The Motherwear Breastfeeding Blog

Two videos demonstrating different methods of hand expressing milk.

In the age of hands-free pumping and adapters for your car's cigarette lighter, hand expressing is pretty much a lost art in this country.  But talk to any mother who pumped before the early '90's, and you might find that her pump was her hand.

Manual expression can still come in (ahem) handy, even if you have a pump.  If you get very engorged, hand expressing often works better than a pump.  If you can't use your pump (on a plane with no battery pack, for example), it's great to know how to do it.  If you have a really fast let down and need to express before getting your baby latched on, hand expressing is so much more convenient than the pump.  And sometimes it can be nice to be able to get a little milk out before your baby latches on.

Below are two videos that show you how.  The first is the Marmet technique (shown at About.com), and the second is the technique used at Stanford Hospital.  You'll notice that the hand placement and motions are different.  I think that both can work, and you may want to try both before settling on one.  

• Marmet Technique
• Stanford Hospital

At Stanford Hospital, the lactation consultants teach each mother how to hand express, and encourage them to do it after every feeding while in the hospital.  They then teach the moms how to spoon feed the colostrum to their babies.  This appears to help mothers' milk come in sooner, and I would guess that it helps reduce babies' weight loss.  At a minimum, it teaches moms this really useful skill.

Have any of you had any luck hand expressing?  Did anyone teach you how?

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Now your pump really can talk to you.

A while back I wrote a post asking if any of you thought that your pumps were talking to you.  Many of you did indeed have pumps with something to say, including:

"Way to go, way to go"
"Let it go, let it go"
"Winnepeg, Winnepeg"
"Lap dog, lap dog"
"Hoover Dam"
"Holyoke ha-wee-oo"
"I'm so tired! I'm so tired!"
"David Bowie, David Bowie"

See the post for the full list.

Now, believe it or not, there's a pump that actually can talk to you.  The EnDeare pump will take a recording of whatever you want - your baby's cry, music, a 'go team!' cheer - and play it back while you pump.

What's next?  And what would you record on this pump to help your milk let down?

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Miss any of these podcasts?

A couple of years ago, when Motherwear asked me to create podcasts for the blog, I almost said no.  I felt nervous about doing recordings, and wasn't sure what people would want to hear.

The president of Motherwear had me meet with the owners of a big yarn store in our area, who do a weekly radio show about knitting.  Their show is produced as a podcast and is very popular.  I went with them to the radio station to watch them record it.  It actually looked like fun, and I committed to giving it a try. 

The funny thing is that I really enjoy the process of putting these podcasts together.  I like reading the books, coming up with questions, and talking with authors.  I've had a chance to talk with people I might never have contacted.

Can you guess which one is the most frequently downloaded from the iTunes store?  A breastfeeding welcome here sticker goes to the first person to guess correctly (leave your guess as a comment).  And if you're feeling friendly, please go to our iTunes store and write a review! 

• Breastfeeding and early sexual abuse, with Penny Simkin
• African American moms and breastfeeding, with Kathi Barber
• How do other mammals do it? With Dia Michels
• What's the problem with those formula company bags? With Alison Stuebe
• Starting solid foods, with Ellyn Satter
• Breastfeeding in the movies, with Sarah Rubenstein Gillis
• Low milk supply: Could it be your hormones? With Lisa Marasco
• So, you want to work in breastfeeding support (just me)
  
• Nursing in public and the law, with Jake Marcus
• Making more milk, with Diana West
• Hathor the Cow Goddess, with Heather Cushman-Dowdee
• Postpartum depression and breastfeeding, with Kathleen Kendall-Tackett
• MilkShare, with Kelly Faulkner
• The Milk Memos, with Cate Colburn-Smith

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Imagine pumping at work with one of these things.

Last Friday my breastfeeding coalition sponsored a training run by Medela for local WIC agencies and other people involved in breastfeeding support.  We had about 20 WIC and other breastfeeding support people there, plus three babies!

The training was on using pumps to sustain breastfeeding.  Our coalition just donated three hospital grade pumps to our local WIC offices, so this training opportunity was well timed.

For me, the best part of the morning was checking out the many different pumps the trainer brought. 

There were hospital grade pumps (the kind you'd use in the hospital or to increase milk supply), frequent use pumps for working mothers, and manual and basic electric pumps for occasional pumping.

But the most interesting for me were the older manual pumps.  I'd heard of the 'bicycle horn' pumps (to the right) but never seen one.  Note that the 'reservoir' where the milk collects holds about 1/4 of an ounce, so it would have to be emptied pretty frequently.  And there's nothing to prevent milk from going back into the bulb part of the pump, which would be almost impossible to wash.

Don't they look like those bulb syringes for babies' noses?  Can you imagine trying to pump at work with one of these things?  Most mothers would probably have done much better with hand expression.

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"The Case Against Breastfeeding"

This month's edition of The Atlantic Monthly features an article by Hanna Rosin entitled "The Case Against Breastfeeding."  Thanks to many of you for emailing me about it!

There are several pieces to the argument she presents, and they roughly follow the perspective of one school of feminist thought (you can read about different feminist perspectives on breastfeeding here):

1) The evidence of better health outcomes for breastfed babies is "thin."
2) Women in some communities feel a lot of pressure to breastfeed.
3) Breastfeeding "keeps women down," and is "a serious time commitment that pretty much guarantees that you will not work in any meaningful way."

I'm going to tackle the first one here, though I have some strong feelings about the others, especially the third. Breastfeeding mothers can't do meaningful work?  It's going to be hard to break that news to the many, many breastfeeding mothers I meet who are working as doctors, teachers, professors, and nurses.  And of course this argument assumes that being a parent is not "meaningful work."

But back to the "thin" evidence for breastfeeding.  I'd like to point out a few things about her argument:

1) The author says that there are so many methodological problems in the research as to undermine the credibility of health claims.  As evidence of this, she points to a meta analysis published in...1984.

I wonder why she didn't cite the 2007 U.S. Department of Health and Human Services (AHRQ) meta analysis, "Breastfeeding and Maternal and Infant Health Outcomes in Developed Countries," which reviewed over 9,000 abstracts, 43 preliminary studies, 43 primary studies on maternal health outcomes, and 29 systematic reviews or meta-analyses that covered approximately 400 individual studies on breastfeeding. The analysis graded each study for methodological quality.  The report states,

"We found that a history of breastfeeding was associated with a reduction in the risk of acute otitis media, non-specific gastroenteritis, severe lower respiratory tract infections, atopic dermatitis, asthma (young children), obesity, type 1 and 2 diabetes, childhood leukemia, sudden infant death syndrome (SIDS), and necrotizing enterocolitis."

And while this topic wasn't raised in the article at all, the study found: "For maternal outcomes, a history of lactation was associated with a reduced risk of type 2 diabetes, breast, and ovarian cancer...Early cessation of breastfeeding or not breastfeeding was associated with an increased risk of maternal postpartum depression."

2) The article argues that breastfeeding provides limited protection against infection because "they never get into the blood." Right.  That's because the components in milk prevent the pathogens from getting into the baby's bloodstream to begin with.  The antibodies in breastmilk coat the lining of the baby's intestine and are pathogen-specific - blocking the bad bacteria and leaving the good bacteria alone, based on messages from the mother's immune system.  The bad bacteria can't get in to the baby's tissues, and leaves the baby's body in its poop.  This is a more efficient form of infection protection, says Dr. Lars Hanson, in The Immunobiology of Human Milk, because when a virus or bacteria does enter tissues, it requires an inflammatory response which involves symptoms of infection (fever, for example) and a higher energy requirement. 

3) But beyond this site-specific immune protection, there is the overall development of the baby's immune system.  Think of it this way: your baby's body is taking notes about what your milk fights in its system, and is remembering it for the next time it encounters that pathogen.  That's called active immunity.  It does this in part through memory T cells, through cytokines and chemokines, which do enter the baby's system through gut, and regulate activation of the immune system, and through other pathways. There are many more ways in which breastfeeding protects babies, but I don't have space for them here. 

I did find a couple of things to agree with in her article:  that there is irony in the fact that the movement to take back infant feeding from the medical establishment is now justified on the basis of medical research; and that women feel trapped between health recommendations and the reality of maternity leave policy in this country.

But all in all, I found this article to be a very selective reading of the research, with comments reflecting a highly specific experience of American motherhood, with a dollop of judgement on top.

If you're like me, this article raised some pretty strong feelings.  I'm going to encourage all of us to be respectful in our comments here.  However you view this article, try to address the arguments, not the person making them, please.

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Are you using the right size flange?

Using the wrong flange size can be painful, and can result in you getting less milk. 

And (isn't what they say about all of us wearing the wrong bra size?) it appears that many of us are using the wrong size.  Research (pdf) suggests that nearly 1/3 of mothers need a larger-than standard flange size.  I've heard that Medela will be including two sizes of flanges in their Pump in Styles soon.

How do you know if you're using the right size?  Medela suggests mothers use the pump and look for several things:

• Is her nipple moving freely in the tunnel?
• Is minimal or no areolar tissue being pulled into the tunnel of the breastshield?
• Does she see a gentle, rhythmical motion in the breast with each cycle of the pump?
• Does she feel the breast emptying all over?
• Is her nipple pain-free?

I'd note that you can't assess whether the nipple is free in the flange without actually watching as you pump, because the nipple often increases significantly in size when you pump.  I have a handy Medela flange fitter (looks like a ruler with cut-out circles), but have found that I misjudge sometimes because the nipple is much smaller when a mom isn't pumping.

Ameda offers a good resource page on this, too, with a couple of pictures to illustrate what it looks like when the flange is too small.

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TSA lets security guards decide how much pumped milk you can take on board.

This is supposed to be an improvement?

You probably recall that in the wake of a foiled liquid bomb plot, the TSA began restricting the amount of liquids passengers could take on board.  This led to stories of mothers having to dump out their pumped milk at the airport, or going to great lengths to freeze, package, and ship milk home.

The TSA website now says that "medications, baby formula and food, breast milk, and juice are allowed in reasonable quantities exceeding three ounces."

The New York Times reports that the current TSA rules on how much breastmilk a mother can bring on board were designed to be "purposely unspecific to give the security officer discretion" in determining how much pumped milk mothers can bring on board. 

The Times reports:

Caren Begun, a public relations executive in Jersey City who had a baby last year, said the lack of specificity made it difficult for her to figure out what to do. “On the Web site, they say you can travel with reasonable quantities of breast milk, but what does that mean?” Ms. Begun asked. “How much milk can I bring on board? What about ice packs? Will I have to taste the milk to show it’s safe? I got a different answer from everyone.”

How can a mother plan her carry-on and checked baggage if she's not sure how the particular guard on duty in her line will define "reasonable quantities?"  I have a feeling that we'll see more stories of milk being dumped into the garbage again.

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January's Carnival of Breastfeeding: Breastfeeding goals.

Welcome to this month's Carnival of Breastfeeding!  This month's theme is breastfeeding goals.  Be sure to check out what other bloggers have to say on this topic at the bottom of this post.

I have a whole lot of breastfeeding goals for this year.  Some of them are:

Finish Spanish for Breastfeeding Support.  Last week my co-author and I finished a final draft of a book which will help breastfeeding support people communicate with mothers in Spanish.  It should be out by this summer, and I'm very excited to have reached this stage.  I'm setting up a website for the book, which will have a 'how do I say this?' forum, extra exercises, and links to breastfeeding resources in Spanish.  Here are a few audio clips from when we were recording the audio portion.

Recruit mothers for a breastfeeding/biopsy study.  As I've mentioned before, I'm helping Dr. Kathleen Arcaro at the University of Massachusetts recruit mothers for an important study on breast cancer.  If you know of a nursing mother who has recently had, or expecting to have, a biopsy, please ask them to contact me.  I've set up a website for this and other studies using breastmilk.

Distribute pumps to WIC.  As a result of some fundraising, my breastfeeding coalition recently purchased three pumps for area WIC offices.  They'll loan them out to mothers who might not otherwise be able to afford to rent one.

Hold a breastpump training.  My breastfeeding coalition is also planning to hold a training on breastpumps conducted by Medela in March.  Email me if you'd like more information (use link on sidebar).

Get the word out about Massachusetts' new nursing in public law.  I recently had 500 business cards printed with sections of our new law on nursing in public.  Our coalition will distribute them, and I'll be trying to think of other ways to raise awareness of the new law.

Help get pumping rooms set up at the University of Massachusetts, Amherst.  For a while a group has been working on setting up pumping rooms at UMass.  So far there is one, newly designated room, and we're hoping for many more.  A list of other campus lactation programs is here. 

Get trained to accept breastmilk donations.  Our breastfeeding coalition has gotten a freezer set up to accept breastmilk donations (see thrilling picture to the left), and as soon as we get trained in how to operate our 'milk depot,' we'll start to receive and ship approved donors' milk to the Mothers' Milk Bank of New England.

Do more podcasts.  You gave me some great ideas for podcast topics last year, and I'm planning on doing them on tandem nursing, extended breastfeeding, sexual abuse and breastfeeding, and breastfeeding and African American moms.

And finally, cut back a little!  I'll be turning over the leadership of our coalition, as well as the responsibility of the newsletter for the Mothers' Milk Bank of New England.  Here's the current newsletter.

Check out these posts from other bloggers participating in this months' carnival (updated throughout the day):

• Zen Mommy's 2009 breastfeeding resolutions
• Secrets of Orual's breastfeeding goals
  
• Hobo Mama's breastfeeding resolutions
• Breastfeeding 1-2-3 on the goal of exclusive breastfeeding for the first six months
  
• Blacktating's breastfeeding goals
  
• Milk Act's breastfeeding goals
• Beautiful Letdown's breastfeeding goals
• Mama Knows Breast's breastfeeding goals
  
• Breastfeeding Mums breastfeeding goals
  

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The New Yorker asks: "If breast is best, why are mothers bottling their milk?"

The New Yorker magazine has a sprawling and provocative article this week by Harvard historian Jill Lepore, which raises the question: "If breast is best, why are women bottling their milk?"

The article's premise is that as more women pump, and has pumping technology has improved, we are entering uncharted territory in which breastmilk is increasingly an entity apart from the mothers who produce it.  We don't know what we think about it.  Is it good? Dangerous? As good as breastfeeding?  The article concludes:

Pumps can be handy; they’re also a handy way to avoid privately agonizing and publicly unpalatable questions: is it the mother, or her milk, that matters more to the baby? Gadgets are one of the few ways to “promote breast-feeding” while avoiding harder—and divisive and more stubborn—social and economic issues. Is milk medicine? Is suckling love? Taxonomical questions are tricky. Meanwhile, mamma ex machina. Medela’s newest models offer breakthrough “2-Phase Expression” technology: phase one “simulates the baby’s initial rapid suckling to initiate faster milk flow”; phase two “simulates the baby’s slower, deeper suckling for maximum milk flow in less time.” These newest machines, the company promises, “work less like a pump and more like a baby.” More like a baby? Holy cow. We are become our own wet nurses.

A good part of the article is a walk through infant feeding history, and at times it felt more to me like an inventory than an argument, but it's worth reading if you're into this stuff.  You know you are.  I particularly liked this parenthetical comment:  "A brief history of food: when the rich eat white bread and buy formula, the poor eat brown bread and breast-feed; then they trade places."

Here are a few sprawling observations of my own about this topic:

It's hard to argue against the idea that we as as a society are confused about breastfeeding, but I don't think that mothers spend too much time futzing around with questions of process vs. product.  Why do women pump?  Mostly because they have to.  For most women, the story looks like this:  "I want to breastfeed my baby.  Uh oh, I have to go back to work.  Hey, there's a pump company that says I can still give my baby breastmilk.  I'll try that.  Well, this isn't very fun.  Is that door really locked?"

Of course this necessity is a result of a national choice.  We lug pumps to work and through TSA security lines largely because our maternity leave policies compare miserably to the rest of the world, as the author recognizes.  And some women don't get a chance to choose at all.  Pumping has become the "privilege" of those of us with white collar jobs.  

Yes, it's all new turf in a way, but we've really been in uncharted territory since the Industrial Revolution - the first time that large numbers of babies spent infancy separated from their mothers.  That's when infant feeding began to change, out of necessity.  Next stop Pump in Style.

Which, by the way, is only a little more than ten years old.  I'm often amazed that pumping at work has become such a 'normal' concept in such a short time.  And I think that the assumption that it's possible sets many women up for a nasty surprise.  Our bodies haven't had thousands of years to evolve to respond to a plastic baby, and it doesn't always work the way we want it to.

From the outside, it probably does look as if we've gone nuts.  We make milk, but we use an machine to take it out, and then we put it into the baby with a piece of plastic.  But this is not something we really want to do.  I've never met a mother who liked to pump.  Most women hate it, and the best it gets is grudging acceptance.  I pumped at work and the best I can say about it is that I liked that I could take the phone off the hook a few times a day. 

Of course, there are other reasons why mothers pump.  Sometimes babies don't latch.  Sometimes there is an experience of pain which pushes mothers to pump (that's when you want breastfeeding and breastmilk to be different entities).  Sometimes women just choose it.  And then there's the often overlooked cause: prior sexual abuse.  Abuse survivors sometimes find the control and more impersonal nature of the pump makes producing milk bearable.  For these women, the machine is a bit of a miracle.

Here's the thing that makes me nervous.  As breastmilk-not-in-the-usual-packaging becomes an increasingly common sight, and as increasing numbers mothers believe (due to advertising) that formula is as good as breastmilk, and as cows are engineered to produce human milk components, where does that leave breasts? Besides billboards.

And now for your thoughts.

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Top ten breastfeeding stories of 2008.

Here's my summary of breastfeeding news from 2008.  In case you're feeling nostalgic, here are the year-end summaries for 2007 and 2006.  Happy new year, everyone!

Goodbye to two revolutionaries who wore pearls.  Edwina Froelich and Betty Wagner Spandikow, two of the seven founding members of La Leche League, passed away in 2008.  They leave behind a legacy of thousands of La Leche League groups around the globe, and a culture in the U.S. which is far more accepting of breastfeeding.  Generations of women and babies owe them a great debt of graditude.  Want to learn more about the founders? Check out this video and this book.

Facebook hears it from nursing moms.  Membership in the "Hey, Facebook, breastfeeding is not obscene!" Facebook group grew to 70,000 after mothers decided to launch an online protest over Facebook's policy of removing some breastfeeding photos.  Thousands of pictures were posted on December 27th, and as of this writing there is still a lot of press on this issue.

Breastfeeding is in.  Breastfeeding initiation rates hit a 20 year high of 77%, according to the CDC, with particular gains among African American moms.  Duration and exclusivity are another story, but all in all it's news to celebrate. 

Unfortunately, so is  the melamine.  Melamine found in Chinese infant formula sickened thousands and resulted in a few fatalities.  It also demonstrated a trend away from breastfeeding in China that mirrors what happened in the U.S. in the 19th century.  Trace amounts of melamine were also found in U.S. formula, prompting calls for improved regulation and the establishment of safety standards. 

BPA is on its way out.  Major retailers like Walmart began pulling bottles with BPA after the Canadian government banned them and the National Institutes of Health expressed "some concern" over the component of some plastics.  Bottle manufacturers finally began following suit, replacing their bottles with BPA-free alternatives.

New laws protect nursing moms.  Mothers in Vermont, Indiana, Colorado, and the Navajo Nation got workplace pumping laws, Rhode Island moms got a nursing in public law, and Massachusetts is on the verge of (finally) of adopting one, too.  The Vermont Human Rights Commission found that Freedom Airlines violated state law when forcing Emily Gillette off of a plane in 2006.  The first fine assessed for a violation of a pumping law was made in June in California.  In a strange case, a woman was sentenced to a night in jail for refusing to serve jury duty while breastfeeding. 

Research continues to show how breastfeeding protects mothers and babies.   More studies released this year demonstrate the power of breastfeeding to prevent cancer, asthma, metabolic syndrome, infections, and many other serious conditions.  Read more about this year's research here.

But our health care system still doesn't get it.  This year brought some discouraging news about our health care system:  hospitals are not doing basic things to support breastfeeding, pediatricians are less supportive of breastfeeding than they were ten years ago, only 8% of women deliver in hospitals that have policies proven to increase breastfeeding success, pharmacists give bad medication advice to nursing women, and OB textbooks contain outdated information.  Not a lot to celebrate here. 

Disasters in China and Burma highlight the importance of breastfeeding in emergencies. The China and Burma tragedies underscored the importance of breastfeeding during emergencies, when water can become contaminated and conditions are unsanitary.  A new heroine was born from the rubble of the major earthquakes that hit China this year - a policewoman who kept nine babies alive by nursing them.

More celebrities breastfeed.  The most famous, of course, was Angelina Jolie, whose cover image nursing one of her twins got the most attention.  But there were many others who talked about breastfeeding their famous babies, including Salma Hayek, Jessica Alba, Christina Aguilera, and many others.  Read more about them in Kelly's round-up.  

There's more, of course - PETA's silly suggestion, and the Vatican urging more images of a nursing Madonna.  Do you have any other stories to nominate?

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