The AAP and its relationship with an infant formula manufacturer

The American Academy of Pediatrics, a well-respected group of physicians, has allowed their logo to be placed on the tag of Mead Johnson's Enfamil-infant formula discharge bag. Because The AAP clearly promotes breastfeeding due to the undeniable health benefits; this collaboration sends an opposing message. The AAP, maternity hospitals, obstetricians, pediatricians, and all allied health services should avoid the practice of dispersing formula or discharge bags. These are not free samples meant to assist new mothers. Distributing formula companies' discharge bags or printed materials is only providing free advertisement for the formula companies. Unfortunately this practice undermines new mothers breastfeeding endeavors. www.BabyFirstLactation.com

IBLCE Calls Upon the American Academy of Pediatrics to Terminate Arrangement with Formula Manufacturer


As a certification body, the International Board of Lactation Consultant Examiners® (IBLCE®) typically only issues statements directly related to IBCLC® certification matters.

However, due to IBLCE’s strong support of the International Code of Marketing of Breast-milk Substitutes, IBLCE is compelled to take the somewhat unusual step of calling upon the American Academy of Pediatrics to terminate its recent arrangement with a formula manufacturer which included the printing of the AAP logo on the formula company discharge bags.

This arrangement does not accord with some of AAP’s own policy statements as well as the evidence base regarding the importance, and primacy of, breastfeeding.

Therefore, IBLCE calls upon the AAP to terminate this arrangement and to demonstrate its commitment to optimal health and nutrition by unequivocal support and promotion of breastfeeding.








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Lactation Consultants help new Moms

Lactation Consultants Increase Breast-feeding

Megan Brooks
December 20, 2013





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Pre- and postnatal visits with a certified lactation consultant (LC) coupled with electronic reminders for healthcare providers to discuss breast-feeding at prenatal visits may boost breast-feeding duration and intensity, new research shows.

The American Academy of Pediatrics recommends exclusive breast-feeding for the first 6 months after birth, followed by continued breast-feeding for 1 year or more as other foods are introduced. Yet less than 75% of infants in the United States are breast-fed at all, and fewer than half are still being breast-fed at 6 months, according to the Centers for Disease Control and Prevention (CDC). Under the Affordable Care Act, private insurers must cover professional breast-feeding support without cost-sharing.

In 2 separate clinical trials, Karen Bonuck, PhD, from the Department of Family and Social Medicine, Albert Einstein College of Medicine of Yeshiva University in New York City, and colleagues found that integrating professional LCs into routine care alone or combined with electronic prompted guidance (EP) from prenatal care providers increased breast-feeding at 3 months postpartum.

The studies were published online December 19 in the American Journal of Public Health.

In the Best Infant Nutrition for Good Outcomes (BINGO) trial, 666 primarily low-income women were randomly allocated to 1 of 4 groups: LC alone, LC+EP, EP alone, and usual care (the control group). The LC protocol included 2 prenatal sessions, a hospital visit, and regular telephone calls postpartum though age 3 months or until breast-feeding ceased.

The study team followed-up with the women periodically to assess breast-feeding "intensity," defined as the percentage of all feedings during the last 7 days that were breast milk. They defined high intensity as 80% or more of feedings involving breast milk, medium intensity as 20% to 79%, and low intensity as 19% or less.

At 3 months, high-intensity breast-feeding was greater in the LC+EP group (17.3%; odds ratio [OR], 2.72; 95% confidence interval [CI], 1.08 - 6.84) and the LC-only group (20.5%; OR, 3.22; 95% CI, 1.14 - 9.09) compared with usual care (8.1%).

In addition, women in the LC+EP group were more likely to initiate breast-feeding, do "any" breast-feeding (vs none) at 1 month, and breast-feed exclusively at 3 months postpartum compared with the control group. The EP group did not differ from the control group on any outcome.

The Provider Approaches to Improved Rates of Infant Nutrition & Growth Study (PAIRINGS) study included 275 women from more economically diverse backgrounds (compared with BINGO participants), many more of whom planned to breast-feed exclusively (62% vs 37% in BINGO).

They were randomly allocated to a usual care control group and a group receiving both the LC+EP interventions. For the PAIRINGS primary outcome of exclusive breast-feeding at 3 months, rates were significantly higher with LC+EP than usual care (16.0% vs 6.2%; OR, 2.86; 95% CI, 1.21 - 6.76).

As in BINGO, any breast-feeding and both high- and medium-intensity breast-feeding were more likely with LC+EP than usual care.

Finding Was Robust in Tough Groups

The researchers point out that black/non-Hispanic, younger, overweight and less-educated women are known to have some of the lowest rates of breast-feeding, and together, these women made up a large majority of those enrolled in the BINGO and PAIRINGS trials.

The findings were "robust in what is traditionally thought of as a difficult-to-support breast-feeding population," Dr. Bonuck noted in an interview with Medscape Medical News.

Although neither trial came close to attaining exclusive breast-feeding for 6 months, as advocated by the American Academy of Pediatrics, about 95% of women in the 2 trials at least started breast-feeding, which exceeds the goal of 82% that the CDC has proposed in its Healthy People 2020 report, Dr. Bonuck points out.

"This study is significant because it shows that integrating lactation consultants into prenatal care increases breastfeeding rates among low income racial/ethnic minority women," Tonse N.K. Raju, MD, chief of the National Institutes of Health's Pregnancy and Perinatology Branch of the Eunice Kennedy Shriver National Institute of Child Health and Human Development, said in news release.

"We need additional studies to see if this and other interventions can enhance breastfeeding by these women beyond a few months," Dr. Raju added.

This research was supported by the National Institute of Child Health and Human Development and the National Institute on Minority Health and Health Disparities. The authors have disclosed no relevant financial relationships.

Am J Public Health. Published online December 20, 2013. Abstract






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Addressing breastfeeding myths | womenshealth.gov

Addressing breastfeeding myths | womenshealth.gov

Read this before visiting a new Mom & Baby

Going to Visit Family or Friends Who Have a New Baby? Follow These Tips!

Posted on September 30, 2013


Baby in Hat

Your friend or family member has a new baby. You want to visit. You want to help. You want to meet that amazing new little person! Before you go, read this primer on how to be a good visitor to a family with a newborn in the house — the kind of visitor who will make the family feel loved, supported, and forever grateful!

Included are guidelines that apply to all visitors, plus tips specifically for close friends and family, long-term visitors, and friends and family who live far away but would like to help nonetheless.

In the United States, we shower attention on families during pregnancy, but not during the postpartum period — when in fact the postpartum period is the time when families need the support of their communities the most! Be a gentle, considerate visitor who puts the family’s needs first. Your thoughtfulness will be remembered and appreciated for years to come!

WHEN AND HOW LONG TO VISIT
◾Always call/message in advance to schedule the visit. Do not drop in unannounced. Be on time.
◾Front-porch meal drop-offs or short (10-15-minute) visits are good in the first several weeks, when families are overtired and commonly not feeling up to hosting company.
◾Longer visits (30+ minutes) are good in the later weeks/months, when long-term helpers (grandparents, etc.) have left; other visitors have stopped coming; and spouses have gone back to work. Mothers often report feeling isolated after 1-2-3 months at home with a newborn (and any other children), and welcome longer visits in the later weeks/months.
◾Very close friends/family may be invited to come for longer or more frequent visits to help in the early weeks, but should always ask the mother what type of visit — short or long — would be most helpful to her.
◾If the mother will be home alone with the baby most of the time (single parent, spouse deployed or working long hours), she may wish for visitors to stay longer. Ask.

PREPARING FOR THE VISIT
◾If you are ill in any way — even the tail end of a cold — stay home. Visit when you are well.
◾Do not wear perfume, scented body lotions, or aftershave. These linger for hours or days after your visit and are often overpowering for baby and mother, who have heightened senses of smell.
◾Leave your pets at home.
◾Leave your children at home. This is especially important in the early weeks, when the family is likely to want quiet, rest, and minimal outside germs. One exception is bringing your children over for a playdate or outing with the family’s older children, outside or away from the family’s house, which you plan to supervise.
◾Bring food. See “Bringing Food” below.
◾Bring small gifts for any siblings in the house, if you can. Gifts that do not make noise are best. Special food treats are a nice, inexpensive option.

DURING THE VISIT
◾Remember that the purpose of the visit is for you to help the family, not for you to spend time with the baby. Now is the time for you – not the family — to prepare food and clean up any messes made during the visit.
◾Do not expect or ask to hold the baby. (Yes, this can be difficult — new babies are so snuggle-able!) Wait for the mother to offer. Many won’t. One big exception is offering to hold the baby after a feeding so the mother can take a shower or a nap.
◾Wash your hands when you arrive, and let the mother know that you have washed them before touching her baby.
◾Greet any siblings enthusiastically. Give a big hello and lots of love to the older children before fussing over the baby — it will make them feel special during a time when the baby is the focus of most adults’ attention.
◾Do a chore. Do it without asking. Or say, “It would make me so happy if I could [do chore XYZ]. Will you indulge me?” (Saying something like this helps ease discomfort the family might feel about having someone clean for them.) Load the dishwasher. Wash the dishes in the sink. Wipe down a counter. Sweep the kitchen floor. Fold that basket of laundry you see sitting there. Take out the trash. Excuse yourself to the restroom and scrub the toilet or wipe down the counters.
◾Or, watch the older siblings, or take them out of the house on an outing.
◾Or, offer to take dogs for a walk, if you’re a dog person. Adjusting to a new baby can be hard for pets, too. They need a little extra love at this time, as well!
◾Give advice only if the parents specifically ask for it. Do not criticize.
◾Follow the mother’s cues about how long a visit she’d like. Remember that it can be very difficult for her to ask you to leave once you are there, even if she truly needs privacy to nurse or pump or perform postpartum self-care.
◾If the family has a premature baby in the NICU, they still need support — lots of it! Tell them “Congratulations!” (they do want their new little one to be acknowledged and celebrated). Ask them how they and the baby are doing, and then really listen. Give them gift cards to restaurants near the NICU; gas cards; or a care package of healthy snacks and drinks that do not need refrigeration (dried nuts/fruit/veggies, trail mix, homemade muffins, snack/granola bars, seltzer water, etc.). If they are staying near the hospital, away from home, offer to pick up mail, water plants, care for siblings or pets, or bring needed things from home to the hospital.

BRINGING FOOD

◾Most families welcome food anytime, but it is often especially welcome at these times: after any other long-term helpers (visiting family, etc.) have left; after the first several weeks when other visitors have stopped bringing food; and when the spouse goes back to work or is away on a business trip.
◾Ask whether the family has set up an online meal-delivery calendar, such as Meal Train or Take Them a Meal. If they have not, organizing one is is a great job for a close friend or family member (see below).
◾Check the family’s Meal Train page (or check with the family) for information about food preferences, sensitivities, and allergies, as well as any other preferences (food delivery times, locations, dates). Respect that information.
◾Bonus points: bring a complete meal (main dish, salad/veggie side, and dessert) and/or meals containing ingredients that promote breastmilk production, such as oatmeal (oatmeal lactation cookies are one option), whole grains, dark leafy greens, beans, vegetables, and nuts/seeds.
◾Avoid bringing foods containing large quantities of those herbs which are known to reduce breastmilk production, such as peppermint and sage.
◾If you do not cook, consider bringing a healthy store-bought ready-to-eat meal (such as rotisserie chicken or a complete dinner from the supermarket) or a collection of healthy snacks that the mother can grab and eat one-handed during the day or while nursing, such as nuts or trail mix (unsalted), dried fruit/veggies, healthy snack bars, precut fruits/vegetables, cheese, hummus, and whole-grain crackers. Trader Joe’s and Costco are great places to buy these things inexpensively.
◾Bring the food in disposable containers or in inexpensive reusable Rubbermaid or thrift store dishes that need not be returned.
◾Consider attaching a note to the meal specifying that the dish does not need to be returned and that no thank-you note is necessary.

IF YOU ARE A CLOSE FRIEND OR CLOSE IN-TOWN FAMILY MEMBER

◾Run an errand. School drop-off, grocery store, Target. For example, call and say, “I am going to the grocery store. What can I get you? I will drop it by on my way home.” Note that it is “What can I get you?” not “Can I get you anything?”
◾Be the one to organize a group of friends/family to deliver meals in the first three weeks (or longer). Use an online organizing service like Meal Train or Take Them A Meal. Be sure to include information about food preferences, sensitivities, and allergies. If the meal-receiving family is not large, have meals delivered every other day so that the backlog of leftovers does not overwhelm the refrigerator before the family can get to them. Spread word of the Meal Train throughout the family’s social circle.
◾Help the family write a Chore/Helper List. This is a list of tasks that other visitors can help with, so that when visitors ask what they can do, the family has immediate answers. Place it in a prominent place, like the refrigerator.
◾Help the family research the baby/parenting information they need, if they would like. With a new baby in the house, it can be hard to find time and energy to research lactation consultants, breastfeeding or postpartum support group meeting information, etc. A list of local maternity and parenting resources can be found here.
◾Lend an ear. Ask the mother how she is feeling, then follow her signals. Do not pry. If she wants to talk about her experiences, she will.
◾Observe the mother for signs that she may be developing postpartum depression (PPD) or anxiety (at least 1 in 5 new moms in the United States do). Know the difference between normal new mom stress and a postpartum mood disorder. Be gentle and compassionate with the mother. Ask her what kind of support would help her feel better. If she wants peer or professional assistance, this page has a list of local and national postpartum support organizations. To better understand what a mother with PPD is experiencing, her friends/family may find it helpful to read Brooke Shields’ memoir, Down Came the Rain: My Journey Through Postpartum Depression.
◾Watch the father for signs of anxiety or depression as well. Postpartum anxiety and depression occur in fathers, too. Like mothers, fathers need sleep, good nutrition, exercise, and alone time to stay well. This page has a great list of resources both for fathers experiencing postpartum depression themselves, and for partners of women experiencing PPD. Additionally, Postpartum Men Online Forum is an online community that these men may find helpful.

IF YOU ARE A FAMILY MEMBER VISITING FOR AN EXTENDED PERIOD
◾Come for an extended visit only if the family has invited you to do so. Never invite yourself.
◾Ask if the family would prefer that you stay in a hotel during your visit. Be gracious if they say yes.
◾Offer nighttime help. Offer to stay up late with baby while they catch a few early-evening hours of sleep. Offer to burp/walk/bounce a fussy baby after a midnight nursing/feeding so that the parents can sleep. Nighttime is often a time when help is scarce but dearly needed.
◾Be their personal assistant. Do whatever they indicate they need. Drive them to appointments or support meetings. Run errands. Grocery shop. Pick up prescriptions. Babysit siblings. Cook. Clean. Do laundry. See “During the Visit” above.
◾Encourage them. Tell them that they are doing a wonderful job. Tell them that you are proud of them. Especially for a nursing mother struggling with breastfeeding, the words, “You are doing a great job,” are magical.
◾If you are a generation older, understand that parenting techniques likely have changed since you last cared for babies. Ask the parents about their parenting philosophies. Follow any specific baby-care instructions they provide. Reading (and following) the same baby-care books that the parents are can be helpful.

IF YOU LIVE FAR AWAY BUT WOULD LIKE TO HELP
◾Pay for the services of someone who can help in person: a postpartum doula, a house cleaner, a diaper service, a grocery delivery service. A list of such local resources is available here.
◾Be part of the family’s virtual support team. Let the mother know that you are a friendly, supportive ear that she can call or Skype at any time, day or night.

IF YOUR SPOUSE OR CHILDREN WANT TO HELP, TOO

As stated above, having a crowd of visitors in the house — or running in and out of the house — can be overwhelming for a family with a new baby. But having a work crew tackle the work literally piling up outdoors? Such a help. If you can bring your own tools (for example, rakes and leaf bags for raking leaves) so you have no need to ask where to find supplies, it’s all the more helpful.
◾Pet care. Walk the dogs. Poop-scoop the yard. Change the litter box or the hamster cage.
◾Yardwork. Mow the lawn. Rake the leaves. Shovel the snow off the driveway and sidewalk. Snow and leaf blowers can be grating on the nerves — avoid them.
◾Garden work. Weed. Pick veggies. Especially good for parents of babies born during harvest season!

FURTHER READING
◾Why Are America’s Postpartum Practices So Rough on New Mothers? (The Daily Beast)
◾A Letter to Grandparents by Penny Simkin
◾After the Birth, What a Family Needs (Gloria Lemay)
◾How To Be the Best Post Partum Visitor in 15 Minutes or Less (There Are No Ordinary Moments)
◾The Answer Is Always “YES!” (Or, How To Help a Struggling New Mom) (Dou-la-la)
◾For Parents: Visitors After the Baby? 10 Tips for New Parents (Huffington Post)
◾For Parents: Is DAD the Ideal Postpartum Doula? (The Birthing Site)
◾For Parents: DONA International’s Postpartum Plan (DONA)

This post has been several years in the making. Sincere gratitude to the many mothers who have contributed, both directly and indirectly, the ideas, suggestions, and wisdom reflected within it!

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Press Release from the USLCA

United States Lactation Consultant Association FOR IMMEDIATE RELEASE Celebrity Breastfeeding and the United States Lactation Consultant Association RALEIGH, N.C. --- Somehow it is news that one celebrity is breastfeeding a two-year-old and another "refuses" to breastfeed. The royals are not immune from infant feeding hype as speculation surrounds Kate Middleton. Will she or won't she? That breastfeeding regularly tops tabloid headlines speaks volumes about our cultural conflicts. Breastfeeding is seen as healthy and good...but potentially scandalous if it takes place in public or beyond infancy. Breastfeeding is viewed as good mothering...but may "ruin" the idealized female body. The American Academy of Pediatrics takes the stand that breastfeeding is not a lifestyle choice, but an important public health initiative. It is the desire of the United States Lactation Consultant Association (USLCA) that every woman have the opportunity to be fully informed about breastfeeding so that she may make the best decision for herself and her family. Women need to know that it is not breastfeeding, but rather pregnancy itself that changes breast latitude and longitude. Women need to know that breastfeeding offers significant protection from breast and ovarian cancer and reduces the risk of type 2 diabetes, high blood pressure, and heart disease. And they need to know that breastfeeding offers their children protection from a host of illnesses and chronic diseases such as ear infections, obesity, respiratory infections, sudden infant death syndrome (SIDS), and even some childhood cancers. And once they do make the decision to breastfeed their babies, women need support to do so. A study published in the journal Pediatrics found that only a third of women meet their own breastfeeding goals. A British study recently concluded that breastfeeding may help children climb the social ladder. The child of Prince Charles and Kate Middleton is unlikely to have difficulty with that climb. Children of celebrities have a head start, too. USLCA is concerned for the children whose mothers don't make headlines. We support the Centers for Disease Control and Prevention, the American Academy of Pediatrics, and Michelle Obama in their call for more Baby-Friendly Hospitals so that breastfeeding gets off to a good start. And we urge Congress to continue funding for breastfeeding peer counselors through the Women, Infant, and Children's (WIC) supplemental food program so that the most vulnerable women and children are more likely to benefit from the health, cognitive, emotional, and social perks of breastfeeding. Breastfeeding support comes from employers, businesses, families, and health care providers. Mother-to-mother counseling and encouragement is invaluable. But when designing breastfeeding support policies and programs and when help in overcoming challenges is needed, International Board Certified Lactation Consultants (IBCLC) are the ones to call. In the maze of breastfeeding helpers, only the IBCLC is required to demonstrate completion of specific college-level, health sciences courses, complete ninety hours of education specific to lactation, and spend hundreds if not thousands of hours in clinical practice before sitting for a rigorous international exam. For healthy mothers and babies, for climbing the social ladder, for the health of the nation, breastfeeding is worth the IBCLC. For more information or to find an IBCLC in your area, visit www.uslca.org.

BabyFirst Lactation video

'Bye nursery; hello rooming-in!

About Projects Who's Involved Newsroom Resources Contact You are here: Home > Newsroom > Goodbye Nursery, Hello Rooming-in Goodbye Nursery, Hello Rooming-in Hospital goes from 10 percent to 100 percent rooming-in in less than a year April 16, 2013 By Cindy Hutter The traditional hub of maternity floors, the baby nursery, is getting a makeover. The nursery is transitioning from the central place for doctors to evaluate babies and families to ogle at newborns to a specialty care area that rarely is used. The new nursery identity is to support the practice of keeping mothers and babies together 24 hours a day, known as rooming-in. The practice helps mother and babies get acquainted, learn feeding cues and establish breastfeeding patterns. Rooming-in is one of the Ten Steps to Successful Breastfeeding External Link, as outlined by the World Health Organization. Birthing facilities who comply with these steps achieve Baby-Friendly External Link status, a designation indicating a commitment to supporting breastfeeding. “It took a lot of teaching to get staff to understand that that we are not doing the mom a favor by taking the baby away from her during the night for her to sleep,” says Marianne Allen, a clinical nurse specialist for Women and Children’s Services at PinnacleHealth System in Pennsylvania. “It’s a change in the mindset of staff that we serve the mother best by teaching her the skills and giving her the confidence she’ll need to take care of her baby in the days to come once she goes home without the safety net of the hospital. The best way to do that is to have them together.” PinnacleHealth is one of 89 hospitals participating in Best Fed Beginnings, a NICHQ-run nationwide project that aims to help hospitals improve maternity care and increase the number of Baby-Friendly designated hospitals in the United States. A significant component to support rooming-in is providing couplet care, meaning the same staff takes care of the baby and the mother. In many hospitals baby nurses take care of the newborns and postpartum nurses take care of the mothers. Having one person take care of both the mother and baby helps promote family-centered care, which is shown to lead to more successful breastfeeding, higher patient satisfaction levels and improved nursing and medical staff communications, according to the Centers for Disease Control and Prevention. “We had to change the whole culture of our unit in that all the postpartum nurses had to be trained for infant care. It was a yearlong process,” explains Teri Grubbs, BSN, director of Women’s Health Services at University Health System in Texas, another hospital participating in Best Fed Beginnings. “Also moving the lactation nurses out of the nursery and on to the postpartum unit helped to support rooming-in and boost our exclusive breastfeeding rates.” What’s in a Name? One challenge to rooming-in is changing the expectations of mothers who want to send their babies to nurseries, not realizing it can make breastfeeding more difficult later. How have these Best Fed Beginnings hospitals been able to deter moms from sending their babies to the nursery? It’s all in the name. The University Health Center renamed its nursery the Neonatal Observation Unit. PinnacleHealth will call theirs the Holding Nursery (starting May 1), which will be a place for babies to get intervention, not care. Greenville Health System in South Carolina went a step further. They put a self-proclaimed “scary” sign on the nursery door that reads: “Authorized Personnel Only. This space is reserved for flu isolation, MRSA isolation, urgent evaluation for sick newborns and procedures. Healthy newborns are assigned to rooms on the Family Beginnings unit. Please see your nurse for more information.” “Overnight the nursery became empty. I was astounded,” says Jennifer Hudson, MD, medical director for Newborn Services at Greenville. “Nurses said the sign really helped to define the space differently and made it look like a place people didn’t want to put their babies. It was the most effective intervention we had so far.” Greenville’s rooming-in rate went from 10 percent in July 2012 to 100 percent in February 2013. Chart showing the increase in the rooming-in rate from July 2012 to March 2013 at Greenville Health System. Credit: Greenville Health System. Click image for larger version. Chart showing the increase in the rooming-in rate from July 2012 to March 2013 at Greenville Health System. Credit: Greenville Health System. Mothers’ reactions to rooming-in has reportedly been overwhelming positive at the three hospitals, with some mixed reactions from second-time moms used to the nursery. “It’s very empowering for families,” said Hudson. “It’s really a positive when it comes to security and safety. We emphasize that mothers get to watch everything we do for their babies, including the first bath, exams and screening tests. Hourly rounding by nurses will ensure that they get the help that they need while families learn about and bond with their newborns." Terri Negron, RN, director of Nursing at Greenville Health System, adds, “While some second-time moms are apprehensive, first-time moms don’t know any different and when they come back, rooming-in will be an expectation.” All three hospitals say the transition to rooming-in has been a team effort. It required support from nurses, doctors, unit leadership and executive management. Staff had to understand the evidence-based reasons for change, be committed to the idea and embrace the changes. It didn’t happen overnight for any of them. “You have to have the nucleus of nurses that are supportive and believe in it,” says Grubbs. “You start with them and you train them and have success and then you train more and have more success. You continue to open the door.”

Breastfeeding nipple shield info

Support for Using Nipple Shields Posted on February 27, 2013 by bfcpgh By Wendy Eson A nipple shield is a thin piece of flexible silicone designed to help a baby who is having trouble latching onto the breast. It is worn over the mother’s nipple during breastfeeding. It is important to assess the need for a shield on an individual basis. Nipple shields are not considered a routine part of breastfeeding and are to be used under the supervision of a lactation consultant. Ideally, they are for short-term use. In addition, they are often helpful in getting a baby back to breast after the introduction of bottle-feeding. They are not designed for nipple pain. BREASTFEEDING SITUATIONS WHERE A SHIELD MAY BE HELPFUL •A baby who is born preterm or late preterm, which is 34-37 weeks gestation. These babies often have trouble with latching at the breast and can tire easily during feeds. There is evidence that nipple shields help these babies keep more active at the breast. •A mother with flat or truly inverted nipples. Caution should be used in determining flat nipples. A good majority of new mothers have some fluid retention in their breasts shortly after giving birth. This is especially true for a mother that has received a lot of IV fluids in labor or certain medications. Nipples in these mothers often appear “flat” due to retained tissue fluid. The areola is also firm, making it difficult for a baby to latch. Mothers should be taught to soften the areola by compressing it with the fingers (Check out this link on Reverse Pressure Softening). This helps move fluids back toward the chest wall and softens the areola. It also draws the nipple out, making latch easier for baby. Mothers can also be shown how to form the end of the breast into a wedge or a “breast sandwich.” This helps baby take in more of the areolar tissue, ensuring a good deep latch at the breast. •A baby who has become accustomed to the firm texture of a bottle nipple. In this instance, a shield can be a good tool in getting baby back to breast. •Rarely, a shield can be used for sore nipples. Once latch has been reviewed and corrected and other issues have been ruled out, a mother with sore, cracked nipples may benefit from a shield as nipples are healing. Having a baby at the breast with a nipple shield is better than not having a baby at the breast, however the shield must be used correctly. Mother’s should observe for good urine and stool output and appropriate weight gain. If this is in order, mother can be assured that baby is effectively transferring milk from the breast. Mother’s should be taught to observe for a good latch with a shield. The baby’s lips should be well flanged, with chin in deep to the breast. If baby is just on the tip of the shield, causing the shield to indent around the nipple, baby may get less milk. Additionally, mothers need to watch for clogged ducts, as the shield can cause reduced milk transfer. A mother whose breasts still feel full after feeding with a nipple shield may consider pumping afterwards to effectively empty to the breast. HOW TO WEAN BABY FROM A NIPPLE SHIELD By definition, to wean from something is to detach from gradually. A mother should allow herself and baby several weeks to come off the nipple shield. Here are some helpful tips: •Always ensure proper latch, bring baby in close and wait for a wide open gape. •With your index finger and thumb, compress the area around the areola to make a breast sandwich or wedge. This makes the nipple firm. Once baby is brought on deep, hold the sandwich until you feel baby suckling well. •Consider pumping to elicit let-down, providing baby with a quick reward. Pumping also helps to elongate the nipple. •Feed baby when somewhat sleepy and not too hungry. They are often easier to put to breast and willing to nurse. •Try latching baby with shield and removing it once let-down has happened. Swiftly place baby back at breast. This “bait and switch” may take several attempts. If baby becomes frustrated with this, allow him to nurse with the shield. The goal is to have a happy baby at the breast. •If it is easier to latch baby at breast with the shield for nighttime feeds, aim for removing it during some of the daytime feeds. DO NOT CUT OFF THE TIP OF THE NIPPLE SHIELD! THIS MAKES FOR SHARP EDGES AND CAN HURT THE BABY. Be patient with yourself and baby as you wean from the shield. Enjoy the time when baby is at the breast and commend yourself for giving your baby the benefits of breast milk!

Breastfeeding...It's only natural

HHS offers moms knowledge, help, and support through a new breastfeeding initiative, It’s Only Natural Today, Surgeon General Regina M. Benjamin, MD, MBA announced the launch of It’s Only Natural, a new public education campaign that aims to raise awareness among African American women of the importance of and benefits associated with breastfeeding and provide helpful tips. It's only natural. mother's love. mother's milk “One of the most highly effective preventive measures a mother can take to protect the health of her infant and herself is to breastfeed,” said Surgeon General Benjamin. “By raising awareness, the success rate among mothers who want to breastfeed can be greatly improved through active support from their families, their friends and the community.” Breastfeeding offers mothers and their babies a healthy start. According to the Centers for Disease Control and Prevention, nearly 80 percent of all women in the United States—regardless of status, race, or income — start out breastfeeding. Among African American women, the breastfeeding rate is almost 55 percent — up from just 35 percent in the 1970s. However, while these rates are improving, breastfeeding rates among African American women remain lower than the rates of other ethnicities in the U.S., particularly among those living in the south. This gap may indicate that African American mothers face barriers to meeting breastfeeding goals and need additional support to start and continue breastfeeding. It’s Only Natural was specifically designed to provide materials that reflect the experience of African American moms. It’s Only Natural was developed to equip new moms with practical information and emotional support from peers, as well as tips and education about the benefits of breastfeeding and how to make it work in their own lives. All of the material is uniquely crafted for African American women. Materials include: •video testimonials from new moms talking about the challenges they have overcome, providing breastfeeding tips, sharing their individual stories, and much more; •articles on a variety of topics ranging from laws supporting breastfeeding to how to fit breastfeeding into your daily life; •two fact sheets, which contain proper holding and latching techniques, as well as information on managing discomfort and how much milk is enough; and •radio public service announcements. To learn more about the campaign, visit www.womenshealth.gov/ItsOnlyNatural. ###

Nightwaking Info

Nightwaking By Teresa Pitman "I slept like a baby." It's a phrase we use to describe a particularly sound sleep. But any parent knows that sleeping like a baby really means waking every few hours...all night long! Babies' sleep cycles differ from those of their parents. Babies spend more time in rapid eye movement (REM) sleep, when they are more likely to waken, and less time in deeper sleep states than children and adults. They also cycle between light and deep sleep stages more quickly than adults do. Nature has designed babies to awaken more frequently to ensure their survival; feeding around the clock gives them the nourishment they need to sustain the rapid growth of infancy. Coping with nightwaking Since babies do wake up at night, parents need strategies to get the rest they need. Keeping baby close, in a crib or bassinet, will make nighttime feeding easier and allow new moms to get a better night’s sleep. Nursing the baby in bed allows mom to relax while feeding the baby. When the baby is close by at night, you can respond quickly before she fully awakens. This tends to help babies fall back to sleep more readily after they've been fed. On the other hand, some babies do fuss a bit as they surface from a light sleep phase, without really waking up. If her eyes are closed and she seems to be trying to get comfortable, don't disturb her by picking her up right away. It might be more helpful to just pat her back gently. You'll soon know if she’s going to "really" wake up. Many parents feel that keeping nighttime interaction very low key encourages their baby to go back to sleep promptly: keep lights, diaper changes and conversation to a bare minimum. Catch up on your sleep by napping when the baby sleeps if you can. Partners can also spell each other off for short periods. Should you train your baby to sleep? Parents, understandably, look forward to getting more rest. But many young infants — particularly those who are breastfed — really need their night feedings, so younger babies should not be pushed to sleep through the night. Reducing the number of feedings will also reduce the milk supply, and it may not be possible to make up the extra milk during the day. After the middle of the first year, some parents may want to teach their baby to sleep more independently. The goal of most sleep-training methods is to have the baby learn to fall asleep on his own, so that when he wakes at night, he won't need his parents to settle him. While some parents have had success with this method, others report that their babies cried for long periods without sleeping any longer. Babies all have their own individual temperaments, and while some adapt easily to a new sleep routine, others seem to need nighttime comforting for a longer time. Parents are all different, too. Some just don't believe in leaving their baby to cry, night or day. Others don't feel nightwaking is much of a problem — especially if the baby only wakes up once or twice for a quick feeding and goes right back to sleep. What works for your family? Sleep researcher and anthropologist James McKenna says parents often feel pressured to get their baby sleeping through the night. "If one thing has damaged parents' enjoyment of their babies, it's rigid expectations about how and when the baby should sleep," he says. "There is nothing wrong with a baby who wakes at night and wants to be with his parents." How you handle nightwaking will depend on your own needs and feelings as well as your baby's temperament and sleep habits. Some parents adapt easily to their baby's nightwaking and continue to function well during the day; others feel desperately exhausted. Some babies will easily learn to settle themselves with just a little nudge from mom and dad; others will become frantically upset if left alone and will cry, literally, for hours. Each family has to work out an approach that best meets everyone's needs. Nightwaking is a challenge for many new parents. Any strategies that help you get enough sleep — bringing baby into bed, napping when the baby naps, taking turns in the night or encouraging baby to sleep longer — can be lifesavers. The good news is that all babies eventually develop more mature sleep patterns, though there is plenty of individual variation in the timing. And, one morning, you'll wake up and realize that it finally happened: your nightwaking baby slept all night. Myths about nightwaking Myth: Most babies are sleeping through the night by two or three months. Some do, but plenty don't. In one survey, less than one-third of babies slept through until morning by four months of age (and nearly one in four took more than a year). Myth: Once the baby sleeps through the night once, nightwaking is over. Baby's patterns are always changing. Many babies who sleep through early on begin waking again later. Myth: Giving the baby cereal will make her sleep through the night. All the available research shows that this is not so. In fact, many older babies who are enjoying a wide variety of foods still wake up at night. Copyright Teresa Pitman. Used with permission. Originally published in Today's Parent. Teresa Pitman is the author of 15 books, including co-author of The Womanly Art of Breastfeeding, 8th revised edition. . . . . . . . . . . Facebook Tumblr Twitter .. Get Involved Join

We must encourage breastfeeding

Best for Babes Newsletter Facebook Twitter RSS Search our site: Ways to help! Beating the Booby Traps that prevent Moms from achieving their personal breastfeeding goals! homeAbout UsMission Credo FoundersBettina’s Story Danielle’s Story Board of Directors Press Events GET HELPExpecting Moms New Moms Nursing in Public Nursing at Work Harassment Hotline C.A.R.E.-WHO AllianceCorporate Media Breastfeeding Organizations Team BfBTeams Join Team BFB Donate/Find a Participant Upcoming Events Sponsors Team BfB – FAQ’s Sign In Take Action donate shopSignature Apparel Nursing Tops and Gowns Baby Gear Posters Pumping Bra The Miracle Milk™ Bracelet Thank You/NIP Cards blogBabeworthy Celeb News Science News Advocacy Support 360 Booby Traps view your cart | checkout Is Breastfeeding a Legal Right? Civil Right? Or a Social Responsibility? By Danielle Rigg, JD CLC | Posted on April 3, 2013 | 1 Comment | Print Page “What kind of a society raises its children on food that will shorten their lives?” I dug this quote up one day while looking for examples of other public health crises that have benefited from celebrity leadership. Turns out they were words first spoken in connection with Farm Aid, but they so perfectly capture the reason why we need a popular cause for healthy infant feeding, that it’s now plastered to my wall. We are what we eat. The food we are given as infants, children and adults, can do one of three things: (1) help us to thrive, (2) sustain us or (3) jeopardize our health. Unfortunately, most of the commercial food supply in the U.S., including infant formula, falls into the latter two categories. And the consequences are horrendous — America spends $2.7 trillion each year on health care costs trying to stop a rising tide of epidemic noncommunicable illness — diabetes, obesity, cancer, heart disease, Crohn’s disease just to name a few. And we are no healthier for it; our mortality rank is 50th in the world, our Infant Mortality rate is 41st, and our Maternal Mortality rate is 50th –WAY behind other developed nations. For many Americans who don’t die, living with disease and chronic suffering has become the NORM. We are one of the unhealthiest populations on the planet despite our spectacular spending on “health care.” READ: Americans Under 50. Read: The Cracks in the Foundation & The First Food. Call me crazy, but the goal last time I checked, was not just to grow or survive, but to flourish and thrive. What parent doesn’t want the latter option — for their babies to reach their optimal potential health, physically and emotionally, for a lifetime? None. That’s right. None. Show me the right-minded mother who wants to see her child’s health compromised by the food she puts in its mouth. She doesn’t exist. But show me the mother who makes feeding decisions based on inaccurate or incomplete information, or the mother who chooses breastfeeding but is Booby-Trapped by poor care, advice and support from the medical and legal system and her community and employer and is forced to formula feed by default, or the mother who doesn’t want to, or can’t breastfeed, but is not given the option of using the next best substitute, donor human milk – she exists, by the millions each year. savethechildrenbfreportWhich is why ‘What your infant is having for dinner’ is not a topic over which moms, businesses or even politicians should be arguing. The debate is over and the evidence is clear: Breastfeeding, followed next in order of preference by pumping or donor milk, is the undisputed “first food” and the foundation of human health and thriving. Yes, infant formula has a place and purpose when breastfeeding or donor milk is not feasible (and believe us, sometimes it really is not and we understand! Read: It’s Not Just About Breastfeeding.) But breastfeeding (and human milk) is first on the list because it is a highly cost-effective way to help PREVENT illness – in both baby and mother, long and short term. Period. If more mothers were supported to reach their personal breastfeeding goals, it would slash billions from the nation’s health care burden, (Read: $13 Billion for Breastfeeding), and it would save and improves lives. Read: Save the Children’s Report. Given our poor collective health and economy, the only question on the table should be how can we as a society pull together to see to it that as many moms as possible are no longer being Booby-Trapped and get the full panoply of support that is required to help them succeed at breastfeeding– at birth, at home, in the workplace, and in public? We should be rolling out the red carpet for moms for paying it forward for us all, we should be throwing open every door for them and thanking them, definitely not shaming them. To be sure, we need a national law that protects a woman’s right to breastfeed and have access to donor milk. This law could be passed as an amendment to existing federal law e.g., the Civil Rights Act, the Pregnancy Discrimination Act, or the American With Disabilities Act, or as a stand-alone. Pipedream? Maybe. But worth fighting for. It is extremely time-consuming to fight to protect mothers and babies on a state level, 50 times over. Moms across the country are organizing under our Take Action wing and other groups to amend laws to make this a reality. Read: Texas Moms Fight for Better Breastfeeding Law. But it’s going to take more than laws to change consumer attitudes and create the kind of total seal change in the way we view and support breastfeeding and moms that we so desperately need. If that’s all that it took, then decades after being told about the health benefits of eating more vegetables, most Americans would be heeding that standard — we still don’t eat enough. And legislation making sexual harassment a form of discrimination would have sufficed to eradicate it from our work spaces — it still takes oodles of employee training, education, and cultural indoctrination to reset behavioral norms. Since we entered the breastfeeding conversation in 2007, Best for Babes has consistently framed breastfeeding as more than a question of the legal right to nurse in public or even as a reproductive right. As a behavior that benefits our collective and individual welfare, breastfeeding is also a shared responsibility, and as such, a human and a civil right. Looking at breastfeeding through the human rights lens helps us go beyond the “legal” issue and get to the moral issue that will drive systemic and cultural change: human milk is so precious and beneficial to us all, that helping moms to breastfeed or have access to donor milk, if needed, is more appropriately a question of social responsibility –like preventing forest fires, educating children, or fighting poverty, hunger and disease. By definition, human rights (and its subclass of civil rights) protect our inalienable rights to dignity, safety, health and life, and to be treated fairly and as equals. Protecting a mom’s basic human right to nourish her baby optimally, and a baby’s basic human right to be nourished optimally, falls squarely within those parameters. Seeing breastfeeding as a human rights issue for children is not a novel concept. The Convention on the Rights of the Child is an international treaty declaring eating a human right for a child. Not surprisingly, the U.S. along with Somalia, are the only countries who have not signed on. Our mother’s and babies should not be discriminated against for exercising their human and instinctive right to breastfeed. And yet, as our Nursing In Public Harassment Hotline proves, daily and in droves, moms are being harassed and discriminated against for following an innate and prescribed behavior that will help ensure their and her baby’s best health. Civil rights are also intended to guard against infringements by both government and the private sector that compromise an individual’s freedom of thought and choice. In the current climate, that freedom is being severely compromised. The infant feeding industry has been hijacked by big business (Big Formula) for the benefit of profit and shareholders. Their predatory and unfair marketing practices rob moms of the freedom to make an informed feeding decision and are largely responsible for the inordinate number of breastfeeding failures. Study after study points to the corrosive effect of formula marketing on breastfeeding initiation and success. Read: the Save the Children Report citing unfair formula marketing as a major barrier to breastfeeding. Read: What is the WHO-Code? And we will emphasize here again, that it is not formula per se, but the aggressive marketing of formula that subverts and sabotages breastfeeding that is the problem. Getting back to framing breastfeeding as a civil liberty, formula manufacturers love to ring the Freedom of Choice bell and co-opt that argument to fit their bill. Big Formula spends billions per year ($50 Billion) to perpetuate a marketing fiction to convince moms that choosing their product is a testimony to the exercise of that freedom. Read: Defeating the Formula Death Star. They want moms to believe that formula-feeding is about exercising personal choice, about which a new mom shouldn’t feel guilty, and over which they emerge as her new “BFF” and “savior.” Nothing could be farther from the truth. True “friends” don’t wreck your chances of succeeding at something, throw their arm around you when you predictably fail, tell you not to feel guilty — “after all you tried Sweetie,” then take your money with the other. The formula industry plays the guilt card like Yo Yo Ma plays a Bach Cello Suite and their rewards are equally grand. The “we are here for you mom” campaign yields approximately $8-$10 billion per year profit. Breastfeeding advocates, educators, scientists, and practitioners, make next to nothing when moms achieve their personal goals. We can attest to that personally. So what kind of a society are we? America is a country that prides itself on liberty and freedom and change and great reversals of course to fulfill those promises –cue the Women’s Suffrage and the Civil Rights Movements. We can do this! Let’s make healthy food for infants, children and adults top of our national priority list – a shared responsibility for the betterment of our individual and collective health –and precipitate our laws, policies, and norms to shift to accommodate our shared goal. Let’s no longer seek to ostracize mothers who breastfeed but rather embrace, cheer and celebrate them! Let’s no longer longer tolerate infringements on our personal freedoms and on our personal health for the benefit of big business. Imagine the laws and the infrastructure that might follow that paradigm shift — paid parental leave? On-site daycare? Routine post-partum home visits by qualified lactation professionals covered by all insurance? Greater access to breastfeeding care for low-income and minority women? More affordable and accessible healthy foods? These practices are already standard in many countries that score high on health indices and on quality of life indices. Reframing breastfeeding as a social responsibility — not just a right — will help to deliver the change we need. What are we waiting for? Do you think breastfeeding is a social responsibility and a human right? To learn more about how you can get involved or support the Mother of All Causes visit www.bestforbabes.org/take-action. You might also like: A Mom With a New Baby Needs Your Help! Science You Can Use: Can skin-to-skin and laid-back ... Real Princesses Do Breastfeed, Even Twins! Should World Breastfeeding Week & Awareness Month be Moved? Lack of Breastfeeding is a Key Factor in Autoimmune & ... LinkWithin Related Posts Plugin for WordPress, Blogger... This entry was posted in Advocacy, Aggressive Formula Marketing, Main Content, Take Action and tagged Best for Babes Take Action, Booby Traps, Breastfeeding Civil Right, Breastfeeding Human Right, Breastfeeding Social Responsibility, Convention on the Rights of the Child, donor milk, Farm Aid, First Food, Human milk, predatory formula marketing, Rights of the Child, Save the Children Breastfeeding Report, thrive. Bookmark the permalink. ← From Karo Syrup to Goat Milk – The Formulas Change, but the Booby Traps Remain the Same One Response to Is Breastfeeding a Legal Right? Civil Right? Or a Social Responsibility? Jennie Bever Babendure says: April 3, 2013 at 9:53 pm Beautiful post! Sharing widely!!! Reply Leave a Reply Your email address will not be published. Required fields are marked * Name * Email * Website Comment You may use these HTML tags and attributes:

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What is the WHO Code and why is it important?

Defeating The Formula Death Star: Using Social Media to Advocate for the WHO Code Posted April 1st, 2013 by Jeanette McCulloch and Amber McCann As presented at the 8th Breastfeeding and Feminism Symposium: March 21, 2013 “Oh no. It looks like the Death Star.” – WHO Code advocate Last year, the world’s largest infant formula company, Nestle, rolled out a new center for managing its social media, described by Reuters as Nestle’s site for reaching consumers and “engaging with the online enemy.” Nestle’s new “digital acceleration center,” designed to both reach consumers and manage conflict, “looks like mission control” with walls of screens where red lights flash when online dissent is detected. Advocates for the fair marketing of formula were disheartened but not surprised to see this well-funded effort to reach mothers and diffuse controversy. How infant feeding choices are marketed matters. It matters enough that formula companies are reported to spend more than $50 million annually in the US alone. It matters enough that the World Health Organization developed an entire set of rules (known as the WHO Code) around how formula should – and should not – be marketed worldwide. Now, the efforts to ensure accurate information about feeding choices have moved online to social media. Those that defend those rules – WHO Code advocates – are working to ensure that those rules are upheld online. But defenders of the WHO Code are up against formula companies that are better-funded and are using the most up-to-date tools and strategies for reaching mothers using the Internet. Sound like David and Goliath? Once you see the technological power of the digital acceleration team, you will see why the online efforts of the formula companies feels like the Death Star of the Star Wars franchise fame. This “formula Death Star” is not going unchallenged. Using the incredible capacity of social media for the advocacy, education, and the mobilization of grassroots efforts, a rag-tag group of rebel forces–online WHO Code activists–are working to protect the WHO Code and breastfeeding families everywhere. What is the WHO Code? The International Code of Marketing of Breastmilk Substitutes (commonly called the WHO Code) was written with the goal of reducing the impact of marketing practices that aim to mislead new and expectant mother into believing that infant formula is nutritionally, immunologically, and otherwise comparable to breastmilk. Despite common misconceptions, the code DOES NOT limit access to or use of formula or related products. The code addresses marketing–and for good reason. When marketing spending on formula goes up, breastfeeding rates go down. The WHO Code was written and adopted in 1981 by the World Health Organization by a vote of 118 to 1 (the United States cast the lone dissenting vote). Thirty-two countries have adopted the code as national law, with 76 others adopting portions of it as law. Ethically and morally, the code should be considered worldwide, even where it has not yet been adopted as law. As providers who work with women, we believe in their capacity to make the best choices for their families, when presented with evidence-based information. If that’s our goal, we have two options: • We can increase marketing budgets for breastfeeding to the levels of formula companies. In the past years, they have spent at least $50 million..OR • We can uphold the WHO Code. We want to make abundantly clear that our support of the WHO Code comes from a desire to ensure ALL families have good information, not from any motivation to instill guilt or shame in families who use formula. The WHO Code does not limit options for mothers. It takes away the barriers to informed choice. As Bettina Forbes of Best for Babes puts it: “The only people who should feel guilty are those who know about the negative impact of formula marketing and do it anyway.” Meeting Us Where We Are Means Using Social Media Social media represents a revolution in communication that rivals the introduction of the printing press. For those of us of childbearing age, the notion of checking into Facebook on our iPhones, tweeting a photo of our dessert or going to Pinterest for a classic recipe instead of our family cookbooks, is second nature. Ninety-three percent of the “Millennial Generation” (those born after 1982 and who “get” technology because they grew up with it being an integral part of their lives) are communicating online, and in the United States, nearly 3 of 4 of them are using a social networking Website, such as Facebook, Twitter, or Pinterest. While the stereotype of the white, suburban mom certainly exists, we access social media widely, regardless of race, ethnicity, or socioeconomic status. We as mothers are the “power users” of social media…and marketers know it! These changes are having a significant impact on how we talk about, learn about, and share information around birth and breastfeeding. More than half of all women responding to one survey expressed their intention to share their birth experience, as it happens, on social media. Moreover, time online increases after the birth—44% of US women spend more time online after a new baby is born, and the likelihood that a new mother will seek breastfeeding information and support online is high. We Are Seeking Information About Health Care — Including Breastfeeding — Online Research tells us that health care providers continue to be the “first choice for most people with health concerns, but online resources, including advice from peers, are a significant source of health information in the United States.” Eighty percent of U. S. Internet users have sought health care information online, and birth and related topics are an area of focus. We are using social media not only to seek information online, but we are also sharing our knowledge with others . . . and our iPhones make it as easy as sending a tweet or replying to a Facebook status update. The savvy marketers at corporations who produce infant formulas are fully aware of these changes. We argue that it is our responsibility, as advocates for breastfeeding families, to understand these changes. We know that there is POWER in using social media to reach and rise up and converse with mothers to affect change. Formula Companies Are Making Significant Investments In Social Media Savvy institutions understand what we’d teach in any “Social Media 101” presentation: social media is an unprecedented tool for listening to and engaging with an audience. Nestle has become a leading example of the use of social media both to reach consumers and to manage conflict and dissent. Nestle is the world’s largest food company and is also among the world’s most controversial corporations. Nestle was founded on the formulation of artificial infant milk. However, Nestle is not alone in its use of social media to reach parents. 10 out 11 infant formula brands commonly available in the United States, have a social media presence. Examples of their use included Facebook pages, Twitter accounts, YouTube channels, mobile apps, sponsored reviews on blogs, and interactive websites. How Do the TOP Breastfeeding Profiles Stack Up? Nestle and other formula companies have used large budgets to build their audiences. While overall marketing budgets are not generally available, at least $50 million was spent on formula advertising in 2004 and Nestle has been reported to have doubled their social media spending in recent years. Compare this to the resources of top breastfeeding organizations. La Leche League International, the breastfeeding advocacy organization with the most significant financial resources had total revenues of $1.5 million in 2011 and spent a little over $115,000 on “public relations, external relations, and advocacy.” Other organizations, like KellyMom, Best for Babes, and Breastfeeding USA have small budgets and rely largely on volunteer efforts. The result? Although all of these organizations make a significant impact on the women they reach, compare the total number of all of their followers on Facebook: about 145,000 as of this writing, to that of Gerber (the Nestle owned brand that manufactures Good Start formula) at more than five million followers. Nestle has used its significant financial resources to hire social media experts and develop tools that have made it a shining example of effective corporate social media strategy. Nestle’s “Digital Acceleration Team” has a trained staff that monitors every mention of Nestle’s brands across various social media platforms. Team members identify negative “emerging issues” by the volume of mentions and respond to those with a high level of engagement with a scripted playbook for team members. http://www.youtube.com/watch?v=ktsMa8hfgY0 The Formula Death Star, as it has become known to WHO Cde activists, can feel overwhelming, both because it limits our capacity to reach families and because it can feel impossible to influence change at the world’s largest food company. However, it is encouraging to remember that Nestle developed these tools in response to its inability to manage an onslaught of angry advocates and consumers. In 2010, Greenpeace activists were able to enact significant changes in how Nestle sources palm oil, thanks to a YouTube video spoof that garnered over 1.5 million views, along with a resulting social media campaign that netted more than 200,000 e-mail complaints. Policy change at Nestle, based on calls from all of us, is possible. Examples of Efforts to Support the WHO Code Online Although Nestle may have the Death Star, rebel forces are pulling together to provide much needed social media support for the WHO Code. A recent campaign demonstrates the power of social media to organize individuals, even without an official organizing body like Greenpeace. A blog post exposing that the Pan-American Health Organization — the regional representative in the Americas for the World Health Organization–accepted more than $150,000 in donations from Nestle sparked outrage among activists who were concerned that the fox was helping to buy the hen house. Within days, a private Facebook group was birthed and experienced rapid growth to 400 members, now at almost 1000 members as of this writing. Each day, members were given specific action steps, including suggested scripts for tweets directed at PAHO and WHO. Members shared impromptu trainings on Twitter use and etiquette, researched the money trail, and quickly developed strategy, including a decision to target WHO and call for a rejection of the Nestle funding. The result: A relatively small group of consumers and advocates, through the use of Facebook and Twitter alone, were able to force the World Health Organization to respond. More importantly, the group began to organize and mobilize motivated individuals (including breastfeeding professionals, volunteers, families, researchers, and advocates!) who will come to the next battle more organized and prepared to engage. How The Rebel Forces Can Defeat The Death Star As the Greenpeace example shows, social media provides all of us with a unique opportunities to influence how companies do business. With ongoing support to the rebel forces, much-needed pressure can be put on Nestle to change its policies; but this will not come without significant work. Some areas that need support: Ongoing consumer support and education around the WHO Code: In our experience, families generally are unaware of the WHO Code, or, if they have heard of it, they believe that it limits access to formula rather than limiting the marketing of breastmilk substitutes. The importance of the WHO Code needs to be distilled into social media-friendly images and infographics to build awareness and support for all future efforts. Ongoing education of maternal health advocates. The WHO Code is about more than just breastfeeding. Anyone concerned with infant and maternal health should be aware of and providing support for the adoptions and enforcement of the WHO Code worldwide. Bring even more social media savvy to the table. After Nestle’s run-in with Greenpeace, it brought in a top notch social media strategist to revamp its approach and provide training for its social media team. Nestle uses sophisticated tools to monitor and respond to issues. The Friends of the WHO Code–and any group hoping to use social media for impact–needs people on hand who are savvy in the use of social media and the funding for some basic tools to make the job collaborative. Keep doing what we know best. One the greatest results of the PAHO/WHO crisis was the assembly of a worldwide community with much work still to do. This and other groups need to use traditional community organizing strategies, incorporating social media to create a more level playing field. To learn more about what you can do to help promote the WHO Code through social media, join the group “Friends of the WHO Code” on Facebook. An earlier version of this post originally appeared in Science and Sensibility. You might also like: Read more: http://www.momsrising.org/blog/defeating-the-formula-death-star-using-social-media-to-advocate-for-the-who-code/#ixzz2PGC4jDLa

Breastmilk is a gift

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6 minute film on the billion dollar formula industry

Breast is Best

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Home About Evidence Giving Birth Based on Best Evidence Can Hospitals Keep Moms and Babies Together after a Cesarean? © by Rebecca Dekker, PhD, RN, APRN of www.evidencebasedbirth.com In my previous article on skin-to-skin care after a C-section, I wrote that skin-to-skin care after a C-section has many benefits for moms and babies. However, I have come to realize that women cannot do early skin-to-skin if they are routinely separated from their babies after a C-section. In order to do early skin-to-skin, women and newborns must stay together—a process known as “couplet care.” However, the vast majority of women are separated from their babies after a C-section. Why don’t more women and babies receive couplet care? Is it possible for hospitals to make the switch from routine separation to routine couplet care after a Cesarean? Keep reading to find out. What is the history of mother-infant separation after birth? Separation of human mothers and newborns is unique to the 20-21st centuries and has been a complete break from natural human history. In the past, infant survival depended upon close and virtually continuous mother-newborn contact. The practice of routinely separating mothers and newborns started around 1900. At the time, most women received general anesthesia that made them and their babies incapable of interaction after birth. Because mothers couldn’t care for their babies, hospitals created central nurseries to care for newborns, and infants were typically separated from their mothers for 24-48 hours. Separation from parents was also meant to ”protect” infants from maternal illnesses (Anderson, Radjenovic et al. 2004). In her book Hypnobirthing, Marie Mongan described her experience of being separated from her infant in the 1950′s… My head was held as the ether cone was forced onto my face. That was the last I remembered. I awakened sometime later, violently ill from the ether, and was informed that I had “delivered” a beautiful baby boy, whom I would be able to see in the morning…. My husband saw our son only through the window of the nursery for the next five days, as no one was allowed to visit when “the babies are on the floor.” Our family bonding was nonexistent. When did things begin to change? In 1961, Dr. Brazelton published a classic study showing that general anesthesia was harmful to newborns (Brazelton 1961). As a result of his research, more people began to move away from using general anesthesia during birth, which resulted in mothers and infants being more alert—and capable of interaction—immediately after birth (Anderson, Radjenovic et al. 2004). In addition, most mothers who give birth by Cesarean receive regional anesthesia instead of general anesthesia, so these mothers, too, are usually alert after giving birth. Furthermore, in the past 30 years, an abundance of research evidence has shown that when mothers and babies are kept close and skin-to-skin after birth, outcomes improve (Moore, Anderson et al. 2012). It is very important for you to understand that when researchers study human mother-newborn contact, keeping mothers and babies together is always considered the “experimental” intervention. In contrast, when researchers study other non-human mammals, keeping mothers and babies together is the control condition, while separating newborns from their mothers is “experimental” (Moore, Anderson et al. 2012). What is routine practice today? Although most mothers now are capable of taking care of their babies after birth, and despite the fact that research overwhelmingly supports couplet care—hospital practices have been very slow to change. Routine separation of moms and babies during the recovery period still happens at 37% of vaginal births in the U.S., with rates ranging widely from state to state. In Alaska, only 5% of babies are separated from their mothers after a vaginal birth, while in Mississippi, 81% of infants are separated from their mothers after a vaginal birth. (Centers for Disease Control, 2010) After most C-sections, babies are sent to the nursery for routine care Credit: brettneilson How often are women separated from their infants after a C-section? Separation of mothers and infants is very common after a surgical birth or C-section. In the U.S., 86% of women who give birth by C-section are separated from their babies for at least the first hour (Declercq, Sakala et al. 2007). With more than one-third of U.S. women now giving birth by Cesarean, this means that a substantial proportion of mothers and babies experience a critical delay in bonding, skin-to-skin contact, and breastfeeding. Research shows that most of the time when babies are separated from their mothers after a C-section it is so that the hospital can provide routine mother/baby care in separate rooms—not because the babies need any kind of special care (Declercq, Sakala et al. 2007). When infants are brought to the nursery while their mothers recover separately, it is common for a nurse to give a first feeding of formula (Elliott-Carter and Harper 2012). What are the benefits to keeping moms and babies together? To read the benefits of keeping moms and babies together, please refer to my article on skin to skin care after a Cesarean. To summarize, babies who receive couplet care—in other words, who stay with their mothers and receive early skin-to-skin care—are 2 times more likely to be exclusively breastfeeding at 3-6 months, compared to babies who receive routine hospital care. You can read about the many other benefits of early skin-to-skin care—and the potential harms of separating mothers and babies— here. Submitted by an anonymous reader. Dads can do skin-to-skin care, too. Everyone can stay together. Are there any potential harms to keeping moms and babies together after a C-section? It is important to know that some mothers may not capable of independently caring for their infants immediately or for several hours after a C-section. For example, if mothers received strong sedatives, are nauseous, or were sleep-deprived for many hours before the Cesarean, then they may need supervision or assistance in caring for their newborns. The mother’s level of awareness and her ability to remain awake when caring for and feeding infants must be assessed and closely monitored by nursing staff, especially when a Cesarean follows a prolonged labor or when sedative drugs have been given (Mahlmeister 2005). In this case, then the father or partner can do skin-to-skin with the infant. Is it possible for hospitals to keep moms and babies together after a Cesarean? Yes, it is possible for hospitals to keep moms and babies together after a Cesarean. Two different hospitals have published quality improvement reports describing how they switched from routine separation to routine couplet care after C-sections (Spradlin 2009; Elliott-Carter and Harper 2012). As both reports were very similar, I will focus on the most recent article by Elliott-Carter (you can read the article for free in its entirety here). Why did this hospital decide to make the change? In 2011, nurses at Woman’s Hospital in Baton Rouge, Louisiana, led a switch from routine separation after Cesareans to couplet care—keeping moms and babies together. The hospital was motivated to change for several reasons, including a desire to stay competitive with other hospitals and repeated requests from patients to not be separated from their babies. Perhaps most compelling, the staff felt it was simply “not fair” that moms who gave birth vaginally were allowed to stay with their babies, while moms who had C-sections were automatically separated from their babies. The C-section rate at Woman’s hospital was 40%, and they have more than 8,000 births per year. So making this change affected 3,200 families per year. How did the hospital change to couplet care? Amy and her baby Kareanna stayed together after a Cesarean– which allowed them to do very early skin-to-skin care. One of the first things the hospital did was put together a leadership team to plan for the change. This team included nurse managers from labor and delivery, postpartum, and newborn care, as well as pharmacists and materials management. The team communicated the plan to other groups (such as medicine). One of the team’s challenges was finding a large enough space where moms and babies could recover together after a C-section. They ended up choosing overflow labor and delivery suites that were big enough to accommodate the couplet. They also modified the existing recovery room (PACU) so that it could be used in case the overflow rooms were full. They moved curtains to make each patient’s space big enough for both mothers and infants to recover together, and they put a radiant warmer for the infant in each recovery space. The team had to make several other small changes. They had to train the recovery (PACU) nurses in neonatal resuscitation. They made sure baby blankets were placed in the heated blanket warmer, and that appropriate medications for both moms and babies were stocked in each room. Perhaps most importantly, staff made a commitment to provide care where the mothers and babies were, instead of always taking the baby away to the nursery. Although taking the baby to the nursery was easier and more convenient for the staff, they realized that keeping the couplet together was best for moms and babies. It took about 6 weeks from the beginning of this process until couplet care was fully implemented. How did it go for this hospital in Louisiana? In the first year after starting couplet care, the percentage of infants who were separated from their mothers dropped from 42% to 4%. Nurses stated that everyone was extremely satisfied with the change—including staff, physicians, and mothers. Nurses report that mothers are able to have skin-to-skin contact earlier, and that the first breastfeeding session goes smoother. Inspired by the bonding they witnessed between moms and babies, nurses decided to delay administration of erythromycin ointment and the vitamin K shot until after the initial breastfeeding. As nurses from the Woman’s Hospital said, “If a hospital that delivers 8,000 infants annually can find a way to decrease the separation of mothers and newborns, concerned nurses everywhere should be able to implement this type of care.” In the ideal situation, mom does skin-to-skin in the operating room. The family is never separated during recovery. So what is the bottom line? Evidence has shown that it is possible—and best practice—for moms and babies to stay together after a Cesarean. If a hospital staff member tells a mother that it is “impossible” for her to stay with her baby after a C-section, that statement is false. Making the switch from routine separation to couplet care can be done—some hospitals have already done so. Although couplet care may be more inconvenient for staff in the beginning, in the end, keeping mothers and babies together after a Cesarean is what is best. Mothers who want to do very early skin-to-skin care and interact with their babies after a C-section should talk with their providers about this mother-friendly and baby-friendly practice. Moms should also talk with their anesthesiologists to make sure that they do not receive sedative drugs unless medically necessary, as these drugs may make some women incapable of early interaction with their newborns. If you want to read more medical research: These researchers describe how critically ill babies had a higher mortality rate when they were separated from their mothers after birth. These researchers found higher cortisol (stress) levels in infants who were not held by their mothers after birth. In this small randomized, controlled study, researchers experimented with keeping moms and babies together after a C-section. Not surprisingly, the intervention group had earlier first mother-baby contact, earlier first feedings, and more stable infant body temperatures. In this landmark study, researchers randomly assigned mother-baby pairs to several different groups, and one of the groups was assigned to mother-baby separation for 2 hours after birth. Mothers and babies who were separated for 2 hours had a higher risk of poor maternal/infant bonding outcomes one year later. This risk was not alleviated by “rooming in” for the rest of the hospital stay. In this animal study, baby horses were separated from their mothers for one hour after birth (intervention group) or left undisturbed with their moms (control group). The separation increased the risk for poor bonding and other adverse social outcomes. If you Google “hospital”, “couplet care” and “cesarean” you will find a large number of hospitals that already offer this mother-friendly and baby-friendly practice. If you liked this article, you may be interested in: The evidence for skin-to-skin care after a C-section An interview with a mother who received skin-to-skin care in the operating room An interview with a mother who asked to stay with her baby after a Cesarean An interview with a doula who helps facilitate skin-to-skin care in the operating room Our Facebook album with amazing photos of skin-to-skin care in the operating room References: 1.Anderson, G. C., D. Radjenovic, et al. (2004). “Development of an observational instrument to measure mother-infant separation post birth.” J Nurs Meas 12(3): 215-234. 2.Brazelton, T. B. (1961). “Effects of maternal medication on the neonate and his behavior ” Journal of Pediatrics 58: 513-518. 3.Centers for Disease Control (2010). Maternity Care Practices Survey. Accessed online January 5, 2013. 4.Declercq, E. R., C. Sakala, et al. (2007). “Listening to Mothers II: Report of the Second National U.S. Survey of Women’s Childbearing Experiences: Conducted January-February 2006 for Childbirth Connection by Harris Interactive(R) in partnership with Lamaze International.” J Perinat Educ 16(4): 9-14. 5.Elliott-Carter, N. and J. Harper (2012). “Keeping mothers and newborns together after cesarean: how one hospital made the change.” Nursing for Women’s Health 16(4): 290-295. 6.Mahlmeister, L. R. (2005). “Couplet care after cesarean delivery: creating a safe environment for mother and baby.” J Perinat Neonatal Nurs 19(3): 212-214. 7.Moore, E. R., G. C. Anderson, et al. (2012). “Early skin-to-skin contact for mothers and their healthy newborn infants.” Cochrane Database Syst Rev 5: CD003519. 8.Spradlin, L. R. (2009). “Implementation of a couplet care program for families after a cesarean birth.” AORN J 89(3): 553-555, 558-562.

Breast pump basics

Breast Pump Basics a. Breast shield: Cone-shaped cup that fits over the nipple and surrounding area. b. Pump: Creates the gentle vacuum that expresses milk. The pump may be attached to the breast-shield or have plastic tubing to connect the pump to the breast shield. c. Milk container: Detachable container that fits below the breast shield and collects milk as it is pumped. Consumer Updates RSS Feed2 Share this article (PDF 508 K)3 On this page: Choosing the Right Pump for You Should You Buy or Rent? Keeping It Clean These days, many new mothers return to the workplace with a briefcase in one hand—and a breast pump kit in the other. For those moms working outside the home who are breastfeeding their babies (and those who travel or for other reasons can’t be with their child throughout the day), using a breast pump to “express” (extract) their milk is a must. The Food and Drug Administration (FDA) oversees the safety and effectiveness of these medical devices. New mothers may have a host of questions about choosing a breast pump. What type of breast pump should they get? How do they decide ahead of time which pump will fit in best with their daily routines? Are pumps sold “used” safe? back to top Choosing the Right Pump for You Kathryn S. Daws-Kopp, an electrical engineer at FDA, explains that all breast pumps consist of a few basic parts: a breast shield that fits over the nipple, a pump that creates a vacuum to express the milk, and a detachable container for collecting the milk. There are three basic kinds of pump: manual, battery-powered and electric. Mothers can opt for double pumps, which extract milk from both breasts at the same time, or single, which extract milk from one breast at a time. Daws-Kopp, who reviews breast pumps and other devices for quality and safety, suggests that mothers talk to a lactation consultant, whose expertise is in breastfeeding, or other health care professional about the type of breast pump that will best fit their needs. Questions for new moms to keep in mind include: How do I plan to use the pump? Will I pump in addition to breastfeeding? Or will I just pump and store the milk? Where will I use the pump? At work? When I’m traveling? Do I need a pump that’s easy to transport? If it’s electric, will I have access to an outlet? Does the breast shield fit me? If not, will the manufacturer let me exchange it? back to top Should You Buy or Rent? There’s also the decision of whether to buy or rent a breast pump. Many hospitals, lactation consultants and specialty medical supply stores rent breast pumps for use by multiple users, Daws-Kopp notes. These pumps are designed to decrease the risk of spreading contamination from one user to the next, she says, and each renter needs to buy a new accessories kit that includes breast-shields and tubing. “Sometimes these pumps are labeled “hospital grade,” says Daws-Kopp. “But that term is not one FDA recognizes, and there is no consistent definition. Consumers need to know it doesn’t mean the pump is safe or hygienic.” Daws-Kopp adds that different companies may mean different things when they label a pump with this term, and that FDA encourages manufacturers to instead use the terms “multiple user” and “single user” in their labeling. “If you don’t know for sure whether a pump is meant for a single user or multiple users, it’s safer to just not get it,” she says. The same precaution should be taken for “used” or second-hand pumps. Even if a used pump looks really clean, says Michael Cummings, M.D., an obstetrician-gynecologist at FDA, potentially infectious particles may survive in the breast pump and/or its accessories for a surprisingly long time and cause disease in the next baby. back to top Keeping It Clean According to FDA’s recently released website on breast pumps4, the first place to look for information on keeping the pump clean is in the instructions for use. In general, though, the steps for cleaning include: Rinse each piece that comes into contact with breast milk in cool water as soon as possible after pumping. Wash each piece separately using liquid dishwashing soap and plenty of warm water. Rinse each piece thoroughly with hot water for 10-15 seconds. Place the pieces on a clean paper towel or in a clean drying rack and allow them to air dry. If you are renting a multiple user device, ask the person providing the pump to make sure that all components, such as internal tubing, have been cleaned, disinfected, and sterilized according to the manufacturer’s specifications. Cummings notes that there are many benefits to both child and mother from breastfeeding. “Human milk is recommended as the best and exclusive nutrient source for feeding infants for the first six months, and should be continued with the addition of solid foods after six months, ideally until the child is a year of age,” he says. The benefits are both short- and long-term. In the short-term, babies can benefit from improved gastrointestinal function and development, and fewer respiratory and urinary tract infections. In the long-term, children who have been breast fed may be less obese and, as adults, have less cardiovascular disease, diabetes, inflammatory bowel disease, allergies, and even some cancers. Cummings adds that moms and their families benefit by the bonding experience and economically as well, since a reduction in acute and chronic diseases in the baby saves money. For women considering this option, FDA ‘s website5 offers resources and information on breast pumps and breastfeeding. These include information on the selection and care of the pumps, in addition to describing signs of an infection or injury related to their use. This article appears on FDA's Consumer Updates page6, which features the latest on all FDA-regulated products. January 14, 2013

Too Few Breastfeeding Studies Done

Is the Medical Community Failing Breastfeeding Moms? By Lisa Selin DavisJan. 02, 20130 Share inShare2 Tamar Levine / Gallery Stock Email Print Share Facebook Twitter Tumblr LinkedIn StumbleUpon Reddit Digg Mixx Delicious Google+ Comment Follow @TIMEHealthland The doctor blamed it on the baby. “She’s not absorbing your milk,” he told Colleen Kelly, in the days after he daughter was born, as the baby lost too much weight and cried constantly. Lactation consultants said, “She’s not latching properly.” Kelly drove through rural Maine for hours to attend breast-feeding support groups and La Leche League meetings, yet the baby went from eight to six pounds and was diagnosed as “failure to thrive.” The baby’s kidneys were x-rayed and blood taken, but doctors found nothing wrong. Not once in her travels did someone suggest that perhaps the problem was Kelly herself, rather than her baby or her ability to latch on. She told doctors that her mother hadn’t been able to produce enough breast milk—could that be happening to her? No, they said. That was an old wives’ tale. But they never even looked at her breasts. “It was clear that none of the doctors or nurses knew enough about breast-feeding to figure out what was happening,” Kelly says. That’s because lactation is probably the only bodily function for which modern medicine has almost no training, protocol or knowledge. When women have trouble breast-feeding, they’re either prodded to try harder by well-meaning lactation consultants or told to give up by doctors. They’re almost never told, “Perhaps there’s an underlying medical problem—let’s do some tests.” (MORE: Breast-Milk Donors Come to the Rescue of a New Mom with Breast Cancer) When women have trouble breast-feeding, they are often confronted with two divergent directives: well-meaning lactation consultants urge them to try harder, while some doctors might advise them to simply give up and go the bottle-and-formula route. “We just give women a pat on the head and tell them their kids will be fine,” if they don’t breastfeed, says Dr. Alison Stuebe, an OB who treats breast-feeding problems in North Carolina. “Can you imagine if we did that to men with erectile dysfunction?” ED, she points out, is within the purview of many doctors’ services, and insurance will cover Viagra, but lactation dysfunction? It doesn’t even exist as a diagnosis, no accompanying health insurance code for which doctors can bill. Within the database of federally funded medical research, there are 70 studies on erectile dysfunction; there are 10 on lactation failure. No one argues that breast is best, but the truth is that breast-feeding is very difficult for many women, and for some, medical problems make it almost impossible without intervention. With the recent bans on giveaways of formula samples in some hospitals, it’s all the more important that the medical community have the tools and knowledge to help mothers breastfeed—or to figure out why they can’t. Until doctors and nurses are properly trained to help, women like Kelly will experience all of the pressure to breastfeed, with none of the support to figure out how. (MORE: 20 Ways To Make Breast-Feeding Easier) What do doctors learn about breast-feeding in medical school? “We learned that it’s what’s best for baby,” said my own pediatrician. “But that’s it.” They’re introduced to evidence that prolonged breast-feeding reduces the possibilities of obesity, SIDS and allergies, but the science of it, what’s happening at the anatomical level? Not so much. “It’s an hour, or a half a day, and [students] don’t remember anything,” says Dr. Todd Wolynn, a Pittsburgh pediatrician and executive director of the Breastfeeding Center of Pittsburgh. There were years, he says, when there was literally nothing said about breast-feeding at all. Why so little heed? “When most of the people who are currently leaders were in training, breast-feeding was really uncommon,” says Stuebe. Many teaching in medical schools today were raised in the better-living-though-chemistry age, when infant formula was thought to trump the attributes of breast milk. (Formula was certainly an improvement over the non-pasteurized cow’s milk that killed many infants at the turn of the 20th century, when breast-feeding was not in vogue). “It’s generational for doctors to think it would be necessary to know anything about breast-feeding.” It didn’t help that formula companies famously sidled up to doctors and nurses and insinuated themselves into hospital protocol; there’s a reason that, until the bans enacted in the last few weeks in some cities, new moms left the hospital with so much Similac swag. In addition, doctors practicing today don’t know where to place breast-feeding problems—breasts are attached to the women, so shouldn’t they be the province of OBs, say pediatricians. And OBs note that breast-feeding is for infants; shouldn’t the baby’s doctor handle it? This leaves breast-feeding problems either to the rare family physicians, or more commonly to lactation consultants who can assist with technical issues—improving the baby’s latch and such—but can’t write prescriptions, check hormone levels or offer a diagnosis. (MORE: Bloomberg’s Breast-Feeding Plan: Will Locking Up Formula Help New Moms?) That’s what a breast-feeding doctor—an OB, pediatrician or family physician with a subspecialty in breast-feeding medicine—would have done in Kelly’s case: a complete physical and medical history (yes, in fact, it is relevant if your mother couldn’t make milk) on mom and baby to see if any physical or anatomical factors were affecting supply. In the mother, they might check the shape of her breasts, to see if they were hypoplastic—a tubular shape that can indicate underdevelopment of the glandular tissue needed to make breast milk—or evaluate her hormone levels, ask if her breast size had increased during pregnancy. Perhaps they’d prescribe a galactogogue, a drug that promotes lactation. Today there are 88 physicians in the entire world who are fellows of the Academy of Breastfeeding Medicine, and have “demonstrated evidence of advanced knowledge and skills in the fields of breast-feeding and human lactation.” But Kelly’s doctors weren’t trained in human lactation, and they told her what many women with lactation failure have been told before: “We’ve never seen this before. You’re the only one.” Yet Kelly is clearly not alone. Dr. Amy Evans, a pediatrician and medical director of the Center for Breastfeeding Medicine in Fresno, CA, says that as many as five percent of all women have underlying medical conditions that prevent or seriously hinder lactation: hypoplasia, thyroid problems, hormonal imbalances, insufficient glandular tissue, among others. But even Dr. Wolynn, who is also a certified lactation consultant, seemed skeptical when I related Kelly’s tale—usually women struggle because they haven’t had enough support in the first few days after giving birth, in his experience. “Very few women really can’t breastfeed,” he said. “That’s very, very, uncommon.” It’s a “normal mammalian function,” he said. Almost everyone can do it. (MORE: Q&A With Breast-Feeding Mom Jamie Lynne Grumet) Because the complexities of lactation failure are so little studied and so often misunderstood, women can often feel that they are at fault, rather feeling like they are suffering from a medical issue for which they need and deserve professional help. Dr. Marianne Neifert writes in her article, Prevention of Breastfeeding Tragedies, “The bold claims made about the infallibility of lactation are not cited about any other physiologic processes. A health care professional would never tell a diabetic woman that ‘every pancreas can make insulin’ or insist to a devastated infertility patient that ‘every woman can get pregnant.’” Luckily, doctors are beginning to take breast-feeding on. Wolynn, Evans and Stuebe are all fellows of the physicians’ organization Academy of Breastfeeding Medicine (ABM). At Wolynn’s practice, all six of the pediatricians on staff are also certified lactation consultants. ABM has developed 25 protocols to guide physicians in treating breast-feeding problems. They’ve successfully lobbied to include breast-feeding issues on the exams for the American Board of Obstetrics and Gynecology and the American Academy of Pediatrics. And the Affordable Health Care Act advises that, as of August 1, health insurance companies should provide “comprehensive lactation support and counseling, by a trained provider during pregnancy and/or in the postpartum period, and costs for renting breast-feeding equipment.” Of course, we’re low on those trained providers, but there are more every day, as medical schools begin to adopt breast-feeding curricula. “It’s probably the most promising times we’ve seen,” says Wolynn. “We’re in the early phases of what I’m hoping in the next five to 10 years will be more appreciated and more considered a real subspecialty,” says Evans. “It’s a whole new area of medicine.” (MORE: Why Most Moms Don’t Reach Their Own Breast-Feeding Goals) Still, there’s work to be done. Health insurance companies need to reimburse doctors for the time they spend attending to breast-feeding issues, to cover galactogogues, and to cover donor breast milk for women with lactation failure. And if we’re going to remove formula samples for women to promote breast-feeding, we better come up with a plan to feed the babies of that 5% of women who can’t sustain them—with 4 million births a year, that’s 200,000 moms who need extra help. Doctors practicing today—especially those treating pregnant women and new mothers—need to know that lactation failure really does happen, and to be familiar with the potential causes of it, so that they can intervene early. Perhaps most importantly, we need to stop demonizing mothers who can’t breastfeed, guilting them into starving their kids with insufficient milk supplies rather than supplementing with formula. Yes, breast-feeding can help prevent SIDS, obesity, childhood leukemia, asthma, and lowered IQ…but none of those matter if your baby is failing to thrive because of malnutrition. In Kelly’s case, once the baby was admitted to the hospital, she began to use formula, fed through a syringe—she was told to avoid bottles because the baby would reject the breast. She stuck with formula, her baby gained weight, and today, “she’s happy, healthy and fine,” Kelly says. But her guilt and shame continued long after the baby recovered. It wasn’t until weeks later, in another doctor’s office, that Colleen happened upon an article that calmed her: some women, it said, can’t breastfeed, for physical reasons. If only her doctors had read that article, too. MORE: Can a Formula Company Really Promote Breast-Feeding and Fight Child Obesity? Read more: http://healthland.time.com/2013/01/02/is-the-medical-community-failing-breastfeeding-moms/#ixzz2GyaT1Ekh