Grandmothering the Breastfeeding Baby

I am the grandmother of a newborn baby boy. Born a little over 3 weeks ago, I’m sitting in the living room of his parents mulling over this new role. No, this is not my first grandchild. But it’s the first one I’ve had the joy of spending uninterrupted time getting to know his little personality, observing his parents in their roles and his older brother adapting to his new role – big brother.

As a lactation consultant, I am invited into homes to observe, assist and recommend in an active role.  There are barriers that must be broken down and boundaries to cross and an instant intimacy created by the need of the moment. As a mother-in-law, mother and grandmother, there are boundaries that must be crossed very hesitantly, if at all. My philosophy of breastfeeding applies in this instance – it is the relationship that we must preserve above all. Breastfeeding, with all its benefits, is primarily about establishing the primal relationship, not just getting breast milk into a baby. Relationship is about building love and respect into an unbreakable bond.

So what can a grandmother do to support the new family? I believe that the same three goals apply to this situation as to any other breastfeeding cohort: protect, promote and support. Protect by being positive and avoid offering solutions that interfere with breastfeeding. That means, don’t offer to bottle-feed the baby so mom can get a good night’s rest. Don’t give the baby a pacifier to hold off for a longer interval between feeds. Don’t buy another infant holding device (bouncer, swing, rocknplay). Don’t make negative observations such as: “your breastmilk looks kind of weak” or “he’s crying again – maybe you didn’t feed him enough” or “he has a rash – maybe you are eating something that he’s allergic to.”  Don’t offer to hold the baby while mom does the laundry or fixes your supper. Instead, be encouraging. Let mom know how proud you are of her, how blessed her baby is to have her, how beautiful she looks nursing your grandchild. If she doesn’t have one, get her a sling and help her learn how to use it for carrying baby. Use it yourself when she needs a break. Watch baby while he spends time in tummy position. Fix a meal, do the laundry. Take an older sibling to the park, or play with him. If mom needs you to hold the baby, by all means enjoy. Learn to hold baby chest to chest, a position most babies really enjoy.

If mom or baby are having some latch or fit issues, get help for them and be a cheerleader. Learn all you can about the establishment of milk supply and how that is done. Ask her how you can best help her reach her own personal goals. Breastfeeding is an important building block in a baby’s life foundation – but it is only one of them.  It also helps to remember that it takes babies 6-8 weeks to gain active control over feeding and moms need support during that time as they try to help their babies learn.  Nothing tops patience and perseverance in that journey!

Nothing in my life has been as rewarding as seeing my children grow up, take a marriage partner and become parents. I almost understand how God must feel when we become fruitful and start sharing our gifts and talents with others, and pass the torch along. I keep that in mind and am grateful for that. And as I anticipate great-grandchildren in the future, I hope to be able to give them the benefit of my hard-earned wisdom too!

 

Pacifiers, Bottles and Pumps, Oh MY!

What does a breastfeeding mother and baby need besides each other? Clearly, they need time and proximity so they can adjust their relationship from a continuous but unconscious provision of warmth, comfort and nutrition by mother of baby to a deliberate but more intermittent provision of those same requirements for baby by the mother. Mother needs the support of those around her to meet her physical and emotional needs while she meets those of the new baby. And this process takes time to develop its rhythm. Like new dancing partners, the dyad must become comfortable and intuitive in their actions, developing trust and coordination over time.

But — what if a separation must occur. Mom can no longer be ever-present to meet her baby’s needs. Or what if baby or mother has a physical issue that affects milk supply or delivery? How can we provide a substitute for both mom and baby that doesn’t undermine the breastfeeding relationship? The market steps in to offer its solutions: bottles, pacifiers and breast pumps! These tools offer and purport to be a temporary solution to bridge the separation on a short term basis, but often present their own challenges to mother and baby.

So, how do we select when presented these “solutions?” First, understand the basic physiology of breastfeeding. How do mothers make and release milk? How do babies obtain that milk? What is the biology that we are trying to mimic? What are the properties of the man-made materials that we use to create these tools? Over the years, inquiring minds have looked at various products on the market to try to determine how these products work and to what degree they either simulate breastfeeding or offer less interference with breastfeeding when used. The problem is, most of the methods used to test products don’t truly match what a baby does when they use the products. Ultrasound studies may show the mechanics baby uses on a bottle, for instance, but can’t really measure the baby’s adaptation to the materials or how the baby changes flow rates by altering the quality or actions used during sucking. Only a very sophisticated real-time system using pressure gauges, ultrasound and sequential weight checks can adequately assess the way a bottle performs for a particular baby. And even that can’t determine how a baby is adapting and accommodating to the bottle.

Some fairly good research has found that pacifiers introduced after the first two weeks and limited to less than 2 hours use during the day do not appear to inhibit milk supply or shorten breastfeeding. In this study, a one-piece pacifier with a rounded nipple and slight flange at the base was used for all babies in the study.(1) In this study, all babies were healthy babies with no identified risk factors such as tongue-tie etc. Early introduction of pacifiers may interfere with baby’s learning curve where he identifies and correlates sucking and swallowing with latching to the breast. Pacifiers are made of materials much firmer than mother’s breasts and do not conform to the baby’s palate. This imprinting period can last up to 6 weeks. An analogy I have sometimes used is this: introducing a pacifier is like giving a young teen porn – it is artificial, highly stimulating, and does not resemble the real shape, feel or action of the real thing. Ear, nose and throat specialists who work with babies with tongue and lip-ties have noted that babies who have used pacifiers a great deal can have issues learning how to open widely and actively extend the tongue to latch onto the breast. If possible, delay pacifiers until they are absolutely necessary, after comfortable and effective breastfeeding is established, and then limit use to less than two hours daily. Avoid orthodontic, flat or bulbous pacifiers.

A skilled IBCLC can assess a baby’s sucking technique, evaluate suck strength and make recommendations for supplementation methods if needed. They can offer suggestions to help the nursing couple to address and overcome any issues encountered.  They can also evaluate mom’s supply and make recommendations for techniques, equipment and supplements as needed.  They can communicate with other healthcare providers to coordinate breastfeeding and family-friendly care.

The research that has been done on bottles includes direct ultrasound and indirect flow studies using a pump setup to mimic the vacuum levels babies use on bottles.(2) Some bottles will deliver nearly an ounce in a minute! This fast of a flow rate will cause a baby to take too much at a time from a bottle, may cause gassiness and fussiness and spitting up. Some bottles will deliver a fast rate of flow if the baby bites on the nipple. When babies must use a bottle and the flow rate or method of obtaining the milk (compression instead of sucking) varies from what is normal during breastfeeding, it can cause bottle or breast rejection. Bottles that drip when held sideways do not necessarily flow fast when baby is sucking. And, bottles that don’t drip, are not necessarily slow flowing when used by the baby. Generally, 5 ounce Newborn Dr. Brown’s bottles with regular size neck, not wide-mouthed, Special Needs Feeders, used with the small line lined up with baby’s nose, Calma feeders, and Munchkin Latch bottle are considered slow-flow, non-compression bottles. Bottles not recommended include Avent, Tommee-Tippee, Momma original, Evenflo original, and many others. This list is subject to change, however, as manufacturers constantly change or quit making products over time. The best way to test a bottle is to buy one only, try squeezing the nipple where baby’s gums would go to check for compression, and offer to baby.

When bottles are recommended for supplementation, it is a good idea to have a lactation consultation to evaluate the baby’s suck and mother’s supply. This can help in choosing the right bottle or another method for supplementation that can help preserve the breastfeeding relationship.

Check out my hand-out on using a bottle under resources. .baby-led-bottlefeeding

(1)Does the Recommendation to Use a Pacifier Influence the Prevalence of Breastfeeding? Jenik AG, Vain NE, Gorestein AN, Jacobi NE, Pacifier and Breastfeeding Trial Group J Pediatr. 2009;155:350-354 (2) Comparison of Flow Rates between Commercial Bottles Karen Gromada, IBCLC unpublished communication.

Breastfeeding Confidence: Are you gaining or giving it away?

Entering Motherhood Unsupported

Let’s face it.  Our culture has totally undermined our confidence and security in ourselves as being dearly loved children, created lovingly and capably by a gracious God. What does that have to do with breastfeeding? Many women have bought into the idea that they are not good enough physically, mentally or emotionally just as they are, to be a woman, a wife or a mother. First, we feel the need to mold ourselves to the Victoria Secret models’ shapes and appearances. We feel a need to use whatever femininity we have to attract a mate. Then, when it’s time to have children, instead of being empowered through education to guide us in doing what we were created to do, birth becomes a maze and we are taught we can’t birth without medical technology. Even when this technology is needed, the way it’s administered can leave us feeling more like victims instead of capable mothers.  Finally, once the baby has been “delivered” (notice the disempowering language of  delivered instead of the mother who partners with God in giving birth!),  we are then expected to produce the life-giving, unduplicatable fluid that the baby needs, on demand, in time and in sufficient quantity.

Every new phase of womanhood is just that–new, uncharted territory!  Everyone’s experience is unique, so despite the best education possible, or no education at all, we venture into the breastfeeding relationship as rookies.

Mixed Messages

In today’s world, the internet, social media and television/radio broadcasts have informed us dramatically that breastfeeding can fail us and the baby. But we are also confronted with the growing body of evidence that breastfeeding is essential and necessary. What to do? Many moms are trying to be preemptive in their preparation. They research all the best herbs for increasing milk supply. They search for the best breast pumps. They look into special diets and techniques. When their babies are born, they are quick to assess and intervene for any perceived difficulty. For other moms, however, the possibility of failure is so daunting, that they never even begin the journey. They opt to formula-feed from the beginning. Better safe than sorry!

Imagine a Better Way: Birth, Breastfeeding and Beginning Again

What if?

But imagine with me for a moment what the world could be like if we could breach the chasm between flying and the fear of failing.  What if moms could find a middle way that empowers women from birth to breastfeeding? That way might include research to identify the best environment for birth for their newborns and themselves. It might include education about the normal progress for mothers and babies during the early time after birth and making plans and contingency plans should unexpected difficulties occur.  But, above and beyond all this planning, let’s include trust. Trust in the birth caregivers she has chosen. Trust in her partner to protect and support her desires. Trust in her family to honor her decisions.

What if moms could develop relationships with other mothers who have journeyed and reached the goal desired? What if they could find supportive professionals to answer questions and guide the journey when needed? What if we treated the breastfeeding relationship as normal and necessary, but respected it as so important that we celebrated the RELATIONSHIP part of it as much as we did the milk-making (FOOD PRODUCTION) part of it? Those who have gone before us could celebrate the choices made, whatever they are, for what they are worth, choices made in the best interests of mother and baby? We could stop blaming ourselves and each other for the past mistakes and sins and move forward from here, learning from the stories of life and love that we each bring to the table.

One Team

I am so tired of hearing about “mommy wars” and “breastfeeding Nazis” and “need for more research before pushing breastfeeding on mothers.” What would happen if we took out the word “breastfeeding” and replaced it with “sex”? No one would stand for a war on sex to make it only used for reproduction!  No one would shame a woman (or man) for seeking professional help if there were issues on either the relationship or reproductive front. Then why is there so much shaming of something just as natural and essential to producing and maintaining life as feeding our children? We need to re-prioritize and support women trying to navigate motherhood and breastfeeding.

Love, Not Fear

Let’s change this paradigm and create an environment that is normal, helpful, supportive and non-shaming to mothers no matter how they feed their babies, while continuing to educate and celebrate what has sustained humanity up until the 20th century.

Let’s start now.  If you are reading this and you didn’t breastfeed your child, or you didn’t breastfeed “properly”, let me be the conduit of forgiveness.  You operated within the knowledge and barriers of your time.  Yes, you had responsibility.  It’s OK to own that and say, “I wish I had known better” or “I wish I had had better support” or “I wish I had made better choices.”  It’s OK to own it.  Then give yourself grace and forgiveness.  When you own something, you are then able to use it for good. Perhaps you will help someone by supporting them or offering to find them the support they need. You don’t have to be in denial or defense, you just move forward.

If you are reading this and in the middle of a feeding struggle, then get the help or accept the help you need, but cherish what you already have. If your issue is low milk supply or latch, don’t give up the breastfeeding relationship, the cuddling and skin-to-skin and eye-to-eye language without words. If you have plenty of milk, but a baby who can’t or won’t latch, take off the pressure. Make bottle-feeding as much like breastfeeding as possible with positioning, allowing baby control etc. Take as much of the stress away as possible by taking each day as it comes. Pray blessings over your baby.

In summary, loss of confidence comes when we allow fear to take control of our actions and thoughts. Fear is paralyzing but it can’t be overcome by will. Perfect love casts out fear (1John 4:1) F.E.A.R. equals False Expectations Appearing Real. Let those who love you understand what your desires are and accept acts of love that are truly loving and supportive. Let love be your guide, knowing that love is the antidote to fear. As you make small steps, your confidence will grow and you can then help others along the way.

 

Alyssa Milano and Breastfeeding Shaming

As if moms don’t have enough to worry about – we have a continued attack on public breastfeeding. This is a first world problem – a USA problem. Like so many other “issues,” those trying to build their ratings find something to project their biases and ignorance upon and try to get some controversy going. EVERYONE knows that if we were in a developing nation where Western marketing machinery had not yet ruined the culture and economy, breastfeeding in public would not even be a topic of conversation. Babies do not have any sense of propriety (as some would define it). They just know when they are uncomfortable and want their needs met. A young baby cannot understand that someone’s guilt might be stirred up by their need to be tended to in the same general vicinity as the casual observer.
The idea expressed in this commercial needs to be distributed.

If we are to help mothers reach recommended goals of breastfeeding to at least a year and hopefully to two, we must first help them reach their OWN goals – whatever that length might be! And currently, 80% of moms do NOT meet their own goals – whether to breastfeed 6 weeks or 2 years! Baby-Friendly Breastfeeding Initiatives and other similar programs are a first step to getting moms off right. But beyond that, the community must be engaged to support these moms. Breastfeeding should be welcome wherever it is safe for a mom and baby to be. Workplace and social accommodations must be championed. Ignorance can be cured with education. Disappointment when goals are not met must be met with determination to help the next mom – not try to downplay the goal!

If you are a friend or relative of a breastfeeding mom, do what you can to encourage and support her. Educate yourself and your community. The babies of the world will appreciate your efforts!

What to do till the lactation consultant gets there

Baby refusing the breast?
Milk supply low?
Baby not getting enough?

Remember these 3 things:
;
1. Feed the baby!
2. Protect your milk supply!
3. Make the breast a happy place!

Feed the baby.The amount a baby needs depends on his or her age and size. Babies between one to 6 months need around 24 ounces of breast milk per day. A 3 day old baby needs at least 4 oz per day, a 5 day old needs 8 oz, etc. A baby who is latching effectively may actually take more than these amounts from your breast. If your baby is under a week old and you believe he or she is not getting enough from direct breastfeeding, try offering small amounts of expressed breast milk by spoon, cup or finger-feeding with a syringe. If your baby is older and requires more than an ounce at a feeding, you may consider using paced bottle-feeding techniques for giving extra milk.

Protect your milk supply. Breast milk production is controlled by hormones in the beginning, but soon switches to local control. This means the more milk is removed from the breast, the more completely drained, the more it will produce in the next hour. When a baby is not effectively removing milk, this tells the breast that it is making too much. Using hand-expression and/or a rental-grade breast pump after feedings may be necessary to protect or build a supply until baby is able to empty the breast more easily. Research has shown that mothers who have effective breast drainage in the first three days (that is defined as 30 breastfeeds or hands-on pumping episodes in 72 hours) have twice as much milk at 10 days after delivery.

Make the breast a happy place. Keep baby skin to skin as much as possible. Baby should be between mom’s breasts, head facing to one side. Mom should be positioned comfortably, propped up with firm pillows with her back and arms supported. Breastfeeding is more than providing milk for your baby – it is setting up a relationship that starts out as meeting a physical need and transitions to meeting an emotional need between mother and child.

All breastfeeding techniques or assistive techniques should include these three concepts.

5 Reasons Breastfeeding is better than Formula

 

You’ve heard it all over the place: breastfeeding is best for your baby. I’m going to disagree. Breastfeeding is the NORMAL way for babies to be nurtured and nourished.  Here’s why.

  1. It’s the normal diet of newborns.  All substitutes for mother’s milk are simply imitations of the original.  But when you try to imitate something – don’t you want the perfect example to start with? That’s hard when it comes to mother’s milk. Why? Because every mother’s milk is custom-made for her individual baby! And it changes according to the baby’s needs, age and environment. Breast milk composition is affected by direct breastfeeding. That’s because the mother’s breast vacuums up little bits of the baby’s saliva which contains information about baby’s system. The mother’s antibody manufacturing system then creates what baby needs and drops it back into mother’s milk for the next feedings. Breast milk is dynamic – not a static substance. As the baby gets older, content changes also with more fat for older babies who tend to spend less time at the breast and need their meal to be “on the go”.
  2. It’s the normal function of breasts. Breasts were designed to make milk. A mother stores some fats during pregnancy that are meant to provide nutrition for the coming baby. These fats are moved out of mom’s body during breastfeeding. Breast milk proteins, sugars, vitamins and minerals are consistent. Mother’s body produces the right type of milk for the baby – even when her diet varies! Failure to breastfeed may result in retained pregnancy weight. Mothers who do not breastfeed are at higher risk of metabolic syndrome, Type 2 diabetes, breast and ovarian cancer, etc. This is an area of research that has only just begun.
  3. It’s the normal location of babies. Babies are not just fed at the breasts. They learn to enjoy closeness to another human being. They listen to mother’s voice, hear her heartbeat as they did in the womb, and associate the feeding experience with comfort and security. Held close to mom, they observe the world and its newness in a safe location. Skin to skin care (the kind that happens naturally in natural breastfeeding) allows baby to use his energy resources for feeding as mother supplies warmth and support through her body.  Not only that, but the mom’s skin transfers healthy bacteria to baby’s skin which forms a first-line defense against stranger bacteria.  This benefit has been identified as one factor in reducing allergies and asthma in later life. This is important for all babies, but particularly those who have been born by Cesarean section or separated from their moms at birth for medical care.
  4. It requires a minimal amount of financial resources. Breastfeeding is less expensive. The extra food mom requires to breastfeed is much cheaper than buying formula. Even if moms need help learning and getting through rough patches in the beginning, the cost of formula is not declining. And there are hidden costs of formula that do not occur with breastfeeding – such as bottles and cleaning utensils, energy for water and cleaning, use of materials for making formula and bottles etc. Someone pays somewhere – whether it be through working a job to earn the money or through tax money supporting the “free” formula available through WIC programs. A standard-sized container of powdered formula will last about 1/2 a week and may cost up to $30. Babies under 2 months should only be given ready-to-feed formula because of the chance of contamination of powdered formulas. This is even more expensive. Babies who are breastfed have fewer infections and this also results in fewer doctor visits with co-pays, etc.
  5. It provides baby with a normal immune system. More and more research is being done to link “gut” health and overall health. Breast milk provides epigenetic factors that help a baby recognize what is “normal” and what is not. This helps reduce allergies, asthma, and many other auto-immune diseases as well as providing protection from casual infections in the baby’s environment. It is now believed that continued breastfeeding while introducing family foods during the second half of the first year helps to reduce the incidence of food allergies.  In addition, when babies who are breastfeeding receive their immunizations, the breast milk helps baby’s immune system have improved results from the immunizations. IQ, dental health and many other factors in a baby’s general health are affected by breastfeeding. When breastfeeding continues through toddler-hood, maximum benefits of breastfeeding are extended.

In summary, breastfeeding is the normal way by which babies move from the world of the womb where they are protected and fed by the placenta. As baby grows, he moves from being a totally dependent individual to an independently functioning individual. Breastfeeding provides that first step that takes this new little human being from the womb to the world.Continue reading