The Motherwear Breastfeeding Blog

Book review: Eat Well, Lose Weight while Breastfeeding.

Eat Well, Lose Weight, While Breastfeeding (Ballantine Books, 2006), by Eileen Behan, R.D. is an updated version of her 1992 book of the same name. 

While there are a number of features to appreciate about this book, my favorite is Behan's low key and reassuring approach to balancing new motherhood with weight loss.  While she acknowledges the pressure many women feel to "bounce back" quickly to an idea shape after having a baby, she states, "while you are breastfeeding, your primary job is to take care of yourself and your baby."

This book has some wonderful practical advice, including meal plans, nutritional information for nursing mothers, and exercise information.  The final chapter provides advice on eating well after weaning. 

She also does a good job taking on the "500 extra calories per day" guideline for nursing mothers, pointing out that for some women this is far too many calories.  She dispels the myths that there is a long list of foods which need to be avoided during breastfeeding, and that a nursing mother must force herself to drink water.  She encourages mothers not to focus on what they shouldn't eat, but "instead, emphasize all the good foods you can have."  She comments on low carb diets while breastfeeding, sugar substitutes, and fish safety. 

When discussing the research on weight loss and breastfeeding, Behan presents only studies which showed minimal or no effect of breastfeeding on weight.  I'm not sure if this was intended as an exhaustive review of the literature on this subject, but there are certainly studies which do show an effect which could have been presented. 

I was disappointed by several statements she made about breastfeeding duration.  One statement, "most doctors currently recommend that mothers not introduce solid foods to their babies for at least four months," should at least have been followed by the AAP recommendation that solid foods not be introduced until babies are six months old.  She also states that one way to view breastfeeding is that "the first nine months are for building the baby, the next nine are for breastfeeding her," though the AAP recommends breastfeeding "for at least the first year of life."  In another section, she states that having a cesarean section birth "will not impact the timing of you milk coming in," though numerous studies (one here) have demonstrated an association between c-sections and delayed onset of mature milk.

Behan warns mothers that lactic acid increases in breastmilk after a nursing mother exercises, which can cause babies to reject the milk.  A number of studies have found that this is only a concern if the mother engages in "exhaustive" exercise (and very few nursing mothers have the energy or motivation to exercise to that point), and sometimes even then there is no effect.  I'm always concerned when I hear this issue raised to nursing mothers, since exercise in the postpartum period is so beneficial for our physical and mental health, and so hard to find time to do.

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Wordless Wednesday: WPA poster

Join the September Carnival of Breastfeeding: Learning about breastfeeding

For the back-to-school season, our upcoming carnival will be on the topic of breastfeeding education.  Please join in by submitting a post!

You might write about:

• How you learned what you needed to know about breastfeeding.
• Training to become a La Leche League leader, lactation consultant, or breastfeeding peer counselor.
• Breastfeeding education in schools and universities.
• Your experience in a breastfeeding class.

We'll be looking for posts that are:

• Well written and grammatically correct
• Thoughtful and directly related to the carnival subject
• Submitted from blogs related to breastfeeding or parenting

Email me your submission by September 15th, 2008.  The carnival will be on Monday, September 22nd, 2008.  Please note that, if your post is selected for inclusion by our regular group of bloggers, you will be asked to link to each of the other participants in the carnival.  We reserve the right to choose posts for inclusion.  Examples of past carnival posts can be found here.

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Breastfeeding and codeine.

Last year the FDA raised concerns about use of codeine in nursing mothers, after a two week old infant died of a morphine overdose resulting from maternal intake of codeine (in less than the amount typically prescribed). 

This issue has been in the news again this week after the release of a Canadian study documenting the same hazard.

Codeine is commonly prescribed for postpartum pain, and can be found in Tylenol 3.  When codeine is ingested an enzyme in our bodies metabolizes it into morphine.  Some mothers are "ultra-rapid metabolizers" of codeine, which means that the enzyme in their system more efficiently process codeine into morphine.  For those mothers, the amount of morphine in their milk is many times higher than others, and the concentration can be fatal to breastfed babies.

Some of us are more likely to be ultra-rapid metabolizers of codeine.  Dr. Thomas Hale, of Texas Tech University, and author of the indispensable Medications and Mother's Milk explains on his forum that the incidence ranges from 1% in Caucasians, to 10% in Greeks and Portuguese, to 29% in Ethiopians.  He also notes that at least 7-10% of Caucasians lack the metabolizing enzyme altogether, and cannot metabolize codeine to morphine, and so codeine is ineffective for these individuals.

So, what else could be used for postpartum pain?  Dr. Hale lists alternatives and guidelines for the use of strong pain killers on his forum.  You can also watch a brief FDA video on this topic.

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More breastfeeding stand-up.

This video is perfect for my late-summer, vacation state of mind.  It's of Amy Wilson, a mother of three under five, known for her one-woman off-Broadway show "Mother Load," a comical look at the cutthroat world of competitive parenting.  This performance was recorded at a 2008 luncheon for Chicago-area moms hosted by Medela.

For more breastfeeding-related stand-up, don't miss this post!

A couple of recent quotes I enjoyed.

Dara Torres:  "Two years ago, the Torres’ Olympic itch returned when, soon after giving birth to her daughter Tessa, she discovered she was swimming fast. At the 2006 Masters World Championships in California, Torres was breastfeeding between events, but still posted slick times."

Angelina Jolie:  "They eat every three hours and I’m getting better at holding them both for [breast]feeding at the same time, so that helps. Usually, the other kids come in and hold them when they finish. They help with the baths and the changing." Brad added, "We try to get them to eat simultaneously for the sake of management, but it gets a little crowded at the bar!"

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How's your breastfeeding Spanish?

Update:  Spanish for Breastfeeding Support is now available!  Buy it here from Hale Publishing, and read more about it at www.spanishforbreastfeedingsupport.com

I'm in California on vacation, but on Saturday I spent the afternoon taping the audio portion of a book I've been working on. 

The book will help people who work in breastfeeding support learn how to do it in Spanish.  Sort of a Medical Spanish book for people who work in breastfeeding support.  More on this project later.

I've uploaded a clip of the audio portion.  Can you leave a comment translating it into English?  For fun, just translate one, and leave the others for other readers to work on!

The first two are shorter:

The last one is longer:

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Motherwear's fall season photo shoot.

I recently had the chance to check out Motherwear's fall line at their photo shoot for the new catalog. 

I got to meet the two models, Genelle and Camila, and their babies Max (3.5 months) and Mathew (10 months).

Fall is my favorite season for weather and also for clothes.  This fall Motherwear will have some great dresses and long sleeved nursing tops in new colors and fabrics.

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Let's talk about the expression "giving up."

Earlier this week I was reading this post about new data showing that 36% of mothers breastfeed until 6 months, and saw a comment by a mother who was offended by the expression "giving up," when used to describe the point when mothers stop breastfeeding.

I've never been comfortable using that expression.  I've seen so many mothers struggle valiantly to try to breastfeed that I just can't see stopping as an act of surrender or failure, which is what I think the term implies.  Whenever I hear a mother describe weaning as "giving up," and I feel a strong urge to point out her successes. 

I even tied myself in knots the other day when I jokingly said, in response to a mother who asked me how long after you wean a young baby your breasts continue to produce milk, "Your breasts don't give up that easy."  I then got really flustered and later in the conversation apologized for implying that anyone was giving up anything.  They looked at me like I'd sniffed too many baby wipes.

What do you think ?  Is this an expression we should give up?

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Pumping through chemotherapy: Jenn Michelle's story.

Today I'm honored to have Jenn Michelle guest posting on the blog.  Jenn Michelle was diagnosed in May with Hodgkin's lymphoma.  She had to wean her daughter in order to start chemotherapy, and is pumping in hopes that she will be able to resume nursing once the treatment is done.

The pictures in this post show Jenn Michelle with her daughter, Jenn Michelle and her daughter at their last nursing session, and "nursing" now.  In another post, Jenn Michelle says that her daughter now kisses and hugs her breasts and her scars all day long: "She's trying to make her mommy all better with her kisses, because she knows that's when she can have her nursies back."

6/13 Yesterday afternoon, shortly before 12:30 pm, I nursed my sweet baby girl for what I can only pray was not the last time.  I sobbed silently, my tears dripping onto her curls while a swarm of my closest friends and family buzzed around the kitchen.  I was losing my religion in the living room and the day was only halfway over.

6/14 The first night after my treatment was awful.  Nugget sobbed hysterically in my arms, giving way to heavy sighs between her defeated attempts for true comfort, until she finally fell asleep.  I cried, and cried, and cried.  And between the tears I apologized over and over to my sweet baby girl for being sick.

6/24  I was so angry the first few times I pumped after staring chemo.  It was like rubbing salt in the wounds.  I couldn't nurse Nugget and I had to stand uncomfortably in the bathroom watching my milk fill up plastic bottles instead of a happy baby.  And then as I would dump the ounces of heartache down the sink a new wound would appear like a gaping mouth to catch my salty tears and sting my aching soul.

You won't find much if you Google "cancer" and "breastfeeding" except for articles about nursing after breast cancer.  "Chemo" and "breastfeeding yields the same contraindication tagline over and over, and "cancer" and "breastmilk" mostly just points you to article after article about this guy who drank breastmilk to fight his prostate cancer.  Those, mostly sensational and local news articles mention milk banks selling milk to cancer patients when they have an excess available to sell.  It costs $3 an ounce.

I've had plenty of time to think about that guy and those $3 ounces while making up songs to the pump's rhythm and calculating how much I'd just poured down the drain. Warning!  Here comes the crunchy freaky part.   Why the !?@* would I want to keep dumping my milk down the drain when other cancer patients are paying good money to get their hands on it?  I don't know what exactly it might do for me, but it sure won't be doing anything at the bottom of the sink, that's for sure.  So I sucked it up and sucked it down.

It was sort of gross at first, though exactly why I'm not sure.  I think it was the temperature.  I can't think of any beverage I regularly consume at body temperature.  But now I'm used to it and pleased by the thought that I might actually be doing something to help save my own life.

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