After suffering a severe traumatic brain injury in December that was originally deemed fatal, Charlotte Rose continues to defy all odds!  Not only is she alive but she is thriving, due in part to her daily infusions of mothers milk.   Read: http://www.bestforbabes.org/miracle-milk-helps-heal-brain-injured-formula-fed-baby 

Charlotte was the very first originally formula-fed child to receive banked breastmilk at St. Mary’s Hospital in Florida.   Since her “awakening” she has received pasteurized banked breastmilk which we purchase from the Mothers’ Milk Bank of Austin. Charlotte is a living testament of the tremendous nutritional and healing powers of breastmilk. As you may already know, pasteurized banked breastmilk is commonly used in neonatal units all over the country but basically unheard of in a Pediatric ICU.  Until Charlotte- that is!

Charlotte Rose after her injury and surgery

Since her homecoming on February 15th, Charlotte has made tremendous strides!  She is holding her head up now and almost sitting up on her own.  Her strength and will to play and perform, even the simplest tasks, is so inspiring.   Physical therapy, occupational therapy and speech therapy have been scheduled with great consideration taken, to ensure her much needed rest.  Recently, I spent a weekend with Charlotte. I tell you there is nothing more life- affirming than being in the presence of this special child. I would like to share the most poignant moment.

Charlotte’s amazing recovery defies all odds–she is smiling!

It wasn’t when she squealed at Elmo or fed herself for the first time or fell asleep in my arms. It was when I carried her outside into the yard. I fully expected her to shield her face from the bright sun by burying her head in my shoulder.  But instead, Charlotte intuitively stretched upward and boldly lifted her face to the sun. She closed her eyes and just let the warm rays stream across her face.  She was very still and peaceful as the beams of light kissed her ivory skin.  I was awestruck!   It was so surreal like she knew exactly what she was doing.

Many people ask me, “What’s the extent of Charlotte’s brain damage? Her deficits? The long-term predictions? I do not dare to know the answers to those questions.  Oh sure, I can spew the medical lingo as well as anyone.  I can profess to know about the complexities of the brain and what’s to be expected. Normally, I am pretty smart and savvy -don’t pull any punches. I am a “shoot from the hip”, reality-based type of person when it comes to medical issues.  But, I confess to you now that I am none of those things when it comes to this child. Charlotte Rose cleaned my clock, flipped my lid and rocked my world!  She simply tossed aside any logic or intelligence I thought I had and replaced in with sheer faith in God and faith in breastmilk!

Here’s where we need your help:  In June, Charlotte will be undergoing a very delicate surgery, cranial reconstruction.  The neurosurgeon will close her skull with the pieces of bone he removed in December. When she was injured, the right side of her skull was opened as a life- saving measure to allow her brain adequate room for swelling.  Because of that, great care must be taken and she has to wear a heavy protective helmet.   Charlotte is only able to eat and drink small amounts, so the banked breastmilk remains the staple of her diet via her gastric tube, which was surgically inserted through her abdomen into her stomach.   Charlotte needs a total of 21 oz of banked breastmilk per day. We are doubly blessed that as a bonus, breastmilk naturally contains the mega doses of Omega 3′s which are vitally important for her brain growth and development.   Can you help us give her the banked breastmilk she needs?  Any donation, $5, $10 or more–makes a huge difference to Charlotte!!

Charlotte playing! Breastmilk contains naturally occurring, easily absorbed omega-3s, a key building block of the brain.

The practitioners involved with Charlotte’s care have confessed at being shocked by her mere survival let alone, her rapid pace of progress. They now admit and accept that this amazing feat is heavily due to the miracle of breastmilk.  Her doctors profess that this regime is critical to her recovery. Unfortunately, the insurance company refuses to pay for the milk . . . so Charlotte’s hope to continue thriving–to continue improving–is only possible because of the many generous contributions to her milk fund. Our hope is to continue to provide this miracle milk™ through her upcoming surgery & recovery.

Unfortunately, we are almost out of “milk” money and she has about 10 weeks until her surgery. We have exhausted all of our own sources so we are reaching out to you.  I imagine you may be thinking “Why not use regular donor milk from one of the milk sharing networks like Human Milk for Human Babies?” The reason is that the hospital and surgeons are adamant that we use only pasteurized banked milk from a bank affiliated with the Human Milk Banking Association of North America until after her recovery from surgery.

If you can help us meet our goal by contributing to the Best for Babes Miracle Milk(TM) Fund for Charlotte- it would be greatly appreciated and surely blessed.

Only $5 buys her an ounce of the Best BOOST she can get to prepare for surgery!

Please donate now at:   http://www.bestforbabes.org/miracle-milk-fund. Please continue to keep this precious child in your thoughts and prayers.

Thank you,

Maria Parlapiano, RN IBCLC aka GrAuntie Maria

Moms who have had breast reduction, breast implants, and other breast surgeries face some specific Booby Traps.

To develop a good list of these barriers, I spoke with Diana West, IBCLC, author many books on breastfeeding, including Defining Your Own Success:  Breastfeeding after Breast Reduction Surgery, The Breastfeeding Mother’s Guide to Making More Milk, and The Womanly Art of Breastfeeding, and founder of the websites bfar.org (for breastfeeding after reduction surgery) and lowmilksupply.org.

In this interview, we discussed the breastfeeding barriers moms face after breast surgeries:

The first barrier that many women run into is the mismatch between reality and what their surgeons have told them.  Many times when women go to have breast reduction, breast augmentation, breast lift, or even breast biopsy, the surgeons will tell them either that it will have no effect on breastfeeding whatsoever, or ‘you can’t breastfeed at all.’  In my case, I was told I could not breastfeed.  Neither of these things is usually the case.  It’s often somewhere in between.

The other thing moms hear [specifically after a breast reduction surgery] is “you’ll have a 50/50 chance of being able to breastfeed.”  That is absolutely unfounded in any science whatsoever.  To put it kindly, it’s a surgeon’s urban myth.  What the surgeons usually mean by this is you’ll have a 50% chance of having a full milk supply.  Again, this is not based in any science whatsoever.  What mothers often hear is “you’ll have a 50/50 chance of having any milk at all, or being able to breastfeed.”  But that’s not true, either.  Saying moms will have 50/50 chance of breastfeeding is just meaningless.

Most plastic surgeons, maybe unless they’ve breastfed their own kids, don’t generally address breastfeeding very much at all.  They don’t understand it; they don’t give enough information.  It would be ideal if the plastic surgeons’ professional organizations had information to give to mothers that explains the risks, realities, and positive outcomes.  Since they haven’t created anything like this yet, the bfar.org website was developed to provide women with this important information both before and after their surgeries.

What mothers need to understand is that – depending on many factors, including the type of surgery, the time since the surgery, and her innate anatomy and physiology –  there is a very real chance that they won’t have a full milk supply at least initially without any measures to increase it.  However, mothers breastfeed all the time without a full milk supply and have a great breastfeeding relationship.  It’s just a matter of the milk, which is ultimately the least important part of the breastfeeding experience.  That’s not what most mothers believe at first, but once you get into it you realize that there’s so much more to it than just the milk.

The second Booby Trap is that mothers often assume that the problems they’re having are related to their surgery.  But as those of us who work with moms every day know, there are a a lot of reasons why women have problems breastfeeding.  There could be a baby-side problem, like tongue tie, or maybe the mom has had tremendous amounts of IV fluids in labor and that makes her breasts so edemetous that she just can’t get the baby to latch.  Or maybe there is some underlying hyperplasia where she doesn’t have enough glandular tissue – this is very common in women who have augmentations.  There could be an underlying hormonal issue like thyroid or PCOS.  There are many different reasons why mothers have trouble breastfeeding or making enough milk.

Diana also discussed the importance of working with a lactation consultant who has special expertise in low milk supply.  Her website lists consultants around the world who have self-identified as having this specialty, and those whom she personally knows are listed with a “Diana Recommends” badge.

They need to work with not only an IBCLC but someone who specializes in low milk production.  Most hospital based lactation consultants are generalists.  So working with a private practice lactation consultant who really gets the special challenges of low milk production and really understands the what needs to be done - extra milk removal in the beginning to calibrate a strong milk supply being key – is paramount.  Insurance is paying for this more now, which is great.  And also the book The Breastfeeding Mother’s Guide to Making More Milk is a resource which allows a mothers to empower themselves.

The Booby Trap here is that few hospitals provide referrals for this kind of specialized help.  According to the CDC, in 2009 only one in four met the benchmark for providing good support and referrals to moms once they leave the hospital – one of the Ten Steps to Successful Breastfeeding.  In 2009, only 27% of hospitals reported that they provided referrals to outpatient breastfeeding support in the community.  So at a critical time to support breastfeeding moms who have had breast surgeries, our hospitals are too often falling short.  Diana’s website referral list is her attempt to bridge this gap.

Did you have breast surgery?  Did you experience any of these Booby Traps?

We’re very excited to share this interview with Lara Audelo, Best for Babes team member, owner of Mama Pear Designs, and author of the new book The Virtual Breastfeeding Culture:  Seeking Mother-to-Mother Support in the Digital Age (with an introduction by Bettina and Danielle)!

Lara joined the Best for Babes team in 2011, helping to support the development of products benefiting the Mother of All Causes, and expanded her role to facilitate the growth of our corporate partners through the C.A.R.E.-WHO Alliance.  We couldn’t be happier about her new book and her willingness to share all that she knows about the culture of online mom-to mom breastfeeding support.

The web provides so much support to breastfeeding moms.  But it’s possible to get Booby Trapped, too.  What are the Booby Traps to look out for online? 

Yes there are certainly Booby Traps online! When a mother-to-be or new mom first starts searching, chances are she is going to go to Google and type in “breastfeeding support,” “breastfeeding facts,” or something similar. The thing that most women just beginning their online quest for breastfeeding information don’t realize is that there is a great deal of information online that can be misleading.

I’d say the most important thing to remember and best way to determine reliability of online resources is to look for evidence-based information, and then to question the source of the material. Obvious conflicts of interest, such as one of the big formula companies offering breastfeeding advice, should raise a red flag. In the beginning it can be a little difficult, but if you spend any length of time looking online for breastfeeding help, it becomes easier to spot sources providing breastfeeding information that might be questionable. And of course, even though the Internet offers more information than we could ever process in our lifetimes, if you are really struggling it is best to seek help when possible from an IBCLC in your area.

In addition to avoiding resources that might be questionable, I think the best advice is to join a community – somewhere with people to encourage, support and share their wisdom with you. I have yet to meet a breastfeeding mom who didn’t want to pay it forward and offer support to the new mom on the block. There Facebook pages, Facebook groups, online forums, Twitter hashtags that can be used and followed, blogs, podcasts – really the various types of support that can be accessed online are impressive. It can be as simple as finding a platform you like, gravitating toward the positive supportive people, and then offering support to those around you, as sometimes we learn more when we help others than when we seek help for ourselves.

In your book you include a number of stories of moms’ experiences getting support for breastfeeding online.  Can you share a few of your favorites? 

I honestly was really moved by all of the stories I chose for the book. Some of them touch on very serious subjects like losing a child and postpartum depression. Others involve working and pumping, and finding donor milk – I think there is a good balance overall. There is one story of a mother, Krysta, whose baby was born weighing just over a pound at 25 weeks.  I love her story because she not only managed to pump for him, but eventually got him to feed directly from the breast. Her spirit and determination is incredibly inspiring, and she is someone who immediately turned to the Internet after giving birth unexpectedly.  She was in the hospital with a fragile baby in the NICU, and knew exactly where to go for help. And they were there for her immediately, as soon as she needed them.  It wasn’t the staff at the hospital; she felt comfortable relying on the moms she had invested time in getting to know up until this point. Imagine if she didn’t have the network of moms to call upon when she needed them.  What might the outcome of her experience have been?

One of my other favorites is from the chapter on Breastfeeding After Reduction (BFAR). Kelly had a breast reduction at age 18, and as a teenager she never gave much thought to how it might impact her ability or choice to breastfeed. Her first birth experience was a c-section that she didn’t want, and she had a tough time with supply while nursing her older daughter. Her birth and breastfeeding experience led her to learn about the possibility of a VBAC for her next birth, and that in turn led her to gain more knowledge about breastfeeding, as she realized that breastfeeding really starts with the birth process. When her younger daughter was born, she achieved her goal of having a VBAC and an unmedicated birth with a doula and a very supportive doctor. She struggled with breastfeeding the second time around in the early months, trying to establish her supply and keep up with her daughter’s increasing demand for milk, but she did end up meeting her breastfeeding goal of one year.  Kelly’s maternal redemption, to finally have the birth and breastfeeding experience she envisioned and longed for, is extremely powerful in my opinion, especially in terms of showing other women what their capabilities are.

I’ve heard hospital education directors lament the fact that mothers now get their information about pregnancy, birth, and breastfeeding online instead of by coming to classes they offer.  They point out that those classes gave new parents social support and often created long-term friendships.  What is lost and what is gained in this shift to online support? 

I think there is great value in having face-to-face support and education, because the Internet can’t replace all real life experiences. But I also think that hospitals are missing out if they don’t find a way to follow up and connect with the mothers that come to their local classes, and offer additional support online. The reality is that women turn to online support because they are comfortable doing so, and it is highly convenient. There is always someone online able to help you. As we know this is a 24/7 job, so chances are if you post a question online, you will get an answer no matter the time of day.  Additionally, hospitals don’t have “warm lines” open around the clock, and sometimes it is easier to type your question silently from your smartphone than to speak on the phone and wake up the sleeping baby at your breast!

I think any woman who has found her tribe online would argue that any friends made via social networking are just as real and valuable than any she might have made in a local birthing or breastfeeding class. I think it’d be hard to measure what is lost in this scenario as mothers turn online, because that would depend on just how valuable the class in your area is that you might be missing. However, I think what is gained is pretty amazing: potentially a wealth of knowledge (if you can avoid the online Booby Traps) and the chance to make friends, both in your local area and abroad.

What has online mom-to-mom breastfeeding support meant to you?  Where do you turn for support and what do you avoid?

Supplementing with breastmilk, not formula, is the best way to go when medically indicated.

A new study making headlines this week suggests that “early limited formula” use actually increases the chances that babies will be exclusively breastfeed later on.

This small study enrolled 40 full-term newborns between 24-48 hours old who had lost more than 5 percent of their birth weight.  Their mothers had indicated their intent to exclusively breastfeed (but appear to have been okay with supplementation for the purposes of this study).  The babies were assigned either to receive formula, consisting of one-third of an ounce of infant formula–about 2 teaspoons–fed by syringe following each breastfeeding, or to continue breastfeeding exclusively. The babies receiving stopped using it when their mature milk came in.

The results:  At the one week, all the babies in both groups were still breastfeeding. But only 10 percent of the babies who had received formula in the hospital were also using formula.  Of the mothers who had exclusively breastfed in the hospital, 24% were using formula.  At three months, the researchers found a similar difference, with 79% of the babies who had received formula breastfeeding exclusively, compared with 42% of the babies who had not received formula.

You may already have picked up on a few problems with this study.  I’ll run through the ones that are the most salient.

Prior research shows that use of formula without medical indication strongly undermines breastfeeding.  This study contradicts decades of prior research, which has demonstrated that early supplementation is associated with shortened breastfeeding duration.

In fact, one recent study found that, of the Ten Steps to Successful Breastfeeding (the basis of the Baby Friendly Hospital Initiative), early supplementation had the most powerful negative effect on breastfeeding rates.  Using CDC data, this study found that having a baby in a hospital which didn’t follow Step 6 (no supplementation without medical indication) was associated with a 10.5 week shortened duration of breastfeeding.

The wrong criteria for newborn weight loss.  Newborn weight loss averages 7%, and intervention isn’t considered necessary unless weight loss exceeds 10%, according to the American Academy of Pediatrics. What problem was this study trying to solve by supplementing babies who had no medical indication for it?

Why try this?  We already know what works.  We already know how to improve breastfeeding rates without the use of formula, and we have known it for some time.  The Ten Steps to Successful Breastfeeding increase breastfeeding duration and exclusivity, and they’ve been around for over 20 years.  But 94% of babies in the U.S. are being born in hospitals which are not Baby Friendly.  And 4 out of 5 hospitals say that they supplement more than 10% of their babies for no medical reason.

Here’s one recent demonstration of the effect of following evidence-based practices, and there are more.  A 2008 CDC study found that “compared with the mothers who experienced all 6 “Baby-Friendly” practices, mothers who experienced none were ∼13 times more likely to stop breastfeeding early.”  Note that this was just 6 of the 10 steps.  The effect of all of the steps would likely have been even greater.

Sample size too small, no controlling for other factors.  This study enrolled only 40 women.  That number makes the conclusions far less reliable than prior research which has examined patterns of thousands of women.  And because the number of women in the study is so small, the authors weren’t able to control for a number of factors known to influence breastfeeding patterns, such as age, income, race, education, parity, and prior breastfeeding experience.

One author has financial ties to formula companies.  One co-author disclosed that he has been a paid consultant to Mead Johnson and Abbot Laboratories, the two largest formula companies operating in the U.S.

Milk came in late for one quarter of the mothers.  Mentioned in the study but not explored was the fact that one in four of the mothers experience a delay in their milk coming in, defined as later than 72 hours.  That’s an indication that there is a problem, and it’s associated with less exclusive breastfeeding long term.  The babies in the formula group got formula, which probably addressed any fussiness on the part of the baby.  Once their milk came in, off they went.

For the mothers in the no-formula group, they were left to fend for themselves.  Picture this:  For these mothers, their milk came in late, they got home and had babies who were freaking out, and it naturally undermined their confidence in exclusive breastfeeding.  Is it any wonder that they turned to formula?  And as the authors point out, once you’re using formula at one week, you’re more likely to be using it at two weeks, and 1 month, and 3 months.  All of the moms whose milk was late coming in should have gotten help establishing lactation, supplementing with their own milk (as show in the image above), and a careful evaluation of supplementation if the baby’s weight loss exceeded 10% consistent with the Academy of Breastfeeding Medicine’s supplementation protocol.  That would have put them on an even playing field with the other moms, and you may have seen different outcomes as a result.  The no-formula group also got a lesson in soothing techniques, to even out the amount of contact each group got from providers.  As Dr. Alison Steube notes, this may have “telegraphed” a lack of faith that exclusive breastfeeding would work out, further driving the tendency of these moms to use formula.

Using formula to supplement instead of human milk.  The number one rule is feed the baby, the number two rule is use the mother’s expressed milk, or donor milk, when possible.  Using a mother’s expressed milk can boost her confidence in her own ability to feed her baby; using donor milk can underscore the superiority of breast milk to any milk substitute.  Wouldn’t this study have been different if it was about the “Effect of Early Limited Human Milk Supplementation on Duration and Exclusivity of Breastfeeding in At-Risk Infants”?

Undermining recent progress.  There are significant efforts underway to reform hospital practices in ways we know to be supportive of breastfeeding.  Prior evidence shows that early supplementation undermines breastfeeding.  So in our view it would be irresponsible for hospitals to switch directions on the basis of a single study of 40 women.

Editor’s Note:  We are very disappointed that the New York Times article failed to include skepticism from highly regarded health experts.  Disseminating the results of this flawed study as “good news for mothers” is irresponsible journalism.   Please read Alison Stuebe, MD’s excellent article, and see the quotes by neonatologist Kathie Marinelli, MD in the TIME.Healthland article.  

Image credit:  Wikimedia Commons

Charlotte has made a miraculous recovery from a fatal traumatic brain injury with the help of donor milk.

Late yesterday, we received this picture and thank you note from Baby Charlotte Rose’s grandmother  wanting to express her gratitude to ALL of the mothers who have donated their milk to help her grandbaby recover from a fatal severe traumatic brain injury.  5 months later, with human milk as her primary nutrition, Charlotte Rose has defied every odd, and is back on track to wellness and thriving.  A huge thank you to all of the moms who spread the milk of human kindness and generously donate your Miracle Milk(R)!

On  behalf of Charlotte , Hannah,  Cabell, Will and I, we would love to wish every mom out there a Happy Mothers Day!  We are so blessed to have so much love and support coming our way through all the prayers, well wishes, and dinners and to everyone who continues to support providing Charlotte with Miracle Milk(R).  Her recovery and health is due to the nourishment that the donor milk provides her.  A special thank you to our Grauntie Maria and her determination to keep the milk coming! We couldn’t do it with out her! Doctors are continually amazed at her progress despite how  serious her brain injury is. Charlotte is such a blessing to us and everyday we are so grateful for her. So enjoy your day; life is such a gift; take time to enjoy it.  Thank you again for all your love and support. Keep those prayers coming – they’re working!!

Annette (Charlotte’s GrandMom)  

Charlotte Rose shortly after her injury and emergency surgery to relieve pressure in her brain.

Charlotte Rose, an 11-month old formula-fed baby, suffered a fatal traumatic brain injury.  Charlotte’s aunt, a nurse and lactation consultant, went to extraordinary lengths to enroll care providers in her plan to help Charlotte heal with banked human milk. You can read more about Charlotte and her journey here.

In June, Charlotte will be undergoing a very delicate surgery, cranial reconstruction.  She needs enough donor milk to get her through that surgery.  Help give Charlotte the banked breast milk she needs.  Only $5 buys her an ounce of the Best BOOST she can get to prepare and recover from  surgery!  

Please donate now at:   http://www.bestforbabes.org/miracle-milk-fund.

Continue to keep this precious child in your thoughts and prayers!

Moms of babies with special needs often face extra challenges to meet their breastfeeding goals.

But in addition to these challenges, they may also encounter a number of Booby Traps.

Any barrier to breastfeeding is a shame, but it’s particularly disturbing when it comes to moms of babies with special needs, since many of these babies are especially in need of the protection breastfeeding provides.  The U.S. Cystic Fibrosis Foundation, for example, recommends breastfeeding for most infants with the disorder “as the primary source of nutrition for the first year of life” based on associations between formula feeding and respiratory infections and slow growth.

I remember helping a mother whose baby was born with a congenital syndrome which causes multiple problems, including deafness.  Knowing that her child faced a tough road ahead, this mother was as determined as I’ve ever seen a woman to breastfeed.  To her, it was an important part of giving her baby the best future she could.

Read:  Extraordinary Breastfeeding:  A CBS News.com Producer’s Story

Shouldn’t we see this spirit reflected in the care we get from our health care providers?  Shouldn’t they should promote the heck out of breastfeeding, provide excellent breastfeeding care, and be the loudest cheerleaders for breastfeeding, applauding moms for expending the extra effort it takes to successfully breastfeed a baby with special needs?

While some moms undoubtedly get great care, too often we hear of the following problems:

Low expectations.  Mothers of special needs babies are often told that breastfeeding isn’t possible.  In the case of infants with Down Syndrome, it was long assumed that breastfeeding was not possible.  But the evidence points in the opposite direction, with one study finding that, with persistence on the part of their mothers,  about half of babies with Down Syndrome breastfed well from birth, another quarter got the hang of it within one week and the remaining quarter took more than a week to master the skill.  In spite of this, some mothers continue to hear that “you can’t breastfeed a baby with Down Syndrome.”

Poor advice.  Mothers may also get non evidence-based care when it comes to breastfeeding.  In Breastfeeding Answers Made Simple, Nancy Mohrbacher reports that in the case of babies with cardiac issues, “some mothers are discouraged from breastfeeding due to the misconception that bottle-feeding is ‘easier’ than breastfeeding.  However, research has found the opposite to be true.”  Oxygen saturation is actually higher during breastfeeding among babies with cardiac issues, who have an easier time coordinating suck-swallow-breathe with breastfeeding than bottle feeding.

Lack of expert help.  Moms of special needs babies nearly always benefit from expert help, but it’s not always available.  Lactation consultants experienced and skilled in helping mothers with issues like cleft lips and palates are not always available in hospitals, and if available they might not have the time it takes to help mothers with specific and complex challenges.  And like mothers of babies born preterm, moms of babies with special needs often are sometimes left adrift in the community after discharge from the hospital – a time when they may need expert help the most.

Poor management of separations.  Special needs babies are more likely to be separated from their mothers for medical procedures, whether they’re taken to the nursery for testing or to the operating room for surgeries.  The management of these separations is critical to ensure continued breastfeeding, but just as when moms are hospitalized, it’s often not taken into consideration.  Imagine the frustration and pain of a mother who has moved heaven and earth to establish breastfeeding with her baby, only to find that she doesn’t have access to a pump while separated from her baby, can’t room in with her baby to allow for nighttime feedings, is restricted in visiting hours for feedings, is told that she can’t breastfeed during painful procedures such as heel sticks, or can’t breastfeed for 6 hours before a procedure requiring sedation (6 hours is the guideline for formula, 4 hours is for breastfeeding/breastmilk).

Could bottle feeding mask other problems?  One interesting point raised by research cited in Breastfeeding Answers Made Simple is that the our providers’ enthusiasm for bottle feeding special needs babies may actually mask other issues.  Breastfeeding is an instinctual behavior.  Those babies who don’t show these instinctual behaviors may have issues which need diagnosis and care, but we won’t see them if the answer to every problem is a bottle.

We know that some of you have received great care for your special needs babies, and we’d love to hear about it.  But for those moms who haven’t, we wish for improved care and attitudes in the future.

What kind of care did you receive for your special needs baby?  Did it help or undermine your efforts to breastfeed?

This post originally appeared on phdinparenting.com on May 6, 2013.    The site crashed a few hours later during the ensuing twitter storm so Phdinparenting.com gave us permission to reprint it here.  

Old news, new victims?

We’ve heard it all before. Corporations want to tell us that they get us. They know what we are thinking, what we are feeling, what we need. And, of course, they have the solution. This year, with its StrongMoms Empower campaign and StrongMoms Empower Summit (happening tomorrow in New York City), Similac (an infant formula brand) is trying to position itself as a leader in creating a more supportive and less judgmental environment for moms.

Do you think you’ve heard this before? Possibly, you’ve heard it from other moms in the social media community who have been preaching it and practicing it for years. Possibly, you’ve heard it from Best for Babes. Their credo, which they wrote about on their site in 2009 (yes, 4 years before Similac decided to co-opt it) is:

Our Credo:

ALL moms deserve to make a truly informed feeding decision and to be cheered on, coached and celebrated without pressure, judgment or guilt.

ALL breastfeeding moms deserve to achieve their personal breastfeeding goals without being undermined by cultural & institutional “Booby Traps“.

You’ll notice Similac co-opted the first part of this, while ignoring the second part. Why is that? It is because they are a big part of the cultural and institutional “booby traps” that Best for Babes wrote about and that I’ve written about numerous times on this site (see societal barriers to breastfeedingor why do moms quit breastfeeding?). Of course formula companies don’t want the moms who use their products to be subject to pressure, judgment or guilt (especially if that makes people afraid to use their products), because they only want there to be warm fuzzy feelings as it relates to their product. But make no mistake, they are not here to support your breastfeeding goals. They are here to slowly undermine your breastfeeding goals with deceptive advertising and unsolicited samples sent to the homes of breastfeeding moms.

It’s Just More ‘Mompaganda’

Similac doesn’t really care about supporting moms. They want moms to think that they care about them. They want moms to feel good about using their product, not guilty. They want moms to get ‘warm fuzzies’ when they think about Similac, instead of having negative feelings of shame, guilt, or judgment. That isn’t horrible, except that their true motivation is to increase sales, not to support moms.

In her guest post on my blog, Carly Stasko wrote about Mompaganda. She wrote:

The logic behind the motherhood brand is simple. Most moms care about the health, happiness and future of their children, and so a “mom-approved” company appears to embrace the same parental values by association. Mothers are seen to be discerning and cautious and safety-oriented. So by extension we conclude, even unconsciously, that a product advocated by other moms must have undergone some kind of vetting.

…
I’ve learned from my early days as a mom that the best guidance comes from parents on the same learning curve as me. Marketing that activates the “mom-brand” to sell products exploit the sense of trust and solidarity that arises naturally between parents.

Similac empowers moms. Moms speak positively about Similac to other moms who trust them. Other moms buy into it. It is a simple concept.

Writing today on the Broad Side about the Similac campaign, Kimberly Seals Allers (who writesMocha Manual) wrote that When Big Pharma ‘Strong’ Arms Moms, We All Lose:

Please forgive me for being suspect. It is certainly true that there is way too much pressure on mothers today, and we all could take a proverbial “chill pill” on the mommy-bashing. But when a multi-million dollar pharmaceutical giant (Similac is owned by Abbott Laboratories) plows millions of dollars into telling mothers to be “strong” and “non-judgmental,” I think I’m rightfully engaged in a side-eye glance.

Selling women messages that sound good on the surface but actually undermine them has been a corporate tactic since at least the 1950s. We aren’t really being supported to be strong moms–whatever that means anyway — we are being sold the idea of “strong” as a marketing tool for corporate interests. There’s a big difference and all parents should take note of the dangerous undercurrents.

What I typically find most insulting is that these corporations are counting on moms not knowing better. That we are so weary from the pressures of motherhood, that we will hang on to any messaging that appears to be a “release valve” without delving one centimeter beneath the surface to find the real facts.

Apparently “strong” does not mean savvy.

But a lot of moms won’t see it that way. Instead of being insulted by the way that corporations are trying to co-opt them to do marketing for free, they’ll be insulted by the fact that someone objects to the campaign. They’ll side with the corporation instead of siding with their fellow moms. How’s that for coming full circle on the supportive environment?

Support That Isn’t Trying to Profit From You

Struck by the similarities between what Similac is trying to say in its campaign and what Best for Babes has been saying for years, I asked Bettina Forbes and Danielle Rigg, the founders of Best for Babes, to comment on it. They told me:

“The problem with the StrongMoms Empower campaign is that it continues to throw mothers to the wolves when it comes to overcoming the Booby Traps(R) that undermine them every day. It keeps the onus on isolated mothers to jump the barbed wire, instead of putting pressure on the 360 degree world around them to demand that mothers get the support and care they need and deserve. Moms already know what is best for themselves and their families; what moms don’t have are enough hospitals, pediatricians, ob-gyns, family members, friends, health professionals, employers and welcoming public spaces to help them succeed without pressure, judgment or guilt.

The C.A.R.E.-WHO Alliance is the first alliance of businesses that have pledged to truly protect healthy infant feeding by (C) cheering on moms, (A) accepting them without judgment, pressure and guilt, (R) referring them to independently certified and qualified feeding specialists, providing (E) evidence-based information, and upholding the WHO-CODE. The Alliance does not give lip service to supporting and “empowering” moms while undermining their decisions and efforts at the same time. The C.A.R.E.-WHO Alliance rewards businesses and professionals who step up to the plate to help moms make informed feeding decisions and to help them achieve their personal goals, whatever those are.

The C.A.R.E.-WHO Alliance supports ALL moms. While an estimated 85% (CDC) of expecting moms want to breastfeed, not all moms want to or can breastfeed, and should be respected for their decision. Sometimes the barriers to breastfeeding are so overwhelming that it is simply not a feasible option. Mothers who cannot or choose not to breastfeed deserve better access to donor milk from an HMBANA human milk bank (currently cost is prohibitive for all but the most fragile infants), they deserve information on informal milk sharing, and they deserve information on the proper preparation of infant formula.

Expecting and new moms need the C.A.R.E.-WHO Alliance in the same way that they need to know which car seats are safe, who are the best pediatricians, and which blogs are trustworthy. What they don’t need is a sham badge or pat on the back from the very companies who are largely responsible for, and profiting from, their misery; companies that have systematically spread misinformation and set up a gauntlet of Booby Traps(R) everywhere mothers turn. If you believe that ALL parents deserve the best information on infant feeding, and deserve to be cheered on, coached and celebrated without pressure, judgment or guilt, make your voice heard! If you believe that every parent deserves to achieve their personal feeding goals without being Booby-Trapped(R), whether that goal is to breastfeed for 2 days, 2 months, or 2 years; and/or pump breastmilk, feed donor milk, or feed infant formula, then join us to grow the C.A.R.E.-WHO alliance! We don’t have millions in marketing budgets, but we are a core of compassionate and passionate mom-advocates who believe in mothers and babies’ rights to health and happiness.”

Where will you stand? With a company with a huge marketing budget and shareholders who are highly vested in getting you on board? Or with a nonprofit that truly wants to help moms meet their own goals? I know which one will make me stronger.

When the phdinparenting.com website is back up this post will be replaced with a link to the original.

At a conference last year, I heard a nurse speaking about the importance of helping mothers with breastfeeding.

“If you were a nurse,” she said, “and you knew for a fact that 80% of your patients were going to have gall bladder surgery, you’d be sure to know a lot about how to help someone who is having gall bladder surgery, right?

“Well,” she said, “80% of our moms are going to initiate breastfeeding, so don’t you think all maternity nurses should know a lot about how to help with breastfeeding?”

You’d think so.  But the unfortunate truth is that the care we get from our nurses can be very uneven.

Of course, there are outstanding, wonderful nurses who go far out of their way to help moms with breastfeeding.  “Angels” is how one mom recently described those nurses to me.  I know many personally.

But there is also no question that many moms get substandard breastfeeding care from their nurses.  And research confirms the problem.  Here are just two studies which illustrate the problem:

• A decent sized study of nurses in pediatric offices in North Carolina found that “The nurses surveyed were involved in breastfeeding support, yet many had incorrect information and negative attitudes toward breastfeeding.”

• This small study of baccalaureate nursing students in Virginia who had completed their obstetric nursing training in breastfeeding found that most (85%) did not know that breastfeeding is recommended for the first year of an infant’s life, only five of the 80 surveyed participants knew the proper management of mastitis, and well over one third (41.3%) of the participants opposed breastfeeding in public.

Why is this?  There are likely many factors, including:

• Poor or inadequate training:  One review found that “There is currently a lack of comprehensive breastfeeding content in nursing curricula across the United States”

• Bad textbooks:  Another review found that nursing textbooks either omit key information or provide “inaccurate and inconsistent” information.

• Attitudes get in the way.  One study of nurses at a hospital where breastfeeding rates were very low concluded that “nurses need support and continuing education to identify personal bias and knowledge deficits which hinder breastfeeding promotion.”

• Too little time?  Breastfeeding support is sometimes viewed as too time consuming given the demands placed on nurses.  But this doesn’t explain why some hospitals seem to do it better than others under similar conditions.

• Predatory marketing:  Among the many forms of formula company marketing to nurses, the makers of Similac created a program called “Night Nurse Nation,” taking advantage of a marginalized group of nurses and the most vulnerable time for new moms during the hospital stay.

Fortunately, evidence is building that, just as with pediatricians, if you provide good training to nurses their skills will improve and moms will be more successful with breastfeeding.

As Diane Spatz, who has written for Best for Babes about breastfeeding in NICUs, says, “educated health professionals transform breastfeeding culture.”  If this is true, we need to do a far better job of training and fostering supportive attitudes among our nurses.

Did you have great breastfeeding care from your nurses?  Substandard care?  How did it impact your breastfeeding experience?

According to the mother, 3 years ago she “ran with the wrong crowd and got into some trouble,” but after posting bail and while awaiting her final court ruling she began to turn her life around.  In that interim, she married and gave birth to a daughter.  The mistakes of her past remained however, and she was recently sentenced to jail.  

On Sunday April 14th, the mother nursed her 3-month old baby one last time before entering Taos County Adult Dentention Center.  She immediately asked the county jail for provisions to pump her breastmilk and was denied.  Needless to say this situation has left her husband and baby’s father, in a very difficult position as he is now left to be a single father of an exclusively breastfed baby without access to the breastmilk his baby needs.  Since his wife entered the detention center, he has been advocating for her right to pump her milk, and even made arrangements for the pumped milk to be stored and picked up to feed their infant daughter. Expressing breastmilk for a new and lactating mother is a medical necessity, he argues.

What looked like it might be a victory and a resolution to the situation at hand, soon proved misleading.  Thanks to the birthing and breastfeeding community who helped the father speak out, the mother was finally granted permission to use a pump.  He reports that the first time his wife was allowed to pump was around 3:00 am on April 17th, 3 days and far too long after her initial request for medical need. The problem which seemed to be solved didn’t stop there. The amount of breastmilk being given to the family is only 2 bags per day of 2 ounces each — 4 ounces of milk is far too little to feed an exclusively breastfed 3 month old baby. In addition, this means the mother is not being given regular and adequate to pump for her to maintain her milk supply and suffer no ill effects from infrequent milk removal. The husband reports that even though his wife has limited communication with him, she has let him know that she is experiencing extreme breast pain and that he believes from her descriptions that a breast infection may have formed.

The baby is now taking a bottle through which she receives a limited supply of breastmilk, but is having a hard time digesting the supplemented formula.

The father has agreed to allow me the privilege of helping to locate donor breastmilk for his baby.  At this time, the family cannot afford shipping costs for donor milk, since he had to quit his fairly new job to care for the baby, and has been taking every odd job he can find time for, such as selling newspapers on the side of the road to get by while a family member watches his daughter.  If you would like to donate your milk to help this family, give us a call on our Best For Babes Nursing In Public Hotline 855-NIP-FREE and we will help connect you with this family. 

Albuquerque Channel 13 News reached out to me wanting to cover this story of a father who is advocating for his wife’s right for proper medical attention in regards to expressing her milk and is also struggling to feed his baby.  He prefers not to be interviewed by any media outlet but to work solely with Best for Babes and our Take Action network of compassionate and influential friends and advocates.   I have been working with the family, the New Mexico Breastfeeding Task Force, and Birth Behind Bars to advocate for the health of this mom and baby.  

The father reports that his wife has been transferred out of county jail and into a womans  correctional facility in Grants, NM where he will begin the process of advocating for his wife all over again.  He hopes that Judge Jeff McElroy will reconsider the family’s request for the mother and baby to remain together in a Carlsbad, NM correctional facility and that the media exposure will encourage people to contact Judge McElroy, asking for his sympathy in this situation.

If you would like to donate your milk to help this family, give us a call on our Best For Babes Nursing In Public Hotline 855-NIP-FREE and we will help connect you with this family. 

Please help us keep the NIP Harassment Hotline Alive!  Donate!

Birth and Breastfeeding in Prison

Doctors, Officials Spar over Washington County Jail’s Breastfeeding Rules

Have you breastfed a baby past the one year mark?

If so, a new study in Pediatrics, which found an association between breastfeeding for a year or more and iron deficiency, might have you a bit alarmed.*  We thought it deserved a closer look.

In this study, researchers examined 1,647 healthy Canadian children between 2008 and 2011 when the children were on average 3 years of age, in order to see if there was an association between how long they were breastfed and the likelihood of iron deficiency and iron deficiency anemia.

They did indeed find an association, measuring about 5% for each additional month of breastfeeding, and a cumulative probability of iron deficiency of 70% for children breastfed for a year or more compared to those breastfed for less than a year. Other factors associated with low iron were younger age, higher birth, and higher daily consumption of cow’s milk.

Their conclusion: “Increased total breastfeeding duration is associated with decreased iron stores, a clinically important association warranting additional investigation.”

So let’s take a closer look.

I asked Dr. Lori Feldman-Winter for her thoughts on this study.  Dr. Feldman-Winter is Division Head of Adolescent Medicine at Cooper University Hospital, Professor of Pediatrics, and Executive Committee member of the American Academy of Pediatrics Section on Breastfeeding.  Readers of our Booby Traps series will remember that she has championed the AAP’s pediatric residency curriculum on breastfeeding.  She has also been very engaged on behalf of the Section on Breastfeeding in the debate over iron supplementation for breastfed babies.

She described this study as “problematic on many levels:”

My first point is that while they recorded and defined exclusive breastfeeding, they chose to analyze duration of any breastfeeding, regardless of how exclusive, and they only had 14% exclusive at 6 months. This leave lots of room to say that diets with mainly formula feeding are perhaps linked to iron deficiency, or if the supplementation was juice or cows’ milk then certainly this would increase the risk.

My next point is to challenge the theory that changes in ferritin in fact lead to problems with iron status. They demonstrate nicely that the iron status rebounds and that there was NO anemia. Thus, perhaps with prolonged breastfeeding there is value in stimulating hematopoiesis.

Additionally, it is not clear to me what the actual values of ferritin were, they only published changes in values, and one assumes this is change for normal range, but it’s not clear.

Other confounding variables not included were mode of delivery or complications with delivery, and addressing issues of timing of cord clamping. It is also not clear if they asked about and controlled for intake of iron supplements.

And as always, it’s important to look for industry ties in research.  One of the nine authors disclosed that he is a consultant to several pharmaceutical companies that make iron supplements and (though this is not stated in the disclosure) either currently or until recently produced infant formula.  It’s worth noting that, like the image for this post shows, some iron drops are made by formula companies.

This study is the latest in a long-running debate about iron supplementation for breastfed babies which has recently become more heated.

In 2010 the AAP began recommending iron supplementation for exclusively breastfed babies starting at 4 months of age.  That recommendation was quite controversial, and the AAP Section on Breastfeeding submitted a letter (co-authored by Dr. Feldman-Winter) challenging this recommendation when it was released.  You can read more about the research basis for the AAP recommendation, the Section on Breastfeeding’s response here.

The letter states, “Given that research has shown potential harm in infant growth and morbidity when iron supplementation is provided to iron-sufficient infants one wonders if universal iron supplementation will be deleterious to the population of developing infants who are breastfeeding exclusively.”  Their alternative to universal iron supplementation:  Delayed cord clamping at birth and screening for at risk babies at 6 months.

The subsequent 2012 AAP breastfeeding policy states only that “supplementation or oral iron drops before 6 months may be needed to support iron stores.”  But based on how the pendulum keeps swinging on this issue, this most recent study may lead to some re-evaluation of that recommendation.

This is all quite confusing to health care providers, let alone parents, and each new turn of events in this story seems to muddy the waters further.  We can only hope that close examination of the evidence and consultation with knowledgeable and breastfeeding-supportive providers will guide us to make the best decisions for our children.

What’s your experience been like with iron supplementation for your breastfed baby?

*This discussion is provided for educational purposes, and does not substitute for medical advice provided by your health care providers.  Please consult them for care suited to your individual needs.