“Geez, got enough kids there?!”

img_8052When you’re pregnant, you’re subject to all kinds of interesting comments and curiosity from complete strangers. While I was pregnant with Willow, an officer asked me if I was trying to smuggle a watermelon into the courthouse while I completed my name change. *Ba dum tss* I laughed politely.

This summer, an older boy with special needs asked me how the baby got into my body and how it was going to get out. Had it been my own child, I’d have gotten rather scientific with him; instead, crickets.

Once baby arrives, the comments and curiosity don’t stop. Today I’ll share with you some of the most memorable comments I received during my parental leave this summer, mostly for entertainment sake, but also because the array of commentary and questioning depicts well trends in our communities.

“Don’t have that baby right here!”

“Don’t have that baby right here!” a stranger demanded after he asked and I answered how far along I was in my pregnancy. “I’ll do my best,” I replied sarcastically.

Interpretation: People are generally afraid of and disgusted by birth. Those feelings are often compelled by the media’s representation of birth. Sometimes people just don’t know what to say. Well then, I say, don’t say anything at all!

“Geez, got enough kids there?!”

It was one of those days that I left the house without my coffee. We made a detour to the closest coffee shop. Anyone with children knows that it must have been an emergency; no one unpacks and repacks three children under five into their vehicle for no good reason. I digress. The four of us entered the shop in perfect fashion. No one wailed, no one side stepped. Everyone was pleasant. It was to my surprise then when an older gentleman–except he wasn’t a gentleman– exclaimed disgustedly, “Geez, got enough kids there?!” I turned to look if there was a larger family behind me. When I realized he was indeed addressing me, I replied, “Hmm, no, not quite yet.” I wished I had thought of something more sharp!

Interpretation: Some people are jerks. That man’s thoughtless comment was relatively harmless, but his face and jerkiness remain burned into my mind. Especially in the early weeks postpartum, moms can be impressionable, so be kind.

“That’s really good for them.”

We’re having our hardscapes completed this autumn, so we’ve been spending a lot of time with concrete workers. One of them noticed that I wear George everywhere I go. “That’s really good for them, wearing the baby like that. It keeps them warm and they can hear your heartbeat. There was a special about it on TV,” he enlightened me. “That’s right,” I replied rather impressed. “And my hands are free!” I added.

Interpretation: Normal mammalian behaviors, like keeping our babies close, are being recognized and applauded. Yay!

“That’s kind of embarrassing!”

We’re also having some touch ups done inside our new home, so the contractors get an unfiltered view of what goes on in our house, like George nursing incessantly. One evening, as I stirred the chicken soup and nursed George in the carrier, Mitch and Jim chatted with me about their next projects. Before they left, they asked how “the little guy” was doing, both peeking their heads into the carrier. “Great,” I replied. “He’s nursing right now.” They both started apologizing profusely, giggling uncontrollably, faces flushed red. “That’s kind of embarrassing!” Mitch exclaimed. “No, it’s not really,” Jim answered. “Hey, a baby’s gotta eat,” I said. Jim shared that his wife nursed their son whenever and wherever. The rouge drained from their cheeks, and we all went about our evenings.

Interpretation: A baby’s gotta eat; there’s no shame in that.

“Where’s the bottle?”

During Iris’s sports class, Willow, George and I hang out at the nearby playground. Willow’s met a friend who also has a sister in Iris’s class. One morning, I got ready to feed George. “Can I watch you feed him?” Willow’s friend asked. “Sure,” I agreed. George latched. I looked at her and smiled. “That’s about it,” I said. “Where’s the bottle?” she wondered. “He doesn’t eat from a bottle,” I explained. “He drinks milk from my body.” At that, she went sprinting over to her uncle– who according to her was supposed to be watching her but was on his phone instead– presumably to tell him that I was feeding my baby from my body.
Interpretation: I introduced breastfeeding to a little girl!

Reflecting on ‘Milk-Born into this World’

This post was written back in May. I intended to publish it then until I decided to take parental leave for the summer.

————————————

I recently had the pleasure of attending Milwaukee County Breastfeeding Coalition’s community screening of Noemi Weis’s documentary Milk- Born into this World.

Immediately, I was struck by the impeccable visuals and stunning intricacies captured. The hills and valleys of a pregnant woman. The dirt under an Auntie’s nails. The creases and wrinkles of the elderly and the newly born.

Overwhelmed by the film’s beauty, I also found myself overwhelmed by the number of topics presented. By introducing the politics, commercialization and controversies surrounding birth and infant feeding, it gave viewers a glimpse into the complexities associated with infant nutrition. It left me wanting so much more though (maybe that was the point.) I found myself lost in the sheer magnitude of topics presented:

Social media. One mother in the film described her relationship with social media and how it became a tool for her to connect with other like-minded mothers. Connecting with women on Facebook encouraged her to practice child-led weaning. She also uses social media to help other mothers share donor human milk.

Training of health workers. The film brought to light the fact that globally, health workers are not properly trained in infant nutrition which can disempower families and can lead to infant death.

Sexuality. “A natural birth is an expression of a woman’s sexuality,” Élisabeth Badinter, Philosopher, Professor, Author stated. Sexuality as it relates to birth and breastfeeding was woven throughout the film. It came to perfect culmination with the montage of Hollie McNish performing her incredible spoken word piece, Embarrassed.  

Marketing of breastmilk substitutes. “Legislation without sanctions is like a toothless bulldog,” Terry Wefwafwa, Head of the Division of Nutrition, Ministry of Health, Kenya said in the film. Milk covered the implementation and enforcement, or lack thereof, of the International Code of Marketing of Breast-milk Substitutes. It demonstrated formula companies’ horrific violations of The Code.

Teen pregnancy and motherhood. The maturity and grace of the 15-year-old mother featured was simply remarkable. Only a snippet of her story shared, I wondered how her age, race and socioeconomic status may have impacted the care she received and the outcome of her birth and infant feeding experience.

Midwifery care. Midwives rock. They improve birth outcomes. Only a traditional midwife featured in the film, of course I wanted more. It could have done viewers such a great service to see the range of midwifery care available. I worry that the depiction of a traditional midwife, although extremely important and of great value, makes “alternative birth” look too exotic.  

Birth intervention. It was mentioned that widespread and often unnecessary intervention during birth results in poor infant feeding outcomes. I vividly recall two women who shared their emotional c-section birth stories caused by unnecessary intervention.

Infant feeding during emergencies. Milk covered the devastation the Philippines suffered after one of the worst typhoons ever recorded and the lasting, tragic effects of artificial milk donations.

Formula feeding. One mother shared that she chose to formula feed because she said it was the best choice for her family. She mentioned that her husband wanted to be able to bond with their baby. (Don’t most dads and partners want to connect with their babies regardless of infant feeding method?) She also said that she knew she needed time away from her baby. (I’m a mother who chooses to breastfeed and I can assure you, I need time away from my children too.) It was interesting to watch this mother interact with her child; I noticed that she did not hold him to feed him the contents of his bottle. Instead, she sat next to him as he held his bottle while relaxing on a pillow. This mother’s comments and the intricacies of her relationship with her baby deserve a film all its own.

Prematurity. Milk showed a baby born at 26 weeks and 1 day and his mother in the NICU. The mother shared her appreciation for donor human milk while she continued to pump for him. A clip showed her using a Q-tip to rub her milk in his mouth before she could even hold him. His tongue undulated. It was incredible to watch this connection!

Human donor milk and human milk banks. The film touched on a brief history of human milk banks and discussed the importance of human donor milk. It highlighted Brazil’s efforts, including a fire department making milk collections in their neighborhoods, just part of the country’s incredible network.

Feminism and women’s empowerment. This theme was woven throughout the documentary.

Policies for working mothers. Milk shed light on the status of paid maternity leave in the U.S. Congresswoman Carolyn B. Maloney voiced her concerns as a champion for breastfeeding mothers.

Stigmatization and Mom Guilt. While breastfeeding mothers shared their concerns about stereotyping, formula feeding mothers also weighed in.

Surely, all of these topics belong in the conversation about birth and breastfeeding. However, each in its own provides such a lush amount of material– enough for a separate film or films about each– it made it challenging to digest them all in one sitting. I would be so thrilled if Weis decided to tackle each separately!

Some final thoughts about Milk- Born into this World:

In roughly an hour and 20 minutes, Milk celebrated diversity through its juxtaposition of several women as they navigated their journeys through motherhood.

While diversity and individuality celebrated, Milk also demonstrated a common thread, one of empowerment and choice, one of Motherhood.

Finally, I exalt Weis for honoring the female connection and feminine power. Some of the most striking moments in the film were of the intense bond between two women– a mother and daughter, a midwife and mentor, a mother and midwife. Still, as I watched I wondered, Where are the men? They are certainly a vital part of this conversation, this agenda. Why were they not represented?
Have you seen Milk-Born into this World? Tell us, what did you think? Learn much, much more about the film here. Click here to host a screening.

George’s Birth Story

I’m baaaaack! I’m so thankful to have had such a wealth of knowledge shared on the blog while I frolicked with my littles during my parental leave this summer. A sincere thank you to all of our guest bloggers. You’re all wonderful! 

For my first week back, I can’t resist not to share with you my most intense experience this summer: the birth of my little Georgie. Without further ado…

We have a tiny new human living with us. We call him George Edward. If there are words to describe how much I love this little guy, I can’t find them. And although I am exhausted to the point of tears, I have never felt so fulfilled. George is so sweet and soft and warm and his scent is intoxicating! He has deep slate eyes, scrawny chicken legs, a wrinkly forehead and two sisters who absolutely adore him.

Willow anticipates her sibling's arrival with art depicting the birth. Characters present: Me with long hair (and nipples), Grandma with lavender hair, the midwife watching close by, Iris- happy about the birth, Willow- frightened by the birth, the baby coming out of my body and the baby crying and Addison in a polka dotted dress. She later changed her mind and said that she was the one happy about the birth, catching the baby.
Willow anticipates her sibling’s arrival with art depicting the birth. Characters present: Me with long hair (and nipples), Grandma with lavender hair, the midwife watching close by, Iris- happy about the birth, Willow- frightened by the birth, the baby coming out of my body and the baby crying and Addison in a polka dotted dress. She later changed her mind and said that she was the one happy about the birth, catching the baby.

This is George’s birth story:

SAMSUNG CSCGeorgie was born into my hands on our bathroom floor on July 20 as the morning sky turned indigo. The sheer intensity of birthing my baby’s head and body shocked me; laboring up until this point had been rather manageable.

It was nearly 1:00 a.m. when I woke to what felt like slight stomach cramping and pressure in my bottom. I had experienced these sensations for several nights prior, but when I went to use the bathroom on this particular morning, I noticed pinkish blood in the toilet. I knew our baby would be coming soon. Trying not to get too excited, I attempted to fall back asleep. Nope, I was much too adrenalized! I washed my face, brushed my teeth, braided my hair and laid out the robe I bought to labor in.

What next, I wondered. On my way downstairs for a cup of tea, I checked on each of my girls, stroked their heads and then nearly squealed with excitement as I thought about the arrival of their baby brother or sister.

I admired fireflies flashing and the moon’s brilliant glow from my dining table as I sipped my tea. I wanted to be outside in the early morning calm and summer heat in the worst way. But without landscaping complete at our new home and a disgusting amount of flying insects swarming our lit porches, I stayed indoors.

Around 1:30 a.m.– remembering that my midwife advised me to contact her as soon as I had an inkling that I might have my baby in the near future– I crafted a text message. The message didn’t wake her. Instead of calling though– because it felt rather discourteous to ring so early in the morning–I went to wake my husband.

“Addison….Addison….Addison….Addison…” my whispers grew louder and louder into a whispery shout. He grumbled.

“Are you ready to have a baby today?”

“Really?!” he woke with enthusiasm. “What is today?”

He proceeded to run through Wednesday’s work schedule declaring approvingly, “Ok, today should be a good day.” He showered, then came downstairs to keep me company.

SAMSUNG CSCWe hung the “Homebirth in Progress: Please Do Not Disturb” sign on our front door, and then we chatted. I don’t remember what about. I do remember giggling a lot. The anticipation was invigorating.  At one point, I joked that rubbing your wife’s feet really gets labor going, so he did.  

After a few more crampy sensations, my first phone call went out to my mom around 2:30 a.m.

“Are we going to have a baby today?!” she answered. Her sparkly energy, as sparkly as the glitter she dusts over her body, conquered her tone. I said I thought so, but wasn’t entirely convinced because the sensations were so mild. Regardless, I thought it best she take her time, but head our way so she would be available to the girls before I went into active labor.

By this time, my husband urged me to call our midwife. At ten to three, I did. I had been having 30 second contractions two to four minutes apart, but had been walking, talking and laughing through them, basically rather unfazed.

Over the phone my midwife wondered, “Any pressure?”

Yes, rectal, I reported. She sounded slightly alarmed, told me she would shower quickly and head our way.

Some time later, my mom arrived. The girls were still sleeping, so we talked about when we would wake them for the birth of their new sibling.  

Our midwife arrived next. It was sometime around 3:30 a.m. She checked my blood pressure and temperature; 108/72, 97.7℉ and the baby’s heart rate and position; 130s, LOA.

Addison offered my mom and our midwife eggs for breakfast. Eggs, for the love of God. Of all the breakfast foods one could enjoy, he made the one that I absolutely could not stomach my entire pregnancy. I had been feeling slightly nauseous prior to the egg scrambling, but now the nausea really started to take over.

To take my mind off of it, I paced and paced. I swayed my hips back and forth, back and forth encouraging the baby to descend further.

Over an hour later around 4:40 a.m., my contractions lengthened to 45 seconds every two minutes. I started to hum through them. True to my character, I couldn’t decide what to do next. (I don’t know what I want, but I know what I don’t want.)

At this point, my midwife talked with me about getting into the tub or shower. We hadn’t planned for a water birth, but I was interested in using water therapy during labor.

SAMSUNG CSCI definitely didn’t want to get into the shower. My hair would get wrecked! Not that it was looking particularly glamorous or anything. The soaking tub did look rather appealing though. Our beautiful soaking tub! (Quick backstory: We added square footage to our home to accommodate this piece. Before we planned to have another baby, Addison suggested that it be a potential birthing tub. Brilliant, I thought. Ultimately, I planned a land birth because of the tub’s narrowness, and because my midwife thought a land birth would allow me a better opportunity to catch my baby in a comfortable position.)

It was glorious. I was comforted surrounded by the warmth of the water and the scent of a wash cloth doused in a calming oil blend.

Addison went to wake the girls. Willow woke and was excited to play with Grandma, but Iris thought it a better idea to fall back asleep in her sister’s room.

While in the tub, I endured around five intense contractions with a lot of pressure. With each one, as Addison noticed my vulva full and swelling, he gently (although relentlessly) encouraged me to get out of the tub so that I could catch the baby as planned. On the final contraction in the water, I yelled for my midwife; my baby was about to be born.

SAMSUNG CSCShe and Addison helped me out of the water onto the bathroom floor where I positioned myself on all fours. At 5:01 a.m., my membranes ruptured onto my hand which I had in place to feel for my baby’s head.

My midwife replied, “Very efficient, Jess!” This comment made me want to laugh, but the intensity of birthing George’s head consumed every grain of me.

SAMSUNG CSCAt 5:03 a.m., my mouth open wide as my body writhed *Cue Johnny Cash’s Ring of Fire*, George’s head came earthside resting in one hand as I supported the rest of my body with the other. My midwife instructed me to wait for the next contraction to birth his body, but it was too late. I shifted my weight as he came slipping out in the same contraction right into my own hands!

SAMSUNG CSCDuring this moment, my midwife informed me that George had a nuchal cord and calmly instructed me to lift it up over his head. As he wailed, I went to unwrap it but found it was too tight for me to comfortably lift over his face. At that, I frantically ordered, “Help me!” and my midwife did.

I don’t quite remember the order of the following events. We were all so consumed with excitement and triumph.

I heard Addison announce in sheer disbelief, “Oh my God, it’s a boy.” I replay that moment over and over and over in my head. You see, he was convinced we were having a third little girl. Confident in his ability to read ultrasounds, he told everyone we were having a girl when he apparently saw a vulva on our 20 week scan.

I observed my sweet baby’s wrinkly, red, wet head and his healthy coating of vernix. Oh, the vernix! I couldn’t believe how much there was. His body’s wet warmth pressed against my abdomen. I felt our cord tug between my legs.   

Through tears and laughter I exclaimed, “Oh sweet boy, oh sweet boy, oh my sweet baby boy!” My redundancy actually started to annoy me, but it’s all I could get out. Admittedly, I was terrified to have a little boy, but the moment I held him in my arms, my heart swelled. A boy!

My mom and Willow entered during this time. It had been the plan for Willow to announce the baby’s gender, so I turned his genitals toward her.

“I can’t tell,” she said timidly.

“What do you see between the baby’s legs?” Addison encouraged her.

“A penis!” Willow really, really, really wanted a brother.

My mom wondered, “Is this baby Walden?”

When I announced he was in fact baby George, she cried a happy tear. George was her dad.

Iris apprehensively entered the birth scene in her diaper and rockin’ bedhead. George and I were surrounded by our beautiful, loving family.

Our birth assistant arrived about six minutes after George’s birth.

At 5:13 a.m., Willow and Iris clamped our cord with the midwife’s help. Willow so desperately wanted to hold her little brother.

Clamping the cord
Clamping the cord

“After I’m done giving birth,” I told her.

While we waited on the placenta, I told Addison he didn’t need to worry about me wanting anymore babies; I didn’t feel like giving birth again. (Fast-forward 18 hours: As I changed George’s diaper and put him into his jammies, I warned Addison that he might want to look into getting a vasectomy if he was sure he didn’t want anymore little ones. George’s utter adorableness already had me thinking about a baby number four [Insert ‘What is wrong with me’ looking emoji here]…. How quickly we forget!)

I was extremely uncomfortable on the towel-laden, tiled bathroom floor still waiting on the placenta’s delivery, so I requested a move to the bed. After what seemed like an eternity, the placenta was born with a relieving gush at 5:34 a.m.

The midwife checked my bottom and reported a first degree laceration on my perineum and skids on my periurethra. No repairs necessary.

We all watched admiringly as Walden, I mean George, crawled to my breast for his first feed. I called George Walden twice! Boy, was I second guessing his name. After much discussion, we all decided that George was indeed the perfect fit.

George measured in at a perfect 20 inches. He weighed 7 pounds 3 ounces which Addison guessed right on the money, just like he had Iris’s. Our little guy sported 34 cm head and 33 cm chest circumferences. Apgar scores totaled 10 and 10 at one and five minutes. Sprightly little dude.

Addison exclaims, "Yes!" guessing George's weight correctly.
Addison exclaims, “Yes!” guessing George’s weight correctly.

George breastfed for the first time at 6:10 a.m. after navigating his way to the tippy-top of my mountainous boob. Little George now satisfied with his first meal, I choked down peanut butter on toast and grape juice. Eating after birth has always been very unappealing to me. At least it wasn’t eggs.

Although several hours later, it seemed so soon that our house was still and silent. The midwives had left, and my mom took the girls to spend some time at her house. Addison, George and I cuddled in bed. George had no trouble sleeping, but Addison and I were preoccupied with the arrival of our new family member. I couldn’t take my eyes off of him.IMG_9007

That afternoon, my brother came to meet his nephew. He had been rooting for a nephew since I became pregnant the first time! He came with lots of cute, little newborn boy clothes.

Later that evening, my mom brought the girls back home before they would depart again for their sleepover. My father in law and a friend came to visit too. We all had pizza for dinner together. When it was time for the girls to return to my mom’s for the night, they protested. This was the first time in herstory that Willow and Iris didn’t think going to Grandma’s was the greatest idea of all time. I suppose George is a pretty good reason to want to stick around. I was apprehensive and saddened to send them off, but Addison and I appreciated the opportunity to have a night alone with George. The girls did just fine once they arrived at Grandma’s.

That night, well, I don’t really remember much from our first night as parents of three. Baby snuggles, sticky meconium diaper changes, nursing. I think that covers it.

The next morning, the three of us had breakfast while we watched a deer and her spotted fawn prance in our backyard. Later, Addison took down our “Homebirth in Progress” sign. My heart sank. My pregnancy was over. The one I had announced to Addison back in November next to the gravel-filled hole that would become the foundation of our home. Our birth, the one I had anticipated for 39 weeks and 5 days, was over.  We would never have those moments back. Taking down the sign elicited a familiar feeling; it’s one I get when I finish a book. No longer involved with those characters, no longer captivated by their stories. It took me almost two weeks to process that feeling of Overness.

In his birthplace.
In his birthplace.

My pregnancy is over. My birth is over. But George is here now. He is an unfinished book. His big sisters’ lives are unfinished books. And I get to be, quite possibly, the most important character in their stories. I get to be their mom.

Nursing an Adopted Baby

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

walls823.5x5
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

walls823.5x5
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.

Laney,Bella, bf 017

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.)