The Motherwear Breastfeeding Blog

"I'm going to a New Year's party, and..." What I tell people about breastfeeding and alcohol.

This is the time of year when I get the calls that go like this:  "I'm breastfeeding and I'm planning on going to a New Year's party.  If I drink, can I breastfeed?"

I'll tell you how I answer this question, but first a little background on alcohol and breastfeeding:

Alcohol passes readily into breastmilk and generally peaks 30 to 60 minutes after consumption, 60 to 90 minutes when taken with food.  The rate at which it is eliminated depends on the mother's size, but generally takes between 1 and 3 hours per drink.  Taking alcohol with food decreases absorption.

Alcohol does not accumulate in breastmilk; it leaves the milk as it leaves the blood.  When your blood alcohol levels are back down, so are your milk alcohol levels.  Babies get roughly 2% of the alcohol in milk that a mother ingests.  Your weight affects how quickly you can process alcohol, and the older your baby is, the more efficiently he or she can process alcohol. 

Alcohol consumption in moderation is considered compatible with breastfeeding.  More specifically, La Leche League notes that "When the breastfeeding mother drinks occasionally or limits her consumption to one drink or less per day, the amount of alcohol her baby recieves has not been proven to be harmful."  Drinking more than this amount has been found to have health and developmental consequences for babies.

So, how do I answer the question about a New Year's party?  Here's the advice I generally give mothers who call me for advice about an occasional use of alcohol, such as a New Year's party:

If you're planning on having one (or perhaps two) drinks at New Year's (and for many women who haven't drunk since before pregnancy, one drink is all it takes!), you can plan on breastfeeding at the party.  To minimize the effect, you can plan on drinking right after you finish a feeding, which will mean that your body will have the most time to eliminate the alcohol from your system before you feed your baby again.  Also try to have some food with the drink, which will reduce the absorption.

If you're planning on having more than two drinks at the party, plan ahead.  Expect not to breastfeed for 2 to 3 hours for each drink you have.  For example, if you have three drinks, plan not to feed for at least 6-9 hours.  See this chart to figure out how long it will take for the alcohol to leave your system given your weight.  Have enough pumped milk availble to feed the baby for as many feedings as you will miss during that time.  Bring your breastpump so that you can pump and discard milk for the missed feedings.  To be clear:  Pumping does not speed the elimination of the alcohol from your system; you are pumping so that you don't get painfully engorged and leak all over your dress.

And this goes without saying:  Think ahead about your driving arrangements so that there is someone who hasn't been drinking who can drive you and the baby home. 

Here are some links to some sites that discuss this in more detail.

• La Leche League's "What about drinking alcohol and breastfeeding?"
• Kellymom.com's page "Breastfeeding and Alcohol"
• A chart showing how long it takes to eliminate alcohol from breastmilk given the mother's weight.
• American Academy of Pediatrics policy on breastfeeding and alcohol use.

This information is presented for educational purposes, and is not a substitute for advice from your doctor or other health care provider.

The top 10 breastfeeding stories of 2006.

It's been quite a year in news about breastfeeding.  Here are my picks for the top ten events in breastfeeding this year.

Top 10 breastfeeding stories of 2006:

1)  Nursing in public incidents and the birth of the national nurse-in.  It was a year of highly publicized run-ins for breastfeeding mothers who tried to nurse in public.  First it was Victoria's Secret in Massachusetts and Wisconsin, then a Texas movie theater, and of course the story of Emily Gillette, who was removed from a Freedom Airlines flight in Vermont after trying to nurse her daughter on board.  The latter sparked the first ever national nurse-in, organized with lightening speed via the web.  The nurse-in was held at 39 airports with over 800 participants (picture at left is from the Columbus, Ohio nurse-in, courtesy of Jen at The Lactivist).  A controversy also erupted over the cover of Baby Talk magazine this year, which featured a nursing baby on its cover.

2)  Researcher faked studies on infant formula.  I put this one near the top because it's an amazing story which, as far as I can tell, was wholly ignored by the U.S. media.  In January the Canadian Broadcasting Corporation (the Canadian equivalent of PBS) aired a three-part investigation on its program "The National," of Dr. Ranjit Kumar Chandra, a Canadian researcher who was found to have knowlingly falsified studies on "allergy reducing" formulas made by Nestle and Mead Johnson in the 1980's.  In at least two cases he released his findings before babies were even recruited for the studies.  The program is available here, and I highly recommend taking a look at it.

3)  List of benefits of breastfeeding keeps getting longer.  I compiled a summary (see post for December 22, below) of the incredible research published in 2006 on the benefits of breastfeeding.  The evidence that breastfeeding protects against a huge range of physical and mental health problems continues to build.

4)  New growth charts finally reflect breastfed babies' growth patterns.  Until recently, the growth charts most babies were measured against was a sample of all-Caucasian, formula fed babies taken in Ohio between 1929 and 1975 who often started solids before 4 months.  Recent research has shown that breastfed and formula-fed infants grow differently, which explains why for years breastfed babies appeared "abnormal" in growth, a finding which frequently led to supplementation.  But no more.  This year the World Health Organization released its new growth charts, which are based on the growth patterns of breastfed babies.  Moreover, the WHO intends that these charts "establish the breastfed infant as the normative growth model."  Makes sense given that this is the way we've fed our babies for nearly all of human history!

5)  Breastfeeding promotion campaign raises strong feelings, awareness.  The national breastfeeding awareness campaign posed the question:  Are we ready to stop talking about the benefits of breastfeeding and instead talk about the risks of not breastfeeding?  The campaign's ads approached the issue this way, with images of pregnant women riding mechanical bulls and log rolling.  The result was lots of discussion and strong feelings, as the New York Times article, "Breastfeed or Else" demonstrated. 

6)  A new symbol for breastfeeding is chosen.  Mothering Magazine held a contest to design a new symbol to represent breastfeeding.  The winner is to the left, and you can see the other nominees and information about the artist here. 

7)  Breast milk donation goes international.  As I wrote about here, a mother in Missouri established the International Breastmilk Project, which ships donor breastmilk to AIDS orphans in South Africa.  The project also gives priority in donation to families grieving the loss of baby.  In a related story, exclusive breastfeeding, even when HIV can be transmitted through the milk, continues to be the safest way of keeping babies alive when the alternative isn't safe, affordable, sustainable, and available.  Trials for a vaccine to prevent transmission through breastfeeding got underway this year.

8)  New legal protections for breastfeeding in six states, federal protections held up again.  New laws protecting breastfeeding went into effect in Arizona, Alabama, Kentucky, Misssissippi, Oklahoma, and Tennessee.  The federal bill on breastfeeding, H.R. 2122, failed again this year, but hopes are high for next year.

9)  Bringing breastmilk on board gets very complicated.  As I discussed here and here, new TSA policies restricting fluids on board airplanes meant that many women discarded their pumped milk, packaged it to be checked with baggage, or tried to figure out cram it into 3 oz. shampoo bottles.  You can still sign an e-petition urging the TSA to change this policy.

10)  Nursing with the stars. That one conjures quite an image, huh?  What I'm trying to point out is that many of the celebrities who had babies this year - and there seemed to be a real boom this year - chose to breastfeed their babies.  I wrote a bit about this here.  For celebrity breastfeeding role model I nominate Gwen Stefani, who has said that she feels that breastfeeding has given her superhuman powers.  For weirdest celebrity breastfeeding story the award has to go to Marie Claire magazine, which faked a photo (not very well, either) of Elizabeth Vargas breastfeeding at her news anchor desk. 

2006 brought many more reasons to breastfeed.

2006 has been a great year for research on the benefits of breastfeeding, and I've compiled a list of this year's findings here.  Next week I'll be doing a summary of the year's breastfeeding news.  Enjoy!

In 2006 we learned that breastfeeding means:

The potential to save 1 million lives a year.   As I wrote here, a British study found that early breastfeeding could save nearly a quarter of the 4 million babies in the developing world who now die within the first month of life.  The study also found that the risk of neonatal death was fourfold higher in children given milk-based fluids or solids in addition to breast milk.

Better mental health.  As I noted here, a study found that children who were breastfed for six months or longer had significantly lower risk for mental health problems such as delinquent, aggressive, and anti-social behavior, and were overall are less depressed, anxious or withdrawn later in childhood.

Fewer ear infections, even when there is a genetic predisposition.  As I wrote about here, researchers have found that breastfeeding can mitigate the effect of a genetic tendency toward ear infections.  This protection against ear infections was found to extend into childhood, long after breastfeeding had stopped.

Less obesity and diabetes, even when there is a family history of the condition.  As I reported here, a study found that children who are breastfed are less likely to become obese and develop diabetes - even if their mothers have those conditions.

Fewer gross motor delays:  One study found that infants who were breastfed were at significantly lowered risk of having delays in gross motor coordination.  The study found that infants who had been exclusively formula fed were 50% more likely to have gross motor coordination delays than infants who had been breastfed exclusively for at least 4 months.

Less chronic bed wetting:  A study of children aged 5 to 13 who had chronic bed-wetting problems which were not explained by a physical cause, found that breastfeeding longer than 3 months may protect against bed wetting during childhood.

Less stress as older children.  As I reported here, a study found that babies who were breastfed, even briefly, had better ability to cope with stress as older children.  The researchers found that children of divorce and separation who were breastfed were less likely to exhibit symptoms of anxiety than children of divorce and separation who were not breastfed, even when controlling for other factors.

Better aligned teeth.  A study from Puerto Rico concluded that breastfeeding is a factor that contributes to the prevention of malocclusion of teeth.

The potential to cut hospitalizations of babies in half:  A study from Spain found that, among children not fully breastfed, 30% of hospital admissions could be avoided for each additional month of full breastfeeding.  The authors estimate that 100% full breastfeeding among 4-month old infants would avoid 56% of hospital admissions in infants under one year of age.

Protection against eczema and asthma.  Another study found that breastfeeding for 4 months reduced the risk for eczema and asthma at 4 years of age. 

Better developmental outcomes for extremely low birthweight babies.  A study tracking the development of extremely low birth weight infants showed a increase in developmental scores among those who were breastfed compared to those who were not.

Less respiratory infections.  A study found a lower risk of respiratory tract infection including pneumonia and recurrent otitis media in children who were exclusively breastfed for 6 months, compared to those who were breastfed for 4 months. 

Reduced risk of cholera when mother is affected.  A study showed that a mother who has cholera and continues to breastfeed provides better protection for her infant against cholera than an afflicted mother who does not breastfeed.

Better ability to cope with painful routine medical procedures.  A metanalysis study showed that babies who were breastfed during painful routine medical procedures had less of an increase in heart rate, reduced proportion of crying time, and reduced duration of crying compared to babies who were soothed with swaddling or a pacifier. 

Less conflict at mealtime.  A study from the U.K indicates that breastfeeding was associated with maternal reports of less negative mealtime interactions and less conflict at mealtimes.

Lower risk of endometrial cancer for mothers.  A study from Japan suggests that breastfeeding reduces mothers' risk of developing endometrial cancer.

No effect on intelligence?  One study that received a lot of attention this year was on the relationship between breastfeeding and later intelligence.  This topic has been studied repeatedly, and the latest study indicated that breastfeeding had little or no impact on a child's intelligence once maternal intelligence is taken into account.  This study was somewhat controversial however, and you can see a rebuttal here, which notes that the researchers failed to take the amount of breastfeeding into account, and notes that "that a table in the study lists a significant association with intelligence for children breastfed more than 29 weeks, but that finding was not mentioned in the text of the paper."

Have I missed a study on the benefits of breastfeeding from 2006?  If you think so, please email or leave a comment on the blog.

Home for the Holidays.

For today's post I thought that I'd put up a piece I wrote earlier on the joys and challenges of being with family at the holidays as a breastfeeding mother.  To see comments on that post, click here.  You can add your own story from this holiday season using the comment link below.

A little update:  The mother I described below did indeed breastfeed at her parents' home at Thanksgiving this year, and found that she had a number of cousins who were very supportive - they had breastfed, too.  She did get some urging from her parents, though, to nurse in the vacant house next door.  I'm not making that up.

Happy holidays, everyone!

It all starts somewhere.

"You're not going to do that at Thanksgiving, are you?"

When I met Amy (not her real name) at the breastfeeding clinic, her baby was a few days old.  Already, her parents had started asking whether she was planning on "doing that" at Thanksgiving.  This was in August.

Needless to say, her parents were not exactly supportive of the idea of their daughter breastfeeding.  When I asked her if she thought her parents could come around over time as they saw it more she said, flatly, "No."

This woman, a physician herself, had no doubts about her decision to breastfeed.  And she had remarkably few problems doing it.  Her challenge, one many of us face, was her family.

Another woman I tried to help, who was attempting to be the first in her family to breastfeed in generations, ended up stopping within a few days.  When she told her family that she was switching to formula one relative told her, "Oh yeah, we didn't think you were going to be able to do it anyway."

Breastfeeding and the many demands of new motherhood can be challenging under the best of circumstances.  But if you don't have family support you're really swimming upstream, and the current is strongest at the holidays.

This is one club I'm happy to say I don't belong to.  I was just about the luckiest mother in the country when it came to family support.  Both my mother (pictured with me in, ahem, 1969, to the right) and my mother-in-law had breastfed their children, at a time when no one did it.  My father-in-law is a pediatrician who is very supportive of breastfeeding.  And when I dug back a little further I realized that the line of breastfeeding in my family was never broken.

I learned that my 91-year old grandmother on my father's side had breastfed her children in the 1930's and 1940's.  She told me:  "It was not the thing to do at the time, but that was just my way."

My other grandmother, whom I never met, emigrated from Japan as a teenager in 1916.  She breastfed all 12 of her children, while raising the family in a tiny house in Honolulu.

So, I didn't really expect to meet much opposition when it came to my decision to breastfeed.  But how did they react when I pumped at work for a year, breastfed into toddlerhood, and let my son wean on his own schedule?

They never said a word.  Not a peep.  See what I mean by lucky?

So, let this thought comfort you if heading home for the holidays feels more like heading into a lion's den:  It all starts somewhere.

If you're the first one in your family to breastfeed, you're paving the way for the next generation.  The family who can't, for reasons of their own, support your decision to breastfeed now, is not the family your children will have.  You'll be there for your daughter or daughter-in-law with cabbage leaves, nursing pillows, and a hug.  You'll teach her a swaddle that would stump Houdini, and cheer when her baby grows a third chin. 

It all starts somewhere, and it can start with you.

A great stocking stuffer for your pregnant friends or breastfeeding support person.

My supervisor at the hospital, Alice, gave each of the lactation consultants this great teaching tool as a holiday gift.

They're called 'belly balls,' and each little ball represents the size of a newborn's stomach.  The smallest (the size of a small marble) is for day 1 of life, the next is for day 3, and the largest (the size of a ping pong ball) is for day 10.

What this illustrates so well is that the small amount of colostrum that a mother makes before her mature milk comes in are just perfect for a baby in the first few days of life.  Many women worry that they aren't producing enough to satisfy their babies, and this concern often leads to early supplementation with formula.  These balls show that a newborn's stomach is just the right size for the amount of milk a mother makes during those first few days.

The write-up on the back of the package states: 

Researchers have found that on Day 1, the newborn's small stomach does not stretch to hold more, as it will even a day or two later.  This explains the experience of countless hospital nurses who have learned the hard way that when newborns are fed an ounce or two by bottle during the first day of life, most of it tends to come right back up.  The walls of the newborn stomach stay firm, expelling extra milk rather than stretching to hold it. 

These belly balls are made by Hollister, a pump company, but you can make your own with a marble, a wooden bead or shooter marble, a ping pong ball, and a little organza bag.  To the right is my homemade version.  My friend Joanna, who works as a lactation consultant at Stanford Hospital, carries one like this around with her from room to room.  How about making one as a stocking stuffer this year?

Please note that these balls can be a choking hazard, so make and use your set of belly balls with this in mind.

Goodbye, breastfeeding clinic.

Tonight was my last breastfeeding clinic at our local hospital.  I've worked at nearly every one of the roughly 300 clinics held over the last two years, first as an intern and then as a certified lactation consultant. 

And, just because I can, I've decided to say my goodbyes to my colleagues and all of the wonderful families I've met in these last two years here on this blog.  I'll continue to teach classes at this hospital, and will be starting up a new breastfeeding clinic program at another hospital.  I'll also run a very limited private practice. 

It's a little hard to explain why I'm leaving the clinic.  These jobs are very hard to come by, so I didn't take the decision lightly.  I guess that I can say that for most of my time there I felt that the hospital wasn't really ready to commit to me.  When the hospital did show interest in me I realized that I didn't want to commit to it.  There are many reasons for this, big and small, but the bottom line is that the idea of staying on gave me a stomach ache, and my stomach is always right.

But this is not what I want to write about!  What I want to talk about is how much fun it has been to run the clinic and how priveleged I feel to have worked with so many extraordinary and inspiring people. 

Where to start?  I've been peed on, sprayed with milk, and have almost fallen on the floor laughing at times.  I've worked with mothers who in their 'real lives' are teachers, lawyers, high school students, social workers, doctors, housekeepers, artists, nurses, dog trainers, musicians, news anchors, and more professors and graduate students than you can shake a stick at (you have to know this community).  I once walked around the clinic for an hour or so with a "Soothie" stuck to the bottom of my shoe.  I've been caught in the middle of several marital disputes, and have helped a number of families recreate their beds on the floor to practice the side-lying position.  I've gotten hugs when a weight check shows progress, and seen hearts break when the news is bad.  I've replaced many pump parts destroyed by dogs. 

My strongest memories, though, will be of the women who I've seen struggle through huge challenges.  It's been so moving to see the lengths to which women will go to make breastfeeding work in the face of pain, problems with supply, hostile family members, and thrush that should be classified a weapon of mass destruction.  We tend to picture mothers and babies in romantic terms - soft focus and pastel shades - but what I've seen is that facing down a breastfeeding challenge is all about courage, strength, persistence, and love that is as fierce as it is tender.

Being in this line of work means that you meet people in a moment of crisis.  Even if breastfeeding is going well, becoming a mother involves crossing the most significant threshold in our lives, and this is inevitably a crisis of sorts - of identity, of changing relationships, of a new understanding of our bodies.  It's truly an honor to be a part of someone's life at that moment. 

So, I say goodbye with a quote from one of the thank you cards I've received, from a mother still happily nursing at 7 months.  I remember them telling me that when they realized the clinic was open they dashed out the door, leaving their dinner on the table.

We've been meaning to write to tell you just how much help you've been to us this year.  We'll never forget the night we barged into your clinic full of tears and thinking we might have to give up nursing.  Anyway, thank you so much!

Thank you, everyone, for an incredible experience.  Do stay in touch!

Breastfeeding can overcome genetic tendency toward ear infections.

Just last week my husband and I were remarking at the fact that our son hasn't had a single infection of any kind in his 3 1/2 years of life.  I remember having lots of ear infections as a child (and faking a few to get out of going to school), and I was expecting our son to have the same experience.

That's why I was interested to see the news this week that researchers have found that breastfeeding can mitigate the effect of a genetic tendency toward ear infections.  Recurrent ear infections, as you know, can lead to hearing problems and learning difficulties.  They're also really hard on parents and not fun for kids.

This month's edition of the journal Pediatrics reports that researchers at the University of Texas identified small variations in two genes which cause greater production of inflammatory signaling molecules and reduce immune system effectiveness.  Having these genetic variations signals an increased risk for ear infections. 

But, Science Daily reports, they found that, "the effect could be counteracted with a practice long known to increase immune resistance: breast-feeding."

"This is a major finding, that breast-feeding neutralized the effect even in kids who had all the genetic polymorphisms," Patel said. "Not only that, they were protected from recurrent infections even later in childhood, long after they stopped breast-feeding."

This is one study of many this year to have drawn a link between breastfeeding and both physical and mental health.  For studies I've written about since September, check out the category "New research on breastfeeding."

I've been itching to do a post about all of the incredible research on the benefits of breastfeeding released earlier this year. I'll get to it in the next few weeks, so check back soon!

Tag, you're it.

I've had a busy week, and it took me until today, just as I was headed out the door to work, to realize that I'd been invited to a party.

Yesterday Angela at Breastfeeding 1-2-3 invited me to a 'come as you are' blog party.  I was instructed to grab a camera and quickly take a picture of myself and post it.  I had to wait until I was back from work, but I did get my 3 1/2 year old to take a few pictures of me.  This is one of the few that actually got parts of my head in the frame.

So, here it is.  This is me, sitting at our computer, wearing my U.N. International Year of Microcredit pajamas.  I can't believe that I was 35 before I realized that you can put on your pajamas right when you get home from work.  Barefoot in Massachsetts in December?  It's a Japanese American thing, and my roots are in California and Hawaii. Bodda you? 

So now it's my turn.  I invite Andi, at Mama Knows Breast, since I've never seen a picture of her.  You're it!

Thanks for helping moms and babies worldwide!

I'm happy to announce that today Motherwear is making a contribution through its Help Moms and Babies Worldwide program. 

Today's contribution goes to Save the Children's Save Newborn Lives program.  Millions of babies die in the developing world each year from largely preventable causes.  This program uses existing low-tech, inexpensive measures to keep babies healthy, such as tetanus immunizations for pregnant women, clean delivery, exclusive breastfeeding, and antibiotics for infections. 

Motherwear chose to donate to this program because of the prominent role breastfeeding promotion plays in the effort.  As I've written about earlier, millions of lives could be saved by the promotion and support of exclusive breastfeeding. 

So, thanks to everyone who made their purchases through this program!  You're making a difference in the lives of mothers and babies worldwide.

If you're interested in participating, here's how the program works:  When you shop at Motherwear through this program you save $10 on an order of $50 or more, and Motherwear donates a percentage to the U.S. Fund for UNICEF, Habitat for Humanity, and Save the Children.

Want to join January's Carnival of Breastfeeding?

Each month a group of five of us breastfeeding bloggers are joining forces to bring you posts on a theme.  In the blogging world, these events are called carnivals.  Don't ask me why.  So far we've done carnivals on the themes Home for the Holidays, and Gifts for the Breastfeeding Mother, and it's been lots of fun.

January's theme will be New Year's Resolutions.  We'll be writing on that theme and would be happy to include other bloggers' thoughts on the topic.  The carnival will take place on Monday, January 1st, 2007.  Submissions are due by December 23rd, 2006.

If you have a blog and are interested in participating, please email me at motherwearblog@gmail.com.  We are looking for:

• Posts that are well written and grammatically correct
• Writing that is thoughtful and on topic (New Year's Resolutions)
• Blogs that are on topics that are of interest to readers of breastfeeding blogs (parenting, breastfeeding, etc.)

We're looking forward to reading your thoughts on this topic!