I was recently playing around with the Environmental Working Group's Skin Deep database, checking to see exactly how bad my shampoo is for me, when I noticed that the database includes information on nipple creams.
Had any of you noticed that, or used the information to decide which one you use (if any)?
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I'm very pleased to share a guest post by Dr. Marianne Neifert, author of Great Expectations: The Essential Guide to Breastfeeding. I had been wanting to write about "late preterm" babies - born between 34 and 36 weeks gestation for a while now. Those of you who have had a baby born at this age know that these babies can pose particular breastfeeding challenges.
I hope that you find this post useful!
Just a Few Weeks Early
Breastfeeding Challenges in Late-Preterm Infants
By Marianne Neifert, M.D.,
Until recently, babies born a few weeks early -- between 34 and 36 weeks gestation -- were referred to as near term infants. However, the designation, near term, implies that an infant is almost term or almost fully mature, and the misnomer has often caused health professionals and parents to underestimate the medical risks in this large, vulnerable population of infants. Recently, the American Academy of Pediatrics has recommended that infants born at 34, 35, or 36 weeks gestation be referred to as late-preterm infants to emphasize that these babies are physiologically immature and have special health care needs compared to full term infants (born between 37 to 41 weeks). In addition, the mothers of late-preterm infants are more likely to have medical complications themselves, such as gestational diabetes, high blood pressure, or C-section delivery.
The Rising Incidence of Late-Preterm Births
The proportion of all U.S. births that are late preterm has increased over the past 15 years. Late-preterm infants now comprise over 9% of all births, and account for more than 70% of all preterm births (<37 weeks gestation), representing nearly 400,000 babies each year. Although the reason for the increase in late-preterm deliveries is not well understood, one explanation is the increased use of fertility treatments, which has lead to a rise in pregnancies with twins and higher multiples. Half of all twins and 90% of all triplets are born preterm. Other possible contributors to the rise in late-preterm births include the rise in cesarean section births (now 30% of all deliveries), the need to deliver some infants early due to medical complications, and more pregnancies occurring among women at an older age. In addition, performing elective labor inductions or elective cesarean sections for no clear medical or obstetrical reason sometimes leads to the unintentional delivery of a late-preterm infant. Both expectant mothers and obstetricians need to know the importance of avoiding late-preterm delivery unless it is medically necessary.
Medical Complications among Late-Preterm Infants
Because many late-preterm babies are the size of infants born at full term, health care professionals may not always give these at-risk infants the special treatment and careful screening they deserve. Instead, hospital personnel and parents tend to treat these apparently healthy infants as if they were developmentally mature. Late-preterm infants have been called imposter babies because many of these "slightly early" newborns masquerade as full-term infants, appearing to need no special care after birth and being discharged as early as term babies. Yet, babies born even a few weeks early have an increased risk of medical complications after birth and may require a longer hospital stay than full-term infants. Late-preterm infants are more likely to develop low blood sugar, severe jaundice, breathing difficulties, and infections; to have difficulty maintaining their body temperature; and to experience feeding problems and excessive weight loss after birth. Late-preterm infants also are more likely to be re-admitted to the hospital in the early weeks of life for medical complications, including newborn jaundice, breastfeeding difficulties, dehydration, and possible infections.
The brain and nervous system are among the last systems to mature during fetal development, and some studies show that late-preterm infants have a higher risk of developmental and behavioral problems compared to full-term babies. Late-preterm infants also have a higher rate of birth defects and an increased risk of sudden infant death syndrome. For all these reasons, late-preterm infants require close monitoring, evaluation, and follow-up after birth.
Breastfeeding Challenges among Late-Preterm Infants
The initiation of successful breastfeeding can be especially challenging for smaller, developmentally immature, late-preterm infants. These babies often have trouble latching on to the breast correctly and may be unable to breastfeed effectively at first because of their lower muscle tone and tendency to tire easily. Inadequate breastfeeding increases a newborn's risk for severe jaundice and excessive weight loss.
Continue reading "Guest post: Was your baby an "impostor?"" »
Some of you - you know who you are - have been reading this blog since the beginning, and some of you are new to it.
For everyone, but especially to those of you who are new to the blog, I thought I'd list some of my favorite posts from the nearly 700 I've posted since September of 2006:
From 2006-2007:
From 2007-2008:
From 2008-2009:
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Dr. Mindi Palmer Fried
is a mother of two and a family wellness chiropractor with an office in Easthampton, Massachusetts. She specializes in the care of pregnant
women, infants, and children of all ages.
She is board certified by the Academy Counsel on Chiropractic Pediatrics
(CACCP).
Many people react with shock and horror at the idea of
taking an infant to see a chiropractor.
And most folks don’t see a link at all between chiropractic and
breastfeeding. I’d like to address those
concerns in this post.
I’d like to start with two premises that are central to chiropractic:
First, the nervous system is the master system of our bodies – it controls and coordinates the function of every organ, tissue and cell in your body. Without the nervous system, our bodies are just organic blobs.
Second, our bodies are self healing and self regulating as long as there is no interference. Our bodies are designed to be healthy and work properly We don’t have to teach our bodies how to heal from a cut – we don’t even have to put a bandage on it – our bodies clot, repair and renew themselves totally on their own.
Stress comes in many forms, but can be narrowed down to three general categories: Physical, chemical and emotional. Physical stress happens when we fall down, get in a car accident, sit in an uncomfortable chair, always carry a 10 pound purse on one shoulder – things that happen to your physical body are physical stressors. Chemical stressors are things that we take in – through our mouths like caffeine, drugs, fast food, and trans-fats, through our lungs like environmental pollutants, and through our skin – like the chemicals in the skin “care” products we use. Emotional stressors can be work, relationships, death of a loved one, and can also be internal – how you talk to yourself. (A good guideline – if you wouldn’t talk to your loved one the way you talk to yourself, you need to rethink your self talk!).
I can hear you say – “What does this have to do with babies? Babies don’t get stressed!” Sure, maybe they aren’t at work with a screaming boss, but they’ve just been through a very intensely stressful experience called birth – remember that? Even the most natural childbirth can be traumatic, and for that reason, I recommend that EVERY baby, regardless of symptoms, be checked out by a chiropractor that is trained to see babies.
Birth can place a special stress on the upper neck, especially in instances where there are interventions used to help get the baby out like forceps or vacuum, and even when it’s just a practitioner using the baby’s head as a lever to help get the rest of the body delivered. (Although most babies who have been delivered by c-section have the “perfect head” because they haven’t been squeezed through the birth canal, they often have more issues because they are pulled from the womb without the benefit of the propulsive forces called contractions pushing them out.) These stresses can cause a subluxation in the baby’s upper neck, which can have a very close relationship with the process of breastfeeding. When the joints in the upper neck aren’t working the way they should, a baby may have difficulty opening his mouth very wide or turning her head to one side or the other. Some specific symptoms to look for that would indicate subluxation include latching well on one side but not on the other, a weak suck, difficulty opening the mouth wide enough to latch, Mom complaining of pain with a latch that appears normal (especially if it’s only on one side), and Mom noticing that one breast isn’t getting emptied as well as the other.
Of course, breastfeeding involves more than just the baby – don’t forget about you when it comes to chiropractic care. Not only can chiropractic help with the changes from all the stressors that she experienced while pregnant and with delivery. A study was published in 2007 about chiropractic care helping mothers with low milk supply produce more milk. Given the premises I mentioned earlier – this makes perfect sense. Chiropractic care was simply removing the interference that was not allowing these women’s bodies to produce the milk they needed. Again, the nervous system is in charge here - it sends the messages to the brain to release prolactin and oxytocin, the hormones you need to produce and let down milk.
A chiropractor who has had special training on working with
babies will know exactly how to adapt their care to fit the tiny body of the
infant. An adjustment (what we
chiropractors call the correction for a subluxation) is often given with just a
pinky fingertip, and so slight that it is imperceptible to most folks seeing
it. A good place to find a chiropractor
who has been trained to work with babies is the International Chiropractic
Pediatric Association website – www.ICPA4Kids.org. There is a doctor locator button on the main
page there.
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Dr. Alison Steube, whom I interviewed for this podcast on formula gift bags, is co-author of a new study showing that breastfeeding offers some protection against breast cancer for premenopausal women with a family history.
The study, to be published in the Archives of Internal Medicine, found:
"Women who had a first-degree relative with breast cancer had a lower risk of developing the disease if they had ever breastfed than if they had never breastfed. The association did not appear to change based on duration of breastfeeding, whether breastfeeding was exclusive or whether the woman experienced amenorrhea (absence of menstruation) as a result. There was no association between breastfeeding and breast cancer among women without a family history.
Women who did not breastfeed but used medication to suppress breast milk production also appeared to have a lower risk of breast cancer than women who neither breastfed nor used lactation suppression. This association could be related to disordered involution, or a malfunction in the process by which mammary tissue returns to its pre-pregnant state caused by engorgement and inflammation, the authors note."
More posts on breast cancer and breastfeeding are here. More on this study is here at the New York Times.
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So, in this post I'm going to wade into a topic* against my better judgment and the advice of my husband.
I didn't want to write about this because 1) I know next to nothing about autism, and 2) sometimes if you say "don't worry" people respond by thinking, "What?!? There's something to worry about?!?" So you are hereby ordered to take a deep breath before reading the rest of this post.
Here's the issue: Recently there has been a lot of online discussion about breastfeeding and autism. This discussion was prompted by a two-year old article on the UCSF website, which discusses a rat study that suggests a link between high levels of PCBs in milk and neuro-developmental disorders like autism.
Here are the points I'd like to make:
1) Research to date suggests an inverse relationship between breastfeeding and autism. Let's get something straight before proceeding - I am not, not, not suggesting that formula feeding causes autism. Got that? I am going to present the findings of the very few studies that have looked at feeding method and autism incidence, so that you can clearly see that the research to date hasn't borne the idea of a causal link between breastfeeding and autism out at all. Here they are: This study, based on parent surveys, found an association between breastfeeding (and also DHA/ARA supplemented formula) and lowered risk of autism. This study on casomorphins found an inverse relationship between breastfeeding and a risk factor for psychomotor delays and other diseases such as autism. This older study on weaning and autism found an inverse relationship between breastfeeding and autism incidence. This analysis of three studies in which babies with higher levels of dioxin exposure through breastmilk than exist today were measured in terms of health and developmental outcomes. It found that breastfed babies had better mental development than formula fed babies.
2) Formula has PCBs and other pollutants, too. Sometimes I think that this issue gets framed in terms of "toxins or no toxins," but the truth is that your choice is between breastmilk which contains pollutants and formula which contains pollutants. Dr. Kathleen Arcaro, environmental toxicologist at the University of Massachusetts said in an interview for this blog that "pollutants are widely distributed [i.e. in the air, in water] and therefore are in cow’s milk and formula." Some pollutants, like PAH, are found in higher amounts in formula than in breastmilk. Viewed this way, why wouldn't you choose the food which delivers many other health and developmental advantages for both of you?
3) Levels of PCBs in breastmilk are going down. Dr. Arcaro noted in the same interview that "the good news is that the concentration of some lipophilic (fat-loving) environmental pollutants in breast milk is decreasing. For instance the level of many pesticides (DDT and its metabolites) and polychlorinated biphenyls (PCBs) has greatly decreased over the last 30 years." PDBE levels have increased, but some states have started to ban their use.
4) Rats are not humans. Enough said.
For more, check out these past posts on toxins and breastfeeding and formula.
We should all be concerned about toxins in breastmilk. And we should all be conerened about autism. But let's not jump to the conclusion that one causes the other.
*Many thanks to Heather, creator of Hathor the Cowgodess, who currently draws and blogs at mama-is.com, for the use of her drawing in this post. My podcast interview with her is my favorite one - check it out!
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Whenever anyone asks me about nipple piercings affecting breastfeeding, I tell them that it doesn't - and that they should take the ring or post out before nursing!
But a recent study has me re-thinking this a little bit.
A study from Australia reported on:
The women, ranging in age from 25 to 37, produced minimal amounts of milk from their pierced breasts despite frequent breast pumping and help from a lactation consultant. The medical team at the University of Western Australia used ultrasound to study mammary blood flow, breast anatomy and milk ejection in the women.
Researchers concluded that the most likely explanation was that the piercings caused milk duct obstructions, although only one blockage stood out in ultrasound images. That patient had obvious scarring from accidental tear-out of a nipple ring. Another patient had had an allergic reaction to her piercing. The third had no previous complications.
They conclude: “These cases indicate that nipple piercing may cause complications leading to duct obstruction so that only minimal amounts of milk can be removed from the breast during lactation.” They also note that "Women with piercings typically have no trouble breastfeeding, so the risk of lactation complications is probably small."
My advice has reflected La Leche League's conclusion: "There is no evidence to suggest that a woman's pierced nipples will have any effect on her ability to breastfeed." But this study makes me think that these situations may require a little more attention, especially when infection or scarring has occurred.
It does make sense to me that some scarring or severing of milk ducts could occur when the place of piercing is also the terminus of all of the milk ducts, and that that could inhibit milk flow. I also wonder if nerve damage could have occurred, since nerves in the breast are responsible for sending the message to the brain to release the milk-making hormones. That said, I've worked with many moms who had had piercings, and it didn't seem to affect breastfeeding at all.
Have you nursed after piercings? Any experience to share?
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While the importance of breastfeeding to babies' health is widely recognized, the effects on mothers' health is less well known. So, I thought I'd point out some of the ways that breastfeeding protects moms, too.*
Physical health:
Faster weight loss. There's a reason why your body puts on extra weight (that isn't the baby and requisite fluids) during pregnancy. Our extra fat is there to be used as a fuel source for breastfeeding. You can burn up to 500 calories per day just making milk (though the amounts vary by individual), and that's where those stores go.
Shrinking of the uterus after birth. The oxytocin released when a baby nurses contracts the uterus, protecting mothers against postpartum hemorrhage.
Lowered breast cancer and ovarian cancer risk. As discussed in more detail in this interview with breast cancer researcher Dr. Kathleen Arcaro, breastfeeding is protective against breast cancer. A recent federal meta-analysis suggests that breast cancer risk can be reduced by up to 28%, and ovarian cancer by up to 21%.
Lowered risk of heart disease, diabetes, and metabolic syndrome. Newer research investigating the effects of breastfeeding on heart health, insulin control, cholesterol, blood pressure, and diabetes are finding strong associations between breastfeeding and lowered risk for these serious health problems.
Delayed return to fertility. This is most relevant in areas of the world where access to other forms of contraception is limited, but exclusive breastfeeding (among other criteria) delays the return to fertility. In many parts of the world this is critical in spacing of pregnancies. Of course, you can become pregnant while breastfeeding, so be sure to get more information before using breastfeeding as a form of contraception.
Emotional health:
Protection against postpartum depression. Breastfeeding, through the hormones released when a baby nurses, protects against postpartum depression. It's also true, though, that breastfeeding difficulty can be a potent trigger of depression. The good news is that when breastfeeding is the cause of depression, depression lifts when breastfeeding problems are fixed. That's why it's so important to get good help with breastfeeding as soon as possible. There's far more information on this topic in this podcast interview with Dr. Kathleen Kendall-Tackett.
Increased maternal self confidence. Research has shown that breastfeeding increases women's feelings of self confidence as mothers.
Ease of bonding. Of course, mothers who bottle feed bond with their babies, too, but breastfeeding provides a particularly powerful, hormonally mediated means of bonding.
*This post is part of the carnival of the Women's Health Blogfest. Check out these other posts on the topic of women's health below:
Angela White at Blisstree's Breastfeeding 1-2-3 - Helpful Skills of Breastfeeding Counselors
Angie Tillman, RD, LDN, CDE - You Are Beautiful Today
Anthony J. Sepe - Women's Health and Migraines
Ashley Colpaart - Women's health through women
Charisse McElwaine - Spending too much time on the "throne?"
Danielle Omar - Yoga, Mindful Eating and Food Confidence
Diane Preves M.S.,R.D - Balance for Health
Joan Sather - A Woman's Healthy Choices Affect More Than Herself
Laura Wittke - Fibro Study Recruits Participants
Liz Marr, MS, RD - Reflecting on Family Food Ways and Women's Work
Marjorie Geiser, MBA, RD, NSCA-CPT - Healthy Women, Healthy Business: How Your Health Impacts a Powerful Business
Marsha Hudnall - Breakfast Protein Helps Light Eaters Feel Full
Michelle Loy, MPH, MS, RD - A Nutritionista's Super Foods for Super Skin
Monika Woolsey, MS, RD - To effectively work with PCOS is to understand a woman's health issues throughout her life
Rebecca Scritchfield, MA, RD, LD - Four Keys to Wellness, Just for Women
Renata Mangrum, MPH, RD - The busy busy woman
Robin Plotkin, RD, LD - Feeding the Appetites of the Culinary, Epicurious and Nutrition Worlds-One Bite at a Time
Sharon Solomon - Calories, longevity and do I care
Terri L Mozingo, RD, CDN & D. Milton Stokes, MPH, RD, CDN of One Source Nutrition, LLC - Crossing the Line: From Health to Hurt
Wendy Jo Peterson, RD - Watch Your Garden Grow
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I'm sharing a favorite section of the book Breastfeeding Made Simple (my review) today.
I love thinking about human infant feeding in the context of other animals. Maybe it's geeky but I find it fascinating (see podcast here) and really helps shed light on our own babies and why our milk is so different.
From Breastfeeding Made Simple, with permission.
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I was recently reading a great handout by Lisa Marasco on galactagogues (foods, herbs, and medications that increase milk supply), and thought I'd share some of the information on foods.
I interviewed Lisa on hormonal causes of low milk supply when her book, The Breastfeeding Mother's Guide to Making More Milk, co-authored with Diana West, came out. I also read Mother Food, which has great information on increasing milk supply using foods and herbs.
Before working to increase your milk supply, you need to first determine if it's actually in need of a boost. There are many things that can make you think that it's low when it's not. If it's truly a concern, galatctagogues shouldn't be your first step. Feeding frequently and effectively, ensuring that the latch is good, breast compression, pumping after feedings, and skin to skin are at the top of the list. A trained breastfeeding suppport person can help with all that. Herbs and prescription medications would be the next things to explore with your health care provider.
So, which foods were listed on the handout as increasing milk supply?
Last year I wrote about making lactation cookies, which contains oats, as well as brewer's yeast, another traditional galactagogue. Whether or not they help with milk supply, there's really good!
Have any of you found that any of these foods helped your milk supply?
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