The Romanticized Myth of What Constitutes Successful Breastfeeding- An Apology

by Jessica Martin-Weber

Dear Leakies,

This is my 5th version of this letter. I’m going to finish this one.

But first I’m going to do something I’ve never done here before:

To hell with the WHO Code

That’s a picture of Sugarbaby receiving a bottle. A bottle of my milk. Taken 2 years ago by my wonderful husband, I love this photo. So much love and pride captured in this moment. A vital moment in me reaching and achieving my breastfeeding goals. And that bottle wasn’t even kind of a “booby trap” to my breastfeeding goals.

Still, I never shared it with any of you here, on Facebook, Twitter, or Instagram.

Why haven’t I shared this or images like it with The Leaky Boob community before now? Why is this my 5th attempt at this letter? It’s simple:

Shame.

Yep. I have harbored shame. Not shame that my babies have received bottles, no, I have absolutely no shame that I’ve fed my children as I needed to. No, my shame came from using a bottle made by a WHO Code violating company. (To learn about what the International Code of marketing of Breastmilk Substitutes is, go here.) Only, that’s not really the shame I’m holding either, do you know how hard it is to find a bottle that’s not made by a WHO code violator? Nearly impossible.

No, my shame goes way beyond even the WHO Code, bottle feeding, or supporting a WHO Code violator.

My shame is that I haven’t cared about the WHO Code for 3 years, but felt I had to in order to be a “good” breastfeeding supporter.

My shame is that I played along, even became a part of the self-appointed WHO Code policing brigade for a time, even though I knew all along, deep down in my heart, that the almighty WHO Code was creating barriers.

My shame is that I felt righteous supporting the WHO Code. The original purpose of the WHO Code was so pure, so right, so good, how could I not support it?

My shame is that I upheld an artificial picture of what it looked like to successfully breastfeed and called it supporting the WHO Code.

My shame is that my actions supported the WHO Code more than they supported women, babies, and families.

But my shame is not that my babies were fed, not that they were loved, not that they sucked on an artificial teat.

To hell with the WHO Code

Look at that big sister love and pride!

Screw shame. I’m done. And I’m sorry. I’m deeply sorry that it has taken 3 years for me to find my courage to take the stand I live but never shared here.  I’m sorry that I’ve not been honest.

Because this is what successful breastfeeding has looked like for me:

To hell with the WHO Code

And so is this:

to hell with the WHO Code

For every single one of my 6 beautiful children, bottles and breast have been a part of me reaching my goals. And not just because I had to go back to work. I choose to go back to work, I love working and am a better parent when I work, but even when I didn’t work outside the home, I elected to partially bottle feed my milk to my baby. This was a positive thing for me as I get physically stimulated very easily and as an introvert found the need to create some space for myself. I did better mentally and emotionally, which meant I was in a healthier place mentally and emotionally to parent my children. It was the best healthy choice for us. I have never, not once, regretted it. Today, with a breastfeeding 2.5 year old, I also don’t believe it ever interfered with our breastfeeding nor did bottles have a negative impact on me reaching my breastfeeding goals.

In fact, I firmly believe that without bottles, I would have quit breastfeeding early on.

And see the big child in this photo bottle-feeding her baby sister my milk?

to hell with the WHO code

Do you see that eye contact? *melt*

She was mostly formula fed.

I don’t have any shame about that either. In fact, I’m damn proud that when the time came I could make the right decision for us to stop breastfeeding and switch to formula. The regret I have felt about that has been artificial and circumstantial, never true. It took a lot of courage for me to make that decision and it was the right one. I would make it again if I had to. I will support you if it’s the decision you need to make as well. We’ve been vocal here that breastfeeding doesn’t have to be all or nothing to be successful, I just haven’t been visible with that reality for myself.

Through The Leaky Boob I have contributed to a beautiful yet often unattainable depiction of what it looks like to breastfeed. In my attempt to normalize breastfeeding and provide support up what breastfeeding looks like, I have held up at the breast breastfeeding as being more beautiful, more important, more viable, more worthy of sharing and discussing and promoting than any other infant feeding methodology.

I support people before I support a feeding method.

to hell with the WHO Code

Sugarbaby’s big sisters loved to give her a bottle

I look at these photos of my baby receiving bottles and I see a beautiful, important, viable feeding worthy of sharing and discussing and promoting. Normalizing breastfeeding (bottle-feeders will tell me they feel that is normalized) and normalizing bottle-feeding(breastfeeders will tell me they fell that is normalized) shouldn’t be in competition with each other. What really seems to need to be normalized is caring for children. Parenting. Without it being a contest or a platform to boost how we feel about ourselves.

Feeding your child is real, no matter what they are fed or the mode of delivery. It’s real, it’s important, it’s complicated, and parents deserve support as they navigate this terrain. I am sorry that The Leaky Boob has, at times, failed to communicate that. I a sorry if instead of being a part of building your confidence, I’ve been a part of tearing it down. Deeply sorry.

I know there are those who will tell me I haven’t failed and I appreciate that.

I also know there will be those that will tell me that I haven’t failed until now. I appreciate that too.

But for the last 4 years as The Leaky Boob I have not been entirely honest with you. As a public voice in breastfeeding support, I have contributed to a mythical image of breastfeeding. I wish I could say it wasn’t intentional but it was and of the 4 years I’ve been doing The Leaky Boob, I have wrestled with this for three years. Motivated by fear, I allowed myself to present a picture of my breastfeeding journey and an idealized image of “successful” breastfeeding that simply wasn’t true. Well, not true for me anyway and likely not true for many of you. And I know holding that ideal up was damaging for some and a sort of betrayal for others. It wasn’t that I overtly lied, it was more of an omission of truth. I was wrong to do so and I am sorry.

A few weeks ago I was sitting with a friend of ours, a new dad who was bragging about how his wife and son had worked so hard at breastfeeding and just the day before, at close to 8 weeks old, had fed directly from the breast for all of the feeds. He said something that struck me: “you know, I think they’ve been breastfeeding, we’ve worked so hard but it’s not like you ever see pictures of breastfed babies getting bottles. Our lactation consultants were great but it’s a lot of work, a lot of time, a LOT of money, you know? The work you do is so important, we were on The Leaky Boob all the time and we have found a lot of help and support there but we still felt alone. I mean, it feels like it’s not as real if we’re giving a bottle, nobody ever talks about that. Does anyone else go through this?”

I was confronted with the reality of my failure on my couch.

to hell with the WHO code

Babies feeding babies here. So much big sister love!

Leakies I am sorry I never shared images of my babies and other babies receiving bottles. I was wrong to only ever present a side of my infant feeding journey that was safe for me as a public breastfeeding supporter. Anxious that I would be inviting drama and attacks from other breastfeeding supporters, educators, blogs, organizations, and my own readers, I didn’t want to risk being accused of being a WHO Code violator by posting pictures of my babies with their bottles. Specially since I do make some income from The Leaky Boob, I was concerned that if I ever even showed bottle feeding some would think it was sending the wrong message.

But message or not, this is the truth: my babies, all 6 of them, got bottles. One got mostly formula in her bottles. Back when I was attending women as they had their babies, often I was helping a new mother and baby pair with their first few feedings while my baby was at home getting a bottle of my milk. And every single bottle my babies have received was manufactured by a WHO Code violating company. I’ve never once regretted that, never once felt guilty for it, never once wished it was another way. But I did feel afraid to show it.

My incredible husband, Jeremy, The Piano Man, has never had a problem sharing these images though and not because he doesn’t understand the WHO Code or is unaware of the barriers women face when it comes to breastfeeding. When he came home one day with a new bottle and I stressed about having a WHO Code violating bottle in our house, that it couldn’t be posted anywhere online, and that I felt sick giving money to a Code violating company, he simply looked at me and calmly said “I thought this was about feeding our daughter.” I sterilized that bottle and moved on, knowing I wouldn’t post any photos of the offending bottle. But he did. And the very first comment on the photo was this:

WHO Code

E bottle feeding A copy IG bottle feeding comments redacted

I understand where the commenter was coming from and she wasn’t giving anyone a hard time but it’s true, because of the half truth I had shared, it was strange to see one of my baby’s drinking from a bottle. But it wasn’t strange that she was receiving one, it was actually a part of our normal infant feeding routine.

Bottles were an important part of me reaching my breastfeeding goals. Without bottles, I’m not sure I would have made it as far as I have and I’m pretty certain I would never have even started The Leaky Boob. I have talked about using bottles and formula feeding my second daughter, but I never shared images and I carefully couched sharing those experiences as safely as I could so as not to invite controversy.

I have let go of my shame and my fear.

By intentionally keeping that part of my breastfeeding journey quiet, by not sharing images of my baby receiving a bottle, by just sharing images of my babies feeding only at my breasts, and by neglecting the real life bottled-up aspects of the breastfeeding journeys of others, I perpetuated a romanticized myth of what constitutes successful breastfeeding.

I am sorry. Please forgive me.

With all my love, sincerely,

~Jessica

bottle feeding and breastfeeding The Leaky Boob Sugarbaby

Do you use bottles? How do you feel about using bottles? Do you share pictures on social media of your baby receiving bottles? Need help bottle-feeding your breastfed baby? Check out this articleFacebook page, and this book.

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9 Reasons you may be uncomfortable with seeing breastfeeding

by Jessica Martin-Weber
Photo from Instagram user Jeniholland.

Photo from Instagram user Jeniholland.

We’re well into the 21st century yet breastfeeding appears to still make many people uncomfortable.  I keep hoping those individuals that get upset about the biologically normal way to feed a baby are really a rarity but, unfortunately, it still seems to be a hot button issue.  Regardless of how a woman is most comfortable feeding her baby, be it uncovered at the breast, covered at the breast, a bottle of expressed breastmilk, or a bottle of formula, plenty of people are uncomfortable witnessing a woman feeding her child and any form of breastfeeding seems to especially elicit vocal expressions of discomfort from others.  I identified 9 reasons people may be uncomfortable seeing breastfeeding be it on social media or in person settings and tried to offer some solutions in overcoming what is essentially a discomfort about babies being fed.  And that brings us to our first point:

  1. Agism.  Breasts aren’t the issue for you, nope.  You just don’t think babies and small children have the right to eat in public.  Or you think that every. single. time they do eat the experience should be charged with connection and intimacy between that child and their care-giver, staring deeply into each others’ eyes approximately 8-24 times a day and not witnessed by anyone else.  Those babies, they need to keep that stuff happening in private!  And yes, a baby or the needs of a small child should actually come second to your own personal comfort about what you witness.  Older people, that’s a totally different story, they can eat when they need to eat and for the most part, where they need to eat and how they need to eat it without harassment, expectation of high level bonding, or a blanket.  On the go, sitting at a table in public, while reading a book or talking with friends, it’s fine for those over the age of 2 to eat in public and even for them to post pictures of their meals on social media.  But those babies better at least keep it under wraps!  Spending some time watching just exactly how adults eat or watching this video could be key in getting you over your prejudices.  No?  You don’t discriminate against babies eating in public?  Ok, have you considered that you could have…
  2. Boob-phobia.  It’s a real thing, check it out.  Perhaps you’re uncomfortable by the sight of breastfeeding because you have Mastrophobia, a phobia of breasts (or cousins gynophobia, a fear of female parts, or papillaphobia, a fear of nipples) and seeing breastfeeding makes you want to run away.  Which maybe that’s what you should do, complete with screaming and waving your arms hysterically.  Or do what I do when watching a scary movie, hide behind a pillow only risking a peek here and there.  Actually though, if you do really have boob-phobia, you should seek professional help.  If that’s not it though, maybe it’s…
  3. Brainwashing.  Which is totally understandable and you can’t help the cultural conditioning that has brainwashed you into thinking breasts are truly only for sexual pleasure.  You’re a victim of marketing and fear.  Boobs aren’t for babies, boobs are for men/selling cars/selling beer/selling clothes/selling sex/selling music/selling movies/selling… selling, or at least that’s what the prevailing messages in much of society seems to be selling.  If this is an issue, walking around with a blanket over your head to cut out these messages could be the solution.  But maybe you are completely immune to marketing and the societal messages thrown at us from every which way, in which case it could be…
  4. Judgment.  You believe, and the reasons why are unimportant (certainly not fear or brainwashing), that breasts that aren’t properly shielded and covered belong to an immoral, immodest individual of low character.  Women that don’t keep those things contained and pull them out and stick them in the mouth of their hungry child must not have a shred of decency and you judge them for that.  Even if they define modesty or decency differently than you do.  Such as “it would be indecent of me not to feed my child when they are hungry…”  Heading to the bathroom to have your dinner may be exactly what you need to get you over this unfortunate character flaw.  Not a judgmental person?  Don’t care what other people do?  Then maybe you’re uncomfortable with seeing breastfeeding because…
  5. Insecurity.  It could be anything.  Insecurity about your own breasts (male or female), insecurity about your friend/father/husband/brother/son seeing someone’s breasts (which of course means you make sure they avoid all malls, sports shows, magazines, and movies), insecurity in seeing someone breastfeed their child when you didn’t/don’t breastfeed yours, insecurity that breastfeeding or not breastfeeding is some kind of mark of “good parenting”, insecurity that others may be uncomfortable with someone else breastfeeding and you feel the need to make sure everyone (but the breastfeeding pair) is comfortable, or maybe just insecurity that humans are all mammals.  Whatever it is, and it could be anything, you personally battle insecurity and rather than face it in yourself you project your issues on to others.  Sitting next to a breastfeeding mother while she feeds her child and having a conversation with her may do the trick.  Not insecure?  If you’re confident enough to not be threatened by a woman feeding her child, could it be…
  6. Confusion.  You get grossed out by the sight of breastfeeding because of two words: body fluids.  It freaks you out that body fluids are free-flowing from a woman right into her baby!  Who needs to see that, right?  It doesn’t matter that it’s only natural because, hello, pooping, peeing, and sex are natural too and you don’t want to see any of THAT in public either, right?  It’s certainly only a matter of time before they’re bottling those body fluids up and feeding them to children too, I’m sure.  Fake urine will be flooding the shelves in no time, specially formulated to be just like the real thing.  Aside from the obvious fact that you really can’t see it happening during the act of breastfeeding, basic biology helps clear this up a bit: breastmilk = nutrition, urine/feces = waste, genital secretions = not food.  Some time studying basic nutrition and biology and understanding the basic differences should fix that right up.  Get the difference and not confused?  Moving on then, maybe it’s…
  7. Misogyny.  This goes along with the brainwashing point but it’s a little deeper.  If you’re uncomfortable seeing breastfeeding because of misogyny, you actually hate women and consider them less than men.  As such, their bodies are purely for men and a woman that would dare exercise her autonomy in using her body as she should choose, well she’s just asking for it, isn’t she?  A breastfeeding woman is just rubbing it in your face, isn’t she?  How dare she act as though she independently has worth and power over her own body.  Besides, seeing breasts in use in such an a-sexual way is a bit unsettling.  You haven’t sanctioned this and it’s uncomfortable to think that you have something in common with human babies. The way through this could be quite painful: start listening to women and catch a production of the Vagina Monologues.  But you’re not a misogynist?  Totally down with women as equals?  Great!  So what about…
  8. Denial.  There are people that spend time researching the emotion of disgust and have a disgust scale.  What is it, why do we experience it, etc.  Some triggers of disgust are understandable, like food contamination disgust.  We don’t want to get sick.  Obviously.  So why are you disgusted by breastfeeding, AKA, feeding babies?  It’s possible, these researchers theorize, that you just don’t like to be reminded of your animality.  Humanity is good in your mind but anything that connects you to the animal side of humans grosses you out.  That humans are mammals (creatures with mammary glands that use their mammaries to feed their young) is a fact you would rather forget.  Watch some Discovery channel, you’ll have to eventually confront that breastfeeding our young isn’t the only animal-like behavior we homo sapiens have.  Not that?  Then…
  9. Unfamiliarity.  When we’re not used to seeing something it can be startling when we come across it.  This isn’t your fault, you’re just not familiar with this as normal and actually expect the alternative to the biological norm instead.  You just haven’t seen breastfeeding enough to be totally down with it.  The fix to this one is pretty easy, see more breastfeeding.  You’ll get over your discomfort the more you see it and soon it will become just as normal as it actually is.  Don’t worry, more and more women are doing their part in feeding their babies in public, with and without covers, and you’ll get more comfortable with it the more you see them out and about or posting their photos on social media so hang in there, there’s hope for you yet!

 

________________________

 What would you add to our list?  Why do you think people may have issues with witnessing breastfeeding or encountering breastfeeding images?  If you’re uncomfortable seeing breastfeeding, why do you think that is?   Did you used to be uncomfortable seeing breastfeeding but are ok with it now?

________________________

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Bottle Feeding Breastfed Babies

 

by Tanya Lieberman, IBCLC, with Amy Peterson, IBCLC

We’re very pleased to share an interview about bottles and breastfed babies today. We asked Amy Peterson, IBCLC, co-author of Balancing Breast and Bottle: Reaching your Breastfeeding Goals, to answer our questions.

For those of you who combine bottles with breastfeeding – whether you’re pumping at work, supplementing, or use a bottle for occasional separations – bottle and nipple selection can be confusing. For those of you whose babies refuse bottles, it can be very frustrating!

We hope that the information she shares below is helpful. Amy offers more information on bottlefeeding breastfed babies on her website.

Many bottles are advertised as “easing the transition from breast to bottle” and back again. What do you think of these claims? Are they independently verified?

These claims are very misleading. Just as every mother’s breast has a unique shape and flow, every baby has a unique suck/swallow cycle. What works well for one baby might be terrible for another. Parents need to observe their own baby sucking on a bottle nipple and analyze if the latch and swallow look similar to that on the breast. In our book, we use a tool called the SIMPLE Method that guides parents step-by-step on how to choose a bottle nipple for their own baby’s unique latch.

We are not aware if such advertising claims have been verified. However, we do know that this type of marketing is in violation of the International Code of Breastmilk Substitutes. This international health policy document, adopted by many countries excluding the U.S., is designed to protect families from underhanded marketing ploys such as words or pictures idealizing artificial feeding. Comparing a bottle to breastfeeding—even if it contains breastmilk—is idealizing that brand.

In our professional experience of helping babies combine breast and bottle-feeding, we have found that the nipples which claim to be best for breastfed babies are often the worst choice. The bottle nipples that are best for breastfed babies have a gradual transition from tip to base.

You and your co-author tested 37 bottles. What were the features you were comparing, and what did you learn about the range of bottles that you’d most want parents of breastfed babies to know?

We tested two different aspects of bottle nipples. First, we measured dripping by looking at the number of drips and the size of each drip. Then we hooked up bottles to a hospital grade breast pump to determine how fast bottles flow. After performing these tests, we compared the results to see if bottle dripping and flow rate were related.

The results were surprising. First of all, about half of the nipples, regardless of a non-“no drip” label stopped dripping within five seconds of tipping them upside-down. That was important for us because many bottle companies claim their nipples are “no drip,” implying that bottles that don’t drip are a better choice. To rule out the importance of dripping, we did further testing.

Second, we measured the size of the drip for those bottles that did drip. The most important thing we found was dripping does not equal a higher amount of liquid. Bottles that appeared to drip a lot often had less volume. Frequently it is assumed that a fast dripping bottle has a large amount in the drip. We discovered that a bottle may drip frequently, but with a low output. So, it is impossible to judge the size of the drip with the naked eye. Stated another way, the number of drips doesn’t mean more liquid is coming out.

As for flow, the term “slow” is not standard. To determine flow, we hooked up bottles to a hospital grade breast pump and measured the amount of liquid collected after 20 cycles. We found there was a wide range of “slow.” For example, the fastest nipple was eleven times faster than the slowest nipple. Following testing, we ranked nipples from slowest to fastest in Appendix C of Balancing Breast and Bottle. This is important because if a nipple flows too quickly, a baby’s suck will become disorganized. Likewise, a nipple might be too slow for some babies. A parent needs to watch their baby’s response to bottle-feeding rather than relying on package labeling. If a parent thinks the bottle is flowing too fast, try a different nipple in the package, and/or try a different brand.

The most fascinating results came from comparing the data of these two tests (drip and flow). Dripping is different than flow; they are not related. Most breastfeeding books suggest turning a bottle over to see how fast it drips in an effort to select a bottle with a slow flow. This suggestion is not accurate. We tested a nipple that dripped an average of 56 times when tipped over, but had a slow flow. Then, we looked at a no-drip nipple and much to our surprise, found it flowed 10.6 times faster. Big difference! Dripping is not related to flow.

Parents are often advised to begin breastfed babies on “slow flow nipples,” but even nipples advertised as “slow flow” can seem very fast. Are there any that are as slow as you think is appropriate?

As mentioned earlier, the term “slow” is not standardized. Nonetheless, it is important to begin with a slow nipple. If a nipple flows too quickly, a baby’s suck will become disorganized. For breastfeeding babies, it is best to choose a flow that mimics mom’s flow. For this reason, it is hard to say one or two brands are “best” since flow varies from mother to mother. Likewise, a nipple might be too slow for some babies. This is why we ranked the bottles and listed them in our book.

It is also important to remember that flow is only one aspect of choosing a bottle. If the baby’s mouth placement is wrong, regardless of the flow, baby will bring bad habits to the breast and still be in danger of early weaning.

For parents who are struggling to get their breastfed babies to take bottles, and who are exploring different bottles, what should they be looking for?

Moms need to consider the nipple shape and their baby’s mouth placement on the nipple. Ideally, the nipple chosen will gradually flare from the nipple length to the nipple base. This shape allows the tip of the nipple to reach far back into the baby’s mouth as the breast does, and then helps the baby to feed with the mouth open. Quite often a “narrow neck” nipple has a shape that reaches far into the baby’s mouth and allows for gradual widening of the baby’s lips.

A shape that often does not work well is a wide neck nipple where the nipple length meets the nipple base at a right angle. This nipple shape promotes what we call “straw” sucking, where the baby’s mouth closes around the length of the nipple and doesn’t open for the base. When babies “straw” suck on a bottle nipple, we often see gaps in the corners of the baby’s mouth which leads to leaking milk, gulping air, etc. This is quite different than breastfeeding.

One bottle feeding method is called “paced feeding.” Can you describe it and explain why it might be helpful to a breastfed baby? What are some signs that a baby is becoming overwhelmed while bottle feeding?

Paced feeding refers to helping a baby eat more slowly from the bottle. Pacing became popular in 2002, before flow had been studied. The idea behind pacing is that by helping the baby rest briefly during bottle-feeding, moms can more closely mimic how the baby naturally feeds at the breast. When a baby breastfeeds, the mother has several let-downs during the feeding. Between let-downs, the baby’s sucking slows and baby can rest briefly. If a baby is feeding from a fast flow “slow flow” nipple, the suck/swallow will be disorganized. Pacing helps the baby have rest periods while bottle feeding that naturally occur at the breast. Now that we know flow can be controlled by choosing an appropriate nipple, we have another technique in our bag of tricks to help babies be more coordinated when feeding from a bottle.

It is important to note that most babies can pace themselves once they master bottle-feeding with the right nipple. How do you pace? First, listen for swallowing while the baby is breastfeeding, noting when the baby naturally pauses and rests. Then apply the same rhythm to bottle-feeding. Also of importance is positioning. With bottle-feeding, support the baby in a more upright position because the flow of some bottles increases when the baby is laying back to feed (another element we tested).

Do all breastfed babies require pacing? No, in fact, imposing pacing can disrupt the natural feeding rhythm of a baby and cause harm when over used. Babies who are “good” feeders, meaning they have a normal, rhythmic suck/burst cycle, do not need pacing. It has been our experience that once a baby has mastered bottle feeding, it is no longer necessary for the parent to impose pacing.

Some signs of a poor bottle-feed include gulping, catch-up breaths, fast feeds, leaking milk from the sides of the mouth or down the chin, baby who has a furrowed brow looking very concerned, and a baby who pulls away from the bottle. For these babies, nipple shape and flow need to be double checked, and this becomes a good time to use pacing. Pacing also is an excellent technique for NICU and other high risk babies that are having feeding difficulties.

Lastly, we would like every caregiver who uses a bottle to know that dripping bottles given before a baby begins sucking usually cause the baby to pull back or flat out refuse the bottle. Caregivers need to be sure the nipple is not dripping when the bottle is offered to the baby. Allow the bottle to stop dripping or keep the milk tipped down in the bottom of the bottle. This topic is further explored on our website.

 

 

 Tanya Lieberman is a lactation consultant (IBCLC) who has helped nursing moms  in hospital and pediatric settings.  She writes and produces podcasts for several  breastfeeding websites, including  Motherwear,  Motherlove Herbal Company, and  the Best for Babes Foundation.  Tanya recently authored Spanish for Breastfeeding Support, a guide to help lactation consultants support Spanish-  speaking moms.  Prior to becoming a lactation consultant she was senior  education policy staff to the California legislature and Governor, and served as a  UN civilian peacekeeper.  Tanya is passionate about supporting nursing moms, and especially to eliminating the barriers so many moms face in meeting their breastfeeding goals. She lives in Massachusetts with her husband, her 8 year old son and her 1 year old daughter.

 

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Nipple confusion, bottles, and alternative feeding options

On January 17, 2012 in the United States, Medela, best known for their pumps, launched their latest “feeding innovation”, the Calma.  The Calma is a bottle that seeks to eliminate nipple confusion and flow preference by making a bottle fed baby work for its milk, similar to how your little one must compress and suck at your breast to get milk out.  According to Medela, this “supports an easy transition from the breast to the teat and back.”

As a registered International board certified lactation consultant, I am very skeptical of these claims.

I have often heard that nipple confusion is a myth, foisted on mothers to keep them stuck to their brand new babies, to keep them from leaving the house, to subjugate us all.  This is simply not true.  Nipple confusion happens.  I have seen numerous cases of it in my practice.  Babies become nipple confused for three reasons – flow preference, difference in movements, and difference in feel.  Medela has the right idea on part of the equation.  Babies that are given a lot of bottles in the early period can decide that it’s not that fun to work a breast when this plastic thingy is way easier.  Most bottles, even the slowest flowing, flow faster than milk from a breast.  However, your baby also moves their mouth differently to get the milk from a bottle than from a breast.  The jaw and tongue movements are not even close to the same, and trying to transfer the movements from one to another can frustrate and upset your baby.  After all, if your baby is new, this whole eating thing is new, too.  Why complicate it?  There’s a bonus too: a baby nursing at the breast will develop their mouth in a way that will help with prettier smiles and better speech, too!

The third part of the equation is the different feel.  If you are giving your baby a softer breast and a harder silicone, they may very well like the way that a bottle feels more – especially since that silicone is, again, delivering milk faster and the mouth movements are different.   Medela hasn’t really done anything to cure that.  I’ve seen and felt the Calma, and, I assure you, it will not be mistaken for breast tissue anytime soon.

The easiest way to prevent nipple confusion is by waiting to introduce a bottle until four to six weeks (three to four at the earliest) and to simply offer the breast more than the bottle.  Some families have other situations, though, that don’t make the whole four to six week thing possible.  So what is a modern mom to do?  For many of us, it is not feasible to never give milk from anywhere but the breast.  We have work, and school, and other children, and obligations, and, man, sometimes Mommy just needs a day (or an hour or two) off.   But babies still have to eat during that time!  And what if your baby has issues with latching at the breast, or you are inducing a supply, or you need to do some supplementing?

Luckily, being a modern mom means that we have some awesome options available to us.  There is spoon feeding, where you can hand express colostrum or milk directly into a spoon and give it to your baby.  This works best in the beginning, when your baby isn’t taking in much milk yet – it would be a fairly long process for a family feeding an older infant.  To spoon feed, you simply use a clean spoon, hold the baby in an upright position (like sitting) and put the spoon at the lower lip, giving small amounts and letting the baby go at their own pace.  A spoonful can be considered a full feeding if you are dealing with a newborn.

Cup feeding is another option.  Cups are widely available, cheap, and easy to use.  Your infant won’t take the cup from your hands and drink like a big kid, of course, but will instead lap at the milk kind of like a baby animal might.  There are special cups sold for cup feeding, but it might be easier and cheaper to just use a shot glass.  With cup feeding, like spoon feeding, you’ll hold the baby supported and upright.  You’ll put the cup to the lips and tilt slightly so that the baby can easily lap at the milk (not so it’s pouring into his or her mouth.)  Allow the baby to eat at his or her own pace.  It may take a while, but that is ok!  Babies shouldn’t be gulping down their feeds – when they do, they often overeat, which can hurt their tummies and set a bad precedence of wanting more than they need.

You can also use what’s called a supplemental nursing system, or SNS.  SNSs are generally a bottle type thing hooked to a long tube.  You put the milk in the bottle part, and then you can do one of two things with the tube.  First, you can use it on the breast, either by sticking it in a nipple shield (which you should only use if followed by a lactation consultant for sizing and to negate any potential complications that might arise) or by taping the end near the nipple so that the baby gets an extra boost of liquid while nursing.  This can be really helpful if you’re relactating or increasing a milk supply, if your baby needs to be supplemented but is nursing well, or if you have a preemie or baby with suck issues that maybe doesn’t milk the breast as effectively as they should be.  You can also use a SNS to finger feed your baby.  With that, you attach the tube to your finger, and the baby sucks the finger to get the milk.  A lactation consultant can even help you use this method to train or retrain your baby to suck properly.  SNS systems can be hard to clean, so please carefully read the instructions and check with a health care provider for any extra precautions you should take if you have a preemie or immune compromised baby.

If you have an older baby (4 months or so) that’s just now getting around to taking milk in another way, you can try forgoing bottles altogether and working on cup training or using sippy cups.  Sometimes the difference is interesting enough for an older baby who has rejected bottles.  As with any of the other methods, the goal is to allow your baby to learn and go at their own pace.  Be prepared for this to be a messier endeavor with an older baby who is starting to show some independence.  You will probably have to help them to hold and tilt the cup – they may not be content with the idea of you holding it all yourself, and you may have some spills in the process.

But what if none of these methods work for you?  Maybe your care provider is balking, or you are annoyed and uncomfortable with one or all of the methods, and you really, really just want to use a bottle.  In that case, instead of purchasing the reportedly $15 a piece Calma, I would try Fleur at Nurtured Child’s method of baby-led bottlefeeding.  In fact, any time you are bottlefeeding, you should use this method.  It is the ideal way to feed a baby from a bottle and encourage any care-takers that will be feeding your baby with a bottle to utilize this method as well.  In choosing a bottle, there is no really good evidence that I have seen showing that a certain bottle or nipple is better than another for breastfeeding.  There are a lot of nipples that are supposed to be similar to your breast in look and feel, but in my time in the bottle aisle, I never saw any that made me go, “That looks EXACTLY like my boob.  That one, right there, with the wide base and medium sized nipple!!”  My kids never really liked the wide bottomed nipples, although they are often touted as being awesome for breastfeeding babies.  When it all boils down to it, most of that is hype.  When selecting a bottle, select the one you think might work that is in your budget.

If you are giving milk due to a breastfeeding problem, be sure to discuss methods and supplements with a medical professional with good lactation training.  Ask a lot of questions.  If supplements are ordered, get a LOT of information on them.  Why do you need to supplement?  How long does your medical professional want you to supplement?  How much should you supplement?  How often should you supplement?  Can you use your own expressed breast milk?  What is the plan of action for weaning from supplementing?  If your baby isn’t nursing well at the breast, you will likely need to do some pumping along with the supplementing to keep your supply healthy while you work through the problem.  Find out how often you need to pump and how you should store your breastmilk – especially if your baby is hospitalized and you are transporting it.

There are other feeding options for more serious problems, such as cleft lip/palate as well. That type of situation needs to be followed very closely by a lactation professional and physician to ensure that the baby’s unique situation is being addressed.

If you are going to be separated from your baby for another reason – work, school, or just going out – remember to think of your magic number.  This is the number of times your baby breastfeeds in a normal day (and, yes, that can vary.  Just take an average.)  You want to be sure that you are replicating that amount of times by a combination of pumping and nursing.  This will help to keep your milk supply plentiful.

In the end, there is no product on the market that can magically be just like your breast and provide your baby the exact same experience.  Luckily, there are many options for your baby and your family that will help you to achieve your breastfeeding goals.

 

 
 Star Rodriguiz, IBCLC, is a breastfeeding peer counselor for a WIC in the Midwest and has just started her private practice as an IBCLC (her Facebook page is here, go “like” for great support).  She also sits on the  breastfeeding task force in her town, is helping her  community’s Early Head Start redefine  their breastfeeding support, and is the  driving force behind a local breastfeeding campaign.  In  the remainder of her free  time, she chases around her nursling and preschooler.
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