The Motherwear Breastfeeding Blog

New WIC breastfeeding package rewards exclusive breastfeeding

I'm pleased to share a guest post today by Rachel Colchamiro, Director of Nutrition Services, and Breastfeeding Coordinator for the state of Massachusetts. 

I asked Rachel to write about the new package of benefits for breastfeeding moms participating in the WIC, the Supplemental Nutrition Program for Women, Infants and Children.

As you'll see, some recent changes make it especially beneficial to breastfeed exclusively.

This past October, WIC programs across the country rolled out the first major changes to WIC foods in 34 years! 

The changes are exciting.  Families can now receive fruits, vegetables, whole grains and baby food as well as stronger support for breastfeeding. 

From the wonderful feelings that nursing brings—to the long list of illnesses that breastfeeding protects against for both infants and their mothers—nothing compares to breastfeeding.  WIC knows that breastfeeding is the best choice for most families.

To get breastfeeding off to the best possible start, the new WIC food package strongly encourages exclusive breastfeeding.   Since giving formula in the early weeks may prevent mothers from making enough breast milk, WIC helps protect a mother’s milk supply by not offering formula to breastfed babies in the first month of life. 

In turn, fully breastfeeding mothers receive a greater variety and amount of foods than anyone else participating in the program.  Fully breastfed infants receive more than twice the amount of baby foods than formula-fed babies from six months of age until their first birthday.  Throughout an infant’s first year of life, the new WIC benefits are greater for women who choose to offer their babies more breastmilk than formula.

WIC is so much more than a food program.  Families receiving WIC benefits receive nutrition education, health assessment and referrals in addition to their checks for healthy foods.  During pregnancy and after babies are born, WIC offers a wide variety of free breastfeeding services.  Families can always come to WIC with questions about feeding babies and for breastfeeding support.  Many WIC programs offer mother-to-mother breastfeeding peer counseling and some even provide access to breast pumps. 

For more information about the WIC program and the new food packages, please call 1-800-WIC-1007 or visit the national WIC website.

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Breastmilk donations for Haiti not being used.

Reflecting the chaotic environment for aid in earthquake devastated Haiti, the urgent call for breastmilk donations issued by a number of organizations last week appears to no longer be valid. 

Late last week the several health agencies issued a statement calling for a halt to the breastmilk shipments being sent to Haiti, and a Navy spokesman indicated that milk sent for use aboard the USS Comfort hasn't been used.  

Time Magazine reports:

Through a complicated chain of communication involving various members of Congress, the U.S. Department of Health and Human Services and breast-feeding organizations galore, the Human Milk Banking Association of North America (HMBANA) dispatched two coolers' worth of donated breast milk to Haitian preemies being cared for on the U.S.S. Comfort, the floating hospital anchored near Port-au-Prince. "The fact that there is a doctor on board this ship who understands the importance of breast milk is just amazing," says Amanda Nickerson, executive director of the International Breast Milk Project, which arranged the shipment of 140 3-oz. bottles of milk. Quick International Courier, a New York City–based firm that specializes in out-of-the-ordinary cargo, handled as a pro bono matter the delivery, which involved dry ice and rapid-fire transfers between Southwest Airlines, a charter flight and finally a military helicopter.

The HMBANA cargo supplements what is likely the world's only nautical milk bank. When one of the pediatricians on board the Comfort, Dr. Erika Beard Irvine, realized that she had only three cases of formula upon arrival, she connected with breast-feeding Navy moms who had deployed and didn't know what to do with their breast milk. Beard Irvine is storing their pumped milk in the ship's freezers and feeding it to the babies under her care, including one preemie born on board.

...In the U.S., milk banks rigorously screen donors, then pasteurize, process and freeze their milk before distribution. When it's shipped to sick babies across the country, it's nestled in dry ice. Unrefrigerated, breast milk — like cow's milk — turns rancid.

That's why the World Health Organization, UNICEF and the United Nations World Food Programme issued a joint statement Jan. 21 that the necessary infrastructure isn't yet in place to utilize donated breast milk on the Haitian mainland.

MSNBC reports:

But the staff on the U.S. Navy ship [Comfort] said they haven't used the milk out of concerns raised by OFDA and other agencies. Mothers aboard the Comfort are urged to nurse their own babies and there’s infant formula available to children whose mothers cannot or will not breast-feed, said Lt. David Shark, a U.S. Navy spokesman.

I understand why it doesn't make sense to send donor milk to the mainland at this point, but I'm a little confused about why donations sent to the Comfort can't be used.  The babies aboard the Comfort must be at at least a high a risk of potentially fatal complications like necrotizing enterocolitis as babies in the U.S. (see this video on how breastmilk prevents it, and this post on the cost of treating a case).  Then again, maybe I shouldn't be too surprised.  There are plenty of U.S. hospitals that don't use donor milk in the NICUs, and an emergency is probably a difficult time to convince people of its safety and value.

I also hope that this doesn't put a damper on the resurgence of interest in donor milk banking.  Our milk banks have been experiencing a decline in donations due to H1N1, and they are still needed in many areas to help domestic hospitals care for their premature and critically ill patients.

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Viola Lennon, co-founder of La Leche League, passes away.

Viola Lennon, one of the seven founding members of La Leche League, passed away last week at the age of 86.

Viola was one of the "revolutionaries who wore pearls," who dared to talk about breastfeeding at a time when newspapers wouldn't even print the word breast (hence the name La Leche League) and the medical establishment scoffed at the idea.  Her efforts, like those of the other founders and the thousands of women who followed in her footsteps, was a driving force behind making breastfeeding accepted, valued, and even normal, in the U.S. and around the world.

The Chicago Sun-Times reports in her obituary:

When other women met the co-author of The Womanly Art of Breastfeeding -- soon in an eighth edition -- it wasn't unusual for them to hug her, said her daughter Maureen Lennon Zeeb. At a La Leche conference in Mackinac Island, "This woman literally dropped her bags when she saw my mother and was weeping. She came up to my mother and said, 'You don't know how you changed my life.' People would ask us if we wouldn't mind if they got a picture taken with her. They wanted her autograph."

Though Mrs. Lennon and other founders of the League were rock stars in the world of mothering, they remained humble as they marveled at how their group had grown.

"Every single thing we were advocating then is now standard pediatric practice -- to nurse soon after birth and to nurse frequently, instead of on a rigid schedule," said Mary Lofton, an early member.

In 2007 Edwina Froehlich, another of the founding members, passed away.  For those of you interested in the early days of La Leche League, and the founding members' struggles to support breastfeeding, I'd highly recommend The Revolutionaries Wore Pearls.

And the video below on the founders, which includes a great clip of Princess Grace's speech to the 1971 La Leche League conference, is also great.

Study: Common antidepressants can delay milk coming in

A new study has found an association between the use of some common antidepressant medications and delayed of milk "coming in."  An article on the study reports:

"The breasts are serotonin-regulated glands, meaning the breasts' ability to secrete milk at the right time is closely related to the body's production and regulation of the hormone serotonin," said Nelson Horseman, PhD, of the University of Cincinnati and co-author of the study. "Common antidepressant drugs like fluoxetine, sertraline and paroxetine are known as selective serotonin reuptake inhibitor (SSRI) drugs and while they can affect mood, emotion and sleep they may also impact serotonin regulation in the breast, placing new mothers at greater risk of a delay in the establishment of a full milk supply."

In this study, researchers examined the effects of SSRI drugs on lactation using laboratory studies of human and animal cell lines and genetically modified mice. Furthermore, an observational study evaluated the impact of SSRI drugs on the onset of milk production in postpartum women. In this study of 431 postpartum women, median onset of lactation was 85.8 hours postpartum for the SSRI-treated mothers and 69.1 hours for mothers not treated with SSRI drugs. Researchers commonly define delayed secretory activation as occurring later than 72 hours postpartum.

Note that this study concerns mothers who were taking antidepressants at the time of their babies' births.  I don't think any claims are being made about the use of antidepressants after the onset of full milk production.

As I'm sure you know, delayed milk "coming in" can have some serious consequences, especially if it isn't managed well.  The drill goes something like this:  delayed onset of mature milk leads to higher than normal weight loss in the baby, which leads to supplementation, which can lead to compromising of the milk supply and/or nipple preferencing if the supplementation isn't done carefully.  It can also increase the risk of jaundice.

I checked my handy copy of Medications and Mothers' Milk, and there is no mention of this effect in the write ups for fluoxetine (Prozac), sertraline (Paxil), paroxetine (Zoloft).

Obviously, mothers aren't usually on antidepressants in pregnancy unless there is a very good reason for it, so in most cases this probably can't be avoided.  But this new evidence makes me wonder if we shouldn't consider telling mothers (as we should - but usually don't - for other things that can cause a delay, like diabetes), that it might take a little longer for their mature milk to come in.

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Urgent call for breastmilk donations for Haiti.

Here's a press release on breastmilk donations for Haiti, just released from numerous breastfeeding organizations:

URGENT CALL FOR HUMAN MILK DONATIONS FOR HAITI INFANTS

The Human Milk Banking Association of North America (HMBANA), United States Breastfeeding Committee (USBC), International Lactation Consultant Association/United States Lactation Consultant Association (ILCA/USLCA), and La Leche League International (LLLI) are jointly issuing an urgent call for human milk donations for premature infants in Haiti, as well as sick and premature infants in the United States.

This week the first shipment of human milk from mothers in the United States will be shipped to the U.S. Navy Ship “Comfort” stationed outside Haiti. “Comfort” is currently set up with a neonatal intensive care unit and medical personnel to provide urgent care to victims of the earthquake. An International Board Certified Lactation Consultant stationed at the U.S. Navy base in Bethesda, MD is assisting with providing breast pump equipment and supplies to the “Comfort.” Dr. Erika Beard-Irvine, pediatric neonatologist, is on board the “Comfort” to coordinate distribution of the milk to infants in need. HMBANA, USBC, ILCA/USLCA, and LLL are responding to requests to provide milk for both premature infants and at-risk mothers who have recently delivered babies on board the U.S.N.S. Comfort, but an urgent need exists for additional donations.

At the current time, the infrastructure to deliver human milk on land to Haiti infants has not yet been established. As soon as that infrastructure is in place, additional donations will be provided to older infants.

Mothers who are willing to donate human milk should contact their regional Mothers’ Milk Bank of HMBANA. A list of regional milk banks is available at the HMBANA website at www.hmbana.org.

Currently milk banks are already low on donor milk. New milk donations will be used for both Haiti victims as well as to replenish donor supplies to continue to serve sick and premature infants in the U.S. Donor milk provides unique protection for fragile preterm infants. Financial donations are also strongly encouraged to allow HMBANA, a nonprofit organization, to continue serving infants in need.

UNICEF, the World Health Organization, the Emergency Nutrition Network, and medical professionals all recommend that breastfeeding and human milk be used for infants in disasters or emergencies. Human milk is life-saving due to its disease prevention properties. It is safe, clean, and does not depend on water which is often unavailable or contaminated in an emergency. Relief workers, health care providers, and other volunteers are urged to provide support for breastfeeding mothers to enable them to continue breastfeeding, and to assist pregnant and postpartum women in initiating and sustaining breastfeeding.

For more information, contact HMBANA at 408-998-4550 or www.hmbana.org . Additional information can be provided from the United States Breastfeeding Committee at 202-367-1132 (www.usbreastfeeding.org), ILCA/USLCA at 1-800-452-2478 (www.ilca.org  or www.uslca.org ), or La Leche League at 847-519-7730 (www.llli.org).

Three new films related to breastfeeding.

Several films on breastfeeding topics are, or will soon, be out:

One, called Formula Fed America, is directed by Leslie Ott, a mother who struggled with breastfeeding and wanted to explore our culture's attitudes toward breast and formula feeding.  You can see a trailer on the film website.

Another, called Mother's Milk, is an 11 minute film about a mother who loses a baby and discovers breastmilk donation.  You can read more about it here.

The third, already out, is an award-winning Peruvian film called The Milk of Sorrow.  It's described as a film about "a legacy of violence and oppression passed down through breastmilk."  Please be warned that the story concerns violence against women in Peru's recent past.  

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Formula maker to sell human milk product.

So, this is getting really complicated.

Let's start with the product.  Preterm babies who are in the NICU often need "human milk fortifier" in addition to breastmilk, to increase the intake of certain nutrients.  You might think that something called "human milk fortifier" is made of human milk, but it's actually made from cow's milk.  You English teachers can tell me if this is a case of a misplaced modifier.  These fortifiers are currently sold by formula makers, such as Mead Johnson, and Abbot. 

Recently a company called Prolacta Bioscience began making a fortifier that is actually made from human milk.  Prolacta processes donated milk to create a fortifier to use with NICU babies in addition to their own mothers' milk.  Prolacta's website points to a recent study (pdf) showing improved outcomes for babies who receive the human milk fortifier, compared to those who received the non-human milk fortifier.  

Prolacta is a for-profit company.  Women who donate milk processed by Prolacta, or to any milk bank for that matter, are not paid for their milk.  Some donors are recruited through the International Breastmilk Project (IBMP), a non-profit which is best known for sending breastmilk to AIDS orphans in South Africa.  According to the IBMP, 25% of milk they receive is sent abroad, and 75% of the milk remains in the U.S. to be made into Prolacta's human milk fortifier.  Prolacta makes a donation to the IBMP for every ounce donated, and processes and sells the fortifier.  According to the IBMP website, donor mothers are "required to check a box saying that they understood that 75% of donated milk would remain with Prolacta for critically-ill infants in the U.S."  I don't know if they are informed that the fortifier is made by a for-profit company.  More questions and answers about this partnership are on the IBMP website.

So, the recent news is that Abbot Nutrition, a formula company, will be adding the Prolacta fortifier (made with human milk) to their line of products, and will be selling it to NICUs across the country.  The Prolacta website states that this will make their human milk fortifier more available to hospitals and their patients.  It's fair to assume that Abbot will also profit by having this product in their line.  As far as I know, this is the first time a formula company has sold a human milk product.

So, aside from a comment about grammar, I've tried very had to stick to the facts here.  Now you tell me what you think of all this.

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Breastmilk donations for Haiti, and a shortage of donor milk in the U.S.

Many of you are interested in the question of whether or not donor breastmilk can be sent to Haiti.  Here's an update from over the weekend on this question.

The International Breastmilk Project, which ships donor milk to South Africa and other countries, posted this notice on their website: 

We have received an enormous amount of calls from mothers who want to donate their milk to Haiti. Due to the perishable nature of frozen breast milk, we must wait until the infrastructure is in the place to handle a donation.

When will you be donating breast milk to Haiti?
Currently the conditions in Haiti are not such that a donations would be possible, but things are changing each day. Once the infrastructure is in place and and we have a partner there who can distribute the breast milk, then we will do everything possible to arrange a donation.

What can I do to help?
You can donate your breast milk through the Human Milk Bank Association of North America by calling 1-866-998-4550. If we are able to make a donation to Haiti, we want to make sure that the milk supply is available, and currently supply in the US is low. If a donation to Haiti is not possible, then the milk will be used in the United States for babies in the NICU and cases where it is medically necessary.

A Salem, Oregon newspaper reports that a drive is being conducted for breastmilk donations for Haiti through the Adventist Medical Center's donor milk depot.  Prospective donors are being asked to call the Human Milk Banking Association of North America for screening.

Meanwhile, a Denver newspaper reported that the Mother's Milk Bank of Denver has a severe shortage of donor milk, due in part to the H1N1 virus.  I wasn't aware of this, but they report that mothers who have either had or have been vaccinated for H1N1 have to wait for a period of time before they can donate.  This has caused the donor pool to dwindle in recent months, and now their stocks of donor milk are running very low.

Bettina at Best for Babes spoke with Pauline Sakamoto, president of the Human Milk Banking Association of North America, who has been in touch with people running orphanages.  She told Bettina that “people from the orphanage are walking through the rubble and literally picking up orphaned babies off the street.”  Bettina writes that Pauline is "urging relief organizations to especially focus on finding any surviving breastfeeding mothers, and to make them a priority for receiving food, water, and shelter so that they can begin tandem nursing orphaned babies."  Read Bettina's excellent post here.

I don't want to rain on the parade here, but the more I think about sending breastmilk to Haiti the more I think it would have to be planned very, very carefully.  Certainly, for babies who are orphaned and for whom a wet nurse can't be found, donor milk would be lifesaving and should be a top priority.  But here are a few considerations:  First, as the International Breastmilk Project points out, it doesn't make sense to send milk when there is no or unreliable power to keep it refrigerated.  Second, any substitute for a mother's own milk can undermine her milk supply, leaving her less able to feed her own baby when the substitute is gone, so special care would have to be taken to protect mothers' milk supplies.  That's why the saying "feed the mother, support her breastfeeding" is key here.  Fortunately for Haitian babies and mothers, particularly in this emergency, Haiti has a strong breastfeeding culture, and the introduction of bottles and any substitutes for mothers' own milk has to be done in ways that don't undermine that tradition and infant health.

* Photo courtesy of the Human Milk Banking Association of North America.  Want to get email updates from the Motherwear Breastfeeding Blog?  Subscribe here.  Want an RSS feed? Subscribe here.  Want to subscribe to our breastfeeding podcasts on iTunes?  Click here.

World Health Organization says breastfeeding is priority in Haiti earthquake disaster.

The World Health Organization this week issued a press release identifying five urgent health priorities for in earthquake ravaged Haiti.

Among them was "ensuring breastfeeding is continued."

As I've written before, in disaster situations breastfeeding can truly be lifesaving.  From the news I've heard it sounds as if there is a severe shortage of clean water, and this can lead to disease which can quickly become fatal in infants.  In spite of this, there are many persistent myths about breastfeeding in emergencies.

Last year during World Breastfeeding Week, which focused on the role of breastfeeding in emergencies, WHO director Margaret Chan made these comments:

The life-saving role of breastfeeding during emergencies is firmly supported by evidence and guidance...In all situations, the best way of preventing malnutrition and mortality among infants and young children is to ensure that they start breastfeeding within one hour of birth, breastfeed exclusively...until six months of age and continue breastfeeding with appropriate complementary foods up to two years or beyond. Even in emergency situations, the aim should be to create and sustain an environment that encourages frequent breastfeeding for children up to at least two years of age.

Unfortunately, a widespread misconception assumes that stress or inadequate nutrition, commonly seen during emergencies, can compromise a mother’s ability to breastfeed successfully. News stories from devastated areas often include reports of mothers who have given birth and are "not producing enough breast milk". During emergencies, unsolicited or uncontrolled donations of breast-milk substitutes may undermine breastfeeding and should be avoided. Instead, the focus should be on active protection and support of breastfeeding by, for example, establishing safe “corners” for mothers and infants, one-to-one counselling and mother-to-mother support.

I read Mountains Beyond Mountains, about Paul Farmer and his work in Haiti, last year.  I just can't imagine how much misery this earthquake has caused.

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What the rhesus monkey experiments on attachment can tell us about breastfeeding.

PBS has been showing a new series called This Emotional Life recently.  I caught the first episode, which was largely about attachment. 

In this episode they showed some footage from the classic rhesus monkey experiments on attachment, conducted in the 1950's and 60's.  I had read about the experiments but had never seen any video on them, and it was so striking to see the footage.  I've posted a clip (not from the show's website) below.

In these experiments, baby rhesus monkeys were taken from their mothers at birth and raised with no physical contact.  They were then given the choice between two "mothers," a wire mother which had a bottle which could feed the monkey, and a cloth monkey which couldn't feed the monkey but felt soft. 

The monkeys would consistently run to the feeding mother for food, but would spend all of the rest of the time clinging to the cloth mother.  What isn't shown in the clip below is that after being deprived of any real social and physical interaction, they also grew up to be quite emotionally disturbed. 

What can we take from this related to breastfeeding?  A lot, I think.

For me, the message is:  it's not just about the milk.  No doubt you know how special breastmilk is - full of species specific perfectly composed nutrition, immune protection tailored to the pathogens in each mother and baby's environment, and proven to protect against numerous threats to infant and maternal health.  But that's only part of what makes breastfeeding special.  The other part is the nursing relationship - a closeness and means of attachment which occurs when a baby feeds.

I think that this message is valuable to at least two groups of people.  First, for all of the partners who feel frustrated because they're unable to feed their babies (at least before a bottle is introduced, if it is).  The message to them, I think, is that bonding isn't really about food.  Babies bond with people who make them feel secure and loved.  And that's what happens when you walk the halls in the middle of the night, holding your baby.  You don't need to make milk to do that.

I think it's also a message for mothers who can't breastfeed exclusively.  Sometimes I see mothers who have to use a supplemental nursing system - that clunky bottle/tube contraption which allows supplementation at the breast - or who supplement after feedings.  No doubt they've wondered if the whole production is worth it when their babies aren't getting all of their nutrition by feeding at the breast.  I think that the message from these studies is that any time at the breast has value.  Or, as someone recently put it to me, there is such a thing as mothering at the breast.

This isn't meant at all as a dig at women who exclusively pump, and who obviously bond with their babies, too!

Above all, the message I take from these studies is best summed up by British pediatrician Donald Winnicott, who said, "There is no such thing as a baby.  There is a baby and someone."

What do you take from these experiments?