First Blood, Then Milk

A reading from this week's Breastfeeding Politics & Policy class stopped me in my tracks, for obvious reasons.

"I think she looks like you," [the lactation consultant] says with a wink.

"I'm adopted," I say blankly. It's a telling response. I'm so accustomed to discounting the physical resemblance people claim they see between me and my own mother that I forget Faith and I are related. Even though I have the episiotomy stitches to prove it. Which, right now, are hurting me a lot.

Lisa studies me for a while.

"So am I," she replies slowly. Then she shows me a picture of her own (breastfed) daughter, now eight years old. Bright eyes, mile-wide grin, she looks like a miniature version of her mother.

And that's when I know it is no accident that Lisa has devoted her career to helping mothers forge abiding, biological bonds with their babies. Nor is it any accident that I desire this relationship so deeply. Your body out of mine. From my body into yours. First blood, then milk. These are the living threads that weave mother and child together. As much as I love my adoptive mom, this bond is a connection we never had. And as for the unknown woman who gave birth to me, we were lost to each other before I was even as old as Faith is now. And for about the twelfth time today, I begin to cry.

-- Having Faith: An Ecologist's Journey to Motherhood"
by S Steingraber. Excerpt from the chapter titled "Mamma"

Another rumination of mine on adoption:

When DNA Isn't Just DNA

Calculated Risk: New Milkscreen Calculator Product for Breastfeeding Mothers

There's a new product hitting the aisles. Milkscreen Calculator claims to evaluate a lactating woman's supply and tell her whether her production is adequate. Is it designed to reassure nursing mothers, or to prey on their insecurities? Who designed this? And how exactly does it work?

Brought to you by Upspring Baby, the same company that created the alcohol test strips for breastmilk, Milkscreen Calculator is introduced on their webpage like so:

DO YOU MAKE ENOUGH BREASTMILK FOR YOUR BABY?
GET MILKSCREEN CALCULATOR

Many moms wonder: How much breastmilk do I make, and is it enough for my baby?
 
Take the new Milkscreen Calculator test and learn:

• How much breastmilk you are making
• If you need to increase breastmilk production
• Baby's weight gain and weight percentiles
• How to naturally increase breastmilk production
• How to overcome common breastfeeding problems

It's no secret that anxiety and insecurity about milk supply are leading causes of premature weaning. Milkscreen Calculator states that "50% of moms stop breastfeeding because they are concerned they are not making enough for their baby." In a video interview,  Dr. Susan Landers, a fellow of the Academy of Breastfeeding Medicine who helped develop the Calculator, she explains that the product was indeed intended primarily to reassure mothers who have unfounded fears about their supply.

How does this work? From what I can tell on the site, the product you purchase is basically just a container into which you measure your pumping output. After registering on their site and filling out a questionnaire which collects more data on you and your baby, you are given a pumping schedule. In the example cited in the FAQ video, you are to nurse your baby at a set time, then pump three different times at hourly intervals. You will then enter your data online and receive an analysis of your supply, such as this example:

I should fully admit right up front that I have a hard time being objective about this. As someone who works with nursing mothers in my clinical training to become an IBCLC (supervised by preceptors at all times), it breaks my heart to think that a mother who was producing well but did not respond well to pumping (or had a faulty pump, or poorly fitted flanges, or any number of other variables) could potentially be told that her supply was inadequate by this product. There are mothers who have successfully breastfed their babies exclusively, with perfectly healthy weight gain, who report never being able to elicit more than a few drops from a pump. Perhaps it was an equipment issue, perhaps hand expression might have worked for her, who knows? What would Milkscreen Calculator tell a mother like this?

Conversely, if it's used on a newborn (they state not to use it prior to 8 days old, but day 9 is still very, very early), honestly, mom might still be producing well due to that postpartum hormonal abundance . . . and baby might actually have some issues that prevent them from actively transferring well. So baby feeds passively on mom's surplus letdown for a while, and a few weeks later, her supply actually does start to dwindle because the demand end of the supply & demand equation was never strong enough. But hey, the Milkscreen told her everything was just fine.

In a few places on the site, the company mentions that moms that were found to have low supply according to their calculations may want to consult with a pediatrician or a lactation consultant (after trying some of their automated suggestions for increasing supply). Which, in my mind, begs the question, wouldn't a better effort be to increase access to IBCLCs in the first place? By the time a mother in this position seeks professional help - if in fact she does or can - she may be facing an uphill battle to bring her supply back on top of addressing the root cause of the baby's poor transfer.

To give the company the benefit of the doubt, I do believe the intention was to create a product that would reassure most mothers that their supply is normal and healthy - after all, for most women, it is, as long as poor management doesn't interfere with the natural process. Does it succeed in this goal? Or is it more likely to just exploit their fears? A little from column A, a little from column B?

What do YOU think? Am I overreacting in my concern? (It would hardly be the first time. True fact.) If this product is a helpful and accurate one, and my reasoning is faulty, I would love to be reassured by an explanation. Building confidence in new mothers is a very, very good thing; I am far from convinced that a preprogrammed Calculator is the right tool for that job.

*****

UPDATE 10/5/12:

Yesterday, I received an email from the CEO of Upspring Baby. I share it here with her permission,

Dear Dou-la-la,

I am the CEO of UpSpring Baby and saw your recent post about our new product, Milkscreen Calculator.  I thought you raised some very reasonable questions, and many of the same ones that were raised when we launched the product at the annual ILCA conference in July. 

We recognize that this is a complex product that is intended to address a common concern of new moms:  that their milk production may not be sufficient to support their baby’s needs.  Milkscreen Calculator’s mission is to help moms overcome this common worry, either by reassuring her that her production is normal (in most cases), or by helping her overcome a high or low supply by directing her to an LC.  We know many moms quit breastfeeding, or begin formula supplementation, because they think they are not making enough breast milk.  The main purpose of this product is to educate mom and help her gain the confidence she needs to continue breastfeeding.  And for women with low or high production, we hope the test will give them the extra encouragement they need to seek professional help so they can increase or decrease their production.

If you are interested in discussing the product further, I would appreciate the opportunity to speak with you directly.  While we have tried to anticipate most of the basic issues, I’m sure there are more things we can learn from experts in the field.  Prior to launching the product, we sought input from LC’s and pediatricians who have specific expertise in breastfeeding medicine in order to be as thorough as possible. 

 

Thank you,

Caroline

What do you think? 

Our Babies, Our Guts, Or: What Napoleon Dynamite Can Teach Us About Breastfeeding

Mmm, Gut Flora

Is it normal for a breastfed baby to go for days without pooing? How about weeks? It comes up fairly regularly (puns always intended around here) in online breastfeeding-related support groups, and the conventional wisdom/majority opinion is inevitably that infrequent stooling in exclusively breastfed infants is fairly common and thus, it is normal. But what do we mean by "normal"? If by normal (in this context) we really mean common, then yes, that's true. But does that, therefore, equal healthy?

Usual pattern of discourse:

One parent: "My baby usually went for 4 or 5 days without pooing. Then she'd have a huge blowout/poo all day on the fifth day."

Another parent: "Breastmilk is such a perfect substance that the baby's body just absorbs it all! Breastfed babies don't need to poo regularly." 

Third parent: "Yes! Breastmilk is used so efficiently that there isn't any waste. Mine used to poo explosively once a week. It was just her 'natural rhythm', I guess."

Me: "But . . . if a baby not pooing is a sign that the body is 'absorbing it all', then what does it mean when a baby actually poos? That they are not using it so efficiently and aren't getting the nutrients? And if they are then having blowouts later - doesn't that mean they were not 'using it so efficiently that there is no waste' after all? (And on to information about infrequent stooling sometimes being a symptom of food sensitivities, suggesting a look into gut healing if it;s feasible for the mom, etc, blather, rinse, repeat.)"

You get the idea. I'm always conflicted about this topic and its usual pattern because the women arguing in favor of infrequent infant stooling ARE breastfeeding advocates and are trying to encourage and reassure other mothers. I can't NOT support that right? The intention is so good.

I posit that something being common does not, in itself, mean that it is therefore healthy. 

This frequent conversation was on my mind when I shared this link from The Healthy Home Economist on Facebook yesterday and enjoyed the brief discussion that followed. From her post on relieving baby constipation:

"As little as ten to fifteen years ago, it was almost unheard of for a breastfed baby to be constipated.  In fact, the baby books at that time almost universally stated that breastfed babies don’t get constipated. Nowadays, however, this situation is becoming more commonplace and the continuing decline in the quality of the diet of nursing mothers is a likely reason.

While it is an unpopular position within the breastfeeding community, the diet of the mother clearly impacts the quality of her breastmilk (fats, vitamins and minerals in breastmilk vary considerably based on the mother’s diet although protein and immunoglobulins do not) and studies such as the Chinese Breastmilk Study confirm this.

"Suggesting that a lactating mother can eat whatever she wants and still produce quality breastmilk is also irresponsible and defies all common sense and historical study of healthy traditional cultures which put great emphasis on the quality of the diet of nursing mothers."

I appreciate that she's willing to state an  unpopular opinion on two matters: That even a breastfed baby needs to stool regularly (the body "using it so efficiently" does not mean that there is zero waste and that it just dissolves magically; that's simply not how human digestion functions, whether said human is an infant or an adult), and that maternal diet DOES in fact have an impact on breastmilk composition. Yes, breastmilk absolutely IS still preferable to formula, even with a suboptimal diet, but that does not mean a nutritionally inadequate diet and a healthful diet (and what "healthful" means definitely and obviously varies from individual woman to individual woman) are therefore equivalent.

I think we as breastfeeding professionals and advocates are frequently afraid to address maternal diet because we don't want to create additional pressure on mothers, and I completely get that. I don't want moms to feel that they have to eat "perfectly", and opinions also do vary on what optimal nutrition even is, I know. (Believe me, I know.  Vegetarian? Vegan? Paleo? Raw? Low Carb? Macrobiotic? Kosher? Gluten-free? SAD? GAPS? FODMAPS? Aiiiieeeeee!)  

However, I do feel sometimes that we're assuming that women's commitment to breastfeeding is so fragile and tenuous that giving information that includes suggesting improvement to their nutrition, within whatever their means are (more on that in a sec) will cause them to throw up their hands and give up. I want to give moms more credit than that. Yet I have also heard (as in read-on-forums) moms deciding to formula feed because they can't afford a perfect organic diet for themselves, so what's the point? Clearly we need to do a much better job of getting accurate info out there re: this. 

To wit, while this very conversation was taking place, a comment was posted on an article about the Bloomberg initiative: "[Breastfeeding is] only healthier IF the mother eats properly and chooses to not take in UNHEALTHY substances. . ." 

To which my classmate Catherine replied: "Right. Because all those cows whose milk is being used to make Similac are on an organic diet (and eating "properly" - so no grains) and are never given unhealthy substances." Those cows are not farmed on a different, uncontaminated planet, either.

Christie Haskell then summed it up neatly: "We want people to know that eating healthy does make things better for baby, but we don't want to fuel the idea that if you don't eat healthy, you might as well formula feed either." This is the dilemma.

My wise friend Arwyn, famed for her excellent blog Raising My Boychick, offered some important perspective with some difficult but extremely relevant thoughts, thoughts that we should keep in mind whether approaching this from either an advocacy role or a professional one:

[T]he majority of toxins in milk come from our own stored backlog, which were laid down when WE were fetuses and infants and children. They come from car fumes and factory fumes and "fire retardants" and water pollution, from a thousand things we cannot control and which big money is invested in preventing us from regulating. Does diet make a difference? Yeah, of course it does. But I think any conversation about diet that takes place outside of a dominant cultural conversation about how our waters and lands and air and food are polluted is the wrong approach.

Arwyn makes very important points - I always appreciate her asking the tough questions. I think it's important to have address ALL of these things. Socioeconomic issues, environmental contaminants, AND also maternal nutrition. And as an IBCLC-to-be, the subject I know most about is the latter, so therefore, it's what I'm most qualified to speak about - that doesn't mean I don't recognize the other things as significant factors. I don't have expertise in social justice or environmental science, but I do in human lactation  It's the area in which I have the best chance of making any significant impact as a professional, therefore it is the main focus of my voice on this matter. She is absolutely right that I still need to remember to consider the big cultural picture - and check my privilege - on a regular basis in all of these conversations.

It is absolutely true that our own health has already been dramatically affected by our grandmothers, quite literally - I say all the more reason to do what we can for our grandchildren in addition to our nurslings. I think we can strive to increase access and be sensitive and empathetic about resource inequity - and also not perpetuate myths in our roles as professionals or advocates about breastfed babies only needing to poo once a month-ish.

No conversation about this would be complete without a link to Jennifer Tow, who is one of the most experienced  and brilliant IBCLCs on the planet, and her poetic musings on "The Gut, Microbes and Poop":

Someday, I am going to write “Confessions of an IBCLC Heretic”, because for almost 20 years, I have been saying that it is absolutely not normal for babies of any age to have fewer than several significant bowel movements per day. Not per week! Per day. The more I learn about the gut and the gut-brain axis, the more I have to learn. But, I am confident that human milk is not “all used up” and that babies are not “efficient enough that there is no waste”.

Such comments do not even bear up under the scrutiny of common sense. If all those babies who stop pooping at 4-6 weeks are using up all the milk, what are the babies who are pooping 6-8 times per day doing? Making it?

And finally, even Napoleon Dynamite knows that maternal diet impacts milk composition.
 
 

Napoleon Dynamite: [drinks glass of milk] The defect in that one is bleach.
FFA Judge No. 1 : That's right.
Napoleon Dynamite : Yessssssssss.
Napoleon Dynamite : [drinks second glass of milk] This tastes like the cow got into an onion patch.
FFA Judge No. 2 : Correct.
Napoleon Dynamite : Yessssssssss. 

[Side note: Lily has taken lately to saying "Yesssssss," whenever she's mildly excited about something, and sounds exactly like Napoleon here.]

Difficulty Conceiving/Difficulty Breastfeeding: POLL

The last time we updated our intake forms at my school's breastfeeding clinic, we made sure to add a checkbox with "Difficulty conceiving?" to the maternal health history section. Reasons for fertility issues are myriad, but can definitely give us some clues as to possible underlying hormonal issues that can affect supply (more on that in an upcoming post, I hope). 

Yet in my (limited) experience so far, few mothers who sought fertility treatment received any indication from any of their prenatal care providers that they might in fact experience some challenges in the breastfeeding department. Before we get into the whys and wherefores, I thought it might be a good idea to get a sense of how common this lack of information is, however informal the poll.

So, would you pass this along to anyone you know who has experienced fertility treatments and might be willing to share this info? And of course, answer it yourself if it applies to you? I'd be most grateful.

This is just the opening of a potential ongoing conversation. There are many complex layers to this, and much to discuss.

[And hello there, o patient readers! I do indeed still exist, though between coursework for school and various other exciting outside projects (including promising memoir stuffs), I sometimes barely have time to parent, let alone wax lactosophical around here, much as I love to do so. I'm hoping that will start to change soon. Cheers!]

Getting Off the Medela Teat

(I am SO not really.)

By way of introductory comments, I first need to hail the revival of Just West of Crunchy, which was rendered out of commission by a terrible crash. Welcome back! Secondly, I'm going to point you in the direction of a Very Important Post: The Problems With Medela.


What's that you say? Problems? With Medela? But - they make breastfeeding products! They promote breastfeeding, right? And I love my slick Pump In Style. How can you have problems with them? 

Trust me, I understand. I was right there with ya. Here's the thing. I have my own post addressing my concerns about Medela, as some of you might remember, but JWOC's post is incredibly detailed and thorough (heck, I included a link in my own piece) and does a bang-up job of explaining why everything with Medela is not as rosy as it might seem. 

The issues fall into two major categories: Medela's very-much-intentional violation of the WHO International Code Marketing Breastmilk Substitutes (henceforth known as "The Code"), and Medela's very-much-intentional production of open-system, mold-vulnerable, single-user-only, landfill-destined pumps. I'd excerpt from JWOC's and my posts, but I'd end up excising them almost in their entirety, so please, go ahead and click through and check them out.

Why this is timely for me now: Here I am, in Boob School, knowing all of this . . . and turning around to distribute Medela nipple shields, and Medela hydrogel packs, and Medela Supplemental Nursing Systems, and Medela breast shells; and then there's Medela microwave steam cleaning kits, and Medela storage bags, and Medela sanitizing wipes, and on, and on, and on. I do it with an internal wince - but I do it. And this is definitely representative of many (I would venture to say most) lactation consulting environments. I would expect this in hospitals, as they rent out the Medela-manufactured hospital grade pumps (the only kind that are approved and safe to be used by more than one mother), but they're present to the point of ubiquity even in environments like Birthingway's clinic.

So I have to wonder: Is there any way to change this? Is Medela so pervasive that even among those who know about the Code violations and the worries about their pumps, ethical concerns have to be shelved because their products are so indispensable? We know about some other excellent pumps, of course. Other companies produce 'accessories' that are on par with Medela's as well - I've written to some of them to ask for samples for our clinic. Yet I feel like a stronger statement could be made by our profession as a group, if we acted collectively.

I'd love to hear from others working in lactation consulting environments. Are there any out there that are Medela-free? I genuinely do not know. Are they in private practice? Or might there be any Medela-free hospitals? What about hospitals that qualify as Baby-Friendly? What is their position on accepting and promoting Medela products? The Baby Friendly Initiative was started by the WHO (in conjunction with UNICEF); it would be odd to me if a Baby Friendly hospital were to distribute products made by a Code-violating company - but again, I don't know one way or the other.

Can we start talking about this?

One last thing: Another excellent post on Medela was written by PhD in Parenting. It's linked to in my own original Medela post, but it's worth mentioning again here, not just because it's great but because many of you (especially if all this is new information) might be wondering what the big deal is. Okay, so they're not perfectly perfect, but why spend time attacking Medela when the formula companies are the real culprits? I think she summarizes the objections to criticizing Medela so well here:

I don’t want to be overly critical of Medela. I think the company does a great job promoting and facilitating breastfeeding. Most of the information on its website is wonderful. Most of its products are of the highest quality. I have been nothing but happy with my Medela products. However, I do think that some of their current actions to promote their bottles are inappropriate. It would not be difficult for Medela to continue to promote breastfeeding and sell its bottles without promoting them. However, it has chosen to ignore the WHO Code and push more bottle imagery and bottle messaging on moms (more on why bottle imagery and messaging is hurtful here). The result is that Medela is directly pushing bottles on moms and also doing so indirectly via the Medela Mavens and others who might pick up on the message about how breastfeeding ties you down, so you really need a pump and bottles so you can get your hair done.

 To be clear, on a sliding scale this is not even close to Enfamil or Nestle or other formula companies. Not even close. But I would argue, and others do argue, that any violation of the WHO Code weakens its potential impact. We cannot say “it’s okay because you are Medela,” but then slap Nestle on the hand for everything it does wrong.

Alfie On A Shelf: An Alternative to Creepy Elf Surveillance

Y'all have probably seen Elf On A Shelf, the combination of book and ornament/decoration/toy that's become a big holiday hit - a phenomenon, even. The idea is that he's Santa's tiny spy, who monitors the children in every household, comes to life when no one is watching, and reports back to the North Pole with nightly reports on who's been naughty and who's been nice. It takes the deeply ingrained cultural idea of Santa Claus as bestower of karma and brings it to a whole new Orwellian level (not to mention the Chucky doll creep factor). And it's hugely popular.

Some parents are just fine with this, and might find it a useful tool*. It's totally not my style of being, though, and I know it squicks some other like-minded parents out, too. What to do? It's always fun to find new holiday traditions, and I see the appeal of introducing a new game every year - with the original Elf, you move him around each night and the kids try to find his new surveillance spot. I'm the type of person who likes things like leaving hoofprints and making Reindeer Crap cookies, so I totally get the fun of finding novel ways to engage in holiday hijinks. So I devised an alternative.

I hereby present Alfie On A Shelf, a friendly reminder to treat your child with unconditional love this holiday season, and try to avoid the temptation to depend on bribes as a means of controlling our kids' behavior, naughty and nice lists notwithstanding.

Anyone have an in with a manufacturer?


*Disclaimer: I totally understand that every child is different, and some parents may find it useful to introduce rewards in some situations. Even parents who hold unconditional parenting as an ideal do find it necessary at times. And using the concept of Santa to introduce the idea of karma or other values is legitimate, even if I disagree. It should go without saying, but I know these things can be sensitive among parents, and it's always worth acknowledgement. 

Thanks to Rebekah Folsom for the Photoshopping!

Beyond Reckless

I must express regrets that I'm too wrapped up in both studying for my Oregon massage therapy licensure exam and Boob School homework to address this properly in my own wordstuffs, but lucky for me, Barbara Herrera (Navelgazing Midwife) took the words right out of my brain.

I posted a link to this important post about the Lisa Barrett debacle by 10 Centimeters on my Facebook page. In the thread that ensued, a sarcastic comment to the effect of "I'm soooo glad you all know what's best and have decided to control every mother's birth" was posted. And Barb's reply, well, warranted me lifting it almost in its entirety, in the interest of me shouting it from the rooftops.

The reality is FOUR BABIES DIED in her care. That is not disputed by anyone. No verdict needs to be given by anyone. That is a FACT. FOUR. And TWO within a very short time. These are babies that DIED. Gone. Forever. That their mothers will never breastfeed, but will feel their breasts swell trying to sustain the babies that are gone. Buried. Or cremated.

Midwives do not lose babies like this without being beyond reckless. Taking the cases she's taken... and bragged about... is vile beyond anything anyone supporting homebirth could imagine.

Hollering about a women's rights in birth is one thing, but doesn't ANYONE have a responsibility to see that everyone comes out alive and healthy? Why HAVE a midwife if you want to do anything and everything? Midwives like Lisa make homebirth look like the stupidest thing a woman could ever want to do -and that simply is not so.

Homebirth NEEDS parameters in order to be safe. Every woman is NOT a candidate for a homebirth. And until the hollering masses like you lose babies yourselves at the hands of these horrid midwives, you're likely to continue being the sheeple you profess to not be. Instead of sheeple towards the medical way, you're sheeple thinking you can "Trust Birth" no matter what.

But, you'll be wrong. Just ask the moms of those babies that died because of Lisa Barrett.

Testify, Barb. Amen.