The Motherwear Breastfeeding Blog

Dr. Seuss for nursing moms

How is it that I never posted this before?

If you like this one, you may want to check out How the Grinch Stole Breastfeeding, and a very Seuss-like parable, The Zoops.

Dr. Seuss for Nursing Moms

Would you nurse her in the park?
Would you nurse him in the dark?
Would you nurse him with a Boppy?
And when your boobs are feeling floppy?

I would nurse him in the park,
I would nurse her in the dark.
I’d nurse with or without a Boppy.
Floppy boobs will never stop me.

Can you nurse with your seat belt on?
Can you nurse from dusk till dawn?
Though she may pinch me, bite me, pull,
I will nurse her `till she’s full!

Can you nurse and make some soup?
Can you nurse and feed the group?
It makes her healthy strong and smart,
Mommy’s milk is the best start!

Would you nurse him at the game?
Would you nurse her in the rain?
In front of those who dare complain?
I would nurse him at the game.
I would nurse her in the rain.

As for those who protest lactation,
I have the perfect explanation.
Mommy’s milk is tailor made
It’s the perfect food, you need no aid.

Some may scoff and some may wriggle,
Avert their eyes or even giggle.
To those who can be cruel and rude,
Remind them breast’s the perfect food!

I would never scoff or giggle,
Roll my eyes or even wiggle!
I would not be so crass or crude,
I KNOW that this milk’s the perfect food!

We make the amount we need
The perfect temp for every feed.
There’s no compare to milk from breast-
The perfect food, above the rest.

Those sweet nursing smiles are oh so sweet,
Mommy’s milk is such a treat.
Human milk just can’t be beat.

I will nurse, in any case,
On the street or in your face.
I will not let my baby cry,
I’ll meet her needs, I’ll always try.
It’s not about what’s good for you,
It’s best for babies, through and through.

I will nurse her in my home,
I will nurse her when I roam.
Leave me be lads and ma’am.
I will nurse her, Mom I am.

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New York Times: "Acne cream? Tax sheltered. Breast Pump? No."

The New York Times just published an article on whether breast pumps can qualify as a medical expense for the purpose of tax sheltered flex spending accounts.

As the headline reads, acne cream made the cut.  The article explains:

That is because the Internal Revenue Service has ruled that breast-feeding does not have enough health benefits to quality as a form of medical care.

Those regulations are part of the health care overhaul, which takes effect in January. They affect flexible spending accounts, which allow millions of Americans to set aside part of their pretax earnings to pay for unreimbursed medical expenses.

While breast-feeding supplies weren’t allowed under the old regulations either, one major goal of the health care overhaul was to control medical costs by encouraging preventive procedures like immunizations and screenings.

Despite a growing body of research indicating that the antibodies passed from mother to child in breast milk could reduce disease among infants — including one recent study that found it could prevent the premature death of 900 babies a year — the I.R.S. has denied a request from the American Academy of Pediatrics to reclassify breast-feeding costs as a medical care expense.

In some respects, the biggest roadblock for mothers’ groups and advocates of breast-feeding is one of their central arguments: nursing a child is beneficial because it is natural.

I.R.S. officials say they consider breast milk a food that can promote good health, the same way that eating citrus fruit can prevent scurvy. But because the I.R.S. code considers nutrition a necessity rather than a medical condition, the agency’s analysts view the cost of breast pumps, bottles and pads as no more deserving of a tax break than an orange juicer.

What say you?  Should pumps count as preventative medical supplies for the purpose of flex spending accounts?

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My baby's coping strategies for oversupply and fast let down

A few months ago I wrote about wanting to wait and see how my daughter would cope on her own with my oversupply and fast let down. 

There are many things I could have done to calm down my supply and help slow the flow for her, but I really wanted to see what she would come up with. 

She doesn't choke or sputter anymore, and I'm relieved about that.  Wouldn't it be a bummer to sit down at each meal knowing that at some point you were going to choke?

Here are the three strategies she's come up with so far:

1)  She pulls off when the flow is too fast.  Milk flies everywhere.  If in public, this is followed by frantic efforts not to spray innocent bystanders.

2)  When she doesn't want any more milk and wants to continue nursing for comfort, but there's still more coming, she'll take a few sucks, pull off, and let the milk pour out of her mouth.  She'll continue doing this for a while.

3)  Again, when she's done eating but it's still coming and she still wants to nurse, she pulls off and sucks on her hand, keeping her head right next to the breast as if she's still nursing.

I know this is bragging, but smart baby, huh?

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The October Carnival of Breastfeeding: The birth/breastfeding continuum

Welcome to the October Carnival of Breastfeeding!  Check the bottom of this posts for links to other posts on this topic.

This carnival topic was inspired by a podcast interview I recently did with Linda Smith, author of The Impact of Birthing Practices on Breastfeeding.  In it, she discusses the effects of epidurals, c-sections, and other common birthing practices on breastfeeding. 

This interview made me think a lot about my two births and how they may have affected breastfeeding. 

My first birth was with nurse midwives and a doula in a California hospital with great birth statistics.  After stalling at 7 cm, my labor was augmented with pitocin, and I reached full dilation.  After a 34 hour labor (unmedicated until the 32nd hour) my son was born by cesarean section.  My son had some respiratory difficulty which led to him being whisked away and returning to me at about one hour after the birth.  He then had respiratory infection which led to pnemonia, and he stayed in the nursery for 10 days to receive antibiotics.  The whole experience ended up being very traumatic for me.

Surprisingly, given all of these problems, breastfeeding went off without a hitch.  My son latched on by himself, which I missed seeing because I was looking at my doula when it happened.  I remember seeing her jaw drop, and looking down to see him latched on.  I had no pain, no supply problems, no latching difficulty.  There was no lactation consultant at this hospital at the time, and I don't remember receiving any help other than to set up the pump during our separation.

My second birth was with nurse midwives and a doula at a Massachusetts hospital with outstanding birth statistics.  After stalling (yes, again) at 7 cm, I had an epidural and quickly reached full dilation.  The birth was a VBAC, after a 30 hour labor and over 3 1/2 hours of pushing.  All newborn procedures were done with my baby on my chest.  My daughter also appeared to be fighting an infection (though this appeared to be mild and nothing was ever cultured), and stayed at the hospital to receive a seven day course of antibiotics.  She stayed in my room during the treatment.  I was so thrilled to have had a healthy baby and to have done so by VBAC.  I can't remember how long I held her skin to skin, but my husband says it was a lot.

Breastfeeding again went beautifully.  My daughter didn't self attach, but did nurse well in the first hour.  No latch difficulty, pain, or supply problems.  My milk was late in coming in, but when it did there was a lot of it.  The lactation consultant at this hospital, whom I love, was on vacation when I delivered, but since I'm a lactation consultant myself I didn't really feel the need for any help.  The only comment about breastfeeding was from one nurse, who said, "You're nursing so much, are you sure you aren't in any pain?" 

Here are a few thoughts I have about the relationship between my births and my breastfeeding experiences, in no particular order:

• Thinking back on it, there were a number of things I did that set me up to have a good breastfeeding experience, though at the time I'm not sure I was thinking about breastfeeding as much as trying to have an intervention-free birth.  They included my choice of providers, hiring doulas, and writing birth plans stressing as few interventions as possible.
• The most difficult part of my son's birth was to not have been able to see and hold him until the end of the first hour.  I know that at some hospitals things are changing, and that babies born by c-section (barring complications) are placed on their mother's chest immediately after the birth.  I do hope that this becomes standard practice.
• My daughter didn't self attach after the birth, and I attribute this to the medication I had in labor.
• I'm pretty sure that the epidural used in the labor with my daughter caused me to have a fever postpartum, which probably led to closer examination of my daughter.  Linda Smith notes that "Epidural analgesia raises the mother's temperature in a dose-dependent manner.  Elevated maternal temperature is associated with increased risk of infant fever, possibly due to an inflammatory effect; increased investigation for infant sepsis..."
• In both cases of infections after birth, I was able to remain at the hospital.  This obviously made a huge difference in terms of breastfeeding; having to commute back and forth to the hospital would have made breastfeeding far more challenging.
• Having my daughter in the room with us was also a lot more supportive of breastfeeding than having my son in the nursery, especially after c-section surgery.

Looking back, what's conspicuous about these experiences from a breastfeeding point of view is what didn't happen.  In both situations the assumption was that things would go fine as long as I was breastfeeding on cue and pumping when a separation was necessary.  I felt no pressure to anything than what I was doing, which was nursing a lot and holding my baby skin to skin (as much as I could).  The lesson?  Pick your providers, both for birth and for breastfeeding, carefully.

What can you do to have a birth that gives you the best odds of having a good start with breastfeeding?  Listen to the interview and you'll hear what the evidence says.  You can also write a breastfeeding-friendly birth plan to make sure that your providers know your wishes in advance. 

Check out these posts from other bloggers on our theme (updated throughout the day):

Lights and letters: How to Start Breastfeeding and Why the Birth You Have Matters

Tales from the Crib: On Not Being Discouraged

Mama Eve: Birth & Breastfeeding

Massachusetts Friends of Midwives: Early Intervention Lactation Help

Baby Fingers: My Breastfeeding Relationships: Hospital vs Homebirth

Mama Bear: Long, wide shadow of a bad birth

Tumbling Boobs: Nursing After Surrogacy or Adoption

Blacktating:  Did my birth experience set me up to fail at breastfeeding?

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Holistic Moms Network's "Nursing our Future"

I thought you'd enjoy this great video showing that you can indeed nurse anywhere!

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"Las dos"

On Monday I spoke at the Massachusetts Breastfeeding Coalition conference on the topic of "las dos" and how to increase exclusive breastfeeding among Latinas.  "Las dos" is slang used by Latina/Hispanic moms to describe feeding by both breastfeeding and formula.

I think that the talk went well (though you wouldn't believe how much I dread public speaking).  Some representatives of an incredibly successful program in Hartford, Connecticut were there, and it was a real treat to meet them.

I thought I'd share some of the main points of the talk, and would love to hear from those of who who are familiar with this, either as mothers or as breastfeeding support people.

Here were the take away messages:

1)  On the whole, Latinas initiate breastfeeding in higher numbers than the U.S. average (80% compared to about 75%).  But Latinas also supplement more than the average (at two days, 33% compared to 25%).

2)  Breastfeeding and supplementation patterns vary a lot by subgroup.  For example, Mexican American moms breastfeed at high rates (80%), Puerto Rican moms at lower rates (50%).  This is reflective of breastfeeding patterns in the culture of origin (92% breastfeeding initiation in Mexico, 65% in Puerto Rico).  It's important to know these differences when working with mothers and designing programs. 

3)  There are a number of reasons why Latinas plan to do "las dos."  Some are concerns common to mothers of many backgrounds (return to work or school, discomfort with nursing in public, concern about breast changes), and others are more specific to the mothers' culture (high value placed on very chubby babies, belief that breastmilk lacks vitamins, strong influence of grandmothers who may not have breastfed or done so exclusively, belief that negative emotions can spoil breastmilk, belief that special diet is necessary to make enough milk). 

4)  Several things are very effective at increasing exclusive breastfeeding: the Baby Friendly Hopsital Initiative, postpartum breatfeeding support, and peer counselor support.  One program which provides prenatal and postpartum support to mothers who deliver in a Baby Friendly Hospital in Hartford breastfeed were found to have exclusive breastfeeding rates which are 15 times higher than controls.

I also talked about social marketing campaigns, such as the one the Massachusetts Breastfeeding Coalition recently launched.  Three of the posters from the campaign are posted here, and you can read about the development of one of the slogans (featuring my husband) here.  And as a group we worked on creating 'scripts' to use when talking with moms who want to supplement.

Let's hear from you Latina moms, and those of you who work with Latina moms.  Your thoughts about any of this?

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Review and give away: The Nursing Mother's Companion and Breastfeeding Diary

The Nursing Mother's Companion is the breastfeeding book I read when I was pregnant. 

I distinctly remember reading it while sitting in a rocking chair in the newly set up baby's room (little did I know that this was going to be them most underutilized square footage in our house).  At some point I recall yelling to my husband in another room, "Hey, this is going to be a lot of work!"  I also referred to it for information on how to pump at work.  And I'll never forget showing my husband the picture of a mom with engorged breasts, and saying, "Um, I think I look like this."

This book is celebrating its 25th anniversary, and is now out in a 6th edition.  I have the pleasure of offering 3 copies of it, as well as a new breastfeeding diary, to readers of this blog.  See the end of this post for information on how to enter to win.

Here's what I really like about this book:  It's organized in a way that makes it really easy to find the information you need.  And since you usually need information quickly, and often in the middle of the night, the organization of the book is really valuable.  I'm also a very 'cut to the chase' kind of reader, and while I enjoy and learn from personal stories, I wanted a book that focused directly on the things I needed to know.  The survival guides in this book fit the bill.

What's new in this edition?  There is an updated and expanded pumping section with guidelines for a good flange fit, updated references including suggested links to some good sites, mentions of kangaroo care, biological nurturing, dysphoric milk ejection reflex, vitamin D, and the inclusion of the WHO growth charts in the appendix.  What's missing?  I would have liked to see a mention of posterior tongue tie in the tongue tie discussion, and the drawn illustrations which show moms with hairstyles and clothes that are badly in need of an update. 

The new Nursing Mother's Companion Breastfeeding Diary is a companion to the, um, Companion, and is intended to help moms keep track of feedings, pumping, and supplementation.  I approached this book with a little skepticism because I worry sometimes that tracking can cause more problems than it solves (as I wrote about another breastfeeding log book), but I have to say that I like this diary a lot.  The chart which the mother fills in has the usual "input" and "output" fields (though by day 55 I think most of us would do anything than record poop).  But what makes this book really valuable is the guidance on each page.  There is great information for each stage of breastfeeding here, provided day by day as you go along.  The opposite page provides space for recording thoughts and observations.  It has a nice stay-flat design, and parenting quotes on each page, and I think it would make a nice keepsake.  A ribbon bookmark would have been a nice touch.

And, importantly, it ends at two months.  That, I think, encourages us to ditch the pen and paper take the full leap of faith that breastfeeding is working, however it's working. 

To enter to win one of three *sets* of these books, leave a comment below by October 25, 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.  Disclosure:  I received a review copy of each of these books from the publisher.

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Actually, I do want to be used as a pacifier.

So I think that a few of you interpreted my post about how to know when a baby is "done" by recognizing nutritive vs. non-nutritive nursing to mean that I don't think that comfort nursing is important or valuable.

Quite the opposite.  I know without a doubt that breastfeeding is not just about 'feeding, and I absolutely encourage, support, and value comfort nursing.  In fact, I spent quite a lot of my time doing it these days.  Being able to comfort your baby with nursing is one of the best parts of breastfeeding, in my opinion.  When I think back on my nursing experiences I'll remember milk a whole lot less than I'll remember the cozy feeling of cuddling up on the couch with my babies and nursing for as long as they wanted.

That's why I can't stand the advice, "Don't let your baby use you as a pacifier."  I want to make t-shirts that say, "Actually, I do want to be used as a pacifier." 

My point in challenging the "he'll come off when he's done" mantra is that I think it creates an expectation that just doesn't match reality.  That feels like a set up.

Here's a scenario that a number of you described in the comments to Monday's post:  You're a new mom at home, and you believe that all nursing is nutritive, and you think that a feeding is done when your baby says, "check, please!" and comes off the breast.  But your baby doesn't just come off the breast.  He keeps nursing and nursing and nursing, and you think that he's eating the entire time.  Can you see how that would lead to a lot of frustration, fear and guilt?  Maybe enough to think that breastfeeding is not for you?

I think that we owe it to moms to make sure that they understand what's happening during a feeding so that they can make their own decisions about how they want feedings to go.  Then you can decide.  Need to end a feeding after the eating part is over so you can take a shower or pick up your older child from school?  Great.  Want to cuddle up on the couch and nurse for hours on end?  Fabulous.

As a La Leche League leader said at the last meeting I attended, breastfeeding is a relationship, and there has to be a balance between what each of you needs.  To navigate this relationship, I think it's helpful to know what is happening when you nurse.

Below is a cartoon that expresses my feelings about what breastfeeding is "made of," from Heather at Mama is...  You can listen to a podcast interview with her, too!

So, how *do* you recognize sucking vs. swallowing?

On Monday I wrote about the importance of recognizing sucking and swallowing in figuring out what your baby is doing at the breast.  It's how you can figure out if your baby is eating or nursing for comfort.*  I think that this is more helpful than the common advice to wait until your baby comes off the breast on his or her own.

So, I thought I'd post two videos of a babies who are doing some of both. 

In the first video you see a baby who taking several sucks and then a swallow, with some pauses.  The sucks are the more rapid, shorter jaw movements.  The swallows are the longer, slower jaw movements, with a tiny pause when the jaw gets to the bottom.

In the second video you see a baby who is doing solid swallowing, with very few sucks.  I'm posting this one because you can really hear the swallows.  Some babies are very noisy eaters, and I can hear the swallows from across the room.  Others are so quiet I have to get my ear right up next to the baby's mouth.  But either way, the sound of swallowing is good to recognize.

Both these videos were taken at the Jack Newman Breastfeeding Clinic and Institute in Toronto.

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*Please see Monday's post for some situations in which this wouldn't apply.

"She'll come off the breast when she's done."

Today I'd like to challenge a bit of breastfeeding orthodoxy. 

Most breastfeeding books advise that when a baby is done with a feeding, he will "come off the breast on his own."  In fact, I used this phrase in a book I wrote a few years ago.

But I've always been uncomfortable with this idea, because I only rarely see babies do this.  Nearly every baby I've seen will continue to nurse as long as they can, coming off the breast on their own only when they're asleep and can't keep a seal on the breast.  If a baby remains awake through a feeding, they almost always require a little assistance to end the feeding.  Both my babies would stay on until 2047 if I let them.

Now, I'm guessing that part of the problem is that there are different definitions of "done."  Done eating and done nursing are not the same thing, since babies get a lot of comfort out of nursing after they've gotten a belly full of milk.  But if you define "done" as finished both eating and comfort nursing, many mothers would never have a chance to go to the bathroom.  (One exception are mothers who have a big oversupply or fast let down, whose babies sometimes come off to save themselves from drowning!) 

Here's what I feel much more comfortable advising:  When your baby is swallowing (and I show how to recognize swallowing) she's eating.  Obviously, she's not done at that point.  Once you see nearly all sucking and few swallows, she's nursing for comfort.  When you see that, your baby is comfort nursing.  At that point, you can decide how long you want to continue nursing.  There's nothing wrong with comfort feeding, and there'sHow long will a feeding be?  There's no right answer.  It will vary by mother, baby, and from feeding to feeding.  One thing is for certain:  The clock can't tell you when your baby is done, but your baby can.

This advice assumes that the baby is gaining weight well and breastfeeding is going fine, and might not be appropriate in a situation where a baby is sleepy, preterm, jaundiced or otherwise ill, or when a mother has a low supply.  It also assumes on cue feeding, and that a mother is past the colostrum stage.

But in most cases I think that this guideline works a lot better.  What do you think?

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