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Sleeping with the enemy- PAHO of The World Health Organization accepts funding from Nestlé

By Laura Griffin and Jessica Martin-Weber.  This post takes a look at the relationship between Nestlé and the Pan American Health Office of The World Health Organization.  Laura breaks down why this relationship is a conflict of interests, why parents and breastfeeding supporters should care, and what we can do. 

On October 19th, Reuters reported that the Pan American Health Office (PAHO) of The World Health Organization (WHO) had gone against previous policy and accepted funding from industry, including from Nestlé who donated $150,000.  I do not believe that this unsupportive support is going to do anyone any good.  Except maybe Nestlé.  Just as formula companies breastfeeding hotlines are marketing gimmicks masquerading as support, so is Nestlé’s donation to the Pan American Health Office.  Make no mistake, a company as savvy as Nestlé would never give such a substantial donation if they did not believe the dividends would be worth their investment.

Nestlé is the most boycotted company in the world, due in no small part to their serial violation of the International Code of Marketing of Breastmilk Substitutes (WHO Code). The WHO Code was drawn up in 1981 to protect the health of mothers and babies from predatory marketing, pressure, and false claims about infant formula.

formula advertising WHO code violating Nestle

Around the world they have made claims that their formula is good for babies brain development “like breastmilk” and perfect “for the hungry full-term infant”. Nestlé’s has invested countless dollars and hours to market their formula products specifically to women that would otherwise breastfeed, utilizing images and language that implies an “as good as” or even superiority comparison of their product to breastmilk.  They have coerced women in third world countries into formula feeding using sales people dressed as nurses and giving out free samples. The samples run out after the mothers’ milk has dried up and, often unable to afford the formula, they resort to watering it down to make it last longer. There is often no clean water source for these women to use for formula which brings further risks to the health of their children. I am incredibly lucky to live where it is rare for an infant to die of malnutrition or diarrhoea but in these developing countries it is a very real risk, exacerbated by this predatory marketing.

Please, reader, understand that this is not a case of “formula bashing”. I believe that women who need or choose to formula feed should be allowed to do so without lies or pressure from companies who are more interested in profit than health. They deserve to be able to trust the product they use. They deserve to be the foremost consideration of the formula company.  The honorary chairman of Nestlé, Helmut Maucher once said “Ethical decisions that injure a firm’s ability to compete are actually immoral”. Every family, whether breastfeeding, formula feeding, or both, deserves more than this!

This is not the philosophy of a company we want to join forces with the Organization entrusted with our health and that of the most vulnerable people in the world. I personally consider it unethical for PAHO to have partnered with a company who have violated the WHO countless times and have consistently put profit before the health of their customers.  To say nothing of the irony that several, if not all, of the preventable chronic diseases of the world today that PAHO and WHO are supposed to be fighting such as obesity, type 2 diabetes, high blood pressure, high cholesterol, and more are linked directly to the very food-like products that come from Nestlé.

Four of the most prominent chronic diseases – cardiovascular diseases (CVD), cancer, chronic obstructive pulmonary disease and type 2 diabetes – are linked by common and preventable biological risk factors, notably high blood pressure, high blood cholesterol and overweight, and by related major behavioural risk factors: unhealthy diet, physical inactivity and tobacco use.

~ Integrated Chronic Disease Prevention and Control from The World Health Organization’s website, emphasis mine.

 

A petition has been started by “Friends of the WHO Code” calling for an end to this partnership and for the return of Nestlé’s money. The petition can be found here.  There has been a call to boycott Nestlé for a very long time for a number of reasons not just limited to their unethical marketing practices of their infant feeding products but also because of known problems within their supply chains of production involving the very worst forms of child labor including harmful settings, abuse, child slavery, and kidnapping.  Standing against Nestlé is advocating for mothers and children around the world far beyond formula, read about the problem with chocolate here.

What can you do?

  • If you feel that Nestlé has no place at the PAHO-WHO table, then please sign and share the petition and share this information with friends and family.  Often, when I explain why my family boycotts Nestlé and their subsidiaries, I receive shocked responses that this company that works so hard to put forth a family friendly face of support is in fact regularly undermining the very people they claim to support.  People simply have no idea.
  • Tweet @WHO and @pahowho using the hashtag #NoNestle to express your concern over this leading health organization accepting funding from a private company known to violate their very own code of ethics in marketing breastfeeding substitutes.
  • Follow @NestleFail on twitter to support the cause and follow the latest information on holding Nestlé and other companies accountable for the predatory marketing tactics.
  • Join the Facebook page “Friends of the WHO Code” to stay informed of this situation and to know how to participate further as a voice for mothers and children.
  • Consider participating in the boycott of Nestlé products as every cent you spend on their products goes toward the profits of a company that repeatedly exhibits questionable ethics and jeopardizes maternal/child health through out parts of the world.
Please understand, this is not about using formula, it’s not even about Nestlé’s formula.  This is about standing together to hold accountable the organizations that are responsible for gathering and distributing life saving health information and to let corporations know that ethical practices and authentic caring for people matter far more than slick marketing and donation gimmicks.  Will you stand with us?

Blaming the milk? Is it the breastmilk or something else?

This post made possible in part by the generous support of Motherlove Herbal Company.

Fairly often on The Leaky B@@b Facebook page we see questions from moms concerned about their milk or explaining that they had to wean because they were told their milk was “bad.”  Moms ask about getting their milk tested, wonder about boosting fat content, and are concerned that their milk is making their baby sick.  Unlike issues with latch, milk supply, infection or, blaming breastmilk is often more ambiguous.  It isn’t uncommon for concerns to be rooted in outside sources; family expressing doubt that the mother’s milk is good enough, health care providers that suggest perhaps formula would be a more accurate, and formula marketing promising improved brain development and “closer to breastmilk than ever” so parents can sleep easier.  Even if their little one is growing well and meeting developmental milestones, there can be overwhelming concern that something is wrong with the milk and if their sweet offspring is anything other than the standard of a smiling, chubby, easy-going, and bright eyed Gerber baby, the milk is often the first thing blamed for a breastfed baby.

 

Why blame the milk?

Other than the reality of living in a culture where breastfeeding is not the accepted normal way to feed a baby but is just one option, why do so many people jump to the idea that there must be something wrong with the mother’s milk if the baby is “too” fussy, gassy, clingy, or any other possible problem?  Very few question if another mammal’s milk is good enough for their young, why are quick to suspect the quality of milk of human mothers?  Ignorance is a significant factor, too many people don’t understand what is normal behavior for a health, breastfed infant but I don’t think that’s the only reason.  Deep down I suspect there are other issues at play.

 

The perfect baby.

The old adage that children are to be seen and not heard is socially accepted as out of date however, our actions and reactions to children reveal otherwise.  If you don’t have a cherubic smiling baby all the time, there must be a reason, a reason that must have an easy fix.  A reason that probably starts with the parents.  And what could be an easier fix than a bottle of prepared, measured, and “scientifically formulated” breastmilk substitute?  With all that formulating, there can’t be anything wrong with it such as what you last ate… or so some are inclined to believe.

 

Out of touch.

With a good portion of a generation or two of mothers having no experience of breastfeeding, many in society are out of touch as to what’s normal in a breastfed baby.  New standards have been established based on a product derived from milk intended to grow an animal that starts out weighing anywhere between 50-100 pounds and can grow to weigh a ton (literally, not figuratively) as an adult.  An animal that has 3 stomachs.  Growth charts have been based on this product and for a long time nobody even thought there should be a different chart for breastfed babies and health care professionals and parents alike accepted the growth patterns of a formula fed infant as the standard.

Be sure your health care provider is using the correct chart with your child, ask if they are using the WHO growth chart for breastfed infants.

 

Obsessed with food.

Our culture is obsessed with food.  Eating it, not eating it, where it comes from, where it doesn’t come from, how much it costs, who is eating it, who isn’t eating it, how much we’re eating, etc.  It’s pretty dang hard to measure breastmilk coming straight from the breast.  If you can’t measure it, can’t see it, how can you obsess about it?

 

Women, your bodies are broken.

From monthly fertility cycles to sexual arousal, from birth to breastfeeding, from feminine hygiene to body shape, society consistently tells women there’s something wrong with their bodies.  A quick glimpse at vintage ads will show that this has been the case for a long time.  Douche it, pinch it, pull it, augment it, decrease it, measure it, plump it, thin it, paint it, perfume it, shave it, cut it, bind it, CHANGE IT!  Above all, hide what connects us with our animal side and don’t trust it.  Breastmilk is suspect because it comes from our body.  There must be something wrong with it.  The overwhelming message is that our bodies are broken.

 

Don’t judge me.

Whatever a mom’s reason to not breastfeed, whether there were physical issues, a lack of support, lack of information, or just not wanting to; nobody wants to be judged.  Finding camaraderie can be reassuring no matter what the reason.  Most moms don’t want other moms to fall short of their goals and they genuinely want to support but that support can also offer comfort to the one extending it if they feel even slightly judged because they didn’t breastfeed.  Blaming the milk for not being good enough or of making the infant sick can bring comfort that it wasn’t anything they did or didn’t do.  It’s not that they are looking for excuses but with the other reasons shared it can be that finding a reason as ambiguous as there being something wrong with the milk a relief that things didn’t work out.

 

Sex, sex, and more sex.

Breasts are sexual.  There’s no denying it.  But then so are other parts of the body that we use for other purposes… such as the neck holding up our heads and an erotic zone, our lips for kissing and talking, our hands for caressing and working, and so on.  Most of western society has over emphasized the sexual nature of the human female breasts but that doesn’t mean that they are a completely asexual part of the female anatomy.  That over emphasis has created problems though.  Problems that are easy to avoid thinking about if we just don’t use our breasts to feed our babies.  The balance is off between the breasts as a food source for a woman’s young and the sexuality of breasts.  Since women’s body’s are broken, babies should be perfect, we’re obsessed with food, and we don’t want to be judged, blaming breastmilk for any potential issues helps us to keep that overemphasis on the sexual nature of breasts so we don’t have to be confronted with the misogynistic objectification of women quite as overtly if we never have to see a breast being used in another capacity.

 

The reality is that most of the time it’s not going to be the milk to blame for problems with baby.  Once normal behavior, including normal emotional, psychological, attachment, and developmental behaviors are understood and eliminated as the cause of presenting symptoms, there are many other factors to be evaluated before even considering breastmilk.  When breastmilk truly is the problem these babies get sick very fast and in very distinct ways that require quick interventions.  And when there are more mild issues such as sensitivities to foods the mother has eaten, slow weight gain of the infant, or other such concerns, the answer rarely is to stop feeding breastmilk.  With the support of an informed health care provider and an IBCLC, most issues related to breastmilk can be worked through and the milk isn’t actually to blame.  Problems happen and sometimes the actual breastmilk needs to be considered before we rush to blame breastmilk for every physical discomfort or behavior we would rather not see in our babies and let’s truly help moms reach their personal breastfeeding goals, setting babies on the right track for a normal standard of health with the appropriate diet for human babies; breastmilk.

 

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 Have you wondered if your breastmilk was ok?  Do you think we have unrealistic expectations that lead to confusion between what is normal and what are real problems?

An overview to making an educated choice about formula

Star and I worked together on this post as a result of seeing a need to answer some questions and provide information on infant formula.  I believe that breastfeeding advocates and educators often provide only “formula is bad” kind of information that isn’t helpful for the parent that seriously needs to consider formula options for their child.  This article is intended to be a resource for those that will be using formula and would like information as they go about making their decision and for those that want to offer genuinely supportive support to all families, regardless of the feeding method employed.  There will be further information on formula available soon but for now, we hope this is helpful for those that need it.  It is my hope that breastfeeding advocates and educators will be able to provide quality information on formula when necessary and do so in a supportive manner.  Let’s truly support families and be a safe source of information on infant nutrition, free of judgment and profit-making agendas.  If you are a breastfeeding mom that needs to supplement with formula or switch entirely over to formula, be sure to consult not only with your child’s doctor but also an IBCLC in making your formula choice.  ~Jessica 

What are the questions and why do we need to look at them

Babies and breastmilk go together perfectly.  Breastmilk is the optimal, normal standard of infant nutrition, and I love the fact that I am in a profession where I can help mothers to achieve their goals where breastfeeding is concerned.  While I am a hugely passionate breastfeeding advocate I am not anti-formula.  Something that seems to confuse some people but it boils down to respecting the fact that we all make choices in feeding our babies, and sometimes formulas are a part of that choice.  Formula feeding moms love their babies just as much as breastfeeding moms do and want their babies to grow and thrive.  During some hiccups in my own breastfeeding relationships, I used commercial infant formulas as a supplement and I am thoroughly unashamed of that fact.  However, formula can be such a dirty word in infant feeding communities, and there’s a lot of confusion over it.  What kinds are there?  Which formulas are better than others?  Should I use commercially made formulas or make my own?  And how do we mix them?

 

The different types of formula

First of all, let’s address the varieties of formula.  There are three major types that are available: cow’s milk based formulas, soy formulas, and protein hydrolysate formulas.  Cow’s milk is the least expensive and most common.  They are nutritionally appropriate for most babies and engineered to be as close as possible to breastmilk recognizing they can not completely replicate all that is breastmilk.  However, some babies may not do well on these.  Some common reasons for not using cow’s milk formulas are allergies to the protein in the cow’s milk or the family’s desire to avoid animal products for their babies.

The next variety of formula is soy.  Soy formulas are not recommended for preemies.  They do not contain animal proteins, so they are useful in some medical situations or if a baby has issues with those proteins.  They can also be used by families who adhere to a lifestyle that avoids animal products.  A review by the AAP in 2008 found very few medical reasons to utilize soy formula.  There are also concerns that soy could interfere with the thyroid, immune system, or the reproductive system.  Those concerns have not yet been proven to be warranted, although the AAP did advocate for further testing.  Bottom line?  Unless your baby needs soy formula or you have some family reason that you are choosing to avoid animal products, it is probably not necessary.

The last of the three major commercial varieties is the protein hydrolysate formula.  These are also called hypoallergenic formulas.  Really, these will generally be ordered by a doctor to combat an issue like allergies to both the soy and the cow’s milk formulas.  Most people aren’t buying these over the counter because they’re just such an amazing choice.  They’re typically very expensive and needed only in specific cases.

 

Standards and regulations

Formula is held to certain standards of nutrition by the FDA.  (Note: this is different than being approved or regulated by the FDA.  However, there are standards of nutrition that must be met or the FDA will take action.)  Therefore, there is typically not significant difference between generic and name brand formulas of the same type.  There are pretty negligible differences between organic and nonorganic formulas, too.  Basically, with organic formulas, there is a certain standard for the production of the ingredients in the formulas.  Organic formulas have not been proven to be better for babies.  They are sometimes sweetened with organic cane sugar, which can make them taste sweeter.  This might be a problem – babies could develop a taste for sweeter foods or overeat due to the taste – but these are theories that have not been proven with peer reviewed research.

Homemade formulas are touted by many people and websites, but they are not something that I would ever recommend to a client or anyone else, for that matter.  There absolutely are risks associated with feeding an infant commercial formula, but there are even more risks to non-commercial formula.  No health body that I’m aware of recommends homemade formulas.  With commercial formula, you are getting something that is built to have the most optimal nutrition possible when breastmilk is not an option.  With homemade formula, there are a plethora of risks, running from nutritional imbalances to severe infections from pathogens in the ingredients.  In the days before commercialized formula, babies had to be supplemented with other things to keep away conditions like scurvy and there were deaths due to babies ingesting contaminated products.  Do it yourself is awesome for cleaning products or baby food or many other things.  It’s not good for your baby, though.  This is particularly true in a young baby with an immature gut, or digestive tract where the risk of illness from contaminated formula is even higher.  This post takes a thorough look at goat’s milk and homemade formula as alternatives for infant nutrition if you’d like more information.

 

Preparation and safe handling

Preparation of commercialized formula can be a problem, too. We often think that women in developing countries where there is unsafe water or not enough money to purchase the correct quantity of formulas are the ones at risk of incorrect preparation.  Of course, that does happen.  But we also see preparation issues in developed countries, too.  We may not hear about them as often but they certainly occur.

The only kind of formula that is sterile and can pretty much be put in a bottle, heated, and be good to go is ready to feed liquid formula.  Some health organizations recommend that babies under 3 months be fed only ready to feed for this reason.  However, most people use powdered infant formula.  Powdered infant formula is not sterile.  If you have a baby with immune system issues, or an ill baby, it is preferable to use ready to feed.  Using powdered formula in the right way can really help to make it safer.  You want to prepare formula on a clean surface, with freshly washed hands, and put it in clean, sterile equipment.  The World Health Organization recommends that you use water that has been boiled and then allowed to cool for no more than 30 minutes.  You should mix this water with the powdered formula (the EXACT AMOUNT called for on the can.  There are generally scoops with the formulas, and you should use the correct amount of level scoops) and then cool it to a suitable temperature by running the feeding implement (bottle, cup, whatever) under cool/cold water or placing it in cool or cold water.  It should be fed to the baby right away and leftovers should be discarded.  For more information, see the WHO guidelines for the safe preparation, storage, and handling of powdered infant formula.

 

Social issues and real support

Now that we’ve talked about types and preparation – and if I didn’t cover something that you have a burning desire to know about, please, comment or message myself or Jessica and I will find it out for you – let me step on a soapbox for a minute.  We know that breastmilk is optimal nutrition and that formula is recommended by the World Health Organization as the 4th best option for infant nutrition (following milk from the mother’s breast, expressed milk from the mother, and donated milk from another lactating woman).  But we simply cannot go on acting like formula is a poisonous, horrible thing that only uneducated, mean parents feed to their poor defenseless babies.  Some of the horrible comments that I have seen about formula and formula feeding mothers lately are ridiculous.  Would it be awesome if all babies everywhere could get breastmilk, either from their mothers or from donated milk?  Sure.  Is that likely to happen in the not too distant future?  No.  (Look here and here for information on being a donor or if you need donated milk for your baby.)  If we can meet moms where they are and provide the information they are seeking without judgment, we can be a trusted source for education and support and moms won’t have to turn to the formula companies as their primary origin of information.

I am the first person to step up and say that formula should be better regulated, that marketing should be reined in, that we deserve the best possible product for the smallest and most defenseless of our citizens.  But those are issues with the formula companies or manufacturing, not issues with mothers who can’t or won’t breastfeed.  Every mother I have ever met has a wide variety of factors and reasons that came into play when she chose how to feed her baby.  Discounting those things or casting blame or shame on her for them quite frankly sucks.   A real advocate supports women in general and knows that not everyone will make the same choice as her.

 

 
 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.

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.

 

A Translation Guide for Navigating the Terrain Between Breastfeeders and Formula-Feeders

Talking about breastmilk or formula can be difficult to navigate with a loose, slippery, and uneven terrain.  One second you think you have sure-footing and the next you’re on your butt.

I’m not going to deny that hurtful phrases come from breastfeeding supporters, occasionally in the form of personal attacks, and if you’ve personally experienced that, I’m truly sorry.  Please know that most of us just want to get information out there, encourage others and want to see babies fed.  Including me.

More often I see what are truly meant as innocuous statements of information and education that are simply misunderstood.  All of us experience life through a variety of personal filters and we often have sensitive areas that automatically put us on our guard and we may take things as a personal attack when that’s hardly the intent.  When it comes to feeding babies all those devoted moms doing their best have some serious passion.

An article is released sharing the findings of a new study that revealing some new findings about breastmilk or there may be some issues with formula and hundreds of comments pour in with things like “formula is the same thing, really and all the breastfed kids I know are sick all the time but my formula fed kids have genius IQs and are never sick” or “you know, not everyone can breastfeed so I guess I’m a bad mom because my breasts just didn’t work.”  To add fuel to the fire there are the comments that say things like “See, this is why I’m so glad I gave my babies the best and breastfed.”  And really, what does saying something like that do for anyone?  Heaven forbid it be an article on a formula recall and the “so glad I breastfeed, breastmilk is never recalled” comments start flooding Facebook newsfeeds and loading the comments section on blogs and articles.  Nothing like rubbing someone’s face in their scary circumstances and flaunting “sucks to be you!”  If we’re not careful we cross the line from passionate advocacy into plain ol’ bullying.

Then there’s the mom celebrating her success in breastfeeding, sharing “So excited we’ve made it to 6 months without even one drop of formula!  GO BOOBIE MILK!  WOOT!”  In that moment that mom is inviting everyone to a party at her house because she’s truly excited about her accomplishment.  But just as sure as she’s about to pop the cork on that sparkling grape juice to pour a round for everyone someone says something like “I don’t know why everyone has to be so down on formula, it makes moms that use it feel bad.”

They probably don’t mean to be a Debbie Downer and they don’t intend to dismiss the celebration of that mom (or maybe they do, I can’t really say) but stirring in their internal narrative of parenting confidence are insecurities on this issue, perhaps closer to the surface than they realized.  Instead of being able to celebrate with that mom, they are having to deal with their own less than happy feelings and defend, at least to themselves, their reality.

Thankfully, most of the time people can just say some encouraging and supportive words.  Once in a while, far more often than I’d like, the communication deteriorates.  Quickly.  As though we’re trying to have an important conversation but lack the skills.  Like we’re speaking different languages.

Maybe we need an interpreter?  What follows is my light-hearted attempt at some translations to help us navigate these slippery slopes.

 

It’s not a put down on formula feeding mothers when breastfeeding advocates say:

 

“Breastfeeding is the normal way to feed a baby.”

What we don’t mean:  “Formula feeding moms are less of a mother and less than normal.”  We know that’s not true.  We also know that breastfeeding isn’t (yet) accepted as normal in society.  We certainly don’t mean that it is always easy or even possible for every mom.  Or that formula feeding moms don’t deserve to be treated as normal, loving, caring mothers because we know they are normal, loving, caring mothers.  Nope, none of those things are what we mean.

What we do mean:  Breastfeeding is the biologically normal way to feed a baby.  A mother’s body is programmed to breastfeed and a newborn baby is programmed TO breastfeed.  Meaning that, barring any physical difficulties, babies are born ready to breastfeed; the delivery of the placenta signals the mother’s breasts to produce milk to feed, the mother’s body biologically responds to birth by producing milk, and human milk is (usually) the perfectly formulated food biologically for a human baby.

 

“I’m proud to breastfeed.”

We don’t mean:  “I’m better than a formula feeding mom.”  Just like being proud to be a mother isn’t a put down to those aren’t mothers, so being proud of breastfeeding isn’t a put down to those that don’t breastfeed.

We do mean:  Breastfeeding is important to us and sometimes it’s hard and comes with recognized challenges.  We’re celebrating our accomplishment of something we value as important for ourselves.  We’re also recognizing that there is a lot in our society that sabotages moms that want to breastfeed and combating that can be challenging.

 

“I love the bond I have with my baby with breastfeeding.”

We don’t mean:  “Moms that don’t breastfeed aren’t as connected to their babies.”  Feeding a baby is a deep connection no matter how it’s done and is just one way parents bond with their babies.  Most of us know moms that formula-fed and are incredibly bonded to their children and don’t doubt for a second that formula-feeding moms deeply love their children.

We do mean:  This is something we consider special and helps us feel connected to our child.  That, to us, breastfeeding has a deep feeling of interconnection that goes beyond something we can explain but we try even thought words fail us.  Feeding our babies with our milk and at our breasts is one way we feel deeply bonded to our babies.

 

“I’m so glad I’ve never had to give my baby formula” or “I’m so glad she’s not had 1 drop of formula.”

We don’t mean:  “Formula feeding moms are lazy or giving their babies poison.”  Nope, it’s not a commentary on what someone else does.  We’re not saying that somehow formula feeding moms should be ashamed of giving their babies formula or that never giving a baby formula is some dividing line between the good moms and the bad moms.

We do mean:  Like being proud of breastfeeding, not giving their baby formula just feels like a personal accomplishment.  It is in no way a reflection of our opinion of anyone else’s choice or situation, merely an acknowledgment of a personal goal.

 

“Breastfeeding is beautiful!”

We don’t mean:  “It’s perfectly beautiful all the time.”  Finding something beautiful doesn’t mean it’s easy or right for everyone and it doesn’t even mean we always enjoy the experience.

We do mean:  Not only do we NOT find it gross, we also think it is special, something wonderful, and to be celebrated.  It is more than nutrition to us and is a beautiful experience we treasure even though it has plenty of challenges along the way.  We also know that not everyone agrees with us, that’s part of why we say it though so we can hope to change negative cultural attitudes toward breastfeeding.

 

“Breast is best!”

We don’t mean:  “The moms that breastfeed are the best moms and the moms that don’t are just ok or bad.”  That’s not it at all.  In fact, this slogan came first from formula companies when they were forced to acknowledge that breastmilk was a superior product to formula.  They had to acknowledge that but had to find a way that could make formula sound normal and breastfeeding to sound like it was a parenting “extra,” an optional choice.

We do mean:  Breast milk is the best food choice available for a baby and young child.  Personally, I don’t care for this statement myself (you can find more on that here) but I know when people say it they aren’t intending anything other than their enthusiasm for breastfeeding and stating a simple fact: breast milk is good for babies.  It’s not a put down towards anyone.

 

“I feel sorry for babies that aren’t breastfed.”

We don’t mean:  “Those kids are just so screwed.”  This comment makes me uncomfortable, I don’t like it.  But I understand where it’s coming from and why it’s said.  Those of us that breastfeed see the joy and delight our own children have in the experience, how they love breastfeeding.  We are completely convinced it is special for both them and ourselves in a purely innocent, sweet way.  While it can be very close to a put down, I don’t believe it usually is intended as such and we don’t actually full on pity children that didn’t get to breastfeed but rather mourn the loss of an experience we consider special.

We do mean:  This is an awkward but genuine expression of sadness for those missing out on something we feel is so special.  Should it be said?  I don’t think so.  But if it is I hope formula-feeding moms can understand it is most likely only because the speaker/writer truly believes every child should get to have the marvelous experience her own enjoyed so much.

 

“There need to be strict regulations regarding the manufacturing and marketing of formula.”

We don’t mean:  “Formula-feeding parents are gullible and fall for the marketing of poisonous formula.”  Voicing the view point that there need to be standards in how formula is marketed and that there should be strict regulations for formula as a product isn’t a reflection on the parents at all.  It may reflect a cynical distrust that formula manufactures have anything other than a bottom line on their mind (Unsupportive Support- For a Profit).  Ultimately though, those of us that believe that the manufacturing and marketing of artificial breastmilk substitutes in infant and toddler nutrition believe so for the good of the children’ receiving the product.

We do mean:  Even if our children don’t receive formula, the children that do are worth higher standards of excellence.  We demand transparency and better regulations for artificial breastmilk substitutes manufacturing for the babies that need it. Formula is necessary, the health of many children depend on it being manufactured with integrity.

 

Before you find yourself careening down a conversation on your butt, try to remember that most people aren’t trying to start something and those that are probably aren’t worth your time.  As a breastfeeding mother, I promise, I’m not trying to push formula feeding parents down.  We’re all just carefully trying to pick our way over the rocks, slippery spots, and potential jabs to enjoy the view life has to offer and with a little bit of sensitivity and understanding going both ways, we can all offer a hand to each other in spite of our differences.

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.

Unsupportive Support- For a profit

In recent years offering breastfeeding support has gained popularity.  Which is a good thing, strange though it is to say.  In fact, it’s uncouth to not be supportive of breastfeeding in light of the magnitude of research showing breastfeeding to be so beneficial to babies and mothers.  So magazines, websites, even businesses now offer frequent support with articles on breastfeeding, pages devoted to trouble shooting potential breastfeeding problems, staff experts responding to breastfeeding questions, and even live support available online or to call in to speak to someone.  In theory it sounds great and in some ways it is.  But even in offering support there are opportunities for unsupportive support.  And this time it’s a little more unsettling because it comes with resounding financial gains to those offering the support raising the question, is it even support at all?  This time in the series on unsupportive support we’re taking a look at the murky waters of advertising support, marketing, and profits.  (We’ve already looked at how breastfeeding advocates can offer unsupportive support here.)

 

How not to support and how to avoid being unintentionally unsupportive- part 7.

Unsupportive support is…

Breastfeeding help hotlines or websites breastfeeding pages sponsored by formula companies.

This one is controversial and I kind of understand why.  But the way I see it this is one of societies most insidious forms of unsupportive support.  It looks like support.  It sounds like support.  It is even advertised as support.  Except it’s run by a company that profits when breastfeeding moms quit breastfeeding.  Maybe I’m cynical but when a company’s profits can be directly tied to how well moms that intended to breastfeed fare in reaching their goal, it just seems a little hard to believe that there are altruistic motives in supporting those moms.  When a website that is supposed to be addressing questions about breastfeeding is plastered with a formula company’s brand with images of smiling, peaceful babies presumably fed with their product all the while supporting content that uses carefully selected language about how hard and difficult it can be to breastfeed and give your baby the best, it’s underhanded marketing to someone looking for help.  This isn’t support, this is marketing, make no mistake.  Formula companies are smart, they would not waste their money sponsoring and creating these sites and helplines if they didn’t feel it increased their branding opportunities and bottom line.  I believe women are smart, they can make their own decisions but I also know that there are times when a decision can be influenced one way or another and when someone is in need of help that super happy looking formula fed baby sure is enticing and the wrong information given to address her particular need could be all that is required for the mother to become a regularly paying customer.  Which is exactly what this form of unsupportive support is counting on.

Free formula samples in breastfeeding support bag in hospitals and doctor offices.

Another controversial one.  Some see removing formula samples from hospital bags and doctor offices as removing a woman’s choice in how she feeds her baby.  I don’t understand that argument, the choice is still there, you just have to pay for it upfront.  Concern is that not giving out free formula samples is being unsupportive to those that choose to formula feed.  That just isn’t the case, not handing formula out to each woman that comes through their doors and gives birth would be more supportive of formula feeding moms in that it would lower the overall expense of formula by the formula companies no longer spending millions on the free samples hospital program.  Those free samples aren’t free anyway.  They are absorbed in the price of the product, it’s all a part of their business plan.  Again, a company would not waste their money handing out free product if it did not yield a return on their brand and profits.  Make no mistake, they aren’t handing out free samples to help moms, they are handing out free samples to hook buyers and to give the impression that the hospital endorses their product.  These companies are smart, and they should be, they have shareholders and employees to take care of.  Formula has it’s place, that’s not the issue here.  Nor is there any judgment on formula feeding.  Rather the problem is that marketing tactics masquerading as support undermine breastfeeding and do so for a profit.  This study reveals how this is unsupportive with numbers such as “Women who didn’t receive the free samples were 3.5 times more likely to be breastfeeding exclusively after 2 weeks…”  (Read more about how the numbers really break down from PhD in Parenting.)  Tacticts to get formula into the hands of moms when they are most vulnerable, exhausted, and in that crucial time when milk supply is being established in those early weeks isn’t supporting them in their attempts to breastfeed.  Nor is it supporting formula feeding families either, instead, these samples going to everyone leaving the hospital with a new baby drives up the price they have to pay at the register for the next 2 years of formula buying.  For those that truly need assistance buying formula to feed their baby, there are options through aid programs that can and should be utilized if necessary and while in the hospital formula should be covered by insurance.  Hopefully more and more states will make the decision Rhode Island made recently to refuse to allow formula samples to continue sabotaging breastfeeding and both breastfeeding moms and formula feeding moms can find some real support from formula companies just by having them back off, stop undermining breastfeeding, and maybe even lower the register cost for their product by not sending the free stuff home with those that really want to breastfeed.  Better idea for support?  Sending the name and number of a lactation consultant home with the mother, free access to a lactation consultant during her hospital stay,  independent breastfeeding resources, and the information on a breastfeeding support group would be real support.

 

If you don’t want to breastfeed then don’t.  I’d encourage you to try it before you completely make up your mind but if you don’t want to do that, nobody’s going to force you.  Your body, your baby, your choice.  And I hope nobody undermines your attempts to formula feed.  Free samples and formula company support advice isn’t about choice, it’s about marketing.  There is a distinct difference there.

If you want to breastfeed beware of the unsupportive support that aims to line someone else’s pockets.  Formula isn’t evil and it can be a needed tool in feeding our babies but it can also sabotage any breastfeeding relationship.  The companies that make it aren’t inherently evil either but they are watching out for their shareholders and bottom line profits before they are concerned about women experiencing breastfeeding success.  The more women that breastfeed, the more it cuts into their profits.  Their marketing tactics are getting more aggressive as breastfeeding gains more mainstream attention and accolades.

Still, some truly supportive support receives financial gain for those offering the support.  Lactation consultants do and should get paid for the work they do.  Even this site earns some income through the sponsorship of the companies whose ad buttons you can see on the side.  So is earning a profit from supporting breastfeeding really only self-serving?  I don’t think so and I don’t think I’m saying that to defend myself.  I don’t think it’s self-serving and thus unsupportive support, for one important reason: there is nothing to gain from a woman not reaching her breastfeeding goal.

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Did you receive samples of formula and did you use them?  Do think formula samples can undermine a breastfeeding mother’s efforts?

Do you feel formula companies can be trusted to dispense advice and support on breastfeeding?

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Unsupportive Support- is your milk good enough?

Continuing the series on unsupportive support come two more gems.  Hit the quality.  Please, if you have the opportunity to come into contact with a breastfeeding women and you can’t say anything supportive… maybe you shouldn’t say anything at all?

How not to support and how to avoid being unintentionally unsupportive- part 2.

Unsupportive support is…

Informing her that her baby must not be getting enough and that’s why her baby wants to eat all the time, saying she can/can’t eat/drink certain foods while breastfeeding, telling her breast milk turns to water after 6 months, that she needs to start them on solids, Sating her baby is too skinny/too fat and needs her diet needs to change, or pretty much anything else that puts down breast milk.

I’ll keep this one short: have you studied human lactation?  Are you well read in the latest scientific research and health care recommendations on infant nutrition?  Have you done anything more than read a couple news articles or listen to a radio personality/TV celebrity talk about breastfeeding?  Unless you can produce researched (as in legit, peer reviewed, scientific research) information backing these claims, don’t ever say anything questioning the quality of her milk or the validity of her feeding choices.  Ever. Are you even qualified to say this stuff?  Go do some research before you spout off ignorance and recite this until it sticks: “I must trust this mom to do what she feels is best and support her along the way.”

Telling a new mom “Isn’t formula just as good as breast milk?  My children were all formula fed and they turned out fine!”

While she’s probably quite happy for you that your children did fine on formula, that’s not the choice she has made for her child.  Her choosing something different isn’t a criticism of your choice, not even a little bit.  You may choose to wear pink yet she never would and that’s no reflection on you, just a difference in what each of you feel is right for yourselves.  She’s taken a lot of time in making her decision just as I’m sure you did in making yours.  You may not realize it, but in questioning her decision like this you are insulting her ability to make the right choices for her family.  And it is her family, her choice to make.  You already got to make your choices for your family or will some day.  If this thought runs through your head the most supportive act you can do is to button it and don’t dare bring it up to her or her partner.  Not even once.  If you’ve already done this, go out of your way to apologize and intentionally let her know you support her breastfeeding.  Put this on the inside of your front door to help you remember this: “I will support her even if she makes different choices than me.”

 

Pulling the quality card is exceptionally manipulative, most moms really want to give their child(ren) the best they can.  Taking a swipe at her for what she’s feeding her child and planting seeds of doubt that maybe, for some reason, her milk is inadequate isn’t supportive.  It becomes very difficult not to take it personally and she doesn’t need the worry you planted.  Breast milk quality is rarely an issue, in fact, breast milk is perfectly engineered to meet her growing child’s needs with a custom blend.  The quality couldn’t be better!  On the rare occasion that there could be an issue an expert on human lactation is better equipped to address it than the people that should be encouraging her in her parenting goals.  Your lack of understanding of normal human lactation and the normal needs of a breastfed child should not be what you draw from to show concern or support.  (A great place to start educating yourself is this post on normal behavior of the breastfed newborn.)

 

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Did some of your support people question if your milk could be any good?

How do you respond when people say unsupportive comments trying to tell you your milk isn’t any good or that formula is just good if not better? 

Tone, filters, and information

Photo by Bas Silderhuis

Whenever I see articles talking about the importance of nutrition in pregnancy I get a little tense.  When recent articles came out about research findings that moms that eat a diverse diet of healthy foods during pregnancy expose their babies to flavors that can help them to be less picky and eat a wide range of healthy foods later, I had a momentary twinge of guilt.  With articles like that I find myself thinking “I guess I screwed up” and then “actually, they eat pretty darn well, thank you.  They turned out fine.”

I eat like crap when I’m pregnant.

An article like this one about how physical activity during pregnancy gives babies a “head start on heart health” cause me to want to curl up in the fetal position and cry that it must be my fault that Smunchie was born with a heart defect and I’ve probably taken years off her life because I didn’t exercise much during pregnancy.  In fact, I hardly got off the couch.

It’s not easy to hear that what we have done as parents may actually give our children a disadvantage or worse, hurt them.  In fact, it can be darn near crippling or lead us to defensive responses of anger.

Those articles all hit a sore spot for me, the vulnerable spot of the reality of my pregnancies.  With every one of my pregnancies so far I have battled hyperemesis gravidarum.  Due to extreme nausea and vomiting I lose tremendous amounts of weight and usually don’t even get back to my prepregnant weight by birth.  With my worst pregnancy I was down to 83 pounds at 5 months pregnant.  Instead of a diverse diet of healthy foods, I can’t even keep down prenatal vitamins and pick what I will attempt to eat based on how it will come back up.  (FYI, ginger burns like hell and saltines rip up your throat and make it bleed.)  Regular IVs, PICC lines and an impressive drug cocktail closer to a cancer patient’s regime than anything pregnancy related get me through my pregnancies sometimes along with TPN and NG tubes.  Usually with multiple hospitalizations.  Kidney failure, liver problems, gall bladder problems, and permanent heart damage from severe dehydration have all come with having my babies.

This article just about broke my heart and the possibility that my children may experience long term health and behavioral issues as a result of my pregnancies is a tough reality to face.  I hate it.  It makes me angry.  I may even get defensive.

Sometimes all I want is someone to tell me it’s ok, that nutrition really isn’t that important and all that matters is that the baby is growing.  Not to dismiss the suffering of HG but to somehow alleviate my fears that artificial nutrition is really not that bad and that poor diet in pregnancy isn’t going to ruin my children for life.  After all, I want to say, Lactated Ringer’s and TPN (total parenteral nutrition) are specially formulated to be just as good as real food, right?

No, no they’re not and they come with some very real risks.  I really don’t want people to lie to me and more importantly, I don’t want to lie to myself.  It’s not even close to “just as good.”  But it is as good as I can get.

I’ve tried it all.  Eating the “right” foods, avoiding the “wrong” foods, detoxing, homeopathy, gut healing, a variety of testing, cleanses, herbs, chiropractic, acupuncture, positive thinking (can’t convince me I’m not puking though), prayer, supposed miracle drugs and so much more.  Nothing has worked.  Some have made it a little less awful.  Every time I’ve been afraid of what the medications will do to my baby but more afraid of what not being on them would mean for both of us.  It is not what I would choose and I grieve the loss of the pregnancy experience I had hoped to have.  And, I have to admit, sometimes when I hear that someone else has the perfect pregnancy with no problems and never even took a Tylenol I not only get a little jealous (or a lot, as in completely green… again) I may even get defensive even though what they’ve said really has nothing to do with me.

Do those articles set out to make me feel guilty that I barely eat during my pregnancies?  No, they are just sharing information and sometimes aim to encourage and inspire moms.  Do the moms celebrating their beautiful pregnancy experience do so to punch me in the gut and knock me down?  I’m pretty sure they are just excited about their own experience.  Does the fact that I have very little physical activity during the prenatal stage of my mothering make me a bad mom?  I don’t think so but it doesn’t mean I don’t wonder from time to time or that it doesn’t hurt a little when I’m faced with the reality that it really isn’t a good thing and could be putting my children at risk.  Blaming the information though doesn’t help me or make my reality better.  Hiding it, or worse denying it, doesn’t help anyone else either.

But maybe I have an acceptable reason that gets me off the hook?  Maybe because I had no choice and couldn’t move off the couch or do a prenatal work out with my IV I “shouldn’t feel guilty.”  (I thought this blog post from Analytical Armadillo about telling others they shouldn’t feel guilty was interesting.)  Some may say that but just as soon as some try to make me feel better about the reality of my situation, others will tell me I “should’ve tried harder.”  In fact, when I was pregnant with Lolie I had multiple psych evaluations and was told that if I just wanted my baby and if I would make up my mind to stop throwing up I would be able to eat.  If only that had worked.  It was in moments like those that I felt like nobody really heard me and my suffering and that maybe I was a really bad mom and didn’t deserve my children.  Where is that line?  When is the problem real “enough” that it  doesn’t deserve criticism?  And who gets to decide that?

What if I had just decided to be that way though?  What if I didn’t have HG and just had a normal pregnancy with normal pregnancy fatigue and nausea and I didn’t eat well or get off the couch?  I’m sure the harsh criticism would have been significantly more and maybe even deserved.  But what if there were other factors that others couldn’t see?  What if my husband wasn’t supportive of my pregnancy and I struggled with wanting my baby but having no support?  What if depression was already an issue for me and pregnancy changes led to more of a mental and emotional health battle?  What if no longer feeling in control of my body brought flashbacks of my sexual abuse history?  What if I was totally terrified at becoming a mother, giving birth or that if I moved wrong I’d hurt my baby?  What if I didn’t tell anybody what was really going on and instead I let people think I was selfish and lazy?

Harsh criticism only goes so far.  Occasionally it will inspire people to change but usually it inspires people to become defensive.  It’s hard to listen from a defensive position.  Dialogue, information sharing and genuine care, on the other hand, help people explore their own situations and choices honestly.  It is important to remember that the tone with which we share information can make a difference, making it personal towards someone else’s choices rarely is effective.  At the same time, when reading and receiving information readers bring their own baggage and filters to the message.  Remaining objective is incredibly challenging particularly when we live in a world where much of what we see and read is intended to rile us up and get a reaction.  A form of entertainment.  Even fairly objective peer reviewed studies can be reported in the news with headlines that immediately spark controversy and raise emotions that really have nothing to do with the study.  One I linked above reads as though women who love their babies will be doing prenatal work outs, leaving unsaid but certainly implied that not working out indicates a woman does not love her baby.  With tones like that the actual message can be a bit hard to accept.

Yet these caveats should not preclude us from sharing information.  In fact, we have a responsibility to share it.  My training as a midwife required me to learn a lot about prenatal nutrition and the impact it has on pregnancy, child birth and the health of the baby.  It took a while but I got over the urge to write in every margin on prenatal nutrition “but not always…”  Because ultimately that response was about me, not the standard, normal, healthy, low risk pregnancy these texts were talking about.  Over time I even developed sympathy for women dealing with normal nausea and vomiting in pregnancy, able to offer up suggestions that could help with their discomfort that never touched mine.  These days I can also legitimately celebrate with those that have healthy, normal pregnancies, gain weight without problem and enjoy food and I don’t take it personally or feel the need to remind them “not everyone can, you know.”  They’re not making a personal indictment against me and even if they were too, life is too short for me to dwell on that and let it get to me.  I know they legitimately don’t understand.  Frankly, I’m glad they can’t, I wouldn’t wish my pregnancies on anyone.  But I risk isolating myself, winding up in a dark, lonely hole of guilt and anger if I remain defensive towards the information and the people sharing it.

Whether we’re talking pregnancy health, birth choices, breastfeeding, formula feeding, or just about any other subject related to the choices we as parents have to make, sensitivity and recognizing our own filters in the conversation go a long way.  We should still share information, we should still read information and we hopefully do this in a safe community where processing the information can happen through trusting and supportive dialogue.  I hope that by keeping in mind the fact that we do not know everything there is to a person’s back story and why they make the choices they do we can remember to be more sensitive in how we share information.  I hope that by keeping in mind the fact that we all bring our own baggage to any topic we can remember to try not to take information sharing as personal jabs.  It is through these steps that we can support one another and make a difference for others.

Mothering Mistakes and the Human Spirit

This guest post is an important one and I’m honored to be bringing it to you.  Mi-Jo Sayegh is a very active member of The Leaky B@@b Facebook page offering encouragement, support and information to others through sharing her experience.  I love this post of hers and feel it is a message so many moms need to hear and take to heart.

When I was pregnant I didn’t know anything about labour or child birth.  I was so busy learning about breastfeeding and gathering all the information I could on that subject, the thought that there was any other way to have a baby, other than in the hospital with pain medication never even occurred to me.

I never got to have the natural birth I had hoped for.

Looking back, I know that there was series of events that led to my c-section.  Was it my fault ? Maybe , maybe not.  The end result was that my daughter had rapid breathing and ended up being in the NICU for 10 days.  I was not allowed to hold her for the first two days of her life, she never had contact with her mother, and was left to cry it out all alone in an oxygen tank.

I was a terrible mother.

It was all my fault.

According to a lot of mothers on the internet, the damage was done, my daughter would be traumatized for life and I couldn’t change it.

I had ruined my baby. This hard start would effect every aspect of her life, and there was nothing I could do about it. It was too late.

My ruined baby hardly ever cried the first year of her life.  She was sweet , content, easy to please and a generally happy little girl.  I’m sorry to say that the same can’t be said for her mother.

I cried, I felt guilty, I blamed myself, I blamed the doctors , and I wallowed in self pity.  Those are all normal emotions, but the worst thing that happened was I became an alarmist.

No one ever knew, but I obsessed about what I would feed her, how it would effect her if she had to cry for a few minutes while I went to the bathroom, whether or not she would be scarred for life if I needed a few hours away and Dad gave her a bottle of pumped milk.

I had visions of terrible things happening to her, of accidents and dangers that lurked around every corner.  I agonized over every potential mistake I never made and ones that I had.  The paranoia became all consuming.

I’m not sure when or why it happened, but one morning I woke up and realized that this way of mothering wasn’t going to work for me. I couldn’t continue living like this.

I remember my mother once telling me that she had not one ounce of guilt over the fact that she formula fed me. When I asked her why, she simply replied that ”You turned out just fine and we can only work with what we know at the time ”

Ok. I know how most people HATE that expression.

I do also, but I mostly hate it when people use it to argue science or dismiss new theories and studies.  My mother accepts that giving me solids very early, formula feeding and letting me watch too much tv were not the best choices and she would never try to claim otherwise.  But she also thought that wallowing in guilt over it could do much more damage to me in the long run.

I must admit that I now think she is right.

The more I think about it, the more right I think she is.  I’m not saying that doing any of these things are mistakes, but I know many mothers who regret choices they have made and let it consume them, I know, because I was one of them.

My guilt and paranoia was getting in the way of me being able to parent effectively. I’m not saying that we don’t have the right to feel guilty, we all have the right to our feelings, but I am saying that the way we act around our children, and the messages we send to them with our own behavior is probably more important than any other parenting choices or mistakes we make.

If I give my daughter the impression that making a parenting mistake is something I should suffer for, or is unacceptable and may ruin her for life, then how can I turn around and tell her it is ok to make mistakes and that it’s not the end of the world?  Surely I can’t, because then I would be a hypocrite.

I have come to terms with the mistakes I’ve made now.

I accept them, I learned from them, and I have moved on.  I don’t get defensive about them, I admit when I could have done things differently, but I am also aware that these mistakes will not alter my child’s entire destiny.  What better life lesson can we give our children than the lesson of self forgiveness ?  I’m a less guilty mom now, but I’m not perfect and that is fine by me.

I believe in informed choices, I believe in trying to do the best we can, but I also believe in the human spirit.  My daughter is going to be fine.  She isn’t ruined.  I only wish it hadn’t taken me so long to realize that. Her spirit is strong, she’s a survivor, and there aren’t many mistakes I could make that will change that, as long as I keep on trying my best and learning from my regrets.

Guilt is ok, it’s an important emotion, but I also now know it doesn’t make me a bad mother to let go of it.

If anything, it has made me a better one.

I want my daughter to grow up knowing there is no such thing as perfection, knowing that I made mistakes and that I am sorry, but that it is ok to forgive yourself.  I want her to see that no matter what sort of mistake she makes, or if she makes choices she regrets, it’s going to be ok, she is going to be ok and that no one expects her to make the right decisions all the time.  I want her to have faith in the human spirit.  I want her to have confidence in her ability to bounce back from anything.  I want her to know that any wrong she makes can be made right and that if it can’t, she has the ability to make it through the hard times.

I want other moms to have faith in that also, for themselves and for their children.  I want other moms to have know I have faith in them.  I want other moms to know that it is ok to feel guilt and regret.  I also want them to realize it’s ok to let it go and that it doesn’t make them uncaring mothers.

We can’t know for sure that when our children get sick, that it isn’t our fault.  We can’t know that the choices we made, the ones we regret, won’t have some sort of impact on them later on in life.   We can know that obsessing about it and letting it get in the way of our day to day life will have a greater impact.  I have no proof of this, but I believe it with all of my heart.

My challenge to you is to try to have a guilt free day today.

Let it go, and enjoy your children.  You are allowed, and you deserve it.  In the end, our memories and our human spirit are all we have.  If we spend our short time here on earth with our children, obsessing about past wrongs, it may end up being the biggest regret we have.