The Motherwear Breastfeeding Blog

Win a copy of "Breastfeeding in Combat Boots"

I'm pleased to share a guest post by Robyn Roche-Paull, author of Breastfeeding in Combat Boots.  Robyn is an IBCLC in private practice an active La Leche League Leader.  In her practice she primarily helps military mothers balance returning to active duty while continuing to breastfeed. Robyn is a US Navy Veteran who successfully breastfed her son for over a year while on active duty as an aircraft mechanic.  Check out the Breastfeeding in Combat Boots website and Facebook page!

You can enter to win a copy of Breastfeeding in Combat Boots by following the instructions at the end of this post!

Over the years, both as an active-duty sailor breastfeeding her own baby, and later, as an IBCLC helping other active-duty moms to breastfeed their babies, I’ve heard the same questions and concerns over and over from military mothers, “Can I breastfeed while on active duty?” and “How often do I need to pump during a 12-hour shift?” While other questions are very specific, such as “I work with JP-8 fueling aircraft every day, can I feed
my baby my pumped milk?” or “I will be deploying to Iraq for four months. Can I pump and ship my milk home from overseas?”

I wrote Breastfeeding in Combat Boots to answer those, and many other questions.  More importantly, I want to reassure and provide military moms with insight into the rewarding, and yes, wonderful aspects of breastfeeding on active duty, while also giving a realistic look at the challenges that lay ahead. And finally, I want to give military breastfeeding moms the tools they need to succeed. I want to show that, except for some very unusual circumstances, with a little preparation, a “can do” attitude, and some creativity, it is possible to breastfeed on active duty.

Breastfeeding in Combat Boots is written primarily for pregnant and breastfeeding moms serving on active duty in any of the five branches of the U.S. military: Air Force, Army, Marines, Navy, and Coast Guard, as well as the Reserves and the National Guard. However, women in other militaries around the world may find the information (except for the policies) in this book applicable to their situations as well.  Women in professions such as firefighting, police, EMT, long-haul trucking, or any other job with unusual hours, time away from home, and heavy physical exertion, or who work in a male-dominated environment
may also find this book to be helpful.

As with other breastfeeding how-to books, I want to make the information as accessible as possible. Breastfeeding in Combat Boots has been written to be read either
straight through from beginning to end, or in sections as the need arises. I’ve structured this book around the military lifestyle and grouped the chapters into five major sections. Each section is prefaced with a true story written by a current or former active-duty mother who breastfed her child(ren) while serving in the military.

Section 1-Indoctrination is devoted to explaining the importance of breastfeeding for you, your baby, and your command, using the latest research and evidence-based information available.

Section 2-Basic Training gives an overview of the basics of breastfeeding and how to survive those all-important first six weeks.

Section 3-Duty Calls discusses the breastfeeding policies of each branch of the military, pumps and pumping basics, and breastfeeding-friendly childcare tips.

Section 4-In the Field examines the many different challenges that military duty presents for the breastfeeding mother, such as workplace environments, HAZMAT, deployments, PRT/PFT, uniforms, and co- worker issues.

Section 5-Off Duty covers the many types of breastfeeding support that are available on and off-base for the military mother.

Within each section, there are several chapters covering the information concisely and in-depth. You will find boxes with tips and techniques, quotes, and statistics that reinforce the information found in the main portion of the chapter. The back of the book has numerous appendices with references, websites, books, and handouts that I have found helpful for active-duty breastfeeding mothers over the years.

In summary, is breastfeeding on active duty worth it? Yes, you bet it is! Breastfeeding is one of the most rewarding things you will ever do. You won’t regret for a moment the time and energy or the love and commitment those bottles of pumped breastmilk represent. The inconveniences you may endure will be worth it a hundred times over when your baby gazes up at you with adoring eyes as he is snuggled up at your breast.  With the number of military mothers I’ve spoken with over the years, I’ve never met one who didn’t tell me it was the hardest thing they ever did…and who also said that it was the one thing they were most proud of.  You can do it too!

To enter to win a copy of Breastfeeding in Combat Boots leave a comment below by September 10th, 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 author.  Please note:  Winners who do not respond to email within 3 days forfeit prize, and alternate winners will be chosen.

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One mother's heartbreak helps another baby survive

I thought that this was a really beautiful and moving story from Kansas City. 

It's not clear to me how the milk donation actually worked, since the story says that the recipient mother couldn't afford donor milk.  I do know that insurance generally only covers donor milk on a case by case basis, but also that milk banks don't turn anyone away for inability to pay. 

In any case, it's another situation which makes me scratch my head about why insurance doesn't yet cover donor milk in these situations. 

A while back I wrote about how much money it could save them, just in preventing one life threatening complication of prematurity, necrotizing enterocolitis, or NEC, which affects as many as one in ten premature babies and according to this news piece has a mortality rate of about one third:

You may have heard that pasteurized donor milk can cost $3.00 to $4.50 an ounce.  That might sound like a lot.  But consider that a tiny preemie who is primarily receiving her mother's own milk may need a supplement of only a few ounces a day.  Then compare that to the estimated $350,000 cost of surgically treating NEC.  That number doesn't even start to take into account the lifelong medical costs from that episode of NEC.    

One other note:  Milk banks always accept milk donations from bereaved mothers whether or not they meet the qualifications for milk donation.

 

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You know that nursing is normal when...

This is a story about frogs and breastfeeding.

We have a fish pond in our backyard which is populated by a family a frogs.  Well, it was until last night when there was a bit of a frog massacre.

One of my son's recent favorite activities to do with his friends has been to catch the frogs and move them into a wading pool, and then build them places to sit with rocks and sticks.  This poor frog family had no idea what they were getting into when they chose our backyard as their home.

So last night we had some friends over for dinner.  They have a preschooler and a toddler, and my son and the older child spent some time moving the frogs from the pond to the pool.  Then the toddler fell into the pond, and in all the excitement the frogs in the wading pool were forgotten.

This morning my son and two other friends found the frogs dead in the pool.  They buried them, and I know that my son feels awful about it. 

There is one surviving frog in the pond, whom the kids had decided was the baby of the family. 

One of his friends said, "Now the baby is going to die, too, because he won't be able to nurse!"

That's how you know when nursing is considered normal in a family, right?

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Goodbye, milk.

                                        Goodbye, milk. 

               We packaged you up today.  It was a family project. 

 

How much of you did we send?  If you were cow's milk, I'd have sent this much of you.

Daddy drove an hour and a half round trip before work to get the dry ice to keep you cold. 

The woman at the ice place said that someone in her family recently had premature twins, and that it's a very good thing I'm doing, sending you off.

You're off to Forth Worth, where I've never been. 

The Mothers' Milk Bank of North Texas is going to process and test you.  Don't worry.  I'm confident you'll    pass.  Then some little babies are going to gobble you up.

                         Reiko says have a nice trip!

 

                       I'll be sending more of you soon...

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My husband, the breastfeeding slogan genius.

A little while back the Massachusetts Breastfeeding Coalition was trying to figure out what to do about "las dos."

"Las dos" (literally "the two" or "both") or "las dos cosas" is slang in Spanish for feeding by both breast and bottle. 

While Latinas as a whole breastfeed at higher than average rates (81% vs. 75%, CDC , 2007), exclusive breastfeeding rates remain low (33% of Latinas supplement before two days vs. 25% U.S. average, CDC, 2007).  I should point out that these numbers don't tell the whole story by any means; different subgroups of Latinas (mothers of Mexican or Puerto Rican descent, for example) breastfeed at very different rates.

Among some Latina moms there is a perception that "las dos" is better for babies than exclusive breastfeeding, for a variety of reasons.  And, like in the general population, the Coalition learned through interviews that many moms don't understand that using formula reduces milk supply.

(I'll be doing a talk about this issue at the Massachusetts Breastfeeding Coalition conference in October.  Ask me if I'm nervous.)

So I told my husband that the Massachusetts Breastfeeding Coalition wanted to design a campaign around "las dos."  My husband, who is fluent in Spanish said, without missing a beat:  "Las dos?  Those (pointing at my breasts) are the only two you need."  Get it?  The only two  you need?

I thought that this was clever, and suggested it to the Coalition board.  After some focus grouping and multiple drafts, the Coalition put out the poster you see here!

The slogan doesn't translate as well into English, but it says, "Las dos (breast and bottle)?  Mom, you have the only two I need.  If you give me formula, you won't produce enough milk for me!  I need only the breast."

So there you have it: real men design breastfeeding slogans.

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Photo Friday: Frog

The only thing my son has said that is the least bit negative about having a baby sister is,

"I think that this frog is even cuter than her."

Have questions about the impact of birthing practices on breastfeeding?

I'm planning a podcast interview with Linda Smith, author of Impact of Birthing Practices on Breastfeeding, now out in a second edition.

Do you have questions about how birthing practices impact breastfeeding?  If so, leave them in the comments section and I'll ask them during the interview.

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You must remember this...

Check out my podcast interview with artist Heather Cushman-Dowdee, and keep these comics coming by Kachingling her (see upper left hand corner)!

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Overheard

Recently heard in my house:

Son:  (watching me nurse the baby) Um, that's really not a good latch.

Husband: Did she (the baby) wake up after 3:00 am?
Me:  I don't think so.
Husband:  Really? I thought she did.
Me:  Well (feeling around), my breasts say she didn't.
Husband:  Oh, then you're probably right.

Husband:  Is this what I think it is splattered on the remote?

Me:  Do you know why I'm pumping milk for the milk bank?
Son:  Yeah.  They give it to moms who don't have enough milk.  And they don't have enough milk because they aren't nursing enough.  (Okay, I haven't told him about supply problems associated with prematurity, or other causes of low supply, but the boy got the supply/demand concept down, right?)

Baby:  Phew! (After making it through yet another forceful let down.  I swear I'm not making that up - she really says it!)

Husband (watching me nurse):  I wish I could do that.  (Meaning nurse the baby.  Said for the millionth time)

(Picture is of my baby's hairy ear!)

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Running a road race without shoes, and what to do if you receive "Baby Un-Friendly" care

I'm pleased to share a guest post by Dr. Alison Stuebe, originally posted on the Academy of Breastfeeding Medicine blog.

Alison is Alison Stuebe, MD, MSc, is a maternal-fetal medicine physician, breastfeeding researcher, and assistant professor of Obstetrics and Gynecology at the University of North Carolina School of Medicine. She is a member of the Academy of Breastfeeding Medicine.  You can hear my podcast interview with her about Ban the Bags.

Imagine you are running your first marathon. You’ve been training for months, and you’re looking forward to the sweet satisfaction of crossing that finish line.  When you arrive at the start, you are dismayed to discover that you didn’t register for a “runner-friendly” race.

An official confiscates your shoes and your water bottle. “We recommend that you run 26.2 miles today,” you are told. “Good luck.”

It’s an absurd way to start a marathon. And if you’re a mom who planned to breastfeed and birthed in an American hospital, it also sounds familiar.  Breastfeeding after an American birth is disturbingly similar to running a road race without shoes.

Consider that the CDC’s mPINC survey found that one quarter of US hospitals routinely formula-feed healthy term infants and 45% routinely provide pacifiers, despite strong evidence that such practices undermines breastfeeding.  Seventy percent of hospitals hand out formula company marketing packs to breastfeeding mothers, despite evidence from multiple studies that this practice directly undermines a mother’s ability to adhere to recommendations to exclusively breastfeed for the first 6 months of life. On a scale of 1 to 100, the mean hospital score for breastfeeding-supportive hospital policies was a 63.

This is the starting line for the American mom’s breastfeeding marathon. “We recommend you breastfeed your baby for six months, but we’re taking him to the nursery tonight for more formula that his tiny stomach can hold in 24 hours, and then we’re sticking a pacifier in his mouth. And because we don’t think you’ll be able to cut it breastfeeding, we’re sending you home with a tote bag filled with formula. Good luck.”

Fortunately, there’s a metric to sort out whether your hospital is going to allow you a fair start: The Ten Steps to Successful Breastfeeding. This internationally-developed standard guides hospitals and birth centers in how to get mothers and babies started breastfeeding successfully. Those that implement all Ten Steps are eligible for designation as Baby Friendly.  As of July 2, 94 US Hospitals and Birth Centers met the standard.

The science backing the Ten Steps is strong: These policies directly impact a mothers’ likelihood of reaching her own breastfeeding goals. Ann DiGirolamo studied the number of steps a mom experienced and her chances of meeting her own breastfeeding goals, and found that 97% of moms who experienced all steps met their own goal to breastfeed for at least 6 weeks, whereas only 70% of moms who experienced none of the steps met their own goals.

Think about this. Three out of ten moms delivering at a “no steps” facility will fail to meet their own infant feeding goals. And because “Baby-Hostile” hospital care is more subtle than an official saying,  “I’m sorry, we don’t allow shoes in this marathon,” three out of ten moms will most likely blame themselves for a painful, disappointing breastfeeding experience.

This World Breastfeeding Week, mothers around the world are celebrating the Ten Steps. If your maternity care set you up for success, take a moment to write a thank you note. And if you endured Baby Hostile care, transform some of your frustration into constructive criticism. Hospital administrators are stunningly responsive to letters from patients — far more responsive than to published articles in peer-reviewed medical journals. Write a letter – here’s a rough draft to get you started.

Dear Maternity Center Director:

I gave birth at your facility in XXX of this year, and I intended to breastfeed my baby. I had looked forward to receiving high-quality care for myself and my baby. The Ten Steps to Successful Breastfeeding are internationally-developed, evidence-based practices that support initiation of breastfeeding. At your facility, I did not receive breastfeeding-supportive care. Specifically, my caregivers did not:

-       Allow me to hold my baby skin-to-skin and initiate breastfeeding in the first hour after birth (Step 4)

-       Provide my baby nothing but breastmilk, unless medically indicated (Step 6)

-       Support my desire to have my baby to room in with me (Step 7)

-       Allow me to breastfeeding on demand, rather than on a schedule (Step 8 )

-       Avoid routine use of pacifiers (Step 9)

-       Provide me with information on breastfeeding support before I was discharged (Step 10)

As a consequence of the poor quality care I received during my maternity stay, I encountered tremendous difficulties with breastfeeding.

I was deeply disappointed in the quality of care I received at your hospital, and I look forward to learning what steps you are taking to improve the care that you deliver to breastfeeding mothers and babies.

Thank you for your attention to this matter.

Sincerely,

Cc: Hospital CEO

Director of Obstetrics

Director of Pediatrics

(Tanya's note:  I'd add a cc to "Risk Management," too)

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