Nursing an Adopted Baby

By Guest Blogger*, Donna Walls, RN, BSN, ICCE, IBCLC, ANLC

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Donna Walls

 

Whenever I mention the topic of breastfeeding an adopted baby, people always look surprised and puzzled and usually have lots of questions. So, here are some answers.

How does it work?

Adoptive nursing is also referred to as induced lactation- meaning the production of milk without the initial start-up process of pregnancy.  In the simplest terms breastfeeding happens between the brain and breasts. Pregnancy starts the process by sending the message to begin milk (colostrum) production, but when the infant begins nursing the real magic happens.

Many women who are in the adoption process have been through a lot–hormonal medications, surgeries and disappointments–so the possibility of nursing can be a very emotional decision.

Do adoptive mothers make enough milk?

As a lactation care provider for many years I have had the privilege of working with many adopting mothers and the most important aspect is not the volume of milk, but the mother and baby breastfeeding relationship. Adopting mothers look forward to sharing the closeness and joy of breastfeeding their baby which is the focus, rather than ounces.

What are the best strategies for getting off to a good start?

Physiologically, pregnancy “primes the pump” preparing the mother’s body for full milk production when the baby arrives. So, many adopting mothers choose to begin “priming the pump” by pumping their breasts before the arrival of the baby. But, how much? How often? It all depends on the mother, her individual situation and whatever works for her and her lifestyle. There are no “rules”, just the idea of sending some messages to the brain that there soon may be a customer for their milk.

Some mothers choose to work with their healthcare provider for medications which mimic pregnancy as preparation for lactation. Others may begin a combination of medications and pumping days or weeks ahead of the expected birth.

It is ideal for the adopting mother to hold her baby skin to skin during the hours after birth and offer the breast as soon as feasible. Whether or not this is possible depends on the contracts drawn between the birth mother and adopting parents and/or birth site policies. Discussion between the birth site staff and birth mother prior to birth of the baby is recommended to work out any concerns or questions that might arise in the first hours and days.

Just as with milk production after pregnancy, early and frequent skin to skin and breastfeeding is the key to optimum milk production and early bonding and attachment.

Since many adopting mothers will not produce a full supply of milk there needs to be a plan for supplemental feeding for the newborn. An at-breast supplementer such as the Lact-Aid or Supplemental Nutrition System provides needed extra milk or formula to the nursling while the baby is at the breast stimulating the mother’s to make milk. Other supplementation methods can be offered such as cup feeding or bottle feeding can be offered, whichever works best for the adopting mother and family.

Too often when developing a plan for adopting mothers we concentrate on the process of inducing milk, and we sometimes forget to teach the breastfeeding basics: correct latch, feeding cues, normal feeding patterns, resources for support and anticipatory guidance for the first days and weeks of lactation. Some adoptive mothers may want to attend a prenatal breastfeeding class (I have seen such women leave the class with a whole support group), while others prefer individual discussion and education.

How can I learn more about adoptive nursing^?

Some resources for information concerning adoptive nursing are the books entitled Breastfeeding Without Birthing by Alyssa Schnell or Breastfeeding the Adopted Baby by Debra Stewart Peterson, both with lots of practical strategies.

Other sources of information and support include:

In summary

Adoptive nursing can be a great opportunity for new adoptive families and reminds everyone that breastfeeding is so much more than a food delivery system, it really is about the sharing, caring and finding love between a mother and her baby.

 

 

^Please note: Some of these texts and websites may recommend medications, including herbal preparations. It is recommended that women consult a professional health care provider to evaluate the safety of such substances for their own health. Medications, including herbs, can have significant side effects.

 

 

*(Ed. Note: Our Milk Way blogger Jess Fedenia is on parental leave for the months of July, August, and September, 2016 to welcome a third child into the family. During Jess’s leave, members of the Healthy Children Project circle are taking up the blogger role.) Thanks to Donna, and all of our guest bloggers for pitching in – we look forward to welcoming Jess back!

Why do Women Choose to Breastfeed (or Keep Breastfeeding)?

By Guest Blogger* Donna Walls, RN, BSN, ICCE, IBCLC, ANLC

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Donna Walls

The reasons women choose are as varied as the women themselves. As a clinical lactation consultant for 29 years now I have often wondered and talked with women and their families about why they chose to breastfeed and even more important why they continue to nurse when problems occur.

There have been many promotional programs over the last decades. Traditionally these have focused on lists of the benefits of receiving human milk for babies, including enhanced cognitive development, reduced risk of allergies and asthma, lower incidence of obesity and diabetes, childhood leukemia and SIDS. More recently breastfeeding advocates began also including the benefits to mothers as well, including lower risk of breast and ovarian cancer, osteoporosis and heart disease among those who choose to breastfeed.

The Department of Health and Human Services has set breastfeeding goals for the nation. In 2010 the goal was to have 75% of mothers beginning to breastfeeding and have 50% still breastfeeding at 6 months and 25% still breastfeeding at 1 year. Now the goals we are currently working toward are 81.9% beginning to breastfeed with 60.6% breastfeeding at 6 months and 34.1% at 1 year by the year 2020. We haven’t met these goals yet but we are closer than ever- yay- the message has been heard.

What have pregnant women said was the message that made sense to them? Of course the health benefits are important, but what are some of the other reasons women give when deciding to breastfeed?

Years ago I had a patient who came to my breastfeeding class, seemed interested and asked a lot of good questions. After class was over and everyone was gone she approached me and said she never planned on breastfeeding, she even thought it was a bit gross and messy but her mother had been diagnosed with breast cancer and she read that breastfeeding can reduce her risk of breast cancer. She breastfed for about 2 years and after a couple months called me to confess that she had, despite her previous opinion, fallen in love with breastfeeding.

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Another mom whose husband was diabetic was breastfeeding as a preventive treatment for her baby. She was never a warm fuzzy person and often talked about feeling blue and being easily stressed, but while she was breastfeeding she noted how much better she felt, how breastfeeding was a welcomed surprise to lift her mood and spirits.

Cost has always been a motivator as well. The cost of purchasing formula can be a deciding factor for many families. According to Kelly Bonyata, BS, IBCLC, the cost of formula feeding an infant for the first 6 months of life can range from $428.96 to $1662.22, depending on type of formula and brand. Some will cite low-to-moderate income families’ ability to get formula through participation in  the USDA Special Supplemental Nutrition Program for Women, Infants and Children (WIC) but, WIC provides only supplemental foods along with nutrition education, it’s not designed to provide all the formula needed. WIC has also done a great job with providing incentivized food packages to breastfeeding families as a means of encouraging breastfeeding.

Other non-health related benefits can also be a big part of the reason to begin or maybe continue nursing. Convenience is often not touted as a benefit, but I believe it should be marketed more vigorously: no formula preparation, no bottle washing and so much easier for nighttime feeds. Travel can also be made easier when there is no need to figure out a way to mix, warm and store feeds in the car, airplane or in hotels.

In 2011 Avery & Magnus, released findings of their work, reporting that mothers who feel prepared, knowledgeable, and confident about breastfeeding typically have better outcomes after birth. It is so unfortunate that that we have many young women who have never seen a nursing baby, much less spend time seeing how it works. In traditional cultures, learning occurred through children watching mothers breastfeed and asking questions about how this thing really works.

With the improving breastfeeding rates in the US, more children are observing breastfeeding,  and attitudes toward public breastfeeding is slowly changing and we are starting to see more moms nursing in stores, restaurants, airports and sporting events. Do we still have a long way to go- Oh yes- but your women are more likely to at least catch a glimpse of breastfeeding now that 10 years ago. It would be great to reach a point where women don’t feel the need to use covers and “hiders” when their babies need to be fed,

A recent study by Amy Brown found that women are also looking for more education of extended family so they can count on getting support from all family members. In the first weeks of breastfeeding support is key. Negative attitudes can be deadly. Many well-meaning friends and family offer “suggestions”, often based on misinformation or old wives tales. Sometimes when a new mother expresses concerns about her baby nursing frequently the immediate response is that she is “starving” her baby and she needs to give formula. When the baby wants to be held and cuddled (normal behavior for newborns) she is often told breastfeeding is spoiling that baby and she needs to let the baby “cry it out” rather than responding the infant’s cues. If the mother runs across any problems or concerns it seems more expedient to give advice to just give formula rather than helping her to fix the problem!

In my clinical practice working with new mothers I kept a journal of responses of mothers coming in for sore nipples. Most were between 1 and 3 weeks post birth.  I asked them why they continued to breastfeed even though they were experiencing problems, some even pain. The responses were from “they told me it would hurt for a week (we really need to dispel that myth quickly) so I just kept going” to “it’s so much cheaper” to the number one answer, “I knew it was the best thing for my baby”.  How sad that because of misperceptions and bad advice these moms had to live through the first week(s) in pain or dreading what should be a beautiful experience with her baby!

What does real support for our breastfeeding moms look like? In a perfect world breastfeeding would be the normal way to feed babies. Women wouldn’t be harassed for breastfeeding in public and all hospitals would provide the kind of care that ensured early successful nursing.

We can continue to educate professionals, extended families and expectant and new parents on the basics of lactation.

More than anything we need to do all we can to build a new mother’s confidence in her own abilities. We can avoid using negative terms such as “your nipples are not the best for breastfeeding” (nipples come in all shapes and sizes but are designed to feed human babies!), “your milk will come in in 3-4 days” (she has milk before the baby is born-colostrum is milk!) or listing all the problems that could possibly happen. Be there to listen, provide realistic anticipatory guidance, offer only evidence-based care, give positive feedback and refer her onward if indeed she has encounters problems beyond your scope.

So let’s listen to what women need and assure we have programs in place to provide the support and education needed for healthier mothers and babies!!

 

 

*(Ed. Note: Our Milk Way blogger Jess Fedenia is on parental leave for the months of July, August, and September, 2016 to welcome a third child into the family. During Jess’s leave, members of the Healthy Children Project circle are taking up the blogger role.)

Connecting to Mother Earth: Toxic chemicals and their impact on maternal child health

By Guest Blogger* Donna Walls, RN, BSN, ANLC, ICCE, IBCLC

 

Every Day is Earth Day!

Donna Walls

Donna Walls

The first Earth Day celebration was in April 22, 1970. The founders of the movement were smart enough to recognize how important it is to care for our planet and soon we were making the connection between the health of the planet and human health. Since that time we begun looking closely into the effects of harmful environmental substances on pregnant women, the developing fetus, infants, children and families.

In 2013 the American College of Obstetricians and Gynecologists and the American Society for Reproductive Medicine released a joint statement that said: “toxic chemicals in our environment harm our ability to reproduce, negatively affect pregnancies and are associated with numerous long-term health problems.” With this statement came a recommendation for all pregnant women to receive information on avoiding toxic chemicals.

What does research tell us about the impact of toxic chemicals, and what implications do findings have for pregnant and breastfeeding mothers?

The environmental chemical exposures that are “of concern” are all around us, including herbicides and pesticides, plasticizing components in all types of plastic, ingredients of personal care products, food additives and cleaning supplies. The specific concerns range from hormone disruption, central nervous system disruptions, cancer and of particular concern to pregnant women are birth defects and pre-term labor. These nasty little chemicals are, unfortunately, hiding in many of the products we use in our everyday life.

One particularly troublesome group of chemicals are known as xenoestrogens or environmental estrogens. These substances are chemically very much like naturally occurring estrogen produced by females and responsible for many of our reproductive physiology. Thanks to estrogen we develop breasts and begin our menstrual cycles in puberty. Throughout our lives the right amount of estrogen helps us prepare for pregnancy and protects us from heart disease and osteoporosis.

Too much estrogen or foreign estrogens can wreak havoc on our reproductive lives. These artificial estrogen-mimicking chemicals will settle into receptor sites on the cells of our breasts, ovaries and uterus, settle into the sites but instead of the normal reaction our bodies react in a “not so normal” way. We are seeing this especially in young girls, with early puberty, sometimes as early as 8 or 9 years old for breast development and menarche or the beginning of the menstrual cycles.

So is this a problem? Doesn’t sound like it, but in fact it is. Remember I said the right amount or right length of exposure of estrogen is good- too much can cause menstrual disorders, infertility and even reproductive cancers. And this is not just a female problem. We first noticed the estrogen feminizing effects in amphibians and reptiles with disappearing genitals after the concentrated use of herbicides and pesticides in the habitat of the Everglade swaps. The same negative effects have been noted in males with newborn males exhibiting smaller penises, scrotums and distance between the scrotum and anus- a shrinking genitalia, with evidence of eventual lower sperm counts.

Some of the most common sources of xenoestrogens are found in foods, plastics and personal care products. Many lotions and soaps contain parabens- labeled as butyl, propyl, ethyl or methyl paraben. Parabens have been associated with breast cancer and lowered milk supply during lactation. Phthalates (pronounced without the ph!) are in plastics and are associated with increased risk of premature birth. Researchers have found that babies and children with high fetal exposures to phthalates had a 70% increased risk of developing asthma, these exposures were through foods- enteric coatings, gels, stabilizers, personal care products, detergents, plastic toys and products, paints, inks, and pharmaceuticals

Another well publicized chemical of concern is bisphenol-A or BPA. Recent studies associate decreased maternal pup rearing behaviors in rats after exposure to BPA during pregnancy. Other negative consequences to BPA exposures include hormone disruption, altered behavior in babies and children, obesity, diabetes, ADHD and cancer. BPA is found in numerous child-related products. Several states: Connecticut, Maryland, Minnesota, Washington, Wisconsin, and Vermont now have laws restricting or banning the sale of child care products containing BPA, such as bottles and sippy cups. Research supports the concern that children are at more vulnerable to the negative effects of BPA. Other sources of BPA include food can linings and an unlikely source is coating of sales receipts.

Tips for a cleaner, safer pregnancy:

  • Avoid using #7 polycarbonate plastic for food or drinks
  • Minimize handling sales receipts
  • Use fewer canned foods- opt for fresh or frozen
  • Use glass, stainless steel or bamboo containers for preparing or storing food
  • Do not heat any plastic food containers in the microwave
  • Breastfeed to avoid bottle exposures- if feeding your milk in a bottle use glass bottles
  • If you are packing food in plastic bags place an unbleached paper towel between your food and the baggie

What about other substances to avoid?

Cleaning products are another source of chemicals of concern. We have all been indoctrinated into the values of being clean, maybe too clean. Some of the cleaning products we are now using are dangerous to our health and maybe destroying the good bacteria our bodies need to maintain a healthy immune system. We love chlorine bleach and believe it may be the best cleaner available- but there is a dark side to chlorine- with too much use it can release chlorine gas that can cause asthma and other respiratory problems. Formaldehyde (also called formalin) is a known carcinogen and is found not only in cleaners but also in bedding and towels- oh my! Ingredients such as Quaternium-15, Quaternium-24, Sodium Hypochlorite (Bleach), Sulfuric Acid, Ammonium Chloride have also been shown to increase respiratory irritation and asthma.

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Laney helps Grandma Donna mix up an eco-and-human friendly household cleaner

Here are safer (and often less expensive) cleaners:

  • Vinegar – sanitizes and removes stains
  • Lemon juice – works safely to disinfect
  • Baking soda – a great all-purpose cleaner
  • Borax – all natural cleanser
  • Cornstarch – easy, natural de-greaser
  • Olive oil – great for dusting and furniture polishing
  • Pure essential oils – natural germ killers and natural fragrances
  • A basic bathroom and kitchen cleaner can be made by mixing equal parts of distilled water and white vinegar. Store in a spritzer bottle for easy use.

For more information and how to make safer product choices visit the Environmental Working Group’s Cleaning Guides.

What about personal care products?

We love to use them, smear them on, scrub with them, spritz and spray and rub them on. But what are the concerns with these products? Americans use a lot of personal care products, a lot! That’s how we unfortunately get such high levels of toxic chemicals in our systems. So the first guideline is to use fewer of these products.

The second guideline is to use products with fewer ingredients. For example, a simple moisturizer for face, hands, and body is olive oil; coconut oil is also a simple, clean way to moisturize. And what about soaps? You only need one, a natural plant-based soap is best like castile or glycerin. These can be used for hands, bathing and shampoo, no need for different products with multiple ingredients. We want to limit the ingredients we know are harmful to the planet and humans such as: 1.4 dioxane, parabens, synthetic dyes and fragrances, PEGs, lead, nail polish and phthalates.

Avoid hand sanitizers and washes with anti-bacterial chemicals such as triclosan which destroys our friendly, helpful bacteria along with the unwanted germs. An easy, non-toxic hand cleaner is 1 oz of distilled water with 30 drops of lavender pure essential oil- all natural, safe and effective.

Here is an easy, inexpensive recipe for a basic hand and body lotion:

  • 3/4 cup base oil (olive, sweet almond, wheat germ)
  • 1 cup aloe gel
  • 1/2 cup shea, mango or cocoa butter.
  • Mix well. Add essential oils as desired

The Environmental Working Group also provides guidance on personal care products and cosmetics.

Lastly let’s look at our foods:

We are reading more and more in the news about the need to get back to basic, real food and the advice holds true for pregnancy as well. Health reports surface daily on the side effects of food additives such as food dyes which are linked to cancer and nervous system disorders, preservatives, hormones and genetically modified organisms. Current recommendations for pregnancy and breastfeeding are simple:

  • Eat low on the food chain- lots of fruits, vegetables, nuts and seeds and whole grains
  • Choose organic whenever possible. Check out the “Clean 15” and the “Dirty Dozen” on the Environmental Working Group web site to help you make cleaner food choices.
  • Minimize processed foods with preservatives, colors and ingredients you can’t pronounce and
  • Avoid synthetic sweeteners- use agave, honey or stevia
  • Avoid genetically modified foods- not listed on labels but choosing organic foods do not allow the use of GMOs
  • Choose fish wisely- go to /www.nrdc.org/health/effects/mercury/guide.asp for current recommendations
  • Avoid pans with non-stick coatings- opt instead for stainless steel or cast iron cookware

Early parenting is a great time to educate yourself about healthy eating habits- it can last a lifetime for your family.

We can’t lock our families up in a pristine bubble but what can we do to protect them?

First, educate ourselves and during pregnancy and breastfeeding we have an extra motivation to learn about the connection between the health of the environment and human health. Then make a plan to make changes: start reading labels, make some simple cleaning products to start using, take a critical look in your kitchen and bathroom cupboards-replace those products that are of concern and talk with family and friends about making simple lifestyle changes. Every positive change you make can make a big difference in the health of your family, and the planet!

 

*(Ed. Note: Our Milk Way blogger Jess Fedenia is on parental leave for the months of July, August, and September, 2016 to welcome a third child into the family. During Jess’s leave, members of the Healthy Children Project circle are taking up the blogger role.)

“We are here together…I am yours and you are mine”: One family’s experience with breastfeeding

By: Holly Hansen , BFA, Project Manager, Healthy Children Project, Inc.*

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Interviewer Extraordinaire, Holly Hansen

At my age, finding out that friends of mine are having a baby isn’t uncommon; last summer I was overjoyed at the news that my dear friend, Nora, was pregnant. I knew how excited she was to start a family, so when Nora told me she was expecting, I was over the moon for her!

Then it hit me: Nora’s going to be a mom. She certainly wasn’t the first of my friends to get pregnant; a handful of friends from high school had gotten married and had children years earlier. But Nora was the first really close friend I knew who was about to make a tiny human and then raise it.

When I was asked to write a couple of blog posts (as Jess herself produces a tiny human), interviewing Nora was one of the first ideas that came to mind. She’s a first-time mother living in New York City, and one of the most compassionate and brave people I know. Talking to Nora about her experience with Baby Price helps continue my education into what motherhood means, and I’m glad to share it with you!

BREASTFEEDING BEGINNINGS:

Did you always know you would breastfeed?

My mom breastfed both my brother and I so I always knew I would someday.

What was your previous exposure to breastfeeding like?

I worked as a babysitter and my mom had a daycare in my house growing up, so I was incredibly familiar with moms who breastfeeding. I was very lucky to have many families I babysat for who breastfed and so I was exposed to how they did it in New York City. One mom in particular would breastfeed in her carrier while we would walk around the city. She was such a role model for normalizing breastfeeding as a normal, on the go, part of her day.

I also watched a lot of YouTube videos and documentaries on breastfeeding right before I gave birth. Reading articles on Kellymom.com so that I would feel confident when starting breastfeeding, or at least know where I could find help if I needed it.

What was it like the first time you were able to breastfeed your child?

Watching my son do the crawl towards my breast was amazing. He needed a little assistance to latch for the first time, but seeing him figure it out and experiencing us figuring it out together and our new relationship was so rewarding. My milk came in fairly fast, and with the help of my midwives, doula, and husband we were able to find success and I felt confident that I was able to create this relationship of breastfeeding.

What (if any) challenges did you encounter while learning to breastfeed?

My left nipple had always been inverted, and so my son would get frustrated when it was time to nurse on that side at first as it would take time to get the nipple to stay for him to latch. So I did experience a couple of plugged ducts on that side and some engorgement which I was able to remedy with a warm wash cloth and Epson salt bath. I loved that I had online resources that helped guide me in clearing up the problem so that I wouldn’t panic. Looking back on it now, it did take time for my nipples to not feel uncomfortable and thank goodness for ice packs and nipple cream! But I knew those minor uncomfortable moments were so worth giving my baby the best nutrients possible.

BREASTFEEDING IN THE CITY

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Nora and Price nursing on the steps of NYC City Hall

Have you ever had to feed/pump in a less-than-ideal place/situation (i.e. subway, audition, etc.)?

My friend gave me a book called The Places You’ll Feed which is a take on Dr. Seuss’s Oh, the Places You’ll Go and oh my, was she right! I quickly learned to feed anywhere and everywhere. I got really good at feeding him in the front pack. I’ve fed him on the subway, in the middle of rehearsal–my favorite memory is doing a reading of a new play in which I was feeding him in the front pack while standing still as a “tree”. I was recently on my way to catch the Amtrak train from NYC to Albany and we were on the go and baby needed to eat, so I carried him in my arms with my boob popped out of my sun dress charging down 8th Ave near Penn Station! A police man gave me a double take when he realized I was nursing and then smiled, gave me a thumbs up, along with a “good for you” nod of approval.

There have been a couple of rehearsals I was at where baby did not come with me, and I actually had to hand express milk into a toilet in a bathroom. That was poor planning on my part; I quickly learned to carry little freezer bags and would hand express my supply if I was at a long rehearsal. Most of the time I had my husband or a friend come hold the baby at rehearsal, and would feed him on a break or while I was not immediately working.

How do you balance breastfeeding while working/travelling for work?

I feel very lucky to have two professions that allow me to bring my baby with me, for the most part. As an Independent Consultant for Arbonne International, I can set my own hours of work which entails video conferences from home, coffee dates and group meeting that not only allow me to bring my baby with, but are encouraged. I have lead trainings over video conference in which I tip up my camera and keep baby in my lap while breastfeeding. I also bring him along to my one-on-one consultations over coffee and when he’s hungry I feed him. I’ve also had the chance to travel on the plane and train and car which has led to some interesting places to feed as well. I quickly took on the motto I once heard a Lactation Consultant say,” Boobies are for Babies, if you don’t like it you can put a blanket over YOUR head,” and so I confidently feed whenever we need. I find that when you feed with love, people respect that it’s you loving your baby. I also pump at night to keep a supply at home for those days he’s with Daddy or those days we need coverage for shows and date nights. We have gotten really good at packing freezer bags and milk in our luggage!

Breastfeeding is sadly still not 100% publicly accepted; have you ever found yourself in a situation where you have faced any negative responses?

I have not had any direct negative comments when I feed. I’ve sensed that some people feel uncomfortable when I do, but I think it comes out of a wanting to respect me and my child; I used to do the same thing when I was around women breastfeeding and now I can’t help but think, “Why was I soooo awkward.” I usually give people permission if they feel like they should give me privacy, that for me, I’m okay if they are okay. I feed my baby with that attitude as if this is an everyday, normal activity, because it is! I think I’m so comfortable doing it now, that sometimes people don’t even realize that I am nursing my little guy. That being said, I do love our one-on-one nursing sessions at home or somewhere quiet and alone for us to connect. I love that I have the freedom to be where I need and want to be, and most importantly be where the best place for my son to eat is and I realize that is going to be different for each Mommy and baby. For Price and I, that is usually on-the-go and no covers or blankets because we like to see each other and not feel tangled up and sweaty.

BREASTFEEDING AND BEYOND:

How (if at all) has your partner been involved with breastfeeding?

My husband has been so incredibly supportive. He propped pillows up around me in the early days to find the right position, watched YouTube videos on positioning before our baby got here and has told me there is not a more beautiful picture than his wife feeding his child. Those loving words, make me feel like a Mommy Goddess and that has given me so much confidence in my ability as a mom. I know breastfeeding has brought us even closer. Those simple words of encouragement not only make me all happy and twitterpated inside, but I actually have witnessed that when I’m pumping in the living room, if he walks in my let down comes faster! Ah, oxytocin the love drug, how fab is that! He also would rub my feet while I would nurse in the early days, and run my ice packs back and forth.

How long do you plan to breastfeed your current child, and will you breastfeed future children?

I feel incredibly confident in listening to my son and his needs and know that breastfeeding is a relationship, but I am hoping to go for at least a year if not 2 years of nursing with my son. We hope to have more children in the future and I’m excited to see the relationship I will get to build through nursing with them. I am also open to the idea of tandem feeding if we have children close in age.

What has been the greatest help to you while navigating these first few months of breastfeeding?

I was a huge fan of Kellymom.com and my doula and midwives were great at prepping me before the baby was here. I also found support in our local mom’s group led by a lactation consultant and sleep coach.

What advice/knowledge do you wish you had known before starting breastfeeding that you would want to pass on to others?

Know that your breasts are going to take a couple weeks, if not a month to get adjusted. I also didn’t realize how many breast pads I would go through. Invest in some really good, comfy sleep/nursing bras to live in. Having to sleep in a bra again was something I wasn’t thinking about pre-baby. I am a huge fan of double layering my clothes. A tank top you can pull down, and a flowing shirt you can wear on top to pull up makes feeding in public feel less exposed. I also highly recommend having nipple cream and cold freezer packs ready for engorgement as your body adjusts to its new function! And most of all, be patient with yourself and your baby. It’s not just about a LATCH, it’s a relationship between two people, it takes time to establish, but that time and focus dedicated to finding out your perfect position is so rewarding. Hang in there and surround yourself with positive people: lactation care providers, moms’ groups, and online support groups are all great to have established before little baby gets here!

How has breastfeeding changed you, your relationship to your partner, etc.?

I feel more confident as a woman, mom and wife breastfeeding. It’s a powerful, yet calm, feeling to be able to be your little one’s sole provider of nutrients. It’s amazing that nature creates the perfect food for our little ones. I feel such a sweet and close connection to my son when we have a nursing session. The way he looks up and smiles at me, that feeling that, “Hey, we are here together! I am yours and you are mine,” that bond is like nothing else I’ve ever felt in my life. To include Daddy, we sing our son the same three songs every night right before bedtime while he nurses. Daddy holds me, while I hold our baby. It’s a great family memory we are creating.

I know many partnerships and cultures avoid feeding in public or don’t even consider breastfeeding because of the sexual nature and association we have with breasts. I’m very much of the mindset that why can’t they be both? I think breasts can be functional and sexy. Life doesn’t have to be black and white. We are flexible beings, and just as a Mom can be strong she can also be vulnerable and I think if we as a culture empower women to follow their instincts, we will begin to release this “shame” about our parenting, birthing, or feeding choices. If we simply just remove the judgement of each other, we can all start to feel strong, confident, and sexy while still being our soft, open, and sensitive selves.

Thank you, Nora, for sharing your experience and insights!

 

 

*(Ed. Note: Our Milk Way blogger Jess Fedenia is on parental leave for the months of July, August, and September, 2016 to welcome a third child into the family. During Jess’s leave, members of the Healthy Children Project circle are taking up the blogger role.)

 

Reflections on the Process of Implementing Change: Highlights from the 2016 MAINN Conference

Guest Blogger: Cindy Turner-Maffei, MA, ALC, IBCLC, Faculty, Healthy Children Project, Inc.*

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Dalarna University, Falun, Sweden

Last week a small team of Healthy Children Project (HCP) faculty members travelled to participate in the Nutrition and Nurture in Infancy and Childhood: Biocultural Perspectives conference in Falun, Sweden. This conference, which is sponsored annually by the University of Central Lancashire (UK) Maternal and Infant Nutrition and Nurture (MAINN) Unit led by the brilliant Fiona Dykes, is held on alternating years in England, or at a different co-sponsoring university. The Reproductive, Infant and Child Health (RICH) unit of Dalarna University hosted the conference, in the shadow of a giant ski jump perched atop the hill over the university campus in rural central Sweden. The conference was attended by more than 150 individuals from 17 countries.

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Conference Convenor Renée Flacking

After a warm welcome from the effervescent conference convenor, Renée Flacking, Dalarna University Prov Vice Chancellor Marie Klingberg-Allvin spoke of the university, known for net-based learning as well as traditional classroom instruction.

Dr. Klingberg-Allvin highlighted a Dalarna University collaboration with Somaliland Universities to offer graduate degree program to midwives in Somalia and Somaliland, where mothers and infants die at one of the one of the highest rates in the world. The potential impact of this work on infant and maternal mortality is immense, and is the subject of a brief, moving video.

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Lars Wallin

First keynote presenter and Dalarna professor Lars Wallin spoke about the NeoKIP (Neonatal Knowledge into Practice) study, which examined a community-based “bottom-up” strategy for reducing infant mortality in 44 Vietnamese communities. This project identified and trained community-based facilitators who were members of the Women’s Union. The facilitators worked with focus groups of health professionals in every targeted community to identify barriers and design and employ strategies to address key barriers using a Plan, Do, Study, Act approach. A lovely descriptive video may be found here.

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Kajsa Brimdyr

During her keynote presentation, HCP faculty member Kajsa Brimdyr CLC, PhD spoke on the topic of Implementing Practice Change Immediately after Birth: An ethnographic approach. Trained as an ethnographer, one who studies cultural practices, Kajsa introduced an ethnographic research frame in the research work conducted by HCP, a midwifery team from Karolinska Institute in Sweden, and the Egyptian Lactation Consultant Association, to study hospital practice around skin-to-skin immediately after birth. Kajsa’s experience, and that of other ethnographic research teams, are also presented in the recently published book edited by MAINN team members Fiona Dykes and Renée Flacking: Ethnographic Research in Infant and Child Health.

 

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Fatuomo Osman

Fatumo Osman, a doctoral student at Karolinska Institute, shared lessons from the Ladnaan Project. Ladnaan is a Somali word for “a sense of health and well-being). This project explored the parenting support needs of Somali refugees living in Sweden. Introducing a theme that resonated through several conference presentations, Ms. Osman highlighted the importance of involving members of the target population in identifying needs, and designing and evaluating programs to address needs.

 

 

 

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Anna Blair

Anna Blair of the Healthy Children Project spoke on the topic of maternal identity, social stigma, and social justice in maternal child health.

 

 

 

 

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Drs. Flacking & Brimdyr introduce Happy Birth Day

On the first evening of the conference, an evening reception at the lovely modern Dalarna University library included entertainment by a musical group, a juggler, and a screening of a segment of Healthy Children’s Happy Birth Day series focusing on gentle, low-intervention birth stories.

 

 

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Karin and Cindy

Karin Cadwell and I presented a crash course on the role of breastfeeding in epigenetics, sharing knowledge about the several ways that human milk (as well as other substances ingested) may signal the expression of the infant’s genetic code.

 

 

Drs. Cadwell & Brimdyr also spoke about research they’ve conducted with Swedish-American teams exploring the impact of epidural medications and synthetic oxytocin on the expression of the primitive neonatal reflexes. (Click the links to view the article and video describing the outcomes regarding epidurals.)

We enjoyed so many other thought-provoking presentations, including these and others:

  • Ragnhild Maastrup of Denmark, sharing results of her study examining the progression of preterm infants to the breast, and factors associated with earlier breastfeeding proficiency in these little ones.
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    Virginia Schmied

    Elaine Burns and Virginia Schmied of Australia exploring the impact of professional, peer counselor and mother support on feeding outcomes. The appreciative inquiry approach of one study was particularly interesting.

  • Doctoral student Victoria Fallon of England, presenting “’Bottled Up’: The emotional and practical experiences of formula feeding mothers.” One of her most striking findings was that a very high percentage of mothers in the study reported feeling guilt, stigma, and the need to defend their infant feeding plans, regardless of how they intended to feed. The impact of these experiences on maternal emotional health could be detrimental.
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    Leena Hannula

    Leena Hannula of Finland presenting about the Neo-BFHI initiative, an initiative developed by a Scandinavian and Canadian team of researchers; recommendations of the Neo-BFHI group can be found here. Later Dr. Hannula presented fascinating findings from a survey of “Adolescents’ breastfeeding intentions in five countries: the influence of attitudes, social norms and shared-parenting beliefs.”

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Gill Thomson

  • Gill Thomson of the University of Central Lancashire (UK) tackling the thorny topic, “Shame if you do, shame if you don’t: women’s experiences of infant feeding.” The potentially devastating impact of shame on maternal self-image is a powerful force to consider in designing campaigns and interventions.

 

 

  • Doctoral student Nicole Bridges of Australia presented “The faces of breastfeeding support: experiences of mothers seeking breastfeeding support online,” a study model utilizing Facebook for research.
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    Angela Cartwright

    Graduate student Angela Cartwright of England, presenting findings of a qualitative study of “Mothers’ experiences of feeding infants with Down Syndrome.” The themes emerging from this study indicate that much more support is needed by mothers tackling the task of feeding babies born with his challenge.

  • Dr. Elizabeth O’Sullivan of Ireland sharing quantitative findings of her research into human milk feeding strategies, intriguing findings to pair with the qualitative findings described earlier by her team.
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Silke Mader

On the final day of the conference, Silke Mader spoke eloquently about her experience as a mother of twins born at 25 weeks gestation in the late 1990s in a presentation entitled Improving the Empowerment of Parents – What do parents need to take over care? The lack of emotional and physical support her family received during her emergency medical treatment, the death of her infant daughter, and the several month long NICU hospitalization of her infant son led eventually to the creation of the European Foundation for the Care of Newborn Infants (EFCNI), which works across Europe to strengthen parent support, and drive the implementation of evidence-based neonatal practice through endeavors such as benchmarking care NICU support and care practices. She reminded the group to seek parental support, and drew special attention to the needs of fathers as well as mothers, as their needs are often invisible to the health care system.

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Drs. Flacking & Dykes closing MAINN 2016

 

Our time at this conference reinforced our belief that people-centered change in supporting birth, infant and child health, and the development of the parent-child bond is possible; in fact, it is happening throughout the world! It was wonderful to be surrounded by so many individuals questing for a better beginning for our families. We left Sweden full of gratitude for the passionate, curious, and innovative hearts and minds that are hard at work to understand the challenges and fuel progress in this crucial field.

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Celebrating MAINN 2016 at the conference dinner Back row: Flacking, Blair & Thomson Front Row: Turner-Maffei, Maastrup & Brimdyr

 

*(Ed. Note: Our Milk Way blogger Jess Fedenia is on parental leave for the months of July, August, and September, 2016 to welcome a third child into the family. During Jess’s leave, members of the Healthy Children Project circle are taking up the blogger role.)