The Motherwear Breastfeeding Blog

Pain from your c-section, long after the birth? Check out my new podcast.

A few years ago I was helping a mom with breastfeeding, and we started talking about her birth.  She said, "You know, no one tells you all the things you can do to help your scar heal well after you have a c-section."

I nodded sympathetically and said, "yeah," but what I was really thinking was, "What?  I had a c-section and I have no idea what she's talking about!  What the heck can you do?"

I recently became a member of the International Cesarean Awareness Network (ICAN), and one of the first things I did was watch a webinar they hosted on caring for the c-section incision area.  I really enjoyed it was able to arrange to interview, for Motherlove Herbal Company, the woman who did the presentation, a New York physical therapist named Isa Herrera who is the author of Ending Female Pain: A Woman's Guide.

In the interview Isa said that some women have pain, numbness and other complaints from their scar for years after their births, and that in some countries in Europe women are automatically referred for physical therapy as part of their recovery.

You can listen to the podcast interview on the Motherlove Blog, or at their free iTunes store. 

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No breastfeeding because of the rotavirus vaccine? President of the Academy of Breastfeeding Medicine responds.

You may have seen on other blogs or on Facebook that CDC scientists recently authored a study suggesting that mothers stop breastfeeding to make the rotavirus vaccine more effective (other people's characterization, not mine).  I overheard it being discussed at a mom's group last week. 

Fortunately, the president of the Academy of Breastfeeding Medicine, the organization representing physicians knowledgeable about breastfeeding, posted a response on the organization's blog. Thanks to Best for Babes for the tip!

It's a complicated issue and I'll leave it to the post to explain it all, but the bottom line is:  Don't panic, don't stop breastfeeding, don't storm the CDC headquarters in Atlanta.  In short, as this war-time parody poster says, Keep Calm and Nurse On.

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Poll: Where did you birth?

NPR reported last week that the rate of home birth has increased pretty dramatically in the last few years (up 25% between 2004 and 2009).  It's still a very small percentage of the total births, less than 1%, but the increase is still notable.

Why the increase?  NPR identified mothers' concerns about the record high c-section rate and liberal use of interventions as one driver of the increase.  One of my (hospital) midwives suggested that the lack of access to VBAC was driving more moms to birth at home.  And when I interviewed Jennifer Block, the author of Pushed, for a podcast on the Motherlove Blog she attributed part of the increase to the Ricki Lake movie, The Business of Being Born.

In any case, when I heard that piece it occurred to me that, while I've posted many polls, I've never asked you where you birthed.  So below is a poll asking just that.  You can vote more than once if you've had more thanone baby.  Me?  2 hospital births.

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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Can you take pseudoephedrine for a cold while breastfeeding?

I had a yucky cold last week.  I was fine during the day using the usual home remedies, but one night I really wanted to be able to sleep well.  So I looked in our medicine cabinet to see what we had.

Yes, yes, I know that taking a cold medicine doesn't shorten the duration of a cold, but I don't think it's a crime to want some relief from the symptoms, especially when trying to take care of small chidren.

I've always cautioned moms against taking pseudoephedrine while nursing, but I wanted a refresher in the concern about it, and what I could take.  So I consulted Dr. Thomas Hale's Medications and Mothers' Milk, 2010.

(If you want the same information I have in this gem of a book - for free - you can call the Dr. Hale's Infant Risk Center!)

Here's what Dr. Hale says about pseudoephedrine's effect on milk supply: 

In a study of eight lactating women who received a single 60 mg dose of pseudoephedrine, the 24 hour milk production was reduced by 24%...While these results are preliminary, it is apparent that mothers in late-stage lactation may be more sensitive to pseudoephedrine and have greater loss in milk production.

Medications and Mothers' Milk has an appendix devoted to over-the-counter cold remedies, and for each of the many cold medicines which contain pseudoephedrine Dr. Hale has written "Probably safe, may suppress milk supply." 

I should note that nearly all of the cold medicines listed had mulitple ingredients, and there may be other concerns related to those medicines.  For example, for many products Dr. Hale has written "observe for sedation" (in the baby, that is).  In a handful of cases he lists medications as "unsafe."  The vast majority are listed as "probably safe," and two lonely products are listed as "safe." Again, if you have questions or concerns about a medication you want to take, call the Infant Risk Center.

Rumaging through our supplies, I found some cold medicine which had no pseudoephedrine but had phenylephrine (a decongestant).  I checked that, too, and read Dr Hale's assessment:  "Because of pseudoephedrine's effect on milk production, concerns that phenylephrine may supporss milk production [sic], have not been confirmed yet.  There is no evidence that this occurs at all."  He does not list "may suppress milk supply" in the Appendix for products containing this ingredient.

I generally ascribe to the precautionary principle when it comes to these things, but I was pretty desperate for a good night's sleep.  So, I decided to take an informed risk and use the product with phenylephrine, one time.  And it did help make it through the night.  I have a strong milk supply, and I didn't notice any dimunition.

I hope that you all make it through cold season in one piece, and that you take advantage of the Infant Risk Center for medication questions!

* This post is provided for educational purposes only.  Please consult your health care provider for care related to this topic.

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This Martin Luther King Jr. Day, we recall some posts on race, ethnicity, and breastfeeding

I thought today might be a good day to compile a number of posts I've done which address issues of race and ethnicity and breastfeeding.

• First, I have a new post up at Best for Babes today entitled "Is there a 'soft bigotry of low expectations' when it comes to breastfeeding?" (link soon) which explores whether African American mothers receive lower quality care because providers expect them not to breastfeed.

• Here's a popular podcast on African American moms and breastfeeding was an interview I did with Kathi Barber, founder of the African American Breastfeeding Alliance

• Here are two posts I did on "Las Dos," the pattern of supplementation among Latina moms, and the campaign I worked on to reduce that practice:  "My husband, the breastfeeding slogan genius," and "Las Dos."

• Here's a plea I wrote for more diversity among lactation consultants.

• And here's an older post on race and other demographic factors and breastfeeding initiation data, called "Who breastfeeds?" and a more recent one describing an unwelcome result from the data, "Big gaps persist."

• While you offered a lot of different explanations for it, I suggested that race and ethnicity could answer the question: "Why do western moms breastfeed more?"

• Here's a recent post on breastfeeding and ethnicity for Best for Babes, specifically cultural practices related to breastfeeding and how hospitals respond.

• A post reporting on a segment on African American moms and breastfeeding on the NPR program "Tell Me More."

• Finally, here's a post about my book Spanish for Breastfeeding Support and a podcast of the audio portion of the first chapter.

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Is your baby "all business" at night? Thank the melatonin in your milk.

This recent study caught my eye because it might explain why many babies (after the newborn period) are "all business" at night - feeding and then returning to sleep without fuss or an awake period.

Adults secrete melatonin at night, and melatonin has a "hypnotic" effect, according to this study.  Babies don't secrete melatonin, but the milk we make at night does contain it.  So the question this study was investigating was whether the melatonin in our milk could account for better sleep and less colic in breastfed babies compared to formula fed babies.

Here are their conclusions:

Melatonin in human milk showed a clear circadian curve and was unmeasurable in all artificial milks.  Exclusive breastfeeding is associated with reduced irritability/colic and a tendency toward longer nocturnal sleep. Breast milk (nocturnal) consists of substantial melatonin levels, whereas artificial formulas do not. We speculate that melatonin which is supplied to the infant via breast milk plays a role in improving sleep and reducing colic in breast-fed infants compared to formula-fed ones.

I just love that melatonin levels in our milk show a "clear circadian curve."  Another example of how intricate - and beautiful - the design of this system is.

Is your baby "all business" at night?  Perhaps this is why!

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New podcast on Biological Nurturing and Laid-Back Breastfeeding, with Suzanne Colson

I have a new podcast up on the Motherlove Blog, an interview on the revolutionary concept of Biological Nurturing and Laid-Back Breastfeeding, with Suzanne Colson.  

Suzanne is the author of An Introduction to Biological Nurturing and the DVD Biological Nurturing: Laid-Back Breastfeeding for Mothers.

We discussed the concept of Biological Nurturing, the primitive neonatal reflexes she has identified, why babies sometimes fight or “box” the breast when feeding in traditionally-taught breastfeeding holds, and why she believes babies are “front feeders” and not “dorsal feeders.”

*One note:  This interview was recorded in the busy hallway at a breastfeeding conference, and as a result the audio is not up to my usual standard.  Hope you enjoy it anyway!

You can listen to the podcast at the Motherlove Blog, or download it through Motherlove's free iTunes store.

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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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2011 in breastfeeding research. And there was a lot of it!

There was a lot of breastfeeding research to report in 2011.  My summary is below.  You can see past annual research summaries for past here:  2009, 2008, 2007, 2006

Studies on babies:

Researchers in Denmark found an association between breastfeeding and lowered risk of epilepsy. The longer babies were breastfed, the greater the protection, and exclusive breastfeeding was also associated with increased protection.

A meta-analysis on SIDS and breastfeeding found that the rate of SIDS was 60 percent lower among infants who had any amount of breastfeeding compared to those who were not breastfed and more than 70 percent lower in infants that been breastfed exclusively for any period of time.

A study published in Pediatrics found that breastfeeding was associated with higher academic achievement in boys, but not girls.  The authors found that predominant breastfeeding for six months or longer was associated with increased math, reading, writing, and spelling scores for boys.

Another breastfeeding/intelligence study found that longer duration of breastfeeding, as well as higher levels of long chain fatty acids in breastmilk (colostrum), were associated with higher mental and psychomotor development at 14 months.

A study found that your children of mothers who had gestational diabetes are less likely to become obese if they are breastfed.

A study in the Journal of Nutrition found that babies who were breastfed had greater leg strength as adolescents. 

Another study found that breastfeeding protects against asthma.

Ear infections are on a steep decline, and increasing breastfeeding rates could be one of the reasons why.

Breastfeeding associated with stronger cardiovascular health at age five.  Strangely, breastfeeding for less than three months or more than six months showed no effect.

Breastfeeding appears to program infants' metabolism.  Breastfed infants in this study had a distinct growth pattern and metabolic profile than formula fed infants.  These differences faded by age three, though blood pressure remained lower in breastfed children.

Breastfeeding is associated with fewer behavioral problems at age five.  They're less likely, according to this study, to lie, steal, be anxious, or hyperactive.

Breastfed children scored higher on math and reading assessments at ages 5, 7, 11, and 14.  Interestingly, breastfeeding for as little as four weeks seemed to have an effect.

Studies on breastfeeding itself:

Two studies (here and here) found that receiving IV fluid during labor can inflate a babies' birth weights, making it appear that they are losing an excessive amount of weight in the first few days, as they shed this fluid. 

A randomized, blinded, controlled study on tongue tie found that fretonomy (clipping the frenulum) decreases nipple pain.  The researchers had intended to determine if it also increases the duration of breastfeeding, but nearly all of the mothers in the "no-clipping" group ended up chosing to have the procedure done, so they couldn't compare!

The U.K. showed a big jump in breastfeeding rates.  One of you suggested that this may have to do with increases in immigration from countries where breastfeeding rates are higher.  Demographics as destiny, again!

Six months of exclusive breastfeeding is just fine for babies, another study found.  This study found that milk supplies were perfectly adequate - in fact, higher than the literature previously reported - and that when moms are well supported, babies gain just fine.

Formula discharge bags are on the decline, a study found.  The percentage of hospitals refusing to distribute the bags in 10 surveyed states doubled (from 14% to 28%) between 2007 and 2010.

A study in Pediatrics found that babies who are fussier get solids earlier than babies who are not.  Babies who were viewed as fussy by their mothers were almost twice as likely to get solids.  In the sample of mothers in the WIC program in North Carolina, "nearly 20 percent of 1-month-olds were fed solid foods or juice. By three months, 70 percent of the children were eating something in addition to milk or formula."

A study from St. Jude's Children's Hospital concludes that childhood cancer survivors should be advised to breastfeed because it breastfeeding has “the potential to influence positively bone mineral density, metabolic syndrome risk factors, cardiovascular disease and secondary tumors - conditions negatively affected by childhood cancer.”

Studies on mothers:

A study from the American Society of Plastic Surgeons found that mothers who have had breast implant surgery and who believe that breastfeeding will cause their breasts to sag are far less likely to succeed with breastfeeding than those who don't hold this belief.  The authors note that "although breasts sag more with each pregnancy, breast-feeding doesn't seem to worsen these effects in women with or without breast implants."

In the first study to show differences in brain activity among moms feeding formula or breastmilk, a study found that breastfeeding mothers showed greater responses to their infant's cry in brain regions related to caregiving behavior and empathy than mothers who relied upon formula as the baby's main food source.

A study found that breastfeeding problems are associated with postpartum depression.  Of note, research has also shown that breastfeeding - when it's going well - is protective against postpartum depression.

Longer breastfeeding duration is associated with higher levels of ghrelin and pancreatic peptide YY at three years postpartum.  This is protective against metabolic syndrome.  This research adds to Dr. Alison's Steube's work drawing connections between breastfeeding and lowered risk of heart disease and metabolic syndrome. 

Few babies in childcare receive pumped milk.  The study pointed to lack of overnight storage of breastmilk as one factor.  They did find a high rate of comfort with the idea among the providers surveyed.

A study found that breastfeeding does not protect mothers against multiple sclerosis relapse.  I found this really disappointing, as prior research had been suggesting the opposite.

Low levels of oxytocin in late pregnancy is linked to higher risk for postpartum depression.  Oxytocin is a key hormone of lactation, so it's not a huge leap to suggest that this is one reason why breastfeeding lowers the risk of postpartum depression.

In a novel set of studies, nursing mothers were viewed as less competent and less likely to be hired than other women.

A study found that mothers who have longer maternity leave initiate breastfeeding at higher rates, and breastfeed longer.

And, finally, a few eyebrow-raising studies:

A study showed that nursing mothers do have a "mama bear" instinct while breastfeeding (see picture of bear in my yard!)

Birds can "lactate," too.  The study analyzed the genes and proteins of the "milk" of pigeons, flamingoes, and male emperor penguins, produce a "milk" with antibodies and fats which serve the same function as mammalian colostrum. These three species are the only ones known to produce this "milk."

An analysis showed that the longer a species nurses its young, the larger brains they have. 

Stem cells in breastmilk can be "programmed" into other cell types. 

The researchers who discovered HAMLET (Human Alphalactalbumin Made Lethal to Tumors) have succeeded in mapping how it kills tumor cells.  HAMLET has been shown to kill over 40 different types of cancer cells, including tumors in the lungs, kidneys, prostate, ovaries and bowel.  The Lund group believes that the protein complex is not formed until the milk is in the baby’s stomach.

A study of 18th and 19th century bones demonstrated the value of breastfeeding in protecting infants.

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