Best for Babes

First of all, apologies for not getting this post up yesterday, or even this morning; I was at a family reunion, and then one kerfuffle (thanks Amy for the new word) after another came up on my radar, and I didn’t have a chunk of time to concentrate.   My kids were out of whack by the time we spilled out of the car, and I have been trying to do a better job of setting clear boundaries between BfB and family time (often unsuccessfully, as I am known to sneak in a text or email reply on a trip to the loo) . . . so here we are, with the first day of World Breastfeeding Week already waning.   Anyhoo . . .

We are really excited about World Breastfeeding Week’s theme this year, which is ”Just 10 steps.  The Baby Friendly Way“   As the Motherwear Blog so persuasively explained, only 8% of our nations hospitals follow just six of those steps.   Only 3% follow all of them as designated by the Baby Friendly Hospital Initiative.    The hospital booby traps are so ginormous that most moms can’t breastfeed exclusively for the first three days, let alone the first 6 months recommended by the American Academy of Pediatrics.  We are working hard to raise awareness of the hospital booby traps (the link I reference most often is this one), and have also developed a close relationship with Baby Friendly USA.   We will be dedicating a separate blog post to our thoughts on Baby-Friendly, and what we can all do to advance it. 

If you are expecting or thinking of starting a family, the single most important thing you can do, long before you go to the hospital or maternity center, give birth at home, or waltz the Ten Steps, is to PREPARE.   This means educating yourself so you can make an informed feeding decision and then arming yourself with the tools that will inspire, prepare and empower you to achieve your personal breastfeeding goals.  

My Baby Experts Simply Breastfeeding DVD is now available FREE online until September 30!

 One of the most powerful tools we have come across since starting Best for Babes is the Simply Breastfeeding DVD by Shari Criso.   We are thrilled that in honor of World Breastfeeding Week (and months August and September around the world); Shari is making the entire class available online FREE of charge . . . a savings of  $29.99 as available on Babies R Us . . . through September 30th!    When I first saw Shari’s DVD, I jumped up on the couch, Tom Cruise style, because it is the first full-length class on DVD that I’ve seen that every expecting mother can use to gain confidence, information, and be reassured.   We endorsed it because it is a best-in-class tool but also because it is modern, non-judgmental, and very importantly, not boring!    Not all breastfeeding classes are teaching evidence-based, unbiased information, in a way that commands interest and attention, and not all moms have access to that information.   Shari has a tremendous track record helping clients near a hospital that is a black hole for breastfeeding, and has some jaw-dropping (literally for those babies!) new techniques.   (We are hoping to find a researcher and funding to create a study that will examine whether watching the DVD will improve breastfeeding rates; based on anecdotal evidence, we think it does!   Shari’s clients have been known to sneak the DVD into the hospital and watch it on their laptops after delivery for help with latches etc.)  Here’s where we need your help:   We would love to have 10,000 people (expecting moms, dads, grandmas, friends, health professionals) watch the class during the next two months, so Shari can make a case to her sponsors to make the class available free permanently.   Please share the free online video with your expecting and new mom friends!     We’re interested to hear what you think!       

We’ll also be celebrating World Breastfeeding Week with lots of hot info, super style, glam giveaways, and actions you can take!  We have a fabulous new celebrity interview coming out, a new line-up of great products that boost your breastfeeding or advocacy style or comfort while helping to grow our cause, and lots of love for our wonderful supporters—from our nearly 7,000 moms on Facebook to the  companies and nonprofits that believe in us to all of those who have helped spread the word, donate or help us in some way–you all make it possible for us to do the work we do.   This World Breastfeeding Week, we celebrate ♥YOU♥!!

A miserable, tongue-tied baby, courtesy of flickr.com

Kudos to the researchers at the University of Florida for drawing attention to a major “Booby Trap” in helping mothers achieve their personal breastfeeding goal, as published online in Pediatrics.  Many in the breastfeeding community have known for a long time that an unusually short frenulum, the connective tissue under the tongue, is more common than people realize and can be easily and quickly snipped by credentialed professionals to allow the baby’s tongue to move properly and milk the breast.   If left undiagnosed and untreated, this condition, commonly called “tongue-tie,” can in severe cases result in low weight gain with a great deal of frustration and suffering for the baby, and extreme nipple pain,  mastitis and frustration and agony for the mother.  Contrary to popular belief, not all doctors are permitted to perform this procedure, so it is important to find one that is (see bottom section).

Says Neonatologist Sandra Sullivan, MD in an article from Futurity.org:  

“It is called a frenotomy, and it is far simpler than a circumcision, which we do fairly routinely . . . It literally takes longer to fill out the consent form for the procedure than to do the actual procedure itself.”

The tongue motions required to breastfeed are more complex than those required to drink from a bottle (hence the benefits to the baby’s jaw & speech development).  Sullivan explains:

“If you take a bottle with an artificial nipple, there is not a lot a baby has to do to get milk.”

“To get milk out of the breast, they have to make a vacuum and if they cannot get their tongue to the roof of their mouth, they cannot do this. They also need to use their jaw and tongue to move the milk along through the milk ducts in the breast.

“If they just bite on the nipple (like a bottle), first, it hurts (the baby’s mother) a lot and second, it blocks off all those little tubes, which keeps the milk stuck in the breast.”

 Isabella Knox, associate professor of pediatrics at the University of Washington says that  4 million babies are born each year, so 40,000 to 100,000 babies are affected by the condition.

“That’s a lot of babies,” Knox says. “I don’t think general pediatrics training gives us a lot of skills in supporting breastfeeding . . .  we don’t really know how to help somebody and for some people it is not always a priority.”

According to Futurity.org, “Sullivan is part of an international organization focused on issues related to tongue ties. She and other members of the group’s screening committee are working to develop a screening tool that would help nurses quickly screen for a tongue tie while assessing the baby after birth.”

“There is not a lot of literature about frenotomy, and there are still a lot of doctors who say, ‘Is this really necessary?’” Sullivan says.

“Whether or not there is an epidemic or whether we ignored tongue ties and are looking for them now, this is something that is coming up more often in nurseries.”

Danielle Rigg, CLC & Co-Founder of Best for Babes, who experienced tongue-tie with her second child  says that “doctors and health care professionals are not only unaware of ankyloglossia or tongue-tie, they often confuse “frenotomy,” which is a very simple, relatively painless and easy to perform procedure for newborns, with “frenectomy,” or “frenuloplasty” a more involved procedure used to free the frenulum in older children and adults who have shown signs of speech and mechanical pathology.  Because of this confusion, it can be hard to find a doctor or health care professional who will perform it.  The other problem, according to Jenny Thomas, MD, IBCLC is that contrary to popular belief, not all doctors (like herself) are allowed to perform the procedure, even if they recognize it and want to fix it.   ”Most area hospitals, clinics and malpractice carriers consider this MORE than a minor office procedure and classify it validly as a surgical procedure, albeit a quick one. That means, for those places, you need surgical credentials (proving you’ve been mentored and have done enough procedures to not get sued). You then get surgical privileges in your institution and then subsequently need increased malpractice insurance,” explains Dr. Thomas.  From what we understand from Dr. Thomas, some hospitals have an ENT (ear, nose & throat doctor) on staff who is educated about tongue-tie and performs all needed procedures, and paying  increased premiums so all doctors can perform them isn’t necessary.  (And then there is a whole debate about whether doctors are over-performing the procedure to make money.)  However, from what we’re hearing from moms, there are plenty of hospitals that don’t have a credentialed doctor performing the procedure, and at those hospitals, moms are up a creek.  To make it worse, some lactation consultants (even IBCLCs) are not experienced in recognizing the condition either, so it’s easily missed.    (On the other hand, we’ve heard of lactation consultants who have, in a pinch, used a sterilized fingernail to slice the frenulum).   

Purchased from Dreamstime.com

Danielle had to track down an oral surgeon, the only one in her area (at that time Montclair, New Jersey) who was willing to do it.   “I went straight from the hospital, and although my daughter was less than two days old, she had already learned painful latching habits and I was already bleeding.  The procedure took less than a minute, there was no blood, my daughter didn’t even cry,” says Danielle.  ”When I tried to thank the surgeon, Dr. Richard Riva of Chatham, New Jersey, he said ”you go nurse that baby, tell me how it feels, and then thank me’.  It immediately felt much better, though as a CLC I knew I would have to work with my daughter to help her re-learn a proper latch before all the pain would go away.  When I expressed my gratitude to Dr. Riva, here were his words of wisdom:  

 ”Every child deserves to have the pleasure of  breastfeeding successfully, and every child deserves the pleasure of licking an ice-cream cone, both of which are aided by this procedure.”   

We’d like to add, that every mom deserves to have a positive breastfeeding experience without the trauma of severe nipple pain caused by this condition and other undiagnosed but easily solved breastfeeding issues.  Danielle should not have had to leap through the extra hoop of finding an oral surgeon outside of the hospital.  Best for Babes hopes that the American Academy of Pediatrics will push for every hospital to have a credentialed doctor who can perform the procedure, education on diagnosis as a requirement in the core pediatrics curriculum in medical school, and that the nurses associations will do the same.   While they’re at it, they should require doctors to complete at least a week-long training similar to what the Healthy Children Project offers to train certified lactation counselors, and/or work with the Academy of Breastfeeding Medicine to develop a curriculum.  Luckily, pediatricians who are already Fellows of the Academy of Breastfeeding Medicine (look for FABM after their initials, similar to FAAP for Fellow of the American Academy of Pediatrics, and FACOG for Fellow of the American College of Obstetrics & Gynecology) are educated in all things breastfeeding.    We’re sure  our friend and supporter Dr. Ruth Lawrence, Chair of the American Academy of Pediatrics Breastfeeding Section, has been working on this for years.  

What can parents do

1.  Get a second opinion.  If you suspect your baby has tongue-tie while still in the hospital, ask if there is an ear nose or throat doctor (ENT) on staff who is trained in diagnosing tongue-tie and performing frenotomies.  You may want to get the opinion of a highly recommended IBCLC (you made need to bring someone in from outside the hospital).  Tongue-tie is not a black and white issue and some will see a problem where others have missed it.   If you can’t get help from within the hospital, see an ENT in private practice, an oral surgeon, or a dentist.  Read the stories here of moms who have navigated this booby trap.

Earth Mama Angel Baby is a proud sponsor of Best for Babes

3. Spread the word to moms.  Share this page with any expecting or new mothers.  If we can prevent even one mother and baby from suffering through this unnecessarily, we will be ecstatic!! 

4.  Be gentle to mothers who couldn’t breastfeed.   There are a lot of mothers out there whose babies were not diagnosed with tongue-tie, suffered miserably, thought they couldn’t produce enough milk, and agonized over their baby’s lack of sufficient weight-gain, blaming themselves or their babies, and quit breastfeeding long before they intended to.   We never judge a mother who quit breastfeeding as “not being committed” because we can not truly stand in her shoes, and most of the time she has been booby-trapped and didn’t know it. 

5.   Write to the American Academy of Pediatrics, send them a link to this post, and send a copy of your letter to any media contacts, urging them to remove this booby trap.

6.  Be the change.   For the last few decades, the focus has been on supplementing babies with formula instead of fixing the problem.  This is going to take work to change, as the formula companies conduct training for health care professionals that teach them how to prey on the fears of mothers that they won’t make enough milk, and will need to supplement with formula, instead of giving them proper medical care.   Sad but true.   Through mainstream marketing and  educational efforts like this blog, our WHO-Code compliant advertising campaign, celebrity interviews, and popular media coverage, we are reaching millions of parents with the information they need to make informed feeding decisions, and achieve their personal breastfeeding goals.   Help us or donate! 

7/3 This post was edited to clarify that not all doctors are allowed to snip frenulums.

7/4 Great comment from our Facebook discussion:

Have you experienced this “Booby Trap”?  Have you had any success with educating your doctor or health care professionals?  Let’s hear it!

Last Tuesday (October 6th) I attended the Big City Moms‘ Biggest Baby Shower Ever, held at the American Girl Place in New York City.     It was an awesome event and the line to get in went down the block.   All three floors were chock full of vendors, delicious treats, and fabulous moms-to-be chatting, checking out the goods, and asking questions about baby car, safety and sleep habits.

Seminars on a variety of topics were held on the first floor every twenty minutes or so.   I thought Big City Moms did a great job addressing subjects that moms are interested in; including sleep, feeding, and safety.    As fun as it is to shop and prepare the nursury it is so important the new mothers have the information they need to make healthy decisions!

The first seminar that I did not want to miss was Dr. Alan Greene speaking about “Feeding Baby Green:  Teaching Your Baby to Love Healthy Foods.”   Boy is this guy excited about babies eating!!   He talked about how babies’ tastebuds are actually most sensitive in utero, and that they practice swallowing before they are born, drinking up to 3 cups of amniotic fluid per day!   Dr. Greene explained that not all nutrients pass through the umbilical cord, and that the baby is actually bonding with and getting to know his mother.    I really appreciated his non-judgmental style of speaking that addressed the concerns of mothers who were planning to breastfeed as well as those who were not.   He talked about “imprinting” and how babies who are breastfed get thousands of different flavors from mothers’ milk, exposing their tastebuds early on, and suggested that formula feeding moms switch brands a few times to change things up.   Dr. Greene doesn’t go for a lot of the standard feeding advice given by many pediatricians, especially as far as allergies and feeding schedules, and he explains why in his book, which was included in the gift bags.   I found his lecture to be super interesting and informative and well, really intuitive!   As a mom I always wondered why introducing solids had to be this highly controlled experiment, when really, babies have been reaching out of the sling for millenia to grab a bit of what’s going into mama’s mouth.

Me and Dr. Alan Greene at the Big City Moms Event

I was fortunate to get a chance to speak with Dr. Greene before his talk . . . I knew about his great work with Healthy Child, Healthy World and was excited to meet him.   I told him about what Best for Babes was doing and right off the bat he bubbled over with enthusiasm and fired off some recent breastfeeding research studies.   It was clear that he is very pro-breastfeeding and very knowledgeable about lactation science.   I told him I thought it was great that the Born Free bottles were BPA-free and hoped that the company would become WHO Code Compliant.  Dr. Greene shared that his wife is a breast cancer survivor (like my business partner, Danielle Rigg), and we talked about how strange it was that the big breast cancer organizations didn’t jump with joy over a recent study showing that women with a family history of breast cancer can reduce their risk by 60% — yes, 60% — if they breastfeed their babies.  We see eye to eye on a number of things and I was thrilled to meet him.

Kelly Rutherford & Me (Bettina Forbes, Co-Founder, Best for Babes)

The last seminar of the evening was actress Kelly Rutherford speaking about “Socially Conscious Mothering.”   She is incredibly down to earth and warm and spent most of the time answering questions from the floor.    She has a very nurturing style and made me feel like we’re all in this together, trying to do our best as parents, picking ourselves and each other up when we fall.   She talked about some of the personal decisions she had made, including tandem nursing (see our interview with her) and her choice not to vaccinate.   I appreciated that she was very open as a mother who is trying to parent in a socially conscious way, and shared her own experience.   I think she is an awesome role model and all the expecting moms really enjoyed talking to her.  Best for Babes is very lucky to have her as a Champion for Moms!

All in all it was a great evening and a great resource for moms-to-be.   Everyone left with a huge gift bag filled with gorgeous items, and better prepared for motherhood!

Best for Babes  had a chance to catch up with busy mom and author Andi Silverman to talk to her about her personal experiences that led her to write Mama Knows Breast:  A Beginner’s Guide to Breastfeeding, for sale on Amazon.com.    We give the book a “thumbs up” for hip design, engaging and witty prose and ”no holds barred” honesty.  It’s a great little introductory book to get you pumped up and psyched up, and a super baby shower gift for a chic mom.  We especially love “From the mouths of moms”:  quotes from real moms that tell it like it is, and will leave you laughing and feeling connected. 

Did you always know you wanted to breastfeed?   If so, why?  If not, what changed your mind?

What kind of advance preparation did you do?   Had you seen anyone nurse?   Were your husband and family supportive?   How about your ob/gyn and pediatrician?   Did you encounter any barriers to breastfeeding while still pregnant and how did you deal with them.

I actually convinced my husband to take a breastfeeding class with me before our son was born.  What a sport he was! He was the only guy in the room.  We paid attention, asked questions, and even took notes.  But beyond that, I didn’t do much else to prepare.  I wasn’t reading parenting books. I was more focused on the pregnancy and how lousy I felt.  I didn’t even ask my family, friends or obstetrician anything about breastfeeding.  I naively thought that it couldn’t be all that hard.

Did your actual breastfeeding experience meet or differ from your expectations?   How so?

Once our son was born, I soon realized that I didn’t remember much at all from that breastfeeding class.  I had forgotten that babies ate around the clock, every two to three hours.  And because I hadn’t done any advance reading, I was in a bit of shock about the intensity of caring for a newborn.  I was very overwhelmed by the lack of sleep.  I wasn’t using bottles of formula or pumped milk, so it was all mom, all the time.  I remember thinking, “When will this cycle slow down? Will I ever sleep again?”

What was the biggest breastfeeding challenge you faced and how did you handle or overcome it?

I got pretty lucky in the breastfeeding department.  Both of our sons latched on easily and grew well.  My biggest (pun intended) “problem” was that I had very severe engorgement.  With our first son, I was pretty shocked when my milk came in and I got rock hard watermelons on my chest.  I remember standing in the shower and weeping in disbelief.  I had no idea what to do about it, so I had to get advice from a lactation consultant.  She told me to use hot wash cloths to get the milk flowing, pump a little to relieve the engorgement and feed as frequently as possible. And lo and behold, it worked!

What motivated you to write Mama Knows Breast and start your online blog?   What has the reaction been so far?

I looked at the other breastfeeding books on the market, and while there were a lot of great ones, they all seemed fairly serious, and medically oriented.  I didn’t find what I could have used– a practical, concise and hip guide to breastfeeding. I wanted a breastfeeding book that would be fun to read.  So, I set out to write “Mama Knows Breast” and started my blog http://www.mamaknowsbreast.com.  Along the way, I’ve been in touch with moms who have so much to share about their breastfeeding experiences.  Everyone has stories to tell.  Stories about successes, challenges, and even failures. 

Best for Babes Comments: Okay, first of all, we think Andi is awesome!   And so is her husband for taking a class—it’s so important to include spouses/partners.  One of the smartest things Andi did was to get the advice of a lactation consultant.   Getting qualified help early can make the biggest difference in avoiding or solving problems.   For help finding a lactation counselor in your area, check out http://www.ilca.org which lists lactation counselors by zip code.  For engorgement, another alternative is to lower your boobs into a basin or sink of hot water and hand express to relieve the pressure—takes less time than a shower and gentler on the nipples than pumping!  By the way, breastfeeding for birth control is just as effective as the pill (0.9-1.2%), provided 1) the baby is 6 months or younger, 2) is being breastfed exclusively on demand (i.e. not overly scheduled) and 3) is not relying heavily on artificial nipples or pacifiers.   World-wide, more babies are kept from being born (which increases child survival) through breastfeeding than all other birth control methods (Thapa et. al., Nature, 1988)!   

Best for Babes is thrilled to be included in a list of the “Top 100 Blogs for Expecting Mothers.”    Posted by Ultrasound Technician Schools, this list is a handy guide to some great websites and blogs for expecting and new moms and/or parents.    It is the kind of list that I wish I had known about when I was pregnant with my first baby!

Good blogs can help you feel like you are not alone in whatever you are experiencing (and trust us, you are definitely not alone) and connect you to a community of other mothers.   The best ones are inspiring, encouraging, and evidence-based.   This means that the information is rooted in the latest scientific information, which is extremely important with regards to breastfeeding.    All too often new moms are vulnerable to myths and misinformation, so make sure there are scientific references to the material you read!  

At Best for Babes, we footnote and reference scientific studies so that you and your doctors, family members and friends know that you are getting the best, most accurate information. 

Special thanks to Utrasound Technician Schools for featuring Best for Babes!