. Basically, a breastfeeding mom needs to "eat to hunger" and "drink to thirst" in most situations and she'll lose weight. Usually, just making sure snacks are healthy can be the main thing to focus on... a bowel of fruit is probably a healthier choice than the quick and easy candy bar. A brisk walk during the day, with baby in a carrier or stroller, can help mom get over any weight loss plateaus... and perhaps help her feel better, too!
There are lots of reliable weight loss programs out there specific to breastfeeding moms. These can help her safely lose weight without affecting her milk supply. Working with her doctor is also a good idea.
Here are a couple of good resources:
Breast is best for weight loss?
Breast-feeding guilt trips aren't limited to talk of babies' health.
What about the new mom's figure?
Nov. 12, 2009
Today, the New York Times introduces us to a new reason to make mothers feel bad about not breast-feeding: all that fat around their bellies. "Breast is best" used to be just the ticket to send a new mom directly to Guilt Island, but now you don't even need to invoke the health of her formula-fed baby. Instead, just point out that she's still wearing those stretchy maternity pants to hide her post-baby pooch -- because, apparently, the hot new regimen for postpartum weight loss is expelling milk. That's right: Breast pumping instead of pumping iron.
The Times' Catherine Saint Louis begins the article with the tale of Jessica Jochim, a woman who "was the envy of her co-workers at Babies 'R' Us" because she returned after three months of maternity leave wearing size 4 jeans. "Yet, exercise was a pre-baby relic. She wasn’t dieting, either," says Saint Louis. "In fact, every two hours, she snacked as if on cue." Intrigued? Jealous? Feeling homicidal? Salivating in anticipation of her weight loss trick? She continues: "What was her secret? Breast-feeding her newborn James on demand, and using a breast pump to take milk home to him." Voilà! Babies: The new miracle weight loss pill. Or, as Saint Louis calls it, it's the "Get Out of Dieting Jail Free card."
Click here to read more...
Sunday, November 8, 2009
Your attitude and tone of voice can make a world of difference in how people accept your responses. The approaches and phrases listed below are helpful for dealing with criticism.
Review them and choose the ones that are most comfortable for you.
- Use "I" messages instead of "YOU" messages. (Rather than "You always criticize me" try "I really don't like to be criticized.")
- I'd like to discuss something. Is this a good time for you?
- I feel (angry, hurt, etc.) when...
- Having your support means so much to me.
- It's amazing how much research has been done over the years. It must surprise you to see me doing _______. I hope I'll be able to handle it well when Abbey starts her own family.
- Everyone has to make the decision they feel is best for their situation.
- I'm glad that you care so much about the baby. I've thoroughly researched the topic and feel comfortable with my decision. I'd be glad to share my info with you.
- I realize that this is an individual decision, and I'd really appreciate your giving me a chance at this.
- My doctor has stated...
- The American Academy of Pediatrics feels...
- That gives me a lot to think about!
- Your love and concern for the baby really shows.
- That's certainly another way of approaching it.
- I'm glad that ___________ worked well for you and your baby.
- We're really at odds here. Let's just agree to disagree and still stay friends, OK?
- I think we're losing sight of our goal here, which is the baby's well-being. Let's back up a little.
- This is a topic that has been debated and argued for generations. Let's not fall into that trap, OK?
- There are some valid points to both sides here.
- You could be right.
- I'd like some time to think about what you just said.
- Let's remember that we're both on the same side here.
- Can we save the arguments for truly vital topics?
- It's a very individual decision, and I'd never try to impose my viewpoints on someone else.
- Maybe the topic of _______ should go along with religion and politics: Not a good conversation topic for us.
- Discussing __________ can really get me worked up. I'm sorry if I said anything out of line. Let's change the subject.
- How about a compromise? You don't mention __________and I won't criticize your driving anymore.
- We're Abbey's parents and this is the decision we've made.
- You feel very strongly about this, I can see.
- This works for our family in our situation, but it might not work for you.
- Just Smile. :-)
Ways To Prevent Criticism:
- Be discreet if at all possible.
- Don't set yourself up for a discussion you don't really want to have.
- Avoid issues where you anticipate disagreement. Focus instead on areas where you have something in common.
- Offer an explanation of why you do things before you are asked. Do this in a gentle way, letting them know how happy you and the baby are. Be sure you give them permission to do things differently. (See #6 & 29 above)
- Appear confident and happy with the way you do things, even if you are not. Don't express doubts to people who don't agree with you.
Rise above criticism as much as you can without a "holier than thou" attitude. A positive non-threatening reply works best. In rising above criticism, making light of things often works.
Sometimes it's best to ignore the criticism and consider the source. People often feel defensive and attack when someone is doing things differently.
If you know you will be in a situation where your actions will be criticized, prepare ahead of time by practicing some of these responses. Create your own as needed. Practicing the responses you prefer in front of a mirror or with an understanding friend, will help you to be more confident.
When you are in the situation, pause a moment and take a deep, relaxing breath before answering.