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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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).

My favorite web resources for some common breastfeeding concerns.

Welcome to the January carnival of breastfeeding!  Be sure to check out the other participating bloggers' posts at the bottom of this one.

This month's theme is favorite webpages and blog posts.  My list consists of places I frequently send moms for information on specific breastfeeding topics.  I print some out to use as handouts, too.

Many of these are from kellymom.com, my favorite resource on the web for breastfeeding issues:

Nipple shields - especially helpful on how to stop using them

Reverse cycling

Weaning from formula supplements

Extended breastfeeding fact sheet

Night weaning

Plugged ducts and mastitis

Forceful let down and oversupply

Milk blisters

Is this cheating?  There are a few posts on this blog I recommend to moms frequently:

Being told your baby is too big or too small?  Make sure you're using the new growth charts

Taking a bottle (with a video I love)

Brrr...ouch!  It's the season for Raynaud's

And here are a few other web resources I recommend a lot:

Latch on video - Ameda

LactMed (for medication questions) - National Institutes of Health

Oversupply/overactive let down - Texas WIC

Tongue tie - American Academy of Pediatrics

Inducing lactation - Ask Lenore

Increasing milk supply - lowmilksupply.org

Breastfeeding after breast surgeries - bfar.org

Check out these posts from other participating bloggers (updated throughout the day):

• Breastfeeding 1-2-3: Thrush and breastfeeding
• Chronicles of a Nursing Mom:  Increasing Milk Supply
• Good Enough Mummy:  Filling the Information Gap
• Baby Dust Diaries:  Inspiration for a Nursing Mama's Soul
• Hobo Mama:  Full term breastfeeding posts and pages
  

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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?

Lactation cookie mix in a jar

So the gift-giving season is over, but breastfeeding is year-round, right?

I meant to post this earlier, but it got lost in my draft posts.  It's still a great idea for any time of year.

This website sells a mason jar of lactation cookie mix, to which you add a few fresh ingredients.  Of course you can make your own, using the recipe I used a few years ago to make cookies for my breastfeeding support group.

Just a quick reminder that these cookies are not designed to dramatically increase your supply.  They may or may not give you a little boost.  For information on ways to increase your milk supply, please see this podcast interview with Diana West, co-author of The Breastfeeding Mother's Guide to Making More Milk.

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The top ten breastfeeding stories of 2009

Here's my summary of the year's most significant stories related to breastfeeding.  If you're feeling nostalgic you can see my 2008, 2007, and 2006 summaries, too.

The Case Against Breastfeeding.  Probably the biggest ruckus in the breastfeeding world was caused by an article in the Atlantic Monthly, titled "The Case Against Breastfeeding," which essentially made the arguments that a) there is scant evidence for the superiority of breastfeeding over formula feeding, and b) breastfeeding "keeps women down."  You can read my response here if you like, as well as other reactions, from groups as influential as the American Academy of Pediatrics.  This article was followed by a similar one in the Times of London.

Far fewer people than those who read The Case Against Breastfeeding saw this article about Dr. Michael Kramer, one of the researchers whose work was cited in the article.  Described as "spitting tacks" over how his work was characterized, he says that his findings were "grossly misinterpreted," and that "there really isn't any controversy about which mode of feeding is more beneficial for the baby and the mother."  He called the articles "sensationalist" and accused the journalists of misquoting him in order to support their opinions.

Salma Hayek and "the latch heard round the world."  Salma Hayek turned even more heads than usual when she nursed a baby (not her own) while on a goodwill mission to Sierra Leone.  This ignited a debate about cross nursing, particularly of babies in need. For more of the year's celebrity breastfeeding stories, see this week's celebrity round-up guest post.

New HIV recommendations should reduce transmission through breastmilk in developing world.  In what may lead to a major advance in the prevention of mother-to-child transmission of HIV through breastfeeding, the World Health Organization is now recommending that mothers take antiretroviral drug therapy during the course of breastfeeding.  For a more thorough description of this policy change and its implications, see this post.  

Formula marketing issue heats up; plastics industry plots campaign to make us want to ingest BPA.  An eagle-eyed reader of this blog was the first to point out that a formula company website was using a page header calling their product "the breastmilk formula," and one formula company revealed a new "nightime formula" which is actually exactly the same as their "reflux formula" (added rice starch).  And notes from an industry meeting of plastic executives revealed that they considered launching a campaign to promote BPA, using a pregnant mother as their 'holy grail' spokesperson.

Recession hits breastfeeding support programs.  Around the country, breastfeeding support programs, became victims of the economic downturn.  One of the premier lactation programs on a university campus, UC Davis, wasn't immune, losing its breastpumps and lactation specialist support.

Breastfeeding and the law in the spotlight.  New laws were enacted, most notably for my state (Massachusetts).  And in some of the first judicial tests of lactation laws, an Ohio court case dodged the issue of whether pumping at work is protected under the state's pregnancy discrimination law, and a California employment commission found that it was illegal to fire a mother for breastfeeding on the job. 

Countries inch closer to using breastfed growth as the norm.  In the biggest practical endorsement yet of the World Health Organization's new growth charts which use the breastfed baby as the normative growth pattern, the U.K. largely adopted the charts for use in the National Health Service.  Next up, the American Academy of Pediatrics?  A girl can hope.

WIC changes food package to push exclusive breastfeeding.  I'll be publishing a guest post explaining this in more detail soon, but the news is that this year WIC began distributing an enhanced food package for mothers who breastfeed exclusively.  Exclusive breastfeeding moms now get the largest and most varied food package of all, and get the largest quantities and most varied baby foods once their babies turn 6 months old.  The hope is that these incentives will significantly improve the rate of exclusive breastfeeding among moms enrolled in WIC.

Best for Babes Foundation launches new ad campaign.  The Best for Babes Foundation created an attractive and persuasive new ad campaign, and the ads have appeared in national pregnancy magazines.  Best for Babes' advocates to eliminate the "booby traps" that stand in the way of breastfeeding success.

Toxins in breastmilk and formula in the news again.  Several studies were released on toxins in breastmilk and toxins in formula, and the blogosphere briefly became fixated on the question of whether toxins in breastmilk cause autism.  Want the facts?  See this post. 

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2009 brings yet more reasons to breastfeed

Every year brings more and more studies showing the power of breastfeeding to protect infant and maternal health, and 2009 is no exception.  Below is a summary of some of the more publicized research.  You can read my summaries of 2006, 2007, and 2008, too.

Child health:

• Infants who are breastfed are less likely to be abused
• Breastfeeding protects infants against Sudden Infant Death Syndrome (SIDS)
• Breastfeeding is associated with higher academic achievement
• Breastfeeding reduces risk of childhood obesity and metabolic syndrome in children
• Breastfeeding is effective in providing pain relief in newborns

Maternal health:

• Mothers who breastfeed, and particularly those who have gestational diabetes during pregnancy, have a lower risk of developing metabolic syndrome
• Breastfeeding provides protection against premenopausal breast cancer for women with a family history
• Mothers who breastfeed have a lower risk of coronary disease
• Mothers with multiple sclerosis have a lower risk of relapse within a year after their babies' births if they breastfeed
• Women who breastfed were less likely when they were older to have developed high blood pressure, diabetes, high cholesterol and cardiovascular disease

Other studies of interest:

• Using antiretroviral drugs during breastfeeding is now recommended for mothers with HIV
• There are several types of stem cells in breastmilk
• Nipple piercings may impact breastfeeding after all
• Weaning to start multiple sclerosis medications may actually increase the risk of relapse
• Environmental toxins in breastmilk not shown to have an impact on infants.  A study also found perchlorate in infant formula
• Maternal smoking is associated with lower rates of breastfeeding initiation, and earlier weaning

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Taking care of yourself during the holidays

Welcome to the December Carnival of Breastfeeding! 

This month's theme is taking care of yourself during the holidays, and you'll find more great posts on this topic at the bottom of this one. 

Here are some of my tips for taking care of yourself during the holidays:

Eat, drink, sleep, be merry.  Remember Maslow's hierarchy of needs?  At the bottom are the physiological needs, like food, water, and sleep.  Without them, it's pretty hard to have a good time.  So make sure you eat, drink (especially), and sleep enough to keep you energized and in good spirits.  Not doing these things depletes your immune system, making it easier for a simple plugged duct to develop into mastitis, too.

Accept help.  Whether it's the offers to hold the baby while you (fill in the blank), or help carrying luggage, accept whatever help is offered.  And don't be shy about asking for it either.  There will be plenty of opportunities for you to pay it forward later.

Prioritize feedings.  Delayed feedings and missed naptimes can wreak havok on a child's mood and temper, so be clear upfront that you want to maintain the routines that are the most important to your child's - and your - well being.  This may mean missing out on things here and there, but the reward is an overall happier time.

...but even if you do, expect some reverse cycling.  Remember that babies and toddlers often respond to changes in environment by changing up their feeding schedule.  Too distracted by family and friends during the day?  No problem, says your toddler, who is perfectly happy to feed all night to make up for it. 

Check out these great posts from other carnival contributors (updated throughout the day):

Cave Mother: A Mother's Christmas
Mama Knows Breast: A Breastfeeding Poem: 'Twas the Breastfeeder's Nighttime
Chronicles of a Nursing Mom: Don't Forget the Pump!
Blisstree.com's Breastfeeding 1-2-3: Breastfeeding and Dehydration
Accidental Pharmacist: Motherhood Statement
Hobo Mama:  How to Take Care of Yourself
Mommy News and Views:  The Holidays and Being a Breastfeeding Mom
Breastfeeding Mums: Looking After Yourself During the Holidays:  7 Tips for Breastfeeding Mums
The Adventures of Lactating Girl: Breastfeeding and Holidays
Breastfeeding Moms Unite:  Taking Care of a High Needs Baby at the Holidays

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Guest post: Christine on how to handle criticism while breastfeeding in public.

I'm pleased to share a post today by Christine Howell, a full time mother and freelancer who frequently writes about online degrees for Online College Guru.

So, you are a new mom and making your best attempt at breastfeeding your infant. You’re at home trying to nurse your new baby and struggling to get the baby to have that perfect latch. Finally, after multiple attempts, there's silence, no more screaming, your baby is eating and very happy!

Breastfeeding can be quite challenging at times, especially with new mothers. Since breast milk offers numerous benefits to newborns, many mothers want to pass those along to their baby. But it is not always possible to feed your infant in the comfort of your own home at all times. Babies are not aware of eating schedules and need to eat when they are feeling hunger, which could be anytime, anywhere. They depend on us to supply that food, along with the comfort and connection that is associated with breastfeeding.

So, maybe you are at the local library, mall or park and your baby is rooting and displaying other hunger cues and needs to eat now. It looks like you have to breastfeed in public. Despite your best efforts at getting your baby to latch on, your nervousness and lack of privacy is making you even more uncomfortable and many people are now looking your way. Some individuals are even making unpleasant faces at you, as if breastfeeding in public is a lewd act. How do you handle such criticism, particularly if you are a new mother?

Unfortunately, we live in a society where women are overly sexualized, in particular our breasts. Because of that mentality, many see breastfeeding in public almost as a crime. Despite laws stating that mothers are permitted to nurse their child in public, many mothers continue to receive negative reactions and comments from people and store owners.

There are many approaches to handle this criticism. First, try ignoring these disrespectful comments. Second, ask a question back or comment back to that individual and enlighten them about why breast milk is so vital for a baby’s development. There are also some ways that mothers can make themselves feel more comfortable about nursing in public. First, try practicing at home in front of a mirror. You will be able to see how much of your breast is showing (which is not much, because your baby practically covers you), and help decide whether or not to cover up more. A nursing canopy or nurse sling makes it comfortable for both baby and you while breastfeeding. Wearing a nursing bra and by wearing clothes that are suitable to nurse makes it easier to breastfeed your baby. You will not be exposing too much while out in public and also these clothing items will make you feel more comfortable, thus setting your baby at ease and will be more easy to feed.

Sometimes there is just too much noise or too many distractions in public for the baby and you may need to have the baby latch on in private first. Finally, by socializing with other breastfeeding mothers, will enable you to seek out any advice and or suggestions regarding breastfeeding in public.

Having that confidence about breastfeeding in public will show other mothers that they have support and can nurse their babies in public also. The more mothers that breastfeed their babies in public, the more society will accept that as the norm.

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