The Motherwear Breastfeeding Blog

Study: Pumping method affects milk composition for preterm infants

Following on their study on milk volume and method of expression, which showed that a combination of pumping and hand expression (a technique termed "hands on pumping") yields more milk for preterm infants, a team at Stanford University School of Medicine has shown that pumping method also affects milk composition.

The study, led by Dr. Jane Morton, found:

The researchers’ findings confirmed that moms [of very preterm infants] who used hands-on pumping had higher fat content in their milk than women relying on electric pumps alone...

“People have suspected that mothers would be able to get more fat-rich milk with hands-on pumping but it’s never been demonstrated before,” said Jane Morton, MD, a community pediatrician who was the new paper’s first author. The suspicion arose because milk composition changes during a feeding, shifting from more-dilute milk at first to richer, higher-fat “hindmilk” at the end. Because of its high fat content, the hindmilk is more viscous, which may explain why it’s difficult to remove this milk with an electric pump alone. But extracting more high-fat hindmilk could give preemies an important calorie boost.

Dr. Morton says that her next research question is whether this higher-fat milk is sufficient to meet preemies' needs without the use of human milk fortifier.  This fortifier, with the exception of the human-milk product made by Prolacta Bioscience, is made from cow's milk.  Cow's milk products have been shown to increase the risk of the life-threatening condition necrotizing enterocolitis.

Another question many moms may have is whether the same applies for full term infants.  Here's a post I wrote on two different methods of hand expression, in case you'd like to conduct an experiment of your own!

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Top 10 breastfeeding stories of 2011.

Here's my summary of the biggest news in breastfeeding in 2011. I think you'll agree that it was a banner year, especially for the elimination of some important barriers to breastfeeding. 

You can read my lists from prior years here: 2010, 2009, 2008, 2007 and 2006.  Feel free to tell me what I've missed!

Surgeon General issues a Call to Action to Support Breastfeeding. Surgeon General Regina Benjamin kicked off the year by issuing a bold statement in support of breastfeeding.  It outlines steps needed to eliminate the barriers that keep so many mothers from reaching their breastfeeding goals, and forms the basis of the administration's policy initiatives in breastfeeding support (see CDC point below).

Target nurse-ins put spotlight on nursing in public.  In the final week of the year, protests were held at an estimated 100+ Target stores after mother-of-four Michelle Hickman was harassed and humiliated at a store in the Houston area.  Target's slow response and inconsistently applied policy of supporting nursing moms in its stores was a contrast to an earlier protest at Whole Foods, which ended in the store welcoming the protesters and establishing a written policy supporting nursing in their stores.

First Lady Michelle Obama promotes breastfeeding.  Could you ask for a higher profile advocate for breastfeeding than First Lady Michelle Obama?  As part of her Let's Move campaign to combat childhood obesity, she announced that she would work to eliminate hospital barriers to breastfeeding by pushing for an increase in the number of Baby Friendly hospitals.  This announcement became fodder for some high profile voices on the right who viewed it as an example of government over-reaching its authority.

Insurance coverage for breastfeeding support and pump rentals now required.  The U.S. Department of Health and Human Services issued regulations requiring that insurance companies cover "Comprehensive lactation support and counseling, by a trained provider during pregnancy and/or in the postpartum period, and costs for renting breastfeeding equipment."  On August 1, 2012, these support services will be offered by insurance, with no co-pay or other cost-sharing.

Breastpumps become tax deductible and eligible for FSA accounts.  Reversing an earlier position, the IRS made breastpumps and related supplies tax deductible, and eligible for purchase using funds in an FSA account.  This is a bit complicated, so I recommend starting by reading this post and comments before assuming that you'll be able to benefit.

The CDC pushes for more Baby Friendly Hospitals.  After noting that U.S. hospitals are "a very long way from where we need to be" in implementing practices known to increase breastfeeding success, the CDC announced a new $6 million initiative to support the certification of more hospitals as Baby Friendly.  We currently have less Baby Friendly hospitals than Ecuador, so this is a welcome effort!

Kaiser announces Baby Friendly push at all hospitals.  Anyone noticing a theme here?  Health care giant Kaiser Permanente, which cares for more moms and babies than any other system in the U.S., announced that all 29 of its hospitals will either become Baby Friendly or be evaluated by their exclusive breastfeeding outcomes by the Joint Commission.  

Formula discharge bags are on the way out.  One of the thorniest issues when it comes to obtaining Baby Friendly status is the issue of the formula company "gift bags" given to most women on discharge from the hospital.  But grass roots organizing as well as government pressure has led to a marked decrease in the number of hospitals giving them out.  A study found a doubling of bag-free hospitals in ten states, and Rhode Island recently made news by became the first state to go completely "bag free."

Donor milk starts to become the standard of care in NICUs, shortages loom.  Modern donor milk banking celebrated its 100th anniversary a few years ago, and I think that this year marked the burgeoning acceptance of donor milk as mainstream therapy in NICUs.  Buoyed by research showing that donor milk can save lives, more and more hospitals are making donor milk the standard of care for preemies born before a certain number of weeks gestation or below a certain birth weight.  And the non-profit milk banks have been a victim of their own success; with demand rising they've seen increasingly frequent shortages.

Online mother-to-mother milk sharing continues to grow.  This was on my top ten list last year, but I thought it deserved to be on this year's list, too.  Milk sharing through the internet has grown dramatically, with the organization Human Milk 4 Human Babies now engaging over 20,000 members in 52 countries.

Mothering Magazine shuts down print publication.  The only magazine I know of that put breastfeeding at the top of its agenda shut down as a print publication this year.  For years, Mothering Magazine was the safe, supportive corner of the media universe for nursing mothers.  While mothering.com is still up and offering content on breastfeeding, birth, and other parenting issues, it's just not the same as receiving the magazine in the mail, or seeing it on the news stand.  

So, all in all, a great year for breastfeeding, wouldn't you say?

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Guest post: Amber's celebrity breastfeeding round-up for 2011

I'm very pleased to share this round-up of celebrity breastfeeding news for 2011, wonderfully written by Amber McCann, lactation consultant, owner of Nourish Breastfeeding Support, and pop culture officionado. 

A special thank you to Kelly, who wrote these round ups for 2007, 2008, 2009,and 2010! 

I am a wife and mother first.  An International Board Certified Lactation Consultant (IBCLC) second.  And absolute lover of all things celebrity/reality TV/famous people third.  Well...actually, there are many other things in my life more important than my "all things celebrity" obsession but I will admit to finding greater joy in a People magazine than in Better Homes and Garden or the New York Times!  It was a great year for stories about breastfeeding among the Hollywood set so let's celebrate the end of the year by looking back at some fantastic moms (and dads!) and their babies.

Victoria Beckham:  One of my very favorite celebrity breastfeeding stories of this past year was about superstar Victoria Beckham and her new daughter, Harper Seven.  After having 3 boys, the Beckhams (Victoria and her mega-athlete husband, David) welcomed their long-awaited daughter and this time, things were different.  Their three sons had been fed formula but Victoria said, "I'm doing everything differently this time.  I want it all to be natural and perfect for my little girl." It is not often that a family that has previously fed formula chooses to breastfeed subsequent children.  Unfortunately, things were not perfect and Victoria suffered from a slipped disk in her back during her daughter's birth.  What would be a challenging situation in normal circumstances is increasingly so when learning to feed with a new baby.  Three cheers for her husband who, as it was widely reported, supported mom and baby by holding up Harper to breastfeed!  Excellent teamwork and a great example of how dads are an important piece of breastfeeding success!  

Miranda Kerr:  Another example of a mama who is proud to breastfeed and let the world know it!  Miranda, a supermodel and one of the faces of Victoria's Secret, and her actor husband Orlando Bloom, welcomed baby Flynn in early January and soon shared a beautiful photograph of an early breastfeeding moment.  She continued to be publicly supportive of breastfeeding moms by publishing several posts about breastfeeding on her Kora Organics blog and famously tweeting about breastfeeding backstage at several fashion shows.

Kourtney Kardashian: Kourtney, one of the Kardashian sisters who are ever present in the reality tv world, has been vocal about breastfeeding her son, Mason.  She blogged about her weaning journey in March of this year.  She said, "When my angel was born and my breasts filled up with milk, we got to work and I was nursing almost every hour at times.  I love it and so did he." With a story like so many mothers, she set a goal of breastfeeding for 6 months and when his 6 month birthday arrived, she decided to nurse for a year.  A year came and went and together, they continued on.  Kourtney also talked about the pressure she received from others to wean and how she and Mason navigated that time.  Kudos to Kourtney and Mason!  She is now pregnant with her second child and I'm looking forward to hearing more about her breastfeeding experience.

Pink: Singer Pink and her motocross-legend husband, Carey Hart, became parents when Willow Sage joined their family in June. She spoke lovingly about her husband's role in their family and famously said, "As long as my boobs are at home at a certain hour, I can do whatever I want."  She is learning to balance motherhood and her career in front of the whole world.

Mariah Carey:  Big thumbs up to Mariah and her husband, Nick Cannon, for breastfeeding their twins, Moroccan and Monroe.  Unfortunately, they fell victim to some less-than-evidence-based advice regarding drinking dark beer as a way to bring in a milk supply quickly.  (For more information about the effect of beer on milk supply, check out this excellent post by Best for Babes and Diana Cassar-Uhl).  But more than that, they fell victim to unethical healthcare workers who not only gave bad advice, but called in Child Protective Services when she followed it.  Now, we don't know exactly how the whole thing went down but, as a fellow mother, I can't imagine the stress and strain an investigation in the first days of parenthood would bring.  My heart goes out to all of them and I want to give them a big thumbs up for doing everything they could do to breastfeed their babies.

Elton John:  Finally, Elton John and his partner, David Furnish are providing donated milk to their new son, Zachary.  In their case, he is receiving milk from their surrogate mother.  While many news outlets trumpeted this as a case of excess and luxury, the increased focus on the role of non-profit milk banks to provide breastmilk for critically ill infants and those in the NICU and mother-to-mother milk sharing this year led to better understanding about the options available for babies who are not with a mother who is able to breastfeed.  High profile celebrities, like Elton John and Neil Patrick Harris last year, are bringing the conversation about donor milk to the masses.  

Of course, these are just 6 great celebrity breastfeeding stories but thankfully, there are many more!  Also check out what Laila Ali, Ali Landry, Kim Zolciak,Tia Mowrey, and Alyssa Milano had to say about their breastfeeding experiences.

2012 is already heating up as a great year for new celebrity babies.  I'm looking forward to see how Beyonce, Hilary Duff, Jessica Simpson, and breastfeeding pros Jennifer Garner and Maggie Gyllenhaal all bring breastfeeding to the forefront of pop culture this year!

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Image credit for all celebrity images:  Wikimedia Commons

Favorite posts from 2011

In case you missed them, here are some of my favorite posts from the Motherwear Breastfeeding Blog in 2011:

A visit to the Mother's Milk Bank of San Jose

"There is no nutritional emergency"

What's in donor milk?

First baby wearing second baby

What did your cankles have to do with your baby's weight loss?

"Booby Traps" in your OB or midwife's office

Breastfeeding and race:  Why we need more lactation consultants of color

Can you "supplement" your baby with Vitamin D by increasing your own levels?

Can you guess which role I had in the Passover play?

Six misconceptions about extended breastfeeding

Cows engineered to produce "human milk," and why Bessie will never, ever replace you

Lactation after Loss: A brochure to support mothers experiencing perinatal loss

Seven reasons why breastfeeding is usually easier the second time around

When the Booby Fairy doesn't arrive:  New podcast on insufficient glandular tissue.

New podcast on Baby-Led Weaning:  Can you really skip the purees? 

How do other mammals nurse?

Joint Commission urges moms to "speak up" to get evidence-based care.  But isn't that their job?

Review and give away:  Breastmilk jewelry

Wikileaks shows U.S. Embassy lobbied against Philippines formula law

Breastfeeding, the second time around

Here's how I know that it can hurt to nurse when you're teething

I can nurse, too

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Milk banks facing "unprecedented" shortage

A while back I interviewed Pauline Sakamoto, director of the Human Milk Banking Association of North America, on the Motherlove Blog.

She talked about the increase in demand for donor milk over the last ten years, and how milk banks sometimes struggle to meet the demand.

But recently, as hospitals have rapidly been changing their policies to make donor milk the standard of care for  preterm babies under certain gestational ages and weights, the rate of increase has become even steeper. 

The result, according to this article on MSNBC, is an "unprecedented" shortage in donor milk:

“For the last four months, everyone has been struggling to find enough milk,” says Pauline Sakamoto, executive director of the Mothers’ Milk Bank in San Jose, Calif. 

Donors are willing, but demand is growing faster than supply. The total supply increases 8 percent to 10 percent every year, Sakamoto says, but “the demand has just outpaced our ability to collect the milk. It’s mainstream medicine now.”

Just last year, the banks had enough milk to supply babies who weren’t even in the hospital, such as infants whose mothers had a double mastectomy or the full-term babies who couldn't keep formula down but whose mothers couldn't breastfeed, says Sakamoto, herself a former donor. “I can’t serve them anymore. And as a nurse and as a mom, I can’t handle that.”

With regard to mother-to-mother milk sharing, the donor milk banks are urging qualified moms to consider milk banks:

Many informal milk-sharing website have sprung up in recent years, but both Updergrove and Sakamoto urge women to consider donating to the nonprofit milk banks instead, because they prioritize the highest-need cases. For a healthy full-term infant, Updergrove points out, an extra 200 ounces of milk represents only about eight meals. For that struggling preemie, it means so much more, she said: “You could save a lot of lives by donating your milk to the milk bank.”

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A final goodbye to my donor milk, at the new Mothers' Milk Bank of New England

On Monday I dropped off the last of my milk donation to the new Mothers' Milk Bank of New England. 

I got to see the new lab, pasteurization machine, and office, and chat with Naomi, the Executive Director, and Andrea, donor coordinator. The milk bank just recently processed its first milk. 

It's taken a lot of effort over a number of years to get to this point (long time readers of this blog will remember the Idea Blob contest), and it was such a pleasure to see it come to fruition.

Below, some pictures of the visit:

250 ounces of milk in the cooler at our home, a two hour drive from the milk bank.

We arrive at the milk bank and immediately lose a shoe.

The milk gets checked in and weighed, then...

is put in a big freezer.

There's a little play space for kids who must wait, complete with Mr. Potato Head.

Naomi Bar-Yam, Executive Director, shows me the containers for the final product.

D is for Dispensable Milk, or DDD?

Naomi and us before we get on the road. 

And it turns out that there is a playground behind the milk bank building, where my daugther has her very first swing experience.  Think she liked it?

We had a peaceful ride home.

Video: Donor and recipient moms from the Mothers' Milk Bank of Ohio

My daughter turns one next week, so I'm nearing the end of my term as a milk donor.  I thought this video was a nice reminder of why I've been donating.

I had planned to donate to the Mothers' Milk Bank of Ohio, but their minimum donation amount was 200 ounces, and I was worried that I might not be able to pump that much.  So I donated to the Mothers' Milk Bank of North Texas. 

As it turns out, I had a whole lot more than 200 ounces to donate.  I should reach 11 gallons by my daughter's birthday.

Profile of me as a milk donor

There's a cute profile of me as a milk donor up on the Milkies Blog.

It includes this picture of my daugther enduring yet another shipping of milk to the Mothers' Milk Bank of North Texas.

It was nice to be able to explain why I donate, the value of donor milk, and how to become a donor.  Check it out!

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My presentation on milk banking

A few weeks ago I gave a presentation to the physicians at the pediatric office where I work on donor milk banking. 

We're planning to have a donor milk collection station for the Mothers' Milk Bank of New England at this office, and the doctors wanted to learn more about how donor milk banking works.

I thought I'd share it with you, so here it is as a pdf: Donor milk banking presentation  I think it's a good introduction to the topic.

The picture at right is from my visit to the Mothers' Milk Bank of San Jose.

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Photo Friday: Milk donation #4