Tuesday, October 2, 2012

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? 

21 comments:

  1. I'm not a fan. I agree with all your points, plus I really didn't like the product's recommendation too consult a pediatrician about breastfeeding issues. That's enough of a booby trap on its own.

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  2. The only way to calculate milk production is to weigh your child before and after every feeding, around the clock. And the # doesn't even matter anyway, as some babes need 3 oz per feeding to be healthy, and some need 7 oz! This is dumb.

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  3. WTF? 23oz a day? I mean, how can they measure that? I can only pump 1-2oz a day while most EP moms get 8+oz a day, but I have enough milk to exclusively feed two kids at a time, no problem. I'd be interested in trying this just to freaking debunk it.

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  4. Oh good, another way to make a new breastfeeding mom feel insecure about her supply. I was just thinking that I've been seeing way too many moms get cocky about how much milk they pump.
    Sarcasm aside, I don't think you're overreacting at all. Some moms do not respond well to pumps. As you mentioned, it could give a false "your milk supply is awesome!" and hide a potential issue. I'd be very curious to hear the experience a mom who used this product.

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  5. Ugh. I actually am really disappointed that someone who is an FABM worked on this! I really hope ABM members would have an issue with this product. I agree that this seems like it's a pretty high risk for both false positives and false negatives. And in the end, even if it gives a mother accurate reassurance, where does that get her? She still is dealing with the same concerns that brought her to the product in the first place (overly concerned family members, fussy baby, etc. etc.) with no ideas about how to proceed from there.

    I would need to see great research that this product prolongs breastfeeding in low-confidence moms to support it!

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  6. This product is far from the best solution to this problem. It makes me sad to think of a mom sitting at home crying about her supply and relying on a piece of machinery to tell her that everything's going to be ok. The best solution is not only increasing access to IBCLCs (which in some ways I feel should be reserved for the problematic cases) but simply teaching those who already are in contact with moms during the early phases (RNs, docs, midwives, lay counsellors, etc.) more about normal newborn behaviour, supply and demand, and so on. Moms should be getting this reassurance from real people. I also worry that for the small number who really don't produce enough, this product may delay them getting good help.

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  7. I also think that educating family members of new moms is a crucial piece. I think grandparents especially could use education about normal newborn behaviour. Our health unit is starting a project on this.

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    1. Such a good point. How many of this generation's grandmothers' first piece of advice for dealing with a fussy infant who might not be on the most ideal sleep schedule is, "Have you tried giving him formula? Maybe he's hungry?" They mean well, but it is not encouraging to first time moms.

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  8. I am in ABSOLUTE agreement with you. While the produce *may* have good intentions, directing a new mother to *schedule* feedings so she can measure her output puts her supply at risk! Watch the baby, not the clock is BF 101 and this product disrupts that. Not good...

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  9. Unless this product's sole function is to weigh the baby before and after a feeding, then NO WAY can this product accurately measure a mother's milk supply. Any lactation specialist KNOWS that pumping is NOT a good indicator of supply. Seriously, was this product launch paid for by Abbott Labs? Because that's the only way I can honestly see this product making it onto the market. Lactation consultants should KNOW BETTER.

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    1. EXACTLY!! Of course, if the LCs who actually support this thing are like the LCs at the hospital where DS was extracted (meaning worthless) they wouldn't know any better. I hope this product gets yanked from shelves and buried before it does too much damage to babies and mothers.

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  10. So, used correctly, I don't have a problem with this product. That means the product should include a very strongly worded disclaimer that this is just a first step in seeing if there might be an issue - along with LOTS of support and resources if the answer is low supply. I wish I had something like this with my first child. He was diagnosed as failure to thrive when, after 3 weeks, he was still below his birth weight. He slept all the time because he was not consuming enough calories to stay awake. I thought he was just a really "good" baby. Ugh. I look back now at the photos of his "saggy baggy elephant" skin on his arms and legs and want to cry. I wish I had had more guidance and support in the early days. When I finally did meet with an LC, it wasn't a very good one. She immediately pulled out formula and informed me that I had no other choice, as my child was starving. I didn't even know what I didn't know back then. She put us on reglan and a strict schedule for nursing - no advice about feeding on demand, according to his cues or even the option of a supplemental feeding system or pumping after feeding and then she brushed off my suggestion that he may have a tongue tie. Needless to say, I never was able to EBF my first born and, by 10 months, my milk was gone. For the next 2 children, I knew more, so I was able to do more. BUT, had I had a way to know that I was struggling with low supply from earlier on, maybe I would have sought help sooner which could have led to better results. I am a very strong supporter of BF'ing, NIP, extended BF'ing, etc. But, when I hear women who have not struggled with low supply criticize others for not trying hard enough, it tears me up inside. I hope noone would ever again have to struggle to feed their child like I did, but, if someone did walk a mile in my shoes, they would understand the horrible feelings of failure as a mother, and as a woman, that unsuccessful BF can lead to. I am proud to say that, with the knowledge I now have and with proper support and the use of domperidone, by my 3rd child, I EBF/pumped for 5 months, while working 50-60 hours a week. After that point, I could not keep up with his demands, so I did supplement for 7 months - usually 8-10oz. a day. At 27 months, he is still nursing 2-5x a day. Nursing my children was the hardest, but one of the most worthwhile thing I've ever done.

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    1. You are a wonderful mother, and I am proud to call you my womban sister.

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  11. Having read a lot about the product, their response and reasoning, as well as your own argument, I still feel it is an incredibly irresponsible product.

    Let me use myself as an example... I have hyposplasia. My children were both exclusively breastfed until their toddler years (my 3-1/2 year old is still nursing). I had to nurse much more frequently than most people as a result, but in doing so, was able to never supplement. However, aside from a brief period when my son was a newborn, I was incredibly unsuccessful with pumping. My breasts could be full, my baby could gulp away for an hour, yet if I got an ounce out of a breast, it was a miracle.
    So, for someone like me who produces less milk over the same amount of time as most women, and therefore feeds more often, all this product would have done was CAUSE worry where none was needed.
    I believe that will be the case with many women. This does not educate them. Not one bit. It doesn't take into account personal physiology, pump response, ANYTHING of any true use. While sure, there will be moms who use it and are comforted their supply is fine, it has just as much, if not more, potential to backfire and convince a mother her supply IS poor and rather than seeking help, she's likely to just supplement.
    Sorry, but I think it's a terrible idea and will continue to voice my opinion about it.

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  12. I think this is a bad idea.

    If I'd used it I would have been told I was starving my daughter - I never got much out at all with pumping. That was trying a number of different pumps and some with help from midwives to ensure I was pumping correctly.

    She was exclusively breastfed until 6 mths, and still feeds at just over 3 years old. She is the healthiest, most energetic child you could hope for. So obviously was (and is) getting what she needs from me.

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  13. I can't believe we have been nursing and nourishing babies for milenias without this product! What a horrible idea this is. Just one more way to undermine and mothers trust in her own body to do what it should. I would not be surprised if this company was somehow tied to the formula companies.

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  14. Honestly – I thought it was a joke when I read the words “Milkscreen Calculator”. Worst. Idea. Ever.

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  15. i think I would never need this if I am nursing. it will only add my insecurities.

    It's a mother's instinct to know when her baby is starving.

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  16. I'm against. Mothers would be better off getting the information about wet/poopy diapers and the right growth charts without having to buy this product and waste their time pumping first. La Leche League is free, and amazing, and IBCLC's are specialists...referring to a pediatrician or other doctor who is not an IBCLC is just going to create more problems when there may not have even been a problem to begin with. If they really want to help, spend some money promoting LLL and IBCLC's.

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  17. The product has been pulled from the market. Alleluia!

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