The Motherwear Breastfeeding Blog

Photo Friday: A smile before nursing

I've been getting a lot of these looks right before nursing. Big smiles, too.

Life doesn't get much better than this.

Moms Rising launches petition on formula evidence issue.

Last week I relayed a story about formula companies fighting a proposed requirement that their products be independently evaluated before taxpayers pay a premium to provide them through the WIC program.

If you were upset by this story, you have a place to vent.  Moms Rising has launched a petition on this topic.

The petition argues that "an independent review of "functional ingredients" could save the taxpayers and the average new parent a lot of money while also making sure that all babies get the products that really offer benefits."

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Were you in the lucky 8%?

World Breastfeeding Week is just around the corner, and in my area there will be three events to celebrate.  To see a map showing events around the country, check this La Leche League page.

I'll be representing the Mothers' Milk Bank of New England at one event at a local hospital.  If you live in my area and are interested in becoming a donor, please stop by our table.  Now that I'm donating milk I should be even better prepared to answer questions about the process!

The theme of this year's celebration is "Breastfeeding: Just 10 Steps. The Baby Friendly Way."  You can find downloadable posters and other materials here.

What are the Ten Steps, and why should you care?  So glad you asked! 

The Ten Steps are hospital policies demonstrated by research to support breastfeeding and yield better breastfeeding rates.  They are the basis of breastfeeding-friendly care in hospitals, and implementation of them can lead toward certification as a Baby Friendly Hospital.  This list of policies was created by UNICEF and the WHO as part of the Baby Friendly Hospital Initiative.

The problem is that here in the U.S. we are almost guaranteed to give birth in hospitals that do not follow the Ten Steps.  In fact, CDC data shows that only 8.1% of mothers deliver in hospitals that follow just six of the Ten Steps. 

That's one of the reasons why we have only 94 Baby Friendly hospitals, while the rest of the world has nearly 15,000.  (For fun, check out this list of the number of Baby Friendly hospitals by country.  Ecuador alone has 141, and China has over 6,000.)  Fortunately, the number here is increasing.  We just have a long way to go.

So, if so few hospitals have adopted these policies they must be pretty radical, right?  Well, here they are.  And remember, less than 10% of U.S. hospitals follow at just six of these.

1. Have a written breastfeeding policy that is routinely communicated to all health care staff.
2. Train all health care staff in skills necessary to implement this policy.
3. Inform all pregnant women about the benefits and management of breastfeeding.
4. Help mothers initiate breastfeeding within half an hour of birth.
5. Show mothers how to breastfeed, and how to maintain lactation even if they should be separated from their infants.
6. Give newborn infants no food or drink other than breast milk, unless medically indicated.
7. Practice rooming-in - that is, allow mothers and infants to remain together - 24 hours a day.
8. Encourage breastfeeding on demand.
9. Give no artificial teats or pacifiers to breastfeeding infants.
10. Foster the establishment of breastfeeding support groups and refer mothers to them on discharge from the hospital or clinic.

We can do better, right?  This World Breastfeeding Week, I hope we'll renew our commitment to pushing hospitals to adopt policies that support, not undermine, breastfeeding.  Here's an example of how this is happening in our community.

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Motherwear's fall photo shoot

It's another hot day here, so it's hard to think about fall. 

But Motherwear has been thinking fall for weeks.  They held their fall line photo shoot a few weeks ago.  Below are a few outtake pictures to give you a feeling for the process of putting together a season's worth of great nursing clothes. 

 

Department of Labor issues fact sheet on pumping law (and says if others get paid to smoke, you get paid to pump).

Last week a mom asked me a question on behalf of a friend who was having trouble with her employer about pumping at work.  She lives in a state which has no state law on pumping at work, but the new federal law applies to her company.

Employees at her workplace are given break time.  Employees use it for various purposes, including smoking.  But when she approached her boss about pumping, she was told that he pumping time would have to be off the clock.

As it happens, the Department of Labor issued a fact sheet on the pumping law just last week, and it happens to clarify the requirements of the law on this very point.  The fact sheet is also written in clear enough language for it to be really useful if you need to speak with your employer about pumping.

Here's what it says:

Employers are not required under the FLSA to compensate nursing mothers for breaks taken for the purpose of expressing milk.  However, where employers already provide compensated breaks, an employee who uses that break time to express milk must be compensated in the same way that other employees are compensated for break time. (emphasis added)

So it looks to me as if this mother would be entitled to the same compensation as the employees who are using the time to smoke, go to the bathroom, text, or whatever else they do. 

More questions and answers about the law are available on the U.S. Breastfeeding Committee site.

Michelle Obama on breastfeeding to fight childhood obesity

Michelle Obama in aspeech to the NAACP this month:

And finally, it’s one thing we can think about, is working to make sure that our kids get a healthy start from the beginning, by promoting breastfeeding in our communities.  (Applause.)  One thing we do know is that babies that are breastfed are less likely to be obese as children, but 40 percent of African American babies are never breastfed at all, not even during the first weeks of their lives. 
 
And we know this isn’t possible or practical for some moms, but we’ve got a WIC program that’s providing new support to low-income moms who want to try so that they get the support they need.
 
And under the new health care legislation, businesses will now have to accommodate mothers who want to continue breastfeeding once they get back to work.  (Applause.)  Now, the men, you may not understand how important that is.  (Laughter.)  But trust me, it’s important to have a place to go.

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Want to know how the authors of The Womanly Art of Breastfeeding answered the question?

So far 'breastmilk from a bottle' is winning handily over "formula from the breast" in this week's poll. 

I thought you might want to know how the authors who posed this question answered it in The Womanly Art of Breastfeeding (review and contest).  Here's their response:

There's no right answer, but in today's world, many women would automatically choose the product over the process because human milk gets all the glory.  Studies of human milk are straightforward; relationships are hard to study.  We have tons of research on the importance of a precious fluid that just happens to be delivered from your breast.  But this book also celebrates the relationship - the heart of breastfeeding - not just the fluid.  Breastfeeding is a connection as well as a food source, a baby's first human relationship, designed to gentle him into the world with far more than just immune factors and good nutrition.  It's a way of mothering your baby - a relationship that develops feeding by feeding, building trust, closeness, knowledge of each other, and a deeply connected attachment that lasts long after weaning.

This is in a section entitled, "What makes this book different from other breastfeeding books?" 

Do you get the impression is that the authors come down in favor of the breastfeeding relationship over breastmilk, if forced to choose?  Your thoughts, please!

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Poll: Formula from a breast or breastmilk from a bottle?

In the introduction to the new edition of The Womanly Art of Breastfeeding (see Monday's post for review and contest) the authors pose this question:

What if you had to choose?  You can either bottle-feed your baby with scheduled feedings and little body contact, but with your milk in the bottle.  Or you can breastfeed your baby, responding to his cues, but only formula comes out of your breasts. 

Which would you choose?  You'd be choosing between the product of human milk and the process of breastfeeding...and you couldn't have both.

I thought I'd ask you which you'd choose.  Tell us in the poll below, and if you'd like, tell us why in the comments.

Book review and give away: The Womanly Art of Breastfeeding, 8th edition

See how to enter to win one of three copies at the bottom of this post. 

A few years ago I gave a talk to a class of nutrition students at a local university.  One of the students asked, "What technological advances have been made in breastfeeding recently?" 

I was stumped.  Technological advances?  Well, maybe pumps have gotten better, and some insights about breast physiology and about breastmilk are the result of technology, but really, nature had this one figured out long ago.

If I had to assign a theme to the 8th edition of the La Leche League classic,  The Womanly Art of Breastfeeding, I think that this would be it.  Many of the updates come from wonderful new research and documentation of babies and mothers' innate instincts.  Baby-led breastfeeding and biological nurturing, to name a few.

This isn't just a minor updating of this classic book.  It's a major rewrite, with some wonderful additions and changes:

1)  Partners are in.  This may sound funny, but the first thing I checked when I received an advance copy was whether the terminology regarding mothers' partners had changed.  I was pleased to see that 'husband' had been changed to 'partner.'  You may or may not see it this way, but I'd been bothered by the statement in the last edition:  "we are convinced that breastfeeding and mothering progress more easily" in households with a husband, wife, and children.   Not all nursing mothers are married or partnered.  Many of the mothers I work with are partnered, and often legally married to, other women.  I find this change to "partner" to be far more inclusive and respectful of the diversity of breastfeeding families.

2) "Technique" is out.  The latch and positioning section has had a very significant revision, with a strong emphasis on baby-led and 'laid back breastfeeding.'  This represents a departure from the way breastfeeding positions have traditionally been taught (cradle, cross cradle, football, etc.).  In fact, the section that does mention these positions has an "if you must know" feel to it, and there is some rejoicing at the lack of a "list of instructions" for latching the baby on.  At the risk of seeming behind the times, I have to say that I have mixed feelings about this.  Obviously I only see mothers who are having problems, but I find that a more directive approach is almost always a life saver for moms having pain and latch difficulty.  I do use a baby-led approach to initiate feedings, but I usually encourage moms to be pretty directive when the baby actually latches.  I also know that there are many roads to the same destination, and I'm willing to give anything a try (though I'm not sure how we'll do a reclining position in a doctor's office).  I guess I'm all for letting babies lead, as long as they don't lead you into a dark alley.  Clarification:  I just re-read this and realized that it makes it sound as if I'm not a big fan of baby led or laid back breastfeeding.  I am.  I've particularly found baby-led breastfeeding to be a wonderful approach, and I've seen it help a lot of moms, especially with breast refusal, nipple confusion, and weaning from nipple shields. 

3)  Breastfeeding begins with birth.  There is a prominent focus on the relationship between birth and breastfeeding.  This is timely given the current trend toward medicalization of childbirth, and because there is often little discussion of the effect of birthing practices on breastfeeding.  The irony, of course, is that when the first, mimeographed edition of The Womanly Art was published, mothers were just starting to push back against twilight sleep and the wide use of obstetrical interventions.  We've come full circle.

4)  Modern concerns, new tools.  In a nod to the realities of 21st century motherhood, this edition includes entire chapters on sleep and working and breastfeeding, as well as a section on exclusive pumping.  There are new practical tools, such as a "tech support" section with quick reference information on topics like blebs, engorgement, and mastitis.  There is a tear sheet toolkit with selected pieces of information moms are likely to refer to and might want on their refrigerators.

5)  But it's still an art.  Finally, acknowledging the current emphasis about the power of breastmilk, sometimes to the exclusion or dismissal of breastfeeding, there is an argument in this book for the art of breastfeeding.  Put another way, this book, while integrating the best of modern technology, never strays from the breastfeeding relationship itself.  Just like nature intended. 

To enter to win one of three copies, leave a comment below by July 26, 2010.  One entry per person, U.S. addresses only.  Winner will be chosen using random.org, notified by email, and announced in the comments section.  Book will be mailed by publisher.  Please note:  Winners who do not respond to email within 3 days forfeit prize, and alternate winners will be chosen.

I received a review copy of this book from the publisher.

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The formula fight you haven't heard about

An article this week in the Washington Post caught my eye.  It's titled "Lobbying fight over infant formula highlights budget gridlock." 

Here's the story:  WIC is the country's largest purchaser of infant formula.  In 2002, the formula companies started including additives such as DHA and more recently probiotics to their formulas.  These formulas sell for a premium.

Then in 2004, Congress included a provision in the WIC reauthorization bill which prohibited states from requiring or omitting certain ingredients.  The article states:

You can guess what happened next: Formula makers began submitting bids only for the costlier products.  A February 2010 Agriculture Department study pegged the added cost at $91 million annually, more than a tenth of the infant formula budget.  Now new formulas with even more ingredients -- and even higher prices -- are being offered through WIC.

All well and good if the pricier formulas were clearly better for babies. (The best thing for babies is breast milk, but that's another matter.) Manufacturers claim that the additives promote brain and eye development, and that the evidence for this is overwhelming. But while the Food and Drug Administration has approved the additives' safety, it has not -- because it says that's not part of its mandate -- looked into whether they have the claimed beneficial effects.

No one expects WIC to go back to the old formula.  In fact, it's not even available.  The real issue is what happens as these kinds of ingredients proliferate.  DHA and ARA are turning up in everything from baby foods to eggs to juice, along with other ingredients such as prebiotics, probiotics, lutein and lycopene.  Additives are threatening to become The Thing That Ate the WIC Budget.

WIC is now up for reauthorization again, and this time the Senate Agriculture Committee has included a provision requiring the USDA, which runs the WIC program, to get the best scientific advice before determining whether taxpayers should spring for more costly products.

The formula companies are, not surprisingly, very upset about this provision.  They market their products as far superior to prior products, and don't appear to want to subject them to independent review.  But obviously the bigger issue is that if such a review were to not show a clear benefit, they might not be able to sell it to their largest customer anymore. 

A lobbyist for the formula industry argues that if the new formulas are subject to scientific review they will result in depriving poor women and women of color of the newer formulas.  But the author of the article points out that advocacy groups for these women, such as the National WIC Association, are in favor of the amendment. 

Best of all, the lobbyist argues that "the issue was being pushed by unnamed "lactivists" who want to force all women to use breast milk."

The article cites this as an example of special interest influence in Washington.  It certainly shines a light on what a big business formula is.  But to me, the story is about how formula companies are permitted to create products used on millions of the most vulnerable members of our society, without having to prove their safety or purported health benefits to any independent, scientific body.  They are obviously nervous about having to do so.  I guess I have to wonder, if they're so confident of the superiority of their products, what's the big deal? 

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