Best for Babes is thrilled to add Leading Lady, a premier nursing intimate apparel company, to our family of sponsors who truly care about moms and babies and who help us to Beat the Breastfeeding Booby Traps(R)!  Leading Lady came aboard recently as a Presenting Sponsor of the first-ever Celebrity Breastfeeding Awareness Event on April 14 and helped to ensure that our Hollywood leading ladies – -Kelly Preston, Jenna Elfman, and Laila Ali – and the party they threw, were a huge success!  We’re delighted to work with them to help moms and babies.

And even better, we are excited to share Leading Lady’s support of the Mother of All Causes with you Babes!  Now through June 30th, Leading Lady is offering their gorgeous Azalea chemise at a $5 discount, and for each gown sold will make a $1 donation to Best for Babes! The chemise is a perfect blend of ease, support, and style, or as we like to say “You can be nurturing, glamorous and powerful all at the same time!” It has an inner sling and shelf bra, as well as quick, one-handed clasp for easy nursing.   Fashionable,  comfortable, beautiful and functional, the chemise is destined to make you feel fabulous while giving your best to your babe and helping another mom and babe out along the way.

We think this chemise would look great with a pair of capris or shorts and heels, along with a wrap or tie sweater, making nursing while out and about easy and stylish.   It also does double-duty as a nightgown.  We (and Jenna, Kelly and Laila–see them with Leading Lady!) got to touch and examine the chemise first hand at Jenna’s house and can speak to the quality and affordability.   You deserve to treat yourself! 

How would you wear it? 

Have you heard about the new book, Breasts: A Natural and Unnatural History?

The author, Florence Williams, was inspired to write the book when, while breastfeeding her child, she wrote an an article for the New York Times in which she had her breastmilk tested for flame retardants (PBDEs).  The article is a sobering account of the way our bodies reflect the state of our environment.

In Breasts, Williams addresses toxins and breastmilk again, stating that breasts “soak up pollution like a pair of soft sponges.”  It’s enough to make any mom wonder if she’s endangering her child by doing the most natural of things.

But before anyone concludes that breastmilk is unsafe – and research shows that this information can indeed scare women into not breastfeeding – let’s review some facts:

1) Levels of some chemicals in breastmilk have been going DOWN in recent years.  Yes, there are chemicals present in breastmilk, and levels of some of them are increasing at a worrying rate.  But as Dr. Kathleen Arcaro, an environmental toxicologist at the University of Massachusetts who studies pollutants in breastmilk as well as breast cancer, explained to me in an interview, “the good news is that the concentration of some lipophilic (fat-loving) environmental pollutants in breast milk is decreasing.  For instance the level of many pesticides (DDT and its metabolites) and polychlorinated biphenyls (PCBs) has greatly decreased over the last 30 years.”

2) There are toxins in formula, too, sometimes in higher amounts.  You have to feed your baby something.  So are your choices breastmilk which reflects our environmental exposures, or a perfect, chemical-free food?  No!

Dr. Arcaro notes that “pollutants are widely distributed [i.e. in the air, in water] and therefore are in cow’s milk and formula.”  Or put more colorfully by Dr. Jack Newman, “There are toxins in formula. Why would everything on earth be polluted, even the far reaches of the Arctic, but not formula?”

A 2009 CDC study of ten different types of formula found found that “perchlorate was a contaminant of all commercially available [formulas] tested.”  The FDA has found BPA and trace amounts of melamine in some formulas, and a study out this month found arsenic in an organic toddler formula.  One chemical, PAH, is found in the highest levels in formula and cow’s milk, and lowest levels in breastmilk.

I share this not to scare formula feeding mothers but to emphasize that there is no perfect choice.  The choice is between two foods which reflect the polluted state of our environment:  one confers protection against numerous health problems and one does not.  I get very disturbed thinking of mothers turning away from breastfeeding – and thereby increasing their babies’ risk of disease (see Table 1) – for fear of chemical exposure, only to unknowingly feed their babies formula which contains the same substances of concern, and lacks any immunity-building substances.

3)  Breastmilk may actually protect babies from the chemicals in it.  A hot-off-the-press study has concluded that breastfed babies, due to a healthy bacteria in breastmilk called bifidobacterium actually metabolize perchlorate.  The study found, “breast-fed babies can metabolize the environmental contaminant perchlorate, decreasing their risks of detrimental developmental effects from exposure.”  As Williams noted in her New York Times article, “breast milk appears to be at least partly protective against the effects of toxic chemicals.”  We are only now beginning to understand the constituents of breastmilk and how they interact with a baby’s body.  Who knows how else breastmilk might be protective?

4) Research has found no adverse consequences of some key chemicals found in breastmilk.  A recent study comparing the health and development of babies exposed to dioxins (nearly twenty years ago, when exposure to dioxins was more common) through breastmilk and those fed formula found no adverse health consequences for the breastfed babies, and significantly better developmental outcomes for those who were breastfed.  This confirms the findings of prior research. Williams cites similar findings regarding exposure to PCBs through breastmilk.

5) Not everything in the environment or your diet makes it into your milk.  Our bodies have several systems that regulate what gets into our milk, and it’s worth understanding how it works in this context.  In order for a substance to get into breastmilk, it must pass through a number of “screens.”  Some things we ingest are destroyed in our digestive system, eliminated from our bodies, or held in our livers before they even enter our bloodstream, which is where they may transfer into milk.  And not everything that enters our bloodstream makes it into our milk, either.  Only substances that are small enough in molecular weight to squeeze in between our milk making cells, or fat-soluble enough to ‘hitchhike’ through the cell walls, make the cut.  And (in an act I consider to be just a little bit miraculous) once the level in our bloodstream declines, some substances that make it into milk actually move out of the milk, back into our bloodstream.  Even when something harmful does make it into your milk, your baby’s gut may destroy it or poop/pee it out before it can enter her bloodstream.  Of course, these systems are not foolproof, and it’s important to emphasize that some harmful substances can enter milk can pose a threat to your baby.  Much more on this topic can be found on Dr. Thomas Hale’s website.

6)  Short of you being poisoned, breastfeeding is recommended.  The CDC states:  “Breastfeeding is still recommended despite the presence of chemical toxins. The toxicity of chemicals may be most dangerous during the prenatal period and the initiation of breastfeeding. However, for the vast majority of women the benefits of breastfeeding appear to far outweigh the risks. To date, effects on the nursing infant have been seen only where the mother herself was clinically ill from an toxic exposure.“  The International Lactation Consultant Association states in their position paper (pdf) that, “with the exception of maternal poisoning, breast milk remains a safe, life-enhancing method to feed and nurture infants and young children.”

7) Concerned?  Take action to protect your baby and the environment.  We can take steps, in both personal and public spheres, to make ourselves and our milk freer of chemicals of concern.  We can take a number of other simple steps, as outlined by Healthy Child, Healthy World, to reduce our exposure.  We can selectively shop for pesticide-free produce (without breaking the bank) using the Environmental Working Groups Dirty Dozen list (available as an app), and use cleaner personal care products.

The solution is not to stop nursing, but to stop polluting.  So finally, and most importantly, we can advocate for better regulation of chemicals in our environment, through many organizations working to make our world, and the lives of our children, healthier.

*Some content from in this post was originally published on the Motherwear Breastfeeding Blog.

This post made possible by Leading Lady

The online world was abuzz yesterday with the release of Time Magazine’s newest cover, featuring the portrait of a young, slender mother breastfeeding her 3-year old. The image garnered some intense attention and it is no surprise why: Many Americans are uncomfortable with the idea of breastfeeding – especially breastfeeding that goes beyond the first year of life. It’s a Booby Trap that often keeps nursing past infancy “closeted.”

The fact is, babies are biologically and evolutionarily designed to nurse well into toddlerhood to reap the full benefits . . .even their cute one-size-fits-all button noses are built for dining at the breast and remain until about the age of 5. The American Academy of Pediatrics recommends breastfeeding for one year “or longer as mutually desired by mother and infant.” The World Health Organization (and Health Canada) recommends breastfeeding “for up to two years of age and beyond.” The American Academy of Family Physicians states, “breastfeeding should ideally continue beyond infancy, but this is not the cultural norm in the United States and requires ongoing support and encouragement, noting a number of benefits of nursing past infancy, and stating that the estimated “natural weaning age for humans is between two and seven years.”  See this for the benefits of “full-term” breastfeeding, and this for the biggest misconceptions. And if you aren’t breastfeeding, or couldn’t or didn’t breastfeed, read this.

But because breastfeeding past one year is often hidden from view, it might appear that children such as the one on the Time cover just don’t exist . . . but they do. Best for Babes collects and shares celebrity stories to increase the cultural acceptance of breastfeeding. The celebrity stories below show that this “uncommon” act of nursing a toddler might be more common than you think.

Kelly Preston, one of Best for Babes’ Champions for Moms, was recently interviewed about breastfeeding her 16 month old son, Benjamin.

“I am still breastfeeding Benjamin and it has been incredibly rewarding and healing. . . . I am also sad to hear that so many moms are being discouraged from breastfeeding past a few months when there are clear benefits to nursing much longer.”

Salma Hayek is a movie star who
proudly breastfed her daughter, Valentina, for more than 15 months.

“When I see how much good it is doing her, I can’t stop.”

Kelly Rutherford, star of Gossip Girl and another of Best for Babes’ Champions for Moms was continuing to breastfeed her 3-year old son when her daughter was born in 2009.

“My son is busy doing other stuff and it’s more of a comfort thing, but it is really cute when they are nursing together. He just looks at her, and checks her out, and puts his hand on her little feet. It gives him this close-up intimate look at her, and it’s very beautiful to see them to kind of get to know each other. ”

Gwen Stefani shared with The Guardian in 2007 that she was
breastfeeding her son Kingston well into his second year,

“I don’t know when I’m going to stop breast-feeding,…
I’ll just keep going while I can.”

Mayim Bialik has been very vocal about
her experience breastfeeding her boys into their toddlerhood and beyond.

“When I see my precious son gaze into my eyes and grin that milky grin – the same eyes that looked into mine minutes after he careened out of my body; the eyes that convinced me that my only job was to keep this child thriving with the miraculous resources given to me through my body- not much else matters.”

Erykah Badu, who has added the titles of birth advocate and doula alongside those of singer and songwriter, had this to say about her child,

“When I first had the baby, I breastfed for two years straight, so we were together for two years of his life every day, all hours of the day.  So I was two people, and I eventually morphed back into one.”

Jada Pinkett Smith shared with Fit Pregnancy
in 2000 about breastfeeding her son, Jaden.

“[I breastfed him] a good 18 months. That baby never even saw a bottle. He went everywhere with me — premieres, award shows. I would just find a back room and hook him up.”

Nelly Furtado, singer and mother,
took her breastfeeding daughter with her on tour in 2006.

“I’m a lot more comfortable with myself now,” she says. “I was pregnant for nine months and breast-feeding for two years.”

Finally, legend has it that Michael Jordan was breastfed until he was 3 years old. His mother, Deloris Jordan, has reflected:

“I feel this is why he is the athlete he is.”

As more celebrities breastfeed their children and choose to share this experience with the public, let’s cheer them on and celebrate each and every moment, moving it from uncommon to common.

How do you feel about breastfeeding beyond one year? What could change in our culture that would encourage mothers towards extending the time before weaning?

Best for Babes is about cheering on ALL moms– those who breastfeed for any amount of time, those who wanted to but were booby-trapped, those who can’t or decide not to, and those who pump or donate milk!   We’ve got some really great deals for Mother’s Day that will celebrate the Babe in your life, let her know how much you appreciate her for being the Miracle Maker she is, and support the important work we do to further the health of moms and babies!  Happy Mother’s Day, with love…

The Amamante Signature Nursing Gown for Best for Babes® This classic black gown outfitted in our rhubarb pink trim demonstrates perfectly why we say you can be sexy and nurturing at the same time!  Regular Price $42.99, Special Mother’s Day Price $34.99.

The Jewel Minx Best for Babes® Miracle Milk™ Bracelet  Celebrate that special Babe for the human milk she makes, uses, or donates! This exquisite bracelet will lavish her with love, reminding her daily that moms are the Miracle!  Regular Price $48.00, Special Mother’s Day Sale 10% off! Enter Code MOTHER10 at checkout- sale good until May 31, 2012.

The Annee Matthew for Best For Babes® Nursing Tee Finally, the fabulous nursing tee for Babes! Super-comfy and stylish: half sleeves for all seasons, extra length for both pregnancy and easy breastfeeding! Mother’s Day special 10.00 off, Regular Price $49.00, Sale Price $39.00, Enter Code MOMS10 at checkout– price good through the end of May.

The Pumpease for Best for Babes® The PumpEase in Best for Babes signature rhubarb pink is Wonder Woman and Madonna all-in-one – fit for a SuperBabe!  Get 30% off for Mother’s Day, Regular Price $38, Sale Price $26.60!

The Moby Wrap for Best for Babes® The Moby Wrap is a delicious experience for both mamas and babies– giving both extra cuddle and snug time and making breastfeeding access easy.  Reversible to solid colors. Also comes in black with our signature rhubarb pink monogram.  Regular Price: $52.95, Mother’s Day Special 20% off with code BFBMom until 5/31/12.

The Melinda G® Best for Babes® Nursing Cami  is a perfect all-in-one top for summer.  Breastfeeding mamas tend to run warmer, especially in the heat! Superior support via it’s full nursing bra underneath, fast and easy access for a thirsty babe, and breezy tank design to keep mom comfy and cool.   Regular Price: $54. Mother’s Day Special: $49.50.

This is the 41st post in a series on Booby Traps, made possible by the generous support of Motherlove Herbal Company.

We are so very pleased to share the second of a two part guest post by Karen Gromada, MSN, RN, IBCLC, FILCA, on Booby Traps for moms of multiples.  Karen is the author of the classic Mothering Multiples, and is recognized as a leading expert on breastfeeding twins (and more).

While a lot has been written about nursing multiples, we haven’t seen a comprehensive explanation of the barriers moms face.  So we think this post will be a classic!

Peer Booby Traps

Mothers of multiples sometimes booby-trap breastfeeding for another mother when they proclaim, “You won’t survive infancy with multiple infants unless you…

• “Get them on the same (strict) schedule right away!”
• “Use sleep training so they soon sleep through the night (even if each must cry it out).”

Strict day or nighttime schedules can undermine milk production and may interfere with weight gain for one or more babies. Plus, trying to impose such schedules often adds to the stress of caring for multiples by creating an unrealistic expectation for many young infants and putting unnecessary pressure on a new mother.

Also considered a Booby Trap by those who need the company of other mothers of multiples but aren’t yet ready to leave breastfed babies at home is a parents/mothers of multiple club that welcomes the mother but frowns on breastfed babies accompanying her to meetings.

Booby Trapping Yourself?

Finally, a mother of multiples may Booby-Trap herself. For instance, the mother who expects each of her babies to have the exact same breastfeeding pattern or assumes each of her preterm babies to make the transition to direct breastfeeding at the exact same time and in the exact same way is setting Booby Traps for herself. Each multiple-birth infant is an individual. More likely than not, one former preterm multiple will be ready to move to exclusive breastfeeding before the other(s). Also, one is more likely to need more frequent breastfeeding or more time to breastfeed than the other(s).

Mothers often Booby-Trap themselves by thinking there is a problem with breastfeeding when an issue has little or nothing to do with the actual breastfeeding. Often the issue is really about coping with two or more times the usual number of babies. But breastfeeding easily gets all mixed up with the two (or more) babies issues. It becomes another case of shooting the messenger (breastfeeding).

A huge self-detonating booby trap common among mothers of multiples is that they tend to “should” on themselves! Mother who think they should be able to care for babies, older children, household tasks, their careers, etc. as they might do or have done with a previous single baby set themselves up for frustration. When circumstances interfere with a mother of multiples’ breastfeeding goals, too many mothers blame themselves instead of the circumstances. Mothers who think they should be able to “do it all” without physical help  and emotional support are in for the biggest boom of Booby Trap bombs!

How Moms of Multiples can Avoid the Booby Traps

Don’t add to the minefield of Booby Traps. A mother of multiples is more likely to avoid Booby Traps if she:

• Prepares to begin breastfeeding under a variety of circumstances – preterm or full-term birth; vaginal, cesarean or a combination of delivery methods; supportive or unsupportive partner, family or friends; etc. For more information or ideas, review the FAQ at my web site.
• Develops a birth plan designed to help breastfeeding (or milk expression) that includes skin-to-skin contact at birth if babies are late preterm or term, and with less mature preterm infants as soon as possible. (Skin-to-skin contact is called Kangaroo Care in the NICU. Be a “squeaky wheel” about making it happen!) A fill-in-the-blanks birth plan for twins and some triplet sets is available on my website.
• Develops a cheering squad of breastfeeding supportive professionals, family and friends who understand and will reinforce her breastfeeding goals.
• Finds where she can rent a hospital-grade breast pump in case she must express milk for babies that came early or any that is not yet able to breastfeed effectively.
• Expects late preterm/term newborns to cue and begin breastfeeding within the first hour of birth; plans to hand express colostrum within the first hour if one/more babies cannot yet breastfeed. Then Maximize Milk Production with Hands-on Pumping by combining the breast pump with hands-on techniques until all babies breastfeed well.
• Accepts help with household tasks or an older child, which free her to breastfeed and/or express milk for her babies.
• Allows time for a daily routine to develop as she and her babies adjust and get to know one another better.
• Distinguishes breastfeeding issues from issues related to having two (or three or more) the usual number of babies.
• Celebrates what she and her babies accomplish and lets go when babies or breasts force her to take a detour for any amount of time.

This Mother’s Day post is dedicated to the millions of moms who don’t or can’t breastfeed.  I am now one of them since breast cancer took my breasts, at age 37.  It’s for all of the moms who decide not to breastfeed, whether for personal reasons or pursuant to medical recommendations.  And it’s for the approximately 2 million moms each year who WANT to breastfeed, but end up bottle-feeding because they are undermined by the Booby Traps– the institutional, legal and cultural barriers to breastfeeding.  It is our sincerest wish that this article be an opening for women to begin to heal around this deeply emotional issue. 

We understand that breastfeeding is a really loaded subject.  How could it not be when  it’s touted as “the best” but moms are routinely given poor breastfeeding care and advice and scant societal support?  They wrestle (often alone) with whether to start or stop nursing, and most have bad experiences along the way leading to guilt, blame, anger, regret and unpleasant memories.   Some moms absolutely can’t breastfeed due to conditions like Insufficient Glandular Tissue – a disorder that often goes undiagnosed and unabetted by a medical establishment that is not educated about lactation.  Or because they have no breasts – like me or Christina Applegate, or unfortunately,  thousands of other young women.   Others wind up pumping though that was decidedly not their plan.  Which is why we have the utmost compassion for moms who don’t breastfeed and we believe it’s time we called a big TIME-OUT to let the healing among women on both sides of this “fence” begin!  New mothers should not be at war with each other when it’s the Booby Traps which are to blame for the disproportionate number of nursing failures and for breeding the backlash against breastfeeding itself – especially when breastfeeding involves more than feeding from the breast.

The Dalai Lama once described breastfeeding as the “first act of… affection and compassion” a mother can give to her baby.  What he was referring to was that eating to an infant isn’t just about filling a tummy – it’s the primary way an infant connects, bonds, and communicates.  To both an infant and a mother, feeding time is actually biologically-patterned to be an intimate exchange, an instinctive orchestrated dance,  delivering food but also pleasure, comfort, safety, security, warmth and trust.  It’s a whole body and mind ‘experience’, not simply an act that satisfies hunger.  It’s why we ALL feel gooey when we get to “feed the baby.”  Feeding is an act of LOVE.

This is all really good news for moms who don’t breastfeed, because it leaves a lot more than ‘dining from the breast’ up for grabs around mealtimes.  Especially if you aren’t breastfeeding, this information is vital.  As mothers we all want what’s best for our babies.  We make the best decisions we can based upon our circumstances and the information and influences in our lives.  Not breastfeeding can be an opportunity to do more to connect with your baby in ways you might not have noticed or understood.  And by experiencing the amazing ways that you and she fit together, you’ll feed her stomach and help her get settled more easily, and you’ll feed the intuitive nurturer in you too.

Seeing the world from your baby’s (and your biology’s) point of view makes all of this clearer.  Moms and babies are still very much one unit after birth–they’re interdependent.  Human babies are born while still in the process of their development  – their brains continue to mature for years, their immune-systems are immature and fragile.  They need a lot more nurturing, attention, and care compared to other mammals, i.e., tigers or canines, who are capable of walking for months or of going long stretches without their mothers or without eating.  Human babies need lots of touch, close physical contact and frequent small (<1-2 oz) meals to thrive.

So what’s mom got to offer to accommodate that?  Plenty besides milk –moms are made with just the hard and soft-wiring babies need:  there’s no better heater than mom — your boobs can warm up when they detect even a single degree drop in your baby’s body temperature!; the sound of your heartbeat and your breathing help your baby regulate her own;  and that maximum visual field of only 10-12 inches your newborn’s got? That’s the exact span between a mother’s breast and a mother’s face making it possible for babies to make eye contact with you while eating and demonstrating again how feeding- time is loving- time to a baby, and a good reason to not let them dine alone by “propping the bottle” or facing them outward.

Knowing more about how your baby and you are wired, should make you feel like the super-power you are!  You are your baby’s “natural habitat” – the physical place where she safely transitions from life within to life without the womb – everything she needs is there even without the food: warmth, security, familiar sounds, comfort, a blueprint for trust and relationships.  Think about how delicious it is to hold your naked baby and how much you look forward to touching and smelling her bare skin.  That’s not superfluous behavior– science confirms that that’s an instinct of both of yours and one that delivers physiologic and psychological benefits!  Intimate contact, touch and swift responsiveness teach a baby trust.  And studies show that trust keeps stress levels low and immune and growth systems high.

There are a number of ways you can connect with your baby that are pleasurable for you both and can enhance the feeding experience:

• Enjoying your Magical Hour– the first hour after birth naked belly-to-belly with your baby and experiencing your baby crawl to the breast. Awesome! Moms who ask for and get this uninterrupted time report a not-to-be-missed experience AND say they feel more confident as mothers a year later even if they don’t go on to breastfeed!  These babies also score higher at self-regulating (soothing) at one year of age just from that one seminal experience;
• Feeding your baby skin-to-skin “at” the breast/chest.  Studies have shown that this can improve digestion and enhance absorption (Uvnas-Moberg et al. 1987; Uvnas-Moberg 2003);
• Consider using safe donor milk — the undisputed next-best substitute to breastfeeding and pumping;
• Not being separated from your baby, especially during the hospital stay, and holding her skin-to-skin as much as possible.  Because babies are physiologically not set up for independent life, newborns don’t like to be removed from the  warmth, familiar smells, sights and sounds of its mother and will protest with a very distinctive distress cry (Christenssen et al. 1995). This is often the reason a well-fed baby who has been put down after feeding appears unsatisfied — not because they haven’t had enough milk.  If separation and cries continue, a newborn will go into a ”protest-despair” mode where their bodies produce stress hormones, their heart and breathing rate decrease, and their body temperature falls (Michelsson et al. 1996);
• Feeding on your baby’s early hunger cues (as opposed to a schedule).  Long before your new baby begins to cry for food, she will let you know that she needs to eat, starting with beginning to squirm in her sleep, then lip smacking, then putting her hands to her mouth or rooting (opening her mouth and trying to latch onto whatever she senses near her cheek), then crying.  Crying is a late feeding cue and should be avoided according the American Academy of Pediatrics;
• Feeding your baby smaller amounts more frequently.  Newborns stomachs are tiny — the size of a “large shooter marble” on day one, are not capable of stretching (Seammon and Doyle 1920) and can hold less than an ounce comfortably.  They stretch to the about the size of a large walnut by day 3 (Zangen et al. 2001) but still only accommodate about an ounce at a time.  At 2 weeks, their tummies have expanded and they can eat about 2-2.5 ounces per feeding.  Overfilling the tank can cause regurgitation and introduce your baby to an unnatural sense of fullness.  Eating in smaller increments means newborns eat many times per day — 8-12 –not just every 4 hours;
• Wearing your baby;
• Sleeping close to your baby;
• If you have been diagnosed with IGT or some other cause of low milk supply, consider using donor milk and a lactation aid that makes it possible to feed a baby at the breast without a full milk supply.

I have often said that if I had gone on to have a third baby, I would still have given us that Magical Hour after birth and let her make her way to my barren chest symbolically.  I would have used donor milk and I would have fed her skin-to-skin on my bare chest, gazing into her eyes, as much as possible.

So go ahead Mom, indulge the both of you –cuddle, snuggle, cherish and savor that baby  whether you are breastfeeding or not!

Happy Mother’s Day, with love…

What was your most delicious experience with your baby?

This is the 40th post in a series on Booby Traps, made possible by the generous support of Motherlove Herbal Company.

We are so very pleased to share the first of a two part guest post by Karen Gromada, MSN, RN, IBCLC, FILCA, on Booby Traps for moms of multiples.  Karen is the author of the classic Mothering Multiples, and is recognized as a leading expert on breastfeeding twins (and more).

While a lot has been written about nursing multiples, we haven’t seen a comprehensive explanation of the barriers moms face.  So we think this post will be a classic!

Booby Traps for Mothers of Multiples

Women expecting multiples report a desire to breastfeed at rates as great or greater than
those having a single baby. More than 70% say they plan to breastfeed. And if women find all kinds of Booby Traps hidden along the road when breastfeeding a single newborn, the woman planning to breastfeed two, three or more newborns steps onto a minefield! Here are a few of the typical booby traps mothers of multiples face.

Prenatal Booby Traps

Prenatal Booby Traps include both institutional and cultural ones. Often there is overlap, such as the healthcare professionals, family members, friends, members of a parents of multiples club or total strangers who seem compelled to say, “Breastfeed twins (triplets, quadruplets, etc.)?  That’s a nice idea but…

• “You’d have to be crazy to do that!”
• “It will be too hard on you.”
• “It’s not worth the hassle.”
• “You can’t make enough milk for two (three, four, etc.) babies.”
• “You can’t breastfeed twins (or more) exclusively, so why even try?”
• “You’ll need to supplement or you’ll never get any sleep.”
•  (Yada, yada ad nauseum!)

These comments are often accompanied by a patronizing rolling or winking of the eyes, giving the impression the person is adding, “Yeah, sure you’ll breastfeed twins (or more), ha, ha.”

Actually, many, and perhaps most, mothers can exclusively breastfeed twins or more whether their breasts are small or large. The issue is often more one of enough hours in the day for cue-based feedings than the body’s ability to produce enough. And there may be a bit more of a learning curve when breastfeeding two or more newborns, especially if they are preterm or small for gestational age but, once working as a breastfeeding team, nothing could be easier, more convenient or more restful. Breastfeeding means spending more time with the babies rather than investing time in shopping/purchasing, cleaning equipment, preparing (sometimes different artificial baby milks for different babies), heating, storing, etc. – and for an inferior product!

When obstetric healthcare providers approach multiple pregnancy as a disease and treat all expectant mothers of multiples in a “one size fits all” manner, it reinforces a notion that one’s body doesn’t work right, especially for women whose multiples are the result of assisted reproductive technology. It also may trigger a cascade of medical interventions that can contribute to a delay in initiating breastfeeding or milk expression with multiple newborns.

Hospital Booby Traps

Hospital Booby Traps occur more often with early breastfeeding because multiples are more likely to be born preterm and small for gestational age. Mothers are somewhat more likely to experience certain complications, such as pregnancy-induced hypertension (PIH, also known as pre-eclampsia) or postpartum hemorrhage. So babies are more likely to require special care and mothers may receive medication or treatments that interfere with early breastfeeding.

However, institutional Booby Traps may also occur as the result of “one size fits all” multiple birth care. More than half of twins and almost 100% of triplets and higher multiples are delivered surgically; some of these deliveries are not related to a complication but are performed electively, “in case a complication develops.” Even in uncomplicated twin or triplet pregnancies, induction or elective cesarean is often “pushed” by late preterm or early term gestation. Then early mother-babies skin contact and breastfeeding (or milk expression) within the first hour get lost – often unnecessarily – within the “drama” of a multiple birth.

Institutional and cultural booby traps bombard the breastfeeding mother of multiples
during early and later postpartum. Mothers report pressure to supplement from postpartum staff or family and friends before they ever leave the hospital – no matter how each baby is breastfeeding. In addition to NICU booby traps already cited, some NICUs still place multiples in different areas rather than close together in the same area. Also, staggered discharge of one baby before the other(s) affects frequency of breastfeeding or pumping for each baby. Poor post-discharge support includes failure to develop realistic plans for continued milk expression and of transition babies to breast once home and coping with the needs of two or more young babies.

The Booby Traps continue when (or once) each baby is breastfeeding well. Feeling exhausted?  Feeling overwhelmed? Having a low-confidence day? Rather than praise the mother for how well she is doing and point out that most of her feelings are related to having more than the usual number of babies, everyone from the pediatrician to family, friends, parents of multiples club members and total strangers rarely hesitate to provide an “out” for the mother of multiples by suggesting she supplement with formula or introduce some early solid food. (A personal “favorite” is the pediatrician who says, “Hey, don’t feel bad. I’ve never had a mother who could exclusively breastfeed twins [or triplets, etc.].” Really? I wonder why this pediatrician doesn’t see exclusively breastfed multiples after voicing that kind of self-fulfilling prophecy concept!)

Breastfeeding Support Booby Traps

On the other side of the booby trap coin is the breastfeeding advocate who fails to recognize that breastfeeding (or breastmilk-feeding) two, three or more the usual number of babies is not the same as breastfeeding a single baby. Mothers will tell you that breastfeeding multiples is more than the mechanics of latch or observing for signs of effective milk transfer during suckling. It’s also the logistics of juggling more than one newborn when two (or more) are crying at the same time! It’s the exhaustion of week after week of no more than an hour or two of uninterrupted sleep. It’s a feeling of being overwhelmed when giving more than 100% yet feeling as if no one’s needs are being met.

Mothers of multiples report they’ve been told by lactation consultants or counselors and peer supporters or leaders who have never breastfeed multiples themselves that “You may not have enough milk for two (three, more) unless you…

• “Always breastfeed two at once.”
• “Always assign each a particular breast,” or “Never assign each a particular breast!”
• “Pump after every feeding (even when babies are term and breastfeeding well).”
• “Pump every 2 hours for 20 minutes (for preterm multiples).”
• “Sure, a nice personal double pump is as good as a hospital-grade rental pump once your milk ‘comes in.’”
• “Use a tube at breast (finger-feed, syringe-feed, etc.) for any supplements. If you give a bottle, the babies will get nipple confused and then have trouble latching.”

How demoralizing! Many of these “rules” don’t take into account the research evidence about milk production nor do they acknowledge the physical and emotional toll of caring for multiple (often preterm) newborns and figuring out the differences in their individual needs. Mothers of multiples need strategies for breastfeeding and expressing milk that are based in their current reality. Whether for physical or psychosocial reasons, some mothers may also need strategies for offering occasional or regular supplements of mom’s milk, or possibly artificial infant milk, if they are to continue to breastfeed (or pump). Also, different strategies work for different breastfeeding “teams” – there is no one way to breastfeed multiples.

This concludes the first part in this two-part post on Booby Traps for Moms of Multiples.

In the second part of this post, Karen will discuss Peer Booby Traps, how Moms Booby Trap themselves, and her best advice for How Moms of Multiples can Avoid the Booby Traps.  

Are you a mom of multiples?  Did you experience any of these Booby Traps?  What made a difference for you in breastfeeding your babies?

*Image credit:  International Symbol for Breastfeeding, modified for twins tandem nursing by Robby Poore. 

Lacy Naud during the Oriflamme 50 earlier this month, for Team BfB!

We cheered wildly for Team Best for Babes So Cal member and nursing mom, Lacy Naud, when she completed her first “ultra-marathon” in early April–50 gorgeous but grueling kilometers (31.4 miles) that challenged but did not dissuade her from reaching her long-held goal.  Lacy ran for her own daughter and for the millions of moms who every year are prevented from reaching their personal breastfeeding goals by the Booby Traps(R)  – the cultural and institutional barriers.   Her commitment to herself, her daughter, and the Mother of All Causes is unflappable and proof that together we can change the culture and the course of our collective health!  

Lacy’s got a super-charged passion for fitness and for fueling the fight to give moms the support they need to succeed – -but Team BFB is for anyone who cares about their Babes, big and small, to race to beat the booby traps and put prevention first!  From the Marine Corps Marathon to a 5k walk, run, ride or stroll, in your hometown, Team Best for Babes is putting the heat on the Booby Traps!  To join or start a team near you, go to  www.bestforbabes.org/team-bfb. 

Here’s Lucy’s big day in her own words:   

Two years ago I was on a path to complete my first ultramarathon but during the early stages of training I happily became pregnant.  With a passion for fitness, I dove into a prenatal exercise plan and finished a marathon at 21 weeks pregnant. After taking a break from running to give birth to my beautiful girl, I resumed running about 4 months postpartum and started on the grueling path to rebuild my running base.

The Miracle is YOU BABE!

Running postpartum was a game-changer in my running career. Nearly all  of my training runs have been behind a stroller, some runs as long as 15 miles (with plenty of mid-run playtime out of the stroller and  booby-snacks for my girl!). When I needed home hill training I strapped my daughter in our ergonomic carrier and hiked up Cowles Mountain taking full advantage of the training opportunity the
additional 25 pounds of cuteness provided. I was determined to go  after that ultra goal.

Post-race with her daughter...the wind beneath her wings!

April 7, 2012, I headed to Anza Borrego State Park, San Diego County, to take on my first 50K (31.4 miles). The out-and-back course had a mixture of terrain…single track along the Pacific Crest Trail, a more than 2000-foot drop into the desert, a run through the beautiful desert scenery of Box Canyon, and then the climatic 5+ mile climb back up via Oriflamme Canyon. I faced more challenges, physical and mental, in that race than in any other race I have ever run. Thinking of holding my daughter afterwards kept my feet moving relentlessly forward for a finishing time of 8:01:06. I was proud to wear the Miracle Isn’t the Bra racing tank and to help raise awareness of BfB’s growing cause. I’ll be wearing that tank again for the upcoming PCT50 Trail Run…50 miles in a stand against the Breastfeeding Booby Traps™!

Lacy hits the ground again on May 12 for her first 50 mile race.  To sponsor Lacy visit her personal page at: http://teambfb.bestforbabes.org/2012/socalbabes/

What Booby Trap would you race, run, or walk to Beat? 

As soon as I got this week’s issue of People Magazine in my hot little hands, I did two things:

1) looked for Kelly Preston’s picture in “Star Tracks” and a mention of Best for Babes and Healthy Child Healthy World in connection with the celebrity event she hosted with Jenna Elfman and Laila Ali on April 14th . . . it was on page 20!  Squeee!  Yay for getting positive messages about breastfeeding and non-toxic living under the eyes of 3.5 million readers!

2) read the article about Beyoncé to see whether there was any mention of breastfeeding. Although I hunt for breastfeeding mentions in any expecting and new mom celebrity stories I read, I was particularly eager to see if Beyonce mentioned anything because of the huge media storm she set off when she was sighted nursing Blue Ivy in public, a topic that became so hot it made Time magazine.  We’ve also been secretly hoping we could get Beyoncé to breastfeed on Sesame Street so that it can be seen as a normal and natural part of educating and raising children.

Sure enough, on page 71, Beyoncé credits breastfeeding with her ability to lose her pregnancy weight.  We also learn that she breastfed until Blue was 10 weeks old.   There goes our hopes for a Beyoncé breastfeeding gig on Sesame Street.

On the bright side, we think it’s great that Beyoncé breastfed AT ALL, and we love her for breastfeeding in public and being a positive role model to millions of moms who admire her glamor, talent, and business savviness.   I’m sure some advocates are disappointed that she didn’t make it to 3 or 6 months, but we’re focusing on the fact that she made it through the first few days (most moms encounter huge Booby Traps in the hospital), and through the learning curve of the first 2-6 weeks.   So many moms give up during this period (and it is not their fault!) because they are being undermined by a multitude of insidious cultural and institutional barriers to breastfeeding.   African-American women face even greater barriers to breastfeeding, so the fact that Beyonce lasted as long as she did makes her double the hero to us!   When 100% of the moms who want to breastfeed can make it past the first 6 weeks, we’ll know that 3 and 6 months is within reach.

So let’s congratulate Beyoncé:  Every ounce counts, and you did us proud, girl!  And let’s also congratulate celebrities like Kelly Preston, whose story of “still” breastfeeding her son for 16 months was viewed 250,000 times in 48 hours, effectively making it a public service announcement.  (We love what she shared with Best for Babes,  too). No matter how long celebrities breastfeed, the fact that they are doing it, showing it off, and sharing about it, is something for us all to celebrate!  All celebrity breastfeeding stories have inspirational and educational value for mainstream America, whether they breastfed for 2 days, 2 months, or 2 years.

Do you get disappointed when celebrities stop breastfeeding?

One of the biggest issues in breastfeeding is the disparity in breastfeeding rates among different races.

The gap between African American women and women of other races, while closing, remains the most salient example.  The breastfeeding initiation rate of African American moms, which in 2007 was 60%, compared to the overall U.S. rate of 75%.

But it turns out that a big part of the solution is right in front of our noses.  It’s evidence-based care and following proper infant feeding protocol, neatly packaged as the Ten Steps to Successful Breastfeeding, which forms the basis of the Baby Friendly Hospital Initiative.

Evidence is accumulating that not only does following the Ten Steps improve breastfeeding success rates in general, it actually eliminates or significantly reduces  race-based disparities.

Consider the following examples:

One study of Baby Friendly hospitals in the U.S. found that “breastfeeding rates were not associated with number of births per institution or with the proportion of black or low-income patients.”  In other words, whether you had a large or small population of women who were African American, breastfeeding outcomes were the same.  Disparity?  Poof!

Here’s another study, of Boston Medical Center, which became a Baby Friendly Hospital in 1999.  The rate of breastfeeding among African American women went from 34% in 1995 to 74% in 1999.  Yes, that’s super impressive on its face. But consider this:  the overall breastfeeding rate went from 58% to 78%.  So that means African American moms were within 4 percentage points of the overall hospital rate.  A study found that, “Among a predominantly low-income and black population giving birth at a US Baby-Friendly hospital, breastfeeding rates at 6 months were comparable to the overall US population.”  Disparity?  Gone, baby, gone.

And this data, from the California WIC Association shows that, “for hospitals with policies such as those outlined in the BFHI that support breastfeeding, these disparities
are significantly reduced.”  The California WIC Association, using data from the state Department of public health, reports that overall hospital exclusive breastfeeding rate in California hospitals is 57%.  The rate for African American moms at non-Baby Friendly hospitals is 46%.  At Baby Friendly hospitals?  62%.  This is only slightly lower than the rate of exclusive breastfeeding at Baby Friendly hospitals for all other races.  Disparity?  What disparity?

Yes, we need more culturally-appropriate care.  We need to check our assumptions at the door, and to sustain breastfeeding we need support from “moms like us” in the community.  But the single most important thing we can do is one that benefits all moms: practice evidence-based breastfeeding care, such as found at a BFHI USA hospital.

Did you birth at a Baby Friendly Hospital, or one that follows most of the Ten Steps?  How did these policies (or lack of them) affect your breastfeeding experience?